Medicine and Health Sciences Commons^™

Lxr Acts As A Differentiator In The Regulation Of Fas And G6pdh Gene Expression Under Insulin Resistant Conditions, Jaafar Hachem

Dissertations

Diabetes is a chronic disease that effects 10 percent of the world’s population and causes more than 1.5 million deaths a year and billions of dollars in associated health care cost. It can lead to very serious complications such as renal failure, liver cirrhosis, heart attack, and vision loss. The most common type of diabetes is type 2 diabetes. Type 2 diabetes arises when blood glucose levels remain chronically high due to insulin resistance. The reason for this elevation is due to the failure of insulin to allow tissues to uptake glucose causing problems in subsequent metabolic pathways. Over the …

The Impacts Of Aging, Sedentarism, And Exercise On Neurotrophic Factor Expression And Innervation In The Heart And The Effects Of Treatment With Α-Cgrp On Heart Function, Gabriel Almeida Alves

Dissertations

Neurotrophic factors (NFs) are important molecules responsible for development, differentiation, regeneration, and maintenance of new and mature neurons. Neurotrophic factors act as neurocytokines and may assist with the regulation of axonal and dendritic arrangements and synaptic plasticity between neurons themselves or with other non-neural target tissues. In this study, we analyze the levels of two NFs: glial cell line-derived neurotrophic factor (GDNF) and nerve growth factor (NGF). Cardiomyocytes produce these neurotrophic factors which assist with the innervation pattern of the heart. The heart is innervated by the two branches of the autonomic nervous system; namely the sympathetic nervous system and …

Cardiac Electrophysiology: Exploring Racial And Gender Outcomes Of Treatment Of Paroxysmal And Persistent Atrial Fibrillation Using Sotalol And Dofetilide, Nicole Lanette Bradford-Love

Dissertations

Purpose

The purpose of this study is to explore the association between gender and racial lines in the conversion and sustainment of normal sinus rhythm (NSR) from paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation using the anti-arrhythmic drugs (AADs) sotalol and dofetilide.

Methods

A secondary data analysis was performed to assess the relationships of the independent and dependent variables listed above. Using SPSS v. 24 descriptive statistics were obtained and initially evaluated for accuracy with histograms. A cross-tabulation frequency table was produced to determine the number of variables that fell into each dependent category. Following this, the frequencies were …

A Signal Detection Framework For Evaluating The Effects Of Feedback On Stroke Recognition, Jordan D. Bailey

Dissertations

The impact of stroke on the lives of individuals and the healthcare system is considerable. Damage from stroke can be reduced if the treatment is administered at the appropriate time so early recognition is essential. One problem is that strokes present in a variety of ways that sometimes do not fit into the Facial drooping, Arm weakness, Speech difficulties and Time (FAST; American Heart Association, 2019) acronym. Signal detection is one way to measure decision making under conditions of uncertainty (e.g., discriminating stroke symptoms and risk factors from other symptoms, and non-risk factors). The methodology also allows us to consider …

Occupational Therapy As Part Of A Team-Based Approach In Primary Care Settings, Lydia Royeen

Dissertations

The purpose of this project was to study issues related to occupational therapists integrating into primary care settings, as part of a team-based approach and to best meet the needs of the clients.

This is a mixed methods study that examined quantitative and qualitative data for members of the primary care team and occupational therapists working in primary care clinics. The Team Climate Inventory-14 (Kivimaki & Elovainio, 1999) was selected as the quantitative measure because it examines themes related to team functioning, which include vision, participative safety, task orientation, and mutual support. Participants completed a semi-structured interview that examined themes …

Training Practitioners On The Effects Of Psychotropic Medication Via A Web-Based Platform, Anita Li

Dissertations

Many individuals diagnosed with autism spectrum disorders (ASD) receive multiple therapeutic services in an attempt to supplement behavioral therapy. These services include pharmacological interventions. Two drugs, risperidone (Risperdal) and aripiprazole (Abilify), are FDA-approved to treat “irritability” in children with ASD. Research shows that the effects of risperidone and aripiprazole on irritability varies greatly across treated individuals. Therefore, individualized monitoring and evaluation must be conducted to provide the physician with data to determine if the medication is resulting in desired changes and effects. Certified behavior analysts are trained in data collection and experience high levels of contact with individuals diagnosed with …

A Phenomenological Investigation Of Women’S Infertility And Miscarriage Grief Experiences, Tristan Mcbain

Dissertations

Infertility and miscarriage are reproductive losses that often produce grief reactions in affected women. This phenomenological study investigated the grief experiences of infertility and miscarriage through the ambiguous loss and disenfranchised grief frameworks in order to better understand both the obscurity of reproductive loss and how the resulting grief may be invalidated.

Sixteen women volunteered to participate in this study and each fell into one of the following three categories: women affected by infertility without miscarriage (4); women affected by miscarriage without infertility (4); and women affected by infertility and miscarriage (8). A phenomenological hermeneutic approach was utilized to uncover …

Administrative Barriers To Compliance With The 2010 Ncaa Policy On Concussion Management, Tyler Norman

Dissertations

Concussions and concussion management in sport have become a polarizing public health issue. The best concussion assessment practices and “return-to-play” guidelines have been debated in both the scientific arena and in the media. At risk is the health of the athletes when proper diagnosis and treatment are not accurate for this potentially devastating injury.

Recent research estimates that approximately 1.6 – 3.8 million sport-related concussions occur each year in the United States (Brady, 2011), which can lead to chronic disease, swelling of the brain, cognitive impairment, chronic headaches, mood disorders, depression, blurred vision, double vision, cranial hemorrhaging and death if …

Concussion In Student Athletes: Prevention, Assessment, And Recovery, Miriam A. Carroll-Alfano

Dissertations

The research presented in this study examines concussion among athletes from the perspectives of prevention, assessment, and recovery. The first study examines concussion education for high school athletes by surveying 157 collegiate athletes, who primarily attended high school in Illinois and Indiana, about the previous concussion education, including whether they received mandated education, the methods and providers of education, and their ability to name a variety of concussion symptoms. This study finds that despite legislative mandates in these states, 20% of student-athletes continue to report not receiving concussion education in high school, with females more likely to report not receiving …

Training Pediatric Primary Care Providers In Behavior Management Strategies, Kate Burger

Dissertations

Childhood mental health disorders are a significant public health concern in the United States. It is estimated that every year 13 to 20% of children living in the United States experience a mental health disorder (National Research Council and Institute of Medicine, 2009). Despite the clear need for mental health care, less than half (45.6%) of children with one or more emotional, behavioral, or developmental conditions receive treatment from a mental health professional (The National Survey of Children's Health, 2007). There is growing evidence that integrating mental health services into pediatric primary care can result in increased treatment access as …

Beta-Testing Of An Interactive Multimedia Computer Program Of Exposure Therapy For Ptsd, Marie C. Barrett

Dissertations

Posttraumatic Stress Disorder (PTSD) results in significant impairment for the individual and substantial costs to society. Research indicates that cognitive behavioral psychotherapy (CBT) is the most effective treatment for PTSD and that among CBT treatments, exposure therapy is the treatment technique with the strongest evidence to recommend it for PTSD treatment. Computerized programs that deliver evidenced-based treatments offer a potential solution to barriers that prevent individuals from accessing and completing treatment. The present study evaluates the clinical and practical functionality of a computer-based program designed for the treatment of PTSD. Results indicate that completion of the program is associated with …

Primary Care Physician Delivered Brief Behavioral Intervention For Adult Obesity And Associated Health Conditions, Julia C. Huston

Dissertations

Obesity is a chronic health condition with prevalence rates that have continued to rise steadily over the past 30 years to the point that it has now been declared a global epidemic and a serious public health concern. Obesity is associated with significant physical and economic costs, primarily resulting from co-occurring health conditions that increase the risk of morbidity including type II diabetes, hypertension, dyslipidemia, stroke, coronary heart disease, and respiratory problems. Despite the dissemination of several obesity treatments, including pharmacotherapy, lifestyle modification, and bariatric surgery, the prevalence and severity of obesity continues to rise. Federal guidelines recommend the use …

Incidence Of Head Injury Among Synchronized Skaters: Rates, Risks, And Behaviors, Gretchen L. Mohney

Dissertations

Data regarding risk and rates for head injury and concussion specific to the sport of synchronized skating is absent from literature. This study investigated the rate and risk for head injury and concussion as a function of team level, identified behaviors to include education, neurocognitive baseline screening and protective equipment utilization, and the implementation of return to sport protocols.

An anonymous cross-sectional survey was implemented at the 2018 U.S. Synchronized Skating Championships. Participants were female members of a qualifying team, ages 13 and older, at the intermediate participation level and higher. The survey response rate was 42% (520/1232). Among the …

Is Preoperative Functional Status A Predictor Of Postoperative Mortality, Morbidity And Quality Of Life In Open Heart Patients?, A. Kate Macphedran

Dissertations

The very nature of mortality and morbidity surrounding cardiac surgery is complex with numerous risk factors involved and researchers have found functional status to be a stronger predictor of outcomes than the admitting diagnosis. Preoperative functional status, however, is not measured by any of the cardiac risk scores. Functional status can be objectively measured using validated outcome tools such as the Late-Life Function and Disability Instrument (LLFDI). In 3 studies, the impact and association of functional status changes over time was explored in patients who have undergone elective open heart surgery. Analyses in Study 1 demonstrated significantly improved functional status …

Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care. This dissertation consists of three studies related to this topic. The first is a quantitative study about advance directives and attitude toward death. The advance directive completion rate among adults in the …

Meeting The Needs Of Students With Traumatic Brain Lnjury, Heather K. Koole

Dissertations

School reintegration following pediatric traumatic brain injury (TBI) presents a number of challenges. This dissertation comprises three studies exploring common themes of best practice, training, and supporting success for students with TBI in school settings.

Study 1 reports the results of a survey of 70 speech-language pathologists (SLPs) who responded to questions about their use of clinical activities that described more or less contextualized services. Current literature supports contextualized service delivery as best practice. Findings indicated that 98% of participants reported using at least one contextualized practice. Higher use of contextualized practices was associated with working in schools (compared to …

The Intersection Of Depression, Partner Violence And Poverty During The Perinatal Period, Catherine L. Kothari

Dissertations

Problem: Despite the wealth of research documenting the individual links between maternal depression, partner violence, and poverty, important gaps remain regarding their combined interactions, and their variation related to perinatal timing (pregnancy and postpartum). The current dissertation examined the interplay of these phenomena across perinatality.

Methods: This dissertation utilized secondary analysis of telephone survey data from a representative sample of women recruited during their postpartum hospital stay and interviewed four times over the subsequent 18 months. Linear regression was used for predictive modeling of fixed effects, and generalized estimating equation regression was used for multivariate analysis of temporal trends.

Findings: …

Numerical And Experimental Investigation Of Orthopaedic Fracture Fixation, Bipinchandra Patel

Dissertations

Poor bone fracture fixation leads to malunion, delayed union, non-union, or infection. These malunited fractures affect a bone’s ability to carry loads. Patient outcomes regarding fixation quality can be affected by the healing environment and human factors such as bone quality and surgeons’ perception. Furthermore, the stiffness and strength of the screw-plate construct affect the healing environment. Therefore, this dissertation investigates the stiffness and strength of the non-locking (conventional) and locking (fixed angle) type screw-plate constructs and the factors that contribute to them, such as screw-plate interface, screw design, bone density, cortical bone thickness and load orientation. Additionally, the surgeon’s …

Grip Strength, Multimorbidity, And Disability, Amy M. Yorke

Dissertations

The presence of two or more chronic health conditions, also known as multimorbidity, is one of the most prevalent health disorders experienced by adults. Adults with multimorbidity and functional limitations represent clinical and financial challenges to the current health care system. The purpose of this three-paper dissertation is to examine the relationship between grip strength, multimorbidity, and the prediction of disability in adults. Data from the 2008 Health and Retirement Study (HRS), a nationally representative, longitudinal study completed on Americans age 50 years and over, are used for the dissertation.

The objective of the first paper is to investigate the …

An Examination Of Executive Function, Mild Cognitive Impairment And Fall Risk In Community Dwelling Older Adults, Jennifer A. Blackwood

Dissertations

The aim of this three-paper dissertation was to examine the relationship between fall risk, executive function (EF) and mild cognitive impairment (MCI) in community dwelling older adults. Papers one and two describe how mild changes in cognition influence performance on four measures of fall risk, the Five Times Sit to Stand Test (FTSTS), usual gait speed, the Timed Up and Go (TUG) test, and the Activities Specific Balance Confidence Scale (ABC) in a group of community dwelling older adults. The third paper describes if participation in a progressively challenging domain specific computerized cognitive training intervention influenced performance on measures of …

Comparisons Of Three Analytical Techniques For Measuring Absolute And Relative Temperature Changes During Ultrasound Treatment, Michael G. Miller

Dissertations

Ultrasound is a thermal modality that utilizes acoustic energy to promote heating. While there are many factors that affect heating of body tissues, the effects of skinfold thickness and skin temperature upon ultrasound heating have not been studied extensively. In addition, while temperature typically follows a linear trend, past research typically uses ANOVA or regression analysis to examine this relationship; but these models examine the within-subject effects (time) and between effects (usually groups) at the group level, not the individual level. Therefore, the purposes of this study are to determine if skin temperature and skinfold thickness are predictors for intramuscular …

Preference Assessments For Older Adults With Dementia: Utility Of The Mswo Procedure And Assessment Of The Stability Of Preference, Paige B. Raetz

Dissertations

Individuals with dementia suffer from a variety of cognitive deficits that can lead to a lack of engagement in activities. In recent years, researchers have begun to look at ways to assess preferences in hopes that increased identification of leisure items may lead to increases in engagement. Due to the decline in cognitive status a simple questionnaire may not be sufficient to assess preference for this population. As a result, several recent studies have incorporated the use of systematic preference assessments to assess preference for leisure activities with adults with dementia using a paired stimulus format. The purpose of the …

Evaluation Of Verbal Behavior In Older Adults, Amy Gross

Dissertations

Older adults make up a large and increasing portion of the population (U.S. apply those assessments to the evaluation of verbal behavior in older adults with and without dementia. The research addressed two questions. First, in what way do verbal behavior problems differ between older adults with and without dementia? Second, does language deteriorate in a pattern compatible with Skinner's analysis of functionally independent verbal operants? Thirty-one participants were categorized into Control (n=15) and Dementia (n=16) Groups based on their score on the Dementia Rating Scale-2. Verbal behavior assessments were administered to participants on two occasions, separated by one week. …

Visual Impairment And Eye Care Among Older Americans: Secondary Analysis Of The Behavioral Risk Factor Surveillance System (Brfss), Amy L. Freeland

Dissertations

The aim of this three-paper format dissertation is to explore three topics relevant to public health and vision loss. The three papers are independent studies, yet build upon each other by first describing the population of people aged 40 years and older in the United States in terms of visual impairment, diagnosed eye disease/injury, and their use of eye care, and then next exploring the factors that influence eye care use for both the general population and the subpopulation of people with diagnosed diabetes. The first paper provides a state-level examination of the characteristics of people aged 40 years and …

The Impact Of Telemonitoring On Self-Efficacy, Emotional Well-Being, And Clinical Outcomes In Patients With Chronic Obstructive Pulmonary Disease Or Heart Failure, Jaclyn West-Frasier

Dissertations

Telemonitoring is the remote monitoring of patients' health status using telecommunications and information processing technologies. This pilot study analyzed data collected through a parent study that randomized 46 home health patients to either standard care (SC) or standard care with the addition of telemonitoring (TM). The telemonitoring device used in this study provided daily transmission of physiologic data and patients responses to questions about their disease and symptom management. Data analysis was completed to address the question whether telemonitoring, as part of standard home care for patients with chronic obstructive pulmonary disease (COPD) and patients with heart failure (HF), has …

Developmental, Psychosocial, And Economic Predictors Of Healthy Newborns In Michigan’S Teenage Pregnancies, Cheryl Lauber

Dissertations

Teenage pregnancy is a critical health indicator. Using a risk reduction model, this study examined the relationship between the characteristics o f the teenage mother i and her newborn. The research questions were: ( I) what risk factors are associated with poor birth outcomes, (2) is addressing each factor the best way to reduce the risk, and (3) has the overall risk changed as the birth rate has declined? Developmental, psychosocial and economic risks were identified as independent variables, while age and race were mediators.

Combining the birth certificate records of women under age 20 from 1990 through 1997 resulted …

Effects Of Exercise And Psychosocial Stress On Blood Glucose In Non-Insulin Dependent Diabetics, Lisa Renae Clemensen

Dissertations

Non-insulin dependent diabetes often has serious consequences for individuals if blood glucose is not maintained within relatively normal ranges. Exercise and stress have been enumerated as important variables for the control of blood glucose in non-insulin dependent diabetics.

This study compared blood glucose and stress for eight exercise and eight matched control non-exercise adult noninsulin dependent participants. A prospective home monitoring design was used to monitor daily blood glucose, stress, and physical activity via multiple measures for six days.

Results indicated that control participants had significantly higher average blood glucose readings and higher blood glucose variability. Daily stress measures did …

Neuropsychological And Socioemotional Subtypes Of Childhood Externalizing Disorders: Cluster And Validation Analyses, Grant Jackson Butterbaugh

Dissertations

The purpose of this exploratory and confirmatory contrasted-group classification study was to determine if specifically predicted (Hypothesis 1) and externally valid (Hypotheses 3 and 4) subtypes of childhood externalizing disorders could be identified, using previously obtained neuropsychological (NP), socio-emotional (SE), and historical variables. Cross-classification validity was evaluated to determine if subjects NP and SE subtype memberships could be predicted using either their SE and NP subtype memberships or their SE and NP variable scores, respectively (Hypothesis 2). Subjects (n = 117) were 6-to-14-year-old boys and girls with normal intelligence, elevated scores on the Delinquency and/or Hyperactivity scales of the Personality …