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Community college women do not obtain the HPV vaccine at the same rate as university women. The aim of this study was to discover the perceptions of community college women in relation to the human papillomavirus (HPV) and associated cancers, the perceived barriers and benefits of obtaining the HPV vaccination, and how health behavior decisions may be impacted by self-concept. A qualitative research design incorporating thematic analytic was used to analyze interviews whose questions were specifically guided by the health belief model. Student volunteers aged 18 to 45 years were recruited from a large urban community college. An inductive thematic approach allowed the development of themes and codes based on the interviews conducted with the participants. The results of the study indicated that these women had a persistent lack of knowledge about resources and were confused due to the lack of readily available information regarding HPV and who may be susceptible to the potentially serious impact of having one of the cancer-causing strains. Recommendation include building collaborative initiatives with public health organizations, providing education about HPV at the college level, and making information about prevention and treatment more easily accessible to the public using social media centered on HPV and subsequent cancer prevention. Public health initiatives where sexual health is a topic must include an emphasis on HPV education, prevention, and treatment. Implications for positive social change include advocating for better health education for college students and heightened awareness for parents and families about HPV. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Noncompliance to treatment assignment is widespread in randomized trials and presents challenges in causal inference. In the presence of noncompliance, the most commonly estimated effect of treatment assignment, also known as the intent-to-treat (ITT) effect, is biased. Of interest in this setting is the complier average causal effect (CACE), the ITT effect among compliers. A further complication arises when the outcome variable is partially observed. My research focuses on estimating the distribution of a site-specific CACE in a multisite randomized controlled trial (MRCT) by maximum likelihood (ML). Assuming compliance missing at random (MAR). We express the likelihood as an integral with respect to random effects that cannot be evaluated analytically. We derive ML estimators by a combination of the EM algorithm and Newton Raphson method conditional on random effects and, then, integrate each estimator and the likelihood with respect to the random effects by adaptive Gauss Hermite quadrature (AGHQ). Next, we extend this approach to both outcome and imperfect compliance MAR. A distinctive feature of the approach is to estimate a site-specific CACE and its variance over sites efficiently. We applied our method to data sets from two MRCTs with imperfect compliance: the e-assist intervention trial to assess the effectiveness of the e-assist intervention in promoting colorectal cancer screening outcome fully observed; and the National Study of Learning Mindsets trial to evaluate the effectiveness of a growth mindset program in improving academic achievement outcomes MAR among ninth-graders.

The United States continues to grow in both population and diversity. The trigger for this project was the dramatic increase in patient diversity in Texas and the lack of adequate cultural competency training for providers at a Texas oncology clinic network. Clinicians must increase their self-awareness and knowledge to provide culturally competent care. The literature review found multiple educational modalities, across many health care disciplines, used by researchers to improve the cultural competency of health care providers. This project sought to improve satisfaction and adherence of patients over the age of 25 diagnosed with cancer by increasing provider cultural sensitivity and self-awareness of bias within 3 months of cultural competency training. The project sample was 14 advanced practice providers, 10 APRNs and 4 PAs. The educational plan for this project included an evidence-based course and a follow-up focus group to reinforce learning. Quantitative data were analyzed using the Cultural Competence Assessment tool to compare participants' anonymous pre- and post-education with the Wilcoxon signed-rank test. The data indicated that cultural awareness and sensitivity increased following training, with median scores increasing from 6.09 to 6.55, p = 0.03. The data do not suggest that cultural competence and behavior changed after training, as median scores went from 3.96 to 4.23 after training, p = 0.06. Overall, the focus group participants agreed about improving self-awareness, identifying biases, improving patient experience by asking more open-ended questions, and being vulnerable. The project implications include improvement in provider knowledge and increased self-awareness, which promote individualized, culturally sensitive care. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This study evaluated New Jersey school psychologists' knowledge, attitudes, skills, and practice related to school re-entry for children with cancer. In the United States in 2020, it was predicted that 11,050 children would be diagnosed with cancer before the age of 15 (American Cancer Society, 2020). Students with cancer will miss school for an extended period due to health issues, parent concerns regarding the school, and child concerns about peers (Boles, 2017; Harris, Walcott, Jefferson & McCammon, 2012). Survivorship rates are on the rise; thus, researchers anticipate an increase in reintegration to school (Harris, 2009). Reintegration is essential to a child's social, emotional, and academic well-being (Boles, 2017; Harris, 2009). Given a school psychologist's training and background, they would be an ideal person to coordinate care between the hospital, school, and family and facilitate re-entry (Mayer et al., 2005; Prevatt et al., 2000). New Jersey school psychologists completed a survey about their knowledge, practices, skills, and training related to school re-entry for students with cancer. Quantitative data included descriptive statistics, which were used to examine survey responses. Classical qualitative analyses were conducted for open ended items relating to barriers to engaging in activities related to school re-entry for students with cancer, and the impact of COVID-19 on practice related to re-entry for students with cancer. Most respondents indicated that their district does not have a protocol for school re-entry. School psychologists in New Jersey reported that they have not had formal training in this area and if they did have training, it was less than adequate. Similarly, respondents indicated that they have little knowledge and skills related to school re-entry. Despite their limited training, respondents indicated that they are interested in more training in this area. Many indicated that they agreed that school psychologists should facilitate the re-entry process and that they would feel comfortable doing so. Overall, these findings are consistent with previous literature that suggests that while school re-entry is a critical part of a treatment plan, many school psychologists and/or counselors do not have the training and/or access to a protocol to facilitate the process. This work provides evidence of school psychologists' lack of knowledge, skills, and training in this area but also highlights their interest in engaging in this work. The present study provides compelling evidence for the need for education, training, and a streamlined set of guidelines, for school psychologists. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Breast cancer is a significant public health problem. Globally, breast cancer is the most common form of cancer and is the leading cause of cancer-related mortality in women. African American women population has a higher mortality rate due to breast cancer when compared to non-Hispanic White women. Additionally, breast cancer incidence rates are also relatively higher in young African American women compared to their non-Hispanic White counterparts. Early detection remains the most important strategy for combatting breast cancer that can significantly reduce the mortality rate. It has been observed that breast cancer has a more devastating effect on younger African American population compared to non-Hispanic White, and therefore, educating younger women aged 18-49 can have a positive impact on changing behaviors and making better strides to emphasize the importance of breast cancer screening. The objective of this research study is to understand the current knowledge and perception of young African American female college students regarding breast cancer and help identify the gaps that exist in their knowledge, perception, health behaviors, and screening practices. To fulfil the objectives of this study, an integrative literature review was conducted to generate systematic evidence regarding current breast cancer screening motivators and challenges in African American women population. Additionally, data was collected from college students regarding their knowledge and perception of breast cancer, screening habits, and associated health behaviors using a self-administered questionnaire. The survey questions for breast cancer related knowledge and breast cancer related perception were developed using a modified version of the pre-validate Breast Cancer Awareness Measure (BCAM) questionnaire and the Champion's revised Health Belief Model Scales (CHBMS). The common motivators identified for breast cancer screening in African American women included knowledge about cancer, personal experiences, and other factors including ease of transportation, presence of female healthcare providers in the screening facility, and easy access to healthcare facilities. The barriers identified were categorized into five groups: (1) lack of knowledge; (2) concerns about screening related costs; (3) perception of breast cancer and the associated fear; (4) individual or personal factors; and (5) other factors including religious and fatalistic beliefs, perceived discrimination, and accessibility. For the survey based study, the final sample consisted of 623 participants, of which 518 (83.1%) students were non-Hispanic Whites and 105 (16.9%) students were African Americans. Statistical analysis revealed that most of the students had moderate knowledge about breast cancer, its symptoms, and its risk factors. There was no statistically significant difference in breast cancer related knowledge scores between the non-Hispanic White and the African American student groups after adjusting for the covariates education, income, and family history of breast cancer. Additionally, no statistically significant difference in breast cancer related knowledge scores was observed between students who had a family history of breast cancer and students who did not have a family history of breast cancer after adjusting for the covariates education, income, and ethnicity. The breast cancer related perceived susceptibility scores were statistically significantly different between non-Hispanic Whites compared to the African American group [F(1,607) = 17.184, p = 0.001] after adjusting for the covariates education level, income, and family history of breast cancer. However, the effect size was small (0.028), which indicated that ethnicity only accounted for 2.8% of the variance in breast cancer related perceived susceptibility. Similarly, there was a statistically significant difference in breast cancer related perceived benefit scores between the non-Hispanic White and the African American student groups [F(1,607) = 7.778, p = 0.005] after adjusting for the covariates education, income, and family history of breast cancer. However, the effect size was small (0.013), indicating that ethnicity only accounted for 1.3% of the variance in breast cancer related perceived benefits. A statistically significant difference in breast cancer related perceived susceptibility scores was observed between students who had a family history of breast cancer and students who did not have a family history of breast cancer [F (1,607) = 58.407, p < 0.001], with a medium effect size (0.088), that indicated that family history accounted for 8.8% of the variance in breast cancer related perceived susceptibility. There was no statistically significant difference in breast cancer related perceived barrier scores between the non-Hispanic White and the African American student groups after adjusting for the covariates education, income, and family history of breast cancer. Additionally, no statistically significant difference in breast cancer related perceived benefit and perceived barrier scores were observed between students who had a family history of breast cancer and students who did not have a family history of breast cancer after controlling for the covariates education, income, and ethnicity. Only 29.7% of the total students had an adequate breast cancer screening practice. However, a higher percentage of African American students had adequate screening practices (42.9%) compared to non-Hispanic White students (27%). Statistical analysis further revealed a statistically significant difference in breast cancer related screening habits between the non-Hispanic White and the African American student groups [F(1,607) = 13.916, p < 0.001] after adjusting for the covariates, although the effect size was small (0.022), which indicated that ethnicity accounted for 2.2% of the variance in breast cancer related screening practices. It was also observed that there was a statistically significant association between screening practices and knowledge level for breast cancer (x[superscript 2][2] = 12.783, p = 0.002), although the level of association was small (0.143). There was no statistically significant difference in breast cancer related health behaviors between the non-Hispanic White and the African American student groups, after adjusting for the covariates education, income, and family history of breast cancer. Additionally, there was no statistically significant association between health behaviors and knowledge level for breast cancer. The findings from this study will contribute to the currently limited resources that are available on the knowledge, perception, and screening behaviors of young African American college students. Although a higher number of interventions have been developed for this specific population over the last few years, however, the results from this study indicated that further research is required to understand the complex relationship between the different covariables and the knowledge, perception, and screening practices of breast cancer in African American population. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Adolescents newly diagnosed with cancer must navigate medical, psychosocial, and educational issues when confronting and coping with this life-threatening illness. Frequent hospitalizations, intense therapy, and continual medical appointments disrupt attendance at school, social, and community events. Decreased school participation and attendance may have negative consequences for these adolescents. Across disciplines, research supports that school connectedness is a protective factor associated with improved adolescent health, psychological, and academic outcomes. However, there is limited research exploring school connectedness in adolescents newly diagnosed with cancer. This qualitative inquiry uses dimensional analysis method to uncover the multiple dimensions of school connectedness in this population. Semi-structured interviews with nineteen adolescents explored school relationships and experiences at time of cancer diagnosis. The findings of this inquiry form a situation specific theory uncovering the nature of school relationships and factors that impact school connectedness in these adolescents. The dimensions of school connectedness are understood from the perspective, "Connection Reconciliation: Me, You, & Learning," within the context of "School Days & Ways," "The Boom," and "The Pause" and contextual subdimensions "Social Scenes," "Shared Experiences," and "Seeing & Being With." "Refocusing" and "Relational Links" establish the conditions under which adolescents newly diagnosed with cancer strive to restore connections to self, others at/from school, and learning, as they engage in the process of "Keeping & Letting Go." The consequence that follows from the perspective, and through the process, is "A New View," comprising a new outlook toward themselves, relationships, and learning. The findings provide a theoretical foundation for understanding why, where, when, and how adolescents with newly diagnosed cancer restore broken and unraveled school relationships while not attending school. This research provides implications for education, practice, and policy as well as information for nurses, health care providers, and school personnel to assist adolescents newly diagnosed with cancer. For example, nurses can collaborate with school personnel to develop interventions and facilitate opportunities for these adolescents to feel included, valued, supported, and connected. Additionally, knowledge from this study may inform future research, lead to hypotheses for quantitative studies examining school connectedness and symptom clusters, and direct school connectedness instrument development and testing. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

While zinc (Zn[superscript 2+]) is a vital ion for cell function and human health, we are still learning about how Zn[superscript 2+] concentration and localization is regulated and the role that Zn[superscript 2+] fluctuations may play in regulating cell signaling and cell fate. Here, we use fluorescent tools to study the interaction between Zn[superscript 2+] and cell signaling pathways that play a role in cell growth and proliferation. Importantly, we use small, non-toxic Zn[superscript 2+] concentrations to ensure that our Zn[superscript 2+] changes are closer to what cells would experience in the body and not stress-inducing. We demonstrate that both ERK and Akt dependent signaling is activated by Zn[superscript 2+] and that Zn[superscript 2+] -dependent ERK signaling is driven by Ras activation, contradicting one of the major hypotheses in the field. Our sensors shed light on how cells respond to an important micronutrient in real time. We also design and use fluorescent Zn[superscript 2+] sensors to measure vesicular Zn[superscript 2+] concentrations in insulin-producing and prostate cells, two secretory cell types where Zn[superscript 2+] dis-regulation has been linked with disease. We improved sensor design for vesicular targeting by using cargo proteins as localization domains and taking into account vesicular pH and the role that it plays on fluorescent protein signal. We also demonstrate that the pancreatic [beta]-cell line MIN6 contains much higher vesicular Zn[superscript 2+] than the prostate cancer cell line LnCaP, on a single-cell level. Finally, in an effort to incorporate more active learning in the college classroom, I present work from two fellow graduate students and myself on a case study exercise for the undergraduate metabolism classroom. This case study has been presented in six recitation sections with positive student feedback and is accepted for publication at the National Center for Case Study Teaching in Science. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The advances in medicine today have created an emerging population of student-survivors, school-aged children living with and/or recovering from serious health conditions (Bauman, 2010). Each school day in the United States, 46 young people, or the equivalent of two classrooms of students, learn they have cancer (Cure Search National Childhood Cancer Foundation, 2010). These statistics reflect the fact that cancer is one of the most chronic illnesses in childhood. Most serious childhood medical issues will have life-long ramifications. This qualitative research study is comprised of an in-depth review of the research literature and the responses and information gathered from two professionals. The purpose of the study is to identify common issues faced by student-survivors and to examine the relationship between psychosocial support and school performance. The results indicate that there is a commonality of psychosocial issues that affect this population. Chronically ill children are experiencing school related problems and the information being exchanged between the trinity of professionals, which includes-educators, medical professionals, and mental health professionals- to families is inconsistent and confusing thwarting access to resources. It can be concluded that the needs of this population are not being met in the traditional context of the public school system and that teachers are feeling ill prepared to serve them, but that positive school experiences, in one form or another, amidst childhood illness can provide the social structure necessary to alleviate the feelings of isolation and psychological distress commonly experienced. An appendix presents a Chart of Transcribed Expert Interview Responses.

The University of Wisconsin--La Crosse offers the first web-based medical dosimetry program in the nation. There is no data to research a program of this type. This research consisted of the evaluation of other distance education programs including health profession programs in addition to face-to-face medical dosimetry programs. There was need to collect and analyze student perceptions of online learning in medical dosimetry. This research provided a guide for future implementation by other programs as well as validated the University of Wisconsin--La Crosse program. Methodology used consisted of an electronic survey sent to all previous and currently enrolled students in the University of Wisconsin--La Crosse medical dosimetry program. The survey was both quantitative and qualitative in demonstrating attitudinal perceptions of students in the program. Quantitative data was collected and analyzed utilizing a five point Likert scale. Qualitative data was gathered based on the open-ended responses and the identifying themes from the responses. The results demonstrated an overall satisfaction with this program, the instructor, and the online courses. Students felt a sense of belonging to the courses and the program. Considering that a majority of the students had never taken an online course previously, the students felt there were no technology issues. Future research should include evaluation of board exam statistics for students enrolled in the online and face-to-face medical dosimetry programs. Appended are: (1) Benchmarks for Success in Internet-based Distance Education; (2) Cover Letter for Survey; (3) Implied Consent Form; (4) Survey of UW-L Online Medical Dosimetry Program; and (5) Data Collection and Analysis. (Contains 8 tables.)

This paper reviews the research on how siblings respond to another sibling who has survived childhood cancer. The paper examines the siblings' ability to cope, adjust, and adapt to this stressor. Relevant interventions are also discussed. The research indicates that although siblings may experience heightened emotional and behavioral problems, overall their psychological adjustment is adequate and not altogether different from siblings in healthy families. The two strongest predictor variables appear to be the compound variable gender/age and the presence of problems existing before diagnosis. The siblings' level of maturity and ability to overcome stressors contributed to a healthy adjustment. When the siblings' level of ability to adapt is considered, those who are categorized as dysfunctional have more difficulty than siblings classified as resilient. Finally, interventions that promote family cohesiveness, adaptability, and open communication facilitated healthy coping, adapting, and adjustment. (Contains 46 references.) (Author/GCP)

The use of health information and health information technology by consumers is a major factor in the current healthcare systems' effort to address issues related to quality, cost, and access. Patient engagement in the healthcare process through access to information related to diagnoses, procedures, and treatment has the potential to improve health outcomes. In this study we analyzed a dataset that was representative of the U.S. population. Despite the efforts to increase the use of patient-focused technologies, there is an overall low level of use of personal healthcare management and these studies indicate that there are significant disparities in the use of health information and technology by American adults by demographic, socioeconomic, and health-related factors. Individuals with one or more chronic conditions have an increased likelihood of using personal healthcare management than individuals with no chronic conditions. Similarly, individuals with a cancer diagnosis are more likely to use personal healthcare management than individuals with no chronic conditions. Education was the factor that was most strongly associated with personal healthcare management across all populations investigated in this research. U.S. adults reporting college level education were up to 2.8 times more likely to use personal healthcare management than those with less than college level education. Similar disparities were found related to personal healthcare management use based upon family income, access to a usual place for receiving healthcare, and insurance coverage. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Health information is increasingly being shared online not just by credentialed sources such as physicians or health organizations, but also by patients with personal experience with a health concern. This dissertation proposes a new measure of vigilance-avoidance, or tendency to approach or avoid threatening stimuli, in order to understand how individual differences in this personality characteristic might influence selection and processing of online information about health. Two online experiments focusing on the topic of breast cancer were conducted to explore how individual levels of vigilance-avoidance moderate the effects of health message threat, community endorsement (e.g., online recommendations), and source type (patient- or physician-generated information) on selective exposure, perceptions of credibility, and helpfulness ratings. Results of these studies indicate that vigilance-avoidance interacts with these source, message, and community characteristics to influence both online health information selection behaviors and evaluations of online health information. Women who are more vigilant spend more time reading threatening health information and evaluate it as more credible than women who are more avoidant, suggesting that they may be more likely to find health information more credible simply because it is negative. Additionally, women who are more avoidant spend more time reading low threat information than high threat information. Women who are more avoidant also spend even less time looking at credible health information from a physician than they do information from a patient, suggesting that when allowed to selectively expose themselves to information, they may miss key messages from credentialed medical sources that are important to their overall health. Overall, results from these studies suggest that our tendency to approach or avoid health information, as well as our potential to trust and find it credible, are dependent on these key personality characteristics--a novel contribution in the areas of health, selective exposure, and information evaluation research. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Situated in the larger questions of how to support the educational engagement and positive psychosocial development of young people with cancer, the purpose of this exploratory study was to address gaps in the literature and build understanding of how young people use digital and Internet-connected technologies in ways that support their social and academic engagement. Through a multiple case-design, I examined the school-based and everyday (outside of school) technology uses of five young people. This study found that the cancer experience changed or reframed a young person's motivational engagement with school. Doing well academically was a sign of a normalcy and an opportunity to gain control over some aspects of life amidst rapid change and uncertainty with one's health. Uses of digital and Internet-connected technologies afforded opportunities for young people to participate and have a felt academic presence in school without being physically present. The young people used different technologies in different ways depending on their learning preferences, the publicness of their experience, and/or their desire for personal privacy. Additionally, digital and Internet-connected technologies afforded young people and their families the opportunity to actively build community and construct and/or maintain identity across life spaces (e.g., home, hospital, school) in ways that fostered social support and social learning experiences. The everyday technology-uses of young people with cancer included the actions and practices of maintaining and managing existing relationships, building new supportive relationships, creating new roles and identities outside of their "sick role," and being there for others as a source of social support and learning. This study also found that technology uses challenged schools' instructional and policy assumptions about the meaning of being "in-class" or "present" for the purposes of learning and earning academic credit. Schools' uses of these technologies to support young people with cancer revealed classical or Cartesian epistemological underpinnings that were encoded in schools' curricula and pedagogies. To the extent that such underlying worldviews continue to guide schools' actions and practices, even when technologies are used to support young people with cancer, their full potential uses may not be realized. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This paper reviews research literature pertaining to the pain and anxiety associated with pediatric cancer and the use of hypnosis as an adjunct treatment. It is noted that pain and anxiety are most often associated with the procedural treatment of cancer, and that the literature suggests that both pain and anxiety are multi-faceted constructs. This review focuses on the pain and anxiety associated with treatment of the disease (bone-marrow aspirations, lumbar punctures, and chemotherapy), rather than the disease itself. The general results of the literature review suggest that pain and anxiety are significant aspects of unique pediatric cancer conditions, and that hypnosis can be effective in helping to alleviate the distress associated with cancer treatment. Limitations of the present research are considered; it is noted that assessment of cancer-related pediatric distress is difficult because only a small number of instruments are available for measuring distress and because the assessment process must take into account the developmental stage and coping styles of the child. Hypnosis is viewed as a behavioral technique that can help the child distort, displace, or transform the perception of pain, and self-hypnosis is viewed as a way of empowering the child which has both medical and non-medical benefits. Recommendations are made for future research, both in the area of pain assessment and in the field of hypnosis for children. (NB)

Introduction: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1--evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2--identify the perceived barriers and facilitators to timely reporting, and 3--reengineer the current reporting process to improve turnaround time. Method: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. Result: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

As the number of individuals surviving cancer continues to rise, short and long term effects of cancer and its treatment that result in physical, psychosocial, and spiritual needs unique to the care of the cancer survivor has not been addressed in nursing curricula. The Institute of Medicine (IOM, 2005) recommends that all health care providers are educated on the care of cancer survivors. Nurses in all areas of practice will provide care for cancer survivors. This descriptive qualitative study explored faculty beliefs and practices regarding the inclusion of caring for the cancer survivor in undergraduate nursing curricula. Faculty knowledge of the term "cancer survivor" and their beliefs and practices regarding the placement of theory and clinical experiences on cancer survivorship were explored. Qualitative content analysis revealed themes and patterns related to the barriers and facilitators for disseminating information on the gap in content on care of the cancer survivor. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The two studies in this dissertation identify and address two related research gaps in literature on healthcare virtual support communities. Study one suggested that the exclusive emphasis on social support behavior and its impacts on individual well-being in virtual support communities has led to the neglect of another type of social interaction that also promotes individual health-companionship activities. It is thus argued that in order to gain a deeper insight into the online support phenomenon, the consideration of companionship activities, in addition to social support exchange, is necessary. To bridge this gap in the literature, I contrasted individual engagement in support behavior and companionship activities that took place in two large online discussion forums--one for patients with breast cancer and the other for patients with prostate cancer. Based on the identification of the two types of social activities, the mutual-dependence between individuals' participation in these activities, and gender differences in their activity engagement are also hypothesized and tested. In the second study, I argued that in the literature of virtual support communities little attention has been paid to conceptualizing the determinants of social support provision. Drawing from social capital theory, the second study attempts to bridge this gap by presenting a model that applies the structural, relational, and cognitive dimensions of social capital to theorize the social determinants of the provision of informational and emotional support in virtual support communities. Through the use of qualitative content analysis and machine learning techniques, messages from a virtual support community for women with breast cancer are analyzed. The analysis results are used to test the proposed framework modeling support provision. The purpose of this dissertation is to advance the understanding of online socio-behavioral dynamics of virtual support communities. It also helps provide insights into the design of such communities and the delivery of patient-focused healthcare interventions. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation presents my explorations in both molecular biology and science education research. In study one, we determined the "ADIPOQ" and "ADIPORI" genotypes of 364 White and 148 Black BrCa patients and used dominant model univariate logistic regression analyses to determine individual SNP and haplotype associations with tumor or patient characteristics in a case-case comparison. We found twelve associations between individual SNPs and patient or tumor characteristics that impact BrCa prognosis. For example, the "ADIPOQ" rs1501299 C allele was associated with ER+ tumors (OR = 4.73, p = 0.001) among White women >50 years of age at their time of diagnosis. Also, the A allele was more frequent in the Black patient population among whom more aggressive subtypes are common. Similarly, the "ADIPORI" rs12733285 T allele was associated with both PR+ and ER+ tumors. (OR = 2.18 p = 0.001; OR = 1.88 p = 0.019, respectively). Our data suggest that several polymorphisms individually or as specific "ADIPOQ" and "ADIPOR1" haplotypes are associated with tumor characteristics that impact prognosis in BrCa patients. Thus, genotyping additional groups of patients for these SNPs could offer insight into the involvement of adiponectin signaling allele variance in BrCa outcomes. In our second study, we examined 1) how teachers' beliefs about themselves and their students influence the fidelity of implementation of their enactment of a technology-rich curriculum, and 2) how professional development support during the enactment leads to changes in teacher beliefs. From the analysis of two teachers' experiences through interviews, surveys, journal entries, and video recordings of their enactments, several different themes were identified. For example, teachers' beliefs regarding students' ability to learn using the curriculum influenced the fidelity of implementation and student learning. These observations led to the development of a model of professional development that would promote faithful implementation. This model included teaching of content knowledge, practice with the technology, modeling of classroom management skills, and reflective feedback of enactments in formal and informal environments. The implications of these findings are discussed in relation to professional development programs and curriculum designs seeking to institutionalize the practices of scientists in schools with a high level of fidelity of implementation. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The purpose of this sequential, explanatory mixed methods research study was to understand what factors influenced African American maternal intentions to get their daughters aged 9 years to 12 years vaccinated in Alabama. In the first, quantitative phase of the study, the research questions focused on identifying the predictive power of eleven variables, representing selected factors associated with maternal intentions to vaccinate their daughters. The data were collected via a self-developed instrument that used a mixed mode survey design that was web-based (N = 14) and paper-based (N = 228). Participant demographics were analyzed using descriptive statistics. A binary, logistic regression analysis identified four variables best predicting maternal intentions towards HPV vaccinating their daughters against HPV: perceived barrier: information; perceived barrier: daughter too young for the vaccine; culture: future-time orientation; and subjective norms. In the second, qualitative phase were selected from the quantitative phase to explore the results from the statistical tests in more depth. Nine participants were selected using a stratified proportional subgroup sampling design and a maximal variation principle. Data collection included use of semi-structured interviews from five participants with positive intentions and four participants with negative intentions. Seven themes related to maternal intentions to vaccinate their daughters against HPV emerged in the thematic analysis of each participant and across the participants: role of knowledge, interpersonal influences, personal experiences, cultural influences, benefits of HPV vaccination, barriers of HPV vaccination, and vaccination uptake recommendations. For each participant, the themes differed in the number and similarity subthemes comprising them. There were similarities and differences among the participants in the study, while there were more similarities among participants in each group (those with positive intentions and those with negative intentions). "Perceived barriers" and "future-time orientation" were the most discussed themes. "Vaccination uptake recommendations" and "interpersonal influences" were other reasons mothers chose to or not to vaccinate their daughters. The results of the quantitative and qualitative phases were integrated while interpreting the outcomes of the entire study. Based on the findings from the quantitative and qualitative phases of the study, recommendations were made for a theoretical, culturally-tailored intervention to promote HPV vaccination uptake among African American girls aged 9 to 12 years. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Hispanics have a disproportionate burden of poorer cancer outcomes. "Promotores" (community health workers) have been shown to be effective in delivering interventions to this population. However, little is known about what aspects of the "promotores" influence the delivery of a cancer education intervention as well what interactions between "promotores" and the population influence the priority population's subsequent intentions to change health behaviors. Thus, this study had two main aims: 1) examine which psychosocial determinants of "promotores" influence the number of Hispanic residents reached by "promotores" in educational interventions; and 2) examine the effects of "promotores'" psychosocial determinants and their relationships with Hispanic "colonia" residents on residents' intentions to change health behaviors after receiving a cancer education intervention delivered by "promotores." Study participants included "promotores" and adult Hispanic "colonia" residents living in unincorporated sub-divisions lacking basic infrastructure and services in four south Texas border counties who participated in a cancer education intervention. "Promotores" attended an eight-hour training on cancer prevention, treatment, and healthy survivorship for breast, cervical, and colorectal cancers. "Promotores" then delivered 1.5-hour cancer education interventions to residents. Analysis was conducted with STATA 12.0, using regression models and multilevel mixed-effects linear regression models to assess associations between dependent and independent variables. For aim one, "promotores'" age and years of experience influenced their delivery of a cervical cancer education intervention to Hispanic "colonia" residents. For aim two, "promotores'" psychosocial determinants were not significant in predicting the residents' behavioral intentions; however, the number of formal trainings received from "promotores" by Hispanic residents', their satisfaction with the promotora-delivered training, and their trust in the "promotores'" messages were significant in predicting the residents' behavioral intentions. These are the first examinations of potential relationships between psychosocial determinants of "promotores" and selected outcomes in a cancer education intervention delivered to Hispanic "colonia" residents. Findings suggest numerous areas for exploration in future studies. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation examines the impact of internet technologies on the field of health communication. Access and use of health communication technologies has and will continue to become increasingly important to manage and treat chronic conditions and other ailments, particularly in the context of health care reform that promotes improved quality of care along with cost-saving measures. Through examining internet adoption rates, its use as a source of health information, and its influence on the patient-provider encounter, findings highlight ways in which the internet can be leveraged to help health consumers, health providers, health care organizations, and health insurance companies transition into the digital age of health care and health promotion. Data from the 2003 and 2008 Health Information National Trends Survey (HINTS) are used to examine online technologies for health communication among U.S. adults. HINTS, a nationally representative repeated cross-sectional survey, is developed and implemented by the National Cancer Institute (NCI) to measure knowledge, attitudes, and practices related to health information and media use, reflecting the growing reliance on internet sources for health and illness information. Three studies based on HINTS incorporating diffusion models and communication theories to describe the use of online technologies for health information and communication are presented. The first study demonstrates that the largest growing disparity in internet use is among women and men, with women significantly outpacing men between 2003 and 2008. A proposed disparities diffusion model suggests that other disparities in internet use are neither growing nor shrinking - that is, vulnerable populations remain at a disadvantage. The second study shows that internet use for health information continues to grow among both internet users as well as non-users. This suggests that non-users get online health information through surrogates, supporting a "team" approach to health information seeking. The third study demonstrates that the first source an individual uses for health information can influence the patient-provider encounter. Specifically, compared with individuals who use a health provider as a first source, those who use the internet have on average a more negative experience with their provider. Health consumers will continue to use online technologies for health information; thus, it is imperative for health care providers and organizations to implement policies and procedures that acknowledge and incorporate online health information into the care process to improve satisfaction, quality of care, and ultimately health outcomes. As new technologies expand throughout populations and are integrated more into decisions regarding health and wellbeing, findings from this dissertation can be used to support intervention and policy development. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Foreign-born residents face significant challenges accessing and receiving quality healthcare in the U.S. These obstacles include a lack of information on how to access care, fear, as well as communication and cultural barriers (Portes, Fernandez-Kelly & Light, 2012). Increasing healthcare providers' knowledge regarding a patient's culture as well as endemic rare diseases can serve to reassure and assuage patient discomfort. However, studies focused on educating healthcare providers regarding rare diseases that are restricted to or predominantly found in culturally distinct populations are lacking in the published literature. This knowledge deficit is of concern, since healthcare providers will need to become familiar with these less common diseases as the U.S. population continues to become more culturally diverse (Purnell & Paulanka, 2008). Previously published reports have demonstrated that e-learning, the use of internet technologies to improve knowledge and performance, is an effective method to educate healthcare providers (Caroll, Booth, Papaioannou, Sutton, & Wong, 2008; Childs, S., Blenkinsopp, E., Hall, A., & Walton, G., 2005). The present study explores the use of an e-learning intervention to educate oncology nurses about a specific rare disease, Adult T-Cell Leukemia/Lymphoma (ATLL) and the two cultures affected by this disease; Haitian and Japanese. A validated competency questionnaire was employed to assess Haitian and Japanese cultural awareness as well as ATLL disease-focused knowledge among oncology nurses completing the e-learning intervention versus oncology nurses who did not complete the e-learning intervention. A total of 28 oncology nurses were enrolled; 14 nurses were non-randomly assigned to the e-learning intervention and 14 nurses were not given the e-learning intervention. A change in mean scores (pretest vs. posttest), derived from specific components of the evaluation questionnaire, for oncology nurses who completed an e-learning intervention versus those who did not were as follows: 2.43 versus 0.07 (p = 0.002) for knowledge of ATLL; 2.71 versus -0.07 (p <0.001) for questions related to Japanese Cultural Awareness; and 1.86 versus -0.36 (p = 0.008) for questions related to Haitian Cultural Awareness. These findings suggest that oncology nurses who completed an e-learning intervention demonstrated improved ATLL knowledge, and Japanese and Haitian cultural awareness than those who did not complete the e-learning intervention. This is the first study to assess the amount of knowledge nurses gain by completing an e-learning intervention focusing on a rare disease found in a culturally distinct population. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation evaluates the effectiveness of a customized educational health intervention on sexual health and female cancer prevention among young women in Pakistan and evaluates the applicability of the integrated model of behavior prevention (IM) when predicting three health behaviors among this population. The study used randomized experimental design with one treatment group and one control group. The results of the study suggest that exposure to web-based customized heath information has positive effect on behavioral intentions to perform breast self-exams and get vaccinated for human papillomavirus, but not for condom use. It was also found that exposure to the website did not have an impact on the constructs in the IM model that should predict behavioral intentions. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Introduction: Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings. Methods: This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based physicians (n = 2,785), and women age 45 and older who visited a physician from 2008-2010 (n = 8,348). Chi-square analysis, ICD-9 coding and logistic regression analysis were performed to analyze the weighted data. Results: Physician EMR use was not significantly associated with the odds that a woman would have a mammogram provided/ordered. However, significant findings of the study indicate that women on Medicare/Medicaid/SCHIP (OR=0.633, 95% CI 0.271-0.919) have significantly lower odds of receiving mammography screenings compared to women who have private insurance. In addition, women who visit obstetrics/gynecology (OR = 0.190, 95% CI 0.142-0.254) and internal medicine practices (OR = 0.553, 95% CI 0.393-0.778) have significantly lower odds of receiving a mammography, compared to women visiting general/family practices. Conclusions: Women age 45 and older who have private are more likely to have a mammogram ordered or provided by a physician, compared to those women who are poor or without insurance. Based on our findings, women are having more general/family physicians providing them with routine care, and that these physicians are experiencing difficulty referring Medicare/Medicaid/SCHIP patients for specialty care. This may be due to patients being reluctant to pay a co-pay for mammography screenings, the short supply of specialists in the area, long waiting lists for specialists, specialists not accepting or limiting the number of patients who are covered by Medicare/Medicaid/SCHIP or self-pay, and low reimbursement rates. Further research is needed to uncover the true reasons as to why physicians are ordering/providing mammography screenings for women who are poor or on Medicare/Medicaid/SCHIP at lower rate than women who have private insurance. In 2014, the Affordable Care Act is set to expand preventive services under the Medicaid program to cover recommended preventive services and immunizations. The referral process will be less difficult for physicians who refer self-pay and Medicare/Medicaid/SCHIP patients to specialists because patients will no longer have a co-pay for mammography screenings. In addition, we acknowledge that the HITECH statue authorizes incentive payments through Medicare and Medicaid to physicians and hospitals that use EMRs privately and securely to achieve specified improvements in care delivery. The incentive payments will help encourage physicians in all specialties to improve the ordering/providing of mammography screenings to women who are on Medicare/Medicaid/SCHIP in all races, ethnicities, and socioeconomic backgrounds. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Cancer can be one of the most serious diseases that can result in a costly reduction in the quality of life. Among a number of cancer risk factors, tobacco use has been identified as the leading preventable cause of deaths. Prior research has suggested that cancer information seeking may be a pre-step to adopt health protective behaviors that can prevent the development of cancer. However, little is known about factors that lead cancer information seeking behaviors of smokers, former smokers and nonsmokers. The purpose of this study was two-fold. First, it aimed to offer a model by merging constructs that have been shown to be effective to predict health preventive behaviors, especially cancer information seeking behaviors, with the more recent factors. Second, it examined cancer information seeking behaviors, proposed by the model, comparing smokers, former smokers and nonsmokers. This study used the first cycle of the Health Information National Trends Survey 4 data set collected in 2012. Path analyses were employed to test the proposed relationships among risk perception, perceived ambiguity, cancer worry, self-efficacy, response efficacy, and cancer information seeking for sub-groups, segmented by smoking status. Results from the path analysis featuring a multiple group comparison indicated that the proposed model did not fit the data well. Thus, separate path analyses were subsequently conducted for smokers, former smokers and nonsmokers. One of the main findings was the roles of risk perception and cancer worry in cancer information seeking. Regardless of smoking status, risk perception was positively related to cancer worry, and then, cancer worry was positively related to cancer information seeking. In addition, perceived ambiguity affected cancer information seeking via response efficacy and cancer worry. Greater perceived ambiguity was associated with less response efficacy for all three groups and with greater cancer worry for former smokers and nonsmokers. Then, subsequently, response efficacy was positively associated with cancer information seeking for former smokers and nonsmokers. Finally, although not hypothesized, self-efficacy was negatively associated with risk perception for smokers and former smokers. The findings of this study provide a better understanding of cancer information seeking behaviors of smokers, former smokers and nonsmokers. Additionally, they suggest that health communication professionals should design messages to increase risk perception and cancer worry as well as to decrease perceived ambiguity, which may in turn help lead effective cancer prevention efforts. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Cervical cancer is the second most frequent cancer in women around the world and affects half a million women per year. The World Health Organization (WHO) estimates that 275,000 women die every year, and 80% to 85% of these deaths occur in low-resource countries in Africa and South America. In Peru, cervical cancer has the highest incidence and the second highest mortality rates of cancers among women. Currently, the screening techniques such as the Papanicolau (Pap) test, in which some cells from the cervix are examined under a microscope to detect potentially pre-cancerous and cancerous cells, and the Visual Inspection with Acetic Acid (VIA), in which the surface layer of the cervix is examined through visual inspection after washing it with 3% to 5% acetic acid (vinegar) for one minute, are part of the national health policy in Peru. The Pap test is mainly used in urban areas in Peru. However, there are some challenges related to spreading the Pap test throughout the whole country: lack of quality and standardization of the readings of Pap smears, shortage of trained personnel, uneven processing of samples resulting in diagnosis and treatment delays, and lack of even basic laboratory infrastructure, all of which impacts greatly on the sustainability of this procedure in remote and/or poor settings. Extensive research has shown that computational solutions are a viable and suitable aid for overcoming these barriers. However, the majority of these solutions are commercial products that are not affordable for developing countries, such as Peru. In this context, developing a strategy, algorithm and open source computational implementation that recognizes normal vs. abnormal Pap smears can ultimately provide a cost-effective alternative for developing countries. The dissertation-specific objectives are to: 1) determine the characteristics of normal vs. abnormal Pap smears through expert consultation and relevant literature, 2) collect Pap smear data sets and run preliminary experiments to compare two pattern recognition algorithms in terms of features and classification performance, and 3) assess the accuracy, sensitivity and specificity of the proposed cervical cancer screening approach for classifying normal vs. abnormal Pap smears compared to experts' review. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Health information technology has become more prevalent in hospitals, physician offices, clinics, and other areas of medical treatment, especially since the federal government passed legislation to offer incentive payments for the meaningful use of electronic health records (EHRs). Previous research demonstrated a decrease in medical errors as well as a decrease in overall healthcare costs when EHRs were used. Registered nurses represent one population that has been pressured to utilize the EHR, has suffered stress during the process, and was forced to adapt to the challenges inherent with installation of the software, ongoing updates to hardware and software, and multiple changes in work flow, often without any feedback into the activities that directly affected them. This experimental, quantitative research examined the effect of technostress creators and inhibitors on the perceived productivity of oncology nurses as they used an EHR to increase the safety, quality, and effectiveness of healthcare for patients with cancer. A total of 228 nurses who gave direct care to patients and used an EHR for that care provided responses to the survey. Of that number, only three were in the experimental group and completed the continuing education intervention, which was significantly below the required sample size. Therefore, this intervention was not analyzed. Of the remaining respondents, 112 nurses between the ages of 18 and 65 met the criteria for the control group and completed the survey. Multivariate linear regression showed an inverse relationship between productivity and the technostress creators and inhibitors. As technostress increased, the nurse's perceived productivity decreased. As technostress decreased, the nurse's perceived productivity increased. Age and level of nursing education were analyzed yet were not significant predictors of productivity. Other demographic data was collected and may be utilized in future research. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Introduction: Little is known about how group cohesion develops in online support group communities. Previous research suggests that message content, self-disclosure, and emotional expression may be central to this process. The purpose of this study was to identify linguistic and qualitative characteristics of participants' messages that predict how other participants respond in an asynchronous discussion board for cancer-related distress. Method: 525 discussion board messages posted by 116 participants in the health-space.net trial were collected. Linguistic Inquiry and Word Count (2001) was used to identify linguistic markers of emotional expression and pronoun use. Message topics were identified using qualitative analysis. Logistic regression and chi-square analyses were used to evaluate whether linguistic characteristics and message topics predicted receiving a response from other survivors in the online group. Results: Messages were more likely to receive a reply if they had higher word count, OR = 0.30, p = 0.001, or fewer second person pronouns, OR = 0.923, p = 0.040. Messages were less likely to receive a reply if they evidenced high levels of positive emotion, OR = 0.94, p = 0.03. The most common message topics related to self-disclosure (51%), the group (38.5%), medical experiences (30.9%,), and experiences related to the website (30.1%). Several types of message topics were associated with greater likelihood of a reply: self-disclosure (p < 0.001), medical experiences (p = 0.01), relationship issues (p = 0.05), and introductory posts (p < 0.01). Implications: Informing participants how to introduce themselves to the group (i.e., detailed and self-focused messages discussing personal issues such as the effects of illness on life and relationships) could promote cohesion and enhance overall intervention engagement. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Background: Breast cancer (BC), the most common cancer diagnosed in women in the United States, is a heterogeneous disease in which age-specific incidence rates (ASIRs) differ by race and mortality rates are higher in blacks than whites. Goals: (i) understand the reasons for the black-to-white ethnic crossover in the ASIRs; (ii) formulate a plausible explanation for higher BC mortality in blacks; and (iii) develop statistical models and computing tools for estimating BC survival. Methods: We collected incidence, survival, demographic, clinical and treatment data of BC in black and white women from NCI's SEER database. Incidence rates were stratified by the status of estrogen and progesterone receptor (ER, PR). Time period and birth cohort effects on incidence rates were estimated by age-period-cohort analysis. Multivariate Cox regression analysis was utilized to develop statistical models for prediction of BC survival. The accuracy of the models was assessed by c-indexes and calibration plots. Results: Analysis of ASIRs of BC phenotypes stratified by the ER and PR status showed that: (i) the black-to-white crossover in the corresponding incidence rates was absent; (ii) ASIRs for a given BC phenotype in black and white women are proportional in each age interval; (iii) blacks have lower risk for the [ER+, PR+] BC phenotype, higher risk for [ER-, PR-] and almost equal risk for [ER+, PR-] compared to whites; and (iv) mortality rates differ by race only for the [ER-, PR-] phenotype. This suggests that: (i) carcinogenesis in aging, leading to the development of each of the considered BC phenotypes, is similar in whites and blacks; (ii) the crossover is a result of not taking into account hormone receptor status; and (iii) the difference in race-specific mortality is due to larger death rates for [ER-, PR-] blacks. Six Cox Proportional Hazards models (stratified by age group and lymph node status) were developed. The models fit well the observed data, are well calibrated, and have good discrimination power (c-indexes) between cases. Based on these models, a web-based tool was developed to instantaneously estimate BC survival probability when given a patient's personalized demographic and clinical data. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Qualitative phenomenological methodology was used to explore the lived experiences of African American women diagnosed with breast cancer. Phenomenology focuses on the meaning of the lived experiences of individuals experiencing a concept, structure, or phenomenon (Creswell, 2007). The purpose of phenomenological research is to identify phenomena as perceived by the individual. Utilizing an existential perspective, the focus of this study was to uncover meaning which defined the essence of the participants' experiences. Seven African American women diagnosed with breast cancer participated in this study. The participants' ages ranged from 33-63 years. A semi-structured interview process with open-ended questions was utilized to gain an understanding of the participants' personal experiences related to the phenomenon. Data was analyzed using Interpretative Phenomenological Analysis (Smith, 2004) to ascertain emergent themes and to interpret the meaning of the participants' breast cancer experience. Seven common themes emerged from the cases. Those themes included: spirituality; support systems; self-care; resiliency; existential meaning; education; and perception of counseling. These seven themes will help to provide insight into how counselors can help to facilitate emotional wellness within this particular population. Implications and recommendations for counselor educators, counselors, and counselors-in-training with this population are also addressed. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The role of the modern radiation therapist is directed and driven by the organizational system. Changes affecting their role are implemented as a response to changes in the industry. Operations of the modern cancer center, with new and changing treatment technologies bring questions regarding the learning process of radiation therapists at a time when optimal patient care requires informed radiation therapists with good independent judgment abilities. Radiation therapists monitor accuracy through a human interface with technology. It is through this interaction where levels of awareness and critical judgment are called upon to control the outcome. Problem recognition for the user is heavily dependent on foundations of knowledge to connect a screen display to the unseen treatment processes occurring within the treatment room. The purpose of this qualitative case study was to understand how staff radiation therapists learn new skills and build on existing knowledge within a highly technical environment. This study used a socio-technical frame providing structure to my research and data analysis according to the multi-layers of socio-technical systems. Three research questions focusing on the organization's infrastructure, info-structure, and info-culture guided this study to answer the broad research question, how do radiation therapists learn new skills to develop a "knowledgeable practice" in a highly technical environment? My interpretation of the data, based on Situated Learning Theory describes the growth and development of "Junior Rangers" within the organization. The same principles provide the framework to describe linkage between the removal of processes (participation), the loss of a practice for the profession linked with diminishing boundaries to develop maximum potential for the role of the radiation therapist. I correlate the loss of participation with the emergence of a treatment practice with a limited knowledgeable practice. Resting on modern socio-technical literature, reported behavioral patterns and perspectives of technical socialization, and a review of the literature across various industries, I conclude with the argument of the loss of foundational knowledge through a process of "knowledge appropriation." Foundational radiation therapy knowledge is appropriated by technology and replaced with the knowledge required to operate the new equipment and technology. Data from the case study; supporting literature; situated learning perspectives; and findings from a workflow cross analysis of pre and post technology processes forms the argument of knowledge appropriation. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The diagnosis and treatment of cancer in adolescence requires that adolescents and their caregivers learn to transition and adjust to the challenges associated with cancer. The aim of this phenomenological study was to generate a detailed examination of the experiences of four caregivers and their adolescent children, 11 to 18 years of age, undergoing treatment for cancer as they transitioned between the healthcare and education systems. This study sought to understand the meaning of the lived experiences in order to provide a clearer picture of the nature and scope of the experience. Schools are an important part of this change process; they are no longer just a place that students will perhaps return to if they become healthy enough. Practitioners need to understand the meaning of the experiences from the adolescents', as well as their caregivers' perspective, in an attempt to improve the unique needs of this population, provide appropriate interventions, and improve educational programs in order to prevent or relieve distress in these patients and their families. The findings in this study have global implications for the development of policies and procedures in the medical as well as the education field for providing the best support for all students including those adolescents with cancer (AWC). Through the formation of the Students with Cancer Advisory Team (SCAT), this community of individuals can help prepare the AWC and their caregivers as they transition between the diagnosis, treatment, and re-entry back into the school setting. This researcher encourages educators and the medical field to coordinate and collaborate with other education and social service agencies to better serve the AWC and their families by providing a seamless delivery of services facilitating them in leading a fulfilling life, despite the psychological, physical, and social effects of cancer. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The purpose of the research was to explore the self-directed learning and transformational learning experiences among persons with bipolar disorder. A review of previous research pointed out how personal experiences with self-directed learning and transformational learning facilitated individuals' learning to manage HIV, Methicillan-resitant "Staphylococcus" aureus (MRSA), prostate cancer, and breast cancer to maintain their health. In addition, participants in a study examining self-management of bipolar disorder identified educating one's self as important for staying well. However, unexplored in the previous research was how self-directed learning and transformational learning experiences transpired among persons who were self-managing bipolar disorder. The three research questions focused on experiences prompting learning, personal experiences with learning self-management, and personal experiences contributing to strategies for staying well. Of the 12 individuals initially inquiring about participating in the research, 8 individuals voluntarily participated. These male and female participants' ages ranged from 25 to 67. The audio taped interviews ranged from 90 minutes to over two hours in length. Two participants provided feedback about the interview questions, which were refined to address their comments. The research method was heuristic inquiry and consisted of six phases: (a) initial engagement, (b) immersion, (c) incubation, (d) illumination, (e) explication, and (f) culmination. The heuristic process permitted my being embedded in the conversations about learning how to self-manage bipolar disorder to stay well as both researcher and research participant. The culmination of analysis resulted in 14 emergent themes describing: (a) the role of meaning making and acceptance as prompts to learning, (b) how barriers were negotiated and resources engaged to facilitate learning to self-manage to stay well, and (c) the importance of acquiring strategies for staying well. Emerging from these 14 themes were key experiential events among participants learning to self-manage bipolar disorder to stay well. Participants had to make meaning of bipolar disorder in order to accept the diagnosis and begin to engage in learning, which transpired through self-directed learning and transformational learning experiences. Taking ownership of learning to self-manage to stay well was an expression of personal autonomy and self-determination. Personal motivation and personal experiences were valuable resources supporting and enabling learning to stay well. Proactive behavior facilitated taking action on one's behalf to stay well. The benefit of an autodidactic approach to learning to self-manage bipolar was participants' sharing their knowledge about managing bipolar disorder and their compassion for others with bipolar disorder. Findings from the current research point out how individuals with bipolar disorder can learn to self-manage to stay well. Personal commitment to learning was essential for staying well. Commitment emerged from making meaning of the diagnosis, accepting of the diagnosis, and taking ownership of learning how to stay well. Transformational learning and self-directed learning transpired from participants' personal experiences in learning how to self-manage bipolar disorder. Through autonomous learning experiences, they gained confidence in self-management and they became proactive about taking actions best serving their well being. A proactive approach empowered actions and led to autonomous decisions for staying well. Through self-directed learning, participants identified best practices for caring for self and informing treatment decisions. Reframing of personal experiences facilitated gaining new perspectives. Reflections on past experiences enabled participants to inform their future actions and decisions for self-managing bipolar disorder. Engaging others in conversations made personal narratives about living with and self-management of bipolar disorder available as learning resources and personal stories to embrace. Stories of self or stories about others transpired as teaching moments through transformational learning and self-directed learning. By engaging others in the narratives of self, participants witnessed new views and dimensions of learning how self-manage their bipolar disorder to stay well. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The population consisted of oncology care providers affiliated with the Gynecologic Oncologic Group (GOG). The research indicated that the model was able to explain 32.4% of the variance in behavioral intention to adopt a CDS system. The results indicated a significance correlation between social influence and facilitating conditions on an oncology care provider's behavioral intention to use a CDS system. The variables of performance expectancy and effort expectancy demonstrated no significant correlation with behavioral intention. Recommendations include creating an environment of positive social influence coupled with training and support programs designed to integrate CDS systems into the care provider's clinical routine. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Caregiver burden and distress have been associated with informal caregivers. Research findings on the specific aspects of the caregiving role that influence burden are mixed. Factors such as amount of time per day giving care and specific characteristics about the disease progression have been linked to caregiver burden and distress. Other findings suggest that caregiver burden and distress may be associated with disease characteristics, but caregiver personality traits are the major factor that influences caregiver burden. The purpose of this study was to use a variety of instruments to assess the relationship between traits that the caregiver comes into the caring situation with (resiliency, social support, spirituality, hope) and caregiver burden, within different caregiving populations. Caregivers giving care to individuals with Alzheimer's disease, Amyotrophic Lateral Sclerosis, or cancer were the caregiving groups of interest. A convenient sample of 95 informal caregivers completed the battery of instruments through an online survey tool. Differences between the three caregiving samples were assessed in terms of burden and distress. Hierarchical regression models were created to understand the roles gender, time giving care, activities assisted with, resiliency, social support, spirituality, and hope play in predicting caregiver burden and distress. Psychometric properties were assessed on all six instruments used in this study. Cluster analytic techniques were used to cluster caregivers based on a number of attributes to better understand the caregiving population. Results from this research indicate that resiliency, social support, spirituality, and hope significantly predict caregiver burden and distress. Amount of time giving care per day, number of months giving care, and activities that the caregiver assists with did not play a significant role in predicting caregiver burden or caregiver distress. The three caregiving groups were unequal in size, but reported similar levels of burden and distress. Two caregiving clusters were created based on this sample. Caregivers who had higher levels of resiliency, social support, spirituality, and hope (cluster one) were significantly less burdened and distressed than caregivers who reported lower levels of resiliency, social support, spirituality, and hope (cluster two). This research adds to the body of work within caregiver burden and distress. The findings suggest that burden is a factor of different aspects of the caregiver rather than the disease characteristics and progression of the person receiving care. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Friends, family, and community provide important support and help to patients who face an illness. Unfortunately, keeping a social network informed about a patient's health status and needs takes effort, making it difficult for people who are sick and exhausted from illness. Members of a patient's social network are often eager to help, but can be unsure of what to do; they must balance their desire to help with trying not to bother a sick friend. In this dissertation, I describe research on how people share health information within their existing social networks and present technology to create informed, helpful networks. I used a mixed methods approach of interviews and an online questionnaire to provide a detailed analysis of what health information people share, who they share with, mode of transmission, and why people share personal health information. My research culminates in the design of new technology that enables patients to create an informed network and catalyzes helping activities within that network. I used participatory design methods with breast cancer patients and survivors to ensure that the design is based on a firm understanding of users' goals, priorities, constraints, and current sharing practices. Together, we designed a technology that allows a patient to keep their social network up to date, solicit help from their network, field offers of help, and collaborate through discussions. The design is motivated by the insight that a more informed social network is better able to provide needed help and support. Advocating that patient-centered technology should allow users to share personal health information with others comes with the responsibility to contribute to the effort to create usable privacy interfaces. I present a method for evaluating the transparency of privacy controls and use this method to identify a transparent icon that can be embedded within interfaces to show how information is being shared. Embracing the complex picture of how patients manage and share personal health information with others will ultimately improve the technology available to support patients. I contribute a better understanding of current sharing practices and technology to enable patients to create informed, helpful social networks. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation has two primary concerns: (i) evaluating the uncertainty and prediction capabilities of a nanodiamond drug delivery model using Bayesian calibration and bias correction, and (ii) determining conceptual difficulties of multi-scale analysis from an engineering education perspective. A Bayesian uncertainty quantification scheme is used to analyze computational and experimental data for the localized cancer drug delivery system. Since this system is largely unknown, assessing the uncertainty at various developmental stages as well as on different physical scales is important to determine functioning of this system. Adsorption of DOX (a cancer fighting drug) to nanodiamonds is measured in two ways: (1) experimentally via UV Visible Spectroscopy and (2) numerically using stochastic molecular dynamics simulations. These two sets of data are used in a Bayesian calibration and bias correction analysis such that the pH is the input parameter, the percentage of carboxyl, the functional group on the surface of the nanodiamond, is the calibration parameter, and both modeling and experimental errors are accounted for in the uncertainty analysis. The acid dissociating constant pK[subscript a] value of the nanodiamond is also used for system calibration. A Bayesian bias correction analysis is also performed to measure the impact of nanodiamond aggregation. From these analyses, an estimate of the uncertainty in the system is determined, the optimal pK[subscript a] value and percentage of carboxyl is found, the impact of the experimental and modeling physical scale differences is examined, the impact of clustering is measured, and a research path to further reducing the system uncertainty is given. The second research issue covered in this dissertation addresses how to effectively teach this type of high-level, cross-disciplinary thinking, and multi-scale research to future engineers. The conceptual hurtles present in understanding multi-scale analysis were identified through one-on-one interviews with scientists and engineers spanning the experience spectrum (undergraduate students, graduate students, postdoctoral fellows, and professors). From these interviews, important issues involving understanding and teaching multi-scale analysis were documented. From there, a Northwestern course was modified and taught to specifically address many of these issues. Then a follow-up survey was conducted to rank these many issues in terms of importance. This is the first research to specifically address the role that multi-scale thinking has on conceptual understanding. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Individuals with a cancer-predisposing genetic trait have a lifetime risk to develop cancer approaching 100 percent, and cancer often strikes early in age, before standard recommended cancer screening begins. Identifying hereditary cancer predisposition through genetic cancer risk assessment (GCRA) allows for intensified measures to prevent cancers or detect them at an earlier, more treatable stage. There is a surge in demand for GCRA services across the nation, but few clinicians with adequate training to provide GCRA services. The City of Hope Cancer Center conducts a multimodal GCRA training course for physicians (MDs), advanced practice nurses (APNs) and genetic counselors (GCs), delivered through nine weeks of distance didactics and five days of face-to-face case-based workshops, followed by 12 months of prescribed Web-based professional development activities. As currently designed, the course cannot meet increasing demands for cancer genetics training. This study employed a quasi-experimental design with a nested process component to compare knowledge, case-based skills and professional self-efficacy outcomes of clinicians who engaged in case-based training concurrently with distance-mediated didactic learning through Web-based case conferencing (intervention group) with outcomes of clinicians who participated in the established course design, with case-based learning conducted through face-to-face workshops (comparison group). The process component employed survey and roundtable discussion group methods to gain insights about the Web conference learning experience from the perspectives of the intervention group participants. A preliminary cost analysis was also conducted to compare the expense of face-to-face workshops with those of Web-based case conferences. Ninety-six clinicians participated in the study. The comparison group (n = 44) and the intervention group (n = 52) were each comprised of two cohorts who participated in the course in the years 2009 and 2010, respectively. The majority of participants in both groups were female (86 and 89 percent, respectively), Caucasian (82 and 73 percent, respectively) and had some GCRA practice experience (84 and 94 percent, respectively). No statistically significant differences were found between cohorts or groups in composition of practice discipline (MDs, APNs and GCs), practice setting, years in clinical practice, previous GCRA experience, or in baseline knowledge, case-based skills or professional self-efficacy scores. Results of comparative analysis revealed statistically significant pre-to-post increases in both comparison and intervention groups on knowledge, case-based skills and professional self-efficacy scores (p less than 0.000 for each variable). Pre-to-post between-group comparisons were statistically significant on percent change in knowledge (p less than 0.015) and in post-knowledge score (p less than 0.000). Pre-to-post changes in case-based skills and professional self-efficacy scores were comparable between groups, with no statistically significant differences (p less than 0.33 and p less than 0.30, respectively). Results support (and in knowledge outcomes, exceed) the hypothesis that intervention group outcomes would be equivalent to comparison group outcomes on established course pre-post assessments. Findings from the process analysis revealed that the Working Group learning experience generated new learning and reinforced existing knowledge in a broad spectrum of GCRA-related knowledge and skills domains. Engagement in Working Group helped participants identify, reflect upon and articulate individual knowledge and skills deficits. These findings, combined with feedback on limitations, connectedness and communication during Working Group participation, will inform the development of a practical, more accessible new course design that incorporates Working Group Web conferencing as a key source of distance-mediated case-based training aligned with the highest standards of accountability in continuing medical education (CME). Further research to examine the effectiveness of this and other Web-based case conference and tumor hoard environments will enhance the learning potential of CME-accredited distance-mediated case conferencing, and will contribute to the body of theoretically- grounded approaches to continuing medical education and professional development. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation introduces a new multimedia security system for the performance of object recognition and multimedia encryption in security and medical applications. The system embeds an enhancement and multimedia encryption process into the traditional recognition system in order to improve the efficiency and accuracy of object detection and recognition while protecting multimedia data. The dissertation then focuses on the system's enhancement and encryption processes, and presents contributions to the area of image enhancement and multimedia encryption. For the purposes of image enhancement, a new enhancement measure called the second-derivative-like measure of enhancement (SDME) is introduced to quantitatively evaluate the enhancement algorithm's performance. This is followed by the introduction of a new 3D CT baggage image enhancement algorithm for homeland security applications. Computer simulations and comparisons demonstrate that the presented algorithm significantly improves the visual quality of objects in the original CT images while reducing background noise. The quantitative SDME measure results and 3D visualizations verify the algorithm's excellent enhancement performance. To improve the visual quality of medical images and thereby improve the efficiency and accuracy of early cancer detection, a new nonlinear filter, called the Alpha-Weighted Quadratic Filter (AWQF), is integrated with human visual system based decomposition and unsharp masking techniques to enhance mammograms for breast cancer detection. To enhance prostate MR images for prostate cancer detection, the same filter is integrated with alpha-trimmed mean separation and logarithmic enhancement techniques. Simulation results and comparisons are given to demonstrate the enhancement algorithms' excellent performance when it comes to enhancing mammograms and prostate MR images. In order to enhance the efficiency and security of existing encryption algorithms, five parametric recursive sequences and their transforms are developed and applied to multimedia scrambling/encryption. The recursive sequence transforms are integrated with the Fibonacci bit-plane decomposition method and the newly introduced (" n, k, p")-Gray code bit-plane decomposition for image and object encryption. Based on the concept of using one set of security keys to encrypt the original image and a different set of security keys to reconstruct the image to obtain the final encrypted image, a discrete parametric cosine transform is used for image encryption. Despite the fact that the edge map has been used traditionally for image compression, enhancement, and recognition, it has never been used for image encryption. This dissertation investigates the use of the edge map for applications in image encryption. The edge map is integrated with the 3D Cat Map for image encryption and with the chaotic logistic map for encrypting medical images for the sake of privacy protection. The concept of the edge map is then extended further to produce a binary "key-image", which can either be a bit-plane or an edge map obtained from any other image. Computer simulations, comparisons and security analysis demonstrate the excellent performance of the presented encryption algorithms when it comes to multimedia encryption. The contributions of this dissertation are as follows: (1) A new multimedia security system for object detection and multimedia encryption (2) Image enhancement: (a) A new SDME measure for quantitatively evaluating the enhancement algorithm's performance (b) A new 3D CT baggage image enhancement algorithm using alpha weighted mean separation for homeland security applications (c) A new alpha weighted quadratic filter for mammogram enhancement (d) A new human visual system decomposition based algorithm for mammogram enhancement (e) A new nonlinear unsharp masking scheme for mammogram enhancement (f) A new prostate MR image enhancement algorithm using the alpha-trimmed mean separation and nonlinear filtering (g) A new logarithmic enhancement algorithm using nonlinear filtering for prostate MR image enhancement (3) Multimedia encryption: (a) Five new parametric recursive sequences and their transforms for multimedia encryption, including the truncated P-Fibonacci sequence, P-Lucas sequence, ("n", "k," "p")--Gray code, P-recursive sequence and the parametric M-sequence. (b) A new 2D P-recursive transform (c) Two P-recursive transform based multimedia encryption algorithms in the spatial and frequency domains (d) A new truncated Fibonacci p-code bit-plane decomposition (e) A new ("n," "k," "p")--Gray code bit-plane decomposition (f) A new image encryption algorithm using the P-Fibonacci transform and decomposition (g) A new selective object encryption algorithm using the truncated Fibonacci p-code bit-plane decomposition (h) A new image encryption algorithm using the ("n," "k," "p")--Gray code and its decomposition (i) A new image encryption algorithm using the Discrete Parametric Cosine Transform (j) A new image encryption algorithm using the edge map and a new 3D Cat Map (k) A new medical image encryption algorithm using the edge map and chaotic logistic map (l) Two image encryption algorithms using binary key-images: one uses bit-plane and the other uses the edge map. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Translational research has proven to be a powerful process that bridges the gap between basic science and medical practice. The complexity of translational research is two-fold: integration of vast amount of information in disparate silos, and dissemination of discoveries to stakeholders with different interests. We designed and implemented a hybrid knowledge discovery framework. We developed strategies to leverage both traditional biomedical databases and Health Social Network Communities content in the discovery process. Heuristic and quantitative evaluations were carried out in Colorectal Cancer and Amyotrophic Lateral Sclerosis disease areas. The results demonstrate the potential of our approach to bridge silos and to identify hidden links among clinical observations, drugs, genes and diseases, which may eventually lead to the discovery of novel disease targets, biomarkers and therapies. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Excessive production of pro-inflammatory mediators by activated brain microglia plays an important role in abnormal neuronal function and cognitive deficits. Studies have shown that the intake of flavonoids is inversely related to cognitive decline and dementia in people 65 years of age or older. Luteolin, a flavonoid found in high concentrations in celery, green pepper, and perilla leaf and seeds, has been shown to reduce pro-inflammatory molecules produced by lipopolysaccharide (LPS)-stimulated macrophages, fibroblasts, and intestinal epithelial cells. However, the anti-inflammatory effects of luteolin on neuroinflammation have not been studied. Therefore, we investigated whether luteolin may attenuate neuroinflammation mediated by activated microglia and subsequently modulate age-associated cognitive decline. Initially, we observed the anti-inflammatory and neuroprotective effects of luteolin "in vitro". Luteolin inhibited LPS-stimulated production of tumor necrosis factor (TNF)-[alpha] and interleukin (IL)-1[beta] at both the gene and protein levels in BV-2 microglial cells. Luteolin also suppressed LPS-induced nitric oxide (NO) and prostaglandin (PG) E [subscript 2] by regulating mRNA expression of inducible nitric oxide synthase (iNOS) and cyclooxigenase (COX)-2, respectively. Treatment of Neuro.2a neuronal cells with conditioned media from LPS-stimulated microglia resulted in neuronal cell death. More importantly, treating microglia with luteolin prior to LPS reduced neuronal cell death in a dose-dependent manner. Additionally, we sought to determine whether luteolin also regulates IL-6 production and the mechanism by which luteolin exerts this anti-inflammatory effect. Pretreatment of primary murine microglia and BV-2 cells with luteolin inhibited LPS-stimulated IL-6 production at both the mRNA and protein levels. Moreover, we found that this anti-inflammatory effect of luteolin works through c-Jun-N-terminal kinase (JNK) and transcription factor, activator protein-1 (AP-1). Luteolin also had similar anti-inflammatory effects "in vivo". In adult mice, drinking water supplemented with luteolin for three weeks reduced LPS-induced IL-6 in plasma and hippocampus 4 h after peripheral injection of LPS. Finally, given these potent anti-inflammatory properties of luteolin, as well as the inverse relationship between flavonoid intake and cognitive decline in older persons and aged animals reported by others, we explored whether dietary supplementation of luteolin can ameliorate age-related deficits in spatial working memory and reduce inflammatory molecules in aged brain. Adult and aged mice were provided control or luteolin supplemented diet for four weeks. Dietary supplementation of luteolin attenuated the age-related spatial working memory deficits along with alleviating hippocampal IL-1[beta] and major histocompatibility complex (MHC) class II mRNA expression in aged mice. Collectively, these studies showed that luteolin might be a promising agent for preventing neuroinflammation and neuronal cell death mediated by activated microglia and consequently, attenuating age-associated cognitive decline. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Estrogenic hormones exert their effects through binding to Estrogen Receptors (ERs), which work in concert with coregulators and extranuclear signaling pathways to control gene expression in normal as well as cancerous states, including breast tumors. In this thesis, we have used multiple genome-wide analysis tools to elucidate various ways that are utilized by extranuclear-initiated estrogen receptor pathways to impact gene expression in MCF-7 breast cancer cells. In the first part of the thesis, in order to investigate the impact of estrogen-mediated extranuclear-initiated pathways on global gene expression, we used estrogen-dendrimer conjugates (EDCs), which, because of their charge and size, remain outside the nucleus and can only initiate extranuclear signaling. We showed that inputs from both nuclear and extranuclear ER signaling pathways are important in regulating patterns of gene expression in breast cancer cells. In the second part of the thesis, in order to identify ER[alpha] and ERK2 binding sites after E2 and EDC treatment in MCF-7 cells, we performed chromatin immunoprecipitation (ChIP) followed by genome-wide microarray analysis. We found that ERK2 binding sites are associated with E2 regulated genes as well as genes whose expression correlates with ER expression in breast tumors and ncRNAs, which thus might impact tumor physiology and progression at multiple levels. In the third part of the thesis, in order to elucidate the mechanisms that the MAPK pathway utilizes to impact ER[alpha] action in breast cancer cells, we compared the gene expression profiles of MCF-7 cells to that of MCF-7 cells where ERK1 or ERK2 were depleted using RNAi technology. Our findings revealed that ERK1 and ERK2 regulate distinct sets of physiological processes by modulating basal expression as well as E2-mediated transcriptional regulation of many critical target genes in breast cancer cells. In the final part of the thesis, we focused on the crosstalk between ER[alpha] and Aryl Hydrocarbon Receptor (AhR). Our data suggest that a tertiary complex forms between ER[alpha], AhR and RIP140 and this complex, possibly through switching the function of one of ER[alpha] coregulators from a coactivator to a corepressor, controls the magnitude and duration of ER[alpha]-mediated gene stimulation. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The physiologic effects of estrogen action through the estrogen receptor (ER) are widespread, as this hormone exerts actions in both reproductive (e.g., uterus) and non-reproductive (e.g., bone, brain) tissues in both men and women. As such, the regulation of the activity of this ligand-activated transcription factor is highly relevant to the maintenance of normal physiology, and its disregulation can lead to various disease states, including one of the most deadly and well-recognized, breast cancer. As with many pathologies, early diagnosis provides the patient with much better chances of survival; however, once a diagnosis has been made, treatments that specifically target the molecular initiation of the disregulated cellular proliferation result in the greatest attenuation of tumor progression. As not all women have estrogen-receptor positive breast cancer, both the presence of ER and the functionality of the receptor at the start of treatment must be evaluated. With this information, ER positive breast cancers have conventionally been treated with either antagonist ligands for the receptor that shut off ER action or antagonists of the aromatase enzyme that produces the endogenous activating ligand estradiol. Unfortunately, within months to years, all of these tumors will eventually develop resistance to current treatments, making the discovery of novel methods of ER inhibition vital to continued success in control of breast cancer through targeted endocrine therapies. Herein, we first discuss a novel approach for the inhibition of the estrogen receptor, the use of small molecules to interrupt the protein-protein interaction between the ER and the primary coactivator in a cascade leading to the upregulation of many genes driving cellular proliferation. This "direct" inhibition will be contrasted with current methods whereby ER action is turned off via the "indirect" action of antagonist ligands. We have approached the identification and biological evaluation of these compounds from several different standpoints. In Chapter 2, we apply an assay capable of identifying these direct inhibitors of ER/coactivator binding that we have termed Coactivator Binding Inhibitors (CBIs). Through a collaboration with the Molecular Libraries Screening Center at Emory University, this assay was optimized and utilized in the screening of over 86,000 compounds in a search for potent compounds that work through this novel mechanism. Chapter 3 presents the work of various synthetic chemists in our laboratory who have made libraries of CBIs based on various structural scaffolds acquired by either directed design or high-throughput screening approaches. The structure-activity relationship of these compounds is explored through both "in vitro" and cell-based assays of ER action. Chapter 4 carries these studies further and examines the most potent compounds from Chapter 3 in more complete biological systems. These experiments provide information regarding CBI activity in a more complete model of breast cancer. The compounds are also evaluated on other nuclear hormone receptors and, most thoroughly, on the androgen receptor, the one nuclear hormone receptor known to bind coactivators through an interaction sequence comprising larger, hydrophobic amino acid side chains. Due to known difficulties with interrupting protein-protein interactions with small molecules, we attempted to tether both CBIs and ER ligands to a recruiting element that would bind a cellular chaperone protein that might provide a greater steric force more effective in preventing coactivator binding. These results will be discussed in Chapter 5. Finally, the determination of the ER status of a tumor is invaluable in choosing most effective treatment for a breast cancer patient. In Chapter 6 we study the protein product of a highly estrogen-regulated gene, carbonic anhydrase XII and examine the potential for this enzyme to act as an endogenous reporter of estrogen receptor action using imageable inhibitors of this protein. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Cancer is now the second leading cause of death for Americans, behind heart disease. By current estimates, up to two thirds of cancer diagnoses could be avoided or prevented with behavior changes such as the adoption of healthier lifestyles. One way that individuals learn about cancer is through the news media. Of all of the sources of health information available to consumers, news media rank among the most accessible and trusted sources; however, little is known about how cancer-related messages in the news media can affect consumers. Most studies focus on aggregate trends or other sources of health information instead of the news media. At the same time, self- and response-efficacy are two widely used variables in health research. Perceptions of self-efficacy relate to an individual's knowledge of how to perform a health behavior (e.g., a skin cancer self-exam) and his or her degree of confidence in performing that behavior. Perceptions of response efficacy relate to the extent to which an individual believes performing the behavior can prevent or mitigate some undesired health outcome (e.g., dying from skin cancer). This experiment looks at how messages about self-efficacy and response efficacy influence individuals' attitudes toward the behavior and behavioral intention, two key predictors of behavioral performance. In this study, six news stories about cancer were manipulated to contain both types of efficacy messages, self-efficacy messages only, response efficacy messages only, or no efficacy messages, for a total of 24 news stories. In a between-subjects, multiple-message design, participants were randomly assigned to read one of the 24 news stories and report the attitudes toward the behavior, behavioral intentions, perceived susceptibility, perceived severity, cancer anxiety, perceived self-efficacy, perceived response efficacy, and demographic descriptors. Results revealed few significant relationships; efficacy messages had little effect on participant attitudes or behavioral intentions, except in certain situations. The conditions where both types of efficacy messages were present had more of an impact on attitudes toward the behavior compared to conditions where no efficacy messages were present, but the same effect did not emerge for behavioral intentions. No mediating influences of perceived self-efficacy, perceived response efficacy, perceived susceptibility, perceived severity, or cancer anxiety emerged. Individuals with higher levels of perceived susceptibility reported stronger behavioral intentions to perform the behavior, but this was unrelated to efficacy message condition. Reasons for the lack of significant results and ethical considerations of this research are explored. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Interaction of estrogen receptor [alpha] (ER[alpha]) with 17[beta]-estradiol (E[subscript 2]) facilitates binding of the receptor to estrogen response elements (EREs) in target genes, which in turn leads to recruitment of coregulatory proteins. To better understand how estrogen-responsive genes are regulated, our laboratory identified a number of proteins that associate with the DNA-bound ER[alpha]. Our studies demonstrate that the nonmetastatic protein 23 homolog 1 (NM23-H1) interacts with ER[alpha], increases ER[alpha]-ERE complex formation, influences ER[alpha]-mediated transcription and associates with the promoter region of the endogenous estrogen-responsive progesterone receptor (PR) gene. Furthermore, we show that a second protein, Apurinic/apyrimidinic endonuclease 1 or redox factor-1 (Ape1/Ref-1), interacts with ER[alpha], promotes the ER[alpha]-ERE interaction, influences ER[alpha]-mediated transactivation, and selectively associates with endogenous, estrogen-responsive genes in MCF-7 cells. Our findings suggest that NM23-H1 and Ape1/Ref-1 are instrumental in modulating expression of estrogen-responsive genes. Interestingly, we demonstrate that Ape1/Ref-1 and NM23-H1, as well as the oxidative stress proteins Cu/Zn superoxide dismutase (SOD1), thioredoxin (Trx) and protein disulfide isomerase (PDI) are overexpressed in human breast cancer tissues. These studies provide a novel link between DNA repair, redox regulation and modulation of ER[alpha]-mediated transcription. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Cervical cancer is a diagnosis that has a profound psychosocial impact, constituting a physical and emotional crisis for patients as well as family. In general, research indicates that the choice of treatment and the stage of the disease are instrumental in determining the psychosocial adjustment. Disruptions are likely to occur in self-esteem, sexuality, intimacy, and communication. The complexities of both the disease and the treatment of cancer make research design a difficult task. While a few researchers have been able to define and operationalize important factors, the research in general is lacking in well controlled studies. Variables such as age of the patient, stage of the disease, pre- and post-treatment functioning, and the treatment approach are important components that affect the rehabilitation process. All of these areas need better control and further assessment in future studies. In regard to rehabilitation, strategies need to address the patient as well as her partner. The psychosocial intervention should include a strategy that considers emotional needs and conveys accurate information and education about diagnosis, treatment, and rehabilitation. While intervention is necessary at the early stages of treatment, it is essential that it continue in order to address long-term adjustment issues frequently found with cancer patients. (LLL)

Malignant pleural mesothelioma (MPM) is a lethal cancer causally associated with asbestos exposure. MPM carries a dismal prognosis and few effective treatment options currently exist. Immune checkpoint blockade (ICB) immunotherapies have repeatedly demonstrated efficacy in clinical trials for MPM since 2017 and have received regulatory approval in many industrialised countries since 2020. Despite its efficacy, the mechanisms behind these ICB responses remain unknown, partially because many canonical pan-cancer biomarkers are less reliable in MPM, but also due to a scarcity of translational data. This project therefore aimed to characterise MPM's complex tumour immune microenvironment and elucidate mechanisms of response and resistance to ICB, focussing on tumour-associated macrophages (TAMs) and cytotoxic T lymphocytes (CTLs). Bioinformatic deconvolution algorithms, a syngeneic mouse model and multiplex fluorescent immunohistochemistry were used to quantify these key leukocytes and evaluate their clinical impact. Deconvolution-defined TAMs were associated with poor clinical outcomes and lower CTL infiltration, though inter-algorithm discrepancies emerged. Murine mesotheliomas were dominated by myeloid cells, particularly macrophages, while anti-tumour lymphocytes were scarce, indicating failure to recapitulate the complex microenvironment of human MPM, which discouraged ICB experiments. However, multiplex staining of biopsies obtained before nivolumab administration revealed several differentiators of clinical response, including high CTL density within programmed death ligand 1 (PD-L1)+ tumours and tertiary lymphoid structures (TLS), especially mature TLS with distinctively zoned secondary follicles. TLSs also epitomised a 'hot' microenvironment, existing primarily in tumours with substantial anti-tumour infiltrates of B lymphocytes and naïve T lymphocytes. These latter findings shed light on mechanisms of ICB response in MPM in agreement with evidence from lung cancer and melanoma, further suggesting actionable candidate biomarkers for future patient stratification. Being the first histopathological data from ICB-treated MPM, and the first data implicating TLS in MPM drug response, these results should be validated in future patient cohorts and could be refined further when supplemented with connected 'omics data.

Precursor B-cell acute lymphoblastic leukaemia (pre-B ALL) is a haematological malignancy characterised by immature proliferation of B-cell lineage blasts. Current standard of care treatment for pre-B ALL involves multi-drug regimens of chemotherapy agents which despite high curative rates are often poorly tolerated by patients, inducing off-target side effects. To address this unmet clinical need, this project has identified for the first time a novel anticancer agent comprised of three phospholipase A2 (PLA2) enzymes. The compound, denominated PA-PLA2, was purified from Pseudechis australis snake venom using Reverse-Phase High Performance Liquid Chromatography, and validated by matrix assisted laser desorption ionisation-time of flight mass spectrometry and sequencing. Using a combination of cell-based functional assays and flow cytometry, PA-PLA2 was identified to induce caspase-independent necrotic cell death in two pre-B ALL cell lines representative of paediatric (Reh) and adult (SD-1) disease. Employing RNA-sequencing, protein- and phospho-proteomics analysis with time course Western blotting, elucidated PA-PLA2's mechanism of action to be RIPK1 and Akt dependent, inducing necroptosis in Reh cells and stunted cell cycle progression via Akt/p27Kip1 signalling in SD-1 cells. Importantly, PA-PLA2 treatment had minimal effects on the cell viability of a range of normal, peripheral blood and bone marrow-derived stem cells obtained from patient samples, with assays in donor citrated whole blood samples demonstrating PA-PLA2 to be non-haemolytic. Finally, by using a custom panel of 48 compounds, PA-PLA2 was identified to act synergistically in combination with the pre-B ALL induction phase chemotherapy agents, Cytarabine and Idarubicin. Collectively, the findings from this project support the future use of snake venom toxins in pre-B ALL treatment. The identification, validation and characterisation of PA-PLA2 represents a platform for future investigations using animal venoms as natural sources for therapeutic agents, with further clinical investigation in more clinically relevant models needed to translate this thesis' findings.

Neuroblastoma (NB) is a deadly childhood cancer that has an orphan disease status, and the most malignant forms of the tumours have MYCN amplification. There is significant unmet medical need and urgency to develop new treatments for high-risk NB patients, as clinical research on rare diseases of children is very challenging. We revealed that higher PRMT5, MYCN, and E2F1 levels are poor prognostic factors in NB according to their Kaplan-Meier survival plots and then we hypothesized that PRMT5-E2F1-MYCN pathway might have potential prognostic value in NB. We characterized NB cell lines in terms of sensitivity to the PRMT5 inhibition by using genomic and transcriptomic assays in order to gain better insight into the underlying molecular mechanism of sensitivity to PRMT5 inhibition. We used T1-44 compound to inhibit PRMT5 biochemically. We found that MYCN amplified NB cancer cells were significantly more sensitive to the PRMT5 inhibition (p < 0.0062) and T1-44 treatment induced higher number of differentially expressed and alternatively spliced events in the high E2F1/MYCN expressing cell line when compared with the low E2F1/MYCN expressing cell line. We characterized differentially spliced apoptotic genes upon 200 nM treatment with T1-44 for 72 hours as these genes might have a functional impact on cell fate, we found that T1-44 induced differential splicing of apoptosis genes BCL2L11 and CDK10 in MYCN amplified compared with non-MYCN amplified NB cells. Our results highlight the role of the PRMT5, E2F1, and MYCN axis in the alternative splicing pathway and its clinical relevance in MYCN amplified NB patients. MYCN amplification is observed in many other cancer types beyond NB. Therefore, we believe that our findings will also contribute to the targeted therapy efforts in other cancer types as well.