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Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards Jan 2022

Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards

All ETDs from UAB

Universal access to palliative care (PC) is a human right that much of the world has not accomplished and educating a PC workforce is critical to PC advancement. Higher PC disparities exist in low-and-middle income countries, such as Jamaica. The World Health Organization Public Health Model and the International PC Initiative’s PC roadmap emphasize the importance of PC education. The purpose of this mixed methods dissertation study was to investigate the PC experiences and educational needs of healthcare interprofessionals who provide care for patients with late-stage serious illnesses in Jamaica. Three specific aims incorporated quantitative investigation of physicians’, nurses’, and …

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Role Of Partnership In Hiv-Related Outcomes In Heterosexual Individuals Newly Diagnosed With Hiv, Maira Sohail Jan 2021

Role Of Partnership In Hiv-Related Outcomes In Heterosexual Individuals Newly Diagnosed With Hiv, Maira Sohail

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A supportive intimate partner has shown to be helpful in HIV care of men who have sex with men, and in some African heterosexual couples; however, knowledge on this phenomenon among heterosexual people with HIV (PWH) is limited in the United States context. This project included two quantitative studies and one qualitative study to examine the role of intimate partnership in HIV care among heterosexual, newly diagnosed PWH. Both quantitative studies were conducted among heterosexual, newly diagnosed (2013-2017) individuals at the University of Alabama at Birmingham (UAB) 1917 Clinic. The first study examined the role of partnership (un-partnered, unmarried-partnered, and …

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From Classrooms To Polluted Communities: Scientific Inquiry In Birmingham, Alabama And Beyond, Sarah Jeanne Adkins-Jablonsky Jan 2021

From Classrooms To Polluted Communities: Scientific Inquiry In Birmingham, Alabama And Beyond, Sarah Jeanne Adkins-Jablonsky

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Nearly half of all U.S. students who declare science majors in college do not graduate with science degrees within six years. Improvements in science outcomes are linked with active-learning pedagogies such as Course-based Undergraduate Research Experiences (CUREs). However, despite the need for education reform particularly in Alabama, active-learning interventions are severely understudied in Alabama universities. Chapter 1 describes novel CUREs at four colleges in Birmingham, AL: The University of Alabama at Birmingham (UAB); Jefferson State Community College (JSCC), Samford University (SU), and Birmingham Southern College (BSC). Chapter 2 shows how an agar art CURE, The Art of Microbiology, impacts student …

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Social Inclusion Among People With Mobility Limitations In The Global South, Shane Burns Jan 2021

Social Inclusion Among People With Mobility Limitations In The Global South, Shane Burns

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An estimated 15% of the world’s population have a disability—roughly 80% of whom live in the Global South. People with disabilities experience profound social disparities that affect their quality of life and social inclusion. Due to the array of cultural perspectives and institutional capacities around the globe, provision of disability rights can come with its challenges. In many cultural contexts, people have moral beliefs about disability that result in shame. More medicalized beliefs toward disability are often the result of medical infrastructure that offers goods and services. Using a framework that arrays these moral and medical dimensions, I theorized that …

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Service Profiles In Substance Use Disorder Treatment: The Role Of Institutional And Organizational Factors, Reena Joseph Kelly Jan 2021

Service Profiles In Substance Use Disorder Treatment: The Role Of Institutional And Organizational Factors, Reena Joseph Kelly

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Substance use disorders (SUDs) are a growing crisis globally and in the US, and place an enormous health, social, and financial burden on the nation. To address the complex nature of SUDs, treatment typically involves a combination of different types of services to address the medical, behavioral and social needs of the patient and care is often delivered by specialized SUD treatment facilities. Despite recommendations for a broad suite of services, individual facilities vary in the specific services that they offer. This study examined whether and why systematic differences exist between treatment facilities based on their service mix and whether …

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Characterization Of The Metabolic And Cognitive Features Of A Novel Alzheimer’S Disease Rat Model Along With Investigation Of Its Gut Microbiota Change Over Time, Akash Nagarajan Jan 2021

Characterization Of The Metabolic And Cognitive Features Of A Novel Alzheimer’S Disease Rat Model Along With Investigation Of Its Gut Microbiota Change Over Time, Akash Nagarajan

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Alzheimer’s disease (AD) is currently the fifth highest cause of death in the United States and affects primarily individuals of very old age (>80 yrs.). Aging is known to be the biggest risk factor of AD. Recent studies have shown that AD patients have an altered gut microbiota composition. To investigate whether the Alzheimer’s disease pathology in the brain could drive gut microbiota changes during the adult and late life stage of the rat, we performed 16S ribosomal RNA sequencing on the fecal samples of the animals at 14 months and 20 months of age. We found a distinctive …

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Embodied Fat Stigma And Health Beliefs About Exercise And Diet, Brie Scrivner Jan 2021

Embodied Fat Stigma And Health Beliefs About Exercise And Diet, Brie Scrivner

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The purpose of this dissertation is to examine how individuals navigate the cultural mandate for thinness, which pressured individuals to pursue weight loss through exercise and restrictive diets. While sustainable weight loss is not probable for the majority of people, there are still significant physical and mental health benefits to be had from engaging in regular, enjoyable movement. For many, physical activity is an important component of a healthy lifestyle. It can improve quality of life for individuals regardless of weight, body size, chronic illness, or disability. However, many fitness facilities focus on weight loss as the most essential goal …

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Neonatal Murine Cytomegalovirus Infection Disrupts Synapse Remodeling During Development, Jerome Moulden Jan 2021

Neonatal Murine Cytomegalovirus Infection Disrupts Synapse Remodeling During Development, Jerome Moulden

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Human cytomegalovirus (HCMV) is a complex double stranded DNA betaherpesvirus. Its linear DNA in enclosed in an icosahedral capsid, and has a genome size of about 230kb and encodes about 170 genes. Primary infection with HCMV lead to a lifelong persistent infection. HCMV can also be transmitted across the placenta and infect the developing fetus leading to infection of the newborn infant, an infection which is commonly described as congenital HCMV infection. In the United States, the prevalence of congenital HCMV infection is between 0.2-1.2%. Approximately 5-15% of these newborn infants will develop long-term neurological damage resulting, motor disorder, cognition …

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Multidrug-Resistance, Antibiotic-Associated Acute Kidney Injury, And Poor Disease Prognosis In Community-Acquired Bacterial Pneumonia, Adeniyi J. Idigo Jan 2021

Multidrug-Resistance, Antibiotic-Associated Acute Kidney Injury, And Poor Disease Prognosis In Community-Acquired Bacterial Pneumonia, Adeniyi J. Idigo

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In this dissertation research, I examined the challenges of treating patients with bacterial community-acquired pneumonia (CAP) with the purpose of identifying risk factors linked with multidrug-resistant (MDR) Pseudomonas, treatment toxicity, and poor disease prognosis. I used a retrospective cohort study design to explore a clinical cohort of patients admitted to the University of Alabama at Birmingham hospital network who had bacterial pneumonia diagnosis assessed to be from community transmission between January 2013-December 2019. Electronic medical records were accessed for socio-demographic and clinical information. First, I examined the local prevalence/incidence of Pseudomonas CAP and MDR Pseudomonas CAP, and the relationship between …

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Structural Changes To Desmosomal Architecture During Assembly And Maturation, Reena R. Beggs Jan 2021

Structural Changes To Desmosomal Architecture During Assembly And Maturation, Reena R. Beggs

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Desmosomes are macromolecular junctions important in adhesion and resisting mechanical stress in epithelial and cardiac tissue. Desmosomes have a complex architecture with transmembrane cadherins, desmogleins and desmocollins, constituting the adhesive interface and plaque proteins, including plakoglobin and desmoplakin, binding the cadherin tails and integrating with intermediate filaments. Dysregulation of desmosomes occurs in many disease states, such as cardiomyopathies, skin diseases, and various cancers. While mature desmosomes' structure is generally understood, less is known about desmosome architecture during assembly and recycling. Desmosomes are dynamic, biochemically intractable, and diffraction-limited, making them challenging to study. To overcome these obstacles, I applied the super-resolution …

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The Role Of Visa Status And Acculturation In The Health Of Us Immigrants, Serra Sevde Hatipoglu Jan 2021

The Role Of Visa Status And Acculturation In The Health Of Us Immigrants, Serra Sevde Hatipoglu

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Using data from the 2003 New Immigrant Survey, I examined the association between visa status and acculturation with physical, mental, and self-rated health among immigrants residing in the United States. The primary predictor variable in the study is immigrant visa status. The outcome variables of interest include physical health as any morbidity (chronic diseases), mental health as depressed (as defined by the DSM-IV) and self-rated health (poor self-rated health). Using logistic regressions, I found those with unfavorable visa statuses have worse mental, physical, self-rated health compared to the favorable visa holders. I used inverse odds ratio weighted (IORW) mediation method …

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Undergraduate Students’ Perspectives On Mental Health Services, Resources, And Supports During Covid-19: A Qualitative Dissertation, Amy Hutson Chatham Jan 2021

Undergraduate Students’ Perspectives On Mental Health Services, Resources, And Supports During Covid-19: A Qualitative Dissertation, Amy Hutson Chatham

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During the COVID-19 pandemic, increased isolation from supportive relationships, uncertainty about the future, fear of illness, and lack of traditional life-events took a toll on university student mental health. It is important to understand undergraduate students’ mental health needs during the COVID-19 pandemic and their desires for support from their institutions of higher education. Existing studies have documented increased rates of depression, stress, and anxiety among university undergraduates; however, these studies rarely illuminate students’ perspectives on mental health services, resources, and supports that they need during and because of the COVID-19 pandemic. This phenomenological study explored the perspectives of undergraduate …

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Effect Of Patient-Level Characteristics On Fluoroquinolone Susceptibility, Jeffrey Alan Franks Jan 2020

Effect Of Patient-Level Characteristics On Fluoroquinolone Susceptibility, Jeffrey Alan Franks

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Antimicrobial stewardship programs are becoming more widespread to combat antibiotic resistance. This study aimed to evaluate the influence of patient-level characteristics on fluoroquinolone susceptibly among five gram-negative isolates to help better their implementation. We performed a retrospective analysis of patients over the age of 18 for five gram-negative isolates (Acinetobacter species, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa). We utilized Cox proportional hazards to determine the risk of patient-level characteristics, for both hospital and community-acquired infections, on fluoroquinolone resistance between 2016 and 2019. The population sample consisted of 8,285 patients receiving fluoroquinolones for at least one of the …

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Impact Of Different Human Coronaviruses (Hcovs) On Pediatric Patients At A Tertiary Pediatric Hospital – Retrospective Study, Abdulsalam Alsulami Jan 2020

Impact Of Different Human Coronaviruses (Hcovs) On Pediatric Patients At A Tertiary Pediatric Hospital – Retrospective Study, Abdulsalam Alsulami

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Background: Human Coronaviruses (HCoV) are important pathogens associated with respiratory disease in humans and animals. The majority of HCoVs are emerging human pathogens with 7 known types causing human disease and 5 being identified in the last 2 decades. Methods: We performed a retrospective review of all encounters with known HCoV at a tertiary pediatric hospital from January 2015 until January 2018. Electronic medical records (EMRs) were reviewed for demographic data, HCoV type, viral copathogens, time to testing, admission, need for increased intensity of care (HLC), requirement for supplemental oxygen, radiographic findings suggestive lower respiratory tract disease (LRT) when available …

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Cd8 T-Cell Responses To A Diverse Virus: Adaptation And Cross-Reactivity In Hiv Vaccination, Sushma Boppana Jan 2020

Cd8 T-Cell Responses To A Diverse Virus: Adaptation And Cross-Reactivity In Hiv Vaccination, Sushma Boppana

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In the four decades since human immunodeficiency virus (HIV) was discovered, significant progress has been made in treating HIV infection and in understanding the viral and immune dynamics underlying disease pathogenesis. However, in spite of scientific advances, HIV remains a significant global health issue, and an effective preventative vaccine has yet to be created. Many groups have demonstrated the importance of CD8 T cells in viral control during natural HIV infection and believe that CD8 T cells could contribute to vaccine efficacy by alleviating disease course in individuals who became infected despite vaccination. One major obstacle to inducing potent CD8 …

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Early Childhood Quality Of Education And Late-Life Cognitive Function In A Population-Based Sample From Puerto Rico, Cheyanne Celine Barba Jan 2020

Early Childhood Quality Of Education And Late-Life Cognitive Function In A Population-Based Sample From Puerto Rico, Cheyanne Celine Barba

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In general, greater years of education is associated with reduced risk of cognitive impairment in older adulthood, but the strength of this association has been found to differ by study population. Additionally, quality of education is understudied, despite evidence that quality of education and, in turn, literacy, may be additional indicators of cognitive reserve. This thesis examined years of education, literacy, and childhood quality of education indicators in relation to late-life cognitive outcomes in an older Puerto Rican population. We hypothesized that greater years of education, literacy, and quality of childhood education would be positively associated with each other, as …

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Toxin Secretion By Mycobacterium Tuberculosis, Uday Tak Jan 2020

Toxin Secretion By Mycobacterium Tuberculosis, Uday Tak

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Mycobacterium tuberculosis (Mtb) is a highly infectious airborne bacterial pathogen, and the causative agent of human tuberculosis. Mtb infects approximately one-third of the human population, and is responsible for more deaths than any other infectious disease in the history of mankind. Mtb is an intracellular pathogen and primarily infects myeloid cells, such as macrophages in the human lung. In macrophages, Mtb establishes a replication niche within membrane-bound vacuoles named phagosomes, while subverting immunity. The intracellular survival of Mtb depends on manipulation of host cellular processes through secreted effector proteins. Ultimately, this intracellular vacuole is ruptured by the type VII secretion …

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Understanding The Impact Of Diet And Obesity On Anti-Tumor Immunity And Therapeutic Efficacy In Kidney Cancer, Rachael Miller Orlandella Jan 2020

Understanding The Impact Of Diet And Obesity On Anti-Tumor Immunity And Therapeutic Efficacy In Kidney Cancer, Rachael Miller Orlandella

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Obesity is regarded as a major risk factor for developing renal cell carcinoma (RCC). Advanced-stage RCC exhibits chemotherapeutic resistance, but is responsive to immunotherapies such as the immune checkpoint inhibitor anti-programmed cell death-1 (anti-PD-1). Despite some clinical successes, response rates remain low for anti-PD-1 monotherapy (20-30%). Preclinical evaluations of immunotherapeutic strategies typically use lean mice and do not account for patient comorbidities. This may explain the underwhelming success rates following clinical translation of new cancer treatments. Recent studies found that obesity was associated with favorable outcomes and responses to immunotherapy in melanoma. However, the effects of obesity on anti-tumor immunity …

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Novel Hiv Adaptation Strategy Against Host Cd8 T Cell Immunity, Kai Qin Jan 2020

Novel Hiv Adaptation Strategy Against Host Cd8 T Cell Immunity, Kai Qin

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Since the 1980s, HIV infection has caused millions of death and tremendous economic losses worldwide. Despite great scientific advances, the only effective therapy to date, antiretroviral therapy (ART), merely delays disease progression yet cannot eradicate viral infection. Therefore, an effective HIV vaccine that can prevent the acquisition of infection would be a desirable alternative. The critical role of CD8 T-cell immunity in HIV infection has been well documented and therefore not surprisingly a great deal of effort has been focused on developing an effective CD8 T-cell based HIV vaccine. However, by far, such CD8 T-cell based HIV vaccine trials have …

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Protective Host Responses During Acute And Chronic Lung Exposure To Aspergillus Fumigatus, Joseph Mackel Jan 2020

Protective Host Responses During Acute And Chronic Lung Exposure To Aspergillus Fumigatus, Joseph Mackel

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Aspergillus fumigatus is an environmental airborne fungus that acts as both an opportunistic pathogen and an allergen. In immunocompromised hosts, A. fumigatus can germinate in the lung, cause tissue damage and pneumonia, and disseminate to other organs, causing a disease termed invasive aspergillosis (IA). In severe asthma, sensitization to fungi such as A. fumigatus is associated with more severe disease. Determination of host and fungal factors that drive immunoprotection versus immunopathogenesis in both of these settings will ultimately enable therapeutic modulation of immune responses to improve disease outcomes. In this body of work, we build on recent findings that implicate …

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Copper Dependent Inhibitors Subvert Common Resistance Mechanisms In Staphylococcus Aureus And Inhibit Crucial Metabolic Pathways, Cameron Crawford Jan 2020

Copper Dependent Inhibitors Subvert Common Resistance Mechanisms In Staphylococcus Aureus And Inhibit Crucial Metabolic Pathways, Cameron Crawford

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The effective antibiotic pool is shrinking with antibiotic resistance a constant problem that threatens to make our current therapies obsolete. To combat this, new drug screening methodologies are required since the traditional drug screens are offering limited results or only improvements upon current treatments. This work expands upon the idea that transition metal toxicity can be preferentially targeted towards bacteria. Specifically, the focus is on copper dependent inhibitors that quickly work to eliminate Staphylococcus aureus. S. aureus is a particularly threatening bacteria with high strain variability, a litany of survival and virulence factors, and multiple drug resistance mechanisms that are …

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Vagal Mediated Heart Rate Variability And Cognitive Impairments In Hiv-Seropositive Women, William C. Nicholson Jan 2019

Vagal Mediated Heart Rate Variability And Cognitive Impairments In Hiv-Seropositive Women, William C. Nicholson

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Regardless of sufficient viral suppression, HIV exerts an ongoing inflammatory process that promotes chronic autonomic nervous system (ANS) dysfunction, accelerates physiological aging, and increases the risk of developing a spectrum of cognitive disorders (known as HIV-associated neurocognitive disorders [HAND]). Given this, identifying pathological mediators of this inflammatory response could provide insight into the mechanisms driving HAND. The vagus nerve (indexed by vagal-mediated heart rate variability [vmHRV]) could provide such a mediator as it regulates ANS activity via reciprocal cardio-neural pathways, which regulate inflammation and homeostasis. Vagal dysfunction is associated with persistent inflammatory signaling (e.g., stress or inflammatory-based disorders [such as …

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Early Life Stress And Immune Responses In Adult Rat Kidneys, Ijeoma E. Obi Jan 2019

Early Life Stress And Immune Responses In Adult Rat Kidneys, Ijeoma E. Obi

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Globally, human studies show overwhelming associations between adverse childhood experiences and cardiovascular disease (CVD) and CVD risks throughout adult life. As early as 6 years old, there are significant associations between childhood adversity and inflammation, and those association are observed throughout adult life as well. Over a decade ago, rodent models were used to establish the importance of the immune cells in hypertension, which is the major risk factor in developing CVD. Although these associations in humans are important, they pose several limitations that can be overcome by the use of animal models to study the molecular mechanisms that are …

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Hpv And Hsv Associated Clinical Conditions Among People Living With Hiv-1 Infection, Yuanfan Ye Jan 2019

Hpv And Hsv Associated Clinical Conditions Among People Living With Hiv-1 Infection, Yuanfan Ye

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This dissertation research focuses on investigating health burdens of HPV- and HSV- associated clinical conditions (CC) in people living with HIV-1 infection (PLWH) in the Southeastern United States. I designed a retrospective study using the UAB 1917 HIV Clinic Cohort. Electronic health records of PLWH attending the clinic for HIV-care between January 2006 and March 2019 were obtained and reviewed. I first examined incidence rates and trends of anogenital HPV- and HSV-associated CC. Then I adopted a new algorithm to group longitudinal CD4 cell counts based on their trajectories. I compared it with nadir and median CD4 cell counts in …

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Exploring The Link Between Dietary Fiber, The Gut Microbiota And Estrogen Metabolism Among Women With Breast Cancer, Ayse G. Zengul Jan 2019

Exploring The Link Between Dietary Fiber, The Gut Microbiota And Estrogen Metabolism Among Women With Breast Cancer, Ayse G. Zengul

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Breast cancer continues to be a very prevalent disease and impacts over 260,000 new patients per year in the United States. The gut microbiota composition may affect breast cancer risk by modulating various hormonal metabolites including endogenous estrogens. Dietary factors impact gut microbial ecology and influence the regulation of estrogen metabolism. Current evidence supports the potential role of dietary fiber in breast cancer prevention and its possible modulating influence on serum estrogen levels through the gut microbiota associated with β-glucuronidase activity. However, this mechanism is not clearly understood. In this study, we aimed to explore the associations between dietary fiber, …

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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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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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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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Self-Tracking Practices: The Roles Of Social Contexts And Chronic Conditions, Aowen Zhu Jan 2019

Self-Tracking Practices: The Roles Of Social Contexts And Chronic Conditions, Aowen Zhu

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The rapid development of mobile health (mHealth) technologies is propelled by the culture of disease prevention and management. Smartphone applications and wearable devices provide valuable personal data for self enhancement. In addition to health promotion, people with chronic conditions are using apps and devices to monitor symptoms and behaviors. There is great potential for self-tracking practices to reduce health care cost and improve population health. However, the emphasis on personal responsibility of individuals’ health may hinder the long-term effectiveness of self-tracking practices. The purpose of the study is to examine the associations between social contexts and self-tracking practices, chronic health …

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Diet, Physical Activity, And Healthy Aging In People Living With Hiv, Josh Newson Muhammad Jan 2018

Diet, Physical Activity, And Healthy Aging In People Living With Hiv, Josh Newson Muhammad

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As life expectancy for people living with HIV (PLWH) has increased, healthy aging in this community has become an emerging public health concern. Although the benefits of adopting healthy diets and regular physical activity are well-documented, implementing strategies for lifestyle modifications among older PLWH remains a challenge. The complex milieu of social, physiological and economic burdens encountered by PLWH exposes this population to increased risk for adverse health outcomes, especially from preventable metabolic diseases. The interaction of diet, physical activity and social determinants of health in persons who are HIV positive is an understudied area. The aim of this dissertation …

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