Medicine and Health Sciences Commons^™

Discussing History Of Mental Illness During Prenatal Genetic Counseling: Patient Interest And Comfort, Sarah Nimrichter

Theses and Dissertations

Purpose: This study aimed to explore patient interest in and comfort with discussing a personal and/or family history of mental illness with a genetic counselor during a prenatal genetic counseling session. Methods: Participants included pregnant women who met with a genetic counselor for routine prenatal screening/testing counseling at Palmetto Health USC Medical Group Department of OB/GYN. Following their appointment, they were given a copy of the invitation to participate, questionnaire, and mental health resource page by the genetic counselor who performed their genetic counseling. Results: Forty participants completed questionnaires. 70% of participants indicated some level of interest in discussing mental …

Implementation Of Provider And Workflow Strategies To Increase Adherence To Tqip Guidelines In Traumatic Brain Injury, Regina Thompson

Theses and Dissertations

Traumatic brain injury (TBI) is a leading cause of death and permanent disability worldwide. The American College of Surgeon’s Trauma Quality Improvement Program (TQIP) has developed a set of recommendations for the management of trauma-related injuries, including TBI. The objective of this evidenced-based practice project was to implement provider- and workflow-based strategies to improve adherence to TQIP recommended guidelines for the placement of intracranial pressure (ICP) monitors. The primary outcome measured was number of ICP monitors placed post-intervention.

The author reviewed available literature and found six articles pertaining to guideline implementations. Analysis of the literature was performed utilizing Melynk and …

Role Of Mir-489 In Her2 Positive Breast Cancer, Yogin Patel

Theses and Dissertations

Human epidermal growth factor receptor 2 (HER2 or ErBb2) is a receptor tyrosine kinase overexpressed in 20-30% of breast cancers and associated with poor prognosis and outcome. Dysregulation of several micro RNAs (miRs) plays a key role in breast cancer progression and metastasis. In this study, we screened and identified miRs dysregulated in HER2-positive breast cancer cells. Molecular study demonstrated that miR-489 was specifically downregulated by the HER2-downstream signaling, especially the MAPK pathway. Restoration or overexpression of miR-489 in HER2-positive breast cancer cells significantly inhibited cell growth in vitro and decreased the tumorigenicity and tumor growth in xenograft mice. Mechanistically, …

Environmental Links To Ectopic Kidney Diseases, Firas Alhasson

Theses and Dissertations

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the western culture and worldwide. Its morbidity has been raising and it has become a burden on the public health. NAFLD is associated with other metabolic diseases such as Diabetic Mellitus and hypertension. NAFLD is a wide spectrum of symptoms, from an accumulation of fat in the liver (cirrhosis) to production of scar tissue (Fibrosis). The liver along with other distal organs such as the kidney and cardiovascular system can be damaged as ectopic manifestations of NAFLD. Contamination of drinking water with Cyanobacterium toxin (Microcystin) and water disinfection …

Interactive Effects Of Domoic Acid Allelopathy, Salinity, And Eutrophication On Estuarine Phytoplankton Community Structure, Elise Van Meerssche

Theses and Dissertations

Coastal regions and estuaries are particularly sensitive to the increase in nutrient loading and river runoff, threatening the ecosystems with possible spreads in harmful algal blooms (HABs). As an example, blooms of toxic Pseudo-nitzschia species can release acute concentrations of the neurotoxin domoic acid (DA) in the water column. When ingested at concentrations higher than 20 ppm, DA can cause the death of marine birds, marine mammals and even humans. The main objectives of my research were to determine the drivers of Pseudo-nitzschia abundance and toxicity and to assess how these drivers influenced the phytoplankton community structure and DA allelopathy. …

Mechanisms Of Rad51d-Dependent Repair Of Dna And Telomere Damage Induced By Interstrand Crosslinking Agents And Thiopurines, Nicole M. Reilly

Theses and Dissertations

Mutations in homologous recombination (HR) genes increase genomic instability, an enabling characteristic of cancer. However, the status of these same genes can also determine chemotherapy outcomes. RAD51D is a breast and ovarian cancer susceptibility gene that is an important component of HR. Mammalian cells defective for RAD51D have extensive chromosomal aberrations and are more sensitive to the interstrand crosslink-inducing agent mitomycin C (MMC) and the thiopurine 6-thioguanine (6TG). Previously, the RNF138 E3 ubiquitin ligase was identified to promote RAD51D ubiquitination, and loss of RNF138 also increased cellular sensitivity to MMC. Ubiquitination assays were used to show that a 3-ubiquitin modification …

The Effect Of A Compassion Fatigue Awareness And Self-Care Skills Educational Program On Retention Among Certified Nursing Assistants Working In A Veterans Nursing Home, Michele M. Dreher

Theses and Dissertations

Background: Compassion fatigue is defined as the emotional and physical exhaustion that can affect helping professionals and caregivers over time. Certified nursing assistants (CNAs) are at high-risk for compassion fatigue due to their daily exposure to those who are suffering from a myriad of chronic medical and behavioral illnesses along with repeated workplace stressors. If not addressed early, compassion fatigue can adversely impact a CNA’s wellbeing and quality of resident care. Compassion fatigue is associated with high absenteeism, high turnover, and low retention rates. Despite these challenges, there is no published research on the effects of a workplace compassion …

Exploring Alternative Therapeutic Interventions For The Treatment Of Leigh Syndrome, Stephanie Martin

Theses and Dissertations

Leigh syndrome is the most common mitochondrial disease, affecting 1:40,000 live births. It manifests with symptoms including ataxia, cognitive impairment, motor difficulties, and stroke. Leigh syndrome is a genetic condition caused by mutations in either the nuclear DNA or mitochondrial DNA that affects the assembly of the electron transport chains. Death typically occurs around 2-3 years of age, due to respiratory failure, as the body cannot produce sufficient ATP for survival. The genetic basis of Leigh syndrome means that there is no cure, and current treatments of the symptoms have proven ineffective. This thesis proposes two different therapeutic approaches for …

Association Of Objective Measures Of Sleep And Inflammation Markers On Police Officers: A Cross-Sectional Analysis, Megan R. Buss

Theses and Dissertations

Police officers are a unique occupational group due to the fact that they have more health problems than many other occupations. These health problems could be a result of elevated inflammation markers caused by poor sleep. Sleep influences circadian rhythms, which thereby influences the function of the immune system. The immune system is responsible for the body’s inflammatory response using pro-inflammatory cytokines such as IL-6, CRP, Fibrinogen, and TNF-a. These cytokines can become elevated if disruption of the sleep cycle occurs. Elevated levels of inflammatory markers are associated with increased risk of cardiovascular disease. Police officers also work shifts and …

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal, Shibani Kulkarni

Theses and Dissertations

Child undernutrition is a serious issue in Nepal as 36% of children below five years of age are chronically undernourished. Reducing child undernutrition is an important priority to prevent adverse effects through the life course that perpetuate the cycle of undernutrition and poverty.

Women’s intra-household bargaining power is an important determinant of child nutrition. Intra-household bargaining power is an individual’s relative social and economic position within the household to access and control resources, and influence decision-making. In our research, we use women’s intra-household bargaining power as a resource for care, which enables women to be exposed to nutrition information, gain …

Forensic Patient Flow: An Imbalance Between Capacity And Demand, Versie J. Bellamy

Theses and Dissertations

Background: The United States (U.S.) has an ever-growing incarcerated population. The sheer volume of this population coupled with inefficient patient flow through the judicial and health care systems, create a large imbalance between the high demand for services and the capacity to deliver them. The delay in criminal defendants accessing mental health services is impacted by the lack of patient flow, which creates barriers to entering and exiting the forensic hospital system. The increasing demand for inpatient forensic services, coupled with a static supply of resources, warrants further intervention by treatment and service providers. Identifying and removing barriers to patient …

An Evidence-Based Evaluation Tool To Assist Healthcare Providers In Their Assessment Of Effective Mhealth Applications For The Management Of Chronic Health Conditions, Sara Belle Donevant

Theses and Dissertations

Mobile health (mHealth) apps are considered a viable option to improve chronic disease management. Healthcare providers are now recommending mHealth apps for patient use to assist in managing chronic diseases. However, healthcare providers may have difficulty locating effective, evidence-based mHealth apps for patients as there are currently over 325,000 available health apps (Research2Guidance, 2017). Limited evaluation tools are available to assist healthcare providers in this process. Therefore, our goal was to develop an online mHealth evaluation tool to assist healthcare providers in the selection of evidence-based mHealth apps.

After creating a comprehensive pool of mHealth features, healthcare providers provided feedback …

Effect Of Resveratrol On The Development Of Eczema, Christopher Carlucci

Theses and Dissertations

Atopic dermatitis is a type of eczema characterized by chronic inflammation of the skin, affecting millions of people worldwide. Resveratrol, a naturally occurring stilbenoid, is widely believed to exhibit beneficial effects on a host of chronic diseases. Although some previous studies have aimed to evaluate the effects of resveratrol on the pathogenesis of atopic dermatitis, this relationship remains ill-defined. We have previously established that mast cell activation, remodeling, and cellular infiltration in the hypodermis all begin prior to the IgE-mediated immune response in an atopic dermatitis mouse model, and that this early pathogenesis is directly related to an increase in …

A Longitudinal Analysis Of Shiftwork And Self-Reported Depression In A Police Cohort, Meghan Holst

Theses and Dissertations

Background: Shiftwork is associated with many chronic diseases stemming from the disruption of circadian rhythms. Police officers have a high risk for many adverse conditions including depression. Abnormal bodily functions, such as increased stress and disturbed sleeping patterns, may play an important role in the development and severity of depression. This study was designed to assess the association between depressive symptoms and shiftwork in a police cohort from Buffalo, NY

Methods: This longitudinal analysis consists of 470 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Data were collected during visit 3 between 2004-2005 and visit …

Referential Indexing: The Role Of Space In Reference Processing, Cameron Smith

Theses and Dissertations

A number of studies have suggested that spatial representations are used during language comprehension in a number of different paradigms (e.g. Ferreira et al., 2008; Gunter et al., 2015). These studies have largely focused on the visual modality, suggesting that people may use spatial cues in the visual environment to aid them in language comprehension. Importantly, the primary modality of spoken language is audition, which raises the question of whether the reliance on spatial information is specific to referents that are visible or at least were visible at some point. Thus, in this study, we examined whether spatial representations are …

Effect Modification By Stroke To The Relationship Between Tooth Loss And Cognitive Decline, Amanda Collins

Theses and Dissertations

Background: A decline in cognitive functioning is one of the greatest burdens that older adults face. Studies indicate that periodontal disease is positively associated with cognitive decline. The link between stroke and cognitive decline is well-established, and literature supports that tooth loss and stroke are associated as well, but the role that stroke plays in the relationship between tooth loss and decline in cognitive functioning is, as of yet, unclear. This study uses data from the REGARDS cohort to examine the effect of stroke on the relationship between periodontal disease and cognitive function.

Methods: The REGARDS cohort is comprised of …

Food Insecurity And Hypertension Prevalence, Awareness, Treatment And Control, Alexandra N. Luttrell

Theses and Dissertations

Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; …

Progress Monitoring Timing Effects In Speech And Written Language Therapy, James P. Blaida

Theses and Dissertations

Progress monitoring is a crucial aspect of speech-language pathology. Without it, speech-language pathologists (SLPs) have little way of determining if patients are making progress with the implemented therapy. Currently, most SLPs perform progress monitoring during therapy. This study compared the traditional, status-quo, method of progress monitoring to that of progress monitoring performed before therapy begins in an effort to determine if a timing change would affect therapy outcomes. 2 boys, receiving articulation therapy, and 1 girl, receiving spelling therapy, each had 1 treatment goal for the during condition and 1 treatment goal for the before condition. The children all received …

Neuroanatomical Correlates Of Speech And Melody Repetition In Chronic Stroke, Sarah Elizabeth Bradford

Theses and Dissertations

The ability to repeat speech is impaired in most individuals with aphasia. Recent evidence suggests damage to area Spt (boundary of the parietal and temporal lobes at the Sylvian fissure) may cause the repetition difficulties commonly seen in aphasia. This study examined if such repetition impairments are specific to speech or reflect a more general repetition deficit, and determined how regional and network brain damage predict repetition impairments. Participants in the chronic phase of stroke (N=47) listened to a series of ten five-second melodies that consisted of six tones and repeated the melody (by humming) following its presentation. The participants’ …

Chemotherapy Knowledge And Health Literacy Among Women With Breast Cancer, Pearman Detreville Parker

Theses and Dissertations

Chemotherapy education is imperative for patients to gain the knowledge to manage side effects, adhere to prescribed cycles, and recognize the severity of symptoms that require immediate provider contact. Two vital factors – the readability of teaching materials and the patient’s health literacy – must be considered during chemotherapy education. However, materials are often not assessed for readability. Further, the influence of a patient’s health literacy level and demographic factors on chemotherapy knowledge has not yet been investigated. The specific aims are to: (1) critique the readability and format of chemotherapy education materials; (2) explore how women with breast cancer …

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey, Serdar Aydin

Theses and Dissertations

The World Health Organization (WHO) defines health system as comprising of all the organizations, resources, and institutions dedicated to improving health. Health systems have a responsibility not just to improve the health of the population they serve but to provide financial protection against the costs of illness and to respond to people’s expectation with dignity. Besides, healthcare satisfaction and consumer satisfaction have become the latest trend in measuring quality to have a competitive advantage or best practice in the healthcare industry. Over the past 30 years, consumer satisfaction has gained widespread recognition as a measure of quality in many services …

Hiv In The United States: A Spatial Examination Of Testing And Outcomes, Sazid Shameem Khan

Theses and Dissertations

The main objectives of this dissertation were to provide a complete depiction of the prevalence of HIV across the United States and to assess HIV testing trends among various subpopulations. Additionally, we focused on measuring spatial access to HIV testing resources across the U.S. South, where HIV is rapidly becoming more burdensome and resources have historically been allocated disproportionately. We sought to identify disparate populations and locations that require further focus moving forward to stem the HIV epidemic. We utilized a variety of data sources such as the Behavioral Risk Factor Surveillance System (BRFSS) which was used to assess national …

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity, Caroline Glagola Dunn

Theses and Dissertations

Faith-based research and partnerships are becoming more popular as an approach to address the health of underserved populations including racial and ethnic minorities and rural populations. Despite growing interest in faith-health partnerships, little research is available assessing faith-based interventions as potential leverage points for the prevention of childhood and adolescent obesity and the promotion of healthy behaviors. This research aimed to examine the potential for such partnerships within the context of ongoing research partnerships in South Carolina. Specifically, the first study assessed current peer-reviewed literature to determine reporting of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM elements) in faith-based nutrition …

Integrating Genetic Counseling And Testing In The Pediatric Oncology Setting: Parental Attitudes And Influencing Factors, Lauren Renee Desrosiers

Theses and Dissertations

Cancer predisposition syndromes (CPS), caused by germline pathogenic variants in tumor suppressor genes and oncogenes, are genetic conditions that put an individual at increased risk to develop cancer. It is estimated that 10-15% of children with cancer have an underlying CPS. Although genetic testing for these conditions has become routine in the adult setting, incorporation of germline genomic technologies into pediatric cancer care has not occurred as rapidly. The purpose of this study is to assess desire for genetic counseling and testing services among parents of children with cancer to provide parental insight in the incorporation of genomic technologies in …

Utilization Of The Usda Supertracker System In High Schools: A Quality Improvement Project, Twanda D. Addison

Theses and Dissertations

Obesity is a major chronic care condition proven to affect more than 12 million children and adolescents, age 2 to 19; categorizing approximately 17% of America’s youth as obese or overweight. As a result, Congress established federal mandates targeting obesity by enforcing nutritional policies for cafeteria and competitive foods to enhance learning environments. Establishing federal nutritional guidelines in education allows more than 31 million children to receive meals at a free or low cost in more than 96,000 public and nonprofit private schools. As such, the purpose of this quality improvement project is to compare individual food choices with the …

Role Of Cox2 In Cellular Senescence, Mingxiao Feng

Theses and Dissertations

The survivors of childhood cancers are often associated with adverse late effects including hypoplasia, fatigue, and infertility, which are characteristics of aging. However, the underlying mechanisms of the late effects of chemotherapy are still elusive. We have found that transgenic cyclooxygenase-2 (COX2) expression causes premature aging phenotypes. Since COX2 expression is highly induced by various chemotherapeutic agents, we further investigated the possible link between COX2 and the late effects of chemotherapy. Treatment of juvenile wild-type mice with doxorubicin (DOX), an anthracycline-based chemotherapeutic agent, resulted in premature aging phenotypes and escalated cellular senescence level in various tissues. We found that tissue …

Spiritual Care In Cancer Genetic Counseling: Patient Perceptions Of Methods, Christopher Michael Spencer

Theses and Dissertations

The integration of spirituality into medical care is a growing area of debate among professionals, involving a delicate balance between serving patients who may benefit from this without alienating those who would not. To date, little research has targeted spirituality in cancer genetic counseling, particularly concerning the various methods a genetic counselor can use to address spirituality with their patients. A paper questionnaire was created and distributed to patients following their cancer genetic counseling appointments to gain insight on their perception of these methods. Fifty-two participants completed this questionnaire. The eight different spiritual integration methods presented each showed positive responses …

Polyp Detection During Colonoscopy Among Uninsured Patients In South Carolina, Lauren Hill

Theses and Dissertations

Little information is known on what demographic, behavioral, and procedural factors influence the number of polyps found during a colonoscopy screening for colorectal cancer (CRC). The main objective of this study is to describe the polyp detection rate (PDR), number of polyps removed, and predictors of polyp count overall and for high-risk polyps among uninsured patients undergoing colonoscopy in the Colorectal Cancer Prevention Network (CCPN) program of South Carolina. We performed a secondary data analysis on CCPN data for colonoscopies performed between May 2014 and May 2017. We assessed the association of polyp count with the following variables: age, race, …

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics, Anna Victoria Mesa

Theses and Dissertations

The growing prevalence of chronic disease among the U.S. Hispanic population has drawn increasing attention to modifiable behaviors such as diet in an effort to curb the burden of disease among this population. While factors affecting dietary intake among U.S. Hispanics have been largely studied, this study broadens the scope of existing analyses from examining the role of individual-level factors, including acculturation, to also include environmental factors such as neighborhood ethnic composition. Multilevel mixed modeling was employed to test the interaction of individual acculturation with neighborhood ethnic composition to predict vegetable intake among a sample of U.S. Hispanics. Individuals who …

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …