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Articles 35791 - 35820 of 38430
Full-Text Articles in Entire DC Network
Structural Analyses Of Streptococcus Agalactiae Sortases, Baldeep Khare
Structural Analyses Of Streptococcus Agalactiae Sortases, Baldeep Khare
All ETDs from UAB
Multi-drug resistance in Gram-positive bacteria is a growing and unwavering challenge for twenty-first century medicine. The enzyme sortase, identified just around the turn of the century, has since become a promising target for development of anti-infective drugs. Streptococcus agalactiae or Group B Streptococcus (GBS), encodes multiple sortases, which participate in various processes and whose functions are only beginning to be understood in detail. Sortases are cysteine proteases that are crucial for Gram-positive pili biogenesis. Two classes of sortases, class C and class A, participate in the assembly of structural components (pilins) to form the pili and subsequent anchoring of the …
A Cluster Analysis Based On The Health Belief Model Of Alacare Patients At High Risk For Osteoporosis, Elizabeth M. Kitchin
A Cluster Analysis Based On The Health Belief Model Of Alacare Patients At High Risk For Osteoporosis, Elizabeth M. Kitchin
All ETDs from UAB
The prevalence of osteoporosis and subsequent fragility fractures will continue to rise as the American population ages. The high personal and medical costs of fragility fractures have been well documented. Taking calcium and vitamin D supplements are important strategies for lowering the risk of sustaining a fragility fracture and for improving the efficacy of prescription osteoporosis medications. The purpose of this study was to determine if patients in a home health setting in Alabama (Alacare) who are defined as high risk for a fragility fracture could be segmented via cluster analysis based on the constructs of the Osteoporosis Health Belief …
Broad And Potent Neutralizing Antibody Responses Elicited In Natural Hiv-2 Infection, Rui Kong
Broad And Potent Neutralizing Antibody Responses Elicited In Natural Hiv-2 Infection, Rui Kong
All ETDs from UAB
Little is known about the potency, breadth and epitope specificities of neutralizing antibody (Nab) responses elicited in natural HIV-2 infection. Analysis of plasma specimens from 64 HIV-2 chronically-infected subjects in a single round infectivity assay (JC53bl-13/TZM-bl) revealed median reciprocal IC50 Nab titers of 1.7x105, 2.8x104 and 3.3x104 against three primary virus strains, HIV-27312A, HIV-2ST and HIV-2UC1, respectively. A subset of 5 plasma samples was tested on 17 additional HIV-2 strains, and similarly high Nab titers were observed against all but four viruses. These Nab titers were higher, by orders of magnitude, than HIV-1 Nab titers in plasma from chronically infected …
Structural And Functional Studies On Group A Streptococcal Bacteriophage Hyaluronidase, Joo Hyoung Lee
Structural And Functional Studies On Group A Streptococcal Bacteriophage Hyaluronidase, Joo Hyoung Lee
All ETDs from UAB
Aberrant hyaluronan production is frequently associated with tumors where the elevated levels of tumoral hyaluronan are often associated with higher expression levels of cellular hyaluronidases that produce saturated hyaluronan fragments with divergent pro-tumoral activities. In this thesis, we provide evidence that different hyaluronan metabolism of bacteriophage hyaluronidase (HylP) elicits distinct alteration in breast cancer cell behavior. We demonstrate through comparative analysis with bovine testicular hyaluronidase (BTH) that higher enzyme activity, specificity for hyaluronan and production of unsaturated oligosaccharides render HylP to have profound effects on growth, migration and invasion activities of breast carcinoma cells, whereas BTH and its saturated metabolites …
Multilayered Nanostructured Diamond Coatings For Temporomandibular Joint Prostheses, Leigh Booth
Multilayered Nanostructured Diamond Coatings For Temporomandibular Joint Prostheses, Leigh Booth
All ETDs from UAB
Disorders of the temporomandibular joint (TMJ) may lead to pain, discomfort and reduced function in many patients. When less invasive treatment methods have been exhausted, a TMJ prosthesis may be used to restore joint mobility and function. Currently available TMJ prosthesis designs feature metal-polyethylene or metal-on-metal wear couples; though these devices have been used to successfully restore joint function, the generation of wear debris may lead to adverse reactions at the implant site (such as inflammation or osteolysis). To further reduce wear and potentially increase the lifetime of these devices, nanostructured diamond (NSD) coatings on the articulating surfaces of Ti-6Al-4V …
Estrogen Increases Stress Resilience And Hippocampal Synaptic Physiology In The Learned Helplessness Model Of Depression In Female Rats, Teruko Michelle Bredemann
Estrogen Increases Stress Resilience And Hippocampal Synaptic Physiology In The Learned Helplessness Model Of Depression In Female Rats, Teruko Michelle Bredemann
All ETDs from UAB
A recent focus of psychiatric research is estrogen related mood disorders such as postpartum depression and major depressive disorder in women. It is now clear that women are more susceptible to depression in response to stress during reproductive events when ovarian hormones are low or fluctuating. Depressive episodes are characterized by feelings of helplessness and despair as well as learning and memory impairments that have been linked to the hippocampus. Thus, decreased functioning of hippocampal circuits likely contributes to the cognitive symptoms associated with depression. Preclinical research shows that stress, which triggers depressive episodes, decreases the ability of excitatory synapses …
The Predictability Of C-Reactive Protein, Lipoprotein-Associated Phospholipase A2, And Depression On Later Health Outcomes In Patients Experiencing A First-Time Stroke, Mary King Brethour
The Predictability Of C-Reactive Protein, Lipoprotein-Associated Phospholipase A2, And Depression On Later Health Outcomes In Patients Experiencing A First-Time Stroke, Mary King Brethour
All ETDs from UAB
Stroke is the third leading cause of death and the most common cause of neurologic disability for adults in developed nations. Strokes trigger an acute inflammatory response prompted by brain tissue injury at the infarct site and the surrounding ischemic penumbra raising plasma levels of inflammatory markers. C-reactive protein (CRP), an acute-phase inflammatory marker, has been significantly correlated with infarct size and post-stroke complications. Lipoprotein-associated phospholipase A2 (Lp-PLA2) may also predict long-term cardiovascular risk in the stroke population. In addition to physiologic changes, up to 60% of all stroke survivors are known to experience depression, which may contribute to decreased …
Role Of Ras Proteins In Malignant Peripheral Nerve Sheath Tumors, Nicole Marie Brossier
Role Of Ras Proteins In Malignant Peripheral Nerve Sheath Tumors, Nicole Marie Brossier
All ETDs from UAB
Malignant peripheral nerve sheath tumors (MPNSTs) arising in patients with neurofibromatosis type I (NF1) are null for the tumor suppressor neurofibromin, a negative regulator of signaling from both classic Ras (H-Ras, N-Ras and K-Ras) and R-Ras (R-Ras, R-Ras2/TC21, M-Ras/R-Ras3) subfamily members. Treatment of these tumors with Ras-targeted agents such as farnesyltransferase inhibitors has proven unsuccessful, likely due to the inability of these agents to successfully target all of the Ras isoforms regulated by neurofibromin. Thus, determining which Ras isoforms are critical for MPNST pathogenesis would be of therapeutic value. In this dissertation, we first review the clinical manifestations of NF1 …
Altered Dna Methylation Of Repetitive Elements May Explain The Modified Risk Of Cervical Intraepithelial Neoplasia (Cin) Associated With Genetic Polymorphisms Of The Folate Metabolic Pathway In The Us Post Folic Acid Fortification Era, Suguna Badiga
All ETDs from UAB
Despite the controversy regarding the adverse effects of exposure to higher folate concentrations on health outcomes particularly cancer, there has been paucity of research to understand the biological mechanisms affected by such exposures in relation to the risk of developing pre-cancer or cancer. We have recently addressed this concern by demonstrating that higher plasma folate concentrations were not associated with greater risk of being diagnosed with higher grades of cervical intraepithelial neoplasia (CIN 2+) especially in women with sufficient plasma vitamin B12 concentrations. Higher plasma folate was also associated with a pre-cancer protective level of peripheral blood mononuclear cells (PBMC) …
Fracture Strength Of All-Ceramic Restorations After Fatigue Loading, Balasudha Baladhandayutham
Fracture Strength Of All-Ceramic Restorations After Fatigue Loading, Balasudha Baladhandayutham
All ETDs from UAB
Fracture strength of monolithic and bilayered LAVA and e. max lower molar crowns after load cycling was measured and compared. The study included three groups (n = 8) from LAVA zirconia and three groups from e. max lithium disilicate to compare influences of different layers, thicknesses and manufacturing techniques. Prefabricated anatomically designed crowns were cemented to dies made from Z 100 composite resin using Rely X Luting Plus resin modified glass ionomer cement. Cemented crowns were stored at 37° C for 24 hours then cyclic loaded to test fatigue properties. The crowns were loaded to 200,000 cycles at 25N at …
Antimicrobial Effectiveness Of Silver-Releasing Elastomeric Ligature Ties, Matthew Christopher O'Dell
Antimicrobial Effectiveness Of Silver-Releasing Elastomeric Ligature Ties, Matthew Christopher O'Dell
All ETDs from UAB
Introduction: Fixed appliances make satisfactory oral hygiene a greater challenge for the orthodontic patient. Improper oral hygiene during orthodontic treatment can cause enamel demineralization resulting in unesthetic white spot lesions. A new approach to providing protection against demineralization during treatment has been to incorporate antimicrobial agents into elastomeric ligature ties. A recent elastomeric ligature tie uses the antimicrobial characteristic of silver to help prevent formation of white spot lesions. The purpose of this in vitro study is to determine the antimicrobial effectiveness of a silver-releasing elastomeric ligature tie (OrthoShield Safe-T-Tie) against Streptococcus mutans and compare its results with a selenium-containing …
Role Of The Cystine/Glutamate Exchanger In Glioma Cell Biology, Toyin Adeyemi Ogunrinu
Role Of The Cystine/Glutamate Exchanger In Glioma Cell Biology, Toyin Adeyemi Ogunrinu
All ETDs from UAB
Changes in the glioma microenvironment including oxygen (O2) levels, supply of amino acid such as L-glutamate and L-cystine and glutathione (GSH) concentrations play a critical role in glioma biology. Previous data from our laboratory and others have implicated the L-cystine/L-glutamate exchanger, system xc- in the invasion and proliferation of cancers including glioma. The central aim of this dissertation was to characterize the contribution of L-cystine uptake, GSH synthesis and L-glutamate release to migration and proliferation of glioma cells. In my first study, I examined the role of system xc- mediated L-glutamate release on glioma migration. I show that activation of …
Fenofibrate And Insulin Resistance, Corrie E. Paeglow
Fenofibrate And Insulin Resistance, Corrie E. Paeglow
All ETDs from UAB
Both animal and human models suggest that fenofibrate, a medication widely prescribed to decrease triglycerides, also decreases insulin resistance. In the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) cohort, which included 780 individual who took 160 mg of micronized fenofibrate daily for three weeks, fenofibrate was found to decrease HOMA-IR by -0.24 units, (95% CI: -0.32, -0.14), insulin by -0.65 uU/mL (95% CI: -0.97, -0.34) and glucose by 2.46 mg/dL (95% CI: -2.51, -2.42). In a meta-analysis of 19 studies that included 1,297 individuals without diabetes and 196 individuals with diabetes treated with fenofibrate for three weeks or …
Impact Of Site Development Techniques In The Soft Tissue Height On Single Implant Supported Prosthesis In The Anterior Maxilla, Juan Francisco Pardo
Impact Of Site Development Techniques In The Soft Tissue Height On Single Implant Supported Prosthesis In The Anterior Maxilla, Juan Francisco Pardo
All ETDs from UAB
Background: Implant placement should be based on a restoration-oriented treatment plan with correct three-dimensional positioning to allow optimal support and stability of surrounding hard and soft tissues. After tooth extraction the alveolus remodels producing changes in the soft tissues contours. This may translate into the inability to place the implant or in a non-esthetic restoration. In contemporary esthetic implant dentistry, the main objective is to maintain the socket dimensions and soft tissue contours to allow ideal implant placement and to provide a harmonious restoration. Objective: To evaluate if socket grafting with FDBA with or without PRP or rhPDGF in site …
The Effects Of Apolipoprotein Mimetic Peptides On Inflammation And Oxidative Stress, Toral Rohit Patel
The Effects Of Apolipoprotein Mimetic Peptides On Inflammation And Oxidative Stress, Toral Rohit Patel
All ETDs from UAB
Coronary Artery Disease (CAD) is the leading cause of deaths worldwide, including the United States. Atherosclerosis remains the primary cause of CAD, and is a leading target for drug treatments. Despite advances in treatments, many questions remain unanswered pertaining to the mechanisms of the treatments on inflammation and oxidative stress. We hypothesize that peptides 4F and Ac-hE18A-NH2 act as anti-inflammatory factors and reduce oxidative stress. We also hypothesize that these peptides require apolipoprotein A-I (apoA-I) to increase paraoxonase-1 (PON-1) activity. The effects of administering peptides 4F and Ac-hE18A-NH2 on oxidative stress were evaluated through the analysis of plasma from apoA-I-null …
Homelessness In Birmingham, Al: An Analysis Using The Local Homeless Management Information System And Surveys From Local Supportive Housing Programs, Adrian Kendall Smith
Homelessness In Birmingham, Al: An Analysis Using The Local Homeless Management Information System And Surveys From Local Supportive Housing Programs, Adrian Kendall Smith
All ETDs from UAB
A homeless management information system (HMIS) records and stores a client's demographic information and his/her service utilization history while allowing for case management opportunities between the client and service provider. HMISs are changing the way communities serve their homeless populations and how agencies serving the homeless interact with their clients and other agencies. With a focus on the city of Birmingham, its local HMIS, and the local agencies using HMIS this research seeks to answer the following questions: How can the homeless management information system help us to better understand the homeless population in Birmingham? What are the different approaches …
Associations Among Measures Of Engagement With Kp.Org And Clinical Outcomes, Heather J. Sobko
Associations Among Measures Of Engagement With Kp.Org And Clinical Outcomes, Heather J. Sobko
All ETDs from UAB
USING MEASURES OF ENGAGEMENT WITH KP.ORG TO DETERMINE ASSOCIATIONS WITH SELECTED CLINICAL OUTCOMES HEATHER J. SOBKO SCHOOL OF NURSING ABSTRACT Introduction The purpose of this retrospective cohort study was to examine patterns of use of an electronic personal health record among adults diagnosed with diabetes, hypertension or hyperlipidemia. Intermediate behavioral measures (medication possession ratios) and physiological measures of metabolic control for diabetes (hemoglobinA1c), hypertension (blood pressure) and hyperlipidemia (low density lipoprotein) were examined. Methods Administrative data from Kaiser Permanente Georgia were analyzed. Adult members of with selected chronic diseases of diabetes, hypertension or hyperlipidemia who used the Kaiser Permanente electronic …
Ultrasound Elasticity Measurements As A Predictor For Arteriovenous Fistula Maturation, Anna Sorace
Ultrasound Elasticity Measurements As A Predictor For Arteriovenous Fistula Maturation, Anna Sorace
All ETDs from UAB
This research thesis examines the applicability of using ultrasound imaging to quantify arterial elasticity and assess potential of arteriovenous fistula maturation in chronic kidney disease (CKD) patients. Tissue-specific abnormalities have proven useful for identifying disease states within oncology, cardiovascular and musculoskeletal system. Using ultrasound-based imaging to evaluate arterial elasticity is a noninvasive and novel technique. It has the potential to contribute further insight into chronic kidney disease fistula failure and become a noninvasive prognostic indicator. Reliable vascular access is critical for delivery of adequate hemodialysis treatment to CKD patients and to maintain long-term connections for dialysis. An arteriovenous fistula is …
Molecular Piracy In The Mobilization Of Staphylococcus Aureus Pathogenicity Island 1, Michael Spilman
Molecular Piracy In The Mobilization Of Staphylococcus Aureus Pathogenicity Island 1, Michael Spilman
All ETDs from UAB
Staphylococcus aureus bacteriophage 80α is a temperate, double-stranded DNA phage that serves as a "helper" phage for the mobilization of several S. aureus pathogenicity islands (SaPIs), including SaPI1. When mobilized by 80α, SaPI1 genomes are packaged into smaller phage-like transducing particles composed of 80α capsid (gp47), scaffolding (gp46) and portal (gp42) proteins. In this dissertation, I utilize electron microscopy and biochemistry to tease apart the structural and genetic controls and consequences of SaPI1 as a molecular pirate. More specifically, I show that two SaPI1 proteins shift assembly from 63-nm, T = 7 icosahedral capsids to 47-nm, T = 4 capsids, …
"The Role Of Health Promotion In Physical Therapy Survey" Reliability And Validity Testing", Jaca Stephens
"The Role Of Health Promotion In Physical Therapy Survey" Reliability And Validity Testing", Jaca Stephens
All ETDs from UAB
ABSTRACT Purpose: Physical therapists (PTs) have a unique opportunity to play a meaningful role in educating patients on health and wellness to prevent chronic conditions, such as cardiac disease, cerebrovascular disease, pulmonary disease, cancer, diabetes, and obesity. No instrument has been validated to measure physical therapists' views on health promotion and their practices. The purpose of this study was to evaluate the validity and reliability of a health promotion survey designed for physical therapists. Method: An expert panel of 9 physical therapists assessed the content validity of "The Role of Health Promotion in Physical Therapy Survey." as developed by Rea …
Calcium Dynamics Of Glial Cells And Genetic Influences On Behavior Of The Nematode Caenorhabditis Elegans, Randy Franklin Stout
Calcium Dynamics Of Glial Cells And Genetic Influences On Behavior Of The Nematode Caenorhabditis Elegans, Randy Franklin Stout
All ETDs from UAB
A major challenge in neuroscience is understanding how the different neural cell types work together to process information and produce a behavioral output. Glial cells of the human brain have long been thought to act as support for the fundamental cell to cell communication at the core of cognition: neuronal synaptic communication. Research over the past several decades measuring glial activity and experimentally controlling glial cells in rodent model systems has shown that the two macroglia sub-types of glial cells (astrocytes and oligodendrocytes) have active roles in establishment, maintenance, and modulation of synaptic communication in the mammalian brain. Much of …
Protective Factors Against Relapse For Practicing Nurse Anesthetists In Recovery From Anesthetic Opiates, Elizabeth Laura Wright
Protective Factors Against Relapse For Practicing Nurse Anesthetists In Recovery From Anesthetic Opiates, Elizabeth Laura Wright
All ETDs from UAB
Introduction: Addiction to anesthetic opiates is an occupational hazard for anesthesia providers, which includes nurse anesthetists. Several factors influence this hazard risk, including, genetic make-up, personality traits, and job stress. Also of great concern is the risk of relapse if an anesthesia provider returns to work, which can be as high as 40%. However, there are nurse anesthetists who have successfully returned to the practice of anesthesia while in recovery from addiction to anesthetic opiates. These nurse anesthetists have first-hand experience with the challenges of recovery when faced with continual access to opiates, and their experience can help others in …
Role Of Vdr In Host Immune Response To Porphyromonas Gingivalis Infection, Gulam Yezdani
Role Of Vdr In Host Immune Response To Porphyromonas Gingivalis Infection, Gulam Yezdani
All ETDs from UAB
Porphyromonas gingivalis is one of the etiologic factors of periodontal disease, a chronic inflammatory disorder characterized by the destruction of periodontal connective tissue and the subsequent loss of alveolar bone. Epidemiological and genetic studies have indicated an association between periodontal disease and the vitamin D system. However, little is known regarding how vitamin D signaling regulates the inflammatory immune process of this disease. The purpose of the study was to understand the role of the vitamin D receptor (VDR) in regulating the host response to P. gingivalis infection by using a dual chamber mouse model. These chambers served both as …
Assessment Of Mitochondrial Stressors On Cellular Bioenergetics, Blake Reid Zelickson
Assessment Of Mitochondrial Stressors On Cellular Bioenergetics, Blake Reid Zelickson
All ETDs from UAB
The mitochondrion plays a central role in the maintenance of bioenergetic function through the production of ATP and essential metabolites. The development of mitochondrial bioenergetic defects is a hallmark of important pathologies such as cardiovascular and liver diseases. It is well established that a decrease in mitochondrial function, typically of 20-40%, is associated with the progression of these pathologies. Causal relationships have been more difficult to establish because of the challenge of assessing mitochondrial function in a cellular setting. Specifically, it is known that mitochondria function at less than their maximal respiratory capacity and the remainder, known as reserve or …
In Vivo Interactions Between Virus Genomes And Host Proteins For Members Of The Order Picornavirales, Erik Michael Lenarcic
In Vivo Interactions Between Virus Genomes And Host Proteins For Members Of The Order Picornavirales, Erik Michael Lenarcic
All ETDs from UAB
A significant number of pathogens of economical and medical importance are positive sense RNA viruses. Their genomes enter host cells and subvert them to support virus growth. These large-scale changes involve the co-opting of cellular proteins through interactions with viral RNA and proteins. Characterizing these interactions leads to a better understanding of viral life cycles and the identification of new antiviral therapies. The order Picornavirales contains viruses that infect a wide array of eukaryotes. Their genomes serve as a messenger RNA (mRNA) that is translated by host ribosomes cap-independently through an internal ribosome entry site (IRES). Most members of the …
The Relationship Between Family Structure And Social Anxiety In Young Adults, Brandie Michelle Wagner
The Relationship Between Family Structure And Social Anxiety In Young Adults, Brandie Michelle Wagner
Honors Capstones
No abstract provided.
The Intestinal Extracellular Matix As An Innate Regulator Of Effector T-Cell Responses, Kayci Renee Huff
The Intestinal Extracellular Matix As An Innate Regulator Of Effector T-Cell Responses, Kayci Renee Huff
All ETDs from UAB
Extracellular matrix (stroma) regulation of mucosal T-cell function is incompletely understood. Here we uncovered a role for intestinal stromal products in the innate regulation of effector T-cells. Stroma-conditioned media (S-CM) derived from normal human intestinal stroma (TGF-&betahi/IL-6lo/IL-1ßlo) significantly down-regulated T-cell proliferation and IFN-&gamma production compared to S-CM derived from inflamed Crohn's mucosa (TGF-&betahi/IL-6hi/IL-1&betahi). Antibody neutralization studies showed that TGF-&beta in normal S-CM inhibited T-cell proliferation and IFN-&gamma production, whereas IL-6 plus IL-1&beta in Crohn's S-CM promoted T-cell proliferation, and the IL-1&beta alone promoted IFN-γ and IL-17 release. Importantly, stromal cells in normal tissue produce TGF-&beta and contribute to mucosal homeostasis …
Exhaustion Renders Cd8 T Cells Unresponsive To Antigen-Independent Activation And Is Characterized By Il-18 Receptor Downregulation, Jennifer T. Ingram
Exhaustion Renders Cd8 T Cells Unresponsive To Antigen-Independent Activation And Is Characterized By Il-18 Receptor Downregulation, Jennifer T. Ingram
All ETDs from UAB
During many chronic infections virus-specific CD8 T cells succumb to exhaustion as they lose their ability to respond to antigenic activation. Combinations of interleukin (IL)-12, IL-18, and IL-21 have been shown to induce the antigen-independent production of IFN-γ by effector and memory CD8 T cells. In this study we investigated whether exhausted CD8 T cells are sensitive to activation by these cytokines. We show that effector and memory, but not exhausted, CD8 T cells produce interferon-gamma (IFN-γ) and upregulate CD25 following exposure to certain combinations of IL-12, IL-18, and IL-21. This unresponsiveness was associated with downregulation of the IL-18 receptor …
Substance-Dependent Tasc Offenders Taking Psychotropic Pharmacotherapy--Associated Factors, Substance Use Outcomes, And Criminal Diversion Outcomes, Dorothy Octavia Jackson
Substance-Dependent Tasc Offenders Taking Psychotropic Pharmacotherapy--Associated Factors, Substance Use Outcomes, And Criminal Diversion Outcomes, Dorothy Octavia Jackson
All ETDs from UAB
Current evidence suggests that persons with co-occurring disorders (COD) are at risk for poorer treatment outcomes in terms of substance use and recidivism. Studies have examined this trend in incarcerated individuals, but few have examined COD offenders under community supervision. The purpose of this study was to develop a predictive model to identify offenders under community corrections supervision with substance use diagnoses who were actively taking psychotropic medications (SUPM) as an index of COD and to compare demographics, social histories, and sexual risk behaviors for SUPM offenders to offenders with a substance use disorder (SUD) only and those who met …
Teaching Breast Health To Adolescent Females In High School: Comparing Interactive Teaching With Traditional Didactic Methods, Jacqueline Anita Horton
Teaching Breast Health To Adolescent Females In High School: Comparing Interactive Teaching With Traditional Didactic Methods, Jacqueline Anita Horton
All ETDs from UAB
Breast Health Knowledge Breat Health Beliefs