Medicine and Health Sciences Commons^™

Consensual Qualitative Research: Replicability Of Results And Social Reliability Of Process, Nicholas Morrison

Doctoral Dissertations

To solidify further their scientific footing, qualitative approaches would ideally demonstrate that they yield replicable information about a phenomenon under study. Although consensual qualitative research (CQR; Hill, 2012) proposes a rigorous, multistep method to enhance interjudge reliability and instill confidence in the results, it remains unclear if multiple uniformly trained teams analyzing the same stimulus set would arrive at similar analytic output (i.e., replicability—a high form of trustworthiness). Moreover, it is unclear if replicability (or lack thereof) might be influenced by the process through which CQR judges arrive at their output (i.e., social reliability). Addressing these gaps, this …

Cytochrome P450 Monooxygenase-Mediated Lipid Metabolism In Obesity And Colon Tumorigenesis, Weicang Wang

Doctoral Dissertations

Colon cancer is a major public health issue: it is expected to have 140,250 new cases and 50,630 deaths during 2018, making colon cancer the third most common type of cancer and the second leading cause of cancer death in the United States. Obesity is associated with enhanced colonic inflammation, which is a major risk factor of colorectal cancer. Currently, more than 35% of adults and nearly 17% of children are obese. Considering the obesity and colon cancer epidemic in the United States, there is an urgent need to identify novel therapeutic targets for obesity and colon cancer. Here, using …

Protein Detection And Structural Characterization By Mass Spectrometry Using Supramolecular Assemblies And Small Molecules, Bo Zhao

Doctoral Dissertations

Mass spectrometry (MS) has played an increasingly prominent role in proteomics and structure biology because it shows superior capabilities in identification, quantification and structural characterization of proteins. To realize its full potential in protein analysis, significant progress has been made in developing innovative techniques and reagents that can couple to MS detection. This dissertation demonstrates the use of polymeric supramolecular assemblies for enhanced protein detection in complex biological mixtures by MS. An amphiphilic random co-polymer scaffold is developed to form functional supramolecular assemblies for protein/ peptide enrichment. The influences of charge density and functional group pK_a on host-guest interactions …

The Social Process Of Dying In The Hospital: A Grounded Theory Study, Alyson Prokop

Doctoral Dissertations

The majority of deaths in the United States occur in the hospital (Xu, Kochanek, Murphy, & Tejada-Vera, 2010). Because there is little understanding of the meaning behind this delicate social process for the patient, the purpose of this study was to develop a theory that describes the social processes one undergoes during the in-hospital end-of-life phase. Grounded theory methodology was chosen to understand this phenomenon and then explain it theoretically (Charmaz, 1990). The data used to develop the theoretical model was previously collected by StoryCorps and therefore components of secondary analysis were taken into consideration. Stories that are housed at …

Engineering Nanomaterials For Imaging And Therapy Of Bacteria And Biofilm-Associated Infections, Akash Gupta

Doctoral Dissertations

Infections caused by multidrug-resistant (MDR) bacteria pose a serious global burden of mortality, causing thousands of deaths each year. The “superbug” risk is further exacerbated by chronic infections generated from antibiotic-resistant biofilms that are highly resistant to available treatments. Synthetic macromolecules such as polymers and nanoparticles have emerged as promising antimicrobials. Moreover, ability to modulate nanomaterial interaction with bacterial cellular systems plays a pivotal role in improving the efficacy of the strategy. In the initial studies on engineering nanoparticle surface chemistry, I investigated the role played by surface ligands in determining the antimicrobial activity of the nanoparticles. In further study, …

Three Essays On Data-Driven Optimization For Scheduling In Manufacturing And Healthcare, Ekin Koker

Doctoral Dissertations

This dissertation consists of three essays on data-driven optimization for scheduling in manufacturing and healthcare. In Chapter 1, we briefly introduce the optimization problems tackled in these essays. The first of these essays deals with machine scheduling problems. In Chapter 2, we compare the effectiveness of direct positional variables against relative positional variables computationally in a variety of machine scheduling problems and we present our results. The second essay deals with a scheduling problem in healthcare: the team primary care practice. In Chapter 3, we build upon the two-stage stochastic integer programming model introduced by Alvarez Oh (2015) to solve …

Cross-Cutting Narratives Of Opioid Use Disorder Among Pregnant Women And Mothers: Implications For Humanistic Care, Alice Fiddian-Green

Doctoral Dissertations

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, …

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Multi-Level Barriers To Art Adherence Among Hiv-Infected Women In Rural Eswatini: A Mixed Methods Approach, Nozipho Becker

Doctoral Dissertations

Eswatini has the highest global prevalence of HIV despite universal access to free treatment. Lack of compliance continues to be a significant challenge for HIV care and management programs throughout the country. Studies investigating barriers to antiretroviral therapy (ART) adherence, particularly in women, who are the most vulnerable to HIV infections, are limited. The disproportionate impact of HIV on women can be attributed to multiple risk factors at the individual, household, and community/structural levels. Women living in rural settings are particularly at risk as a result of socio-cultural and environmental vulnerabilities such as oppressive traditional practices, intimate partner violence, and …

Combining Human Factors And Data Science Methods To Evaluate The Use Of Free Text Communication Orders In Electronic Health Records, Swaminathan Kandaswamy

Doctoral Dissertations

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion …

Game-Assisted Rehabilitation For Post-Stroke Survivors, Hee-Tae Jung

Doctoral Dissertations

Stroke is a leading cause of permanent impairments among its survivors. Although patients need to go through intensive, longitudinal rehabilitation to regain function before the stroke, patients show poor engagement and adherence to rehabilitation therapies which hampers their recovery. As a means to enhance stroke survivors' motivation, engagement, and adherence to intensive and longitudinal rehabilitation, the use of games in stroke rehabilitation has received attention from research and clinical communities. In order to realize this, it is important to take a holistic, end-to-end research approach that encompasses 1) the development of game technologies that are not only entertaining but also …

Estimating Age-Specific Contraceptive Use For Spacing Of Childbirth For All Countries In Sub-Saharan Africa From 1985 To 2030 Using A Bayesian Hierarchical Time Series Model, Gregory Guranich

Masters Theses

Contraceptive usage for spacing of childbirth is an important indicator for understanding family planning practices as well as fertility transitions. Fertility transition are especially important in sub-Saharan Africa where fertility remains high in many countries. However, estimates and short-term projections are generally not available for countries in this region. We developed a Bayesian hierarchical time series model to estimate and project usage of contraceptives for spacing by 5-year age groups for all countries in sub-Saharan Africa for the years 1985-2030. Estimating country-age-year specific usage is challenging due to limited data availability. We use Bayesian hierarchical models to share information across …

Markov Decision Process Approach To Strategize National Breast Cancer Screening Policy In Data-Limited Settings, Vijeta Deshpande

Masters Theses

Early diagnosis is a promising strategy to reduce premature mortalities and for optimal use of resources. But the absence of mathematical models specific to the data settings in LMIC’s impedes the construction of economic analysis necessary for decision-makers in the development of cancer control programs. This thesis presents a new methodology for parameterizing the natural history model of breast cancer based on data availabilities in low and middle income countries, and formulation of a control optimization problem to find the optimal screening schedule for mammography screening, solved using dynamic programming. As harms and benefits are known to increase with the …

Gestational Weight Gain, Offspring Asthma And Wheeze Phenotypes In Project Viva, Kathryn Wagner

Masters Theses

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. …

Assessing The Association Between Physical Activity And Prediabetes Using The National Health And Nutrition Examination Survey 2007-2014, Mabeline Velez

Masters Theses

Prediabetes, a condition in which glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes, affects approximately 37% of adults in the United States and is a major public health concern. Extensive research has evaluated the association between physical activity (PA) and type 2 diabetes; however, few studies have examined the association between PA and prediabetes. Therefore, we evaluated the association between PA (including leisure time, occupational and total) and prediabetes status among adults, stratified by gender, using multinomial logistic regression models fit to serial cross-sectional 2007-2014 National Health and Nutrition Examination Survey …

Making The Invisible Visible: Adolescent Caregiver Experiences In Multiple Sclerosis, Renee Crizer

Doctoral Dissertations

Multiple Sclerosis, a chronic, debilitating neurological disease is typically diagnosed during the child bearing and child rearing ages of 20-50. Therefore, many people diagnosed with Multiple Sclerosis have children and adolescents living at home. With approximately 400,000 people in the United States currently diagnosed with multiple sclerosis and 10,000 new cases each year, a group of caregivers have emerged that are often unrecognized and potentially at risk: a group of young caregivers. The aim of this study was to explore the lived experience of individuals who provided care for a family member with Multiple Sclerosis during their adolescence. This qualitative, …

Associations Between Adverse Childhood Experiences And Attitudes Towards Abuse Against Women And Children Among Adolescents And Young Adults In Malawi, Nellipher Lewis Mchenga

Doctoral Dissertations

The purpose of this study was to examine attitudes towards abuse against women and children between adolescents, aged 13 to 17, who had adverse childhood experiences (ACEs) and those who did not, and young adults, aged 18 to 24, who had ACEs and those who did not. The study also evaluated whether the region of residence moderates the relationship between participants’ adverse childhood experiences and attitudes towards abuse against women and children. Secondary data collected from adolescents and young adults aged 13 to 24 between September and October of 2013 in the Violence Against Children and Young People Malawi Survey …

Impact Of Footwear On Mechanisms Of Knee Osteoarthritis Progression, Ethan Steiner

Masters Theses

Knee osteoarthritis (OA) is a debilitating disease affecting the entire knee joint by inducing pathological changes to the cartilage and menisci. Currently, the etiology of OA is not completely understood. However, altered gait mechanics, specifically increased joint loading, of OA patients have a clear association with both symptomatic and structural OA progression. Non-surgical intervention tools, such as variable stiffness shoes (VSS), have been developed as a way to decrease loading within the knee joint. However, with external moments being surrogate measures for knee loading, it is unclear if changes in knee moments with the footwear are sufficient to result in …

A Computational Simulation Model For Predicting Infectious Disease Spread Using The Evolving Contact Network Algorithm, Buyannemekh Munkhbat

Masters Theses

Commonly used simulation models for predicting outbreaks of re-emerging infectious diseases (EIDs) take an individual-level or a population-level approach to modeling contact dynamics. These approaches are a trade-off between the ability to incorporate individual-level dynamics and computational efficiency. Agent-based network models (ABNM) use an individual-level approach by simulating the entire population and its contact structure, which increases the ability of adding detailed individual-level characteristics. However, as this method is computationally expensive, ABNMs use scaled-down versions of the full population, which are unsuitable for low prevalence diseases as the number of infected cases would become negligible during scaling-down. Compartmental models use …

Development And Cross-Validation Of A Cadence-Based Metabolic Equation For Walking, Christopher C. Moore

Masters Theses

The ACSM Metabolic Equation is a widely recognized equation for predicting metabolic intensity from walking speed. However, an equation that uses an observable metric (i.e., cadence [steps/min]), accounts for individual characteristics, and is validated across walking conditions may enable more accessible and accurate predictions of walking intensity. PURPOSE: To develop metabolic equations that predict metabolic intensity (oxygen consumption; mL/kg/min) from cadence using a large treadmill walking dataset (Study One) and cross-validate these equations during overground unconstrained and cadence-constrained walking conditions (Study Two). METHODS: In Study One, 193 adults (21-81 years) completed treadmill walking bouts while oxygen consumption was measured with …

Patient Sex And Physician Adherence To Treatment Guidelines For Non-Purulent Cellulitis, Rebecca Goldberg

Masters Theses

In 2015, participating US Emergency Departments (EDs) reported approximately 2.8 million visits related to skin and soft tissue infections (SSTIs). Studies indicate that there may be disparities by patient sex in physician treatment guideline adherence rates as a result of a gender bias during physician-patient interactions; however, only two epidemiologic studies have investigated the role of patient sex in guideline adherence rates for SSTIs. These prior studies were limited in size and covariate assessment. Thus, the magnitude and direction of the effect of patient sex is uncertain, warranting further research. Therefore, we conducted a large prospective study to elucidate the …

Antipsychotic Drug Use And Postmenopausal Breast Cancer Risk In The Women’S Health Initiative (Whi): A Prospective Cohort Study, Anna George

Masters Theses

Breast cancer is the most prevalent form of cancer and the second leading cause of mortality, affecting 1 in 9 women in the United States. Recent studies have shown that antipsychotic drug use is associated with increased prolactin levels, which, in turn, is associated with increased risk of breast cancer. However, studies of the association between antipsychotic drug use and the risk of breast cancer are sparse and have largely been conducted in homogenous populations. Therefore, we evaluated this relationship in postmenopausal women (N = 119 524) in a diverse population of the Women’s Health Initiative (WHI) cohort. Antipsychotic drug …

Mechanisms And Mitigation Of Skeletal Muscle Fatigue In Single Fibers From Older Adults, Aurora Foster

Masters Theses

Skeletal muscle fatigue is the contraction-induced decline in whole muscle force or power, and can be greater in older versus young adults. Fatigue primarily results from increased metabolism elevating phosphate (P_i) and hydrogen (H⁺), which alters myosin-actin interactions; however, which steps of the myosin-actin cross-bridge cycle are changed and their reversibility are unclear. PURPOSE: This study sought to: 1) Examine the effects of elevated P_i and H⁺ on molecular and cellular function, and 2) Test the ability of deoxyadenosine triphosphate (dATP), an alternative energy to adenosine triphosphate (ATP), to reverse the contractile changes induced …

Dysphagia Management In Schools: A Survey Of Speech-Language Pathologists, Catherine Felicetti

Masters Theses

Introduction: To date, few research studies have evaluated pediatric feeding and swallowing practices in school systems across the United States. This study aims to i) understand the factors that impact a speech-language pathologists (SLPs) level of comfort in providing these services, ii) to identify barriers to service provision, iii) develop a concrete understanding of a SLPs role in providing feeding and swallowing services in a school setting, and iv) to identify the types of service suggested by school-based SLPs in response to a fictional case study.

Methods: School-based SLPs and clinical fellows were invited to participate in a 10-15 minute …

Cultural And Family Challenges In Type Two Diabetes Self-Care For Puerto Rican Identified Hispanic Adults, Jalil Johnson

Doctoral Dissertations

ABSTRACT CULTURAL CHALLENGES IN TYPE TWO DIABETES SELF-CARE FOR PUERTO RICAN IDENTIFIED HISPANIC ADULTS FEBRUARY 2019 JALIL A. JOHNSON, B.S.N., MIDDLE TENNESSEE STATE UNIVERSITY M.S., UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL, WORCESTER Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Dean Stephen Cavanagh Background: Puerto Rican identified Hispanics are disproportionately affected by type 2 diabetes and co-morbid conditions compared to their white counterparts. Culturally tailored interventions improve self-care for Hispanic populations. Interventions should be tailored to the targeted Hispanic subgroup. The intersection of Familism in Puerto Rican culture as it influences type 2 diabetes self-care is not well understood. Research Aims: The …

Young Adult Early Childhood Home Visitors’ Perceptions Of Fan (Facilitating Attuned Interactions) And Its Potential Protection To Burnout, Lee Mackinnon

Doctoral Dissertations

ABSTRACT YOUNG ADULT EARLY CHILDHOOD HOME VISITORS’ PERCEPTIONS OF FAN (FACILITATING ATTUNED INTERACTIONS) AND ITS POTENTIAL PROTECTION TO BURNOUT FEBRUARY 2019 LEE MACKINNON, B.A., WILLIAMS COLLEGE Ed.M., HARVARD UNIVERSITY Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Claire E. Hamilton This qualitative study investigated the experience of young adult early childhood home visitors in the training and implementation of a family engagement tool, Facilitating Attuned Interactions (FAN) (Gilkerson, 2015). Using Interpretative Phenomenological Analysis, the case study explored how 5 home visitors, who were under 30 years of age, viewed their training and use of FAN in three components of their …

Hybridized Polymeric Nano-Assemblies: Key Insights Into Addressing Mdr Infections, Ryan Landis

Doctoral Dissertations

Multidrug-resistant (MDR) bacteria contribute to more than 700,000 annual deaths world-wide. Millions more suffer from limb amputations or face high healthcare treatment costs where prolonged and costly therapeutic regimens are used to counter MDR infections. While there is an international push to develop novel and more powerful antimicrobials to address the impending threat, one particularly interesting approach that has re-emerged are essential oils, phytochemical extracts derived from plant sources. While their antimicrobial activity demonstrates a promising avenue, their stability in aqueous media, limits their practical use in or on mammals. Inspired by the versatility of polymer nanotechnology and the sustainability …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Changes In Muscle Control And Coordination In Novel Task Learning, Sangsoo Park

Doctoral Dissertations

Learning many daily life motor skills is critical for survival and the quality of living in humans. As children, we develop walking and running patterns to move the body from point A to B without falling, and we learn to grasp a wide variety of objects during activities of daily living. Motor skills can be properly performed by appropriate muscle activations which are controlled by the central nervous system. How does the central nervous system develop and fine-tune its control strategy to learn a new motor skill? The aim of this dissertation was to better understand how human participants alter …

Direct Printing Of Conductive Inks For Organic Electronics And Wearable Microfluidics, Aditi Naik

Doctoral Dissertations

This dissertation examines the direct printing of conductive inks on polymeric substrates for applications in organic electronics, microfluidic valving systems, and wearable sweat sensors. The inexpensive production of solution-based electrodes with high electrical conductivity is necessary to enable the next-generation of printed, flexible, and organic electronics. Specifically, the optimization and printing of liquid-phase graphene ink and nanoparticle-based silver ink by soft nanoimprint lithography and inkjet-printing is discussed to achieve printed functional devices. Using scalable low-cost patterning systems, these flexible applications are compatible with roll-to-roll processing, enabling large-scale manufacturing. This research expands the knowledge of high-resolution printing optimization for the direct …