Medicine and Health Sciences Commons^™

Improving Blood Pressure Control In Esrd Through A Supportive Educative Nursing Intervention, Zorica Kauric-Klein

Wayne State University Dissertations

ABSTRACT

IMPROVING BLOOD PRESSURE CONTROL IN ESRD THROUGH A

SUPPORTIVE EDUCATIVE NURSING INTERVENTION

by

ZORICA KAURIC-KLEIN

May 2011

Advisor: Dr. Nancy T. Artinian

Major: Nursing

Degree: Doctor of Philosophy

Problem: Hypertension in chronic hemodialysis (HD) patients contributes significantly to their morbidity and mortality. Statistics indicate the hypertension rate amongst HD patients ranges from 75 to 100 %. Studies have indicated that adherence rates to self-care behaviors related to salt and fluid intake and medication regimens are very poor in the HD population. Traditional hypertension management strategies have been found to be largely ineffective. There is modest evidence indicating that interventions …

Chemotherapy For Lung Cancer: Determinants Of Guideline Adherence And Associated Patient Outcomes, Ramzi George Salloum

Wayne State University Dissertations

Evidence-based guidelines recommend chemotherapy for medically fit patients with stage II-IV non-small cell lung cancer (NSCLC). Adherence to chemotherapy guidelines has rarely been studied among large populations, mainly because performance status (PS), a key component in assessing chemotherapy appropriateness, is missing from claims-based datasets. Among a large cohort of patients with known PS, this dissertation describes chemotherapy use relative to guideline recommendations and identifies patient factors and outcomes associated with guideline concordant use. Among these patients 29% do not receive guideline recommended chemotherapy treatment, missing opportunities for cure or receiving chemotherapy with more risk of harm than benefit, thereby likely …

Axogial Communication Mediated By Soluble Neuregulin-1 And Bdnf, Zhenzhong Ma

Wayne State University Dissertations

During peripheral nervous system development, successful communication between axons and glial cells including Schwann cells in peripheral nervous system and oligodendrocytes in central nervous system, is required for the proper functions of both neurons and glia. Three types of alternatively-spliced proteins belonging to the neuregulin1 (NRG1) gene family of growth and differentiation factors are essential for Schwann cell survival and peripheral nerve development. While membrane-bound NRG1 forms (type III) has been strongly implicated in the regulation of myelination process at late stage of Schwann cell development, little is known about the role of soluble, heparin-binding forms of NRG1 (type I/II) …

Mechanisms Of Persistent Translation Arrest Following Global Brain Ischemia And Reperfusion, Jill Theresa Jamison

Wayne State University Dissertations

ABSTRACT

MECHANISMS OF PERSISTENT TRANSLATION ARREST FOLLOWING GLOBAL BRAIN ISCHEMIA and REPERFUSION

by

JILL T. JAMISON

December 2011

Advisor: Donald J. DeGracia, Ph.D.

Major: Physiology

Degree: Doctor of Philosophy

The information presented here studies the mechanisms that underlie persistent translation arrest (TA) following global brain ischemia and reperfusion (I/R). To summarize the main findings I have discovered a new mechanism for prolonged post-ischemic TA that correlated exactly with in vivo translation rates and correlated precisely with cell outcome. Through the extensive colocalization studies, my results indicate that the mRNA granules are ribonomic structures involved with mRNA regulation. This finding is …

Probabilistic Models For Patient Scheduling, Adel Alaeddini

Wayne State University Theses

In spite of the success of theoretical appointment scheduling methods, there have been significant failures in practice primarily due to the rapid increase in the number of no-shows and cancelations from the individuals in recent times. These disruptions not only cause inconvenience to the management but also has a significant impact on the revenue, cost and resource utilization. In this research, we develop a hybrid probabilistic model based on logistic regression and Bayesian inference to predict the probability of no-shows in real-time. We also develop two novel non-sequential and sequential optimization models which can effectively use no-show probabilities for scheduling …

The Impact Of Folate Deficiency On The Base Excision Repair Pathway: Analysis Of Enzyme Coordination In Response To Dna Damage And Imbalanced Repair, Amanda Pilling

Wayne State University Dissertations

The condition of folate deficiency has been implicated in carcinogenesis, with the strongest evidence formulated in colon cancer. The role of folate in DNA repair, DNA synthesis and methylation reactions renders this nutrient an valuable target for studying the onset and progression of cancer. Using molecular techniques to determine gene and protein expression, enzyme activity and methylation status elucidates the mechanism of DNA repair and damage in folic acid deficient animals in response to carcinogen. The findings presented in this study indicate failure to remove and repair damage in the condition of folate deficiency and suggest that the accumulation of …

Circadian Rhythm Of Cortisol And Estradiol In Healthy Women, Karyn G. Butler

Wayne State University Dissertations

ABSTRACT

CIRCADIAN RHYTHM OF CORTISOL AND ESTRADIOL IN HEALTHY WOMEN

by

KARYN G. BUTLER

AUGUST 2011

Advisor: Dr. Jean E. Davis

Major: Nursing

Degree: Doctor of Philosophy

Daily variation in human processes and behaviors has been identified for centuries. Study of these circadian rhythms demonstrates their role in human health. Sickness behaviors include alterations in affect, sleep quality and energy. The study of the relationship between circadian rhythms has been limited to isolated rhythms. The role of temporal relationships among rhythms has received little attention. Sickness behaviors are prevalent in many disorders including depression, cancer, and autoimmune disorders. Two hormones …

Estrogen Sulfotransferase (Sult1e1) Expression And Function In Mcf10a-Series Breast Epithelial Cells: Role As A Modifier Of Breast Carcinogenesis And Regulation By Proliferation State, Jiaqi Fu

Wayne State University Dissertations

Estrogen sulfotransferase (SULT1E1) catalyzes the sulfonation of estrogens, which limits estrogen mitogenicity. TaqMan Gene Expression assays were used to profile the mRNA expression of estrogen receptor (ERα and ERβ) and estrogen metabolism enzymes including cytosolic sulfotransferases (SULT1E1, SULT1A1, SULT2A1, and SULT2B1), steroid sulfatase (STS), aromatase (CYP19), 17β-hydroxysteroid dehydrogenases (17βHSD1 and 2), CYP1B1, and catechol-O-methyltransferase (COMT) in an MCF10A-derived lineage cell culture model for basal-like human breast cancer progression and in ERα-positive luminal MCF7 breast cancer cells. Low levels of ERα and ERβ mRNA were present in MCF10A-derived cell lines. SULT1E1 mRNA was more abundant in confluent relative to subconfluent MCF10A …

Hedgehog Signaling: A Potential Therapeutic Target For Non-Small Cell Lung Cancer, Ma'in Yehya Maitah

Wayne State University Dissertations

The American Cancer Society estimated that 222,520 Americans were diagnosed with lung cancer and 157,300 died of lung cancer in 2010 (Jemal et al. 2009, 225-249;Jemal et al. 2011, 69-90). The clinical outcome of patients diagnosed with non-small cell lung cancer (NSCLC), the major lung cancer sub-types, is very poor, which calls for innovative research for finding novel therapeutic targets and agents for better treatment outcome.

Emerging evidences have suggested that a phenomenon called Epithelial-to-Mesenchymal Transition (EMT), which shares similar molecular characteristics with cancer stem-like cells, contributes to lung cancer treatment failure. In view of the fact that EMT process …

Perceived Familial Socialization And Ethnic Identity: Factors Associated With Physical Activity, Eating Behavior Patterns, And Social Physique Anxiety In African American Middle Adolescents, Nutrena H. Tate

Wayne State University Dissertations

Purpose: African American adolescents experience higher rates of obesity and have an increased risk of obesity related diseases than Caucasian American adolescents. Despite culturally sensitive obesity preventive interventions, obesity rates are increasing within the African American adolescent population. Current obesity interventions claim to be culturally sensitive, but do not address how ethnic identity and parental influences on body image and body change may affect the efficacy of the interventions. The purpose of this study was to examine the sociocultural factors related to weight behaviors and cognitions in African American adolescents. Differences based on socioeconomic status (SES), gender, and residential status …

Expression Of Microbial Rhodopsins In Retinal Neurons With Subcellular Targeting Motifs: For The Study Of The Structure/Function Of Aii Amacrine Cells And For Vision Restoration, Chaowen Wu

Wayne State University Dissertations

Protein-targeting motifs serve as addresses for subcellular protein localization. This feature of targeting-motifs was used to study the retina. The first part of the dissertation reports in the axonless spiking AII amacrine cell of the mammalian retina a dendritic process sharing organizational and functional similarities with the axon initial segment, the typical site of action potential initiation. This process was revealed through viral-mediated expression of channelrhodopsin-2-GFP (ChR2-GFP) with the AIS-targeting motif of sodium channels (NavII-III) and was shown to be the site of spike initiation. The second part of the dissertation aimed to improve microbial rhodopsin-mediated gene therapy for vision …

Examining The Relationship Among Physical And Psychological Health, Parent And Peer Attachment, And Cyberbullying In Adolescents In Urban And Suburban Environments, Jemica Monique Carter

Wayne State University Dissertations

Cyberbullying is a new phenomenon that has received substantial attention via media. An extensive review of the literature revealed limited nursing research on this topic. The purpose of this study was to examine the impact of cyberbullying on adolescents' physical (e.g., headache, stomachache, etc.) and psychosocial (e.g., self-esteem, depression, post traumatic stress syndrome, etc.) outcomes. Individuals who experience repeated traditional bullying are at increased risk for experiencing repeated incidents of cyberbullying. Research has shown that effects of cyberbullying may be more traumatic than traditional bullying because victims can be bullied 24 hours and 7 days a week, on and off …

Optimal Port Placement And Automated Robotic Positioning For Instrumented Laparoscopic Biosensors, Brady King

Wayne State University Dissertations

OPTIMAL SURGICAL PORT PLACEMENT AND AUTOMATED ROBOTIC POSITIONING FOR RAMAN AND OTHER BIOSENSORS

by

BRADY KING

January 2011

Advisors: Dr. Abhilash Pandya, Dr. Darin Ellis, Dr. Le Yi Wang, and Dr. Greg Auner

Major: Computer Engineering

Degree: Doctor of Philosophy

Medical biosensors can provide new information during minimally invasive and robotic surgical procedures. However, these biosensors have significant physical limitations that make it difficult to find optimal port locations and place them in vivo. This dissertation explores the application of robotics and virtual/augmented reality to biosensors to enable their optimal use in vivo.

In the first study, human …

The Effects Of Racially-Motivated Emotional Arousal On The Eating Behaviors Of African American Women, Lenwood W. Hayman

Wayne State University Dissertations

Disparities between African Americans and Caucasians remain vast across a wide variety of health indicators. Chronic stress has been identified as a risk factor for a variety of chronic illnesses and poor health outcomes. One type of chronic stress that has been linked to health disparities is the stress associated with experiences of racial discrimination. The stress African Americans encounter as a result of their racist experiences contributes to a chronic elevation of their physiological stress response. In addition to stress, a major risk factor for coronary heart disease and diabetes is obesity, which has been established as a major …

Hospital Quality And Medicare Payment: A Theoretical And Empirical Investigation, Jinghua Huang

Wayne State University Dissertations

Does Medicare's payment rate for a hospital stay influence the quality of care received by a patient? We examine this question, theoretically and empirically. First, a model is developed which generates the key hypothesis -- that Medicare's payment rate per admission should be positively related to care quality. We then test this hypothesis by estimating the relationship between Medicare's DRG payment for pneumonia, heart failure and heart attacks and care quality, using clinically-recognized measures of the quality of pneumonia care, heart failure care and heart attack care. Newly available data on acute hospitals in 2007 from "Hospital Compare" (maintained by …

Social Workers' Knowledge And Attitudes About Treating Children With Attention Deficit Hyperactivity Disorder, Angelah Dawn Gomez

Wayne State University Theses

The current research seeks to understand how social work students and social work professionals increase their knowledge about AD/HD and how they formulate their attitudes about the disorder. The literature provided illustrates the many components of AD/HD risks, etiology, treatments, and professional opinions about the disorder. AD/HD is one of the most studied childhood mental health disorders in the nation. However, there is little research providing insight to social workers' knowledge and attitudes about the disorder. This is especially alarming because social workers are one of the largest professional populations to provide mental health services to children and their families. …

Analysis Of Gaba And Glutamate In The Mouse Dorsal Striatum, Stella Wisidagamage

Wayne State University Theses

ABSTRACT

ANALYSIS OF GABA AND GLUTAMATE IN MICE BRAIN

by

STELLA WISIDAGAMA

May 2011

Advisor: Dr. Tiffany Mathews

Major: Chemistry (Analytical)

Degree: Master of Science

GABA and glutamate are the predominant inhibitory and excitatory amino acid neurotransmitters in the central nervous system (CNS), respectively. However, their altered levels cause several neurological diseases including Parkinson's and Huntington's disease, schizophrenia, and epilepsy. It is important to measure their levels in the extra- and intracellular environments to better understand and develop improved therapeutics that will treat these neurological disorders. The principle aim of this study is to study the impacts of different endogenous …

Neuropathological Diagnosis Of Alzheimer's Disease: The Relationship Between Postmortem Assessment, Cognitive Function And Functional Status In Centenarians, Emily Elizabeth Richardson

Wayne State University Theses

Several sets of neuropathological criteria have been used for the postmortem diagnosis of Alzheimer's Disease (AD), but few studies have examined these criteria in the oldest old. For this study, we examined a sample of centenarians, all of whom received AD assessments using four different neuropathological criteria: Khachaturian, Braak and Braak, CERAD, and NIA-R. Findings indicate that NIA-R criteria differed significantly from CERAD and Khachaturian criteria. In addition, NIA-R and CERAD criteria predicted performance on the MMSE and three FOME indices; Braak and Braak criteria predicted performance on the MMSE and one FOME index. Finally, we examined the relationship between …

Objective Physical Activity And Sleep Characteristic Measurements Using A Triaxial Accelerometer In Eight Year Olds, Susan Ann Harrington

Wayne State University Dissertations

Background: Secular trends demonstrate that young children are less active and sleep less. Inequity in an individual's energy balance is known to have poor health outcomes. Academic achievement, academic behavior, and weight status are proxy indicators for health and psychosocial outcomes in this study. Current guidelines in place for sleep and physical activity in childhood are the result of data collected in the form of self-reports. Quantification and qualification of physical activity dimensions and sleep characteristics are essential not only for the purpose of clearly establishing parameters but also for the intent of verifying optimal health outcomes and evaluating interventions …

Mechanisms Of Translation Arrest Following Focal Brain Ischemia, Monique K. Lewis

Wayne State University Dissertations

MECHANISMS OF TRANSLATION ARREST FOLLOWING FOCAL BRAIN

ISCHEMIA

by

MONIQUE K. LEWIS

August 2011

Advisor: Dr. Donald DeGracia

Major: Physiology

Degree: Doctor of Philosophy

The loss of blood flow to the brain is termed ischemia and the subsequent resumption of blood flow is termed reperfusion. Brain ischemia and reperfusion (I/R) occurs primarily following resuscitation from cardiac arrest and stroke and presents one of the most significant clinical challenges. At present, there are no clinically effective pharmacologic interventions to halt brain damage following I/R. The major Aim of this dissertation will be to investigate possible mechanisms involved in neuron death following …

Work-Family Boundary Management Strategies: Examining Outcomes, And The Role Of Fit, Madhura Chakrabarti

Wayne State University Dissertations

As more and more people attempt to effectively manage the simultaneous demands of work and family, researchers are now trying to investigate the various ways by which people choose to do so. The present study investigated the concept of boundary management strategies that describes the work-family interface in terms of cognitive, physical, and behavioral boundaries between work and family domains that individuals actively try to manage in order to balance the two worlds. Research in boundary management strategies has been minimal due to the the novelty of the construct. In this study, specific individual and organizational outcomes like work-family conflict, …

Effects Of Two Group Approaches On Life Satisfaction And Mood Of Older Females In Nursing Homes, Bede Redpath Ryan

Wayne State University Dissertations

The purpose of this study was to examine the effects of two group counseling therapy interventions on levels of life satisfaction and mood disturbance of older women, age 65+, living in two Detroit-based skilled nursing home facilities. This quasi-experimental, two-treatment group design examined the pretest-posttest data of two group counseling therapy interventions, Group Art Therapy (GAT) and Group Life Stories Narrative Therapy (GLSNT). Seventeen participants completed the bi-weekly, 90-minute sessions, over a four-week period. A univariate ANCOVA with group membership as fixed independent variable was used to compare life satisfaction post scores with pre scores as covariates. Mean scores were …

Computer Simulation In Mass Emergency And Disaster Response: An Evaluation Of Its Effectiveness As A Tool For Demonstrating Strategic Competency In Emergency Department Medical Responders, Daniel Joseph O'Reilly

Wayne State University Dissertations

This study examined the capability of computer simulation as a tool for assessing the strategic competency of emergency department nurses as they responded to authentically computer simulated biohazard-exposed patient case studies. Thirty registered nurses from a large, urban hospital completed a series of computer-simulated case studies of virtual biohazard-exposed patients. The completed case studies were assessed by the host computer according to computer-programmed criteria. The same case studies were also assessed by a trio of emergency medicine physicians acting as subject matter experts according to their own criteria. The results of this study demonstrated a significant correlation between computer-assessed and …

The Potential Role Of Innate Immunity In The Pathogenesis Of Post-Operative Adhesions, Jennell White

Wayne State University Dissertations

Post-operative adhesion development occurs in the vast majority of patients following abdominal surgery and is a natural occurrence of peritoneal-wound healing. These fibrous bands may form within the first 5-7 days post-surgery and have the ability to cause a distortion in the normal anatomical positioning of abdominal organs. Consequently, adhesions are major contributors to small bowel obstruction, infertility, and severe pelvic and abdominal pain. Physiological processes responsible for adhesion formation remain obscure though it is believed to involve cell migration, proliferation, and differentiation of several cell types including mesothelial cells, fibroblasts, and inflammatory and immune cells. Substances released from these …

Processing Random Signals In Neuroscience, Electrical Engineering And Operations Research, Kalyan Raman

Wayne State University Dissertations

The topic of this dissertation is the study of noise in electrical engineering, neuroscience, biomedical engineering, and operations research through mathematical models that describe, explain, predict and control dynamic phenomena. Noise is modeled through Brownian Motion and the research problems are mathematically addressed by different versions of a generalized Langevin equation. Our mathematical models utilize stochastic differential equations (SDEs) and stochastic optimal control, both of which were born in the soil of electrical engineering. Central to this dissertation is a brain-physics based model of cerebrospinal fluid (CSF) dynamics, whose structure is fundamentally determined by an electrical circuit analogy. Our general …

Human Trophoblast Survival And Invasion In The Developing Placenta: Autocrine Regulation By Hbegf, Philip Jessmon

Wayne State University Dissertations

HBEGF is a multifunctional protein in early pregnancy that induces cytotrophoblast (CTB) cell differentiation to an invasive phenotype, protects against apoptosis, and is involved in an autocrine signaling mechanism that leads to its own protein synthesis. CTBs exist in a low O₂ environment during the first 10 weeks of implantation, during which they invade the decidualized uterine stroma. Inhibitors of intracellular signaling pathways demonstrated that at 20% O₂ HBEGF induces an increase in cell migration through the ERK, MAPK14, JNK, or PIK3 pathways downstream of signaling through its ERBB receptors. Also downstream of these four pathways, HBEGF induces …

Associations Of Trauma, Nightmares, And Quality Of Life In Urban African American Adolescents, Barbara Peterson

Wayne State University Dissertations

Purpose: Exposure to trauma in youth is pervasive particularly among urban, African American teens. Nightmares are considered a hallmark symptom of Posttraumatic Stress Disorder (PTSD) and are associated with poor sleep quality and poor quality of life in adults. Research about nightmares in adolescents is lacking, and these relations have not been previously examined. The purpose of this study was to examine the relationships among nightmare frequency, nightmare distress, PTSD severity, sleep quality, and quality of life in teens.

Theory: The Roy Adaptation Model was used to conceptualize nightmares as focal stimuli reducing adaptation in teens. Nightmares may heighten memories …

Effect Of Dimethylarginine Dimethylaminohydrolase In The Development Of Salt Sensitivity, Samar Abdulla Nasser

Wayne State University Dissertations

Salt sensitivity is associated with a rise in blood pressure (BP) occurring during sodium loading and/or a fall in BP during sodium restriction that exceeds random fluctuations in BP. Salt sensitivity is more common in African American than Caucasian hypertensives and is also present, in normotensive African Americans. The mechanism or mechanisms resulting in salt-sensitive hypertension are multiple and include both activation of the renin angiotensin system via increases in angiotensin II and reductions in the endogenous vasodilator, nitric oxide (NO). An important means of NO downregulation is through asymmetric dimethylarginine (ADMA), an endogenous NO inhibitor, which is largely metabolized …

Effects Of Managed Care On The Health And Health-Care Of The Non-Elderly With Diabetes, Meihua Lu

Wayne State University Dissertations

This dissertation attempts to examine the quality effect of managed care plans (as compared with traditional fee-for-service plans, or FFS) on the health outcome and health care use of patients with diabetes. As the number of diabetics is growing rapidly with many of them are relying on managed care plans, knowing better the effects of different plans on health status and health care utilization is of great interest and significance to consumers, employers, and policymakers, especially at a time that universal health care is under being implemented.

Using up-to-date data from MEPS, a nationally representative survey, I compared 484 HMO …

The Role Of The Sparc Acidic Domain And Egf-Like Module In Glioma Migration, Invasion, And Signaling, Heather M. Mcclung

Wayne State University Dissertations

THE ROLE OF THE SPARC ACIDIC DOMAIN AND EGF-LIKE MODULE IN GLIOMA MIGRATION, INVASION, AND SIGNALING

HEATHER M. MCCLUNG

Advisor: Sandra A. Rempel, Ph.D.

Major: Pharmacology

Degree: Doctor of Philosophy

We have previously shown that Secreted Protein Acidic and Rich in Cysteine (SPARC) is upregulated in all astrocytoma grades and increases tumor cell migration and invasion. It is thought that different domains within the protein may regulate SPARC functions, suggesting domain-specific targeting to inhibit invasion. To enhance our understanding of SPARC-mediated invasion, we first confirm, at the protein level, our previous cDNA array results, that SPARC increases expression of the …