Medicine and Health Sciences Commons^™

A Comparison Of Clinical Trial And Model-Based Cost Estimates In Glaucoma – The Case Of Repeat Laser Trabeculoplasty In Ontario, Omar Akhtar

Electronic Thesis and Dissertation Repository

Background and objective: For cost-effectiveness analyses (CEA) of glaucoma interventions to be of use they require valid and accurate cost and effectiveness data. Costs remain understudied relative to effectiveness. The impact of cost estimation methods on resultant estimates is unknown in glaucoma. Direct measurement of costs is labour-intensive and expensive. Decision-analytic modelling of costs using literature sources, expert opinion, institutional experience and assumptions provides a quicker, less laborious alternative to empirical costing. A lack of long-term effectiveness data in chronic diseases like glaucoma means that modelling is widespread and inevitable, both for CEAs and budget impact projections. The same problem …

Overcoming Barriers To Screening For Anal Intraepithelial Neoplasia For Persons Living With Hiv, Brandon Hastings

Doctor of Nursing Practice (DNP) Projects

Screening has proven an effective strategy in the management of diseases that plague the population. This technique has proven to be most effective when screening is conducted with those who are most at risk for developing the targeted illness and when the frequency of screening follows set guidelines. Currently there are no nationally recognized screening guidelines for anal intraepithelial neoplasia (AIN). Screening for AIN stands to reduce overall incidence of anal squamous cell carcinoma through destruction of the dysplastic cells before they become cancerous. The goals of this project were to identify the patient population that stands to benefit the …

Prostate Cancer Microparticles As A Next Generation Screening Tool For Prostate Cancer, Khurram M. Siddiqui

Electronic Thesis and Dissertation Repository

Currently available screening tests for prostate cancer (PCa) are neither very sensitive nor specific. Microparticles (MP) are submicron tumor cell fragments released by PCa cells into the circulation and offer a possible means of sampling the tumor. We evaluated the utility of a MP blood test using nanoscale flow cytometry to distinguish patients with PCa from patients with benign prostatic hyperplasia (BPH). We used monoclonal antibodies against prostate specific membrane antigen, gastrin releasing peptide receptor and ghrelin peptide ligand.

We found higher but statistically insignificant, PSMA and Ghrelin dual +ve MP counts in the BPH group. Our results show that …

Combating Hiv/Aids In Marginalized Communities: Papua And West Papua Provinces, Indonesia, Bani Cheema

Master's Theses

My study focuses on foreign aid and local initiatives for HIV/AIDS prevention in eastern Indonesia using the provinces of Papua and West Papua as a case study. The two provinces are home to indigenous tribal groups that are socioeconomically marginalized and most affected by the epidemic. My research investigates behavior change communication as a principal strategy undertaken by multiple organizations for HIV/AIDS prevention in this region. I take a qualitative approach by examining the effectiveness of this strategy in local communities and by revealing social and cultural barriers that impede success. Obstacles that negatively impact prevention efforts include structural violence, …

Investigating Cortical Changes In Cervical Spondylotic Myelopathy Using Functional Magnetic Resonance Imaging, Proton Magnetic Resonance Spectroscopy And Diffusion Tensor Imaging, Izabela Kowalczyk

Electronic Thesis and Dissertation Repository

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older adults. CSM can present abruptly with severe symptoms of neurological impairment or insidiously with a slow stepwise deterioration. There is no current imaging modality or biomarker that can help predict which patient will successfully respond to conservative versus surgical treatment. The goal of this thesis was to follow CSM patients longitudinally to assess how brain function, metabolism, and structure correlate to clinical outcomes in the context of recovering neurological function following surgery.

Chapter 1 of this thesis will provide a detailed literature review of the …

Are Patients At The Centre Of Care?: A Qualitative Exploration Of Myotonic Dystrophy Type 1 (Dm1), Kori A. Ladonna

Electronic Thesis and Dissertation Repository

Health care for individuals living with myotonic dystrophy (DM1)—an uncommon, life-limiting neurological condition for which there are few treatments—may be challenged by patients’ symptoms including cognitive and behavioral impairments. Is patient-centered care—which incorporates the values, experiences and expertise of patients and their caregivers—feasible or achievable? Uncovering patients’ and their caregivers’ experiences of living with DM1, their health care expectations, and their health care providers’ (HCP) perspectives about care is essential for examining patient-centered care in this population. Therefore, the purpose of this research is to: (1) add patients’ and caregivers’ voices to the literature, (2) explore on-going care provision for …

An Examination Of Factors That Influence Health Behaviors Among Low Income African American Women With Type 2 Diabetes In Memphis, Tn: A Qualitative Inquiry Using Mixed Methods, Adole Muruako

Theses and Dissertations (ETD)

Obesity and type 2 diabetes are increasing health concerns in the United States, particularly among women and minorities. Generally, research has highlighted the health disparities that exist among African American women, especially as these disparities relate to obesity and type 2 diabetes. In Memphis, TN, the ZIP codes of 38106 and 38109 have the highest rates of diabetes hospitalizations in the city. Further, African American women in Memphis, TN have been identified as being most vulnerable to experiencing a potentially avoidable hospitalization due to chronic disease. The purpose of study was to identify factors that may impact African American overweight/obese …

Hemoglobin A1c And The Diagnosis Of Diabetes And Prediabetes In Children And Adolescents, Jennifer Mcguire Hitt

Theses and Dissertations (ETD)

Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold …

Effect Of Nedd4 Haploinsufficiency On Insulin Sensitivity, Adiposity And Neuronal Behaviors, Jingjing Li

Theses and Dissertations (ETD)

The neural precursor cell expressed developmentally down-regulated gene 4 (NEDD4) is a HECT-type E3 ubiquitin ligase that has received broad attention in recent years. Many of its reported substrates are active players in metabolism, implying a potential role of NEDD4 itself in metabolic regulation. Since homozygous Nedd4 deletion leads to embryonic or perinatal lethality, we investigated the function of NEDD4 in metabolic regulation in vivo, using Nedd4- haploinsufficient mice in a high fat diet-induced obesity (HFDIO) model.

Our studies show that Nedd4-haploinsufficient mice fed a normal diet (ND) exhibited decreased body weight in both genders and proportionally reduced tissue mass …

Development Of A Turkey Coccidiosis Vaccine Candidate: An Attenuated Line Of The Protozoan Parasite, Eimeria Meleagrimitis, Thilakar Rathinam

Graduate Theses and Dissertations

Coccidiosis is an economically important enteric disease of poultry caused by protozoan parasites belonging to the genus Eimeria. Drugs are most commonly used to control coccidiosis. Widespread usage of anticoccidial drugs in the field has resulted in development of drug resistant strains and consequently decreased drug efficacy. An alternative control strategy using attenuated vaccines is desired. A series of experiments was designed to identify, isolate and attenuate a strain of a common and pathogenic species of Eimeria of turkeys, E. meleagrimitis.

Sensitivity of field isolates of turkey coccidia to the anticoccidials drugs amprolium, clopidol, diclazuril, and monensin was investigated. A …

Identification And The Significance Of Selective Proteins In Bile And Plasma Of Normal And Health-Compromised Chickens, Balamurugan Packialakshmi

Graduate Theses and Dissertations

During the last 50 years, animal breeding programs in commercial poultry have made significant progress in the bodyweight gain of broilers but led to several metabolic and skeletal disorders. Lameness associated with proximal femur known as femoral head separation (FHS) or femoral head necrosis (FHN) is one of the major metabolic disorders in poultry industry. In order to select for healthy chickens, markers that can distinguish between healthy and affected birds are required. Biomarkers from blood represent an ideal and rich source of markers which can be obtained using minimally invasive methods. The biomarkers were explored in an experimental model …

The Role Of Mcl-1 In The Heart: Gateway From Life To Death, Xi Wang

Theses and Dissertations (ETD)

MCL-1 is an essential BCL-2 family member that promotes the survival of multiple cellular lineages, but its role in cardiac muscle has remained unclear. Here, we have demonstrated that cardiac-specific ablation of Mcl-1 results in a rapidly fatal, dilated cardiomyopathy preceded by loss of myofibrils and cardiac contractility, abnormal mitochondria ultrastructure, defective mitochondrial respiration, and impaired autophagy. Genetic ablation of both pro-apoptotic effectors (Bax and Bak) could largely rescue the lethality and impaired cardiac function induced by Mcl-1 deletion. However, Mcl-1-, Bax-, and Bak-deficient hearts still revealed mitochondrial ultrastructural abnormalities and displayed deficient mitochondrial respiration, and are hypersensitive to chronic …

Group Iv Cytosolic Phospholipase A2Α Is Critical For The Development Of Angiotensin Ii-Induced Hypertension And Associated Pathogenesis, Nayaab Shehbaz Khan

Theses and Dissertations (ETD)

Angiotensin II (Ang II) activates cytosolic phospholipase A2α and releases arachidonic acid (AA) from tissue phospholipids. AA metabolites mediate or modulate one or more renocardiovascular effects of this peptide and have been implicated in hypertension. Since AA release is the rate limiting step in eicosanoid production, it is possible that cPLA2α might play a central role in the development of Ang II-induced hypertension. To test this hypothesis, we investigated the effect of Ang II infusion for 13 days by micro-osmotic pumps (700 ng/kg/min), on systolic blood pressure and associated pathophysiological changes in wild type (cPLA2α+/+) and cPLA2α-/- mice. Ang II …

Sustained Adrenergic Signaling Promotes Cervical Cancer Progression, Nouara C. Sadaoui

Dissertations & Theses (Open Access)

Background: Chronic stress and sustained adrenergic signaling are known to promote tumor progression. The underlying mechanisms behind this process are not well understood. We examined the effects of sustained adrenergic signaling on cervical cancer progression through increased expression of HPV oncogenes, E6 and E7.

Materials and Methods: ADRβ expression levels were examined in patient-derived cervical cancer samples. We used an orthotopic model of cervical cancer to investigate the effects of restraint stress on tumor growth and metastasis. We evaluated the in vivo effects of a β-blocker, propranolol, and HPV E6/E7 siRNA. In vitro, ADRβ positive cervical cancer cells were …

Acanthamoeba Spp. As Reservoirs For Transmission Of Norovirus, Tun-Yun Hsueh

Graduate Theses and Dissertations

Human noroviruses (HuNoV) are the most common cause of foodborne disease outbreaks in the United States and the most common food commodities implicated in HuNoV outbreaks are leafy greens; however, the vehicle of transmission and point of contamination are often unknown. Here, we hypothesize that common free-living amoebae (FLA) ubiquitous in the environment may act as reservoirs of HuNoV and facilitate the transmission of these pathogens to fresh produce. The objective of this research was to first evaluate the interaction/association between HuNoV surrogates and Acanthamoeba by incubating them together and analyzing virus titer associated with amoeba through an 8 day …

Autoimmune Susceptibility Imposed By Public Tcrβ Chains, Yunqian Zhao

Theses and Dissertations (ETD)

The major histocompatibility complex (MHC) is the strongest genetic risk factor for autoimmunity. It acts together with a corresponding TCR repertoire, yet, considering the extent of the repertoire's diversity, how this imposes disease susceptibility on a population is not well understood. We address the hypothesis that shared or public TCR, those present in most individuals, modulate autoimmune risk. High resolution analyses of autoimmune encephalomyelitis-associated T-cell receptor β chain (TCRβ) showed preferential utilization of public TCR sequences, implicating them in pathogenesis. Disease-associated public TCRβ, when transgenically expressed in association with endogenously rearranged T-cell receptor α chain (TCRα), could further endow unprimed …

Lung Cancer Survival Disparities In Nevada, Chima Osuoha

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lung cancer is the leading cause of cancer death in both men and women in the United States. Nevada shows moderate incidence rates of lung cancer for men but high rates for women. Little is known about the lung cancer experience and survival characteristics of the nearly 2000 new cases occurring every year in the State. The purpose of this study was to measure the extent to which geographic area of residency, gender, race, health insurance, social economic status (SES) and stage at diagnosis were associated with survival in patients diagnosed with lung cancer in Nevada. This was a retrospective …

Pathogenic Role Of Acrolein In Alcoholic Liver Disease., Wei-Yang (Jeremy) Chen

Electronic Theses and Dissertations

Alcohol is the most socially accepted addictive drug, and it can cause alcoholic liver disease (ALD), which is a major cause of morbidity and mortality in the United States and worldwide. Animal and human studies demonstrate that chronic alcohol consumption causes a pro-oxidant environment in the liver and increases hepatic lipid peroxidation and the accumulation of by-products such as acrolein and 4-hydroxynonenal. Acrolein is the most reactive and toxic aldehyde generated through lipid peroxidation. Also, acrolein is a major component of cigarette smoke, and there is increasing evidence that smoking negatively impacts the incidence, severity, and clinical course of chronic …

Development Of Models For The Study Of The Molecular Mechanisms Of Host Restriction And Adaptation Of Hantaviruses., Ryan Carroll Mcallister 1988-

Electronic Theses and Dissertations

Hantaviruses, family Bunyaviridae, are present throughout the globe in a variety of mouse, rat, mole, vole, shrew, or bat species. Hantaviruses persist for the lifetime of the animal reservoir, while causing no signs or symptoms of disease. Only the rodent-borne hantaviruses cause disease in humans. In contrast, a “spillover” infection of a hantavirus into a nonreservoir rodent species results in an asymptomatic acute infection. We and others in the field are interested in understanding the biology of these virus-host interactions and mechanisms that underlie these three very different outcomes. The second chapter of my thesis focused on probing the intrahost …

Enhancement Of Antimicrobial Activity Of Naturally Occuring Phenolic Compounds By Nano-Particle Mediated Delivery Against Listeria Monocytogenes, Escherichia Coli O157:H7, And Salmonella Typhimurium, Madhuram Ravichandran

Graduate Theses and Dissertations

Food-borne illnesses are of major concern in the U.S. and worldwide. Salmonella,Listeria,E. coli O157:H7 continue to be some of the major foodborne pathogens. Recurring recalls due to these pathogens demand critical antimicrobial strategies to decontaminate the food through its procession from farm to fork. In our study, we combined the effectiveness of naturally occurring phenolic compounds individually, with/ without ethylenediamine tetraacetic acid (EDTA) and/or Nisin and nanoparticle delivery to improve the antimicrobial potential of the compounds against Listeria monocytogenes (L.m.), Salmonella Typhimurium (S.T.), and Escherichia coli O157:H7 (E.c.), in brain …

Increasing Hpv Vaccination Rates Using Social Marketing Strategies, Sharon Wilson Catledge

Doctoral Projects

The human papillomavirus (HPV) is the most common sexually-transmitted infection (STI). Approximately 20 million Americans between the ages of 15 and 49 years currently have HPV with > 6.2 million new HPV infections estimated to occur each year. Yet, HPV vaccination rates remain relatively low. More than 40 strains of HPV are transmitted through genital contact during vaginal, anal, or oral sex and can infect males and females. In addition to causing genital warts, HPV is associated with cervical, vulvar, vaginal, anus, penile, and oropharyngeal cancers. In women, the most prominent type of cancer is cervical with > 12,000 diagnoses each year …

Regulation Of C-Reactive Protein Gene Expression And Function, Avinash N. Thirumalai

Electronic Theses and Dissertations

Human C-reactive protein (CRP) is the prototypic acute phase protein whose serum concentration increases rapidly during inflammation. CRP is also associated with atherosclerosis; it is deposited at lesion sites where it may interact with modified lipoproteins. There are 2 major questions regarding CRP: 1. How is the serum concentration of CRP regulated? 2. What are the functions of CRP in atherosclerosis?

Our first aim was to determine the role of the constitutively expressed transcription factor Oct-1 in regulating CRP gene expression. We found that Oct-1 overexpression inhibited (IL-6+IL-1β)- induced CRP gene expression; maximal inhibition required the binding of Oct-1 to …

Elucidating Cellular Signaling Pathways That Contribute To The Immunopathogenesis Of Aplastic Anemia, Christina M. Kuksin

Doctoral Dissertations

Aplastic Anemia is a rare immune mediated bone marrow failure disease that is mediated by autoreactive T cells that cause destruction to the stem, progenitor, and stromal cells in the bone marrow. Because little is known about the etiology of the disease, our lab has developed a major MHC mismatch GVHD model to examine cellular pathways in autoreactive T cells that contribute to disease. We examined three pathways that are important in T cell activation and differentiation and asked if they were important in the development of Aplastic Anemia. First, we were able to show that expression of active PKCθ …

Effect Of Chemotherapeutic Treatment Schedule On A Tissue Transport Model, Dan E. Ganz

Masters Theses

Current chemotherapeutic treatment schedule prediction methods rely heavily on PK/PD-based models and overlook the important contribution of tissue-level transport and binding. Tissue-level transport and binding phenomena are essential to understanding drug delivery and efficacy in tumors. Drugs with desirable PK/PD properties often fail in vivo due to poor tissue-level transport. We developed an in silico method to predict the effect of treatment schedule on efficacy that couples PK/PD with tissue-level transport. Treatment schedules were implemented on theoretical drugs with different PK/PD and transport properties. For each drug with a given clearance rate, diffusivity, and binding, treatment schedules consisting of one …

Increased Body Weight In Adulthood Following A Peripubertal Stressor And Proposed Mechanism For Effects Of Increased Adiposity On Estrogen-Dependent Behaviors, Christina F. Gagliardi

Masters Theses

Exposure to certain stressors during a sensitive period around puberty can lead to enduring effects on an animal’s response to estradiol. In estradiol-influenced behaviors, such as sexual receptivity, hippocampal-dependent learning and memory, depression-like behavior, and anxiety-like behaviors, exposure to a peripubertal stressor such as shipping stress or an injection of lipopolysaccharide (LPS) can eliminate or even reverse the normal response to estradiol. In addition to regulating these behaviors, estradiol play a role in the regulation of body weight. While some of the previous studies touched on short-term effects on body weight, no systemic long-term study of the effects of a …

Latino Men Managing Hiv: An Appraisal Analysis Of Intersubjective Relations In The Discourse Of Five Research Interviews, Will Caston

Dissertations and Theses

Latino men, particularly those who have sex with other men, have been disproportionately affected by HIV/AIDS. Scholars have sought for nearly two decades to understand how various social and cultural factors in the Latino community exacerbate HIV risk among these men. Although following the advent of life-sustaining medications in 1996, HIV is often regarded as a manageable chronic illness, as opposed to a death sentence, scant attention has been devoted to how HIV-positive Latino men experience managing the illness. Among studies that have focused on HIV-positive persons' illness management, few Latino men have participated.

Using the Appraisal framework from Hallidayan …

Neural Stem Cells As A Model To Study Huntington’S Disease, Rawan Bakhsh

Dissertations, Masters Theses, Capstones, and Culminating Projects

Huntington’s disease (HD) is a heritable neurodegenerative disorder that affects muscle coordination and diminishes cognitive abilities, by affecting the medium spiny neurons in the brain. In HD patients, neurons are damaged and destroyed because of the toxicity of the mutant Huntington protein (mHtt). The mechanism of how mHtt protein affects the neurons is unknown. In this study we explored the effects of mHtt expression by looking at changes in huntingtin localization, changes in the expression and co-localization of related proteins and differences in cell morphology. We examine how this expression affects the cytoskeletal structures using neural stem cells Q7 (wild …

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

Electronic Thesis and Dissertation Repository

Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …

Lymphedema: Pathophysiology, Diagnosis & Management, Bernadine Cruz

Nursing Student Class Projects (Formerly MSN)

Lymphedema is a disfiguring condition whose hallmark is progressive, increasing swelling which occurs as a result of the accumulation of protein rich fluid in interstitial spaces. Those individuals who are affected suffer from either primary lymphedema or secondary lymphedema; the pathophysiology of both conditions is similar. Lymphedema can be a chronic, acute, or transient alteration, which can eventually lead to keratinization of the skin. An increase in the incidence of lymphedema has also been observed with increase in levels of obesity.

Therapeutic Hypothermia Following Cardiac Arrest, Cassandra Patrick

Nursing Student Class Projects (Formerly MSN)

According to the Sudden Cardiac Arrest Foundation (2014), each year, 424,000 people in the U.S. (more than 1,000/day) experience EMS-assessed out-of-hospital non-traumatic sudden cardiac arrest. This is roughly equivalent to the number of people who die from Alzheimers’ disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicides combined (Sudden Cardiac Arrest Foundation, 2014). It is estimated that the likelihood of surviving an out-of-hospital cardiac arrest (OHCA) to hospital discharge can be as low as 6% to 8% (Williams, Calder, Cocchi & Donnino, 2013). Additionally an estimated 200,000 hospitalized …