Medicine and Health Sciences Commons^™

Table-To-Text: Generating Descriptive Text For Scientific Tables From Randomized Controlled Trials, Qiang Wei

Dissertations and Theses (Open Access)

Unprecedented amounts of data have been generated in the biomedical domain, and the bottleneck for biomedical research has shifted from data generation to data management, interpretation, and communication. Therefore, it is highly desirable to develop systems to assist in text generation from biomedical data, which will greatly improve the dissemination of scientific findings. However, very few studies have investigated issues of data-to-text generation in the biomedical domain. Here I present a systematic study for generating descriptive text from tables in randomized clinical trials (RCT) articles, which includes: (1) an information model for representing RCT tables; (2) annotated corpora containing pairs …

Understanding Motivation To Lead In Nurses, Janete Sheiner

Dissertations and Theses (Open Access)

Background: Nurse leaders are indispensable to the delivery of quality, patient-centered care. They are influential in the practice environment, contributing to front-line staff job satisfaction. They work to improve retention, turnover, organizational health, and patient outcomes. Yet, there is a dearth of research investigating the motivating factors that appeal to, encourage, discourage, and help retain nurse leaders in their roles. The forecast of a shortage of nurse leaders, along with the reluctance of nurses to assume leadership roles, is affecting healthcare organizations throughout the United States. An in-depth understanding of the underlying factors related to motivation that appeal to, encourage, …

Caregivers Of Medically Fragile Children With Technology Needs, Vuong Prieto

Dissertations and Theses (Open Access)

Background: Medically fragile children (MFC) with technology needs have complex and challenging health care needs in the home setting. Providing care can have both negative and positive psychological and social impacts on the caregivers’ health related quality of life (HRQOL).

Aims: a) To examine the relationship between caregiver burden, caregiving satisfaction, and HRQOL in caregivers of MFC with technology needs. b) To identify caregiver and child related variables of caregiver burden and caregiving satisfaction.

Methods: A cross sectional study was conducted over four months at a children’s hospital and outpatient clinics. Caregivers completed three one-time surveys (Zarit Burden Interview, Caregiving …

Left Ventricular Assist Device Adjustment Impacted By Patient Trajectory: A Qualitative Exploratory Study, Brittany Rhoades

Dissertations and Theses (Open Access)

Background: Left Ventricular Assist Devices (LVADs) are used as advanced therapy for advanced heart failure in order to sustain patients until a heart transplant is available (bridge to transplant, ‘BTT’) or until the end of life (destination therapy, ‘DT’). Despite the differences in treatment trajectory, BTT and DT patients are provided the same education. Currently it is unknown if the two groups compare to living with the LVAD regarding adjustment.

Aims: The aim of this study was to explore LVAD patient experience, describe how patients construct the impact of the LVAD on daily life and self-care and compare the findings …

Pediatric Intensive Care Hospitalization: Sibling Experience, Karla Abela

Dissertations and Theses (Open Access)

Prior research on the impact of pediatric intensive care unit (PICU) hospitalization on families have been predominantly focused on the parents, yet siblings who visit the ill child in the PICU environment remain understudied. The aim of this study was to describe the experiences of 9- to 17-year-old siblings of acutely critically ill or injured children. A generic qualitative approach using one-to-one interviews, observations, and clinician notes was used to gain an understanding of the experience of siblings who visited the PICU. Qualitative analytic methods were used to analyze the data. The findings from 16 siblings (mean age 6.3 years) …

Latino Perspectives In Childhood Fever Management: A Focused Ethnography, Darlene Acorda

Dissertations and Theses (Open Access)

Background: Fever is the most common presenting complaint in the pediatric setting. Latino parents have greater misconceptions and are less knowledgeable of fever compared to other groups. They are more likely to believe that fever can cause serious harm and to present to the emergency department for non-emergent illness. Latino health practices are heavily influenced by cultural beliefs, yet few studies have focused on parental fever perception in this rapidly growing population. It is estimated that by 2050, 32% of the U.S. child population will be of Latino descent. Understanding the Latino perspective is a critical first step to …

Maternal And Newborn Outcomes For Women Living With Hiv In Adapted Group Prenatal Care, Jodi Behr

Dissertations and Theses (Open Access)

Background: For women living with HIV (WLWH), managing HIV and their pregnancy can be challenging. WLWH have been identified at risk for lower adherence to prenatal care, increased maternal HIV Plasma RNA levels, decreased newborn gestational age, and newborn birth weight. Improved outcomes have been found with group prenatal care. Maternal and newborn outcomes for WLWH and their newborns in group prenatal care compared to WLWH and their newborns in individual care have not been evaluated.

Purpose: The aims of this study were to evaluate group differences between WLWH who attended individual prenatal care appointments (IC) compared to WLWH who …

Sample Size Calculations For Longitudinal Mediation Analysis With Continuous-Time Markov Chain Variables, Abigail Christine Sedory

Dissertations and Theses (Open Access)

Mediation is a type of analysis used to determine the causal mechanism linking a predictor and an outcome through a mediator variable. Various research has examined the inclusion of different variable types for the predictor, mediator, and outcome. However, no studies include the presence of a continuous-time Markov chain (CTMC) as any of the components in a mediating model. If researchers wanted to design a study with a CTMC in the mediating process, one of the first steps would be to determine the minimum number of subjects or observations needed to detect a significant mediating effect. Therefore, in this study, …

Nudging Quality Improvement In Cancer Care: Influence Of A Clinical Decision Support System To Nudge Adherance To Evidence Based Guidelines In Adult Cancers, Debra Patt

Dissertations and Theses (Open Access)

Cancer care is changing rapidly. Understanding of the increasing subtypes of cancer and exponentially increasing therapeutic interventions are unprecedented due to the rapid pace of scientific discovery and clinical innovation. This immense change within the field, lends itself to quality control initiatives, especially among general oncology providers who see a wide array of cancer types as general oncologists will see many different tumor types, and most of which have several potential treatment choices that have grown over time. Evidence-based pathways are an effective way to nudge quality control by presenting choice architecture at the point of care to facilitate guideline …

Understanding Participation In A Workplace Physical Activity Intervention Using Self-Determination Theory: The Booster Break Study, Kathleen Ochipa

Dissertations and Theses (Open Access)

Abstract: Sedentary behavior can lead to premature mortality, cardiovascular disease, Type 2 diabetes, and cancer incidence. Office workers are at risk for high amounts of sedentary behavior. Even brief bouts of physical activity that interrupt sedentary behavior can improve office workers’ physical and mental health. The workplace is an optimal setting for increasing physical activity and reducing sedentary behavior among office workers. However, limited literature exists related to the characteristics of participants that adhere to workplace physical activity interventions. This study aimed to identify characteristics of participants who enrolled in the Booster Break program, a 15 minute once-daily intervention during …

Economic Evaluation Of Implementing Hpv Vaccine Promotion Interventions For Cervical Cancer In The United States, Chi-Fang Wu

Dissertations and Theses (Open Access)

The HPV vaccine has been proven as a safe and effective method for preventing cervical cancer. However, the HPV vaccine coverage rate in the U.S. is suboptimal. Various interventions have been implemented to improve HPV vaccine coverage. However, evidence of the cost-effectiveness of HPV vaccine promotion interventions is lacking. We conducted an economic evaluation to assess HPV vaccine promotion interventions of cervical cancer in the U.S. Firstly, a systematic review was conducted to review evidence on interventions aimed at increasing HPV vaccine coverage and to summarize the cost and effectiveness of these interventions. We included 56 HPV vaccine promotion studies …

Comparison Of Interactive Electronic Versus Standard Document Method For Obtaining Patient Informed Consent, Jermaine Mcmillan

Dissertations and Theses (Open Access)

The primary objective of this study was to determine whether participants who received an interactive electronic consent (EC) had a better understanding of a medical procedure (apheresis) compared to those who received the standard document (SD) consent. The study was conducted with apheresis donors whose responses were used to determine if the EC facilitated better comprehension and retention of consent information by the study participants than by SD consenting methods. By comprehension, the goal was to have participants who can understand, summarize, or make judgments based on the content presented in the informed consent. By retention, the goal was to …

A Partial Likelihood Approach To Longitudinal Categorical Data Using A Continuous Time Semi-Markov Chain Model, Kusha A. Mohammadi

Dissertations and Theses (Open Access)

Longitudinal studies have been critical in understanding the characteristics of chronic diseases or interventions. Since many processes have natural multi-categorical responses over time, multi-state stochastic models have been used to estimate the transition rates between stages. Some multi-state models applied in practice assume the Markov property. The Markov property constrains the sojourn distribution to be exponentially distributed. While useful theoretical properties arise by the Markov assumption, we will consider a more flexible framework by allowing arbitrarily distributed waiting times. This describes a semi-Markov process which has already been applied to various fields in Public Health. Similar to Markov model developments, …

Pediatric Wound Care: What Can We Learn From A Systematic Review Of The Literature? Using A Systematic Review And A Clinical Consensus Group To Assess The Quality And Content Of Systematic Reviews Focusing On Pediatric Wound Care. Then Providing And Analytical Outline For Creation Of Pediatric Wound Care Guidelines For Evidence Based Clinical Practice, Ryan Krasnosky

Dissertations and Theses (Open Access)

Background: Wound care practices for neonatal and pediatric patients including the category of products, specific products within each category, and length of application of the products have created lack of standardized evidence-based guidelines for treatments in clinical practices. This dissertation addresses this concern by encompassing three crucial steps in developing evidence-based clinical guidelines for wound care specialists. Using a three-paper method, an expert consensus group was formed, a systematic review of reviews completed and a process for creating clinical decision trees created. Methods: Criteria for selection of the consensus group members included: 1) Research graduate active in Pediatric Wound Care …

Statistical Methods For Functional Annotation-Based Rare Variant Association Analysis, Yiding Ma

Dissertations and Theses (Open Access)

Despite ongoing large-scale population-based whole-genome sequencing (WGS) projects such as the TOPMed program, WGS-based association analysis of complex traits remains a tremendous challenge. External biological knowledge, such as functional annotations based on the ENCODE, Epigenomics Roadmap and GTEx projects, may be helpful in distinguishing causal rare variants from neutral ones; however, each functional annotation can only provide certain aspects of the biological functions. Our knowledge for selecting informative annotations a priori is limited and incorporating non-informative annotations will introduce noise and lose power. In the first part of this dissertation, we propose FunSPU, a versatile and adaptive test that incorporates …

An Assessment Of Outpatient Clinic Room Ventilation Systems And Possible Relationship To Disease Transmission, Kristin G. King

Dissertations and Theses (Open Access)

The delivery of healthcare in the United States is shifting from a largely inpatient model to an outpatient services model, but the physical infrastructure for outpatient clinics or medical offices may not be as robust as inpatient hospitals regarding whole room ventilation requirements. Guidelines for the design of healthcare facilities and national standards for ventilation establish generally acceptable ventilation rates for outpatient clinics, but it is unclear if these standards are actually being integrated into these settings. Published peer reviewed literature indicates that inadequate ventilation rates can be a risk factor in airborne transmission of infectious diseases in outpatient clinics, …

The Influence Of Brand Equity On Prescriber Behaviour In A Multisource Drug Market, Wanjiku Kariuki

Dissertations and Theses (Open Access)

When a patent expires, innovator (brand-name) drugs lose their monopoly status and new generic competitors are free to enter the market. Theoretically, free market entry and exit should lead to a drop in the price of the innovator drug as per the tenets of perfect competition. Yet instead of prices decreasing, innovator drug prices are often minimally impacted by generic competition and the innovator continues to maintain both market power and market share – a phenomenon labelled the generic competitor paradox (Scherer, 1993) That the expected supply and demand dynamic is less pronounced in multisource drug markets, suggests that non-price …

Development Of A Culinary Nutrition-Based Training For Dietitians And A Clinic-Based Nutrition Intervention To Improve Health Outcomes Among Low-Income Minority Patients, John Wesley Mcwhorter

Dissertations and Theses (Open Access)

Substantial evidence demonstrates the relations between a healthy dietary pattern rich in fruits, vegetables, and whole grains and a lower risk of chronic diseases including type 2 diabetes. Despite well supported studies, programs, and public health campaigns presenting the health benefits of consuming a healthy dietary pattern, most Americans fall far short of the recommendations. Further, the compounding effects of food insecurity and the consumption of energy-dense and nutrient-deficient foods disproportionately affect low income minority populations. Culinary medicine (CM) and food prescription programs are gaining popularity as tools for (1) decreasing food insecurity; (2) increasing personal agency; (3) promoting healthy …

The Intersection Of Diet, Health And The Environment: Plant Based Diets And Public Health, Christine E. Jovanovic

Dissertations and Theses (Open Access)

Both globally and within the United States, chronic disease has become a major driver of mortality and morbidity. In the United States in 2017, the top ten causes of mortality accounted for 74% of all deaths [2]; of these causes, half are closely linked to diet (heart disease, cancer, stroke, Alzheimer’s and diabetes). [3] In 2013, Ioannidis estimated that 26% of deaths and 14% of disability adjusted life years (DALYs) in the United States may be attributable to dietary risk factors, controlling for obesity. [4] At the same time, diet also has an important impact on the environment. Direct emissions …

Shared Decision Making In The Care Of Post-Acute Psychiatric Individuals With Serious Mental Illness, Natalie J. Maples

Dissertations and Theses (Open Access)

Severe mental illness in adults refers to a group of mental health conditions including schizophrenia and schizoaffective, bipolar and major depressive disorders. These conditions are often characterized by recurring symptoms, multiple hospitalizations, and significant disability. The public health concern with these conditions is amplified because many individuals with severe mental illness fail to engage in outpatient treatment. Methods to support greater rates of participation in outpatient treatment are needed. Encouraging participation in medical decision making is viewed as one method to optimize patient empowerment, increase engagement in care and decrease the negative outcomes that often characterize this population. Shared Decision …

Exploring Community-Based Weight Loss Initiatives, Retention, And Motivation, Miriam Martinez

Dissertations and Theses (Open Access)

Obesity puts individuals at risk of developing diabetes, cardiovascular disease, and cancer. Traditionally obesity was primarily perceived as a personal disorder requiring treatment at the individual level. Strategies to prevent obesity have shifted to an ecological approach. Organizations such as the World Health Organization recommend population based community approaches that connect people, families, schools, and municipalities. Community programs to facilitate weight loss are an effective strategy to reach large populations. The overall goal of this study is to assess community programs, factors associated with retention, and motivation for completing a community weight-loss initiative. A systematic review was conducted to characterize …

Personalized Estimation And Causal Inference Via Deep Learning Algorithms, Yuanyuan Liu

Dissertations and Theses (Open Access)

Personalized approaches have shown great potential to transform modern medicine. As challenging as it may sound, we are making tremendous progress with the help of data sciences and machine learning. Two fundamental tasks in data sciences are prediction and inference. In this dissertation, I proposed to address these two tasks using deep learning approaches in the setting of personalized medicine. First, I developed a novel framework to estimate individualized treatment effects (ITE), which quantified the variation in response to the same treatment among patients with heterogeneous profiles. The ITE estimation has the potential to replace the one-size-fits-all average treatment effects …

Using Technology To Reduce Barriers In Community Health: An Intersection Between Broadband Access, Ehr & Telehealth Adoption In Federally Qualified Health Centers, Renita Madu

Dissertations and Theses (Open Access)

While Federally Qualified Health Centers (FQHCs) provide affordable, high quality, accessible and cost–effective primary health care to all individuals regardless of their inability to pay, patients continue to have difficulty accessing affordable primary care as well as broader specialty services that other patients may receive living near larger health systems and hospitals. Health information technology (HIT) serves as a cost-effective means to overcome barriers related to accessing care, particularly for individuals living in rural and remote areas. We examined if the key influencers of an FQHC’s structure, broadband access and/ or state and federal policies impacted the utilization of telehealth …

Estimating Means And Distributions Of Count Data From Surveys Invoking Complex Sampling Designs: Application To Measuring Cross-Sectional And Lifetime Alcohol Intake From Nhanes And Nlsy, Elysia A. Garcia

Dissertations and Theses (Open Access)

It is often of interest to measure the distribution (i.e. mean and percentiles) of count outcomes from national survey data to assess population consumption and guide public health efforts for substances such as alcohol, cigarettes, marijuana, and other illicit or licit drugs. Currently available methods for estimating the distribution of dietary intakes do not immediately lend themselves to estimating the consumption of substances measured as counts, nor do they accommodate the complex design elements – strata, cluster, and weight – characteristic of national surveys. We introduce an accurate methodology, called the Survey Adjusted Count (SAC) method, and an associated SAS …

Understanding Factors That Impact Health Behaviors And Access To Healthcare Among Youth Experiencing Homelessness, Kathryn Rosales Gallardo

Dissertations and Theses (Open Access)

Youth experiencing homelessness (YEH) have a high risk of adverse health outcomes and their utilization of healthcare services is low. This dissertation aims to further understand factors that impact YEH’s health behaviors and access to healthcare services. This dissertation is in the form of three manuscripts that each contribute to the overall aim. In manuscript 1, we examined the rates and correlates of human papillomavirus (HPV) vaccination initiation and completion among a sample of YEH in seven U.S. cities using logistic regression models. We found that HPV vaccination completion is low among male (19%) and female (37%) YEH. Among male …

A Mixed- Methods Examination Of The Healthcare, Social Support, And Religious Needs Of Sexual And Gender Minority (Sgm) Older Adults In Texas, Jennifer Lynn Holcomb

Dissertations and Theses (Open Access)

Shared historical and social contexts influence a generational group’s needs, risk factors, and resiliency mechanisms. Sexual and gender minority (SGM) older adults have experienced structural exclusion and systematic discrimination throughout their lifetime. The minority stress model posits that SGM individuals experience stressors, like discrimination, unique to their social status which affect physical and mental health. SGM older adults experience worse physical and mental health outcomes than their heterosexual peers suggesting unique needs for SGM older adults. Research also points to resiliency mechanisms that offset the impact of stressors on SGM older adults. The examination of these needs and resiliency mechanisms …

Trends In Injection Drug Use In Texas Treatment Facility Admissions, Cara Dahlhausen

Dissertations and Theses (Open Access)

This is a serial cross-sectional secondary analysis of drug treatment admissions records from the TEDS-A from years 2013-2017. The prevalence of injected drug use was calculated for each year and analyzed across the five-year period using a chi-square test to determine the presence of significant change in injection drug use from 2013 to 2017. Prevalence of injection drug use also will be calculated for each year by drug type (heroin, methamphetamine, and cocaine), age, sex, ethnicity and race, and will be analyzed for trends using a chi-square test.

Consider Us: Analysis Of National Mammography Screening Recommendations On African American Women, Gayla M. Ferguson

Dissertations and Theses (Open Access)

Breast cancer is the second most common cause of cancer related death in women in the United States with one in eight women expected to develop the disease in their lifetime. Unfortunately, breast cancer is the leading cause of cancer related death among African American women. African American women are four times more likely to die from breast cancer that Caucasian women. Mammography screenings are the most effective method of reducing breast cancer mortality in African American women. This study aimed to determine if the changes made to the mammography screening recommendations put forth by the U.S. Preventive Services Task …

The Role Of Dna Methylation In White Matter Hyperintensity Burden: An Integrative Approach, Yunju Yang

Dissertations and Theses (Open Access)

Cerebral white matter hyperintensities (WMH) on MRI are an indicator of cerebral small vessel disease, a major risk factor for vascular dementia and stroke. DNA methylation may contribute to the molecular underpinnings of WMH, which are highly heritable. We performed a meta-analysis of 11 epigenome-wide association studies in 6,019 middle-aged to elderly subjects, who were free of dementia and stroke and were of African (AA) or European (EA) descent. In each study, association between WMH volume and each CpG was tested within ancestry using a linear mixed model, adjusted for age, sex, total intracranial volume, white blood cell count, technical …

Social Work Involvement In Hurricane Harvey Relief Efforts, Claire Crawford

Dissertations and Theses (Open Access)

Hurricane Harvey brought 33 trillion gallons of rainfall to Texas and Louisiana and damaged more than 100,000 homes in August 2017. Social workers worked during and after the storm to provide services to those affected. The primary research question guiding this dissertation was: What were social workers’ experiences as they were involved in relief efforts during and immediately after Hurricane Harvey? The study group comprised 39 participants (35 female, 4 male); of these, 19 were masters-level social workers who volunteered at shelters in Houston following Hurricane Harvey, 14 were masters-level social workers who worked at a pediatric children’s hospital on …