Medicine and Health Sciences Commons^™

A Systematic Review Up To 2018 Of Hiv And Associated Factors Among Criminal Justice-Involved (Cji) Black Sexual And Gender Minority Populations In The United States (Us), Russell Brewer, Santhoshini L Ramani, Aditya Khanna, Kayo Fujimoto, John A Schneider, Anna Hotton, Leo Wilton, Tania Escobedo, Nina T Harawa

Faculty, Staff and Student Publications

Black men who have sex with men (BMSM) and Black transgender women (BTW) are impacted by dual epidemics of HIV and incarceration. We advanced understanding of the relationship between criminal justice involvement, HIV, and other key HIV-related characteristics among these key populations in the US. We conducted a systematic review up to 2018 and 47 articles met the inclusion criteria of scientific publications involving quantitative findings of US-based HIV-related studies focused on criminal justice-involved (CJI) BMSM and BTW. Overall, there was a dearth of studies focused specifically on BTW. Criminal justice involvement was relatively high among BMSM and BTW and …

Diagnosis Of Intrauterine Pregnancy Despite The Presence Of Etonogestrel Implant, Ryan J. Sawyers, Pratik M. Parikh Do, Jose Lazaro Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

A Digital Healthcare Application For Patient Monitoring And Assessment, Brandon Shumin

All Theses

The COVID-19 pandemic strained our healthcare resources and exacerbated the existing issues of primary care shortages and burnout rates for healthcare professionals. Due in part to these factors, telehealth has seen more wide-spread use during this time. However, current asynchronous telehealth applications require stable Internet to function fully. Since many medically underserved populations in the United States lack Internet access in their homes, an application that offers patient monitoring and assessment could extend their access to medical resources. This work proposes such a digital healthcare application for iOS devices and evaluates it based on the system requirements of availability, data …

Improving Patient Safety, Patient Flow And Physician Well-Being In Emergency Departments, Vishnunarayan Girishan Prabhu

All Dissertations

Over 151 million people visit US Emergency Departments (EDs) annually. The diverse nature and overwhelming volume of patient visits make the ED one of the most complicated settings in healthcare to study. ED overcrowding is a recognized worldwide public health problem, and its negative impacts include patient safety concerns, increased patient length of stay, medical errors, patients left without being seen, ambulance diversions, and increased health system expenditure. Additionally, ED crowding has been identified as a leading contributor to patient morbidity and mortality. Furthermore, this chaotic working environment affects the well-being of all ED staff through increased frustration, workload, stress, …

Unlocking The Pediatric Transcriptome: A Combinatorial Approach For Total Rna Analysis, William Schleif

All Dissertations

The transcriptome is an oft-studied target in the pursuit to better understand the functional elements of the human genome as part of genomic research. The transcriptome possesses its own unique set of challenges that hamper utilization of RNA-based discoveries and translation into actionable findings. Scientific progress thus far has expanded annotated reference genes for protein-coding and non-coding (nc) regulatory transcripts, yet much of the variation from splicing events or retention of other regions remain an open challenge, especially in children. This dissertation explores the current state of diagnostic and methodological barriers in front of the full unlocking of the transcriptome, …

Genetics And Genomics Education Among Physician Assistants, Wesley Patterson

All Dissertations

This dissertation comprises five chapters to describe genetics and genomics education among physician assistant/associate (PA) students and practicing PAs. Chapter I introduces the gap in supply and demand of genetic services, the need for non-genetics healthcare providers to fill the gap, and the PA profession as a solution.

Chapter II is a rapid literature review that summarizes the available literature regarding genetics and genomics education for PAs. A paucity of literature exists to describe the current state of PA genetics-genomics education. The few studies retrieved describe content being taught in PA programs, the number of genetics-genomics contact hours PA students …

Mortality Among Patients With Covid-19 And Different Interstitial Lung Disease Subtypes: A Multicenter Cohort Study., Joy Zhao, Brandon Metra, Gautam George, Jesse Roman, Joseph Mallon, Baskaran Sundaram, Michael Li, Ross Summer

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Cognitive Preference And Skill Acquisition: The Relationship Between Student Nurse Anesthetists And Certified Registered Nurse Anesthetists Thinking Styles, Thomas Diller

Electronic Theses and Dissertations

Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making.

The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher …

Investigating Force-Velocity Profile Alterations And Methodology After Traditional Resistance Training, Joseph D'Amato

Electronic Theses and Dissertations

The purposes of this dissertation were to examine the agreement the agreement between double integration using the trapezoidal method and measurements for push-off distance to create force-velocity profiles, examine the change in push-off distance between loading conditions when force-velocity profiling, and to observe the alterations in mechanical outputs of force-velocity profiles after 15-weeks of off-season training. The major findings are as followed. Using double integration with the trapezoidal method may be a reliable way to estimate push-off distance, despite a small systematic bias. This bias should have negligible effects on push-off distance and therefore not alter or effect calculations in …

Gene Therapy For Fibrodysplasia Ossificans Progressiva: Feasibility And Obstacles, Elisabeth M W Eekhoff, Ruben D De Ruiter, Bernard J Smilde, Ton Schoenmaker, Teun J De Vries, Coen Netelenbos, Edward C Hsiao, Christiaan Scott, Nobuhiko Haga, Zvi Grunwald, Carmen L De Cunto, Maja Di Rocco, Patricia L R Delai, Robert J Diecidue, Vrisha Madhuri, Tae-Joon Cho, Rolf Morhart, Clive S Friedman, Michael Zasloff, Gerard Pals, Jae-Hyuck Shim, Guangping Gao, Frederick Kaplan, Robert J Pignolo, Dimitra Micha

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare and devastating genetic disease, in which soft connective tissue is converted into heterotopic bone through an endochondral ossification process. Patients succumb early as they gradually become trapped in a second skeleton of heterotopic bone. Although the underlying genetic defect is long known, the inherent complexity of the disease has hindered the discovery of effective preventions and treatments. New developments in the gene therapy field have motivated its consideration as an attractive therapeutic option for FOP. However, the immune system's role in FOP activation and the as-yet unknown primary causative cell, are crucial issues …

Pharmacological Interventions For The Treatment And Control Of Shivering In Adult Patients Undergoing Elective Surgery Under Regional Anaesthesia: A Systematic Review And Meta-Analysis, Malika Hameed, Naureen Akber Ali, Khalid Ahsan, Mohsin Nazir

Department of Anaesthesia

Intraoperative shivering is quite common after regional anaesthesia, which not only increases the total body oxygen requirement but also causes discomfort to the patients. The aim of this systematic review is to determine the effectiveness of pharmacological agents administered intra-operatively for treating shivering in adult patients who are undergoing elective surgery under regional (i.e., central neuraxial) anaesthesia so that an optimal choice of an agent can be recommended for clinical application. A literature search was carried out using PubMed, Cochrane Library, CINAHL databases, and hand searches to identify relevant studies. After literature screening and information extraction, a systematic review was …

Cervical Cancer Programme, Kenya, 2011–2020: Lessons To Guide Elimination As A Public Health Problem, Valerian Mwenda, Woki Mburu, Joan-Paula Bor, Mary Nyangasi, Marc Arbyn, Steven Weyers, Philippe Tummers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths in 2020. Kenya has implemented cervical cancer interventions for more than a decade. We describe the evolution of the cervical cancer programme over the last 20 years and assess its performance.

Methods: We searched the Ministry of Health’s archives and website (2000–2021) for screening policy documents and assessed them using seven items: situational analysis, objectives, key result areas, implementation framework, resource considerations, monitoring and evaluation and definition of roles/responsibilities. In addition, a trend analysis was performed targeting screening and disease burden indicators in …

Are Kenyans Likely To Use Covid-19 Self-Testing Kits? Results From A Cross-Sectional Survey, Griffins Manguro, Sonjelle Shilton, Sharon Omenda, Patrica Owira, Deepshikha Batheja, Abhik Banerji, Sophie Chabeda, Marleen Temmerman, Walter Jako, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Objectives: To understand the public’s perceptions around rapid SARS-CoV-2 antigen self-testing in Kenya, including the drivers of acceptability, willingness to pay, and adherence to hygiene and prevention recommendations following a positive self-test.

Methods: A household-based, cross-sectional survey, using a 35-item questionnaire, was conducted in Mombasa and Taita–Taveta counties, Kenya, during August 2021. Individuals aged ≥18 years were enrolled using a stratified sampling approach.

Results: There were 419 participants (mean age 35.7 years). A minority (10.5%) had ever tested for SARS-CoV-2. If SARS-CoV-2 self-testing were available, 39.9% and 41.5% would be likely and very likely, respectively, to use it. If unavailable …

Immune Checkpoint Inhibitors In Luminal Gastrointestinal Malignancies: Going Beyond Msi-H/Dmmr, Tmb And Pd-L1, Daniel S. Lefler, Adam E. Snook, Babar Bashir

Department of Medical Oncology Faculty Papers

In luminal gastrointestinal tumors, immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1 and CTLA-4 have been investigated in multiple settings. The indications for these drugs are primarily dependent on specific biomarkers that imply immunogenicity: overexpression of PD-L1, tumor mutational burden, loss of mismatch repair proteins (dMMR) and/or high microsatellite instability status. Although these markers can be both predictive and prognostic, there is variability in how they are measured and used to guide therapies. Moreover, the use of ICIs can be further refined with a better understanding of the tumor microenvironment and interactions with other available therapies. The purpose of this review …

Infection And Transmission Determinants Of Flea-Borne Rickettsioses, Hanna J. Laukaitis

Graduate Theses and Dissertations (2019 - present)

The genus Rickettsia is comprised of Gram-negative, obligate intracellular bacteria that are spread by hematophagous arthropods. Elucidating the factors conferring rickettsial virulence has perplexed investigators for decades, complicated by the lack of efficient genetic tools necessary to uncover rickettsial- and vector-specific factors contributing to persistence. The advent of transposon mutagenesis has enabled the field to make vast developments in uncovering novel rickettsial mechanisms utilized in various host backgrounds. Thus, the aim of this study was to generate Rickettsia felis transposon mutants and characterize novel phenotypes associated with genetic disruption in an arthropod background. Distribution of rickettsiae is reliant on the …

How Valuable Are Clinical Neuropsychological Assessments? A Meta-Analysis Of Neuropsychological Tests With Comparison To Common Medical Tests And Treatments, Murphy N. Harrell

Graduate Theses and Dissertations (2019 - present)

There has been a general decrease in neuropsychological assessments at a time when medical diagnostic technology and treatments have expanded, leading to a faulty assumption that medical tests and healthcare treatments provide more reliable or valid data than psychological assessments. A landmark report from the American Psychological Association’s (APA) Psychological Assessment Work Group (PAWG) found that validity coefficients for many psychological tests were indistinguishable from those of medical tests (Meyer et al., 2001). An updated systematic review of the advancement in neuropsychological testing is essential to the continued advancement of the value of neuropsychological assessment in healthcare. This meta-analysis sought …

Neuropsychology Of Primary Headache Disorders: A Meta-Analysis, Jasmin H. Pizer

Graduate Theses and Dissertations (2019 - present)

Objective: A meta-analysis was conducted comparing cognition on clinical measures between individuals with a primary headache disorder (PHD) and healthy controls (HC). Data Selection: The University of South Alabama Libraries’ OneSearch and PubMed, with a uniform search-strategy, were used to locate original research comparing cognition between PHD and HC samples. Analyses were modeled under random effects. Hedge’s g was used as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2. Data Synthesis: The initial search interval spanned inception–May 2021 and yielded 6692 results. Fifty-seven studies were analyzed. Meta-analysis showed a significant combined effect size …

An Examination Of Sex-Differences In Quadriceps Fatigability During High- And Low-Intensity Contractions, Katie G. Kennedy

Graduate Theses and Dissertations (2019 - present)

The purpose of the current study was to compare sex-differences in quadriceps fatigability following both high- and low-intensity repeated, isometric contractions. Twenty-four (12 males, 12 females) participants completed two experimental visits consisting of repeated, isometric contractions of the knee extensors at 30% (LT) and 70% (HT) of maximal voluntary force (MVIC) until failure. Prior to, and immediately following the fatiguing contractions, strength, voluntary activation (VA), and peak twitch torque (PTT) were assessed while measuring surface electromyographic amplitude of the vastus lateralis (VLAMP) and vastus medialis (VMAMP ). Fatiguing bouts were assessed via mean torque (TQMEAN), total repetitions completed, torque coefficient …

Prediction Of Breast Cancer-Related Lymphedema By Dermal Backflow Detected With Near-Infrared Fluorescence Lymphatic Imaging, Melissa B Aldrich, John C Rasmussen, Sarah M Desnyder, Wendy A Woodward, Wenyaw Chan, Eva M Sevick-Muraca, Elizabeth A Mittendorf, Benjamin D Smith, Michael C Stauder, Eric A Strom, George H Perkins, Karen E Hoffman, Melissa P Mitchell, Carlos H Barcenas, Lynn E Isales, Simona F Shaitelman

Faculty, Staff and Student Publications

PURPOSE: Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL.

METHODS: In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and …

A Cluster-Randomized Controlled Trial To Assess The Impact Of A Nutrition Intervention On Dietary Behaviors Among Early Care And Education Providers: The Create Healthy Futures Study, Dania Mofleh, Ru-Jye Chuang, Nalini Ranjit, Jill N Cox, Christine Anthony, Shreela V Sharma

Faculty, Staff and Student Publications

Create Healthy Futures is a self-paced, web-based intervention on improving healthy eating behaviors among Early Care and Education (ECE) providers. We examined the impact of web-based Create Healthy Futures on diet quality measured by the Alternative Healthy Eating Index (AHEI) 2010, dietary behaviors, and related psychosocial and environmental factors among ECE providers. A cluster randomized controlled trial (CRCT) was implemented with baseline surveys administered from October 2019-January 2020, intervention implementation from April-May 2020, and post-intervention from May 2020-August 2020. Centered-based ECE programs under the Pennsylvania Head Start Association (n = 12) were recruited and randomized to intervention (n = 5) …

When The Costs Outweigh The Benefits: Examining Variations In Nulliparous, Term, Singleton, Vertex And Elective Cesarean Delivery Rates Across The United States, 2016-2020, Kathleen Tatro

Electronic Theses and Dissertations

The overutilization of cesarean deliveries is a major public health issue in the United States (U.S.). The rates of cesarean deliveries have increased substantially from the mid 1990s. Low-risk, defined as nulliparous, term, singleton, vertex (NTSV) pregnancies with no medical indication of need, and elective cesarean deliveries have been implicated as drivers of these increases. Elective cesarean deliveries are NTSV cesarean deliveries in which no trial of labor was attempted. There is a lack of clear rationale as to the noted increases in cesarean delivery rates as the evidence shows that these procedures provide no additional health benefits to mothers …

Perceived Discrimination And Injury At Work: A Cross-Sectional Study Among Latino Day Laborers, Lynn N Ibekwe, John S Atkinson, Rosalia Guerrero-Luera, Yesmel A King, Maria L Rangel, Maria Eugenia Fernández-Esquer

Faculty, Staff and Student Publications

BACKGROUND: Given the stigma of their undocumented status and their high prevalence of workplace injury, understanding the impact of discrimination on Latino day laborers (LDLs) is a critical public health issue.

METHODS: We surveyed LDLs (N = 149) and assessed their sociodemographics, experiences of and perceived reasons for discrimination, and work-related injury. A logistic regression examined the association between discrimination and injury, adjusting for sociodemographics. Next, Chi-square tests identified perceived reasons for discrimination associated with injury which were then included in a second logistic regression to test their association with injury, adjusting for discrimination and sociodemographics.

RESULTS: Participants reported a …

Perceived Discrimination And Injury At Work: A Cross-Sectional Study Among Latino Day Laborers, Lynn N Ibekwe, John S Atkinson, Rosalia Guerrero-Luera, Yesmel A King, Maria L Rangel, Maria Eugenia Fernández-Esquer

Faculty, Staff and Student Publications

BACKGROUND: Given the stigma of their undocumented status and their high prevalence of workplace injury, understanding the impact of discrimination on Latino day laborers (LDLs) is a critical public health issue.

METHODS: We surveyed LDLs (N = 149) and assessed their sociodemographics, experiences of and perceived reasons for discrimination, and work-related injury. A logistic regression examined the association between discrimination and injury, adjusting for sociodemographics. Next, Chi-square tests identified perceived reasons for discrimination associated with injury which were then included in a second logistic regression to test their association with injury, adjusting for discrimination and sociodemographics.

RESULTS: Participants reported a …

Awareness Of Human Papillomavirus And Reported Human Papillomavirus Vaccine Uptake In A High-Risk Population, Trisha L Amboree, Jane R Montealegre, Paige Padgett Wermuth, Osaro Mgbere, Kayo Fujimoto, Charles Darkoh

Faculty, Staff and Student Publications

INTRODUCTION: Disparities in human papillomavirus (HPV) awareness and HPV vaccine uptake are likely exacerbated among racial/ethnic minority populations living in low-income areas. This study aims to determine the prevalence and correlates of HPV awareness and HPV vaccine uptake in an urban, low-income, racial/ethnic minority population.

METHODS: Secondary data analyses were performed in 2021 using 380 participants aged 18-45 years from the 2019 National HIV Behavioral Surveillance for high-risk heterosexuals, which monitors HIV risk behaviors among individuals living in high-poverty, high HIV prevalence neighborhoods. Prevalence estimates and modified Poisson regression models were used to assess the relationship between HPV awareness and …

Association Of Disease Outcomes With Physical Activity In Multiple Sclerosis: A Cross-Sectional Study, Trinh L T Huynh, Stephanie L Silveira, Brenda Jeng, Robert W Motl

Faculty, Staff and Student Publications

Purpose/Objective Research: This study examined combinations of disease outcomes (i.e., walking, cognition, and symptoms) as correlates of physical activity subgroups (insufficiently active vs. sufficiently active) in persons with multiple sclerosis (MS).

RESEARCH METHOD/DESIGN: This study included 213 participants who completed walking and cognitive function tests and self-report measures of symptoms and physical activity. Multivariate analysis of variance and discriminant function analysis identified combinations of MS outcomes associated with physical activity.

RESULTS: The sample had a mean age of 49.6 years (

CONCLUSION/IMPLICATIONS: The findings identified walking endurance and limitations, processing speed, depression, and fatigue as primary correlates of physical activity …

Vasopressin Resets The Central Circadian Clock In A Manner Influenced By Sex And Vasoactive Intestinal Polypeptide Signaling, Kayla E. Rohr, Thomas Inda, Jennifer A. Evans

Biomedical Sciences Faculty Research and Publications

Background/Aims: Circadian rhythms in behavior and physiology are programmed by the suprachiasmatic nucleus (SCN) of the hypothalamus. A subset of SCN neurons produce the neuropeptide arginine vasopressin (AVP), but it remains unclear whether AVP signaling influences the SCN clock directly.

Methods: Here, we test that AVP signaling acting through V1A and V1B receptors influences molecular rhythms in SCN neurons. V1 receptor agonists were applied ex vivo to PERIOD2::LUCIFERASE SCN slices, allowing for real-time monitoring of changes in molecular clock function.

Results: V1A/B agonists reset the phase of the SCN molecular clock in a time-dependent manner, with larger magnitude responses by …

Role Of Physical Therapists In The Management Of Individuals At Risk For Or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022, Ellen Hillegass, Kathleen M. Lukaszewicz, Michael Puthoff

Physical Therapy Faculty Research and Publications

No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association’s Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key …

Covid-19 Risk Perceptions And Health Behaviors In Puerto Rico, Charlie Vidal, Page D. Dobbs, Emily Herrman, Daniela Ameijeiras Mena, Ches Jones

Health, Human Performance and Recreation Faculty Publications and Presentations

Preventative health behaviors were encouraged for all at the beginning of the COVID-19 pandemic. However, as the pandemic continued after 2020, some people stopped implementing all measures. It is unknown if people living in Puerto Rico continued to perform preventive health behaviors throughout the pandemic. The purpose of this study was to explore if the risk perceptions of COVID-19 were associated with preventative health behaviors among Puerto Ricans during the COVID-19 pandemic. A sample from Puerto Rico (N = 285) was recruited from January to March 2021 to participate in a cross-sectional, online survey about health behaviors and risk …

Mediating And Maintaining Methylation While Minimizing Mutation: Recent Advances On Mammalian Dna Methyltransferases, Xiaodong Cheng, Robert M Blumenthal

Faculty, Staff and Student Publications

Mammalian genomes are methylated on carbon-5 of many cytosines, mostly in CpG dinucleotides. Methylation patterns are maintained during mitosis via DNMT1, and regulatory factors involved in processes that include histone modifications. Methylation in a sequence longer than CpG can influence the binding of sequence-specific transcription factors, thus affecting gene expression. 5-Methylcytosine deamination results in C-to-T transition. While some mutations are beneficial, most are not; so boosting C-to-T transitions can be dangerous. Given the role of DNMT3A in establishing de novo DNA methylation during development, it is this CpG methylation and deamination that provide the major mutagenic impetus in the DNMT3A …

Assessing The Practicality Of Using A Single Knowledge-Based Planning Model For Multiple Linac Vendors, Raphael J Douglas, Adenike Olanrewaju, Lifei Zhang, Beth M Beadle, Laurence E Court

Faculty, Staff and Student Publications

Purpose: Knowledge-based planning (KBP) has been shown to be an effective tool in quality control for intensity-modulated radiation therapy treatment planning and generating high-quality plans. Previous studies have evaluated its ability to create consistent plans across institutions and between planners within the same institution as well as its use as teaching tool for inexperienced planners. This study evaluates whether planning quality is consistent when using a KBP model to plan across different treatment machines.

Materials and methods: This study used a RapidPlan model (Varian Medical Systems) provided by the vendor, to which we added additional planning objectives, maximum dose limits, …