Doctor of Philosophy

dissertationTrichotillomania is an understudied chronic condition with unknown etiology and epidemiology that affects a significant number of girls and women. This study addressed the overarching question, What are the experiences and perceptions of women who engage in hair pulling? "Trichotillomania: A Journey of Personal Empowerment" was a qualitative study of 22 women that addressed their lived experience of hair pulling and their assigned meaning of their hair pulling. Data were collected through in-depth interviews with each participant. A grounded theory approach to analysis was applied to the data. The narratives of the participants yielded an understanding of when and why hair pulling took hold, how others' conceptualizations of trichotillomania created barriers to accountability and acceptance, and how women empowered themselves to conceptualize their hair pulling and to determine the role that hair pulling plays in their lives. The women's conceptualizations of trichotillomania, based on their experiences and perceptions of their hair pulling, provided clear evidence for why it is so important to include hair pullers in the global conversation on trichotillomania

Optimism in Independence: The European Central Bank after the 2008 Global Financial Crisis

The effects of the 2008 Global Financial Crisis (GFC) on finance and monetary policy continue to be widespread. Now, policymakers are seeking to determine the best approach for managing and resolving the crisis; one such strategy has been to delegate more legitimacy to independent central banks. When will a political leader support or undermine the legitimacy of an independent central bank in the aftermath of an economic crisis? We argue that the central mechanism for determining a change in views of central bank legitimacy is the optimism of the political elites. Therefore, if a government is optimistic about its chances of retaining power and securing economic recovery, it will be more likely to issue positive, legitimizing statements toward its independent central bank. We test this argument using the compelling and critically important case of the European Central Bank following the 2008 Global Financial Crisis, and we determine that the level of political optimism has a strong impact on the continued legitimacy of independent central banks. In so doing, our study highlights the complicated strategic political choice of using central banks to respond to financial crises

Global Health Leadership Pathway: A Novel Approach to Global Radiology Curriculum Integration for Residents

Purpose: Our radiology residency programs are at an academic medical center in the southeastern United States and are accredited by the Accreditation Council for Graduate Medical Education (ACGME). During the initial eight years of our department’s global health program, 22 residents participated in our global health collaborations with a related $31,000 in extradepartmental travel awards. Increasingly, residents applying to our program convey interest in the integration of global health into their careers as radiologists. To that end, our administration, global health faculty, and residency program directors created and approved a Global Health Leadership Pathway (GHLP). The Pathway spans all years of radiology training to provide curriculum support with the aim of ensuring that our residents have the knowledge and skills necessary to become future leaders in global health. Description: The GHLP is a residency track that residents apply to join with a related radiology clinical education, global health specific curriculum throughout all training years, integration of the RAD-AID Certificate of Proficiency in Global Health Radiology, individual mentorship, and participation with an international elective. Structured education on global radiology, epidemiology, access implications, and related methodologies give our residents the opportunity to learn best practices for sustainability in global health. Conclusion: Because of increasing interest and due to the past successful involvement of our radiology residents in global health, our department created this Global Health Leadership Pathway to give our trainees the educational resources to support their future leadership and involvement in the academic field of global health

Studies of the Suitability of Fowlpox as a Decontamination and Thermal Stability Simulant for Variola Major

Variola major, the causative agent of smallpox, has been eradicated from nature. However, stocks still exist; thus, there is a need for relevant decontamination studies, preferably with nonpathogenic simulants. Previous studies have shown a similarity in response of vaccinia virus and variola major to various decontaminants and thermal inactivation. This study compared vaccinia and fowlpox viruses under similar conditions, using disinfectants and temperatures for which variola major data already existed. Most disinfectants showed similar efficacy against vaccinia and fowlpox, suggesting the utility of fowlpox as a decontamination simulant. Inactivation kinetics studies showed that fowlpox behaved similarly to variola major when treated with 0.1% iodine and 5.7% polyethyleneglycol nonylphenyl ether, 0.025% sodium hypochlorite, 0.05% sodium hypochlorite, and 0.1% cetyltrimethylammonium chloride and 0.05% benzalkonium chloride, but differed in its response to 0.05% iodine and 0.3% polyethyleneglycol nonylphenyl ether and 40% ethanol. Thermal inactivation studies demonstrated that fowlpox is a suitable thermal simulant for variola major between 40°C and 55°C

Interventional Radiology Readiness Assessment Tool for Global Health

The Interventional Radiology Readiness Assessment Tool for Global Health is a new tool to methodically evaluate the environment of a medical institution for interventional radiology services given the existing infrastructure. Global health provides an exciting opportunity for interventional radiology to impact health outcomes in developing countries. A systematic and thoughtful approach to integrating interventional radiology services in the health care institutions of resource poor countries is needed in order to maximize global health efforts and outcomes. The IR Readiness Assessment Tool is available as on online form and in PDF format under Additional Files below

Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities

Background: For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri. Methods: We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3-7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits. Results: Four main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST via telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency (p \u3c 0.05) and impact (p \u3c 0.01), while atypical behaviors decreased (p \u3c 0.01). For caregivers\u27 outcomes, only confidence in skills (p \u3c 0.05) and parental sense of competence (p \u3c 0.05) showed a positive change. Conclusion: Our results support the feasibility of implementing the WHO-CST program via telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility via telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children

A comparison of skinfolds and leg-to-leg bioelectrical impedance for the assessment of body composition in children

BACKGROUND: This field-based investigation examined the congruence between skinfolds and bioelectrical impedance in assessing body composition in children. METHODS: Subjects were 162 female and 160 male children 10–15 years of age. Skinfold measures obtained at the triceps and medial calf and a leg-to-leg bioelectrical impedance system were used to determine percent fat using child-specific equations. Pearson product moment correlations were performed on the percent fat values obtained using skinfolds and bioelectric impedance for the entire data set. Separate correlations were also conducted on gender and age/gender subsets. Dependent t tests were used to compare the two techniques. RESULTS: Percent fat did not differ between skinfolds and bioelectrical impedance for the total subject pool. Bioelectrical impedance overestimated percent fat in girls by 2.6% and underestimated percent fat in boys by 1.7% (p < 0.01). Correlations between skinfolds and bioelectrical impedance ranged from r = 0.51 to r = 0.90. CONCLUSIONS: Leg-to-leg bioelectrical impedance may be a viable alternative field assessment technique that is comparable to skinfolds. The small differences in percent fat between the two techniques may have limited practical significance in school-based health-fitness settings

A comparison of skinfolds and leg-to-leg bioelectrical impedance for the assessment of body composition in children

BACKGROUND: This field-based investigation examined the congruence between skinfolds and bioelectrical impedance in assessing body composition in children. METHODS: Subjects were 162 female and 160 male children 10–15 years of age. Skinfold measures obtained at the triceps and medial calf and a leg-to-leg bioelectrical impedance system were used to determine percent fat using child-specific equations. Pearson product moment correlations were performed on the percent fat values obtained using skinfolds and bioelectric impedance for the entire data set. Separate correlations were also conducted on gender and age/gender subsets. Dependent t tests were used to compare the two techniques. RESULTS: Percent fat did not differ between skinfolds and bioelectrical impedance for the total subject pool. Bioelectrical impedance overestimated percent fat in girls by 2.6% and underestimated percent fat in boys by 1.7% (p < 0.01). Correlations between skinfolds and bioelectrical impedance ranged from r = 0.51 to r = 0.90. CONCLUSIONS: Leg-to-leg bioelectrical impedance may be a viable alternative field assessment technique that is comparable to skinfolds. The small differences in percent fat between the two techniques may have limited practical significance in school-based health-fitness settings

Human cytomegalovirus uracil DNA glycosylase associates with ppUL44 and accelerates the accumulation of viral DNA

BACKGROUND: Human cytomegalovirus UL114 encodes a uracil-DNA glycosylase homolog that is highly conserved in all characterized herpesviruses that infect mammals. Previous studies demonstrated that the deletion of this nonessential gene delays significantly the onset of viral DNA synthesis and results in a prolonged replication cycle. The gene product, pUL114, also appears to be important in late phase DNA synthesis presumably by introducing single stranded breaks. RESULTS: A series of experiments was performed to formally assign the observed phenotype to pUL114 and to characterize the function of the protein in viral replication. A cell line expressing pUL114 complemented the observed phenotype of a UL114 deletion virus in trans, confirming that the observed defects were the result of a deficiency in this gene product. Stocks of recombinant viruses without elevated levels of uracil were produced in the complementing cells; however they retained the phenotype of poor growth in normal fibroblasts suggesting that poor replication was unrelated to uracil content of input genomes. Recombinant viruses expressing epitope tagged versions of this gene demonstrated that pUL114 was expressed at early times and that it localized to viral replication compartments. This protein also coprecipitated with the DNA polymerase processivity factor, ppUL44 suggesting that these proteins associate in infected cells. This apparent interaction did not appear to require other viral proteins since ppUL44 could recruit pUL114 to the nucleus in uninfected cells. An analysis of DNA replication kinetics revealed that the initial rate of DNA synthesis and the accumulation of progeny viral genomes were significantly reduced compared to the parent virus. CONCLUSION: These data suggest that pUL114 associates with ppUL44 and that it functions as part of the viral DNA replication complex to increase the efficiency of both early and late phase viral DNA synthesis