Medicine and Health Sciences Commons^™

Collaborative Models Of Care In The Appalachian Region Of Tennessee: Examining Relationships Between Level Of Collaboration, Clinic Characteristics, And Barriers To Collaboration, Jeffrey Ellison

Electronic Theses and Dissertations

Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic.

For the present study 136 surveys were completed by providers working in primary care …

The Effects Of Vertically-Oriented Resistance Training On Golf Swing Performance Variables, Austin R. Driggers

Electronic Theses and Dissertations

The purpose of this study was to examine the effects of vertically-oriented resistance training on golf driving performance. Ten Division-I collegiate golfers completed 2 resistance training sessions per week for 10 weeks during the fall tournament season. Pre- and posttraining assessments of strength-power and golf performance were compared. To assess strength-power, jump height, peak force, and peak power (PP) were measured from static and countermovement (CMJ) vertical jumps; peak force and rate of force development from 0-250 ms were measured from an isometric mid-thigh pull. Golf performance was assessed in terms of ball launch speed (BS), spin rate, carry yardage …

Effects Of Step Training On The Kidneys Following Spinal Cord Injury In Rats., Pradeepa Poudyal

Electronic Theses and Dissertations

Detrusor-sphincter dyssynergia after chronic spinal cord injury (SCI) leads to over-distention, high bladder pressures and vesico-ureteric reflux into the kidney, resulting in repeated infections and pyelonephritis. Given the importance/limited knowledge of SCI effects on the upper urinary tract, this study assessed expression of two proteins in the kidneys of contused (T9) male rats relative to controls that are indicative of tissue stress/damage (TGFβ, CD11b). The impact of two therapeutic rehabilitation strategies, 60 minutes of step training and general exercise, was then assessed on these protein levels relative to non-trained SCI controls, plus the effectiveness of a shorter training duration (30 …

The Impact Of Inflammatory And Immune Response-Related Genetic Variants On Prostate Cancer Risk Among Men Of African Descent., Dominique Zilpha Jones

Electronic Theses and Dissertations

Background: In the U.S., prostate cancer (PCA) metastasis is associated with a 5-yr survival rate of 29% and disproportionately affects men of African descent. Single nucleotide polymorphisms (SNPs) may serve as genetic markers to identify individuals at high risk of developing PCA. Methods: We examined main and joint effects of 119 inflammatory and immune response-associated SNPs among men of African descent (535 controls, 279 cases) via logistic regression (LR) and entropy-based-multi-factor dimensionality reduction (MDR) modeling. Results: MDR yielded highly synergistic [(TLR10, TLR6 and IRF3), (TLR2, IRAK4), (IL1R2, IL10, IL10RA)] interaction …

The Role Of Porphyromonas Gingivalis In The Regulation Of Epithelial-Mesenchymal Transition Markers In Migration., Akintunde Ojo 1981-

Electronic Theses and Dissertations

A relationship between periodontal disease and oral squamous cell carcinoma (OSCC) has been demonstrated in recent studies. Porphyromonas gingivalis’ antigen have been found in oral cancer cells. The embryonic program “epithelial-mesenchymal transition” (EMT) is thought to trigger cancer invasion by allowing tumor cell propagation. The objective of this study was to examine the role of P. gingivalis in the expression of ZEB1, vimentin, and repression of miRNA-200 family as EMT prognostic markers in cancer cell metastasis. Human telomerase immortalized gingival keratinocytes (TIGK) cells were challenged with P. gingivalis strain ATCC 33277 in vitro for 24h at MOI 50 and 100. …

Lunasin Reduces The Melanoma Stem Cell Population In Vitro And Inhibits Tumor Proliferation In Vivo., Christopher Paul Shidal

Electronic Theses and Dissertations

Lunasin is a 44 amino acid peptide derived from the soybean seed that has been shown to have cancer chemopreventive and chemotherapeutic properties. In this study, we investigated the potential utility of lunasin as a chemotherapeutic in a melanoma model. Initial studies showed that lunasin has little activity against established melanoma cell lines in vitro using adherent culture methods; however, lunasin’s in vitro activity was significantly higher in non-adherent colony-forming assays in soft agar and oncosphere assays. These results led us to investigate whether lunasin selectively affects cancer initiating cells (CIC) that are known to be present in these melanoma …

Biomarker Discovery Of Liver Diseases Using Mass Spectrometry-Based Metabolomics., Xue Shi

Electronic Theses and Dissertations

Metabolomics has emerged as one of the latest of the "-omics" disciplines that can detect metabolite biomarkers in biological samples. The diverse characteristics of metabolites make the analytical platform challenging in metabolomics. Two bioanalytical platforms were developed in this study to investigate metabolite abundance changes under different biological conditions. We first developed a bioanalytical platform that coupled linear trap quadruple - Fourier transform ion cyclotron mass spectrometer (LTQ-FTICR MS) with direct infusion chip-based nano-electrospray ionization (DI-nESI) and applied it to study polychlorinated biphenyls (PCB) effects on non-alcoholic fatty liver disease (NAFLD). We also employed this platform in conjunction with in …

Assessing The Social And Ecological Factors That Influence Childhood Overweight And Obesity, Katie Callahan

Electronic Theses and Dissertations

The prevalence of childhood overweight and obesity is increasing at an alarming rate in the United States. Currently more than 1 in 3 children aged 2-19 are overweight or obese. This is of major concern because childhood overweight and obesity leads to chronic conditions such as type II diabetes and tracks into adulthood, where more severe adverse health outcomes arise. In this study I used the premise of the social ecological model (SEM) to analyze the common levels that a child is exposed to daily; the intrapersonal level, the interpersonal level, the school level, and the community level to better …

Regulation Of C-Reactive Protein Gene Expression And Function, Avinash N. Thirumalai

Electronic Theses and Dissertations

Human C-reactive protein (CRP) is the prototypic acute phase protein whose serum concentration increases rapidly during inflammation. CRP is also associated with atherosclerosis; it is deposited at lesion sites where it may interact with modified lipoproteins. There are 2 major questions regarding CRP: 1. How is the serum concentration of CRP regulated? 2. What are the functions of CRP in atherosclerosis?

Our first aim was to determine the role of the constitutively expressed transcription factor Oct-1 in regulating CRP gene expression. We found that Oct-1 overexpression inhibited (IL-6+IL-1β)- induced CRP gene expression; maximal inhibition required the binding of Oct-1 to …

Nicu Culture Of Care For Infants With Neonatal Abstinence Syndrome: A Focused Ethnography, Monica M. Nelson

Electronic Theses and Dissertations

Purpose: The purpose of this ethnographic study was to describe the culture of care and nonpharmacological nursing interventions performed by NICU nurses for infants with NAS. Background: Infants with NAS are increasingly being cared for in the inpatient hospital setting by NICU nurses. Interventions used for the care of premature and sick infants in the NICU may or may not be the exact interventions that should be used for the care of the fragile infant with NAS. Research studies on the nonpharmacological nursing care of infants with NAS encompass 5 main areas of practice: environment, adequate rest and sleep, feeding, …

Therapeutic Camps And Their Impact On The Family Of Children With Special Health Care Needs: A Mixed Method Study, Brandi Lindsey

Electronic Theses and Dissertations

Children with a chronic illness or disability can encounter many difficulties throughout their lifetimes. Respite care through therapeutic summer day camps is a service used to relieve the physical and mental strains placed on caregivers while also creating unique opportunities to benefit the child. There are gaps in the literature surrounding therapeutic camps and their benefit for the family and their ability to manage the child’s special health care need. The purpose of this study is to determine how respite care in the form of a therapeutic summer day camp for children with special needs impacts a family’s ability to …

Retinal Synaptic Function In The Absence Of The On Pathway., Kathryn Marie Heath Fransen

Electronic Theses and Dissertations

Complete Congenital Stationary Night Blindness (cCSNB) is a rare hereditary retinal disorder characterized by abnormal night vision. cCSNB is caused by postsynaptic defects in On bipolar cells (BCs) and is identified by the presence of an electroretinogram (ERG) with a normal a-wave, corresponding to photoreceptor function, and the absence of a b-wave, corresponding to a failure of On BC function. Through the study of genetic mutations in mouse that result in no b-wave ERG phenotypes, several proteins have been identified that play crucial roles in On BC signal transmission. I focused on four mouse models of cCSNB; Nyxnob (Nyctalopin mutant), …

Study Of Novel Nanoparticle Transport And Drug Release For Cancer Treatment., Christopher Gene England 1988-

Electronic Theses and Dissertations

Nano-scale particles sized 10—400 nm administered systemically preferentially extravasate from tumor vasculature due to the enhanced permeability and retention effect. Therapeutic success remains elusive, however, because of inhomogeneous particle distribution within tumor tissue. Insufficient tumor vascularization limits particle transport and also results in avascular hypoxic regions with non-proliferating cells, which can regenerate tissue after nanoparticle-delivered cytotoxicity or thermal ablation. In this study, gold nanoparticles were functionalized with phosphatidylcholine (two-layer) or phosphatidylcholine and HDL (three-layer) in the formation of “layered” nanoparticles. The diffusivity of both two- and three layered colloidal gold nanoparticles and silica gold nanoshells were examined in 3D cell …

Pathogenic Role Of Acrolein In Alcoholic Liver Disease., Wei-Yang (Jeremy) Chen

Electronic Theses and Dissertations

Alcohol is the most socially accepted addictive drug, and it can cause alcoholic liver disease (ALD), which is a major cause of morbidity and mortality in the United States and worldwide. Animal and human studies demonstrate that chronic alcohol consumption causes a pro-oxidant environment in the liver and increases hepatic lipid peroxidation and the accumulation of by-products such as acrolein and 4-hydroxynonenal. Acrolein is the most reactive and toxic aldehyde generated through lipid peroxidation. Also, acrolein is a major component of cigarette smoke, and there is increasing evidence that smoking negatively impacts the incidence, severity, and clinical course of chronic …

Classification Of Clinical Outcomes Using High-Throughput And Clinical Informatics., Alexander Carswell Cambon

Electronic Theses and Dissertations

It is widely recognized that many cancer therapies are effective only for a subset of patients. However clinical studies are most often powered to detect an overall treatment effect. To address this issue, classification methods are increasingly being used to predict a subset of patients which respond differently to treatment. This study begins with a brief history of classification methods with an emphasis on applications involving melanoma. Nonparametric methods suitable for predicting subsets of patients responding differently to treatment are then reviewed. Each method has different ways of incorporating continuous, categorical, clinical and high-throughput covariates. For nonparametric and parametric methods, …

Pathogenic Role Of Phosphodiesterase 4 (Pde4) In The Development Of Alcohol Induced Hepatic Steatosis., Diana Veronica Avila

Electronic Theses and Dissertations

Alcohol induced hepatic steatosis is a significant risk factor for progressive liver disease. Steatotic hepatocytes have increased sensitivity to injury produced by inflammatory cytokines, particularly TNF. Cyclic adenosine monophosphate (cAMP) has been shown to play a significant role in the regulation of both TNF production and lipid metabolism. However, the role of altered cAMP homeostasis in alcohol mediated hepatic steatosis and injury has not been studied. cAMP levels are tightly regulated by phosphodiesterase family of enzymes. Our recent work demonstrated that increased expression of hepatic PDE4, which specifically hydrolyzes and decreases cAMP levels, plays a pathogenic role in the development …

Self-Regulation Theory And Self-Monitoring Of Blood Glucose Behavior In Type 2 Diabetes Mellitus., Jennifer E. F. Ward

Electronic Theses and Dissertations

The present study examined self-monitoring of blood glucose (SMBG) as part of a selfregulatory process of health decision-making using the Self-Regulation Model of illness perceptions, or Common Sense Model. Participants were N=185 individuals with type 2 diabetes from a specialty diabetes clinic prescribed subcutaneous insulin or other injectable diabetes medication at least daily. Collected information included both medical chart data and self-report questionnaires completed prior receiving lab results. Self-care burden was generally high; the modal prescribed times per day of injecting insulin was 4 with modal SMBG recommendations of 3-4 times per day. Participants reported high adherence to prescribed medication …

Development Of A Thin-Film Porous-Microelectrode Array (P-Mea) For Electrical Stimulation Of Engineered Cardiac Tissue., Hiren Vrajlal Trada 1977-

Electronic Theses and Dissertations

Electrical stimulation has been increasingly used by research groups to enhance and increase maturation of cells in an engineered cardiac tissue (ECT). Current methods are based on using off-the-shelf wires or electrodes to deliver a stimulus voltage to the in-vitro tissue in culture medium. A major issue with this approach is the generation of byproducts in the medium due to the voltage levels required, which are typically in the range of 5V-10V. No solution currently exists that can accomplish electrical stimulation of cells in an ECT at a low voltage level. Therefore, in this study a novel, porous, thinfilm, microelectrode …

Boundary Contour Based Surface Representation., Yong Su

Electronic Theses and Dissertations

We receive most information about our surrounding space and objects through the eyes. To reconstruct the 3D space and objects in the visual system from the 2D retinal images, surface representation must be a critical intermediate stage in the visual processing stream. It is hypothesized in the dissertation that the visual system represents textured surface by a border-to-interior strategy: boundary contours would be encoded first and then border-ownership assignments would be resolved. This process would solve the related problems such as figure-ground segregation, surface depth relationship, occlusion, transparency, etc. As a result, the boundary contours of the surfaces would be …

The Effect Of Spinal Cord Injury On Vagal Afferents., April N. Herrity

Electronic Theses and Dissertations

Spinal cord injury (SCI) is a significant public health concern that leaves patients with a multitude of life-long disabilities. Major complications of SCI apart from paralysis, include deficits in bladder and bowel function. Lower urinary tract dysfunction continues to remain a top priority issue affecting quality of life for this population. The majority of visceral organs receive a dual sensory innervation from both spinal nerves as well as the vagus nerve. Following SCI, the vagus nerve is a potential pathway through which information from regions below the level of a spinal injury can travel directly to the brainstem, bypassing the …

Signaling Mechanisms In Regenerative Myogenesis., Sajedah M. Hindi 1986-

Electronic Theses and Dissertations

Skeletal muscle constitutes a highly plastic and malleable tissue that rapidly and profoundly adapts to various environmental and physiological stimuli. This response takes place by means of regulated signaling transduction which elicits changes in gene expression, biochemical, and metabolic properties. Adult muscle is composed by alignment of multinucleated, post mitotic muscle fibers formed during embryonic and neonatal development. Residing in the niche of mature muscle fibers is a small population of undifferentiated muscle progenitors termed satellite cells. Satellite cells are muscle stem cells that carry out regenerative response in adult myofibers. Coordinated signaling emitting from terminally differentiated muscle fibers and …

Predictors Of Lifestyle Behaviors, Trust Of Health Care Provider, And Utilization Of Health Services Among Adolescents Living In A Rural Area., Heather Karolyne Hardin

Electronic Theses and Dissertations

Background: Adolescents have elevated morbidity and mortality rates associated with risk-taking behaviors, but utilize health services at low levels. There is little evidence concerning health behavior, trust of health care provider, or utilization of health services among adolescents living in rural areas. Purpose: The purpose of this study was to examine individual characteristic variables and determine the extent to which these variables influence lifestyle behaviors, trust of health care provider (HCP), and utilization of health services among adolescents attending public high school in rural Indiana. Methods: This study used a cross-sectional, quantitative design. Instruments used in this study were …

An Examination Of The Relationship Between Sense Of Coherence, Engagement In Health Behaviors, And Individual Coping Style., Dean Todd Misener 1973-

Electronic Theses and Dissertations

Stress is a pervasive issue among traditional college students; affecting their choice in health behaviors, and overall academic performance. What is not clear is why some students, despite the pervasiveness of stressors are able to do well in school and maintain/improve their health, while other students struggle to maintain their health and do poorly in school. Aaron Antonovsky theorized that when confronted with a stressor a person with a high sense of coherence (SOC) will be motivated to cope, believe the challenge is understood and that the necessary resources to cope with the stressor are available. Overall, Antonovsky theorized that …

Extracellular Matrix Proteins And The Liver-Lung Axis In Disease., Veronica L. Massey

Electronic Theses and Dissertations

No abstract provided.

Shape/Image Registration For Medical Imaging : Novel Algorithms And Applications., Ahmed Magdy Shalaby 1982-

Electronic Theses and Dissertations

This dissertation looks at two different categories of the registration approaches: Shape registration, and Image registration. It also considers the applications of these approaches into the medical imaging field. Shape registration is an important problem in computer vision, computer graphics and medical imaging. It has been handled in different manners in many applications like shapebased segmentation, shape recognition, and tracking. Image registration is the process of overlaying two or more images of the same scene taken at different times, from different viewpoints, and/or by different sensors. Many image processing applications like remote sensing, fusion of medical images, and computer-aided surgery …

Modulation Of The Ovarian Cancer Humoral Response By Tumor-Derived Exosomes., Carolyn Denise Roberson

Electronic Theses and Dissertations

The pathogenesis of epithelial ovarian cancer is complicated by its diagnosis during the latter stages of the disease resulting from lack of symptoms or from presence of symptoms that mimic other conditions. Because of the often fatal prognosis by the time of actual detection, efforts are being made to better understand the host immune response to ovarian cancer. In this study, the contributions of the humoral immune response were investigated by focusing on the role of tumor-derived exosomes and their ability to modulate humoral immune responses. First, ovarian cancer patient-derived free circulating antibodies were investigated for immunoreactivity to patient antigen. …

Development Of Models For The Study Of The Molecular Mechanisms Of Host Restriction And Adaptation Of Hantaviruses., Ryan Carroll Mcallister 1988-

Electronic Theses and Dissertations

Hantaviruses, family Bunyaviridae, are present throughout the globe in a variety of mouse, rat, mole, vole, shrew, or bat species. Hantaviruses persist for the lifetime of the animal reservoir, while causing no signs or symptoms of disease. Only the rodent-borne hantaviruses cause disease in humans. In contrast, a “spillover” infection of a hantavirus into a nonreservoir rodent species results in an asymptomatic acute infection. We and others in the field are interested in understanding the biology of these virus-host interactions and mechanisms that underlie these three very different outcomes. The second chapter of my thesis focused on probing the intrahost …

Maternal Perception Of Child Body Weight And Physical Activity Behavior Patterns: Interactions With Gender And Ethnic Minority Status Of Preschool Children, Kayla F. Brooks

Electronic Theses and Dissertations

Childhood overweight and obesity is a complex disease that requires early identification and intervention. Little research has investigated the influence of maternal perception of child body weight on reported child physical activity behaviors and importance to change these behaviors. Using parent survey and child body mass index (BMI) data, the current study evaluated the difference between maternal perception of child weight status and reported physical activity and sedentary behavior levels amongst preschool-aged children. Reported child physical activity and sedentary behavior levels were not significantly different depending on maternal misperception. A significant interaction, however, between maternal perception of child body weight …

Sleep-Related Arousal And Spontaneous Movement Properties In Methadone-Exposed Neonates: A Videographic Assessment On The First Or Second Postnatal Night, Hira Shrestha

Electronic Theses and Dissertations

Prenatal substance exposure such as alcohol, nicotine, and opiates is known to modulate autonomic regulatory function during sleep, and to decrease arousability and spontaneous movements (SM). SM during sleep may reflect a protective mechanism for immature patterns of arousals. Neurodevelopmental compromise in sleep and arousal systems may underlie sudden infant death syndrome (SIDS) risk in which infants expire during sleep. Previous studies from our laboratory found abnormal patterns of neonatal arousal, sleep fragmentation, and deficits in sleep-related SM in infants with prenatal alcohol exposure. In this study, prenatal exposure to methadone was hypothesized to disrupt the development of sleep and …

Mental Health Referral In Primary Care: Influence Of A Screening Instrument And A Brief Educational Intervention, Michael T. Miesner

Electronic Theses and Dissertations

Although less than half of all patients with mental disorders seek mental health treatment per se, approximately 80% of all people will visit their primary care physician (PCPs) within a year (Strosahl, 1998). However, it is not well understood how to best handle patients presenting with mental health issues in primary care practices. The purpose of this project was to implement an intervention involving a screening measure for anxiety and mood disorders in a primary care setting to increase the volume of anxiety and mood disorder screening, to increase the accuracy of disorder detection, and to also enhance PCPs patterns …