Doctor of Healthcare Administration (D.H.A.), Franklin University, 2021, Health Programs

Routine HIV testing for adults 65 years and older is imperative for prevention and treatment efforts among the vulnerable population. To date, limited research exists that examines associations between sex in HIV testing, HIV risk perception, and HIV risk among adults who are 65 years and older. Certain risk behaviors can lead to missed testing opportunities for some Medicare beneficiaries aged 65 and older, increasing the likelihood of new HIV transmissions and late-stage diagnoses. A federal mandate requires that Medicare Part B (outpatient insurance) cover annual wellness visits, which allow providers and beneficiaries to develop personalized prevention plans of care. However, Medicare does not offer routine HIV testing to beneficiaries 65 years and older, unless they specifically ask for a test (risk perception) or considered at risk (actual risk). This quantitative, cross-sectional, causal-comparative research design was guided by the health belief model (HBM) and theory of gender and power (TGP). Chi-square tests analyzed secondary data from the 2018 National Health Interview Survey, Adult Sample file regarding HIV testing, HIV risk perception and HIV risk among non-institutionalized adults, 65 years and older. The significance of statistical tests was determined at the .05 alpha level. Study findings revealed a significant association between sex and HIV testing prevalence, with men (24.3%) testing more frequently than do women (20.1%). Findings also revealed a significant association between sex and HIV risk. Men (41%), when compared to women (22%), were almost twice as likely to have at least one factor increasing HIV risk. There was no significant association between sex and HIV risk perception. Findings revealed that both men (99.6%) and women (99.6%) equally lacked HIV risk perception.

Committee: Mary Bynum DHA (Committee Chair); Cynthia Smoak DHA (Committee Member); Chenelle Jones PhD (Committee Member) Subjects: Aging; Gender Studies; Gerontology; Health; Health Care; Health Care Management; Health Education; Public Administration; Public Health; Public Health Education

Doctor of Philosophy, Case Western Reserve University, 2021, Anthropology

In an effort to combat the staggeringly high rates of opioid overdose deaths in the US, Overdose Education and Naloxone Distribution (OEND) clinics were established. This study was a collaborative partnership with a local urban hospital committed to harm reduction through their community-based OEND clinic. This study's purpose was twofold. First, to understand who utilized OEND clinics and the factors affecting their HSB (i.e. number of Naloxone kits). Second, to understand how OEND clients framed their understanding of their SUD and if their model of addiction affected HSB. The study was comprised of three distinct phases. Phase 1 Quantitative assessment examined the demographic characteristics (i.e., gender, race, education, SES, occupation), mental health concerns (i.e., anxiety, depression & general distress), breadth and satisfaction of social support, and addiction beliefs in 235 clients from a local OEND clinic in Cleveland, Ohio. Since all participants in this study were already a part the OEND clinic, the number of naloxone kits will serve as a proxy for HSB. Phase 2 Qualitative Assessment explored how 61 of the enrolled clients framed their understanding of their substance use disorder (SUD). Qualitative interviews were coded for themes related to SUD beliefs, the type of stigma experienced by clients as a function of their drug use, and their motivation behind the decisions to seek out Naloxone. Phase 3 involved informal clinic observations to understand clients' experiences and interactions with OEND clinic staff. Gaining a better understanding of patients' health-seeking behaviors (HSB) at OEND clinics is a critical first step along the road to combatting the opioid epidemic. Phase 1 data revealed that clients who chose to engage in the HSB of OEND clinic were primarily unemployed, Caucasian males who were approximately 38 years of age. They were highly anxious, depressed, and in need of more social support to assist in their recovery. The majorit (open full item for complete abstract)

Committee: Lee Hoffer (Committee Chair); Janet McGrath (Committee Member); Jill Korbin (Committee Member); Brian Gran (Committee Member) Subjects: Behavioral Sciences; Cultural Anthropology; Health; Mental Health; Public Health; Social Research

Master of Science, University of Toledo, 2016, Spatially Integrated Social Science

Goal: To determine the factors affecting patients' perceived benefits of 1) adherence packaging, 2) medication therapy management (MTM), 3) delivery, 4) automatic refill, and 5) refill synchronization. Additionally, to determine the patients perceived benefits that predict their interest in participating in a pharmacy service. Methods: This cross-sectional exploratory study used convenience sampling to survey participants over a seven-week period. Survey questions were designed through elicitation interviews. Validity (factor analysis) and reliability (Cronbach's alpha) were assessed. Linear regression and logistic regression were conducted. Results: A total of 304 surveys were collected. The majority of the participants were not aware of refill synchronization (68.4%), MTM (58.2%), and adherence packaging (77.3%). Age (p=0.018) and the number of medications (p=0.028) a participant contributed the most to how patients perceived the benefit of services. Participants who perceived adherence packaging (B=3.098), MTM (B=2.286), delivery (B=5.148), automatic refill (B=12.047), and refill synch (B=1.598) will help them feel more in control of taking their medication were more likely to participate in the service. Conclusion: In an effort to increase patient participation in pharmacy services, pharmacies need to assess patients' perceptions and cater their services to address the patients' beliefs.

Committee: Sharrel Pinto PhD (Advisor); Amit Patel PhD (Committee Member); Sadik Khuder PhD (Committee Member) Subjects: Pharmacy Sciences

Doctor of Philosophy (PhD), Ohio University, 2013, Communication Studies (Communication)

Worldwide, oral diseases (e.g., cavities, gum diseases, etc.) are major public health problems. Research has shown that individuals' beliefs and perceptions can influence behavior. Identifying individuals' beliefs and perceptions that influence oral hygiene behaviors may pave the way towards understanding these oral health and hygiene behaviors. Little is known about South Africans' oral hygiene behaviors and their cultural beliefs that surround these behaviors. Most available research on oral hygiene in developing countries relates to behaviors from the Western dental system. Thus there is a gap in data on the South African population regarding the oral health beliefs that surround both their indigenous and adopted Western behaviors. This dissertation research sought to validate the use of an Oral Health Beliefs Survey (OHBS) that assesses South Africans' oral health and hygiene beliefs within the constructs of the health belief model (HBM). Additionally, this study examines individual level variables to determine whether HBM constructs are associated with oral health and hygiene behaviors of South Africans. This exploratory study is the first step at establishing a framework for understanding current perceptions about oral health and hygiene in South Africa, as well as determining what factor(s) influence(s) the ability to practice healthier oral health behaviors. Findings from this study will be helpful in guiding future research and health communication campaigns on oral health and hygiene in South Africa. Suggestions for future researchers include taking either a structure-centered or culture-centered approach to uncover how culture shapes oral health-related beliefs and behaviors.

Committee: Benjamin Bates Ph.D. (Committee Chair); Amy Chadwick Ph.D. (Committee Co-Chair) Subjects: Communication; Health

Doctor of Philosophy, The Ohio State University, 2005, Mechanical Engineering

The dynamic behavior of a piecewise-nonlinear mechanical oscillator with parametric and external excitations is investigated. The viscously damped oscillator is subjected to a periodically time-varying, piecewise nonlinear restoring function. Typical applications represented by this oscillator are highlighted. A multi-term harmonic balance formulation is used in conjunction with discrete Fourier transforms and a parametric continuation scheme to determine steady-state motions of the system due to both parametric and external excitations. The accuracy of the analytical solutions is demonstrated by comparing them to direct numerical integration solutions and available experimental data for a special case. Floquet theory is applied to determine the stability of the steady-state harmonic balance solutions. This solution method is first applied on a single-degree-of-freedom piecewise nonlinear time-varying system to find steady state period-1 and period- ( >1) motions. The system is characterized by a symmetric restoring function, which consists of three segments: a clearance (dead-zone) segment and two continuously nonlinear segments defined by a linear component, a quadratic term and a cubic term. Detailed parametric studies are presented to quantify the combined influence of clearance, quadratic and cubic nonlinearities within reasonable ranges of all other system parameters. A comparison between time-varying and time-invariant systems is also provided to demonstrate the influence of the parametric and external excitations on a piecewise nonlinear system. As a specific application, an elastic sphere-plane interface is studied by using this solution method. The dynamic model of the sphere-plane system includes both a continuous nonlinearity associated with the Hertzian contact and a clearance-type nonlinearity due to contact loss. The accuracy of the dynamic model and solution method is demonstrated through comparisons with experimental data and numerical solutions. A (open full item for complete abstract)

Committee: Ahmet Kahraman (Advisor) Subjects: Engineering, Mechanical

Doctor of Philosophy, Case Western Reserve University, 2006, Genetics

Low-density-lipoprotein receptor related protein 5 (LRP5) is a single pass transmembrane receptor that belongs to LDL receptor super-family. One function of LRP5 is to bind to a family of secreted glycoproteins (Wnt ligands) and transduce Wnt signaling. Mutations in LRP5 cause the autosomal recessive Osteoporosis-Pseudoglioma syndrome (OPPG), which is characterized by skeletal fragility due to markedly reduced bone mineral density and by congenital or childhood-onset of blindness. Additional mutations in LRP5 result in autosomal dominant high bone mass (HBM) diseases that are characterized by increased bone mineral density and a reduced incidence of skeletal fracture. This work describes in vitro biochemical studies that delineate the mechanism by which mutations cause HBM (chapter 2), the clinical and molecular features of OPPG (chapter 3), and in vivo studies of Lrp5 knock-out mice to understand the roles of the receptor in osteoblast function and their response to mechanical stress (chapter 4). Since LRP5 protein plays an important role in maintaining healthy bone mineral content, the findings presented in this thesis advanced our understanding of the mechanisms of several rare skeletal diseases, and provided new insights into common skeletal disorders, such as osteoporosis.

Committee: Matthew Warman (Advisor) Subjects: Biology, Genetics