Medicine and Health Sciences Commons^™

Frequency Of Copy Number Variants Involving The Sex Chromosomes In A Clinical Setting, Autumn Vara

Dissertations and Theses (Open Access)

Copy number variants (CNVs) are a common finding in the clinical setting and contribute to both genetic variation as well as disease. Recently, studies have described the accumulation of multiple CNVs as a disease modifying mechanism. While it has been characterized how additional CNVs may play a role in phenotype, in which ways and to what extent sex chromosomes are involved has not been fully described. We performed a secondary data analysis using the DECIPHER database on 2,273 de-identified individuals with 2 CNVs. CNVs were designated primary and secondary based on our criteria and characteristics of both CNV groups were …

Exosomal Communication By Metastatic Osteosarcoma Cells Modulates Alveolar Macrophages To An M2 Tumor-Promoting Phenotype And Inhibits Tumoricidal Functions, Kerri Wolf

Dissertations and Theses (Open Access)

Osteosarcoma metastasizes to the lung, and there is a link between the predominance of tumor promoting immunosuppressive M2 macrophages in the metastases and poor patient survival. By contrast, M1macrophage predominance correlates with longer survival. M2 macrophages can be induced by various stimuli in the tumor microenvironment, including exosomes, which are 40- to 150-nm vesicles that are involved in intercellular communication and contribute to tumor progression and immune evasion. Recognizing that tumor cells can influence the tumor microenvironment to make it more permissive and because of the link between M2 dominance and curtailed patient survival, we evaluated the effect of …

Genetic Counselors' Experiences With And Approaches To Discordant Genotypic And Phenotypic Sex Detected Via Non-Invasive Prenatal Testing, Emily Stiglich

Dissertations and Theses (Open Access)

As the use of non-invasive prenatal testing becomes more ubiquitous during pregnancy, genetic counselors (GCs) will see clients more frequently for discordant sex identification via non-invasive prenatal testing (NIPT-DSI). Thus, it is imperative to investigate what GCs consider important when counseling about NIPT-DSI and assess how GCs perceive their role in such cases. Prenatal and pediatric GCs were surveyed regarding previous experiences of NIPT-DSI, comfort levels of topics relating to NIPT-DSI, and perceived importance of potential discussion topics in a counseling session (n = 108). The survey consisted of two vignettes, presenting cases of NIPT-DSI identified prenatally in one …

Loss Of Caspase-8 Function In Combination With Smac Mimetic Treatment Sensitizes Head And Neck Squamous Carcinoma To Radiation Through Induction Of Necroptosis., Burak Uzunparmak

Dissertations and Theses (Open Access)

Caspase-8 (CASP8) is one of the most frequently mutated genes in Head and Neck Squamous Carcinomas (HNSCC), and mutations of CASP8 are associated with poor overall survival. The distribution of these mutations in HNSCC suggests that they are likely to be inactivating. Inhibition of CASP8 has been reported to sensitize cancer cells to necroptosis, a unique cell death mechanism. Here, we evaluated how CASP8 regulates necroptosis in HSNCC using cell line models and syngeneic mouse xenografts. In vitro, knockdown of CASP8 rendered HNSCCs susceptible to necroptosis induced by a second mitochondria-derived activator of caspase (SMAC) mimetic, Birinapant, when combined …

An Exploration Of Neuroanatomical Signatures Of Pediatric Bipolar Disorder Using Structural Neuroimaging, Jonika Tannous

Dissertations and Theses (Open Access)

Bipolar Disorder (BD) is diagnosed using the Diagnostic and Statistical Manual (DSM) criteria, which relies heavily on symptomatology. This method, however, lends itself to error due to variance in symptom expression and is further complicated during childhood and adolescence- a period marked by major anatomical and behavioral changes. Therefore, in order to institute early and effective interventions, it is imperative that we develop more objective methods of mood disorder characterization and diagnosis. Two proposed solutions for accomplishing this task include 1) the generation of normative development models to assess BD risk and 2) data-driven clustering of patients based on specific …

Mcp-1 Release Modulation Through Interaction Of Pulmonary Endothelial Cells And Mesenchymal Stromal Cells, Kaavya Giridhar

Dissertations and Theses (Open Access)

Background: Ischemic stroke is a leading cause of death and long-term disability

around the world. Current treatment options are limited to the administration of

tissue plasminogen activator (tPA) and/or endovascular therapy, administered within

a limited time window. However, cell-based therapies such as mesenchymal stromal

cells (MSCs) have increasingly shown great promise for ischemic stroke recovery

with some therapies already in various stages of clinical trials. Intravenous (IV)

administration of the MSCs leads to the entrapment of these MSCs in the lungs.

These entrapped MSCs interact with the pulmonary endothelial cells (PECs) and

could modulate the immune response through the release …

Development Of Fully Balanced Ssfp And Computer Vision Applications For Mri-Assisted Radiosurgery (Mars), Jeremiah Sanders

Dissertations and Theses (Open Access)

Prostate cancer is the second most common cancer in men and the second-leading cause of cancer death in men. Brachytherapy is a highly effective treatment option for prostate cancer, and is the most cost-effective initial treatment among all other therapeutic options for low to intermediate risk patients of prostate cancer. In low-dose-rate (LDR) brachytherapy, verifying the location of the radioactive seeds within the prostate and in relation to critical normal structures after seed implantation is essential to ensuring positive treatment outcomes.

One current gap in knowledge is how to simultaneously image the prostate, surrounding anatomy, and radioactive seeds within the …

Patient, Hospital And State-Level Policy Characteristics Associated With Prevalence Of Treating Opioid Use Disorder In United States Emergency Departments, Rafeek Adeyemi Yusuf

Dissertations and Theses (Open Access)

The opioid crisis in the United States was declared a public health emergency due to escalating and untoward human, financial, and systemic consequences and effects on the nation. Opioid use disorder (OUD) comprising opioid abuse and dependence is devastating because of its associated chronic relapsing nature, overutilization of healthcare services, rising morbidity and mortality rates, and high cost of care. Efforts to address this have not made significant positive impacts. It is thus imperative to reassess the influence of factors associated with OUD. This study answered the question, what patient-, hospital-, and state-level policy factors were associated with prevalence of …

Identifying Risk Factors For Chronic Kidney Disease Of Unknown Origin In Six Central American Countries And Houston, Texas, Erika Figueroa-Solis

Dissertations and Theses (Open Access)

Chronic kidney disease (CKD) is a public health problem that is recognized worldwide. The type of CKD in Central America does not fit the “usual” CKD encountered in countries with upper middle-income economies, and is also often referred to as CKD of undetermined cause (CKDu). Evidence suggests that CKDu is a disease of occupational origin that can be brought on by a combination of exposures: hot environments, high physical job demands, inadequate hydration protocols, and effects of other nephrotoxic agents. Many gaps remain in knowledge related to CKDu and its putative risk factors, geographic distribution, distributions of renal function in …

Predictors Of Kidney Transplant Receipt And Medicare Costs For Patients, Parisa Asgarisabet

Dissertations and Theses (Open Access)

Background: The objectives of this study were to first understand whether a dialysis center’s ownership status modified the association between informing end-stage renal disease (ESRD) patients about transplantation options and patients’ transplantation status; and second, to understand whether Medicare’s Prospective Payment System (PPS) implementation affected the cost of care for ESRD patients from Medicare’s perspective.

Method: This study used the United States Renal Data System (USRDS) data containing information on all ESRD patients in the US, linked to Medicare claims. To address the first objective, a multi-level analysis using mixed effect multinomial logistic regression model was conducted with …

Vaxinsight: An Artificial Intelligence System To Access Large-Scale Public Perceptions Of Vaccination From Social Media, Jingcheng Du

Dissertations and Theses (Open Access)

Vaccination is considered one of the greatest public health achievements of the 20th century. A high vaccination rate is required to reduce the prevalence and incidence of vaccine-preventable diseases. However, in the last two decades, there has been a significant and increasing number of people who refuse or delay getting vaccinated and who prohibit their children from receiving vaccinations. Importantly, under-vaccination is associated with infectious disease outbreaks. A good understanding of public perceptions regarding vaccinations is important if we are to develop effective vaccination promotion strategies. Traditional methods of research, such as surveys, suffer limitations that impede our understanding of …

Perceptions Of Nurses After The First Year Of Practice: Expectations And Reality, Susan R. Lesser

Dissertations and Theses (Open Access)

Background: The nursing profession is facing a critical shortage stemming from retirement of experienced nurses, increasing healthcare needs of an older population, and more inclusive healthcare coverage. Newly licensed nurses (NLNs) have been the long-term plan to fill the gap. Despite the support from nurse residency programs (NRPs), many of these graduate nurses are leaving their first position. This turnover of nurses is detrimental to the nursing shortage, and financially burdensome for health care systems.

Purpose: Two aims were explored: 1) to better understand the perceptions of newly licensed nurses after the first year of practice about their expectations and …

Hiv-Related Discriminatlon And Cervical Cancer Screening In Zambia, Crystal J. Cazier

Dissertations and Theses (Open Access)

Background: The Republic of Zambia has the third-highest incidence of cervical cancer in the world, where approximately 700,000 women over age 15 are living with HIV. Women living with HIV (WLHIV) are at increased risk for cervical cancer. While literature suggests that discrimination is a barrier to HIV care, no studies have explored if discrimination experienced in HIV clinics is related to cervical cancer screening using nationally representative datasets. Objective: The primary objective of this study was to examine whether perceived discrimination by healthcare workers due to HIV status is related to having been screened for cervical cancer among WLHIV. …

Cholesterol Efflux Capacity And Its Association With Metabolic Syndrome In A Multi-Ethnic Population (Dallas Heart Study): A Cross-Sectional Study, Oludamilola Akinmolayemi

Dissertations and Theses (Open Access)

Metabolic syndrome (MetS) is a multi-component risk factor for cardiovascular disease (CVD) and type 2 diabetes. MetS has been found to be associated with increased risk of incident CVD, cardiovascular morbidity and mortality, and prevalence atherosclerosis. Cholesterol efflux capacity (CEC) is a measure of the functional property of high-density lipoprotein cholesterol (HDL-C). In addition, it characterizes the ability of HDL-C to accept cholesterol from extra-hepatic cells in the periphery to the liver and has been shown in clinical studies to be inversely associated with atherosclerosis cardiovascular disease (ASCVD) and incident cardiovascular disease (CVD) . Low HDL-C is one of the …

Examining The Relation Between Social Capital And Physical Activity Across Life Stages, Leigh Ann Ganzar

Dissertations and Theses (Open Access)

Physical inactivity in adults increases the risk for adverse health outcomes, including non-communicable diseases and premature death. Children who are not sufficiently physically active face increased risk for non-communicable disease risk factors, mental health issues, and poor academic performance. Despite these risks, the majority of people do not achieve sufficient physical activity levels. Social capital is an aspect of the social environment that can shape physical activity behavior throughout different life stages. The three studies of this dissertation sought to assess the association between social capital, from both the cohesion and network perspectives, and physical activity behavior in different life …

Insuring The Integrity Of Global Registries, Aardhra Meenakshi Venkatachalam

Dissertations and Theses (Open Access)

Data quality is a priority in public health because it is used for public health program planning and implementation, research, as well as policy. The information gleaned from the data allows us to assess health status, and improve health needs. This paper evaluated methods for cleaning, managing and addressing missing data in the Lagos State Ambulance Service registry. The techniques included screening, data organization, diagnostic phase, treatment phase and a missing data phase to holistically handle the data. The percentage of systemic errors was reduced through the use of the 5-step method. Missing data was informative for state of origin, …

Nonlinear Functional Models On Causal Inference, Rong Jiao

Dissertations and Theses (Open Access)

Statistical analysis has experienced significant progress on association study, but it remains elusive to understand the etiology and mechanism of complex phenotypes. As a major analytical platform, association analysis may hamper the theoretic development of biomedical science and its application. Thus, many researchers suggest making the transition from association to causation. The mainstream of research in genetics and epigenetics data analysis focuses on statistical association or exploring statistical dependence between variables. Despite significant progress in dissecting the genetic architecture of complex diseases by genome-wide association studies (GWAS), the signals identified by association analysis can only explain a small proportion of …

Additional Graduate Degrees Associated With Promotion Among Primary Care Clinical Faculty, Michael A. Hansen

Dissertations and Theses (Open Access)

Introduction: Many young and ambitious physicians purposefully seek out meaningful careers in academic medicine, yet there are no evidence-based findings to assist these individuals in how to succeed in advancing their careers in this unique work environment. For early and mid-career faculty, a growing number of trainings and opportunities are available but with little insight as to which choices may have the biggest impact. One common perception is the need for additional advanced training, such as a Master of Public Health. Aims and Method: This study sought to provide evidence-based information about additional training by quantifying the benefit of added …

Vasopressor Titration In Medical Intensive Care Patients With Septic Shock: A Descriptive Study, Daniel Arellano

Dissertations and Theses (Open Access)

Background: Vasopressor therapy in patients with septic shock can lead to harmful effects.

Objective: To describe vasopressor titration in patients with septic shock.

Methods: Single-center descriptive study of 60 intensive care unit (ICU) patients to calculate rates for events of failure to titrate, incorrect titration, and correct titration in 15- minute intervals for the duration of vasopressor therapy. Total hospital and ICU days, mortality rate, vasopressor dose and time, and the impact of hydrocortisone on vasopressor use were examined.

Results: During the total vasopressor infusion time of 2598 hours, 5395 failure-to-titrate events were noted. There were 316 incorrect titrations and …

An Exploration Of Psychosexual Functioning And Factors Affecting The Prophylactic Decision-Making Process In Women Of Childbearing Age With A Brca 1/Brca2 Mutation, Alexis Hayes

Dissertations and Theses (Open Access)

Background: A breast cancer type 1 and type 2 susceptibility protein (BRCA1/BRCA2) gene mutation carries an 85%- 90% lifetime risk of developing breast cancer and a 27%-65% chance of developing ovarian cancer. There is minimal evidence regarding how psychosexual functioning, the psychological well-being in regards to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (18 - 49) with a BRCA gene mutation. Diagnosis of a BRCA gene mutation presents a dilemma where life-changing medical decisions must be made to prevent breast and ovarian cancer. Throughout decision-making and following surgical prophylactic interventions, such …

Mhealth Acceptance And Usage Among South Asian Adults In The U.S., Padmavathy Ramaswamy

Dissertations and Theses (Open Access)

Background: Modifiable lifestyle factors such as physical inactivity and unhealthy diet contribute to the increased risk of cardiovascular diseases (CVD) and diabetes (DM) in South Asians (SAs) (Volgman et al., 2018). Interventions using mobile health (mHealth) have demonstrated feasibility and potential efficacy for ethnic minorities (Bender et al., 2018), and have the potential to be of preventive and therapeutic value in reducing the burden of CVD and DM in SAs living in the US. However, there is a gap in knowledge regarding the usage and acceptance of mHealth among SAs.

Purpose: The objectives were to examine the overall …

Predictors Of Short-Term Residential Treatment Completion Preceded By Detoxification For Opioid Use Disorder, Christopher Gideon

Dissertations and Theses (Open Access)

Background and Significance: Deaths related to opioid overdose are increasing. Treatment for opioid use disorder (OUD) is necessary to help prevent future opioid abuse, and often involves opioid detoxification, followed by short-term residential treatment, typically lasting about 28 days. Literature regarding OUD and short-term residential treatment is limited. Predictors of short-term residential completion, including whether detoxification was performed, may help addiction professionals individualize treatments. This study’s purpose was to determine predictors of short-term residential completion treatment for OUD, and whether detoxification prior to entering residential treatment may also be a factor in residential completion.

Method: De-identified data regarding …

Understanding Diabetes Health Beliefs And Health Practices In Vietnamese Americans, Linda Sheen

Dissertations and Theses (Open Access)

Background: Diabetes related complications resulting in mortality and morbidity are higher among Vietnamese individuals living in the U.S. with diabetes. Few studies have examined the personal perceptions and cultural beliefs pertaining to disease management. An in-depth understanding of perception and cultural beliefs in regard to diabetes self-management is needed for the development of culturally appropriate interventions in this population.

Purpose: Two specific aims were explored: 1) To explore how Vietnamese individuals living in the U.S. with prediabetes and diabetes conceptualize diabetes self-management and; 2) to understand how Vietnamese individuals living in the U.S. with prediabetes and diabetes integrate …

Factors Affecting Antiretroviral Treatment Entrance, Adherence And Retention Among Hiv Patients In Nigeria And Uganda, Nnenna Ananaba

Dissertations and Theses (Open Access)

Introduction: The maximum benefits of antiretroviral therapy (ART) are achieved when HIV patients follow through the HIV Care Continuum. Understanding the factors that impact the Care Continuum are key in minimizing late ART uptake while increasing treatment retention and adherence in sub-Saharan Africa. Objectives: To explore factors that impact the various phases of the HIV Care Continuum, we review trends in median CD4 cells count and presentation with HIV advanced disease stage between 2013 and 2017. We also examined treatment retention rates and the impact of food security on ART adherence. Methods: Two datasets were reviewed. One dataset consists of …

Characterizing Risk & Burden Of Lower Cranial Neuropathy (Lcnp) As Late Effect Among Oropharyngeal Cancer Survivors, Puja Aggarwal

Dissertations and Theses (Open Access)

Background: Lower cranial neuropathy (LCNP) is a rare but potentially disabling late effect of radiotherapy (RT) and other head and neck cancer therapies. Survivors who develop late LCNP may experience profound functional impairment with deficits in swallowing, speech, and voice. The aims of this research were: 1) to quantify the cumulative incidence of late LCNP and identify clinical predictors of late LCNP; 2) to investigate the impact of late LCNP on severity of cancer treatment-related symptoms, general functional impairment (GFI), and single item scores of the most severe symptoms; and 3) to quantify the association of late LCNP with swallowing-related …

Coy Arjate Adrusted Response Adaptive Randomization Designs With Targeted Learning, Hai Zhu

Dissertations and Theses (Open Access)

Since Food and Drug Administration (FDA) issued the very first draft guidance in 2010, adaptive designs have been considered to be one of the most promising approaches to make drug development more efficient and less costly. Two approaches, covariate-adjusted response-adaptive (CARA) randomization and adaptive seamless phase II/III design (ASD) have garnered growing attention recently. However, most of the CARA designs are based on parametric models and suffered from model misspecification. The research of incorporating CARA into ASD is also limited and whether type I error rate can be controlled has not been answered. In this dissertation, a new family of …

Association Between Childhood Maltreatment And Type 2 Diabetes Mellitus: A Retrospective Cohort Study In The United States, Diep N. Poulos

Dissertations and Theses (Open Access)

This retrospective cohort study analyzed self-reported and biological data collected from MIDUS in 2004-2006 to understand the association between the types of childhood maltreatment (CM) and Type 2 Diabetes Mellitus (T2DM). The central hypothesis of this study is that childhood maltreatment is positively associated with adult onset diabetes (T2DM). CM has been associated with lifelong morbidity and an increased risk in chronic diseases such as diabetes and heart disease (Bernstein RE, 2013). In this study, CM was defined by the Childhood Trauma Questionnaire (CTQ). The CTQ has three types of abuse: physical, sexual, emotional, and two types of neglect: physical …

The Potential Impact Of Restricting The Sale Of Tobacco At Tobacco Retail Outlets Surrounding Schools Across Major Metropolitan Areas Of Texas On Tobacco Advertisements, Udoka C. Obinwa

Dissertations and Theses (Open Access)

Retail outlets that sell tobacco (ROST) are the leading channel of advertisements and promotional efforts for tobacco companies. Tobacco companies strategically target youth, young adults, racial and ethnic minorities and individuals in lower SES areas with more advertisements, which in turn influences their tobacco use behavior. Researchers have proposed instituting place-based restriction strategies as a way to control tobacco use. This dissertation examined the potential impact of i) restricting the sale of tobacco at ROST within 1000ft of schools and 2000ft of colleges and ii) restricting the sale of tobacco at ROST within 500ft of other ROST, on the number …

Studying The Properties Of Seamless Phase Ii/Phase Iii Clinical Trials Under Covariate Adaptive Randomization, Garrett Miller

Dissertations and Theses (Open Access)

Covariate adaptive randomization is an allocation procedure used in clinical trials that seeks to balance treatment groups. While this method has been shown to reduce bias due to imbalanced treatment groups, the effects of covariate adaptive randomization have not been studied under seamless Phase II/Phase III clinical trials that incorporate short-term endpoint information and treatment selection. Therefore, this analysis sought to determine whether these adaptive randomization methods can be applied to seamless Phase II/Phase III trials while preserving Type I error. In addition, this analysis sought to create R-packages that employ seamless Phase II/Phase III techniques to provide analysis tools …

Patient-Perceived Patient-Centered Medical Home Characteristics And Healthcare Utilization, Expenditure And Quality, Alissa Ratanatawan

Dissertations and Theses (Open Access)

The patient-centered medical home (PCMH) model is a care delivery model which patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand with the aims to improve healthcare quality while keeping healthcare cost growth under control. The objective of this study was to analyze health service utilization, expenditure and quality of civilian noninstitutionalized US adult population in healthcare facilities that have 3 domains of PCMH features, which are comprehensive care, patient-centered care, and accessible care, using patient’s perspective from the 2016 Medical …