BS, Kent State University, 2014, College of Nursing

There has been a dramatic increase in obesity in children globally. The World Health Organization (WHO) has estimates (as cited in Gaffney, Kitsantas, Brito, & Kastello, 2014) that over forty-million children under the age of five years old are overweight or obese. Not only is it affecting adults, it is also a growing concern for children as well. Trends have shown that obesity is increasing with no hint of slowing down. Nutrition and lifestyle are the key factors affecting obesity. What if a parent is unaware of how much a child should be eating or what they should be eating? Without this knowledge, children could be overfed or fed an unhealthy diet. Family education regarding proper pediatric nutrition is lacking in inner-city communities and communities with high poverty rates, which can be evidenced by the climbing rate of obesity in children within these areas. A child can be taught the difference between healthy and unhealthy foods, but needs the support of their caretakers to prepare and organize meals to help avoid becoming over weight. The objective of this project is to develop an easy-to-use guide about healthy pediatric nutrition from infancy through adolescence for family education purposes. This guide has been designed in simplistic terms in order to be used by families with limited knowledge of key guidelines to healthy pediatric nutrition through examples and factual information and focuses on the major points of infant, toddler, preschool, school-age, and adolescent nutrition through examples and facts.

Doctor of Philosophy in Engineering, Cleveland State University, 2024, Washkewicz College of Engineering

Leveraging electronic health record data requires sophisticated methods that can optimally process this information to improve clinical decision-making. Artificial Intelligence (AI) promises to process healthcare data faster, for lower costs, and more accurately than conventional processes. Deep learning applied to longitudinal electronic health records (EHR) holds promise for disease prediction, but a systematic methods comparison has yet to be reported. Despite the promises of this technology, challenges remain in the current approaches to predicting a disease. There remains an unmet need for developing a gold-standard disease prediction framework for EHR data that can be reliably applied across many diseases. This research proposes a generalized deep learning approach that is amenable to predicting a vast number of diseases by integrating multiple streams of longitudinal clinical data and genomic features to maximize the predictive power over a broad spectrum of diseases. I provide empirical validation of the proposed solution using data from multiple datasets; including comprehensive simulated datasets and a real-world EHR datasets. The ultimate goal of this research is to develop a generalized deep learning approach that is amenable to predicting a vast number of diseases using longitudinal clinical data from the EHR.

MA, University of Cincinnati, 2024, Arts and Sciences: Psychology

Chronic pain can disrupt adolescents' attention. Such interruptions, in turn, may negatively impact one's overall functioning, causing frustration and distress when trying to engage in important tasks (e.g., schoolwork). This experience has been referred to as cognitive intrusion of pain (Attridge et al., 2015). To date, only one adult self-report measure of cognitive intrusion of pain exists: the Experience of Cognitive Intrusion of Pain Scale (ECIP). This is a critical gap in the literature, as there is currently no known measure of experienced cognitive intrusion of pain for pediatric chronic pain patients. The current study examined the psychometric properties of an adapted version of the ECIP (ECIP-A) among children and adolescents (ages 11-18) with pediatric chronic pain. Data were collected from pediatric chronic pain patients (N = 194) presenting for treatment at a tertiary pain clinic at a large Midwestern children's hospital. Exploratory analyses were conducted for deeper understanding of the current sample, as this is the first study to assess the ECIP-A in pediatric patients with chronic pain. The current sample consisted of 81.9% self-identified as Non-Hispanic White and 77.5% female chronic pain patients. There were no significant differences in ECIP-A scores between males and females, across patient age, or across primary pain condition. ECIP-A scores and Pain Frequency-Severity-Duration composite scores were significantly correlated, indicating that as pain symptoms increase, so does cognitive intrusion of pain (r = 0.23, p = 0.002). Confirmatory factor analysis (CFA) results supported a one-factor model for the ECIP-A, with excellent model fit (?2 = 30.24, df = 23, p = 0.14; CFI = 0.99, TLI = 0.99, RMSEA = .042 (90% CI 0.00 - 0.078), and SRMR = 0.021). Results suggest excellent internal consistency of ECIP-A scores (Cronbach's alpha = 0.94). Pearson correlations indicated good convergent and discriminant validity, as the ECIP-A was moderately and p (open full item for complete abstract)

DNP, Walsh University, 2023, Nursing

Nurses that care for pediatric patients with behavioral disorders and aggression in a non-psychiatric setting face unique challenges. Pediatric nurses are usually not trained to care for children with aggression and behavioral outbursts, which result in high rates of burnout. Providing formal trauma-informed patient care education and training to pediatric nurses can improve their confidence and the quality of care in managing patient aggression. The purposes of this study were to a.) examine if Welle behavioral-management training is effective in improving pediatric nurse confidence in the management of pediatric aggression in a non-psychiatric setting and b.) examine the relationship between demographic characteristics and nurse confidence. A convenience sample of 13 registered nurses employed on the pediatric medical-surgical unit who received the Welle training educational intervention were recruited to participate in this study. A one-group pretest post-test study design was used to assess registered nurses' level of confidence in managing pediatric patients with aggression before and after the Welle training. To measure nurse confidence in the management of pediatric aggression, The Incidence of and Attitudes Toward Aggression in the Workplace questionnaire was administered before and up to two weeks after the Welle training. Results indicate that the Welle training was effective in improving nursing confidence scores in the management of patients with aggression. Findings from this study provide information on how training and education can improve nurse confidence scores in the management of pediatric aggression. These findings can be useful when designing nursing orientation programs and standardizing aggression management education across health systems.

MS, University of Cincinnati, 2023, Medicine: Clinical and Translational Research

Patients with heterotaxy syndrome and congenital heart disease (CHD) experience inferior cardiac surgical outcomes. Heart transplantation outcomes are understudied, however, particularly compared to non-CHD patients. Data from the United Network for Organ Sharing and Pediatric Health Information Service databases were used to identify 4,803 children (<18 years) undergoing first-time heart transplant between 2003-2022 with diagnoses of heterotaxy (n=278), other-CHD (n=2,236), and non-CHD cardiomyopathy (n=2,289). Heterotaxy patients were older (median = 5 yr) and heavier (median = 17 kg) at transplant than other-CHD (median = 2 yr and 12 kg), and younger and lighter than cardiomyopathy (median = 7 yr and 24 kg) (all p<0.001). UNOS status 1A/1 at listing was not different between groups (65-67%; p=0.68). At transplant, heterotaxy and other-CHD patients had similar rates of renal dysfunction (12% and 17%), inotropes (10% and 11%), and ventilator-dependence (19 and 18%). Compared to cardiomyopathy, heterotaxy patients had comparable renal dysfunction (9%, p=0.06) and inotropes (46%, p=0.10) but more hepatic dysfunction (17%, p<0.001) and ventilator-dependence (12%, p=0.003). Rates of ventricular assist device (VAD) were: heterotaxy-10%, other-CHD-11% (p=0.84 vs. heterotaxy), cardiomyopathy-37% (p<0.001 vs. heterotaxy). The one-year incidence of acute rejection post-transplant was comparable between heterotaxy and others (vs. other-CHD, p=0.69; vs. non-CHD, p=0.08). While overall post-transplant survival was significantly worse for heterotaxy than others (vs. other-CHD, p=0.03; vs. non-CHD, p<0.001), conditional one-year survival was comparable between heterotaxy and others (vs. other-CHD, p=0.63; vs. non-CHD, p=0.35). In conclusion, children with heterotaxy syndrome experience inferior post-heart transplant survival, although early mortality appears to influence this trend, with one-year survivors having equivalent outcomes. Given similar pre-transplant clinical status (open full item for complete abstract)

PhD, University of Cincinnati, 2021, Arts and Sciences: Psychology

School anxiety is a prevalent and disabling mental health concern among children and adolescents with chronic pain, representing a principal driver of school avoidance and difficulties with academic performance. The only available measure of school anxiety—the School Anxiety Inventory (SAI)—lacks adequate content specificity for measuring school anxiety among youth with chronic pain. The purpose of this study was to inform the development of a modified version of the SAI by exploring the unique school situations that are anxiety-provoking for youth with chronic pain and characterizing the nature of symptoms experienced in these situations. Adolescents with chronic pain (n=16) completed a semi-structured qualitative interview focused on their experiences with anxiety in school-related academic and social contexts. We employed deductive and inductive approaches to thematic analysis to extend the empirical understanding of school anxiety as it is experienced by adolescents with chronic pain. We identified six key themes within the data, each of which informed the generation of a set of new items designed to capture anxiety related to negative interactions with teachers and peers, falling behind with schoolwork, and struggles with concentration and fatigue. These items were refined with feedback from adolescents with chronic pain (n=5) and a team of expert clinicians (n=3), which informed the creation of a modified version of the SAI: School Anxiety Inventory for Chronic Pain (SAI-CP). Results from this study underscore the importance of addressing anxiety early in treatment among youth with chronic pain using tailored approaches that consider their unique sources of anxiety and the symptoms experienced in these situations. Future research is needed to evaluate the psychometric properties of the SAI-CP and to improve the suitability of the measure for use in research and clinical settings.

Master of Science, The Ohio State University, 2020, Dentistry

Purpose: To investigate opioid prescription fill patterns following pediatric/adolescent dental procedures in central/southeastern Ohio. Methods: This population-based, retrospective cohort study utilized health insurance claims from a pediatric Medicaid accountable care. Patients aged ≤ 18 who had a dental procedure during 1/2012-2/2019 were identified and claims were searched to identify opioid prescription fills within 14 days post-procedure. Results: Overall, 512,922 encounters were included. The overall opioid prescription fill rate was 4.9%. Rates decreased throughout the study from 6.1% (95% CI: 5.9-6.3) in 2012 to 3.4% (3.1-3.8) in early 2019. When limited to extractions and endodontic procedures, the overall prescription fill rate fell from 15.7% (15.2-16.1) in 2012 to 9.5% (8.5-10.4) in early 2019. The most common opioids were hydrocodone (68.6%) then codeine (24.7%) with marked annual reductions in codeine prescription fills among children <14. In 2017-2018, surgical extractions (risk difference (RD): 40.7; 95% CI: 38.6-42.9) and older patient age (RD for 18 year-olds: 21.9; 19.8-24.0) were strong risk factors for filling an opioid prescription. Conclusions: Post-procedure opioid prescription fill rates have decreased significantly since 2012 among pediatric/adolescent Medicaid enrollees undergoing dental procedures in central/southeastern Ohio. Substantial differences in likelihood of filling a prescription remain by procedural and demographic variables.

Doctor of Philosophy, The Ohio State University, 2020, Biomedical Engineering

Motor vehicle crashes (MVC) are the leading cause of cervical spine (c-spine) injuries in children below 18 years of age. However, there have been reports of increasing injury trends around five year of age. In automotive safety, this age typically corresponds with a transition of child restraint systems: from a harnessed device to a booster seat which use the adult seatbelt. Anthropomorphic test devices (ATDs) and finite element modeling are commonly used to predict the biomechanical responses of pediatric occupants during MVC. However, a lack of experimental pediatric c-spine data results in the use of scaling techniques of adult male biomechanical responses to assess pediatric injury risks. These scaling techniques seldom represent the vast changes the c-spine undergoes from childhood to adulthood. Pediatric ATDs lack the ability to represent the nuances of growth and development of the pediatric c-spine and often result in poor biofidelity, or the ability to accurately predict and reproduce biomechanical responses of children. There is a need to understand the biomechanical response of the pediatric c-spine in a way that accounts for anatomical and developmental differences between children and adult males. Therefore, the objective of this study is to quantify the cervical spine range of motion, strength and stiffness of children 5–7 years old. A custom testing device was developed and validated to quantify pediatric c-spine strength and stiffness in the sagittal and coronal planes while range of motion (ROM) was quantified for all major planes of motion. Isometric strength was measured at a neutral neck position, 0° of axial deviation, and at mid-range of motion, 30° of axial deviation in each plane. During testing muscle activation was assessed and maximum voluntary isometric contractions (MVIC) were quantified for each participant. Dynamic concentric strength and stiffness values were quantified at a dynamic rate of 30°/s. Children had equal ROM in all pl (open full item for complete abstract)

MS, University of Cincinnati, 2019, Medicine: Clinical and Translational Research

Objectives: To define the proportion of pediatric patients that seek medical advice or evaluation for poorly controlled fracture pain, identify factors associated with an increased likelihood of requesting assistance, and explore caregiver opioid preferences for fracture pain management. Methods: We performed a cross-sectional study of a convenience sample of 251 children and their caregivers presenting to the orthopedic surgery clinic in a tertiary care children's hospital. Children 5–17 years old presenting within 10 days of injury for follow-up for a single extremity, non-operative long bone fracture(s) were eligible. Participants completed a survey and then a retrospective chart review was performed. The primary outcome was seeking unscheduled evaluation or advice for poorly controlled pain prior to the first routine follow-up appointment by one or more of the following 4 methods: (1) call to the primary provider, orthopedic surgery, emergency department (ED) or urgent care (UC), or other family-defined expert; (2) ED or UC visit; (3) scheduling a visit with the primary provider; (4) rescheduling to an earlier orthopedic surgery clinic appointment. Factors associated with the primary outcome were assessed using bi-variable analysis via Wilcoxon rank sum test for continuous data and Chi-square or Fisher's exact test for categorical variables. Results: Overall, 7.3% (18/245) of participants sought unscheduled evaluation or advice for poorly controlled pain. The two most common reasons for seeking help were to obtain over-the-counter (OTC) medication dosage information (64.7%) or a stronger analgesic (29.4%). Children who sought evaluation or advice for poorly controlled pain were more likely to be Hispanic or Latino (16.7% vs 2.2%, p=0.0319), have a leg fracture (44.4% vs 14.5%, p=0.0014), or have a fracture that was overriding (16.7% vs 4.4%, p=0.0255), translated (50.0% vs 16.7%, p=0.0006), or required manual reduction (50.0% vs 18.9%, p=0.0021) under cons (open full item for complete abstract)

PHD, Kent State University, 2018, College of Nursing

Children and adolescents worldwide experience pediatric chronic non-cancer pain (PCNCP) significant enough to contribute to functional disability and negatively impact family functioning, mental health, school attendance, social activities, and sleep patterns. For some youth, an intensive interdisciplinary pain treatment (IIPT) approach is recommended to address the multifactorial complexity inherent with this condition. While these programs demonstrate a strong evidence base and are supported by experts, research is lacking to explain why such effectiveness is demonstrated or how this change occurs. A study utilizing Interpretative Phenomenological Analysis (IPA) methodology was conducted to better understand and communicate the perspectives of adolescents currently enrolled in an IIPT program. Six participants, ages 14 to 17, were interviewed. One overarching theme, leap of faith, emerged during data analysis, along with four subthemes, living miserably on the edge, diving in, buried treasure, and charting new waters. This study leads to a fuller understanding of how adolescents perceive, make sense of, and ascribe meaning to their experiences while engaged in an IIPT program for PCNCP and serves as a foundation for future research exploring mechanisms of therapeutic change in this population.

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

Adherence to a prescribed plan of care in chronically ill patient populations of all ages is a global challenge. Failure to adhere to prescribed medications, treatments, and recommended self-care behaviors can lead to poor health outcomes and increased health care costs. Pediatric oncology, immunodeficiency, and hematopoietic stem cell transplant (HSCT) patients are at increased risk of developing treatment-related toxicities including infections, oral complications, and deconditioning, especially when they are non-adherent to prescribed self-care behaviors. Evidence indicates the risk for these toxicities can be reduced by participation in key activities of daily living (ADL), including daily bathing with chlorhexidine gluconate (CHG), physical activity and oral hygiene, known as ADL 1-2-3. Despite this evidence, many patients fail to perform these important ADL during their inpatient treatment, when they are most susceptible. Pilot testing of a paper token economy system demonstrated increased engagement in ADL 1-2-3 in a small group of inpatient pediatric HSCT patients who had a history of non-adherence with these self-care behaviors. The results of the pilot study suggested furthering this effort through the design and building of a digital token economy system. The primary DNP scholarly project aim is to improve overall adherence to ADL 1-2-3, as well as compare adherence between one group of patients receiving the current standard of care and a second group of patients receiving a novel digitalized token economy intervention in addition to the current standard of care. The DNP project serves as a feasibility study for a larger scale randomized controlled trial and therefore includes measurement of intervention fidelity in support of this National Institute of Health grant funded research.

PhD, University of Cincinnati, 2017, Nursing: Nursing - Doctoral Program

Background: In 2013, over 39,000 children in the United States died, with approximately 80 percent of deaths occurring in a pediatric critical care unit. The death rate for critically ill children treated in pediatric critical care units decreased by half in the last two decades, yet remains at 2.39 percent. There is a small body of current knowledge which examines the lived experience of nurses who care for dying children, the grief they experience, and how they individually or with the aid of organizational interventions resolve their grief. No current studies have examined the culture nurses create that helps them collectively manage work-related grief. Purpose: The purpose of this study was to explore how nurses in two pediatric critical care units use shared behaviors to help manage work-related grief and continue providing care in the stressful pediatric critical care environment. Method: Focused ethnography was the method used to examine the shared culture nurses create that helps them manage work-related grief. Thirty-three informants were interviewed, 20 from the pediatric intensive care unit (PICU) and 13 from the cardiac intensive care unit (CICU). Data were comprised of interviews, and researcher reflections, with themes and domains abstracted from the data. Findings: Study findings demonstrated that PICU and CICU nurses had very different strategies for grief management. These differences were explicated in the five domains abstracted from the research data. The five domains were further broken down into themes. Domain I: Values and Beliefs reviewed shared values and beliefs held by critical care nurses in both units. Themes which comprised this Domain are: Always Learning – Always New, Dignity in Life – Dignity in Death, Bringing Comfort, and Meaning in Work. Domain II: Causes of Grief, was comprised of the themes: Hyper-Responsibility, Prevented from Bringing Comfort, Bonding, Alive One Day, Dead the Next, and Acuity of the Unit. (open full item for complete abstract)

Master of Science, The Ohio State University, 2014, Dentistry

Enamel defects in primary teeth predispose children to early childhood caries and are often not detected nor intervened upon until damage from caries has occurred. In this study, we utilized a novel imaging device, the ProScope digital microscope, to assess the enamel quality in vivo of young children ages 9 months -3 years. We also used a parental survey and medical record review to elucidate factors leading to defects in our population. Based on clinical exam, patients were separated into intact and defective enamel groups. The final sample included 45 children with intact enamel and 30 children with enamel defects. ProScope images were captured with a 100x lens during the exam and were later assessed based on the modified Developmental Defects of Enamel index by five raters. We found that children in the defective enamel group had higher dft scores of 1.34 vs. 0.29 (p=0.008), more caregivers who smoke in the home at 50% vs. 26.7% (p=0.04), and more parents reporting soft teeth in their children at 33% vs. 6.7% (p=0.003). The ProScope, when compared to the gold standard of visual clinical exam for detecting enamel defects, had a sensitivity of 82.7% and specificity of 77.3%. We found an inter-rater reliability of 0.438 among the five raters. We concluded that enamel defects in primary teeth might be the missing link between maternal smoking and offspring caries rates as reported in previous studies. Additionally, children with enamel defects and children identified by their parents as having soft teeth had a higher risk of dental caries, and therefore those children should receive increased preventive care and counseling. The ProScope was useful for evaluating enamel defects, but might be best suited for serial evaluation of enamel defects and incipient carious lesions to document progression over time in the same patient.

Doctor of Philosophy, The Ohio State University, 2012, Psychology

Purpose: To determine whether children with arterial ischemic stroke (AIS) display deficits in cognitive functioning and explore factors that may account for individual variability in cognitive outcomes following AIS. Participants and Methods: Participants included 36 children with AIS, which occurred from the perinatal period to childhood but at least 1 year prior to assessment. A comparison group of 15 children with asthma were included to control for acute medical illness requiring hospital admission. Participants ranged from 6 to 15 years of age at the time of the study. Children completed measures of general cognitive ability, attention and executive functions, and processing speed. Children also were assessed using the Pediatric Stroke Outcome Measure (PSOM), a standardized assessment of neurological function. Children in the AIS group also completed an MRI, which was used to determine stroke location and measure lesion volume. Results: Mean cognitive scores fell within the average range for both groups. Compared to children with asthma, children with AIS performed significantly worse on a measure of inhibitory control. Group differences for the remaining cognitive measures were in the same direction but did not reach statistical significance. Children with AIS performed significantly lower than normative populations on several cognitive measures. The PSOM total severity score was significantly negatively correlated with general cognitive ability and processing speed. Stroke volume was significantly negatively correlated with verbal skills and general cognitive ability. Results suggest that greater stroke severity was associated with lower cognitive functioning. Socioeconomic status (SES) was also related to verbal functioning, general cognitive ability, inhibitory control, and processing speed. Stroke location, lesion laterality, age at stroke, and sex were not significantly related to cognitive outcome. Regression analyses indicated that after controlling (open full item for complete abstract)

Doctor of Philosophy, Case Western Reserve University, 2010, Nursing

Little evidence exists regarding best practices for pediatric end-of-life care in Thailand. Most studies from Western cultures focus on adult patients; available studies in pediatrics focus on care delivered outside the intensive care unit (ICU). Nearly all pediatric deaths in Thailand occur in ICUs. This study aimed to explore nurses' perceptions of the quality of dying and death, barriers and facilitators to providing pediatric end-of-life care in Thai ICUs and examine relationships among these variables. The study framework was based on Donabedian's structure, process and outcome model. A descriptive correlational design was used on a convenience sample of 129 neonatal and pediatric ICU nurses from two university hospitals in Thailand. Data were collected using self-administered anonymous versions of the Modified Quality of Dying and Death and the Modified National Survey of Critical Care Nurses regarding End-of-Life Care surveys. Open-ended questions were used to elicit data on additional barriers and facilitators not addressed by the standardized instruments and to obtain suggestions to improve pediatric end-of-life care. The results revealed that critical care nurses perceived a moderate quality of dying and death for infants and children in Thai ICUs (Mean = 52.89, SD = 15.43). The overall model demonstrated all three barrier and facilitator predictors (patient-family-related, healthcare-professional-related, and organizational-related) significantly affected the quality of dying and death (p < .001) with 33-34% of the variance explained. Barriers and facilitators related to healthcare professionals significantly contributed to quality of dying and death. The highest ranked of these healthcare-professional-related barriers were having disagreement among physicians about direction of care, time constraints, and insufficient knowledge of end-of-life care. The three highest ranked healthcare-professional-related facilitators were agreement of physicians about di (open full item for complete abstract)

PHD, Kent State University, 2025, College of Arts and Sciences / Department of Psychological Sciences

The present study sought to describe characteristics of avoidant/restrictive food intake disorder (ARFID) among children who completed a feeding evaluation through an outpatient, multidisciplinary feeding clinic and were evaluated by pediatric psychology. This study aimed to identify the proportion of children diagnosed with ARFID, symptom presentations, psychological and neurodevelopmental comorbidities, and weight status among children with ARFID. In addition, the present study examined associations among symptom presentations, psychological and neurodevelopmental comorbidities, child problematic mealtime behaviors, and child body mass index. Children (2-12 years of age) and one parent/legal guardian per child were included in the present study, using archival data. Families completed an initial evaluation for child feeding difficulties within a freestanding children's hospital. Evaluations that did not involve the presence of pediatric psychology were excluded from the study. Child data were retrieved from the electronic medical record, including height/weight, demographic and diagnostic information, and parent-report Behavioral Pediatrics Feeding Assessment Scale. Of N = 363 children who completed a feeding evaluation involving pediatric psychology, 289 (79.6%) children were diagnosed with ARFID by psychology. Most children with ARFID (M age = 6.03, SD = 2.52) were White/Caucasian (83.0%) males (73.0%). Fear of aversive consequences was identified in 65.7% of children, lack of interest in 15.2%, and sensory sensitivity in 65.7%. Twenty-seven percent had comorbid autism spectrum disorder (ASD), 17.0% attention-deficit/hyperactivity disorder (ADHD), and 12.1% generalized anxiety disorder. Children had underweight (8.0%), healthy weight (64.0%), and overweight/obesity (28.0%). The odds of having ADHD increased by 111% (OR = 2.11, 95% CI [1.0, 4.46]) for children with lack of interest. There was a significant association between ASD and child problematic mealtime be (open full item for complete abstract)

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

Background: Serum vitamin D (VD) deficiency and vitamin D receptor (VDR) polymorphisms have been associated with the development and severity of inflammatory bowel disease (IBD). Deletion of intestinal epithelial VDR results in more severe murine colitis, and transgenic over-expression of intestinal epithelial VDR ameliorated both spontaneous and chemical models of colitis. Aims: To associate disease severity and short term outcomes with serum VD fractions and rectal VDR expression in pediatric Ulcerative Colitis (UC), and to explore key biologic pathways mediated by VDR. Methods: 431 newly diagnosed pediatric UC patients from 29 centers were enrolled in the PROTECT study. Clinical severity was determined using the Pediatric Ulcerative Colitis Activity Index (PUCAI), and endoscopic severity was determined using the Mayo endoscopic sub-score. In 206 UC and 20 controls, the global pattern of rectal gene expression was determined using RNA sequencing. Free and total serum VD fractions were measured and bioavailable VD was calculated. Mucosal healing at week 4 was defined as fecal calprotectin (FCP) < 250 mcg/g. Results: Adjusted and unadjusted models revealed that while higher bioavailable VD and rectal VDR expression were associated with lower clinical severity at diagnosis (p<0.001), only higher rectal VDR expression was associated with lower endoscopic severity (p=0.0016). Consistent with this, higher levels of baseline rectal VDR expression were associated with higher rates of week 4 clinical remission (PUCAI<10, p=0.03) and mucosal healing (38% in the highest tertile vs. 14% in the lowest tertile, p=0.02). Higher baseline rectal VDR expression remained significantly associated (p=0.003) with week 4 mucosal healing in a multivariable model which included serum albumin and pan-colitis. Gene set enrichment analysis was applied to 5296 genes differentially expressed between UC patients and controls (1.5 fold-change and FDR of 0.001), and core bi (open full item for complete abstract)

Master of Science, The Ohio State University, 2005, Graduate School

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

Doctor of Philosophy, Case Western Reserve University, 2025, Epidemiology and Biostatistics

Malaria remains a global health challenge with over 600,000 deaths annually. Ninety-five percent of the global malaria burden occurs in children living in sub-Saharan Africa. In regions with moderate to high mosquito-borne transmission of Plasmodium falciparum, the most lethal of the 5 Plasmodium species that infect humans, children are repeatedly infected and by age 10 to 12 years develop naturally acquired immunity (NAI). NAI is characterized by protection from symptomatic febrile illness and severe malaria that can lead to death. However, NAI does not protect against chronic asymptomatic blood stage infections that serve as a major reservoir of transmission by local mosquito vectors. Current evidence indicates that host inflammatory responses and the progressive development of NAI in African children is heterogeneous that is, in part, due to genetic polymorphisms, ecologic factors such as residence near mosquito breeding sites, and the use of insecticidal bed nets among other factors. This heterogeneity is relatively unexplored with respect to the innate and adaptive immune mechanisms that underlie NAI. To address this gap in knowledge, we evaluated cellular and molecular responses of African children at healthy baseline, during acute febrile (“uncomplicated”) Plasmodium falciparum malaria, and upon recovery in whole blood of 40 children from Burkina Faso and peripheral blood mononuclear cells of 8 children from Kenya. Cell-type proportion estimates were obtained by deconvolution using RNA sequencing and genome-wide DNA methylation data. Unsupervised learning algorithms identified two distinct immune response groups in children, designated as Type 1 and Type 2, from both Burkina Faso and Kenya. The response designation was based on patterns of cell-type proportions, DNA methylation and gene expression. The two types were predominantly quantitative, with response Type 2 exhibiting larger changes of cell type counts, DNA methylation and gene expression from asymp (open full item for complete abstract)