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Admixture Mapping Of Subclinical And Clinical Cardiovascular Disease Among African Americans, Aditi Shendre Jan 2016

Admixture Mapping Of Subclinical And Clinical Cardiovascular Disease Among African Americans, Aditi Shendre

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The purpose of this dissertation is to evaluate the association of local European ancestry (LEA) with subclinical and clinical cardiovascular (CV) disease (CVD) among African Americans in three prospective cohorts from the United States. CVD burden is higher among African Americans compared to other racial/ethnic groups and prevention efforts have led to the evaluation of subclinical measures of CVD such as carotid artery intima-media thickness (CIMT), and risk factors including the underlying genetic component of the disease. Admixed populations such as African Americans may have increased risk of disease as a result of the increased prevalence of a disease among …


Neurobiological Consequences Of Perinatal Ssri Exposure, Matthew Edward Glover Jan 2016

Neurobiological Consequences Of Perinatal Ssri Exposure, Matthew Edward Glover

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Selective serotonin reuptake inhibitors (SSRIs) have been a mainstay pharmacological treatment for women experiencing depression during pregnancy and postpartum for nearly three decades. Recently, though, growing evidence indicates that early-life SSRI exposure triggers long-lasting behavioral abnormalities. Clinically, children exposed to SSRIs in early life exhibit increased internalizing behavior, reduced social behavior, and increased risk for depression in adolescence. Similarly, in rodents, perinatal SSRI exposure leads to increased traits of anxiety- and depression-like behavior. Interestingly, certain individuals are more susceptible to early-life SSRI exposure than others, suggesting that perinatal SSRI exposure poses greater risks for negative outcome within certain populations; however, …


The Matricellular Protein Ccn1 Potentiates Fibrogenic Responses To Lung Injury, Ashish Kurundkar Jan 2016

The Matricellular Protein Ccn1 Potentiates Fibrogenic Responses To Lung Injury, Ashish Kurundkar

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Normal wound healing is a well-coordinated reparative response to injury aimed at restoring the normal tissue function. The dynamic interactions between cells and ex-tracellular matrix (ECM) regulate and dictate the fate of tissue repair process. Fibrosis is a dysregulated wound healing with excessive deposition of ECM and loss of tissue func-tion. Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic disease of lung with no cure. Matricellular proteins are non-structural matrix proteins which regulates the cellular functions by directly binding to cell surface integrins and/or indirectly modulating growth factor signaling. Matricellular proteins are emerging as critical mediators of tissue injury …


14-3-3 Proteins Regulate Mutant Lrrk2 Kinase Activity And Neurite Shortening, Nicholas Lavalley Jan 2016

14-3-3 Proteins Regulate Mutant Lrrk2 Kinase Activity And Neurite Shortening, Nicholas Lavalley

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Mutations in leucine-rich repeat kinase 2 (LRRK2) are the most common known cause of inherited Parkinson’s disease (PD), and LRRK2 is a risk factor for idiopathic PD. How LRRK2 function is regulated is not well understood. Recently, the highly-conserved 14-3-3 proteins, which play a key role in many cellular functions including cell death, have been shown to interact with LRRK2. In this study, we investigated whether 14-3-3s can regulate mutant LRRK2-induced neurite shortening and kinase activity. In the presence of 14-3-3θ overexpression, neurite length of primary neurons from BAC transgenic G2019S-LRRK2 mice returned back to wildtype levels. Similarly, 14-3-3θ overexpression …


The Role Of Ppar-Delta In Regulating Cardiomyocyte Proliferation And Angiogenesis In Post-Myocardial Infarction Adult Heart, Yishu Ding Jan 2016

The Role Of Ppar-Delta In Regulating Cardiomyocyte Proliferation And Angiogenesis In Post-Myocardial Infarction Adult Heart, Yishu Ding

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Limited regeneration capacity is the main cause of heart failure following myocardial infarction (MI) in adult mammals. Emerging evidence supports that adult cardiomyocyte proliferation and myocardial angiogenesis could be enhanced, especially under MI condition. Peroxisome proliferator-activated receptor δ (PPARδ) is a key transcriptional regulator of lipid metabolism, mitochondrial biogenesis, anti-inflammation, and antioxidant defense in the heart. PPARδ signaling is involved in cell proliferation in many cell types. However, whether PPARδ is also determined cardiomyocyte proliferation and angiogenesis in the heart is unknown. Based on a high-through-put screening hit on cultured cardiomyocytes conducted by our collaborator, I have focused on establishing …


Three-Dimensional Age-Related Changes Of The Adult Male Face, Catherine Haynie Haynie Jan 2016

Three-Dimensional Age-Related Changes Of The Adult Male Face, Catherine Haynie Haynie

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Objectives: The adult population is a fast growing subgroup of orthodontic practices. The facial soft tissues of adults are different from adolescents, and there is significant sexual dimorphism in the aging of facial soft tissue. It is imperative for the orthodontist to understand how aging effects the soft tissues of the face, and to know how male and females differ in this process. The objectives of this study include: 1.) Identification of trends in facial aging among a Caucasian male and African American male sample utilizing three-dimensional surface imaging technology. 2.) Comparison of the aging effects between the Caucasian and …


Patient Engagement Functionalities Facilitated By Health Information Technology: An Examination Of The Adoption Rate And Financial Performance Among U.S. Hospitals, Oghale Elijah Asagbra Jan 2016

Patient Engagement Functionalities Facilitated By Health Information Technology: An Examination Of The Adoption Rate And Financial Performance Among U.S. Hospitals, Oghale Elijah Asagbra

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The Centers for Medicare and Medicaid (CMS) meaningful use requirement, as well as documented evidence suggest that health information technology (HIT) has the potential to promote patient engagement and consequently improve quality and reduce cost. This prompts a better understanding of hospital adoption of HIT for patient engagement. The purpose of the three papers presented in this dissertation is to examine hospital adoption of health information technology (HIT) to facilitate patient engagement. Emphasis is placed on the functionalities (i.e., functions or capabilities) offered by these technologies that have been determined to allow patients be more involved in their care because …


Exploring Bacteriophage P22 As A Selective Molecular Scaffold And Molecular Sensor, Gregory Joseph Bedwell Jan 2016

Exploring Bacteriophage P22 As A Selective Molecular Scaffold And Molecular Sensor, Gregory Joseph Bedwell

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The virus capsids of many dsDNA bacteriophage are finely tuned macromolecular machines. Their functionality begins at assembly, when their capsids are built under the guidance of a class of proteins referred to as scaffolding proteins. The scaffolding protein of bacteriophage P22 is a flexible, highly elongated protein that binds to the interior surface of the P22 procapsid via its C-terminal domain. The finding that N-terminus is dispensable for procapsid binding prompted the development of chimeric scaffolding protein molecules, wherein N-terminal residues of scaffold are replaced with a variety of different peptide sequences or functional proteins that are then encapsidated within …


Retention Of Cad/Cam Crowns Luted With A Novel Biomimetic Cement, Nan Xiang Jan 2016

Retention Of Cad/Cam Crowns Luted With A Novel Biomimetic Cement, Nan Xiang

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Objectives: To measure the tensile strength of e.max copings cemented with resin, calcium silicate and calcium phosphate cements following thermocycling. Methods: 40 extracted non-carious mandibular premolar teeth were examined and selected using Keyence microscope for no carious cracks etc.were mounted in acrylic. The teeth were placed in a lathe and prepared to uniform dimensions (22° total taper) using a flat-end tapered diamond bur (846.11.025HP, Brasseler) and a 3mm preparation height. The surface area of the prepared surface was calculated with digital microscopy. The teeth were scanned with a Cerec 3 (Sirona) digital scanner. E.max crowns were milled using Cerec 3 …


Glycosyltransferases Involved In The Glycosylation Of Serine-Rich Glycoproteins From Streptococci, Fan Zhu Jan 2016

Glycosyltransferases Involved In The Glycosylation Of Serine-Rich Glycoproteins From Streptococci, Fan Zhu

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Serine - rich repeat glycoproteins (SRRPs) play important roles in mediating bac-terial attachment to a variety of host and microbial surfaces. They have been im-plicated in the development of tissue infections such as pneumonia, infective en-docarditis, meningitis and oral infectious diseases. Streptococcus parasanguinis, one of the commensal streptococci present in the oral cavity, utilizes its fimbriae to mediate the initial attachment to the tooth pellicle. Fap1 (Fimbriae-associated-protein 1), the first identified SRRP, is the subunit of the fimbriae which utilizes proteins encoded by an 11-gene cluster (gly-gtf3-dGT1-galT2 and secY2-gap1-gap2-gap3-secA2-gtf1-gtf2) to mediate its glycosylation and secretion. The key enzymes responsible for …


A Study Of The Relationship Between Nasion Perpendicular And The True Vertical Line, Jeffrey Shelley Jan 2016

A Study Of The Relationship Between Nasion Perpendicular And The True Vertical Line, Jeffrey Shelley

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A STUDY OF THE RELATIONSHIP BETWEEN NASION PERPENDICULAR AND THE TRUE VERTICAL LINE JEFFREY ALBERT SHELLEY JR. DEPARTMENT OF ORTHODONTICS ABSTRACT The purpose of this study is to assess the relationship between Nasion perpendicular and the true vertical line between patient groups using cephalometric analysis. Materials and Methods: Ninety-six adolescent patients comprised the sample for this study. Subjects were between 10 and 18 years old, with no major craniofacial deformity. Three groups of patients were divided in to three groups (Class I, Class II and Class III) based on their skeletal antero-posterior relationship. Pre-treatment lateral cephalometric radiographs were taken with …


16s Rrna Gene Sequencing To Evaluate The Effects Of Six Commonly Prescribed Antibiotics, Kendall Slaton Jan 2016

16s Rrna Gene Sequencing To Evaluate The Effects Of Six Commonly Prescribed Antibiotics, Kendall Slaton

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16s rrna gene sequencing to evaluate the effects of six commonly prescribed antibiotics kendall slaton, dmd dentistry abstract introduction: the rapid antibiotic sensitivity test (rast) is a novel in-office culture and sensitivity system for endodontic infections. the purpose of this research was to validate the rast system as a viable, in-office alternative to antibiotic sensitivity testing using turbidity, to determine antibiotic sensitivities of endodontic infections. methods: aspirates were taken from the root canals of nine necrotic human teeth at the initiation of root canal therapy. these samples were cultured in the rast medium and antibiotic sensitivity to six antibiotics was …


Measuring Reproductive Norms And Stigma And Examining Their Roles In Unintended Pregnancy-Related Health Behavior Among Young Adult Women, Whitney Smith Jan 2016

Measuring Reproductive Norms And Stigma And Examining Their Roles In Unintended Pregnancy-Related Health Behavior Among Young Adult Women, Whitney Smith

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Substantial disparities are observed in rates of unintended pregnancy and the health consequences of unintended pregnancy in the United States, with these events and outcomes occurring more frequently among young adult women and women in the southern region. The contribution of social norms and stigma to these disparities is unclear. This dissertation is comprised of three manuscripts examining unintended pregnancy-related norms and stigma, and their health implications among young adult women aged 18-24 in Birmingham, Alabama. The aims of the dissertation are to (1) elucidate perceptions of norms and stigma regarding unintended pregnancy and pregnancy decisions (abortion, adoption, and parenting), …


The Function Of Prmt1 In Normal And Abnormal Megakaryopoiesis, Hairui Su Jan 2016

The Function Of Prmt1 In Normal And Abnormal Megakaryopoiesis, Hairui Su

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Protein arginine methylation is a common type of post-translational modifications. Protein arginine methyltransferase 1 (PRMT1) is the predominant PRMT that is involved in diverse physiological and pathological processes in mammalian cells. Dysregulation of PRMT1 is often positively correlated with cancer development, yet many aspects of PRMT1’s role in cancer, especially in acute megakaryoblastic leukemia (AMKL) remain unclear. We identified two PRMT1-methylated substrates and how they impact normal and abnormal megakaryopoiesis. In this dissertation, we demonstrate that dual-specificity protein phosphatase 4 (DUSP4) and RNA binding motif protein 15 (RBM15), two crucial factors for megakaryocytic (MK) differentiation, are methylated by PRMT1 and …


The Experience Of The Expectant Mother Follwing A Diagnosis Of A Fetal Anomaly, Janet Adams Tucker Jan 2016

The Experience Of The Expectant Mother Follwing A Diagnosis Of A Fetal Anomaly, Janet Adams Tucker

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THE EXPERIENCE OF THE EXPECTANT MOTHER FOLLWING A DIAGNOSIS OF A FETAL ANOMALY JANET ADAMS TUCKER Introduction: The experience of pregnancy complicated by a fetal anomaly diagnosis is comprised of many concepts: uncertainty, information needs, stress and anxiety, waiting, decision-making dilemmas, isolation, fragmented health care, multiple losses and grief, foreknowledge, acceptance and adaptation. There is great variance in what is understood about each concept. The purpose of this study was to explore uncertainty and waiting among expectant mothers from the time period of a prenatal diagnosis of a fetal anomaly through the post-partum period. Methods: A descriptive phenomenological approach was …


The Relationship Between Hospital Interdepartmental Transfers And Patient Experience, Betty O. Mortensen Jan 2016

The Relationship Between Hospital Interdepartmental Transfers And Patient Experience, Betty O. Mortensen

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This study examined the potential relationship between interdepartmental transfers and perceptions of adult patients who were admitted and discharged from a 300-bed, not-for-profit community tertiary hospital in the Midwest. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publically reported comparative data tool measuring hospital patient experiences. As consumers, patients are more informed about their own health and are challenging the quality and service of care provided by hospitals. The value-based purchasing reimbursement model has become a new challenge for hospitals. Historically, hospitals were reimbursed through a volume driven model. Comparatively, the value-based model focuses on …


Examining The Impact Of Emergency Department (Ed) Registered Nurse (Rn) Staffing On Ed Patient Experience, Deana L. Nelson Jan 2016

Examining The Impact Of Emergency Department (Ed) Registered Nurse (Rn) Staffing On Ed Patient Experience, Deana L. Nelson

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EXAMINING THE IMPACT OF EMERGENCY DEPARTMENT (ED) REGISTERED NURSE (RN) STAFFING ON ED PATIENT EXPERIENCE DEANA NELSON DOCTOR OF SCIENCE IN HEALTH SERVICES ADMINISTRATION ABSTRACT Patient experience ratings are important to healthcare organizations from both a clinical and financial perspective. Studies examining the relationship between patient experience and nurse staffing are prevalent in the inpatient setting, but not as much is known about how staffing affects these ratings in the Emergency Department (ED). This study examined the relationships between ED RN staffing, patient expectations and patient experience ratings, using a conceptual framework adapted from Donabedian’s structure/process/outcome model, and expectancy disconfirmation …


Altering Metabolism In The Tumor Microenvironment To Enhance Anti-Tumor Immunity For Lung Cancer, Cara Schafer Jan 2016

Altering Metabolism In The Tumor Microenvironment To Enhance Anti-Tumor Immunity For Lung Cancer, Cara Schafer

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Overcoming cancer cell immune escape represents a fundamental obstacle in the treatment of cancer. Indoleamine 2,3-dioxygenase (IDO)-expressing myeloid-derived suppressor cells (MDSCs) are known to induce oxidative stress and alter amino acid metabolism within the tumor microenvironment (TME). The tryptophan (Trp)-catabolizing action of IDO not only promotes T cell tolerance and evasion but is also associated with impaired quality of life in cancer patients. We have previously demonstrated that a novel combination therapy, consisting of MDSC-depleting gemcitabine and a superoxide dismutase mimetic, prolonged survival of tumor-bearing mice by enhancing CD8+ memory T cell metabolism. We identify that combination therapy inhibits IDO …


Retentive Strength At The Zirconia Implant Abutment And Titanium Base Interface With Different Surface Treatments, Celin Arce Jan 2016

Retentive Strength At The Zirconia Implant Abutment And Titanium Base Interface With Different Surface Treatments, Celin Arce

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Screw-retained zirconia implant crowns with an internal titanium base have favorable mechanical properties compared to single piece zirconia implant crowns; however, they require adequate bonding between the zirconia crown and the titanium base. This study measures the retention between a titanium base and a full contour zirconia implant crown following different surface treatments of their bonded surfaces. Full contour zirconia implant crowns were fabricated to fit a 3.5mm titanium base. The crowns were bonded to the titanium bases following 4 protocols (n=15): no surface treatment (Group 1), MDP-primer on the intaglio of crown and exterior of base (Group 2), alumina …


The Relationships Between Patient Satisfaction, Market Share, And Hospital Financial Performance, David W. Au Jan 2016

The Relationships Between Patient Satisfaction, Market Share, And Hospital Financial Performance, David W. Au

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Quantitative scores enumerating patient experience with care have been introduced to healthcare via the Patient Protection and Affordable Care Act of 2010. Consumers can now compare with relative ease, different healthcare providers on the basis of standardized metrics. As government mandated transparency initiatives become commonplace as a result of the law, hospitals are more cognizant of how patient experience with care (operationalized using Hospital Consumer Assessment of Healthcare Providers and Systems: HCAHPS) has an impact on where patients decide to seek treatment. The proliferation of technological tools now enables patients to make meaningful quality and cost comparisons across providers. HCAHPS …


Fcrl5 Counter-Regulates Natural And T Cell-Independent Immunoglobulin Production By Innate-Like B Cells, Eugene John Becker Jan 2016

Fcrl5 Counter-Regulates Natural And T Cell-Independent Immunoglobulin Production By Innate-Like B Cells, Eugene John Becker

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At homeostasis and during the initial phases of primary responses to pathogens, humoral host defense is chiefly coordinated by specialized B cells known as splenic marginal zone (MZ) and body cavity-derived B-1 B cells. These front line immune mediators are termed “innate like” due to their ability to secrete broadly-reactive natural antibodies and respond rapidly to antigens in a T cell-independent manner. The production of natural antibodies possessing specificities for self-antigens allows clearance of cellular debris, maintenance of homeostasis and protection from infections that can also predispose the host to immunological disease. However, how the functions of these specialized cells …


Methods For Measuring Individually Experienced Temperature And Food Intake In Controlled Thermal Environments, Molly Bernhard Jan 2016

Methods For Measuring Individually Experienced Temperature And Food Intake In Controlled Thermal Environments, Molly Bernhard

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The three studies to be presented assess individual-level heat exposure in free-living urban and rural environments and assess food intake in randomized controlled trials in a 2-hour exposure, and a 7-hour crossover heat exposure. The first interest was broad: examining heat exposure and its relation to potential health outcomes. To examine whether heat exposure could be measured in free-living organisms, a light and temperature monitoring device was repurposed and used in a pilot study of individual-level heat exposure in urban and rural community members. Differences between the current and most commonly accepted way of estimating heat exposure, weather station datasets, …


A Comparison Of Soft Tissue Topographical Norms For The Local Ethnic People Of Zimbabwe And African American Norms Based On 3dmd Soft Tissue Photography, Elvin Bhaskar Jan 2016

A Comparison Of Soft Tissue Topographical Norms For The Local Ethnic People Of Zimbabwe And African American Norms Based On 3dmd Soft Tissue Photography, Elvin Bhaskar

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Introduction: The purpose of this study is to determine the soft tissue topographical norms for the local ethnic people of Zimbabwe and compare them with the African American norms based on 3dMD soft tissue photography. The rationale for the study is to evaluate how the soft tissue drape over the facial skeleton correlates with the different soft tissue analysis widely available today. This study seeks to establish an average base on which clinicians can treat people according to their cultural esthetic perceptions. Previous reported studies only evaluate small numbers of populations and it is well known that different races and …


Structure-Function Relationships In The Sec7 Guanine Nucleotide Exchange Factor Gbf1, Jay Manoj Bhatt Jan 2016

Structure-Function Relationships In The Sec7 Guanine Nucleotide Exchange Factor Gbf1, Jay Manoj Bhatt

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All eukaryotic cells contain a secretory pathway composed of membrane-bound compartments connected by vesicles that transport cargo from the endoplasmic reticulum (ER) through the Golgi apparatus to various destination within and outside the cell. The Golgi Brefeldin A-resistant Factor 1 (GBF1) is required for protein traffic between ER and Golgi and within the Golgi. GBF1 belongs to a family of Guanine nucleotide Exchange Factors (GEFs) that stimulate the nucleotide exchange of GDP for GTP on small GTPases called ADP-ribosylation factors (ARFs). Once GTP-bound, ARFs become active and initiate a cascade of events that lead to vesicle formation. Thus, GBF1 is …


The Role Of Glutamate In Immune Cell Infiltration And Excitotoxic Mechanisms In Autoimmune Demyelination, Kirsten Scarlett Evonuk Jan 2016

The Role Of Glutamate In Immune Cell Infiltration And Excitotoxic Mechanisms In Autoimmune Demyelination, Kirsten Scarlett Evonuk

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Multiple sclerosis is the most common neurological disorder in young adults. Current treatments modulate the immune system, but no treatments prevent central nervous system damage. Inflammation occurs even during disease remission, contributing to ongoing damage and resulting in disease progression. The lack of neuroprotective treatments despite continued inflammatory onslaught in the central nervous system indicates the need for therapeutic discovery in this area. One potential therapeutic target is glutamate, whose dysregulation in multiple sclerosis has been implicated in excitotoxic cellular death. Herein we describe the roles of glutamate in multiple sclerosis and explore the blockade of a source of excitotoxic …


Novel Biomarkers For Parkinson Disease, Kyle Bradley Fraser Jan 2016

Novel Biomarkers For Parkinson Disease, Kyle Bradley Fraser

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Parkinson disease (PD) is the most common neurodegenerative movement disorder for which no treatments exist capable of slowing progression of the disease. One obstacle slowing the development of novel therapies is the lack of molecular biomarkers for PD prognosis, tracking of disease progression, and assessing efficacious target engagement of compounds that do reach clinical trials. Missense mutations in LRRK2 account for between 1-5% of late onset PD and lead to increases in LRRK2 kinase activity and LRRK2 autophosphorylation. This thesis characterizes the secretion of LRRK2 into extracellularly secreted microvesicles called exosomes. We find that kinase-active LRRK2 is secreted within exosomes …


Copper Chaperone In Streptococcus Mutans Biofilm Formation And Dispersion Of Biofilms By Small Molecules, Sandra Stephanie Garcia Jan 2016

Copper Chaperone In Streptococcus Mutans Biofilm Formation And Dispersion Of Biofilms By Small Molecules, Sandra Stephanie Garcia

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Dental caries, commonly known as tooth decay, is characterized by the destruction of the tooth’s hydroxyapatite, the primary mineral of enamel. Tooth decay is caused by the combination of poor salivary flow, frequent dietary sugar intake, poor dental hygiene, and the prevalence of cariogenic bacteria. Exposure to sucrose promotes Streptococcus mutans to form a cariogenic biofilm, which is the major risk factor for dental caries. Currently there are no anticaries therapies that selectively target S. mutans biofilms. In this study, we identified small molecule 3F1 which was capable of selectively dispersing S. mutans biofilms and utilized it to determine whether …


Serum Vitamin D And C-Reactive Protein: Predictors Of Glucose Control In African-Americans With Type 2 Diabetes?, Mary Luree Garvin-Surpris Jan 2016

Serum Vitamin D And C-Reactive Protein: Predictors Of Glucose Control In African-Americans With Type 2 Diabetes?, Mary Luree Garvin-Surpris

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Introduction African-Americans experience more years of life lost as a result of complications from type 2 diabetes mellitus (T2DM) than any other racial or ethnic group. Evidence suggests that serum 25(OH)D (serum vitamin D), generally low in African-Americans, may play a role in glucose control. In addition, elevated levels of chronic low-grade inflammation, measured by C-reactive protein (CRP), may also relate to glucose control. The purposes of this study were to determine whether serum 25(OH)D and CRP are independent predictors of glucose control in adult African-Americans with T2DM, after controlling for other factors associated with glucose control, and to examine …


Genetic Enhancer Screen With Transition Zone Mutant Nphp-4 Reveals Novel Interactions With Mutation Affecting Intraflagellar Transport And Endocytic Pathways, Scott Henke Jan 2016

Genetic Enhancer Screen With Transition Zone Mutant Nphp-4 Reveals Novel Interactions With Mutation Affecting Intraflagellar Transport And Endocytic Pathways, Scott Henke

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Cilia are hair-like microtubule based protrusions from the cell membrane. The Transition Zone (TZ) is a vital sub-domain of cilia and is located at the base of the cilium above the basal body at the entry point into the cilium. While multiple proteins associated with Nephronophthisis (NPHP), Bardet-Biedl Syndrome (BBS) and Meckel Gruber Syndrome (MKS) have been found to specifically localize to this region, little is known about their function. However, because non-ciliary proteins ectopically localize to the cilium in TZ mutants, it is hypothesized that TZ proteins control the trafficking of signaling proteins into and out of the cilium. …


Comparing The Quality Of End Of Life Cancer Care In The Medicare Population Prior To And After The Enactment Of The Medicare Prescription Drug, Improvement And Modernization Act Of 2003, Rene Jooste Jan 2016

Comparing The Quality Of End Of Life Cancer Care In The Medicare Population Prior To And After The Enactment Of The Medicare Prescription Drug, Improvement And Modernization Act Of 2003, Rene Jooste

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Reimbursement for chemotherapy could account for two thirds of the income for oncologists in private practice. The Medicare prescription drug improvement and modernization act of 2003 (MMA) brought about a dramatic change in the way physicians were reimbursed for delivering chemotherapy in an attempt to slow the skyrocketing costs of drugs and Medicare costs for covering these drugs . The MMA reduced Medicare reimbursements for covered outpatient prescription drugs from 95% to 85% of the average wholesale price. In 2005, a new payment system was instituted that reimbursed fee-for-service providers for drugs at the national average sales price plus 6%. …