Digital Commons Network^™

Comparison Of Neovascular Age-Related Macular Degeneration Populations In The United States, Susan Lynette Coultas

Walden Dissertations and Doctoral Studies

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the United States in people who are 50 and older. The safety and efficacy of aflibercept for the treatment of late stage neovascular AMD (NAMD) has been demonstrated by clinical trials among several populations; however, it is unclear whether all NAMD patients respond in the same manner as was studied in the clinical trials. The purpose of this study was to examine if populations of patients treated with aflibercept for the treatment of NAMD were significantly different from one another in terms of health characteristics, treatment regimens, …

An Evaluation Of The Screening And Management Of Patients With Type 2 Diabetes, Laura A. Cahoe

DNP Projects

Purpose: This purpose of this project was to evaluate preventive screening practices and adherence to guidelines for patients with type 2 diabetes (T2DM) as recommended by the American Diabetes Association (ADA) and United States Preventive Services Task Force (USPSTF) in the primary care setting. The specific aims were to: 1) determine the percentage of patients who received recommended screenings from the ADA, 2) determine the percentage of patients who received recommended screenings from the USPSTF, and 3) determine if the proportion of patients to receive the recommended screenings met established benchmarks set by Healthy People 2020 (HP2020).

Methods: A retrospective …

A Healthy Herd: Addressing The Justifications For Vaccine Denial And Applying The Health Belief Model To The Current Anti-Vaccination Movement, Sarah L. Mchugh

Honors Program Theses

The purpose of this thesis is to explore and analyze the existing literature regarding the refusal to receive vaccinations designed specifically to prevent Measles-Mumps-Rubella (MMR), which has spurred a serious public health issue that puts every unvaccinated person at risk. It will investigate the reasons people refuse to get vaccinations for themselves or their children. The analysis of the current situation and the application of the Health Belief Model to the related factors will provide potential explanations regarding how the decision-making process may strengthen efforts towards increasing vaccination rates.

Whsc1l1 Regulates Estrogen Receptor Activity In Sum44 Breast Cancer Cells, Jonathan Curtis Irish

Wayne State University Dissertations

Breast cancer is the most common cancer and the second leading

cause of cancer death in women. While ER-positive breast cancer subtypes are initially

well-managed by targeted therapies targeting estrogen signaling, many women are

suffering from recurrence of a more aggressive, hormone insensitive cancer 5 or more years after initial remission. Late recurrence of hormone resistant breast cancer in patients

who were previously successfully treated with anti-estrogen therapies worsens

overall long-term outcomes, and specific oncogenic mutations may be driving late recurring aggressive disease in these patients. More complete characterization of the oncogenome of

a tumor may allow for the possibility …

Implementation Of Hiv Drug Resistance Testing In Kenya, Horacio Duarte, Ingrid Beck, James Munyao, Molly Levine, Catherine Kiptinness, Bhavna Chohan, Samah Sakr, Michael Chung, Lisa Frenkel

Internal Medicine, East Africa

Background: Testing for HIV drug resistance prior to antiretroviral therapy (ART) is standard of care in the United States but is rarely performed in Africa due to its high cost. The prevalence of HIV drug resistance is increasing in resource-limited settings (RLS). An affordable and feasible strategy is needed in RLS to identify individuals with drug resistance and prescribe effective ART. Our group developed a low-cost oligonucleotide ligation assay (OLA) that detects mutations conferring resistance. Little data exists on implementing HIV drug resistance testing in RLS. Here, we describe the implementation of OLA in one laboratory in Kenya and discuss …

A Case Of Refractory Thrombotic Thrombocytopenic Purpura Treated With Plasmapheresis And Rituximab, Nicholas Kirui, Ahmed Sokwala

Internal Medicine, East Africa

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder with no prevalence or incidence studies in sub-Saharan Africa. Acquired TTP has several causes, all of which lead to decreased activity of von Willebrand factor cleaving protease (ADAMTS13) due to autoantibodies that are directed towards ADAMTS13. We report a case of a 46-year-old man who presented with most of the classic clinical manifestations of TTP.

Short Communication: Analysis Of Minor Populations Of Human Immunodeficiency Virus By Primer Identification And Insertion-Deletion And Carry Forward Correction Pipelines, Paul Hughes, Wenjie Deng, Scott C. Olson, Robert W. Coombs, Michael Chung, Lisa M. Frenkel

Internal Medicine, East Africa

Accurate analysis of minor populations of drug-resistant HIV requires analysis of a sufficient number of viral templates. We assessed the effect of experimental conditions on the analysis of HIV pol 454 pyrosequences generated from plasma using (1) the ‘‘Insertion-deletion (indel) and Carry Forward Correction’’ (ICC) pipeline, which clusters sequence reads using a nonsubstitution approach and can correct for indels and carry forward errors, and (2) the ‘‘Primer Identification (ID)’’ method, which facilitates construction of a consensus sequence to correct for sequencing errors and allelic skewing. The Primer ID and ICC methods produced similar estimates of viral diversity, but differed in …

Incidence And Factors Associated With Nonalcoholic Fatty Liver Disease Among Patients With Rheumatoid Arthritis, Ani K. John

Walden Dissertations and Doctoral Studies

Nonalcoholic fatty liver disease (NAFLD) has become one of the most common hepatic diseases worldwide, making the diagnosis and management of NAFLD an emerging public health issue. Theories associated with NAFLD surmise that inflammation may be the root cause, along with the complex interplay of other chronic conditions such as obesity, metabolic syndrome, diabetes, dyslipidemia, and cardiovascular disease (CVD). It is unknown if other inflammatory conditions such as rheumatoid arthritis (RA), along with the use of methotrexate (MTX), might confer increased risk for NAFLD. Longitudinal data collected from a retrospective cohort of 17,481 adult RA patients in the United States …

A Requirement For Y841 In Jak3 Enzymatic Activity And Hematopoietic Cancers, George Steven Martinez

Open Access Theses & Dissertations

A medical need exists for successfully treating people afflicted with leukemia, especially those who develop drug resistant forms. Relapse leukemia cases are particularly high within Hispanic populations where this disease is among the most frequently occurring cancer. Fourteen somatic mutations have been reported in Janus tyrosine kinase 3 (Jak3), including M511I and A573V, from patients with various forms of leukemia. To monitor drug sensitivity, a model system was developed. Indeed, many of these mutations have been shown to possess transforming ability in cell lines such as the IL-3 dependent pro-B cell line Ba/F3. As such, Ba/F3 cells were transformed to …

Determining The Role Of Poly [Adp-Ribose] Polymerase 1 (Parp-1) In Retroviral Infection, Luis Valdes Rodriguez

Open Access Theses & Dissertations

Possible links between PARP-1 and HIV-1 have been previously reported but the role of this protein during viral infection has remained elusive. Based on the high evolutionary conservation of PARP-1, from Drosophila to humans, we have been able to counteract the difficulties related with the functional redundancy manifested in the PARP family by studying the influence of PARP-1 on the expression of an endogenous retrovirus using the chicken B lymphoblastoid cell line DT40, this cell line exhibits low PARP-1 functional redundancy and is viable after PARP-1 knockout. We have determined that the transcription level of the endogenous retrovirus RAV-1 is …

Synthesis Of Neoglycoproteins/Neoglycopeptides And Their Immunological Evaluation In The Context Of Chagas Disease, Nathaniel Scott Schocker

Open Access Theses & Dissertations

The protozoan parasite, Trypanosoma cruzi, the etiologic agent of Chagas disease (ChD), has a cell surface covered by immunogenic glycoconjugates. A synthetic glycoarray containing non-reducing α-galactopyranosyl moieties related to mucin O-glycans of the parasite T. cruzi was evaluated by a chemiluminescent enzyme-linked immunosorbent assay (CL-ELISA) with sera from patients with chronic ChD, revealing the disaccharide Galα(1,3)Galβ as the immunodominant glycotope (Chapter 2). This disaccharide comprises the two terminal sugars of the known immunodominant glycotope Galα(1,3)Galβ(1,4)GlcNAcα, which is expressed on glycosylphosphatidylinositol-anchored mucins of the infective trypomastigote stage of T. cruzi and triggers high levels of protective anti-α-Gal antibodies (Abs) in infected …

Surgical Intensivist And Global Critical Care: Is There A Role?, Jana B.A. Macleod, Orlando C. Kirton, Linda L. Maerz

Abington Jefferson Health Papers

No abstract provided.

Nutritional Status And Tuberculosis Risk In Adult And Pediatric Household Contacts, Omowunmi Aibana, Xeno Acharya, Chuan-Chin Huang, Mercedes C Becerra, Jerome T Galea, Silvia S Chiang, Carmen Contreras, Roger Calderon, Rosa Yataco, Gustavo E Velásquez, Karen Tintaya, Judith Jimenez, Leonid Lecca, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Studies show obesity decreases risk of tuberculosis (TB) disease. There is limited evidence on whether high body mass index also protects against TB infection; how very high body mass indices influence TB risk; or whether nutritional status predicts this risk in children. We assessed the impact of body mass index on incident TB infection and disease among adults and children.

METHODS AND FINDINGS: We conducted a prospective cohort study among household contacts of pulmonary TB cases in Lima, Peru. We determined body mass index at baseline and followed participants for one year for TB infection and disease. We used …

Effect Of Mobile Phone Text Messages Reminders On Uptake Of Routine Immunization Among Children In Pakistan- Study Protocol For A Randomized Clinical Trial, Abdul Momin Kazi, Murtaza Ali, Khurram Zubair, Hussain Kalimuddin, Syed Asad Ali

Department of Paediatrics and Child Health

Introduction: Routine Immunization (RI) is considered one of the best public health interventions to decrease child morbidity and mortality. The RI coverage in Pakistan is still well below the desired level, leading to continued polio transmission, large measles outbreaks and thousands of deaths from vaccine-preventable illnesses. Different innovative and cost effective strategies are required to look into for enhancement in vaccination uptake and coverage. We plan to test the effectiveness of reminders to parents/caregivers on cell phones through short messaging system (SMS) in improving vaccine uptake and on-time routine immunization for children in Pakistan.
Methods and Analysis: A parallel-randomized controlled …

Expression And Functions Of Il-24 And Socs3 In Pseudomonas Aeruginosa Keratitis In A C57bl/6 Mouse Model, Bing Xu

Wayne State University Dissertations

The aim of this study was to elucidate the expression and functions of interleukin (IL)-24 and suppressor of cytokine signaling 3 (SOCS3), and their regulatory relationship in C57BL/6 mouse corneas in response to Pseudomonas aeruginosa (PA) infection. Among IL-20R cytokines, only IL-24 was induced at both mRNA and protein levels by the infection, and this upregulation was dampened by flagellin pretreatment. Time course studies revealed that IL-24 expression was markedly elevated, followed by a subsidence and second elevation, a pattern shared with SOCS3 but not IL-1β or IL-6. Silencing of IL-24 enhanced S100A8/A9 expression, and suppressed SOCS3, IL-1β, IL-1RN, and …

Patterns Of Human Herpesvirus-8 Oral Shedding Among Diverse Cohorts Of Human Herpesvirus-8 Seropositive Persons, Rachel A. Bender Ignacio, Jason D. Goldman, Amalia S. Magaret, Stacy Selke, Meei-Li Huang, Soren Gantt, Christine Johnston, Warren Phipps, Joshua Schiffer, Richard Zuckerman

Dartmouth Scholarship

Human herpesvirus-8 (HHV-8), the etiologic agent of Kaposi sarcoma (KS), establishes lifelong latent infection with periodic lytic replication (“shedding”) at mucosal sites, especially the oropharynx. Patterns of HHV-8 shedding are not well understood, and require elucidation to better predict risk of HHV-8 related malignancies in those infected. We sought to characterize patterns of HHV-8 oropharyngeal shedding among diverse cohorts that enrolled HHV-8 seropositive persons.

Typical Hus: Evidence Of Acute Phase Complement Activation From A Daycare Outbreak, T M. Brady, C Pruette, L F. Loeffler, Darcy Weidemann, J J. Strouse, E Gavriilaki, R A. Brodsky

Manuscripts, Articles, Book Chapters and Other Papers

The clinical manifestations of typical hemolytic uremic syndrome (HUS) encompass a wide spectrum. Despite the potentially severe sequelae from this syndrome, treatment approaches remain supportive. We present the clinical course of a child who contracted Shiga toxin-positive E. coli (STEC) from a daycare center during an outbreak. Utilizing the modified Ham test which is a rapid, serum-based functional assay used to detect activation of the alternative pathway of complement as observed in atypical HUS, patient sera revealed evidence of increased complement activation in the acute phase of the syndrome but not after resolution. Further, this complement activation was attenuated by …

Reducing Overutilization Of Testing For Clostridium Difficile Infection In A Pediatric Hospital System: A Quality Improvement Initiative., J Michael Klatte, Rangaraj Selvarangan, Mary Anne Jackson, Angela Myers

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Study objectives included addressing overuse of Clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing.

METHODS: A multifaceted initiative was developed, and components included multiple provider education methods, computerized order entry modifications, and automatic declination from laboratory on testing stool specimens of nondiarrheal consistency and from children ≤12 months old. A run chart, demonstrating numbers of nondiarrheal plus infant stool specimens submitted over time, was developed to analyze the initiative's impact on clinicians' test-ordering practices. A …

Slug Bug: Quality Improvement With Orchestrated Testing Leads To Nicu Clabsi Reduction., Anthony J. Piazza, Beverly Brozanski, Lloyd Provost, Theresa R. Grover, John Chuo, Joan R. Smith, Teresa Mingrone, Susan Moran, Lorna Morelli, Isabella Zaniletti, Eugenia K. Pallotto

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices.

METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 …

Allergic Diseases And Internalizing Behaviors In Early Childhood., Maya K. Nanda, Grace K. Lemasters, Linda Levin, Marc E. Rothenberg, Amal H. Assa'ad, Nicholas Newman, David Bernstein, Gurjit Khurana-Hershey, James E. Lockey, Patrick H. Ryan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVES: The relationship between allergic diseases and internalizing disorders has not been well characterized with regard to multiple allergic diseases or longitudinal study. The objective of this study was to examine the association between multiple allergic diseases in early childhood with validated measures of internalizing disorders in the school-age years.

METHODS: Children enrolled in the Cincinnati Childhood Allergy and Air Pollution Study underwent skin testing and examinations at ages 1, 2, 3, 4, and 7 years. At age 7, parents completed the Behavior Assessment System for Children, Second Edition (BASC-2), a validated measure of childhood behavior and emotion. …

Proceedings Of The Working Group Session On Fertility Preservation For Individuals With Gender And Sex Diversity., Courtney Finlayson, Emilie K. Johnson, Diane Chen, Elizabeth Dabrowski, Yasmin Gosiengfiao, Lisa Campo-Engelstein, Ilina Rosoklija, Jill Jacobson, Margarett Shnorhavorian, Mary Ellen Pavone, Molly B. Moravek, Herbert J. Bonifacio, Lisa Simons, Janella Hudson, Patricia Y. Fechner, Veronica Gomez-Lobo, Rachel Kadakia, Angela Shurba, Erin Rowell, Teresa K. Woodruff

Manuscripts, Articles, Book Chapters and Other Papers

Children and adolescents with gender and sex diversity include (1) gender-nonconforming and transgender individuals for whom gender identity or expression are incongruent with birth-assigned sex (heretofore, transgender) and (2) individuals who have differences in sex development (DSD). Although these are largely disparate groups, there is overlap in the medical expertise necessary to care for individuals with both gender and sex diversity. In addition, both groups face potential infertility or sterility as a result of desired medical and surgical therapies. The Ann & Robert H. Lurie Children's Hospital of Chicago (Lurie Children's) gender and sex development program (GSDP) provides specialized multidisciplinary …

International Survey On Skin Patch Test Procedures, Attitudes And Interpretation., Luciana K. Tanno, Razvigor Darlenski, Silvia Sánchez-Garcia, Matteo Bonini, Andrea Vereda, Pavel Kolkhir, Dario Antolin-Amerigo, Vesselin Dimov, Claudia Gallego-Corella, Juan Carlos Aldave Becerra, Alexander Diaz, Virginia Bellido Linares, Leonor Villa, Lanny J. Rosenwasser, Mario Sanchez-Borges, Ignacio Ansotegui, Ruby Pawankar, Thomas Bieber, Wao Junior Members Group

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Skin patch test is the gold standard method in diagnosing contact allergy. Although used for more than 100 years, the patch test procedure is performed with variability around the world. A number of factors can influence the test results, namely the quality of reagents used, the timing of the application, the patch test series (allergens/haptens) that have been used for testing, the appropriate interpretation of the skin reactions or the evaluation of the patient's benefit.

METHODS: We performed an Internet -based survey with 38 questions covering the educational background of respondents, patch test methods and interpretation. The questionnaire was …

Inhibition Of Bacterial Growth And Prevention Of Bacterial Adhesion With Localized Nitric Oxide Delivery, Julia Osborne

Dissertations, Master's Theses and Master's Reports

Bacterial infections continue to be a problem at the site of an indwelling medical device, and over the years, various bacterial strains have become more resistant to current antibiotic treatments. Bacterial infection at an indwelling medical device can be dangerous and affect the performance of the medical device which can ultimately lead to the failure of the device due to bacterial resistance to treatment.

Nitric Oxide (NO) has been shown to possess antibacterial properties to prevent and inhibit bacterial growth. NO releasing coatings on indwelling medical devices could provide a reduction in bacterial infections that occur at the device site …

Diagnostics Of Primary Immunodeficiencies Through Next-Generation Sequencing., Vera Gallo, Laura Dotta, Giuliana Giardino, Emilia Cirillo, Vassilios Lougaris, Roberta D'Assante, Alberto Prandini, Rita Consolini, Emily G. Farrow, Isabelle Thiffault, Carol J. Saunders, Antonio Leonardi, Alessandro Plebani, Raffaele Badolato, Claudio Pignata

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Recently, a growing number of novel genetic defects underlying primary immunodeficiencies (PIDs) have been identified, increasing the number of PID up to more than 250 well-defined forms. Next-generation sequencing (NGS) technologies and proper filtering strategies greatly contributed to this rapid evolution, providing the possibility to rapidly and simultaneously analyze large numbers of genes or the whole exome.

OBJECTIVE: To evaluate the role of targeted NGS and whole exome sequencing (WES) in the diagnosis of a case series, characterized by complex or atypical clinical features suggesting a PID, difficult to diagnose using the current diagnostic procedures.

METHODS: We retrospectively analyzed …

Putting Prep Into Practice: Lessons Learned From Early-Adopting U.S. Providers’ Firsthand Experiences Providing Hiv Pre-Exposure Prophylaxis And Associated Care, Sarah K. Calabrese, Manya Magnus, Kenneth H. Mayer, Douglas S. Krakower, Adam I. Eldahan, Lauren A. Gaston Hawkins, Nathan B. Hansen, Trace S. Kershaw, Kristen Underhill, Joseph R. Betancourt, John F. Dovidio

Faculty Scholarship

Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers’ adoption of PrEP into clinical practice. This qualitative study explored PrEP providers’ firsthand experiences relative to six commonly-cited barriers to prescription – financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation) – as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced …

Childhood Obesity, A Public Health Crisis: Narrative Review Of Public Health Interventions For Childhood Obesity, Sumera Aziz Ali, Savera Aziz Ali, Nadir Suhail, Shiyam Sunder Tikmani, Gulshan Bano

Community Health Sciences

Introduction: Child obesity is the major pediatric public health crisis of the current century and its trend is increasing in the developing countries due to nutrition and epidemiologic transition. Considering the burden of childhood obesity and its associated outcomes need for obesity prevention in children has become priority both for government and researchers.
Objective: The objective of this review is to provide the updated knowledge and evidence from various research studies, designed to provide interventions either in school or at home.
Methodology: Electronic databases like Google scholar, PubMed and Sciencedirect were used as search engines. Key terms used during the …

Medical Community Distrust And The Influenza Vaccination Rates Of Black Americans, Kenyatte Irby Winston

Walden Dissertations and Doctoral Studies

Black Americans experience influenza vaccination rates that are lower than the rates of other ethnic groups. Low influenza vaccination rates among the Black community are associated with higher influenza infection rates, influenza-related hospitalizations, and higher influenza mortality rates. There is a belief within the Black American community that the medical establishment does not have the Black American patient in its best interest, leading to feelings of distrust. The purpose of this study was to determine if the distrust of the medical community is a relevant factor in the low influenza vaccination rates of Black Americans aged 18 and older in …

The Association Of Cancer Development In Patients With Systemic Lupus Erythematosus, Rose Michelle Coley

Walden Dissertations and Doctoral Studies

The Association of Cancer Development in Patients with Systemic Lupus Erythematosus by

Rose Michelle Coley

MPH, Walden University, 2011

BS, University of Mount Olive, 2008

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Public Health

Walden University

March 2016

Both cancer and autoimmune diseases have been associated with numerous factors that may independently lead to the development of either disease. When these factors overlap the difficulty in assessing association is compounded. The numerous factors that are thought to cause systemic lupus erythematosus (SLE), which leads to the development of cancer, makes the study …

Barriers To Exclusive Breastfeeding Among Mothers During The First Four Weeks Postpartum, Jessy V. Thomas

Walden Dissertations and Doctoral Studies

According to the World Health Organization, breastfeeding is natural and the most effective way of nourishment to feed infants and young children to ensure child health and survival. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding during the first 6 months of life. Although exclusive breastfeeding has been shown to reduce the occurrence of adverse health outcomes to the infant and mother, the duration of exclusive breastfeeding remains relatively low in the United States. The theory of planned behavior was used as a theoretical framework for this study. The purpose of …

Breastfeeding Education For Women With Diabetes, Pregnancy-Induced Hypertension And Multiple Gestations, Oluwapelumi Adefunmike Adeboyejo

Walden Dissertations and Doctoral Studies

Breastfeeding is considered a public health concern due to increased maternal/infant mortality and morbidity rates associated with persistent low rates in breastfeeding. Providing early breastfeeding education for women with diabetic, pregnancy-induced hypertension and multiple gestations can result in higher persistence rates and a decrease in maternal and infant mortality and morbidity rates. This quality improvement project provided early prenatal breastfeeding education for women with diabetes, pregnancy-induce hypertension and multiple gestations at a private clinic in Long Beach, Southern California. Evidence-based literature reviews were conducted through CINAHL and Medline (2009-2014). The descriptive study used for the project was made up questionnaires …