Medicine and Health Sciences Commons^™

Tunable Dual-Phase Dual-Drug Delivery System Using A Plga Microparticle/Pva Hydrogel Composite, Timothy John Eck

Theses and Dissertations

Current drug-eluting coatings have demonstrated controlled long-term, sustained release but have only tried to mitigate short-term burst release as a negative side effect. For applications like wound healing, there is a need for a drug-eluting coating which is adjustable in both short- and long-term release, independent of each other. We present a tunable dual-phase dual-drug delivery coating composed of drug-loaded polymer microparticles and drug-loaded hydrogel which can control short term and long term release individually in this study. This coating was created using lidocaine and dexamethasone encapsulated in poly(D,L-lactide-co-glycolide) particles combined with lidocaine- and dexamethasone-loaded poly(vinyl alcohol) hydrogel. Hydrogel drug …

Mri Image Regression Cnn For Bone Marrow Lesion Volume Prediction, Kevin Yanagisawa

Theses and Dissertations

Bone marrow lesions (BMLs), occurs from fluid build up in the soft tissues inside your bone. This can be seen on magnetic resonance imaging (MRI) scans and is characterized by excess water signals in the bone marrow space. This disease is commonly caused by osteoarthritis (OA), a degenerative join disease where tissues within the joint breakdown over time [1]. These BMLs are an emerging target for OA, as they are commonly related to pain and worsening of the diseased area until surgical intervention is required [2]–[4]. In order to assess the BMLs, MRIs were utilized as input into a regression …

Transportation Needs Of Older Adults In Suburban And Rural Areas, Dahai Han

Theses and Dissertations

The fact that the average age of the world's population is increasing, which is more pronounced in developed countries, necessitates the understanding of the challenges faced by older adults in accessing transportation services. With advancing age, individuals may experience age-related changes that can notably affect their driving capabilities, emphasizing the importance of alternative transportation alternatives. This challenge is more evident in suburban and rural settings, where transportation choices are limited, and older adults often find themselves without access to suitable transportation alternatives. Given that mobility plays an essential role in maintaining social connections, accessing healthcare services, and fulfilling daily needs, …

A Comparison Of Ground Reaction Forces And Muscle Activity Of The Tsunami Bar® Against A Rigid Barbell During Back Squat Phases, John Carver Middleton

Theses and Dissertations

An Institutional Review Board (IRB)-approved study was conducted to investigate the effects of the Tsunami Bar® (TB), a flexible barbell, on ground reaction force (GRF) production and muscle activity in the quadricep, hamstring, and gluteal muscle groups during phases of the squat exercise and compare the effects to the effects to using a rigid barbell (RB). A two-by-two repeated measures Analysis of Variance (ANOVA) test was used to compare the results. Descriptive statistics showed significantly higher GRFs for the TB during the unweighting phase, significant differences in GRFs between speeds for each phase, significantly higher forces on average with the …

Chemical And Polymer Characterization Of The Potential Modes Of Degradation Of An Injectable Nucleus Pulposus Replacement Device, Antonio G. Abbondandolo

Theses and Dissertations

HYDRAFIL™ is a poly(vinyl alcohol)/poly(ethylene glycol)-based hydrogel nucleus pulposus replacement device that is injected in situ and has demonstrated efficacy in lowering the prevalence and pain associated with back. In this work, we developed a method to analyze HYDRAFIL™ polymer composition using (TGA) and characterized intermolecular bonding interactions within the hydrogel through (FTIR). To function as a permanent implant for nucleus pulposus replacement, HYDRAFIL™ must be stable when exposed to a multitude of degradation pathways, namely, thermal, chemical, and mechanical. We subjected HYDRAFIL™ to accelerated thermal and chemical degradation pathways and described compositional, physical and chemical property changes using a …

Development Of A Crosslinked Osteochondral Xenograft And A Collagen Stabilizing Intra-Articular Injection To Remediate Cartilage Focal Lesions To Prevent Osteoarthritis, Mark Lewis Mosher

Theses and Dissertations

Osteoarthritis is one of the most common causes of disability in adults in America. It is a progressive and degenerative disease where the articular cartilage is broken down and lost from the surfaces of bones causing chronic pain and swelling in the joints, and currently has no cure. The most commonly osteoarthritis starts from a focal lesion on the cartilage surface, which will expand on the surface and downwards through the thickness of the tissue. The current gold standard for correcting cartilage focal lesions is the osteochondral autograft/allograft transplantation (OAT), which replaces the defect with a fresh osteochondral graft. The …

Full-Body Biomechanical Characterization Of Children With Hypermobile Ehlers-Danlos Syndrome During Gait And Activities Of Daily Living, Anahita Alahmoradiqashqai

Theses and Dissertations

Hypermobile Ehlers-Danlos syndrome (hEDS) is an inherited connective tissue disorder, often under-diagnosed, and presenting with frequent chronic pain and severe musculoskeletal symptoms that can drastically reduce the quality of life during one’s life span. While there are limited quantitative approaches in the literature on adult movements, the biomechanics of movements during activities of daily living (ADLs) in children have not been investigated comprehensively. Therefore, the primary purpose of this dissertation was to characterize the biomechanics of the musculoskeletal system and investigate the biomechanics of hEDS by quantifying joint dynamics and muscle activations during ADLs and gait in the pediatric population. …

Evaluating The Military Medical Evacuation Dispatching And Delivery Problem Via Simulation And Self-Exciting Hawkes Process, Virbon B. Frial

Theses and Dissertations

The location, allocation, and utilization of military medical evacuation (MEDEVAC) resources significantly impact the quality and timeliness of medical care to injured troops. In 2009, Secretary of Defense Robert Gates introduced the Golden Hour mandate that entails the evacuation of critically-injured troops to military treatment facilities (MTFs) within an hour to prevent further complications. To develop high-quality policies that improve MEDEVAC system performance, several papers in the current literature assume that MTFs have both the capacity and capability of treating any patient, regardless of the type of injury. However, these assumptions are unrealistic when conducting high-intensity operations. While acknowledging MTF …

Modeling Of Patient-Specific Periaortic Mechanics And Pulmonary Artery Hemodynamics Based On Phase-Contrast Magnetic Resonance Imaging Sequences., Johane H. Bracamonte

Theses and Dissertations

Inverse modeling in cardiovascular medicine is a collection of methodologies that can provide non-invasive patient-specific estimations of clinical risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs.

Herein, three different phase contrast magnetic resonance imaging (MRI) modalities were implemented as input data, displacement encoding with stimulated echoes (DENSE MRI) applied, and time-resolved velocity encoding phase-contrast MRI, in 1D and 3D, applied to pulmonary artery (PA) hemodynamics.

A model to account for the effect of periaortic interactions due to static and dynamic structures …

Theta Burst Brain Stimulation In Painful Diabetic Neuropathy Patients: Investigating Neural Mechanisms, Bhushan Thakkar

Theses and Dissertations

Chronic pain (CP) is a significant contributor to disability and disease burden globally. In 2019, approximately 50.2 million adults (20.4% of the US population) experienced chronic pain, contributing to $560-635 billion in direct medical costs. In addition, the worldwide prevalence of diabetes mellitus has reached epidemic proportions and is set to increase to 629 million by 2045. Almost 50% of patients with diabetes present with diabetic neuropathy (DN), and one in five patients with diabetes presents with painful DN (pDN) which is the most common cause of neuropathic pain (NP) in the US. Symptomatic treatment is the mainstay of management …

Therapeutic Approaches For Respiratory Distress Syndrome, Franck J. Kamga Gninzeko

Theses and Dissertations

Respiratory distress syndrome (RDS) is characterized by shortness of breath and low oxygen levels. RDS affects the neonatal and adult populations. In the neonatal population, RDS can be classified as NRDS (Neonatal respiratory distress syndrome), while in adults, it is known as ARDS (acute respiratory distress syndrome). This dissertation examines a therapeutic approach to NRDS and a mechanistic approach to ARDS with in vivo and in vitro models of lung injury. NRDS is characterized by a deficiency or lack of surfactant. Surfactant is an essential compound composed of phospholipids and proteins to prevent the lungs from collapsing. There are several …

Development And Optimization Of A Low Volume Air-Jet Dry Powder Inhaler (Dpi) Platform For The Delivery Of High Dose Aerosolized Powder To Infants, Connor Howe

Theses and Dissertations

The goal of this research project was to develop an infant air-jet dry powder inhaler (DPI) platform for high-efficiency nose-to-lung (N2L) aerosol administration to infants through optimization of individual system components followed by expansion of the system to higher doses and different formulations using a new approach. Primary challenges associated with aerosol delivery to infants using the N2L route include the extremely narrow extrathoracic airways, short inspiratory times (~0.2 sec), low safe airway pressure (H₂O), and very low volumes of air (~10 mL) available to form the aerosol. The infant air-jet DPI system was comprised of three main …

Effects Of Seat And Axle Position On Pain, Pathology, And Independence In Pediatric Manual Wheelchair Users With Spinal Cord Injury, Hannah Frank

Theses and Dissertations

Manual wheelchair (MWC) users with spinal cord injury (SCI) rely heavily on their upperextremities to complete daily occupations. Due to repetitive shoulder use during wheelchair mobility and propulsion, MWC users are at greater risk of shoulder pain and shoulder pathology, and thus decreased independence, and lower quality of life. The relative fit of the wheelchair and its parameters are critical and can further impact the user’s propulsion biomechanics. Parameters such as seat angle and axle position may put the user in detrimental shoulder positions for longer periods of time, impacting health outcomes even more. Although the effects of wheelchair setup …

Fabrication And Comparative Study Of Horizontal And Vertical Electrospun Protein-Polysaccharide Nanofiber Biomaterials, Ashley Rivera-Galleti

Theses and Dissertations

The use of biocompatible and biodegradable composite materials for biomedical applications has attracted the attention of many researchers in the past few years. In this study, we fabricated nanofibers of silk fibroin and cellulose and its derivatives to amalgamate their unique properties into a single material. The production of these nanofibers via electrospinning is of particular interest, and whereas several studies have been done on normal nanofibers, the formation of branched nanofibers is an exciting area not currently explored. Blend solutions are formed by dissolving silk and cellulose/cellulose acetate in formic acid separately and mixing to achieve the desired ratios. …

Establishing A Mechanistic Link Between Disturbed Flow And Aneurysm Formation In A 3d Cerebral Bifurcation Model, Nesrine Bouhrira

Theses and Dissertations

The effect of disturbed flow profiles on the endothelium have been studied extensively in systemic vasculature, but less is known about the response of the blood-brain barrier (BBB) to these flow regimes. Here we investigate the effect of steady and pulsatile disturbed flow on the integrity of the BBB using a three-dimensional, perfusable bifurcation model consisting of a co-culture of endothelial cells with mural and glial cells. Experimental flow patterns predicted by computational fluid dynamics mimic in vivo flow regimes, specifically the presence of a recirculation zone immediately downstream of the bifurcation reveal periodic changes in the instantaneous shear stress …

Nebulizer-Based Systems To Improve Pharmaceutical Aerosol Delivery To The Lungs, Benjamin M. Spence

Theses and Dissertations

Combining vibrating mesh nebulizers with additional new technologies leads to substantial improvements in pharmaceutical aerosol delivery to the lungs across therapeutic administration methods. In this dissertation, streamlined components, aerosol administration synchronization, and/or Excipient Enhanced Growth (EEG) technologies were utilized to develop and test several novel devices and aerosol delivery systems. The first focus of this work was to improve the poor delivery efficiency, e.g., 3.6% of nominal dose (Dugernier et al. 2017), of aerosolized medication administration to adult human subjects concurrent with high flow nasal cannula (HFNC) therapy, a form of continuous-flow non-invasive ventilation (NIV). The developed Low-Volume Mixer-Heater (LVMH) …

Intermittent Theta Burst Stimulation: Application To Spinal Cord Injury Rehabilitation And Computational Modeling, Neil Mittal

Theses and Dissertations

Loss of motor function from spinal cord injuries (SCI) results in loss of independence. Rehabilitation efforts are targeted to enhance the ability to perform activities of daily living (ADLs), but outcomes from physical therapy alone are often insufficient. Neuromodulation techniques that induce neuroplasticity may push the limits on recovery. Neuromodulation by intermittent theta burst transcranial magnetic stimulation (iTBS) induces neuroplasticity by increasing corticomotor excitability, though this has most frequently been studied with motor targets and on individuals not in need of rehabilitation. Increased corticomotor excitability is associated with motor learning. The response to iTBS, however, is highly variable and unpredictable, …

Survey Of Airflow Around A Heated Manikin As A Simulated Aeromedical Evacuation Patient On A Litter With Computational Fluid Dynamics Models, George P. Lemmer

Theses and Dissertations

Aeromedical Evacuations remain the predominant method used to transport patients from forward deployed areas of operations to secure locations with more robust medical infrastructure. Transportation of chemical warfare casualties and infectious patients require additional attention to prevent cross contamination. Specific airflow characteristics paired with environmental control system settings are a gap in scholarly literature. Based on the available literature computational fluid dynamics models were created to simulate the airflow around a patient represented by human geometry using commercially available software. In order to compare simulated and experimental results a heated manikin was placed in the MURPHEE aerosol exposure chamber and …

Toward Precision Medicine With Nanopore Technology, Trang Andrea Vu

Theses and Dissertations

Currently, when patients are diagnosed with cancer, they often receive a treatment based on the type and stage of the tumor. However, different patients may respond to the same treatment differently, due to the variation in their genomic alteration profile. Thus, it is essential to understand the effect of genomic alterations on cancer drug efficiency and engineer devices to monitor these changes for therapeutic response prediction. Nanopore-based detection technology features devices containing a nanometer-scale pore embedded in a thin membrane that can be utilized for DNA sequencing, biosensing, and detection of biological or chemical modifications on single molecules. Overall, this …

Patients’ Needs And Preferences Regarding Radiology Test Results On Patient Portals, Mansour Abdulaziz Almanaa

Theses and Dissertations

Introduction and significance: Radiology exams are an important part of health care. To enhance the quality of health care, health care services need to be delivered in ways that meet patients’ needs and preferences. Patients were found to be interested in the timely receipt of radiology test results. One of the easiest and fastest ways to deliver radiology test results to patients is via online patient portals. It seems, however, that the method of providing radiology test results through patient portals has not reached its full maturity; it still needs a great deal of improvement. Therefore, participation of the end-readers …

Examining Healthy Community Design Characteristics And Its Influence On Physical Health, Alvin T. Yip

Theses and Dissertations

Current trends in obesity rates associated with the community layout constitutes research towards understanding the interaction between the two in order to improve the public's physical health. Successes in healthy community planning studies for the public can be harnessed and implemented within the microcosm of military bases to yield similar results. Four factors were recognized through an in-depth academic literature review that showed positive influence on physical health and physical activity. They are access to green space, highly connected pedestrian and bicycle networks, access to public transportation, and integrated mixed land use. The four healthy planning strategies formed the necessary …

Preferred Treatment Methods For Patients With Inflammatory Bowel Disease, James L. Deitschel

Theses and Dissertations

Shared decision making is the concept of physicians involving patients in the treatment planning process. The University of Maryland Medical Center is interested in applying shared decision making to the treatment of patients with Inflammatory Bowel Disease (IBD). The two treatment methods analyzed in this study were medical management and surgery. To explore patient preferences between these two alternatives, a discrete choice experiment (DCE) was employed. The responses for the DCE were binary, so logistic regression models were explored. The conditional logistic regression model was determined to be the most appropriate for this analysis. After step-wise regression was performed, a …

The Impact Of Aging And Mechanical Injury On Alveolar Epithelial And Macrophage Responses In Acute Lung Injury And Inflammation, Michael S. Valentine

Theses and Dissertations

Patients with severe lung pathologies, such as Acute Respiratory Distress Syndrome (ARDS), often require mechanical ventilation as a clinical intervention; however, this procedure frequently exacerbates the original pulmonary issue and produces an exaggerated inflammatory response that potentially leads to sepsis, multisystem organ failure, and mortality. This acute lung injury (ALI) condition has been termed Ventilator-Induced Lung Injury (VILI). Alveolar overdistension, cyclic atelectasis, and biotrauma are the primary injury mechanisms in VILI that lead to the loss of alveolar barrier integrity and pulmonary inflammation. Stress and strains during mechanical ventilation are believed to initiate alveolar epithelial mechanotransduction signaling mechanisms that contribute …

Formulation And Validation Of Nanoparticle Controlled Delivery For Chemotherapeutic Drug Products, Shani L. Levit

Theses and Dissertations

Taxol, a formulation of paclitaxel (PTX), is one of the most widely used anticancer drugs, particularly for treating recurring ovarian carcinomas following surgery. Clinically, PTX is used in combination with other drugs such as lapatinib (LAP) to increase treatment efficacy. Delivering drug combinations with nanoparticles has the potential to improve chemotherapy outcomes. In this study, we use Flash NanoPrecipitation, a rapid, scalable process to encapsulate weakly hydrophobic drugs (logP in vitro. Encapsulating either PTX or LAP into nanoparticles increases drug potency. When PTX and LAP are co-loaded in the same nanoparticle, they have a synergistic effect that is greater than …

Strategies And Devices For Improving Respiratory Drug Delivery To Infants And Children With Cystic Fibrosis, Karl Bass

Theses and Dissertations

Cystic Fibrosis (CF) is a degenerative disease, which causes thickening of the airway surface liquid and reduced mucociliary clearance, which provides an ideal habitat for bacterial infections. Early treatment of CF in children can prevent chronic infection, improve quality of life, and increase life expectancy. The most predominant bacteria found in CF-diseased lungs is Pseudomonas aeruginosa (Pa), which can be treated with inhaled tobramycin. Excipient enhanced growth (EEG) powder formulations are well suited for administering tobramycin to children, as the EEG approach provides minimal upper airway loss and targeted drug delivery. This method uses an initially small aerosol for high …

Development Of A Torque-Based Device For The Quantification Of Arm Rigidity In Patients With Parkinson’S Disease, Georgina O. Miller

Theses and Dissertations

Parkinsonian rigidity is caused by the inability of the muscles to relax and extend properly, due to reduced dopamine levels and often begins on one side of the body before spreading contralaterally. The current standard for determining joint rigidity in a clinical setting is a test completed by the clinician based on the feel of the relaxed wrist and elbow joints as they are passively flexed and extended and a series of ordinal rating scales, the Movement Disorder Society’s – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr Scale (H&Y), and Parkinson’s Disease Questionnaire-39 (PDQ-39). These methods are used …

Data Science Methods For Standardization, Safety, And Quality Assurance In Radiation Oncology, Khajamoinuddin Syed

Theses and Dissertations

Radiation oncology is the field of medicine that deals with treating cancer patients through ionizing radiation. The clinical modality or technique used to treat the cancer patients in the radiation oncology domain is referred to as radiation therapy. Radiation therapy aims to deliver precisely measured dose irradiation to a defined tumor volume (target) with as minimal damage as possible to surrounding healthy tissue (organs-at-risk), resulting in eradication of the tumor, high quality of life, and prolongation of survival. A typical radiotherapy process requires the use of different clinical systems at various stages of the workflow. The data generated in these …

The Effect Of Intermittent Theta Burst Stimulation On Biceps Corticomotor Excitability In Non-Impaired Individuals And Individuals With Tetraplegia, Blaize Majdic

Theses and Dissertations

Neuromodulation of the primary motor cortex (M1) in pair with physical therapy may be a promising method for improving motor outcomes after spinal cord injury (SCI). Increased excitability of the corticospinal motor pathways (i.e. corticomotor excitability) has shown to be associated with improved motor learning and skill acquisition. Intermittent theta burst stimulation (iTBS) is a form of non-invasive brain stimulation which can increase corticomotor excitability, as measured by an increase in the amplitude of motor evoked potentials (MEPs). However, the ability for iTBS to increase the corticomotor excitability of proximal muscles such as the biceps, and muscles affected by spinal …

Astrocyte Sensitivity To Dopamine In Culture And Ex Vivo, Ashley L. Galloway

Theses and Dissertations

Dopamine is critical for processing of reward and etiology of drug addiction. Astrocytes throughout the brain express dopamine receptors, but consequences of astrocytic dopamine receptor signaling are not well established. This thesis illustrates effects of dopamine on cultured astrocytes and astrocytes in brain slices (ex vivo). In striatal cultures, extracellular dopamine triggered changes in astrocytic Ca²⁺ signaling and rapid concentration-dependent stellation of astrocytic processes that was not a result of dopamine oxidation, but instead relied on both cAMP-dependent and cAMP-independent dopamine receptor signaling. To isolate possible mechanisms underlying these structural and functional changes, whole-genome RNA sequencing was …

Epigenetic And Purinergic Regulation Of Mast Cells Mediator Release, Zahraa Abdulmohsin Mohammed

Theses and Dissertations

Mast cells (MCs) are well known for their implications in allergic reactions. They are also known to have multiple functions in the innate and adaptive immune system. Their activation plays an essential role in many aspects of physiological and pathological conditions. Allergies are considered chronic conditions that affect more than 60 million people in the U.S. These diseases are driven by the activation of MCs in response to IgE-mediated antigen, rendering these cells as targets for the management of allergies and asthma. Therefore, this research considers the understanding of their activation and the regulation of their response to be an …