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Association Of Race/Ethnicity And Population Density With Disparities In Timeliness Of Rectal Cancer Therapy, Susanna S. Hill Apr 2020

Association Of Race/Ethnicity And Population Density With Disparities In Timeliness Of Rectal Cancer Therapy, Susanna S. Hill

GSBS Dissertations and Theses

Objective:

Access to care is key to effective rectal cancer treatment. We hypothesized that ethnic/racial minorities living in high population density areas would have the greatest delays in cancer care compared to whites living in medium population density areas.

Methods:

Using 2004-2016 National Cancer DataBase data, we identified stage I-III patients with invasive rectal adenocarcinoma who underwent surgery. The data were analyzed by race/ethnicity (whites, blacks, or Hispanics) and population density (metropolitan or urban/rural). Multivariable ANCOVA was performed to evaluate the duration of time from diagnosis to surgery.

Results:

The study population consisted of 76,131 patients ...


Evaluation Of A Tiered Opioid Prescribing Guideline For Inpatient Colorectal Operations, David C. Meyer Apr 2020

Evaluation Of A Tiered Opioid Prescribing Guideline For Inpatient Colorectal Operations, David C. Meyer

GSBS Dissertations and Theses

Background:

In light of the opioid epidemic, reducing excess prescription quantities while tailoring to patient need is key. We previously created an opioid prescribing guideline using retrospective institutional data to satisfy the majority of patients’ opioid needs following inpatient colorectal surgery.

Objective:

This study sought to prospectively validate an institutional prescribing guideline based on previously-defined opioid consumption patterns following inpatient colorectal operations.

Methods:

We carried out a cohort study comparing opioid prescribing and consumption patterns before (7/18 – 1/19) and after (9/19 – 2/20) adoption of a tiered opioid prescribing guideline for inpatient elective colorectal operations (colectomies, proctectomies ...


Trends, Predictors, And Consequences Of Child Undernutrition In India, Apurv Soni Apr 2019

Trends, Predictors, And Consequences Of Child Undernutrition In India, Apurv Soni

GSBS Dissertations and Theses

Background: India has the highest number of undernourished children worldwide. Understanding trends, predictors, and consequences of child undernutrition is important to inform strategy for addressing this public health crisis.

Methods: We used data from four National Family Health Surveys (1992-93, 1998-99, 2005-6, 2015-16 NFHS) to examine trends of undernutrition before and after the 2005 implementation of the National Rural Health Mission, India’s flagship public health initiative (Aim 1). We used the 2016 NFHS to build a predictive model that identifies infants at-risk for child undernutrition (Aim 2). Lastly, we used data from the 2005 and 2012 India Human Development ...


Physiological And Psychological Stressors Associated With Glucose Metabolism In The Boston Puerto Rican Health Study, Andrea A. Lopez-Cepero Mar 2019

Physiological And Psychological Stressors Associated With Glucose Metabolism In The Boston Puerto Rican Health Study, Andrea A. Lopez-Cepero

GSBS Dissertations and Theses

Background: Puerto Ricans experience high prevalence of type 2 diabetes (diabetes). Stress is a risk factor for diabetes. The allostatic load (AL) model explains how stress influences disease through a chain of physiological changes. Puerto Ricans experience psychological and physiological (obesity and high glycemic load (GL)) stressors linked with diabetes, yet how these stressors impact the AL chain and how their interplay affects glucose metabolism remains unknown.

Methods: Using data from the Boston Puerto Rican Health Study, this thesis sought to examine: 1) the relationship between GL and primary AL markers, 2) the interaction between perceived stress and GL on ...


Religiosity And Patient Activation And Health Outcomes Among Hospital Survivors Of An Acute Coronary Syndrome, Hawa Ozien Abu Mar 2019

Religiosity And Patient Activation And Health Outcomes Among Hospital Survivors Of An Acute Coronary Syndrome, Hawa Ozien Abu

GSBS Dissertations and Theses

Background: Religious involvement is widespread and may influence patient engagement with their healthcare (patient activation) and health outcomes. This dissertation examined the association between religiosity and patient activation, changes in health-related quality of life (HRQOL), readmissions, and survival after hospitalization for acute coronary syndrome (ACS).

Methods: We recruited 2,174 patients hospitalized for ACS in Georgia and Central Massachusetts (2011-2013) in a prospective cohort study. Participants self-reported three items assessing religiosity – strength/comfort from religion, petition prayers for health, and awareness of intercessory prayers by others. Patient activation was measured using the 6-item Patient Activation Measure. Generic HRQOL was assessed ...


Interpersonal Discrimination, Gendered Race, And Cardiovascular Disease Inequities: Application Of The Emerging Identity Pathology Model, Ganga S. Bey Mar 2019

Interpersonal Discrimination, Gendered Race, And Cardiovascular Disease Inequities: Application Of The Emerging Identity Pathology Model, Ganga S. Bey

GSBS Dissertations and Theses

An emerging framework, the Identity Pathology (IP) model, partially addresses persistent uncertainties about the primary causes of disparities in cardiovascular health (CVH) between black and white women and men through outlining how identity beliefs associated with social group membership lead to predictable differences in the health-damaging effects of discrimination exposure. Using data from the CARDIA cohort, this doctoral thesis seeks to: 1) propose a novel psychosocial characteristic, identity pathology, that drives the distribution of reported race and gender discrimination in health-relevant ways, 2) assess whether there are group differences in the effects of multiple versus single forms of discrimination on ...


Understanding The Experience And Evaluating The Occurrence Of Depression In A Sample Of Pregnant Veterans, Aimee R. Kroll-Desrosiers Jan 2019

Understanding The Experience And Evaluating The Occurrence Of Depression In A Sample Of Pregnant Veterans, Aimee R. Kroll-Desrosiers

GSBS Dissertations and Theses

Background: The Veterans Health Administration (VHA) encourages depression screening and treatment for pregnant veterans; however, rates of depression symptoms and treatment utilization during pregnancy have not been well-studied.

Methods: We used data from the Maternity Care Coordination for Women Veterans cohort study. Specifically, our aims were to: 1) examine rates and correlates of depression symptoms in a sample of pregnant veterans; 2) understand mental health care treatment utilization and explore the experiences of veterans accessing mental health care at the VHA during pregnancy; and 3) examine VHA mental health provider's perspectives on depression screening and treatment in the perinatal ...


Factors Associated With Weight Management Counseling During Primary Care Clerkships, Karen M. Ashe Jan 2019

Factors Associated With Weight Management Counseling During Primary Care Clerkships, Karen M. Ashe

GSBS Dissertations and Theses

Background: The United States Preventive Services Task Force guidelines support screening and provision of intensive multi-component behavioral counseling for adults who have obesity. One barrier to providing such counseling is lack of training in medical school. Not much is known about factors associated with medical students’ perceived weight management counseling (WMC) skills or whether preceptors model or teach WMC during primary care clerkships.

Methods: A mixed methods approach addressed factors affecting WMC training during primary care clerkships. A secondary analysis of 3rd year medical students (n=730) described students’ perceived WMC skills, attitudes and frequency of engagement in 5As ...


Predictors Of Patient Activation At Acs Hospital Discharge And Health Care Utilization In The Subsequent Year, Rebecca L. Kinney Aug 2018

Predictors Of Patient Activation At Acs Hospital Discharge And Health Care Utilization In The Subsequent Year, Rebecca L. Kinney

GSBS Dissertations and Theses

Background. AHA guidelines have been established to reduce Acute Coronary Syndrome (ACS)-related morbidity, mortality and recurrent events post-discharge. These recommendations emphasize the patient as an engaged member of the health care team in secondary prevention efforts. Patients with high levels of activation are more likely to perform activities that will promote their own health and are more likely to have their health care needs met. Despite evidence and strong expert consensus supporting patients as active collaborators in their own ACS care, the complexity and unexpected realities of self-managing one’s care at home are often underestimated. This study seeks ...


Ventricular Arrhythmias Complicating Coronary Artery Disease: Recent Trends, Risk Associated With Serum Glucose Levels, And Psychological Impact, Hoang V. Tran Jun 2018

Ventricular Arrhythmias Complicating Coronary Artery Disease: Recent Trends, Risk Associated With Serum Glucose Levels, And Psychological Impact, Hoang V. Tran

GSBS Dissertations and Theses

Introduction: Ventricular arrhythmias (VAs) are common after an acute coronary syndrome (ACS) and are associated with worse clinical outcomes. However, little is known about recent trends in their occurrence, their association with serum glucose levels, and their psychological impact in ACS setting.

Methods: We examined 25-year (1986-2011) trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of VAs, and the association between serum glucose levels and VAs in patients with an acute myocardial infarction (AMI) in the Worcester Heart Attack Study. Lastly, we examined the relationship between in-hospital occurrence of VAs and 12-month progression of depression and anxiety ...


National Trends In Elective Ileal Pouch-Anal Anastomosis For Ulcerative Colitis, Chau Maggie Hoang Jun 2018

National Trends In Elective Ileal Pouch-Anal Anastomosis For Ulcerative Colitis, Chau Maggie Hoang

GSBS Dissertations and Theses

Background: Recent national trends and distribution of ileal pouch-anal anastomosis (IPAA) procedures for patients with ulcerative colitis (UC) are unknown. We examined the frequency of use of elective IPAA procedures among patients with UC and the distribution of IPAA procedures across more than 140 U.S. academic medical centers and their affiliates.

Methods: Data were obtained from the University HealthSystem Consortium for patients with a primary diagnosis of UC admitted electively between 2012 and 2015.

Results: The mean age of the study population (n=6,875) was 43 years and 57% were men. Among these, one-third (n=2,307) underwent ...


Evaluating Multi-Level Factors Influencing Adolescent Sugar Sweetened Beverage Consumption, Christina F. Griecci Mar 2018

Evaluating Multi-Level Factors Influencing Adolescent Sugar Sweetened Beverage Consumption, Christina F. Griecci

GSBS Dissertations and Theses

Background: Sugar sweetened beverages (SSBs) comprise the largest source of added sugars in US adolescents’ diets. SSB consumption is pervasive in US culture and is a critical risk factor for weight gain and obesity in adolescents. This thesis evaluates multi-level factors that influence adolescent SSB consumption.

Methods: The first two aims of this thesis utilized data from the cross sectional, internet based Family Life, Activity, Sun, Health and Eating (FLASHE) study to: 1) examine availability of SSBs in multiple settings (home, school, neighborhood) and adolescent SSB consumption, 2) examine the associations between perceptions of parenting practices and adolescent SSB consumption ...


Opioid Use And Safety In United States Nursing Homes, Jacob N. Hunnicutt Mar 2018

Opioid Use And Safety In United States Nursing Homes, Jacob N. Hunnicutt

GSBS Dissertations and Theses

Background: Opioids are often used in nursing homes to manage non-malignant pain, but little is known about their long-term use, initiation, and comparative safety.

Methods: We used the Minimum Data Set 3.0 from 2011-2013 merged to Medicare and facility characteristics data to study opioid use and safety among older, long-stay residents. The specific aims were to examine the 1) prevalence of long-term opioid use; 2) geographic variation in the initiation of commonly used opioids (oxycodone, hydrocodone, tramadol); and 3) comparative safety of commonly used opioids and fracture hospitalizations.

Results: One in seven long-stay residents were prescribed opioids long-term. There ...


Use Of Clinicaltrials.Gov Registry In Systematic Reviews And Meta-Analyses: A Master's Thesis, Richeek Pradhan Nov 2017

Use Of Clinicaltrials.Gov Registry In Systematic Reviews And Meta-Analyses: A Master's Thesis, Richeek Pradhan

GSBS Dissertations and Theses

Ensuring the objectivity of systematic reviews and meta-analyses (SRMA) begins with comprehensive searches into diverse resources mining primary studies. Guidelines for systematic reviews recommend authors to routinely search of trial registries to identify unpublished studies. In this dissertation, I investigated the utilization of ClinicalTrials.gov (CTG), the world’s largest clinical trial registry that contains data from clinical trials of products that are subject to United States Food and Drug Administration (FDA) regulation, as an information resource in SRMAs. First, I examined the use of various information resources including CTG in SRMAs published from 2005-2016, and identified the factors associated ...


Barriers To Healthcare Access And Patient Outcomes After A Hospitalization For An Acute Coronary Syndrome And Other Acute Conditions, Nathaniel A. K. Erskine Nov 2017

Barriers To Healthcare Access And Patient Outcomes After A Hospitalization For An Acute Coronary Syndrome And Other Acute Conditions, Nathaniel A. K. Erskine

GSBS Dissertations and Theses

Background: Guideline-concordant therapies for survivors of an acute coronary syndrome (ACS) hospitalization require healthcare access, something that millions of Americans lack.

Methods and Results: Using data from a prospective cohort study of over 2,000 survivors of a hospitalization for an ACS in central Massachusetts and Georgia from 2011 to 2013, the first two aims of this thesis sought to identify the post-discharge consequences for survival and health status of having: 1) financial barriers to healthcare, 2) no usual source of care, and 3) transportation barriers. We found that patients lacking a usual source of care and having a transportation ...


Characterization Of Severe Malaria In Liberian Children 5 Years Old And Younger, Patricia A. Mcquilkin May 2017

Characterization Of Severe Malaria In Liberian Children 5 Years Old And Younger, Patricia A. Mcquilkin

GSBS Dissertations and Theses

Malaria continues to be a challenging problem in the developing world, and the burden of this life threatening disease continues to be borne by young children living in Sub Saharan Africa. One of the biggest challenges to the prevention and control of this problem lies in accurately diagnosing malaria, and distinguishing it from the many other febrile illnesses which present in children in this age group.

Liberia is a West African country with a high burden of malaria. Very little is known about the presentation of severe malaria in children aged 5 years old and younger in Liberia. We undertook ...


Recent Trends In Sepsis Mortality, Associations Between Initial Source Of Sepsis And Hospital Mortality, And Predictors Of Sepsis Readmission In Sepsis Survivors, Christine Motzkus Apr 2017

Recent Trends In Sepsis Mortality, Associations Between Initial Source Of Sepsis And Hospital Mortality, And Predictors Of Sepsis Readmission In Sepsis Survivors, Christine Motzkus

GSBS Dissertations and Theses

Background: Sepsis, a leading cause of US deaths, is associated with high mortality, although advances in early recognition and treatment have increased survivorship. Many aspects of sepsis pathophysiology and epidemiology have not been fully elucidated; the heterogeneous nature of infections that lead to sepsis has made fully characterizing the underlying epidemiology challenging.

Methods: The University HealthSystem Consortium (UHC) from 2011-2014 and the Cerner HealthFacts® database from 2008-2014 were used. We examined associations between infection source and in-hospital mortality in the UHC dataset, stratified by age and presenting sepsis stage. We examined recent temporal trends in present-on-admission (POA) sepsis diagnoses and ...


Impact Of Intra-Articular Injection Use On Patient-Reported Outcomes Among Patients With Knee Osteoarthritis, Shao-Hsien Liu Mar 2017

Impact Of Intra-Articular Injection Use On Patient-Reported Outcomes Among Patients With Knee Osteoarthritis, Shao-Hsien Liu

GSBS Dissertations and Theses

Background: Knee osteoarthritis (OA) is the most common type of OA and is a major cause of pain and thus results in disability for daily activities among persons living in the community. OA currently has no cure. In addition to the conflicting recommendations from clinical guidelines, evidence about the extent to which long-term use of intra-articular injections improves patient outcomes is also lacking.

Methods: Using data from the Osteoarthritis Initiative (OAI), marginal structural models (MSMs) applying inverse probability treatment weights (IPTW) were used to examine the effectiveness of intra-articular injections and changes in symptoms over time. The specific aims of ...


Patient And Social Determinants Of Health Trajectories Following Coronary Events, Lisa Nobel Mar 2017

Patient And Social Determinants Of Health Trajectories Following Coronary Events, Lisa Nobel

GSBS Dissertations and Theses

More than 1.2 million Americans are hospitalized annually with an acute coronary syndrome (ACS); many impaired quality of life after discharge with an ACS. This dissertation focuses on two novel aspects of patient health status (PHS) after ACS: how it can be predicted based on the socioeconomic status (SES) of the patient, and how it evolves over time. We used data from TRACE-CORE, a longitudinal prospective cohort of patients hospitalized with ACS. We measured PHS using both the SF-36 mental and physical component subscales (MCS and PCS) and the Seattle Angina Questionnaire (SAQ) health-related quality of life (HRQoL) and ...


The Role Of Late Antigen In Cd4 Memory T Cell Formation During Influena [I.E. Influenza] Infection: A Dissertation, Bianca L. Bautista Oct 2016

The Role Of Late Antigen In Cd4 Memory T Cell Formation During Influena [I.E. Influenza] Infection: A Dissertation, Bianca L. Bautista

GSBS Dissertations and Theses

While memory CD4 T cells are critical for effective immunity to pathogens, the mechanisms underlying their generation are poorly defined. Although extensive work has been done to examine the role of antigen (Ag) in shaping memory formation, most studies focus on the requirements during the first few days of the response known as the priming phase. Little is known about whether or not Ag re-encounter by effector T cells (late Ag) alters CD4 memory T cell formation. Since influenza infection produces a large, heterogeneous, protective CD4 memory T cell population, I used this model to examine the role of late ...


Evaluating Acceptability, Feasibility And Efficacy Of A Diabetes Care Support Program Facilitated By Cellular-Enabled Glucose Meters: A Dissertation, Daniel J. Amante Oct 2016

Evaluating Acceptability, Feasibility And Efficacy Of A Diabetes Care Support Program Facilitated By Cellular-Enabled Glucose Meters: A Dissertation, Daniel J. Amante

GSBS Dissertations and Theses

Background. Diabetes requires significant disease management, patient-provider communication, and interaction between patients, family members, caregivers, and care teams. Emerging patient-facing technologies, such as cellular-enabled glucose meters, can facilitate additional care support and improve diabetes self-management. This study evaluated patient acceptability, feasibility, and efficacy of a diabetes care support program facilitated by cellular-enabled glucose meters.

Methods. A two-phase study approach was taken. Get In Touch – Phase 1 (GIT-1) was a 1-month pilot involving patients with type 1 and type 2 diabetes. Get In Touch – Phase 2 (GIT-2) was a 12-month randomized controlled crossover trial involving patients with poorly-controlled type 2 diabetes ...


Predictors Of Post-Injury Mortality In Elderly Patients With Trauma: A Master's Thesis, Charles M. Psoinos Jul 2016

Predictors Of Post-Injury Mortality In Elderly Patients With Trauma: A Master's Thesis, Charles M. Psoinos

GSBS Dissertations and Theses

Background: Traumatic injury remains a major cause of mortality in the US. Older Americans experience lower rates of injury and higher rates of death at lower injury severity than their younger counterparts. The objectives of this study were to explore pre-injury factors and injury patterns that are associated with post-discharge mortality among injured elderly surviving index hospitalization.

Methods: We queried a 5% random sample of Medicare beneficiaries (n=2,002,420) for any hospitalization with a primary ICD-9 diagnosis code for injury. Patients admitted without urgent/emergent admission were excluded, as well as patients presenting from inpatient hospitalization or rehabilitation ...


Barriers And Facilitators To Deaf Trauma Survivors’ Help-Seeking Behavior: Lessons For Behavioral Clinical Trials Research: A Master’S Thesis, Melissa L. Anderson May 2016

Barriers And Facilitators To Deaf Trauma Survivors’ Help-Seeking Behavior: Lessons For Behavioral Clinical Trials Research: A Master’S Thesis, Melissa L. Anderson

GSBS Dissertations and Theses

Deaf individuals experience significant obstacles to participating in behavioral health research when careful consideration is not given to accessibility in the design of study methodology. To inform such considerations, we conducted a secondary analysis of a mixed-methods study that explored 16 Deaf trauma survivors’ help-seeking experiences. Our objective was to identify key findings and qualitative themes from consumers' own words that can be applied to the design of behavioral clinical trials methodology. In many ways, the themes that emerged are what we would expect of any research participant, Deaf or hearing – a need for communication access, empathy, respect, strict confidentiality ...


Frailty And Outcomes In Liver Transplantation: A Dissertation, Natasha H. Dolgin Apr 2016

Frailty And Outcomes In Liver Transplantation: A Dissertation, Natasha H. Dolgin

GSBS Dissertations and Theses

In recent years, the transplant community has explored and adopted tools for quantifying clinical insight into illness severity and frailty. This dissertation work explores the interplay between objective and subjective assessments of physical health status and the implications for liver transplant candidate and recipient outcomes. The first aim characterizes national epidemiologic trends and the impact of Centers for Medicare and Medicaid quality improvement policies on likelihood of waitlist removal based on the patient being too frail to benefit from liver transplant (“too sick to transplant”). This aim includes more than a decade (2002–2012) of comprehensive national transplant waitlist data ...


Contraceptive Utilization And Downstream Feto-Maternal Outcomes For Women With Substance Use Disorders: A Dissertation, Gillian J. Griffith Mar 2016

Contraceptive Utilization And Downstream Feto-Maternal Outcomes For Women With Substance Use Disorders: A Dissertation, Gillian J. Griffith

GSBS Dissertations and Theses

Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy.

Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with ...


Conceptualizing, Understanding, And Assessing Research Literacy In A Diverse Population: A Dissertation, Lauren R. Powell Mar 2016

Conceptualizing, Understanding, And Assessing Research Literacy In A Diverse Population: A Dissertation, Lauren R. Powell

GSBS Dissertations and Theses

Background: Racial and ethnic minorities are under-represented participants in health-related research. Comprehension and understanding of the research process are a barrier to research participation. A potential approach to engaging underserved populations in research is through improving research literacy, which we define as “the capacity to obtain, process and understand basic information needed to make informed decisions about research participation.”

Methods: Through primary data collection and mixed-methods approaches, this doctoral thesis seeks to: 1) define and conceptualize the domains, determinants, and impacts of research literacy through the development of a multi-component comprehensive framework, 2) operationalize research literacy by developing and psychometrically ...


Gender Differences In Choice Of Procedure And Case Fatality Rate For Elderly Patients With Acute Cholecystitis: A Masters Thesis, Courtney E. Collins Dec 2015

Gender Differences In Choice Of Procedure And Case Fatality Rate For Elderly Patients With Acute Cholecystitis: A Masters Thesis, Courtney E. Collins

GSBS Dissertations and Theses

Background: Treatment decisions for elderly patients with gallbladder pathology are complex. Little is known about what factors go into treatment decisions in this population. We used Medicare data to examine gender-based differences in the use of cholecystectomy vs. cholecystostomy tube placement in elderly patients with acute cholecystitis.

Methods: We queried a 5% random sample of Medicare data (2009-2011) for patients >65 admitted for acute cholecystitis (by ICD-9 code) who subsequently underwent a cholecystectomy and/or cholecystostomy tube placement. Demographic information (age, race), clinical characteristics (Elixhauser index, presence of biliary pathology), and hospital outcomes (case fatality rate, length of stay, need ...


Diet Quality And Evening Snacking In Relation To Sleep Duration And Quality Among Women With Young Children: A Dissertation, Rui Sherry Xiao Nov 2015

Diet Quality And Evening Snacking In Relation To Sleep Duration And Quality Among Women With Young Children: A Dissertation, Rui Sherry Xiao

GSBS Dissertations and Theses

Background: Mothers’ diets impact their health and the health of their children, but diet quality is suboptimal among women with young children. Evening snacking among women with young children, especially consumption of high-calorie, high-carbohydrate snacks, may impact overall diet quality and glucose metabolism. Short sleep duration and poor sleep quality may be potential risk factors. We examined whether sleep duration and poor sleep quality were associated with diet quality and evening snacking among women with young children.

Methods: Data were from the National Health and Nutrition Examination Survey (NHANES) 2005-2012, nationally representative cross-sectional surveys of noninstitutionalized U.S. population. Eligible ...


Attention Deficit/Hyperactivity Disorder, Screen Time, Physical Activity, And Diet Quality: A Dissertation, Carol Curtin Jul 2015

Attention Deficit/Hyperactivity Disorder, Screen Time, Physical Activity, And Diet Quality: A Dissertation, Carol Curtin

GSBS Dissertations and Theses

Background. Emerging evidence suggests that youth with attention deficit/hyperactivity disorder (ADHD) may engage in sub-optimal health behaviors including high levels of screen time, low physical activity participation, and consumption of poor diets. These are independent risk factors for adverse health outcomes, and health-related behavior patterns established in childhood can track into adulthood. Thus, identifying and addressing dietary and physical activity habits in sub-populations of youth have important implications for health over the lifespan. The specific aims of this dissertation were to: (1) compare screen time between youth with and without ADHD and to assess its relationship to ADHD symptomatology ...


Sentinel Lymph Node Biopsy In Elderly Patients With Intermediate Thickness Melanoma: A Masters Thesis, Kate H. Dinh May 2015

Sentinel Lymph Node Biopsy In Elderly Patients With Intermediate Thickness Melanoma: A Masters Thesis, Kate H. Dinh

GSBS Dissertations and Theses

Background: A landmark study suggested that wide excision of intermediate-thickness melanoma with sentinel lymph node biopsy (SLNB) and subsequent completion lymph node dissection (CLND) for regional disease may improve prognostication and disease-free survival (DFS) compared with those undergoing wide excision alone. However, these benefits were relatively small and not associated with an improvement in disease-specific survival (DSS). It remains unknown if SLNB and subsequent treatments are beneficial in elderly patients who have a decreased overall (OS) due to other causes.

Methods: Adults ≥ 70 years of age, who underwent surgical intervention for intermediate-thickness cutaneous melanoma from 2000-2013 were identified from a ...