Medicine and Health Sciences Commons^™

Evaluating Changes In Patient Anxiety Regarding Classic Cancer Genetic Testing Versus Expanded Multiplex Cancer Genetic Testing, Andrew Todd Alfonso

Theses and Dissertations

Multiplex cancer genetic testing by next generation sequencing (NGS) offers genetic counselors and patients new options for testing multiple genes beyond BRCA1 and BRCA2, increasing both the yield of positive results and the number of variants of uncertain significance (VUS). This pilot study explored three psychosocial questions related to multiplex cancer genetic testing: 1). Do anxiety levels differ in patients with results of familiar single gene testing versus those with results of multiplex cancer genetic testing of unfamiliar genes? 2). Do different results (i.e., negative, positive, or VUS) affect patient anxiety levels in the post-results period? 3). Is patient anxiety …

Variant Reclassification In Cancer Genetic Testing: Are Genetic Counselors Prepared? A Review Of Current Practices, Niamh Gemma White

Theses and Dissertations

Purpose: Cancer genetics has emerged as a critical specialty within the field of genetic counseling. Advancements in research are constantly uncovering new insights into the genetics of cancer and inherited cancer syndromes. It is crucial that genetic counselors and the institutions in which they work are in sync with these advancements. Currently, multiplex or multi-gene cancer testing is rapidly being adapted into the cancer genetic counseling setting. The ‘hot topic’ of an increased likelihood of receiving variant results following such testing has been explored in depth in the literature. However, research surrounding genetic counseling practices and the reclassification of VUS …

An Evidence-Based Approach To Prepare Interdisciplinary Team Members For Implementation Of The Abcde Bundle, Jessica Murner Hamilton

Theses and Dissertations

Quality improvement projects contribute to the development of evidence-based management strategies for successful implementation of evidence-based practices in health care, thus reducing the risk of change implementation failure. This study assessed practice change implementation strategies for the awakening and breathing trial coordination, delirium assessment and management, early exercise and mobility (ABCDE) bundle. The ABCDE bundle is an evidence-based, interdisciplinary framework for managing pain, agitation, and delirium, reducing the duration of mechanical ventilation, and supporting early mobility in critically ill patients. The purpose of this study was to implement a nurse-driven initiative to design and put into place an evidence-based approach …

Eye Movements Of Individuals With Aphasia During Reading And Scene Viewing, Kimberly G. Smith

Theses and Dissertations

Purpose: This project characterized eye movements of individuals with aphasia and age-matched participants during reading and scene viewing.

Methods: Individuals with aphasia (N=24) and age-matched controls participants (N=24) completed three eye tracking studies. Study 1 examined task-related changes in eye movements for scene search, scene memorization, text-reading, and pseudoreading. Ex-Gaussian, analysis of variance, and correlational analyses were used to compare differences in eye movements across tasks and participant groups. Study 2 examined how oculomotor and linguistic processing influence eye movements for textreading and pseudo-reading. In addition to the statistical analyses used in Study 1, four case studies were carried out …

Exploring The Association Between Network, Cognitive, Structural Social Capital And The Risk Of Clinical Depression In Taiwan, Yun-Hsuan Wu

Theses and Dissertations

Depression is the one of most common mental health conditions in Taiwan. Although evidence suggests that social capital is associated with depression, few studies have comprehensively explored the influence of social capital on depression. Also evidence in Taiwan is limited in comparison to other Western countries. Data from the 1997 Taiwan Social Change Survey (n=2,598), which is the only dataset that contains the best available information to measure and compare all three dimensions of social capital (network, cognitive, and structural social capital), were used to examine the association between three dimensions of neighborhood- and individual-level social capital and depression among …

Environmental Exposures And Childhood Pulmonary Function, Pallavi Prakash Balte

Theses and Dissertations

Fetal origins of adult disease hypothesis states that adverse influences early in developmental period and particularly during intrauterine life can result in permanent changes in physiology which may lead to increased disease risk of chronic diseases in adulthood. Both fetal and adolescent period are critical time periods for development of lungs. Any adverse environmental exposures during these critical periods of lung growth is a form of programming which can have long term effects on pulmonary function. The purpose of this dissertation was to examine the association between different environmental exposures and pulmonary function in children and late adolescents. The first …

Statewide Scale-Up Of Group Prenatal Care In South Carolina, Kristin M. Van De Griend

Theses and Dissertations

Background: Poor birth outcomes and racial disparities in birth outcomes in South Carolina are widely recognized problems. To improve maternal and child health outcomes, especially among vulnerable groups, universal access to timely, appropriate, and effective care should remain a priority through increased availability and accessibility. An interagency collaborative in South Carolina expanded CenteringPregnancy (CP) from two to five medical practices throughout the state. CenteringPregnancy is associated with improved birth outcomes and reduced rates of racial disparities in preterm birth throughout the United States. Important questions in the literature remain about strategies and determinants of scaling up sexual and reproductive …

Characterization Of Stard4 And Stard6 Proteins In Human Ovarian Tissue And Human Granulosa Cells And Cloning Of Human Stard4 Transcripts, Aisha Shaaban

Theses and Dissertations

Progesterone is essential hormone for pregnancy, which is produced by the human corpus luteum in early pregnancy until the placenta assumes this function. Transport of the cholesterol from the outer to the inner mitochondrial membrane is the rate limiting step for the de novo synthesis of pregnenolone (the precursor to progesterone), a process mediated by STARD1. STARD1 contains a C-terminal lipid binding domain which binds cholesterol and an N-terminal domain targeting STARD1 to the mitochondrial membrane. Unlike STARD1, STARD4 and STARD6 proteins lack a mitochondrial targeting sequence; however, they can bind cholesterol and increase steroidogenesis in model systems. In this …

Experiences Of Parents Caring For Infants With Rare Scalp Mass As Identified Through A Disease-Specific Blog, Miranda Worthen, Tara Leonard, Thomas Blair, Nalin Gupta

Faculty Publications

Background: Delayed subaponeurotic fluid collection (DSFC) is a self-limited disorder of unknown etiology characterized by a benign, fluid-filled mass in the subaponeurotic layer of an infant's scalp. While a few case series describe DSFC, the experiences of families whose infants develop this condition have not previously been reported.Methods: We used a disease-specific blog to evaluate the experiences of 69 families affected by DSFC. We identified self-reported clinical features of DSFC and qualitatively analyzed the families' experiences with obtaining a diagnosis and care for their infants.Results: Infants presented in several clinical settings, and multiple diagnostic procedures were administered, including ultrasound (46%), …

Easing My Burden: A Grounded Theory Study Of Kidney Transplant Recipients' Experience With Their Transplant Coordinators, Gwen E. Mcnatt

Dissertations

Organ transplantation holds the promise of new life or better life for thousands of Americans every year. Transplantation involves a process that stretches over time beginning at referral, moving to transplantation and long term care. The transplant coordinator is considered an integral part of this care. Transplant coordinators are considered so important to the care of these patients that transplant centers are required to have at least one transplant coordinator by federal regulations.

The role of the transplant coordinator, however, is not well defined. Although many of the role dimensions attributed to transplant coordinators are consistent with nursing practice, the …

The Role Of Vitamin D In Diabetes And Cardiovascular Disease: An Updated Review Of The Literature, Dimitrios Papandreou, Zujaja Tul Noor Hamid

All Works

© 2015 Dimitrios Papandreou and Zujaja-Tul-Noor Hamid. The dietary reference values for Vitamin D were set primarily considering its role in bone health, but with the discovery of Vitamin D receptors throughout body tissues, new links with other health conditions are now studied, such as for diabetes and cardiovascular diseases (CVD). This paper shall analyze and examine all new research studies carried out, especially in 2013-2015 regarding diabetes mellitus (DM) and cardiovascular diseases (CVD). Vast research has been carried out to establish strong relationship between Vitamin D serum levels, supplementation, diabetes, and CVD. However, the results from researches identified in …

Best Practice For A Standardized And Safe Registered Nurse Shift Handoff, Nancy Rankin Ewing

Theses and Dissertations

One of the most important times for the delivery of patient care occurs during the change of shift handoff between professional nurses. This complex interchange of information and responsibility carries with it distinct possibilities for error that can adversely affect a patient’s hospitalization, safety, and the quality of patient care outcomes (Blouin, 2011; Hilligoss & Cohen, 2011). Communication errors, including errors during shift handoff, account for more than 70% of sentinel events that occur in the provision of healthcare in the acute care setting (Federwisch, 2007; Streeter, 2010). Poorly conducted and unstructured shift handoffs are known to result in delayed …

Plasmablastic Lymphoma Of The Oral Cavity With Breast Recurrence: A Case Report, Zarka Samoon, Romana Idrees, Nehal Masood, Tayyaba Zehra Ansari

Department of Radiation Oncology

Background: Plasmablastic lymphoma is an aggressive variant of diffuse large B cell lymphoma, mostly found in the oral cavity and associated with human immunodeficiency virus. There are no clear guidelines for its treatment. Therapies more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone are not associated with a prolonged survival. Lymphomas of the breast are rare, in one series representing 0.14% of all female breast malignancies, with diffuse large B cell lymphoma comprising up to 55% of all cases. Only one case of plasmablastic lymphoma involving the breast has been reported in the literature.CASE PRESENTATION: A 30 year old Pakistani woman, …

Evaluating The “Family-Centered” Approach Of Pediatric Multidisciplinary Down Syndrome Clinics: A Parents’ Perspective, Devon A. Haynes

Theses and Dissertations

Down syndrome is the most common genetic cause of intellectual disability. Individuals with Down syndrome usually display mild to moderate intellectual disability, developmental delay, characteristic facial features, and an increased risk for birth defects and various medical problems. Multidisciplinary clinics were established to address the multi-system health concerns for Down syndrome, increase adherence to medical management guidelines, and provide coordinated and comprehensive care for the patient. Research has examined the beneficial effect of a multidisciplinary approach to patient care and medical outcomes; however, no studies have been done which evaluate the psychosocial aspect of the care provided.

We hypothesized that …

Exploring How The Risk Of Sudden Cardiac Death Is Discussed In Families With A Diagnosis Of A Sads Condition, Kristin Anne Wiley

Theses and Dissertations

Sudden arrhythmic death syndrome (SADS), where death is secondary to cardiac arrhythmia, is associated with several cardiac ion channelopathies, including long QT syndrome and Brugada syndrome, as well as cardiomyopathies such as hypertrophic cardiomyopathy and dilated cardiomyopathy. Many of these conditions often present in childhood or adolescence. This study investigates how diagnoses of cardiac diseases associated with SADS are communicated within families. A questionnaire was distributed through cardiac disease-focused support groups and organizations. Data from 114 parents who have a child with a SADS condition were used for analysis. Based on the responses, parents explained the risk of SADS in …

Cluster Analysis With Batch Effect, Yifan Tang

Theses and Dissertations

Clustering, as a fundamental process in data science, is frequently used in preliminary data analysis. Batch effects are a powerful source of variation that can come from many sources in data collection, and influence data. We propose a method to simultaneously remove batch effects and perform cluster analysis. We see a batch effect as a fixed value added on to each batch, and do not make assumptions about the distribution of batch effects. We represent the data using a Gaussian mixture model, and use the EM algorithm to estimate the cluster means, the cluster covariance matrices, and the batch effects, …

Soil Arsenic And Lead Concentrations And Preterm Birth: Investigating Racial Disparities, Sources, Neighborhood Effects, And Spatial Patterns, Pamela Harley Thornton Davis

Theses and Dissertations

Preterm birth, generally defined as birth at <37 weeks of gestation, is an important public health issue that has multiple risk factors related to characteristics of both the mother and her environment. The purpose of this dissertation was to examine potential sources of spatially interpolated (kriged) environmental concentrations of arsenic (As) and lead (Pb) in residential soils and preterm birth in a Medicaid population of mothers giving birth in South Carolina (SC) from 1996-2001. The first objective was to investigate if a racial disparity existed for estimated soil As and Pb concentrations, after adjusting for proximal and distal sources of these metals (including distance and direction to industrial facilities) in a subset of SC Medicaid mothers living in areas of SC where soil samples were collected and analyzed for these metals. The second objective was to test the hypothesis that estimated soil As and Pb concentrations were associated with increased odds of early (<34 weeks) and late (34-36 weeks) preterm births in the same subset of SC Medicaid mothers, after adjusting for individual and neighborhood level risk factors, and examine if measure of neighborhood deprivation and racial residential segregation modified these associations. The third objective was to examine if early and all preterm births, aggregated at the county level, varied spatially and/or temporally in SC for all Medicaid mothers giving birth from 1996-2001 in Bayesian models.

For the first objective, black mothers had significantly higher estimated As and Pb soil concentrations than white mothers in the study population (adjusted betas were 0.12 and 0.22 for As and Pb, respectively; all p<0.006), and proximal sources of metals (e.g., percent of Census block group are covered by roads) were more strongly associated with estimated soil As and Pb concentrations than composite As and Pb releases from industrial facilities categorized by distance from and direction to Census block groups in which maternal residences were located.

For the second objective, estimated soil concentration of neither As nor Pb were associated with increased odds of early or late preterm birth after adjusting for maternal and neighborhood level risk factors. Only individual level covariates were associated with these birth outcomes, and associations were stronger for early as compared to late preterm births. Neighborhood deprivation and racial …

Longitudinal Association Between Television Watching, Computer Use And Meal Frequency And Risk Markers In Diabetes Among Youth With Diabetes, Chao Li

Theses and Dissertations

BACKGROUND AND OBJECTIVES: Television watching and computer use are considered to be the main sedentary behaviors in children and youth. However, their longitudinal impact on HbA1c and serum lipids among youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) are under-studied. Sedentary behavior is normally assessed by questionnaire in large epidemiological studies, however, its measurement by questionnaire has not been evaluated among youth with diabetes. Also, no recent studies have evaluated the optimal meal frequency for glycemic control in youth with T1D and T2D; for this reason nutritional guidelines on meal frequency for youth with diabetes are vague. …

The Influence Of Self-Reported Degree Of Masculinity/Femininity On Condom Use Among Black Men Who Have Sex With Men In The Deep South, Elizabeth D. Peeler

Theses and Dissertations

In the United States, 50,000 Americans are diagnosed with HIV each year (CDCa, 2014). The HIV/AIDS epidemic has had a particularly devastating impact on the southern U.S., especially the Deep South – Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina (Reif, Whetten, Wilson, McAllaster, Pence, Legrand, & Gong, 2014). The Deep South, while only composing of 36% of the national population, accounts for 50% of all people living with HIV/AIDS in the nation (Human Rights Watch, 2010). No other population has been hit harder than men who have sex with men (MSM; Prejean, Tang, & hall, 2013). Black MSM …

Examination Of The Association Of Receipt Of Opioid Therapy And Lung Cancer Patient Survival Rates Among South Carolina Medicaid Recipients, Jametta Sade Magwood

Theses and Dissertations

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to …

Interpregnancy Weight Change And Adverse Maternal Outcomes, Chelsea Lynes

Theses and Dissertations

Obesity during pregnancy is associated with a high risk of adverse maternal outcomes. Little is known about how weight change between consecutive pregnancies impacts subsequent pregnancy complications and newborn outcomes. This study aimed to explore the association between interpregnancy BMI change and adverse maternal outcomes, specifically, gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, non-repeat cesarean delivery (C-section), and vaginal birth after cesarean delivery (VBAC). The study sample was derived from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Consecutive Pregnancy Study, which collected data from 20 hospitals in Utah utilizing electronic medical records and International Classification …

Sexual Assaults Among University Students: Prevention, Support, And Justice, Rebecca B. Reingold, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Sexual assault is common among college-aged women (18 to 25 years), with 1 in 5 reporting having experienced these crimes during their college years. Acute and long-term consequences of sexual assault may include physical trauma, sexually transmitted infections, posttraumatic stress disorder, depression, and substance abuse. Survivors have the option of reporting assaults to the university or to the police, but the goals of these 2 systems—and women’s experiences with them—can be quite different. The criminal justice system’s principal aim is to adjudicate guilt, but the university has the broader purpose of fostering a safe learning environment.

This article explores how …

Models Of Survivorship Care Provision In Adult Patients With Haematological Cancer: An Integrative Literature Review, K Taylor, R Chan, L Monterosso

Nursing Papers and Journal Articles

Purpose: Increasing numbers of haematology cancer survivors warrants identification of the most effective model of survivorship care to survivors from a diverse range of haematological cancers with aggressive treatment regimens. This review aimed to identify models of survivorship care to support the needs of haematology cancer survivors.

Methods: An integrative literature review method utilised a search of electronic databases (CINAHL, Medline, PsycInfo, PubMed, EMBASE, PsycArticles, Cochrane Library) for eligible articles (up to July 2014). Articles were included if they proposed or reported the use of a model of care for haematology cancer survivors.

Results: Fourteen articles were included …

Advance Care Planning In 21st Century Australia: A Systematic Review And Appraisal Of Online Advance Care Directive Templates Against National Framework Criteria, T Luckett, P Bhattarai, J Phillips, M Agar, D Currow, Y Krastev, P Davidson

Nursing Papers and Journal Articles

Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia.

Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was …

Adaptation Of International Guidelines On Assessment And Management Of Cancer Pain For The Australian Context, M Lovell, T Luckett, F Boyle, J Stubbs, J Phillips, P Davidson, I Olver, J Von Dincklage, M Agar

Nursing Papers and Journal Articles

Aim: To develop clinical practice guidelines for screening, assessing and managing cancer pain in Australian adults.

Methods: This three phase project utilised the ADAPTE approach to adapt international cancer pain guidelines for the Australian setting. A Working Party was established to define scope, screen guidelines for adaptation, and develop recommendations to support better cancer pain control through screening, assessment, pharmacological and non-pharmacological management, and patient education. Recommendations with limited evidence were referred to Expert Panels for advice before the draft guidelines were opened for public consultation via the Cancer Council Australia Cancer Guidelines Wiki platform in late 2012. All comments …

Assessment Of The Impact Of Attention Deficit Hyperactivity Disorder On Type 1 Diabetes, Kellee Miller

USF Tampa Graduate Theses and Dissertations

Individual day-to-day management and effective control of type 1 diabetes (T1D) is ultimately driven by decisions made by the individual. Individuals with attention deficit hyperactivity disorder (ADHD) have a higher tendency to be inattentive, impulsive, and hyperactive. Attention deficits and impulsivity among adolescents and adults with T1D could result in poor diabetes management through infrequent self-monitoring of blood glucose and inadequate insulin dosing – key components of achieving optimal glycemic control.

This study included 7,380 adolescents and young adults, ages 13-25 years, participating in the T1D Exchange clinic registry (median age 17.4 years, duration 7.7 yrs, 50% female, 81% white). …

A Comparative Study Of Two Prediction Models For Brain Tumor Progression, Deqi Zhou, Loc Tran, Jihong Wang, Jiang Li, Karen O. Egiazarian (Ed.), Sos S. Agaian (Ed.), Atanas P. Gotchev (Ed.)

Electrical & Computer Engineering Faculty Publications

MR diffusion tensor imaging (DTI) technique together with traditional T1 or T2 weighted MRI scans supplies rich information sources for brain cancer diagnoses. These images form large-scale, high-dimensional data sets. Due to the fact that significant correlations exist among these images, we assume low-dimensional geometry data structures (manifolds) are embedded in the high-dimensional space. Those manifolds might be hidden from radiologists because it is challenging for human experts to interpret high-dimensional data. Identification of the manifold is a critical step for successfully analyzing multimodal MR images.

We have developed various manifold learning algorithms (Tran et al. 2011; Tran et al. …

Separating Autoimmune And Anti-Tumor Responses With Hsp70iq435a, James Mahon

Master's Theses

Vitiligo and melanoma are both melanocyte-derived diseases; vitiligo progresses through the autoimmune-targeted destruction of healthy melanocytes while melanoma results from uncontrolled proliferation of cancerous melanocytes. Treatment of vitiligo with HSP70iQ435A inhibits the DC-mediated auto-immune response against melanocytes in vitiligo mouse models; this raises the concern that treatment with this modified HSP may also inhibit natural anti-tumor responses against melanocyte-derived melanoma tumor cells.

We hypothesized that HSP70iQ435A prevents migration of melanocyte-antigen reactive T cells to the skin in a way that is mechanistically different from anti-tumor responses to melanoma and therefore would not have a negative effect on anti-tumor responses. We …

The Multimodal Brain Tumor Image Segmentation Benchmark (Brats), Bjoern H. Menze, Andras Jakab, Stefan Bauer, Jayashree Kalpathy-Cramer, Khan M. Iftekharuddin, Syed M.S. Reza

Electrical & Computer Engineering Faculty Publications

In this paper we report the set-up and results of the Multimodal Brain Tumor Image Segmentation Benchmark (BRATS) organized in conjunction with the MICCAI 2012 and 2013 conferences. Twenty state-of-the-art tumor segmentation algorithms were applied to a set of 65 multi-contrast MR scans of low-and high-grade glioma patients-manually annotated by up to four raters-and to 65 comparable scans generated using tumor image simulation software. Quantitative evaluations revealed considerable disagreement between the human raters in segmenting various tumor sub-regions (Dice scores in the range 74%-85%), illustrating the difficulty of this task. We found that different algorithms worked best for different sub-regions …

Examination Of Corporal Punishment From Three Perspectives: A Recommended Corporal Punishment Counseling Model And Its Application, Ayla Akbash

Khazar Journal of Humanities and Social Sciences

The corporal punishment has been examined through three different of perspectives, and a new psychological counseling model has been suggested for corporal punishment. The suggested model (CPC) has been applied in a psychological counseling group therapy. Consequently, new psycho-social developments such as behaviors, attitudes, emotions, opinions and experiences thoughts related to corporal punishment have been observed. Counseling sessions and evaluations have been presented in the study as well.