Digital Commons Network^™

Prevalence, Sample Size, And Power Investigation In Neoadjuvant Therapy For Breast Cancer Clinical Trials, Jennifer So

Public Health Theses

Common practice in neoadjuvant therapy clinical trials for breast cancer that use pathological complete response rate (pCR) as an endpoint are conducted within a Human Epidermal Growth Factor Receptor 2 (HER2) indication group for both Estrogen Receptor - positive (ER+) and Estrogen Receptor - negative (ER-) cancers. Given the clinical background and trends of breast cancer therapy trials, this study aims to demonstrate in cases where the observed prevalence and response rates may be so different from the expected values that priori sample size calculation and power analyses were based on, that dangers may arise in producing an insufficiently powered …

Effect Of Exercise On Vo2max In Breast Cancer Survivors Taking Aromatase Inhibitors: The Hormones And Physical Exercise (Hope) Study, Mia Sorkin

Public Health Theses

Purpose: The purpose of this study was to investigate the effects of a yearlong exercise intervention compared to usual care on cardiorespiratory fitness in sedentary breast cancer survivors who were taking aromatase inhibitors and experiencing arthralgia.

Methods: Participants were randomized to either an exercise intervention group that met twice weekly with a personal trainer or usual care. Participants completed self-administered questionnaires, including reporting demographic and personal characteristics, and a graded treadmill test using a modified Branching protocol at baseline and at the end of the 12-month study. T-tests and chi-squared analyses were used to assess change in cardiorespiratory fitness, measured …

Silicosis, Tuberculosis (Tb) And Hiv/Aids: The Triple Epidemic Among Gold Mineworkers In South Africa (Literature Review And Policy Analysis), Surabhi Srivastava

Public Health Theses

The scourge of the triple epidemic of silicosis, tuberculosis (TB) and HIV/AIDS has plagued the South African gold mineworkers, with black mineworkers in particular, for over two decades now. Factors such as oscillating migration patterns, hazardous working conditions, and crowded living arrangements allow for the perfect conditions needed to sustain and amplify the epidemic within this population. The objective of this thesis is to provide a detailed review of the epidemiological literature regarding the different aspects of the silicosis, TB and HIV epidemic in South Africa, followed by an in-depth analysis of the current policy response, and its implications for …

Comparisons Of Patients With Recurrent Vs. Incident-Only Clostridium Difficile-Associated Diarrhea: A Case-Control Study Of Treatment Effectiveness At Yale New Haven Hospital, 2010-2011, Mark Stuntz

Public Health Theses

Background: Clostridium difficile infection (CDI) is the most frequent cause of hospital-acquired infectious diarrhea in developed countries. Approximately 19-20% of affected patients will experience a symptomatic recurrence following their first episode of Clostridium difficile-associated diarrhea (CDAD). Risk factors for the initial CDAD episode have been well-documented, however, epidemiologic risk factors for recurrent CDAD have not been described in as much detail. It is hypothesized that initial treatment could be a risk factor for recurrent CDAD. The CT Emerging Infections Program (EIP) conducts laboratory-based surveillance for CDAD in New Haven County, however, routine surveillance does not collect treatment data. Therefore, we …

Modeling Of Ambient Black Carbon Concentration Using Traffic, Temporal And Meteorology Data In Connecticut, Kunfeng Sun

Public Health Theses

Black carbon is a component of fine particle pollution that exerts adverse effects on both global climate change and human health. It is produced through incomplete combustion of fossil fuels and biofuels. Therefore, some of its major emission sources are diesel engines, residential heating and industry. Due to its strong ability to absorb solar energy, black carbon is one of the major contributors to global warming. In addition, black carbon and other fine particle pollutants can be inhaled into the lower respiratory track, causing and exacerbating health conditions such as asthma, chronic obstructive pulmonary disease, low birth weight, cardiovascular diseases …

Characteristics And Clinical Outcomes Of People Living With Hiv/Aids Participating In A Home-Delivered Meal Program In New Haven, Ct., Isy Victoria Tavarez

Public Health Theses

ABSTRACT

Background: Food insecurity is an issue of great concern among people living with HIV/AIDS (PLWHA). Food insecurity can lead to anxiety, and depression which is in turn associated with poor medication adherence. Food insecurity is a threat to the nutritional status of PLWHA. PLWHA already have a higher energy demand due to the presence of the virus. The lack of food intake can further compromise the immune system and encourage wasting. Because Food insecurity is such a concern among PLWHA, Caring Cuisine which is a program run by Aids Project New Haven in CT, delivers meals for clients who …

Community Greenspace's Impact On Perceived Health Of New Haven Adults, Bridget Elizabeth Teevan

Public Health Theses

Background: In 2008, for the first time in history, urban space is the predominant dwelling place of the human race, which raises concerns about how the presence or absence of green spaces influences the health of residents. The Urban Resources Initiative (URI) in New Haven, Connecticut offers a Community Greenspace Program that provides community members with resources for designing and stewarding an area within their neighborhood. The goal of this study is to determine if these community-developed green spaces improve the self- perceived health of the adults living in that neighborhood.

Methods: Data on self-perceived health was gathered from the …

Mdi-Specific Igg Exposure Biomarker And Role Of Intervention, Ann Y. Teng

Public Health Theses

Background:

Diisocyanates are sensitizing agents that are used in many industries in the production of polyurethane foams, coatings and other products. Methylene diphenyl diisocyanate (MDI) exposure can occur through dermal and inhalation routes resulting in sensitization and leading to isocyanate asthma. MDI-specific IgG (MDI-IgG) bio-monitoring has been proposed to be used as a predictor of exposure.

Methods:

A prospective longitudinal study was used to assess annual MDI- IgG serum markers in 223 workers in a fabric-coating company. Kaplan Meir Survival Analysis determined whether there was a difference in seroconversion based on exposure level. A Cox proportional hazard model was used …

Is Time Since Food Safety Training Associated With Inspection Score?, Mary Traglia

Public Health Theses

Objective: To determine if the time since food safety training is associated with inspection scores in class III and IV kitchens in Connecticut

Methods: Ledge Light Health District, which represents five towns in southeastern CT, provided 2011 inspection records and qualified food operator (QFO) training certificates for licensed kitchens in its jurisdiction. Establishments were included in analysis if they were class III or IV and had one identifiable QFO present at the time of inspection, with the corresponding QFO training record on file. Data was collected on establishment type, QFO certifying exam, inspection score, and risk factor violations. A linear …

Age Differences In Social Support And Mental Health In Male Veterans, Melissa Rachel Weiner

Public Health Theses

Psychological concerns among United States veterans of all ages are considerable, however social support may help improve the mental health of these individuals. The protective effect of social support on mental health has been observed in older and younger samples of veterans, but it is unclear whether social support may be more beneficial at certain life stages. By assessing cross-sectional survey data from a large sample of veterans using an extreme groups approach (EGA), the impact of perceived support, structural support, and community integration on mental health difficulty and screening positive for a mental disorder was assessed. The effect of …

Evaluation Of Malaria Surveillance In Bhutan, 2006-2012, Nicole Gail West

Public Health Theses

Bhutan is embarking on elimination over the course of the next decade. The purpose of this evaluation is to assess the ability of the current surveillance system to meet the objectives of the Vector-borne Disease Control Programme (VDCP), to highlight the priorities of the surveillance system as the nation transitions into an era of elimination, and to identify areas that require attention for this goal to be achieved. An evaluation of the national malaria surveillance system of Bhutan from 2006 to 2012 was conducted using the CDC updated guidelines for evaluation. National malaria surveillance data, written VDCP protocols, and informal …

Neighborhood Level Socioeconomic Status And Rurality And Shiga Toxin-Producing Escherichia Coli Incidence: Connecticut, 2000-2011, Bridget Morrissey Whitney

Public Health Theses

Background: Shiga toxin Escherichia coli (STEC) O157 and other STEC strains are a well-known cause of enteric illness. National estimates are that STEC O157 causes approximately 96,534 illnesses every year in the United States, with another 168,698 illnesses caused by non-O157 STEC serotypes. Determining economic and sociodemographic factors associated with enteric disease incidence may provide new understandings of the transmission of these illnesses, particularly community transmission, and may prove useful in the prevention of disease.

Methods: A total of 764 incident STEC cases were reported in CT from 2000 to 2011. Incident cases were geocoded based on the case's address …

Remote Monitoring Of Implantable Cardioverter-Defibrillators From 2006 To 2010: Patterns Of Utilization And The Impact Of New Current Procedural Terminology Codes, Yao Yang

Public Health Theses

Background: The PREDICt-RM study found that Remote Patient Monitoring (RPM) was used by less than half of eligible patients with implantable cardioverter-defibrillators (ICDs) between 2006 and 2010 despite guideline recommendations. We investigated whether the addition of new Current Procedural Terminology (CPT) codes for RPM in January 2009 had impact on utilization of RPM technology and whether the impact varied by race or geographic region. Methods: We used multivariable logistic regression to determine whether subjects in the PREDICt-RM study cohort receiving an ICD post-coding change were more likely to enroll in an RPM program or activate RPM (transmit RPM data) within …

Distinct Trends In 30-Day Observed And Risk-Standardized Mortality Rates Of Acute Myocardial Infarction Patients, 2005-2010, Caroline Yoo

Public Health Theses

In the effort of comparing health care quality across hospitals and profiling hospitals, the Centers for Medicare and Medicaid Services (CMS) utilize risk-standardized outcome in which the hospital-level outcome is standarized adjusting for patient-covariates using hierarchical model for patients outcome clustered within hospital. Even though standardized measure is useful for comparing hospitals, we believe the analysis of observed hospital-level outcome without standarization can reveal additional information at the hospital-level. The implication of using both types of mortality rates was studied in the context of analyzing 30-day mortality trend of Acute Myocardial Infarction (AMI) patients. Therefore the objective of this study …

Assessing Diabetes Integrated Patient Education And Glucose Control And Differential Diabetes Treatment Response By Gender In Jordan, Osama Zayyad

Public Health Theses

Background: Between 1994 and 2004 the prevalence of diabetes in Jordan increased from 13.0% to 17.1%. Among individuals with diabetes in Jordan, 54% had unsatisfactory blood glucose control. In response to the diabetes epidemic in Jordan, the National Center for Diabetes Endocrinology and Genetics (NCDEG) was founded. NCDEG's primary objective is to improve diabetes treatment in Jordan, and does so by offering treatment facilities specific for diabetic patient needs. In 2008 NCDEG began implementation of an integrated patient education strategy (IPE). Certified diabetes educators joined NCDEG and were provided space within each diabetes clinic within the center for individual patient …

The Influence Of Maternal Nutrition Intake On The Birth Weight Of Newborns In Lanzhou, China, Weiwei Zhang

Public Health Theses

Background:

The objective of this paper is to evaluate the role of maternal nutrition intake before and during pregnancy on infant birth weight. Self-reported data on intake of 94 nutrients during four time periods (one year before pregnancy and during the three trimesters of pregnancy) was collected from over 7,000 women during 2010-2012 in Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China.

Methods:

Hierarchical clustering and k-means clustering were performed to detect any potentially influential nutrients. Principal Component Analysis (PCA) was used to reduce the dimension of predictors and linear regression analysis was subsequently conducted to fit new …

Marital Satisfaction And Health Of Older Adults With Chronic Pain And Their Spouses: The Role Of Individual Differences In Attachment, Lu Zhou

Public Health Theses

Abstract

Attachment theory provides a useful framework for understanding how caregiving dyads maintain feelings of security in reaction to a loved one's chronic condition. To our knowledge, no existing research has examined associations among individual differences in attachment (anxiety, avoidance), health, and relationship satisfaction in later-life marriages in which one individual suffers from chronic pain. In this study, we examined similarity of attachment orientation between spousal caregivers and care recipients, and the influence of one's attachment orientation on one's own, as well as their partner's, depressive symptoms, physical conditions, and marital satisfaction.

Seventy-seven individuals with chronic pain and their spousal …

The Influence Of Maternal Obesity On Adolescent Obesity In Santiago, Chile, Yunnuo Zhu

Public Health Theses

Objective: To examine the relationship between adolescent obesity and associated maternal obesity variables of interest, specifically maternal pre-pregnancy obesity and maternal obesity 10 years postpartum.

Design: Secondary data analysis of a longitudinal study in Santiago, Chile (N=786 adolescents). Variables were extracted from multiple waves of data collection. The maternal obesity variables of interest and covariates were stratified by gender and associations of interest examined using univariate logistic regression analyses and multivariate logistic regression models with missing data imputation. Covariates included were birth weight percentile, breastfeeding for 6 months, father's presence, maternal age, and maternal education.

Results: Adolescent obesity was associated …

Terrorizing Wikileaks: Why The Embargo Against Wikileaks Will Fail, Samuel C. Cannon

Colorado Technology Law Journal

No abstract provided.

The Large Immortal Machine And The Ticking Time Bomb, Susan Landau

Colorado Technology Law Journal

No abstract provided.

The Business Of Startup Law: Alternative Fee Arrangements And Agency Costs In Entrepreneurial Law, Sarah Boulden

Colorado Technology Law Journal

No abstract provided.

Challenges For Emerging Art Forms Under The Visual Artists Rights Act, Martina Hinojosa

Colorado Technology Law Journal

No abstract provided.

Sexual Risk Behaviors Among Adolescents In Port-Au-Prince, Haiti, Jasmine Winslow Carver

Public Health Theses

Introduction: In the past decade, young people in Haiti have been engaging in riskier sexual behavior. The present study investigates correlates of sexual risk behaviors among adolescents in Port-au-Prince, Haiti.

Methods: The cross-sectional study included anonymous face-to-face interviews with 200 (108 male and 92 female) 13 to 18 year old participants. Data were collected on demographic, family and psychosocial characteristics and four sexual risk outcomes: having a history of sexual intercourse, early sexual debut, multiple sexual partners and condom use at last sexual intercourse. Unadjusted and adjusted logistic regression models were generated for each outcome and a composite sexual risk …

Effects Of Traumatic Brain Injury On Domestic Violence Survivors, Elizabeth Marie Martin

Honors Program Theses

Very little research exists on the topic of traumatic brain injury within the context of domestic violence. The purpose of this research is to increase the body of knowledge on traumatic brain injury in domestic violence survivors. More specifically, this research serves to understand the frequency of traumatic brain injury among domestic violence survivors with the subsequent foci of analyzing the relationship between traumatic brain injury and domestic violence, identifying the impact of traumatic brain injury on domestic violence survivors, and discovering strategies for serving domestic violence survivors who have sustained traumatic brain injury. A secondary data analysis of a …

Epidemiology Of Malaria Infection Among School Aged Children In Kintampo North District, Ghana, Jennifer Du Mond

Public Health Theses

In June 2010 286 children from 16 participating schools were enrolled, with no more than one child from each household. Serum samples, fecal samples, and household surveys were used to assess the associations between the presence or density of malaria parasites and risk factors including nutritional status, hookworm infection, household risk prevention behaviors, and serum measures of parasite-specific immunoglobulin G (IgG).

Anthropometric and nutritional indicators were not associated with either outcome, nor was total malaria IgG. The primary risk factors for presence of infection included the house being sprayed in the past year (OR=0.04, p<0.001), child having a health care visit in the past year (OR=0.39, p<0.001), household malaria in the past year (OR=0.37, p=0.001), hookworm antibody density, with higher quartiles associated with elevated risk, greater household food insecurity, and geographic location.

Primary risk factors for elevated …

Attitudes And Beliefs Towards Medication-Assisted Treatment (Mat) For Substance Dependence And Abuse Among Fishermen In Eastern Malaysia: Determining Barriers And Facilitators To Mat Scale-Up, Rebecca Kim Erenrich

Public Health Theses

Background: High rates of injection drug use and HIV have been found in the fishermen of Kuantan, Malaysia. Medication assisted treatment (MAT) is the most efficacious modality for treating opioid dependence and abuse, yet currently available MAT options appear unsuitable for this population. Therefore this study explores whether depot naltrexone, a new, long-acting type of MAT, would be an acceptable treatment to the fishermen of Kuantan.

Methods: Forty in-depth interviews were conducted with injection drug using fishermen of Kuantan and the neighboring village of Beserah. This report is an interim analysis of 26 of those interviews so far transcribed, translated, …

Resilience And Its Mediating Effect On The Relationship Between Life Stress And Health-Related Quality Of Life In Older Adult People Living With Hiv/Aids, Xindi Fang

Public Health Theses

Background: By 2015, 50% of all HIV/AIDS cases in the United States will be persons 50-plus years of age. Very little, if any, research has examined resilience in older people living with HIV/AIDS (PLWHA). This research explored the conceptual construct of resilience and investigated the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in PLWHA over fifty.

Methods: Data from a sample of 299 PLWHA over 50 was analyzed using structural equation modeling (SEM) to define a hypothesized Resilience construct (represented by Coping Self-Efficacy, Active Coping, Hope/Optimism and Social Support) and to …

Breastfeeding And Obesity Among Mothers And Children: A Double-Edged Sword, Jasmin Marie Harpe

Public Health Theses

Obesity continues to be a public health issue, especially among children and women of childbearing age. Breastfeeding results in weight loss among postpartum women, as well as protects growing children from obesity. To date, no reviews have simultaneously analyzed the impact of breastfeeding on obesity for mothers and children. In addition, this review is novel in that it provides evidence from both observational and intervention studies. The primary objectives of this systematic review of studies in the United States (2000-2013) are to: (1) describe the association between obesity and breastfeeding across the developmental lifespan (2) identify the impact of breastfeeding …

Epidemiology And Characterization Of Methicillin-Resistant Staphylococcus Aureus From Swine Workers In Romania, Eileen Damin Huang

Public Health Theses

Methicillin-resistant Staphylococcus aureus (MRSA) is a potent human pathogen associated with high morbidity and mortality worldwide. Livestock are known reservoir for MRSA, which pose substantial health risks for livestock farmers and their community contacts. However, little is known about MRSA among swine workers in Eastern Europe. In this study, we conducted a prevalence survey of swine workers in Romania. Three livestock-associated S. aureus strains (spa type t034, t011, and t4872) and one community-associated S. aureus strain (spa type t321) were isolated from workers on seven commercial swine farms in Transylvania. The rate of MRSA carriage in workers was 6.8%. Veterinarian …

Lymphedema In Ovarian Cancer Survivors: Assessing Diagnostic Methods And Risk Factors, Neel Subramanian Iyer

Public Health Theses

Purpose: Lymphedema is a poorly understood but significant side effect of treatment for gynecologic cancer. We sought to determine the prevalence of lower limb lymphedema (LLL) in a sample of ovarian cancer survivors via three different diagnostic methods while also evaluating the agreement between each method and assessing potential risk factors for LLL. Methods: LLL was measured via self-report questionnaire, optoelectric perometry, and evaluation by a certified lymphedema specialist in women (n = 48) who had completed treatment for their ovarian cancer and were physically inactive. Results: LLL prevalence ranged from 19-42% depending on the diagnostic method, with the self-report …