Medicine and Health Sciences Commons^™

Sufferance For Snuff Puffs: The Acceptability And Behavior Of Smoking Marijuana And Tobacco Inside The House, Eusabeia Silfanus, Oliver Lopez, Vincent Berardi

Student Scholar Symposium Abstracts and Posters

Secondhand smoke (SHS) released from indoor smoking contributes to household air pollution, releasing large quantities of fine particulate matter which can pose negative health outcomes, especially for developing children who spend most of their time at home. The increased legalization of marijuana increases its recreational and medicinal use along with its acceptability. With tobacco use remaining prevalent, the use of marijuana and/or tobacco remains common and may occur inside the home. Project Fresh Air conducted in San Diego County studies the air quality in households (n = 298) with at least one adult smoking tobacco and/or marijuana living with at …

Psychiatric Morbidity Among Patients On Treatment For Tuberculosis At A Tertiary Referral Hospital In Western Kenya, Robina Momanyi, Edith Kwobah, Philip Owiti, Henry Nyamogoba, Lukoye Atwoli

Internal Medicine, East Africa

Background Mental disorders account for nine percent of the overall global burden of disease and are among the top ten leading causes of disability. Mental illness and tuberculosis share risk factors including poverty, overcrowding, stigma, poor nutrition, substance use and retro-viral disease co-infection. Presence of mental illness in tuberculosis delays health-seeking, affects drug adherence, increases cost of treatment, prolongs disease duration, lowers quality of life, and increases mortality. Early diagnosis, linkage, and treatment of psychiatric morbidity among patients with tuberculosis would improve outcomes for both. This study thus aimed to determine the prevalence and factors associated with psychiatric morbidity among …

Patients’ And Physicians’ Beliefs And Attitudes Towards Integrating Personalized Risk Estimates Into Patient Education About Left Ventricular Assist Device Therapy, Kristin M Kostick-Quenet, Benjamin Lang, Natalie Dorfman, Jerry Estep, Mandeep R Mehra, Arvind Bhimaraj, Andrew Civitello, Ulrich Jorde, Barry Trachtenberg, Nir Uriel, Holland Kaplan, Eleanor Gilmore-Szott, Robert Volk, Mahwash Kassi, J S Blumenthal-Barby

Center for Medical Ethics and Health Policy Staff Publications

Background: Personalized risk (PR) estimates may enhance clinical decision making and risk communication by providing individualized estimates of patient outcomes. We explored stakeholder attitudes toward the utility, acceptability, usefulness and best-practices for integrating PR estimates into patient education and decision making about Left Ventricular Assist Device (LVAD).

Methods and results: As part of a 5-year multi-institutional AHRQ project, we conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers), analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards integrating PR in decision making. Patients, caregivers and coordinators emphasized that PR can help to better understand a …

Advancing Genomics To Improve Health Equity, Ebony B Madden, Lucia A Hindorff, Vence L Bonham, Tabia Henry Akintobi, Esteban G Burchard, Kellan E Baker, Rene L Begay, John D Carpten, Nancy J Cox, Valentina Di Francesco, Denise A Dillard, Faith E Fletcher, Stephanie M Fullerton, Nanibaa' A Garrison, Catherine M Hammack-Aviran, Vanessa Y Hiratsuka, James E K Hildreth, Carol R Horowitz, Chanita A Hughes Halbert, Michael Inouye, Amber Jackson, Latrice G Landry, Rick A Kittles, Jeff T Leek, Nita A Limdi, Nicole C Lockhart, Elizabeth O Ofili, Eliseo J Pérez-Stable, Maya Sabatello, Loren Saulsberry, Lorjetta E Schools, Jennifer L Troyer, Benjamin S Wilfond, Genevieve L Wojcik, Judy H Cho, Sandra S-J Lee, Eric D Green

Center for Medical Ethics and Health Policy Staff Publications

Health equity is the state in which everyone has fair and just opportunities to attain their highest level of health. The field of human genomics has fallen short in increasing health equity, largely because the diversity of the human population has been inadequately reflected among participants of genomics research. This lack of diversity leads to disparities that can have scientific and clinical consequences. Achieving health equity related to genomics will require greater effort in addressing inequities within the field. As part of the commitment of the National Human Genome Research Institute (NHGRI) to advancing health equity, it convened experts in …

Public Attitudes, Interests, And Concerns Regarding Polygenic Embryo Screening, Rémy A Furrer, Dorit Barlevy, Stacey Pereira, Shai Carmi, Todd Lencz, Gabriel Lázaro-Muñoz

Center for Medical Ethics and Health Policy Staff Publications

Importance: Polygenic embryo screening (PES) is a novel technology that estimates the likelihood of developing future conditions (eg, diabetes or depression) and traits (eg, height or cognitive ability) in human embryos, with the goal of selecting which embryos to use. Given its commercial availability and concerns raised by researchers, clinicians, bioethicists, and professional organizations, it is essential to inform key stakeholders and relevant policymakers about the public's perspectives on this technology.

Objective: To survey US adults to examine general attitudes, interests, and concerns regarding PES use.

Design, setting, and participants: For this survey study, data were collected from 1 stratified …

Special Anatomy Series. Imaging Inner Ear Structures With High-Frequency Ultrasound: Application To Physical Rehabilitation Space Medicine., Jeffrey Strakowski, Han Zhang, Millard Reschke, Faye Y Chiou-Tan

Neuroscience Articles

OBJECTIVE: The objective of this paper is to document the feasibility of image acquisition, image optimization, and sonographic appearance of the exposed anatomic windows of cadaveric inner ear dissection for purposes of potential future clinical evaluation as part of the developing area of physical and rehabilitation space medicine.

METHODS: Cadaveric dissection of the inner ear was conducted with the goal of exposing areas relevant to vestibular balance. Middle and inner ear structures of 3 human cadavers were imaged with multiple broadband transducers, including emphasis with higher frequency transducers.

RESULTS: The images were best optimized with 17 MHz and 22 MHz …

Patterns Of Undertreatment And Overtreatment In Adjuvant Radiotherapy For Early-Stage Endometrial Cancer Based On Molecular Classification, Otilia Ciobanu, Yixuan He, Alicia R Martin, Jill S Remick, Joseph W Shelton, Tony Y Eng, David C Qian

Faculty, Staff and Student Publications

The quality improvement study examines the use of risk-adaptive adjuvant radiotherapy in women with non–mismatch repair deficiency endometrial cancer.

Translating Motivational Interviewing For The Hpv Vaccine Into A Computable Ontology Model For Automated Ai Conversational Interaction, Nicole Moore, Muhammad Amith, Ana C Neumann, Jane Hamilton, Lu Tang, Lara S Savas, Cui Tao

Faculty, Staff and Student Publications

Human papillomavirus (HPV) vaccinations are lower than expected. To protect the onset of head and neck cancers, innovative strategies to improve the rates are needed. Artificial intelligence may offer some solutions, specifically conversational agents to perform counseling methods. We present our efforts in developing a dialogue model for automating motivational interviewing (MI) to encourage HPV vaccination. We developed a formalized dialogue model for MI using an existing ontology-based framework to manifest a computable representation using OWL2. New utterance classifications were identified along with the ontology that encodes the dialogue model. Our work is available on GitHub under the GPL v.3. …

Abnormality Of Early White Matter Development In Tuberous Sclerosis Complex And Autism Spectrum Disorder: Longitudinal Analysis Of Diffusion Tensor Imaging Measures, Siddharth Srivastava, Fanghan Yang, Anna K Prohl, Peter E Davis, Jamie K Capal, Rajna Filip-Dhima, E Martina Bebin, Darcy A Krueger, Hope Northrup, Joyce Y Wu, Simon K Warfield, Mustafa Sahin, Bo Zhang, Tacern Study Group

Faculty, Staff and Student Publications

Background:

Abnormalities in white matter development may influence development of autism spectrum disorder in tuberous sclerosis complex (TSC). Our goals for this study were as follows: (1) use data from a longitudinal neuroimaging study of tuberous sclerosis complex (TACERN) to develop optimized linear mixed effects models for analyzing longitudinal, repeated diffusion tensor imaging metrics (fractional anisotropy, mean diffusivity) pertaining to select white matter tracts, in relation to positive Autism Diagnostic Observation Schedule–Second Edition classification at 36 months, and (2) perform an exploratory analysis using optimized models applied to all white matter tracts from these data.

Methods:

Eligible participants (3-12 months) …

Physical Activity Policies At National And Subnational Levels: A Study In Colombia, Costa Rica, Ecuador, And Mexico, Juliana Mejía Grueso, Michael Pratt, Eugen Resendiz, Deborah Salvo, Gloria Isabel Niño Cruz, Nubia Yaneth Ruiz Gómez, Rafael Alexander Leandro Gómez, Inés Revuelta Sánchez, Gerardo Alonso Araya Vargas, Angélica María Ochoa Avilés, Raúl Francisco Pérez Tasigchana, Alejandra Jáuregui, Pedro C Hallal, Andrea Ramírez Varela

Faculty, Staff and Student Publications

Background: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries.

Methods: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were …

Risk Evaluation In Occupational Safety And Health Research: Results From A Benchmarking Exercise Of Federal And Academic Irbs, Sarah A Felknor, Jessica M K Streit, Angela M Morley, John D Piacentino

Faculty, Staff and Student Publications

OBJECTIVE: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment.

METHODS: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings.

RESULTS: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk …

Investigating The Role Of The Gut Microbiota On Immune Checkpoint Inhibitor-Mediated Colitis, Taylor Halsey, Robert Jenq

Dissertations and Theses (Open Access)

Immune checkpoint inhibitors (ICIs) have been revolutionary in the fight against cancer by recruiting the host immune system as an agent for attack on malignant cells. Unfortunately, immune-related adverse events (irAEs), including ICI-mediated colitis (IMC), are common side effects that result from immune cell mediated damage on healthy tissues. Recent studies have highlighted a role for the gut microbiota in modulating ICI-mediated anti-tumor responses, but less is known regarding how the gut microbiota may impact on irAEs. Considering that the gastrointestinal tract harbors thousands of unique microbial species, many of which are known to modulate the immune system, microbes and …

Acute Pain Prediction In Oral Cavity And Oropharyngeal Cancer Patients Receiving Radiation Therapy, Vivian Salama

Dissertations and Theses (Open Access)

Oral-Cavity and oropharyngeal cancers (OC/OPC) are types of head and neck cancers that are increasing in incidence domestically. Radiation therapy (RT) is crucial in OC/OPC management. Pain is a common and challenging symptom for most patients during therapy, as nearly all patients undergoing locoregional RT in OC/OPC require analgesia for acute iatrogenic pain. Moreover, about 45% of long-term survivors report chronic pain, with more than 10% exhibiting severe chronic pain. Pain control is challenging due to the multifactorial clinical, molecular, and cellular etiology of cancer/therapy pain, as well as variation in pain assessment and the non-uniform management of pain between …

Patient Understanding Of Fetal Sex Versus Gender In The Context Of Routine Cell-Free Dna Screening, Mindy Kolodziejski

Dissertations and Theses (Open Access)

Non-invasive prenatal testing (NIPT) is the current standard of care to screen for fetal aneuploidy using cell-free DNA (cfDNA). NIPT screens for sex chromosome aneuploidies (SCAs) and in doing so, can predict fetal chromosomal sex. Despite sex and gender being distinct concepts, many patients refer to NIPT as “the gender test” and elect testing in order to find out predicted fetal sex and assume gender. Our study aimed to evaluate and describe patient understanding of sex and gender in the context of receiving routine prenatal genetics education (PGE) on NIPT. A survey was developed with the goal of assessing patient …

Evaluation Of An End-To-End Radiotherapy Treatment Planning Pipeline For Prostate Cancer, Mohammad Daniel El Basha, Court Laurence, Carlos Eduardo Cardenas, Julianne Pollard-Larkin, Steven Frank, David T. Fuentes, Falk Poenisch, Zhiqian H. Yu

Dissertations and Theses (Open Access)

Radiation treatment planning is a crucial and time-intensive process in radiation therapy. This planning involves carefully designing a treatment regimen tailored to a patient’s specific condition, including the type, location, and size of the tumor with reference to surrounding healthy tissues. For prostate cancer, this tumor may be either local, locally advanced with extracapsular involvement, or extend into the pelvic lymph node chain. Automating essential parts of this process would allow for the rapid development of effective treatment plans and better plan optimization to enhance tumor control for better outcomes.

The first objective of this work, to automate the treatment …

Cord Blood-Derived Invariant Natural Killer T Cells As A Platform For Allogeneic Chimeric Antigen Receptor Cell Therapy, Maison Grefe

Dissertations and Theses (Open Access)

Chimeric antigen receptor (CAR) T cells have revolutionized the treatment of hematopoietic malignancies achieving >50% complete response rates in numerous refractory/relapsed B cell malignancies. However, there are challenges that hinder CAR-T efficacy and bar the broader use of this therapy in patients. One approach to address these challenges is to create a safe allogeneic CAR cell product by using cells that do not cause graft versus host disease (GvHD). Invariant natural killer T (iNKT) cells are an ideal candidate as they are restricted to the monomorphic CD1d protein in contrast to HLA restricted αβ-T cells and therefore are safe in …

Inclusion Of Adoption As A Pregnancy Management Option In Prenatal Genetic Counseling Practice, Emma Billings

Dissertations and Theses (Open Access)

Prenatal genetic counselors are essential to providing education, psychosocial support, and guidance on pregnancy options to patients who receive a fetal diagnosis of an anomaly or genetic condition. Therefore, genetic counselors should be well-educated on comprehensive pregnancy management options consisting of parenting, abortion, and adoption. The landscape of adoption education in genetic counseling practice was last characterized in 2010 by Perry and Henry, revealing substantial variability in both the inclusion of adoption-specific education in genetic counseling program (GCP) curricula and the discussion of pregnancy options with patients in prenatal practice. As a result, the authors published a call to action …

Methods For The Prediction Of Osteoradionecrosis Resulting From Head And Neck Cancer Radiation Therapy, Brandon Reber

Dissertations and Theses (Open Access)

Head and neck cancer (HNC) is the sixth most diagnosed cancer worldwide with over 600,000 patients diagnosed every year. One of the primary methods to treat HNC is through radiation therapy (RT). While RT is effective at treating HNC, late toxicities resulting from treatment can occur months to years post-treatment and can cause debilitating quality of life changes for HNC survivors. One of these late toxicities is osteoradionecrosis (ORN), which is the death of bone due to radiation. For HNC, the mandible is commonly affected and can cause challenges chewing, swallowing, and physical appearance changes. Several factors indicate the pressing …

Retinoid X Receptor As A Mediator Of Post Stroke Recovery By Reversing Age-Associated Phenotypes Of Microglia/Macrophages, Shun-Ming Ting

Dissertations and Theses (Open Access)

After stroke, microglia (MG) and blood-derived macrophages, together (MF), clear dead cells and cellular debris in the infarcted brain through phagocytosis. However, the phagocytic capability of MF declines with age. Age-related changes in MF phenotype also include overactive inflammatory responses to stroke-induced brain injury, altogether resulting in poor recovery after stroke. Retinoid-X-receptor (RXR) is a pleiotropic transcription factor. Our studies suggest that RXRa enhances MF phagocytic functions, reduces inflammatory responses, and improves post-stroke recovery. To establish phenotypes of aging MF, MG were MACS-sorted from the brains of young adults (2-4 months old) and aged (18-20 months old) mice for transcriptomic …

Impact Of Genetic Counseling On Patient Empowerment After Diagnosis Of Fetal Anomaly, Carley Brueckner

Dissertations and Theses (Open Access)

Approximately 3-5% of pregnancies are affected by fetal anomalies, often leading to structural and functional differences that impact infant health and mortality. When anomalies are identified on prenatal ultrasound, genetic counseling (GC) and genetic testing may be offered to investigate the potential for a possible syndromic cause. Genetic counselors provide education on the chance for a genetic etiology, available testing options, potential changes in medical intervention related to an identified etiology, and psychosocial counseling and resources. Regardless of a patient’s testing decision, genetic counseling should include psychosocial counseling to support and empower patients in a time of prognostic uncertainty and …

Epiregulin As A Novel Target For Antibody-Drug Conjugate Development For The Treatment Of Colorectal Cancer, Joan Jacob

Dissertations and Theses (Open Access)

Antibody-drug conjugates (ADCs) are a fast-growing class of molecularly targeted therapies with 13 currently approved and over a 100 in clinical trials. ADCs consist of a monoclonal antibody (mAb) conjugated to a potent cytotoxic payload to selectively target tumor antigens highly expressed on the cell surface. ADC development has been limited in colorectal cancer (CRC) by the lack of novel and effective therapeutic targets. Epiregulin (EREG), is an epidermal growth factor receptor (EGFR) ligand that is highly expressed in CRCs of different subtypes and mutational statuses with low expression in normal tissues. Here, we have characterized the role of EREG …

Interrogating Therapeutic Resistance To Oncogenic Krasg12c-Based Therapies In Colorectal Cancer, Oluwadara Coker

Dissertations and Theses (Open Access)

Colorectal cancer is the second leading cause of cancer-related deaths and the third most common cancer in the United States. Although KRAS is mutated in 50% of patients with metastatic CRC (mCRC), it has historically been a challenging therapeutic target. The recent approval of novel covalent inhibitors selective for KRASG12C mutation have entered the clinic, which has not only marked a major milestone in cancer drug discovery but has also intensified efforts to directly target other KRAS mutations that have also successfully entered the clinic. However, treatment-associated resistance mechanisms have long threatened to attenuate clinical benefit through either adaptive or …

Molecular Basis Of Cell Membrane Adaption Against Daptomycin In Enterococcus Faecalis, April Nguyen

Dissertations and Theses (Open Access)

Daptomycin is a last-resort lipopeptide antibiotic that disrupts cell membrane (CM) and peptidoglycan homeostasis (Grein et al., 2020a; Müller et al., 2016a). Enterococcus faecalis has developed a sophisticated mechanism to avoid daptomycin killing by redistributing CM anionic phospholipids away from the septum. The CM changes are orchestrated by a three-component regulatory system, designated LiaFSR, with a possible contribution of cardiolipin synthase (Cls) (Cesar A Arias et al., 2011a; Khan et al., 2019b; Palmer et al., 2011a; Panesso et al., 2015a; Reyes et al., 2015a). However, the mechanism by which LiaFSR controls the cell membrane response and the role of Cls …

Dissecting The Relationship Between Mucin 5ac And The Lung/Gut Microbiome In The Pathogenesis Of K-Ras Mutant Lung Cancer, Maria T. Grimaldo

Dissertations and Theses (Open Access)

Non-small cell lung cancer, including its most common subtype, lung adenocarcinoma (LUAD), is the leading cause of cancer-related deaths worldwide. In LUAD patients, KRAS mutations are the most common oncogenic driver alteration. Given KRAS is upstream to many signaling pathways involved in cell survival and cytokine production, interventions against KRAS-mutant lung cancers are prone to develop acquired resistance. Thus, there is a need to develop alternate targeting strategies and test combination therapies for improved intervention. Previously, we have found that KRAS-mutant LUAD (KM-LUAD) patients whose tumors harbor high expression of Mucin 5 AC (MUC5AC), a main airway secretory mucin, have …

Development Of Systems For Processing And Managing Donations For The William A. Burnard Warming Center, Landon Corbett

Undergraduate Honors Capstone Projects

Structure is important for any organization to have success and grow. Thus, having a good inventory system can make a huge difference. This project set out to investigate and develop a system that would be able to monitor incoming donations, inventory levels, and items given away to guests. The inventory method needed to be as automated as possible because the warming center volunteers were already busy with other responsibilities.

While many softwares were researched, my proposed solution was created with a combination of Google Sheets and Google Forms, as it is free and can be customized to the specific needs …

Locally Injectable Peptide Hydrogel For Conversion Of Temozolomide And Codelivery Of Sirna In Glioblastoma Multiforme Treatment, Megan Pitz

All Dissertations

Traditional treatment methods for glioblastoma multiforme (GBM) are largely unsuccessful, with a 5-year survival rate of 5.6%. Temozolomide (TMZ), the only chemotherapy FDA-approved for GBM treatment, is a hydrophobic prodrug that is stable in an acidic pH and begins converting to its active form at a physiological pH of 7.4. However, complete conversion of TMZ is observed only at a higher pH, and only about 30% of administered TMZ reaches the central nervous system. Therefore, there is a need for new treatment methods that maximize TMZ delivery to and efficacy at the tumor site. Self-assembling peptides are a unique class …

Going, Going, Gone: The Influence Of Job And Home Demands And Resources On Emergency Department Nurse Turnover, Jordan Gail Smith

All Dissertations

Nurse turnover, which challenged healthcare organizations even before the pandemic, reached alarming rates across hospitals worldwide during COVID-19. Due to the unprecedented and stressful nature of the pandemic, recent investigations have focused primarily on exploring job demands and nurse turnover intentions. While job demands are critical to understanding turnover, this narrow scope ignores the possible influence of other factors such as job resources and demands and resources external to the work domain. This study utilized archival qualitative data from a longitudinal survey of Emergency Department clinicians to analyze research questions and hypotheses. The first aim of this study was to …

Challenges Beyond Addiction: Maternal Experiences With Postpartum Substance Use Disorder Recovery And Perspectives Of Reproductive Healthcare Providers, Leah Holcomb

All Dissertations

Substance use disorders (SUD) impact millions of pregnant and postpartum people in the United States. With the increasing rates of perinatal substance use and the risk of overdose and death during the postpartum period, understanding overall functioning and the needs of postpartum persons is critical for informing interventions to reduce the impact of substance use within the perinatal period. The goal of this research is to explore the needs of postpartum people navigating SUD recovery.

This dissertation investigates postpartum maternal functioning within the context of early SUD recovery, as well as the comfort of reproductive healthcare providers (RHPs) to care …

Examining Current Capacity Of Healthcare Systems: Identifying Potential Adaptations For Children And Youth With Special Healthcare Needs, Caitlin Koob

All Dissertations

Children and youth with special healthcare needs (CYSHCN) are a growing proportion of the pediatric population, accounting for 23% of children in South Carolina (SC). Children with medical complexity (CMC) are a subgroup of CYSHCN who experience the most complex conditions and comprise

This dissertation investigates equitable healthcare access, service quality, and health and well-being among CYSHCN and their families, within the context of SC’s healthcare system. Three studies make up this dissertation, focusing on various aspects of healthcare access and experiences of CYSHCN and their families.

Dyslexia Training: The Impact On The Perceptions And Knowledge-Base Of Pre-Professionals Preparing To Work In K-12 Educational Settings, Colby Fowler

Graduate Theses and Dissertations

This research explores the perceptions and understanding of dyslexia among first-year graduate students in speech-language pathology. Employing survey methodology, specifically a pre- and post-survey approach, this research investigates the attitudes and knowledge that the participants have in understanding and addressing dyslexia at the beginning of their graduate training. The study seeks to uncover the existing awareness, potential misconceptions, and the overall preparedness of these emerging professionals in dealing with individuals affected by dyslexia. Through a comprehensive survey analysis, the research aims to contribute valuable insights that can inform the development of targeted educational strategies and interventions within speech-language pathology programs, …