Medicine and Health Sciences Commons^™

Aligning Eye Care Provider Beliefs With Behaviors: Exploring And Improving Ocular Surface Disease Decision-Making In A Cataract Surgery Clinic, Amy Hellem

Communication (PhD) Dissertations

Millions of cataract surgeries are performed every year in the United States, yet both surgeon reports and patient reports indicate that practices are not utilizing the diagnostic tests and treatments that are advocated in the medical literature to identify and manage ocular surface disease prior to surgery. As a result, patients risk suffering several significant consequences with regard to their vision, comfort and safety. Personal observations from my 25 years of experience working with ophthalmologists and optometrists led to curiosity regarding the root cause of undertreatment of ocular surface disease. Specifically, I had the impression that eye care providers held …

Estradiol Signaling Improves Extinction Memory Recall To Combat Cue-Induced Heroin Relapse In Rats, Jordan S. Carter

MUSC Theses and Dissertations

We are in the midst of an opioid use disorder (OUD) epidemic. While several treatments mitigate a range of factors contributing to return to use, or relapse, the power of drug-conditioned environmental cues to precipitate relapse have not been adequately addressed. One treatment modality targeting cue reactivity, cue exposure therapy (CET), exacerbated relapse in individuals with OUD, perhaps due to a deficit in extinction memory recall (EMR). Here, EMR is the ability to override the drug-cue association and prevent relapse. Interest remains in combatting cue-induced relapse, potentially by introducing a pharmacologic adjunct with CET to enhance EMR. In the following …

Redefining Ed Utilization: A Rabies Post-Exposure Prophylaxis Perspective, David Bennington

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Rabies, though rare in the United States, remains a lethal viral disease with significant public health implications. Post-exposure prophylaxis (PEP) through timely administration of rabies vaccines and rabies immune globulin (RIG) is critical for preventing the progression of the virus following potential exposure. However, the current system of healthcare delivery in the United States has witnessed an alarming trend: the unnecessary utilization of emergency department (ED) visits for rabies PEP, including follow-up vaccinations. This paper aims to examine and address this issue through a review of the factors contributing to the inappropriate use of ED services for rabies treatment.

Through …

Relationship Between Fentanyl Misinformation And College Students' Intentions To Administer Naloxone, Zoe Ryon

Honors Undergraduate Theses

Background: The news media has spread misinformation about the toxicity and potency of fentanyl, exaggerating the extent to which bystanders could be harmed by fentanyl when responding to overdose situations. College students are increasingly among the victims of opioid overdose, and their peers may be the nearest person capable of administering naloxone – an overdose reversal medication. However, college students who fear incidental exposure to fentanyl may be worried about administering naloxone.

Objective: I sought to understand the relationship between undergraduate college students’ perceptions of the risks of fentanyl and their intentions to administer naloxone in an overdose situation.

Methods: …

Health Literacy And Maternal Health: A Rapid Systematic Review, Goldy Olivier

Honors Undergraduate Theses

In comparison to other high-income nations, the U.S. maintains the highest maternal mortality rate, especially among Black women. Factors like the growing maternal age and restricted family planning clinics have been noted to contribute to this phenomenon. However, the impact of health literacy on maternal has yet to be reviewed. Health literacy in the U.S. has long been determined to be a social determinant of health more broadly, and it may likely play a role in maternal health as well. Consequently, a systematic review of health literacy and its association with maternal health outcomes is warranted. The goal of this …

Harnessing Antagonistic Pleiotropy: Tolc-Dependent Coliphages Can Drive Reduced Antibiotic Resistance In E. Coli, Cooper Mckenna

CMC Senior Theses

The rise of multidrug-resistant (MDR) bacterial pathogens has been a growing concern in healthcare around the world, and bacteriophage (phage) therapy is a promising method to combat MDR infections. One defense mechanism of E. coli against antibiotics is the TolC-AcrAB efflux pump. At the same time, some phages use TolC as a surface receptor to infect the cell. This puts TolC at a crossroads in which it is beneficial to the bacteria to protect against antibiotics but harmful by allowing phage infection, creating the potential for evolutionary trade-offs. Previous research has identified only three TolC-dependent phages and shown phage-resistant E. …

Traditional Chinese Medicine: Employing Integrative Medicine As An Approach To Treat Cancer, Jade Hudson

CMC Senior Theses

This thesis explores the history of Traditional Chinese Medicine (TCM) through its depiction in the four classics of TCM and examines the evolution of the field to date. The five categories of TCM treatments analyzed in this paper include acupuncture, dietary therapy, herbal medicine, moxibustion, and physical exercise. Research highlights significant positive outcomes in cancer patients who incorporate TCM alongside modern cancer treatments, such as reduced nausea, vomiting, fatigue, anorexia, pain, and improvements in quality of life and overall well-being. However, notable risks associated with TCM herbal medicine and moxibustion underscore the need for further research into these practices before …

Gut Dysbiosis Correlates With Covid-19 Severity, Ednita Escobar

CMC Senior Theses

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) impacts not only respiratory but also gut and oral microbiomes, influencing the manifestations of COVID-19. Each person’s unique microbiome consists of microorganisms such as bacteria, fungi, and viruses, some of which are symbiotic and others potentially harmful. Alterations in the gut microbiome, specifically, can affect the severity and symptoms of COVID-19. A review of studies indicate a pattern of gut dysbiosis in COVID-19 patients characterized by a decrease in beneficial microbiota and/or an increase in opportunistic pathogens. This gut imbalance correlates with disease severity, suggesting that the gut microbiome plays a significant role …

Sex Differences In The Effects Of Cortisol On Muscle Characteristics: A Meta-Analysis, Natalie Bitetti

CMC Senior Theses

Background: Cortisol plays a central role in both muscle breakdown and growth. These effects are highly dependent on dose and interactions with other hormones. It is known that men and women show considerable differences in their muscle structure and physiology, which are largely driven by hormonal differences. Cortisol release patterns may also vary between the sexes, with current research showing considerable disagreement. The interplay between cortisol and muscle, two highly variable and sexually dimorphic factors, may prove to have different effects in males versus females.

Objective: This meta-analysis integrates existing research on sex differences in cortisol-muscle physiology with existing research …

Driven By Change: The Impact Of Macroeconomic Shifts And Covid-19 On New Vehicle Sales, Jackson Aldrich

CMC Senior Theses

This paper examines the impact of macroeconomic factors and the COVID-19 pandemic on new vehicle sales. In order to address these two topics, a two-pronged approach was used with separate regression models. The macroeconomic variables include monthly supply of new homes, CPI for urban public transportation, unemployment rate, disposable personal income, inflation expectation, consumer sentiment, average gas prices, and total vehicle miles traveled which were regressed on total vehicle sales from 1978-2022. The regression results confirmed and supported current literature and highlighted the importance of the housing market and unemployment rate on new vehicle sales. The COVID-19 pandemic model variables …

The Emergence Of Aedes Aegypti In California: Implications For Ecosystems And Public Health, Jose Ruiz

CMC Senior Theses

This literature review delves into the emergence and impact of Aedes aegypti, the yellow fever mosquito, in Southern California. My investigation begins with an exploration of the physical characteristics, historical background, and its significance as a vector. Notably, Aedes aegypti's historical role as a vector for yellow fever during the 19th century shapes the foundation for understanding its effectiveness in disease transmission and demonstrates the potential of its negative impact on Southern California residents. I examined the habitat preferences and behaviors of Aedes aegypti, emphasizing its adaptability to urban environments and its effect as a daytime feeder with a limited …

Effect Of Dopamine-2-Receptor Manipulation On Social Interaction And Social Decision-Making In Juvenile Fish, Kiren Kanazawa

CMC Senior Theses

Animals interact in intricate social networks. Social behavior is imperative in shaping relationships, in communication, and adapting to changing environments. Despite its profound effects on individual fitness and health, neural-molecular mechanisms behind social behavior and social decision-making continue to be identified. In the present study, we focused on the regulation of social behavior by the Dopamine-2-Receptor (D2R), based on its role in context-dependent social behavior. We used juvenile African cichlid fish, Astatotilapia burtoni, to investigate the effect of dopamine signaling manipulation on their aggressive, territorial, and affiliative behaviors. We hypothesize that D2R manipulation affects social decision-making in juvenile A. burtoni. …

Effects Of The Injury Recovery Process On Neuromuscular Activation In An Uninjured Ankle, Mark Tankersley

CMC Senior Theses

This study was conducted to observe the effects of changed activity levels due to a major lower extremity injury on ankle function in the uninjured leg. Neuromuscular activation in the Gastric Medialis (GAS) and Tibialis Anterior (TA), the muscles primarily responsible for movement at the ankle, was assessed in 8 athletes at the Claremont Colleges while walking on a flat surface, stepping up a 15º incline, and stepping up a 27º incline. Athletes were split into two groups based on injury condition: a “recovered” group (n=4) who had suffered a major lower extremity injury in the last two years in …

Exploring The Impact Of Caffeine, Alcohol, And Opioids On Intraocular Pressure: A Comprehensive Analysis Of Short-Term And Long-Term Effects On Vision, Jake Prieto

CMC Senior Theses

Coffee, alcohol, and opioids are addictive drugs commonly used in modern society, yet their impact on ocular health remains ambiguous. This systematic review aims to elucidate this ambiguity by examining their effects on intraocular pressure (IOP). Utilizing IOP as a metric, both short-term and long-term effects are evaluated across individuals with irregular IOP levels and healthy subjects. Furthermore, the study analyzes choroidal thickness as an additional measure to reinforce or challenge the findings regarding IOP, leveraging the inverse relationship between the two metrics concerning elevated IOP-related illnesses, such as open-angle glaucoma (OAG).

A comprehensive literature search was performed through Google …

Employing A Machine Learning Approach In Precision Oncology To Predict Pik3ca Functional Status And Identify Phenocopying Variants Of Deleterious Pik3ca Mutations, Javier Castillo

CMC Senior Theses

The following proposal describes a modular machine learning approach that detects malfunctioning genes and pathways in cancer using the transcriptome of cancer patients. The transcriptome is underused in precision oncology and, combined with machine learning, can aid in the identification of hidden responders. Applied to the PI3K/AKT/mTOR pathway, this method can be used to predict PIK3CA functional status and identify phenocopying variants of deleterious PIK3CA mutations. The classifier will do this by integrating RNA-seq, copy number, and mutation data from tumors to determine the functional status of PIK3CA using a set of learned gene-specific weights. The classifier will then be …

Improving Screening For Intimate Partner Violence Amongst Older Adults, Olivia Bell

Honors Undergraduate Theses

This systematic literature review was conducted to gather a better understanding of screening for intimate partner violence (IPV) among older adults. IPV affects millions of people every year. Many screenings are conducted with women of reproductive age in medical settings, not older adults. This study focused on ways to improve screenings for older adults by addressing topics including elder abuse and IPV and the lack of resources/knowledge for IPV survivors who are older adults. This study was a literature review conducted with the University of Central Florida’s PRIMO database to find articles on IPV among older adults over the last …

Inclusivity Of In Vitro Fertilization Clinic Websites, Erin Donahue

Honors Theses and Capstones

In the world, many people cannot naturally conceive children. They may be infertile, lack an intimate partner, or be in a same-sex relationship. Artificial reproductive technologies (ARTs) are catered to the aforementioned population. ARTs are fertility treatments that assist people with the fertilization of gametes and/or implantation of embryos. One of the most popular ARTs is in-vitro fertilization (IVF). IVF is a medical procedure in which an egg is fertilized by sperm in a lab so it can develop into an embryo. That embryo can then be implanted directly into the uterus. This quality improvement project aims to determine the …

Student Perspectives On The Adequacy Of Mental Health Curriculum Within The College Of Health And Human Services At Unh, Brianna Lee Meyer

Honors Theses and Capstones

This study aims to understand the confidence students in future healthcare oriented majors feel in regards to treating or interacting with individuals with mental health conditions. It also aims to understand the effect of students' in-major education, outside-major education, and lived experience on this confidence level. Students within the College of Health and Human Services at UNH were the participants who completed a short Qualtrics survey online. The survey collected data from Likert scales and short-answer questions. The Likert scales were then analyzed with a regression and descriptive statistics, while the short-answer questions were analyzed with thematic analysis. The study …

Non-Invasive Monitoring Device For Early Detection Of Breast Cancer Related Lymphedema, Amy Prendergast

Honors Theses and Capstones

Breast Cancer Related Lymphedema (BCRL) is a common co-morbidity in cancer survivors following neoadjuvant therapies such as chemotherapy, radiation, and/or surgery. It is brought about by the disruption in the lymphatic system (think lymph node biopsy) that leads to a buildup of lymphatic fluid in the arm. Current diagnostic strategies for this condition are merely retroactive, and fairly limited in the parameters that are examined to ensure patient well-being long term. We hypothesize that with an approach that mimics bioimpedance spectroscopy analysis, we will be able to provide a clinical support tool that would better determine early stages of lymphedema …

A Case Study In Prospective Program Evaluation, Sarai Rosemary Combs

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Evaluation is a helpful tool in public health to provide transparency about community interventions and programs. The following is a prospective evaluation of a case study, looking at a recently designed program by the Lexington-Fayette County Health Department, as a capstone project for the Health Management and Policy concentration of the Masters in Public Health program of the College of Public Health. The health department developed a series of online training modules to increase knowledge of Methicillin-resistant staphylococcus aureus (MRSA) and other similar organism outbreaks and how to respond to these outbreaks. The program targets were Fayette County Public School …

Characteristics Of Congenital Syphilis Cases In Kentucky 2019-2023, Ines Roy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract:

Background: The incidence of congenital syphilis (CS) has increased both in the United States (US) and globally and remains a public health concern. In Kentucky alone, there has been a significant increase in CS cases, from 9 cases in 2019 to 27 cases in 2023. CS is a preventable disease, but testing and immediate treatment are critical to prevent its spread. We have limited knowledge regarding Kentucky’s characteristics and behavioral factors that may be associated with this rise. The goal of this study is to identify characteristics and potential risk factors that contribute to the rise of CS in …

The Distribution Of Cp-Cre Cases From 2013-2020 In The Commonwealth Of Kentucky, Hannah Hiscox

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Multidrug-resistant organisms (MDROs), particularly Carbapenem-Resistant Enterobacterales (CRE), pose a significant threat to public health due to their resistance to multiple antibiotics, including carbapenems. CRE infections, especially those producing carbapenemases (CP-CRE), are associated with high morbidity and mortality rates, making them a growing concern in healthcare settings. Despite the prevalence of CRE infections in the United States, limited data exist on the incidence and distribution of CP-CRE infections in specific regions, such as the Appalachian counties of Kentucky.

This study aimed to investigate the cumulative incidence and distribution of CP-CRE cases in Appalachian and non-Appalachian counties of Kentucky, as well as …

A Case Study In Program Evaluation, Iantha Wright

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The framework for program evaluation is a systematic way of improving and accounting for public health actions by providing practical, feasible, ethical, and accurate information. As a practical, non-prescriptive tool, it guides public health professionals through the essential steps in program evaluation. The framework uses the six steps to understand how to improve and conduct assessments effectively. Additionally, it emphasizes integrating stakeholders and using ongoing evaluation strategies to plan effective interventions, improve existing programs, and demonstrate the efficient use of resources.

Demographic And Behavioral Characteristics Of People Who Help Others Inject Drugs: A Study Of People Who Inject Drugs In Appalachia Kentucky, Ryli Hockensmith

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: This study aims to understand the demographic and behavioral characteristics of people who inject drugs (PWID) who assist others with injection, hereafter “injection assistors,” and assess the characteristics of injection assistors compared to PWID who do not assist others with injection in Appalachian Kentucky.

Methods: A cross sectional secondary data analysis of data collected from 433 PWID enrolled in the ongoing Kentucky Outreach Service (KyOSK) was performed. Logistic regression analyses were performed to compare injection assistors to those who do not assist others on demographic, behavioral, service usage, and harm reduction characteristics.

Results: In total, 128 (29%) PWID reported …

Mail-Based Or Home Delivery Services: Preferences Among People Who Inject Drugs In Appalachian Kentucky, Su Su Zin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To explore acceptability of delivery-based syringe services program (SSP) among people who inject drug (PWID) in Eastern Kentucky and compare those who wanted to participate in delivery-based SSP to those who did not.

Methods: This was a cross-sectional analysis of data from PWID who injected drugs to get high in the past 30 days (n=246) collected during the baseline assessment administered to the Gateway2Health cohort. Chi-square tests, t-tests, univariate and multivariable logistic regressions were calculated between independent variables and the outcome variable (likelihood of participating in a delivery-based SSP).

Results: 52.9% of PWID reported being likely to participate in …

Human Papilloma Virus Type 16 Seroprevalence Among Men Living With Hiv, Ashley Duff

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives: Individuals living with HIV are at a higher risk for developing human papillomavirus-driven oropharyngeal cancer (HPV-OPC). There are no methods for early detection; however, HPV16 E6 antibodies have been identified as a promising early marker. The objective of this study was to evaluate seroprevalence and predictors of HPV16 E6 seropositivity among men living with HIV.

Methods:2,334 men aged 40+ living with HIV with blood specimens banked within the Tennessee Center for AIDS Research (TN-CFAR) biorepository were evaluated using HPV multiplex serology. Seroprevalence of HPV16 antibodies was calculated for all HPV16 proteins analyzed (L1, E1, E2, E4, E6, E7). …

A Case Study In Program Evaluation, Sierra L. Williams

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Lexington-Fayette County Health Department (LFCHD) developed an education program targeted toward infectious disease outbreaks. The program ensures timely reporting and action during an infectious disease outbreak within the Fayette County Public Schools (FCPS) system. I have been tasked with evaluating the program and its implementation of training modules through pre and post-surveys to determine if the program is significantly increasing the overall knowledge of program participants and make recommendations for how program aspects can be improved.

Program Evaluation Case Study, Grace Mullikin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Program evaluation case study utilizing Center for Disease Control and Prevention's Case Evaluation Framework.

The Influence Of Drd2 Polymorphism Exon 8 C/T (Rs6276) On Manifestations Of Delirium Tremens & Alcohol Withdrawal Seizures, Naomi Schneider

Honors Theses and Capstones

This study explores the correlation between the DRD2 Polymorphism exon 8 C/T (rs6276) and manifestations of delirium tremens (DT). DT is a condition that is clinically diagnosed utilizing two characteristic symptom manifestations: the presence of delirium and severe alcohol withdrawal. It is not entirely understood why DT can occur in some patients, but evidence has suggested that genetic predisposition can play a role. Utilizing the National Institutes of Health (NIH) All of Us Research database and performing a secondary analysis of existing genomic data, this candidate gene association study aims to determine the genotype frequencies within three cohorts: a healthy …

การศึกษาผลของน้ำมันปลาต่อประสิทธิศักย์และผลข้างเคียงของยาไอโซเตรทติโนอินขนาดต่ำ ในการรักษาสิวปานกลางถึงรุนแรง เปรียบเทียบกับการรับประทานยาไอโซเตรทติโนอินอย่างเดียว, ปานเพชร สังขสัญญา

Chulalongkorn University Theses and Dissertations (Chula ETD)

ไอโซเตรทติโนอินเป็นยารักษาสิวชนิดปานกลางถึงรุนแรง แต่มีข้อจำกัดจากผลข้างเคียง ปัจจุบันพบว่า น้ำมันปลาช่วยลดผลข้างเคียงของยาได้ และการละลายในไขมันได้ดียังอาจช่วยเพิ่มการดูดซึมของยา ทำให้ผลการรักษาสิวดีขึ้น การศึกษานี้มีวัตถุประสงค์เพื่อประเมินประสิทธิศักย์ของยาไอโซเตรทติโนอินขนาดต่ำที่รับประทานร่วมกับน้ำมันปลาในการรักษาสิวปานกลางถึงรุนแรง และผลต่อผลข้างเคียงของยา โดยเป็นการศึกษาแบบสุ่ม เปรียบเทียบแบบปกปิดสองฝ่าย และออกแบบเพื่อพิสูจน์ความไม่ด้อยกว่า (ขอบเขตความไม่ด้อยกว่า = 5) ผู้เข้าร่วมวิจัยอายุ 18–25 ปี ซึ่งมีสิวปานกลางถึงรุนแรง (Investigator Global Assessment; IGA ≥ 3) จะถูกสุ่มให้รับยาไอโซเตรทติโนอิน ขนาด 10 มิลลิกรัม ร่วมกับน้ำมันปลา 1 กรัม หรือยาหลอก รับประทานวันละครั้ง เป็นระยะเวลา 3 เดือน ตัวชี้วัดประสิทธิศักย์ ได้แก่ จำนวนสิว และคะแนน IGA ส่วนผลข้างเคียง ได้แก่ ระดับไตรกลีเซอไรด์ในเลือด ค่าเอนไซม์ตับ และผลข้างเคียงทางผิวหนังและเยื่อเมือก จากผู้เข้าร่วมวิจัยทั้งหมด 75 คน (กลุ่มน้ำมันปลา = 37 คน; กลุ่มยาหลอก = 38 คน) พบว่ากลุ่มที่ได้รับน้ำมันปลาสามารถลดจำนวนสิวทั้งหมดได้ไม่ด้อยกว่ากลุ่มยาหลอก (-6.4; 95%CI: -17.5 ถึง 4.6) และมีการสูญเสียความชุ่มชื้นของผิวน้อยกว่า (ค่าความแตกต่างของ corneometer เฉลี่ย = 8.97; 95% CI: 2.76 ถึง 15.18) นอกจากนี้ ระดับไตรกลีเซอไรด์ในเลือดของกลุ่มน้ำมันปลายังเพิ่มขึ้นน้อยกว่าอย่างมีนัยสำคัญ (–12.6 มก./ดล.; 95% CI: –23.0 ถึง –2.1) สรุป: การใช้น้ำมันปลาร่วมกับยาไอโซเตรทติโนอินขนาดต่ำให้ผลไม่ด้อยกว่ายาเพียงอย่างเดียวในการรักษาสิว อีกทั้งยังมีประโยชน์ในการควบคุมระดับไตรกลีเซอไรด์ในเลือดและรักษาความชุ่มชื้นของผิว จึงสนับสนุนบทบาทของน้ำมันปลาเป็นการรักษาเสริม โดยเฉพาะในผู้ป่วยกลุ่มเสี่ยงที่มีแนวโน้มจะเกิดไตรกลีเซอไรด์ในเลือดสูง