Major depressive disorder (MDD) is a disorder defined by mood disturbance, but the deficits in emotional reactivity that accompany MDD are not yet fully characterized. Researchers have utilized the emotion-modulated startle paradigm to investigate emotional responding among depressed individuals with mixed results. Inconsistent results may be due in part to the heterogeneity of mood disorders, including variation in mood severity. The current study utilized an emotion-modulated startle procedure with 33 individuals currently experiencing a major depressive episode, 25 individuals currently experiencing a minor depressive episode (mD), and 31 healthy controls. Severity of depression, anxiety, and positive and negative mood states were ascertained on the sample. Emotion-modulated startle failed to differentiate between mood disordered individuals and healthy controls. However, results found a significant association between abnormal patterns of emotion responding and positive affect (PA), such that individuals with low PA showed exaggerated responding to unpleasant stimuli. The results suggest that PA may be an important dimension in mood disorders that underlies abnormal emotional responses.

Chronic pulmonary diseases include a wide range of illnesses that differ in etiology, prevalence, symptomatology and available therapy. A common link among these illnesses is their impact on patients’ vital function of breathing, high symptom burden and significantly impaired quality of life. This dissertation research evaluates disease severity, symptom burden and health behaviors of patients with three different chronic pulmonary conditions. First, alpha-1 antitrypsin deficiency (AATD) is an inherited condition that typically is associated with an increased risk of early onset pulmonary emphysema. This study examines differences in demographic, health, and behavioral characteristics and compares clinical outcomes and health related behaviors and attitudes between two severe genotypes of AATD - ZZ and SZ. The findings of the study suggest that patients with SZ genotype and less severe form of deficiency report higher number of exacerbations, comorbidities, as well as unhealthy behaviors such as lack of exercise and current smoking. In addition, individuals with the more severely deficient ZZ genotype are more adherent to disease management and prevention program recommendations and maintain a healthier lifestyle than individuals with SZ genotype. Second chronic lung disease examined in this research was chronic obstructive pulmonary disease (COPD), the fourth leading cause of death and second leading cause of disability in the United States. Prevalence and burden of cough and phlegm, two of the most common symptoms of the COPD, were assessed among participants of the COPD Foundation’s Patient-Powered Research Network (COPD PPRN). In addition, association between patient-reported levels of phlegm and cough, clinical outcomes and patients’ quality of life were evaluated. Participants’ quality of life was assessed using Patient Reported Outcome Measurement Information System instrument PROMIS-29. Association between changes in symptom severity over time and patient-reported quality of life were examined. Findings of this study indicated that severity of cough and phlegm were associated with higher number of exacerbations, greater dyspnea, and worsened patient-reported quality of life including physical and social functioning. Improvement in cough and phlegm severity over time was associated with better patient-reported quality of life. Third pulmonary illness described in this dissertation is non-cystic fibrosis bronchiectasis (NCFB), a rare and etiologically diverse condition characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Association between presence of Pseudomonas aeruginosa (PA), one of the most frequently isolated pathogens in patients with NCFFB, and disease severity was assessed utilizing enrollment data from the Bronchiectasis and NTM Research Registry (BRR). NCFB disease severity was evaluated using modified versions of validated in large international cohorts instruments, the Bronchiectasis Severity Index (BSI) and FACED. The findings of this study indicate that PA infection is common in NCFB patients, and presence of PA in patients’ sputum is associated with having moderate and high severity of bronchiectasis. In addition, the results of this study suggest that the two severity assessment instruments classify patients with NCFB differently which may be attributed to a greater number of severity markers utilized in the calculation of the BSI compared to FACED. In conclusion, the proposed dissertation aims to enhance understanding of differences in health outcomes between genotypes of AATD within AlphaNet registry, and to guide future health-promoting behaviors. It highlights the burden of common symptoms such as cough and phlegm in patients with COPD within COPD PPRN and their association with patients’ quality of life. In addition, it introduces modified indices of NCFB severity and emphasizes high burden of the disease in patients with presence of PA within the US BRR.

Intimate Partner Violence (IPV) affects approximately one in four women every year in the United States (Black et al., 2011). As a result, determining the potential implications IPV has on the victims requires extensive research and education. The manner in which a victim is responded to by others following abuse may have important implications for their adjustment following IPV. Identifying factors that contribute to the quality of responses towards victims of violence can help to inform future intervention and prevention programs; assist in decreasing mental health problems, and reduce the incidence rates of IPV. The purpose of the present study was to examine dating violence myths and victim blaming depending on severity of violence among male and female college students. A sample of 927 male (n = 222) and female (n = 705) psychology undergraduate college students were randomly assigned to receive one of four hypothetical vignettes depicting varying levels of dating violence (i.e., yelling, punching a hole in the wall, shoving, and physical assault). Respondents completed measures of perceived severity of violence presented in the vignette, victim blame, and adherence to domestic violence myths. Gender had a significant effect on severity of violence depicted in the least severe condition F(1,246) = 5.03, p = .03. Additionally, gender had a significant effect on blaming tendencies in the least severe condition F(1,238) = 9.98, p = .02. However, gender did not have a significant effect endorsement of dating violence myths a. Study findings’ implications, limitations and future directions will be discussed.

Numerous consequences of sexual assault have been identified, including psychological consequences such as posttraumatic stress disorder (PTSD) and health-risk behaviors such as substance misuse. Previous research has indicated that survivors of sexual assault may engage in substance misuse (i.e. alcohol and other illicit and prescription drug use) in attempt to suppress negative thoughts, memories, and flashbacks of the assault. The present study seeks to expand on and examine health-risk behaviors among undergraduate college women after the experience of sexual assault. Although many researchers have focused on the use of alcohol following sexual assault, less have studied non-medical use of prescription drugs (NMUPD) as an alternative method of maladaptive coping. NMUPD has recently been identified as the fastest rising recreational substance among college populations. With NMUPD becoming a norm among college students in recreational settings, exploring NMUPD for alternative uses seems like the next logical step in research. This study views sexual assault on a continuum starting from unwanted sexual contact and ending in completed rape. This study aims to bridge the gap in research by attempting to connect the risky behavior of NMUPD to coping with any experience on the sexual assault continuum among college undergraduate women. Participants with and without a history of sexual assault were recruited for the present study. Participants completed a measure of sexual assault history and severity, along with questionnaires assessing current alcohol, marijuana, and NMUPD use

Hospitals stand to lose millions of dollars in revenue due to patients who leave without treatment (LWT). Grounded in queueing theory, the purpose of this correlational study was to examine the relationship between daily arrivals, daily staffing, triage time, emergency severity index (ESI), rooming time, door-to-provider time (DTPT), and LWT rates. The target population comprised patients who visited a Connecticut emergency room between October 1, 2017, and May 31, 2018. Archival records (N = 154) were analyzed using multiple linear regression analysis. The results of the multiple linear regression were statistically significant, with F(9,144) = 2902.49, p < .001, and R2 = 0.99, indicating 99% of the variation in LWT was accounted for by the predictor variables. ESI levels were the only variables making a significant contribution to the regression model. The implications for positive social change include the potential for patients to experience increased satisfaction due to the high quality of care and overall improvement in public health outcomes. Hospital leaders might use the information from this study to mitigate LWT rates and modify or manage staffing levels, time that patients must wait for triage, room placement, and DTPT to decrease the rate of LWT in the emergency room.

Purpose. The purpose of this study was to evaluate whether severe victimization experiences, and psychological and social resources were shared risk factors for internalizing only, externalizing only, and co-occurring internalizing and externalizing disorders among victimized substance-using adolescents. Method. Data for this cross-sectional study were obtained from a multisite research project. Adolescents, ages 11-18, participated in a comprehensive screening program for substance abuse at 106 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)-funded grantee sites throughout the United States. Results. Longer duration/frequent victimization, more than one type of victimization, recent victimization, low self-efficacy beliefs and available sources of emotional support were related to co-occurring internalizing and externalizing disorders. Victimization by a trusted person, however, was only related to internalizing disorders. Conclusion. The findings show that some indicators of severe victimization experiences, psychological and social resources are shared risk factors for internalizing, for externalizing, and for co-occurring internalizing and externalizing problems, thus providing support for the common factors model of co-morbidity. These findings suggest that practitioners in substance abuse treatment must thoroughly assess for severe victimization experiences among adolescents presenting with co-occurring mental health issues. Treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their MH needs. Particular emphasis may be placed on enhancing self-efficacy and social skills, so that adolescents may benefit from their available sources of support.

The degree of academic achievement following early onset brain injury is poorly understood. Furthermore, it is unclear if academic success can be predicted by age of onset or other lesion variables (e.g., size, laterality). The purpose of the current study was to describe patterns of academic achievement in individuals with childhood-onset focal brain lesions and to determine the role of variables in the plasticity or vulnerability of the developing brain with regard to achievement. Academic achievement data were collected from 58 individuals with childhood-onset focal brain lesions. The participants' reading, spelling, and arithmetic scores, as measured by the Wide Range Achievement Test, were analyzed in relation to several neuroanatomical variables, including lesion laterality, lesion site, and lesion size. The relationship between achievement and gender, age of onset, etiology, age at testing, and time since lesion onset was also identified. As a group, achievement scores did not differ from normative data, and the majority of the sample demonstrated adequate skills in each domain. However, the frequency of deficits was larger than expected when compared to base rates, suggesting vulnerability to early insult. Achievement scores were correlated with intelligence scores, but did not differ based on lesion laterality, lesion site, age of onset, or etiology. Size of lesion was significantly correlated with reading and spelling but not with arithmetic outcomes. Gender differences were identified, with males performing significantly better on the arithmetic measure than females. The age of onset, age at testing, and time since lesion onset were not correlated with achievement scores in any domain. No interactions were found between lesion laterality and gender or lesion site and lesion laterality. An interaction between gender and lesion site was found, but the significance of the finding is unclear. The current findings provide mixed evidence for the plasticity-vulnerability debate, as many individuals were able to achieve adequate academic skills whereas others demonstrated significant impairments. Further research is needed to elucidate factors that may predict achievement outcomes in individuals with childhood-onset focal brain injury.

The National Institutes of Health recommends the development of conceptual models to increase rigor and improve evaluation in research. Validated models are essential to guide conceptualizations of phenomena, selection of variables and development of testable hypotheses. Structural equation modeling (SEM) is a methodology useful in model testing due to its ability to account for measurement error and test latent variables. The purpose of this study was to test a model of The Geriatric Cancer Experience in End of Life as adapted from Emanuel and Emanuel's framework for a good death using SEM. It was hypothesized that the model was a five-factor structure composed of clinical status, physical, psychological, spiritual and quality of life domains and that quality of life is dependent on the other factors. The sample was comprised of 403 hospice homecare patients. Fifty six percent were male, 97% were white with a mean age of 77.7. Testing of the model used AMOS statistical software. The initial five-factor model was rejected when fit indices showed mis-specification. A three-factor model with quality of life as an outcome variable showed that 67% of the variability in quality of life is explained by the person's symptom experience and spiritual experience. As the number of symptoms and the associated severity and distress increase, the person's quality of life significantly decreases (ß -0.8). As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion) the person's quality of life significantly increases (ß 0.2). This is significant to nursing because the model provides a useful guide for understanding the relationships between symptoms, spiritual needs, and quality of life in end of life geriatric cancer patients and suggests variables and hypotheses for research. This study provides evidence for a strong need for symptom assessment and spiritual assessment, development of plans of care inclusive of symptom control and spiritual care, and implementation and evaluation of those plans utilizing quality of life as an indicator for the outcome of care provided by nurses.

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a serious sleep disordered affecting up to 24% of men and 9% of woman in the middle aged population. The current standard for the OSAHS diagnosis is Polysomnography (PSG), which refers to the continuous monitoring of multiple physiological variables over the course of a night. The main outcomes of the PSG test are the OSAHS severity measures, such as the Respiratory Disturbance Index (RDI), Arousal Index, Latencies and other information to determine the macro sleep architecture (MSA), which is defined by Wake, Rapid-eye-movement (REM) and non-REM states of sleep. The MSA results are essential for computing the diagnostic measures reported in a PSG. The existing methods of the MSA analysis require the recording of 5-7 electrophysiological signals, including the Electroencephalogram (EEG), Electroculogram (EOG), and the Electromyogram (EMG). Sleep clinicians have to depend on the manual scoring of the overnight data records using the criteria given by Rechtschaffen and Kales (R&K, 1968). The manual analysis of MSA is tedious, subjective and suffers from inter- and intra-scorer variability. Additionally, the RDI and the Apnea-Hypopnea Index (AHI) parameters although used as the primary measures of the OSAHS severity, suffers from subjectivity, low reproducibility and a poor correlation with the symptoms of OSAHS. Sleep is essentially a neuropsychological phenomenon, and the EEG remains the best technique for the functional imaging of the brain during sleep. The EEG is the direct result of the neuronal activity of the brain. However, despite the potential, the wealth of information available in the EEG signal remains virtually untapped in current OSAHS diagnosis. Although the EEG is extensively used in traditional sleep analysis, its usage is mainly limited to staging sleep, based on the four-decade old R&K criteria. This thesis addresses these issues plaguing the PSG. We develop a novel, fully-automated algorithm (Higher-order Estimated Sleep States, HESS-algorithm) for the MSA analysis, which requires only one channel of the EEG data. We also develop an objective MSA analysis technique that uses a single, one-dimensional slice of the Bispectrum of the EEG, representing a nonlinear transformation of a system function that can be considered as the EEG generator. The agreement between the human and the proposed technology was found to be in the range of 70%-87%, which are similar to those, possible between expert human scorers. The ability of the HESS algorithm to compute the MSA parameters reliably and objectively will make a dramatic impact on the diagnosis and treatment of OSAHS and other sleep diseases, such as insomnia. The proposed technology uses low-computation-load Bispectrum techniques independent of R&K Criteria (1968) making real-time automated analysis a reality. In the thesis we also propose a new index (the IHSI) to characterise the severity of sleep apnea. The new index is based on the hemispherical asymmetry of the brain and is computed from the EEG coherence analysis. We achieved a significant (p=0.0001) accuracy of up to 91% in classifying patients into apneic and non-apneic group. Our statistical analysis results show that the IHSI carries potential for providing us with a reproducible measure to assist in diagnosing of OSAHS. With the proposed methods in this thesis it may be possible to develop the technology that will not only attempt to screen the OSAHS patients but will be able to provide OSAHS diagnosis with detailed sleep architecture via home based test. These technologies will simplify the instrumentation dramatically and will make possible to extend EEG/MSA analysis to portable systems as well.

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with systemic manifestations characterized by auto-antibodies directed against different parts of the cell nucleus including DNA, histones and ribosomes. The systemic inflammation can cause damage to multiple organs, e.g., kidneys, skin, heart, lungs and the nervous system. Rheumatoid arthritis (RA) is another autoimmune rheumatic disease characterized by auto-antibodies, mainly directed against the Fc-part of immunoglobulin G (rheumatoid factor (RF)) but also against citrullinated peptides/proteins (ACPAs). The inflammation in RA primarily involves the joints resulting in inflamed synovial tissue and destruction of cartilage. The aetiology of both SLE and RA is unclear but there is a genetic contribution predominantly of genes involved in inflammation. The diseases are believed to be multifactorial, or complex, meaning that multiple genes interact with environmental, infectious and hormonal factors, thus increasing the risk of developing disease. The aim of this study was to investigate different candidate genes involved in functions of the immune system and their relationship with SLE and RA susceptibility and severity. The patients and controls were from the four northernmost counties of Sweden, which is a fairly homogenous population well suited for genetic studies. Two single nucleotide polymorphisms (SNPs) in the oestrogen receptor α (ESR1) gene were analysed in SLE. No association was found between the SNPs and SLE per se however the minor alleles (PvuII C and XbaI G) were associated with skin manifestations and later disease onset, thus representing a milder form of the disease. A SNP in the programmed cell-death 1 (PDCD1) gene, which codes for PD-1, an inhibitory molecule involved in T-cell activation, was studied. No association was seen between the risk allele (PD-1.3A) and SLE susceptibility but a strong association was found with renal disease. A risk allele of the protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene that codes for a protein called Lyp which acts as a negative regulator of T-cell receptor (TCR) signalling was significantly associated with SLE in three different case-control sets across Sweden. Both PDCD1 and PTPN22 were independently associated with renal disease. The PTPN22 gene has been associated with numerous autoimmune diseases and was evaluated in another auto-antibody producing disease, RA. From the Medical Biobank of northern Sweden samples donated before the development of symptoms of RA were identified. In these individuals, who subsequently developed RA, the 1858T risk allele in combination with ACPAs gave a high relative risk (&gt;132) for developing RA. The association between PTPN22 and RA was confirmed in a larger material of patients with early RA. The 1858T allele, of the three SNPs investigated, was shown to be the true risk allele associated with auto-antibody positive RA. A functional role of PTPN22 in TCR-mediated activation of T cells from patients with SLE and RA was not demonstrated. In conclusion, minor alleles of two SNPs in the ESR1 gene were associated with a milder form of SLE. The risk allele in the PDCD1 gene was associated with renal disorder in SLE. The risk allele 1858T of the PTPN22 gene was associated with SLE, particularly with renal disease. The 1858T allele in combination with auto-antibodies was a risk factor for developing RA. In early diagnosed RA, the 1858T allele was highly associated with RA and in particular with auto-antibody positive RA.