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Biomanufacturing Of Micro-Myocardial Tissue Through Suspension Differentiation With Improved Yields, Purity, And Quality, Asher M. Kahn-Krell Jan 2022

Biomanufacturing Of Micro-Myocardial Tissue Through Suspension Differentiation With Improved Yields, Purity, And Quality, Asher M. Kahn-Krell

All ETDs from UAB

Despite major advances in revascularization and drug therapy for post-myocardial infarction (MI) heart failure (HF), heart transplantation remains the only curative therapy to prevent progressive and debilitating disease. Researchers have long sought a replenishable and expandable source of cardiomyocytes (CMs), the primary functional cell in the heart muscle, for a broad array of applications related to the treatment of HF ranging from direct implantation to high throughput drug testing. The lack of cell cycle activity and cell division in adult CMs prevented the development of an expandable primary cell line. However, with the discovery of high efficiency stem cell differentiation …


Pkd-1 Signaling Inthe Regulation Of Cancer Stem Cell-Like Features And Cancer Cell Interactions With Endothelial Cells In Breast Cancer And Pancreatic Neuroendocrine Tumor, Yichen Hailey Guo Jan 2022

Pkd-1 Signaling Inthe Regulation Of Cancer Stem Cell-Like Features And Cancer Cell Interactions With Endothelial Cells In Breast Cancer And Pancreatic Neuroendocrine Tumor, Yichen Hailey Guo

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Cancer stem cells (CSCs) are a subpopulation cancer cells that play critical roles in tumor progression, recurrence, metastasis, and drug resistance. CSCs are characterized by self-renewal and plasticity. Protein kinase D-1 (PKD-1) signaling regulates CSC/stemness features in both breast cancers and pancreatic neuroendocrine tumors. In PNETs, PKD-1 signaling regulates not only stemness properties of cancer, but also epithelial-mesenchymal transition (EMT). PNETs are typically well vascularized and heterogeneous. Everolimus (an mTOR inhibitor and the 2nd generation derivative of rapamycin) has been approved as a targeted chemotherapy for PNET patients. Unfortunately, nearly all patients will progress on treatment due to drug resistance …


Exploring The Influence Of Family History Before And After Type 2 Diabetes Development Through Statistical Analysis Of Biomarkers And An Educational Intervention, Jessica Johnson Denton Jan 2022

Exploring The Influence Of Family History Before And After Type 2 Diabetes Development Through Statistical Analysis Of Biomarkers And An Educational Intervention, Jessica Johnson Denton

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The prevalence of type 2 diabetes is increasing at an alarming rate in both children and adults worldwide. Timely identification of those at risk for type 2 diabetes is essential to reduce morbidity and mortality and to mitigate the toll on families and the healthcare system. Family history is an effective, universal tool that can be used to identify individuals at risk for type 2 diabetes before they acquire additional risk factors. Understanding how family history contributes to biomarkers associated with diabetes in healthy individuals could facilitate the creation of early screening and prevention strategies designed for this specific at-risk …


Il-2-Mediated Stat3 Activation Controls Effector T Regulatory Cell Development, Emma C. Dean Jan 2022

Il-2-Mediated Stat3 Activation Controls Effector T Regulatory Cell Development, Emma C. Dean

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Heterogeneity in phenotype and function of Treg cells is becoming increasingly appreciated, especially in the context of creating potent Treg cell–based therapeutics in the treatment of inflammatory bowel disease. One of the barriers to developing such therapeutics is the limited understanding of the signals that play a role in the development of Treg cell subsets. Here, we found STAT3 signaling to be enriched in induced IL-10 competent Treg (iTreg) cells in the colon. Through the development of a new in vitro system, we found that STAT3 was required for proper development of IL-10 competent iTreg cells and that IL-2 regulated …


History Of Allergy, Atopy, Infectious And Autoimmune Disease And Risk Of Multiple Myeloma, Tony B. Zbysinski Iii Jan 2022

History Of Allergy, Atopy, Infectious And Autoimmune Disease And Risk Of Multiple Myeloma, Tony B. Zbysinski Iii

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Multiple Myeloma (MM) is a plasma cell malignancy, which is defined in part by antibodies and complexes of immunoglobulin (Ig) heavy and light chains (IgH and IgL). Previous associations of immune-stimulating conditions such as allergic, autoimmune, and infectious conditions and the risk of multiple myeloma (MM) are inconsistent. However, these studies were conducted in populations of European ancestry, leaving the possibility that these conditions may contribute to the excess risk of plasma cell proliferative disorders observed among Black Americans. Therefore, we assessed MGUS, a precursor condition to myeloma, and MM risk related to a history of allergy, atopy, infections and …


Epigenetic Regulation By O-Glcnac Alters Anti-Fibrotic Gene Expression In Ipf Fibroblasts, Qiuming Wu Jan 2022

Epigenetic Regulation By O-Glcnac Alters Anti-Fibrotic Gene Expression In Ipf Fibroblasts, Qiuming Wu

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Idiopathic pulmonary fibrosis (IPF) is an age-related chronic disease with a me-dian survival period of 3-4 years [1]. Although FDA has approved two drugs that may slow the disease process, there is no effective treatment [2]. IPF is characterized by the excessive deposition of collagen, which leads to deformation of alveolar structure, loss of lung function, and ultimately death [3]. Anti-fibrotic genes such as cyclooxygenase-2 (COX-2) and Heme Oxygenase 1 (HMOX-1) are usually suppressed in the pathogenesis of IPF [4-6], while the mechanisms responsible for the repression of anti-fibrotic genes in IPF are incompletely understood. More evidence has shown that …


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 …


Labor Union Membership Tenure And Midlife Health: A Gendered Perspective, Clifford Ross Jan 2022

Labor Union Membership Tenure And Midlife Health: A Gendered Perspective, Clifford Ross

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The benefits of labor unions have not gone unstudied. Individuals in labor unions have better access to lower cost/more substantial health insurance plans, higher quality pension plans, and better wages leading to increased lifetime earnings. Even though many of these benefits create important pathways that could lead to better health, unions have been paid little attention in health literature. Additionally, in the modern workplace Mothers are offered lower starting salaries, are perceived as less competent, and face a penalty regarding hiring, promotion, and workplace educational opportunities. Compared to men, women with children see an income gap 20 cents wider than …


A Comparison Of Growth Factor Release Between Platelet Rich Fibrin And Recombinant Human Platelet Derived Growth Factor Bb (Rhpdgf-Bb) And Beta-Tricalcium Phosphate: An In Vitro Analysis, Maggie Ann Misch Jan 2022

A Comparison Of Growth Factor Release Between Platelet Rich Fibrin And Recombinant Human Platelet Derived Growth Factor Bb (Rhpdgf-Bb) And Beta-Tricalcium Phosphate: An In Vitro Analysis, Maggie Ann Misch

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Patients presenting with significant alveolar bone loss can pose challenges for the clinician. Traditional bone augmentation techniques may be inadequate in achieving necessary gains to restore missing teeth with dental implants. The adjunctive use of growth factors may accelerate the healing process and enhance tissue regeneration. GEM21S is a product that includes a recombinant growth factor approved by the Federal Drug Administration for oral surgery. It is delivered as a two-component system: 1) recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and 2) betatricalcium phosphate (β-TCP).[1] The research on GEM 21S for ridge augmentation is mostly limited to case studies.[2- 4] Biologically, …


Evaluating Cannabinoid Interference And Drug Stability In Oral Fluid For Dui/D Testing, Jasmine Maxwell Jan 2022

Evaluating Cannabinoid Interference And Drug Stability In Oral Fluid For Dui/D Testing, Jasmine Maxwell

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Oral fluid (OF) drug testing was first applied in the workplace and pain management facilities, and is now being applied to DUI/D (Driving Under the Influence of Drugs) cases to help establish probable cause and for laboratory evidentiary confirmation. OF drug testing is efficient due to its easy, fast, gender-neutral and OF sample collection is minimally invasive compared to blood and urine. The objective of this study is to investigate the stability of cannabinoids in OF specimens over time. Limit of detection and potential matrix and analyte interference will also be evaluated. The ANSI/ASB Standard 036 for Method Validation in …


A Systematic Study Of Data Security Issues In Smart Home Iot Devices, Hilal Nur Issi Jan 2022

A Systematic Study Of Data Security Issues In Smart Home Iot Devices, Hilal Nur Issi

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The best description of IoT comes from the International Telecommunication Union (ITU), which defines it as "a global infrastructure for the information society, enabling advanced services by interconnecting things based on existing and evolving interoperable information and communication technologies" (ITU, 2013). Different things, equipment, and household are employed in daily living in our world. The advantages that smart technology provides have piqued the curiosity of academics and practitioners alike. Home appliances have received a lot of attention, since smart technology has been extensively explored and put into practice. A great deal of research has gone into automating the house, making …


A 15-Year Retrospective Analysis On After-Hours Dental Emergencies In A Children's Hospital Setting, Alexandra An-Yen Chen Jan 2022

A 15-Year Retrospective Analysis On After-Hours Dental Emergencies In A Children's Hospital Setting, Alexandra An-Yen Chen

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Dental emergencies are one of the most common oral health complications and can exhibit a detrimental impact on a child’s physical and psychological development; additionally, it may impose economic challenges for the family. Purpose: The purpose of this study was to analyze the after-hours dental emergency visits in the past 15 years at the Children’s of Alabama (COA) Hospital Emergency Department. Methods: A retrospective chart review between January 2007 and December 2021 was conducted. Patients’ demographics, type of dental complaint, and management were evaluated for overall characteristics in the 15 years and trends in 5-year increments. The impact of the …


Evaluation Of Repair Strength Of Conventional, Milled, And Printed Resin Provisional Crown Materials With Different Surface Treatments And Repair Resins, Bright Jesuk Chang Jan 2022

Evaluation Of Repair Strength Of Conventional, Milled, And Printed Resin Provisional Crown Materials With Different Surface Treatments And Repair Resins, Bright Jesuk Chang

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Statement of Problem: Provisional (also known as interim or transitional) restorations are important in fixed prosthodontics to evaluate long-term esthetics, phonetics, and function while protecting the tooth preparation from bacterial infiltration and maintaining periodontal health. Recent advances in CAD/CAM technologies have allowed these restorations to be either milled or printed. However, there is a lack of literature regarding the repair and reline of these milled and/or printed restorations. Purpose: To evaluate the repair strength of conventional, milled, and printed resin provisional crown materials with different surface treatments and repair resins. Materials and Methods: This in vitro study examined the shear …


The Shifting Nature Of Empire: Vandalia And Other Plans For New Colonies West Of The Allegheny Mountains Before The American Revolution, Michael Davis Jan 2022

The Shifting Nature Of Empire: Vandalia And Other Plans For New Colonies West Of The Allegheny Mountains Before The American Revolution, Michael Davis

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North American westward expansion following the end of the Seven Years’ War is a subject that has been dealt with by many historians from both sides of the Atlantic. The American push west of the Allegheny Mountains facilitated political divisions and divergent visions that would advance the push for independence from the British Empire and contribute to the creation of a new authority and a new kind of empire. This paper focuses on one aspect of this significant area of late-colonial and early republican American history. New western colonial schemes emerged from the ashes of the global war with France …


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 …


Adaptive Functioning And Academic Achievement In Survivors Of Childhood Acute Lymphoblastic Leukemia: Associations With Executive Functioning And Socioeconomic Status, Victoria C. Seghatol-Eslami Jan 2022

Adaptive Functioning And Academic Achievement In Survivors Of Childhood Acute Lymphoblastic Leukemia: Associations With Executive Functioning And Socioeconomic Status, Victoria C. Seghatol-Eslami

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No abstract provided.


Predictors And Disparities Associated With Pain (Pandda-P) Study: A Comparison Of Pediatric Rheumatology Patients, Kathryn Ann Thompson Jan 2022

Predictors And Disparities Associated With Pain (Pandda-P) Study: A Comparison Of Pediatric Rheumatology Patients, Kathryn Ann Thompson

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Background: Chronic pain is a prominent feature of many pediatric rheumatic conditions. However, the diagnosis, experience, and treatment of musculoskeletal pain varies by condition. Therefore, the overall aim of the present study is to elucidate group differences and examine biopsychosocial correlates of pain in children with juvenile idiopathic arthritis (JIA), juvenile primary fibromyalgia syndrome (JPFS), non-specific chronic pain (NSCP), and pain-free controls.Methods: We recruited 117 (66% female, 73% White) school-aged children from Children’s of Alabama Rheumatology and Allergy Clinics and the community. Participants self-reported their pain, physical function, sleep, pain-related stigma, and somatic symptoms and underwent experimental pain tasks. Caregivers …


Examining Family Health Through Family-Centered Care Within An Organizational Context, Bria Kathryn Morgan Jan 2022

Examining Family Health Through Family-Centered Care Within An Organizational Context, Bria Kathryn Morgan

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Introduction: Family health is characterized as a multi-dimensional process that is shaped by a number of social determinants. Similar to individual health, various domains work in conjunction and intersect to produce family health. Family-centered care is one of the many ways that healthcare providers can support health, however, little is known about if and how it is beneficial for family health. Considering the relevance of an organizational context, this study seeks to understand the delivery of care within an organization and providers’ perceptions of family-centered care. Data/Methods: Using the case of the Ronald McDonald House, this study integrates qualitative content …


Three Essays On Federally Qualified Health Centers: Competition, Patient-Centered Medical Home Adoption, Quality Quartiles Ranking And Financial Performance, Hani Al-Maliki Jan 2022

Three Essays On Federally Qualified Health Centers: Competition, Patient-Centered Medical Home Adoption, Quality Quartiles Ranking And Financial Performance, Hani Al-Maliki

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he following three essays examine the Federally Qualified Health Center (FQHC) industry. The first essay attempts to provide a description on what constitutes a competitive environment for FQHCs located in California, the second explores the impact of FQHC market competition on Patient Centered Medical Home (PCMH) adoption, and the third essay aims to test the relationship between the adoption of PCMH and FQHCs’ performance. The first essay utilizes Porter's Five Forces model to identify competitive forces in the FQHCs environment to fill a gap in the literature. Building on the first essay, the second essay using Porter’s generic strategies explores …


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 …


Applying The Hospitalist Model Of Care To Cardiovascular Acute Care Delivery, Ginger K. Biesbrock Jan 2022

Applying The Hospitalist Model Of Care To Cardiovascular Acute Care Delivery, Ginger K. Biesbrock

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The hospitalist model for managing patients in the hospital setting has been in existence for over 20 years. The hospitalist model for non-specialty care has been found to improve the efficiency of care, maintain quality of care, and support a higher degree of guideline adherence. However, there has been little research focusing on the use of the hospitalist model for specialty care. As cardiovascular programs have begun to adopt the hospitalist model, many are asking if this model is more effective than the traditional model. The main concern is the potential disruption to the patient-physician relationship that occurs with the …


Access To The Kidney Transplant Waitlist For People Living With Hiv, Brittany A. Shelton Jan 2022

Access To The Kidney Transplant Waitlist For People Living With Hiv, Brittany A. Shelton

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People living with HIV (PLWH) have experienced substantial increases in life expectancy, largely attributable to improvements in care such as antiretroviral therapy. As a result, there has been a concurrent increase in the development of aging-related comorbidities such as end-stage organ disease. One such comorbidity is kidney disease. Concerningly, PLWH are at disproportionately higher risk of chronic kidney disease and end-stage kidney disease (ESKD) as compared to HIV-negative counterparts. Kidney transplantation is the ideal therapy for ESKD as it is both cost-effective and provides a significant survival benefit and yet, despite excellent transplant outcomes among PLWH, access to transplantation among …


Targeting The Frataxin Transcriptional Defect As A Therapeutic Approach For Friedreich's Ataxia, Anna Maria Schreiber Jan 2022

Targeting The Frataxin Transcriptional Defect As A Therapeutic Approach For Friedreich's Ataxia, Anna Maria Schreiber

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Friedreich’s ataxia (FRDA) is the most common inherited ataxia worldwide. This autosomal recessive neurodegenerative disorder manifests in the central and peripheral nervous system but also affects the cardiovascular and endocrine systems. No effective treatment is available. FRDA is caused by expansion of GAA repeat tracts in intron 1 of the frataxin (FXN) gene on both alleles. An inverse correlation between FXN levels and GAA repeat length exists. Frataxin is a mitochondrial protein participating in iron-sulfur (Fe-S) cluster formation. Frataxin deficiency results in reduced activity of Fe-S-containing enzymes involved in critical biological processes, such as cellular respiration and DNA repair. Expansion …


Non-Mean Ambulatory Blood Pressure Monitoring Parameters And Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-Based Studies, Swati Sakhuja Jan 2022

Non-Mean Ambulatory Blood Pressure Monitoring Parameters And Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-Based Studies, Swati Sakhuja

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High mean blood pressure (BP) on ambulatory BP monitoring (ABPM) is a strong risk factor for left ventricular hypertrophy (LVH), an early manifestation of hypertension-related cardiovascular disease (CVD). Typically, 48-72 systolic and diastolic BP (SBP and DBP) readings are obtained on a 24-hour ABPM recording. The large number of readings from ABPM allows for the estimation of parameters beyond mean BP that capture level and fluctuation in BP over 24-hours, which may be useful for identifying individuals at high risk for CVD. The measures of BP level other than mean BP obtained from ABPM recording include BP load (percentage of …


An Examination Of The Relationship Between The Role Of The Chief Diversity Officer And Hospital Financial Performance And Patient Experience Measures, Kemberly L. Blackledge Jan 2022

An Examination Of The Relationship Between The Role Of The Chief Diversity Officer And Hospital Financial Performance And Patient Experience Measures, Kemberly L. Blackledge

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Healthcare organizations drive to achieve hospital measures has much to do with strategies put in place by the executive leadership team and resources of the firm. Forces such as regulatory changes reducing hospital payments and external forces such as social injustices leave executives turning to innovative ways to improve the bottomline. This study examined the Chief Diversity Officer (CDO) and the relationship with hospitals measures of financial performance and patient experience for hospitals with a CDO and without a CDO. Hospitals with a CDO can deploy organizational strategies such as diversity management and cultural competencies. These strategies are important because …


Restoring The Sphingolipid Balance In Glioblastoma, Cyntanna C. Hawkins Jan 2022

Restoring The Sphingolipid Balance In Glioblastoma, Cyntanna C. Hawkins

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Glioblastoma (GBM) is a highly aggressive brain tumor with a median survival of 15 months even with standard of care—surgical resection, radiotherapy, and chemotherapy. Two of the key characteristics contributing to this malignancy are its highly invasive phenotype and resistance to the chemotherapy, temozolomide (TMZ). We, and others, have identified the sphingolipid balance as a driver of these phenotypes with dysregulated sphingolipid metabolism seen in GBM patient samples. The ceramidases, specifically acid ceramidase (ASAH1), mediate the balance between ceramides and sphingosine-1-phosphate (S1P). ASAH1 breaks down ceramides ultimately forming S1P. While ceramides induce cell death, S1P promotes migration and cell survival. …


Analysis Of Excess Mortality At The County Level In Alabama By Socioeconomic Factors, Abigail Jo Tucker Jan 2022

Analysis Of Excess Mortality At The County Level In Alabama By Socioeconomic Factors, Abigail Jo Tucker

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Objective: Analyze county level socioeconomic factors and their association with Covid-19 excess mortality in Alabama.Methods: Linear regression analyses were used to evaluate the association between potential risk factors assessed using the American Community survey (n = 40 counties and county clusters) and excess mortality in 2020 per 100,000 population. Excess mortality came from a previously published paper by Ackley et al. Results: Median household income (per 1,000 dollars); an average county median household income that 1,000 dollars higher was associated with 6 per 100,000 lower excess mortality (β= -5.953 p-value


The Role Of Nitric Oxide And Cyclic Guanosine Monophosphate Signaling In Arteriovenous Fistula Maturation, Maheshika S. Somarathna Jan 2022

The Role Of Nitric Oxide And Cyclic Guanosine Monophosphate Signaling In Arteriovenous Fistula Maturation, Maheshika S. Somarathna

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Vascular access is the single most important component of the hemodialysis procedure and the arteriovenous fistula (AVF) is the most preferred type. However, 60% of AVFs created fail to mature successfully for dialysis use (AVF maturation failure). AVF maturation failure is primarily the result of 1) intimal hyperplasia formation (IH) and 2) poor vascular outward remodeling. Currently, a major unmet clinical need in the field is the lack of effective therapies to treat/prevent AVF maturation failure due to the poor understanding of molecular mechanisms. This proposal is designed to: 1) elucidate the pathologic significance of nitric oxide (NO) and cyclic …


Leaders Of 21st Century Education: A Study Of School Administrator Perceptions Of Technology In Alabama, Caroline M. Obert Jan 2022

Leaders Of 21st Century Education: A Study Of School Administrator Perceptions Of Technology In Alabama, Caroline M. Obert

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School leaders occupy a crucial position to implement new initiatives in schools. Due to advancing education technology, school administrators are expected to adjust and improve their competencies to meet the current educational technology demands. This research study aims to investigate Alabama school administrators’ technological leadership behaviors based on their self-reported perceptions. Also, differences in leadership behaviors across demographics were explored. The research study involved a quantitative non-experimental research design using Schoenbart’s (2019) research study approach as the study template. Participants included Alabama elementary, middle, and high school administrators. Data were collected using the online ELTS questionnaire version. Data were analyzed …


Tissue Engineered Cardiac Muscle Patches With Human Pluripotent Stem Cells Enhance The Repairing Efficacy Of Infarcted Cardiac Muscle In Mouse Model, Xi Lou Jan 2022

Tissue Engineered Cardiac Muscle Patches With Human Pluripotent Stem Cells Enhance The Repairing Efficacy Of Infarcted Cardiac Muscle In Mouse Model, Xi Lou

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Myocardial infarction (MI) remains one of the major contributors to heart failure, which can lead to death, and there has been a lack of effective treatments so far. Human pluripotent stem cells (hPSCs) have been found to be an encouraging candidate for MI treatment. But it is facing challenge of low engraftment, limited integration of transplanted cells with host myocardium. To enhance the therapeutic efficacy of stem cell therapy of MI treatment, two approaches have been explored: 1)The first approach was to overexpress N-cadherin (CDH2), a cell-cell adhesion molecule, in human induced pluripotent stem cell-derived cardiomyocytes (CDH2-hiPSC-CMs), and examine its …