Digital Commons Network^™

The Effect Of Maxillary Sinus Anatomical Variations, Surgical Considerations, And Patient Factors On Volumetric Changes Following Lateral Wall Sinus Floor Elevation Technique For Up To 8 Years, Mengyi Shi

All ETDs from UAB

jectives: The aim of this retrospective study is to assess the long-term dimensional stability, or shrinkage, of the lateral window sinus grafts using cone beam computed tomography scans (CBCT) and radiographic software. Material and Methods: All patients from UAB Periodontal Graduate Clinic with available records of sinus augmentation via the lateral window approach with delayed implant placement between 2014 and 2019 were screened for having two follow up CBCT scans of diagnostic quality. The first scan must be completed within 6-9 months of lateral window sinus floor elevation (LWSFE) and prior to implant placement. The second CBCT must be taken …

The Relationship Between Nurse And Therapy Staffing Levels And The Medicare Patient-Driven Payment Model Reimbursement During The Covid-19 Pandemic, Roland T. Shapley Jr

All ETDs from UAB

The Patient Driven Payment Model (PDPM) brought about a paradigm shift in the way skilled nursing facilities are reimbursed, by linking complexity of care to beneficiary need, expanding case-mix adjusted components by including a non-therapy ancillary and speech language pathology component, and limiting the volume of therapy services provided. The COVID-19 pandemic wreaked havoc upon the nursing home industry that gave rise to high patient and staff infections and fatalities, declining occupancy rates, and nursing shortages, compelling the Department of Health and Human Services to provide $4.9 billion in CARES Funding to skilled nursing facilities (SNFs). Using Payroll Based Journal, …

Association Between Regional Covid-19 Vaccine Hesitancy And Reported Positive Covid-19 Cases In The Southern United States, Orielle Caudle

All ETDs from UAB

The use of vaccinations has been shown to be beneficial in pandemics in the past, and in some cases, it has led to elimination of a particular disease (i.e. polio). The COVID-19 vaccination can also serve the same purpose, however, vaccine hesitancy within specific regions of the country may prevent and/or dilute the effectiveness of the vaccine. Vaccine hesitancy can be defined as a delay in acceptance, or refusal despite the availability of vaccine services. Southern regions have consistently had the lower vaccination rates compared to its other regional counterparts, even as the pandemic progressed and death rates increased over …

A Prospective Randomized Clinical Trial To Compare Side Access Mucosal Releasing Incision (Samri) And Sulcular Tunnel Access And Root Coverage Procedures With Coronally Advanced Flap And Acellular Dermal Matrix (Adm) To Treat Teeth With Gingival Recession And Lack Of Adequate Keratinized Tissue. A Pilot Study, Karen Younghee Jo

All ETDs from UAB

Aims. The primary aim of this randomized, blinded, controlled clinical trial was to compare clinical and patient-centered outcomes obtained following soft tissue grafting utilizing the Side Access Mucosal Releasing Incision (SAMRI) or Sulcular Tunnel Access (STA) procedures with acellular dermal matrix (ADM) and coronal flap advancement to treat Miller Class I and II recession defects on single rooted teeth. Methods. Five patients and eight recession defect sites with Miller Class I or II gingival recession and £ 2mm of keratinized tissue at each site were randomly divided into two groups (A: SAMRI, B: STA) and were treated and evaluated for …

Racial Differences In The Association Of Insulin Resistance With Risk Of Incident Heart Failure In Participants Of Regards, Nirav Patel

All ETDs from UAB

Background: Insulin resistance is linked to the development of heart failure (HF). However, there is limited understanding of the racial differences in the association of insulin resistance with the risk of incident HF among individuals without diabetes. Objectives: In a US national cohort of Black and White participants, we sought to evaluate: 1) the relationship between insulin resistance with incident HF participants, and 2) whether there are racial differences in the association of insulin resistance with HF. Methods: We examined >16,000 participants without HF and diabetes at baseline from the REGARDS cohort. Cox regression modeling was used to assess the …

Assessing The Impact Of The Covid-19 Pandemic On Metastatic Lung Cancer Time To Treatment Initiation, Health Care Resource Utilization, And Costs In The United States, Teresa M. Zyczynski

All ETDs from UAB

The COVID-19 pandemic has derailed normal operations in the health care delivery systems in the United States (US) and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess time to treatment initiation (TTI) with systemic cancer therapy in patients with newly diagnosed metastatic lung cancer, metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. The retrospective claims …

The Use Of Vesgen For Analysis Of Retinal Vasculature In Pulmonary Arterial Hypertension, Mariana Desiree Dupont

All ETDs from UAB

Pulmonary artery hypertension is a chronic and progressive disease leading to right heart failure and, ultimately, death if untreated. The goal of the studies in this dissertation was to determine if fluorescein angiography (FA), and color fundus angiography (CF) imaging could be used to garner critical information about retinal changes in individuals with pulmonary artery hypertension (PAH). VESsel GENerational Analysis (VESGEN) is a noninvasive computer program that assigns branching generation to large and small vessels. VESGEN was utilized to investigate vascular alterations in FA, and CF imaging investigating disease progression in PAH. This dissertation demonstrated that PAH patients had aberrant …

Applying Pet Imaging To Cancer Immunotherapy To Improve Clinical Outcomes, Kirsten M. Reeves

All ETDs from UAB

The use of biomarkers has significantly enhanced patient outcome by improving diagnosis, personalizing therapy, and monitoring therapeutic response yet most cancers remain non-responsive. Thus, there is a need to better understand the underlying biological mechanisms and tumor microenvironment to enhance therapeutic efficacy. Molecular imaging, including magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) are used to assess response during oncology therapy. Molecular imaging can also provide a noninvasive approach to accurately quantify biomarkers correlated with the tumor microenvironment, including glucose metabolism and hypoxia. 18F-Fluoromisonidazole (18F-FMISO) hypoxia targeted cellular uptake has been shown to correlate with negative …

Regulation Of Stromal Cells Through Inflammatory Signalling, Victoria Matkins

All ETDs from UAB

The bone marrow is a complex organization of hematopoietic and nonhematopoietic cells that form niches to maintain systemic homeostasis during stress and disease. Stromal cells are non-hematopoietic cells first proposed in 1978 in the bone marrow to be essential for hematopoietic stem cells (HSC). Since then, mesenchymal stromal cells (MSC) have been shown to be critical for the HSC self-renewal, retention, and differentiation through chemokines, cytokines, and adhesion molecules. However, like HSCs, MSCs are multipotent progenitors that differentiate into osteoblasts, adipocytes, and chondrocytes to from tissues of the skeletal, endocrine, and connective systems. These multipotent progenitors are tightly regulated in …

Optimal Antero-Posterior Position Of The Maxillary Central Incisors And Its Relationship To The Forehead In Adult Hispanic Females, Balraj Bains

All ETDs from UAB

Objective: The objective of this study is to investigate the relationship of forehead inclination to anteroposterior position (AP) of the maxillary central incisors in adult Hispanic females. Materials and Methods: 70 participants were recruited for this study and smiling profile photographs were taken. All images were deidentified and placed in standardized dimension of 7.5” by 6.5”, which were then added to a PowerPoint to be evaluated by a judging panel. 24 Adult Hispanic Females (AHF) made up the control group and were seen to have an optimal incisor AP position. 46 AHF were in the study group and were judged …

The Role Of Alternative Payment Models In Pharmaceutical Services And Outcomes, Matthew G. Parker

All ETDs from UAB

A persistent challenge within the healthcare sector is balancing cost containment for health services and the quality of care associated with these services. This challenge has reinvigorated interest in alternative payment models (i.e., risk-sharing, shared savings, capitation), arrangements between payers and healthcare providers that structure reimbursement for services based on health outcomes. Although much research has assessed the association between these payment models and financial outcomes for medical services, there is a paucity of research that has likewise assessed pharmaceutical outcomes (i.e., electronic prescribing, evidence-based prescribing, medication adherence). The papers comprising this dissertation contribute to this limited body of research …

Il-22 Mediated Host Defense During Attaching-Effacing Pathogen Infection, Baiyi Cai

All ETDs from UAB

Intestinal infections are a cause of morbidity and mortality worldwide and remain a public threat. Interleukin (IL)-22 is central to host immune responses in the intestine during infection and inflammation. IL-22 can be produced by both innate and adaptive immune cells, yet their relative contributions to host protection remain unclear. Here we demonstrated the specific role and mechanism for IL-22 from innate and adaptive sources to protect the host. Using the Citrobacter rodentium (C.r) model, we found that IL-22 from innate cell, protect the host during early infection. IL-22 induces epithelial production of polymorphonuclear neutrophils (PMN) recruiting chemokine CXCL1, CXCL2 …

Predictors Of Us Hospital Responsiveness To International Patient Inquiries, Suzanne M. Garber

All ETDs from UAB

Medical travel has been growing at a steady rate as global travel has also increased. However, with the advent of COVID-19, all global travel came to a screeching halt, including travel intended for medical purposes across borders. Now that travel is resuming worldwide, American hospital administrators are anxious to fill their beds with more profitable, international patients to make up for revenue losses incurred during the pandemic. Existing literature on the topic of medical tourism focuses on the role of patient initiative, choice, and risk-taking behaviors with little mention of hospital leadership’s ability or desire to construct a management strategy, …

The Requirement Of Transcriptional Lim Complex Co-Regulators For Pancreatic Endocrine Cell Development And Function, Eliana Davi Toren

All ETDs from UAB

The prevalence and tremendous impact of diabetes mellitus has made glucose regulation of the insulin-producing -cell and surrounding pancreatic islet of Langerhans a center of public and research interests alike. A comprehensive understanding of these hormone-producing cells begins with their developmental origins. What are the genetic cues and participants in the tightly orchestrated process of their formation? Investigating the earliest determinants of islet-cell fate not only allows us to deeply understand mature - and islet-cell function, but also produces a data-driven template for how these cells can be reproduced in future stem-cell based diabetes therapies. LIM transcriptional complexes are indispensable …

Molecular Imaging Of Cancer For Detection And Monitoring Of Response To Combination Therapy, Tiara S. Napier

All ETDs from UAB

Imaging is a primary component of cancer care and aids in diagnosing, response assessment, and monitoring. Molecular imaging techniques provide visualization of unique tumor biology that can be used to personalize treatment. Key features of an effective biomarker are sensitivity, specificity, and ability to provide clinical value beyond that of other types of information already available at the time of diagnosis. For particularly heterogeneous cancer subtypes, such as glioblastoma (GBM) and triple negative breast cancer (TNBC), reliable biomarkers can be challenging to identify and there are few tar-getable receptors for therapy. Our findings demonstrate that quantifying tumor EGFR (panitumumab-IRDye800CW), granzyme …

Evaluating The Association Among Demographic, Disease, And Symptom Profiles And Quality Of Life In Connective Tissue Disease-Related Interstitial Disease, Lanier O'Hare

All ETDs from UAB

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Connective tissue disease-related interstitial lung disease (CTD-ILD) results in an unrelenting symptom burden and may progress to death. The morbidity and mortality associated with CTD-ILD likely has a profound impact on individuals’ quality of life (QOL). Quality of life is a phenomenon that has yet to be sufficiently described in the literature on CTD-ILD. The factors associated with QOL in other chronic lung diseases have been described, but because of the different clinical and demographic characteristics of CTD-ILD, it is unknown if these same factors are associated with QOL in CTD-ILD. The purpose of this study was to examine …

Study Of The Effects Of Contusion Spinal Cord Injury And Optogenetic Stimulation On Lower Urinary Tract Function, Salvador A. Lopez

All ETDs from UAB

Lower urinary tract (LUT) dysfunction is a detrimental ailment that negatively affects a person’s independence, health, and overall quality of life. More specifically, LUT dysfunction as a result of spinal cord injury (SCI) is seen in more than 17,000 cases per year and of those cases, <20% are discharged from care with normal micturition1. Initially, after SCI, there is an acute period of spinal shock when the urinary bladder is flaccid and underactive, while the external urethral sphincter (EUS) that constricts the bladder outlet quickly becomes tonically active. In days to weeks after injury, spinallymediated, reflex bladder contractions re-emerge2-4. Numerous studies have examined aspects of LUT function using various models of SCI, primarily utilizing complete transection injuries. This set of studies first examined the effect of moderate to severe midthoracic contusion SCI on LUT function by examining cystometrogram (CMG) and EUS recordings, bladder/spinal cord morphology, sensory innervation of bladder tissue, and spinal neuronal activation in female mice. This model of SCI produced significant changes in normal bladder function as well as altered bladder morphology, including a robust loss of bladder afferent nerve fibers necessary for micturition. Inhibition of histone deacetylase 6 (HDAC6) has been shown to prevent the loss of sensory nerve fibers in mouse hind paw tissue5, thus HDAC6 inhibition was examined as a possible strategy to prevent the observed loss of sensory nerve fibers in bladder tissue post-SCI. iv Mice were treated using intraperitoneal injections of inhibiting compounds ACY-1083 (10 mg/kg) or Tubacin (5 mg/kg). Treatment resulted in significant improvements in CMG measures and sensory innervation of the bladder wall. Finally, optogenetic stimulation was examined using an adenoassociated virus containing cre-recombinase for cre-dependent expression of channelrhodopsin (ChR2) in both spinal intact and SCI mice. The ability to spare afferent axons in bladder tissue post-SCI through HDAC6 inhibition allowed ChR2 expression in sensory nerve fibers. Direct photostimulation of the bladder using various parameters of duration (1, 2, 5, 10 sec continuous stimulation) and power (0.1mW/mm2, 0.95mW/mm2, 6.50mW/mm2) resulted in the ability to control bladder contractions in both spinal intact (SI) and SCI animals, allowing for on-demand voiding post-injury.

Nutrition Practices And Body Composition In Infants Born Preterm, Maggie Jerome

All ETDs from UAB

Adequate nutrition and optimal growth are critical goals of clinical care for premature infants in the NICU due to rapid brain growth and development that occur during this time. Emerging evidence suggests that body composition in preterm infants is predictive of neurodevelopmental and metabolic outcomes later in childhood. The objective of this dissertation is to investigate factors affecting premature infant growth and body composition, including high enteral protein supplementation, nutrition during the first two weeks of life, and race of infants born at 22-32 weeks gestational age admitted to the UAB NICU. In a pilot study, 56 preterm infants were …

Predicting Change In Quality Of Life In Patients With Advanced Cancer And Family Caregivers Using Gps Data, Kyungmi Lee

All ETDs from UAB

Patients with advanced cancer and their family caregivers often experience poor quality of life. Measuring patient and caregiver physical and mental quality of life is typically performed using participant reported outcome measures, especially validated questionnaires. However, this self-report approach has several limitations, including recall bias, respondent burden, and social desirability bias. One potential solution to these limitations may be to use passive data collected by personally owned smartphones (e.g., GPS data) to model and assess the quality of life in family caregivers and patients with advanced cancer. Yet, there is no evidence to date that passively collected smartphone data is …

Heart Rate Variability And Stress In The Intensive Care Unit Nursing Workplace, Paula Miller Levi

All ETDs from UAB

Intensive care unit (ICU) nurses work in a demanding environment, facing repeated encounters with trauma and ethical issues when caring for patients. Psychological stressors can include death of patients, violent acts by patients or their families, caring for suffering patients, and moral distress from performing futile care. These factors place ICU nurses at increased risk of developing post-traumatic stress disorder (PTSD). Suffering from chronic PTSD symptoms can negatively impact nurses’ psychological and physical health. There are also consequences for patients and hospitals, including increased risk for substandard care, decreased government reimbursements from poor patient satisfaction scores, and retention issues. Few …

Exploring The Influence Of Psychosocial Stress And Inflammatory Properties Of The Diet On Cardiometabolic Risk And Gut Microbiome Health Among Young Adult Women Of Birmingham, Alabama, Rachel Olivia Knight

All ETDs from UAB

Concerning trends for obesity, diabetes, heart attacks, and obesity-related cancers, or cardiometabolic disease (CMD), are developing within the emerging and young adult/adulthood (EYA) population. Evidence supports the concept that chronic stress leads to physiologic dysregulation, reduced mental health, chronic diseases, and reduced longevity; however, these are not inevitable outcomes, and resilience or vulnerability is determined by interacting environmental and biobehavioral factors. Although CMD manifests clinically in older adulthood, disease pathophysiology begins earlier, and thus, EYA is a critical time for observation and intervention. Growing evidence indicates inflammation is a major risk factor in CMD development and may be exacerbated by …

Relationship Between Neighborhood Deprivation And Epigenetic Age Acceleration With Pain In Adults With Musculoskeletal Pain, Pamela Jackson

All ETDs from UAB

Residents of high-deprivation neighborhoods shoulder a greater burden of age-related health conditions, including experiencing worse chronic musculoskeletal pain outcomes, compared to residents of more affluent neighborhoods. Advancing age is a risk factor for chronic health conditions, which epigenetic modifications may explain. Epigenetic age acceleration occurs when an individual’s epigenetic age is older than their chronological age, and that discordance has been identified as a strong predictor of age-related conditions. Epigenetic age acceleration has also been correlated with neighborhood deprivation. However, the mechanisms for neighborhood disparities in chronic musculoskeletal pain remain unclear. The purpose of this dissertation study was to examine …

Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards

All ETDs from UAB

Universal access to palliative care (PC) is a human right that much of the world has not accomplished and educating a PC workforce is critical to PC advancement. Higher PC disparities exist in low-and-middle income countries, such as Jamaica. The World Health Organization Public Health Model and the International PC Initiative’s PC roadmap emphasize the importance of PC education. The purpose of this mixed methods dissertation study was to investigate the PC experiences and educational needs of healthcare interprofessionals who provide care for patients with late-stage serious illnesses in Jamaica. Three specific aims incorporated quantitative investigation of physicians’, nurses’, and …

Cell Type-Specific Diurnal Variation In Hippocampus Physiology, Lacy Kathryn Goode

All ETDs from UAB

Circadian rhythms are biological processes that cycle across 24 hours. Driven endogenously by widely expressed and highly conserved clock genes that compose the circadian molecular clock, circadian rhythms are exhibited in numerous facets of physiology across nearly every tissue throughout the body. Diurnal rhythms in cognition, long-term potentiation (LTP), and the expression of clock genes in hippocampus subfields support a role for circadian regulation of hippocampus physiology. However, little is known regarding the circadian molecular clock and diurnal rhythms in neurophysiology at the cellular level. Here, we characterized diurnal differences in spatial memory, LTP, excitability of and synaptic transmission onto …

Synergy Between Stenotrophomonas Maltophilia And Pseudomonas Aeruginosa During Polymicrobial Airway Infections, Melissa Skye Mcdaniel

All ETDs from UAB

Stenotrophomonas maltophilia is a Gram-negative bacillus that can act as an opportunistic pathogen in patients with respiratory diseases, including cystic fibrosis (CF) and ventilator-associated pneumonia. Infection with S. maltophilia is associated with worse lung function, but it remains unclear if this organism contributes directly to lung function decline. Lung infections are often polymicrobial, and S. maltophilia can be isolated from the lung with the key pulmonary pathogen Pseudomonas aeruginosa. In the first half of this work, we investigated the pathogenicity of S. maltophilia alone and during polymicrobial infection with P. aeruginosa. We used respiratory infections in mice to assess persistence …

Three Heads Are Better Than One: A Structural Look At Staphylococcal Bacteriophage Capsids, N'Toia Chivon Hawkins

All ETDs from UAB

Staphylococcal species such as S. aureus and S. epidermidis are opportunistic pathogens that are the leading causes of nosocomial infections. They have become of growing concern due to the virulence factors that they have acquired as well as their inability to be treated due to resistance to antibiotics. Bacteriophages have increasingly become a popular contender for eliminating these pathogens, however not every phage is suitable for the job. Size of the genome, life cycle, the ability to mobilize genomic material, and host range all factor into how well-suited a phage is to be used as a therapeutic. In this dissertation …

Health Disparities In Cardiometabolic Risk Among African American And European American Adults, Catharine A. Couch

All ETDs from UAB

African American (AA) individuals are disproportionately burdened by cardiometabolic disease, including type 2 diabetes (T2D) and cardiovascular disease (CVD), and associated risk factors. The objective of this dissertation research was to investigate pathophysiological and lifestyle contributors to racial disparities in cardiometabolic disease including beta-cell dysfunction, ectopic fat, the natriuretic peptide system, and diet. These first three risk factors, beta-cell dysfunction, ectopic fat, and the natriuretic peptide system, were explored in a cross-sectional study of young AA and European American (EA) adults. The fourth risk factor, diet, was explored in a large, national cohort of black and white adults. First, we …

Hedgehog Signaling Rewires M2 Macrophage And Regulatory T Cell Metabolism Within The Tumor Microenvironment Of Breast Cancer, Dominique C. Hinshaw

All ETDs from UAB

Current treatments for breast cancer offer little relief to patients with metastatic disease. A contributory factor to tumor growth and metastasis is aberrant up-regulation of developmental signaling pathways such as the Hedgehog (Hh) signaling pathway. This pathway is aberrantly activated in breast cancer and contributes to tumor progression and metastasis. The success of these events is highly influenced by the surrounding immune microenvironment. Macrophages exist along a spectrum of M1 (tumor-eradicating) to M2 (tumor-promoting), while regulatory T cells (Tregs) are an immunosuppressive cell type. The predominant functions of M2 macrophages and Tregs include dampening the immune response and promoting wound …

Intrinsically-Photosensitive Retinal Ganglion Cells And Their Functional Roles, Kevin Q. Chang

All ETDs from UAB

This project was conducted in Old World monkeys and focused on characterization of the intrinsically photosensitive retinal ganglion cells (ipRGCs) as they pertain to the pupillary light reflex, as well as on the neuroanatomical and electrophysiological characterization of the suprachiasmatic nucleus (SCN) of the hypothalamus as it pertains to circadian rhythms. A custom antibody was developed against the human melanopsin gene. We validated the antibody using western blot and immunohistochemistry. The functional role of ipRGCs in driving pupillary responses was investigated through immunotoxin-induced ablation in Rhesus macaques with the antibody conjugated to saporin. As hypothesized, the pupillary light reflex and …

Comprehensive Characterization Of Structural Variations Using Long-Read Sequencing Data, Yu Chen

All ETDs from UAB

Structural variants (SVs) contribute to genomic diversity and play pathogenic roles in a wide range of genetic disorders. Accurate characterization of SVs is critical for genomic research and studies of disease mechanisms. The rapid development of Third-Generation Sequencing (TGS) technologies has largely increased sequencing read length compared to Next-Generation Sequencing (NGS), bringing both great potentials and challenges in SV discovery through alignment-based and assembly-based approaches. In order to take full advantage of TGS data, I have developed a suite of bioinformatics tools focusing on comprehensive characterization of SVs. For the alignment-based SV discovery, I have developed DeBreak to identify SVs …