Medical Genetics Commons^™

A Stakeholder-Informed Conceptual Framework For Evaluating Genomics In Precision Oncology, Julie A. Wiedower

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This dissertation explores the value of genomic testing in precision oncology with an emphasis on how US payers conceptualize and prioritize elements of value. This research aims to address gaps in understanding payer perspectives and proposes a stakeholder-informed framework for evaluating genomic testing in oncology. To achieve this aim, the presented research investigates payer perspectives, value-based cancer care priorities, and the conceptual understanding of the value of a genetic diagnosis to establish a framework for value with the payer audience in mind. Chapter 1 outlines relevant background information relating to the genomic revolution and challenges in translating genomic testing technologies …

The Genomic Landscape And Prognostic Impact Of Kras, Stk11, And Smarca4 Mutations And Co-Mutations On Survival Outcomes In Non-Small Cell Lung Cancer, Peter Manolakos

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Non-small lung cancer (NSCLC) accounts for 85% of lung cancer cases, and Kirsten rat sarcoma viral oncogene homolog (KRAS), Serine/Threonine Kinase 11 (STK11), and SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4) mutations and co-mutations have been increasingly recognized for their potential prognostic significance. However, clear knowledge gaps remain regarding which treatments should be selected for patients who present clinically with KRAS/STK11 or KRAS/SMARCA4 co-mutations, as outlined in Chapter 1. Despite significant clinical development advancements in immunotherapy and targeted therapy, a deeper understanding of the influence of these genomic …

The Characterization Of Cacna1a-Related Hemiplegic Migraine, Donna P. Schaare

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CACNA1A-related Hemiplegic Migraine (HM) is a rare neurodevelopmental disorder characterized by paroxysmal episodes of hemiparesis/hemiplegia with or without headache. The presentation of CACNA1A-related HM can range from mild HM events in neurotypical individuals to life-threatening prolonged periods of hemiplegia with cerebral edema in individuals with baseline neurodevelopmental features. CACNA1A-related HM has been studied extensively in its familial form, Familial Hemiplegic Migraine type 1 (FHM1), but the often more severe disorder attributed to de novo variants, Sporadic Hemiplegic Migraine type 1 (SHM1), has had limited description. Genetic resources and the 3^rd edition of the International Classification of …

Nutrigenetic And Dietary Factors Impacting The Relationship Between Linoleic Acid And Apolipoprotein B, Gregory Nacarelli

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This dissertation investigates the relationship between the omega-6 fatty acid, linoleic acid (LA), and the cardiovascular disease (CVD) risk marker apolipoprotein B (apoB). ApoB is considered to be the most important causal marker of CVD. However, the impact of LA on CVD risk has been subject to debate within the scientific literature, with various studies showing LA can decrease or increase apoB concentrations. To foster more clarity regarding this relationship, we first investigated all dietary, macronutrient, micronutrient, and nutrigenetic factors that impact concentrations of apolipoproteins via a narrative analysis approach. We found that more Westernized diets containing more processed foods, …

Weight Maintenance, A Prognostic Factor That Mediates The Incidence Of Dementia: From Genetics To Etiologies, Sunny Chen

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Objectives: Alzheimer’s disease-related dementia is a devastating neurodegenerative disease that affects millions of people. The goal of this work is to investigate biological mechanisms such as weight loss and mitochondrial function that can serve as prognostic factors for dementia, healthy aging, and longevity.

Methodologies: This work consists of two separate systematic literature reviews, and an investigational study. The first review examined existing studies on weight trends in dementia. The second review investigated the role of mitochondria and its associated gene TOMM40 in aging. The third paper included a nested case control analysis of weight change patterns before and …

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

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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

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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 …