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The role of community health workers in enhancing home and community-based services in American Indian communities
Get PDFObjectives Describe the role and benefit of Community Health Workers in American Indian communities as a novel solution to meeting home and community-based service (HCBS) needs. Methods Short communication based on extant literature and current policy challenges. Results Community health workers (CHW) play an essential role in various healthcare settings particularly in American Indian (AI) communities working to close gaps in preventive and comprehensive healthcare accessibility. CHWs close these gaps through providing expertise in culturally oriented and familial support, educating communities on acute and chronic illnesses and wellness, and dispelling misinformation regarding health issues. However, integration and application of CHWs into home- and community-based services has limited recognition and utilization in healthcare systems and healthcare payment. Robust training/credentialing pathways and sustainable funding streams are essential for the integration of CHWs into the formalized healthcare provider team. Barriers that prevent this integration include inconsistencies in documentation, lack of stable funding, and a lack of formal professional recognition. Conclusions Previously successful models of CHW integration promote formalized training programs, professional development opportunities, earning certifications, and promoting collaboration between CHWs and providers. Innovation Applying CHW use in HCBS can increase community wellness while mitigating impacts of health disparities in HCBS for an often-under-resourced set of communities – our nation's American Indian communities
Nitrogen burial restored oyster reefs
No full textThe purpose of this work is to quantify nitrogen burial rates in restored oyster reefs within different habitat contexts. Direct measurements of nitrogen burial are lacking but could inform an important component of water quality regulation by estuarine habitats
Comparison of Long-term Trends in Inpatient Utilization and Costs Between Medicaid Expansion and Non-Expansion States
Get PDFThe Affordable Care Act’s (ACA) Medicaid Expansion significantly increased access to health insurance coverage, yet its long-term effects on hospital utilization remain understudied. This study examines the impact of Medicaid Expansion on inpatient utilization trends across early-expansion (2010-2014), late-expansion (2015-2022), and non-expansion states. Using state-level data from the Healthcare Cost and Utilization Project (HCUPnet) from 2006-2022, a state-level and aggregated interrupted time series (ITS) analysis were conducted to assess changes in inpatient discharges, length-of-stay, and hospital costs-per-stay stratified by payer type across 35 states. Findings from the state-level ITS analysis indicate that in early-expansion states, Medicaid Expansion led to an immediate but short-term shift in the payer mix with a statistically significant increase in Medicaid-covered hospital visits and a nominal decrease in uninsured visits. However, these trends were not sustained in the long term as Medicaid discharges declined and uninsured hospitalizations began to rise again. Additionally, while hospital costs-per-stay decreased among all expansion types in the short-term, these reductions were also not maintained over time. Length-of-stay for uninsured visits experienced a statistically significant decrease in the short-term but rose again in the long-term with a similar long-term trend observed for Medicaid visits. These findings suggest that while Medicaid Expansion alleviated hospital strain in the short-term, its long-term effects on utilization remain limited. The aggregated ITS analysis, based on averaged outcomes across states grouped by Medicaid Expansion status, shows a similar pattern—highlighting a statistically significant short-term increase followed by a long-term decreasing trend in Medicaid hospital discharge rates in the early expansion group compared to the late and non-expansion groups. This suggests some promising outcomes in hospital utilization for states that have expanded Medicaid. Future research should monitor and inform improvements in the implementation and sustainability of the program which should aim not only to increase access to essential health services but also to address the multifaceted social and economic drivers of health.Master of Public Healt
IMPROVING EDUCATION ACCESS AND QUALITY IN GRANVILLE AND VANCE COUNTIES THROUGH POLICIES ADDRESSING GRADE LEVEL PROFICIENCY AND DISCIPLINARY ACTION
Get PDFThis proposal focuses on how to improve education access and quality in public schools in Granville and Vance Counties. Through our research it became evident that kindergarten through twelfth grade school districts struggle to address the chronic racial and socioeconomic disparities impacting student success. We are recommending that the County Boards of Education enact short-term suspension reform, multigenerational learning, and implicit bias training as first steps to improve education in the public school system. As a social determinant of health, education affects not only academic and career advancement in the short-term, but also lifelong well-being and the health of the next generation. We believe that through policy change and engagement with community stakeholders, Granville and Vance Counties can provide high quality, equitable education to all school-aged residents.Master of Public Healt
Increases in the Association Between the Rates of Synchronous and Metachronous Metastases over Time
Get PDFBackground: This study investigates the association between synchronous and metachronous metastases across various cancer types, evaluating whether that relationship has evolved over time. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER)-8 dataset from 1975 to 2020 were retrospectively reviewed. For each of the 18 solid tumor types, the crude rates of synchronous and metachronous metastases were estimated from the SEER database. For each of the years assessed (from 1975 to 2015 at 10-year increments), linear regression analyses were conducted to quantify the relationship between the rates of metachronous metastasis and synchronous metastasis across all cancer sites. The degrees of association over time were compared using a Fisher’s z-transformation. Results: At all time points considered, there was a significant association between the rates of metachronous and synchronous metastases (all p values < 0.05 for 5-year follow-up data). The degree of that association tended to increase over time (R = 0.59, 0.60, 0.66, 0.80, and 0.87 for 1975, 1985, 1995, 2005, and 2015, respectively), with the p value of the z-score comparing the many R values over time varying from 0.04 to 0.48. Conclusions: There appears to be an increasing association between the rates of synchronous and metachronous distant metastases over time. The exact cause of this increasing association is unknown. However, it appears to have occurred somewhat contemporaneous with the increasing use of more-accurate imaging studies (e.g., FDG-PET). Newer, targeted radiotracers for PET may provide the landscape for a prospective evaluation of the role of imaging
Statistical Challenges in Sequencing Data: Addressing Uncertainty in Analysis
Get PDFThe advancement of high-throughput sequencing technologies has revolutionized biological research. However, these technologies also introduce new statistical uncertainties. In this work, we present novel statistical methods that account for statistical uncertainties and best practice to mitigate bias in analyzing sequencing data. In project 1, we focus on detecting allelic imbalance on the isoform level, caused by non-coding variants in the regulatory regions. This analysis requires accounting for inferential uncertainty, caused by multi-mapping of RNA-sequencing reads. Our proposed method, SEESAW, uses Salmon and Swish to offer analysis at various levels of resolution, while accounting for inferential uncertainty. In project 2, we address the challenge of detecting cell composition changes using paired single-cell RNA-sequencing (scRNA-seq) data in cancer research. We proposed a novel approach scSTMseq, a topic modeling-based framework designed to infer cell clusters and estimate clustering uncertainty while integrating cell-level covariates, such as time. We coupled this framework with Multivariate analysis of variance for repeated measures to infer cell composition changes. In project 3, we explored the CRISPR inference/activation screens to study the regulatory roles of non-coding elements. Unlike standard scRNA-seq, scaling-based normalization introduces selection bias due to correlations between perturbation states and the sequencing depth, which complicates the case-control classification. We demonstrated this bias and proposed Poisson regression as a better alternative for normalization in the CRISPR-i/a studies.Doctor of Philosoph
THE ROLE OF GLUTATHIONE PEROXIDASE 4 AT THE INTERFACE OF TUMOR METABOLISM, DIET-INDUCED OBESITY, AND TREATMENT EFFICACY IN TRIPLE NEGATIVE BREAST CANCER
Get PDFReactive oxygen species are a double-edged sword – they are the products of several metabolic processes required to sustain life, but in excess can cause oxidative damage. Breast cancer remains the second-leading cause of cancer-related death in the US. Obesity is an established risk factor for several aggressive breast cancer subtypes, and is also associated with increased breast cancer metastasis and mortality. On a mechanistic level, hypertrophic adipocytes and cancer cells exhibit oxidative stress and altered redox homeostasis, influencing therapeutic outcomes. While oxidative stress contributes to cancer progression, understanding the complex interplay between obesity-induced metabolic changes and redox signaling in triple negative breast cancer (TNBC) presents a unique opportunity to develop targeted therapeutic strategies for this historically treatment-resistant disease.In this dissertation, we aimed to understand how obesity and TNBC, both as metabolic diseases, affect lipid-specific oxidative stress in the context of tumor metabolism and response to current front-line therapies. Using preclinical models, we characterized a specific metabolic interaction between oxidative stress and TNBC, and established the effect of lipid oxidative stress on TNBC progression. We then utilized this metabolic interaction to identify a mechanism by which tumor burden can be reduced more effectively in obese mice following orthotopic transplantation of TNBC cells. Finally, we utilized front-line therapies, including chemotherapy (carboplatin) and immunotherapy (anti-CTLA4 plus anti-PD1), to identify lipid oxidative stress as a critical regulator of treatment response specifically in the context of obesity. These findings identify a mechanism of lipid oxidative stress by which tumor progression and treatment response can be altered specifically in obesity-driven TNBC. Moreover, we demonstrate that targeting lipid-mediated redox defense, alone or in combination with current anticancer therapies, represents a promising therapeutic strategy for TNBC, particularly in the context of obesity.Doctor of Philosoph
How Does That Make Me Feel? The Role of Affective Forecasting in Health Behavior Change
Get PDFThe importance of affective processes for health behavior change is well-established, but little research has assessed the accuracy and impact of affective forecasts for health behaviors. In a longitudinal study of 8 health behaviors (N = 574), we addressed the following: (1) How accurate are affective forecasts about health behaviors? (2) Does accuracy influence health behavioral performance? (3) Does accuracy influence future motivation? (4) What factors contribute to forecasting accuracy? We found that people generally underestimated how good health behaviors would feel. Both overestimation and underestimation predicted lower behavioral performance and motivation. However, accurate forecasts predicted increased behavior and motivation, above and beyond Reasoned Action Approach variables and habit. Additionally, forecasts that were positive and accurate were associated with increased behavior and motivation. Higher anticipated affect, increased behavioral performance, and greater use of cognitive reappraisal improved forecasting accuracy. This study underscores the importance of affective forecasting for health behavior change.Master of Art
"Aquí, nadie se muere de hambre": Food Acquisition, Care, and Food Sovereignty in Immokalee, Florida
Get PDFThis dissertation examines the everyday practices of food sharing as care and gardening as food sovereignty within the food acquisition strategies of immigrant farmworkers, specifically women, in Immokalee, Florida. In collaboration with Cultivate Abundance, a local community garden, this ethnographic project centers the ways in which farmworkers from Haiti, Guatemala, and Mexico navigate life amid the impact of an unequal food system rooted in isolation, systemic racism, and classism, a phenomenon known as food apartheid. Uniquely positioned as the laborers and consumers of the industrial food system, the food acquisition of farmworkers in Immokalee goes beyond grocery stores: it extends into acts of food sharing, gardening, and placemaking to construct their food landscapes. “Aquí, nadie se muere de hambre” brings attention to the time and money expended in “the choreography of everyday food acquisition”: the hyper-mobile food acquisition strategy in which farmworkers travel across Immokalee and Southwest Florida to shop for food. It illuminates how farmworkers’ shared situaciones (Spa., precarious statuses including economic, immigration, etc.) shape this choreography. By being attuned to their situaciones, care emerges in farmworkers’ shared rides to neighboring big-box retail stores, the relaying of information about upcoming local food pantries, the food intercambios (Spa., sharing of food) using food from their workplaces, and the seed exchanges between friends and neighbors. These acts of care transform into gestures of love, revealing how farmworkers are active participants in their food acquisition strategies. Throughout this dissertation, I focus on the “everyday” to bring attention to how this constant movement of food has become ordinary to farmworkers in Immokalee. This project captures the power of immigrant farmworkers’ relation-making abilities, their motivations to care for one another, and their visions of a food future where they too can access and grow food with the tastes of home.Doctor of Philosoph
Improving Colorectal Cancer Screening in Average-Risk Adults in Custody: Effects of Provider Education, Educational Brochure, and Reminders
Get PDFIn the United States (US), the incarcerated population is disproportionately overrepresented by people from lower social economic status including racial minorities, those with low education background and poor health literacy. As such, this population tends to have a high rate of chronic medical disease, mental health disorders, high rates of substance use and preventable cancer including colorectal cancer (CRC). As noted in the general population, there is also an increase in early age onset (EAO) of CRC in the justice involved individual with most professional organizations including the American Cancer Society (ACS), US Preventive Service Task Force (USPSTF) and others, adjusting the age of initial CRC screening to begin at age 45 and extend to age 75 years. Screening with a guaiac Fecal Occult Blood Test (gFOBT) decreases the incident and mortality but is underutilized in correctional facilities. To increase the uptake of CRC in a Minimal Security Facility in Southeastern (MSFS) US, we implemented an Evidence-Based Practice (EBP) strategy to increase the uptake of CRC screening to 80% using gFOBT in every community as recommended by the National Colorectal Cancer Roundtable (NCCRT). The strategies included Health Care Provider Education, Adult in Custody (AIC) education, email reminder, face to face meetings including town hall meetings, posting educational resources about CRC screening in the housing unit and in the medical unit to increase awareness for CRC screening. At project conception, baseline data indicated 116 AICs eligible for CRC screening, 58.6% (68) completed screening, 36.2% (42) needed CRC screening and 5.2% (6) refused. At project initiation, 101 AICs were eligible for CRC screening, 70.2% (71) completed screening, 22.2% (22) needed CRC screening, and 7.9% (8) refused representing an 11% increase from six months earlier. Following EBP intervention implementation, there CRC screening rate among the 101 eligible increased from 70.2% to 74%. However, no AIC among the 45-49 aged, predominantly African American and Hispanic, completed CRC screening during the project.Doctor of Nursing Practic