Medicine and Health Sciences Commons^™

Physical And Chemical Stability Of Spray Dried Sugars And Protein-Sugar Molecuiar Mixtures For Inhalation, Venkatesh Naini

Theses and Dissertations

The feasibility of producing inhalable microparticles of sugars and protein-sugar molecular mixtures using spray drying was investigated as an alternative to conventional micronization techniques. Four sugars; lactose (L), trehalose (T), sucrose (S) and mannitol (M) were spray dried using a commercial bench-top spray dryer and their physicochemical stability, with respect to particle size, moisture uptake and crystallinity changes, investigated after storage at 23%, 52%, 75% and 93% relative humidity (RH) and 25 °C for 30 days. Two crystalline size fractions (“coarse” = 125-212 μm and “fine” = 44-74 μm) of each sugar, were also characterized, as possible replacements for lactose …

Determinants Of The New Entry Of Hmos Into A Medicare Risk Contract: A Resource Dependence-Diversification Model, Chih-Wen Pai

Theses and Dissertations

The purpose of this study is to examine the determinants of the new entry of an HMO into a Medicare risk contract using a resource dependence—diversification model. This study is conducted through a non-experimental, panel design With one year time lag. An HMO’s market is defined as the service area. The primary sample for this study is composed of 440 HMOS that do not have a Medicare risk contract as of January 1994.

Data for the variables are extracted from the 1994 and 1995 InterStudy and Group Health Association of America (GHAA) directories, the 1996 Area Resource File, the 1994 …

Pharmacokinetics And Pharmacodynamics Of Ethanol In Healthy Volunteers: Effects Of Input-Rate And Degree Of Ethanol Exposure On Subjective And Objective Measures Of Impairment, Vijay A. Ramchandani

Theses and Dissertations

The goal of this project was to investigate the effect of input-rate (oral and intravenous) and degree of exposure on the pharmacokinetics of ethanol and on subjective and objective measures of impairment, as well as on the development of acute tolerance to the effects of ethanol in young, healthy volunteers.

The primary objective of this research was to test the following hypotheses: 1) the rate and degree of ethanol exposure (oral and intravenous) in normal healthy males and females affect the pharrnacokinetics (PK) and pharmacodynarnics (PD) of ethanol in a non-linear fashion; 2) the EEG changes after ethanol administration correlate …

Evaluation Of Cannabinoid Receptor Interaction Of Anandamide, The Endogenous Cannabinoid Receptor Ligand, Irma Bateman Adams

Theses and Dissertations

Recent evidence implicates anandamide as the endogenous ligand for the cannabinoid receptor. One purpose of this study was to determine the structural requirements for anandamide's receptor interaction and the influence of phenylmethylsulfonyl fluoride (PMSF), an enzyme inhibitor, on receptor affinity. A second objective was evaluation of the correlation between affinities of the analogs and in vivo pharmacological activities. The ability of anandamide and analogs to displace [3H]- CP 55,940 was determined by a filtration assay. Displacement curves for anandamide in the presence of PMSF produced a Ki of 89 ± 10 nM; without PMSF the Ki increased to 5400 ± …

Computer Modeling Of Anatomical Structure: A Representative Example Of Modeling The Inguinal Canal, Jason Michael Highsmith

Theses and Dissertations

As computers become an increasingly important part of medical education, a proper understanding of the techniques and applications of computer aided modeling is vital. An initial overview of medical imaging and the techniques of computer modeling is presented. Construction of three-dimensional models of anatomical structures is then discussed in great detail with specific focus on modeling structures like the inguinal canal. The inguinal canal is one region where computer modeling efforts should be directed because it presents a special challenge. Understanding the walls, borders and layering of the inguinal canal is especially difficult but vital to accurate clinical diagnoses of …

Effect Of Oral Alendronate On Bone Mineral Density And The Incidence Of Fractures In Postmenopausal Osteoporosis, Uri A. Liberman , M.D., Ph.D., Stuart R. Weiss , M.D., Johann Bröll , M.D., Helmut W. Minne , M.D., Hui Quan , Ph.D., Norman H. Bell , M.D., Jose Rodriguez-Portales , M.D., Robert W. Downs , Jr., M.D., Jan Dequeker , M.D., Ph.D., Murray Favus , M.D., Ego Seeman , M.D., Robert R. Recker , M.D., Thomas Capizzi , Ph.D., Arthur C. Santora , M.D., Ph.D., Antonio Lombardi , M.D., Raksha V. Shah , M.A., R.D., Laurence J. Hirsch , M.D., David B. Karpf , M.D.

Internal Medicine Publications

BACKGROUND

Postmenopausal osteoporosis is a serious health problem, and additional treatments are needed.

METHODS

We studied the effects of oral alendronate, an aminobisphosphonate, on bone mineral density and the incidence of fractures and height loss in 994 women with postmenopausal osteoporosis. The women were treated with placebo or alendronate (5 or 10 mg daily for three years, or 20 mg for two years followed by 5 mg for one year); all the women received 500 mg of calcium daily. Bone mineral density was measured by dual-energy x-ray absorptiometry. The occurrence of new vertebral fractures and the progression of vertebral deformities …

A National Survey Of The Arrangements Managed-Care Plans Make With Physicians, Marsha R. Gold , Sc.D., Robert Hurley , Ph.D., Timothy Lake , M.P.P., Todd Ensor, Robert Berenson , M.D.

Health Administration Publications

Abstract

Background. Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians.

Methods. In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide. Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independentpractice–association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs).

Results. Respondents from all three types of plan said they emphasized careful selection of physicians, although the group or staff HMOs tended to have more demanding requirements, …

Virginia Dental Journal (Vol. 72, No. 3, 1995)

Virginia Dental Journal

No abstract provided.

Virginia Dental Journal (Vol. 72, No. 2, 1995)

Virginia Dental Journal

No abstract provided.

Organizational Slack, Efficiency, And Quality Of Care In Acute Care Hospitals, Kyung Ii Youn

Theses and Dissertations

The relationship between technical efficiency and quality of care in hospitals is studied in the context of resource availability in hospital organizations. The resource availability of hospitals is conceptualized by organizational slack.

An integrated model is developed encompassing the source of organizational slack, its impact on technical efficiency and on quality of care, and its impact on the relationship between efficiency and quality. Organizational threat as an environmental factor affecting the level of slack is measured by the level of competition and regulation. Organizational slack is measured using financial and operational indicators of the hospitals. Technical efficiency is estimated by …

Virginia Dental Journal (Vol. 72, No. 4, 1995)

Virginia Dental Journal

No abstract provided.

Virginia Dental Journal (Vol. 72, No. 1, 1995)

Virginia Dental Journal

No abstract provided.

Nmda Receptor-Mediated Synaptic Plasticity In Developing Mammalian Visual Pathways, Gregory S. Perens

Theses and Dissertations

Precise connections in many mammalian nervous systems require a great deal of remodeling during development. In the visual system, many excess synapses are originally formed in the lateral geniculate nucleus and striate cortex. Only the correct set of axon terminals are retained during normal development, while imprecise ones withdraw. The mechanism by which only correct axons are retained requires neural activity, and may be regulated by specific receptors at synapses.

The transmission of neural signals at these synapses is carried out in part by the glutamate-activated NMDA receptor. It is hypothesized that NMDA receptor activation plays a crucial role in …

The Linkage Between Hospitals And Nursing Homes: Alternative Approaches To Minimizing Transaction Costs, Herng-Chia Chiu

Theses and Dissertations

Finding more efficient ways to organize and deliver medical care is a major policy and management concern in the United States. High levels of expenditures for administrative and coordinating functions are attributed to the fact that health care systems are not "seamless" and that excessive transaction or friction costs are incurred in the exchanges between providers and purchasers and among providers. Renewed interest in vertical integration as a means to addressed these problems is being explored in the empirical literature, but rigorous theory-based investigations are rare. This study is a theory-based exploration of how hospitals address the "make-or-buy" decision of …

The Impact Of The Tau Mutation On Reproductive Function In The Golden Hamster, Eliza Leake Thomasson

Theses and Dissertations

The tau mutation affects the circadian system of the golden hamster primarily by decreasing the period of the activity cycle from 24 to 20 hours. To study the effect of this mutation on reproductive function in the golden hamster, 3 experiments have been designed. In the first experiment, wild-type and tau female hamsters will be maintained in conditions of 14:10 LD and 11.7:8.3 LD, respectively. Blood samples will be taken and analyzed by radioimmunoassay (RIA) to determine the timing of the proestrus LH surge. In the second experiment, wild-type and tau males will be transferred to shortened photoperiods of 10:14 …

Determinants Of Continuity Of Care For Persons Transitioning From State Psychiatric Facilities To Communities, Sarah P. Farrell

Theses and Dissertations

When individuals with serious mental illness are discharged to the community, continuous and coordinated care are both desirable and necessary. A lack of continuity places the individual at risk for becoming lost to further services.

This study explores continuity of care for persons discharged from state psychiatric facilities in Virginia to communities. Continuity of care is defined as the successful initiation and maintenance of face-to-face contact by CSB staff with individuals to be discharged from state hospitals, and the subsequent provision of services post-discharge. This study identifies factors that influence continuity of care, examines the degree to which these factors …

Lipopolysaccharide-Reactive Immunoglobulin E Is Associated With Lower Mortality And Organ Failure In Traumatically Injured Patients, Joseph T. Dipiro, Robert G. Hamilton, Thomas R. Howdieshell, N. Franklin Adkinson Jr., Arlie R. Mansberger Jr.

Publications from the Office of the Dean

Antilipopolysaccharide (anti-LPS) immunoglobulin G (IgG) and IgM have been associated with protection from LPS effects in vivo. We investigated the presence of IgE and anti-LPS in 32 patients that had experienced severe traumatic injury and in 35 healthy volunteers; we also investigated whether IgE anti-LPS was associated with important clinical events. Plasma samples were collected daily from patients in the intensive care unit and on one occasion from volunteers; the samples were assayed for IgE anti-LPS. IgE anti-LPS was assayed by enzyme-linked immunosorbent assay with monoclonal anti-human IgE as the capture antibody. Detection was accomplished with biotin-labeled LPS (Escherichia coli …

Virginia Dental Journal (Vol. 71, No. 2, 1994)

Virginia Dental Journal

No abstract provided.

Inactivation Of Hit Cell Ca2+ Current By A Simulated Burst Of Ca2+ Action Potentials, L. S. Satin, S. J. Tavalin, P. D. Smolen

Pharmacology and Toxicology Publications

ABSTRACT A novel voltage-clamp protocol was developed to test whether slow inactivation of Ca2+ current occurs during bursting in insulin-secreting cells. Single insulin-secreting HIT cells were patch-clamped and their Ca2+ currents were isolated pharmacologically. A computed ,3-cell burst was used as a voltage-clamp command and the net Ca2+ current elicited was determined as a cadmium difference current. Ca2+ current rapidly activated during the computed plateau and spike depolarizations and then slowly decayed. Integration of this Ca2+ current yielded an estimate of total Ca influx. To further analyze Ca2+ current inactivation during a burst, repetitive test pulses to + 10 mV …

Virginia Dental Journal (Vol. 71, No. 3, 1994)

Virginia Dental Journal

No abstract provided.

Review Of The P53 Tumor Suppressor Gene And Its Role In Gliomas, James Dearing Christian

Theses and Dissertations

The following review of the p53 tumor suppressor gene will be discussed with particular attention to its role in human gliomas, as well as the various advances that have brought this molecule to the forefront of cancer research. A review of tumorigenesis focuses on the molecular mechanisms that convey neoplastic characteristics upon a normal cell. It is discussed how the coordinate advances in chromosome analysis and molecular techniques enabled the p53 gene to be categorized as a "tumor suppressor gene" and applied to various forms of cancer, including colorectal and lung carcinoma. The focus of the review will be on …

Virginia Dental Journal (Vol. 71, No. 1, 1994)

Virginia Dental Journal

No abstract provided.

Virginia Dental Journal (Vol. 71, No. 4, 1994)

Virginia Dental Journal

No abstract provided.

A Causal Model Of Hospital Volume, Structure And Process Indicators, And Surgical Outcomes, Myra Boles

Theses and Dissertations

This research developed and tested a conceptual model to explain why higher volumes of certain surgical procedures lead to better patient outcomes. The model incorporated hospital structural characteristics and process of care indicators to explain the volume-outcome relationship. The volume-outcome relationship was further examined longitudinally to determine stability over time and to substantiate the causality implied by the conceptual model.

A sample (n=1752) of acute-care, general hospitals was selected from hospitals that performed, in 1990, at least one surgical procedure on Medicare patients of the following: reduction of hip fracture, cholecystectomy, hip replacement, carotid endarterectomy, and pacemaker insertion. For the …

Modulation Of The Humoral Immune Response By The Sympathetic Nervous System, Tracey Lynn Spriggs

Theses and Dissertations

The immune system is critical for the maintenance of homeostasis. Due to the fact that a coordinated effort between organ systems is required for internal stability, it has been postulated that the immune system interacts with the neuroendocrine system. Clinical, anatomical, and receptor studies have provided evidence for a bi-directional communication between the nervous and immune systems. The goal of the present studies was to determine the potential influence of the sympathetic nervous system (SNS) on the primary antibody forming cell (AFC) response.

The adrenergic neurotoxin, 6-hydroxydopamine (6-OHDA), has been utilized extensively by researchers to explore the possible relationship between …

Radiosurgery For Malignant Brain Tumors, Michael Jino Yun

Theses and Dissertations

Radiosurgery using the Linear Accelerator or the Gamma Knife has proven to be an effective treatment modality for malignant brain tumors. In comparison to other treatments, radiosurgery can be performed on an outpatient basis and is noninvasive (Table 5). Due to the functional properties of radiosurgical devices, they are ideal for patients who are unable to undergo surgical removal of their brain tumors. The sharp dose drop—off beyond the tumor margin allows for high dosage tumor irradiation while sparing normal brain tissue. Many procedures that involve radiosurgery use it as a ”boost” therapy in conjunction with surgical resection and whole …

Monitoring Neuromuscular Blockade At The Adductor Pollicis And Orbicularis Oculi With Split Dosing Of Mivacurium Chloride, Stephen F. Palmerton

Theses and Dissertations

Twenty ASA class I and II patients between the ages of 15 and 64 years undergoing surgical procedures requiring neuromuscular blockade and general anesthesia were selected at random to participate in this study. Patients taking medication known to interfere with neuromuscular blockade were excluded. All patients were given 2 mg of midazolam IV as a premedication. In the operating room, routine monitors were connected and baseline blood pressure, pulse and respirations were recorded with subsequent recordings at 5 and 10 minutes following induction of anesthesia.

Indirect stimulation of the ulnar nerve was achieved by placing ECG electrodes 2 cm and …

Facilitation Of Penicillin Haptenation To Serum Proteins., Joseph T. Dipiro, N. Franklin Adkinson Jr., Robert G. Hamilton

Publications from the Office of the Dean

Traditionally, penicillin binding to serum proteins was believed to be a passive chemical process; however, it appears to be facilitated by serum factors. The objectives of this in vitro investigation were to examine facilitated penicillin haptenation, to study the kinetics of haptenation, and to determine the nature of haptenation-facilitating factors. The model involved addition of [3H]benzylpenicillin to serum or albumin solutions (at pH 7.3 to 7.4) and incubation at 37 degrees C for up to 72 h. The extent of penicillin binding to proteins in serum was found to be four- to fivefold higher than with solutions having comparable concentrations …

In Vitro Protein Binding Of Cefonicid And Cefuroxime In Adult And Neonatal Sera., John M. Benson, F. Douglas Boudinot, Andrew T. Pennell, Francesca E. Cunningham, Joseph T. Dipiro

Publications from the Office of the Dean

The levels of in vitro protein binding of cefonicid and cefuroxime in human adult and neonatal sera were compared.Binding parameters for each drug were determined within the concentration range of 25 to 3,000 micrograms/ml.Cefonicid exhibited concentration-dependent protein binding in both types of sera, with more extensive binding in adultserum at all concentrations. Two classes of binding sites were found: a high-affinity, saturable site and a low-affinity, nonspecific site. Cefuroxime also showed two-class, concentration-dependent protein binding in adult serum, but bindingin neonatal serum was to a single class and was independent of drug concentration. Parameters for class 1 binding sites for …

Virginia Dental Journal (Vol. 70, No. 1, 1993)

Virginia Dental Journal

No abstract provided.