Medicine and Health Sciences Commons^™

Prevalence And Predictors Of Secondary Traumatic Stress In A National Sample Of Emergency Nurses: A Cross-Sectional Study, Christian Paige Owen

Dissertations and Theses (Open Access)

Background: Emergency nurses experience traumatic situations as part of their professional role, leaving them vulnerable to secondary traumatic stress (STS). The distressing behaviors and symptoms of STS negatively impacts their well-being and ability to provide high quality care. Studies report that emergency nurses experience high levels of STS but less is known about how STS is influenced by their coping strategies and work-related factors. Further evidence is needed to better understand predictors of STS in order to support strategic efforts to improve the well-being and retention of nurses working in trauma-prone environments.

Aims: The specific aims of this study sought …

The Association Of Discrimination And Coping Style On Cardiovascular Health Among South Asian Individuals In The Masala Study, Raji Pillai

Dissertations and Theses (Open Access)

Objectives: South Asian individuals (SAs) are found to have a heightened state of inflammation contributing to increased cardiovascular disease (CVD). Additionally, social determinants like discrimination are also associated with risks for CVD in SAs. This study examined the associations between discrimination and inflammation and whether an association between discrimination and self-rated health (SRH) is moderated by coping styles among SAs living in the United States to inform effective coping strategies against discrimination.

Design: This secondary data analysis used data from 1164 SAs (mean age = 57 years, SD 9.4, 48% women) enrolled in the Mediators of Atherosclerosis in South Asians …

Proof-Of-Concept For Converging Beam Small Animal Irradiator, Benjamin Insley

Dissertations and Theses (Open Access)

The Monte Carlo particle simulator TOPAS, the multiphysics solver COMSOL., and

several analytical radiation transport methods were employed to perform an in-depth proof-ofconcept

for a high dose rate, high precision converging beam small animal irradiation platform.

In the first aim of this work, a novel carbon nanotube-based compact X-ray tube optimized for

high output and high directionality was designed and characterized. In the second aim, an

optimization algorithm was developed to customize a collimator geometry for this unique Xray

source to simultaneously maximize the irradiator’s intensity and precision. Then, a full

converging beam irradiator apparatus was fit with a multitude …

Mutational Landscape Of Noncoding Ultraconserved Elements In Human Cancers: Functional Relevance And Clinical Utility, Recep Bayraktar

Dissertations and Theses (Open Access)

The mutational landscape of phylogenetically ultraconserved elements (UCEs), especially those in noncoding DNA regions (ncUCEs), and their functional and clinical relevance in cancers remain poorly characterized. In this thesis, we perform a systematic analysis of whole-genome sequencing (WGS) data from the International Cancer Genome Consortium (ICGC) and in-house targeted sequencing of 13,736 UCEs and demonstrate that ncUCE somatic alterations are pervasive. Using a genome-wide multiplexed CRISPR knockout screen in colorectal cancer (CRC) cell lines, we show that the loss of several mutated ncUCEs impacts cancer cell proliferation. In-depth functional studies in vitro and in vivo further reveal that UCE_11311 is …

Sleep Disturbances In Adults With Tsc: Influences Of Treatment And Clinical Features, Kirstin Risgaard

Dissertations and Theses (Open Access)

Tuberous sclerosis complex (TSC) is a rare genetic condition caused by pathogenic variants in the TSC1 or TSC2 genes. TSC is characterized by a multisystem, neurocutaneous phenotype including skin lesions, hamartomas, and epilepsy. Additionally, TSC can present with an array of behavioral, psychiatric, academic, psychosocial, intellectual, or neuropsychological difficulties comprehensively known as TAND, or TSC-associated neuropsychiatric disorders. Sleep disorders are a common feature of TAND; however, they are not well characterized in the adult TSC population. Likewise, little is known about how clinical features of the condition and commonly prescribed medications impact sleep. Therefore, this study aimed to determine the …

Mismatch Repair Deficient Neoantigen And Associated Circulating T-Cell Receptor Repertoires In Lynch Syndrome, Ana Bolivar

Dissertations and Theses (Open Access)

Lynch Syndrome (LS) is the most common inherited colorectal cancer (CRC) syndrome. It constitutes the perfect model to understand DNA mismatch repair deficient (MMRd) carcinogenesis, which underlies 15% of early-stage CRC. LS patients develop MMRd tumors with high loads of shared neoantigens (neoAgs), which are recognized by the immune system. Previous research has concentrated on discovering neoAgs and their potential as targets for vaccines in LS patients. However, these studies have primarily identified shared neoAgs from cancers, lacking detailed information on targetable neoAgs present in precancerous lesions. Understanding this landscape of pre-cancer derived neoAgs is crucial for intercepting cancer development …

Uncovering Capillary Endothelial Cells Response During Lung Injury-Repair, Celine Shuet Lin Kong

Dissertations and Theses (Open Access)

Once thought to be a homogenous population, capillary endothelial cells (ECs) have embodied organotypic specialization and heterogenous properties, both during homeostasis and tissue injury. In the lung, capillary ECs consist of two distinct populations, CAP1 and CAP2s; how each population responds to diverse tissue injury is incompletely understood. In this thesis, I report the induction and function of a truncated isoform of Ntrk2, Ntrk2^-tk (lacking the tyrosine kinase domain) in multiple injury models. Using a combinatorial approach of single-cell multiome, mouse genetics and viral infection models, I found that Ntrk2^-tk is broadly induced in CAP1s after the initial …

Molecular Mechanisms Of Opioid Use Disorder In Human Brain Models, Emily Mendez

Dissertations and Theses (Open Access)

Opioid use disorder (OUD) is a national and global public health crisis with no end in sight. While studies from animal models hint at widespread epigenetic and transcriptomic alterations of opioid drugs, the molecular consequences of long-term exposure to opioid drugs in human brain is still unclear, and human-centered translational models are necessary to discern the human cell type-specific effects of OUD.

Using postmortem brain Brodmann area 9 (BA9) from the UTHealth Brain Collection for Research on Psychiatric Disorders, I identified angiogenic gene networks perturbed in the RNA and protein of OUD subjects, as well as downregulation of many neuron-correlated …

Investigating The Role Of The Gut Microbiota On Immune Checkpoint Inhibitor-Mediated Colitis, Taylor Halsey, Robert Jenq

Dissertations and Theses (Open Access)

Immune checkpoint inhibitors (ICIs) have been revolutionary in the fight against cancer by recruiting the host immune system as an agent for attack on malignant cells. Unfortunately, immune-related adverse events (irAEs), including ICI-mediated colitis (IMC), are common side effects that result from immune cell mediated damage on healthy tissues. Recent studies have highlighted a role for the gut microbiota in modulating ICI-mediated anti-tumor responses, but less is known regarding how the gut microbiota may impact on irAEs. Considering that the gastrointestinal tract harbors thousands of unique microbial species, many of which are known to modulate the immune system, microbes and …

Acute Pain Prediction In Oral Cavity And Oropharyngeal Cancer Patients Receiving Radiation Therapy, Vivian Salama

Dissertations and Theses (Open Access)

Oral-Cavity and oropharyngeal cancers (OC/OPC) are types of head and neck cancers that are increasing in incidence domestically. Radiation therapy (RT) is crucial in OC/OPC management. Pain is a common and challenging symptom for most patients during therapy, as nearly all patients undergoing locoregional RT in OC/OPC require analgesia for acute iatrogenic pain. Moreover, about 45% of long-term survivors report chronic pain, with more than 10% exhibiting severe chronic pain. Pain control is challenging due to the multifactorial clinical, molecular, and cellular etiology of cancer/therapy pain, as well as variation in pain assessment and the non-uniform management of pain between …

Patient Understanding Of Fetal Sex Versus Gender In The Context Of Routine Cell-Free Dna Screening, Mindy Kolodziejski

Dissertations and Theses (Open Access)

Non-invasive prenatal testing (NIPT) is the current standard of care to screen for fetal aneuploidy using cell-free DNA (cfDNA). NIPT screens for sex chromosome aneuploidies (SCAs) and in doing so, can predict fetal chromosomal sex. Despite sex and gender being distinct concepts, many patients refer to NIPT as “the gender test” and elect testing in order to find out predicted fetal sex and assume gender. Our study aimed to evaluate and describe patient understanding of sex and gender in the context of receiving routine prenatal genetics education (PGE) on NIPT. A survey was developed with the goal of assessing patient …

Evaluation Of An End-To-End Radiotherapy Treatment Planning Pipeline For Prostate Cancer, Mohammad Daniel El Basha, Court Laurence, Carlos Eduardo Cardenas, Julianne Pollard-Larkin, Steven Frank, David T. Fuentes, Falk Poenisch, Zhiqian H. Yu

Dissertations and Theses (Open Access)

Radiation treatment planning is a crucial and time-intensive process in radiation therapy. This planning involves carefully designing a treatment regimen tailored to a patient’s specific condition, including the type, location, and size of the tumor with reference to surrounding healthy tissues. For prostate cancer, this tumor may be either local, locally advanced with extracapsular involvement, or extend into the pelvic lymph node chain. Automating essential parts of this process would allow for the rapid development of effective treatment plans and better plan optimization to enhance tumor control for better outcomes.

The first objective of this work, to automate the treatment …

Cord Blood-Derived Invariant Natural Killer T Cells As A Platform For Allogeneic Chimeric Antigen Receptor Cell Therapy, Maison Grefe

Dissertations and Theses (Open Access)

Chimeric antigen receptor (CAR) T cells have revolutionized the treatment of hematopoietic malignancies achieving >50% complete response rates in numerous refractory/relapsed B cell malignancies. However, there are challenges that hinder CAR-T efficacy and bar the broader use of this therapy in patients. One approach to address these challenges is to create a safe allogeneic CAR cell product by using cells that do not cause graft versus host disease (GvHD). Invariant natural killer T (iNKT) cells are an ideal candidate as they are restricted to the monomorphic CD1d protein in contrast to HLA restricted αβ-T cells and therefore are safe in …

Inclusion Of Adoption As A Pregnancy Management Option In Prenatal Genetic Counseling Practice, Emma Billings

Dissertations and Theses (Open Access)

Prenatal genetic counselors are essential to providing education, psychosocial support, and guidance on pregnancy options to patients who receive a fetal diagnosis of an anomaly or genetic condition. Therefore, genetic counselors should be well-educated on comprehensive pregnancy management options consisting of parenting, abortion, and adoption. The landscape of adoption education in genetic counseling practice was last characterized in 2010 by Perry and Henry, revealing substantial variability in both the inclusion of adoption-specific education in genetic counseling program (GCP) curricula and the discussion of pregnancy options with patients in prenatal practice. As a result, the authors published a call to action …

Methods For The Prediction Of Osteoradionecrosis Resulting From Head And Neck Cancer Radiation Therapy, Brandon Reber

Dissertations and Theses (Open Access)

Head and neck cancer (HNC) is the sixth most diagnosed cancer worldwide with over 600,000 patients diagnosed every year. One of the primary methods to treat HNC is through radiation therapy (RT). While RT is effective at treating HNC, late toxicities resulting from treatment can occur months to years post-treatment and can cause debilitating quality of life changes for HNC survivors. One of these late toxicities is osteoradionecrosis (ORN), which is the death of bone due to radiation. For HNC, the mandible is commonly affected and can cause challenges chewing, swallowing, and physical appearance changes. Several factors indicate the pressing …

Retinoid X Receptor As A Mediator Of Post Stroke Recovery By Reversing Age-Associated Phenotypes Of Microglia/Macrophages, Shun-Ming Ting

Dissertations and Theses (Open Access)

After stroke, microglia (MG) and blood-derived macrophages, together (MF), clear dead cells and cellular debris in the infarcted brain through phagocytosis. However, the phagocytic capability of MF declines with age. Age-related changes in MF phenotype also include overactive inflammatory responses to stroke-induced brain injury, altogether resulting in poor recovery after stroke. Retinoid-X-receptor (RXR) is a pleiotropic transcription factor. Our studies suggest that RXRa enhances MF phagocytic functions, reduces inflammatory responses, and improves post-stroke recovery. To establish phenotypes of aging MF, MG were MACS-sorted from the brains of young adults (2-4 months old) and aged (18-20 months old) mice for transcriptomic …

Impact Of Genetic Counseling On Patient Empowerment After Diagnosis Of Fetal Anomaly, Carley Brueckner

Dissertations and Theses (Open Access)

Approximately 3-5% of pregnancies are affected by fetal anomalies, often leading to structural and functional differences that impact infant health and mortality. When anomalies are identified on prenatal ultrasound, genetic counseling (GC) and genetic testing may be offered to investigate the potential for a possible syndromic cause. Genetic counselors provide education on the chance for a genetic etiology, available testing options, potential changes in medical intervention related to an identified etiology, and psychosocial counseling and resources. Regardless of a patient’s testing decision, genetic counseling should include psychosocial counseling to support and empower patients in a time of prognostic uncertainty and …

Epiregulin As A Novel Target For Antibody-Drug Conjugate Development For The Treatment Of Colorectal Cancer, Joan Jacob

Dissertations and Theses (Open Access)

Antibody-drug conjugates (ADCs) are a fast-growing class of molecularly targeted therapies with 13 currently approved and over a 100 in clinical trials. ADCs consist of a monoclonal antibody (mAb) conjugated to a potent cytotoxic payload to selectively target tumor antigens highly expressed on the cell surface. ADC development has been limited in colorectal cancer (CRC) by the lack of novel and effective therapeutic targets. Epiregulin (EREG), is an epidermal growth factor receptor (EGFR) ligand that is highly expressed in CRCs of different subtypes and mutational statuses with low expression in normal tissues. Here, we have characterized the role of EREG …

Interrogating Therapeutic Resistance To Oncogenic Krasg12c-Based Therapies In Colorectal Cancer, Oluwadara Coker

Dissertations and Theses (Open Access)

Colorectal cancer is the second leading cause of cancer-related deaths and the third most common cancer in the United States. Although KRAS is mutated in 50% of patients with metastatic CRC (mCRC), it has historically been a challenging therapeutic target. The recent approval of novel covalent inhibitors selective for KRASG12C mutation have entered the clinic, which has not only marked a major milestone in cancer drug discovery but has also intensified efforts to directly target other KRAS mutations that have also successfully entered the clinic. However, treatment-associated resistance mechanisms have long threatened to attenuate clinical benefit through either adaptive or …

Molecular Basis Of Cell Membrane Adaption Against Daptomycin In Enterococcus Faecalis, April Nguyen

Dissertations and Theses (Open Access)

Daptomycin is a last-resort lipopeptide antibiotic that disrupts cell membrane (CM) and peptidoglycan homeostasis (Grein et al., 2020a; Müller et al., 2016a). Enterococcus faecalis has developed a sophisticated mechanism to avoid daptomycin killing by redistributing CM anionic phospholipids away from the septum. The CM changes are orchestrated by a three-component regulatory system, designated LiaFSR, with a possible contribution of cardiolipin synthase (Cls) (Cesar A Arias et al., 2011a; Khan et al., 2019b; Palmer et al., 2011a; Panesso et al., 2015a; Reyes et al., 2015a). However, the mechanism by which LiaFSR controls the cell membrane response and the role of Cls …

Dissecting The Relationship Between Mucin 5ac And The Lung/Gut Microbiome In The Pathogenesis Of K-Ras Mutant Lung Cancer, Maria T. Grimaldo

Dissertations and Theses (Open Access)

Non-small cell lung cancer, including its most common subtype, lung adenocarcinoma (LUAD), is the leading cause of cancer-related deaths worldwide. In LUAD patients, KRAS mutations are the most common oncogenic driver alteration. Given KRAS is upstream to many signaling pathways involved in cell survival and cytokine production, interventions against KRAS-mutant lung cancers are prone to develop acquired resistance. Thus, there is a need to develop alternate targeting strategies and test combination therapies for improved intervention. Previously, we have found that KRAS-mutant LUAD (KM-LUAD) patients whose tumors harbor high expression of Mucin 5 AC (MUC5AC), a main airway secretory mucin, have …

Latent Classification Of Multi-Model Non-Homogeneous Continuous-Time Markov Chains, Joonha Chang

Dissertations and Theses (Open Access)

The continuous-time Markov chain (CTMC) model and latent clustering models are commonly used to study longitudinal measures of categorical outcomes. Because of its simple but powerful Markovian property, CTMC models have been widely used in medical and public health researches. Due to limitations in the standard CTMC model, there have been some studies on non-homogeneous continuous-time Markov chain (NH-CTMC) that utilized time-dependent rates, but the progresses have been limited. NH-CTMC can be more powerful than CTMC by its default nature of time-dependent rate that can be fitted to a wider range of applications in medical studies. In this study, we …

Prevalence Of Adverse Childhood Experiences And Its Dose-Response Association With Anxiety-Related Stress Symptoms In Young Adults Ages 18 To 44 Years Old In The United States, Kenechukwu O. Nwosu

Dissertations and Theses (Open Access)

Introduction: Adverse childhood experiences are common in the United States with about 64% of the population affected. Adverse childhood experiences are predictors of many chronic diseases including mental illnesses like anxiety. Though non-Hispanic whites are mostly afflicted by anxiety compared to their racial counterparts, minority races like non- Hispanic Black/African Americans disproportionately suffer more dire consequences due to the chronicity of untreated conditions which often result from lack of access to care among other barriers. Methods: This is a retrospective cross-sectional study. BRFSS 2022 data set was used to identify 56,598 respondents, ages 18 to 44 years old for analysis. …

Decoding Disease Mechanisms: Unraveling Large-Scale Biological Data For Novel Therapeutic Target Discovery, Yuntao Yang

Dissertations and Theses (Open Access)

This dissertation leverages large biological datasets and data-driven research to enhance our understanding of complex human diseases, deploying a unified narrative across three interconnected bioinformatics studies. Each study targets a different biological level, including genes, proteins, cells, and tissues, to uncover disease mechanisms and speed up the discovery of potential therapeutic targets.

The first study addresses gene-level analysis in the context of bladder cancer. It integrates gene expression data from lab models with clinical survival data to identify new therapeutic targets. This research pinpoints the IL6/JAK/STAT3 signaling pathway as a promising target for treating SMARCB1-deficient bladder cancer, demonstrating how combining …

Radiation-Induced Lymphopenia: Understanding, Predictive Modelling And Developing Photon And Proton-Based Mitigation Strategies, Yan Chu

Dissertations and Theses (Open Access)

It is well recognized that the effectiveness of radiotherapy (RT) requires an intact adaptive immune system, while lymphocytes are highly radiosensitive and are prevalent in the “dose bath” of radiation surrounding the tumor volume. Furthermore, it has been shown that, for nearly all disease sites, radiation-induced lymphopenia (RIL) is associated with poor outcomes. Recently, we observed compelling evidence of significant differences in the lymphocyte-sparing effects of proton therapy (PT) vs. photon (or x-ray) therapy (XRT) attributable to the differences in magnitudes of the dose baths of the two modalities. In addition, previous work has further demonstrated that both patient-specific and …

An Informatics Framework For Representing, Detecting, And Measuring Citations Of Biomedical Datasets, Xu Zuo

Dissertations and Theses (Open Access)

Biomedical research is inherently data-intensive, emphasizing the necessity of making data findable, accessible, interoperable, and reusable (FAIR) to expedite scientific breakthroughs. Despite the importance, data creators often do not receive sufficient recognition and lack the motivation to publish datasets in accordance with FAIR principles, primarily due to inadequate incentives. Citations serve as a means to attribute credit for dataset creation, track dataset usage, and assess the impact of data. Implementing standardized data citations could significantly enhance the discoverability of data and foster the maintenance of high-quality datasets. Initiatives like DataCite and the FAIRsharing community have been instrumental in addressing this …

Feasibility And Measurement Of Bedside Pumping In The Nicu: A Mixed Methods Study, Jessica Gomez

Dissertations and Theses (Open Access)

Abstract

Background: Supporting preterm infants with mother’s own milk (MOM) can improve health outcomes and decrease mortality.¹ Freshly pumped MOM, within four hours of expression, has the highest availability of bioactive components versus stored MOM. However, fresh milk is often not readily available due to the disconnected process of breastfeeding that occurs with preterm infants in the NICU. One convenient solution to improve access to fresh MOM is for the mother to pump at the infant's bedside. This intervention could improve the mother's pumping experience and provide the infant access to fresh MOM.

Purpose: This study aimed to evaluate …

Lifestyle Behaviors Before And After Diagnosis Of Type 2 Diabetes: Findings From The Nurses’ Health Studies, Amelia E. Roebuck

Dissertations and Theses (Open Access)

Short- and long-term changes in diet or physical activity in relation to type 2 diabetes mellitus (T2DM) and factors associated with behavior change with adequate inclusion of relevant confounding and effect-modifying variables have been minimally explored. The objective of this research was to examine changes in diet and physical activity following a diagnosis of T2DM and identify sociodemographic, medical, psychosocial, and lifestyle factors associated with changes in dietary or physical activity behaviors. This dissertation utilized two prospective cohorts of U.S. female nurses participating in the Nurses’ Health Study (1976-2016) and Nurses’ Health Study II (1989-2017). Linear mixed effects modeling was …

Translational Research Targeting Biliary Tract Cancer, Yan Zhu

Dissertations and Theses (Open Access)

Biliary tract cancer (BTC) is malignant tumor that originates from the biliary tract, including cholangiocarcinoma (CCA) and gallbladder cancer (GBC). In this translational research program targeting BTC, we focus on three aspects: the development of a combination treatment against CCA, the exploration of the immune background of GBC, and the establishment of a CCA mouse model mimicking mutation profiles of CCA patients.

Patients with cholangiocarcinoma have poor clinical outcomes due to late diagnoses, poor prognoses, and limited treatment strategies. To identify novel drug combinations for this disease, we have conducted a genome wide CRISPR screen anchored on the bromodomain and …

Deciphering The Role Of Huntingtin In Endosomal Functions, Yue Yu

Dissertations and Theses (Open Access)

Huntington's disease (HD), a neurodegenerative disorder, is a result of an abnormal expansion of CAG trinucleotide repeat encoding an extended polyglutamine (polyQ) tract in the coding region of Huntingtin (HTT) gene. While antisense oligonucleotide (ASO) strategies aimed at lowering mutant HTT levels seemed promising, recent clinical trials were unsuccessful due to worsening patient outcomes in the ASO treatment group compared to the placebo. This may be attributed to potential adverse effects resulting from decreased levels of normal HTT, which could play a pivotal role in brain functions and HD progression. The impact of reduced HTT levels on cellular functions and …