Medicine and Health Sciences Commons^™

Evaluating Religiosity Across The Lifespan And Fatalistic Beliefs Among Patients Of A Chronic Care Management Intervention Program With Type 2 Diabetes, Cindy Lynn Salazar

Dissertations and Theses (Open Access)

The overall goal of the present study was to assess the effect of fatalistic beliefs and lifetime religiosity on glycemic control and blood sugar monitoring behavior among Mexican-American participants of a chronic care management intervention program of the Rio Grande Valley. In order to achieve these aims, a mixed methods prospective longitudinal study design was utilized among approximately 500 participants of the Salud y Vida program. Qualitatively, a phenomenological approach was used to analyze semi-structured interview data assessing fatalism and religiosity and type 2 diabetes management among 15 participants stratified by engagement in the Salud y Vida program. Fatalistic beliefs …

Primary Care Shortage And Physician Migration In Texas: Analysis And Policy Implications, Adele Semaan

Dissertations and Theses (Open Access)

This study aims to gain a better understanding of primary care (PC) physician movements in Texas between 2010 and 2014. The first and second objectives were to identify the person- and place-specific factors associated with those physicians moving to PC shortage counties. The third objective was to clarify the policy landscape related to PC shortage and identify any associations these policies had with changes to PC physicians’ movements. The methods combined quantitative and qualitative approaches. The study used data on licensed physicians from the Texas Medical Board, and data on Health Professionals Shortage Areas from the Texas Health Professions Resource …

Big Tobacco. Big Marijuana? Longitudinal Trends And Multi-Directional Tobacco And Marijuana Use Among Youth And Young Adults In Texas, Shannon Rogers

Dissertations and Theses (Open Access)

Due to the pace of legal changes in marijuana policy, shifting trends in marijuana use, and emerging products in the tobacco product marketplace (e.g., ecigarettes), the cycle of risk between marijuana and tobacco use is not currently wellunderstood. I used longitudinal data from two parallel rapid response surveillance studies of youth (aged 12-19 years) and young adults (aged 18-25 years) living in the five counties (Bexar, Dallas, Harris, Tarrant, and Travis) that surround the four largest cities in Texas (Austin, Houston, San Antonio, and Dallas/Fort Worth). I used Generalized Linear Mixed Models (GLMMs) and six-panel cross-lagged regression models to analyze …

Evaluating The Impact Of Heal Pregnancy Intervention On Breastfeeding Initiation And Duration, Dolly Noel Rinehart

Dissertations and Theses (Open Access)

Despite nationwide improvements in breastfeeding behaviors, many minority, low-socioeconomic status women in the United States fail to follow breastfeeding recommendations. Healthy Eating Active Living (HEAL), a free antenatal program in Houston, Texas, teaches pregnant women healthy lifestyle behaviors and promotes breastfeeding. The objective of this paper was to determine the impact of HEAL on breastfeeding initiation and length of breastfeeding duration among predominantly low income, minority, underserved women in Houston, TX. Methods: HEAL is a natural experiment rooted in Social Cognitive Theory and Theory of Planned Behavior. Data was collected from two sources, the HEAL pregnancy post-delivery survey and the …

Assessing The Relationship Between University Environmental Health And Safety Program Resourcing And Ultimate Outcomes, Jason R. Shyu

Dissertations and Theses (Open Access)

College and university campuses contain a diverse set of potential health and safety risks mixed with a population that is equally varied. Such a combination requires effective risk management programs adapted to address these challenges. Methods currently exist to predict risk financing premiums and institutional risk control resources (inputs), but there are no models addressing relationships to final Environment Health & Safety (EHS) program outcomes (outcomes such as injuries or illnesses). Publicly available data obtained from the University of Texas System Office of Risk Management describing their 14 campuses was combined with publicly available data from the National Science Foundation …

Role Of Disinfectants In The Eradication And Propagation Of Clostridiodes Difficile Infection, Tasnuva Rashid

Dissertations and Theses (Open Access)

Introduction:

Clostridioides difficile is a motile, gram-negative, toxin-producing bacteria responsible for the majority of the nosocomial as well as community-acquired infection in the US and worldwide. A high rate of morbidity, mortality, recurrences, healthcare cost coupled with frequent epidemic outbreaks with drug-resistant strains has classified C. difficile as a pathogen with an urgent threat to human health. Current guidelines regarding disinfectant use are either limited or absent or are not effective in reducing the environmental burden of C. difficile. The aims for this study was first to determine the in vitro efficacy of select hospital disinfectants in eradicating the spores …

Machine-Learning And Statistical Subgroup Analyses Of Vasopressor Choice For The Treatment Of Non-Traumatic Subarachnoid Hemorrhage Using Electronic Health Records, Emy Anu Thomas

Dissertations and Theses (Open Access)

Abstract: Subarachnoid hemorrhage (SAH) is a life-threatening stroke caused by bleeding in the subarachnoid space. Delayed cerebral ischemia, a risk factor for death during non-traumatic SAH treatment, is often prevented by inducing hemodynamic augmentation through the administration of vasopressors. The three common vasopressors administrated to SAH patients are dopamine, phenylephrine, and norepinephrine. A recent study using Electronic Health Records (EHR) of nontraumatic SAH patients identified that the administration of phenylephrine is associated with lower hospital mortality; however, this study did not consider heterogeneity in treatment effects. Therefore, the goal of this paper is to study the heterogeneity in vasopressor treatment …

The Use Of Neoadjuvant Brachytherapy In Endometrial Cancer, Alison Yoder

Dissertations and Theses (Open Access)

Uterine cancer is the most common gynecologic malignancy in the United States with almost 62,000 cases expected in 2019. In general, treatment consists of primary surgery possibly followed by adjuvant radiation and/or chemotherapy. However, in cases with cervical involvement or when the patient is a non-surgical candidate, neoadjuvant treatment can be employed; specifically, neoadjuvant radiation with or without brachytherapy and/or chemotherapy. There have not been any large-scale studies looking at the addition of brachytherapy to external beam radiation in the neoadjuvant setting and whether or not its addition improves outcomes. In order to analyze this, the National Cancer Database was …

The Relationship Between Social Media Use And Depression In College Students: A Scoping Review, Susan Wu

Dissertations and Theses (Open Access)

Background: In 2017, 17.3 million adults in the U.S. (7.1% of all U.S. adults) have had at least one major depressive episode, with individuals ages 18-25 having the highest prevalence of major depression at 13.1%. Studies have looked at the association between social media (SM) use and depression with mixed findings. The goal of this research is to conduct a scoping review of existing evidence for the relationship between SM use and depression among college students.

Methods: Searches for articles published in the scientific literature were performed on PubMed, Embase and Scopus. Articles selected followed an inclusion criteria: studied SM …

Evaluating The Multivariate Relationship Between Breastfeeding, Early Childhood Obesity, Asthma, And Mental Illness In Dallas, Tx, Sitara Weerakoon

Dissertations and Theses (Open Access)

The aim of this study was to examine the associations between breastfeeding, asthma and mental illness in North Texas children aged two to five years, and to explore whether these associations are explained by the presence of obesity. The study population comprised of 1,174 children whose caregivers responded to a 2015 survey administered by Children’s Health and the Health & Wellness Alliance for Children. Information on breastfeeding, BMI, asthma, and mental illness were self-reported by primary caregivers. Of the 1,174 children, 61% were breastfed, 13% had asthma, and 17% had a mental illness. The odds of having asthma were 2.28 …

Numerical Study For Seamless Clinical Trials With Covariate Adaptive Randomization, Mengxi Wang

Dissertations and Theses (Open Access)

One important goal of the pharmaceutical industry is to evaluate new therapies in a time-sensitive and cost-effective manner without undermining the integrity and validity of clinical trials. Adaptive seamless phase II/III designs (ASD) have gained popularity for accelerating the drug development process and reducing cost. Covariate adaptive randomization (CAR) is the most popular design in randomized controlled trials to ensure valid treatment comparisons by balancing the prognostic characteristics of patients among treatment groups. Although adaptive seamless clinical trials with CAR have been implemented in practice1, the theoretical understanding of such designs is limited. In addition, current approaches to control the …

Long-Term Outcomes After Endovascular Stent Placement For Long-Segment Superficial Femoral Artery Lesions, Nader Zamani

Dissertations and Theses (Open Access)

Objective: Endovascular intervention is commonly pursued as first-line management of symptomatic, long-segment superficial femoral artery (SFA) disease. The relative effectiveness and comparative long-term outcomes among bare metal stents (BMSs), covered stents (CSs), and drug-eluting stents (DESs) for long-segment SFA lesions remain uncertain.

Methods: A retrospective cohort study identified patients with symptomatic SFA lesions measuring at least 15cm who successfully received an endovascular stent (BMS, CS, or DES). The outcomes were patency, patient presentation upon stent occlusion, amputation free survival (AFS), and all-cause mortality. Proportional hazards regressions and a multinomial logistic regression model were used to control for significant confounders.

Results: …

Lymphocyte-Specific Tyrosine Kinase Expression In Ovarian Cancer: A Valuable Prognostic Indicator, Emily Moss Hinchcliff

Dissertations and Theses (Open Access)

Cellular immune response, specifically tumor infiltrating lymphocytes (TILs), has been correlated to survival in epithelial ovarian cancer; however, specific gene expression patterns for this response remain poorly understood. The objective of this research was to investigate the prognostic and biologic significance of immune-related gene expression in high grade serous ovarian cancer (HGSOC). To do so, a panel of immune related gene expression was evaluated in HGSOC utilizing The Cancer Genome Atlas (TCGA) and validated in an independent cohort of ovarian tumors. Based on the strong association with survival, the cohort was grouped into LCK (lymphocyte specific tyrosine kinase) high and …

Clinical Diagnostic Whole Exome Sequencing For Infants In Intensive Care Settings: Outcomes Analysis And Economic Evaluation, Hadley Stevens Smith

Dissertations and Theses (Open Access)

Whole exome sequencing (ES) is an extensive form of genetic testing and increasingly used as a diagnostic tool. Clinical uptake of genome-scale sequencing occurred without clear guidelines for application or robust information regarding potential impact on patient health outcomes or cost of care. For infants in intensive care with suspected genetic conditions, ES can be especially powerful to identify a specific diagnosis and inform crucial decisions about medical care. However, little is known about the cost-effectiveness of ES compared to other diagnostic strategies. This project first assessed the literature on pediatric clinical ES. Then, using electronic medical record, diagnostic laboratory, …

Fire Department Support And Physical Activity Of Volunteer Firefighters: A Cross-Sectional Examination, Sarah Wagner

Dissertations and Theses (Open Access)

Greater health and fitness of volunteer firefighters protects them from cardiovascular disease-related deaths, reduces risk of injury, and improves job performance, which subsequently provides better protection for the majority of the U.S. population who is served by volunteers. Given the strong social support system characteristic of the U.S. fire service, there seems to be potential opportunity to influence the behaviors of firefighters by creating a culture that promotes healthy habits rather than unhealthy. Objective: Determine the association between fire department culture’s encouragement of physical activity and volunteer firefighters’ moderate- to vigorous-intensity aerobic activity. Methods: A cross sectional analysis was performed …

Evaluating The Impact Of Early Initiation Of Antiretroviral Therapy (Art) On Patient Outcomes Among Hiv-Infected Adolescents And Young Adults In Uganda, Hilda Sekabira Nakalema

Dissertations and Theses (Open Access)

Introduction: Since the introduction of anti-retroviral therapy (ART), treatment initiation criteria have continually been revised to start these lifesaving drugs before onset of advanced disease and optimize ART benefits for people living with HIV. However, little is known about the effect of these changes on treatment outcomes among young people. We evaluated the effect of such a policy change on long term adherence and treatment outcomes among young people, aged 15-24 years.

Methods: We conducted a retrospective cohort analysis of young people, 15-24years old, who started ART from January 2012 – December 2016. We used administrative data from the District …

Ends Device Types And Subsequent Use Of Combustible Tobacco Products Among Texas Youth, Aslesha Sumbe

Dissertations and Theses (Open Access)

The aims of the study were to determine whether ENDS device types (i.e., disposable devices, replaceable cartridges, and refillables) at initial, or first ENDS use is longitudinally associated with subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) and continued, past 30-day use of combustible and ENDS products. This study is a secondary analysis of data from the Texas Adolescent Tobacco and Marketing Surveillance system (TATAMS) study, a longitudinal cohort study of students who were in the 6th, 8th, and 10th grades (n = 3907) during the 2014-2015 academic year. Data were collected every 6 months, from 2014-2018. Using data …

Dynamic Competing Risk Model For Multi-Type Recurrent Events With Dependent Termination, Alokananda Ghosh

Dissertations and Theses (Open Access)

Cardiovascular disease (CVD), defined by the World Health Organization (WHO) as diseases that involve the heart and/or blood vessels is the number one cause of morbidity and mortality worldwide. In the United States more health care dollars are spent managing and treating CVD and/or its complications than any other disease process. Coronary heart disease (CHD) is the leading cause of deaths (43.8%) attributable to CVD, followed by stroke (16.8%), hypertension (9.4%) and heart failure (HF) (9%). CVD-related deaths and attendant morbidities, which include lifelong disability are in many cases preventable. This research proposes a dynamic risk model that handles multi-type …

Sex-Hormone Fluctuations And Their Effects On Sexual Function In Ius Users, Kaley Ferguson

Health, Human Performance and Recreation Undergraduate Honors Theses

Introduction: Despite intrauterine systems (IUS) being one of the most effective contraception methods available to women, fewer than 6% of women in the United States who use contraceptives rely on IUSs as their primary method. Instead, many women rely on the oral contraceptive pill. The effects of oral contraceptives on sex-hormone (i.e., progesterone, estrogen, androstenedione, and testosterone) levels and their subsequent impacts on sexual function and mood are well-studied; however, the impact of hormonal IUSs on these factors has not been established. This research is important because undesirable changes in sexual function and mood are reported as reasons for discontinuing …

The Effects Of Vml On Satellite Cell Mechanics Distal To The Defect Site, Jessica Lee

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Volumetric muscle loss (VML) is defined as a permanent loss of muscle tissue and function. Recent studies have used biomedical interventions such as decellularized matrices and autologous repair to enhance muscle regeneration of these injuries. Furthermore, exercise has also been shown to aid in the regenerative response. Biomedical interventions and physical activity help to attenuate severe fibrosis as well as encourage satellite cell activation in VML models. However, it is not known whether these interventions affect muscle tissue distal to the injury site. Purpose: The purpose of this study was to evaluate the effects of autologous muscle grafting and …

How Infant Positioning Impacts Hip Motion And The Associated Implications For Babies With Hip Dysplasia, Lauren Buchele

Biomedical Engineering Undergraduate Honors Theses

Developmental dysplasia of the hip (DDH) refers to a group of disorders, ranging from slight instability (Grades 1-3) to a severe dislocation (Grade 4) of the femoral head from the acetabulum [1]. In order to treat DDH in infants, a reduction procedure and the use of a lower body harness to secure the hip joint as the bones and ligaments re-form properly is typically prescribed. The Pavlik Harness is currently the “gold-standard” orthopedic device used to place hips in proper positioning. However, little research has been reported on the biomechanical affects during use of these device types.

Although the Pavlik …

Quadriceps And Gluteus Medius Activation With Increasing Task Speed During A Lateral Step-Down, Mat Auger, Elisabeth Groeber, Nick Nolan, Morgan Stefanoff, Aswin Vijayan, Dave Werner, Allison Kinney, Joaquin A. Barrios

University of Dayton Doctor of Physical Therapy Annual Research Symposium

Clinically, slower task performance is thought to increase task demands. Interestingly, few studies have explored altering task rate on electromyographic (EMG) muscle activity, particularly in the lower extremity.

An Integrative Approach To Mindfulness-Based Symptom Management For Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Lisa Barer

Mindfulness Studies Theses

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic health condition; its etiology is poorly understood, and treatment options are limited to management of symptoms. Current recommended treatment options are controversial, and evidence of effectiveness is limited. This paper proposes a novel model for symptom management of ME/CFS using mindfulness-based interventions, cognitive behavioural therapy (CBT), and relaxation techniques. A comprehensive review of available evidence is used to support this approach. The idea is that, working synergistically, these three approaches, grounded by mindfulness-based principles, can address many of the symptoms of the illness and help patients better cope and manage their day-to-day …

An Exploratory Study Of Suboxone (Buprenorphine/ Naloxone) Film Splitting: Cutting Methods, Content Uniformity, And Stability, Kristin L. Reindel, Michael J. Deangelis, Alexander S. Ferrara, Kelly Conn, Elizabeth Phillips, Anthony Corigliano, Fang Zhao

Doctoral External Publications

Suboxone films are U.S. Food and Drug Administration approved to treat opioid dependence. While the package insert states that films should not be cut, physicians often prescribe film fractions for treatment and tapering. There is no data to support this practice, and this study was initiated to evaluate cutting methods, content uniformity, and stability of split films. Suboxone 8-mg buprenorphine/2-mg naloxone films were split using four methods: 1) ruler/razor cut, 2) scissor cut, 3) fold/rip, and 4) fold/scissor cut. United States Pharmacopeia Chapter <905> was used to evaluate the weight variation and content uniformity of split films. The stability of split …

Serial Neuropsychological Assessment Toward A Reliable Concussion Protocol, Daniel J. Soden

Doctor of Psychology (PsyD)

With more than 10,000 Sports Related Concussions (SRCs) per year at the collegiate level, interdisciplinary teams are often tasked with determining when an athlete may return to activity (Zuckerman et al., 2015). Due to neurochemical changes following an SRC, athletes are vulnerable to further injury if they suffer another head injury before given appropriate time to heal (Giza & Hovda, 2014). Cognitive testing is routinely utilized to detect the presence of cognitive dysfunction and aid in individualized treatment planning. Because athletes often demonstrate practice effects when retested, it is difficult to distinguish if the athlete is demonstrating cognitive dysfunction. Reliable …

A Program Evaluation Of Physician Medical Clinic’S Approach To Chronic Pain, William Summers

Doctor of Psychology (PsyD)

Chronic pain costs up to $635 billion dollars annually and impacts 25.3 million adult U.S. citizens (Nahin, 2015). Treatment options have typically included opioid medications, which potentially causes harm with long-term use and has contributed to an epidemic of opioid misuse. Treatment has expanded beyond monotherapy to include holistic approaches to health, such as occupational therapy and mental health therapy. The present study sought to evaluate the effectiveness of group therapy as it is conducted in a rural Oregon clinic using the Quadruple Aim to measure treatment outcomes (Bodenheimer, & Sinsky, 2014). Participants diagnosed with chronic pain and placed on …

Disease And De Soto: A Bioarchaeological Approach To The Introduction Of Malaria To The Southeast Us, Kelly Marie Schaeffer

Graduate Theses and Dissertations

It is well known through documentation in historical accounts that numerous diseases were introduced to the Americas during the time of Spanish and French exploration. Diseases such as smallpox, measles and yellow fever have been credited in playing a role in the Spanish conquest of the New World through drastic Native American population decline. Many researchers have studied the biological consequences of European contact, some using direct skeletal analyses to study changes in Native American health and disease. However, one major population disease that has not been part of these discussions is malaria. This is mostly due to the current …

Downregulation Of Thromboxane A2 And Angiotensin Ii Type 1 Receptors Associated With Aging-Related Decrease In Internal Anal Sphincter Tone., Ipsita Mohanty, Jagmohan Singh, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Aging-associated decrease in internal anal sphincter (IAS) tone (AADI) is a major contributor in the rectoanal incontinence (RI). To determine the pathogenesis of AADI, we investigated the effect of aging on GPCR activation and related downstream signaling. We particularly investigated two GPCRs that characterize IAS smooth muscle cells (SMCs): thromboxane A ₂ and angiotensin II type 1. Two groups of Fischer 344 rats (6-month-old [young group] and 26-month-old [old group]) were employed to determine the GPCR function by isometric contraction, the expressions of GPCRs, and their downstream regulatory signaling proteins (regulator of G-protein signaling 2, RGS2; GPCR Kinase 5, GRK5; …

Discontinuation Of Proton Pump Inhibitor Use Reduces The Number Of Endoscopic Procedures Required For Resolution Of Walled-Off Pancreatic Necrosis., Patrick C. Powers, Ali Siddiqui, Reem Z. Sharaiha, Grace Yang, Enad Dawod, Aleksey A. Novikov, Amy Javia, Cynthia Edirisuriya, Arish Noor, Tayebah Mumtaz, Usama Iqbal, David .E Loren, Thomas E. Kowalski, Natalie Cosgrove, Yordano Alicea, Amy Tyberg, Iman Andalib, Michel Kahaleh, Douglas G. Adler

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives: Endoscopic drainage/debridement of symptomatic walled off necrosis (WON) using lumen-apposing metal stents (LAMS) is both safe and effective. While endoscopic management of WON is the standard approach to treatment, the ideal concomitant medical therapy remains unclear. The purpose of this study was to further elucidate the effect of proton pump inhibitor (PPIs) therapy on the technical and clinical success of endoscopic treatment of WON.

Methods: Two hundred and seventy-two patients in 8 centers with WON managed by endoscopic drainage using LAMS were evaluated. Patients were followed for at least 6 months following treatment. The patients were divided …

Eat Better, Move More: An Educational Program Teaching Healthy Exercise Habits To Low-Socioeconomic Elementary School Students, Haley Davis

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The unhealthy habits of our modern culture show a concern for our future generations. The combination of our genotype with social and cultural interactions can lead to obesity. This study was conducted because there is little evidence of school-based interventions for the health of ethnic minority students. The purpose of this study was to evaluate to what extent the Eat Better, Move More (EBMM) program exercise content affected 4^th and 5^th grade students exercise habits. A convenience sample of twelve fourth-grade and twelve fifth-grade students completed the EBMM exercise module. A quasi-experimental design was used through a single …