Medicine and Health Sciences Commons^™

Impact Of Prenatal Exposure To Antidepressants On Adverse Birth Outcomes, Sudeepti Pahuja

Theses and Dissertations

BACKGROUND: There has been an increase in the diagnosis of depression and the use of antidepressants, especially in women of childbearing age, in the past decade. This has drawn attention to the potential impact of depression and antidepressants on pregnancy and fetal development.

OBJECTIVE: (i) To determine the impact of prenatal exposure to antidepressant on the risk of adverse birth outcomes. (ii) To assess the effect of type of antidepressants on the risk of adverse birth outcomes using selective serotonin reuptake inhibitors as the referent group. (iii) To assess the effect of duration and time of prenatal exposure …

Applications Of Multimedia Resources Developed As Part Of The Virtual Cell Animation Collection In Undergraduate Introductory Biology, Eric Edward Goff

Theses and Dissertations

Calls for reform in undergraduate STEM education have arisen from an increased need for well-trained biology graduates in the future scientific workforce. To address this need, many institutions have focused on a pedagogical restructuring of instructional practices to promote deeper conceptual understanding of core biological concepts. This study investigates the implementation of multimedia resources as a possible reliable supplement to undergraduate introductory biology and aims to provide empirical evidence on the instructional best practices of their use. As a central part of this study, we focus on one specific multimedia package, the Virtual Cell Animation Collection, due to its developmental …

Analysis Of Food Exposures In Foodborne Disease Outbreaks, Alecia T. Alianell

Theses and Dissertations

Foodborne illness remains a serious public health problem in the United States in general as well as South Carolina in particular. Obtaining good food ingestion histories as well as possible risky environmental exposures is one of the earliest, most important tasks to complete in any foodborne outbreak investigations. Because time is of the essence in investigations, we have evaluated a rarely used biostatistical method, Random Forests, to data obtained from DHEC. Random Forests has the potential to facilitate more rapid identification of foods or environmental exposures that may be associated with outbreaks. We also examined previous cases of salmonellosis using …

Adoptees’ Experiences With Direct-To-Consumer Genetic Testing: Emotions, Satisfaction, And Motivating Factors, Anna Childers

Theses and Dissertations

Public awareness of the role of genetics in disease continues to expand along with the use of direct-to-consumer genetic testing (DTC-GT). One subset of customers taking advantage of the growing DTC-GT market is adoptees. Prior research has shown that adoptees appear to be more motivated than non-adoptees to learn about their genetic disease risk but have similar responses to health-related information acquired through DTC-GT. In this exploratory qualitative study, fourteen adoptees were asked about their motivations for pursuing DTC-GT; satisfaction with results; emotions throughout the process; and interest in meeting with a genetic counselor. Motivations for pursuing DTCGT fell into …

Assessment Of Patient Satisfaction With The Provision Of Fertility Information In Women With Lynch Syndrome, Rachel Elizabeth Hickey

Theses and Dissertations

Lynch Syndrome (LS), one of the most common hereditary cancer syndromes, is primarily known for its substantially increased risks for colorectal cancer. The incidence of gynecologic cancers (endometrial and ovarian cancers) equals or exceeds the incidence of colorectal cancers in female patients with LS. The prevention and treatment methods for these cancers can drastically affect fertility and reproduction. Previous studies with cancer patients have revealed challenges in acquiring information related to these topics; thus far, no research has assessed whether there is an informational gap regarding fertility information for women in the LS population. The purpose of this study was …

Exercise Recommendations For Active Adults At Risk For Sudden Cardiac Death: “Can I Continue To Exercise?”, Kacie Lynn Baker

Theses and Dissertations

Sudden arrhythmic death syndrome (SADS) is due to genetic conditions associated with cardiac ion channelopathies and cardiomyopathies. Many of these conditions have exercise guidelines regarding eligibility and disqualification recommendations for competitive athletes through the American Heart Association and the American College for Cardiology. This study investigates how medical professionals communicate these exercise recommendations to patients, and in turn, how well patients understand these recommendations. The study also explores motivations for either continuing or discontinuing an exercise practice after a diagnosis. A questionnaire was distributed through cardiac disease-focused support groups and organizations. Data from 67 individuals with a SADS condition were …

Mast Cells And Lipid Cross-Talk In Skin Inflammation, Piper Alexandra Wedman

Theses and Dissertations

Atopic dermatitis (AD) is an inflammatory skin disease whose pathogenic mechanisms remain unclear. Using a validated human AD-like mouse model, we observed that skin remodeling started at a pre-symptomatic stage of AD that included cellular infiltration of the hypodermis, accompanied with activated/degranulated mast cells (MC). Local MC activation was quantified using a novel method of computer-assisted image analysis we developed and reported. Using a variation of this method, we defined morphometric parameters allowing for quantitation rather than scoring of cellular infiltration. Cell recruitment correlated with MC activation, chemokine production and increased levels of sphingolipid sphingosine-1-phosphate (S1P), produced by sphingosine kinase-1 …

The Perceived Utility Of Personalized Genomic Medicine In Individuals With A Family History Of Heart Disease: A Pilot Study, Dana Margaret Mittag

Theses and Dissertations

According to the World Health Organization (2005), cardiovascular disease (CVD) is the number one cause of death in most countries. Assessing a patient’s risk for heart disease may include incorporating factors such as their gender, age, weight, tobacco history, cholesterol, blood pressure, family history, and more recently, genetics. Genome-wide association studies (GWAS) have made it possible to identify risk loci for many of the common, complex disorders, including coronary artery disease (CAD). As the medical genetics community undergoes a shift from a genetics focus to a genomics oriented focus, genomic medicine is becoming more accessible. Research has begun to examine …

A Quality Improvement Project To Reduce The Incidence Of Clostridium Difficile Infection Through Implementation Of Evidence-Based Terminal Clean Procedures, Tamara Cook

Theses and Dissertations

Hospital-acquired infections (HAIs) are a huge economic burden and threat to patient health and outcomes. Clostridium difficile is the most common HAI. Effective hand hygiene and proper environmental cleaning procedures are significant to preventing the spread of C. difficile infections. The research question used to guide this project is: Does the use of a monitoring system for post C. difficile isolation terminal clean procedure reduce the rate of hospital-acquired C. difficile in the acute care population? A thorough organizational assessment was performed and directed this project to identify causes that may contribute to the recurrences of C. difficile infections. The …

Exploring Spatial Patterning And The Impact Of Obesogenic Built Environments For Youth Obesity, S. Morgan Hughey

Theses and Dissertations

Youth obesity is a major public health concern due to an array of physical, social, and psychological health consequences. Residential location, often referred to as ‘place’, has continued to emerge as a key health determinant with studies showing that where a child lives impacts their health. Environments where it is easy for individuals to have low levels of physical activity – either by discouraging active behavior or promoting sedentary behavior – and easy for individuals to consume unhealthful foods – either by the limited availability of healthful foods or increased availability of unhealthy foods – have been coined ‘obesogenic’. Additional …

Impact Of Medicare Reimbursement Policy Change On The Utilization, Risks, And Costs Associated With Erythropoiesis-Stimulating Agents In Cancer Patients With Chemotherapy-Induced Anemia, Minghui Li

Theses and Dissertations

Background: Erythropoiesis-stimulating agents (ESAs) are biological drugs used to stimulate the production of red blood cells. ESAs are commonly prescribed for cancer patients with chemotherapy-induced anemia and chronic kidney disease (CKD) patients with low levels of hemoglobin. Due to the increasing safety concerns, Centers for Medicare and Medicaid Services (CMS) issued a Medicare reimbursement policy change for ESAs in cancer patients to regulate the utilization of ESAs. For chemotherapy-induced anemia, when patients had solid tumors, multiple myeloma, lymphoma, or lymphocytic leukemia, ESA treatment is reimbursable by CMS only when the hemoglobin level is < 10g/dL.

Objectives: The objectives of this study were …

The Association Between Sexual Risk Behaviors Of Latinos And Hiv Knowledge In South Carolina, Danielle Nicole Sill

Theses and Dissertations

HIV/AIDS inordinately impacts Hispanics/Latinos, which are the fastest growing minority group in the United States. 16,222 South Carolinians are infected with HIV, with 70 new cases being diagnosed each month. Few studies have been conducted to determine if HIV knowledge is associated with sexual risk behaviors in South Carolina. Bilingual/bicultural interviewers conducted a survey of Latinos living in the Pee Dee and Midlands regions of South Carolina. The survey consisted of questions regarding demographic characteristics, HIV knowledge, and sexual risk behaviors. We enrolled 203 participants in which 193 were eligible for our study (97 females and 96 males). We hypothesized …

Prenatal Methylmercury Exposure In A South Carolina Coastal Cohort, Alexis Donohue

Theses and Dissertations

Objectives: Methylmercury is a neurotoxin that has the ability to cross the placenta and adversely affect the developing fetus. Our primary objective was to investigate whether prenatal methylmercury exposure varied longitudinally, and whether differences were associated with maternal characteristics.

Methods: Pregnant mothers were recruited in Charleston, South Carolina (8-17 weeks gestation) (n=78). Blood samples were collected during both early (11.8 ± 1.7 weeks) and late (35.3 ± 2.0 weeks) gestation. Blood total mercury and methylmercury concentrations were analyzed. Upon enrollment in the study, mothers filled out a sociodemographic questionnaire that included questions regarding maternal age, race/ethnicity, and education level. Additionally, …

The Association Between Clinical Recognition Of Depression And Unplanned Hospital Readmission Among Older Adults, Karen M. Jones

Theses and Dissertations

Purpose

The likelihood of a depression diagnosis may differ based on whether the patient was seen in an inpatient or outpatient setting. Depression has been associated with an increased risk of a 30-day readmission. The purpose of this study was to determine the level of agreement (concordance) between depression diagnosis as identified by inpatient and outpatient records and examine the relationship between depression diagnostic concordance and 30-day readmission.

Methods

Using universal administrative claims data from South Carolina, we examined inpatient and outpatient records. The analysis was restricted to Medicaid recipients aged 55 years and older with a primary admitting diagnosis …

Best Practice For Screening Adult Patients With Psoriasis For Polyautoimmunity: Celiac Disease, Rheumatoid Arthritis And Crohn’S Disease, Susan Danielle Ashbaugh

Theses and Dissertations

The purpose of this quality improvement project was to determine if screening primary care patients with psoriasis will improve early detection of celiac disease (CD), rheumatoid arthritis, and Crohn’s disease (CrD). The aim of this project is to assess the utility of early screening in patients with psoriasis in order to facilitate earlier diagnosis of CD, RA and CrD, which would consequently initiate earlier treatment and improve long-term patient outcomes. Genetic and population-based studies suggest that individuals with psoriasis have a greater risk of also having CrD, CD or RA, than do individuals without psoriasis. The literature also suggests that …

Association Of Gestational Weight Gain During Twin Gestations And Adverse Maternal Outcomes, Kerry Spillane

Theses and Dissertations

Objective: To examine the association between gestational weight gain (GWG) in twin gestations and the odds of adverse maternal outcomes.

Setting and Participants: Study population included 3,081 women with a twin gestation delivered between 23-42 gestational weeks from 19 hospitals across the United States (2002-2008) participating in the Consortium on Safe Labor (CSL) study.

Main Outcomes: Main outcomes of interest included: gestational hypertension, preeclampsia, gestational diabetes mellitus, and cesarean delivery.

Methods: Quantile regression estimated the 25th and 75th percentiles of total GWG, respective of pre-pregnancy BMI and gestational age at delivery, and was used to create our new total GWG …

Functional Role Of The Homeobox Transcription Factor Six1 In Neoplastic Transformation Of Human Keratinocytes, Maria Hosseinipour

Theses and Dissertations

The homeobox transcription factor SIX1 contributes to both tumor development and progression. Numerous studies have determined that the inappropriate expression of embryonic genes, in particular transcription factors, contributes to carcinogenesis. SIX1 is essential for the development of numerous organs including the auditory and olfactory system as well as the kidney, by promoting proliferation, survival and migration of progenitor cells during embryogenesis. SIX1 has also been shown to increase cancer cell proliferation, survival and invasion. The aberrant expression of SIX1 occurs in numerous adult and pediatric cancers. We have previously determined that our in-vitro model system for HPV16-mediated tumorigenesis shares many …

Individual Differences In Markers Of Cholinergic Signaling Correlating To Fear And Extinction Learning, Grace C. Jones

Theses and Dissertations

Posttraumatic stress disorder (PTSD) results when individuals are exposed to a life threatening event, assault, serious injury, or other traumatic incident. Individuals with PTSD are impaired in their ability to extinguish fear memories, resulting in intrusive symptoms that impair their ability to live otherwise healthy lives. It remains unclear why some individuals exposed to traumatic events develop PTSD while others do not. Acetylcholine has been shown to play a critical role in fear learning, but its role in fear extinction is not well understood. This study utilized a rat model of fear learning and extinction to determine if individual differences …

An Evidence-Based Process Change To Improve Mammography Adherence, Tara E. Smalls

Theses and Dissertations

Breast cancer is a significant disease—affecting 12% of American women in a lifetime. Breast cancer costs $180 billion annually in healthcare expenditures and productivity. Mammography has been identified as the greatest tool to mitigate morbidity, yet in many organizations, mammography compliance rates are decreasing. This process improvement was conducted to address the barriers to patient follow through with mammography and to recommend strategies to improve the current breastscreening process.

Principles of the Six Sigma DMAIC framework were utilized to analyze the breast-screening clinic process. Chart reviews and organization databases were applied to determine mammography adherence. The opportunities to improve current …

Assessment Of Providers’ Perception And Knowledge Of Overactive Bladder In Women: A Quality Improvement Project, Helen Wambui Ngigi

Theses and Dissertations

Background: OAB is defined by subjective symptoms, rather than objective measure, the patient’s perspective is important in managing OAB (Hung et al., 2013). As such providers need to capture the patient’s perspective of their OAB symptoms and their impact on the quality of life. A patient work up helps providers determine the cause of the symptoms as well as the degree of bother to the patient (Barkin, 2016). The diagnosis of OAB is essentially clinical and can be performed through structured questionnaires (Juliato et al., 2016). When conducting a patient history, it is important to determine the onset and severity …