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Full-Text Articles in Medicine and Health Sciences
The Use Of An Open-Label Placebo To Treat Cancer-Related Fatigue In Cancer Survivors, Theresa Walker Hoenemeyer
The Use Of An Open-Label Placebo To Treat Cancer-Related Fatigue In Cancer Survivors, Theresa Walker Hoenemeyer
All ETDs from UAB
Background: A placebo is an inert substance (e.g., sugar pill) or procedure (e.g., sham surgery) that should confer no beneficial effects. Nonetheless, typically, 30-50% of those randomized to placebos report significant benefits. New studies indicate that the use of disclosed or open-label placebos reduces self-reported symptoms among patients with irritable bowel syndrome, migraine attacks, and major depression. Methods: The investigator conducted a 7-week pilot study to evaluate the feasibility and effects of an open-labeled administration of placebo pills on patient-reported clinical and psychosocial outcomes among cancer survivors seeking relief from cancer-related fatigue. The specific aims of this study were to: …
Measuring Reproductive Norms And Stigma And Examining Their Roles In Unintended Pregnancy-Related Health Behavior Among Young Adult Women, Whitney Smith
All ETDs from UAB
Substantial disparities are observed in rates of unintended pregnancy and the health consequences of unintended pregnancy in the United States, with these events and outcomes occurring more frequently among young adult women and women in the southern region. The contribution of social norms and stigma to these disparities is unclear. This dissertation is comprised of three manuscripts examining unintended pregnancy-related norms and stigma, and their health implications among young adult women aged 18-24 in Birmingham, Alabama. The aims of the dissertation are to (1) elucidate perceptions of norms and stigma regarding unintended pregnancy and pregnancy decisions (abortion, adoption, and parenting), …
Individual, Family, And Social Factors Associated With Adolescent Obesity: A Policy Relevant Focus, Janice Marguerite Utley
Individual, Family, And Social Factors Associated With Adolescent Obesity: A Policy Relevant Focus, Janice Marguerite Utley
All ETDs from UAB
INDIVIDUAL, FAMILY, AND SOCIAL FACTORS ASSOCIATED WITH ADOLESCENT OBESITY: A POLICY RELEVANT FOCUS JANICE M. UTLEY PUBLIC HEALTH ABSTRACT This dissertation is comprised of three papers that examined individual, family, and social factors associated with adolescent overweight and obesity with the aim of generating data that could inform the design of policy interventions to prevent or reverse rising prevalence. The first investigation was a type of literature review called a scoping study that examined the extent, range, and type of research activity on adolescent obesity that used a multilevel or hierarchical design to look at two or more contextual areas …
Development Of A Conceptual Framework For Pediatric Preparedness Healthcare Coalitions: A Pilot Study, Bryan K. Breland
Development Of A Conceptual Framework For Pediatric Preparedness Healthcare Coalitions: A Pilot Study, Bryan K. Breland
All ETDs from UAB
Natural or man-made disasters overwhelm the resources of a healthcare organization and strain or compromise the provision of medical services to rapidly expanding patient populations. Public and private healthcare organization routinely plan and exercise systems and responses intended to bolster medical care capabilities and increase the capacity of the organization during crisis events. Providers of pediatric emergency medical service are particularly vulnerable to disaster surge, since many pediatric emergency services operate consistently at near capacity. In recent years, policy-makers and medical professionals have begun to look toward healthcare coalitions as a mechanism to rapidly expand resources and capacity for patient …
Impact Of And Adoption Trends Of Hit In Cancer Care, Willi L. Tarver
Impact Of And Adoption Trends Of Hit In Cancer Care, Willi L. Tarver
All ETDs from UAB
The three discrete research projects which make up this dissertation provide empirical evidence on the impact of, and adoption trends of, health information technology (HIT) as it pertains to cancer care. The findings of these studies are important as they provide insight into the potential of HIT to improve the quality of cancer care in the US. The results of this dissertation suggest that based on the current literature, HIT interventions seem to be more successful when targeting physicians, care in the prevention phase of the cancer continuum, and/or decision making. Separately, when seeking to understand the adoption of electronic …
Three Studies On Cardiovascular Health: Modifiable Risk Factors And Health Expenditures In Medicare, Kristal Jo Aaron
Three Studies On Cardiovascular Health: Modifiable Risk Factors And Health Expenditures In Medicare, Kristal Jo Aaron
All ETDs from UAB
This dissertation comprises a series of studies conducted on modifiable risk factors as they contribute to cardiovascular health and disease and their associated health service expenditures and utilization. Specific topics in this compilation include (1) exploring the role of dietary sodium and potassium intake in cardiovascular health and disease; (2) examination of direct health expenditures in the Medicare-linked REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort as associated with Life’s Simple 7 (LS7), a composite measure of cardiovascular health defined by the American Heart Association (AHA) that is based on seven modifiable risk factors (blood pressure, blood cholesterol, …
Cost Effectiveness Of Hypertension Treatment: New Model, Methods, And Focus On African Americans, Gabriel Saidimu Tajeu
Cost Effectiveness Of Hypertension Treatment: New Model, Methods, And Focus On African Americans, Gabriel Saidimu Tajeu
All ETDs from UAB
This dissertation focuses on the potential benefits of hypertension (HTN) treatment for the general population and African Americans (AAs) specifically. We undertake three research projects that are interconnected. First, using a systematic review methodology we assess the current state of the cost-effectiveness of HTN treatment literature in order to identify potential gaps in the cost-effectiveness literature, methodological shortcomings, and provide policy makers and researchers with a summary of the current findings as well as methods used in the literature. Second, building off our findings in paper 1, we construct a cost-effectiveness model. We assess the cost-effectiveness of HTN treatment not …
Trends, Market Correlates, And The Impact Of Health Information Exchange, Saurabh Rahurkar
Trends, Market Correlates, And The Impact Of Health Information Exchange, Saurabh Rahurkar
All ETDs from UAB
The purpose of this dissertation is to examine the effects of Health Information Exchange (HIE) as well to evaluate hospital and market characteristics related to trends in HIE adoption. Widespread HIE is believed to boost efficiency, reduce health care costs, and improve outcomes; as such numerous efforts have aimed to promote and facilitate HIE by providers. Despite this, over a quarter of all hospitals in the U.S. do not participate in HIE and thus it is essential to examine the evidence for the theorized benefits from HIE. As such, the first paper systematically reviews the literature examining the relationship of …
Promoting Worksite Stair Use By Launching The "Stepping Up" Campaign, Lynne A. Obiaka
Promoting Worksite Stair Use By Launching The "Stepping Up" Campaign, Lynne A. Obiaka
All ETDs from UAB
Background: Obesity and overweight contribute to worksite absenteeism and decreased productivity. Encouraging employees to frequent the stairs is one approach towards increasing worksite physical activity. Methods: An explanatory, mixed methods research design was used to explore the impact of a health communications campaign entitled "Stepping Up" on worksite stair use in health department employees. The campaign included octagonal shaped posters similar to traffic signs, email prompts and printed materials. A pretest and posttest were administered before and after the intervention to assess stair use frequencies and identify predictors. A Wilcoxon signed-rank test for related samples, Spearman correlations and multiple rank …
Urbanization And Land-Use Change In Puerto Maldonado, Peru: Categorizing The Landscape Using High-Resolution Satellite Imagery For Potential Use In Public Health Research, Laura Brianna Gast
Urbanization And Land-Use Change In Puerto Maldonado, Peru: Categorizing The Landscape Using High-Resolution Satellite Imagery For Potential Use In Public Health Research, Laura Brianna Gast
All ETDs from UAB
Environmental change, especially rapid urbanization, has measurable effects on human health. Over 70 percent of the global population is expected to live in urban areas by 2025, and at least 1 in 3 of these individuals will live in extreme poverty. Living in a slum or shantytown exposes individuals to health and safety risks including inadequate sanitation, lack of access to clean water, air pollution, violence, over-crowding and risk of infectious disease. Remote sensing technologies are an effective tool for detection and prediction of areas with significant land use change, which enables identification of populations with the highest risk of …
Relationship Between Diabetes And Indoor Air Pollution: An Exploratory Analysis, Sandeep Mishra
Relationship Between Diabetes And Indoor Air Pollution: An Exploratory Analysis, Sandeep Mishra
All ETDs from UAB
India has the second highest number of people with diabetes. The high prevalence of diabetes in India cannot be explained on the basis of established risk factors like obesity. The role of air pollution in diabetes has recently received attention. Studies have indicated the possibility that air pollution generated by traffic might be associated with increased risk of diabetes. Published literature lacks studies that assess the relationship between indoor air pollution and diabetes, although indoor air pollution can lead to higher levels of pollutants in house compared to traffic pollution. The current study determined the relationship between indoor air pollution …
Evaluation Of Environmental Factors And Dengue Fever In Sri Lanka Using Geospatial Tools, Meghan Tipre
Evaluation Of Environmental Factors And Dengue Fever In Sri Lanka Using Geospatial Tools, Meghan Tipre
All ETDs from UAB
The incidence of dengue fever has increased exponentially in Sri Lanka, from 24.4 cases per 100,000 in 2003 to 165.3 per 100,000 population in 2013. Despite concerted effort by the Sri Lankan government, dengue control remains a challenge in the country, indicating a need for novel approach for dengue prevention and control. The aim of this research was to identify environmental risk factors that may be associated with dengue incidence rate at the Gram Niladhari Divisions level (smallest administrative unit) in Colombo city, Sri Lanka, using geospatial tools such as remote sensing and geographic information system. These factors included climate …
Three Studies On Family Meals: Examining The Predictors Of Family Meals And Its Impact On Adolescent Health, Samantha Sittig Goldfarb
Three Studies On Family Meals: Examining The Predictors Of Family Meals And Its Impact On Adolescent Health, Samantha Sittig Goldfarb
All ETDs from UAB
This three-manuscript dissertation addresses gaps in the literature related to the predictors of family meals and its impact on adolescent health behavior. Sharing dinner as a family has been promoted by the media and many researchers as an ideal environment to enrich the parent-child bond and subsequently reduce adolescent risk behaviors such as substance use and delinquency. This dissertation centers on three topics, in particular: (1) the nature of the family meal literature given the multiple adolescent health behavior outcomes, study designs, and model types investigated and used by researchers, (2) the impact of family dinners on adolescent school problems, …
Patient And System Level Factors As Predictors Of Adherence To Antiretroviral Therapy Appointment Schedules In Cambodia, Gary T. Daigle
Patient And System Level Factors As Predictors Of Adherence To Antiretroviral Therapy Appointment Schedules In Cambodia, Gary T. Daigle
All ETDs from UAB
PATIENT AND SYSTEM LEVEL FACTORS AS PREDICTORS OF ADHERENCE TO ANTIRETROVIRAL THERAPY APPOINTMENT SCHEDULES IN CAMBODIA GARY T. DAIGLE EPIDEMIOLOGY / INTERNATIONAL HEALTH ABSTRACT On-time attendance at clinical appointments by patients on antiretroviral therapy (ART) is essential to the prevention of medication interruptions, viral rebound, drug resistance, and long term mortality. An observational study conducted in 2010, Enablers and Adherence to Antiretroviral Therapy in Cambodia, sought to identify factors that predict on-time clinical appointment attendance by patients on ART. These factors were classified as either ART patient level factors (e.g. demographic, clinical) or patient care and support system level factors …
Socio-Demographic Characteristics, Medical Indications, And Perinatal Outcomes Associated With Interventional Early Term Delivery, Kelley Swatzell
Socio-Demographic Characteristics, Medical Indications, And Perinatal Outcomes Associated With Interventional Early Term Delivery, Kelley Swatzell
All ETDs from UAB
Non-medically indicated deliveries, resulting from obstetrical intervention in an effort to avoid delivery at a later date, are frequently referred to as elective deliveries. These were increasingly occurring in early term gestations of 37.0 to 38.7 and frequently resulting in adverse neonatal outcomes such as sepsis, hypoglycemia, respiratory distress disorder the need for mechanical ventilation. In addition to concerns regarding adverse neonatal and maternal health outcomes, elective early term delivery increases health care costs due to prolonged hospital stays and NICU admissions. Efforts taken to reduce elective early term deliveries include public service announcements, educational programs, performance incentives and reimbursement …
The Effect Of Medicaid Dental Coverage On Dental Care Utilization Among Older Americans, Ahyuda Oh
The Effect Of Medicaid Dental Coverage On Dental Care Utilization Among Older Americans, Ahyuda Oh
All ETDs from UAB
This dissertation examines the impact of Medicaid dental coverage on dental care utilization and oral health outcome of low-income elderly and non-elderly adults, using a fixed-effects model with longitudinal data of all states and multiple years from the Behavioral Risk Factors Surveillance System (BRFSS). By exploiting within-state variation over time in adult Medicaid dental coverage, the study estimates the effects of Medicaid dental coverage on dental care utilization (i.e., dental visits and dental cleanings) and oral health outcome (i.e., tooth loss). The study evaluates the effects of Medicaid dental benefits with preventive dental services on each of the three dental …
Gender Norms, Sexual And Reproductive Behaviors And Acceptability Of Male Circumcision Among Men In Western Jamaica, Melonie Walcott
Gender Norms, Sexual And Reproductive Behaviors And Acceptability Of Male Circumcision Among Men In Western Jamaica, Melonie Walcott
All ETDs from UAB
This dissertation consists of three papers designed to assess the association between gender norms and men's sexual behaviors, reproductive practices, and acceptability of male circumcision (MC). The data for this study were obtained from a cross-sectional, interviewer-administered questionnaire survey of 549 men aged 19-54 years, conducted in the western region of Jamaica between June to August 2011. In the first paper we found increased odds of reporting multiple sex partners among men with moderate (AOR =2.2; 95% CI=1.4 - 3.5) and high (AOR = 4.4; 95% CI =2.2 - 8.8) support for inequitable gender norms. Similarly, men with moderate (AOR= …
The Relationship Of Religiosity, Spirituality And High-Risk, Rev Tommie Lee Watkins Jr
The Relationship Of Religiosity, Spirituality And High-Risk, Rev Tommie Lee Watkins Jr
All ETDs from UAB
Religion and spirituality are important concepts for many Black MSM. While many social factors may be associated with the increasing disparity of HIV infection among Black MSM, high levels of religiosity and spirituality prevalent in Black culture may be correlated with high risk behavior among Black MSM and may help explain this population's increasing incidence of HIV infection. Research supports a relationship between religiosity, spirituality, and high risk behavior among populations. Some research has suggested that religiosity and spirituality among Black MSM may be correlated but are multifaceted constructs. Conclusions suggest that among Black MSM these constructs account for certain …
Studies On Distracted Driving: Three Papers Examining The State Of The Literature And The Impact Of Texting Restrictions On Motor Vehicle Crash-Related Fatalities And Hospitalizations, Alva Oletia Ferdinand
Studies On Distracted Driving: Three Papers Examining The State Of The Literature And The Impact Of Texting Restrictions On Motor Vehicle Crash-Related Fatalities And Hospitalizations, Alva Oletia Ferdinand
All ETDs from UAB
ABSTRACT This three-paper dissertation addresses gaps in the literature focused on distracted driving and the impact of regulations aimed at reducing its prevalence. With the widespread proliferation of mobile phone usage and more sophisticated in-vehicle entertainment and information systems, it is now commonplace for drivers to engage in non-driving activities (also referred to as "secondary tasks") while driving. It is widely believed that distracted driving is positively related to motor vehicle crashes and other undesirable driving outcomes. This dissertation specifically focuses on three topics: (1) the nature of the distracted driving literature given the numerous secondary tasks, driving performance outcomes, …
Interracial Couple Status In Relation To Birth Outcomes Among Singleton Infants Born To U.S. Resident Mothers, 2004-2008., Su Jin Jeong
Interracial Couple Status In Relation To Birth Outcomes Among Singleton Infants Born To U.S. Resident Mothers, 2004-2008., Su Jin Jeong
All ETDs from UAB
Due to the growing trend in interracial marriages in the United States, the issue of birth outcomes to infants born to such couples deserves more attention and examination. The purpose of this population-based, cross-sectional, observational study is to examine the association between interracial couple status and birth outcomes (i.e. low birth weight, very low birth weight, preterm birth, very preterm birth, small for gestational age) among singleton infants delivered in the United States. Interracial couples are defined as those in a relationship who are not of the same race or ethnic designation. Non-Hispanic white, non-Hispanic black, Hispanic, Asian, Chinese, Filipino, …
Identification And Biochemical Investigations Of Rhamnose And Glycoprotein In Mycoplasmas, David Jordan
Identification And Biochemical Investigations Of Rhamnose And Glycoprotein In Mycoplasmas, David Jordan
All ETDs from UAB
Mycoplasmas are host-specific human and animal pathogens within the class of wall-deficient bacteria named Mollicutes and have smaller sizes and genomes than the walled bacteria. Mycoplasma genome sequences reveal few if any genes for synthesis of a glycocalyx. Nevertheless, we find that mycoplasmas produce glycolipids, glycoprotein, and polysaccharides. Using gas chromatography and mass spectrometry, glucose, mannose, rhamnose, and galactose were detected in the glycolytic species Mycoplasma pneumoniae and Mycoplasma pulmonis. All of these sugars except galactose was found in Mycoplasma arthritidis. Rhamnose was in the rare D configuration in the glycolytic species and in both D and L forms in …
Uptake Of Antenatal Care Services And Pregnancy Outcome In Kumasi, Ghana, Asundep Ntui
Uptake Of Antenatal Care Services And Pregnancy Outcome In Kumasi, Ghana, Asundep Ntui
All ETDs from UAB
A prior study reported a 44.6% prevalence of adverse pregnancy outcomes in Kumasi, Ghana. This study investigated factors that may influence antenatal care (ANC) utilization and their association with adverse pregnancy outcomes; defined as low birth weight, stillbirth, preterm delivery or small for gestational age among pregnant women in Kumasi. A quantitative cross sectional study of 643 women, age 19-48 years who presented for delivery at select public hospitals and private traditional birth attendants from July through November 2011 was conducted. Information on socio-demographic characteristics and other factors associated with ANC attendance was collected using a structured questionnaire. Medical and …
Association Between Cc Chemokine Ligand 3-Like-1 (Ccl3l1) Gene Copy Number And Rheumatoid Arthritis In African Americans, Mawuli Kwame Nyaku
Association Between Cc Chemokine Ligand 3-Like-1 (Ccl3l1) Gene Copy Number And Rheumatoid Arthritis In African Americans, Mawuli Kwame Nyaku
All ETDs from UAB
Gene copy number of the CC Chemokine ligand 3-Like-1 (CCL3L1) located on chromosome 17 position q12 varies between ethnicities. Previously, gene copy number of CCL3L1 greater than the ethnic median copy has been associated with an increased risk of Rheumatoid Arthritis. Three later studies found no association between CCL3L1 and RA. All studies were conducted in non-African Americans and an objective of this study was to determine this association in an African American cohort. CCL3L1 shares significant homology with three other genes within the same cluster; CC Chemokine ligand 3 (CCL3), CC Chemokine ligand 3-Like-2 (CCL3L2) and CC Chemokine ligand …
Centering Pregnancy And Adverse Pregnancy Outcome: An Evaluation Of Group Prenatal Care In A Rural Western Kentucky Clinic, Lorie Wayne Chesnut
Centering Pregnancy And Adverse Pregnancy Outcome: An Evaluation Of Group Prenatal Care In A Rural Western Kentucky Clinic, Lorie Wayne Chesnut
All ETDs from UAB
CenteringPregnancySmiles [TM] (CPS), a group prenatal care program with an oral health component, has demonstrated promising results in urban communities with primarily low-income minority women. This study examined three questions: 1) Do women who participate in CPS have better birth outcomes than those who participate in traditional prenatal care, even after adjusting for maternal characteristics and risk factors? 2) Is level of exposure to the intervention associated with improved birth outcomes? 3) Do women with dental infection have an increased risk of poor birth outcomes? Data were abstracted from medical records and birth certificates. Birth outcomes for women enrolled in …
The Impact Of The State Children's Health Insurance Program's Unborn Child Ruling On Foreign-Born Latina Prenatal Care Utilization And Birth Outcomes, 2000-2007, Jonathan Hawthorne Drewry
The Impact Of The State Children's Health Insurance Program's Unborn Child Ruling On Foreign-Born Latina Prenatal Care Utilization And Birth Outcomes, 2000-2007, Jonathan Hawthorne Drewry
All ETDs from UAB
In 2002 the State Children's Health Insurance Program (SCHIP) "unborn child ruling" was established to provide prenatal care (PNC) to low income women otherwise without health insurance. The majority of foreign-born (FB) Latinas otherwise ineligible for PNC should have benefited most from the ruling. In late 2003 six states incorporated the UCR into their state plan amendments, providing a natural experiment for policy analysis. This study used cross-sectional pooled natality data from 2000-2007 to estimate the effect of the UCR on prenatal care utilization (PNCU) and birth outcomes. A differences-in-differences econometrics model was employed using policy enacting and non-enacting states, …
The Use Of Red Rules In Patient Safety Culture, Lisa Kaye Jones
The Use Of Red Rules In Patient Safety Culture, Lisa Kaye Jones
All ETDs from UAB
This study examines the use of Red Rules in patient safety culture. The presence of a strong culture of patient safety has become a critical component in reducing medical errors. Some hospitals are implementing Red Rules as a patient safety strategy with disciplinary consequences if not followed. The use of Red Rules and patient safety culture seem to be inconsistent. The theoretical framework for control-based and commitment-based management was utilized to develop and address four hypotheses. The hypotheses address the impact of Red Rules on 1) staff perceptions of safety, 2) frequency of events reported, 3) number of events reported, …
The Impact Of Community Health Centers On Prostate Cancer Screening Behaviors Of African American Males: A Mixed Methods Study, Michael C. Taylor
The Impact Of Community Health Centers On Prostate Cancer Screening Behaviors Of African American Males: A Mixed Methods Study, Michael C. Taylor
All ETDs from UAB
THE IMPACT OF COMMUNITY HEALTH CENTERS ON PROSTATE CANCER SCREENING BEHAVIORS OF AFRICAN AMERICAN MALES: A MIXED METHODS STUDY MICHAEL C. TAYLOR UAB SCHOOL OF PUBLIC HEALTH DEPARTMENT OF HEALTH BEHAVIOR ABSTRACT Federally qualified community health centers have a significant impact upon uninsured and low income populations in the United States by providing low cost primary care and preventive services. The purpose of this mixed methods study was to determine the impact of community health centers (CHCs) on African American males' prostate cancer screening behavior in a major Southern city. A sequential explanatory mixed method model was used to assess …
Studies In Public Health Systems And Services Research: Three Papers Examining The Market Environment, Quality Improvement, And Community Partnerships, Valerie A. Yeager
Studies In Public Health Systems And Services Research: Three Papers Examining The Market Environment, Quality Improvement, And Community Partnerships, Valerie A. Yeager
All ETDs from UAB
This dissertation, comprised of three publishable manuscripts, addresses various identified gaps in the literature focused on public health systems and services research. Public health systems and services research includes studies that examine the organization, financing and delivery of public health services in communities, and the impact of these services on public health. Specifically, this dissertation focuses on three topics: (1) the measurement of the health care market environment of local public health departments, (2) community characteristics related to quality improvement strategies in local public health environments, and (3) the longitudinal changes in public health partnerships and how these partnerships relate …
The Effect Of Changes In Tort Laws On Cesarean Section Rates In The United States, Allison Jean Taylor
The Effect Of Changes In Tort Laws On Cesarean Section Rates In The United States, Allison Jean Taylor
All ETDs from UAB
"Defensive medicine", medical practice decisions based on fear of malpractice litigation and where risks may outweigh health and cost benefits, is a proposed contributor to increasing cesarean rates in the U.S. Some studies suggest that changes in laws governing medical malpractice actions may decrease the cesarean rate by relieving pressures driving defensive medicine. This study examined whether, in states that have adopted certain tort reform measures, the probability of having a cesarean delivery is lower following implementation of the reform measures. A database of state legislation and court decisions and National Center for Health Statistics natality data files (1991-2004) were …
Experimental Determination Of Shielding Requirements For Pet Medical Facilities, Bradley Scott Brinkley
Experimental Determination Of Shielding Requirements For Pet Medical Facilities, Bradley Scott Brinkley
All ETDs from UAB
Purpose: Shielding considerations are important for designing a positron emission tomography/computed tomography (PET/CT) imaging facility, because of the high energy (511 keV) of electron-positron annihilation photons. Since radiation emitted from patients administered PET radiopharmaceuticals includes lower-energy scattered photons, a given thickness of lead attenuates more of the radiation than it would for a monoenergetic beam of 511 keV photons. A more accurate determination of the effective attenuation coefficient of lead for the spectra of photon energies emitted from PET/CT patients could reduce the shielding requirements necessary to adequately protect public health. In this work, the spectra of energies emitted from …