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Exploring Dose Effect Of An Early Palliative Care Intervention For Advanced Heart Failure Patients, Rachel Duncan Wells Jan 2019

Exploring Dose Effect Of An Early Palliative Care Intervention For Advanced Heart Failure Patients, Rachel Duncan Wells

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Heart failure (HF), a progressive condition with reduced quality of life (QoL) and high healthcare use, affects 6.5 million US adults. Research supports positive effects of palliative care integration into HF care, but there is limited consensus about the most beneficial intervention ‘dose’ (e.g. amount, duration, frequency, intensity). To date, no studies examining dose in palliative care HF interventions have been completed. Therefore, we examined dose using an existing data from the ENABLE CHF-PC trial (Educate, Nurture, Advise, Before Life Ends Comprehensive Heart Care for Patients and Caregivers; NCT02505425). Operationalizing dose as dichotomous complete/noncomplete of all intervention components (6-weekly, psychoeducational …

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Characterization Of The Tgfb Pathway And Its Role In Prostaglandin Metabolism In C. Elegans, Muhan Hu Jan 2019

Characterization Of The Tgfb Pathway And Its Role In Prostaglandin Metabolism In C. Elegans, Muhan Hu

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Cell to cell communication is fundamental to all life processes, from fertilization to death. The TGFߟ superfamily is a large family of proteins that is involved in a wide array of physiological and pathological processes, including development, wound healing, immune system function, cancer, and reproduction. This group of signaling peptides is well conserved across many organisms, from basic nematode to humans. While many studies have aimed to delineate the functions of TGFߟ, they have also unveiled the complexity of this multifunctional family of ligands. In this thesis, I take advantage of the simple C. elegans model system to study the …

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The Role Of The St6gal-I Sialyltrasferase In Protecting Tumor Cells From Hypoxic Stress, Robert Brent Jones Jan 2019

The Role Of The St6gal-I Sialyltrasferase In Protecting Tumor Cells From Hypoxic Stress, Robert Brent Jones

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An emerging concept in cancer biology is that surface glycosylation can play important roles in the regulation of cancer development and progression. Our group and others have shown that ST6Gal-I, a sialyltransferase that adds α2-6-linked sialic acids to N-glycosylated proteins, is upregulated in many cancers. Furthermore, data has indicated that ST6Gal-I acts as a pro-survival factor in a variety of settings, including resistance to chemotherapeutic drugs, radiotherapy resistance, and serum deprivation. The work presented in this dissertation adds to this understanding of ST6Gal-I’s role as a potent pro-survival factor and explores ST6Gal-I’s function in aiding tumor cells to survive hypoxic …

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Bk Polyomavirus Activates The Dna Damage Response To Hijack Host Cell Cycle Control, Joshua L. Justice Jan 2019

Bk Polyomavirus Activates The Dna Damage Response To Hijack Host Cell Cycle Control, Joshua L. Justice

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BK Polyomavirus (BKPyV) is a DNA tumor virus that latently infects the >90% of humanity. BKPyV infection is inconsequential in healthy individuals; however, the immunocompromised carry increased risk of viral reactivation that can lead to a number of genitourinary diseases. Overall, BKPyV reactivation is a major risk factor for kidney dysfunction and failure following solid organ transplantation. There are no approved therapeutics to treat BKPyV infection, therefore studies have focused on understanding the host/virus interactions that drive infection to identify therapeutic targets. The PyV genome is small and does not encode a polymerase. Cellular transformation by the viral oncogene, T …

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A Microfocal Effect In Photoreceptor Light Capture, Vasantha Kumari Kanukuntla Jan 2019

A Microfocal Effect In Photoreceptor Light Capture, Vasantha Kumari Kanukuntla

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In human eyes, accomodation brings light rays into focus on the retina in order to achieve a clear images. The plane of best focus within the depth of the retina is thought to be within the photoreceptor layer, but pinpointing the exact focal position axially has not been determined. With help of adaptive optics aberration correction and its ability to have microscopic control of a retinal stimulus, we explored how sensitive human subjects are to defocus on the micron scale. We found that focal position can be reliably judged within 0.02 D, which is equivalent to about 6 microns in …

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The Electronic Health Record And The Clinical Informatics Researcher: A Journey To Predicting False Positive Alerts With Patient Characteristics, Timothy Kennell Jan 2019

The Electronic Health Record And The Clinical Informatics Researcher: A Journey To Predicting False Positive Alerts With Patient Characteristics, Timothy Kennell

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Since their introduction in the 1960s, electronic medical systems have brought with them tremendous opportunities and difficult challenges. In order to address patient safety, Clinical Decision Support (CDS) was added to the system, many times in the form of "pop-up" alerts. However, traditional alert typically do not incorporate enough patient-specific context resulting in inaccurate warnings. In response, clinicians override many of them. However, the high exposure to false positive alerts results in alert fatigue, a desensitization to future ones. This issue decreases patient safety by causing clinicians to ignore legitimate alerts. Despite some shortcomings, the data in modern Electronic Health …

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Sexual Health Risk And Hiv Prevention: An Exploratory Study Of Behavior Among Heterosexual, African American Men And Women In Birmingham, Alabama., Kiko J. King Jan 2019

Sexual Health Risk And Hiv Prevention: An Exploratory Study Of Behavior Among Heterosexual, African American Men And Women In Birmingham, Alabama., Kiko J. King

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ABSTRACT The Deep South of the U.S. continues to have increased incidence of new cases of HIV since its inception, despite many advancements in HIV testing, treatment, and prevention. According to data by the CDC, rates are increasingly high among heterosexual African American (AA) men and women compared to their non-AA counterparts (CDC/HIV, 2017). In 2015, heterosexual transmission accounted for a share of new diagnoses for AA men and is the most common transmission route for AA women (KFF, 2017). The primary population affected by HIV/AIDS in Alabama is men who have sex with men (MSM) at 62.2%, followed by …

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Structural And Functional Insights Into The Influenza A Virus Non-Structural Protein 1 Effector Domain, Alex Kleinpeter Jan 2019

Structural And Functional Insights Into The Influenza A Virus Non-Structural Protein 1 Effector Domain, Alex Kleinpeter

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The influenza A virus (IAV) non-structural protein 1 (NS1) is a highly multifunctional viral protein responsible for antagonizing the type-I interferon (IFN) response to infection. NS1 has therefore been identified as a potentially effective target for the development of novel anti-influenza compounds. Furthermore, it is important to understand the molecular underpinnings driving NS1 function to more effectively elucidate antiviral targets. In this dissertation, we have contributed significant insight into NS1’s potential as an antiviral target, and the structure-function relationships driving its activity in an infected cell. First, we structurally characterized the binding of two known influenza inhibitors (A9 and A22) …

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Effects Of Protein Timing And Energy Balance On Body Composition In Collegiate Athletes, Ashley Licata Jan 2019

Effects Of Protein Timing And Energy Balance On Body Composition In Collegiate Athletes, Ashley Licata

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The current literature indicates that energy balance and protein consumption influence body composition. However, the effects of protein intake, timed protein supplementation, and energy balance on body composition have not yet been fully investigated in collegiate athletes. The purpose of this research was to assess collegiate athletes using hourly food and exercise data to examine how protein timing and energy balance relate to body composition. Aims 1 and 2 focus on collegiate female soccer athletes and further our understanding of the potential roles that protein amount and frequency and hourly energy balance play in optimizing fat mass and fat-free mass. …

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External Root Resorption In The Orthodontic Patients, Frank Earl Litchfield Jan 2019

External Root Resorption In The Orthodontic Patients, Frank Earl Litchfield

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External Apical Root Resorption (EARR) is a side effect of orthodontic treatment that results in root shortening in about one-third of orthodontic patients. Great variability among patients exists in their susceptibility to this multifactorial condition, and both treatment and patient specific factors contribute to EARR. Root resorption values were found to be higher in Hispanics compared to Asians and Caucasians (1). However, the prevalence of EARR is not well documented in all populations. Since African Americans represent the largest minority group in the United States, establishing the prevalence and risk factors for EARR within this ethnicity is important. Objective: To …

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Design, Develop And Manufacture A Low-Cost 32-Channel Biosignal Amplifier And D/A Converter Device For Multi- Electrode Neural Recording, Yen-Tze Liu Jan 2019

Design, Develop And Manufacture A Low-Cost 32-Channel Biosignal Amplifier And D/A Converter Device For Multi- Electrode Neural Recording, Yen-Tze Liu

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In the current market, there are many multichannel neural recording devices are available. However, they are either very expensive or physically big so that it cannot be used too close to the specimen because of the space limitations due to experimental setting such as Faraday cage, microscope, and other stimuli apparatus. In addition to that, the large electronic devices in the cell recording area are susceptible to create electrical noise, especially if they are not battery operated. This thesis work will try to deliver solutions following three main problems. The first problem we address is the device cost per recording …

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Smile Outcome Comparison Of Orthodontic Cases Treated With Different Extraction Patterns, Gregory Long Jan 2019

Smile Outcome Comparison Of Orthodontic Cases Treated With Different Extraction Patterns, Gregory Long

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Extraction of premolar teeth for orthodontic purposes is a common treatment approach. The effects of premolar extraction on the occlusion and the face have been studied extensively in the past. To date, however, the effects of premolar extractions on the smile have not been comprehensively quantified in the literature. The purpose of this study was to compare the smile outcome of patients treated with premolar extractions. Methods: This retrospective case-control study established 4 groups of 33 patients each for comparison. Three groups of patients with the same malocclusion were treated with different premolar extraction patterns. The remaining group of patients …

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Insuring Graduation: An Analysis Of The Association Between Student Health Insurance And Graduation, John Robert Lovett Jan 2019

Insuring Graduation: An Analysis Of The Association Between Student Health Insurance And Graduation, John Robert Lovett

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Most college students have access to basic health services through their campus’ college health program. Unfortunately, students who lack health insurance may be limited in their access to health services beyond the acute care provided, which may manifest in a myriad of adverse outcomes; ultimately resulting in withdrawal from college without graduating. Student health insurance plans (SHIPs) are high-quality, affordable insurance plans specially designed to meet this need. This study utilized survival analysis to examine the temporal nature of college graduation behavior, as it related to student health insurance status. The results of this study show no significant relationship between …

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An Exploratory Study Of The Influence Of Perceived Organizational Support, Coworker Social Support, The Nursing Practice Environment, And Nurse Demographics On Burnout In Palliative Care Nurses, Marcia Ann Lowe Jan 2019

An Exploratory Study Of The Influence Of Perceived Organizational Support, Coworker Social Support, The Nursing Practice Environment, And Nurse Demographics On Burnout In Palliative Care Nurses, Marcia Ann Lowe

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AN EXPLORATORY STUDY OF THE INFLUENCE OF PERCEIVED ORGANIZATIONAL SUPPORT, COWORKER SOCIAL SUPPORT, THE NURSING PRACTICE ENVIRONMENT, AND NURSE DEMOGRAPHICS ON BURNOUT IN PALLIATIVE CARE NURSES MARCIA A. LOWE SCHOOL OF NURSING ABSTRACT Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in healthcare, including nursing, medicine, and social work. Working with palliative care patients and their families is innately challenging and may predispose nurses to burnout. The purpose of this study is to examine the influence of perceived organizational support (POS), coworker social support, the nursing practice environment, and nurse …

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Light Transmission And Wear Of Translucent Zirconia After Conventional And Fast Sintering Cycle, Anvita Maharishi Jan 2019

Light Transmission And Wear Of Translucent Zirconia After Conventional And Fast Sintering Cycle, Anvita Maharishi

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ABSTRACT Introduction: Zirconia is classified by the mole percentage of yttria contained in the zirconia. The most strong and opaque material contains 3 mol % yttria, intermediate strength and opacity contain 4 mol %, and whereas 5 mol % is the weakest but most translucent zirconia. Refined zirconia powder is pressed into a mold to form a disc which is then milled to form a restoration. Post milling of sintered zirconia restorations is necessary to obtain final mechanical and physical properties of the restoration. Traditionally conventional sintering cycles required 6-8 hours to sinter. Whereas, fast sintering cycles have been have …

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Structural Studies Of Some Proteins Responsible For Bacterial Pathogenesis, Kartik Manne Jan 2019

Structural Studies Of Some Proteins Responsible For Bacterial Pathogenesis, Kartik Manne

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A wide range of infections is attributed to the pathogenesis of Gram-positive bacteria. The emergence of multi-drug-resistant Gram-positive pathogens has been a significant health concern and present serious therapeutic challenges globally. Some of the common Gram-positive bacterial species like Streptococcus pneumonia, Group B Streptococcus, and Staphylococcus aureus are infectious by employing several virulence factors for initial adhesion, colonization, biofilm initiation and dispersion, complement evasion, nutrient acquisition, and infection. The structural insights into these virulence factors are essential for understanding their mode of action, and also for developing a new class of antibiotics; a significant interest of many researchers. Pneumococcal adhesive …

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Endothelial N-Glycan Hypoglycosylation Enhances Cd16+ Monocyte Adhesion: A Role For Alpha-Mannosidases, Kellie Regal Mcdonald Jan 2019

Endothelial N-Glycan Hypoglycosylation Enhances Cd16+ Monocyte Adhesion: A Role For Alpha-Mannosidases, Kellie Regal Mcdonald

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Monocyte extravasation through the endothelial layer is a hallmark of atherosclerotic plaque development and is mediated by heavily glycosylated surface adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1). Human monocytes have been classified into three distinct groups: classical (anti-inflammatory; CD14+/CD16-), nonclassical (patrolling; CD14+/CD16++), and intermediate (pro-inflammatory; CD14++/CD16+). The CD16+ nonclassical / intermediate monocytes have been implicated in atherosclerosis progression and their levels positively associate with adverse cardiac events. However, there is a relative lack of understanding as to whether there are distinct mechanisms that regulate CD16+ vs. CD16- monocyte adhesion to the inflamed endothelium. Our previous data identified a high-mannose …

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Provider-Sponsored Health Plans In The Post-Reform Era, Katherine Ann Meese Jan 2019

Provider-Sponsored Health Plans In The Post-Reform Era, Katherine Ann Meese

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The rise and fall of managed care in the 1980s and 1990s saw many hospitals and health systems in the United States enter and subsequently exit the health insurance market in the form of provider-sponsored health plans (PSHP). The passage and implementation of the legislation such as the Patient Protection and Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA) has ushered in an era of value-based reimbursement methods and a heightened focus on population health management, which has stimulated health care organizations to contemplate health plan ownership as a logical strategy. This study examined market …

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Reported Clinical And Financial Performance Of Hospitals With Physician Ceos Compared To Those With Nonphysician Ceos, Leon Moores Jan 2019

Reported Clinical And Financial Performance Of Hospitals With Physician Ceos Compared To Those With Nonphysician Ceos, Leon Moores

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Leaders impact organizational behavior and performance, and CEOs may have greater impact via numerous proposed mechanisms. Because of this, organizations expend considerable resources recruiting and selecting CEOs and may benefit from information suggesting a positive impact on organizational performance based upon measurable CEO characteristics. Little work has been done comparing the performance of hospitals with physician CEOs versus non-physician CEOs, in spite of the ease of identification of this characteristic and extant leadership theories suggesting a relationship between technical expertise and success in leading highly technical organizations. We compared multiple measures of reported clinical and financial performance and our linear …

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The Benefit Of Resilience: Examining The Roles Of Family Resilience And Parental Education In Child Anxiety, Bria Kathryn Morgan Jan 2019

The Benefit Of Resilience: Examining The Roles Of Family Resilience And Parental Education In Child Anxiety, Bria Kathryn Morgan

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Extensive literature addresses the associations between parental education and children’s mental health outcomes; however, the role of parental education and family resilience in child anxiety is unclear. The purpose of this study is to obtain a greater understanding of the role of parental education in child anxiety. Additionally, the study aims to investigate the role and potential varying effects of family resilience. Building upon Bowen’s Family Systems Theory and Walsh’s Systems Theory of Family Resilience, I hypothesize that parental education will be negatively associated with child anxiety and that family resilience will be negatively associated with child anxiety. I also …

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Identification Of Bottleneck Locations From Analysis Of National Performance Management Research Data Set (Npmrds) Records, Xinyun Pan Jan 2019

Identification Of Bottleneck Locations From Analysis Of National Performance Management Research Data Set (Npmrds) Records, Xinyun Pan

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The traveling public is enduring traffic congestion on a regular basis which is a serious problem for the society. Congestion has negative impacts on transportation users’ convenience and satisfaction, results in lost productivity, increases stress and health related issues, has negative environmental impacts, increases fuel consumption, negatively affects travel reliability and increases travel time and delays. Traffic bottlenecks are often associated with traffic congestion. They represent a localized disruption of traffic flow due to a specific physical condition (such as insufficient roadway capacity or poor geometric design) or due to a temporary situation that restricts traffic flow such as a …

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Automating Personal Safety Among Different Age Groups, Jayun Patel Jan 2019

Automating Personal Safety Among Different Age Groups, Jayun Patel

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Personal Safety has always been crucial to one’s life. Many different threats are faced by people in their day to day lives. These threats differ with different age groups that affect their health and well being. Different threats affect people, which include birth defects, falls, drowning, health problems, abuse, suicide, homicide, and sexual violence [39]. Many other threats occur every day but these threats are the common threats that are faced by most of the people at different ages. These threats can affect the victims in terms of the health of the person, and the physical and mental well being …

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Examining Teachers' Perceptions And Practices Of Family Engagement With Families Of Emergent Bilinguals In Pre-Kindergarten And Kindergarten Classrooms: A Mixed Methods And Multiple Case Study, Julie I. Paul Jan 2019

Examining Teachers' Perceptions And Practices Of Family Engagement With Families Of Emergent Bilinguals In Pre-Kindergarten And Kindergarten Classrooms: A Mixed Methods And Multiple Case Study, Julie I. Paul

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This study addressed pre-K and kindergarten teachers’ perceptions and practices of family engagement with families of students who are Dual Language Learners/Emergent Bilinguals. The study employed an explanatory sequential mixed methods design (Quan --> QUAL) (Creswell & Plano-Clark, 2018). To address the purpose of the study, the overarching mixed methods question was: How do pre-K and kindergarten teachers engage families of all their students and families of students who are emergent bilinguals? Mixing of the strands occurred after the quantitative data was collected. Quantitative results helped develop the semi-structured interview protocol for the qualitative phase of the study. Qualitative results …

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Bayesian Hierarchical Negative Binomial And Zero-Inflated Negative Binomial Models For High-Dimensional Analyses With Applications To Human Microbiome Count Data, Amanda H. Pendegraft Jan 2019

Bayesian Hierarchical Negative Binomial And Zero-Inflated Negative Binomial Models For High-Dimensional Analyses With Applications To Human Microbiome Count Data, Amanda H. Pendegraft

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The human microbiome was first described as an “ecological community of commensal, symbiotic, and pathogenic microorganisms that literally share our bodyspace”. These microorganisms, also known as microbes and bacteria, are known for participation in human health. For example, microbes extract energy from foods that are otherwise indigestible, synthesize vitamins and amino acids necessary for important bodily functions, and protect hosts against disease-carrying pathogens. Therefore, the pursuit of human microbiome research is important for understanding the influence of microorganisms throughout human systems. Human microbiome research is founded on advances in next-generation sequencing technology. Namely, the identification of microbes that constitute the …

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Organizational Characteristics And Environmental Factors Associated With Hospitals Identified As Consolidation Targets, Christi Pierce Jan 2019

Organizational Characteristics And Environmental Factors Associated With Hospitals Identified As Consolidation Targets, Christi Pierce

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In today’s dynamic healthcare landscape, hospitals face uncertainty and pressure from changing reimbursement schemas, intense government regulation, technological advances, consumer demand and workforce scarcity. These increased pressures have led to an acceleration of consolidation activities as hospitals position themselves to cope with a dynamic and complex external environment by maximizing resources, creating economies of scale and expanding access to care. Despite increased hospital consolidation activity, little is known about what makes a hospital attractive as a consolidation target to an acquiring hospital, particularly post-ACA. The purpose of this study was to evaluate the organizational characteristics and environmental factors associated with …

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Three Essays In Hospital Financial Distress: Prediction, Antecedents And Organizational Response, Neeraj Avinash Puro Jan 2019

Three Essays In Hospital Financial Distress: Prediction, Antecedents And Organizational Response, Neeraj Avinash Puro

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The following essays examine the financial distress in acute care hospitals in the United States. The first essay examines the accuracy of prediction models of financial distress, the second explores the factors associated with financial distress and the third essay examines organizational response to financial distress. The first essay compares the predictive ability of three financial distress prediction models: modified Altman Z score (1993), Ohlson O score (1980) and Zmijewski (1984) to more accurately predict financial distress in U.S acute care hospitals. Building on the first essay, the second essay uses the most accurate predictive model to examine acute care …

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The Reductive Stress Reducto-Mir: Emerging Insight Into Microrna-671, Justin Michael Quiles Jan 2019

The Reductive Stress Reducto-Mir: Emerging Insight Into Microrna-671, Justin Michael Quiles

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Excessive accumulation of reactive oxygen and nitrogen species (ROS/RNS) promotes cardiac pathophysiology. Although extreme oxidative burden is cytotoxic, ROS/RNS are continually generated within multiple domains of cardiac myocytes, and these species play fundamental roles in signal transduction through reversible thiol oxidation. Nuclear factor, erythroid 2 Like 2 (Nfe2l2/NRF2) is activated by ROS/RNS and binds cis regulatory antioxidant response elements (AREs) to induce the expression of a host of thiol oxidoreductases which regulate signaling events at the post-translational, transcriptional and epigenetic levels. Although oxidative stress has been linked to cardiac disease, adaptive processes in the heart require reduction-oxidation (redox) reactions as …

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Determination Of The Role Of Smu_833 In The Fitness And Virulence Of Cariogenic Streptococcus Mutans, Katherine Lynn Rainey Jan 2019

Determination Of The Role Of Smu_833 In The Fitness And Virulence Of Cariogenic Streptococcus Mutans, Katherine Lynn Rainey

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Dental caries, commonly known as tooth decay, is the most common infectious disease worldwide. The main etiological agent of dental caries is Streptococcus mutans which can readily form a biofilm on the surface of teeth and produce acids through the metabolism of dietary sugars, which is largely responsible for the demineralization and subsequent destruction of tooth enamel. In addition, S. mutans synthesizes extracellular glucosyltransferases (Gtfs) capable of breaking apart dietary sucrose and polymerizing the glucose subunits into the sticky glucan matrix of the biofilm, imperative for the formation of robust, three-dimensional biofilms. Currently used caries therapies are not species-specific and …

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Increasing Living Kidney Donation Through Advocacy And Patient Navigation, Rhiannon Deierhoi Reed Jan 2019

Increasing Living Kidney Donation Through Advocacy And Patient Navigation, Rhiannon Deierhoi Reed

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As the prevalence of kidney disease continues to increase in the United States, the gap between the need for organs and available kidney donors is growing as well. Deceased donor organs alone are insufficient to meet this need, and transplant centers have turned their focus to living donation to address the shortage. However, the frequency of living kidney donation has been declining in the US since 2004. Changes in the health of the US population have been suggested as one possible explanation for the decline, but currently these assertions remain anecdotal. A second theory with more published evidence attributes the …

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The Role Of Suppressor Of Cytokine Signaling 3 In Neuroinflammatory Disease, Zhaoqi Yan Jan 2019

The Role Of Suppressor Of Cytokine Signaling 3 In Neuroinflammatory Disease, Zhaoqi Yan

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The Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT) pathway plays a critical role in cytokine-mediated responses in both innate and adaptive immunity, and dysregulation of the JAK/STAT pathway is linked to many inflammatory disorders. Multiple Sclerosis (MS) is an inflammatory demyelinating disease that affects the central nervous system, and both innate and adaptive immunity are involved in disease progression. STAT3 signaling is critically involved in MS pathology and is negatively regulated by Suppressor Of Cytokine Signaling 3 (SOCS3). Both increased STAT3 activation and reduced SOCS3 expression are observed in immune cells from patients with MS. Although the role of …

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