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Articles 1 - 30 of 115
Full-Text Articles in Medicine and Health Sciences
An Exploratory Study Of The Influence Of Perceived Organizational Support, Coworker Social Support, The Nursing Practice Environment, And Nurse Demographics On Burnout In Palliative Care Nurses, Marcia Ann Lowe
All ETDs from UAB
AN EXPLORATORY STUDY OF THE INFLUENCE OF PERCEIVED ORGANIZATIONAL SUPPORT, COWORKER SOCIAL SUPPORT, THE NURSING PRACTICE ENVIRONMENT, AND NURSE DEMOGRAPHICS ON BURNOUT IN PALLIATIVE CARE NURSES MARCIA A. LOWE SCHOOL OF NURSING ABSTRACT Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in healthcare, including nursing, medicine, and social work. Working with palliative care patients and their families is innately challenging and may predispose nurses to burnout. The purpose of this study is to examine the influence of perceived organizational support (POS), coworker social support, the nursing practice environment, and nurse …
The Strategy Of Federally Qualified Health Centers: The Influence Of Context And Performance Implications, Seongwon Choi
The Strategy Of Federally Qualified Health Centers: The Influence Of Context And Performance Implications, Seongwon Choi
All ETDs from UAB
The three papers included in this dissertation attempt to provide empirical evidence on the relationship among strategies employed by Federally Qualified Health Centers (FQHCs), the contextual factors and consequent performance. The findings of these studies contribute to the existing body of literature on FQHC strategies and performance. In addition, the findings also provide key practical implications to FQHC managers as well as policymakers. Overall, the results of this dissertation suggest that the FQHC strategy on spatial differentiation is associated with a set of organizational and environmental factors. However, there was little support for the relationship between Medicaid expansion and FQHC …
Nursing Staff Approaches To Providing Oral Hygiene In Stroke Survivors With Dysphagia: A Grounded Theory Study, Willard Edward Brewer
Nursing Staff Approaches To Providing Oral Hygiene In Stroke Survivors With Dysphagia: A Grounded Theory Study, Willard Edward Brewer
All ETDs from UAB
The purpose of this qualitative grounded theory study was to explore how the nursing staff approaches oral hygiene in stroke survivors with dysphagia during the rehabilitation phase of recovery and what guides their decisions. Oral hygiene is a proven effective task known to prevent systemic health disparities (i.e. aspiration pneumonia, diabetes, gastrointestinal disparities, and even stroke). However, there are no current evidenced-based guidelines that provide instruction on how to execute oral hygiene to stroke survivors with dysphagia. Little is known about how nurses make decisions to implement oral hygiene in stroke survivors with dysphagia. Using a theoretical sampling strategy, data …
Examining The Role Of Perceived Benefits And Barriers In Physical Activity Behavior For Cancer Prevention And Control, Matthew Cole Ainsworth
Examining The Role Of Perceived Benefits And Barriers In Physical Activity Behavior For Cancer Prevention And Control, Matthew Cole Ainsworth
All ETDs from UAB
Physical activity (PA) is important for health outcomes like breast cancer, but most U.S. adults do not meet recommended guidelines. Behavioral theories like the Social Cognitive Theory (SCT) have demonstrated success in PA behavior change, but perceived benefits and barriers are understudied. PA time barriers are shared between healthy and cancer survivor populations, and study of time use in breast cancer survivors using mobile phone technology like the Life in a Day (LiaD) app would support future intervention development. We conducted 3 studies to investigate benefits and barriers to PA in adults and time use among breast cancer survivors to …
Non-Surgical Correction Of Anterior Open Bites Using Temporary Anchorage Devices, Kimberly Spencer Butts
Non-Surgical Correction Of Anterior Open Bites Using Temporary Anchorage Devices, Kimberly Spencer Butts
All ETDs from UAB
Objective: The purpose of this study is to determine the skeletal, dental and soft tissue effects that occur as a result of maxillary posterior TAD intrusion; to compare treatment outcomes of growing patients to a growing matched control group; and to present a simplified TAD intrusion technique. Methods: This is a retrospective cohort study using lateral cephalometric radiographs of 16 (5 male, 11 female, average age 38y 4m) non-growing patients and 16 (5 male, 11 female, average age 13y 11m) growing patients with anterior open bite malocclusions treated with temporary anchorage devices (TADs) to intrude the maxillary posterior segments. Growing …
Novel Biomarkers For Parkinson Disease, Shijie Wang
Novel Biomarkers For Parkinson Disease, Shijie Wang
All ETDs from UAB
Parkinson disease (PD) is the second most common neurodegenerative disorder with no reliable biochemical biomarkers for disease prediction or progression, nor disease-modifying treatments to slow the relentless progression. Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are known to increase LRRK2 kinase activity and increase the risk for late-onset PD. In this thesis, I discovered that LRRK2 is secreted into exosomes in urine and CSF, where LRRK2 kinase activity, reflected by autophosphorylation at pS1292 site, is preserved and reflective of cytosolic LRRK2 levels. In a cohort of biosamples from LRRK2 mutation carriers and matched controls, with and without PD, …
Characterization Of Chemical Uptake And Aryl Hydrocarbon Receptor Mutations In Zebrafish, Jaclyn Paige Souder
Characterization Of Chemical Uptake And Aryl Hydrocarbon Receptor Mutations In Zebrafish, Jaclyn Paige Souder
All ETDs from UAB
In a society driven by technology and industry, we must be increasingly aware of how changes to our environment impact our health. This is especially true concerning embryonic development, which is easily influenced by extra-embryonic factors, including environmental contaminants. Determining how exogenous compounds are absorbed, which receptors they act through, and how these receptors act endogenously is important to fully understand to what extent developmental exposures impact fetal and adult health. I have used the zebrafish model system to address these questions for two classes of environmentally-relevant chemicals—estrogens and dioxins. First, I developed an assay to measure the uptake of …
The Closed Eye As A Model For Dry Eye Disease, Cameron Kenneth Postnikoff
The Closed Eye As A Model For Dry Eye Disease, Cameron Kenneth Postnikoff
All ETDs from UAB
Every night, during sleep, the tears of the closed eye become significantly more inflammatory, with a notable influx of neutrophils. Preliminary studies suggested that these neutrophils were significantly different than blood-isolated neutrophils, with an increased concentration, upregulated surface expression of inflammatory membrane receptors, but inability to respond to inflammatory stimuli. The purpose of this dissertation was to better understand the contribution of this neutrophil population to ocular surface homeostasis and dry eye disease. Chapter One presents an introduction to the tear film and ocular surface, along with an introduction to dry eye disease and neutrophil biology. Chapter One also discusses …
Investigating The Relationship Between Nurse Burnout And Self-Reported Medication Administration Errors In Alabama Hospitals, Aoyjai Prapanjaroensin
Investigating The Relationship Between Nurse Burnout And Self-Reported Medication Administration Errors In Alabama Hospitals, Aoyjai Prapanjaroensin
All ETDs from UAB
Background: Approximately 30% to 60% of nurses report high levels of burnout worldwide. Nurse burnout may impact vigilance and job performance. Nursing job performance may decrease due to lowered alertness if nurses have high levels of burnout, and this issue may be related to the act of committing a medication error. Of the very few studies exploring the relationship between nurse burnout and medication errors, the findings are conflicting. The purpose of this study is to examine the relationship between nurse work environment characteristics, burnout levels and self-reported medication administration errors as well as patient safety grades among nursing staff …
Receptor Sialylation By St6gal-I Promotes Tumor Progression By Enhancing Tumor Cell Survival And Epithelial To Mesenchymal Transition, Colleen Maeve Britain
Receptor Sialylation By St6gal-I Promotes Tumor Progression By Enhancing Tumor Cell Survival And Epithelial To Mesenchymal Transition, Colleen Maeve Britain
All ETDs from UAB
The upregulation of a certain subset of glycosyltransferases was an early marker for cancer development. Specifically, ST6Gal-I, which adds an α2-6 linked sialic acid to N-glycans on proteins bound for the plasma membrane or secretion, is selectively upregulated upon malignant transformation. Our laboratory has shown that ST6Gal-I is implicated in many facets of tumor biology and is an important mediator of tumorigenesis. For example, ST6Gal-I activity promotes the survival of cells when challenged with hypoxia, FasL, or TNFα, confers resistance to chemotherapeutics, enhances tumor cell migration and invasion, and fosters a cancer stem cell phenotype. The work presented in this …
A Survey Of Shoulder Injuries In Commercial Truck Drivers Using A Retrospective Medical Record Review, Bryan Combs
A Survey Of Shoulder Injuries In Commercial Truck Drivers Using A Retrospective Medical Record Review, Bryan Combs
All ETDs from UAB
Introduction: Musculoskeletal injuries in the occupational setting have significant impact on the worker, employer, and healthcare system. Commercial truck drivers (CTD) experience some of the highest rates of injury, missed days of work, and workers’ compensation costs compared with other workers. In this population, back injuries occur most commonly, followed by shoulder injuries which require 5 times more days away from work. Commercial truck drivers are significantly impacted by shoulder injuries; however, little is known about the unique mechanisms of injury, specific injuries, or possible preventative measures among this group of workers. Methods: A retrospective medical record review was completed …
Investigating The Rho-Kinase (Rock) Signaling Pathway As A Therapeutic Target In Alzheimer’S Disease, Benjamin Wade Henderson
Investigating The Rho-Kinase (Rock) Signaling Pathway As A Therapeutic Target In Alzheimer’S Disease, Benjamin Wade Henderson
All ETDs from UAB
Current estimates project that there are approximately 5.4 million Americans affected by Alzheimer’s disease (AD). While this number is expected to dramatically increase in the years to come, there is currently no disease modifying therapeutic to prevent or slow AD progression. Cognitive decline is a clinical hallmark of AD, while accumulation of amyloid-β (Aβ) is a pathological hallmark. Work in the field has demonstrated that mitigating Aβ levels may serve as a rational therapeutic avenue to slow progression of the disease. Pharmacologic inhibition of the Rho-associated protein kinases (ROCK1 and ROCK2) is proposed to curb Aβ levels, and mechanisms that …
Assessing Diabetes Risk Among Hispanic Populations: Development And Validation Of A Risk Score Using Readily Available Information, Lucia Juarez
All ETDs from UAB
Background: Diabetes prevalence is increasing worldwide affecting vulnerable popula-tions, in particular Hispanics living in the United States (U.S.). The burden of diabetes and its complications can be reduced by identifying those at high risk and routing them to treatment and intensive behavioral interventions. Aim: The aim of this study is to develop and validate a simple score to identify undiag-nosed diabetes among Hispanics living in the U.S. Methods: A representative sample of Hispanics living in the U.S. was used to develop and validate the score. Logistic regression was used to identify significant risk factors and model coefficients were used to …
Smile Outcome Comparison Of Orthodontic Cases Treated With Different Extraction Patterns, Gregory Long
Smile Outcome Comparison Of Orthodontic Cases Treated With Different Extraction Patterns, Gregory Long
All ETDs from UAB
Extraction of premolar teeth for orthodontic purposes is a common treatment approach. The effects of premolar extraction on the occlusion and the face have been studied extensively in the past. To date, however, the effects of premolar extractions on the smile have not been comprehensively quantified in the literature. The purpose of this study was to compare the smile outcome of patients treated with premolar extractions. Methods: This retrospective case-control study established 4 groups of 33 patients each for comparison. Three groups of patients with the same malocclusion were treated with different premolar extraction patterns. The remaining group of patients …
Healthcare Cybersecurity: Building A Cyber Vulnerability Profile For U.S. Hospitals, Gemini O. Majkowski
Healthcare Cybersecurity: Building A Cyber Vulnerability Profile For U.S. Hospitals, Gemini O. Majkowski
All ETDs from UAB
Digital transformation in healthcare has offered exponential advances in capabilities and efficiencies improving access, quality of care, chronic disease management, public health surveillance, and population health. However, the speed of change left security lagging, exposing cyber vulnerabilities that cost the U.S. $6.2 billion dollars annually, at an average cost of $2.2 million dollars, and 3,128 records breached per incident. Despite significant investments to close the gap on cyber vulnerabilities, cybersecurity remains a critical issue. Little research has been done to build a cyber vulnerability profile for U.S. hospitals. In this study, U.S. hospitals with reportable breach and without reportable breach …
Characterizing The Hiv-1 Envelope N-Glycan Shield, Audra Ann Hargett
Characterizing The Hiv-1 Envelope N-Glycan Shield, Audra Ann Hargett
All ETDs from UAB
In 2017, there was an estimated 1.8 million new HIV-1 infections worldwide. Development of an effective HIV-1 vaccine would begin to quell this global pandemic. HIV-1 envelope (Env) glycoprotein is the main vaccine candidate target due to the immune systems ability to generate broadly neutralizing antibodies (bnAbs) against Env. Approximately 90 N-glycans form a glycan shield that is the primary interface between the virus and host immune system. Key glycan motifs within the glycan shield are targets for bnAbs and are necessary for HIV-1 infectivity. Herein, we explore how naturally occurring mutations alter the glycan shield and HIV-1 Env function. …
Applying Markov Processes To Model Disability In Relapsing Multiple Sclerosis Patients, Anastasia Hartzes
Applying Markov Processes To Model Disability In Relapsing Multiple Sclerosis Patients, Anastasia Hartzes
All ETDs from UAB
Modeling disability in multiple sclerosis (MS) is challenging due to its complexity and non-linearity, with utilized methodology having many limitations. Lack of a suitable biomarker has led to relying on statistical models to understand disease progression. Markov methodology has been limitedly applied to the clinically-assessed Expanded Disability Status Score (EDSS), but not to patient-reported Patient Determined Disease Steps (PDDS); both measure disease progression and disability, and neither have been analyzed using the Test of Lumpability (TOL). It is common practice to aggregate these scores for computational or inferential convenience; in the case of Markov Chains (MC), combining states is referred …
Regulation Of St6gal-I In Cancer: Sox2 Identified As Novel Driver Of St6gal-I Expression, Kaitlyn Alexandra Dorsett
Regulation Of St6gal-I In Cancer: Sox2 Identified As Novel Driver Of St6gal-I Expression, Kaitlyn Alexandra Dorsett
All ETDs from UAB
ST6Gal-I is a sialyltransferase that functions to add an 2-6 linked sialic acid to N-linked glycoproteins. The expression of ST6Gal-I is upregulated in many cancers at both the mRNA and protein levels. ST6Gal-I has also been shown to promote cancer stem cell (CSC) characteristics including chemoresistance, tumor-initiating potential, and spheroid growth. However, the transcriptional drivers of ST6Gal-I expression in stem-like cells remain largely unknown. Herein we highlight that SOX2 and ST6GAL1 are both located on one of the most commonly amplified chromosomal segments in cancer, amplicon 3q26. Copy number gains in both SOX2 and ST6GAL1 are observed in roughly 25% …
Competitive Strategies Of Hospitals: Antecedents And Association With Financial Performance, Akbar Ghiasi
Competitive Strategies Of Hospitals: Antecedents And Association With Financial Performance, Akbar Ghiasi
All ETDs from UAB
In this three-paper dissertation, first, we examined the relationship between strategic group membership and hospital financial performance in terms of operating margin. The results revealed the important role of strategy on financial performance of a hospital. In the second paper, organizational and environmental antecedents of hospital’s business strategy choice were studied. The results showed that environmental and organizational factors may predict the business strategy choice of hospitals. The third paper investigated the moderating effect of environmental instability on the relationship between strategic group membership and financial performance. Environmental instability does not strongly affect the relationship between hospital strategic group membership …
Baf Chromatin Landscaping During Bone Formation And Maintenance, Tanner Cole Godfrey
Baf Chromatin Landscaping During Bone Formation And Maintenance, Tanner Cole Godfrey
All ETDs from UAB
Bone loss is a worldwide problem resulting in increased risk of fracture. Osteoblasts are responsible for bone synthesis; therefore, treatments promoting osteoblast differentiation and/or activity would result in increased bone formation. The regulation of DNA accessibility is a key mechanism controlling gene expression and cellular differentiation. BAF (BRG1 Associated Factor) mediated chromatin remodeling increases DNA accessibility by sliding or ejecting nucleosomes. This process can occur in a cell type specific manner based on the composition of BAF. In many tissue types, a unique combination of BAF subunits has been identified to be responsible for the maintenance or differentiation of that …
O-Glcnac Regulation Of Inhibitory Circuits, Kavitha Abiraman
O-Glcnac Regulation Of Inhibitory Circuits, Kavitha Abiraman
All ETDs from UAB
Post translational modification of proteins plays a crucial role in regulating their function, and the role of one such modification, termed O-GlcNAcylation, is understudied. O-GlcNAcylation involves the dynamic cycle of adding and removing an O-linked N-acetylglucosamine (O-GlcNAc) by the enzymes O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA), which are highly expressed in the hippocampus. Enzymes that catalyze O-GlcNAcylation are found at both presynaptic and postsynaptic sites, and O-GlcNAcylated proteins localize to synaptosomes. We have shown that acute and selective increase in O-GlcNAcylation of AMPAR GluA2 subunits underlies expression of a novel form of LTD at CA3-CA1 synapses (O-GlcNAc LTD), as well …
The Smile Attractiveness Of Patients Successfully Treated According To The Finishing Standards Of The American Board Of Orthodontics, Tayem Abou Saleh
The Smile Attractiveness Of Patients Successfully Treated According To The Finishing Standards Of The American Board Of Orthodontics, Tayem Abou Saleh
All ETDs from UAB
Smiling is the most useful way people can use to express their emotions, therefore, it is critical to build our treatment plan not just around establishing a stable functional occlusion but also to achieve beautiful harmonious smile. It has been suggested that the smile may be made up of 3 components: Gingival component, soft tissue component, and dental component, and the ultimate smile beauty can be achieved by trying to find the balance in between these components. We collected 68 smiling photos for cases were taken to American board of orthodontics clinical exam and they were considered successfully treated, all …
Identifying Associated Risk With Exposure Ti Weapon Carrying Among Emerging Adults Living In Disadvantaged Urban Areas In Birmingham, Tolulope Aduroja
Identifying Associated Risk With Exposure Ti Weapon Carrying Among Emerging Adults Living In Disadvantaged Urban Areas In Birmingham, Tolulope Aduroja
All ETDs from UAB
IDENTIFYING ASSOCIATED RISK WITH EXPOSURE TO WEAPON CARRYING AMONG EMERGING ADULTS LIVING IN DISADVANTAGED URBAN AREAS IN BIRMINGHAM TOLULOPE ADUROJA HEALTH EDUCATION/HEALTH PROMOTION ABSTRACT Weapon carrying is a public health concern due to its association with a serious injury, disability or death, and adverse health-related outcomes. Weapon carrying among youth is associated with both intrinsic or internalizing and extrinsic or externalizing factors (Stayton, 2011). Violence in youth and young adults is the 2nd leading cause of death (homicide) in Alabama. Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from …
Identification And Application Of Gingival Mesenchymal Stem Cells For Dental Tissue Regenration, Yousuf Al-Aboosi
Identification And Application Of Gingival Mesenchymal Stem Cells For Dental Tissue Regenration, Yousuf Al-Aboosi
All ETDs from UAB
Mesenchymal stem cells have been very attractive treatment modality in regenerative medicine, but not so much in regenerative dentistry. This can be attributed to the difficulty in obtaining dental origin stem cells without extracting a tooth or other invasive procedures. Autogenous gingival graft harvested from palatal tissue is used as the gold standard for treating single tooth recession. The healing of the gingival graft has been shown to be mostly depended on the recipient side more than the graft itself. This study is aiming to find if the palatal tissue has cells with mesenchymal characteristics that are helping in the …
[68ga] Labeled Radiopharmaceuticals For Diagnostic Applications Beyond Sstr And Psma Imaging, Abdullah Alosaimi
[68ga] Labeled Radiopharmaceuticals For Diagnostic Applications Beyond Sstr And Psma Imaging, Abdullah Alosaimi
All ETDs from UAB
Imaging with radiolabelled peptides is an important technique used in medical imaging fields that can lead to significant advances in patient care. These tracers are utilized to target a variety of receptors, in particular, specific-receptors which are overexpressed on tumor cells. Recently, the application of Positron Emission Tomography (PET) radiotracers for medical imaging has grown significantly due to the high sensitivity and specificity of this technique. In particular, 68Ga is one of the most favorable PET radioisotopes, due to its short half-life, low radiation dose, generator production, and same day imaging procedures. [68Ga]-DOTATATE, which targets somatostatin receptors (SSTR) overexpressed on …
Bioactive Materials: Ion Release & Recharge, Wear, Gloss & Hydroxyapatite Formation, Mohammed Badahman
Bioactive Materials: Ion Release & Recharge, Wear, Gloss & Hydroxyapatite Formation, Mohammed Badahman
All ETDs from UAB
Introduction : Dental caries is one of the most prevalent chronic diseases 1. Unfortunately, there have been numerous failures with the treatment rendered, the materials used and how they are used. One significant cause for dental restoration failure is secondary caries and the need to replace the existing restoration. It has been reported that more than half of the restorations placed have been replaced because of recurrent caries. New materials and techniques have been developed to enhance adhesives in dentistry and improve the bonded interface however that interface still remains the weakest component of composite restorations. Marginal degradation and the …
Mechanisms Of Acute Kidney Injury: The Role Of Ferritin Heavy Chain In Renal Heme-Unology, Laurence Marie Black
Mechanisms Of Acute Kidney Injury: The Role Of Ferritin Heavy Chain In Renal Heme-Unology, Laurence Marie Black
All ETDs from UAB
The kidneys are complex, multi-faceted organs that are responsible for regulatory processes, such as fluid homeostasis, hormone production, blood pressure regulation, and systemic toxin removal. Sudden disruption of these processes by acute kidney injury (AKI) causes rapid decline in renal function as well as significant morbidity and mortality. AKI is a significant clinical concern, affecting up to 13.3 million people globally each year and has the propensity to progress to chronic kidney disease (CKD), though the mechanism remains undefined. One reason for this is due to the lack of understanding of models used to study both AKI and CKD, hindering …
Significance Of Acculturation, Assimilation, And Allostatic Load As Risk Factors For Obesity Among Hispanics, Yenni Elvia Cedillo
Significance Of Acculturation, Assimilation, And Allostatic Load As Risk Factors For Obesity Among Hispanics, Yenni Elvia Cedillo
All ETDs from UAB
Obesity has increased during the last two decades in the United States (U.S.) and is considered a major risk factor for chronic diseases within the Hispanic community. The burden of obesity in Hispanics is associated with higher rates of morbidity and mortality and an increase in healthcare costs. Hispanics’ challenges after migration extend to subsequent generations, putting the population at risk for disease development. Specifically, migration can lead to the adoption of health behaviors, beliefs, values, and language of the host country, a process known as acculturation, which has been associated with changes in health behaviors. Among the Hispanic population, …
St6gal-I Mediated Sialylation Promotes Pancreatic Ductal Adenocarcinoma Progression And Chemoresistance, Asmi Chakraborty
St6gal-I Mediated Sialylation Promotes Pancreatic Ductal Adenocarcinoma Progression And Chemoresistance, Asmi Chakraborty
All ETDs from UAB
ST6Gal-I adds α2-6 sialic acids to select N-glycosylated cell surface receptors, thereby modulating receptor function and intracellular signaling. ST6Gal-I is upregulated in various carcinomas and confers cancer stem cell (CSC) properties evidenced by tumorspheroid growth, chemoresistance and tumor initiating potential. In pancreatic ductal adenocarcinoma (PDAC), ST6Gal-I conferred gemcitabine resistance by abrogating DNA damage and altering expression levels of gemcitabine metabolism genes. Further, ST6Gal-I promoted resistance to chronic gemcitabine treatment. Additionally, metastatic clones of a PDAC cell line had increased ST6Gal-I expression and ST6Gal-I knockdown enhanced gemcitabine sensitivity. To investigate the physiological consequences of ST6Gal-I in PDAC, murine models were used. …
A Study Of Enamel Thickness Of Permanent Maxillary Canines, Daniel Diaz Rubayo
A Study Of Enamel Thickness Of Permanent Maxillary Canines, Daniel Diaz Rubayo
All ETDs from UAB
Introduction: Tooth agenesis is defined as the lack of development of a tooth. Maxillary lateral incisors have been reported to be missing in 2.2% of the population in the United States of America. Two treatment options are available: opening the space to restore the missing tooth with a dental prosthesis; or close the space by moving the adjacent teeth into the space and substituting the missing lateral incisor with the maxillary canine. With a wider crown and a more convex labial surface than lateral incisors, canines require a significant amount of reduction in order to achieve an adequate occlusion and …