Doctor of Nursing Practice , Case Western Reserve University, 2017, School of Nursing

Background: Asthma is a serious public health concern for children. Prevalence rates are at epidemic proportions in minority pediatric populations with alarming disparate rates for emergency department visits and hospitalizations. School based asthma education is a viable intervention to address barriers to asthma control and improve self management skills. Steeped in rich historical evidence, Open Airways for Schools is the leading school based asthma self management program to date. Although schools have been identified as the ideal environment to provide asthma self management education to children, there are notable and extensive barriers to effective implementation. This prevailing educational gap precludes the ability to adopt recommended school based asthma education. Purpose: The purpose of this study was to use existing data to determine the effectiveness of Open Airways for Schools in improving asthma self management and self knowledge skills in public elementary school children residing in high needs communities receiving instruction by trained nursing student Open Airways for Schools facilitators within a multi site academic practice partnership. Methodology: The creation of a multi site academic practice partnership served to address the educational gap by leveraging resources between a local asthma coalition, three baccalaureate nursing programs and several high needs public school districts on Long Island, New York. As a result of this enduring academic practice partnership, a data set of 377 existing validated pre and post-test Open Airways questionnaires was collected between September 2013 and December 2015 but never analyzed for significance. Findings: In this one group pretest/posttest design for existing data, paired t test analyses revealed statistically significant improvement for both asthma self management skills and self knowledge (p = .000). Greatest increases for asthma self management included the ability to avoid tri (open full item for complete abstract)

Committee: Deborah Lindell DNP, MSN, RN, CNE, ANEF (Committee Chair) Subjects: Education; Health Care; Health Education; Nursing; Public Health Education

Doctor of Philosophy, The Ohio State University, 2018, Nursing

Background & Purpose: In the United States, asthma affects 6.1 million children and is one of the most common causes of school absenteeism. Asthma is also a major public health issue, accounting for more than $56 billion in annual healthcare costs. Children with asthma are at higher risk of having anxiety/depression and subsequently, higher morbidity and mortality. Few intervention studies have specifically targeted children with asthma and anxiety/depressive symptoms and no scalable school-based interventions are in use. The purpose of this pilot study was to assess the feasibility and acceptability of a school-based, cognitive behavioral skills-building intervention on 8 – 12-year-old children with asthma and anxiety/depression. Methods: A one-group, pre/posttest with a 6-week follow-up post intervention was used to assess the feasibility, acceptability and preliminary effects of Creating Opportunities for Personal Empowerment (COPE) for Asthma on anxiety and depressive symptoms, asthma management self-efficacy, symptom perception, asthma illness representations, controller medication in 8 – 12-year old children with asthma and anxiety/depressive symptoms. Repeated measures ANOVA was used for variables using three time-points, while paired t-tests were used for comparisons using two time-points. Results: Thirty-two children participated in COPE for Asthma. Analyses indicated that COPE for Asthma is feasible for 8 – 12 year-old-children with asthma and anxiety. Significant reductions were found in anxiety, missed doses of the asthma controller medication, and the caregiver completed Pediatric Symptom Checklist, all with moderate to large effect sizes. Significant increases were found in Personal Beliefs, Child-Asthma Self Efficacy, Child Asthma Illness Representations, with moderate to large effect sizes. Conclusions: COPE for Asthma is highly feasible for small groups in the school setting and should be tested in a pilot randomized controlled trial to det (open full item for complete abstract)

Committee: Bernadette Melnyk PhD (Committee Chair); Kimberly Arcoleo PhD (Committee Co-Chair); Barbara Warren PhD (Committee Member); Dawn Anderson-Butcher PhD (Committee Member) Subjects: Behavioral Sciences; Health; Health Sciences; Nursing

Master of Science (MS), Wright State University, 2018, Computer Science

Asthma is a high-burden chronic inflammatory disease with prevalence in children with twice the rate compared to adults. It can be improved by continuously monitoring patients and their environment using the Internet of Things (IoT) based devices. These sensor data streams so obtained are essential to comprehend multiple factors triggering asthma symptoms. In order to support physicians in exploring causal associations and finding actionable insights, a visualization system with a scalable cloud infrastructure that can process multimodal sensor data and Patient Generated Health Data (PGHD) is necessary. In this thesis, we describe a cloud-based asthma management and visualization platform that integrates personalized PGHD from kHealth kit and outdoor environmental observations from web services. When applied to data from an individual, the tool assists in analyzing and explaining symptoms using "personalized" causes, monitor disease progression, and improve asthma management. The front-end visualization was built with Bootstrap Framework and Highcharts. Google's Firebase and Elasticsearch engine were used as back-end storage to aggregate data from various sources. Further, Node.js and Express Framework were used to develop several Representational State Transfer services useful for the visualization.

Committee: Amit Sheth Ph.D. (Advisor); Krishnaprasad Thirunarayanan Ph.D. (Committee Member); Maninder Kalra Ph.D. (Committee Member); Valerie Shalin Ph.D. (Committee Member) Subjects: Computer Science; Health

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

For African American children living in poverty in Cincinnati, access to regular healthcare can be limited. A School Based Health Center (SBHC) provides onsite comprehensive coordinated care during the school day while parents are at work. When a child receives asthma care at the SBHC; the Nurse Practitioner (NP) must send home the Child Asthma Control Test (C-ACT) with the child for the parent to complete. The C-ACT forms are often returned incomplete or not at all which is problematic since the C-ACT informs the asthma action plan and the ongoing asthma management of the child. The purpose of this project was to determine caregiver's self-reported understanding of the CACT and the preferred method of communication with the caregivers. The project took place in an inner-city school with a sample size of 68 parents whose children with asthma attended the SBHC. A self-reporting survey was sent to the parents to assess their understanding and communication practices. Twenty two surveys were returned completed. Responses indicated parents did not understand or know how to complete the C-ACT, and needed further information. Additionally, parents preferred method of communication was a paper C-ACT sent home with the child.

Committee: Kim Toole DNP, APRN, CPNP (Committee Chair) Subjects: Nursing

MA, University of Cincinnati, 2017, Arts and Sciences: Psychology

Asthma is a chronic obstructive lung disease that affects nearly 19 million adults in the United States (CDC, 2015). If not well controlled through medical intervention, asthma can result in significant rates of morbidity and mortality. One important contributor to the negative impact of asthma is the presence of psychopathology, particularly panic psychopathology (Goodwin et al., 2010; McCauley et al., 2007). In order to better understand the association between asthma and panic psychopathology, recent literature has begun examining the role of anxiety-related cognitive risk factors in asthma outcomes. This work has primarily focused on the cognitive risk factor of anxiety sensitivity (AS; fear of arousal-related sensations; McNally, 2002) and found that higher levels of anxiety sensitivity are predictive of poorer asthma outcomes (Avallone et al., 2012; McLeish et al., 2011; McLeish et al. 2016). An important next step in this area of work is to explore associations between asthma and other anxiety-related cognitive risk factors. One such factor to examine in this regard is distress tolerance (DT), defined as an individual's perceived or behavioral capacity to withstand distress related to aversive affective states (Simons & Gaher, 2005; Zvolensky et al., 2011). Indeed, low DT is associated with increased risk for anxiety disorders as well as greater AS (Keough et al., 2010). Therefore, the aim of the current study was to examine the unique predictive ability of self-reported global and behavioral distress tolerance, as well as tolerance of fear and anxiety in terms of asthma control, asthma-related quality of life and lung function among non-smoking adults with current asthma. (n = 61; 61.9% female, 54.8% African-American, Mage = 34.72, SD = 13.58). Results indicated that, after controlling for the effects of age, race, and anxiety sensitivity, greater self-reported DT significantly predicted better lung function (ß = .39, t = 2.80, p < .01), asthma control (ß = (open full item for complete abstract)

Committee: Alison McLeish Ph.D. (Committee Chair); Kristen Jastrowski Mano Ph.D. (Committee Member); Sarah Whitton Ph.D. (Committee Member) Subjects: Psychology

MS, University of Cincinnati, 2014, Medicine: Clinical and Translational Research

Background: The Asthma Predictive Index (API) and persistent wheezing phenotype have been associated with childhood asthma. Previous studies have not assessed their ability to predict objectively confirmed asthma. Objective: The aim of this study is to determine whether the API and persistent wheezing phenotype at age three can accurately predict asthma confirmed at age seven in a high risk birth cohort. Methods: Data from the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a high risk prospective birth cohort, was used. Asthma was defined as: parent-reported or physician-diagnosed asthma objectively confirmed by a change in FEV1 of = 12% post bronchodilator or a positive methacholine challenge (PC20 = 4 mg/ml); or prior treatment with daily asthma controller medication(s). The API and persistent wheezing were assessed at age three. Multivariate logistic regression was used to investigate the relationship between confirmed asthma at age seven and API and persistent wheezing at age three with adjustment for multiple covariates. Results: At age seven, 103 of 589 (17.5%) children satisfied the criteria for asthma. Confirmed asthma at age seven was significantly associated with a positive API (adjusted [a]OR=13.3; 95% CI [7.0-25.2]; p <0.01) and the persistent wheezing phenotype (aOR = 9.8 [4.9-19.5]; p <0.01) at age three. Allergic persistent wheezing was associated with a significantly higher risk of asthma (aOR = 10.4 [4.1-26.0]; p <0.01) than non-allergic persistent wheezing (aOR = 5.4 [2.04-14.06]; p <0.01). Conclusions & Clinical Relevance: At age three a positive API was associated with the highest risk of objectively confirmed asthma at age seven. These results validate the API as a clinically useful tool for predicting future asthma in school-age children.

Committee: Erin Nicole Haynes Ph.D. (Committee Chair); David Bernstein M.D. (Committee Member); Linda Levin Ph.D. (Committee Member); Patrick Ryan Ph.D. (Committee Member) Subjects: Environmental Health

MS, University of Cincinnati, 2012, Engineering and Applied Science: Electrical Engineering

The primary objective of this thesis is to develop a prototype of a smart inhaler system for use by asthma patients. Asthma is a chronic condition that mostly affects adolescents. It is a condition that requires continuous monitoring of the symptoms in order to provide an effective course of treatment. It also requires a strict adherence to medication prescribed by the physician. The smart inhaler system has been developed to provide frequent monitoring of the symptoms. Additionally the device provides a record of inhaler usage so that the physician can assess the patients level of adherence. Thus the physician is provided with usage information and patient status that is necessary to help the patients to better control the symptoms and lead a healthy normal life. The key features of the system are the capability to perform spirometry tests, a user interface to obtain information from the patient regarding his/her condition and a record of the frequency with which the inhaler is used. Apart from this, an alarm is also provided so that the patient does not forget to take their medication. All the data is stored in non-volatile memory and can be retrieved by the physician at a later date so that they may be able to provide treatment based on the test data obtained over an interval of time rather than just one set of tests that are done during a regular checkup. The smart inhaler system is comprised of a differential pressure sensor, a SD card memory and a PICDEM PIC 18 Explorer Demonstration Board that includes a PIC18F8722 microcontroller, a LCD Display, Push Buttons and a daughter board socket for the PICTailTM Daughter Board that includes the connection interface for a SD/MMC card. This thesis details the design, implementation and testing of the prototype smart inhaler system.

Committee: Fred Beyette PhD (Committee Chair); Carla Purdy PhD (Committee Member); Philip Wilsey PhD (Committee Member) Subjects: Electrical Engineering

Master of Science, The Ohio State University, 2008, Graduate School

Committee: Not Provided (Other) Subjects:

MS, University of Cincinnati, 2024, Medicine: Clinical and Translational Research

Background and Objectives: Patients with severe asthma are a small proportion of patients with asthma, but make up a substantial part of the costs, morbidity, and mortality of pediatric asthma. The use of injectable biologic medications has been shown to improve asthma symptom burden, reduce exacerbations and improve lung function in children with severe asthma in several clinical trials. However, little is known about adherence to biologic medications in pediatrics. The objective of this study is to describe adherence to biologic medications in pediatric asthma and evaluate risk factors related to adherence. The relationship of biologic therapy adherence and asthma outcomes will also be examined. Methods: A retrospective medical chart review was performed of patients with severe asthma treated at Cincinnati Children's Hospital Medical Center who had been prescribed biologic therapy. Medication administration information was extracted and the rate of adherence was calculated over the first 6 months and 12 months of therapy. Adherence was characterized by medication type, dosing frequency, demographic factors, and atopic features. The effect of biologic therapy on asthma related outcomes was analyzed using Wilcoxon signed-rank test and the relationship of adherence to asthma related outcomes was analyzed using logistic regressions. Results: Patients demonstrated 75% adherence to biologic therapies during the first 6 months of therapy (standard deviation (SD) = 25.3%) and 63% adherence over the first 12 months (SD = 29.0%) of treatment. Differences in adherence at 6 months were observed between types of biologic therapies with benralizumab having the highest rate of adherence (85.9% (SD= 17.0%) over 6 months, 79.5% (SD= 26.7%) over 12 months). There were no significant differences in adherence at 6 or 12 months based on age, sex, race, ethnicity, number of allergies, distance to the medical center from home, or eosinophil count. Asthma outcomes were (open full item for complete abstract)

Committee: Patrick Ryan Ph.D. (Committee Chair); Rachelle Ramsey Ph.D. (Committee Member); Md Monir Hossain Ph.D. (Committee Member); Theresa Guilbert (Committee Member) Subjects: Medicine

MS, University of Cincinnati, 2024, Engineering and Applied Science: Computer Science

Asthma is a widespread chronic respiratory disease which is poorly understood despite significant research efforts into its etiology. Some of the difficulty involved is due to its heterogeneous nature and the wide variety of factors involved. Developing a predictive model for asthma risk would help us to better model and predict asthma and develop better treatments and protocols for its management. Bayesian networks are a useful tool that have been use to learn relationships embedded in an observed dataset, but causality cannot be inferred from any relationships learned in this way. Bayesian networks also are sensitive to the composition of the given dataset, and relationships present in only subsets of the data may not be identified. We propose a methodology that integrates structural equation modeling with Bayesian networks to facilitate the development of predictive models of asthma to incorporate causal information based on domain knowledge. We also utilize clustering to identify and model unique subsets of the population with potentially unique relationships of various factors relevant towards asthma. We have applied this approach with NHANES data to model the risk of asthma in subpopulations of residents of the United States. We have also validated several steps in our methodology to demonstrate its effectiveness for developing predictive models for asthma risk in specific subpopulations. We believe that this methodology can be extended to many real world complex processes with heterogeneous phenotypes to create robust models and find new insights.

Committee: Tesfaye Mersha Ph.D. (Committee Chair); Vikram Ravindra Ph.D. (Committee Member); Raj Bhatnagar Ph.D. (Committee Member) Subjects: Computer Science

PhD, University of Cincinnati, 2024, Medicine: Neuroscience/Medical Science Scholars Interdisciplinary

Posttraumatic Stress Disorder (PTSD) is a highly prevalent psychiatric disorder. Inflammation, and specifically severe asthma, has been implicated in PTSD through genetic and epidemiological studies, though few studies have explored mechanisms. Previous studies in our lab have noted deficits in extinction, a PTSD-relevant fear behavior, in a severe, but not mild/moderate model of allergic airway inflammation induced by aeroallergen house dust mite (HDM) that had been accompanied by an increase in brain Interleukin 17 A (IL-17A)+ cells. T helper 17 (Th17)/IL-17A immune responses are regulators of severe, neutrophilic airway inflammation, suggesting it may be responsible for observed severity-dependent extinction deficits. However, we had yet to demonstrate the mechanistic role of Th17/IL-17A. In this dissertation, we utilized a model of mild/moderate and severe asthma to assess differences in extinction, a PTSD-relevant behavior, and explore the dependence of this effect on Th17/IL-17A. Additionally, we pursued the role of a novel immunosensory node, the subfornical organ (SFO) as a mediator of lung-to-brain communication. It is uniquely positioned to respond to peripheral immune insults as it has a “leaky”, fenestrated blood-brain barrier (BBB) and contains a variety of cell types (microglia, astrocytes, neurons, pericytes, endothelial cells, etc.). Thus, the SFO serves as a unique window connecting the periphery, the central nervous system, and an extinction regulatory brain region, the infralimbic cortex. We hypothesized that HDM-induced Th2/Th17 airway inflammation selectively impairs extinction via SFO-engaged mechanisms. Chapter 2 pursued the hypothesis that extinction deficits are associated with an HDM-induced Th2/Th17- phenotype, representing severe airway inflammation, but not a Th2-skewed response, representing mild/moderate and that these deficits were driven by IL-17A signaling. To achieve this, we utilized a model of severe airway inflammation in (open full item for complete abstract)

Committee: Eric Wohleb Ph.D. (Committee Chair); James Herman Ph.D. (Committee Member); Renu Sah Ph.D. (Committee Member); Teresa Reyes Ph.D. (Committee Member); Ian Lewkowich Ph.D. (Committee Member) Subjects: Neurosciences

Master of Sciences, Case Western Reserve University, 0, Systems Biology and Bioinformatics

This study aimed to investigate the impact of beta blockers on cardiovascular patients with asthma. We hypothesized that beta blockers, especially non-selective ones, might pose greater health risks. After matching controls and treatment groups from the Cleveland Clinic Foundation (2010-2018) and the National Health and Nutrition Examination Survey (1999-2018) data, our analysis revealed that beta blockers were associated with a reduction in the number of glucocorticoid bursts (OR 0.776, 95% CI [0.733-0.822]), fewer asthma exacerbations (OR 0.796, 95% CI [0.648-0.978]), and less frequent ER visits (OR 0.425, 95% CI [0.298-0.607]). The non-selective ones alone did not yield statistically significant results. However, cardio-selective ones were associated with even fewer health risks, with odds ratios of 0.761 for glucocorticoid bursts, 0.766 for asthma exacerbation and 0.283 for ER visits. Therefore, it is suggested that beta blockers, particularly cardio-selective ones, could be more widely used in patients with both cardiovascular disease and asthma.

Committee: Gurkan Bebek (Advisor); Scott Williams (Committee Member); Rosanna Watowicz (Committee Member); Joe Zein (Committee Member) Subjects: Bioinformatics; Biomedical Research; Medicine

PhD, University of Cincinnati, 2023, Medicine: Immunology

Asthma has been on the rise globally for decades, but the underlying causes are still unclear. The rapidity of the rise in asthma argues against a solely genetic etiology. Instead, changes in our surrounding environment alter our daily exposures, altering our gut microbiota, also known as dysbiosis. A well-established risk factor for asthma, dysbiosis is a side effect of many asthma risk factors; air pollution, diet, cesarean birth, farm upbringing. The mechanisms underlying dysbiosis driven asthma development however are not well understood, particularly in the context of severe asthma. Despite studies observing distinct gut microbiota between non-asthmatic and mild/moderate asthmatics, very little work has been done to understand the dysbiosis mechanisms underlying the development of severe asthma. In this dissertation, we have developed a model of a transient early neonatal dysbiosis that delays the progression of gut microbial maturation, which we have termed “delayed microbial maturation” or DMM. We demonstrate that DMM mice sensitized to house dust mite (HDM) allergen develop a more severe form of asthma with increased airway hyperresponsiveness (AHR), as well as a more pronounced frequency of Th17 cells, phenotypes consistent with the presentation of severe asthma patients. These effects were durable, manifesting whether allergen sensitization occurred during or following resolution of the dysbiotic period, suggesting epigenetic factors may underlie DMM aggravation of allergic asthma development. Interestingly, while the lung epithelial response is usually considered the primary driver in asthma pathogenesis, we found evidence suggesting the effects of IL-17 were most pronounced in the mesenchymal compartment of the lung. Thus, these data provide novel insight into a previously observed, but mechanistically undefined, connection between dysbiosis and severe asthma. From these studies exploring DMM and allergic asthma it was observed that even in (open full item for complete abstract)

Committee: Ian Lewkowich Ph.D. (Committee Member); Satish Madala Ph.D. (Committee Member); William Zacharias M.D. Ph.D. (Committee Member); Sing Sing Way M.D. Ph.D. (Committee Member); Joseph Qualls Ph.D. (Committee Member) Subjects: Immunology

Doctor of Philosophy (PhD), University of Toledo, 2023, Biomedical Sciences (Medical Microbiology and Immunology)

Harmful algal blooms are on the rise globally and pose serious health concerns due to the release of cyanotoxins, which are harmful to humans and the environment. Microcystin-LR (MC-LR) is one of the most frequently produced cyanotoxins and has recently been detected in aerosols generated by the normal motions of affected bodies of water. However, the human pulmonary health effects of MC-LR aerosols remain largely unknown. It has been previously observed that MC-LR exposure has a pro-inflammatory influence on the airways of mice, however this has yet to be observed in the context of aerosol exposure. Additionally, it is unknown whether this is a concern for human airways as the potential inflammation and associated downstream effects have yet to be thoroughly characterized. Therefore, we set out to address these knowledge gaps. Herein we describe MC-LR mediated pro-inflammatory signaling in a 3D model of primary human airway epithelium. We further characterize this inflammation utilizing inherent biological variation in a strain and sex comparison of a murine model of MC-LR aerosol inhalation. Here, we found an upregulation of type 1 and type 17 immunity characterized by neutrophilic inflammation. Next, we addressed the potential risk for patients with the pre-existing airway inflammatory disease, neutrophilic asthma. Using both an in vitro and in vivo model, we demonstrate that asthma-related pro-inflammatory signaling was further upregulated after MC-LR exposure. Finally, we propose a novel mechanistic explanation for the pro-inflammatory responses which involves the amplification of NF-κB activity through the inhibition of protein phosphatase 1 (PP1) and 2A (PP2A).

Committee: Steven Haller (Committee Chair); David Kennedy (Committee Co-Chair); Nikolai Modyanov (Committee Member); James Willey (Committee Member); Mark Wooten (Committee Member) Subjects: Biomedical Research; Immunology; Toxicology

Doctor of Philosophy, The Ohio State University, 2022, Environmental Science

We spend 90% of our time indoors where we are exposed to diverse microbial communities which can have profound effects on human health outcomes. Advances in DNA-based technologies offer greater ability to quantitatively measure indoor fungal communities and more accurately assess the influence of environmental conditions on fungal communities as well as the influence of fungal exposures on health. Trends are emerging in our understanding of pathways between built environments, indoor microbiomes, and ultimately human health, but much remains uncertain. Fungal diversity is consistently and inversely associated with development of asthma and allergic disease. Further, seasonal variation in asthma and allergy is well established. So too is the relationship between asthma development and sensitization to select allergenic fungi. However, the influence of fungal exposures—including diversity, total fungal concentration, and select fungal taxa—on measures of asthma morbidity is still not well understood. The influence of season and other indoor environmental conditions or occupant behaviors in shaping these measures of fungal exposure is also understudied. The goal of this work is to investigate novel associations between measures of childhood asthma morbidity and fungal exposures, and to examine the effect of comprehensive occupant behaviors and indoor environmental characteristics—including conditions mediated by season—on indoor fungal communities. Bedroom floor dust samples were collected from two cohorts: the New York City Neighborhood Asthma and Allergy Study (NAAS) and the Columbia Children's Center Environmental Health (CCCEH) birth cohort. DNA extracted from floor dust samples was analyzed using quantitative polymerase chain reaction and next-generation sequencing in order to obtain total fungal concentration, fungal diversity metrics, and concentration of individual fungal taxa. Fungal diversity was significantly and inversely associated with asthma symptom freq (open full item for complete abstract)

Committee: Karen Dannemiller PhD (Advisor); Jeffrey Bielicki PhD (Committee Member); Jiyoung Lee PhD (Committee Member); Virginia Rich PhD (Committee Member); Matthew Perzanowski PhD (Committee Member) Subjects: Environmental Health; Microbiology

PhD, University of Cincinnati, 2022, Medicine: Epidemiology (Environmental Health)

Background: While the link between allergens and asthma has been studied extensively, less is known about the mechanisms by which indoor allergen (IA) exposure predisposes children to asthma and wheezing phenotypes. The relation between indoor allergens, DNA methylation, asthma, and wheezing phenotypes were examined in a well-established birth cohort: the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS). Objectives: To assess the relationship between indoor allergen exposure during early childhood (age 1) and DNA methylation at age 12. To identify DNA methylation profiles associated with asthma and wheezing phenotypes. To evaluate whether DNA methylation mediates the association between IA exposure and asthma, persistent asthma, or wheezing phenotypes. Methods: Indoor allergens (Alternaria, cat, dog, house dust mite, and cockroach allergens) and 36 species of mold of the environmental relative moldiness index (ERMI) were collected from house dust samples and quantified at age 1. Asthma and wheezing were assessed at 12 years; persistent asthma was defined as having asthma symptoms at age 12 and a prior diagnosis of asthma at age 7. DNA methylation was measured from whole blood collected at age 12 and quantified using the Infinium Methylation EPIC (850k) BeadChip microarray. An epigenome-wide association study was performed to detect differentially methylated CpGs (DMCs) and regions (DMRs) associated with IAs exposure and ERMI and then interrogated whether the DMCs were associated with asthma, persistent asthma, and wheezing phenotypes at age 12 years. Robust linear regression models were used to estimate the associations between IA exposure and DNA methylation. Baron and Kenny's steps were used to detect whether specific DMCs act as mediators influencing the relationship between IA exposure or ERMI with asthma, its persistence, and wheezing phenotypes. Results: From 262 CCAAPS children, 15 DMCs and 3 DMRs were associated with exposure to three o (open full item for complete abstract)

Committee: Kelly Brunst Ph.D. (Committee Member); Patrick Ryan Ph.D. (Committee Member); Tiina Reponen Ph.D. (Committee Member); Liang Niu Ph.D. (Committee Member) Subjects: Epidemiology

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2022, Nursing

This pilot project aimed to evaluate if interventions in the pediatric asthma patient (age 4-11 years) could reduce acute asthma exacerbations by providing education and alerts for early awareness of poor air quality to caregivers. The project intended to aid in evaluating incidences when the air quality index (AQI) was greater than 101 concerning outcomes of participant response, communication, and education outreach. There were four study aims to assess baseline knowledge, to provide educational materials, to send out notifications when air quality was poor (AQI>101), and to assess the impact via a post-project survey. Project results revealed that most of the participants (75%) had either “not heard of” or were “unsure if they had previously heard of” the AQI. Half of the participants (50%) were “unsure” or “not aware” that air quality could impact asthma status. The post-project survey revealed that 66% felt that knowledge obtained would alter future actions regarding air quality. The survey data and the open-ended replies demonstrate that this project provides an opportunity to help participants better understand the Air Quality Index (AQI) and how to use that knowledge to understand that reducing exposure to air pollutants promotes improved control of asthma symptoms.

Committee: Elizabeth Bragg Ph.D., RN (Advisor) Subjects: Environmental Health; Nursing

Doctor of Philosophy, University of Akron, 2022, Chemistry

Methanotrophic bacteria absorb methane and oxidize it as their sole source of carbon and energy. Almost all methanotrophic bacteria contain an extensive network of Intracytoplasmic membrane (ICM). The ICMs contain particulate methane monooxygenase (pMMO), which is the initial enzyme in the metabolism of methane. Due to the accumulation of high lipid content in the form of ICM and the formation of polyhydroxybutyrate (PHB), there is a growing interest in utilizing these bacteria to convert the ICM and PHB to biofuel. Structural aspects of the ICM have been characterized by transmission electron microscopy. However, the dynamics and functional role of ICMs remain elusive. A rapid fluorescence microscopy method to visualize ICMs in situ using lipophilic dyes was developed in Chapter III. The extent to which ICM formation occurs in cells depends on the concentration of copper. The ICM formation was visualized and quantified in type I methanotroph Methylotuvimicrobium alcaliphilum (comb. Nov. 20Z) by tracking the bulk copper conversion spectroscopically and by live single-cell confocal imaging. Both methods showed a lag phase prior to the increase in ICM amounts over time. During the ICM formation, there was a significant amount of cell to cell heterogeneity. Further, rapid in-vivo quantification of the PHB method was developed to determine the conditions that enhance the PHB accumulation in methanotrophs. A rapid and cost-effective single cell PHB analysis through fluorescence microscopy by staining via Nile Blue A (NBA) in type II methanotroph Methylocystis sp. Rockwell was described in Chapter IV. NBA stained both the outer membrane of the cell and individual granules of PHB, distinctly but not the ICMs. The ICMs in Methylocystis. sp. Rockwell resides peripheral to the inner membrane whereas PHB is present in the cytoplasmic region. Methylocystis sp. Rockwell accumulated PHB when grown in ammonium mineral slats (AMS) medium, regardless of nitrogen or carbon stress. PH (open full item for complete abstract)

Committee: Adam Smith (Advisor); Sailaja Paruchuri (Committee Member); Nic Leipzig (Committee Member); Chrys Wesdemiotis (Committee Member); Yi Pang (Committee Member) Subjects: Biology; Chemistry

Master of Arts, Case Western Reserve University, 2022, Psychology

Pediatric atopy, or the susceptibility to develop atopic diseases such as eczema, allergies, and asthma, is associated with developmental vulnerability, occurrence of neurodevelopmental disorders, and parent stress. Children with atopic diseases often exhibit developmental concerns related to hyperactivity, inattention, emotion dysregulation, and executive functioning. Parents of children with atopic illness often experience heightened stress related to symptom uncertainty and worry regarding their child's social, behavioral, and academic functioning. This study examined how developmental vulnerability and assets, parent stress, and parent coping vary as a function of child group (i.e., Atopy vs healthy controls) and the relationship between developmental vulnerability and parent stress. Results demonstrated increased total developmental risk and behavioral and emotional developmental vulnerability for children with atopy. Knowledge regarding the association between atopy and developmental vulnerability can assist pediatric primary care providers in identifying developmental risk for young patients so families can access necessary early intervention services.

Committee: Elizabeth Short (Committee Chair); Rita Obeid (Committee Member); Sarah Hope Lincoln (Committee Member) Subjects: Behaviorial Sciences; Developmental Psychology; Early Childhood Education; Health; Psychology

Doctor of Philosophy, Case Western Reserve University, 2022, Nursing

Background. Asthma is the most common chronic illness of child. Younger children are at the greatest risk for increased morbidity and mortality. Caregivers of these children take on increased responsibilities compared to caregivers of children without a chronic illness, and it is known that this can increase stress and decrease quality of life. Problem. It is not known what coping strategies or psychosocial interventions are most effective at improving both child and caregiver outcomes. Previous research has focused heavily on caregiver education, and has often considered caregiver quality of life only as a means to ensure better child health outcomes. The few identified caregiver centered psychosocial interventions have had mixed results. Resourcefulness Training© has been effective at reducing stress and improving caregiver quality of life in caregivers in a variety of contexts. It is not currently known if increasing resourcefulness would decrease stress and increase quality of life in the caregivers of children with asthma. Purpose: To understand the relationships among antecedent contextual variables, perceived stress, resourcefulness, and overall quality of life in caregivers of children with asthma in order to better understand the population and determine if there is a need for Resourcefulness Training© for caregivers of children with asthma twelve years old and younger. Methods: A cross-sectional correlational design with one group and data collection at one time point was used. A sample size of 51 participants was obtained online. Pearson correlations, bivariate regressions, and multivariate regressions were used to explore the relationships among antecedent contextual variables, perceived stress, resourcefulness, and quality of life. The study was guided by Zauszniewski's Middle Range Theory of Resourcefulness and Quality of Life©. Results: Resourcefulness was not a significant predictor of overall caregiver quality of life, and did not mediat (open full item for complete abstract)

Committee: Jaclene Zauszniewski (Committee Chair); Sandra Russ (Committee Member); Marguerite DiMarco (Committee Member); Christopher Burant (Committee Member) Subjects: Nursing