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The Effects Of River Sediment, Endosulfan, And Moderate Hypoxia On Blue Crabs (Callinectes Sapidus) From The Tidal, Freshwater James River, Laura Williams Nov 2012

The Effects Of River Sediment, Endosulfan, And Moderate Hypoxia On Blue Crabs (Callinectes Sapidus) From The Tidal, Freshwater James River, Laura Williams

Theses and Dissertations

Juvenile male blue crabs move into the tidal, freshwater James River during warmer months to feed and grow by undergoing molting. In crustaceans, growth and molting are hormonally controlled. The physiological effects of a multiple-stressor environment are determined by comparing the blue crab’s oxygen uptake after exposure to pure sand, James River sediment, or endosulfan-spiked sand. The effect of multiple stressors on molting is measured by the activity level of N-acetyl-ß-glucosaminidase (NAG), an enzyme in epidermal tissue important to molting. The oxygen uptake was decreased by exposure to James River sediment but not for exposure to endosulfan for seven days. …


Perceived Stress And Surgical Wound Cytokine Patterns, Valentina Lucas Nov 2012

Perceived Stress And Surgical Wound Cytokine Patterns, Valentina Lucas

Theses and Dissertations

Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed …


Marie Von Ebner-Eschenbach's Ohne Liebe: A Translation And Commentary, Steven L. Peris Nov 2012

Marie Von Ebner-Eschenbach's Ohne Liebe: A Translation And Commentary, Steven L. Peris

Theses and Dissertations

This thesis explores a short drama of Marie von Ebner-Eschenbach, Without Love. It provides not only a complete English translation of the work, but also an interpretative introduction. By first examining the life of Ebner-Eschenbach, I am able to provide insight to the origins of the play. Because Ebner-Eschenbach faced so much opposition in her drama writing career this one act play becomes more relevant. It contains similar themes to her other works such as: gender roles, the role of the aristocracy, and love in marriage. Without Love examines the role of love in marriage by providing the reader …


Role Of Tyrosyl-Dna Phosphodiesterase (Tdp 1) On Repair Of 3′-Phosphoglycolate (3′- Pg) Terminated Dna Double-Strand Breaks (Dsbs) And In Response To Oxidative Stress, Tong Zhou Nov 2012

Role Of Tyrosyl-Dna Phosphodiesterase (Tdp 1) On Repair Of 3′-Phosphoglycolate (3′- Pg) Terminated Dna Double-Strand Breaks (Dsbs) And In Response To Oxidative Stress, Tong Zhou

Theses and Dissertations

DNA DSBs are most toxic to cells because they can lead to genomic rearrangements and even cell death. Most DSBs induced by ionizing radiation or radiomimetic drugs such as calicheamicin and bleomycin, bear 3′-phosphate or 3′- PG moieties that must be removed to allow subsequent gap filling and ligation. DSBs can be repaired by two main pathways: the homologous recombination (HR) pathway and the non-homologous end-joining (NHEJ) pathway, NHEJ is the primary repair pathway in mammalian cells. While HR repairs single strand breaks (SSBs) or DSBs accurately by using an undamaged copy of the sequence mostly at late S phase …


Costs And Use Of Oral Anti-Cancer Medications Among Senior Medicare Part D Beneficiaries, Nantana Kaisaeng Nov 2012

Costs And Use Of Oral Anti-Cancer Medications Among Senior Medicare Part D Beneficiaries, Nantana Kaisaeng

Theses and Dissertations

Oral cancer drugs are branded and expensive medications that generally do not have generics available. The restrictions of the Medicare Part D program, including the coverage gap and high cost-sharing, and the high cost of oral chemotherapy may lead to patients’ non-adherence to medication. Few studies have examined the cost and utilization of oral anti-cancer medications. This study will be the first to examine the costs associated with the use of oral anti-cancer medications and the impact of cost-sharing and type of prescription drug subsidy on medication discontinuation in the Medicare Part D elderly population. Objectives: To determine the usage …


Investigating A Model For Fetal Alcohol Damage In Caenorhabditis Elegans, Lindsay Kondo Nov 2012

Investigating A Model For Fetal Alcohol Damage In Caenorhabditis Elegans, Lindsay Kondo

Theses and Dissertations

Alcohol use and abuse has many harmful effects, especially to children exposed prenatally, including fetal alcohol spectrum disorders (FASDs). The disabilities due to fetal alcohol exposure continue throughout life and cause major financial burdens to society. The molecular mechanisms underlying FASDs are not well understood. We have taken a genetic approach to characterize ethanol’s effect on changing a discrete cell fate decision during embryogenesis in the nematode, Caenorhabditis elegans (C. elegans). Our preliminary data suggest that ethanol can affect the development of AWC neurons, a pair of olfactory neurons in C. elegans. We suggest that lipids can protect AWC neurons …


Nobody’S Perfect: A Qualitative Examination Of African American Caregivers And Their Adolescent Daughters’ Perceptions Of Adolescent Girls’ Body Image, Michell Pope Nov 2012

Nobody’S Perfect: A Qualitative Examination Of African American Caregivers And Their Adolescent Daughters’ Perceptions Of Adolescent Girls’ Body Image, Michell Pope

Theses and Dissertations

The increasingly high rates of body dissatisfaction among adolescent girls are alarming. Research suggests that cultural norms emphasizing thinness and unrealistic standards of beauty may be contributing to this growing problem. This is concerning given the link between negative body image and a host of unhealthy behaviors in girls. Although historically African American adolescent girls have exhibited higher levels of body satisfaction than their counterparts, there is growing evidence to suggest that this may be changing because of the body-related messages they receive from their parents, peers and the media. The present study examines these messages from both maternal caregivers’ …


Changing The Game: Corporate Social Responsibility In Women's Professional Sport, Lorie Coker Nov 2012

Changing The Game: Corporate Social Responsibility In Women's Professional Sport, Lorie Coker

Theses and Dissertations

Research indicates that female athletes have long occupied marginal and sometimes invisible positions in sport settings and mainstream media. The focus of this study is on understanding and analyzing how race, class, gender, and other forms of oppression shape women’s professional sport using as the focal point, corporate social responsibility (CSR) and the type of mainstream media coverage it receives. The researcher believes that a better understanding of these varied experiences would add depth and knowledge to research on CSR in sport, women and sport research, as well as allow professional leagues and teams to move forward with a more …


Data Acquisition From Cemetery Headstones, Cameron Smith Christiansen Nov 2012

Data Acquisition From Cemetery Headstones, Cameron Smith Christiansen

Theses and Dissertations

Data extraction from engraved text is discussed rarely, and nothing in the open literature discusses data extraction from cemetery headstones. Headstone images present unique challenges such as engraved or embossed characters (causing inner-character shadows), low contrast with the background, and significant noise due to inconsistent stone texture and weathering. Current systems for extracting text from outdoor environments (billboards, signs, etc.) make assumptions (i.e. clean and/or consistently-textured background and text) that fail when applied to the domain of engraved text. Additionally, the ability to extract the data found on headstones is of great historical value. This thesis describes a novel and …


Successful Emergent Literacy Head Start Teachers Of Urban African American Boys Living In Poverty, John Michael Holland Nov 2012

Successful Emergent Literacy Head Start Teachers Of Urban African American Boys Living In Poverty, John Michael Holland

Theses and Dissertations

This integrated methods study used a sequential explanatory design to explore the culturally relevant teaching beliefs of successful emergent literacy Head Start teachers of urban African American boys living in poverty. The study utilized emergent literacy gain scores as a measure of success, a survey of culturally relevant teaching beliefs to describe variation in beliefs within the sample, and two rounds of interviews to explore the context of teacher agency with urban African American boys living in poverty. The four teachers interviewed expressed culturally relevant beliefs integral to their teaching practices. These beliefs were conveyed through descriptions of relationships with …


Microfabrication, Characterization, And Application Of Carbon Nanotube Templated Thin Layer Chromatography Plates, And Functionalization Of Porous Graphitic Carbon, David S. Jensen Nov 2012

Microfabrication, Characterization, And Application Of Carbon Nanotube Templated Thin Layer Chromatography Plates, And Functionalization Of Porous Graphitic Carbon, David S. Jensen

Theses and Dissertations

This dissertation contains the following sections. Chapter 1 contains a detailed description of the theory of thin layer chromatography (TLC). Chapter 2 describes the benefits and practical considerations of elevated temperatures in liquid chromatography (LC). The porous graphitic carbon (PGC) I modified as part of my work is often used in elevated temperature LC. Chapter 3 shows a thermodynamic analysis of chromatographic retention at elevated temperature, and Chapter 4 contains a closer look at the van 't Hoff equation in LC and how it can be used in retention modeling. In Chapter 5, I describe a new procedure for microfabricating …


Deposition And Characterization Of Hydrophobic Coatings, Vipul Gupta Nov 2012

Deposition And Characterization Of Hydrophobic Coatings, Vipul Gupta

Theses and Dissertations

Hydrophobic coatings find application in various sectors of the economy including to electronics, textiles, optical devices, and in scientific and commercial equipment. These different applications demand that different hydrophobic coatings posses a range of properties that may include smoothness or roughness, thicknesses on the order of a monolayer or a micron, robustness or the ability to dissolve quickly, transparency or opacity, water resistance or water permeability, electrical conductivity, oleophobicity, etc. However, whatever the final/desired properties, deposition via dry-deposition processes offers significant advantages, including greater reproducibility, increased environmental friendliness, and cost effectiveness on an industrial scale. Herein I explore the chemical …


A New Approach To Dried Blood Spot Analysis For Newborn Screening Using High Resolution Liquid Chromatography Tandem Mass Spectrometry, John H. Miller Iv Nov 2012

A New Approach To Dried Blood Spot Analysis For Newborn Screening Using High Resolution Liquid Chromatography Tandem Mass Spectrometry, John H. Miller Iv

Theses and Dissertations

The primary purpose of newborn screening is to quickly identify children that are at risk of having a specific disorder in order to start treatment, prevent early death and reduce the chances of permanent physical or mental damage. The current and widely accepted approach used for identification of metabolism disorders involves a flow injection analysis with mass spectrometry detection of acylcarnitines and amino acids. Although this approach is widely accepted and has shown to be sufficient for identification of multiple metabolism disorders the method is not fully quantitative and results often have to be confirmed by second-tier tests. The primary …


Growth Gone Awry: Exploring The Role Of Embryonic Liver Development Genes In Hcv Induced Cirrhosis And Hepatocellular Carcinoma, Martha K. Behnke Nov 2012

Growth Gone Awry: Exploring The Role Of Embryonic Liver Development Genes In Hcv Induced Cirrhosis And Hepatocellular Carcinoma, Martha K. Behnke

Theses and Dissertations

Introduction and methods: Hepatocellular carcinoma (HCC) remains a difficult disease to study even after a decade of genomic analysis. Metabolic and cell-cycle perturbations are known, large changes in tumors that add little to our understanding of the development of tumors, but generate “noise” that obscures potentially important smaller scale expression changes in “driver genes”. Recently, some researchers have suggested that HCC shares pathways involving the master regulators of embryonic development. Here, we investigated the involvement and specificity of developmental genes in HCV-cirrhosis and HCV-HCC. We obtained microarray studies from 30 patients with HCV-cirrhosis and 49 patients with HCV-HCC and compared …


Novel Strategies To Improve Metabolic Parameters And Precondition Diabetic Hearts Against Ischemia/Reperfusion Injury, Amit Varma Nov 2012

Novel Strategies To Improve Metabolic Parameters And Precondition Diabetic Hearts Against Ischemia/Reperfusion Injury, Amit Varma

Theses and Dissertations

Insulin resistance and chronic hyperglycemia promote vascular damage, increase circulating levels of inflammatory cytokines and lead to increased morbidity and mortality. MicroRNAs (miRs) -103/107 have been shown to negatively regulate insulin sensitivity and glucose homeostasis. Based on complimentary binding profiles, the downstream target gene of miR-103/107 is caveolin-1 (Cav-1). We hypothesized that daily administration of the phosphodiesterase-5 inhibitor tadalafil (TAD) ± the curcumin analogue (HO-3867) will attenuate inflammation, improve metabolic parameters and reduce infarct size after ischemia/reperfusion injury (IRI). Furthermore, we propose that TAD therapy will reduce myocardial expression of miR-103/107 and increase mRNA and protein levels of its target …


The Role Of Magl Inhibition In Nicotine Withdrawal And Reward, Pretal Muldoon Nov 2012

The Role Of Magl Inhibition In Nicotine Withdrawal And Reward, Pretal Muldoon

Theses and Dissertations

ROLE OF MAGL INHIBITION IN NICOTINE WITHDRAWAL AND REWARD. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. by Pretal Ishvarlal Patel Muldoon Director: M. Imad Damaj, PhD Professor, Department of Pharmacology and Toxicology Tobacco use is one of the leading causes of preventable deaths worldwide. Nicotine, the main psychoactive component of tobacco, sustains and initiates tobacco addiction. Cessation of nicotine induces a dependence withdrawal syndrome. Recent in vivo studies indicate that the endocannabinoid (EC) system modulates both nicotine reward and withdrawal. The purpose of this proposal is to …


Learning Within A Computer-Assisted Instructional Environment: Effects On Multiplication Math Fact Mastery And Self-Efficacy In Elementary-Age Students, Loraine Jones Hanson Nov 2012

Learning Within A Computer-Assisted Instructional Environment: Effects On Multiplication Math Fact Mastery And Self-Efficacy In Elementary-Age Students, Loraine Jones Hanson

Theses and Dissertations

The primary purpose of this study was to evaluate the effect of basic multiplication mastery (0-12) and self-efficacy outcomes for elementary age students attempting to master multiplication facts in a Computer-Assisted Instructional (CAI) environment. Timez Attack (TA), a modern Internet based 3-D multiplication video game, was the computer program used in this study. Four third- and four fourth-grade classes of students at a public charter school received either 12 20-minute Teacher-Led Instructional (TLI), or TA multiplication practice sessions. Pre- and post Math Attitude Survey (MAS), timed multiplication tests, observations, and informal interviews were used to assess and compare TA and …


Spanish, Nahua, And Maya Narratives On The 1585 Relación Geográfica Map Of Santiago Atitlán, Kaitlan Smith Nov 2012

Spanish, Nahua, And Maya Narratives On The 1585 Relación Geográfica Map Of Santiago Atitlán, Kaitlan Smith

Theses and Dissertations

The 1585 Relación Geográfica Map of Santiago Atitlán, Guatemala gives scholars a rare glimpse of sixteenth- century southern Guatemala. The map displays the use of Spanish, Nahua, and Maya perspectives. The coexistence of indigenous Nahua versus Spanish or European iconographies and narratives is a theme constantly explored in the studies of the Relaciones Geográficas maps. However, the opposition of two different indigenous narratives and iconographies, as well as Spanish, is not. This project examines the convergences and conflicts among these narratives and iconographies as evidenced on the map and in the accompanying text. The individual discussion of each narrative is …


Ultrasound-Induced Phase Change Of Emulsion Droplets For Targeted Gene And Drug Delivery, James R. Lattin Nov 2012

Ultrasound-Induced Phase Change Of Emulsion Droplets For Targeted Gene And Drug Delivery, James R. Lattin

Theses and Dissertations

This dissertation explores the potential of using perfluorocarbon emulsion droplets to add an ultrasound-sensitive element to drug delivery systems. These emulsion droplets may be induced to vaporize with ultrasound; during the rarefactional phase of an ultrasound wave, the pressure around the droplets may fall below the vapor pressure of the liquid forming the emulsion, providing a thermodynamic potential for vaporization. This ultrasound-induced phase change of the emulsion droplet could release therapeutics attached to the droplet surface or aid in drug delivery due to mechanical effects associated with vaporization and expansion, similar to the ability of cavitating bubbles to aid in …


Inspiration: Examining Its Emotional Correlates And Relationship To Internalized Values, David Jennings Ii Nov 2012

Inspiration: Examining Its Emotional Correlates And Relationship To Internalized Values, David Jennings Ii

Theses and Dissertations

The study of inspiration as a psychological construct has received little empirical attention to date. In the present dissertation, I review the empirical literature on inspiration and present a theoretical model and definition of inspiration. In two studies, I tested a Value-Congruent Model of Inspiration and my proposed definition. In Study 1 (N = 134), I explored inspiration’s emotional correlates and tested whether individuals experience greater inspiration if the inspirational content is concordant with individual meaning and values. As predicted, state inspiration was positively related to state levels of admiration, awe, and elevation, and value-congruent stimuli significantly predicted self-reported experiences …


Mechanism Of Action Studies On A New Class Of Anticancer Nucleosides, Megan E. Browning Nov 2012

Mechanism Of Action Studies On A New Class Of Anticancer Nucleosides, Megan E. Browning

Theses and Dissertations

We have completed mechanism of action studies on a new class of anticancer nucleosides typified by a novel nucleoside discovered in our lab, MAP-870. In order to study the mechanism of MAP-870, several experiments were completed on a colorectal adenocarcinoma cell line, HT-29, including trypan blue cell count, sulforhodamine B assays, flow cytometry of cell cycle, propidium iodide incorporation, and phosphatidylserine externalization, Caspase-Glo3/7 assays, DNA fragmentation gel, cyclophilin A release gel, PAMPA, and confocal imaging. Sulforhodamine B assays show that MAP-870 does indeed cause growth inhibition and cell death in the model tested. PAMPA assays show that MAP-870 does not …


Arsenic, Cadmium And Neuron Specific Enolase (Enolase-2, Enolase-Gamma), Expression In Breast And Bladder Cancer, Maureen Achey Soh Nov 2012

Arsenic, Cadmium And Neuron Specific Enolase (Enolase-2, Enolase-Gamma), Expression In Breast And Bladder Cancer, Maureen Achey Soh

Theses and Dissertations

Arsenic and cadmium (Cd+2) are well established environmental pollutants. Human exposure to arsenite (As+3) and Cd +2 have been associated with many types of cancers including skin, bladder, liver, prostate, stomach and lung. Epidemiological studies have associated Cd+2 exposure with breast cancer development while As +3 has not been directly associated with breast cancer development, although both As+3 and Cd+2 have been implicated in estrogen receptor mediated gene transcription and endocrine disruption. In the present study, the ability of both these heavy metals to transform the immortalized human breast epithelial (MCF-10A) cell line was examined. For this purpose, the MCF-10A …


How Six Secondary Science Teachers Make Curricular And Pedagogical Decisions: Influencing Factors, Wade V. Forester Nov 2012

How Six Secondary Science Teachers Make Curricular And Pedagogical Decisions: Influencing Factors, Wade V. Forester

Theses and Dissertations

No abstract provided.


Regulation Of Sensory Neurogenesis In The Trigeminal Placode: Notch Pathway Genes, Pax3 Isoforms, And Wnt Ligands, Jason Samuel Adams Nov 2012

Regulation Of Sensory Neurogenesis In The Trigeminal Placode: Notch Pathway Genes, Pax3 Isoforms, And Wnt Ligands, Jason Samuel Adams

Theses and Dissertations

This dissertation is divided into three chapters, each discussing the study of different regulatory molecules involved in sensory neurogenesis occurring in the trigeminal placode. Chapter one is a spatiotemporal description of Notch pathway genes in chick opV placode by stage-specific expression analysis, showing expression of many Notch pathway genes and effectors in the opV placode. Notch pathway gene expression is primarily confined to the ectoderm with highest expression of these genes at the beginning stages of peak neuronal differentiation. This information preceded studies of the functional roles that Notch signaling has in the opV placode and how it may affect …


Functionalization Of In-Plane Photonic Microcantilever Arrays For Biosensing Applications, Stanley J. Ness Oct 2012

Functionalization Of In-Plane Photonic Microcantilever Arrays For Biosensing Applications, Stanley J. Ness

Theses and Dissertations

Microcantilevers have been investigated as high sensitivity, label free biosensors for approximately 15 years. In nearly all cases, a thin gold film deposited on the microcantilevers is used as an intermediate attachment layer because of the convenience of thiol-gold chemistry. Unfortunately, this attachment chemistry can be unstable when used with complex sample media such as blood plasma. The Nordin group at BYU has recently developed an all-silicon in-plane photonic microcantilever (PMCL) technology to serve as a platform for label-free biosensing. It has the advantage of being readily scalable to simultaneous readout of many PMCLs in array format, and allows integration …


The Role Of Case-Hardening In The Development And Preservation Of Narrow, Vertical-Walled Canyons In Adršpach-Teplice, Czech Republic, Shawn Austin Wiggins Oct 2012

The Role Of Case-Hardening In The Development And Preservation Of Narrow, Vertical-Walled Canyons In Adršpach-Teplice, Czech Republic, Shawn Austin Wiggins

Theses and Dissertations

The geomorphology at Adršpach-Teplice, Czech Republic is dominated by vertical-walled, fracture-controlled features including slot canyons, gorges and pillars. Surfaces of canyon walls in Adršpach are case-hardened and more resistant to erosion than the bulk of the sandstone, which appears to be fundamental to the formation and preservation of canyons. Core and whole rock samples from Adršpach-Teplice were analyzed in thin section, including SEM analysis with cathodo luminescence. XRF and XRD analyses indicated that silica case-hardened surfaces are chemically and mineralogically similar to the rock interior, while iron case-hardened surfaces have an increase in iron present at the surface as the …


Syngas Impurity Effects On Cell Growth, Enzymatic Activities And Ethanol Production Via Fermentation, Deshun Xu Oct 2012

Syngas Impurity Effects On Cell Growth, Enzymatic Activities And Ethanol Production Via Fermentation, Deshun Xu

Theses and Dissertations

A syngas compositional database with focus on trace impurities was established. For this work, ammonia (NH3) and benzene (C6H6) effects on cell growth, enzymatic activities of hydrogenase and alcohol dehydrogenase (ADH), and product formation were studied. NH3, after entering media, will be converted rapidly to NH4+, which will raise the total osmolarity of the media. NH3, as a common nutrient for the cell growth, is not the real culprit for cell growth inhibition. In essence, it is the high osmolarity resulting from the accumulation of NH4+ in the media which disrupts the normal regulation of the cells. It was concluded …


Capture And Characterization Of Dioxygen Reactive Intermediates In Cyp51 Catalysis, Gareth Kent Jennings Oct 2012

Capture And Characterization Of Dioxygen Reactive Intermediates In Cyp51 Catalysis, Gareth Kent Jennings

Theses and Dissertations

The cytochromes P450 (CYPs) are a superfamily of biological catalysts that are ubiquitous throughout the biological domain. CYPs are heme-b containing monooxygenases which oxidize substrates with the help of accessory redox partners. CYP substrates include endogenous compounds required for many biological functions and homeostasis, such as steroids, as well as the majority of clinically used drugs and environmental xenobiotics. The majority of studies that have been performed to date are on P450cam (CYP101) from Pseudomonas putida. Of the numerous reactions catalyzed by CYPs, unactivated carbon-carbon bond cleavage, is one of particular versatility. Being unique in their catalytic mechanisms, the C-C …


Thermodynamic Kinetics And Efficiency Analysis Of Methyl Viologen, Chang Chen Oct 2012

Thermodynamic Kinetics And Efficiency Analysis Of Methyl Viologen, Chang Chen

Theses and Dissertations

Methyl Viologen (MV) is an electron mediator that has great possibilities to be used with an electrode system in which the electrode system provides electrons towards reducing MV species. MV has three redox states and they can be converted to each other via redox reactions on the surface of the electrode. The concentration of the three species of MV was related to the voltage potential applied to the system through a thermodynamic model. With the thermodynamic model the concentration of the three species can be predicted with different applied voltage potentials towards providing guidance for controlling the redox state of …


Care For The Socially Disadvantaged: The Role Of Race And Gender On The Physician-Patient Relationship And Patient Outcomes In A Safety Net Primary Care Clinic., Daniel Baughn Oct 2012

Care For The Socially Disadvantaged: The Role Of Race And Gender On The Physician-Patient Relationship And Patient Outcomes In A Safety Net Primary Care Clinic., Daniel Baughn

Theses and Dissertations

Compared to the general population, socially disadvantaged patients have higher rates of chronic illness and require more complex medical care. They also endorse higher levels of psychological distress and tend to engage in behavioral risk factors such as poor diet, physical inactivity, and smoking. These issues are particularly concerning given that this population tends to adhere less to medical recommendations, has limited access to health resources, and receives poorer treatment from providers. In an effort to address this disparity, The Affordable Care Act will expand health care access to an additional 23 million uninsured and 17 million underinsured Americans. However, …