Medicine and Health Sciences Commons^™

Examining The Role Of Electronic Medical Record Generated Provider Reminders On Provider Offering Of Breast Cancer Screening Services, Charles Beverley, Jr.

Theses and Dissertations

Introduction:Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings.

Methods:This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based …

Bioassay Guided Fractionation Of American Ginseng. A Hexane Fraction Of American Ginseng Suppresses Colitis And Associated Colon Cancer. Mechanism Of Action., Deepak Poudyal

Theses and Dissertations

Inflammatory Bowel Disease (IBD) [Ulcerative colitis (UC) and Crohn's Disease (CD)] is a group of chronic disorders of unknown etiology characterized by inflammation in the gastrointestinal tract associated with a high colon cancer risk. UC is characterized by periods of active disease ("flare-ups"), followed by periods when the disease is inactive ("remission"). The end result is an abnormal immune response with repeated episodes of colonic inflammation. Conventional treatment of UC by aminosalicylates, TNFα inhibitors, and steroids have modest effects, and come with a high risk of side effects including dyspeptic symptoms, gastric ulceration and sometimes hospitalization and deaths. Because of …

Impact Of Physical Activity In The Prevention Of Colorectal Cancer, Sarah Ashley Barnes

Theses and Dissertations

This review evaluates the current understanding of research on the impact of physical activity in the prevention of colorectal cancer. Current biological mechanisms implicated in physical activity and colorectal cancer risk reduction are blood glucose regulation, insulin sensitivity, leptin and adiponectin profiles, inflammation as well as secreted protein acidic and rich in cysteine (SPARC), an exercise induced myokine. Recent literature indicates that 30-60 minutes of moderate to vigorous activity a day is effective against colorectal cancer development, and there is convincing evidence of aerobic exercise as differently beneficial in recruiting mechanisms identified as preventative against colorectal cancer. This article provides …

Postnatal Depression In Mexico: Healthcare Provider Conceptualizations And Policies In The Public Health Sector, Jean Marie Sims Place

Theses and Dissertations

Background: The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) highlight education and training for healthcare providers and the development of a policy framework as core strategies to address maternal mental health in low- and middle-income countries. This research critically examines these strategies with respect to postnatal depression in Mexico. The research 1) addresses how healthcare providers in Mexico conceptualize postnatal depression, and 2) assesses the policies that exist in Mexico regarding postnatal depression, which will inform the next steps for policy development. The research informs appropriate healthcare provider education and training, as well as the next …

A Novel Approach To The Design Of Selective Inhibitors For Cell Cycle Cyclin Dependent Kinases, Tracy Perkins

Theses and Dissertations

CDK2/cyclin A and CDK4/cyclin D1 are proven targets for cancer drug discovery. The development of novel CDK inhibitors, with high selectivity, are being investigated by targeting the cyclin binding groove (CBG) located on the cyclin, the regulatory subunit of CDK. The CBG is a shallow area that is involved in signaling and the inhibition of cell cycle CDKs via endogenous tumor suppressors. Currently, non-peptidic inhibitors are being developed based on the recognition amino acid sequence, HAKRRLIF, of the C-terminal peptide sequence of the CDK inhibitor p21WAF1. Computational design and the utilization of non-natural amino acids are being proposed to identify …

Differential Effects Of The Great Recession On Minority Populations, Samuel Towne

Theses and Dissertations

Times of severe economic flux may burdend individuals at differing levels. The Great Recession affected individuals differently by racial group. Vulnerable individuals who may already be burdened by economic strains and health disparities may benefit from state policies that work to improve the health and health care access of individuals. Medicaid Generosity for parents or childless adults is associated with differences in individuals' health status and reporting forgone medical care. Individuals in states that have higher levels of Medicaid eligibility defined as eligibility in relation to the percent of the Federal Poverty Level report lower levels of poor or fair …

A Preliminary Study Exploring Racial Differences In Triage, Hospitalization Status, And Discharge Medication In An Emergency Department In Graniteville, Sc, Clare Pollock

Theses and Dissertations

Purpose

This study seeks to identify any racial differences present in assigned triage scores, hospitalization status and discharge medications in a rural hospital likely experiencing a surge after a mass casualty incident involving chlorine gas as a result of a train derailment. Differences were examined between Non-Hispanic White and African American adults who were moderately ill and who presented to the emergency department of the closest hospital to the accident site within 24 hours of the incident.

Methods

Non-Hispanic White and African American adults who presented to the emergency department of the closest hospital to the accident site and who …

Food Environment And Birth Outcomes In South Carolina, Xiaoguang Ma

Theses and Dissertations

An increasing number of studies examined the association between neighborhood characteristics and birth outcomes. However, the results can be difficult to compare because of the variety of indicators used to characterize the neighborhood. As an important neighborhood characteristic, the food environment is associated with residents' nutrition status, diet quality, and related health outcomes. In addition, the food environment has been found to influence women's diet quality during pregnancy, which is a key factor in predicting birth outcomes. However to date, studies on food environment and birth outcomes are extremely limited.

This study examined the association between food environment (evaluated by …

Illness-Related Diabetes Social Support And Glycemic Control Among Middle Aged And Older Adults, Favel Leah Mondesir

Theses and Dissertations

Objective

The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC.

Methods

We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence …

Trophic Response To Polycyclic Aromatic Hydrocarbons And Copper In Tidal Flats Of North Inlet, South Carolina, Leslie Lynn Muggelberg

Theses and Dissertations

The trophic link between benthic microalgae (BMA) and fiddler crabs is critical for the ecosystem functioning of estuaries and alterations in this linkage by anthropogenic activities could have cascading impacts on food webs and biogeochemical cycling in these sensitive habitats. Singular and interactive effects of two common pollutants in aquatic ecosystems, polycyclic aromatic hydrocarbons (PAHs) and copper (Cu), were investigated by exposing field collected sediment communities to the contaminants and measuring changes in BMA biomass and community composition in a bioassay design. The consequential impacts on the food web were then explored by examining the effects of PAHs and copper …

Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation And Measurement Issues In Rural Pakistan, Zaeem Haq

Theses and Dissertations

Appropriate nutrition and psychosocial stimulation during the first three years of life can have long-lasting effects on a child's health and development. However, not all children in the world receive adequate nutrition and psychosocial stimulation during this period. There has been enormous interest in developing the evidence on the most effective ways of implementing and assessing early childhood development (ECD) promotion interventions in resource poor settings. Despite the interest, the integration of ECD interventions into pre-existing public health programs, and assessment of these interventions in extended family, rural household environment have not been addressed.

The dissertation research presented here was …

Fishing And Fish Consumption Patterns In The Gullah/Geechee Sea Island Population, Jamelle Heyward Ellis

Theses and Dissertations

The Gullah/Geechee (G/G) people are descendants of West African slaves who remained in seclusion on the Sea Islands of South Carolina, North Carolina, Georgia, and Florida until the end of the Civil War in 1865. In addition to retaining their unique cultural language, they also remain largely a fishing subsistence population. Decades of urban development have reduced the G/G population's access to traditional fishing locations and have increased exposures to environmental contaminants in some bodies of water that are frequently fished by the G/G. Approximately 98.4% of SC rivers and streams and 77.6% of lakes have been assessed for aquatic …

Association Between Breastfeeding And Infant Growth: A Probable Reverse Causality, Shraddha Vyas

Theses and Dissertations

Background: Much conflicting results exist in the association between breastfeeding and infant growth. One of these confusions is related to the temporal sequence between breastfeeding practice and infant growth.

Objective: This study aimed at examining the association and investigating a possible reverse causality between breastfeeding and infant growth.

Method: Infant Feeding Practices Survey II, a national longitudinal database with repeated measurements, following women prenatally and until one year postpartum (N=2914) was used. Mixed linear model assessed the impact of breastfeeding from the 2nd, 4th, 6th and 9th months on infant growth at the 3rd, 5th, 7th and 12th months, respectively. …

Insects As Indicators Of Environmental Stress, De Anna Estella Beasley

Theses and Dissertations

In the face of climate change-related events and anthropogenic disturbances, understanding the impacts of these events on species richness, abundance and distribution is important for us to mitigate biodiversity loss and better predict consequences for the environment and for human life. Insects are excellent models for understanding the consequences of environmental stress due to the sensitivity of their development and behavior. The overall focus of my dissertation research is the investigation of fluctuating asymmetry and oviposition behavior as indicators of environmental stress. My research includes a meta-analysis of published literature, and empirical research that was part of a collaborative initiative …

A Pilot Intervention To Engage Nurses To Lead Transformation Of The Workplace, Molly Patton

Theses and Dissertations

The often toxic work environment in which nurses practice contributes to decreased well-being, job dissatisfaction, and poor retention rates, while negatively impacting quality and patient safety. Most leadership programs and resources target nurses in formal leadership positions and are exclusive of the bedside nurse. The purpose of this research utilization project was to determine immediate and short-term outcomes of an educational leadership workshop for nurses, including intent to change the work environment and subsequent action to change the work environment. The goal was to develop, deliver, and evaluate an evidence-based educational intervention to empower nurses at all levels of care …

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women, Amanda Thomas Langford

Theses and Dissertations

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease characterized by symptoms of urinary urgency, frequency, bladder pain, and chronic pelvic pain in the absence of known pathology. Selection of appropriate treatments depended on the severity of the patient's symptoms and patient's preference. This review found that it is important for providers and patients to set realistic goals for symptom improvement when starting a new treatment.

The purposes of this project was to 1) conduct a substantive literature review on treatment guidelines for IC/PBS, 2) analyze the literature for comparing oral pharmacological interventions and behavioral interventions for IC/PBS, and 3) …

Examining The Relationships Between Religiosity, Spirituality, Internalized Homonegativity, And Sexual Risk Behaviors Among African-American Men Who Have Sex With Men: The Sexual Health In Faith Traditions (Shift) Study, Stacy Whichard Smallwood

Theses and Dissertations

Background: African-American men who have sex with men (AAMSM) are at disproportionate risk for HIV infection. Although the disparities in infection rates between AAMSM and MSM of other groups have been well-documented, little is known about the factors that contribute to the disparity, particularly psychosocial factors. One such factor, internalized homonegativity (IH), has been identified as a potential predictor of AAMSM engagement in risky sexual behaviors. However, little has been known about the ways in which IH manifests itself in the lives of AAMSM, or the role that sociocultural institutions, such as African-American faith communities, play in the development of …

Development Of Proteomic Characterization And Speciation Techniques Utilizing Tryptic Peptides With Maldi-Tof Ms And Lc-Esi Ms-Ms, Jennifer Marie Kooken

Theses and Dissertations

The characterization of microbes which can be opportunists and pathogens (e.g., methicillin resistant Staphylococcus aureus (MRSA)) is important in understanding and potentially treating diseases caused by various bacterial species. Common genera found in the human skin micro-biome include Micrococcus and Staphylococcus, but there only a limited number of tests to differentiate these genera and/or species. My research reflects methods development from distinguishing one closely related genera from another and then expanded to species identification. Tryptic peptides were analyzed by MALDI TOF MS and the mass profiles compared with those of a reference strain in both genus and species identification. Aconitate …

Effects Of Dna Damage And Cdk Inhibitors On The Nucleoli, Vineet Garg

Theses and Dissertations

The nucleolus is the primary site of ribogenesis and consists of three compartments, namely, fibrillar center (FC), dense fibrillar component (DFC) and granular component (GC). Recent studies have observed a novel structure distinct from these three compartments which forms in the nucleolus upon DNA damage called Intranucleolar body (INoB). Previous studies in our laboratory have found INoBs forming in HT1080 fibrosarcoma cell lines after ectopic overexpression of damage-inducible cell cycle inhibitor p21. This INoB formation has been observed to be decreased by Senexin A which is an inhibitor of transcription regulating kinases CDK8/CDK19.

Here we show that INoB formation correlates …

The Relationship Between Electronic Health Record Implementation And Outcomes Of Care For Three Cardiovascular Procedures, Deshia Ann Leonhirth

Theses and Dissertations

Background. The U.S. healthcare movement to improve quality and patient outcomes has prompted investigations into tools that can assist in these aims. Electronic health records (EHRs) are one tool proposed by the Institute of Medicine (IOM). The objective of this original dissertation research was to examine the relationship between electronic health record functionalities and two outcomes of care as proxies for quality: risk-adjusted mortality for abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) and log estimated cost-per-discharge. Methods. This study used 2009-2010 hospital inpatient administrative discharge data from the Nationwide Inpatient Sample (NIS), …

Assessment Of The Effectiveness Of An Innovative Screening Colonoscopy Protocol In Producing High Quality Performance And Outcomes By Trained Primary Care Physicians, Yi Jhen Li

Theses and Dissertations

Colorectal cancer (CRC) is the 3rd most prevalent cancer and 2nd leading cause of cancer death in the U.S. Colonoscopies have been recommended as the preferred screening method to prevent cancer by removing polyps before they transform into cancer. Although colonoscopy every 10 years is considered to be the preferred screening method, it is not perfect mainly owing to the variable quality of screening colonoscopy under community-based practice conditions. Although the effectiveness of colonoscopy in preventing CRC is documented, screening colonoscopy coverage in the US population remains low. This is partly due to low colonoscopy capacity due to a shortage …

Characterization Of The Role Of Fro6 In Metal Homeostasis In Arabidopsis Thaliana, Margo Ellen Maynes

Theses and Dissertations

Iron deficiency is the most common human nutritional disorder in the world today, affecting approximately 2 billon people worldwide, almost a third of the world's population. For most of the world's population, plant foods serve as the major source of dietary iron. One approach that may contribute towards the solution of iron deficiency is the development of crop plants that contain higher levels of bioavailable iron. This project focuses on FRO6, a ferric chelate reductase in Arabidopsis thaliana that is thought to reduce apoplastic iron for transport across the plasma membrane in leaf cells. We hypothesize therefore that FRO6 controls …

The Role Of Host-Tumor Interactions In Liver Metastasis Of Colorectal Cancer, Yu Zhang

Theses and Dissertations

Colon cancer is the third most frequent cancer and the second leading cause of cancer deaths in the United States. Liver metastasis is the major cause of death in colon cancer. Successful metastases depend on productive collaborations between tumor cells and host-derived cells in the tumor microenvironment, target organ environments, and cells in the hematopoietic compartment.

To identify the host-tumor interactions promoting liver metastasis and their molecular and cellular mediators, an orthotopic mouse model of liver metastasis of colon cancer was established that recapitulates all stages of tumor growth and metastasis. A highly metastatic mouse carcinoma cell line CT26-FL3 was …

The Role Of Reactive Oxygen Species In Cell Death Induced By Thymidylate Synthase Inhibitors, Ufuk Ozer

Theses and Dissertations

Thymidylate synthase (TS) catalyzes the reductive transfer of a methyl group from N5,N10-methylenetetrahydrofolate (CH₂-THF) to dUMP, forming dTMP and dihydrofolate (DHF). It is generally accepted that inhibition of the enzyme leads to a deficiency of dTMP, followed by genome damage and programmed cell death. As such, TS has long been viewed as an important target of anti-neoplastic agents, such as 5-fluorouracil (5-FU) and raltitrexed (RTX), which lead to inhibition of the enzyme. Oxidative stress is well-recognized as having a central role in cellular response to a number of DNA damaging agents, and may be a proximate cause of …

An Assessment Of Injury Presentation To Determine Elder Abuse Prevalence In South Carolina, Brittani L. Harmon

Theses and Dissertations

As the number of individuals age 60 years of age and older continues to rise in the United States, the care and safety of this population will be a growing issue. There are many contributing factors and reasons why elder abuse occurs. Elder abuse is an emerging issue; however there is limited research and understanding in the area. There are barriers to the detection and prevention of the issue. Emergency department staff is essential to the identification and detection of possible abuse, and it is important that these providers understand the risk factors and physical manifestations of abuse and neglect …

The Anti-Angiogenic Effects Of Sparstolonin B, Henry Rhodes Bateman

Theses and Dissertations

Sparstolonin B (SsnB) is a novel bioreactive compound isolated from Sparganium stoloniferum, an herb historically used in Traditional Chinese Medicine as an anti-tumor agent. SsnB has demonstrated anti-inflammatory properties, inhibiting Toll-like receptor mediated inflammation in isolated macrophages and in mice. Angiogenesis, the process of new capillary formation from existing blood vessels, is dysregulated in many pathological disorders, including atherosclerosis, diabetic retinopathy, and tumor growth. The goal of the project was to investigate the anti-angiogenic effects of SsnB.

The first part of the project utilized in vitro functional assays to study how SsnB affected endothelial cells. SsnB inhibited endothelial cell tube …

Linking Obesity To Colorectal Cancer: Recent Insights Into Plausible Biological Mechanisms, Catherine Guffey

Theses and Dissertations

Obesity has emerged as a leading environmental risk factor for the development of CRC. However, the mechanisms underlying this relationship have not yet been fully explained. Recent literature has focused on 1) inflammatory processes, 2) adipokines, and 3) estrogen. Obesity-enhanced inflammation is largely orchestrated by increases in adipose tissue macrophages leading to the secretion of TNF-alpha, MCP-1, and IL-6, all of which are linked to CRC. Adiponectin is decreased with obesity and has been reported to be negatively associated with CRC, while leptin, which is increased, is positively associated with the disease. Estrogen has been shown to influence CRC, although …

Resveratrol Attenuates The Development Of Trans-Aortic Constriction (Tac) Induced Heart Failure In Mice, Prakash Kumar Gupta

Theses and Dissertations

Heart failure (HF) still remains the leading cause of morbidity and mortality and imposes severe global affliction and enormous cost on the healthcare system. Although current pharmacological therapies have shown to slow down the progression of HF, but seems to have reached their limits in improving overall patient prognosis. Thus, an immediate call for novel alternate therapies are needed which act independently as well as in conjunction with current treatment modality. Studies were performed in the well-established transverse aortic constriction (TAC) model of chronic pressure overload (PO) in mice. In the first series of studies, Male C57BL6 mice (26-28 g) …

Role Of Microrna-155 In A Mouse Model Of Colon Cancer., Claire Mitchell Midyette

Theses and Dissertations

Colorectal cancer remains the third most common malignancy and the fourth most common cause of cancer mortality worldwide. Dysregulated miRNA levels are associated with several types of malignancies and may serve as important biomarkers and/or therapeutic targets in colorectal cancer. We examined the role of miRNA-155 on tumorigenesis and associated symptoms using a well-characterized mouse model of colorectal cancer. C57BL/6 wild-type mice and miRNA-155-/- mice (n=7-13 group) were given a single injection of AOM (10mg/Kg) followed by 3 cycles of DSS (2% in the water for 1 week followed by 2 weeks of plain water). A C57BL/6 wild-type group that …

High Fat Diet Induced Obesity In A Mouse Model For Colorectal Cancer, Kennerly Clinton Patrick

Theses and Dissertations

Obesity is widely correlated with the incidence of colorectal cancer (CRC). The exact mechanisms that link obesity to CRC risk have not yet been fully established, and only a limited number of animal models are available to study pathways involved in obesity-related colon carcinogenesis. The objective of this study was to determine the influence of HFD-induced obesity on AOM/DSS-mediated colorectal tumorigenesis, tumor proliferation, and symptom severity. Male C57BL/6 mice were fed a novel high fat diet, designed to mimic the standard American diet (12 % saturated fat & 28 % unsaturated fat), at 4 weeks of age until 16 weeks …