Medicine and Health Sciences Commons^™

What Cost Hospital Quality: Performance Uncertainty Under Market Reform, Ronald L. Fisher

Theses and Dissertations

Healthcare is an organizational field that has undergone profound change in the last few decades, an era characterized by market reform. Healthcare production has revealed both economic and quality problems in past eras, and reporting on these problems can be seen to have contributed to pressures for social reform. Yet, the move toward more market-oriented governance structures and design solutions also reflects a wider isomorphic institutional tendency for organizing social order.The conceptual frame work of this study takes a pessimistic stance on whether the market reform has achieved the intended goals with respect to advancing organizational quality performance. The framework …

Discovery Of Lignin Sulfate As A Potent Inhibitor Of Hsv Entry Into Cells, Jay N. Thakkar

Theses and Dissertations

The herpes virus family consists of more than hundred members that infect organisms, of which eight, differing markedly in the biology are known to infect humans. HSV- I is the most common one, causing oral lesions and sporadic encephalitis. These infections are highly prevalent affecting at least one in three individuals in the United States.The entry of the herpes virus into the cell is a two-step process. The initial step involves the cell surface heparan sulfate and glycoproteins in the viral envelope which enables the virus to penetrate into the cell. The second step is the fusion step. Depending on …

Hospitals' Decision To Vertically Integrate Skilled Nursing Units Before And After The Balanced Budget Act, Betty C. Lucente

Theses and Dissertations

The decision to vertically integrate services and deliver care has both management and policy concerns for healthcare in the United States. The change in reimbursement, which was enacted with the Balanced Budget Act of 1997, influenced the availability of post acute services for acute hospital inpatients. Prior to this change, post acute services were reimbursed based on cost similar to the pre DRG era of Medicare reimbursement. The change in payment had the potential to make discharging patients more difficult resulting in a prolonged length of stay without additional payment and at increased costs for hospitals. As a result of …

Relationships Among Stress, Blood Pressure, And Heart Rate Variability In Meditators, Sangthong Terathongkum

Theses and Dissertations

PROBLEM STATEMENT: Growing evidence indicates that psychological stress contributes to cardiovascular diseases through complex neuroendocrine mechanisms. Psychological stress leads to several physiological responses including increased heart rate (HR) and blood pressure (BP) as well as decreased heart rate variability (HRV) through alterations in the autonomic nervous system (ANS), specifically increased sympathetic nervous system (SNS) activity and decreased parasympathetic nervous system (PNS) activity. Meditation is thought to induce an innate relaxation response leading to reduced psychological stress. Findings from past studies have provided inconclusive evidence regarding the direction and strength of relationships among stress, BP, HRV, and meditation practice. PROCEDURES: A …

An Exploration Of How And Why Primary Care Providers Educate Infant Caregivers About Positioning, Amy Greenspon Choffin

Theses and Dissertations

A review of the literature indicates that how infants are positioned is related to the risk of SIDS, the incidence and severity of plagiocephaly, torticollis, and developmental delays. A quantitative approach with survey methodology was used with 66 pediatric primary care providers responding to 26 questions. Overall, PCPs are educating caregivers about sleep positioning with a high frequency. There was a relationship between practice site, and the frequency of sleep positioning education is provided. While the participants provide education about awake positioning, and the use of positioning devices, it was with less frequency than they do about sleep positioning; there …

The Role Of Dna Methylation And Methyl Binding Domain Protein 2 In The Regulation Of Human Embryonic And Fetal Beta Type Globin Genes, Jeremy William Rupon

Theses and Dissertations

The genes of the human β-globin locus are located on chromosome 11 in the order of their expression during development: 5' ε, γ, β 3'. During development, silencing of the 5' gene occurs with activation of the immediate 3' gene. This process occurs twice and is termed hemoglobin switching. The exact mechanism(s) of this process have not been fully described. Herein, we describe a role for DNA methylation and methyl binding domain protein 2 in the transcriptional regulation of the human embryonic and fetal beta type globin genes. Adult mice containing the entire human β-globin locus as a yeast artificial …

Studies On The Molecular Biology Of Naegleru Fowleri And Identification Of N. Fowleri In The Environment, Rebecca Carmean Maclean

Theses and Dissertations

Naegleria fowleri, a free-living ameboflagellate, is the causative agent of primary amebic meningoencephalitis. Healthy humans sporadically become infected with N. fowleri and develop fatal PAM after recreational or work exposure to freshwater; accordingly, there is a need for monitoring the presence of pathogenic amebeflagellates in public freshwater. The present study was conducted to determine whether a nested PCR assay could be used for detection of N. fowleri in freshwater habitats. PCR analysis was used to test samples from Virginia, Connecticut, Arizona, and Oklahoma for the presence of N. fowleri in lakes, ponds, soil, and domestic water supplies. The amebae were …

Pathological Upregulation Of A Calcium-Stimulated Phosphatase, Calcineurin, In Two Models Of Neuronal Injury, Jonathan Elledge Kurz

Theses and Dissertations

Excitotoxic calcium influx and activation of calcium-regulated systems is a common event in several types of neuronal injury. This mechanism has been the focus of intense research, with the hope that a more complete understanding of how neuronal injury affects calcium-regulated systems will provide effective treatment options. This study examines one such calcium-stimulated enzyme, calcineurin, in the context of two common neurological pathologies, status epilepticus and traumatic brain injury.Status epilepticus was induced by pilocarpine injection. NMDA-dependent increases in calcineurin activity were observed in cortical and hippocampal homogenates. Upon closer examination, the most profound increases in activity were found to be …

Autism Spectrum Disorders And Workplace Discrimination: An Empirical Analysis Of Eeoc-Resolved Ada Title I Charges, Wieren Todd Alan Van

Theses and Dissertations

The purpose of this quantitative, non-experimental, retrospective research study was to examine the charges of disability-related, private-sector workplace discrimination made by individuals with Autism Spectrum Disorders (ASDs) to the Equal Employment Opportunity Commission (EEOC), under Title I of the Americans with Disabilities Act (ADA). To date, there has been a lack of research regarding the nature, scope and dynamics of employment discrimination affecting individuals with ASDs.A portion of the EEOC's Integrated Mission Systems (IMS) database was analyzed, drawing upon the following five major categories: (1) charging-party demographics, (2) responding-party characteristics, (3), U.S. region, (4) ADA Title I discrimination charge categories, …

Machismo As A Determinant For Hiv/Std Risk Behavior Among Latino Msm, Jacqueline L. Sears

Theses and Dissertations

Objective: Male-to-male sexual contact is the most common mode of transmission for HIV among Latino men. Psychosocial factors such as machismo, homophobic discrimination, and internalized homophobia have been hypothesized to greatly impact sexual behaviors among Latinos. However, studies investigating the relationship between these psychosocial factors and risky sexual behaviors are limited. This study examined the impact of machismo on risky sexual behaviors among Latino Male who have Sex with Men (MSM).Methods: This study utilized data collected from 254 Latino MSM in 1999 from selected cities within Virginia. The analysis focused on respondent demographic characteristics, psychosocial factors, acculturation, and sexual risky …

Characterization Of Vancomycin Resistance In Staphylococcus Aureus, Paige Mccarthy Fox

Theses and Dissertations

In the past decade, Staphylococcus aureus has developed two distinct vancomycin resistance mechanisms. First, the bacterium is capable of generating a thickened, poorly crosslinked cell wall that creates false targets. These targets cause vancomycin to bind at the periphery of the thickened peptidoglycan, allowing normal cell wall formation to continue at the cell membrane. Second, S. aureus has acquired genes from Enterococcus that encode an alternative stem peptide. The genes, known as van genes, alter the target of vancomycin, rendering vancomycin treatment ineffectual.In this work, we attempted to further characterize both mechanisms of vancomycin resistance. First, a potential link between …

Immunological And Molecular Analyses Of The Borrelia Burgdorferi Ospf Protein Family F, Emily Tran

Theses and Dissertations

In North America, Borrelia burgdorferi is the primary causative agent of Lymedisease which is a growing health concern. The ability of B. burgdorferi to maintain chronic infection indicates that they are capable of immune evasion. A distinguishing characteristic of B. burgdorferi is the large number of sequences encoding predicted or known lipoproteins, including outer surface protein F (OspF). This study analyzes the specificity of the humoral immune response to B. burgdorferi B3 IMI OspF proteins during murine and human infection. Immunoblot analyses revealed a temporal expression of OspF proteins during infection and mapped the immunodominant epitopes which lie within the …

Association Between Smoking, Chemical Exposure And Hearing Loss In An Occupational Setting, Darlene W. Olive

Theses and Dissertations

Objective: Twenty-two million Americans or roughly 8% of the population are hearing impaired. This affects more than just the ability for one to hear. In the last three decades, younger Americans have shown a sharp increase in hearing impairment. Hearing loss affects social and emotional well being and thus has the ability to decrease one's quality of life. This study was designed to examine the association between smoking, workplace chemical exposure, and hearing loss.Methods: This cross-sectional population-based study was conducted in an occupational health clinic setting in Virginia. The study population consisted of employees from local businesses who visited the …

A Needs Assessment For Annual Physical Examination For Selected Richmond Public School Children, Aimee Gibbs

Theses and Dissertations

Introduction: The following risk factors have found to be associated with inadequate health care and have been found to affect the well-being of children: racial or ethnic minority, poverty status, median family income, family structure of household, maternal education level, and parental employment status. Also, there has found to be health indicators including, teen pregnancy, asthma hospitalization, and lead poisoning cases that affect the well-being of a child and are associated with the presence of these risk factors in a population. Objectives: The objectives of this study is to (1) compare the presence of risk factors and health indicators in …

Predictors Of Primary Elective Cesarean Delivery Among Apparently Healthy Pregnant Women In Virginia, Brooke W. Rossheim

Theses and Dissertations

Objectives. The purpose of this cross-sectional study was to evaluate whether certain maternal variables were associated with the performance of a primary cesarean delivery rather than a spontaneous vaginal delivery among apparently healthy pregnant women in the Commonwealth of Virginia.Methods. This study utilized the 2004 Virginia Statistics File for Live Births which contained 103,830 records. From this dataset, the following groups of women were excluded: multiparous women, women who had had a previous delivery by any method, women with medical and obstetric problems, women with any labor and delivery complications, women with premature births and women with multiple gestations. The …

Influence Of Organizational, Operational, Financial Andenvironmental Factors On Hospitals' Adoption Of Computerized Physician Order Entry Systems For Improving Patient Safety: A Resource Dependence Approach, Imre Solti

Theses and Dissertations

This study examines specific organizational, operational, financial and environmental characteristics to identify factors that are associated with increased likelihood of hospitals' CPOE adoption decision in six rollout regions of the Leapfrog initiatives.Resource dependence theory provides theoretical basis for the study. The study is retrospective observational in design. Individual hospitals are the unit of analysis. The Leapfrog Group's 2002-survey collection serves the primary data source. Univariate statistical methods along with bivariate and ordinal logistic regression models are used to analyze the data. The models provided support for multiple hypotheses for both the adoption and early adoption decisions of study hospitals. The …

Small Molecules Binding To Serpins, Junaid Afridi

Theses and Dissertations

Serpins are a unique breed of proteins due to their enzymatic mechanism. Two systems were closely monitored during fluorescent binding studies, the ACT-CHY along with the AT:TRY interaction. Four different conformational variants of each system were studied including the native, cleaved, latent and complex forms. Three different fluorescent dyes were used to identify the conformations including ANS, TNS, and bis-ANS. SI studies and protease assays utilizing both Suc-AAPF-pNA and L-BAPNA were instrumental in determining conformations along with gel electrophoresis studies. The hydrophobic dyes bound to the different serpins with varying KD and ΔFmax due to structural variations among the conformers …

The Role Of Gonadal Hormones On Opioid Receptor Protein Density In Arthritic Rats, Matthew Kren

Theses and Dissertations

The majority of research on the endogenous opioid system has focused on various pain assays and the efficacy of different opioid agonists. However, minimal attention has been focused on the effects of gonadal hormones and their impact on the opioid peptide system. The present study was designed to determine the effects of modulation of gonadal hormones on the opioid receptor protein levels in Complete Freund's Adjuvant (CFA)-treated arthritic and non-arthritic male and female Lewis rats. Midbrain and spinal cord tissues were collected for comparison of the μ, δ, and κ receptor protein levels in arthritic and non-arthritic animals. Male gonadectomy …

The Effect Of Advertising On Attitudes Toward Tobacco Use And Decisions About Smoking Among Virginia Adolescents, John Rosser Matthews Iii

Theses and Dissertations

Purpose: This study seeks to determine 1) whether the type of advertising exposure is associated with adolescent health perceptions of tobacco use, and 2) whether the type of media exposure is associated with initiation plans (non-smokers) or quitting plans (smokers). Methods: This was a cross-sectional survey of middle school students (n=l1,128).Psychosocial variables were knowledge of the risks of tobacco use (range: 3-15) and benefits of being tobacco free (range: 7-35) with higher scores indicating greater understanding. Intentions to quit or initiate were construed as binary variables. Exposure variables were tobacco advertisements or anti-tobacco media messages. Covariates were gender, race, grade …

Characterization Of The Tcof1 Gene Using A Neuroblastoma Cell Line And A Mouse Model, Lin Li

Theses and Dissertations

Treacher Collins syndrome (TCS) is an autosomal dominant craniofacial development disorder and is caused by mutations in the TCOF1 gene. The TCOFl protein treacle is a nucleolar protein and may function in ribosome biogenesis.Previously, we identified downstream candidate genes using microarray analysis after manipulating Tcofl levels in a murine neuroblastoma (NB) cell line. The list of genes includes cell cycle genes as well as the transcription factors Cnbp and Tbx2, which are known to affect the cell cycle through the c-myc and p19-Mdm2-p53-p21 pathways respectively. To further characterize the cellular effects of Tcofl, stably transfected NB cell lines with overexpression …

C - Reactive Protein, Coronary Heart Disease And Ischemic Stroke In The Elderly: The Cardiovascular Health Study, Xia Li

Theses and Dissertations

Background: C-reactive protein (CRP) has been associated with increased risk of coronary heart disease (CHD) and stroke, but much of the research had focused on middle-aged populations with, limited prospective, population-based, longitudinal data. In this study, we examined data from an elderly population and described the distribution of CRP concentrations and the prevalence of elevated CRP levels (>3 mg/l), examined the association between CRP levels and incidence of CHD or ischemic stroke, and assessed the potential interaction of CRP with sex or race on the incidence of CHD or ischemic stroke.Methods: Baseline CRP levels were measured in a cohort …

A Critical Review Of Telomerase Biology And Model Systems For The Study Of Telomerase, Jeremy Charles Aisenberg

Theses and Dissertations

The study of telomere and telomerase biology holds substantial promise in uncovering the molecular process of aging and the treatment of cancers. Studies have shown that telomere shortening is directly linked to cellular aging and that telomerase expression is found in over 85% of human cancers, including 95% of all advanced malignancies. Development of effective model systems to elucidate the molecular mechanisms underlying the role of telomeres and telomerase in the processes aging and cancer is of particular importance. While inbred strains of mice have provided a wealth of information for a variety of pathways and diseases, the mouse model …

Mechanisms Of Iron Acquisition Employed By Neisseria Gonorrhoeae For Survival Within Cervical Epithelial Cells, Tracey Ann Hagen

Theses and Dissertations

Neisseria gonowhoeae has evolved a repertoire of high-affinity iron acquisition systems to facilitate essential iron uptake in the human host. Acquisition of iron requires both the energy-harnessing cytoplasmic membrane protein, TonB, as well as specific outer membrane TonB-dependent transporters (TdTs). The overall goal of this study was to investigate the extra- and intracellular iron acquisition mechanisms of N. gonorrhoeae and determine the role of the TonB and TdTs in this process.The ability of gonococci to acquire potential exogenous iron sources was determined by plate bioassay. Gonococcal growth was promoted by various catecholate and hydromate siderophores; however, growth was not dependent …

The Influence Of Sustained Cb1 Blockade During Adolescence On Breakpoints In A Progressive-Ratio Paradigm, Mayo Jerry Wright Jr.

Theses and Dissertations

The developmental psychopharmacology of cannabinoids is poorly understood and little is known about the developmental consequences of repeated exposure to cannabinoid antagonists. In these experiments, male Long-Evans rats were treated with SR141716A, a cannabinoid antagonist, throughout adolescence and allowed unrestricted access to food. Control groups were treated with vehicle during the same developmental period and allowed either unrestricted access to food or were pair-fed with a member of the SR-treated group. Motivation to work for food was measured in progressive-ratio sessions at varying levels of food deprivation. For rats that consumed fewer calories throughout adolescence, whether because of pharmacological intervention …

Knowledge And Perceived Ambiguity Of Physical Activity Recommendations And Physical Activity In Men And Women In The United States, Laura G. Kiken

Theses and Dissertations

Background: The majority of Americans - especially women - do not meet physical activity recommendations. Having physical activity goals has been associated with physical activity participation, and physical activity recommendations set by public health experts can be viewed as externally set goals. However, past research has shown that goals that are specific rather than ambiguous are more likely to be achieved, and variations in recommendations over time and across sources may have created perceived goal ambiguity.Objectives: This study aimed to (1) examine the extent of physical activity recommendation knowledge among adults in the United States, (2) quantify perceptions of the …

Molecular Localization Of Hypoxia Inducible Factor-1-Alpha In Post-Ischemic Myocardium Following In Vivo Prolyl-4 Hydroxylase-2 Gene Silencing, Julia Antoinette Messina

Theses and Dissertations

Administration of small interfering RNA (siRNA) specific for prolyl-4 hydroxylase-2 (PHD2) results in PHD2 inhibition, Hypoxia Inducible Factor-I (HIF-1) activation, and cardioprotection versus Ischemia Reperfusion (IR). This study observes the effects of siRNA-mediated PHD2 inhibition on the distribution of cardioprotective proteins by immunofluorescence and basic histology. Fifteen mice were divided into 5 groups: PHD2 Control, Non-Targeting scramble (NTS) Control, IR Control, PHD2 IR, and NTS IR. Histologically, tissue damage was reduced dramatically in the PHD2 IR group compared to the NTS IR and IR control groups. From confocal images, total fluorescent pixels and intensities were quantified. The PHD2 IR group …

Passive Immunization During Pregnancy For Congenital Cytomegalovirus Infection, Giovanni Nigro, Stuart P. Adler, Renato La Torre, Al M. Best

Pediatrics Publications

BACKGROUND

Currently, there is no effective intervention for a primary cytomegalovirus (CMV) infection during pregnancy.

METHODS

We studied pregnant women with a primary CMV infection. The therapy group comprised women whose amniotic fluid contained either CMV or CMV DNA and who were offered intravenous CMV hyperimmune globulin at a dose of 200 U per kilogram of maternal weight. A prevention group, consisting of women with a recent primary infection before 21 weeks' gestation or who declined amniocentesis, was offered monthly hyperimmune globulin (100 U per kilogram intravenously).

RESULTS

In the therapy group, 31 women received hyperimmune globulin, only 1 (3 …

Variation In Periodontal Diagnosis And Treatment Planning Among Clinical Instructors, Sharon K. Lanning, Scott D. Pelok, Brent C. Willians, Philip S. Richards, David P. Sarment, Tae-Ju Oh, Laurie K. Mccauley

Periodontics Publications

Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty-seven clinical instructors (periodontists, general dentists, dental hygienists, and first- and second-year periodontal graduate students) reviewed three web-based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. …

Spirituality And The Cognitively Impaired, Kathy Fogg Berry

Case Studies from Age in Action

Educational Objectives

1. Discuss the need to acknowledge and nurture the spirituality of older adults with cognitive impainnent to enhance their health and well-being.

2. Provide tools and suggestions for use in nurturing the spirituality of older adults with cognitive impainnent.

3. Review the response of one resident with cognitive impainnent to spiritually-based programming and support

Case Study For People Who Are Aging: Workworld© Choice Exploration Software, David Ruth, Mark Hill

Case Studies from Age in Action

Educational Objectives

1. To illustrate the usefulness of WorkWORLD, a software package for older Americans with disabilities who have not yet reached retirement age, to determine the financial effects of earnings and the use of work incentives associated with benefits.

2. To show how the software can be accessed and continually updated.

3. To explore the possibility of enhancing WorkWORLD to be useful for those who have reached retirement age but who desire to continue or begin working.