Biostatistics Commons^™

Effect Of The Sava Syndemic On Hiv Viral Suppression Among People Living With Hiv In The United States: A Scoping Review And Meta-Analysis, Jacquelyn Rodriguez

UNLV Theses, Dissertations, Professional Papers, and Capstones

The SAVA syndemic highlights the interconnected and mutually reinforcing nature of substance use, violence victimization, and HIV/AIDS. The synergistic interaction of these conditions creates structural and behavioral barriers that disrupt the HIV care continuum and contribute to significant health inequities. Achieving a suppressed viral load is a critical clinical outcome for people living with HIV, while viral non-suppression can be an indicator of poor health, elevated transmission risk, and disease progression. Still, the association between SAVA factors and viral suppression/non-suppression outcomes within U.S. populations remains inconsistently characterized due to heterogeneous methodologies and variable inclusion of high-risk groups. This mixed-methods study …

Rna’S Symphony: Harmonizing Splice Junctions And Exon Counts For A Novel Approach To Differential Splicing Analysis, Jelard Aquino

UNLV Theses, Dissertations, Professional Papers, and Capstones

Alternative Splicing (AS) plays a critical role in transcriptome complexity and cell-type-specific gene regulation, yet its analysis remains methodologically fragmented, especially in the context of noisy and sparse single-cell RNA sequencing (scRNA-seq) data. This dissertation addresses key computational challenges in AS detection by evaluating existing tools, developing integrative frameworks, and proposing new strategies for improving analysis accuracy in both bulk and single-cell contexts. In chapter 1, I present a comprehensive literature review of computational tools designed for detecting and quantifying AS from bulk and scRNA-seq data. This review outlines major methodological paradigms, including exon-based and splice junction-based approaches, and evaluates …

Empowering Science With The World's First High Accuracy And High Throughput Functional Assay, Christopher Giacoletto

UNLV Theses, Dissertations, Professional Papers, and Capstones

Understanding the functional consequences of genetic mutations remains a central challenge in modern biology, with far-reaching implications for human health and disease. While early systematic methods like alanine scanning and phage display provided foundational insights into protein structure and function, the emergence of high-throughput approaches—such as Multiplexed Assays of Variant Effect (MAVEs)—and predictive tools powered by artificial intelligence have vastly expanded our ability to profile mutational landscapes. However, these methods are often constrained by trade-offs between accuracy, scalability, and biological relevance.This dissertation presents the development and application of the GigaAssay, the world’s first high-throughput functional assay capable of delivering both …

“Do You Even Lift, Bro?”: Correlates Of Muscle Dysmorphia Symptomatology In Filipino Male University Students, Pamela Paula C. Pioquinto

UNLV Theses, Dissertations, Professional Papers, and Capstones

Muscle Dysmorphia (MD) is a subtype of Body Dysmorphic Disorder (BDD) and is marked by the desire to increase muscularity and reduce body fat. MD is typically more prevalent among younger male populations, and it often drives comorbid disorders, including substance abuse, eating disorders, and social anxiety. Despite the growing literature on MD, it remains understudied in certain racial/ethnic populations, such as Filipinos. Acculturation, defined as the process in which an individual adopts, acquires, and adapts to a new cultural environment as a result of immigration, influences body image by reshaping an individual’s perceptions of beauty and muscularity standards. Guided …

Examining Covid-19 Vaccine Hesitancy Among The Nevada African American Population Using The Social-Ecological Model, Katelyn Faulk

UNLV Theses, Dissertations, Professional Papers, and Capstones

In Nevada, COVID-19 vaccines have been widely available to the general population since March 2021; however, even with the wide availability of these vaccines only 40% of the African American population in Nevada has been fully vaccinated against COVID-19 as of May 2023. This is problematic as it has been shown that the African American population is disproportionately affected by COVID-19 with higher rates of cases, hospitalizations, and deaths when compared to other races or ethnicities. Through the literature, it has also been well documented that African Americans may experience hesitancy toward these vaccinations for a multitude of reasons including …

Development Of A Metapgs For Accurate Prediction Of Osteoporotic Fracture, Xiangxue Xiao

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Early identification of individuals at high-risk for osteoporotic fractures who may benefit from preventive intervention is essential. However, the predictive accuracy of the currently used fracture risk assessment tool remains suboptimal. The first aim of this research is to construct genome-wide polygenic scores for the femoral neck (PGS_FNBMD_idpred) and total body BMD (PGS_TBBMD_idpred) and to estimate their potential in identifying individuals with a high risk of osteoporotic fractures. The second aim is to validate the predictive performance of two previously established PGSs (PGS_FNBMD_idpred and PGS_TBBMD_idpred) in an external cohort …

Polygenic Risk Score Development And Validation For Early Detection And Risk Stratification Of Rheumatoid Arthritis And Osteoarthritis In Postmenopausal Women, Yingke Xu

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Around one in four adults worldwide suffer from arthritis. There are more than one hundred different forms of arthritis; the two most common forms of arthritis are rheumatoid arthritis (RA) and osteoarthritis (OA). RA is an autoimmune disease that can cause joint inflammation. Around 1.3 million adults in the US suffer from RA, representing 0.6%–1% of the population. The RA diagnosis in its early stages is difficult since its signs and symptoms are similar to other arthritis. OA is the most common form of arthritis. In the US, around 30.8 million people are affected by this disease. However, OA …

Use Of Healthcare Utilization Records For Analyzing Trends In Clinical Toxoplasmosis: A Comparison Of Nevada And The United States, Elijah Kreutzer

UNLV Theses, Dissertations, Professional Papers, and Capstones

Toxoplasmosis, a zoonotic disease caused by the parasitic protist Toxoplasma gondii, is a ubiquitous, global public health concern with a wide variety of clinical manifestations. Surveillance for the disease is lacking even in developed countries, and what surveillance is present most often focuses on pregnant women. This research investigated trends in clinical toxoplasmosis in Nevada and nationally to address the lack of knowledge concerning how Nevada discharges compare to national discharges in cases of toxoplasmosis. Specifically, this research sought to determine what characterizes toxoplasmosis in Nevada across inpatient, outpatient, and emergency department settings, as well as how these cases differ …

Exploratory Analysis Of The Associations Between Neonicotinoids And Measures Of Adiposity Among Us Adults: Nhanes 2015–2016, Amruta M. Godbole, Sheniz Moonie, Courtney Coughenour, Cai Zhang, Aimin Chen, Ann M. Vuong

Environmental & Global Health Faculty Research

Background: Toxicology studies suggest that neonicotinoids may be associated with adiposity development via thyroid hormone disruption and increased oxidative stress. Prior epidemiological studies report mixed results for the association between neonicotinoids and adiposity measures.

Objective: To examine the association between detectable concentrations of parent neonicotinoids (imidacloprid, acetamiprid, clothianidin) and neonicotinoid metabolites (5-hydroxy-imidacloprid, N-desmethyl-acetamiprid) with adiposity measures among US adults, and whether sex modifies the associations for neonicotinoid metabolites with adiposity.

Methods: National Health and Nutrition Examination Survey (NHANES) 2015–2016 data was utilized to estimate covariate-adjusted associations between detectable neonicotinoids and fat mass index (FMI), lean mass index (LMI), waist …

Depression And Factors Impacting Quality Of Life Among Adults With Asthma Presence In Nevada, Elizabeth D. Kahane, Lung-Chang Chien, Brian Labus, Dharini M. Bhammar, Jocy-Anna Chevalier, Sheniz Moonie

Epidemiology & Biostatistics Faculty Research

Background: Asthma, a chronic, non-communicable disease has been shown to negatively affect mental health and quality of life among adults. Annually approximately 8% of adult Nevadans report current asthma symptoms and 12.6% report having a lifetime diagnosis. The purpose of this study was to evaluate the association between asthma and depression and explore quality of life factors affecting adult Nevadans with asthma. Methods: Using behavioral risk factor surveillance system (BRFSS) data, this study evaluated the association between self-reported asthma and depression in Nevada using weighted multiple logistic regression. BRFSS asthma call-back survey (ACBS) data were used to determine the frequency …

Cellular Dna Effects Of Radiation And Cancer Risk Assessment In Cells With Mitochondrial Defects, J. Chen, D. M. Sridharan, C. L. Cross, J. M. Pluth

Epidemiology & Biostatistics Faculty Research

Mitochondria play a key role in mediating non-targeted effects (NTE) post-radiation exposure. Mitochondrial DNA (mtDNA), due to its less efficient repair as compared to nuclear DNA, is more severely affected by radiation exposure and mutations in essential mtDNA genes can further exacerbate oxidative stress. Our objective was to evaluate the impact of mitochondrial defects on radiation-induced DDR and genomic instability, biomarkers that can foreshadow cancer development. To better understand this relationship, we used commercially available lymphoblastoid cell lines containing characterized mitochondrial mutations and studied the kinetics of DNA damage and relative telomere length (RTL) changes over time post 0.5 Gy …

Traveling Wave Solutions For Two Species Competitive Chemotaxis Systems, T. B. Issa, Richadi B. Salako, W. Shen

Mathematical Sciences Faculty Research

In this paper, we consider two species chemotaxis systems with Lotka–Volterra competition reaction terms. Under appropriate conditions on the parameters in such a system, we establish the existence of traveling wave solutions of the system connecting two spatially homogeneous equilibrium solutions with wave speed greater than some critical number c∗. We also show the non-existence of such traveling waves with speed less than some critical number c0∗, which is independent of the chemotaxis. Moreover, under suitable hypotheses on the coefficients of the reaction terms, we obtain explicit range for the chemotaxis sensitivity coefficients ensuring c∗=c0∗, which implies that the minimum …

Impact Of Neoantigen Expression And T-Cell Activation On Breast Cancer Survival, Wenjing Li, Amei Amei, Francis Bui, Saba Norouzifar, Lingeng Lu, Zuoheng Wang

Mathematical Sciences Faculty Research

Neoantigens are derived from tumor-specific somatic mutations. Neoantigen-based syn-thesized peptides have been under clinical investigation to boost cancer immunotherapy efficacy. The promising results prompt us to further elucidate the effect of neoantigen expression on patient survival in breast cancer. We applied Kaplan–Meier survival and multivariable Cox regression models to evaluate the effect of neoantigen expression and its interaction with T-cell activation on overall survival in a cohort of 729 breast cancer patients. Pearson’s chi-squared tests were used to assess the relationships between neoantigen expression and clinical pathological variables. Spearman correlation analysis was conducted to identify correlations between neoantigen expression, mutation …

Food Insecurity And Adiposity Among Children And Adults Nhanes 2015-2016, Denise Vidal

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Obesity is a preventable disease that has been associated with many adverse health outcomes. A possible factor that may influence adiposity development is food insecurity. Although several epidemiological studies have been conducted examining the association between food insecurity and adiposity among children and adults, results have been inconsistent. Objective: This cross-sectional study investigates the relationship between food insecurity and adiposity among children and adults using recent data from a representative sample of the US population. Methods: We examined 3,391 adults and 2,837 children from the National Health and Nutrition Examination Survey (NHANES) 2015-2016. Household food insecurity was assessed using …

Does Social Support Moderate The Association Between Income And Food Security Status Among Seniors Living In Southern Nevada?, Adugna Teka Siweya

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Income is the strongest predictor of food insecurity among seniors, and social support also an essential factor to help mitigate the effects of food insecurity. However, little is known about the potential role that social support may play as a moderator of the association between income and food insecurity. Thus, we aim to examine social support as a moderator for the relationship between income and food insecurity among seniors. Methods: Logistic regression models were used to analyze data collected in 2019 from seniors residing in Southern Nevada. Predictors of food insecurity, sociodemographic factors, social support variables, and income and …

Optimal Two-Stage Designs Based On Restricted Mean Survival Time For A Single-Arm Study, Guogen Shan

School of Public Health Faculty Research

© 2021 The Author(s) Restricted mean survival time is an alternative measure of treatment effect to hazard ratio in clinical trials with time-to-event outcome. The current methods have been focused on one-stage designs. In this article, we propose optimal two-stage designs for a single-arm study with the smallest expected sample size. We compare the performance of the new optimal two-stage designs with the existing one-stage design with regards to the expected sample size and the expected total study length. The simulation results indicate that the new two-stage designs can save the expected sample size substantially as compared to the one-stage …

Addressing The Ecological Fallacy With Lagrangian Inference, Michael Schwob

Calvert Undergraduate Research Awards

Most epidemiologists elect to use statistical models that use population-level data to make inference on the spread of some virus or disease. This has become commonplace in the fields of epidemiology and biostatistics since most data used to construct and verify epidemic models are recorded at the population-level. Obtaining inference from a population-level model may be beneficial in studying the spread of disease in a homogeneous population, but the use of such models to describe a heterogeneous population results in inadequate inference. The inaccuracy of these models is further amplified when one tries to make individual-level inference from these population-level …

Gardasil Vaccine Trends Within Nevada, California, And The U.S.: A Comparative Study, Karen S. Gutierrez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite decreasing incidence in cervical cancer in the U.S., there continues to be an increase in public health concern for cervical cancer worldwide. Recent studies report that individuals are disproportionately affected based on region, sex, and race. Additionally, the human papillomavirus (HPV) attributable cancers may be reduced between 70% and 90% through the universal use of HPV-vaccines. In order to expand current knowledge and implement intervention programs in Nevada, it is critical to examine the associations among the Gardasil vaccine, cervical cancer screening, and adverse events following immunization as well as to understand the different socio-demographic subgroups affected. To our …

Interplay Of Trna-Derived Fragments And T Cell Activation In Breast Cancer Patient Survival, Nayang Shan, Ningshan Li, Qile Dai, Lin Hou, Xiting Yan, Amei Amei, Lingeng Lu, Zuoheng Wang

Mathematical Sciences Faculty Research

Effector CD8+ T cell activation and its cytotoxic function are positively correlated with improved survival in breast cancer. tRNA-derived fragments (tRFs) have recently been found to be involved in gene regulation in cancer progression. However, it is unclear how interactions between expression of tRFs and T cell activation affect breast cancer patient survival. We used Kaplan–Meier survival and multivariate Cox regression models to evaluate the effect of interactions between expression of tRFs and T cell activation on survival in 1081 breast cancer patients. Spearman correlation analysis and weighted gene co-expression network analysis were conducted to identify genes and pathways that …

Physical Therapy Nontreatment Events With Primary Physical Therapist, Stephen Johnson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Physical therapy improves prognosis reduces stay and is generally helpful in aiding recovery from a wide range of ailments. Nontreatment rates occur for multiple reasons and are also related to the personalities of physical therapists.

Methods: We used data from a research project involving physical therapy at an acute care facility in our community. Our study focused on the retrospectively determined primary physical therapist for each patient. We used the chi-squared tests to compare nontreatment rates between days of the week and disease type and the reasons for nontreatment events. Repeated-measure models were used to evaluate the effect of …

Accurate Confidence Intervals For Risk Difference In Meta-Analysis With Rare Events, Tao Jiang, Baixin Cao, Guogen Shan

Environmental & Global Health Faculty Research

Background: Meta-analysis provides a useful statistical tool to effectively estimate treatment effect from multiple studies. When the outcome is binary and it is rare (e.g., safety data in clinical trials), the traditionally used methods may have unsatisfactory performance. Methods: We propose using importance sampling to compute confidence intervals for risk difference in meta-analysis with rare events. The proposed intervals are not exact, but they often have the coverage probabilities close to the nominal level. We compare the proposed accurate intervals with the existing intervals from the fixed- or random-effects models and the interval by Tian et al. (2009). Results: We …

Evaluating Parents Sociodemographic Factors And Childhood Vaccine Decisions, Mehret Girmay

UNLV Theses, Dissertations, Professional Papers, and Capstones

Vaccination is considered one of the most successful public health achievements of the 20th century. However, with increasing vaccine skepticism emerging over the past decades, there is a threat to the ongoing sustainment of vaccine coverage within all US communities. This study evaluated and compared parents’ sociodemographic factors associated with childhood vaccine decisions. This study is a secondary analysis of 893 parents/guardians, age 18-55 years with child(ren) < 7 years living in the U.S.

Predictive analysis was conducted using multinomial logistic regression modeling was used to examine vaccine decisions (accept, hesitant, and refuse) in relation to parents’ sociodemographic factors. Overall, (66.6%) of parents accepted recommended vaccines, while …

Biological And Practical Implications Of Genome-Wide Association Study Of Schizophrenia Using Bayesian Variable Selection, Benazir Rowe, Xiangning Chen, Zuoheng Wang, Jingchun Chen, Amei Amei

School of Medicine Faculty Research

Genome-wide association studies (GWAS) have identified over 100 loci associated with schizophrenia. Most of these studies test genetic variants for association one at a time. In this study, we performed GWAS of the molecular genetics of schizophrenia (MGS) dataset with 5334 subjects using multivariate Bayesian variable selection (BVS) method Posterior Inference via Model Averaging and Subset Selection (piMASS) and compared our results with the previous univariate analysis of the MGS dataset. We showed that piMASS can improve the power of detecting schizophrenia-associated SNPs, potentially leading to new discoveries from existing data without increasing the sample size. We tested SNPs in …

Factors Associated With Eosinophilic Esophagitis In Nevada, Julia Lorraine Anderson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Eosinophilic esophagitis (EoE) is a rare immune-mediated illness with symptoms that range from difficulty swallowing to food impaction of the esophagus. Most published studies have been documented among patients residing in cool regions with significant annual rainfall. No published studies to our knowledge have been performed examining the healthcare utilization trends of EoE in Nevada. Utilizing two unique databases, the factors associated with EoE healthcare utilization patterns in Nevada were examined. All analyses were performed in R version 3.5.1. This study included a demographic and regional analysis identifying risk factors associated with having an EoE healthcare visit in Nevada. Several …

An Analysis Of Postmastectomy Breast Reconstruction Due To Breast Cancer In Nevada And The United States From 2008-2013, Jenna Webb

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: In the United States, female breast cancer was the leading cause of new cancer cases from 2011-2015. Since the Women’s Health and Cancer Act of 1998 (WHCRA), the federal government mandates employee and private health insurance providers to cover breast reconstruction if they cover mastectomies. Postmastectomy breast reconstruction (PBR) rates increased after the WHCRA, but these rates have remained relatively low throughout recent years. Objective: The objective of this study was to determine factors associated with women having PBR due to breast cancer in Nevada and the United States from 2008 to 2013. Methods: Using two HCUP database, NIS …

Telomeres, Nutrition And Mortality: Risk Factors For The Rate Of Telomere Length Decline And The Associations Between Telomere Length, Nutrition And Mortality, Saruna Ghimire

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Telomeres are nucleoprotein structures located at the ends of eukaryotic chromosomes, thought to protect the DNA from damage. As a person experiences stressors, harmful exposures, and other diseases throughout their life, telomeres are thought to become damaged and their length shortened, decreasing their ability to protect the DNA. Nutrition is an important aspect of healthy aging. Preservation of telomere length (TL) is thought to be one of the mechanisms by which good nutrition can delay or prevent the development of chronic disease and death. Recent evidence of preservation of TL with good nutrition is promising. Thus, the aim of …

Health Disparities Among Sexual And Gender Minorities, Jennifer Keeley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Decades of research has shown that sexual and gender minorities (SGMs) experience adverse health and mental health outcomes to a greater extent than their heterosexual peers. The need to better understand and eliminate health disparities in the SGM population was recognized by the National Institute on Minority Health and Health Disparities (NIMHD) at NIH. The Secretary of Health at the Department of Health and Human Services approved the designation of the SGM population as a health disparities population in 2016 and called for SGM studies to examine the health needs of the SGM population across SGM subgroups via large representative …

The Effects Of Injury On Running Status And Gait Biomechanics, Kristyne Wiegand

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over the past several decades, endurance running has grown steadily as a popular form of physical activity. Running is easily accessible, does not require expensive equipment, and can be performed without specific skill training. Individuals who run also experience health benefits like increased cardiovascular health and reduced risk of all-cause morbidity. Despite these benefits, running is also associated with high rates of musculoskeletal injury. Although researchers have attempted to identify injury risks and mitigate the incidence of running injury, there is still no consensus as to why runners become injured. Research has also attempted to identify biomechanical movement patterns that …

Contributions To Mcmc Methods In Constrained Domains With Applications To Neuroimaging, Sharang Chaudhry

UNLV Theses, Dissertations, Professional Papers, and Capstones

Markov chain Monte Carlo (MCMC) methods form a rich class of computational techniques that help its user ascertain samples from target distributions when direct sampling is not possible or when their closed forms are intractable. Over the years, MCMC methods have been used in innumerable situations due to their flexibility and generalizability, even in situations involving nonlinear and/or highly parametrized models. In this dissertation, two major works relating to MCMC methods are presented.

The first involves the development of a method to identify the number and directions of nerve fibers using diffusion-weighted MRI measurements. For this, the biological problem is …

Prostate Cancer Survival Among Hispanics: A Surveillance, Epidemiology, And End Results (Seer) Population-Based Cohort Study, David Rivas

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hispanics are now the youngest, largest, and fastest growing minority group in the U.S. Prostate cancer (PC) is the most commonly diagnosed cancer in men and is the second-leading cause of cancer deaths among Hispanics. For the first time, we examined PC-specific survival among distinct Hispanic groups that include Mexicans, Cubans, Dominicans, Puerto Ricans, as well as Central and South Americans. We compared these groups to the main reference population in the U.S., non-Hispanic Whites (NHW), after adjustment for prognostic factor risk categories (prostate-specific antigen (PSA) level, Gleason score, and tumor stage), as well as sociodemographic covariates (e.g., health insurance, …