Medicine and Health Sciences Commons^™

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 …

School-Based Sex Education In The United States And Its Association With Sexual And Reproductive Health Outcomes, 2000-2020, Priscilla M. Lopez

Dissertations and Theses

Background: There are significant sexual and reproductive health disparities in the United States (US). A significant proportion of sexual health disparities among adolescents is likely due in-part to inadequate school-based sex education. Sex education encourages sustainable and informed sexual behavior and has the potential reach adolescents prior to sexual debut and throughout the years at highest risk for adverse sexual health outcomes. However, the way in which sex education is defined and operationalized, as described in the literature, varies substantially, which may lead to wide variation in implementation in schools and this might explain the disparities seen. State-level sex …

Improving National Health Management Information Systems: Stakeholder Views In Selected Sub-Saharan African Countries, Marie Donaldson

Dissertations and Theses

Background

Reliable, quality health information is the foundation of measurement and decision making in the health sector. Effective health management information systems can help improve the quality and coverage of health services, aid in policy development, support program implementation, and increase the likelihood that a well-trained health work force with the infrastructure and resources needed to provide appropriate health services will be properly distributed and supplied. There is widespread global agreement that data is a powerful tool. Arming Ministry of Health officials with better access to higher quality data that they know how to use can help improve health services …

Allergy And Anaphylaxis From The Prehospital Perspective, Anthony E. Conrardy

Dissertations and Theses

Anaphylaxis is considered a severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy causing substance. It is estimated that up to 5% of the population has experienced anaphylaxis, with 1% of hospitalizations and 0.1% of emergency department patients having fatal outcomes. We characterized the population of patients encountered by the EMS agency (786 patients) that had a provider impression of “allergic reaction” and then utilized logistic regression models to estimate associations with the administration of epinephrine in the prehospital setting. Additionally, we used incident location data for all patient encounters of the EMS agency …

National Health Insurance Program In Nepal: Early Experiences And Its Effect On Health Service Utilization, Rajani Bharati

Dissertations and Theses

Introduction: Nepal initiated the Health Insurance program in 2016 to achieve Universal Health Coverage by 2030. However, the enrollment rate is low, and people are already starting to drop out. Therefore, this study aimed to explore the demand and supply side (service providers) experiences with Nepal's National Health Insurance Program and its effect on insurance enrollment and health service utilization.

Methods: We employed a mixed-method design. Ethnographic methods were used to explore the rich holistic insights into people's views and actions. We conducted 14 focus group discussions and 20 key informant interviews, mainly in Kailali and Baglung districts. …

The Intersection Of Industry, Occupation, And Job Tasks With Hotel Room Cleaner Musculoskeletal Disorder Injuries: A Methods Approach To The Analysis Of California Workers’ Compensation Data, Pamela Vossenas

Dissertations and Theses

Abstract

Background

Hotel room cleaners are a high-risk occupation for musculoskeletal disorder (MSD) injuries among U.S. hotel workers. The Bureau of Labor Statistics (BLS) publishes occupational injury rate data for Maids and Housekeeping Cleaners, the Standard Occupation Classification closest to the job of a hotel room cleaner, and for the hotel industry, yet the BLS does not cross reference injury rate data by occupation and industry. This lack of occupational injury surveillance data limits MSD injury prevention and intervention efforts targeting this high-risk occupation in the hotel industry. Workers’ compensation (WC) data is another source of administrative data with potential …

The Association Of Psychosocial Stressors With Childhood Asthma: A Cross-Sectional Study Using The National Survey Of Children's Health 2018, Sharon Joseph

Dissertations and Theses

ABSTRACT

Background: Asthma is recognized as a major public health issue for US children. Evidence suggests that psychosocial stressors experienced by parents and caretakers of children and the children themselves can also be associated with childhood asthma prevalence. Psychosocial stressors such as parents’ perception of neighborhood safety/support, as well as experiencing bullying and/or racial/ethnic discrimination can cause physiologic changes in the body favorable for asthma symptoms. However, there is a paucity of evidence regarding associations of these specific psychosocial stressors with the prevalence of childhood asthma. The goals of this study were to investigate the association between three common psychosocial …

Can Racial Disparities In Poor Birth Outcomes Be Partially Attributed To Stress: A Mendellian Randomization Study, Madeline Travers

Dissertations and Theses

In the United States, low birth weight (LBW) is a leading cause of infant death overall, and the leading cause of death for Black infants. Understanding and preventing adverse birth outcomes is a major public health priority. Observationally, there is some evidence to support the hypothesis that maternal stress may be associated with LBW. To clarify the effect of maternal stress exposure on LBW, I conducted three separate-sample instrumental variable analyses with genetic instruments (Mendelian randomization) based on single nucleotide polymorphisms (SNP), from genome wide association studies, strongly (p-value < 5 × 10⁻⁶) and independently associated with neuroendocrine, vascular, and immune measures …

Assessing Hiv Risk, Syndemics, Resilience And Engagement In Care In A Large National Cohort Of Gay, Bisexual And Other Men Who Have Sex With Men In The United States, Javier Lopez-Rios

Dissertations and Theses

Background: HIV continues to be a pervasive public health issue in the United States with more than 1.2 million people living with HIV (PLWHIV) across the nation. Gay, bisexual and other men who have sex with men (GBM) account for over two-thirds of all new HIV diagnoses with racial and ethnic minorities shouldering a large proportion of the burden of disease. Although HIV transmission is predominantly driven by sexual behaviors, there are underlying complex individual, behavioral, and structural factors that contribute to high rates of sexual behavior and subsequent HIV acquisition. Moreover, difficulties remain in maximizing linkage to care …

Exposure Characterization And Assessment Of Airborne Chemicals And Sars-Cov-2 Transmission In New York City Nail Salons, Amelia P. H. Watkins

Dissertations and Theses

Background: Currently, there are 156,000 people employed as manicurists or pedicurists in the United States. Employment in this sector is expected to grow by 10% over the next decade. Exposure assessments have revealed that salon workers are chronically exposed to a variety of substances that cause respiratory sensitization, developmental problems, contact dermatitis, blood, liver, and kidney issues, as well as nervous system impacts. Most recently, the SARS-Cov-2 pandemic has raised the issue of the vulnerability of nail salon workers to airborne infectious diseases as well. This dissertation aims to characterize and assess the chemical exposures that nail salon workers …

Restoration Of Bone Material And Microstructural Properties After Long-Term Remodeling Suppression, Abigail A. Coffman

Dissertations and Theses

Anti-resorptive drugs, principally bisphosphonates (BPs), are the mainstay of osteoporosis treatment. They work by inhibiting bone resorption/remodeling, thus preventing bone loss. However, long-term suppression of bone resorption adversely affects bone tissue mechanical properties, even while conserving bone mass. Lack of remodeling leads to accumulation of fatigue-induced microdamage, altered matrix mineralization and reduction in normal bone tissue heterogeneity, causing impaired strength and fracture toughness. The most severe consequence to patients, while rare, is Atypical Femur Fractures (i.e., complete fatigue fractures of the femoral shaft). To counteract the effects of long-term remodeling suppression, a temporary break in BP treatment (a "drug holiday) …

Osteocyte Activity And Skeletal Muscle Relative Gene Expression Profiling After Short-Term Muscle Paralysis, Michelle Gelbs

Dissertations and Theses

Mechanical loading is essential for maintaining bone tissue. Reduced mechanical loading has been shown to have a negative effect on bone, and can result in the development of disuse osteoporosis. Disuse models of muscle inactivity and immobilization, like the Botox model used in this study, result in changes in the bone microarchitecture, the mechanisms behind which are not fully understood. In a previous four-week Botox disuse study, skeletally mature 20- week-old rats experienced degradation of intracortical bone, increased vascular porosity, and decreased osteocyte lacunar density in the tibiae. The focus of this study was to explicate a potential source of …

Development Of Light Actuated Chemical Delivery Platform On A 2-D Array Of Micropore Structure, Hojjat Rostami Azmand, Hojjat Rostami Azmand

Dissertations and Theses

Localized chemical delivery plays an essential role in the fundamental information transfers within biological systems. Thus, the ability to mimic the natural chemical signal modulation would provide significant contributions to understand the functional signaling pathway of biological cells and develop new prosthetic devices for neurological disorders. In this paper, we demonstrate a light-controlled hydrogel platform that can be used for localized chemical delivery in a high spatial resolution. By utilizing the photothermal behavior of graphene-hydrogel composites confined within micron-sized fluidic channels, patterned light illumination creates the parallel and independent actuation of chemical release in a group of fluidic ports. The …

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 …