Cancer is a major illness in the United Kingdom with differences in prevalence, morbidity and mortality, across the population. The focus of this study is two-fold: firstly, to explore African and African-Caribbean Londoners' experience of cancer services and secondly to use a narrative approach, focused on cancer, specifically related to African and African-Caribbean Londoners, an approach that has not been undertaken previously. Therefore, I also aim to explore whether such a research approach has value as a reseearch tool for these communities. Five research questions frame the focus of the study, namely: What factors affected their experiences of cancer services? How did culture, ethnicity and societal factors influence their experiences? How do those factors influence the stories they tell and the way they tell them? What were good and bad practices which affected their experiences? What is the value of the narrative approach in research related to cancer focused on African and African-Caribbeans? It is intended that this thesis will have a wider methodological relevance for BME health research, as well as relevance for BME cancer service research and provide suggestions on practical application of actions to address some challenges. The African and African-Caribbean communities together form the second largest minority ethnic group in the UK, but health research foucusing specifically on cancer related to these two communities is limited. The incidence of cancer is expected to increase amongst minority ethnic communities for a number of reasons: an aging minority ethnic population and changes in lifestyle and environment. It is therefore essential to gain a greater understanding of issues for African and African-Caribbean communities which either hinders or aids in providing an enhanced positive experience of cancer services in London. London was chosen because it is the most diverse, multicultural, multiracial city in the UK and hence the assumption that it has well-developed health structures and systems in relation to cancer, which meet the diversity of its population. Narrative research using dialogic analysis is the methodology used. In-depth interviews were conducted with twelve participants who were recruited through convenience and snowballing. The nine women and three men in the study originated from Nigeria, Ghana, Kenya, Trinidad and Jamaica. The findings demonstrate that ethnicity, religion and community play a significant part in impacting on their experience with cancer services. The narratives identify factors which reflect positive and negative experiences of the engagement of Africans and African-Caribbeans with cance services. Positive experiences of cancer services were articulated from the narratives, which included clinicians apologising for mistakes and clinicians creating an environment which encouraged a positive relationship between themselves and the patient. Some of the challenges patients articulated have been addressed in previous research. These include: cultural sensitivity, lack of access to information on cancer services, lack of respect, feelings of powerlessness and vulnerability. However, areas this research unearthed from the narratives that are not addressed elsewhere are: the power of church leaders, breast self-examination (BSE) and cultural issues associated with self-examination, acknowledgement of the heterogeneity of African and African-Caribbean communities and how that is played out in health seeking behaviour and beliefs surrounding cancer. Courage and resilience are concepts which are rarely explicitly mentioned or recognised in earlier UK research, including the role black men play as carers, a subject virtually non-existent in health research. As a qualitative research method, narrative research proved valuable in enablinig an understanding of issues that affect African and African-Caribbean communities in relation to cancer and receiving cancer services. Dialogic analysis provides a basis to reveal the depth of the participants lived experience and how those experiences shape their behaviour in relation to cancer care. This thesis illustrates that like all patients with cancer, the cancer experience is an individual phenomenon. However, narratives demonstrate that those experiences are bound up in historical, cultural, social, religious and spiritual perspectives.

Anterior cruciate ligament tears are one of the most common injuries that occur, especially in female athletes. It requires surgery and months of physical therapy to get these athletes back in playing condition. The angle of women's hips and lack of strength of inner quadriceps muscles enhances the risk of injuries to the knees. One specific muscle that is known for being a stabilizer of the knee and may help in preventing ACL tears is the vastus medialis. By understanding what exercises activate this muscle the most, conditioning plans and preventative workouts need to be created to help female athletes stabilize the knee. Therefore, this research could impact the prevention of ACL tears in female athletes. By taking a generalized approach, a variety of exercises in each of the three muscle contractions: concentric, eccentric, and isometric, will be evaluated by a Vernier Electromyography system. For this research, one female will be tested doing all the movements three times to measure the average peak muscle activation for each exercise. This will help prevent outliers and human error. For this study, variables such as percent body fat, BMI, history of exercising, and previous strength were ignored.

The purpose of this study was to establish a polymerase chain reaction (PCR)-restriction enzyme assay for detecting the hereditary hemochromatosis (HHC) mutation, C282Y, in gestational and gestational diabetic subjects in South Florida. DNA samples from 43 gestational subjects were amplified by PCR, digested with RsaI, and analyzed by electrophoresis. An allelic frequency of 2.33%, or 4.65% heterozygosity, was observed. The assay is successful and applicable to future studies on HHC and gestational diabetes.

The diagnosis of Von Willebrand's disease (VWD) may sometimes be difficult because of the variability of the results obtained over time in individuals. Moreover, blood group, age, pregnancy and inflammatory stimuli influence the level of Von Willebrand Factor (VWF). The purpose of this thesis was to screen and characterize antibodies to Von Willebrand factor and to evaluate the most promising ones in a gold- Sol assay for VWF on the CA-6000 analyzer. Seven different lots of Anti-VWF antibodies, 3 polyclonal and 4 monoclonal Ab's were screened and evaluated. Two of these antibodies (Sunol R01358 and MAVWF-AP) were selected for preparation of a Gold coated antibody solution. The preliminary testing of these gold coated antibodies on CA-6000 Analyzer showed no immunoreactivity toward VWF for both individual and pooled plasma (from normal healthy donors). Although measurement of VWF for normal plasma with this technique was not demonstrated, these data will be valuable for future work on the design of sensitive and accurate automated sol Gold Immunoassays for the diagnosis of VWD.

The transition to motherhood is not easy for any new parent but it is especially difficult for the mother of an infant in the Neonatal Intensive Care Unit (NICU). There may be instances in the NICU where the nurses' perception of maternal needs may be incongruent with the mother's perception. Many NICU nurses focus on the physical needs of infants such as cardiorespirartory monitoring, mechanical ventilator support, and I.V. therapy. Mothers may instead be focused on their own need for emotional and psychological support. This study investigated the differences and similarities regarding maternal needs as perceived by the mothers and NICU nurses. A 30 item questionnaire called the Perceived Needs of Family Members of Critically Ill Patients (Norris and Grove, 1986) was given to a group of mothers and a group of NICU nurses. The instrument consists of "needs" statements which are ranked on a Likert Scale from "very important" to "not important". The rankings by mothers and the rankings by nurses were compared. The results of this study demonstrated that the mothers' perceptions and the nurses perceptions of maternal needs were similar in most instances, althought there were some differences. Therefore, it is important that the mothers' needs are accurately identified so that nursing interventions can be developed to meet them.

Recent studies identify infants, toddlers and preschoolers as high risk groups exhibiting vulnerability and increased morbidity rates associated with asthma. The data collected via review of ER medical records, were analyzed using descriptive and inferential statistics, where appropriate. The study was conducted on a convenience sample of 110 asthmatic children brought to a Children's Emergency Room (ER) in West Palm Beach, Florida for urgent care. This retrospective descriptive correlational study examined the relationship between the caregiver's description of the child's presenting illness and degree of the asthma exacerbation upon admission to the emergency department for management. Relationships between/among these variables were also explored for children with or without a primary care provider and health insurance. Research findings lend support to the hypothesis (p = .001) that the lesser the degree of severity of the child's asthma exacerbation, the less likely caregivers will describe respiratory distress as the presenting illness. However, the findings fail to support the hypotheses that caregivers of children with a primary care provider or health insurance coverage are more likely to appropriately describe the presenting illness as respiratory distress. Other findings point to the need for client-tailored management plans to maximize caregivers and/or child learning about asthma and its management, client education and follow up.

This study addresses the hypothesis that the following cell adhesion molecules (CAMs): homing-associated cell adhesion molecule (HCAM), very late antigen-4 (VLA-4) and L-selectin play a role in the trafficking of hematopoietic progenitor cells (HPCs) between the bone marrow microenvironment and the peripheral circulation. In order to ascertain differences in CAM expression based on physiologic compartment, the expression of HCAM, VLA-4 or L-selectin per CD34+ myeloid progenitor cell was assessed between paired samples of blood and marrow. CAM expression was flow cytometrically quantitated in paired samples obtained from patients treated with mobilizing doses of granulocyte-colony stimulating factor (G-CSF) or from normal donors donating for allogeneic transplant. In G-CSF mobilized patients, marrow derived CD34+ myeloid progenitor cells expressed more VLA-4 per cell than those in circulation. In normal donors, marrow derived myeloid progenitor cells expressed more CD34 per CAM expressing (HCAM+, VLA-4+ or L-selectin+) CD34+ myeloid progenitors, colony forming unit (CFU) and long term culture initiating cell (LTCIC) assays of flow cytometrically sorted normal marrow and blood CAM+/-CD34+ myeloid progenitors were performed. L-selectin+CD34+ myeloid progenitors formed a greater percentage of BFU-E colonies and a lower percentage of CFU-GM colonies than all other CAM+/-CD34+ myeloid progenitors sorted from normal blood. In normal donors, CAM+/-CD34+ myeloid progenitors sorted from blood formed significantly more colonies per 106 plated cells than those derived from marrow. L-selectin+CD34+ myeloid progenitors derived from marrow contained significantly more LTCIC (per 106 sorted CAM+CD34+ myeloid progenitors) than those expressing HCAM or VLA-4. In order to determine whether CD34+ myeloid progenitors utilize VLA-4 to bind to fibronectin (FN), in vitro binding assays were performed. Adhesion of normal blood derived VLA-4+CD34+ myeloid progenitors to FN was blocked by the addition of monoclonal antibodies against the α4 subunit of VLA-4. These data suggest a model of HPC trafficking, in which HPCs utilize VLA-4 to adhere to components of the bone marrow microenvironment, while HPC modulation of L-selectin affinity plays an important role in HPC homing and a less direct role in hematopoietic reconstitution.

Smoking during pregnancy is one of the most important modifiable behaviors to affect pregnancy outcome. Smoking patterns vary widely among U.S. Hispanic women according to country of origin, and Puerto Rican women have the highest rates of smoking during pregnancy compared to Mexican women and Hispanics from other countries. Therefore, it is important to examine the attributes of women who quit smoking at pregnancy onset as well as the maternal and fetal outcomes associated with continued smoking among Puerto Rican women. The first study of this dissertation examined the attributes of women who quit smoking at pregnancy onset in a population of predominantly Puerto Rican prenatal care patients. Among women who smoked prior to pregnancy, non-Puerto Rican Hispanic ethnicity, being born outside the U.S., and having a family history of type 2 diabetes were significantly associated with quitting smoking at pregnancy onset, while pre pregnancy daily marijuana use, heavy smoking, having a prior birth, and a high stress score were inversely associated with quitting smoking. Findings may be used to tailor cessation messages and target women at risk of continued smoking during pregnancy. The second study of this dissertation examined the association between smoking and risk of gestational diabetes (GDM) and abnormal glucose tolerance (AGT). This study adds to sparse literature on smoking and abnormal glucose tolerance. Smoking in pre, early or mid pregnancy was not associated with risk of GDM but confidence intervals were wide due to small number of cases. Smoking was associated with a suggestion of decreased risk of AGT, although not significant in multivariate models. Additional research is needed to better understand the effect of smoking on plasma glucose levels and risk of AGT during pregnancy. The third study of this dissertation evaluated the association between smoking during pregnancy and risk of preterm birth and small-for-gestational-age (SGA). The strengths of this study included the assessment of smoking at two time points in pregnancy and the evaluation of preterm birth subtypes. Results supported prior findings in largely non-Hispanic white populations that smoking during pregnancy increases the risk of preterm birth and SGA.

Approximately 80% of people who contract tuberculosis (TB) in the United States are first infected with untreated latent tuberculosis infection (LTBI). LTBI is an ongoing public health concern in people who experience homelessness. Because of the transient nature of this population, it is often difficult for them to adhere to and complete treatment for LTBI. In this quantitative, correlational of a cross-sectional study, secondary data was from a public health clinic in southern U.S. The theoretical framework used for the study was the social ecological framework. Multiple logistic regression was used to determine if a statistically significant predictive relationship existed between sociodemographic factors (i.e., age, gender, shelter type, substance abuse status); medication type (i.e., Directly Observed Therapy versus Self-Administered Therapy (DOT vs SAT); and treatment completion among persons experiencing homelessness treated for LTBI. Age and substance abuse status were found to be related to treatment completion at statistically significant levels (p < .05). A chi-square analysis showed no statistically significant difference in adherence to TB treatment by treatment type (i.e., DOT versus SAT; p = .831). Positive social change could stem from interventions and prevention that focuses on the demographic groups that were found to be related to treatment completion at statistically significant levels to provide support to these groups and increase LTBI treatment completion in people experiencing homelessness.

Stroke recovery is a crucial public health issue in Ghana due to the high rate of mortality and morbidity associated with stroke. The significant role income plays in the onset of stroke has been empirically proven using quantitative research. However, the in-depth insights on the role income plays in stroke recovery are less known and less appreciated, particularly, in middle-income countries such as Ghana. The phenomenological study was purposed to provide in-depth insight into the effect which might exist between income earned by Ghanaian-families and stroke recovery. The theoretical framework underlining this qualitative study was a combination of the Dahlgren-Whitehead Rainbow model and the Ecological model. The research questions were a guide to uncover the perceptions and opinions of stroke survivors on income and environmental risks associated with stroke recovery in Ghana. Using purposive sampling approach, 15 survivors of stroke were interviewed. Data were coded using the Nvivo software package and analyzed thematically. The results revealed that income influences the choice of residence of stroke patients and this increases their exposure to environmental risk which in turn prolongs stroke recovery. Furthermore, the income level of stroke patients influenced their ability to access healthcare delivery thus, receiving medical attention, buying prescribed medication and access to physiotherapy. Positive social change may be benefited through insights provided by this study to affect policy changes in healthcare delivery systems. Thus, incorporating environmental risk issues and income strategies into intervention programs during stroke recovery.