Medicine and Health Sciences Commons^™

Simulation Based Evaluation Of Multiscale Small Area Health Models, Purbasha Dasgupta

Theses and Dissertations

The effects of scale on the analysis of spatial data, often referred to as the modifiable areal unit problem in spatial studies, is one of the issues often encountered in small area health models. These spatial effects of scale are also seen in the areas of disease mapping where data are usually available in counts. Often there is a need to consider the different scales of aggregation that exist within count data, since inferences based on analyses can vary if we change the definition of the unit of analysis. This thesis provides a framework that describes the distribution of relative …

Examining The Influence Of Healthy Eating Identity On Shopping Behaviors, Jordan Brittingham

Theses and Dissertations

Eating identity is shown to be a promising measure capable of enhancing our understanding of nutrition behavior. Persons with healthy eating identities are less likely to consume the typical American diet and report healthier diets in general. While there are several studies linking healthy eating identity and diet, there is currently no research examining healthy eating identity in relation to food shopping behavior, an important aspect of nutritional intake. The purpose of this study was to examine the influence of healthy eating identity on shopping behaviors including supermarket utilization, supercenter utilization, likelihood of shopping at the nearest store, distance to …

Marine Population Connectivity: Range Boundaries And Climate Change, Rhiannon Leigh Rognstad

Theses and Dissertations

Population connectivity, particularly in open systems, is an important metric for understanding population-level processes on both ecological and evolutionary timescales. In coastal marine systems, adults are typically sedentary and dispersal occurs primarily during a larval stage when individuals are transported in ocean currents. Because coastal marine populations exist as networks of interconnected subpopulations, variation in the magnitude and extent of population connectivity can have profound effects on population dynamics and species distribution limits. Connectivity is a complex process, affected by a multitude of factors, including adult inputs and physical dispersal, which operate at multiple scales and may interact. This dissertation …

Quality Improvement Project: A Comparison Of Daily Routine Chest Radiography Versus Clinically-Indicated Chest Radiography In Preventing Ventilator-Associated Pneumonia In Adult Icu Patients On Ventilators: An Evidenced Based Practice Project, Kimberly Mckenney

Theses and Dissertations

Ventilator-associated pneumonia is one of the critical complications identified by a chest x-ray (CXR). However, there is a controversy about the use of CXRs. Overuse of the CXR has also identified concern among the ICU patient population. The purpose of this evidenced-based practice project was to determine if there were differences in patient outcomes when receiving daily routine CXRs as compared to clinically-indicated CXRs. Patient outcomes measured were: ICU length of stay, complications while on the ventilator and ICU mortality, number of ventilator days, diagnostic efficacy, therapeutic efficacy, costs, and radiation exposure The author identified 30 articles in the search …

Weight-Gain And Energy Balance, Benjamin Thomas Gordon

Theses and Dissertations

Energy balance is the result of a dynamic relationship between energy intake (EI), energy expenditure (EE) and energy storage (ES). These three components of energy balance have extremely complicated associations, and all three major components are consistently influenced by physiologic, psychological, and sociologic factors. Concerted changes between EE and EI result in alterations of the ES. Most often in clinical and research settings, bodyweight is used as marker of body composition (i.e., ES) changes. Traditional measurements of bodyweight do not give an accurate portrayal of ES change or the role it has in energy balance. This dissertation supplies new methods …

The Effects Of Multiple Gratitude Interventions Among Informal Caregivers Of Persons With Dementia And Alzheimer's Disease, Cristy Degregory

Theses and Dissertations

The purpose of this group randomized intervention trial was to examine the impact of participation in three telephone-based gratitude interventions on the physical, psychological and social functioning of participants in caregiver support groups who are unpaid family caregivers of persons with dementia and Alzheimer’s disease. Fredrickson’s (2001) Broaden-and-Build Theory informed the investigation of the effect of three gratitude interventions on participants’ levels of gratitude, positive aspects of caregiving, subjective well-being, physical health and mental health. This was a randomized, wait-list controlled study involving informal caregivers involved in support groups. The research questions were: 1.) How does gratitude contribute to subjective …

Periodontal Microorganisms, Obesity, Chronic Inflammation, And Type 1 Diabetes, Georges Joseph Nahhas

Theses and Dissertations

Periodontal disease is a low-grade chronic inflammation in the tissues surrounding the teeth caused by multiple, mostly gram-negative pathogens. It is associated with diabetes, obesity, and chronic inflammation. The specific roles that periodontal microorganism play in these conditions are not well-studied. Hereby, we explored how periodontal bacteria from sub gingival plaque clustered in youth with and without type 1 diabetes, and how such patterns related to body-mass-index percentile (BMI percentile), C-reactive protein (CRP) and adiponectin. Cross-sectional data were collected from 105 youth with type 1 diabetes and 71 without diabetes. Participants were between 12 and 19 years of age receiving …

Impacts Of Adolescents' Emotional And Behavioral Concerns And Social Skills On Parenting Stress, Marissa Miller

Theses and Dissertations

Minimal literature has examined predictors of parenting stress for parents of adolescents and what may contribute to the impact of these predictors, particularly those regarding adolescent behavior. The current study sought to evaluate whether adolescents’ internalizing and externalizing behaviors significantly predicted parenting stress and whether adolescent social skills moderated the relationship. Covariates of gender, age, ethnicity, and socioeconomic status were entered first into a multiple regression moderation model and followed by internalizing and externalizing behaviors, social skills, and interaction terms, respectively. The overall model explained 19 percent of the variance in parenting stress. While internalizing behaviors significantly predicted parenting stress, …

Mcp-1 In Colorectal Cancer: Benefits Of Exercise, Jamie Lee Mcclellan

Theses and Dissertations

The etiology of colon cancer is a complex phenomenon that involves both genetic and environmental factors. However, only about 20% have a familial basis with the largest fraction being attributed to environmental causes that can lead to chronic inflammation. Tumors associated macrophages drive the pro-inflammatory response in the tumor micro-environment and are associated with poor prognosis in certain cancers. Monocyte chemoattractant protein 1 (MCP-1) is thought to be the most important chemokine for recruitment of macrophages to the tumor microenvironment. In chapter 1, we examined the timing and magnitude of the intestinal inflammatory cytokine response in relation to tumorigenesis in …

Metformin Arrests Growth And Induces Apoptosis Of Neuroblastoma Cells, Nadia Al-Sammarraie

Theses and Dissertations

Neuroblastoma is one of the most common solid neoplasms in children, which affects sympathetic neurons with a wide range of genetic abnormalities, especially MYCN amplification, a molecular marker of poor prognosis. Despite advance therapy, still the mortality rate for advance disease is high with frequent relapse and resistance to cytotoxic therapy with evidence of p53 mutation. Metformin, an oral hypoglycemic medication, is a relatively safe and cost effective drug with wide clinical applications, mainly for treatment of Type 2 diabetes. Recent studies have showed promising anticancer effect of metformin on various cancer types, especially on p53 mutant cells. In our …

Design And Development Of A Novel Class Of Cell Cycle Cdk Inhibitors Targeting The Cyclin Binding Groove Utilizing The Replace Strategy, Padmavathy Nandha Premnath

Theses and Dissertations

Inhibition of CDK2 activity in G1 and S phases of the cell cycle can promote selective apoptosis of cancer cells through the E2F1 pathway. Currently available CDK inhibitors target the ATP binding pocket and result in lack of specificity for the cell cycle vs. the transcriptional CDKs. It has been shown that a peptide HAKRRLIF derived from the tumor suppressor p21 binds to the cyclin binding groove (CBG) and selectively inhibits cell cycle CDKs (CDK2/Cyclin A, CDK2/Cyclin E and CDK4/Cyclin D). The CBG is unique to cell cycle CDKs hence targeting this site avoids the inhibition of transcriptional CDKs can …

The Cardio-Protective Effects Of Substance P In Both Ischemia/Reperfusion And And Short-Term Hypoxia Rat Models, Shaiban Jubair

Theses and Dissertations

Substance P, a member of the tachykinin family, is found primarily in sensory nerves. In the heart, substance P-containing nerve fibers surround coronary vessels, making them ideally positioned to sense changes in coronary pressure and/or flow. Recent studies have identified substance P as being protective acutely following ischemia-reperfusion due to its ability to induce coronary blood vessel vasodilation. In addition, studies conducted on non-cardiac tissue have reported substance P to be protective against cell death through a mechanism involving activation of anti-apoptotic AKT pathway. However, the possibility of substance P being similarly cardioprotective has not been reported. Accordingly, the purpose …

Early Screening And Identification Of Preschool Children Affected By Serious Emotional Disorders, Cathy Renee Robey-Williams

Theses and Dissertations

Mental illness has surpassed physical health problems as the leading cause for morbidity and mortality in American children. National prevalence of serious emotional disorders in the 0-5 age group has ranged from 9.5% to 14.2%. Of the 15 million children affected by mental illness, less than 20- 25% receive any treatment. Nationwide, early screening, identification, and treatment of preschoolers with emotional or behavioral disorders have become a critical priority in order to reduce the increasing burden of healthcare costs for mental illness and psychiatric care. The purpose of this study was to test the feasibility of a screening process for …

Gestational Weight Gain, Pregnancy Outcomes, And Use Of Perinatal Health Services, Lujing Zhan

Theses and Dissertations

This dissertation consists of three studies that were undertaken to better understand 1) the role of gestational weight gain (GWG) during early pregnancy on subsequent blood pressure changes and the risk of pregnancy-induced hypertension (PIH), 2) the causal effect of GWG in both early and mid-late pregnancy on the subtypes of preterm births, and 3) the impact of personal capital on the use of perinatal health services (i.e., prenatal care use and preconception care counseling). The first two studies were based on the data from the 1988 National Maternal and Infant Health Survey and the third study employed the data …

Exploring The Association Between Depression And Obesity Among Alzheimer's Patients, Stephanie Clugstone

Theses and Dissertations

Alzheimer’s disease (AD) is a neurological disorder that affects elderly individuals, and is becoming an increasing concern among the aging population of the world. Due to the projected increase in incidence of AD, modifiable risk factors such as depression and obesity should be evaluated, as prevention is the only current option. This study aimed to determine the prevalence of obesity and depression among AD patients, and to evaluate the association between depression and obesity. Patients were chosen from a subset of the South Carolina Alzheimer’s disease registry, which included information about weight status and depression, as well as several other …

Mixture Cure Models: Simulation Comparisons Of Methods In R And Sas, Myra Robinson

Theses and Dissertations

Typical survival methods have the assumption that every subject will eventually experience the event of interest, given enough follow-up time. However, there are some occasions in which a proportion of the population of interest will never experience the event of interest. Therefore, the incorporation of a “cure” fraction in a statistical model is necessary. In this thesis, I comprehensively evaluate mixture cure models in two different statistical software programs: the smcure package in R and the PSPMCM macro in SAS. Extensive simulation studies in R and SAS allow evaluation of the performance of these two models. An additional aspect of …

Impact Of Multi-Hospital System Organizational Structure On Financial Performance And Quality Of Care In Rural Hospitals, George Raul Audi

Theses and Dissertations

Considering the increasing challenge to providing access to affordable healthcare in the United States and its effect on the economy, it is critical for patients, healthcare organizations, financial institutions, and federal and state agencies to understand the impact of different organizational structures within affiliated hospitals. The objective of this study was to investigate the impact of different organizational structures within rural multi-hospital systems (MHS) on the hospitals’ financial performance and the quality of patient care. The data for this study were drawn by linking two national datasets: the 2011 American Hospital Association (AHA) Annual Survey and the 2012 American Hospital …

Effect Of Primary Care Physician Density On Late Stage Cervical Cancer Diagnosis, Emily Haanschoten

Theses and Dissertations

INTRODUCTION: Late-stage cervical cancer diagnosis is an important contributing factor to the cervical cancer mortality rate. Screening for cervical cancer is a vital tool in reducing the number of late-stage cases, preventing incident cases and reducing mortality. Access to care is often a significant barrier to receiving these services. Women who have no usual source of care report significantly lower percentages of Pap tests than women who have a usual source. South Carolina ranks 13th in the US in cervical cancer incidence and 7th in cervical cancer mortality. South Carolina also struggles with a primary care physician shortage, ranking 39th …

Single Nucleotide Polymorphisms In Dna Repair And Oxidative Stress Genes, And Their Interaction With Antioxidants On Prostate Cancer Aggressiveness, Samuel Antwi

Theses and Dissertations

Prostate cancer is the leading invasive malignancy and the second most common cause of cancer death among American men. Despite compelling evidence that oxidative stress, ineffective DNA damage repair, and habitually low antioxidants intake may act in tandem to influence prostate carcinogenesis, few studies have examined gene-diet interactions involving these risk factors. Even fewer studies have examined such interactions in relation to prostate cancer aggressiveness. This study investigated whether single nucleotide polymorphisms (SNPs) in DNA repair- and oxidative stress-related genes modulated associations between antioxidant intake and prostate cancer aggressiveness. We utilized data from the North Carolina-Louisiana Prostate Cancer Project (PCaP) …

Mental Disorders, Mental Health Problems, And Treatment Among Army Recruiters And Recruiting Candidates, 2011-2013: An Examination Of Current Rates In The Recruiting Population, Chadwick Karl Knight

Theses and Dissertations

Purpose: This study sought to determine the prevalence and severity of mental health disorders (MHDs) and/or mental health problems (MHPs) and types of treatments received among soldiers who have or will serve as recruiters. Research Design and Methods: Data were collected between October 2011 to July 2013 from active duty soldiers (N=2,783) attending courses on Fort Jackson at the U.S. Army’s Recruiting and Retention School (RRS). Students consisted of regular active duty soldiers and activated Guard/Reservist that were either recruiters or recruiting candidates. The medical records of participating recruiters and recruiting candidates were reviewed for the prevalence of MHDs and …

Women’S Hiv Prevention Study (Whips): A Proposal To Pilot Test An Hiv Intervention For Older African American Women Living With Hiv, Charsey Cherry

Theses and Dissertations

Despite improvements in treatments over the past 30 years, HIV /AIDS continues to be a major public health threat, particularly among sub-populations such as African American women. Midlife and older adults (those aged 40 years and over) are fast becoming a growing concern for HIV/AIDS infections, particularly older African American women. There has been limited research targeting midlife and older African American women living with HIV that aimed to reduce their transmission of HIV and promote them becoming prevention advocates. In response to this gap in the literature, a culturally tailored intervention guided by the IMB Model of behavior change …

Longitudinal Changes In The Inflammatory Potential Of Diet And Risk Of Cancer In Women, Fred Kinyuytabung

Theses and Dissertations

Introduction: The dietary inflammatory index (DII) assesses an individual’s overall diet quality with regards to its inflammatory potential on a continuum from maximally anti-inflammatory (lower or healthier DII scores) to maximally pro-inflammatory (higher or unhealthy DII scores). The DII measured at one point in time has been associated with cancer risk in previous studies; however, data are lacking regarding the change in DII over time and how these changes impact cancer risk. We assessed changes in the DII, and evaluated associations between cumulative history, and changes over time in dietary inflammatory potential, and risk of colorectal cancer (CRC) and breast …

Enhancing Peripheral Opioid Analgesia: Development Of Viral Vector And Small Peptide Therapies, Sherika Smith

Theses and Dissertations

Chronic neuropathic pain often decreases quality of life, incurs high medical costs and is difficult to treat. Neuropathic pain can develop as a result of nerve damage induced by trauma or diseases such as diabetes and cancer. This type of pain is often resistant to standard treatments for chronic pain. Effective and safe treatments for persistent neuropathic pain remain an unmet therapeutic need. The primary objective of this work was to test the hypotheses that peripheral opioid analgesia can be enhanced using a herpes simplex virus vector gene therapy approach and peripheral opioid tolerance can be prevented by blocking opioid …

Two Studies Of Family-Centered Care Family-Centered Care And Shared Decision Making: Are They The Same Construct? And The Association Of Family-Centered Care And Shared Decision Making With Receipt Of All Needed Prescription Drugs And Emergency Department Visits In Children With Asthma, Barbara Lee Brumbaugh

Theses and Dissertations

Family-Centered Care (FCC) is considered the standard of care in pediatrics, being affirmed in 2003 by the American Academy of Pediatrics (AAP). Family centered practices center around five specific provider actions: (1) did the provider spend enough time; (2) did the provider listen carefully; (3) was the provider sensitive to the needs of the family, including their values and customs; (4) did the provider provide information as needed; (5) did the provider make the caregiver feel like a partner in the care of the child. In addition to FCC practices, shared decision making (SDM) has been indicated as important in …

Effects Of Language Predictability And Speech Rate On Speech Entrainment Performance In Healthy Individuals, Honey Isabel Hubbard

Theses and Dissertations

Speech entrainment, a paradigm in which a participant shadows the speech of an audiovisual model in real time, has been show to benefit individuals with non-fluent aphasia. A study examining the effects of language predictability and speech rate was conducted to understand factors that influence speech entrainment performance.

A recent study by Fridriksson and colleagues (2012) demonstrated that training with speech entrainment significantly increased the number of words participants with non-fluent aphasia were able to produce. Perhaps even more remarkably, these effects showed generalization. As a result, speech entrainment could be used to rehabilitate speech impairment in stroke. However, there …

The Development, Implementation, And Testing Of An Interactive Sexual Health Web-Based Application Intervention To Reduce Sexual Risk Behaviors Among College Students, Dawnyéa Dominique Jackson

Theses and Dissertations

College life is often regarded as a time for exploration and growth. One major area of exploration and growth for college students is sex and sexuality. Growth and exploration involves not only learning how to master these life situations, but also experiencing some negative consequences. Negative consequences for college students engaging in sexual risk-taking behaviors often lead to a high prevalence of sexually transmitted infections (STIs), unintended pregnancies, emotional distress, and large healthcare costs. Given the high prevalence of risky sexual behavior among young adults and the highly negative consequences of risky sexual behavior for this population, it is critical …

Effects Of Hiv-1 Tat Protein On Structure, Function And Trafficking Of The Dopamine Transporter, Narasimha Murty Midde

Theses and Dissertations

The alarming rise in HIV-1 associated neurocognitive disorder (HAND) is, at least in part, associated with HIV-1 viral proteins shed from infected macrophages, including transactivator of transcription (Tat) despite the success of anti-retroviral therapies. The dopamine (DA) system is greatly involved in the progression of HAND and is influenced by psychostimulants like cocaine. The DA transporter (DAT), a key regulator of neurocognitive functions, is a major molecular target for both Tat and cocaine. Our lab previously reported that exposure to Tat decreases DA uptake through allosteric regulation and alters cocaine binding sites in DAT.

In this research project the hypothesis …

Six1 Overexpression Promotes Epithelial– Mesenchymal Transition And Malignant Progression In Models Of Cervical And Colon Cancer, Hanwen Xu

Theses and Dissertations

Inappropriate expression of embryonic genes, particularly homeodomain transcription factors, contributes to tumorigenesis and tumor progression. The overexpression of Six1, a member of the Six family of homeodomain transcription factors, has been found in various human cancers, and is associated with tumor progression and metastasis. We have previously determined that the expression of SIX1 mRNA increased during in vitro progression of human papillomavirus type 16 (HPV16)- immortalized human keratinocytes (HKc/HPV16) toward a differentiation-resistant (HKc/DR) phenotype. However, the mechanism(s) of how Six1 promotes HPV16- mediated transformation remain unknown. In this study, we explored the role of Six1 at early stages and late …

A Multiple Imputation Approach For Semiparametric Cure Model With Interval Censored Data, Jie Zhou

Theses and Dissertations

Interval censored survival data, where the exact event time is only known to lie in an observed time interval, is commonly encountered in practice. Such data analysis may be conducted under the setting where a fraction of patients can be considered as fully recovered and will not experience the event of interest in the future; while the other patients who did not recover totally will have the outcome of interest. We proposed a semiparametric estimation method for the proportional hazard mixture cure model, which is easy to implement and computationally efficient. A multiple imputation approach based on the asymptotic normal …

Longitudinal Evaluations Of Objectively Measured Physical Activity: Capturing The Full Spectrum Of Duration And Intensity, Amanda E. Paluch

Theses and Dissertations

Most physical activity research to date narrows its focus toward intensities and durations only encompassed in the Physical Activity Guidelines of moderate to vigorous intensity in at least 10 minute bouts (MVPA-10). Examining activity in this manner excludes light activity and shorter bouts, sometimes referred to as baseline physical activity (BPA) as it consists of the activity accumulated during daily life at durations and/or intensities below what is recommended. This dissertation provides an evaluation of the entire spectrum of physical activity (PA). Physical activity was studied in a unique way by looking at MVPA-10, then adding shorter bouts and light …