Medicine and Health Sciences Commons^™

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

Theses and Dissertations

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

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

Theses and Dissertations

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

Tuberculosis Screening In New Healthcare Employees: A Comparison Of Quantiferon®-Tb Gold In-Tube Test And Tuberculin Skin Test, Mary C. Giovannetti

Theses and Dissertations

Background: Streamlining onboarding processes for new hires to maximize efficiency and reduce costs while meeting regulatory requirements is a constant challenge for healthcare systems’ Employee Health staff. Health screening is a required step and includes obtaining a detailed health history, tuberculosis screening, drug screens, immunizations, fit for duty examinations, obtaining medical records, clarification of disability accommodations, pre-work screens, and other tests which are time consuming and result in delays in hire dates. Faced with a high volume of potential new employee hires a major southeast healthcare system was concerned about delays in new hire start dates. The two-step tuberculin skin …

Scribes Impact On Patient And Provider Experience In The Outpatient Setting, Kimberly A. Taylor

Theses and Dissertations

The purpose of this project was to evaluate the effectiveness of using scribes in the outpatient setting on patient and provider experience. A mixed methods approach with a convenience sample of voluntary patient participants scheduled for an outpatient appointment was utilized. Two primary care physicians volunteered to receive scribes. Four hospital corpsmen were selected and trained to serve in the scribe role.

This quality improvement project evaluated two aspects of experience during the implementation of the scribes. These included: 1) patient experience as indicated via a pre and post implementation questionnaire; and 2) provider experience as indicated via a pre …

Picturing Rest: A Photovoice Study Of African American Women’S Perceptions And Practices Of Rest, Eboni T. Herbert Harris

Theses and Dissertations

African American women are consistently identified as being less likely to participate in sustained leisure time physical activity (Tussing-Humphreys, Fitzgibbon, Kong, & Odoms-young, 2013), yet more likely to be overweight or obese (Levi, Segal, Laurent, & Rayburn, 2014). There has been a wide range of initiatives directed towards preventing and/or reducing obesity among African Americans, such as targeted physical activity and nutrition interventions involving goal setting, group and individualized counseling, and social support. Previous research focused on African American women’s perceptions toward physical activity, nutrition, and weight; emphasize the consideration of cultural attitudes like placing a high value on rest …

Early Life Factors And Health Outcomes In Children And Mothers, Olubunmi Olufunke Orekoya

Theses and Dissertations

This dissertation focused on early life exposures and their impact on children and mothers’ health. It consists of three distinct studies with an overarching goal of understanding how early life factors influence health outcomes among children and mothers. The broad aims are: 1) to examine the association between maternal gestational weight gain and offspring weight at 1 year, while assessing the mediating role of birth weight; 2) to determine the association between breastfeeding practices and development of allergic conditions (eczema/skin allergy, hay fever/respiratory allergy, and asthma); and 3) to examine the association between breastfeeding and postpartum weight retention at 12 …

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

Theses and Dissertations

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

Recipients’ Perspectives Regarding Expanded Carrier Screening Of Gamete Donors, Erika Kristy Jackson

Theses and Dissertations

Purpose: This study explored the perspectives of intended parents regarding genetic carrier screening of a gamete donor. The main goal of this study was to determine how much genetic carrier screening information a recipient would prefer to receive about potential donors. The study also aimed to identify factors that potentially influence a recipient’s choice of donor based on genetic screening results. Methods: An online questionnaire was developed to assess intended parents’ preferences regarding expanded carrier screening (ECS) of their donors. Participants were recruited from various online support groups and were eligible if they had previously utilized or were currently utilizing …

Synergism Of Quercetin And Sodium Butyrate For Controlling Growth Of Glioblastoma, Matthew Alan Taylor

Theses and Dissertations

Glioblastoma multiforme (GBM), or simply glioblastoma, is the most common and aggressive primary brain tumor, with a prevalence of approximately 20,000 new cases per year in the United States and a 3-year survival rate of just 2%. Quercetin (QCT) is a dietary flavonoid that can be found in common foods such as red kidney beans, cilantro, and onions. Despite little evidence showing any benefits through dietary intake of QCT, various studies show its promising anti-cancer results in vitro. In glioblastoma, QCT is able to cause significant amounts of apoptosis through a variety of mechanisms. These include activation of caspase-9 and …

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

Theses and Dissertations

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

Endocrine Disruption In Largemouth Bass (Micropterus Salmoides) From A Pcb-Contaminated Reservoir, Stephanie B. Laplaca

Theses and Dissertations

There are numerous cases of intersex condition in fish, specifically immature oocytes in testicular tissue, documented in recent literature. Typically, these cases identify a point source input of endocrine disrupting compounds impacting the fish, such as wastewater treatment effluent. Legacy contaminants such as polychlorinated biphenyls (PCBs) have been suggested as endocrine disruptors in fish species. The objective of this study was to assess endocrine disruption in wild largemouth bass (Micropterus salmoides) from exposure to PCBs at a Superfund site in South Carolina on Lake Hartwell (SV-107), where high levels of PCBs in sediment and fish tissue samples have been detected …

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

Theses and Dissertations

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

Objectives: The objectives of this study were …

Adherence Of Nurse Practitioners To Jnc 8 Guidelines, Stephanie E. Averette

Theses and Dissertations

The purposes of the evidence based project were to implement a best practice algorithm for treatment of hypertension (HTN) based on JNC 8 guidelines; compare nurse practitioners HTN pharmacotherapy prescribing practices before and after implementation of a HTN algorithm; and compare hypertensive adult patients’ systolic blood pressure (SBP) readings before and after the implementation of a HTN algorithm. A quasi-experimental pre-test and post-test design was used to collect and analyze data from 61 patient charts to compare nurse practitioner adherence to JNC 8 guidelines for NPs’ prescribing practices and subjects’ blood pressure (BP) outcome before and after the implementation of …

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

Theses and Dissertations

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

Association Of Freestanding Dialysis Facility Size, Quality Incentive Program Scores And Patient Survival, Fozia Ajmal

Theses and Dissertations

Background

In 2011, The Centers for Medicare and Medicaid Services (CMS) has introduced a bundled payment reform along with a Quality Incentive Program (QIP) to bring efficiency in End stage renal disease (ESRD) care. The QIP rates facilities using clinical and reporting criteria, but misses out on patient outcomes. It penalizes facilities not achieving a target score by 0-2% of payments. The small facilities are expected to be impacted more by a reduction in payments. We determined the association between ESRD facility size and QIP scores and the association between QIP scores and patient survival.

Methods

We used the Medicare …

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

Theses and Dissertations

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

The Effectiveness Of Self-Regulated Strategy Development For School-Age Children With Hearing Loss, Jessica Rice

Theses and Dissertations

Purpose: The two-fold purpose of this feasibility study was to determine if (a) self-regulated strategy development intervention would improve the writing skills of children with hearing loss and (b) if self-regulated strategy development intervention would improve the reading comprehension skills of children with hearing loss.

Method: One eleven year-old child with bilateral sensorineural hearing loss participated in this single-subject, multiple probe across behaviors design treatment study which examined the effectiveness of using writing intervention to improve reading comprehension in children with hearing loss. The participant completed three seven-week writing interventions focused on narratives, opinion essays, and persuasive essays. Intervention was …

Garlic Inhibits Inflammation During Dengue Infection, Alex R. Hall

Theses and Dissertations

Dengue virus (DENV) is a mosquito-borne flavivirus that causes significant human disease and mortality in the tropics and subtropics. There has been a recent global trend of increased epidemic activity, and DENV infection is considered a serious emerging health problem worldwide. A relatively unexplored approach to develop new treatments for dengue virus infection and the prevention of severe disease development is through investigation of natural medicines. Inflammation plays both beneficial and harmful roles during the host response to dengue virus infection. Several studies have proposed that it is the oxidative stress response induced by dengue virus infection that is responsible …

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

Theses and Dissertations

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

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

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

Theses and Dissertations

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

Multilevel And Multisectoral Processes Of Implementing Nutritionsensitive Ideology And Programming In Ethiopia’S Development Landscape, Andrea Marie Warren

Theses and Dissertations

This research sought to understand the ways in which ideas and discourses in international development are adapted in a country context. Our particular focus was on how ideas at the international and national level become reality at the subnational and community levels. We primarily examined the sensitization of Ethiopia’s Productive Safety Net Program to nutrition across sectors and down levels of government as a way to understand how the global momentum around nutrition, particularly multisectoral or nutrition-sensitive initiatives, can be translated into action.

The first manuscript delves further into the operational realities of implementing multisectoral nutrition-sensitive programming among the neglected …

Utility Of The Modified Early Warning System Score In Early Sepsis Identification, Lisa E. Hart

Theses and Dissertations

The purpose of this quality improvement project is to improve outcomes for patients presenting to the emergency department with sepsis, realizing that time is a key factor. The appraised evidence indicates that early recognition and prompt treatment improve outcomes and decrease mortality. The evidence further highlights that use of an early warning system, like the Modified Early Warning Score, can assist nurses and providers with recognizing deterioration more quickly and lead to a reduction in time to interventions. Between January 2016 and March 2017, the author conducted a retrospective chart review to compare time to antibiotic administration and lactate measurement …

Internet Speed And The Effect On Health Information Technology Adoption, Matthew W. Yuen

Theses and Dissertations

Background. The Internet has become pervasive in everyday life; the Pew Research Center reported over 84% of Americans use the Internet either on their phone or a computer. However, due to the methods by which the Internet was created, an Internet digital divide was created. The Internet digital divide is the disparity in access and speed of Internet of certain populations. This study looked into the disparity between urban and rural populations and their Internet access in two forms: e-prescriptions adoptions and Internet health information seeking behavior (HISB) through their mobile devices.

Methods. This study used 4 datasets, …

Racism Across The American South: The Association Between Racism On Twitter, Rurality, & Black Mortality, Jarrod Bullard

Theses and Dissertations

Racism can be understood as a system of dominance and power designed to uphold the racially privileged of society. One can be exposed to racism through various mechanisms including the Internet and social media. Evidence indicates that exposure to racism is associated with poor mental and physical health outcomes as well as unhealthy behaviors. Current literature studying the effects of racism focus primarily on experienced or perceived racism. Furthermore, the geographic influence of racism on health at the county level and across levels of rurality is currently unknown. The purpose of this study was twofold; 1.) To explore the geographic …

Marginal Structural Cox Model For Survival Data With Treatment-Confounder Feedback, Yanan Zhang

Theses and Dissertations

In an observational longitudinal study, there can be time-varying exposure/treatment and time-varying confounders. When the confounders affect the exposure and prior exposure also has an impact on levels of confounders, there is treatment confounder feedback. To admit estimation of unbiased causal effects, these conditions need to be hold, exchangeability, positivity, consistency. The traditional method of conditioning on potential confounders does not meet these 3 conditions. Therefore, parameter estimates from traditional Cox model are biased casual effect estimates when the treatment confounder feedback exists. The marginal structural Cox model can be used to address this issue. By calculating and including inverse …

The Impact Of Autoimmune Disease On Breast Cancer Survival, Samantha Truman

Theses and Dissertations

Background Breast cancer is the second leading cause of cancer death for women in developed countries, while autoimmune disease effects approximately 10 million people in the United States, of which approximately 80% are female. Both diseases are associated with hormonal risk factors and are related to the divergent effects of the cellular and humoral immunity that is associated with the T-helper 1 and T-helper 2 immune response. To investigate the potential implications that autoimmune disease may have on breast cancer-specific mortality, we have conducted a population-based retrospective cohort study of women who were diagnosed with breast cancer between January 1, …

Trends In Gestational Weight Gain In South Carolina, 2004 - 2015, Marilyn Elizabeth Wende

Theses and Dissertations

Objective: Excessive and inadequate gestational weight gain (GWG) are associated with a myriad of adverse pregnancy outcomes. The objective of this study was to examine secular trends in GWG in South Carolina (SC) from 2004 to 2015. We hypothesized that there was a trend of higher GWG z scores (GWGZ) over this 11-year time period after adjusting for changes in population characteristics. We also hypothesize that a trend of higher mean GWGZ at higher percentiles is more apparent for African Americans, rural women, and women who are overweight or obese before pregnancy.

Data and Methods: Data came from SC …

Hemodynamic Regulation Of Cardiac Valve Development, Vinal Menon

Theses and Dissertations

It is well established that valvulogenesis is a result of a complex interplay between genetic and environmental factors. Hemodynamics is one such environmental stimulus that is well documented to influence the development of heart valves. Using advanced imaging modalities, such as optical coherence tomography, investigators have better understood the effects of altering hemodynamic loads in the embryonic (avian) heart. However, the field of valvulogenesis is currently stagnant with a paucity of studies aiming to understand the molecular mechanisms influenced/affected by hemodynamic stimuli. Deciphering these pathways is critical from a valve development perspective, but also becomes vital as potential therapeutic targets, …