Medicine and Health Sciences Commons^™

The Global Implementation Of Dolutegravir For Hiv Treatment, Matthew L. Romo

Dissertations and Theses

Background
Dolutegravir, an integrase strand transfer inhibitor, is now recommended by international guidelines as part of preferred antiretroviral therapy (ART) regimens for people living with HIV. In low- and middle-income countries (LMICs), HIV treatment programs are transitioning from non-nucleoside reverse transcriptase inhibitors (NNRTIs) to dolutegravir because of its superior efficacy and tolerability, and high genetic barrier to HIV drug resistance. Along with the optimism surrounding widespread dolutegravir use, key questions regarding its implementation have emerged. In this dissertation, I sought to achieve the following specific aims: Aim 1: Characterize dolutegravir uptake in LMICs and identify potential disparities related to sex …

Identification Of Adhd And Comorbid Disorders In Children: The Potential Role Of Minority Group Membership, Rachel H. Tayler

Dissertations and Theses

Identification of ADHD and Comorbid Disorders in Children: The potential role of minority group membership

by

Rachel Tayler, MSc, MA

Advisor: Sarah O’Neill, PhD

Attention-Deficit/Hyperactivity Disorder (ADHD) affects six million US children. Females, Latinx, and possibly Black children have lower rates of diagnosis than their Male and White non-Latinx peers. ADHD is behaviorally defined, and as such, clinicians' perceptions of symptoms and determination of diagnoses may be influenced by demographic factors such as race, ethnicity and sex.

This vignette study examined whether clinicians' implicit ethnic, racial, and sex biases affect diagnosis of ADHD and comorbid conditions. Psychiatry trainees and pediatricians …

Genomic Epidemiology Of Clostridium Difficile Colonization And Transmission In An Intensive Care Unit Cohort, Brianne Ciferri

Dissertations and Theses

Abstract

Genomic epidemiology of Clostridium difficile colonization and transmission in an intensive care unit cohort

by Brianne Ciferri, MPH

Advisor: C. Mary Schooling, PhD

Introduction: Clostridiodes difficile (C. difficile) is a leading cause of healthcare associated infections (HAI) in the United States and responsible for an estimated incidence of 223,900 cases and 12,800 deaths per year^1,2. C. difficile can cause gastrointestinal illness with symptoms ranging from mild diarrheal illness to a life-threatening condition. C. difficile is an opportunistic pathogen in which spores can live in an undisturbed dormant state within the intestinal tract and become …

Development Of An Injectable Methylcellulose Hydrogel System For Nucleus Pulposus Repair And Regeneration, Nada A. Haq-Siddiqi

Dissertations and Theses

Low back pain is the most common cause of disability in the world and is often caused by degeneration or injury of the intervertebral disc (IVD). The IVD is a complex, fibrocartilaginous tissue that allows for the wide range of spinal mobility. Disc degeneration is a progressive condition believed to begin in the central, gelatinous nucleus pulposus (NP) region of the tissue, for which there are few preventative therapies. Current therapeutic strategies include pain management and exercise, or surgical intervention such as spinal fusion, none of which address the underlying cause of degeneration. With an increasingly aging population, the socioeconomic …

Psychosocial Impacts And Employment Preparedness Of Participating In An Hiv Peer Program: Implications For Tailoring A Vocational Counseling Model For Plwh, Erin R. Mckinney-Prupis

Dissertations and Theses

Background:

Medical advancements in HIV care should have reduced barriers to employment for PLWH, yet in 2017 only 47.7% of PLWH reported being employed, as compared to 62.9% in the general population. Employment is a significant social determinant of health, it impacts a variety of factors related to health, including earned income, access to healthcare, and social connectedness. Quantitative and qualitative studies have identified several concerns PLWH have about entering the workforce; the most pressing being fear of losing benefits. Targeted work readiness programs for PLWH is an important approach to help PLWH overcome their unique barriers to work, such …

Investigating The Impact Of The Nursing Practice Environment (Npe) On Central Line-Associated Bloodstream Infections (Clabsi) Among Older Adults In The Intensive Care Unit (Icu), Kristen A. Cribbs

Dissertations and Theses

Background: Health care–associated infections, resulting from treatment received for medical or surgical conditions in a health care setting, represent a critical public health and patient safety issue, exacting substantial medical, social, and economic costs. The costliest among the leading causes of preventable health care-associated infections is central-line associated bloodstream infections (CLABSI), to which older adults (age 65 years and older) are particularly susceptible, especially during intensive care unit (ICU) stays. A rich body of research has empirically linked the quality of the nursing practice environment (NPE) in hospitals to both positive and negative patient outcomes; yet, surprisingly few studies have …

Patient And Provider Perspectives On Sexual History Taking During Gynecological Care: A Pilot Study In An Academic Family Medical Setting In New York City, Ashley M. Chastain

Dissertations and Theses

Background: In the United States (US), women face a number of serious issues concerning sexual health. Current surveillance data indicates that overall rates of bacterial sexually transmitted infections (STIs) are increasing rapidly. While rates of new diagnoses have decreased, the risks of acquiring HIV are still relatively high for some females, specifically Black/African-American women. In New York City (NYC), where this dissertation research was conducted, similar HIV/STI rates exist among females of reproductive age (aged 15-44). Among women in the US, there are also high estimated rates of other sexual health problems, such as sexual anxiety, sexual dysfunction, and intimate …

Mold, Allergic Diseases And Asthma: Assessing The Validity And Usefulness Of Indoor Air Sampling As A Tool In Providing Health Protective Advice To Occupants, William M. Sothern

Dissertations and Theses

Background: Asthma is a major health problem throughout the world, disproportionately affecting occupants of low-income housing, and exposure to damp and moldy living conditions is recognized as a significant risk factor for asthma and other respiratory diseases. However, there are no authoritative health guidance values (HGV's) for airborne mold, and current scientific thought holds that the establishment of such guidelines is not practicable. Nonetheless, environmental practitioners take air samples for mold as a routine component of their indoor environmental investigations and use the laboratory results as a tool together with other findings to guide recommendations for health protective actions. The …

Rates Of Developmental And Behavioral Screening Of Young Children: Implications For Health Care Policy And Practice, Shirley Berger

Dissertations and Theses

Background: The skills and capacities developed during early childhood are the foundation for a child’s future academic functioning, economic productivity, and lifelong health and mental health. When young children have developmental delays or disabilities, early identification and intervention lead to better outcomes; however, only a minority are identified before school entry. Primary care is an important setting for identification of developmental and behavioral conditions as most young children attend well-child visits regularly and parents expect developmental guidance from pediatricians. Two key pediatric preventive services are recommended: developmental monitoring/surveillance at every well-child visit and developmental screening at 9 months, 18 months, …

Wnt Secretion Proteins Modulate Rankl-Induced Expression Of Aire In Thymic Epithelial Cells, Daniel Pollack

Dissertations and Theses

Thymic epithelial cells (TEC) are essential for a proper adaptive immune response by regulating thymocyte development and establishing central tolerance. In the thymus, TECs differentially express Wnt proteins, which activate canonical and non-canonical Wnt signaling pathways. Wnt signaling is thought to regulate cell survival, proliferation, and development although the direct molecular mechanisms in TECs have yet to be elucidated. The inducible inhibition of canonical Wnt signaling with Dkk1 leads to a rapid loss of TEC progenitors as well as a decline in mature Aire-expressing mTECs. Therefore, we explore the role of Wnt ligands potentially responsible for stimulating and/or regulating Wnt …