Medicine and Health Sciences Commons^™

An Epidemiologic Study Of Vaccination Exemptions And Pertussis Risk, Corinne B. Tandy

Doctoral Dissertations

The incidence of pertussis, a vaccine-preventable disease that can have severe complications in infants, has been increasing in the United States over the past three decades. Vaccine hesitancy and refusal have also increased and are associated with vaccination exemptions, which in turn are associated with outbreaks of vaccine-preventable diseases, including pertussis. Understanding attitudes towards vaccinations and identifying geographic disparities of vaccination exemptions and pertussis risks is useful for guiding control programs. Therefore, the objectives of this study were to: (i) investigate attitudes towards vaccinations; (ii) identify county-level geographic disparities and sociodemographic predictors of vaccination exemptions in Florida; (iii) investigate county-level …

Qualitative And Quantitative Improvements For Positron Emission Tomography Using Different Motion Correction Methodologies, Tasmia Rahman Tumpa

Doctoral Dissertations

Positron Emission Tomography (PET) data suffers from low image quality and quantitative accuracy due to different kinds of motion of patients during imaging. Hardware-based motion correction is currently the standard; however, is limited by several constraints, the most important of which is retroactive data correction. Data-driven techniques to perform motion correction in this regard are active areas of research. The motivation behind this work lies in developing a complete data-driven approach to address both motion detection and correction. The work first presents an algorithm based on the positron emission particle tracking (PEPT) technique and makes use of time-of-flight (TOF) information …

The Psychosocial Experiences Of African American Sexual And Gender Minority Caregivers Of People With Dementia, Lakeva Harris

Doctoral Dissertations

Over 50 million people in the United States provide unpaid care to a family member or friend. One-third of these caregivers (16 million) provide care to someone with Alzheimer’s disease and related dementias (ADRD). Of these caregivers, more than 20% state caregiving has led to a decline in their health. African American caregivers are less likely to report being in very good or better health than their white caregiving peers. Similarly, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) caregivers are more likely to report fair or poor health than their heterosexual, cisgender peers. The overlap of these minoritized identities may …

Examining A Fatigue Management Model That Identifies Risk Factors And Consequences Of Fatigue In Older Individuals, Maral Torossian

Doctoral Dissertations

Fatigue is experienced by 40-74% of older individuals living with a chronic disease. Despite advances in scientific knowledge around risk factors and consequences associated with fatigue, a comprehensive model that can serve as a guide for healthcare providers caring for older individuals with fatigue is lacking. Thus, the purpose of this study was to examine a fatigue model based on the Theory of Unpleasant Symptoms (TUS). The model included psychological, physiological, and situational risk factors of fatigue, as well as fatigue outcomes, such as physical, social, and cognitive performances, perceived health, and quality of life (QOL). This was a secondary …

Polymer-Based Strategies For Therapeutic Delivery To Bacterial Biofilms, Cheng-Hsuan Li

Doctoral Dissertations

Bacterial infections are emerging threat to public health. Antibiotics once provided front-line treatments to bacterial infections; however, bacteria adapted to resist antibiotics through drug resistance mechanisms and biofilm formation. In this dissertation, I describe polymer-based strategies for therapeutic delivery as treatments of bacterial biofilm infections. Initially, I developed a functional polymer for delivering hydrophobic carvacrol (the primary constituent of oregano oil) to the bacterial biofilms. This strategy incorporates a cross-linking strategy to fabricate a robust yet biodegradable nanoemulsion, improving antimicrobial activity of carvacrol and overcoming antimicrobial resistance development. Next, I demonstrated that this functional polymer-based emulsion platform provides a general …

Applied Infectious Disease Forecasting For Public Health, Graham Gibson

Doctoral Dissertations

Infectious disease modeling has emerged as a powerful data driven tool for monitoring outbreaks, assessing intervention strategies, and allocating public health resources. This thesis addresses a variety of challenges faced in real-world infectious disease forecasting. We first present methods for aggregating forecasts made at different spatial scales, where explicitly modeling the spatial dependency would be computationally prohibitive. We then extend the mechanistic model framework to create an operational forecasting model capable of handling real-world COVID-19 surveillance system issues. Finally, we propose a new framework for merging mechanistic and statistical approaches to infectious disease forecasting. This framework allows modelers to construct …

Investigating The Developmental Impacts Of 3,3’-Dichlorobiphenyl (Pcb-11) In Zebrafish (Danio Rerio), Monika A. Roy

Doctoral Dissertations

The environmental pollutant 3,3’-dichlorobiphenyl (PCB-11) is a lower-chlorinated polychlorinated biphenyl (PCB) congener present in air and water samples. Both PCB-11 and its metabolite, 4-PCB-11-Sulfate, are detected in humans, including in pregnant women. The work conducted for this dissertation takes a developmental toxicology approach and uses zebrafish (Danio rerio) to investigate PCB-11’s potential impacts to the liver and pancreas. Chapter 1 introduces PCBs and the current knowledge gaps. Chapter 2 investigates PCB-11 interactions in short-term 4-day exposures with the Aryl hydrocarbon receptor (Ahr) pathway in both 0-20 mM individual and mixture exposures with other Ahr agonists. In Chapter 3, …

High-Dimensional Feature Selection And Multi-Level Causal Mediation Analysis With Applications To Human Aging And Cluster-Based Intervention Studies, Hachem Saddiki

Doctoral Dissertations

Many questions in public health and medicine are fundamentally causal in that our objective is to learn the effect of some exposure, randomized or not, on an outcome of interest. As a result, causal inference frameworks and methodologies have gained interest as a promising tool to reliably answer scientific questions. However, the tasks of identifying and efficiently estimating causal effects from observed data still pose significant challenges under complex data generating scenarios. We focus on (1) high-dimensional settings where the number of variables is orders of magnitude higher than the number of observations; and (2) multi-level settings, where study participants …

Sleep, Reproduction, And Pregnancy, Joshua R. Freeman

Doctoral Dissertations

Sleep, and particularly sleep timing, prior to conception may be important for reproductive and pregnancy health. Evidence of a biological mechanism relating sleep to reproductive health from laboratory studies suggests that sleep may influence the hypothalamic-pituitary-ovarian (HPO) axis. The role of sleep in the HPO axis may also impact many reproductive outcomes including reproductive hormones, ovulation, pregnancy, live birth, pregnancy loss, and adverse pregnancy outcomes. However, epidemiological evidence for associations between sleep, especially sleep timing, and these reproductive health endpoints is limited with most studies typically assessing shift work, and not sleep patterns directly. To address these gaps, we evaluated …

Mental Health And Adiposity: The Effects Of Racial Discrimination And Social Relationships, Nicole D. Fields

Doctoral Dissertations

Excess adiposity is associated with increased risk of cardiovascular disease, type 2 diabetes, and premature mortality. It is well-documented that Black women are disproportionately affected by excess adiposity. Research has focused on lifestyle factors, such as diet and physical activity, to explain the higher prevalence of obesity among Black women compared to white women; however, there is much less research on the association between psychological distress and adiposity, which may be important for understanding racial disparities. To date, no studies have examined the social context by which mental health and physical health are related. Black women in U.S. society live …

Policing And Health: Police Encounters As A Fundamental Cause Of Racial Health Disparities, Richard S. Carbonaro

Doctoral Dissertations

Structural racism has taken many forms throughout American history and to this day continues to drive social, economic, and health inequalities. Mass incarceration is a modern tool of social marginalization with well documented and deep-rooted racial inequalities. Research has continually shown that mass incarceration negatively impacts the health of disadvantaged communities. Even police stops, the most common and mundane form of criminal justice contact has been linked with deleterious health outcomes at the individual and community level. In this dissertation, I identify specific social and biological mechanisms connecting encounters with the police and health outcomes. In the first chapter, I …

Design Of Resposive Oligomeric And Polymeric Interfaces For Sensing And Controlled Release Applications, . Manisha

Doctoral Dissertations

Nature has designed magnificent responsive systems by constructing several interacting molecular level networks for the recognition and propagation of chemical and biochemical information. One of the eminent characteristics of these systems is their capability to quickly transduce molecular scale recognition events into macroscopic or visually observable responses. Inspired by these systems present in nature, we became interested in developing artificial responsive systems with similar capabilities. This dissertation will feature four such systems that employ amphiphilic oligomers and polymers which were chosen as the scaffolds because of their high thermodynamic stability, low critical aggregation concentrations, convenient handles to incorporate functional group …

Community Based Participatory Research Informed Manualization And Piloting Of E-Training Of A Modified Dialectical Behavior Therapy Intervention, Annika M. Miyamoto

Doctoral Dissertations

This study explores the efficacy of delivering modified dialectical behavior therapy (m-DBT) to direct support staff who work with seriously mentally ill patients with neurocognitive deficits using remote web-based technology. The partnering facility for this study is a residential skilled-nursing facility that provides 24-hour care to individuals under conservatorship. Using a previously piloted m-DBT protocol, qualitative feedback was gathered from four participants with background training in psychology and varying experiences with DBT. All participants had direct knowledge of the treatment environment and experience working with the patient population. Gathered feedback was used to revise the m-DBT protocol to be used …

Patient Reported Outcomes In Sickle Cell Disease Examined Within A Conceptual Model, Swapandeep Mushiana, Marsha Treadwell Phd, Sherif M. Badawy Md, Ms, Liliana Preiss Phd, Allison King Md Mph Phd, Barbara Kroner Phd, Yumie Chen Bs, Jeffrey Glassberg, Victor Gordeuk Md, Nirmish Shah Md, Angie Snyder Phd Mph, Theodore Wun Md

Doctoral Dissertations

Objective: To examine the relations between patient reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD related factors and barriers to care would independently contribute to functioning as measured using the PRO domains. Additionally, pain and other SCD related complications are expected to impact the relation between the variables. Methods: Participants completed a 48-item survey that included socio-demographics and PRO measures, such as social functioning, pain impact emotional distress, and cognitive functioning. …

Psychosocial Effects Of Providing Nursing Care To Patients From A Multi-Casualty, School-Associated Shooting Event, William Travis Mccall

Doctoral Dissertations

Secondary traumatic stress describes symptoms consistent with post-traumatic stress disorder but that result from witnessing or experiencing the trauma of another individual through a helping relationship. The associated symptoms include intrusions, avoidance, and hyperarousal. Secondary traumatic stress is also associated with the development of compassion fatigue and burnout. The current state of the science identifies that secondary traumatic stress may affect those nurses who provide care to critically ill or injured patients. Research has most commonly examined the prevalence of secondary traumatic stress, compassion fatigue, and burnout among nurses in emergency department settings. While attention is frequently given to the …

Anti-Inflammatory And Chemopreventive Activity Of Lunasin From Tofu Whey For The Management Of Gastrointestinal Diseases, Cindy Andrea Nieto Veloza

Doctoral Dissertations

Gastrointestinal diseases such as inflammatory bowel diseases (IBD) and colorectal cancer (CRC) are pathological conditions associated with chronic inflammation, characterized by intestinal damage, debilitating symptoms, and detrimental health consequences. The increased risk of CRC in IBD patients, and the adverse effects associated with current therapeutic strategies, point out the need for safer alternatives to reduce chronic inflammation in the bowel. Lunasin is a bioactive peptide naturally occurring in soybeans, with chemopreventive and anti-inflammatory properties demonstrated in several extra-intestinal diseases. However, to date, there is no evidence of the biological activity of lunasin on the gastrointestinal tract as a target site. …

Perseverance: A Focused Ethnographic Study Of The Emergency Triage Nurse, Ellen C. Smithline

Doctoral Dissertations

Introduction: The emergency triage process is not meeting the needs of the patient or the healthcare team. Current and past research has focused primarily on the emergency triage nurse’s ability to accurately designate the triage acuity score, while largely ignoring the impacts of the complex and dynamic environment in which they are immersed. Therefore, the purpose of this study was to describe the factors that influence the decision-making process of the emergency triage nurse (ETN). Method: This was a focused ethnographic study that included four phases. Phase 1 was the grand tour of the emergency triage and waiting room area. …

Young Adult Cancer Survivors And Physical Activity: An Expert Consensus Study, Ann Marie Moraitis

Doctoral Dissertations

Annually, over 1 million adolescents and young adults (YA) are diagnosed with cancer. Cancer survivorship rates in YA are greater than 80%, yet late and long-term symptoms that impact biopsychosocial health persist for this population. Health promotion strategies, including physical activity, are being used to mitigate symptom burden in adults. Research specific to physical activity use in YA is limited. This dissertation addresses physical activity use in YA cancer survivorship. Chapter one of this dissertation introduces the critical need to understand the state of the science of physical activity use on the biological and psychosocial health of YA affected by …

Tai Chi And Mindfulness Training To Improve Balance In People With Multiple Sclerosis: A Community-Based Intervention Study, Julianna Eve

Doctoral Dissertations

Introduction: Tai Chi and meditation have led to improved quality of life, and reduced fatigue and depressive symptoms in people with multiple sclerosis (MS). Tai Chi interventions have successfully improved balance, however the few studies evaluating meditation impact on motor skill improvement have reported conflicting results. Benefits of meditation on improving alertness and attention have been reported, but it is unknown whether these benefits might extend to physical balance. Objective: determine the impact of an 8-week Tai Chi or Mindfulness Based Stress Reduction (MBSR) intervention on physical balance, psychosocial wellbeing, and sensorimotor function; and whether benefits are retained after …

Nurse-Delivered Shoe-Lacing Intervention: Effect On Comfort And Toe Pressures For Active Community-Dwelling Adults (Age 65+), Mary C. Clayton-Jones

Doctoral Dissertations

Significance: Problems with shoe fit are endemic, affect gait and balance and lead to falls. Falls are physically, emotionally, and economically costly. Low-cost, easily implemented interventions, that reduce pain and improve balance meet the “triple aim” of the Institute for Healthcare Improvement. Purpose: Evaluate the impact on community-dwelling adults (65+) of two nursing interventions involving foot repositioning and shoe relacing. Outcome measures: Toe pressures, experiences of pain and comfort. Method: Repeated-measures, mixed-methods lab-based study. Walk #1 Control. Intervention #1, participant’s heel secured to back of shoe, the participant’s chosen lacing pattern snugged. Intervention #2, heel secured to back of …

Mental Health Outcomes Of Various Types Of Fear Among University Students Who Have An Undocumented Legal Status During The Donald Trump Presidency, Liliana Campos

Doctoral Dissertations

Having an undocumented legal status is a risk factor for mental health conditions such as depression and anxiety among university students. Much of the literature on the experiences of university students who hold an undocumented legal status has primarily focused on better understanding the educational, social, financial, and legal challenges among undergraduate students. The literature has addressed how some of these difficulties impact components of their social and mental health wellness. Yet, there is still a dearth of research focused on further understanding the experiences of students who hold an undocumented legal status from a psychological perspective, and specifically, with …

The Use Of Mindfulness Meditation To Increase The Efficacy Of Mirror Visual Feedback For Reducing Phantom Limb Pain In Amputees, Nicolas Sebastian Mills

Doctoral Dissertations

Phantom limb pain is a chronic pain condition that negatively impacts the lives of over half of amputees, and results in considerable morbidity. Currently, there is no gold standard for treatment for phantom limb pain. However, a frequently used intervention is the use of mirror visual feedback, in which the amputee watches the reflection of the adjacent non-amputated limb move and exercise. In the last few decades, mindfulness-based interventions have been increasingly used with individuals living with different types of chronic pain. This study attempts to discover if the addition of a mindfulness-based intervention, such as guided meditation, will augment …

Biomaterials For Soft Tissue Applications, Alisha P. Pedersen

Doctoral Dissertations

Biomaterial applications in the biomedical field have resulted in great advancements in the availability and efficacy of medical devices and therapeutic options for a host of conditions. Applications of biomaterials span all organ systems and tissue types, and have served a range of purposes including mechanical support, drug delivery, tissue regeneration, and reduction of surgical complications. Biomaterials are delineated by their ability to be utilized on or within the body with minimal-to-no adverse reaction and can be manipulated to feature various structures, degradative properties, topographies, and inclusion of bioactive substances or drugs. Soft tissue applications of biomaterials is an expansive …

Rural Hospital Closures And Perceived Access To Care: A Qualitative Descriptive Study In An Appalachian County Of Tennessee, Amanda M. Letheren

Doctoral Dissertations

Background: Tennessee has suffered more hospital closures per capita than anywhere else in the nation. The impact of hospital closures on access to care in rural and economically distressed Appalachian counties of Tennessee is of particular concern because these communities experience great health disparities. Hospital closures may exacerbate these disparities and create additional barriers when accessing care.

Objectives: The aim of this study was to describe community residents’ perceptions of health and access to care following a hospital closure in a rural and economically distressed Appalachian county of Tennessee.

Methods: This study used a qualitative descriptive approach to present community …

Emerging Adults’ Experiences As Receivers Of Sexually Transmitted Infection Disclosures From Sexual Partners: A Three-Part Examination, Kayley D. Mcmahan

Doctoral Dissertations

Each year in the United States, over 20 million cases of sexually transmitted infections (STIs) are diagnosed, mostly among those in the developmental period of emerging adulthood (ages 18-29). Research on STI disclosure to romantic and sexual partners has increased over the last two decades, but this research has (a) generally lacked a developmental and theoretical focus, (b) not examined disclosure recipients, and (c) not been systematically and critically synthesized. To address these limitations, I conducted a three-part examination. First, I systematically reviewed the STI disclosure literature and summarized findings, critical limitations, and future research and intervention directions. Next, I …

Using A Cognitive Behavioral Approach In Individual Counseling With Patients Undergoing Bariatric Surgery, Nina Marie Ditommaso

Doctoral Dissertations

Morbid obesity is linked to physical and psychological well-being. Bariatric surgery has shown tremendous success with rapid weight loss in the patient population with morbid obesity. These patients experience issues with weight regain post-surgery, which can be linked to psychological and social factors. Despite this, mental health counseling is rarely offered in bariatric surgery programs. The primary investigator used a six-session Cognitive Behavioral Therapy (CBT) approach in individual counseling with patients following bariatric surgery. The primary investigator used a single case research design to treat four participants. The primary investigator measured the effectiveness of a six-session CBT treatment, assessing for …

A Collective Metamorphosis Of Breastfeeding Mothers: A Phenomenological Exploration Of A Face-To-Face Healthcare Provider Facilitated Peer Support Group, Emily Alexandria Tucker

Doctoral Dissertations

This research study used phenomenology to examine a face-to-face healthcare facilitated breastfeeding support group. Participant observations and phenomenology were used to address the following research questions: 1) what are the lived experiences of the women participating a breastfeeding support group, 2) how does the group influence their lived experiences, and 3) what were the common experiences of these women? The support group participants were observed while the researcher acted as a participant observer over the course of an eleven-month period. There were a total of seven women interviewed about their lived experiences breastfeeding and attending the support group. Data from …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Interactions Between Titanium Dioxide Nanoparticles (Nps) And Mucin, . Boimin

Doctoral Dissertations

Titanium dioxide nanoparticles (TiO₂ NPs) are widely used in many food, consumer, and industrial products. However, little is known about the overall effects of TiO₂ NPs on the environment or human health. In order to elucidate the fate, transformation, transport, and toxicological impact of TiO₂ NPs, a better understanding is needed of how the physicochemical properties of TiO₂ NPs (e.g. size, charge, curvature, hydrophobicity, and surface functionality) interact with their microenvironments (e.g. pH, temperature, bile acids, microbiome, enzymes, surface-active components, and biopolymers). Living organisms including humans have a natural mechanism to protect themselves from physical, biological, …

Potential Bioactives And Inflammatory Mediators Regulating Adipose Tissue Function In Obesity, Seok-Yeong Yu

Doctoral Dissertations

Obesity is a serious health problem in the U.S. and worldwide and is associated with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Observational studies have also shown an inverse relationship between obesity and reduced bioavailability of fat-soluble vitamins, which is due in part to increased sequestration in expanded adipose tissue (AT). AT serves as the primary site of storage organ for excess energy, however, in morbid obesity enlarged adipocytes exhibit decreased lipid uptake, impaired lipid hydrolysis and oxidation and increased inflammation, which are collectively referred to as AT dysfunction. Substantial evidence characterizes AT …