Digital Commons Network^™

A Rare Presentation Of Systemic Lupus Erythematous With Lymphadenitis, Emily Wittenberg, Antonella Racano, Swetha Ramireddy, Niluka Weerakoon

MERF 2019 - Case Reports

A 26 year old African American female presented with the chief complaint of persistent fever and a single painful axillary lymph node for two weeks. This is a unique case of systemic lupus erythematous (SLE) presenting with painful lymphadenitis. Moreover, the result of her lymph node biopsy was also unusual, showing histiocytic necrotizing lymphadenitis (HNL) presenting in SLE. She presented with a fever of 103 degrees Fahrenheit and a single painful yet mobile axillary lymph node. She had no rash, joint tenderness, or hepatosplenomegaly on physical exam. Initial lab work showed absolute neutropenia and lymphopenia as well as normocytic anemia. …

Dehydrated Hereditary Stomatocytosis Causing Sever Ascites Leading To Pulmonary Hypoplasia And Respiratory Insufficiency In A Neonate, Michael D. Mcdowell Jr, Christopher M. Oermann

Posters

Care Presentation: EM is a 32.5-week EGA infant who was born with sever congenital ascites (following repeated prenatal paracentesis) identified on prenatal ultrasound. Initial chest-abdomen imaging is shown in Figure 1. He required CPAP at delivery but was weaned of high flow nasal cannula with intermittent episodes of prolonged intubation during repeat paracentesis. Paracentesis demonstrated simple ascites rather than chylous fluid. Lymphangiograms demonstrated transient lymphatic leakage with resolution. Genetic evaluation revealed a pathogenic mutation in the PIEZO 1 gene for autosomal dominant DHS. This disorder had reduced penetrance and variable expressivity and symptoms range for absence of clinical features to …

Socioeconomic Inequality In Life Expectancy In India, Miqdad Asaria, Sumit Mazumdar, Samik Chowdhury, Papiya Mazumdar, Abhiroop Mukhopadhyay, Indrani Gupta

Journal Articles

Introduction Concern for health inequalities is an important driver of health policy in India; however, much of the empirical evidence regarding health inequalities in the country is piecemeal focusing only on specific diseases or on access to particular treatments. This study estimates inequalities in health across the whole life course for the entire Indian population. These estimates are used to calculate the socioeconomic disparities in life expectancy at birth in the population. Methods Population mortality data from the Indian Sample Registration System were combined with data on mortality rates by wealth quintile from the National Family Health Survey to calculate …

Identifying Perceived Barriers To Primary Health Care Access In Rural, Medically Underserved Areas, Suzanne Hewitt

Doctoral Projects

Persons living in rural areas designated as having primary care provider shortages often lack access to timely and appropriate levels of care, frequently forcing them to forego care, delay treatment, or seek care in an emergency department for non-urgent complaints. This qualitative study reviewed evidence-based research and data generated from two focus groups sessions to generate a body of distinctive knowledge of the barriers to primary healthcare access as perceived by members of this rural, medically-underserved area of northern California. The theme that was identified, through conventional qualitative content analysis, as most prevalent among subjects was the inability to schedule …

Blockchain Meets Genomics: Governance Considerations For Promoting Food Safety And Public Health, Walter G. Johnson

Journal of Food Law & Policy

Foodborne illness remains an ongoing public health challenge in both the developing and industrialized worlds. In the United States, almost 50 million reported cases of infectious disease occur every year from a food product, resulting in substantial morbidity and mortality with economic burdens to health care and productivity. Despite recognition as a leader in food safety, the U.S. experiences longstanding and novel issues in food safety. Advances in whole genome sequencing (WGS) promise to bolster food safety regulators’ capabilities to identify pathogens and determine their source. However, inefficiencies in tracing food products through the supply chain remain.

Preparation And Evaluation Of Single-Stranded Dna Aptamer-Based Immunological Adjuvant In Broiler Chickens, Adil Sabr Al-Ogaili

Graduate Theses and Dissertations

Mineral oils and metal salts are commonly used as adjuvants to enhance acquired immunity. Recently, monoclonal antibodies (MAbs) and recombinant peptides agonist CD40 receptor have shown remarkable promise for induction of rapid and robust immune responses. Limitations of this approach MAb production costs and multiple administrations due to anti-MAb immune responses. Here we demonstrate the development of a unique and sophisticated DNA aptamer-based alternative for CD40-directed delivery of universal antigens as an alternative in chickens, and potentially other vertebrate species. This receptor, expressed by antigen-presenting cells, acts as a costimulatory molecule for activated T helper lymphocytes. After initially selecting for …

Influence Of Environmental Conditions On Fatty Acid-Induced Changes In Vibrio Cholerae Persistence And Pathogenicity, Abigail Doyle

Honors Theses

Vibrio cholerae, a Gram-negative bacterium, is responsible for the acute intestinal infection known as cholera. This illness is due in part to V. cholerae’s ability to sense and adapt to changing environments as it is ingested into the human body from brackish environments. It was shown in recent studies that this bacteria has the ability to uptake exogenous fatty acids, resulting in changes to V. cholerae persistence and pathogenicity. The aim of this research is to determine the extent to which these additional exogenous UFAs influence the persistence and pathogenicity of V. cholerae throughout its transitional period from brackish environments …

Access Before Evidence And The Price Of The Fda’S New Drug Authorities, Erika Lietzan

University of Richmond Law Review

Sometimes drug innovation seems to happen in reverse. Patients enjoy a treatment for years even though the treatment has not been approved by the FDA or proven safe and effective to the FDA’s standards. (Sometimes this happens because the FDA has declined to take enforcement action.) The agency encourages companies to perform the work necessary to satisfy the United States “gold standard” for new drug approval, however, by promising exclusivity in the marketplace. When a company does this work, at considerable expense, the results are predictable. The new drug is expensive, and patients and payers (and sometimes policymakers) are outraged. …

Something’S In The Water: A Look At How Creativity And Innovation Can Prevent Future Water Crises, Tristan Holiday-Nowden

Creativity and Change Leadership Graduate Student Master's Projects

The purpose of this project is to raise awareness and create a level of consciousness about water, unlike anything we have seen in the past. This project presents a synthesis of current writings and ideologies from the fields of Environmental Science and Water Research. As well as think pieces and informative news articles from various publications.

To illustrate the damaging effects of water contamination, water pollution, and water scarcity; Flint, Michigan will serve as a case study. After diagnosing and defining the problem using the Creative Problem Solving (CPS) framework. This project will explore the challenge and look at the …

Defects In Fetal Mouth Movement And Pharyngeal Patterning Underlie Cleft Palate Caused By Retinoid Deficiency., Regina Friedl

Electronic Theses and Dissertations

Cleft palate is a common birth defect. Etiologic mechanisms of palate cleft include defects in palate morphogenesis, mandibular growth, or spontaneous fetal mouth movement. Cleft palate linked to deficient fetal mouth movement has been demonstrated directly only in a single experimental model of loss of neurotransmission. Here, using retinoid deficient mouse embryos, we demonstrate directly for the first time that deficient fetal mouth movement and cleft palate occurs as a result of mis-patterned development of pharyngeal peripheral nerves and cartilages. Retinoid deficient embryos were generated by inactivation of retinol dehydrogenase 10 (Rdh10), which is critical for production of …

Malaria In Macomb, Michigan, Justin Gardner, Keith Cronovich

MERF 2019 - Case Reports

Evaluation of a patient in whom you suspect a tropical disease requires a thorough history. You must determine the timeline of travel as well the time course of symptom onset and progression. Determine geographic region of travel, mode of transport, sick contacts, animal exposure, insect bites, water sources, sexual contact, vaccine history, and prophylactic medications. What follows is a case of a patient who recently returned from a trip to Africa who was diagnosed with Malaria, as well as pertinent information regarding this disease. A 27 year old male presents to the ED complaining of fever/chills, body aches and headache …

Impact On Antimicrobial Utilization In The Emergency Department Of A Point Of Care Polymerase Chain Reaction Compared To Antigen Testing For Influenza, Jonathan Williams, Nicholas J Mercuro, Amit Vahia, Hira Rizvi, Mujtaba Hameed, Pallavi Bhargava, Odaliz Abreu-Lanfranco, Linoj Samuel, George J. Alangaden

MERF 2019 - Clinical Research

Background: Due to poor sensitivity, the FDA mandated that rapid influenza antigen (IAT) must be phased out by 2018. At our institution, an on-site rapid influenza PCR (PCR) was implemented in emergency departments (ED) at the start of the 2016-2017 influenza season. The purpose of this study was to examine the impact of influenza PCR testing on antimicrobial utilization in the ED. Methods: This multicenter quasiexperimental study included adults over the age of 50 who were tested for influenza, and discharged from the ED. Subjects were matched 2:1 by age, sex, month of testing, and ED site. The pre-implementation group …

Treatment And Outcomes Of Daptomycin-Nonsusceptible Mrsa Bloodstream Infection, Hind Hadid, Mary Perry, Erica Herc, Ana C Bardossy, Helina Misikir, Marcus J. Zervos

MERF 2019 - Clinical Research

Introduction: Daptomycin (dap) is approved as an alternative to vancomycin (van) for therapy of MRSA bloodstream infection (BSI). Cases of therapy failure associated with the emergence of daptomycin-nonsusceptible (DNS) MRSA strains have been documented. Information on the treatment and outcome of DNS MRSA BSI is scarce. This study describes the treatment and outcome of patients (pts) with DNS MRSA BSI at our healthcare center. Methods: This is a retrospective review of pts with DNS MRSA BSI at a tertiary healthcare center in Detroit, MI, between 9/24/2005 and 3/31/2018. The variables collected were: source of BSI, inpatient and discharge antibiotic therapy, …

Jc Virus Induced Longitudinally Extensive Transverse Myelitis In Immunocompromised Patient, Ghada A. Mohamed, Gamal El Din Osman, Hassan Abd El Noor, Daniel Newman, Angelos Katramados

MERF 2019 - Case Reports

Introduction: John Cunningham virus (JCV) is a human polyomavirus that causes a fatal demyelinating disease of the central nervous system (CNS) called progressive multifocal leukoencephalopathy (PML). Primary JCV infection usually occurs asymptomatically in childhood and may result in a chronic asymptomatic carrier state. It remains usually dormant in the kidneys, lympho-reticular system, or brain tissue. Seventy to ninty percent of adults are seropositive for the JC virus and the viral DNA is detected in the urine of 20%-30% of immunologically intact adults. Reactivation of JCV is seen commonly in the setting of HIV infection, hematologic malignancy, or iatrogenic immunosuppression due …

The Association Between Neurocognitive Impairment And Health-Related Quality Of Life Among People Living With Human Immunodeficiency Virus (Hiv)., Philip S. Amara

Capstone Experience: Master of Public Health

Background: Despite the use of combination antiretroviral therapy, HIV associated neurocognitive impairment (NCI) persists in HIV seropositive persons, albeit in milder forms than before therapy was available. Nevertheless, the relationship between NCI and health-related quality of life (HRQoL) is not well known.

Method: Baseline data from the CHARTER study was used to investigate the association between NCI and HRQoL. Factor analysis was employed to summarize the 35-item Medical Outcome Survey questionnaire into physical and mental HRQoL scores. General linear models were employed to investigate the association between NCI, as measured by global deficit scores (GDS), and HRQoL, and to control …

Hepatitis C Virus Screening And Treatment, Dani Loftus, Emily Machens, Crista Jamous

Doctor of Nursing Practice Projects

Hepatitis C Virus (HCV) is classified as a contagious liver disease that can be either acute or chronic, and the illness ranges in severity from mild to lifelong. It is estimated that 2.7 million people in the United States (US) have HCV, but only half are diagnosed. The CDC recommends testing by birth-cohort, focusing on adults born between 1945 and 1965. Three main objectives for this project included implementation of a clinical decision support system (CDSS) for providers, increasing HCV screening by providing education to the support staff in primary care clinics of a local hospital which would increase the …

Drug Quality Assurance To Combat Counterfeit Streptomycin Using Facile, Low Cost Colorimetry, Makayla R. Foster

Theses

An easy to use, low cost colorimetric method to identify the quality and quantity of the tuberculosis (TB) medication, streptomycin was developed. TB is typically treated using a multi-drug regimen comprised of antibiotics such as streptomycin. According to WHO and USAID up to 50% of pharmaceuticals are counterfeit worldwide. The problem intensifies the closer one gets to the point of care. A facile counterfeit detection method, that is specific to only the authentic medication, is essential. Since the 1940s, streptomycin was colorimetrically identified using a 16-hour base hydrolysis process followed by an iron complexation reaction. A tris(maltonato)iron (III) complex was …

The Signaling Pathways Of Metallothionein-Mediated Chemotaxis In Breast Cancer, Jennifer Messina

Honors Scholar Theses

Metallothionein (MT) is a small, thiol rich protein released into the extracellular environment in response to stress. Elevated expression of MT has been linked to many inflammatory diseases including inflammatory bowel diseases, diabetes, and cancer. In breast cancer, high expression of MT has been associated with poor patient prognosis. Previous studies have shown that MT acts as a chemoattractant in lymphocytes, and that UC1MT, a monoclonal anti-MT antibody, can block this chemotactic response. In addition, it has been shown that both Cholera toxin and Pertussis toxin, which are known antagonists of G-protein coupled receptors, can inhibit MT-mediated chemotaxis. Here, I …

Spatial Reorganization Of Histone-Like Nucleoid Structuring Proteins Caused By Silver Nanoparticles, Meaad Alqahtany

Graduate Theses and Dissertations

Silver nanoparticles (AgNPs) and ions (Ag+) can be the new generation of antibiotics due to their antimicrobial effects against bacteria and other microbes. Many studies have shown that AgNPs and suppress the growth of bacteria and damage the cell walls of the microbes; therefore, treating bacterial cells with AgNPs may be a promising method to terminate multi-resistant bacteria. In this work, the effect of AgNPs with two different surface coatings on the spatial reorganization of histone-like nucleoid structuring (H-NS) proteins in Escherichia coli bacteria was investigated using quantitative super-resolution fluorescence microscopy to understand the toxicity and antimicrobial mechanism of AgNPs. …

Identification Of Inhibitors Of The Glutaminyl And Prolyl Trna Synthetases From Pseudomonas Aeruginosa, Yaritza Escamilla

Theses and Dissertations

Antibiotic resistance is a growing global threat and bacterial infections caused by antibiotic resistant bacteria have become increasingly difficult and expensive to treat with most current antibiotics. Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen and a leading cause of nosocomial infections and is the leading cause of mortality in cystic fibrosis patients. Aminoacyl-tRNA synthetases (aaRSs) are a class of enzymes that catalyze the covalent attachment of amino acids to their cognate tRNAs during protein biosynthesis. The glutaminyl- tRNA synthetase from P. aeruginosa was over-expressed, enzymatically characterized and developed into a screening platform for the discovery of chemical compounds that inhibit …

The Development Of Screening Platforms To Identify Novel Anti-Infectives That Inhibit Protein Synthesis In Pseudomonas Aeruginosa, Casey Anne Hughes

Theses and Dissertations

Pseudomonas aeruginosa, a Gram-negative opportunistic pathogen, is a leading cause of nosocomial infections and is becoming increasingly antibiotic resistant. Aminoacyl-tRNA synthetases (aaRSs) catalyze the covalent attachment of amino acids to their cognate tRNAs and serve as validated targets for the development of new anti-infectives. In P. aeruginosa, the genome contains two genes (tyrS and tyrZ) which encode two distinct TyrRS enzymes. The genes encoding both P. aeruginosa TyrRS-Z and TyrRS-S were cloned, overexpressed in E. coli cells, and purified to homogeneity. Both forms of TyrRS were active in aminoacylation and were developed into screening platforms using scintillation proximity …

Roles Of Γδ T Cells In Influenza Infections And Methods For Tcr Expression And Characterization, Xizhi Guo

Theses and Dissertations (ETD)

"Influenza virus is a significant pathogen in humans and animals with the ability to cause extensive morbidity and mortality. Exuberant immune responses associated with immune cell migration/activation and cytokine/chemokine release, can be induced after infections. Recent studies have painted a complex picture of viral clearance and tissue repair in adults. The immune responses in neonatal influenza infections and the potential methods to engineer antigen-specific T cells for immunotherapy against cancers and infections will be the focus of this dissertation." "Compared to adults, infants suffer higher rates of hospitalization, severe clinical complications, and mortality due to influenza infection. We found that …

Generalizations Of The Arcsine Distribution, Rebecca Rasnick

Electronic Theses and Dissertations

The arcsine distribution looks at the fraction of time one player is winning in a fair coin toss game and has been studied for over a hundred years. There has been little further work on how the distribution changes when the coin tosses are not fair or when a player has already won the initial coin tosses or, equivalently, starts with a lead. This thesis will first cover a proof of the arcsine distribution. Then, we explore how the distribution changes when the coin the is unfair. Finally, we will explore the distribution when one person has won the first …

Zika Message Analysis, Alexandria Phipps

Master's Theses

The following study employs the Extended Parallel Processing Model and Theory of Planned Behavior to understand how to create health messages with the greatest influence on individuals’ behavioral intent to adopt mosquito-borne virus protection behaviors. The study employs a 2 (susceptibility) x 2 (self-efficacy) factorial design, evenly distributing the participants between four messages (N=186). Although the selfefficacy manipulation was ultimately unsuccessful, the findings highlighted the significance of perceived susceptibility on one’s intent to adopt protective behaviors. The results exemplify the importance of the theoretical critical point of the EPPM, where danger control shifts to fear control, and the importance of …

The Great Imitator: How Lyme Disease Can Mimic Psychiatric Disorders, Lane Davis

Scientific Kenyon: The Neuroscience Edition

No abstract provided.

Il-6/Jak1 Drives Pd-L1 Phosphorylation And Glycosylation To Promote Cancer Immune Evasion, Li-Chuan Chan

Dissertations and Theses (Open Access)

Glycosylation of immune receptors and ligands, such as T-cell receptor (TCR), major histocompatibility complex (MHC), and co-inhibitory molecules, regulates immune signaling activation, antigen presentation, and immune surveillance. Recent studies revealed that the glycan structures of co-inhibitory molecules are required for receptor-ligand interaction, a critical feature for activating cancer immune evasion. However, it is unclear how oncogenic signaling initiates glycosylation of co-inhibitory molecules to induce immunosuppression. Here we show interleukin (IL)-6-activated Janus kinase 1 (JAK1) phosphorylates programmed death-ligand 1 (PD-L1)-Tyr112, leading to the recruitment of endoplasmic reticulum (ER)-associated N-glycosyltransferase, STT3A, which catalyzes the glycosylation of PD-L1, contributing to its stability. A …

The Characterization Of T-Cell Manufacturing For Adoptive T-Cell Therapies, Amir Alpert

Dissertations and Theses (Open Access)

Adoptive T-cell therapy using genetically modified T cells has emerged as a potential therapeutic option for several malignancies. Central to the production of the cellular therapy is the manufacturing using a stimulation, genetic engineering, and expansion methodology. Within this framework, there is a delicate balance between expansion of the cells to a therapeutically relevant dosage and the need to retain the proliferative potential of the ‘living drug’. I show that as T-cells are expanded for elongated periods of time, they lose their proliferative potential and become functionally senescent despite the presence of multiple proliferative cytokines. In addition, I show that …

Rejuvenation Of The Epigenetic Landscape Of The Aged Brain Through Manipulation Of Circulating Factors, Edward Koellhoffer

Dissertations and Theses (Open Access)

The aging population of the United States is expanding at an alarming rate. The Center for Disease Control and Prevention estimates that the population of those age 65 years and older will reach over 50 million by 2020 and will double to 100 million by 2060. This will not only put a massive strain on national healthcare resources, but will also increase the number of those who are not able to live and function independently. It is becoming increasingly vital to understand how the brain changes with age and mechanisms to possibly protect and rejuvenate the aged brain to a …

Cross-Presentation Is A Source Of Tumor Antigens For Multiple Myeloma Immunotherapy, Alexander A. Perakis

Dissertations and Theses (Open Access)

Cross-presentation is an essential bridge between the innate and adaptive arms of the immune system where antigen presenting cells (APCs) prime cytotoxic T cell responses. We have recently identified cross-presentation as a mechanism by which solid tumors present exogenous antigens. We therefore hypothesized that multiple myeloma would be capable of cross-presentation as these cells are derived from B cells, known APCs. We explored the capacity of multiple myeloma to cross-present PR1, a human leukocyte antigen (HLA)-A2 nonameric peptide that is derived from neutrophil elastase (NE) and proteinase 3 (P3), and the ability to treat multiple myeloma using PR1-targeting immunotherapies. Here …

Role Of Atm In T Cell Dysfunction During Chronic Viral Infections, Juan Zhao

Electronic Theses and Dissertations

Hepatitis C virus (HCV) or human immunodeficiency virus (HIV) infection leads to a phenomenon of inflammaging, in which chronic infection or inflammation induces an immune aged phenotype with T cell dysfunction. Thus, HCV or HIV infection has been deemed as a model to study the mechanisms of T cell infammaging and viral persistence in humans. In this dissertation, T cell homeostasis, DNA damage and repair machineries were investigated in patients with chronic HCV or HIV infection at risk for inflammaging. We found a significant depletion in CD4 T cells, which was correlated with their apoptosis in chronically HCV/HIVinfected patients, compared …