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Knowing Heart, Lisa Phan

Stimulus: A Medical Humanities Journal

No abstract provided.

N-Acetylcysteine Is Associated With Changes In Functional Connectivity In Patients With Parkinson's Disease, Daniel A. Monti, George Zabrecky, Daniel Kremens, Tsao-Wei Liang, Nancy A. Wintering, Faezeh Vedaei, Emily Navarreto, Monisha Gupta, Alicia Steinmetz, Anthony J. Bazzan, Feroze Mohamed, Andrew B. Newberg

Marcus Institute of Integrative Health Faculty Papers

INTRODUCTION: This study assessed the changes in functional connectivity from resting functional magnetic resonance imaging (fMRI) in patients with Parkinson's disease (PD) given N-Acetylcysteine (NAC), the prodrug to L-cysteine and a precursor to the natural biological antioxidant glutathione (GSH). The aim of this study was to determine whether NAC is associated with changes in functional connectivity, particularly in the basal ganglia, and improvements in Parkinson's symptoms.

METHODS: Forty-four patients with PD were randomized to either weekly intravenous infusions of NAC (50 mg/kg) plus oral doses (500 mg twice per day) for six months plus standard of care, or standard of …

Optimizing Practice Facilitation: A Comprehensive Study On Implementation Fidelity And Its Determinants, Demetria Marie Hubbard

ETDs from 2020-2029

Intervention outcomes cannot be fully understood without examining how implementation strategies are delivered. While implementation fidelity to interventions is well recognized as a determinant of effectiveness, the fidelity of implementation strategies—the methods used to support intervention adoption—remains under-documented and under-assessed. Without this information, it is difficult to contextualize why interventions succeed or fail across diverse settings. This three-paper dissertation focuses on practice facilitation (PF), a widely used strategy in primary care quality improvement, as implemented in the Heart Health Improvement Project (HHIP) in Alabama. HHIP, led by the Alabama Cardiovascular Cooperative and funded by the Agency for Healthcare Research and …

Integrated Proteomics To Understand The Role Of Neuritin-1 (Nrn1) As A Molecular Mediator Of Synaptic Resilience In Alzheimer’S Disease, Derian Pugh

ETDs from 2020-2029

Alzheimer’s disease (AD) is the leading cause of dementia in adults over the age of 65, and currently affects approximately 6.9 million people in the United States. By 2060, the number of people age 65 and older with AD is projected to reach 13.8 million, barring the development of disease-altering therapies to prevent, slow or cure AD. Thus, there is a need for progress in the understanding of AD pathophysiology, as well as in the development of diagnostic and therapeutic interventions. Approximately one-third of individuals without dementia at the time of death are found to harbor high levels of amyloid-beta …

Cbct Evaluation Of Planned Vs. Achieved Expansion And Buccal Bone Thickness In Phase I Orthodontic Cases Treated With Clear Aligners, Jared Teeples

ETDs from 2020-2029

Introduction: Within orthodontics, CBCT technology has been used to analyze tooth movement with both fixed appliances and clear aligners. However, little research has evaluated alveolar bone remodeling outcomes in growing patients treated with clear aligner expansion. Methods: This study compared pre-treatment (T0) and post-treatment (T1) CBCTs of Phase I patients treated with clear aligners who had expansion planned in the Invisalign® ClinCheck. CBCTs were collected and analyzed, including 27 maxillary and 22 mandibular arches. The aims were (1) to compare planned vs. actual expansion and (2) to evaluate the arch width (AW) and alveolar bone changes before and after treatment. …

Cysteine Protease Activity In Allergen Recognition And Initiation Of Th2 Allergic Responses, Audrey Rae Meloun

ETDs from 2020-2029

Allergens are non-infectious environmental proteins that can trigger T helper 2 (Th2) cell-mediated inflammation in atopic individuals. Allergens are structurally diverse and typically lack pathogen-associated molecules patterns (PAMPs), which are recognized by pathogen recognition receptors (PRRs). PRRs are the canonical sensors of the innate immune system that typically detect PAMPs in microbes, initiating signaling pathways that drive pathogen clearance. Because allergens generally do not activate PRRs in the same way as infectious agents, alternative detection mechanisms are likely responsible for their recognition and the subsequent initiation of Th2 cell-mediated inflammation. House Dust Mite (HDM), a major indoor allergen, and other …

Exercise Testing And Training For Individuals With Cystic Fibrosis, Najlaa Zayed Alotaibi

ETDs from 2020-2029

Cystic fibrosis (CF) is a progressive genetic disease that impacts multiple systems (e.g., respiratory system). Hence, routine cardiopulmonary exercise testing (CPET) is recommended to track the disease progression in people with CF. Besides the benefits of exercise testing, exercise training is also beneficial for long-term wellness. It is recommended that people with CF engage in at least 30–60 minutes of aerobic exercise 3 days a week. However, despite the significance of exercise testing and training for people with CF, CPET and exercise training are underutilized in international CF centers. According to the literature, the majority of international CF centers use …

Analysis Of Activated Carbon Fiber (Acf) As Particulate Filtration And Volatile Organic Compound (Voc) Media For The Development Of A Dual-Air Purifying Facepiece Respirator, Brie Mcmahan

ETDs from 2020-2029

Exposure to particulate matter (PM) and volatile organic compounds (VOCs) in occupational or public settings poses adverse health outcomes such as respiratory, cardiovascular, reproductive, neurological, carcinogenic morbidity and mortality. Many occupational settings expose workers to PM and VOC concurrently, yet most commercially available respirators are designed to address either particulates or vapors alone. This includes air-purifying respirators (APRs), powered air-purifying respirators (PAPRs), and filtering facepiece respirators (FFRs) with nuisance-level vapor protection, often limited by bulk, discomfort, high pressure drop, and misuse. We identified a need for alternative dual-exposure media and a respiratory protection device that is lighter, and more comfortable …

Development Of Human Trophoblast Cell Surface Antigen-2 (Trop-2) Specific Radiopharmaceutical Tracers, Arnav Vipulkumar Patel

ETDs from 2020-2029

Trophoblast cell surface antigen 2 (Trop2) is closely related to the development and progression of triple-negative breast cancers (TNBC) and is also being investigated as a pan-cancer biomarker. Trop-2 tumorigenesis is mediated by the calcium ion signaling pathways. By accurately predicting and targeting Trop-2 for immunotherapy, precision therapy is crucial. Trop-2 is overexpressed in tumor tissues compared to normal tissues, which makes it a promising molecular target for cancer-targeted therapy. This thesis reports the development and preclinical evaluation of two novel Trop-2-specific radiopharmaceutical tracers derived from the clinically approved antibody-drug conjugate Sacituzumab Govitecan (SG): a full antibody drug conjugate-based tracer …

Staff Education On Metabolic Syndrome Screening In Patients Receiving Long-Acting Injectable Psychotropics, Efetze Metangpa Akana

Walden Dissertations and Doctoral Studies

Summary This Doctor of Nursing Practice project was a staff education initiative designed to improve metabolic syndrome screening practices for patients receiving long-acting injectable psychotropic medications in an outpatient psychiatric setting. People living with serious mental illness face a heightened risk of cardiometabolic conditions, and inconsistent screening leads to delayed detection, avoidable illness, and ongoing health disparities, underscoring the importance of this practice gap within nursing practice due to nurses’ central role in medication oversight and preventive care. A key limitation of the project was the small sample size and short-term evaluation period, which limited generalizability and did not allow …

Self-Stigma Of Seeking Help, Psychological Safety, And Employee Assistance Program Use In Nurses, Latisha Lenee Marshall

Walden Dissertations and Doctoral Studies

Employee assistance programs (EAPs) remain underutilized across various U.S. work sectors, including nursing. There are several barriers that impede nurses from using EAP services, including self-stigma of seeking help (SSOSH) and psychological safety (PS). The purposes of this study, which used the health promotion model as its theoretical framework, were to determine (a) if there was a difference in the level of SSOSH in nurses who have used EAPs and those who have not used EAPs, (b) if there was a difference in the level of PS in nurses who have used EAPs and nurses who have not used EAPs, …

Implementation Of Structured Nursing Leadership Rounding To Improve Hospital Policy Adherence, Irma Rose Maize

Walden Dissertations and Doctoral Studies

Variability in nursing policy compliance contributes to inconsistent clinical practice and compromises the delivery of standardized care. Limited leadership presence, support, and accountability have been identified as significant contributors to this practice gap. This Doctor of Nursing Practice project focused on educating nurse leaders about the importance and benefits of consistent unit-based leadership rounding as a strategy to support frontline nurses and reinforce policy adherence. A structured leadership rounding checklist was developed to guide purposeful, consistent check-ins with nursing staff, facilitating real-time support and identification of barriers to practice. Implementation of the checklist promoted increased leadership accessibility, improved communication, and …

Surviving Staten Island: Black Women’S Narratives Of Resilience, Motherwork, And Embodied Trauma, Jazmin Rivera

Student Theses

This oral history dissertation centers the experiences of six Black women who had formative experiences navigating hostile school and community-based settings on Staten Island during the 1970s, 1980s, and early 1990s. Guided by a conceptual framework that draws on Black orality, Black feminist thought, and endarkened feminist epistemology, this study demonstrates how Black women were required to cross geographic and social boundaries to survive hostile conditions in Staten Island communities and schools. Findings from this study highlight Black women’s use of community cultural wealth to inform their survival strategies and resilience. At the same time, their experiences indicate the potential …

Pandemic Mask Mandates And Closures Were Linked To Increased Gun Violence, Douglas A. Wolf, Emily W. Wiemers, Iliya Gutin, Jennifer Karas Montez, Shannon M. Monnat

Population Health Research Brief Series

Gun violence worsened substantially during the COVID-19 pandemic. This brief summarizes findings from a study using weekly gun violence casualty data from 2016-2021 for 304 U.S. counties from the Gun Violence Archive and COVID-19 policy data from county-level measures of activity restrictions and masking requirements. The authors find that policies requiring masking and activity restrictions were associated with significant increases in gun violence. Indoor masking requirements were linked to a 28% increase in gun violence, while activity restrictions were associated with a 4.2% increase.

Expanding Access To Live Donation Opportunities: Implementing Telehealth Solutions To Enhance The Living Donor Navigator Program, Alexis Carter

ETDs from 2020-2029

Living donor kidney transplantation (LDKT) is the most effective treatment for patients with end-stage kidney disease; however, living donation rates have remained suboptimal over the past two decades. As a result, many interventions have been developed and tailored to increase living donation. The Living Donor Navigator (LDN) Program is one effort designed to help transplant candidates identify potential living donors and guide them through the donation process, using a combination of advocacy and systems training. The LDN Program is a lay-navigator-based intervention that equips participants with the knowledge, communication skills, and confidence needed to identify and engage potential living donors. …

Novel Retinal Biomarker Development In Early Alzheimer’S Disease, Swetha Ravichandran

ETDs from 2020-2029

Alzheimer’s disease is a progressive neurodegenerative disorder that causes damage to the neurons that are present in the brain. Progress in the management and treatment of AD is limited by lack of early diagnostics, which are critical to the development of effective therapies. It is therefore critical to develop non-invasive/cost efficient biomarkers to aid in early diagnosis and interventions to prevent or delay dementia onset. While Positron Emission Tomography (PET) and cerebrospinal fluid assessment have greatest utility, they are not routinely used because they are expensive and invasive, respectively. Retinal imaging offers a promising, low-cost, and non-invasive avenue for detecting …

Early Life Stress Mediates Cardiovascular Disease Risk Through Csf1r And Increases Risk Of Lupus Through Mature B-Cells, Cailin Elizabeth Kellum

ETDs from 2020-2029

The term Early Life Stress (ELS) encompasses traumatic events occurring before the age of 18 such as physical abuse, verbal abuse, household dysfunctions, sexual abuse, childhood neglect, child maltreatment, and adverse childhood experiences. The traumatic psychological and physical experiences in early life are widely known to cause enduring effects on mental and physical health in adulthood. Of note, individuals with ELS have adverse health outcomes earlier in adulthood and with more severity such as in the case of Systemic Lupus Erythematous (SLE), an autoimmune disease. The risk for autoimmunity and cardiovascular disease (CVD) increases with ELS exposure and CVD is …

Awareness And Knowledge Of Juvenile Idiopathic Arthritis Among Orthodontic And Oral And Maxillofacial Surgery Specialties In The United States., Kavita Nayar

ETDs from 2020-2029

Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common chronic pediatric arthritis, frequently involving the temporomandibular joint (TMJ) and resulting in facial growth disturbances, functional impairment, and complex multidisciplinary treatment needs. Despite its clinical relevance, limited awareness and inconsistent management strategies exist among specialists who are involved in the care of these patients including orthodontists, oral and maxillofacial surgeons and rheumatologists. This study aimed to evaluate the understanding, knowledge and interdisciplinary management practices between board-certified orthodontists and oral and maxillofacial surgeons (OMSs) across the United States regarding JIA. Materials and Methods: A cross-sectional survey was distributed electronically via Qualtrics to …

Relationship Between Corneal Biomechanics In Sjögren’S Disease And Risk Factors For Glaucoma Development, Isabella Grace Simmons

ETDs from 2020-2029

Both Sjögren’s disease and glaucoma are known to have abnormal corneal biomechanics that impact their disease progression. The pathophysiology of Sjögren’s disease may also increase the likelihood of developing glaucoma. However, we do not yet know whether the prevalence of risk factors associated with glaucoma in Sjögren’s patients is due to underlying weakened corneal biomechanics. Oculus Corvis ST will be used to evaluate the corneal biomechanics in Sjögren’s patients in relation to the inflammatory mediators in the tear film. These properties will then be correlated with retinal nerve fiber layer and ganglion cell layer thickness. Evaluating these findings will provide …

Lmod1 Modulates Neointimal Lesion Size After Vessel Injury And Stabilizes Smooth Muscle Cell Gene Regulatory Networks During Atherogenic Stress, Sara Wennersten

ETDs from 2020-2029

Phenotypic switching of smooth muscle cells (SMCs) from a contractile to a synthetic state underlies the pathogenesis of several cardiovascular disease (CVD) pathologies, including restenosis and atherosclerosis. Leiomodin 1 (LMOD1), an SMC-enriched actin-binding protein, has been previously found to regulate SMC phenotypic modulation in vitro. However, its contribution to CVD development and progression, along with its influence on gene regulatory networks (GRNs) that inform underlying responses to stress, remains incompletely defined. Here, I combine a mouse injury model, bulk RNA sequencing, and GRN inference to define how reduced LMOD1 expression perturbs SMC physiology during vascular wall remodeling and lipid stress. …

Exploring The Relationship Among Nurse-Specific Factors And Triage Accuracy In The Emergency Setting, Krisada Suamchaiyaphum

ETDs from 2020-2029

Triage is a critical function of emergency nursing practice, directly influencing patient safety, flow, and outcomes in the emergency department (ED). Despite widespread use of standardized triage training and resources, triage accuracy among ED nurses remains suboptimal. The purpose of this three-manuscript dissertation was to examine factors associated with triage accuracy in the ED setting. Manuscript One was an integrative literature review of 14 studies published between 2011 and 2021, with reported triage accuracy rates ranging from 59.3% to 82%. Primary factors associated with triage accuracy were: nurse-specific, patient, and work environment factors. Manuscript Two reported a retrospective study of …

The Influence Of The Mental Health Parity And Addiction Equity Act On Residential Behavioral Healthcare Facility Availability In The United States: A State-Level Analysis, Amanda Mellowspring

ETDs from 2020-2029

The need for accessible, quality behavioral healthcare (BH) has increased dramatically over recent decades. The availability of BH services for patients has long been complicated by high cost, lack of insurance coverage, and location accessibility. BH organizations face ongoing challenges to meet the demand for services including costs of operation, worker shortages, and navigating the payer landscape. The history of BH in the U.S. provides the foundation to conceptualize federal regulations and attempts at parity. Literature regarding federal legislation, such as the Mental Health Parity Addiction and Equity Act (MHPAEA), the Affordable Care Act, and Medicaid expansion; BH facilities and …

Development And Validation Of A Theoretically Informed Instrument To Measure The Antecedents Of Microbreaking Intentions (I-Mami) Of Procedural Healthcare Workers, Robin Riddle

ETDs from 2020-2029

ABSTRACT Work-related musculoskeletal disorders (WMSD) affect 77% of nurses and 60% of surgeons, exceeding rates in other occupational sectors and threatening healthcare workforce sustainability. Microbreaking is brief, strategic pause of 20 seconds to five minutes performed every 20 to 40 minutes during medical procedures. It has demonstrated effectiveness in reducing fatigue, improving accuracy, and lowering physiological stress markers without extending medical procedure duration. Despite this evidence, adoption remains limited, and no theoretically informed instruments exist to measure the behavioral determinants of microbreaking intentions among procedural healthcare workers. Investigators of this three-manuscript dissertation developed and established content and construct validity as …

Psychosocial Outcomes In Adults With Cleft Lip And Palate: Exploring The Relationship Between Cleft Severity, Mental Health, And Treatment Satisfaction, Haley Hannabass

ETDs from 2020-2029

Introduction:This study aimed to examine psychosocial outcomes in adults with cleft lip and palate (CL/P), focusing on how cleft severity (unilateral versus bilateral) influences depression, anxiety, social functioning, oral health–related quality of life, and satisfaction with treatment outcomes. Individuals born with clefts often continue to face psychosocial challenges even after surgical repair, and limited research has compared how these outcomes differ by cleft type in adulthood. Materials and Methods:A cross-sectional design was used, including 24 adults aged 18 years and older who had undergone cleft repair and were finished or in active orthodontic treatment at UAB. Participants completed an online …

Handling Missing Data In Copd Research, Chia-Ying Chiu

ETDs from 2020-2029

Chronic Obstructive Pulmonary Disease (COPD) remains a major global health concern and one of the leading causes of death in the United States, affecting approximately 4.6% of adults and reaching a prevalence of 9.4% in Alabama according to 2024 National Health Interview Survey. The disease imposes a substantial burden on quality of life and healthcare costs and contributes to increased disability-adjusted life years and years of life lost, as highlighted by the 2022 Lancet Commission report. Despite its im-pact, COPD is frequently diagnosed only after irreversible lung damage has occurred, largely due to under-recognized symptoms and limited diagnostic tools. Early …

Apolipoprotein E4 And Its Later-Life Health Effects On The Multiple Sclerosis Population, Dean Zeldich, Chia Hsin Cheng, Yi Guan, Sriman Narain, Bang-Bon Koo

Department of Neurology Faculty Papers

BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS) is a chronic autoimmune disease causing neuroinflammation and neurodegeneration. The apolipoprotein E4 (APOE4) allele, a major genetic risk factor for late-onset Alzheimer's Disease, accelerates cognitive decline and neuroinflammatory processes, including blood-brain-barrier disruption. This study explores the impact of APOE4 on later-life health in MS patients using biomarkers from the UK Biobank.

METHODS: MS patients were grouped by APOE4 carrier status: MS-E4 and MS-nonE4. Age- and sex-matched non-MS controls (control-E4, control-nonE4) were included for comparison. Analyses assessed retinal nerve fiber layer thickness (RNFL) from optical coherence tomography (OCT), blood biomarkers, cognitive performance, and brain magnetic …

Spatially Distinct Cellular And Molecular Landscapes Define Prognosis In Triple-Negative Breast Cancer, Kavitha Mukund, Darya Veraksa, David Frankhouser, Lixin Yang, Jerneja Tomsic, Raju Pillai, Srijan Atti, Zahra Mesrizadeh, Daniel Schmolze, Jovanny Zabaleta, Xiao-Cheng Wu, Mary-Anne Leblanc, Lucio Miele, Augusto Ochoa, Victoria Seewaldt, Shankar Subramaniam

School of Medicine Faculty Publications

Triple-negative breast cancer (TNBC) is a prevalent breast cancer subtype with the lowest 5-year survival. Several factors influence outcomes, but their inherent molecular and cellular heterogeneity are increasingly acknowledged as crucial determinants. Here, we report on the spatio-molecular heterogeneity underlying TNBC tumors in a retrospective, treatment-naive cohort with differential prognoses (17 good prognoses [GPx] >15-year survival and 15 poor prognoses [PPx] < 3-year survival]) profiled using GeoMx Digital Spatial Profiler. Analyses reveal that epithelial and microenvironment (TME) states are transcriptionally distinct between groups. Invasive GPx epithelia show an increase in immune transcripts, with a more immune-rich TME (via IF). PPx epithelia, in contrast, are more metabolically and translationally active, with a mesenchymal/fibrotic TME. Pre-cancerous epithelia in PPx exhibit a presence of aggressiveness, marked by increased EMT signaling and complement activity. We identify distinct epithelial gene signatures for PPx and GPx that can accurately classify diagnostic samples and likely inform therapy.

Amino Acid Pet Tracers For Cancer Imaging And Response Assessment, Ugur Akca

ETDs from 2020-2029

Triple-negative breast cancer (TNBC) and high-grade glioma (HGG) pose significant diagnostic and therapeutic challenges due to their aggressive biology and the limitations of [¹⁸F]FDG PET, which suffers from nonspecific uptake in inflammatory tissues, complicating differentiation of viable tumor from treatment-related effects. Computed Tomography, while strong for structural changes, has limited soft tissue contrast for distinguishing tumor from inflammation, and Magnetic Resonance Imaging, despite superior soft tissue resolution, struggles with differentiating active tumor from post-treatment changes like edema or necrosis due to nonspecific enhancement. These challenges highlight the necessity for complementary and advanced imaging strategies for improved diagnosis and monitoring. This …

Sample Preparation Effects On Liquid Scintillation Counting Quench, Jason Rusch

ETDs from 2020-2029

Liquid Scintillation Counting (LSC) is a critical technique in operational health physics, particularly for contamination surveys. However, common, expedient sample preparation choices often introduce unpredictable levels of quench, compromising the accuracy of results. This thesis investigates the impact of common preparation variables including vial material, cap lining, solid sample matrix presence, cocktail volume, and radioactivity. The impact of these sample preparation variables were evaluated using the quench methods on two fundamentally distinct commercial LSC systems, the Perkin Elmer Tri-Carb 4910TR (employing tSIE correction) and the Hidex 600 SL (employing TDCR correction). A total of 320 samples were evaluated on each …

Physiological And Neuroimmune Effects Of Manual Therapy, Murdi S. Alanazi

ETDs from 2020-2029

Manual therapy (MT) is widely used across healthcare disciplines for the management of musculoskeletal conditions. Emerging evidence indicates that MT may also influence broader physiological systems such as the nervous and the immune systems. However, the mechanisms underlying these effects are still not well understood, and limited evidence exists regarding the neuroimmune effect of MT in neurologically impaired populations such as multiple sclerosis (MS). The overall aim of this dissertation was to investigate the physiological effects of MT, synthesizing current evidence across mechanistic domains, and generating pilot data to inform future research. This dissertation was structured around four manuscripts. The …