Medicine and Health Sciences Commons^™

Regulation Of The Mouse And Human Β-Globin Genes By Krüppel Like Transcription Factors Klf1 And Klf2, Yousef N. Alhashem

Theses and Dissertations

Krüppel-like factors KLF1 and KLF2 are closely related transcription factors with three zinc finger domains in their carboxy-termini. KLF1 (erythroid Krüppel-like factor, or EKLF) plays essential roles in embryonic and adult erythropoiesis. KLF2 is a positive regulator of the mouse and human embryonic β- globin genes. KLF1 and KLF2 have overlapping roles in embryonic erythropoiesis, as demonstrated using single and double knockout (KO) mouse models. Ablation of the KLF1 or KLF2 gene causes embryonic lethality, and double KO embryos are more anemic and die sooner than either single KO. We have shown that KLF1 and KLF2 positively regulate the human …

Noun Clauses In Clinical Child Language Samples, Christine Beate Scoville

Theses and Dissertations

Noun clauses are grammatical constructions that are of relevance both to typical language development and impaired language development. These clauses have been part of published techniques for the clinical analysis of language samples, and computer software for the automated analysis of clinical language samples has attempted to identify noun clauses, with limited success. The present study examined the development and clinical use of noun clauses as well as the automated identification of these clauses. Two sets of language samples were examined. One set consisted of 10 children with specific language impairment (SLI) whose age ranged from 7;6 to 11;1 (years;months), …

From Linkage To Gwas: A Multifaceted Exploration Of The Genetic Risk For Alcohol Dependence, Amy Adkins

Theses and Dissertations

Family, twin and adoption studies consistently suggest that genetic factors strongly influence the risk for alcohol dependence (AD). Although the literature supports the role of genetics in AD, identification of specific genes contributing to the etiology of AD has proven difficult. These difficulties are due in part to the complex set of risk factors contributing to the development of AD. These risk factors include comorbidities with other clinical diagnoses and behavioral phenotypes (e.g., major depression), physiological differences that contribute to the differences between people in their level of response to ethanol (e.g., initial sensitivity) and finally the large number of …

Medication-Related Problems Experienced By Patients During Transitions To Assisted Living, Deanna Flora

Theses and Dissertations

Medication reconciliation is a systematic and comprehensive review of medication regimens during care transitions aiming to prevent adverse drug events. Poorly executed transitions negatively impact patient welfare and cause financial burden. Medication-related problems (MRPs) experienced during transitions to an assisted living facility (ALF) were evaluated. Data was collected from pharmacy records for transitions to an ALF over three months, including demographics, medications, potentially inappropriate medications, and MRPs. MRPs were categorized and summarized using descriptive statistics. Forty-five patients (71% female) experienced 59 transitions. Average age was 85.6 years. Median length of stay away from the ALF was three days. There were …

The Economic Burden Of Opioid Poisoning In The United States And Determinants Of Increased Costs In Opioid Poisoning, Timothy Inocencio

Theses and Dissertations

Introduction: Opioid poisoning has been rapidly increasing in the past decade, and has been driven in large part due to increases in opioid prescribing. This has been accompanied by intervention efforts aimed at preventing and reversing opioid poisoning through naloxone prescription programs. Current literature have not quantified the economic burden of opioid poisoning. Understanding this information can help inform these efforts and bring light to this growing problem. In addition understanding various determinants of increased costs can help to identify the types of populations more likely to have greater costs. Main Objectives: The objectives are 1) to quantify the economic …

Text Messaging As Adjunct To Community Based Weight Management Program, Claudia Bouhaidar

Theses and Dissertations

Obesity ascending rates are still a public health priority. The primary aim of the study was to evaluate the effect of tailored text messages on body weight change in overweight and obese adults in a community based weight management program. A secondary aim was to detect behavioral changes in the same population. The study design was quasi-experimental with pre and posttest analysis, conducted over 12 weeks. A total of 28 participants were included in the analysis. Body weight, eating behaviors, exercise and nutrition self-efficacy, attitude toward mobile technology, social support and physical activity were assessed at baseline and at 12 …

Characterization Of The Expression Of The Intercellular Adhesin Locus In Staphylococcus Aureus, Jamie Brooks

Theses and Dissertations

Poly-N-acetylglucosamine (PNAG) is an important Staphylococcus aureus virulence factor. It is a major component of the extracellular polymeric matrix in biofilms, and contributes to resistance to the innate immune response. The proteins encoded in the icaADBC (intercellular adhesin) operon are responsible for PNAG production. Here, we present evidence of a new mechanism of phase variation for switching off PNAG production that involves slipped strand mutagenesis, along with further insight into the regulation and expression of the icaADBC operon. S. aureus strain MN8m (mucoid) is a spontaneous mutant of strain MN8 (non-mucoid). It is characterized by constitutive overproduction of PNAG, resulting …

The Role Of Megalin In The Transport Of Aminoglycosides Across Human Placenta, Amal Akour

Theses and Dissertations

Background: Intra-amniotic infections (IAIs) are common complications of labor and delivery. If inadequately treated, these infections can lead to significant morbidity and mortality in the mother and the fetus. Intrapartum aminoglycoside (AG) administration is recommended for the management of IAIs. AGs are known to cross the placenta and achieve bactericidal concentrations in fetal serum. However, the highest and most persistent fetal levels are achieved in renal tissue. So, the fetus may be vulnerable to the nephrotoxic effects of AGs. Megalin, a 600 kDaendocytic receptor, is responsible for the uptake of AGs into renal proximal tubular epithelial cells. This receptor is …

Diffuse Traumatic Axonal Injury Within The Visual System: Implications For Visual Pathway Reorganization, Jiaqiong Wang

Theses and Dissertations

Traumatic brain injury is a major health problem with much of its morbidity associated with traumatic axonal injury (TAI). To date, significant insight has been gained into the initiating pathogenesis of TAI. However, the specific anterograde and retrograde sequelae of TAI are poorly understood because the diffuse nature of TAI complicates data analysis. To overcome this limitation, we subjected transgenic mice expressing yellow fluorescent protein (YFP) within the visual system to central fluid percussion injury, and consistently generated diffuse TAI within the optic nerve that could easily be followed in the organized YFP positive fibers. We demonstrated progressive axonal swelling, …

Using Systematic And Engaging Early Literacy Instruction And Digital Books To Teach At-Risk Kindergarteners To Read Target Words, Audra Marie Hales

Theses and Dissertations

The purpose of this study was to examine the effects of using Systematic and Engaging Early Literacy (SEEL) intervention activities that incorporate digital books to teach kindergarteners to read. The study used a single-subject-multiple-baseline-across-behaviors design to compare kindergarten students' reading of comparable CVC words before and after intervention. Four students at-risk for reading difficulties were chosen for the study based on their performance on assessments and their teachers' recommendations. Students were divided into two dyads and received intervention three times a week for 25 minutes for approximately six weeks, or 18 total sessions. Baseline assessment data was collected prior to …

Amelioration Of Experimental Autoimmune Encephalomyelitis Using The Myelin Oligodendrocyte Glycoprotein35-85 Peptide, Vrushali Vinay Agashe

Theses and Dissertations

Multiple sclerosis (MS) is a chronic debilitating disease affecting the central nervous system (CNS) in humans. Experimental autoimmune encephalomyelitis (EAE) remains the primary animal model of MS. MS/EAE are considered to be autoimmune diseases mediated by CD4+ T helper (TH) cells. The role of B cells and antibody is under debate. Previous studies established B cell dependent (induced with recombinant myelin oligodendrocyte glycoprotein, [rMOG]) and B cell independent (induced with the MOG35-55 peptide) animal models of EAE. The identification of a unique B cell epitope (MOG amino acids [aa] 46-85) preceding the identified protective epitope (MOG61-85) led to the hypothesis …

Health Care Informatics Support Of A Simulated Study, Zeinab Salari Far

Theses and Dissertations

The objective of this project is to assess the value of REDCap (Harris, 2009) by conducting a simulated breast cancer clinical trial and demonstration. REDCap is a free, secure, web-based application designed to support data capture for research studies. To assess REDCap's value, we conducted a simulation of a clinical trial study designed to compare the use of two new technologies for breast cancer diagnosis and treatment with current best practice breast cancer diagnosis and treatment. We call the trial, "Real-Time Operating Room BC Diagnostic Treatment (RORBCDT)". The RORBCDT clinical trial is designed to assess the value of a new …

The Relationship Among Maternal Parenting Stress, Coping, And Depressive Symptoms Across Time, Karen Foren Lake

Theses and Dissertations

This study was a secondary analysis in which the relationship among maternal parenting stress, coping, and depressive symptoms over time in 161 low-income mothers who participated in an Early Head Start Pathways Project were examined. Measurements were assessed longitudinally over a 12 year period of time. Direct and indirect relationships were proposed between maternal mastery, pre-existing depressive symptoms, relationship with significant other, child behavior, child temperament, maternal parenting stress, coping, and later depressive symptoms. Results from path analyses showed that when assessed earlier in the childbearing years, mastery, depressive symptoms, relationship with significant other, child temperament, child behavior, and maternal …

Listening To The Voices Of Emerging Adults: The Experience Of Living With Phiv, Constance D. Hill

Theses and Dissertations

The purpose of this descriptive study was to explore the research question: "As an emerging adult what is your everyday experience of living with PHIV?" The purposive sample consisted of six emerging adults living with perinatally acquired HIV (PHIV), who are 18-29 years of age, speak English, and live in the greater Chicago area.

This was an exploratory study using a participatory action approach of photovoice. Photovoice methodology combines photography and participatory action to provide images and the participants' interpretations of their everyday health realities. Five themes which describe the everyday experience of living with PHIV emerged from the thematic …

Childhood Obesity And The Relationship To Well-Child Visits, Nancee Croatt Wozney

Theses and Dissertations

Trends during the past 20 years have revealed a dramatic increase in childhood obesity in the United States. At present, approximately nine million children over 6 years of age are considered obese (Institute of Medicine [IOM], 2011). According to (American Academy of Pediatrics [AAP], 2009) the protocol for obesity care for youth is to monitor the body mass index (BMI) routinely (at least annually) and offer appropriate counseling and guidance to children and their families. A report in the literature indicated that the number of children attending yearly well-child visits that include measurement of BMI is well below the AAP …

A Systematic Framework For Radio Frequency Identification (Rfid) Hazard Mitigation In The Blood Transfusion Supply Chain From Donation To Distribution, Natalie Simone Rahming

Theses and Dissertations

The RFID Consortium is developing what will be the first FDA-approved use of radio frequency identification (RFID) technology to identify, track, manage, and monitor blood throughout the entire blood transfusion supply chain. The iTraceTM is an innovative technological system designed to optimize the procedures currently employed when tracing blood from the donor to the recipient. With all novel technologies it is essential to consider not only the advantages, but also the potential harms that may come about from using the system. The deployment of the iTraceTM consists of two phases: 1) Phase One - application of the iTraceTM from the …

Factors Associated With Bed-Sharing Within Racial Groups In A Sample Of Mothers And Young Infants In Wisconsin, Trina C. Salm Ward

Theses and Dissertations

Since 2005, the American Academy of Pediatrics has recommended a separate but proximate sleep surface for infants (AAP, 2005). However, racial differences in the prevalence of bed-sharing and infant mortality (especially as a result of SIDS or unsafe sleep) continue. Limited research has examined predictors of bed-sharing by racial group, especially the AAP's 2005 policy statement against it. The purpose of this study was to explore maternal-infant bed-sharing and infant sleep position for African-Americans and Whites in a sample of 2,530 respondents (822 African-American and 1,708 Whites) to the Wisconsin Pregnancy Risk Assessment and Monitoring System (PRAMS), a stratified sample …

An Anaylsis Of Patient-Physician Discourse: Comparing Physician Diagnostic Scripts To Patient Social Script Expectations, Denis Grimes

Theses and Dissertations

This study examines how participants interpret physicians' diagnostic discourse and physician interruptions during the patient's disclosure of problems and concerns. Using medical diagnostic scripts written for upper respiratory infections, participants' reactions to physician attentiveness and physician interruptions were measured. When physicians interrupt patients during the patient's disclosure of problems and concerns, interruptions violate patient's social script expectations and negatively affect patient satisfaction. Physicians' demonstrations of attentiveness and explanations of the purposes for the interruptions do not compensate for interruption's effects, and satisfaction with physician behavior is reduced.

Complexity And Uncertainty In Human And Ecological Risk Assessment, Matthew Jordan Dellinger

Theses and Dissertations

Multiple interacting stressors in the environment present increasingly complex risks to human health. Too often, however, the data required for traditional risk assessment are either lacking or unavailable at the necessary spatial or temporal scale. In addition, assessment practices and management policies need to move away from single factor approaches in order to accommodate the reality of complex chemical mixtures and environmental stressors. Recent literature suggests that a paradigm shift is under way. This points to a need for the development of new techniques both for rapid data collection and flexible risk assessment strategies that can adapt to make use …

Predictors Of Healthcare Cost In A Wisconsin Acute Leukemia Population: Utilization Of A State-Level All Payer Claims Database, Patricia Ann Steinert

Theses and Dissertations

Understanding cost predictors of low incidence high cost cancers is increasingly important as the U.S. attempts to control health care costs. Acute myeloid and acute lymphoblastic leukemia are hematologic cancers requiring high cost care.

Using Anderson's model of health care utilization this study explores the influence of patient and community factors on health care costs. Insurance claims cost data obtained from the Wisconsin Health Information Organization provided a sample of 837 acute leukemia patients from April, 2009 and June, 2011. Total, ancillary, inpatient, outpatient, pharmacy and professional services costs were analyzed using a GLM gamma log link regression model to …

Perceived Stress And Surgical Wound Cytokine Patterns, Valentina Lucas

Theses and Dissertations

Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed …

Ige Enhances B Cell-Derived Exosomal Induced T Cell Proliferation, Brooks Keith

Theses and Dissertations

For many years it has been known that the injection of antigen bound to an antibody leads to more than a 1000-fold increase in antigen specific antibody response. This observation holds true for IgE, which is dependent upon CD23 expression, as this enhancement is not present in mice deficient in CD23. It also has been shown that when mice are injected with IgE-antigen complexes also display an increase in antigen specific T cell proliferation. While there are published studies that demonstrate a role for B cell derived exosomes in the activation and proliferation of T cells, none have focused upon …

Role Of Tyrosyl-Dna Phosphodiesterase (Tdp 1) On Repair Of 3′-Phosphoglycolate (3′- Pg) Terminated Dna Double-Strand Breaks (Dsbs) And In Response To Oxidative Stress, Tong Zhou

Theses and Dissertations

DNA DSBs are most toxic to cells because they can lead to genomic rearrangements and even cell death. Most DSBs induced by ionizing radiation or radiomimetic drugs such as calicheamicin and bleomycin, bear 3′-phosphate or 3′- PG moieties that must be removed to allow subsequent gap filling and ligation. DSBs can be repaired by two main pathways: the homologous recombination (HR) pathway and the non-homologous end-joining (NHEJ) pathway, NHEJ is the primary repair pathway in mammalian cells. While HR repairs single strand breaks (SSBs) or DSBs accurately by using an undamaged copy of the sequence mostly at late S phase …

"Being Certain": Moral Distress In Critical Care Nurses, Marian Baxter

Theses and Dissertations

Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.

Investigating A Model For Fetal Alcohol Damage In Caenorhabditis Elegans, Lindsay Kondo

Theses and Dissertations

Alcohol use and abuse has many harmful effects, especially to children exposed prenatally, including fetal alcohol spectrum disorders (FASDs). The disabilities due to fetal alcohol exposure continue throughout life and cause major financial burdens to society. The molecular mechanisms underlying FASDs are not well understood. We have taken a genetic approach to characterize ethanol’s effect on changing a discrete cell fate decision during embryogenesis in the nematode, Caenorhabditis elegans (C. elegans). Our preliminary data suggest that ethanol can affect the development of AWC neurons, a pair of olfactory neurons in C. elegans. We suggest that lipids can protect AWC neurons …

Costs And Use Of Oral Anti-Cancer Medications Among Senior Medicare Part D Beneficiaries, Nantana Kaisaeng

Theses and Dissertations

Oral cancer drugs are branded and expensive medications that generally do not have generics available. The restrictions of the Medicare Part D program, including the coverage gap and high cost-sharing, and the high cost of oral chemotherapy may lead to patients’ non-adherence to medication. Few studies have examined the cost and utilization of oral anti-cancer medications. This study will be the first to examine the costs associated with the use of oral anti-cancer medications and the impact of cost-sharing and type of prescription drug subsidy on medication discontinuation in the Medicare Part D elderly population. Objectives: To determine the usage …

Epid-Based Dose Verification For Adaptive Radiotherapy, Joseph Gardner

Theses and Dissertations

Dose verification is a critical component of adaptive radiotherapy, as it provides a measurement of treatment delivery success. Based on the measured outcome, the plan may be adapted to account for differences between the planned dose and the delivered dose. Although placement of an EPID behind the patient during treatment allows for exit dosimetry which may be used to reconstruct the delivered patient dose via backprojection of the fluence, there have not been any studies examining the basic assumption of backprojection-based dose verification: that deviations between the expected and delivered exit fluences are totally caused by errors in the delivered …

Heart Failure Symptom Clusters And Functional Status, Janet Herr

Theses and Dissertations

Abstract HEART FAILURE SYMPTOM CLUSTERS AND FUNCTIONAL STATUS Janet Kay Herr Ph.D A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University 2012 Major Director: Dr. Jeanne Salyer, Ph.D., R.N., F.N.A.P Associate Professor, Adult Health & Nursing Systems Clinical assessment of heart failure includes symptom identification and the evaluation of the relationship of symptoms to functional status. Symptom clusters are groups of at least 2 or 3 co-occurring symptoms that are related but are independent of other groups of symptoms. The objectives of this study are to: …

A New Approach To Dried Blood Spot Analysis For Newborn Screening Using High Resolution Liquid Chromatography Tandem Mass Spectrometry, John H. Miller Iv

Theses and Dissertations

The primary purpose of newborn screening is to quickly identify children that are at risk of having a specific disorder in order to start treatment, prevent early death and reduce the chances of permanent physical or mental damage. The current and widely accepted approach used for identification of metabolism disorders involves a flow injection analysis with mass spectrometry detection of acylcarnitines and amino acids. Although this approach is widely accepted and has shown to be sufficient for identification of multiple metabolism disorders the method is not fully quantitative and results often have to be confirmed by second-tier tests. The primary …

The Role Of P62 In Osteoclastogenesis And Paget’S Disease Of Bone, Tamer Hadi

Theses and Dissertations

Paget’s disease (PDB) is the second most common metabolic bone disease after osteoporosis, affecting up to 3% of adults over age 55. It is characterized by focal lesions of bone resorbed by hyperactive osteoclasts coupled with rapid formation of highly disorganized, low quality bone formed by osteoblasts. Such lesions cause skeletal deformity, fractures, and other symptoms that significantly decrease quality of life. In 2001, mutations in the SQSTM1/p62 gene were found in a subset of Paget’s patients. The work summarized in this dissertation sought to answer two broad questions: what is the function of p62 in normal bone homeostasis and …