The Role Of Kinases Signaling In Organogenesis, Fatemeh Nasehi

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Kinases are crucial regulators of organ development and differentiation. This thesis investi- gates the roles of TAK1, TGFbeta-Activate Kinase 1 (TAK1/Map3K7), and Akt3 kinases in skeletal, cardiac muscle, and cartilage. TAK1 is pivotal for the differentiation of various organ systems, including sinoatrial node and cartilage, and is responsible for phosphorylat- ing a diverse array of downstream kinases. We identified several novel proteins, including phospho-Akts, that are upregulated in response to TAK1 activation. We discovered severe Dilated Cardiomyopathy (DCM) and cartilage defects in Akt3 mutant mice. Although this mouse mutant has been studied for over two decades, we are the first …

Evaluation Of An Emergency Department Provider Information Update On The Initiation Of Suboxone With A Community Treatment Program Referral For Opioid Overdose And Opioid Use Disorder, Carmen Brewington

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Over 21 million people in the United States (U.S.) require substance use disorder (SUD) treatment; yet less than 4 million people receive treatment (Bressan & Kening, 2023). According to Thomas et al. (2022), opioid overdose deaths are increasing, and improving access to evidence-based treatment is critical. Hospital emergency departments (EDs) play a lifesaving in the emergency treatment of opioid overdoses; but can also serve as gateways to opioid treatment by healthcare providers for opioid addictions (Reuter et al., 2022). Mortality, after an ED visit for opioid overdose, is high (Thomas et al., 2022). Community resources are limited, thus making it …

Going, Going, Gone: The Influence Of Job And Home Demands And Resources On Emergency Department Nurse Turnover, Jordan Gail Smith

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Nurse turnover, which challenged healthcare organizations even before the pandemic, reached alarming rates across hospitals worldwide during COVID-19. Due to the unprecedented and stressful nature of the pandemic, recent investigations have focused primarily on exploring job demands and nurse turnover intentions. While job demands are critical to understanding turnover, this narrow scope ignores the possible influence of other factors such as job resources and demands and resources external to the work domain. This study utilized archival qualitative data from a longitudinal survey of Emergency Department clinicians to analyze research questions and hypotheses. The first aim of this study was to …

Promoting The Integration Of Direct-To-Consumer Genetic Testing Results Into Clinical Practice, Kanesha Glenn

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In recent years, individuals have become interested in what insights direct-to-consumer genetic testing (DTCGT) can offer about their health. These individuals are recommended to discuss their concerns with a healthcare professional, yet most primary care professionals do not have a genetics-focused practice. This dissertation comprises five chapters to describe the integration of DTCGT results into a patient visit. Chapter I discusses the expanding demand between patients with questions about their DTCGT results and the health professionals who have been tasked to interpret these results. Chapter II is a systematic literature review that identifies what health professionals think about results from …

Interpretable Mechanistic And Machine Learning Models For Pre-Dicting Cardiac Remodeling From Biochemical And Biomechanical Features, Anamul Haque

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Biochemical and biomechanical signals drive cardiac remodeling, resulting in altered heart physiology and the precursor for several cardiac diseases, the leading cause of death for most racial groups in the USA. Reversing cardiac remodeling requires medication and device-assisted treatment such as Cardiac Resynchronization Therapy (CRT), but current interventions produce highly variable responses from patient to patient. Mechanistic modeling and Machine learning (ML) approaches have the functionality to aid diagnosis and therapy selection using various input features. Moreover, 'Interpretable' machine learning methods have helped make machine learning models fairer and more suited for clinical application. The overarching objective of this doctoral …

Developing Disinfection Strategies For Controlling Human Norovirus, Sars-Cov-2, And Clostridioides Difficile Endospores In Long-Term Care Facilities, Jinge Huang

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Long-term care facilities (LTCFs) provide an environment favorable for the transmission of three critical human pathogens: human norovirus (HuNoV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and Clostridioides difficile. Given residents in LTCFs are susceptible to infections due to their advanced ages and compromised immune systems, effective environmental surface disinfection plays a crucial role in controlling the spread of human pathogens within these settings and, therefore, mitigates the risk of infections caused by these pathogens. This dissertation aimed to assess the efficacy of various types of disinfectants against two HuNoV surrogates [feline calicivirus (FCV) and Tulane virus (TuV)], two …

Prevention And Reversal Of Elastin-Associated And Phosphate-Dependent Arterial Calcification Using Targeted Nanotherapeutics In Pre-Clinical Models, Fatema Tuj Zohora

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Vascular calcification can be life-threatening, involving calcium phosphate crystal deposits in the blood vessels. The calcification in the intimal layer of the arterial wall is usually associated with atherosclerotic plaque build-up that, in the advanced stage, harbors ‘dispersed’ and ‘spotty’ deposits of calcium phosphate crystals in the necrotic core of the plaque. In contrast, medial arterial calcification (MAC) can form independently of atherosclerosis and appears as ‘Railroad-like’ calcific deposits along degraded elastin lamellae in the medial layer of arteries. The mechanisms of such elastin-associated medial arterial calcification and potential therapies are the key concerns of this dissertation. MAC is common …

In Vitro And In Vivo Diabetic Models For Assessment Of Tissue Engineered Vascular Grafts, Juan Carlos Carrillo Garcia

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Diabetes has become one of the leading causes of lower-limb loss worldwide. Every 30 seconds, a person loses a limb due to diabetic-related vascular complications. About one-third of patients needing lower-limb bypass surgery have debilitated autologous vessels unsuitable for use, and no other good long-term options are available. These detrimental effects on the vasculature are caused mainly by the hyperglycemic and hyperlipidemic conditions derived from diabetes. Under these conditions, an increase in advanced glycation end products (AGEs) and reactive oxygen species leads to irreversible crosslinks of extracellular matrix proteins, accelerating vascular pathology through vascular stiffening, endothelial dysfunction, inflammation, atherosclerosis, fibrosis, …

An Exploration Of The State Of Practice Of Recreational Therapy Within Substance Use Disorder Treatment, Jacqueline Dyke

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Substance Use Disorders (SUD) are widespread in the United States (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017), and treatment based on evidence may be difficult to find (The CASA Columbia National Advisory Commission on Addiction Treatment, 2012). According to the National Council for Therapeutic Recreation Certfication’s most recent survey of the profession, 41.69% of Certified Theraepeutic Recreation Specialists work with people who have SUD. In order to gain insight regarding the current state of practice of recreational therapy (RT) within SUD treatment, a national survey of CTRSs who work in the U.S., serving individuals with SUD as either …

An Interdisciplinary Approach To Online Genetics Education, Pinar Ozmizrak

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This dissertation presents an interdisciplinary approach to online genetics education.

Chapter I provides an overview of remote education and a brief history of genetics. While the COVID-19 pandemic prompted a turn to emergency online education, exposure to this form of delivery has led to increased intentional online education.

Chapter II focuses on computer and technology use in healthcare by nursing students. This study investigated nursing students’ perspectives using a modified version of the Pretest for Attitudes Toward Computers in Healthcare (PATCH) assessment scale to explore students’ ideas about computers and technology in healthcare delivery. According to the PATCH scale, the …

Variability In Anesthesia And Its Implications For Improving Patient Safety, Joshua Michael Biro

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Improving patient safety in anesthesia has proven to be an arduous and challenging task. Despite the many strategies and interventions to improve patient safety that have been employed, patient harm in anesthesia remains a problem. The struggle to reduce patient harm in anesthesia is both attributable to and representative of the complexity of the anesthesia system. In navigating this complex system, anesthesia providers have different approaches to how they accomplish their work, which results in variability in anesthesia practice. This variability provides an immense challenge to designing and implementing efforts to improve patient safety, as rigid interventions are often met …

Evaluation Of Bone And Muscle Quality In Laying Hens Using Quantitative, Radiographic, Computed Tomographic, Biomechanical, And Tissue Level Measures, Cerano Harrison

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Bone quality is an important measure of welfare in laying hens for researchers, veterinarians, and commercial producers who bear the responsibility of providing them with care. Breeding practices that have resulted in high egg productivity of laying hen strains have resulted in an increased susceptibility to developing osteoporosis. Osteoporosis, a decrease in mineralized bone, is accompanied by increased bone fragility that can lead to potentially painful bone fractures that can inhibit some aspects of the birds natural living, respiration and flight being two examples. Current methods of examining laying hen bone quality involve the implementation of diagnostic imaging and biomechanical …

Circumventing Ableism: A Grounded Theory Study Exploring Caregiver Strategies To Promote A Positive Identity, June Furr

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This qualitative research study explores how caregivers and persons with disabilities navigate the rhetoric of disability and caregiving through the interviews of fifteen caregivers and fifteen persons with disabilities using the lens of grounded theory and Burke’s (1952) dramatistic pentad. Significant findings describe how focused disability description can circumvent ableism when rhetorical resources that assist caregivers and persons with disabilities to navigate the rhetoric in disability descriptions are provided. Disability description theory includes the three stages that define, collaborate and revise, and practice and apply a disability description. This qualitative research offers an introduction into the phenomenon of …

Modeling Antihypertensive Therapeutic Inertia And Intensification To Support Clinical Action Toward Hypertension Control, Benjamin Martin

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Background

Hypertension is the leading modifiable risk factor for cardiovascular disease and consequent mortality worldwide. In the U.S., more than half of hypertension cases remain uncontrolled, despite availability of effective pharmaceutical treatment options. Evidence suggests that therapeutic inertia, defined as clinician failure to initiate or increase therapy when treatment goals are unmet, is the most influential barrier to improving hypertension control. Substantial rates of therapeutic inertia have been reported in ambulatory primary care settings where hypertension is typically treated and managed. Understanding and overcoming the forces driving therapeutic inertia in hypertension management is a critical strategy to reach population health …

Development Of A Novel Predictive Model And Prosthetic System To Assess Dynamic Leg Length Based Gait Biomechanics In Lower Limb Prosthesis Users, Therese Parr

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Individuals with transfemoral amputation often rely on a prosthesis as a replacement for their missing extremity’s structure and function. Lower-limb prosthetic devices are developed with the goal of restoring biomechanical abilities and mitigating secondary health risks for users. However, biomechanical deficits for unilateral transfemoral prosthesis users are very common and are induced by both leg length discrepancy (LLD) and current prosthetic design shortcomings. Lack of push off power as well as difficulty shortening the leg for toe clearance can result in gait compensations that lead to asymmetric limb loading, increased muscle activity, and an increased incidence of falling due to …

Comparison Of Covid-19 Diagnostic Testing Methodologies In The U.S., Joseph Blommel

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The onset of the COVID-19 pandemic brought about a world in which diagnostic testing for the virus that is responsible for COVID-19, SARS-CoV-2, became commonplace. Diagnostic testing was required for myriad reasons beyond simple diagnosis. We set out to compare SARS-CoV-2 testing methods, see if differences sensitivity correlated to increased positivity, and to evaluate self-collection methods.

In examining the Limit of Detection (LoD) of tests receiving FDA Emergency Use Authorization (EUA), our findings indicated that there were considerable differences in LoD. However, these differences in observed sensitivity were not correlated with the methodologic differences as reported in EUA documentation.

We …

Influences On Pregnancy: An Exploration Of Maternal Discrimination, An Alternative Model Of Prenatal Care And Health Information Online, Emily Doherty

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In the United States metrics of perinatal health lag far behind peer countries and is characterized by stark disparities. The studies that make up this dissertation seek to elucidate factors influencing perinatal health.

The first and second chapters provide an introduction and extensive review of the literature of factors contributing to perinatal health with specific focus on discrimination and perinatal health; group prenatal care and digital pregnancy health information. The third chapter introduces the methodology to be used by each of the following studies. Subsequent chapters are formatted as individual manuscripts, each presenting background, methodology, results, and discussion.

The fourth …

Opioid Prescribing Practice & Policy – A Study Of Medicaid Pediatric Population In South Carolina, Laksika Sivaraj

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Opioids are widely used as analgesics in different clinical settings, but they are also highly criticized for their downsides. Among the adult population, the addictive nature of opioids continues to be the main concern, while among young children, there are other adverse health outcomes that opioids can cause. These concerns have led the US Food and Drug Administration (FDA) and other professional bodies to discourage opioid prescribing for children. Nevertheless, opioids continue to be prescribed for children for contraindicated health conditions. The goal of this research is to assess opioid prescribing practices for the pediatric population in South Carolina (SC). …

Diagnosis Of Urinary Tract Infections And Rapid Molecular Characterization Of Antibiotic Resistance, Mohammed Harris

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Urinary tract infections (UTIs) are one of the most common infectious clinical entities in both community and hospital settings. They have a broad range of clinical severity yet inflict large epidemiological burden of morbidity and mortality on patients and the healthcare system with billions of dollars in cost of treatment. Understanding what methods are optimal for diagnosing UTIs are critical to mitigate the marked impact and cost of these infections.

Chapter 1 and 2 in this work surveys the broad array of diagnostic modalities for UTIs and highlights their advantages and limitations in the context of the current standard of …

The Role Of Leisure Engagement In Fostering Cognition In Aging, Karen Wenzel

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Leisure activities are a major component of healthy aging, associated with reduced risk of cognitive decline and enhanced cognitive function. However, there is wide variation in the conceptualization and measurement of leisure. Specific leisure activities or domains have been studied in association with cognition in aging. More recently, researchers have noted that attributes of the activity, rather than the activity itself, may be significant. This study explored the current state of knowledge regarding attributes of leisure activities that foster cognition in aging. A literature review using PRISMA Scoping Review guidelines identified objectively and subjectively measured attributes of leisure engagement in …

Diabetes Self-Management Education And Support: Understanding Knowledge And The Impact, Christina Dietz

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Diabetes has reached epidemic proportions in the United States. To address this, many organizations employ diabetes self-management education and support (DSMES) programs to aid in managing the impact of increasing prevalence. The purpose of this dissertation is to examine the impact of two Upstate South Carolina DSMES programs on several process and outcome measures for adults with diabetes, while also identifying current primary care provider DSMES knowledge and perceptions in an Upstate South Carolina health system.

This dissertation found inconclusive results on the impact of DSMES on PCP utilization, retinal exam screening, nephropathy attention, HDL, LDL, TC, and TG. DSME …

X-Ray Interrogated Implantable Chemical And Strain Sensors For Monitoring Implant Associated Infections And Fracture Healing, Apeksha Rajamanthrilage

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Bone fracture healing includes complex and sequence of dynamic events to restore the integrity and biomechanical properties of the bone. While most of the fractures heal without any problem, healing is sometimes compromised. Two significant fracture healing complications are orthopedic implant-associated infections and non-unions/delayed union. These can be interrelated causes as well. Implant-associated infection can cause implant loosening, and as a result, it can delay the fracture healing process. Herein, we describe two different types of sensors that can be used in monitoring biochemical and biomechanical processes of fracture healing using X-rays.

We developed a XELCI (X-ray Excited Luminescence Chemical …

The Impact Of Covid-19 On Recreational Therapists Working In Inpatient Mental Health Settings, Summer Matics

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Since 2020, the novel coronavirus (COVID-19) has impacted the lives of the general public, but healthcare workers including those that work in inpatient mental health settings have seen long-lasting impacts in their workplace. Recreational therapists (CTRSs) are among the mental healthcare workers that have been impacted by the pandemic but there is no existing research that specifically studies their lived experiences. This study used the theoretical foundations and methods of hermeneutic phenomenology in order to describe how COVID-19 has impacted CTRSs’ workplace from a safety perspective, their stress and coping, and also their supervisory duties. Seventeen participants were recruited and …

Data-Driven Biomarker Panel Discovery In Ovarian Cancer Using Heterogenous Data Fusion On Exosomal And Non-Exosomal Microrna Expression Data, Paritra Mandal

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Ovarian cancer (OC) is an aggressive gynecological cancer and is currently the 5th leading cause of deaths due to cancer in women. High mortality rates are attributable to the vague pathogenesis and asymptomatic nature of the early stages. The development of a liquid biopsy for routine OC screening could help identify the disease at an earlier stage, making treatments more likely to be effective thereby increasing survival rates. Exosomes, small (~100nm) extracellular vesicles present in body fluids, have been shown to contain cancer-progression, onset, and related factors, making them good candidates for use in liquid biopsies. However, to date, only …

Highly Adherent Antimicrobial Coatings For Orthopedic Implants, Mikhail Bredikhin

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Fracture-related infections (FRIs) are the most devasting sort of complications associated with fracture fixation devices, as they lead to patients’ morbidity, prolonged hospitalization, amputations, and even death.External fixators additionally suffer from pin site infections (PSIs), which initiate at the skin entry points of the skin-metallic pin interface present in the external fixation of the damaged bones, often causing deep tissue infection and osteomyelitis. Small percutaneous pins, commonly known as Kirschner wires (K-wires), are used to treat complex fractures and deformities.They are drilled inside the diseased bone for the healing period and are left protruding outside the skin for fixation adjustments …

Scuba Diving Social Identity, Type Of Experience, Sociopsychobio Health, Health-Related Quality Of Life, Self-Efficacy, Disability Level, And Personality Among People With Physical Impairments: A Mixed Methods Study, Tania Santiago Perez

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The most common type of disability in the US is mobility or physical impairment, occurring in one in seven adults. Globally, musculoskeletal and neurological conditions account for nearly two-thirds (65.6%) of total physical rehabilitation needs. Approaches that promote healthy community living, rehabilitation, and reduce relapse and rehospitalization among people with physical impairments are critical. Participation in recreational activities and identification with social recreational groups may promote the health, quality of life, and functional abilities of people with physical impairments, contributing to reducing their hospitalization and healthcare needs. This explanatory sequential mixed methods research study had two aims. Using the experience-type …

Radioluminescence Based Biochemical Sensing And Imaging Strategies To Measure Local Drug Release And Ph, Gretchen B. Schober

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In this dissertation we describe methods for measuring infection relevant biochemical analytes using radioluminescent and ultrasound luminescent materials. Films and nanoparticles fabricated with europium doped gadolinium oxysulfide (Gd₂O₂S:Eu³⁺) are used to quantitatively measure radiolabeled pharmaceutical concentration, specifically tritium labeled vancomycin (³H-vancomycin). Europium and dysprosium doped strontium aluminate is used to fabricate an ultrasound modulated, pH sensing film. These methods are indicated for theranostic evaluation of implant associated infection. Bacterial biofilms are inherently resistant to traditional antibiotic treatment and can coat biomedical implants. These biofilm related infections are difficult or impossible to eradicate …

The Influence Of Recreation Engagement On Adolescent Health-Risk Behaviors, Krista Thomas

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The number of adolescents who engage in suicidality is staggering. Adolescence is a unique developmental period where engagement in health-risk behaviors is prominent. Factors influencing engagement in suicidality are vast and occur both internally and externally in the adolescent. Substance use during adolescence has shown an association with increased suicidality. Similarly, bullying, both cyberbullying and in-person bullying, have contributed to adolescent suicidality. Alternatively, recreation engagement has yielded benefits in both psychosocial and physical health for adolescents. However, limited research has identified that engaging in recreation can minimize suicidality. Therefore, the purpose of this study was to explore how substance use, …

Three Essays About Preventing Mental And Behavioral Disorders, Snehal Lopes

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Prevention efforts in the public health field operate at various levels, including primary prevention among those without a disease of interest, secondary prevention among persons at high risk or showing early signs of the disease, and tertiary prevention among persons with the disease. The three essays presented in this dissertation are centered around the theme of prevention, and taken together, have implications for prevention at the primary, secondary, and tertiary levels. Specifically, the essays focus on the prevention of depressive disorders and the prevention of behavioral and mental health correlates for depression in the context of various populations (general adult, …

Adolescent Health Services: Access And Outcomes, Mackenzie Stuenkel

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Adolescence is a unique developmental period during which most lifelong mental health illnesses develop. Interventions and programs targeting adolescent health care utilization and effectiveness often fail to include measures of implementation science including long term sustainability and contextual characteristics. The purpose of this dissertation was to evaluate two programs designed to increase health care utilization and engagement in adolescent populations. Guided by the Practical, Robust, Implementation and Sustainability Framework (PRISM), strengths and weaknesses across model delivery and context of School-based Health Centers (SBHC) were assessed through in-depth interviews with clinicians, managers, and school staff. SBHC outcomes and services were assessed …