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University of Alabama at Birmingham

Theses/Dissertations

2022

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Adverse Childhood Experiences: Connecting The Dots Between Early Life Stress And Asthma Aming Children And Adolescents With Sickle Cell Disease, Brandi Mcclain Pernell Jan 2022

Adverse Childhood Experiences: Connecting The Dots Between Early Life Stress And Asthma Aming Children And Adolescents With Sickle Cell Disease, Brandi Mcclain Pernell

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Sickle cell disease (SCD) is an inherited red blood cell disorder plagued by increased morbidity and premature mortality. Asthma disproportionally affects individuals with SCD and is strongly associated with an increased incidence of pain, acute lung complications and death among this high-risk population. Psychological stress is a well-established contributor and trigger for asthma development and exacerbations. Adverse Childhood Experiences (ACEs) are defined as traumatic experiences occurring before 18 years of age. ACEs occur at the individual, familial (Original-ACEs) and community level (Expanded-ACEs) and can accumulate with time. Chronic exposure to ACEs leads to toxic stress, widespread inflammation and risk for …

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Synergy Between Stenotrophomonas Maltophilia And Pseudomonas Aeruginosa During Polymicrobial Airway Infections, Melissa Skye Mcdaniel Jan 2022

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

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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 …

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Cell Type-Specific Diurnal Variation In Hippocampus Physiology, Lacy Kathryn Goode Jan 2022

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

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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 …

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Effects Of Covid-19 On Ventilator Associated Events (Vaes) Due To Multi-Drug Resistant Organisms (Mdros), Jeffery Asiedu Jan 2022

Effects Of Covid-19 On Ventilator Associated Events (Vaes) Due To Multi-Drug Resistant Organisms (Mdros), Jeffery Asiedu

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The aim of this study was to assess the association between the coronavirus disease (COVID-19) and the odds of ventilator associated events (VAEs). Retrospective analysis on prospectively collected data from 11,307 patients admitted to the intensive care unit (ICU) at the University of Alabama at Birmingham hospital between January 2018 and June 2022 was used. Outcomes considered were Any VAE, IVAC/PVAP, PVAP and MDRO PVAP. Crude and adjusted logistic regression models were used to evaluate the association between COVID-19 and the outcome variables. When a patient has Prior COVID-19, the odds of getting any VAE during the delta period is …

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Predictors Of Us Hospital Responsiveness To International Patient Inquiries, Suzanne M. Garber Jan 2022

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

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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, …

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The Role Of The Bone Marrow Microenvironment In Flt3-Itd Acute Myeloid Leukemia Stem Cell Resistance To Flt3 Inhibition, Nicholas R. Anderson Jan 2022

The Role Of The Bone Marrow Microenvironment In Flt3-Itd Acute Myeloid Leukemia Stem Cell Resistance To Flt3 Inhibition, Nicholas R. Anderson

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Acute myeloid leukemia (AML) is an aggressive, complex hematological malignancy. AML cases with constitutively-activating internal tandem duplications in the Flt3 receptor (Flt3-ITD) represent a distinct subtype of disease with poor prognosis, but unique opportunities for targeted therapy. Flt3-specific tyrosine kinase inhibitors (TKI) have entered clinical practice due to their ability to induce remissions in a large proportion of Flt3-mutant AML patients, but their long-term efficacy remains limited due to the persistence of leukemia stem cells (LSC) in the bone marrow (BM). Herein, we outline the importance of the bone marrow microenvironment (BMM) in harboring LSC through AML development and drug …

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Mevisit: Value-Based Approach To Primary Care Delivery By Mtelemedicine Utilization Applied Through Lean Principles, Neil Coyer Thornbury Jan 2022

Mevisit: Value-Based Approach To Primary Care Delivery By Mtelemedicine Utilization Applied Through Lean Principles, Neil Coyer Thornbury

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Background: Significant issues of inconsistent patient services in the U.S. health system impact health outcomes and create high cost. Limitations of immobility, inefficiency, and accessibility sacrifice patient treatment, delay recovery, and escalate health risks from the lack of primary care physicians. The primary purpose of this study was to examine meVisit, a connective mobile technology, as a feasible primary care solution to address escalating health costs by reducing emergency room (ER) visits and inpatient admissions (IA). Methods: The feasibility study applied descriptive and inferential statistics to secondary data (n=4,024) and compared the two independent patient groups from the same large …

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Effect Of Saliva Contamination On Crown Retention Strengths Of Resin And Rmgi Cements, Bushra Nizami Jan 2022

Effect Of Saliva Contamination On Crown Retention Strengths Of Resin And Rmgi Cements, Bushra Nizami

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Background: The most common contaminant in the oral cavity is saliva. Many studies have shown that contamination with saliva negatively affects the strength of the resin-dentin bond. A literature review by Nair et al reported that 64.6% of studies on the topic show a detrimental effect of salivary contamination on adhesive materials. No published studies were found that thoroughly studied the effects of saliva contamination on RMGIs and resin cements with regards to crown retention rates. Objective: To study the effect of salivary contamination on crown retention strengths of RMGI and resin cements at various stages of bonding and in …

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Low-Dose Dextromethorphan For The Treatment Of Pain In Fibromyalgia: A Single-Blind Placebo-Controlled Crossover Trial, Stephanie Christina Mueller Jan 2022

Low-Dose Dextromethorphan For The Treatment Of Pain In Fibromyalgia: A Single-Blind Placebo-Controlled Crossover Trial, Stephanie Christina Mueller

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Fibromyalgia (FM) is a debilitating chronic pain condition. Its pathophysiology is largely unknown, which has hindered the development of effective treatments. Central sensitization and neuroinflammation have been forwarded as models of FM pathophysiology, both of which indicate the antitussive drug dextromethorphan (DXM) as a potentially effective treatment. DXM is an N-Methyl-D-aspartic acid (NMDA)-receptor antagonist and microglial modulator with anti-neuroinflammatory properties at low doses. It is currently available for clinical use, but has not been tested as a treatment for FM at low dosages. The current study evaluated the effectiveness of DXM in treating FM-associated symptoms of pain, fatigue, cognitive problems, …

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Alzheimer Disease Special Care Units And Nursing Homes' Organizational Performance, Giovanna Pilonieta Ortiz Jan 2022

Alzheimer Disease Special Care Units And Nursing Homes' Organizational Performance, Giovanna Pilonieta Ortiz

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Alzheimer’s disease special care units (AD SCUs) have been adopted to provide specialized care for people with dementia in nursing homes. However, the effects of environmental and organizational factors on AD SCUs adoption by nursing homes and their influence on nursing homes' organizational performance remains unclear. Guided by Resource Dependence Theory, Donabedian’s Structure-Process-Outcome (SPO) framework and the Resource-Based View of Firms perspective, the purpose of the three papers included in this dissertation was to provide empirical evidence of the contextual and organizational factors that influence AD SCUs adoption among nursing homes and how the adoption of AD SCUs impact nursing …

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Applying Pet Imaging To Cancer Immunotherapy To Improve Clinical Outcomes, Kirsten M. Reeves Jan 2022

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

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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 …

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Influencing Factors Of Child Pedestrian Safety In Parking Lots And Residential Streets, Jenni Liveoak Jan 2022

Influencing Factors Of Child Pedestrian Safety In Parking Lots And Residential Streets, Jenni Liveoak

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There is ample data from epidemiological sources that suggest pedestrian risks to young children are a dire public health concern. However, there is very little scientific evidence to adequately understand this concern. Two observational studies revealed potential risks to young pedestrians in non-intersection locations. Both studies unobtrusively observed children between 2-10 years of age and an accompanying adult. First, 124 adult/child dyads were observed crossing from a parked vehicle to the building entrance of six local YMCA locations. Results of this study indicate that adult supervision was inadequate with over 67% of children observed to be unsupervised in the parking …

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The Role Of Protein Translation And Degradation In Aging And Alzheimer Disease Pathogenesis, Harper S. Kim Jan 2022

The Role Of Protein Translation And Degradation In Aging And Alzheimer Disease Pathogenesis, Harper S. Kim

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Protein translation (PT) is an essential cellular process playing crucial roles in growth and development. PT precipitously declines with age in multiple animal species, including humans. It has been implicitly assumed that elevated PT at young ages is beneficial to health while PT ends up dropping as a passive byproduct of aging. However, whether this holds true and how dynamic fluctuations in PT over time impact aging remain unknown. In Drosophila, we show that a transient PT spike in early-adulthood drives aging by triggering dysfunction in protein homeostasis (proteostasis) at old ages. We propose the early-adulthood spike in PT to …

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The Role Of Mitochondrial Genetic Background In Cellular Function, Response To Cell Stress And Disease Susceptability, Jamelle A. Brown Jan 2022

The Role Of Mitochondrial Genetic Background In Cellular Function, Response To Cell Stress And Disease Susceptability, Jamelle A. Brown

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There is a differential susceptibility associated with several diseases including cardiovascular disease (CVD) and hypertension, with Blacks being more likely to develop these conditions. Blacks are also more likely to die from these diseases. To explain the genetic etiology underlying CVD pathogenesis, the primary focus has been on nuclear genetics-environmental interactions, whereas the contribution of mitochondrial genetics is less explored. Therefore, we sought to determine whether differences exist in cellular function and response to cell stress in healthy and diseased individuals with distinct mitochondrial genetic backgrounds. To determine this, we sought first to develop a technique to detect and quantify …

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Effeccts Of Hiv-1 Tat On Tspo, A Biomarker Of Neuroinflammation, Nguyen Thuy Nhu Nguyen Jan 2022

Effeccts Of Hiv-1 Tat On Tspo, A Biomarker Of Neuroinflammation, Nguyen Thuy Nhu Nguyen

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HIV-associated neurocognitive disorders (HAND) produces serious neurological dysfunction for > 50% of people living with HIV (PLWH). As antiretroviral therapy (ART) has transformed HIV into a chronic disease, and since most ART does not effectively cross the blood brain barrier, HAND is predicted to further increase in prevalence in PLWH. The HIV-Trans-Activator of Transcription (Tat) is known to persist in the central nervous system (CNS) of chronically infected HIV+ individuals. In several preclinical studies, HIV-Tat has been shown to be neurotoxic and important for HIV pathogenesis. Translocator protein (TSPO), an 18 kDa mitochondrial protein, has been shown to be increased via …

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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 Jan 2022

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

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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, …

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A Value-Based Framework For Process Alignment In Complex Provisioning Systems, Michael Lipscomb Jan 2022

A Value-Based Framework For Process Alignment In Complex Provisioning Systems, Michael Lipscomb

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Provisioning systems are human-built, process-based systems whose activities are directed toward providing something of value to another entity. The things provided are not limited to any one type but may include, for example, objects, services, and information. Systems under consideration herein are limited to those that are human based, decentralized, and complex. “Human based” means that many of the agents and all the customers of the system are human. “Decentralized” means that agents act beyond central control. Such a system presents different challenges from one in which tasks are delegated from a central authority. In a decentralized system, agents are …

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Roles Of Chemokine Receptors In T Cell Accmulation In Omental Tumors, Mingyong Liu Jan 2022

Roles Of Chemokine Receptors In T Cell Accmulation In Omental Tumors, Mingyong Liu

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The omentum is an adipose tissue in the peritoneal cavity that contains immune aggregates termed milky spots. Functionally similar to conventional lymphoid tissues, these specialized leukocyte clusters harbor effector and suppressor cells, mount immune responses to antigens, and sustain peritoneal homeostasis. However, the pre-existing leukocytes fail to protect the tissue from tumor colonization. In fact, the omentum is frequently involved in peritoneal metastasis, during which the balance between effector and suppressor immune cells is compromised with the latter gaining dominance. Regulatory T cells (Tregs) represent a major immunosuppressive population in the omentum and rapidly accumulate after tumor implantation. The increased …

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Integrated Phenotypic And Molecular Expression Circuits In End-Stage Osteoarthritis, Devin J. Drummer Jan 2022

Integrated Phenotypic And Molecular Expression Circuits In End-Stage Osteoarthritis, Devin J. Drummer

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Osteoarthritis (OA) is a debilitating, inflammatory, joint degeneration disorder, and is the most common form of arthritis. Individuals reaching end-stage OA often pursue elective total hip/knee arthroplasty (THA/TKA) to relieve pain and improve mobility and quality of life. However, approximately one third of THA/TKA patients suffer long-term mobility impairments following surgery, likely in part due to an inability to repair the damaged muscle surrounding the diseased joint. Mechanisms driving this impaired recovery remain poorly understood, therefore it is prudent to interrogate the molecular signatures in skeletal muscle at the time of surgery to provide candidate markers that may improve upon …

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Regional Variations In The Incidence Of Brain Glioma In Adults In Alabama, Mina Lobbous Jan 2022

Regional Variations In The Incidence Of Brain Glioma In Adults In Alabama, Mina Lobbous

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Purpose: Gliomas are the most common primary brain tumor in adults in the US with an annual age-adjusted incidence rate of 4.67 to 5.73 per 100,000 persons. Exposure to ioniz-ing radiation is the only established risk factor for non-hereditary glioma risk. There are several sources of carcinogenic contaminants in northeast Alabama and western Georgia with the Coosa River serving as the region’s primary water source. In this study, we aimed to examine the incidence rate of glioma in northeast Alabama compared to the rest of the state as well as the association of possible environmental exposure on disease risk and …

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Child Schooling And Other Factors Associated With Covid-19 Vaccine Hesitancy Among Adults That Had Not Been Vaccinated In The Fall Of 2021, Ryan M. Fischer Jan 2022

Child Schooling And Other Factors Associated With Covid-19 Vaccine Hesitancy Among Adults That Had Not Been Vaccinated In The Fall Of 2021, Ryan M. Fischer

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Although COVID-19 vaccine hesitancy decreased noticeably over time during the first months of 2021, there was still a high degree of vaccine hesitancy in the United States at the time that the vaccine first became available to adolescents. Data from Phase 3.2 of the U.S. Census Bureau’s Household Pulse Survey (July 21 – October 11th, 2021) was used to conduct an ecological study on COVID-19 vaccine hesitancy that investigated associations between vaccine hesitancy and socio-demographic characteristics as well as child school type (public school, private school, homeschool). Subjects that had not received a vaccine at the time of survey data …

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Guided Exploration Of Military Servicewomen's Healthcare Experiences And Related Outcomes (Gems Hero), Princess Victoria Jane Nash Jan 2022

Guided Exploration Of Military Servicewomen's Healthcare Experiences And Related Outcomes (Gems Hero), Princess Victoria Jane Nash

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Purpose: This study focuses on factors related to healthcare seeking behaviors and utilization of Veterans Affairs primary care services by female African American Veterans. The purpose of this mixed methods study is to assess what factors influence seeking care at VA healthcare facilities. Research Design: This study used a modified explanatory sequential mixed methods design to assess health services utilization and healthcare experiences of African American female Veterans. This research utilized items from the Health Belief model as a guiding framework to highlight factors that could impact VA healthcare utilization. Methodology: Health services utilization analysis used national data from the …

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A Population-Based Assessment Of Severe Maternal Morbidity Among Non-Hispanic Black Women In The United States, Lisa R. Allen Jan 2022

A Population-Based Assessment Of Severe Maternal Morbidity Among Non-Hispanic Black Women In The United States, Lisa R. Allen

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Non-Hispanic Black women (Black women) are disproportionately affected by adverse maternal health outcomes as compared to women of other races. Little is known about the distribution of adverse maternal health outcomes among Black women. Using the 2014 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), a nationally representative sample of hospital discharges in the United States (U.S.) from January 1 through December 31, 2014, we examined severe maternal morbidity (SMM) experienced during delivery hospitalization among Black women. We conducted population-based, cross-sectional studies to examine the distribution of SMM prevalence; assess within-race …

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Effects Of Different Types Of Augmented Feedback On Spatiotemporal Gait Performance And Intrinsic Motivation With Individuals Post Stroke, Saleh M. Alhirsan Jan 2022

Effects Of Different Types Of Augmented Feedback On Spatiotemporal Gait Performance And Intrinsic Motivation With Individuals Post Stroke, Saleh M. Alhirsan

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After a stroke, an individual can be left with physical and psychological deficits, including decreased walking speed, reduced step length, and reduced intrinsic motivation. These deficits affect their performance during rehabilitation sessions, limit daily activities such as walking and stepping, and restrict participation in social roles that involve mobility. Current clinical practice guidelines recommend providing augmented feedback using virtual reality (VR) to enhance walking outcomes after six months of stroke onset. This dissertation shows two novel VR applications designed, especially for individuals’ post-stroke, to induce their fast-walking speed and maximum step length performance, and intrinsic motivation. Three performance conditions were …

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Bacterial Community Structures And Species Delimitation Of Five-Armed Luidia In The Northern Gulf Of Mexico, Michelle D. Shilling Jan 2022

Bacterial Community Structures And Species Delimitation Of Five-Armed Luidia In The Northern Gulf Of Mexico, Michelle D. Shilling

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Luidia spp. (Family Luidiidae) are important predators in the benthic food web and are abundant in near-shore, shallow soft-bottom habitats throughout the northern Gulf of Mexico. Climate change-related environmental changes, such as ocean warming and acidification, are rapidly intensifying in this region and can have consequences for species diversity as well as individual sea star health through modification of host-associated bacterial communities. Our knowledge of sea star-associated bacterial community structure and dynamics is limited and conflicting genetic evidence has called into question the accuracy of species delimitation of five-armed Luidia in the northern GOM. The primary purpose of this dissertation …

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Il-22 Mediated Host Defense During Attaching-Effacing Pathogen Infection, Baiyi Cai Jan 2022

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

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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 …

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Behavioral, Environmental, Social, Psychosocial, And Physiological Factors That Impact The Relationship Between Chronic Lung Disease Status And Susceptibility To Electronic Cigarette Use Or Actual Electronic Cigarette Use, Mohammed M. Alqahtani Jan 2022

Behavioral, Environmental, Social, Psychosocial, And Physiological Factors That Impact The Relationship Between Chronic Lung Disease Status And Susceptibility To Electronic Cigarette Use Or Actual Electronic Cigarette Use, Mohammed M. Alqahtani

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There is surge increase in e-cigarettes among adult vulnerable population such as individuals with chronic lung disease (CLD). Currently, there is a lack of understanding of the factors that may lead to the increase use of e-cigarettes or susceptibility of ecigarette use among individuals who have a history of CLD. Thus, it is crucial to recognize the characteristics of the individuals with CLD and adults without CLD who are susceptible to using e-cigarettes because this may pave the way for the prevention and reduction of tobacco use by identifying the different factors and eventually targeting the related risk factors. In …

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Invisible No More: Lgbtq History & Archiving Projects At Universities In The South, Maigen Sullivan Jan 2022

Invisible No More: Lgbtq History & Archiving Projects At Universities In The South, Maigen Sullivan

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LGBTQ history within the US South is rich and diverse though it has remained mostly absent from mainstream and academic narratives around LGBTQ history generally. In recent years, there has been a growing effort to location, preserve, research and make accessible to the community the history of the Queer and Trans South. Despite stereotypes of the South as a hyper-conservative, homophobic, and transphobic region, many public history and community archiving projects have begun on public universities across the South. This qualitative constructivist grounded theory research explored the ways in which LGBTQ public history and community archiving projects on public universities …

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The Role Ofbiomechanics In Vascular Endothelial Growth Factor Receptor-2 Signaling, Bronte Miller Jan 2022

The Role Ofbiomechanics In Vascular Endothelial Growth Factor Receptor-2 Signaling, Bronte Miller

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Angiogenesis, or the growth of new vasculature from existing blood vessels, is widely considered a primary hallmark of cancer progression. When a tumor is small, diffusion is sufficient to receive essential nutrients; however, as the tumor grows a vascular supply is needed to deliver oxygen and nutrients into the increasing mass. Several anti-angiogenic cancer therapies target VEGF and its receptor VEGFR-2, which are major promoters of blood vessel development. Unfortunately, many of these cancer treatments fail to completely stop angiogenesis in the tumor microenvironment (TME). Since these therapies focus on the biochemical activation of VEGFR-2 via VEGF ligand binding, we …

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Optimal Antero-Posterior Position Of The Maxillary Central Incisors And Its Relationship To The Forehead In Adult Hispanic Females, Balraj Bains Jan 2022

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

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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 …

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