Medicine and Health Sciences Commons^™

Implementation Of A Biometric Screening Program And Wellness Coaching Program In A Hospital Employee Wellness Center, Carl Gastanes

Doctor of Nursing Practice Scholarly Projects

Background: Wellness programs are an emerging priority among organizations concerned about employee wellness and productivity. Data from Long Island Jewish Medical Center (LIJMC) revealed that in 2019 there were 1,690 employee visits to the ER due to chronic diseases; 30% were classified as ER sick visit and 40% of employees who visited the ER had no primary care provider. Many companies use biometric screening and health risk assessment to measure the health of their employees. The purpose of this improvement project was to implement a biometric screening program (BSP) that included wellness coaching to improve the health outcomes of LIJMC …

Host-Pathogen Interactions In A Changing World: Microbes, Mucosal Defenses, And Multiple Hosts, Brandon C. Labumbard

Graduate Doctoral Dissertations

As fungal diseases continue to emerge, research increasingly focuses on host-microbiome interactions and links to disease. Certain skin-associated microbes may benefit hosts by protecting them from invading pathogens. Seasonal changes in the host environment can also result in shifts in the microbial community and pathogen virulence – potentially influencing disease dynamics. I investigated how cutaneous microbial communities differ across hosts, seasons, and Batrachochytrium dendrobatidis (Bd) infection status by sequencing the microbial communities of 1,100 leopard frogs at five locations across the US. Percent anti-Bd function varied seasonally and with Bd infection status. Bacterial communities also varied across locations and time. …

The Role Of Emotion Regulation In Long-Term Weight Loss Maintenance: A Cross-Sectional Study, Karyn M. Aiello

Graduate Masters Theses

While many weight loss interventions have resulted in significant weight loss, maintaining that weight loss long-term continues to be challenging for most, with long-term weight loss maintenance (LTWLM) rates as low as 20% among participants of clinical weight loss studies. Those who struggle with LTWLM exhibit many shared characteristics, including lower mental health composite scores; high levels of perceived stress; and lower rates of adherence to WLM behaviors. One explanation for this might be that emotion regulation (ER) skills are stronger among those who are successful at LTWLM, and therefore more successful at self-regulating for the goal of LTWLM.

The …

Polymorphism & Parasites: Structure, Diversity And Selection Of The Mhcii Genes In A Weakly Electric Fish, Brachyhypopomus Occidentalis, Bruna L. Silva

Graduate Masters Theses

The major histocompatibility complex (MHC) class II molecules play a key role in inducing an immune response, by presenting foreign peptides to T-lymphocytes. They are considered one of the most polymorphic genes in the vertebrate genome and diversity has been associated with species diversification mediated by parasite, viral and bacterial infections. While MHC genes are well documented in teleost fish, none thus far have been described in the Gymnotiform order – a highly diverse group of neotropical electric fishes. Using a combination of a recently annotated genome and whole genome resequencing data, I identified and characterized both the classical MHCII …

On The Roles Of Trait Anxiety And Toll Like Receptor 4 In Amphetamine Sensitization In Adolescent Male Rats, Corey A. Calhoun

Graduate Doctoral Dissertations

Mammalian adolescence can be a difficult transition from childhood to adulthood, where increases in impulsivity and novelty- and risk-seeking are combined with heightened affect and elevated sensitivity to stress. Indeed, during adolescence, first drug use patterns emerge and in the continental United States, increasing misuse of amphetamines has been observed in adolescent youth. Myriad neural mechanisms underlie this shift in adolescence, including the dynamic remodeling of the mesocorticolimbic (MCL) pathway. Repeated drug administration affects neuroimmune substrates within the MCL circuit including toll-like receptor 4 (TLR4)Advances in addiction neuroscience indicate that drugs of abuse activate neural TLR4 and implicate glial TLR4 …

Implementing Universal Depression Screening In A College Health Clinic, Marilyn J. Grabau

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: College students are at high risk for depression, and this carries a considerable burden. The American College Health Association supports depression screening on college campuses recognizing that early identification leads to better outcomes.

LOCAL PROBLEM: The project site is a public university located in New England. The college campus health center incorporates medical and counseling services. From August 2019 to December of 2019, 67% of students seen in the counseling center described depressed mood as the presenting concern. Currently there is no routine depression screening in place.

METHODS: This QI project implemented universal depression screening at the student health …

Employed Mothers’ Satisfaction With The Breastfeeding Provisions In The Patient Protection And Affordable Care Act, Rebecca A. Penders

Graduate Doctoral Dissertations

Objective: Guided by the Conceptual Model for Nursing and Health Policy (CMNHP), the purpose of this study was to determine the extent to which employed mothers perceived satisfaction in their breastfeeding experiences after enactment of the Patient Protection and Affordable Care Act (PPACA) breastfeeding provisions. Methods: The participants (N=507) were employed mothers who returned to work after the birth of their infants and reported hourly pay. Convenience sampling was used to recruit women via La Leche USA Facebook account (LLL USA). Participants completed the Penders Breastfeeding Survey in Research Electronic Data Capture (REDCap). The survey consisted of 39-items; including five …

Developing An Online Health Community For Autoimmune Disease Patients Through Self-Managed Diet, Rachel Greene

Critical and Creative Thinking Capstones Collection

Part I, Autoimmune Disease Management and the Need for Intervention, discusses current and standard Autoimmune Disease- (AI/AID) management and the shortcomings within. Typical AID-management led by healthcare professionals lacks a holistic, symptom-based approach, thus further contributing to the daily chronic pain of the afflicted. This analysis indicates the need to connect those suffering with AID’s to scientific research that has determined strict dieting can significantly reduce symptoms associated with AID’s. Part II, Synthesizing A Model For Online Health Community Engagement, examines the website prototype of Greenebean, which is an online community developed via user-centric design, in a theoretical, physical, and …

Evaluation Of Extracellular Matrix Composition And Rheology As Determinants Of Growth, Invasion, And Response To Photodynamic Therapy In 3d Cell Culture Models Of Pancreatic Ductal Adenocarcinoma, Gwendolyn M. Cramer

Graduate Doctoral Dissertations

Pancreatic ductal adenocarcinoma (PDAC) is a notoriously lethal disease characterized by prominent stromal involvement, which plays complex roles in regulating tumor growth and therapeutic response. The extracellular matrix (ECM)-rich stroma has been implicated as a barrier to drug penetration, although stromal depletion strategies have had mixed clinical success. It remains less clear how biophysical interactions with the ECM regulate invasive progression and susceptibilities to specific therapies. Here, an integrative approach combining 3D cell culture and quantitative imaging techniques is used to evaluate invasive behavior and motility as determinants of response to classical chemotherapy and photodynamic therapy (PDT), in which light …

Identification And Use Of Indicator Data To Develop Models For Marine-Sourced Risks In Massachusetts Bay, Marin M. Kress

Graduate Doctoral Dissertations

The coastal watersheds around Massachusetts Bay are home to millions of people, many of whom recreate in coastal waters and consume locally harvested shellfish. Epidemiological data on food-borne illness and illnesses associated with recreational water exposure are known to be incomplete. Of major food categories, seafood has the highest recorded rate of associated foodborne illness. In total, the health impacts from these marine-sourced risks are estimated to cost millions of dollars each year in medical expenses or lost productivity. When recorded epidemiological data is incomplete it may be possible to estimate abundance or prevalence of specific pathogens or toxins in …

Correlates Of Awareness And Use Of The Hubway Bike Share Program And The Association With Weight Status, Lawrence H. Stahley

Graduate Masters Theses

Objective: The purpose of this study was to examine the correlates of awareness and use of the Hubway bike share program and assess the relationship between use and rates of overweight or obesity. Methods: Two-hundred, fifty-six students, faculty, and staff from the University of Massachusetts Boston (UMB) participated in this cross-sectional study. Participants completed an on-line survey during the fall of 2014 that assessed socio-demographics, behavioral and physical activity characteristics, Hubway awareness, and use of Hubway and personal bikes. Multivariable regression models were conducted to evaluate associations between socio-demographic and behavioral factors, and Hubway awareness, use, and the relationship with …

Examining The Toxicity, Exposure, And Regulatory Approach To Potential Human Health Risks Of The Algal Toxin Domoic Acid, Thomas H. Angus

Graduate Doctoral Dissertations

Domoic acid is a neurotoxin produced by the marine diatom genus Pseudo-nitzschia and causes cell death primarily in the area of the brain responsible for long-term memory. The resulting severe illness has been termed amnesic shellfish poisoning. Domoic acid accumulates in shellfish and planktivorous fish that consume Pseudo-nitzschia, resulting in exposure to humans through consumption of planktivorous seafood. A regulatory standard in seafood was developed shortly after its discovery in 1987 to protect against acute effects. This regulatory standard has not been revised despite significant recent data in the scientific literature.

This dissertation is divided into four sections: (1) …

Heterogeneity, Not Randomness, Sets Challenges For Quantitative Genetics And Epidemiology: A Response To Davey Smith’S “Gloomy Prospect”, Peter J. Taylor

Working Papers on Science in a Changing World

Social epidemiologist Davey Smith (2011) argues that epidemiologists should accept a gloomy prospect: considerable randomness at the individual level means that they should keep their focus on modifiable causes of disease at the population level. The difficulty epidemiology has had in moving from significant population-level risk factors to improved prediction of cases at an individual level is analogous to the lack of success in the search for systematic aspects of the non-shared environmental influences that human quantitative genetics claims overshadow common environmental influences (e.g., the family’s socioeconomic status which siblings have in common). This article responds to the argument and …

The Effects Of Nesting Environment On Neonatal Hypoxic-Ischemic Injury, Laura Grace Rollins

Graduate Masters Theses

Term neonates with hypoxic-ischemic (HI) injury are at risk for devastating neurological sequelae. The objective of this study is to determine if altering the early environment for maternal care-taking impacts the immediate and long-term sequelae of HI offspring. The Rice-Vannucci model was used to induce HI in postnatal day (PND) 7 Long-Evans pups. Litters were assigned to a closed nest (CN) or normal standard housing (SH) condition. Neurobehavioral development, cognitive ability, and stress response were assessed to establish any benefits of the CN condition. Finally, postmortem brain tissue was analyzed for morphometric markers of injury.

Food Insecurity Among Children In Massachusetts, Stephanie Ettinger De Cuba, Deborah A. Frank, Maya Pilgrim, Maria Buitrago, Anna Voremberg, Harris Rollinger, Denise A. Hines

New England Journal of Public Policy

This article focuses on the prevalence among Massachusetts children and families of food insecurity, inadequate access to enough nutritious food for an active and healthy life. It summarizes research findings on the association of food insecurity with less optimal children’s health and development from the prenatal period through adolescence. Food insecurity also correlates with other material hardships, such as housing and energy insecurity. Data show families’ participation in public nutrition and other assistance program is associated with decreased prevalence of food insecurity and with mitigation of its impact on children’s health and well-being. The article concludes with recommendations for policy …

Heterogeneity, Control, Social Infrastructure, And Possibilities Of Participation: Their Interplay In Modern Understandings Of Heredity And In Interpretation Of Science, Peter J. Taylor

Working Papers on Science in a Changing World

This working paper is a prospectus for research, writing, and engagement. It consists of vignettes, sketches of lines of inquiry, and proposals for engagement, all of which concern modern understandings of heredity and development over the life course as well as the social interpretation of science. The various items address a range of areas of science and of its interpretation: heritability studies, the social uses of genetic information, gene-by-environment interaction, personalized medicine, IQ paradoxes, racial group membership, biobanks, and life events and difficulties research. Fresh perspectives in these areas are opened up by examining the ways that research and application …

The Importance Of Metrics And Communication In Cafeteria School Policy, Andre Sanchez, Atreya Chakraborty

Interdisciplinary Perspectives: a Graduate Student Research Showcase

Obesity has become an epidemic amongst American youth in the 21st century, and is spreading not only into other developed nations such as the UK and Australia, but is also beginning to effect developing nations such as India (Bhardwaj, 2008). It is estimated that nationwide, childhood obesity affects around 17% of American children (Center For Disease Control, 2011). Obesity has been linked to many health disorders, including but not limited to, heart disease and diabetes. Subsequently, this rise in childhood obesity is having a severe impact on the healthcare services sector in America, with some studies suggesting childhood obesity in …

A New Interpretation Of The Drug Levodopa In The Treatment Of Parkinson's Disease, Joanne T. Vannah

Graduate Masters Theses

An argument for levodopa induced dyskinesias (LID) as an expression of long term potentiation (LTP) in the striatum is presented. Normally, with an intact nigrostriatal dopamine (DA) input, long term depression (LTD) is expressed in the striatum, however, striatal LTD is lost following DA denervation and chronic levodopa treatment. It is possible that these changes in synaptic efficacy are due to two other chemical modulators, achetylcholine (ACh) and glutamate, which in turn leads to the induction of striatal LTP. ACh and glutamate may produce these changes in motor behavior by affecting the striosomal pathway in addition to their effect on …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

This issue of the journal can be summed up in one word: provocative. At least two articles break new ground. Anthony Robbins and Phyllis Freeman explore the ways in which environmentally oriented public health is uniquely suited to help organized medical care in providing health and in restraining expenditures. Janet Farrell Smith challenges policymakers to look at what will soon become a hot issue — the medical use of genetic information. The genetic testing of children, now becoming prevalent in the foster care and pre-adoptive stage in order to facilitate placement and satisfy prospective parents’ “need to know,” is already …

Genetic Testing: A Cautionary Tale Of Foster And Pre-Adoptive Children, Janet Farrell Smith

New England Journal of Public Policy

Genetic testing of children in the foster care and pre-adoptive stage may be thought to facilitate child placement and satisfy prospective parents’ need to know. But, the policy analysis in this paper recommends great caution, especially given eugenic attitudes in the history of adoption and the risk of creating a second tier of un-adoptable children. Testing should be done only when two conditions are satisfied: test information is medically useful for childhood onset diseases; test information supports and does not diminish the child’s access to present and future healthcare (or the child’s future insurability). Public policy needs to make a …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

On occasion, the New England Journal of Public Policy will devote an entire issue to consideration of a public policy matter of major importance. The AIDS epidemic is such a matter, with a likely impact of overwhelming consequence well into the twenty-first century. The epidemic raises fundamental questions regarding the nature of individual freedom, our responsibilities to others, the always delicate balance between private rights and the public interest, and society's obligation to its "out" groups — whose members it has stigmatized, discriminated against, ridiculed, and treated as less than full and equal citizens. Indeed, it requires us to ask …

The Acquired Immunodeficiency Syndrome In New England: An Epidemiological Review Of The First Six Years, Laureen M. Kunches, Jeanne M. Day

New England Journal of Public Policy

Between 1981 and 1987 — the six-year period following initial recognition of the acquired immunodeficiency syndrome (AIDS) — 1,475 cases were reported among residents of the six New England states. Of nearly 40,000 cases nationwide, 3.8 percent occurred among New England residents, though the region 's population represents 5.5 percent ofthe total United States population. The groups most affected include homosexual or bisexual men (65 percent) and intravenous drug users (20 percent). However, in the two southernmost states — Rhode Island and Connecticut — 32 to 40 percent of all cases have used intravenous drugs. In these states, the male:female …

The Quest For An Aids Vaccine, Robert T. Schooley

New England Journal of Public Policy

More than fifty thousand cases of AIDS have been reported in the United States since the disease wasfirst described in 1981. Many times this number of people are infected with human immunodeficiency virus (HIV), which has been identified as the agent responsible for the illness. The seriousness of the disease, coupled with the relatively rapid spread of HIV, has fueled the effort for development of an effective vaccine.

Much is now known about the life cycle of the virus, and about its structural components. This information, and information about methods of transmission of the virus, form the basis for a …

Aids: Prophecy And Present Reality, Victor De Gruttola, William Ira Bennett

New England Journal of Public Policy

Mathematical modeling of the AIDS epidemic can be useful for policymakers even though precise projections are not possible at this time. Models are useful in establishing ranges for current and future prevalence of HIV infection and incidence of AIDS, as well as in predicting the effect of a given intervention strategy. Most decision makers are using models implicitly when they use epidemiological information as a basis for policy; formulating a model explicitly permits examination of the underlying assumptions. By creating and testing a variety of models, an investigator can determine whether the models reflect more the underlying assumptions or the …

Understanding The Psychological Impact Of Aids: The Other Epidemic, Marshall Forstein

New England Journal of Public Policy

HIV has created two epidemics, one of disease, the other the consequence of the psychological response to that disease. Thus far, behavioral change is the only effective means of interrupting the transmission of HIV. The underlying psychological dimensions of the societal and individual responses to AIDS are discussed, with suggestions for how both rational thinking and irrational fears and anxiety contribute to the development of public policy. Examples are given of how short-term solutions to reduce anxiety may actually create long-term problems, potentially increasing the risk of transmission of HIV. Specific psychological mechanisms that contribute to the epidemic of fear …

U.S. Women And Hiv Infection, P. Clay Stephens

New England Journal of Public Policy

Women are inadequately provided with HIV services and education and are differentially denied access to these. Divisions of race, ethnicity, economic class, and religion, among others, are compounded by sexual discrimination within each of these categories.

Review of current data on women with AIDS reveals that the reporting methods used convey a false impression that women are not at significant risk. Moreover, the persons indirectly affected by AIDS are predominantly women — mothers, sisters, partners, family members, teachers, and human service workers. Thus, AIDS is more of a women's issue than the statistics imply.

Women, as a gender-defined class, face …

List Of Terms

New England Journal of Public Policy

Lists and defines terms relevant to the study of HIV/AIDS that are used throughout this issue of the New England Journal of Public Policy.

Aids: An Overview, Loretta Mclaughlin

New England Journal of Public Policy

"We stand nakedly in front of a very serious pandemic, as mortal as any pandemic there ever has been," said Halfdan Mahler, director-general of the World Health Organization (WHO). "I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming. Everything is getting worse and worse with AIDS and all of us have been underestimating it, and I in particular. We're running scared. I cannot imagine a worse health problem in this century." When asked to compare AIDS to other epidemics, such as smallpox, that have infected and killed over the course …

Neuropsychiatric Complications Of Hiv Infection: Public Policy Implications, Alexandra Beckett, Theo Manschreck

New England Journal of Public Policy

The human immunodeficiency virus (HIV) infects the central nervous system (CNS), causing symptoms in most persons with AIDS-related complex (ARC) and AIDS, and in a significant proportion of those classified as asymptomatic seropositive. The most common clinical syndrome secondary to CNS infection is known as HIV encephalopathy. When sufficiently disabling, HIV encephalopathy is known as AIDS dementia, and must be reported to the Centers for Disease Control as a case of AIDS.

AIDS dementia is a complex of cognitive, affective, behavioral, and motor symptoms which varies widely in its presentation. In some persons, cognitive impairment predominates, manifesting in a loss …

Aids And A-Bomb Disease: Facing A Special Death, Chris Glaser

New England Journal of Public Policy

In 1979 it was called "gay cancer," and it took the life of an acquaintance. Then "gay-related immune deficiency," or GRID, claimed neighbors, friends of friends, fellow activists. I began grief and death counseling with a segment of the population ordinarily concerned with life's ambitions and enjoyments: men in their twenties and thirties. Hospital visits and memorial services became more frequent.

By 1983, when it had come to be called AIDS, my own friends began to be affected. One was a man I dated in seminary, and I was devastated to learn of his illness only upon receiving a notice …