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University of Texas at Tyler

2015

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Articles 1 - 29 of 29

Full-Text Articles in Medicine and Health Sciences

Transcription Factor Runx3 Is Induced By Influenza A Virus And Double-Strand Rna And Mediates Airway Epithelial Cell Apoptosis, Huachen Gan, Qin Hao, Steven Idell, Hua Tang Dec 2015

Transcription Factor Runx3 Is Induced By Influenza A Virus And Double-Strand Rna And Mediates Airway Epithelial Cell Apoptosis, Huachen Gan, Qin Hao, Steven Idell, Hua Tang

School of Medicine Faculty Publications and Presentations

Influenza A virus (IAV) targets airway epithelial cells and exploits the host cell machinery to replicate, causing respiratory illness in annual epidemics and pandemics of variable severity. The high rate of antigenic drift (viral mutation) and the putative antigenic shift (reassortant strains) have raised the need to find the host cell inducible factors modulating IAV replication and its pathogenesis to develop more effective antiviral treatment. In this study, we found for the first time that transcription factor Runx3, a developmental regulator and tumor suppressor, was induced by IAV H1N1 and H3N2, viral RNA, a synthetic analog of viral double-stranded RNA …


Factors Influencing Critical Care Nurses To Speak Up When Patients Are At Risk For Harm: Development Of An Instrument, Deborah Ruth Crumpler Dec 2015

Factors Influencing Critical Care Nurses To Speak Up When Patients Are At Risk For Harm: Development Of An Instrument, Deborah Ruth Crumpler

Nursing Theses and Dissertations

Nurses intervene in situations where patients may be at risk for harm, particularly in critical care units where risk due to severity of illness and complexity of treatment is higher. Although safety improvements have been made, nurses still report barriers to speaking-up. Improvement in skilled communication and true collaboration among health care professionals begins with assessment of the problem. Attitudes and beliefs that influence speaking-up behaviors among critical care nurses have not been well-documented. This research study utilized a mixed-method design framed by the Theory of Planned Behavior to explore factors associated with intention to speak up among critical care …


Disaster Preparedness Education And Resource Needs For Pregnant And Post-Partum Families, Ellen A. Erickson Bonner Nov 2015

Disaster Preparedness Education And Resource Needs For Pregnant And Post-Partum Families, Ellen A. Erickson Bonner

Nursing Theses and Dissertations

Hurricane Katrina in 2005 heightened awareness of the need to educate vulnerable populations on disaster preparedness. However, little has been written specifically on the preparedness needs of the pregnant and post-partum families. Only one article explores disaster preparedness education for this population. To fill this gap. An interprofessional sample (n=115) rated the relevance of the educational topics and birthing kit items proposed by the panel from the previous Delphi study. The education topics were reduced to four themes that explained 66.80% of the variance and the birthing kit items were reduced to six themes that explained 70.99% of the variance.


Technostress Effects On Technology Acceptance By Nurse Faculty, Joseph W. Tacy Nov 2015

Technostress Effects On Technology Acceptance By Nurse Faculty, Joseph W. Tacy

Nursing Theses and Dissertations

Technology is an essential tool used in nursing academia. The rapid changes in technology and required adaptations can result in technostress, but little research exists about technostress among nurse educators. Gaps in this area of research generated several questions regarding the adaption to technology among nurse faculty and the impact technology has on stress, system use, job satisfaction, and intent to stay in the profession. This dissertation explored technostress and its influence on technology use, acceptance, job satisfaction, and intention to stay within the profession. Included are two manuscripts. The first is a concept analysis of technostress. The second manuscript …


Effects Of Light On Riboflavin And Ascorbic Acid In Freshly Expressed Human Milk, Jimi Francis, Darby Dickton Oct 2015

Effects Of Light On Riboflavin And Ascorbic Acid In Freshly Expressed Human Milk, Jimi Francis, Darby Dickton

Health and Kinesiology Faculty Publications and Presentations

Millions of dollars each year is spent funding dairy research to better understand every aspect of milk processing, storage, handling, and shelf life. The dairy industry has shown that in animal milks vitamin C is photo-oxidized when exposed to light, which can cause a cascade of other nutrients that may be affected. Expressed human breast milk has had limited research published, mainly recommendations for storage duration secondary to bacterial growth, with scant research on nutrient quality during handling compared to the animal models. In this study, freshly expressed human milk was placed in containers of varying color/UV sensitivity and exposed …


Effects Of 6-Week Squat, Deadlift, And Hip Thrust Training Programs On Speed, Power, Agility, And Strength In Experienced Lifters, Michael Zweifel Oct 2015

Effects Of 6-Week Squat, Deadlift, And Hip Thrust Training Programs On Speed, Power, Agility, And Strength In Experienced Lifters, Michael Zweifel

Health and Kinesiology Theses

The back squat and deadlift are common resistance training exercises used by Strength and Conditioning professionals to enhance lower body strength and sport performance. A relatively new exercise, the hip thrust, differs from both the squat and deadlift due to its horizontal loading pattern. It may, therefore, potentially impact sporting performance uniquely. The aim of this study was to compare the effects of six weeks of resistance training in the back squat, deadlift, or barbell hip thrust on jumping performance, sprinting speed, change of direction, and strength. Twenty-six subjects (n=26; age=22.15 ±2.2; height=180.17cm ±8.37; weight=87.27kg ±15.72) twenty males and six …


College Undergraduate Students’ Self-Rating Of Their Physical Activity Involvement Over A 7-Day Period, Wycliffe W. Njororai Simiyu, Fletcher J. Njororai Sep 2015

College Undergraduate Students’ Self-Rating Of Their Physical Activity Involvement Over A 7-Day Period, Wycliffe W. Njororai Simiyu, Fletcher J. Njororai

Health and Kinesiology Faculty Publications and Presentations

Purpose: To establish the college undergraduate students’ self-rated physical activity involvement over a 7-day period. Methodology: The study utilized the survey method using the International Physical Activity Short Version of the Questionnaire (IPAQ). The purpose of the questionnaires is to provide a common instrument that can be used to obtain internationally comparable data on health-related physical activity. The study was undertaken at a medium sized campus in the South Western part of U.S.A., with respondents drawn from the College of Nursing and Health Sciences. Results: A total of 220 students responded to the questionnaire. Most of the respondents, 182 (82.73%) …


Health Literacy Impact On National Healthcare Utilization And Expenditure, Rafia S. Rasu, Walter Agbor Bawa, Richard Suminski, Kathleen Snella, Bradley Warady Aug 2015

Health Literacy Impact On National Healthcare Utilization And Expenditure, Rafia S. Rasu, Walter Agbor Bawa, Richard Suminski, Kathleen Snella, Bradley Warady

Pharmacy Faculty Publications and Presentations

Background: Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Methods: Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. Results: The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005- 2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P<.05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about $172 billion. Conclusion: Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expenditures spending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs.


Faculty Experience Of Flipping The Classroom: Lessons Learned, Melinda Hermanns, Jerri L. Post, Belinda Deal Jul 2015

Faculty Experience Of Flipping The Classroom: Lessons Learned, Melinda Hermanns, Jerri L. Post, Belinda Deal

Nursing Faculty Publications and Presentations

"Flipping the classroom" is gaining in popularity. The flipped classroom permits active learning and student engagement whereby the traditional class time is transformed into an active learning experience in which students can apply knowledge and interact with their peers and perform "hands-on" activities. This descriptive phenomenological study focused on the lived experiences of nursing faculty implementing a flipped classroom into the medical/surgical curriculum. The faculty's experience with implementing and adapting to non-traditional teaching learning methods of the "flipped"classroom in their medical/surgical classes is shared. The themes expressed by faculty are presented in the two overall categories of: Faculty concerns and …


Defining "Independent Practice" For Nurse Practitioners In The State Of Texas: Envisioning A Workable Model, Hines Ann Tracy Jul 2015

Defining "Independent Practice" For Nurse Practitioners In The State Of Texas: Envisioning A Workable Model, Hines Ann Tracy

Nursing Theses and Dissertations

Health care reform, an aging population, and a decreasing primary care physician workforce has resulted in questioning of primary health care delivery in the United States. Nurse practitioners are being viewed as the possible answer to primary health care provider deficiencies. This advanced practice role, initially developed in the 1960s, has been shown to be an effective, cost efficient alternative to the medical model of health care delivery. Nurse practitioners' licensure and practice are regulated by each individual state resulting in state-to-state variances in the role. This inconsistency leads to further questions regarding the nurse practitioner role and practice independence. …


Genes Regulating Epithelial Polarity Are Critical Suppressors Of Esophageal Oncogenesis, Xiu-Min Li, Hui Wang, Li-Li Zhu, Run-Zhen Zhao, Hong-Long Ji Jun 2015

Genes Regulating Epithelial Polarity Are Critical Suppressors Of Esophageal Oncogenesis, Xiu-Min Li, Hui Wang, Li-Li Zhu, Run-Zhen Zhao, Hong-Long Ji

Cellular and Molecular Biology Faculty Publications and Presentations

Esophageal cancer is an aggressive disease featured by early lymphatic and hematogenous dissemination, and is the sixth leading cause of cancer-related deaths worldwide. The proper formation of apicobasal polarity is essential for normal epithelium physiology and tissue homeostasis, while loss of polarity is a hallmark of cancer development including esophageal oncogenesis. In this review, we summarized the stages of esophageal cancer development associated with the loss or deregulation of epithelial cell apicobasal polarity. Loss of epithelial apicobasal polarity exerts an indispensable role in the initiation of esophageal oncogenesis, tumor progression, and the advancement of tumors from benign to malignant. In …


Cultural Competence Among Nursing Faculty, Colleen Marzilli May 2015

Cultural Competence Among Nursing Faculty, Colleen Marzilli

Nursing Theses and Dissertations

Research of culture and cultural competence in nursing faculty is vitally important when considering the state of the United States health care system and health disparities that can be reduced through culturally competent care. Recent studies address cultural competence among nurses, but there is limited information exploring cultural competence in nursing faculty. A concept analysis of "cultural competence" using Rodger's method further established the need to examine cultural competence from the perspective of nursing faculty, who are responsible for educating future nurses in culturally competent care. The purposes of this study were to determine the level of cultural competence in …


Nurses' Self-Efficacy For Managing Elder Abuse, Alana Anderson May 2015

Nurses' Self-Efficacy For Managing Elder Abuse, Alana Anderson

Nursing Theses and Dissertations

Elder abuse is a serious issue that negatively affects physical and mental health in a significant portion of the older population. Abuse of older adults is not adequately detected or reported. Nurses have frequent contact with older victims of abuse, providing them the opportunity to play a significant role in detecting, reporting, and intervening in such cases. Nurses are reluctant to intervene due to lack of education on elder abuse and lack of self-efficacy in their ability to properly manage elder abuse. This quantitative, descriptive study was designed to determine whether educational content on elder abuse, perceived capability, and self-efficacy …


Illness Beliefs And Adherence Among Louisiana Adults With Type 2 Diabetes, Denise L. Stagg May 2015

Illness Beliefs And Adherence Among Louisiana Adults With Type 2 Diabetes, Denise L. Stagg

Nursing Theses and Dissertations

Type 2 diabetes mellitus (T2DM) is having an enormous impact on the health of the nation. New cases of diabetes are diagnosed yearly across all states. Currently, 9.3% of the population has diabetes (Centers for Disease Control and Prevention {CDC}, 2014). While the prevalence of this disease is nationwide, it is not evenly distributed. Louisiana currently has a rate of 11.5%, with some parishes having rates of 14.5% (CDC, 2014). This rate places increased demands on healthcare and financial systems in Louisiana. Cultural elements and population distribution may be parts of this phenomenon. While many studies explored new medications and …


Live Model Simulation: Improving Nursing Students' Attitudes And Knowledge Of Alzheimer's Disease, Teresa Maharaj May 2015

Live Model Simulation: Improving Nursing Students' Attitudes And Knowledge Of Alzheimer's Disease, Teresa Maharaj

Nursing Theses and Dissertations

Our country's older adult population (those 65 and older) continues to grow at unprecedented rates yet few nurses are prepared to safely and competently care for them with their challenging needs, especially those with Alzheimer's Disease and Related Dementias (ADRD). Research focused on teaching strategies that influenced students' preconceived attitudes and improved knowledge toward older adults with or without Alzheimer's disease (AD) is limited. This study examined whether a live-model simulation used as a teaching modality could improve student attitudes and knowledge of AD. Findings indicated that within the group of students who participated in the AD lecture and AD …


Comparison Of Ballet And Modern Dance In Terms Of Kinetics, Kinematics And Muscle Activation During Landing For College Dancers, Yayoi Jones May 2015

Comparison Of Ballet And Modern Dance In Terms Of Kinetics, Kinematics And Muscle Activation During Landing For College Dancers, Yayoi Jones

Health and Kinesiology Theses

The dance leap is one of the most difficult techniques to accomplish, and improper landing is a common reason for injuries. The incidence of foot and ankle injuries among modern dancers is much lower than among ballet dancers. Therefore, the purpose of this study was to investigate how modern technique is different from ballet technique and the benefits each provide for both ballet and modern dancers. The primary hypothesis was that ballet dancers would demonstrate greater typical risk factors associated with foot and ankle injuries during landing compared to the modern dancers. The secondary hypothesis was that the ballet leap …


Job Embeddedness: The Differences Between Registered Nurses And Health Care Assistants, Zelda Gibbs May 2015

Job Embeddedness: The Differences Between Registered Nurses And Health Care Assistants, Zelda Gibbs

Nursing Theses and Dissertations

Job embeddedness (JE) directly affects job retention and quality of service. Financial challenges for hospitals demand strategies to ensure superior patient satisfaction scores. Knowledge regarding JE of HCAs is lacking, and studies about the differences between JE of RNs and HCAs in acute care facilities could not be located. Job descriptions for HCAs in acute care facilities are extremely diverse, and RNs feel reluctant to assign responsibilities to HCAs. Job retention, job satisfaction, commitment, and professional relationships can potentially suffer as a result. RNs valued community sacrifices significantly higher than HCAs. Total JE scores between baby boomers and millennials were …


Active Learning And Technology Immersion: Jumping In With Both Feet, Belinda Deal, Jerri L. Post Apr 2015

Active Learning And Technology Immersion: Jumping In With Both Feet, Belinda Deal, Jerri L. Post

Faculty Posters

This poster was presented at the Sigma Theta Tau, Beta Chi Regional Research Conference in Shreveport, LA.


Religious Spiritual Coping In African American Women With Hypertension, Danice B. Greer Apr 2015

Religious Spiritual Coping In African American Women With Hypertension, Danice B. Greer

Faculty Posters

This poster was presented at the 28th Annual Southern Nursing Research Society-Enhancing Value-based Care: Generating New Knowledge, The Southern Nursing Research Society, San Antonio, TX, 2014.


A Dual Conversation About Mentoring: Undergraduate Student Faculty Perspectives, Belinda Deal, Jennifer Grimes Apr 2015

A Dual Conversation About Mentoring: Undergraduate Student Faculty Perspectives, Belinda Deal, Jennifer Grimes

Faculty Posters

This poster was presented at the Sigma Theta Tau, Beta Chi Regional Research Conference in Shreveport, LA.


The Affordable Care Act And Student Perceptions, Jenifer Chilton, Danice B. Greer, Melinda Hermanns, Colleen Marzilli Apr 2015

The Affordable Care Act And Student Perceptions, Jenifer Chilton, Danice B. Greer, Melinda Hermanns, Colleen Marzilli

Faculty Posters

A poster presented at UT Tyler's Faculty Awards, 2015.


Successful Strategies For Recruiting Minority Participants In Clinical Research, Danice B. Greer Apr 2015

Successful Strategies For Recruiting Minority Participants In Clinical Research, Danice B. Greer

Nursing Faculty Publications and Presentations

This presentation discusses the history of and successful strategies for recruiting minorities in participating in clinical research.


Walkable Scores For Selected Three East Texas Counties: Physical Activity And Policy Implications, Wycliffe W. Njororai Simiyu, Fletcher J. Njororai, Billystrom Aronya Jivetti Apr 2015

Walkable Scores For Selected Three East Texas Counties: Physical Activity And Policy Implications, Wycliffe W. Njororai Simiyu, Fletcher J. Njororai, Billystrom Aronya Jivetti

Health and Kinesiology Faculty Publications and Presentations

Introduction: Physical activity has become an important intervention against overweight and obesity cases in the USA and worldwide. One key aspect of physical activity is walking, which has been identified as a component that can easily be incorporated into one’s lifestyle. Recent studies on physical activity have focused on promoting walking as a health enhancing endeavor. In 2010, the proportion of Texas adults who reported no participation in leisure time activity (26.7%) was significantly higher than the national average (24.4%). However, many Texans, like most Americans, are sedentary. Purpose: This study examined the walkability of the environments in selected counties …


Social Support To Reduce Uncertainty In Childhood Cancer In South Texas: A Case Study, Martha Danielle Gunter Feb 2015

Social Support To Reduce Uncertainty In Childhood Cancer In South Texas: A Case Study, Martha Danielle Gunter

Nursing Theses and Dissertations

Parents of children with cancer are faced with the complicated situation of not only learning their child is critically ill, but also of learning how to adapt to life with childhood cancer. For parents of a child with cancer uncertainty can lead to increased levels of stress, anxiety, fear, loss of control and depression. Successful psychosocial and educational interventions in reducing uncertainty in adult populations have been reported. However, these have not been well documented in families dealing with childhood cancer. Discovering how to best provide these interventions in south Texas will provide a foundation for future research interventions in …


Binding Of Cxcl8/Il-8 To Mycobacterium Tuberculosis Modulates The Innate Immune Response, Agnieszka Krupa, Marek Fol, Bozena R. Dziadek, Ewa Kepka, Dominika Wojciechowska, Anna Brzostek, Agnieszka Torzewska, Jaroslaw Dziadek, Robert P. Baughman, David Griffith, Anna K. Kurdowska Feb 2015

Binding Of Cxcl8/Il-8 To Mycobacterium Tuberculosis Modulates The Innate Immune Response, Agnieszka Krupa, Marek Fol, Bozena R. Dziadek, Ewa Kepka, Dominika Wojciechowska, Anna Brzostek, Agnieszka Torzewska, Jaroslaw Dziadek, Robert P. Baughman, David Griffith, Anna K. Kurdowska

Cellular and Molecular Biology Faculty Publications and Presentations

Interleukin-8 (IL-8) has been implicated in the pathogenesis of several human respiratory diseases, including tuberculosis (TB). Importantly and in direct relevance to the objectives of this report quite a few findings suggest that the presence of IL-8 may be beneficial for the host. IL-8 may aid with mounting an adequate response during infection with Mycobacterium tuberculosis (M. tb); however, the underlying mechanism remains largely unknown. The major goal of our study was to investigate the contribution of IL-8 to the inflammatory processes that are typically elicited in patients with TB. We have shown for the first time that IL-8 can …


Effects Of Three Dry Powder Inhalers On Deposition Of Aerosolized Medicine In The Human Oral-Pharyngeal-Laryngeal Regions, Mohammed Ali Feb 2015

Effects Of Three Dry Powder Inhalers On Deposition Of Aerosolized Medicine In The Human Oral-Pharyngeal-Laryngeal Regions, Mohammed Ali

Technology Faculty Publications and Presentations

The dry powder inhaler (DPI) is a popular, effective and convenient drug delivery device for inhalation therapy to treat asthma. However, a large quantity (approximately 54%) of inhaled aerosols deposit in the oropharyngeal region. Deposition in this region is undesirable because it provides minimum therapeutic benefits and has adverse localized or systemic side effects. This study reports a method of examining electrostatic charge effects on deposition of three DPI aerosols (Spiriva Handihaler, Advair Diskus, and Pulmicort Turbohaler) in a cadaver-based cast of the human oral-pharyngeal-laryngeal (OPL) regions. Experimental aerosols were generated from the three commercially available …


Development Of Clinical Judgement For Hispanic And Non-Hispanic Nursing Students: A Comparison Of Traditional And Simulated Clinical Experiences, Eve Marie Rodriguez Jan 2015

Development Of Clinical Judgement For Hispanic And Non-Hispanic Nursing Students: A Comparison Of Traditional And Simulated Clinical Experiences, Eve Marie Rodriguez

Nursing Theses and Dissertations

A mixed method design evaluating for differences in students development of clinical judgment based on clinical experiences. Traditional, combination, and high fidelity simulation clinical experiences were compared. Weekly evaluations based on the Lasater Clinical Judgment Rubric were compared. Students participated in focus interviews at the completion of the study to determine perceptions of the clinical experience in terms of clinical judgment development. There were no differences based on qualitative and quantitative measures. Students in all three groups increased in clinical judgment scores and reported satisfaction in the individual clinical experience.


Child Sex Trafficking-Recognition, Intervention, And Referral: An Educational Framework To Guide Health Care Provider Practice, Cathy L. Miller Jan 2015

Child Sex Trafficking-Recognition, Intervention, And Referral: An Educational Framework To Guide Health Care Provider Practice, Cathy L. Miller

Nursing Theses and Dissertations

Awareness of the plight of children and adolescents who are sexually exploited and trafficked for financial gain has gradually garnered the attention of the public, law enforcement, and health care providers. The discussion is slowly changing to recognize these exploited children and adolescents as victims and not criminals. Marginalization of this population is slowly changing to advocacy. However, with awareness comes responsibility for the health care system to provide improved recognition, intervention, and referral of this population. Increased health care provider responsibility demands a scientifically based framework to guide the development of health care provider education programs. To date, there …


Pharmacologic Activities Of 3’-Hydroxypterostilbene: Cytotoxic, Anti- Oxidant, Anti-Adipogenic, Anti-Inflammatory, Histone Deacetylase And Sirtuin 1 Inhibitory Activity, Jody K. Takemoto, Connie M. Remsberg, Neal M. Davies Jan 2015

Pharmacologic Activities Of 3’-Hydroxypterostilbene: Cytotoxic, Anti- Oxidant, Anti-Adipogenic, Anti-Inflammatory, Histone Deacetylase And Sirtuin 1 Inhibitory Activity, Jody K. Takemoto, Connie M. Remsberg, Neal M. Davies

Pharmacy Faculty Publications and Presentations

Purpose: Delineate the selected pharmacodynamics of a naturally occurring stilbene 3’- Hydroxypterostilbene. Objective: Characterize for the first time the pharmacodynamics bioactivity in several in-vitro assays with relevant roles in heart disease, inflammation, cancer, and diabetes etiology and pathophysiology. Methods: 3’-Hydroxypterostilbene was studied in in-vitro assays to identify possible bioactivity. Results: 3’-Hydroxypterostilbene demonstrated anti-oxidant, anti-inflammatory, cytotoxic, antiadipogenic, histone deacetylase, and sirtuin-1 inhibitory activity. Conclusions: The importance of understanding individual stilbene pharmacologic activities were delineated. Small changes in chemical structure of stilbene compounds result in significant pharmacodynamic differences.