Medicine and Health Sciences Commons^™

Theta Burst Brain Stimulation In Painful Diabetic Neuropathy Patients: Investigating Neural Mechanisms, Bhushan Thakkar

Theses and Dissertations

Chronic pain (CP) is a significant contributor to disability and disease burden globally. In 2019, approximately 50.2 million adults (20.4% of the US population) experienced chronic pain, contributing to $560-635 billion in direct medical costs. In addition, the worldwide prevalence of diabetes mellitus has reached epidemic proportions and is set to increase to 629 million by 2045. Almost 50% of patients with diabetes present with diabetic neuropathy (DN), and one in five patients with diabetes presents with painful DN (pDN) which is the most common cause of neuropathic pain (NP) in the US. Symptomatic treatment is the mainstay of management …

Tummy Time In Infancy: Real-World Assessments And Associations With Developmental Outcomes In Early Childhood, Ketaki Inamdar

Theses and Dissertations

Tummy time or awake, supervised, prone play is an important developmental play position in infancy. Engaging in more than 15 minutes of tummy time per day is associated with a lower risk of plagiocephaly, lower body mass index, and achievement of higher motor scores in full-term and at-risk preterm infants. However, there are significant gaps in the measurement of tummy time in current literature. Conventionally used subjective parent reports have not been validated against gold standard direct observation, and the feasibility and real-world validity of objective solutions such as wearable sensors has not been examined in full-term and at-risk preterm …

Dendrimer-Based Antibiotics For The Treatment Of Bacterial Biofilm In Cystic Fibrosis (Cf), Younan Ma

Theses and Dissertations

Pseudomonas aeruginosa (PA) is the predominant pathogen in chronic lung infections of cystic fibrosis (CF) patients. The most important mechanism of adaptation of PA to host defense and antibiotic treatment is the formation of biofilms within the mucus layer covering the lung bronchi. The effectiveness of antibiotics such as aminoglycosides is significantly attenuated by their limited penetration through thick mucus and embedded biofilm matrix in patients’ lung. Inhaled tobramycin (Tobra), which is the most commonly used antibiotics in the treatment of PA infections for CF patients, is usually found to be in very high concentration in patients’ lung, and yet …

Strategies And Devices For Improving Respiratory Drug Delivery To Infants And Children With Cystic Fibrosis, Karl Bass

Theses and Dissertations

Cystic Fibrosis (CF) is a degenerative disease, which causes thickening of the airway surface liquid and reduced mucociliary clearance, which provides an ideal habitat for bacterial infections. Early treatment of CF in children can prevent chronic infection, improve quality of life, and increase life expectancy. The most predominant bacteria found in CF-diseased lungs is Pseudomonas aeruginosa (Pa), which can be treated with inhaled tobramycin. Excipient enhanced growth (EEG) powder formulations are well suited for administering tobramycin to children, as the EEG approach provides minimal upper airway loss and targeted drug delivery. This method uses an initially small aerosol for high …

Biopsychosocial Variables Associated With The Development Of Chronic Low Back Pain In Healthcare Workers, Jena Pauli

Theses and Dissertations

ABSTRACT

Purpose: Worldwide the incidence and prevalence of acute low back injury with pain (ALBIP) is increasing in healthcare workers (HCW). Approximately 27% of ALBIP result in chronic low back pain (CLBP). The primary aim of this study was to identify biopsychosocial factors that contribute to the development of CLBP. A secondary aim was to examine the predictive value of reliable and valid screening instruments to identify individuals at highest risk for CLBP.

Significance: Low back pain is the second most commonly reported pain condition in the United States, one of the leading causes of sick leave and …

Relationship Of Demographic Characteristics Of Occupational And Physical Therapists Towards Their Knowledge And Attitude On Person-Centered Care In Skilled Nursing Facilities, Sadashiv R. Aggarwal

Theses and Dissertations

The study aimed to assess the relationship of specific demographic characteristics of occupational (OTs) and physical therapists (PTs) with their knowledge and attitudes towards principles of Person-Centered Care (PCC) in skilled nursing facilities (SNFs). The study further examined if knowledge and/or attitudinal differences exist between OTs and PTs towards PCC. The proposed descriptive study used the Person-Centered Care theory, which is a holistic (bio-psychosocial-spiritual) health care delivery approach. PCC delivers services that are respectful and individualized, allowing negotiation of care, and offering choice through a therapeutic relationship where persons receiving care are empowered to be involved in health decisions at …

The Role Of Ceramide In Neutrophil Elastase Induced Inflammation In The Lungs, Sophia Karandashova

Theses and Dissertations

Alterations to sphingolipid metabolism are associated with increased pulmonary inflammation, but the impact of inflammatory mediators, such as neutrophil elastase (NE), on airway sphingolipid homeostasis remains unknown. NE is a protease associated CF lung disease progression, and can be found in up to micromolar concentrations in patient airways. While sphingolipids have been investigated in the context of CF, the focus has been on loss of cystic fibrosis transmembrane conductance regulator (CFTR) function. Here, we present a novel observation: oropharyngeal aspiration of NE increases airway ceramides in mice. Using a previously characterized mouse model of NE-induced inflammation, we demonstrate that NE …

Influence Of Muscle Strength On Mobility In Critically Ill Adult Patients On Mechanical Ventilation, Audrey R. Roberson

Theses and Dissertations

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence …

An Innovative Use Of Technology And Associative Learning To Assess Prone Motor Learning And Design Interventions To Enhance Motor Development In Infants, Tanya Tripathi

Theses and Dissertations

Since the introduction of the American Academy of Pediatrics Back to Sleep Campaign infants have not met the recommendation to “incorporate supervised, awake “prone play” in their infant’s daily routine to support motor development and minimize the risk of plagiocephaly”. Interventions are needed to increase infants’ tolerance for prone position and prone playtime to reduce the risk of plagiocephaly and motor delays. Associative learning is the ability to understand causal relationship between events. Operant conditioning is a form of associative learning that occurs by associating a behavior with positive or negative consequences. Operant conditions has been utilized to encourage behaviors …

Internet-Based Behavior Of It Professionals: Implications For Online Ergonomic Education To Prevent Work-Related Musculoskeletal Disorders, Priyadarshini Pattath

Theses and Dissertations

INTERNET-BASED BEHAVIOR OF IT PROFESSIONALS: IMPLICATIONS FOR ONLINE ERGONOMIC EDUCATION TO PREVENT WORK-RELATED MUSCULOSKELETAL DISORDERS

By Priyadarshini Pattath, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University, 2017 Director: Dr. Robin Hurst, Assistant Professor of Adult Learning, Teaching and Learning,

School of Education

The purpose of this study was to explore the preferences of medium of ergonomic education and views about self-directed online training modules to prevent musculoskeletal disorders in computer professionals and understand their perspectives and experiences about online health information seeking using a …

Influence Of Contextual Factors And Self Efficacy On Self- Management In Parents Of Children With Cystic Fibrosis, Erin B. Booth

Theses and Dissertations

Cystic Fibrosis, a life threatening autosomal recessive genetic disease, is characterized by a defective gene resulting in the production of thick mucus that obstructs the lungs and pancreas. CF requires intensive management performed at the home. An initial pilot study was performed to describe knowledge of CF related diabetes (CFRD) in adults with CF. The findings of this study, which demonstrated that adults with CF lacked sufficient knowledge about CFRD confirmed the need to explore additional factors of self-management guided by a theoretical framework. The second study presented in this dissertation used the Individual and Family Self-Management Theory (IFSMT) to …

Emerging Pathogens In Cystic Fibrosis Patients At Virginia Commonwealth University Medical Center (Vcumc), Emily M. Hill

Theses and Dissertations

Cystic fibrosis (CF) is an autosomal recessive disorder affecting 70,000 individuals worldwide. This disease is characterized by the buildup of mucus in the airways leading to chronic lung infections resulting in pulmonary failure and death in 95% of CF patients. Routine surveillance of CF pathogens using traditional microbiology culture guides management and treatment of CF patients. Molecular profiling studies have revealed emerging pathogens that may play a role in CF lung disease by either directly causing infection or upregulating the virulence factors of classic CF pathogens, such as P. aeruginosa; however, routine CF culture protocols have not been modified …

Mandibular Symphyseal Distraction Osteogenesis (Msdo): Association With Temporomandibular Dysfunction (Tmd) Symptoms, Sheldon Bates

Theses and Dissertations

Background: Transverse mandibular discrepancies are often overlooked during orthodontic treatment. MSDO is a treatment to address this issue, but much debate exists over the long-term implications on the temporomandibular joint (TMJ). Few studies have sample sizes sufficient to draw clear conclusions about the impact of MSDO on TMJ health. Materials and Methods: This study evaluated private practice records including 49 MSDO patients and 57 traditionally-treated controls. The subjects were assessed by TMD exams that evaluated jaw pain and discomfort using visual analog scales, range of motion for opening, right and left lateral, and protrusive movements, and the presence of clenching, …

The Effect Of Oral Care On Intracranial Pressure In Critically Ill Adults, Christina Szabo

Theses and Dissertations

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960’s when ICP monitoring was first introduced in the clinical setting. Until recently few studies have specifically examined the effect of oral care on ICP and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions …

Overexpression Of Serum Response Factor In Astrocytes Improves Neuronal Plasticity In A Model Of Fetal Alcohol Spectrum Disorders, Arco P. Paul

Theses and Dissertations

Neuronal plasticity deficits underlie many of the neurobehavioral problems seen in Fetal Alcohol Spectrum Disorders (FASD). Recently, we showed that third trimester alcohol exposure lead to a persistent disruption in ocular dominance (OD) plasticity. For instance, few days of monocular deprivation results in a robust reduction of cortical regions responsive to the deprived eye in normal animals, but not in ferrets exposed early to alcohol. This plasticity deficit can be reversed if alcohol-exposed animals are treated with a phosphodiesterase type 1 (PDE1) inhibitor during the period of monocular deprivation. PDE1 inhibition can increase cAMP and cGMP levels, activating transcription factors …

Use Of Procalcitonin As A Biomarker Of Bacterial Infection In Acute Liver Failure And Acute Liver Injury, Jody Balko

Theses and Dissertations

Infections in patients with acute liver failure (ALF) and acute liver injury (ALI) are a frequent occurrence. Because ALF and ALI patients share many of the same clinical features as patients with severe sepsis and septic shock, identifying an infection based upon clinical manifestations is extremely difficult. Bacterial culture and sensitivity reports require 24 to 72 hours to be finalized after the need for a culture is suspected and obtained. During this time period, ALF and ALI patients are either not receiving required antibiotic therapy, receiving antibiotic therapy that is not required or not appropriate for the infecting bacterial pathogen, …

Is Gait Training With The Elliptically Based Robotic Gait Trainer (Ebrgt) Feasible In Ambulatory Patients After Stroke?, J. Cortney Bradford

Theses and Dissertations

In response to the potential benefits of task specific training in rehabilitation of gait after stroke and the need for affordable, simple ways to implement it, our group designed the elliptically based robotic gait trainer (EBRGT). A design review of the EBRGT, covering the design goals, an overview of the mechanical and electrical design, and a discussion of the novelty of the device and why it may be beneficial for individuals with hemiparesis secondary to stroke is discussed (Chapter 2). To characterize the new device, a study was performed to determine if the EBRGT produced a gait pattern that mimicked …

Effect Of Posture On Acromiohumeral Distance With Arm Elevation In Subjects With And Without Rotator Cuff Disease Using Ultrasonography, Nitin Kalra

Theses and Dissertations

Objectives: To examine the effects of posture on subacromial (SA) space with arm elevation in patients with rotator cuff disease (RCD) and healthy subjects. Background: Poor posture has been linked to altered scapular mechanics, theorized to lead to excessive SA space narrowing. However, no study has examined the direct effects of posture on SA space using ultrasonography. We hypothesize that when compared to a neutral posture, upright posture will increase SA space and slouched posture will decrease SA space. Methods: Subjects with painful RCD (n=31) and healthy (n=29) shoulders participated. SA space was measured on ultrasound generated images using the …

Retinoic Acid Induced 1 Gene Analysis In Humans And Zebrafish, Bijal Vyas

Theses and Dissertations

Smith-Magenis syndrome (SMS) is a complex mental retardation syndrome caused by deletion of 17p11.2 region or mutation of the RAI1 gene (retinoic acid induced 1). Individuals with SMS typically exhibit speech and motor delays, mental retardation, characteristic craniofacial and skeletal anomalies, and a distinct neurobehavioral phenotype that includes sleep disturbances, stereotypes, and maladaptive and self-injurious behaviors. RAI1 is thought to be a transcription factor modulating the expression of genes involved in a variety of cellular functions. Previous studies have shown the RAI1 gene being induced by retinoic acid (RA), a derivative of vitamin A. RA plays a significant role in …

Outcomes Of Pregnancy In Women With Cystic Fibrosis, Bethany Jean Geldmaker

Theses and Dissertations

Medical advances in disease management has improved quality of life for women with cystic fibrosis (CF) and now enables them to consider pregnancy. The purpose of the study was to examine women's perceptions of how the demands of having CF influenced their ability to care for their children and continue to meet their own health needs. The study design was grounded theory methodology with a complementarity research technique to incorporate qualitative and quantitative data collection. Participants were 12 women recruited over the Internet and through an adult CF newsletter who completed questionnaires for demands of illness (DOlI) and self care …