Digital Commons Network^™

Diagnostic Coding Of Physical Abuse Among Patients Evaluated By A Multidisciplinary Child Protection Team In A Pediatric Level I Trauma Center, Holly Hughes Garza

Dissertations and Theses (Open Access)

Child abuse is a substantial public health problem. Numerous studies have used hospital discharge data coded using the International Classification of Diseases, 9th and 10th Editions, Clinical Modification (ICD-9 and ICD-10) to identify cases of physical abuse seen in hospitals. Published studies on the sensitivity and specificity of ICD coding for physical child abuse are limited using ICD-9, and non-existent with ICD-10. This study examined the accuracy of ICD coding for physical child abuse, among patients less than 18 years of age, who were evaluated due to concern for physical abuse by a Multidisciplinary Child Protection Team (MCPT) during 2012-2013 …

The Prevalence Of Practicing Safety Professionals’ Knowledge, Involvement, And Competency Associated With Workplace Wellness Programs: Gauging The Safety Profession’S Engagement With The Total Worker Health Initiative, Jennifer C. Laine

Dissertations and Theses (Open Access)

The morbidity and mortality burden of occupational injuries and illnesses in the United States became such a public health concern that in 1970 the Occupational Safety and Health Act was signed into law. This law requires employers to provide workplaces “free from recognized hazards” and spurred the development of specific regulations along with the creation of academic and professional training programs to educate individuals about the safety sciences and careers in safety fields. Today there are an estimated 26,000 professionally trained and board certified safety professionals supporting workplace programs across the country, alongside numerous non-certified, but degreed, practicing safety professionals. …

Measuring Goal Attainment In Chronic Disease Self-Management Within Clinical And Research Contexts: Development And Initial Testing Of The Goal Attainment Outcome Measure For Stroke (Gam-S), Barbara Kimmel

Dissertations and Theses (Open Access)

Background and Aims: Self-management (SM) skills help stroke survivors achieve behavior risk factors control. Goal setting and attainment are fundamental for SM. The most salient elements of SM effectiveness and measurements are just beginning to be understood. Investigation of measurement of goal attainment of SM risk factors has been the major aim of the study. My dissertation explores research questions concerning the goal attainment measure using data collected at the Veterans hospital.

Methods and Results: Introductory Chapters 1 and 2, include the background on stroke prevention through self-management interventions and a preliminary literature review of goal attainment in the context …

Human Papillomavirus Vaccination Status And Endorsement Among Undergraduate Nursing Students: A Secondary Data Analysis, Ashley Hollins

Dissertations and Theses (Open Access)

Background: Human papillomavirus (HPV) vaccination has immense potential to prevent HPV-related infections but vaccination rates remain suboptimal. Nurses could potentially increase vaccination rates by providing recommendations and addressing vaccine concerns. As student nurses’ transition into practice, it is important to identify factors that could influence their attitudes and uptake of the HPV vaccine; however, these factors remain unknown.

Purpose: We proposed to: (1) identify factors associated with HPV vaccination status and (2) to identify student nurses’ perception of parental vaccine hesitancy, preferred counseling strategies, and factors associated with intention to counsel parents on HPV.

Methods: The current study was a …

Relationships Among Optimism, Inflammation, And Stroke Recovery, Yun-Ju Lai

Dissertations and Theses (Open Access)

Objective: Post-stroke inflammation is detrimental to the brain and results in an unfavorable recovery. Optimism has been associated with lower inflammation and better health outcomes among people with medical conditions, but no studies have assessed this association in the stroke population. The overall goals were to examine the relationships among optimism, stroke severity, physical disability, and inflammation during hospitalization and evaluate the relationships among optimism, inflammation, and stroke recovery over the three-month post-stroke period.

Methods: This study was a secondary analysis of data collected from the BioRepository of Neurological Diseases biobank. Outcomes included optimism, stroke severity, physical recovery, and inflammatory …

Comparative Analysis Of Early And Late Tracheostomy Among Patients With Acute Heart Failure Exacerbation, Trends, Clinical And Economic Outcome Assessment, From 2005 To 2014 Nationwide, Min Ji Kwak

Dissertations and Theses (Open Access)

Heart failure is one of the leading causes of high morbidity and mortality. Acute exacerbation of heart failure may result in acute respiratory failure, which requires mechanical ventilator support. Despite supportive management, patients can fail extubation of the endotracheal tube and need a tracheostomy to continue mechanical ventilator support. However, optimal timing of tracheostomy has been controversial. Systemic study to assess the clinical and economic outcome of early tracheostomy among patients with acute heart failure exacerbation is lacking. The purpose of the study was to assess the national trend of tracheostomy among those who are admitted for acute respiratory failure …

Concurrent And Concordant Oral And Genital High Risk Human Papillomavirus Infections In The United States Population; Results From National Health And Nutrition Examination Survey (Nhanes), James M. Custer

Dissertations and Theses (Open Access)

Human papillomavirus (HPV) is a common sexually transmitted disease which infects various sites in the body including the genitals, oral cavity, and anal regions. Very little research has assessed the prevalence of concurrent and concordant high risk (HR) HPV oral and genital infections in the general United States population despite the fact that HR HPV oral pharyngeal cancers are on the rise in the US, particularly in men. To further our understanding of HR HPV concurrent and concordant infections we aim to estimate the prevalence of HR HPV concurrent and concordant infections in the U.S. population, and for men and …

Predictors Of Non-Adherence To Primary Care Follow-Up After Diagnosis Of Asymptomatic Hypertension In The Emergency Department, Stephanie Cornell

Dissertations and Theses (Open Access)

Background: One strategy to decrease uncontrolled hypertension is to increase follow-up with primary care after diagnosis of asymptomatic hypertension in the Emergency Department (ED). To improve such interventions, this study identified risk factors of nonadherence among individuals 18-60 years old with a diagnosis of asymptomatic hypertension in the ED and access to care. Methods: Data was obtained from the IBM® MarketScan® Commercial Database between January 2012 and September 2015. Rates of non-adherence to follow-up was determined for individuals discharged from the ED with a primary diagnosis of essential hypertension. Multivariate logistic regression was used to calculate adjusted odds ratios. Demographic …

Estimating The Usual Intake From Fruits And Vegetables Consumed By Children At Baseline In Tx Sprouts, Taryn Alkis

Dissertations and Theses (Open Access)

Background: Past studies developed two- and three-part models to estimate the usual intake of episodically consumed foods in adults but not in children. The goal of this study is to evaluate if the three-part method is successful, by incorporating the dietary screener and two 24-hour recalls, in estimating the usual intake of fruits and vegetables consumed by boys and girls at baseline in TX Sprouts. Methods: Secondary data analysis of two 24-hour recalls and a dietary screener from TX Sprouts. Two approaches were used. First, the three-part model estimated the distribution of the usual intake of fruits and vegetables in …

The Prevalence Of Birth Defects Among Non-Hispanic Asians And American Indians/Alaska Natives In Texas, 1999-2015, Van Le

Dissertations and Theses (Open Access)

Background: Birth defects are disproportionately higher among certain race/ethnic groups. We examined how birth defects prevalence differs among the less studied non-Hispanic (NH) Asian and any American Indian/Alaska Native (AI/AN) populations, relative to NH Whites. Methods: Data were obtained from the Texas Birth Defect Registry from 1999 to 2015 for infants born to Texas-resident mothers who were NH White, NH Asian, or AI/AN. This covers a livebirth population of 2.6 million. Prevalence ratios were calculated for NH Asians and AI/ANs (relative to NH Whites) for 44 birth defects using Poisson regression and were adjusted for maternal age. Results: After adjustment, …

Geospatial Analysis Of Pediatric Tuberculosis In Bohol, Philippines: Disease Clusters And Access To Care, Lauren M. Leining

Dissertations and Theses (Open Access)

Worldwide, children represent approximately 10% of global tuberculosis (TB) cases. We recently reported a high tuberculin skin test (TST)-positive prevalence (355/5,476; weighted prevalence=6.4%) among children (<15 years) throughout the island of Bohol, Philippines, with some geographically isolated communities having prevalence as high as 29%. In this study, we conducted a secondary geospatial and hot-spot analysis of this household-based cluster survey to assess the association between access to care (distance to a health care facility) and TST-positive prevalence. Our analysis indicated that villages with high TST-positive prevalence (≥10%) were significantly further from Provincial Health Office based in the capital city of Tagbilaran in time-distance (p=0.0001, r=0.2387) and kilometers (p=0.0011, r=0.3170). Similarly, prevalence was positively correlated with distance to the municipal Rural Health Unit (RHU), where most receive their medical care, in time-distance (p=0.0055; r=0.0415); however, the association was not significant in kilometers (p=0.3315; r=0.0715). Distance to health care facilities could represent an obstacle to access to care, thereby limiting diagnosis and treatment and resulting in increased risk of transmission to others in the community. Health care outreach in geographically isolated areas is critical to treatment and control of efforts for pediatric TB.

Bayesian Estimation Under Informative Sampling: Investigating The Association Between Depression And Inflammation, Paula Lopez Gamundi

Dissertations and Theses (Open Access)

Survey data is often collected using complex sampling designs so that the probability of being included in the study is related to the outcome of interest (i.e. informative sample). Recently, a novel fully-Bayesian method has been developed for modeling data under informative sampling. Initial results indicate that this novel construction reduces bias in variance estimates compared to other pseudo-Bayesian techniques. The performance of this method has yet to be compared to traditional Frequentist approaches, which typically rely on Taylor series linearization (TSL) or resampling techniques for standard error (SE) estimation. Here, we modeled the relationship between depression and inflammation using …

A Mendelian Randomization Study Of Circulating Gamma Prime Fibrinogen And Total Fibrinogen Levels On Venous Thromboembolism And Ischemic Stroke Subtypes, Jillian Maners

Dissertations and Theses (Open Access)

Introduction: Fibrinogen is a key component of the coagulation cascade, and variation in its circulating levels may contribute to thrombotic diseases, such as venous thromboembolism (VTE) and ischemic stroke. Gamma prime (γ′) fibrinogen is an isoform of fibrinogen and has anticoagulant properties, including inhibiting thrombin and slowing platelet aggregation, that may affect clot formation.

Methods: Two-sample Mendelian randomization (MR) was applied to estimate the causal effect of total circulating fibrinogen and its isoform, γ′ fibrinogen, on risk of VTE and ischemic stroke subtypes using summary statistics from published genome-wide association studies of fibrinogen, VTE, and ischemic stroke, and an unpublished …

Evaluating Religiosity Across The Lifespan And Fatalistic Beliefs Among Patients Of A Chronic Care Management Intervention Program With Type 2 Diabetes, Cindy Lynn Salazar

Dissertations and Theses (Open Access)

The overall goal of the present study was to assess the effect of fatalistic beliefs and lifetime religiosity on glycemic control and blood sugar monitoring behavior among Mexican-American participants of a chronic care management intervention program of the Rio Grande Valley. In order to achieve these aims, a mixed methods prospective longitudinal study design was utilized among approximately 500 participants of the Salud y Vida program. Qualitatively, a phenomenological approach was used to analyze semi-structured interview data assessing fatalism and religiosity and type 2 diabetes management among 15 participants stratified by engagement in the Salud y Vida program. Fatalistic beliefs …

Evaluating The Impact Of Heal Pregnancy Intervention On Breastfeeding Initiation And Duration, Dolly Noel Rinehart

Dissertations and Theses (Open Access)

Despite nationwide improvements in breastfeeding behaviors, many minority, low-socioeconomic status women in the United States fail to follow breastfeeding recommendations. Healthy Eating Active Living (HEAL), a free antenatal program in Houston, Texas, teaches pregnant women healthy lifestyle behaviors and promotes breastfeeding. The objective of this paper was to determine the impact of HEAL on breastfeeding initiation and length of breastfeeding duration among predominantly low income, minority, underserved women in Houston, TX. Methods: HEAL is a natural experiment rooted in Social Cognitive Theory and Theory of Planned Behavior. Data was collected from two sources, the HEAL pregnancy post-delivery survey and the …

Role Of Disinfectants In The Eradication And Propagation Of Clostridiodes Difficile Infection, Tasnuva Rashid

Dissertations and Theses (Open Access)

Introduction:

Clostridioides difficile is a motile, gram-negative, toxin-producing bacteria responsible for the majority of the nosocomial as well as community-acquired infection in the US and worldwide. A high rate of morbidity, mortality, recurrences, healthcare cost coupled with frequent epidemic outbreaks with drug-resistant strains has classified C. difficile as a pathogen with an urgent threat to human health. Current guidelines regarding disinfectant use are either limited or absent or are not effective in reducing the environmental burden of C. difficile. The aims for this study was first to determine the in vitro efficacy of select hospital disinfectants in eradicating the spores …

Evaluating The Multivariate Relationship Between Breastfeeding, Early Childhood Obesity, Asthma, And Mental Illness In Dallas, Tx, Sitara Weerakoon

Dissertations and Theses (Open Access)

The aim of this study was to examine the associations between breastfeeding, asthma and mental illness in North Texas children aged two to five years, and to explore whether these associations are explained by the presence of obesity. The study population comprised of 1,174 children whose caregivers responded to a 2015 survey administered by Children’s Health and the Health & Wellness Alliance for Children. Information on breastfeeding, BMI, asthma, and mental illness were self-reported by primary caregivers. Of the 1,174 children, 61% were breastfed, 13% had asthma, and 17% had a mental illness. The odds of having asthma were 2.28 …

Fire Department Support And Physical Activity Of Volunteer Firefighters: A Cross-Sectional Examination, Sarah Wagner

Dissertations and Theses (Open Access)

Greater health and fitness of volunteer firefighters protects them from cardiovascular disease-related deaths, reduces risk of injury, and improves job performance, which subsequently provides better protection for the majority of the U.S. population who is served by volunteers. Given the strong social support system characteristic of the U.S. fire service, there seems to be potential opportunity to influence the behaviors of firefighters by creating a culture that promotes healthy habits rather than unhealthy. Objective: Determine the association between fire department culture’s encouragement of physical activity and volunteer firefighters’ moderate- to vigorous-intensity aerobic activity. Methods: A cross sectional analysis was performed …

Platiscity Of C. Elegans Germline Stem Cells Under Nutritional And Metabolic Stress, Kenneth Trimmer

Dissertations and Theses (Open Access)

Stem cells are integral for tissue maintenance and fertility. Therefore, understanding how stem cells are regulated under stress is imperative. When confronted with acute starvation, stem cells must conserve energy and metabolites to cope with the lack of an external source. Caenorhabditis elegans germline stem cells (GSCs) are an excellent model for studying stem cell properties and regulation as they can divide throughout the life of the organism. While GSCs are an adult stem cell population, their cell cycle structure more closely mimics mouse and human embryonic stem cells with short G1 and long S phases. In this thesis, I …

Metabolic Control, Quality Of Life, And Body Image In Patients With Glycogen Storage Disease Type Ia, Alexa Bream

Dissertations and Theses (Open Access)

Glycogen storage disease is a group of inborn errors of metabolism, with type Ia being the most common form of the disorder. Glycogen storage disease type Ia (GSDIa) is a multisystemic condition in which individuals have various complications secondary to an inability to properly break down glycogen and to perform gluconeogenesis. Complex management is then necessary for patients and includes dietary modification, frequent cornstarch usage, and evaluation for additional complications such as hepatic adenomas, hypertriglyceridemia, and kidney disease. Previous studies have found lower scores in quality of life and body image in GSDIa patients; however, the specific factors influencing this …

Sustainability In Quality Improvement And Patient Safety Initiatives, Angelo P. Giardino, Eileen R. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term 'evaporation of improvements' addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & …

Steroid Receptor Coactivator-1 Modulates The Function Of Pomc Neurons And Energy Homeostasis, Yongjie Yang, Agatha A Van Der Klaauw, Liangru Zhu, Tessa M Cacciottolo, Yanlin He, Lukas K J Stadler, Chunmei Wang, Pingwen Xu, Kenji Saito, Antentor Hinton, Xiaofeng Yan, Julia M Keogh, Elana Henning, Matthew C Banton, Audrey E Hendricks, Elena G Bochukova, Vanisha Mistry, Katherine L Lawler, Lan Liao, Jianming Xu, Stephen O'Rahilly, Qingchun Tong, Uk10k Consortium, Inês Barroso, Bert W O'Malley, I Sadaf Farooqi, Yong Xu

Children’s Nutrition Research Center Staff Publications

Hypothalamic neurons expressing the anorectic peptide Pro-opiomelanocortin (Pomc) regulate food intake and body weight. Here, we show that Steroid Receptor Coactivator-1 (SRC-1) interacts with a target of leptin receptor activation, phosphorylated STAT3, to potentiate Pomc transcription. Deletion of SRC-1 in Pomc neurons in mice attenuates their depolarization by leptin, decreases Pomc expression and increases food intake leading to high-fat diet-induced obesity. In humans, fifteen rare heterozygous variants in SRC-1 found in severely obese individuals impair leptin-mediated Pomc reporter activity in cells, whilst four variants found in non-obese controls do not. In a knock-in mouse model of a loss of function …

Ic 086 Guide To Hermann Hospital Archive Records, 1869-1998, Hermann Hospital (Houston, Tex.)

Institutional Finding Aids

The Hermann Hospital Archive records consists of administrative records, founding documents, legal papers, maps, photographs, films, videos, oral histories, nursing school records, yearbooks, and artifacts ranging from the late 1800s to 1998 that document the creation, development, and history of Hermann Hospital, the first institution in what is now known as the Texas Medical Center. The materials document the long history of the hospital from its inception to the merger with Memorial Hospital System in 1997. Hermann Hospital Archives contains the institutional records of Hermann Hospital (1925-1997) as well as the Hermann Estate (1914-1985). See more at IC 086.

Ic 084 Guide To Texas Medical Center Historical Resources Project Records, 1973-1991, Texas Medical Center Historical Resources Project

Institutional Finding Aids

The Texas Medical Center (TMC) Historical Resources Project records contain video oral histories of notable personalities associated with or visiting the TMC. Beginning in 1973, the initial group of interviews focuses on individuals involved in the founding or early days of the TMC. Later “video profiles” also include significant visitors to the TMC. Several of these feature national and international figures in cancer research on their visits to Houston. In total the collection features forty-seven unique recordings of interviews with thirty-eight different individuals. All forty-seven unique recordings have been digitized. See more at IC 084.

Ic 061 Guide To University Of Texas, Division Of Continuing Education Records, 1950-1981, University Of Texas Division Of Continuing Education

Institutional Finding Aids

The University of Texas, Division of Continuing Education records contains budgets, grant requests, residency programs, faculty and staff, and other materials pertaining to the Post Graduate School of Medicine, Graduate School of Biomedical Sciences, and Division of Continuing Education from 1950-1981. See more at IC 061.

Household Food Insecurity Positively Associated With Increased Hospital Charges For Infants, Stephanie Ettinger De Cuba, Patrick H. Casey, Diana Cutts, Timothy C. Heeren, Sharon Coleman, Allison R. Bovell-Ammon, Deborah A. Frank, John T. Cook

Journal of Applied Research on Children: Informing Policy for Children at Risk

Objective: To test whether household food insecurity (HFI) was associated with total annual hospitalization charges, annual days hospitalized, and charges per day, among low-income infants (months) with any non-neonatal hospital stays.

Methods: Administrative inpatient hospital charge data were matched to survey data from infants' caregivers interviewed 1998-2005 in emergency departments in Boston and Little Rock. All study infants had been hospitalized at least once since birth; infants whose diagnoses were not plausibly related to nutrition were excluded from both groups. Log-transformed hospitalization charges were analyzed, controlling for site fixed effects.

Results: 24% of infants from food-insecure households …

New Morbidities 2.0, Angelo P. Giardino, Robert Sanborn

Journal of Applied Research on Children: Informing Policy for Children at Risk

Robert Sanborn and Angelo Giardino's introduction for Volume 4, Issue 1: New Morbidities 2.0

We Don't Know What We Don't Know: Post Adoption Support Of Families Caring For Traumatized Children, Patricia Lantis

Journal of Applied Research on Children: Informing Policy for Children at Risk

Parents adopting traumatized children from foster care or from other settings have unique needs for post adoption support. This paper seeks to present those needs from the unique viewpoint of an adoptive physician mother. Circles of care around the child include the family, the community and wider systems of support.

Ic 044 Gude To National Heart And Blood Vessel Research And Demonstration Center Records, 1975-1983, National Heart And Blood Vessel Research & Demonstration Center

Institutional Finding Aids

The National Heart and Blood Vessel Research & Demonstration Center records contains a directory, bulletins, reports, and other various printed material related to the National Heart and Blood Vessel Research & Demonstration Center. See more at IC 044.

Ic 042 Gude To Texas Children's Hospital Historical Archives, 1953-2003, Texas Children's Hospital

Institutional Finding Aids

Texas Children's Hospital Historical Archives contains 10 cubic feet of processed material and 79 boxes of unprocessed material. The later is labeled as the TCH Historical Archives and arrived in the HRC in 2008. See more at IC 042.