Medicine and Health Sciences Commons^™

Probabilistic Modeling Of Disease: Addressing Uncertainties In Within-Host And Population-Level Dynamics, Mariah Boudreau

Graduate College Dissertations and Theses

Mathematical modeling of disease dynamics provides powerful tools to understand, predict, and evaluate emerging diseases. These insights aid public health officials, along with other modelers. With a plethora of models to choose from, it is important to consider a model that encapsulates the stochastic nature of disease dynamics. Stochasticity not only conveys chances of stochastic extinction, but provides probabilistic outcomes, essential for capturing the stochastic nature of the real world. In this thesis, three stochastic models are presented, each addressing uncertainties in mechanisms and interpretation of these models, to aid other modelers and decision makers.Starting with the source of infection …

Towards The Elimination Of Viral Hepatitis In Clinton County, New York, Michael H. Le

Family Medicine Clerkship Student Projects

Chronic viral hepatitis is a major public health issue, affecting approximately 300 million persons globally. In Clinton County, New York, chronic viral hepatitis remains a major concern, with incidence rates for hepatitis C virus infection (HCV) in the top quartile and hepatitis B virus infection (HBV) in the 3rd quartile for the state in 2022. This current study aimed to identify the trends in incidence and prevalence of chronic viral hepatitis in Clinton County, rates of HBV birth dose vaccination, and to reflect on the experiences in treatment and prevention of chronic viral hepatitis at a community health clinic in …

Bayesian Experimental Design For Control And Surveillance In Epidemiology, Bren Case

Graduate College Dissertations and Theses

Effective public health interventions must balance an array of interconnected challenges, and decisions must be made based on scientific evidence from existing information. Building evidence requires extrapolating from limited data using models. But when data are insufficient, it is important to recognize the limitations of model predictions and diagnose how they can be improved. This dissertation shows how principles from Bayesian experimental design can be applied to surveillance and control efforts to allow researchers to get more out of their data and direct limited resources to best effect. We argue a Bayesian perspective on data gathering, where design decisions are …

Nonlinear Relationships Between The Environment And Health, Levi N. Bonnell

Graduate College Dissertations and Theses

Relationships between the environment and health outcomes are complex and likely nonlinear in nature. However, until recently, most studies used ordinary linear regression to model these relationships. The overall goal of this research was to investigate nonlinear relationships between the environment and health. To accomplish this goal, we used several large, national datasets across varying populations and local environments.

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In the first study, we sought to determine the relationship between the density of nonresidential destinations (a proxy for walkability) …

Modeling The Heterogeneous Temporal Dynamics Of Epidemics On Networks, Andrea Joan Allen

Graduate College Dissertations and Theses

Mathematical models of infectious disease are important tools for understanding large-scale patterns of how a disease spreads through a population. Predictions of trends from disease models help guide public health prevention and mitigation measures. Most simple disease models assume that the population is randomly mixed, but real-world populations exhibit heterogeneous patterns in the way people interact. These differences in population structure can be represented by networks. Networks can then be incorporated into disease models by using various interdisciplinary concepts and tools. Yet even network disease models often overlook that populations change over time. In this thesis, two models of infectious …

Measuring The Impact Of Rise Vt: Evaluating Community-Based Obesity Prevention Initiatives With A Standardized Intensity Score, Brianna K. Johnson Bsn, Rn, Ocn, Dnpc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background. Obesity is a leading cause of morbidity and mortality in the US. Rise VT is a multilevel community-based initiative to reduce obesity. The Community Programs and Policies Intensity Score (CPPI) is a standardized metric to evaluate multisector efforts over time, which has correlated with reductions in childhood obesity.

Purpose. The purpose of this project was to quantify the impact of Rise VT using the CPPI score. A secondary aim was to assess the feasibility of using the CPPI score for ongoing program planning and evaluation statewide.

Methods. Interviews with program managers were conducted to gather data related to …

On The Dynamics And Structure Of Multiple Strain Epidemic Models And Genotype Networks, Blake Joseph Mitchell Williams

Graduate College Dissertations and Theses

Mathematical disease modeling has long operated under the assumption that any one infectious disease is caused by one transmissible pathogen. This paradigm has been useful in simplifying the biological reality of epidemics and has allowed the modeling community to focus on the complexity of other factors such as contact structure and interventions. However, there is an increasing amount of evidence that the strain diversity of pathogens, and their interplay with the host immune system, can play a large role in shaping the dynamics of epidemics.

This body of work first explores the role of strain-transcending immunity in mathematical disease models, …

Automated Identification Of Unhealthy Drinking Using Routinely Collected Data: A Machine Learning Approach, Levi N. Bonnell, Benjamin Littenberg, Safwan R. Wshah, Gail L. Rose

Larner College of Medicine Faculty Publications

Background: Unhealthy drinking is prevalent in the United States and can lead to serious health and social consequences, yet it is under-diagnosed and under-treated. Identifying unhealthy drinkers can be time-consuming for primary care providers. An automated tool for identification would allow attention to be focused on patients most likely to need care and therefore increase efficiency and effectiveness.

Objectives: To build a clinical prediction tool for unhealthy drinking based solely on routinely collected demographic and laboratory data.

Methods: We obtained demographic and laboratory data on 89,325 adults seen at the University of Vermont Medical Center from 2011-2017. Logistic regression, …

Association Of Sickle Cell Trait With Exertional Rhabdomyolysis And Atrial Fibrillation., Daniel R. Douce

Graduate College Dissertations and Theses

Sickle cell trait (SCT), sickle cell disease’s carrier status, is a common genetic variant found in many people of African, South Asian, Middle Eastern and Mediterranean descent. While overall considered a benign carrier status, it has been associated with an increased risk of several diseases, including exertional rhabdomyolysis (ER), and chronic kidney disease. While epidemiological evidence links SCT with ER, the actual pathophysiological mechanism less understood. Additionally, while there is an increased prevalence of atrial fibrillation (AF) documented in people with sickle cell disease, studies in individuals with SCT are lacking.

The objectives of this thesis are twofold: The first …

An Analysis Of Beverage Consumption In The United States Using The National Health And Examination Survey 2007-2017, Sean Morris

Graduate College Dissertations and Theses

Sugar-Sweetened Beverages (SSBs) are liquids sweetened with various forms of added sugar. They are the leading source of calories and added sugar in the American diet (Drewnowski & Rehm, 2014; National Cancer Institute, 2016; Powell, Chriqui, Khan, Wada, & Chaloupka, 2013). The health and nutrition literature has increasingly identified added sugars and SSBs as a key potential contributor to a host of public health issues including obesity, type 2 diabetes, hypertension, and cardiovascular disease (Johnson et al., 2009; Malik, Popkin, Bray, Despres, & Hu, 2010; Vartanian, Schwartz, & Brownell, 2007). Concern about these public health crises has recently animated regional …

Chronic Kidney Disease And The Risk Of Venous Thromboembolism, Katharine Lana Cheung

Graduate College Dissertations and Theses

Chronic kidney disease (CKD) affects more than 30 million adults in the U.S. and is strongly associated with cardiovascular events and mortality. Venous thromboembolism (VTE) is the third leading vascular disease, affects up to 900,000 Americans each year and contributes to as many as 100,000 deaths annually. The relationship of CKD and VTE has been described in patients receiving dialysis, kidney transplants recipients and in nephrotic syndrome, however, data supporting the association of VTE in mild to moderate CKD is conflicted. The overall goal of this research was to study the association of CKD and VTE and to understand the …

Genotypes And Phenotypes Of Staphylococci On Selected Dairy Farms In Vermont, Robert Mugabi

Graduate College Dissertations and Theses

The genus Staphylococcus contains at least 47 species and 23 subspecies. Bacteria in this genus are ubiquitous; many are commensals on human and animal skin and can be opportunistic pathogens. In dairy cattle, staphylococci are the leading cause of intramammary infections (IMI) and mastitis. Mastitis is the inflammation of the mammary gland, and is one of the leading infectious diseases causing production losses in the dairy industry. Based on the ability to clot blood plasma in vitro, members of the genus can be divided into two groups: coagulase positive staphylococci (CPS) and coagulase negative staphylococci (CNS). In the dairy industry, …

Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal

Family Medicine Clerkship Student Projects

Each day more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In Vermont, more than 50 people die each year from opioid poisoning. With insurance coverage being a critical component of Opioid Dependence Recovery, many people seeking treatment are unaware of the financial barriers to recovery- namely the out-of-pocket costs associated with treatment. This study sought to provide insight on the financial impact of Opioid Dependence Treatment on the patient, and provide financial assistance information to the Rutland County community.

Provider Opinion: Should We Screen And Counsel Parents Of Teen Drivers Regarding Texting/Distracted Driving?, Daniel Lambert

Family Medicine Clerkship Student Projects

Adolescent texting and driving has been directly responsible for the deaths of 11 teenagers every day. 33% of teenagers in Vermont admit to texting and driving making it one of the most prevalent risky behaviors in their age group. Currently there is no routine screening recommendation for parents with adolescent drivers addressing texting and driving. Mobile application information can improve parental monitoring and prevent texting and driving habits from forming in adolescents.

A New Evolutionary Algorithm For Mining Noisy, Epistatic, Geospatial Survey Data Associated With Chagas Disease, John P. Hanley

Graduate College Dissertations and Theses

The scientific community is just beginning to understand some of the profound affects that feature interactions and heterogeneity have on natural systems. Despite the belief that these nonlinear and heterogeneous interactions exist across numerous real-world systems (e.g., from the development of personalized drug therapies to market predictions of consumer behaviors), the tools for analysis have not kept pace. This research was motivated by the desire to mine data from large socioeconomic surveys aimed at identifying the drivers of household infestation by a Triatomine insect that transmits the life-threatening Chagas disease. To decrease the risk of transmission, our colleagues at the …

The Cardiovascular Epidemiology And Genome-Wide Associations Of Biomarkers Of Innate And Adaptive Immunity: Scd163 And Sil2ra, Jon Peter Durda

Graduate College Dissertations and Theses

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the U.S. and worldwide. Atherosclerosis, the buildup of plaque in the arteries, is a common cause of CVD. For many years, research in atherosclerosis was focused on lipid metabolism and the accumulation of low-density lipoprotein in the arteries. While this research set public health guidelines for lipid management, lipid concentration was not the only factor influencing atherosclerosis and CVD events. Many scientists, as far back as the 1850’s recognized the role of inflammation in the progression of atherosclerotic disease. The continuous low levels of immune activation in the …

Nutrition And Exercise Resources For Clinton County, Paige M. Wood

Family Medicine Clerkship Student Projects

The obesity epidemic is a nation wide problem that has increased prevalence in Clinton County, NY when compared to the surrounding areas. Obesity leads to many co-morbid health conditions and is associated with a large increase in health care spending costs. This brochure tackles the limited resources, such as limited number of fitness centers, lack of nutrition education and an overall lower socioeconomic status, that is present in the Clinton County area. This brochure offers help in these areas through free phone applications which cover nutrition education, healthy shopping guidance, at home exercise routines, motivation, habit trackers and mindfulness exercises.

Immunization Safety: Addressing Parental Safety Concerns, Andrew Gallagher

Family Medicine Clerkship Student Projects

Since 1998, when a fraudulent research paper alleged a connection between the MMR vaccine and autism, increasing numbers of parents are refusing routine childhood vaccinations. Recent research has shown parents’ top vaccine-related concerns included the number of vaccines during the first 2 years of life, administration of too many vaccines in a single doctor visit, and a possible link between vaccines and autism. More than 10% of parents of young children refuse or delay vaccinations, with most believing that delaying vaccine doses is safer than providing them in accordance with the Centers for Disease Control and Prevention’s recommended vaccination.

Primary Care To The Rescue, Again! Autopsy And The Death Certificate, Emily E. Ryan

Family Medicine Clerkship Student Projects

An pre and post testing, an educational module, a presentation, and a dot phrase were developed to improve providers' knowledge of the hospital autopsy and the correct completion of death certificates.

Maternal Hypertension Influences Mortality And Severe Morbidity In Infants Born Extremely Preterm, Carole Anne Mcbride

Graduate College Dissertations and Theses

Worldwide, more than 1 million infants die as a result of premature birth. In the United States, where 1 in 10 births occurs preterm, premature birth is the leading cause of infant mortality. Premature infants have high rates of mortality and morbidity, with the highest rates seen in those infants born extremely preterm -- prior to 30 weeks gestation. Severe morbidity in these infants often contributes to life-long health problems. Maternal hypertension (HTN) is one contributor to preterm birth and also contributes to fetal growth restriction, resulting in birth weights which are small for gestational age (SGA, and generally within …

Evaluation Of Geo-Social Networking Application Use Among Young Adults, Caleb Seufert

Family Medicine Clerkship Student Projects

Background: Since 2009 geosocial networking applications (GNAs) have rapidly emerged as a new technological platform for users to communicate, date, and meet for sex. Popular GNAs include Tinder, Grindr, Bumble, Plenty of Fish, and many more. GNA’s are unique to traditional dating websites in that they allow users to connect with each other based on geographic proximity of their mobile phones. Given the pervasiveness of technology usage among young adults, it is important to understand the potential risks and benefits that GNA-facilitated communication poses on sexual health, emotional well-being, and safety. Popular GNA’s, like Tinder, estimate the majority of …

Lyme Disease Awareness In Downeast Maine, Justin L. Genziano

Family Medicine Clerkship Student Projects

Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the deer tick (Ixodes scapularis). Lyme disease is endemic in the state of Maine with 1,399 probable and confirmed cases reported in 2014. The rate in coastal Hancock County has doubled since 2012, and has the third highest rate of infection in the state.

Medical providers in Hancock County have observed an increase in anxiety and concern about Lyme disease in the community, and have found that much of this is driven by hearsay or unreliable information from the internet. The goal of this project …

Meta-Analysis Of Studies Investigation Of The Effect Of Smoking Cessation On Impatience, Miriam Claire Dash

Graduate College Dissertations and Theses

(DSM-IV-TR/) nor in withdrawal scales. However, a related term, "impatience" is listed in some nicotine withdrawal scales. (Hughes J. R., Measurements of the Effects of Abstinence from Tobacco: A Qualitative Review, 2007). Although impatience is not a synonym of impulsivity, both share the synonym "impetuous". Therefore, impatience can be considered a measure of impulsivity. Although some reviews of the effect of smoking cessation on impatience have occurred, we know of no quantitative review of prospective studies of whether smoking cessation increases impatience.

Purpose: To evaluate the effect of smoking cessation on impatience as measured by the Minnesota Nicotine Withdrawal Scale-Revised …