Medicine and Health Sciences Commons^™

Familial Sex Trafficking In East Tennessee, Mary K. Brannock

Electronic Theses and Dissertations

This dissertation was completed in partial fulfillment of the Doctor of Public Health program at East Tennessee State University. The dissertation follows the Manuscript Format which includes three manuscripts, these manuscripts regard familial sex trafficking and are as follows, a scoping review, an empirical study on regional familial sex trafficking, and a policy implications paper on criminal record relief for survivors of familial sex trafficking.

The scoping review includes eight peer reviewed studies on familial sex trafficking and a summary of grey literature. Thematic analysis was used to map the existing literature onto the Three Ps of human trafficking: Prevention, …

The Association Between Prenatal Care And Postpartum Depression: Current State And Future Directions, Esther Adebayo-Abikoye

Electronic Theses and Dissertations

Background

Postpartum depression (PPD) is a major public health challenge and associated with poor maternal and infant health outcomes. Quality prenatal care decreases adverse outcomes in pregnancy and may reduce PPD risk factors. This study critically reviews the evidence about the role of prenatal care practices in reducing PPD prevalence across population groups and examines the association between prenatal care timing and counseling content with PPD prevalence.

Methods

A scoping review was completed across eight databases to synthesize evidence about prenatal care and PPD across different contextual settings. National data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was used …

Changes In Young Adults’ Perspective On Ageism After Participating In A Virtual Nutrition Education Program With Older Adults, Julianne Hensley

Electronic Theses and Dissertations

The growing older adult population has led to increased ageist tendencies among younger generations. Previous research suggests that ageism is associated with cognitive and physical decline among older adults. This mixed-methods research project examined changes in ageist perceptions among graduate student facilitators and undergraduate nutrition ambassadors after participating in a training that included information about healthy aging, addressing ageism, and communicating with older adults. Results from a secondary data analysis of pre-test/post-test data and thematic analysis of semi-structured interviews with facilitators of Socially Nutritious, a virtual nutrition education program for older adults, indicate that ageist perceptions decreased after the …

Dementia Of The Alzheimer’S Type In Adults With Down Syndrome: Knowledge Among Graduate Students In Physical Therapy, Occupational Therapy, And Speech-Language Pathology., Abigail Regan Donaway

Electronic Theses and Dissertations

This non-experimental study utilized a convenience sample (N = 322) to investigate graduate students in physical therapy (PT), occupational therapy (OT), and speech-language pathology’ s (SLP) knowledge of the connection between Down syndrome and dementia of the Alzheimer's type (DAT). Ninety-two-point-five percent of participants were female, and 79.80% were white. All participants completed a survey comprised of items relating to information about general knowledge (i.e. facts) of the association between DS and DAT, the signs/symptoms that occur in each stage of dementia of the Alzheimer’s type for people with Down syndrome, and familiarity regarding the diagnosis and care. Descriptive and …

Tongue-Tie: Impact On Oropharyngeal Function During Swallow., Kolbie A. Vincent

Electronic Theses and Dissertations

Swallowing is an intricate process involving over 50 muscle pairs and numerous nerves, with dysphagia resulting from deficits in various stages (Hennessy & Goldenberg, 2016). Lingual restriction may adversely impact swallowing function, affecting bolus preparation, size, and overall efficiency. Tongue-tie can pose challenges to speech, chewing, and swallowing (Becker & Mendez, 2022; Chaubal et al, 2011; García-Pola, M. J., et al., 2002). This pilot study seeks to determine how tongue-tie affects swallowing function in an adult male, and whether surgical revision of a submucosal lingual tether leads to measurable changes in oropharyngeal swallow function. Results showed inconsistent changes in diameter …

Exploring Influencing Factors On The Adoption Of Non-Pharmaceutical Interventions During Pandemics: Covid-19 As An Example., Ahmed Abdulmohsen I Alobaydullah

Electronic Theses and Dissertations

Background: Pandemics are associated with loss of life, hospitalizations, and disruption to people’s social and economic lives. As the 2019 pandemic illustrates, COVID-19 can be prevented by pharmaceutical and non-pharmaceutical interventions (NPIs). Recommended measures such as wearing a mask, washing hands, social distancing, and self-quarantine have been proven to curb the spread of the coronavirus. Identifying the factors associated with adherence to NPIs is the first step in understanding which levers of change to pull when designing health promotion interventions such as health communication campaigns. This dissertation explores these factors and proposes a health communication framework during pandemics. Research Questions: …

Control Of Muscle Activation In The Lower Limbs During Leg Cycling After A Motor Complete Spinal Cord Injury., Jae Fish

Electronic Theses and Dissertations

Spinal cord injury (SCI) affects the central nervous system (CNS) causing muscle paralysis and autonomic dysfunctions throughout the body. Muscle activation after SCI is essential to facilitate functional recovery and may be produced via remaining input from supraspinal centers, the central pattern generators (CPG), or muscle stretch reflex responses. In this study, assisted leg cycling is evaluated as a tool to identify the neural structure control of muscle activation after motor complete SCI. Eight individuals with a complete or sensory incomplete SCI between C2 and T5 participated in the study. Participants completed leg cycling trials with and without supraspinal intention …

Modifiers Of The Effects Of Different Dimensions Of Social Support On Cardiac Rehabilitation Adherence., Melissa Amraotkar

Electronic Theses and Dissertations

Introduction: Cardiovascular disease (CVD) is a leading cause of mortality worldwide. Cardiac Rehabilitation (CR) is a Class I, level A indication for treatment and prevention further complications of CVD. The attendance rate for CR in the U.S. is very low, especially among female patients. Dimensions of social support, sex of the support provider, and the quality of primary intimate relationship are associated with health-promoting behavior and may influence CR adherence in patients. Purpose: The purpose of this study was to examine the relationship between dimensions of social support and CR adherence, and whether these relationships were moderated by factors such …

Investigation Of Avaren-Fc's Therapeutic Potential Against Ovarian Cancer., Katarina Lee Mayer

Electronic Theses and Dissertations

This thesis describes the investigation of Avaren-Fc (AvFc), a novel lectin-based therapeutic fusion protein consisting of the recombinant Avaren lectin and the Fc region of human IgG1, against ovarian cancer. AvFc possesses selectivity toward tumor associated N-linked high-mannose-type glycans. The present study demonstrates AvFc’s in vitro activity against OVCA cell lines via antibody-dependent cell-mediated cytotoxicity and its ability to extend the survival of mice challenged with murine ID8 OVCA cells after repeated systemic administration. Furthermore, AvFc treatment in this model was found to increase the presence of peritoneal leukocytes, suggesting a shift toward an improved antitumor immune response. Another key …

Electrochemical Modulation Of Surface Plasmon Wave To Investigate Dna-Based Sensing Platforms And Detection Of Sars-Cov2., Anil Sharma

Electronic Theses and Dissertations

This study offers a thorough comparative analysis of optical and electrical signaling strategies for assessing the electrochemical properties of different redox-labeled DNA-based biosensing platforms. In addition, it illustrates the development of an optical interrogation technique with electrochemical modulation of surface plasmon waves (ECM-SPW) as a route for analyzing and implementing DNA-based hybridization sensors. For those quantitative analyses, we chose a model sensing platform composed of a methylene blue (MB)-modified single-stranded DNA (ssDNA) signaling probe and an unlabeled capture ssDNA probe that complements the signaling probe. Two types of signaling probes were employed in this work: one with MB attached to …

Preclinical Stability Assessment Of Epicertin, A Biotherapeutic Candidate For Ulcerative Colitis Mucosal Healing., Wendy Michelle Kittle

Electronic Theses and Dissertations

EPICERTIN is a biotherapeutic candidate for mucosal healing in ulcerative colitis (UC), a major type of inflammatory bowel disease (IBD). Despite the critical role of mucosal healing in achieving successful remission of UC, there are currently no targeted mucosal healing agents available. EPICERTIN has previously demonstrated epithelial repair and mucosal healing activity in colon epithelial cells, murine colitis models, and tissue explants from IBD patients, highlighting its therapeutic potential to meet this unmet need for UC patients. The development of appropriate chemistry, manufacturing, and controls (CMC) data will facilitate our ultimate goal to bring EPICERTIN to the clinic for a …

Socioecological Factors Associated With The Timing Of Prenatal Care Initiation In Kentucky And Beyond: An Exploratory Study., Melissa B. Eggen

Electronic Theses and Dissertations

Objectives: Early prenatal care is initiated in the first twelve weeks of pregnancy and is a known contributor to improved short- and long-term outcomes for women and infants. Despite its known benefits, many women do not initiate early prenatal care. The purpose of this dissertation was to explore the socioecological factors associated with the timing of prenatal care initiation in the United States and in Kentucky. Methods: Chapter Two of this dissertation used a scoping review methodology to identify barriers and facilitators related to first-trimester prenatal care initiation among women in the United States. Chapter Three of this dissertation used …

Examining The Relationship Between Mass Incarceration, Gender Norms, And Hiv Vulnerability For Formerly-Incarcerated Black Men Who Have Sex With Men And Women., Adrienne B. Smith

Electronic Theses and Dissertations

In 2018, Black Americans represented 42% of new HIV diagnoses, despite comprising only 13% of the population. Moreover, Black men accounted for three-quarters of new HIV cases in 2016, with Black gay/bisexual men contributing to the majority of incidence among Black Americans. Existing literature suggests that individual behavior alone cannot explain these racial inequities in HIV rates. This study aims to explore the role of the criminal legal system (CLS) as a structural determinant of health, given its historical racial implications that disproportionately affect Black Americans. Additionally, the study examines masculinity’s influence as a predictor of risky sexual behavior. This …

A Mixed Methods Investigation Of First-Year Medical Students' Competency Development In The Gross Anatomy Laboratory Context., Emily M. Porta-Miller

Electronic Theses and Dissertations

Competency-based medical education and competency assessment are common in the clerkship years of undergraduate medical education and in graduate medical education; however, they are less commonly included in the preclinical, or basic science, years of medical education. This study investigated the effects of a novel competency-based curricular thread which assessed Communication, Teamwork, and Professionalism competency development of first-year medical students in the gross anatomy lab context. The study employed a convergent parallel mixed methods approach. The quantitative phase used a pretest/posttest design with paired dependent t-tests to determine if students’ exhibited growth, stagnancy, or decline within any of the …

Assessing The Relationship Between Racism In Medicine, Medical Mistrust And Cardiovascular Disease Among Black American Adults., Osayande Agbonlahor

Electronic Theses and Dissertations

Cardiovascular disease (CVD) persists as the leading preventable cause of death and disability among Black Americans in the United States. Structural and psychosocial factors such as racism have been highlighted as a fundamental cause of persistent cardiovascular health disparities in the U.S. This study examined the associations between racism in medicine, medical mistrust and CVD among Black Americans using the Minority Stress Theory as a theoretical framework. This study evaluates the sociodemographic differences in the quality of care received among Black Americans. Data from the Health Information National Trends Survey, 2022 and the Consumer Assessment of Healthcare Provider and Systems …

Reimaging Safety After Sexual Violence: A Qualitative Exploration Of Survivors' Experiences With Formal And Informal Crisis Response Networks., Hallie Ruth Decker

Electronic Theses and Dissertations

Sexual violence (SV) is a highly prevalent public health and human rights concern impacting communities across the United States. SV is associated with a myriad of adverse physical, reproductive, sexual, mental, behavioral, financial, and social health outcomes which may be acute or chronic. Health challenges associated with post-traumatic stress and post-traumatic stress disorder are particularly common among victims and survivors of SV. Engagement in early psychological/psychosocial intervention strategies may prevent or reduce PTSD-related symptomatology after experiencing an SV encounter. Despite the availability of crisis response and support options to support individuals who have experienced SV, significant barriers exist across social …

"They Are Who We Thought They Were": The Influence Of White Supremacist Discourse On Voter Suppression And Black Health., Tanisha Howard Lewis

Electronic Theses and Dissertations

Political systems in the United States have contributed to health outcomes in the through the historic and legal doctrine related to race and racism, segregation, housing, employment, and education. In recent years, significant attention has been given to theorizing the political determinants of health and what it means in the overall conversation about health equity. The equity implications of the political determinants of health are innumerable because they are the origin point of the structural determinants of health and the primary drivers of the social determinants of health, which span from environmental conditions to food security. The focal determinant of …

Comparison Of Specific Jaw Position Measurements On A Static And Dynamic Virtual Patient., Payton Lofton

Electronic Theses and Dissertations

This study aimed to compared the differences in jaw position measurements in protrusive and open/close positions on a static virtual patient created using 3dMD System to those from a dynamic articulation of a virtual patient (MODJAW) as well as measurements between the Cadiax and MODJAW. Six fiducial surface markers were placed on a volunteer subject’s face and dynamic facial scans of protrusive and open/close jaw movement acquired and exported. A CBCT scan was also acquired. The mandible and maxilla were segmented and loaded into Vultus and aligned to the facial scan using the fiducial markers. Results were compared using a …

Rockin’ Rehab: Novel Rocking Chair For Children With Spinal Cord Injury To Enable Trunk Muscle Activation And Detect Muscle Activation Patterns., Johnathan Jay George

Electronic Theses and Dissertations

Introduction: Activity-based locomotor training improves trunk control in children with spinal cord injury (SCI), and there is need for additional activities to allow these children to activate trunk muscles. The purpose of this research was to design, fabricate, and evaluate a rocking chair for children with SCI, and to investigate the activation of muscles during use. Sensorization of the chair to confirm muscle activation is also explored. Methods: Quality Function Deployment (QFD) design methodologies identified and ranked needs and features for the rocking chair. A design was developed and evaluated via finite element analysis. The chair was fabricated and tested …

Biofeedback Using Virtual Reality, Conscious Interoception, And Breathing Exercises Modulates Blood Pressure And Heart Rate Variability In People With And Without Cervical Spinal Cord Injuries., Rachel Torres

Electronic Theses and Dissertations

There is an immediate need for fast-acting blood pressure (BP) modification without the side effects of pharmaceutical interventions for people with cervical spinal cord injuries (SCI), who often suffer from dangerous increases and decreases in BP.^1,2 First, we compared mental to virtual reality (VR) imagery with the addition of breathing exercises and guided interoceptive attention, investigating participants’ ability to volitionally change their BP and heart rate variability (HRV), alternating three-minute stimulating and relaxing training cycles in 17 noninjured (NI) participants and 14 participants with SCI. Second, we trained 13 people with SCI and seven NI control participants for one …

Acute Mechanical Circulatory Support In The Cardiovascular Icu: Investigating The Effects Of An Interactive Cardiovascular Dynamics Simulation Program On Nursing Clinical Judgment., Casey Saulman

Electronic Theses and Dissertations

Introduction: Education on acute mechanical circulatory support (AMCS), a therapy used in the cardiovascular intensive care unit (CICU) to manage cardiogenic shock (CGS) is limited for CICU nurses. There is a need to explore clinical judgment in CICU nurses and provide innovative learning experiences that foster judgment when managing AMCS. Methods: This mixed methods feasibility study investigated the effects of an interactive cardiovascular dynamics simulation program on CICU nurses’ knowledge, clinical reasoning, and clinical judgment. Semi-structured interviews explored the participants’ perceptions of the learning experience. Results: Twenty-one nurses completed the cardiovascular dynamics simulation program. The majority were white (85.7%), female …

Optimization Of Vagus Nerve Stimulation (Vns) And The Use Of Cervical Vns As A Treatment For Heart Failure With Reduced Ejection Fraction, Misty Owens

Electronic Theses and Dissertations

Vagus nerve stimulation (VNS) is a promising neuromodulatory therapy under investigation for a range of disorders, including heart failure, gastric dysmotility, and migraine. Two primary forms of VNS are currently investigated: cervical VNS (cVNS), involving surgically implantation to activate vagal afferents in the cervical branch in the neck and transcutaneous auricular VNS (taVNS) which subcutaneously stimulates the auricular branch in the outer ear. The nucleus of the solitary tract (NTS) serves as a relay-station receiving 90% of vagal afferents, enabling connections with higher-order brain regions and other brainstem nuclei like the spinal trigeminal nucleus (Sp5) and locus coeruleus (LC), facilitating …

Illness Perceptions And Health-Promoting Behaviors: The Buffering Role Of Resilience In Adults With Congenital Heart Disease, Taylor Rose Eldridge

Electronic Theses and Dissertations

Congenital heart defects (CHD) are one of the most prevalent genetic abnormalities, impacting the lives of millions of children, teens, and young adults. Conservative diagnoses estimate that 2.4 million children and adults are living with CHD in the United States (Gilboa et al., 2016). CHD requires consistent cardiac support with multiple surgeries and hospitalizations expected throughout the lifetime, which significantly impacts psychological health. Specifically, patients present with a host of extra-cardiac conditions that impact their quality of life. With advancements in medical technology, mortality rates continue to improve for this population; however, individuals face a number of consequences that impact …

Comparative Analysis Of Acceptance And Commitment Therapy’S Effectiveness In An Intensive Outpatient Program Setting, Efrain Frank Ellin Iii

Electronic Theses and Dissertations

This thesis presents a comparative analysis of acceptance and commitment therapy (ACT) and treatment as usual (TAU) within an intensive outpatient program setting, evaluating their effectiveness in enhancing various dimensions of psychological well-being. Guided by two main research questions, the study investigates whether ACT demonstrates greater or equal effectiveness compared to TAU and if it provides more immediate effects on psychological well-being within three weeks. Utilizing a quasi-experimental design, the research incorporates a comprehensive array of measurement tools to assess outcomes related to anxiety, depression, stress, psychological flexibility, cognitive flexibility, emotion regulation, mindfulness self-efficacy, and life satisfaction among participants. The …

Expectations And Marriageability In African Americans: A Qualitative Content Analysis, Ashley Miller

Electronic Theses and Dissertations

This study aimed to identify individual factors that work alongside structural factors limiting the marriage rate of educated African American men to educated African American women. Previous research identified structural factors related to systemic racism that contribute to the marriage gap between Black men and women in America. The researcher in this study conducted a focus group with three Black men and another focus group with three Black women in order to identify any individual expectations or characteristics that each group considers when evaluating a partner’s marriageability. Data was analyzed using conversation content analysis techniques on focus group responses. Findings …

Standing Posterior Trunk Rotation With Adaptive Proprioceptive Toss, Jennifer Elvir

Electronic Theses and Dissertations

Parkinson’s disease (PD) is a remarkably individualized disease. Nearly every person’s trajectory is unique. One person may experience tremor at an early stage of the disease, while another may experience tremor at a later stage or even not at all. For all PD patients, for certain can expect increasing difficulty as the disease progresses. Parkinson’s disease is responsible for the loss of dopamine which displays itself most notably through motor and cognitive symptom disruption. Although Parkinson’s is a chronic and progressive condition that is irremediable, significant strides have been facilitated to help control and manage the trajectory of the disease. …

Physiological Adaptations Following A Strength Endurance Training Block Performed With Accentuated Eccentric Loading Or Traditional Resistance Training, Alex Long

Electronic Theses and Dissertations

Physiological adaptations were investigated following a strength-endurance (S-E) block prescribed with accentuated eccentric loading (AEL) or traditional resistance training (TRAD). Recreationally trained participants (n = 11 males, 6 females, age = 23.2 ± 4.2 yrs, body mass (BM) = 81.3 ± 22.2 kg, height = 172.1 ± 10 cm) completed a four-week block of concurrent resistance, sprint, and change of direction training. Participants were assigned one of two training conditions, AEL (n = 9) or TRAD (n = 8). Training was identical, except AEL performed 110% eccentric overloading every 1^st, 3^rd, 5^th, 7^{th …}

Investigating Self-Perception Of Speech And Motivation For Return To Intervention For Post Cochlear Implantation In Young Adults, Madison Henry

Electronic Theses and Dissertations

Introduction: Cochlear Implants (CI) are designed to address severe to profound hearing loss. When implantation occurs after language develops, it is referred to as post-lingual (PL) implantation. Currently, no interventions have been identified to address the communication challenges that young adults with PL-CIs may face after they complete post-CI rehabilitation services. This study analyzes if an individualized intervention plan is beneficial for a person with PL-CIs when experiencing changing communication demands in the transition to college or the workforce. Methodology: Baseline assessments were conducted; the results of which allowed for the establishment of four co-constructed goals. These goals were targeted …

Healthcare Provider’S Perceptions On Feeding Difficulties And Educational Practices In Infants With Neonatal Opioid Withdrawal Syndrome (Nows), Katelyn White

Electronic Theses and Dissertations

This study examined healthcare professionals’ perceptions on feeding difficulties experienced by infants with NOWS, the involvement of SLP in care, knowledge and experience levels of professionals, and trends in education and follow up care. A 34-question survey was developed to obtain data from participants involved in the care of exposed infants using the secure webbased RedCap™ platform. Nonparametric inferential statistics and descriptive analysis were used to interpret data. Feeding difficulties in infants exposed were reported by all respondents with SLP involvement reported by 42.2%. Results found that 51.9% of respondents were confident in their ability to educate families about feeding …

Exploring Available Information On The Gut-Brain Axis And Alzheimer’S Disease For Clinicians Making Dietary Recommendations: A Scoping Review, Megan Gibson

Electronic Theses and Dissertations

Abstract: Alzheimer’s Disease (AD) is a complex neurodegenerative disease that requires interprofessional collaboration. Pharmacological options are currently ineffective, increasing the need for preventative strategies to combat the rise of AD. Considerations of gut-targeted interventions have increased as a key component in the prevention of AD, based on the understanding that the state of the gut microbiome can impact cognitive function through the pathway known as the gut-brain axis.

Methods: This scoping review explored information on the gut-brain axis in persons with AD. A comprehensive search was conducted in November 2023. Forty reviews and 13 human studies were analyzed.

Results: There …