Medicine and Health Sciences Commons^™

Impacts Of Environmental Stressors On Native South Dakota Amphibian Physiology And Survival, Danielle Jean Galvin

Dissertations and Theses

Amphibian populations around the world are declining, with some of the most likely drivers behind these declines including emerging infectious diseases and environmental contaminants. To address major gaps in the current literature, I sought to evaluate the effect of two major environmental stressors on various aspects of amphibian physiology: emerging infectious diseases and environmental contaminants. Emerging infectious diseases of amphibians include fungal, viral, and parasitic pathogens which have expanded in host range, either geographically or in competent host species. Environmental contaminants include chemicals which may be naturally occurring in the environment, or which may be introduced to the environment, often …

Exploring Opportunities To Expand And Improve Prep Uptake In Vulnerable Us Communities., Pedro B. Carneiro

Dissertations and Theses

The implementation of preexposure prophylaxis (PrEP) in the United States has fallen short of meeting both 2020 and projected 2030 milestones, with less than one-third of those who would benefit most from PrEP choosing to initiate it. High discontinuation rates and persistently elevated HIV incidence underscore the need for improvement. However, opportunities exist to enhance PrEP uptake, supported by a growing pipeline of PrEP innovations. To achieve this, effective implementation of available tools to combat HIV and the inclusion of all communities as stakeholders are essential. One such tool is event-driven (ED) PrEP, also known as PrEP 2-1-1, which is …

Understanding Veteran Perceptions About Mental Health And Its Treatment, Quinn Turner Stoddard

Dissertations and Theses

Mental health illnesses are a growing issue for a large part of the country, and veterans in particular are vulnerable to the numerous negative effects they pose. Despite the high number of people that may benefit from treatment, a variety of issues with trust, stigma, and attitudes may act as barriers to care utilization. In response, this study investigated the perceptions that veterans within the Pacific Northwest hold in regards to mental health treatment as well as their intentions to seek it out should they require it. Using the integrated model of behavioral prediction (IMBP), data was gathered about veterans’ …

Understanding Influenza Vaccine Hesitancy And Uptake Among U.S. Hispanic Adults During The Covid-19 Pandemic, Helen J. Arteaga

Dissertations and Theses

The health burden caused by seasonal flu is substantial in the general population and each season targeted efforts are needed to decrease the risk of flu illness, hospitalization, and death. Flu risks and the disease burden are disproportionately higher among Hispanic adults, yet little is known about the factors influencing flu vaccine hesitancy and uptake among this marginalized population. This cross-sectional quantitative study used national survey data from the Understanding America Study (UAS) and logistic regression to address three research aims. Aim 1 was to examine the most significant demographic factors associated with flu vaccine uptake among the Hispanic community. …

The Health Impacts Of The Trump Administration Among California Immigrants, Claudia M. Calhoon

Dissertations and Theses

Immigration policy was a marquee issue in the US presidential administration of Donald Trump. Trump’s administration employed both policy and rhetoric related to immigrants to mobilize voters, alter immigration policies and practices, and sustain a narrative of a nation under attack by immigrants. Administration officials were able to undertake these approaches because of existing immigration law, but they did so in more explicitly punitive ways than in recent administrations. The goal of this dissertation is to explore the health impacts of the administration’s practices and their effects. Paper 1 analyzes the immigration rhetoric and policies of US president Donald Trump …

"I Stayed There The Whole Night": Exploring Caregivers' Experiences With The Healthcare System When Caring For A Parent At The End Of Life, Lillian Mehran

Dissertations and Theses

Background: In the United States, there are nearly 53 million individuals serving as caregivers to a loved one. Half of all caregivers are caring for a parent or parent-in-law, and 79% of caregivers are caring for a person aged 50 or older. In New York State, there are an estimated 4.1 million caregivers who collectively provide over 2.6 billion hours of unpaid care, with those caring for a person at the end of life providing twice as many hours of caregiving per week compared to other caregivers. The number of individuals requiring caregiving is expected to increase as a significant …

Obesity Risk And Comorbidities Among Colombians In New York City And In Colombia, Carlos A. Devia

Dissertations and Theses

Introduction: The prevalence of obesity and overweight in adults and children continues to increase worldwide, accounting for the mortality and morbidity from several diseases. Obesity disproportionally impacts Latinos in the United States (U.S.), and despite their diversity in origins, ancestry, and culture, it is still unclear the burden of obesity by specific Latino groups. For example, little information is available about how obesity impacts Colombians in the U.S. (the largest South American population). New evidence also indicates that Latino immigrants may no longer be arriving with healthy weight status to the U.S. because Latin American countries are undergoing epidemiologic and …

Evaluation Of A Place-Based Asthma Reduction Initiative On Asthma-Related Morbidity Among Children In East Harlem And The Impact Of The Covid-19 Pandemic On Health Care Utilization And Medication Adherence Among Medicaid-Enrolled Children, Sarah C. Walters

Dissertations and Theses

Background: In New York City, asthma continues to be the leading cause of hospitalizations and emergency department (ED) visits among children, and disproportionally burdens Black and Latino children in low-income neighborhoods. Place-based, or geographically targeted, programs offer upstream strategies for addressing public health issues in these underserved neighborhoods, and given their targeted nature, quasi-experimental or other observational methods are needed to rigorously evaluate their impact. This dissertation uses multiple methodological approaches to assess the impact of the East Harlem Asthma Center of Excellence (EHACE) – an equity-focused, multi-faceted, place-based asthma mitigation initiative in the East Harlem neighborhood of a New …

Will Clinical Decision Support Mechanisms Reduce The Amount Of Unnecessary Computed Tomography?, Andrea Ciarmello

Dissertations and Theses

Clinical Decision Support Mechanisms (CDSMs) are to patient safety. When used in Radiology, CDSMs can improve radiation dose, quality assurance, and patient care. When paired with the electronic health record, CDSMs provide clinicians with patient-specific data that will help lower healthcare costs and improve patient outcomes. This study demonstrates how introducing clinical decision support mechanisms in electronic health record software will help improve unnecessary CT scans and hinder patient radiation exposure. The ordering physician can now consistently and reliably choose the proper scan each time.

Working Conditions, Type 2 Diabetes Mellitus, And Health Behaviors In Latino And Other Minoritized Groups Living In The United States, Tailisha M. Gonzalez

Dissertations and Theses

Background: Type 2 Diabetes Mellitus (T2DM or ‘diabetes’) poses a significant public health challenge to the healthcare system, economy, and well-being of communities in the United States (U.S.). There are also substantial racial/ethnic and social disparities in diabetes incidence and control that have persisted for decades. For Latinos and other minoritized groups in the U.S., diabetes disparities may be linked to working conditions. Globally, work is considered a major determinant of health and yet studies in the U.S. tend to focus on legacy hazards, such as chemical, biological, and environmental factors. In recent years, occupational health scholars have argued …

Promoting Well-Being Among Intercollegiate Student-Athletes: A Gratitude Intervention Using Positive Psychology, Laura Kruger

Dissertations and Theses

Intercollegiate student-athletes face rising stress and pressures which challenge their well-being and mental health, and sometimes with alarming concerns. Over the years, supportive services and resources specifically available to student-athletes have not evolved at the same pace as student-athlete needs. Also, barriers and stigmas hinder student-athletes from readily accessing supportive mental health services. The high stress of student-athletes can contribute to the development of negative mental health symptoms and impairs positive well-being. Evidence supports how outreach initiatives help student-athletes. Positive psychology, including gratitude as a positive psychological state, has shown benefits to well-being. This experimental study design researched if the …

Intentional Misdiagnosis And Ethical Considerations Of Mental Health Counselors Working With Managed Care, Emily Lake

Dissertations and Theses

Abstract Research has discussed ethical dilemmas for professional counselors working with managed care. Professional counselors are faced with the implications of providing a diagnosis to clients to receive reimbursement by managed care and to assist clients in receiving care. The purpose of the study is to better understand the counselor’s role in intentional misdiagnosis due to billing requirements from insurance companies. Furthermore, the researcher is interested in the personal and professional characteristics of counselors predictive of the decision to engage in intentional misdiagnosis. Participants in this study were asked to complete the Marlowe-Crowne Social Desirability Scale and a researcher-created survey. …

Proteostasis & Neuroinflammation In Alzheimer's Disease, Christa C. Huber

Dissertations and Theses

Alzheimer’s Disease (AD) is a devastating disorder with no disease-modifying agent that stops or reverses the progression of the disease. Exosomes, 50 – 150 nanometers in diameter extracellular vesicles, play a role in intracellular communication and are currently being explored as a therapeutic agent in various diseases. In addition, exosomes possess favorable characteristics as a therapy; however, their low yield following isolation hinders their ability as a therapeutic agent. We exposed neuroprogenitor cells to heat shock (HS) before exosomes were isolated to explore the possibility of increasing exosome secretion. HS-derived exosomes exhibit significantly increased concentration and diameter compared to non-heat …

Researching Medical Treatment Assessments From United States Military Veterans Diagnosed With Substance Use Disorder, And Determining Interest In The Matrix Model Of Treatment For Potential Application In Their Treatment Programs, Christopher R. Strunk

Dissertations and Theses

The purpose of this research study is to learn the beliefs and thoughts on the current state of medical treatment provided to United States (US) military Veterans diagnosed with substance use disorder (SUD), and gauge Veterans’ levels of interest and support in the potential application of the Matrix Model of Treatment (MMT) in their healthcare programs. This proposal focused on verifying the Veterans’ interest in the MMT model since the US Department of Veterans Affairs (DVA) does not currently implement this full-spectrum, 16-week treatment system. It is believed interest will be strong enough to merit supporting its consideration with approving …

Water And Brain Function: Effects Of Hydration Status On Neurostimulation And Neurorecording, Sam Critzer

Dissertations and Theses

Introduction: TMS and EEG are used to study normal neurophysiology, diagnose, and treat clinical neuropsychiatric conditions, but can produce variable results or fail. Both techniques depend on electrical volume conduction, and thus brain volumes. Hydration status can affect brain volumes and functions (including cognition), but effects on these techniques are unknown. We aimed to characterize the effects of hydration on TMS, EEG, and cognitive tasks. Methods: EEG and EMG were recorded during single-pulse TMS, paired-pulse TMS, and cognitive tasks from 32 human participants on dehydrated (12-hour fast/thirst) and rehydrated (1 Liter oral water ingestion in 1 hour) testing days. Hydration …

The Makings Of Creativity And Empathy: Maps Of Maternal Representations, Anielle M. Fredman

Dissertations and Theses

ABSTRACT

The Makings of Creativity and Empathy: Maps of Maternal Representations

by

Anielle M. Fredman

Advisor: Sasha Rudenstine, Ph.D.

The present study investigates the relationship between maternal fantasy of the child and their relationship, and children’s unconscious processes. In addition, the study aims to ascertain the link between maternal representations and aspects of the child’s intrapsychic world, including ego functioning, object relations, and processes of separation-individuation.

Maternal fantasy was measured in an original way with a tripartite typology of Positive, Mixed-Complex, and Contradictory Representations, applied to the Parent Development Interview-Revised Short (Slade et al., 2004), adapted from the Working Model …

A Study Of Verbal Rumination, Relationships, Stress And Identity On Health Communication In Collegiate Athletics, Landon Mary Ellen Kemp

Dissertations and Theses

College athletes are a unique group of individuals as they face many positive and negative challenges when competing in a collegiate sport. Verbal rumination is repetitive talk about a particular issue, accompanied by adverse effects for an individual. Verbal rumination is a common strategy athletes use to cope with difficulties along with managing challenging situations in their athletic program. To explore factors that might inspire or impede verbal rumination in collegiate athletics, the present study examines the quality of coach and teammate relationships, perceived stress and athlete identity. Results revealed the impact of relationships between coaches and athletes in respect …

The Impact Of Resilience And Professional Practice Demographics On The Professional Quality Of Life Of Recreational Therapists, Kelley Mccubbin

Dissertations and Theses

Compassion fatigue can worsen recreational therapists’ quality of life, leaving lasting impacts on a professional’s a professionals' work, home, and social environments. There is little to no research that discusses the impact of resilience and professional practice demographics on compassion satisfaction and compassion fatigue among recreational therapists. This nonexperimental correlational dissertation study examined the impact of resilience and professional practice demographics on the professional quality life (compassion satisfaction and compassion fatigue) in a group of recreational therapists. A total of 677 recreational therapists were analyzed after responding to an online survey that included a professional practice demographic questionnaire, the Professional …

Adaptation To Sport Retirement In Division I Student-Athletes, Andrea Cota Powell

Dissertations and Theses

This dissertation utilizes a mixed-methods design to explore adaptation to sport retirement among Division I student-athletes. Sport retirement is a major life transition that can elicit changes in support systems, identity crises, and feelings of loss, failure, and grief. Transitioning out of sport is a phenomenon that over 90% of collegiate student-athletes experience when their four years of NCAA eligibility expires. It is a phenomenon that all athletes experience at some point in their lives. To transition out of sports, one must adapt to post-sport life. Study one of this dissertation explored the phenomenon of occupational retirement through concept analysis …

Patient Frailty: A Review, Lakshmi Sailaja Kodavati

Dissertations and Theses

According to Geriator (2011), frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes such as falls, incident disability, hospitalization, and mortality. An operational definition of frailty is the existence of at least three out of five observable criteria indicating compromised energetics: low grip strength; low energy; slowed walking speed; low physical activity; and unintentional weight loss (Fried, et al. 2001).

According to Dubois and Charpillet (2017), most transitions into frailty are due to unintentional weight loss which, in turn, impacts gait performance and subsequent general mobility. In this literature review, the …

Effect Of Body Mass Index, Testosterone, And Insulin On Breast Cancer: A Mendelian Randomization Study And Investigation Of Selection Bias, Kezhen Fei

Dissertations and Theses

BACKGROUND: Female breast cancer is the most studied cancer, and the second leading cause of cancer death in women, whose aetiology is still not completely clear. The parallel increase of incident obesity and breast cancer in women worldwide raises the question of the role of adiposity, measured by body mass index (BMI), and of major anabolic hormones, such as insulin and testosterone, on breast cancer. Observational studies are open to confounding making it difficult to clearly demonstrate causal effects. Several mendelian randomization (MR) studies have shown inverse association of BMI with breast cancer. To assess selection bias in MR …

Health Literacy And People Diagnosed With Mental Illness, Beckie Child

Dissertations and Theses

Health literacy is a well-studied concept that has a large literature base. Yet, little is known about health literacy and people diagnosed with mental illnesses, and even less health literacy research speaks to people diagnosed with mental illness. I used a framework and approach of lived experience of psychiatric diagnosis and psychiatric survivor research to conceptualize and inform the study. It explores health literacy with people diagnosed with mental and physical health diagnoses using a small quantitative survey, focus groups, and an individual interview. The findings suggest that health literacy is a dynamic and complex construct that interacts with the …

Examining Demographic And Environmental Factors In Predicting The Perceived Impact Of Cancer On Childhood And Adolescent Cancer Survivors, Nazan Cetin

Dissertations and Theses

Cancer survivors' perceptions on how cancer has impacted their lives has been identified as a "critical predictor" of psychosocial well-being and quality of life outcomes. Given the dramatic increase in survival rates and the long-term health and psychosocial challenges, as well as survivorship care barriers, this study focuses special attention on childhood and adolescent cancer survivors and is guided by Tedeschi and Calhoun's theory of posttraumatic growth and Hammond's theory of distinctiveness. This study aims to examine the influence of demographic (i.e., age at diagnosis, biological sex, race/ethnicity, type of cancer) and environmental factors (i.e., geographical location and insurance type), …

Treatment Disparities In Emergency Medical Services: The Influence Of Race/Ethnicity, Obesity, And English Proficiency, Jamie Kennel

Dissertations and Theses

Different treatment in healthcare settings provided to different social groups of people may lead to disparities in health, quality of life, and life span. Despite the critical role among healthcare services that Emergency Medical Services (EMS) provides disproportionately for marginalized communities, it remains unclear if and to what extent treatment disparities take place in the pre-hospital setting. Guided by the theoretical frameworks of social worth, aversive racism, and stigma, this study utilizes medical chart data from three different public and private datasets to investigate treatment disparities by Emergency Medical Service providers for racial minority, obese, and limited English proficiency patients. …

The Effects Of Language Proficiency On Narrative Macrostructure In Spanish-English Bilinguals, Jenny Magallon

Dissertations and Theses

Bilingual children of the same age may have different narrative skills depending on the quantity and quality of their experiences in the two languages. Thus, children's storytelling skills can vary depending on children's oral proficiency in each language. The present study examined the effects of oral proficiency on story structure in forty 5- to 7-year-old Spanish-English speaking children using Spanish and English samples from story retelling tasks. Language proficiency was measured as continuum of performance using the Spanish-English Language Proficiency Scale (SELPS; Smyk et al., 2013). To estimate the effects of Spanish and English proficiency on story structure, linear regressions …

Radiation Isolation And The Impact Of Care: Nursing Knowledge And Perception Of Radiation Risks, Bae P. Chu

Dissertations and Theses

Background: The safety challenges encountered when employing ionizing radiation to treat patients and manage radiation exposure and contamination have been well established in previous research. However, little is known about nurses’ understanding of the risks associated with ionizing radiation and how they respond to their own perceptions of risk. Although a wealth of literature shows an association between radiation treatment and negative patient experiences, there remains a lack of understanding of the basis of these perceptions among nurses. Increased ionizing radiation diagnoses and treatment means that nurses are at a higher risk of radiation exposure today than thirty years ago. …

Assessment Of Spatial And Temporal Trends Of Exposure To Ambient Fine Particulate Matter And Ozone In New York/New Jersey Metropolitan Area, Subraham Singh

Dissertations and Theses

Background. Exposures to fine particulate matter (PM_2.5; particles with diameter less than 2.5 μm) and ozone (O₃) affect premature respiratory and cardiovascular mortality, morbidity and contribute to the development and progression of sub-clinical and clinical disease. Climate change affects air quality directly by modifying the thermodynamic properties of formation mechanisms and transport patterns, and indirectly, through increased emissions of PM_2.5 and O₃ precursors. The resultant changes in air quality influence human health outcomes through mechanisms of varying scale, timing, and complexity. PM_2.5 and O₃ levels have been declining due to the implementation …

Factors Related To Contraceptive Use And Family Planning Decision-Making In The South Asian Community Residing In New York City, Nandini Shroff

Dissertations and Theses

Introduction: Currently, there are approximately 5.4 million South Asians residing in the United States (U.S.). The limited literature illustrates that contraceptive use is underutilized among Asians and Asian sub-groups, including South Asian Americans, compared to other racial and ethnic groups. Using Los Angeles County Health survey data, one study found that 22% of Asian Americans reported always using condom in the past 12 months compared to 37% of African Americans, 27% of Whites, and 27% of Hispanics. A study among New Jersey women revealed that compared to non-South Asian women, South Asians (SAs) were less likely to have used ever …

Episode Based Payment Models And The Hospital Safety-Net: An Evaluation Of The Center For Medicare And Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program, John A. Gravina

Dissertations and Theses

Episode Based Payment Models and the Hospital Safety-net: An Evaluation of the Center for Medicare and Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program

By John Anthony Gravina

Advisor: Alexis Pozen, Ph.D.

Introduction: Payments for Healthcare services are increasingly being tied to clinical quality, patient experience, health outcomes, and efficiency through value-based payment arrangements (VBP). VBP presents a potential opportunity to reduce healthcare expenditures by requiring providers to take on financial risk associated with the cost and quality of care, therefore aligning payment incentives with the goals of providing higher quality and efficient care. As of 2020, 80 percent of …

The Global Implementation Of Dolutegravir For Hiv Treatment, Matthew L. Romo

Dissertations and Theses

Background
Dolutegravir, an integrase strand transfer inhibitor, is now recommended by international guidelines as part of preferred antiretroviral therapy (ART) regimens for people living with HIV. In low- and middle-income countries (LMICs), HIV treatment programs are transitioning from non-nucleoside reverse transcriptase inhibitors (NNRTIs) to dolutegravir because of its superior efficacy and tolerability, and high genetic barrier to HIV drug resistance. Along with the optimism surrounding widespread dolutegravir use, key questions regarding its implementation have emerged. In this dissertation, I sought to achieve the following specific aims: Aim 1: Characterize dolutegravir uptake in LMICs and identify potential disparities related to sex …