Medicine and Health Sciences Commons^™

Exploring The Physical And Mental Health Disparities In The Transgender Male Community In A Southern Community-Based Medical Lgbtq Organization, Karen E. Musgrove

All ETDs from UAB

This dissertation examined the physical and mental health disparities in the transgender male community in a Southern community-based medical LGBTQ (lesbian, gay, bisexual, transgender, queer) organization via a convergent mixed methods study design. There is a paucity of research on the transgender male community in terms of their physical and mental health care needs, services, and disparities. Quantitative data were col-lected via a chart review of 130 transgender male medical charts at the Magic City Well-ness Center (MCWC). The MCWC transgender male medical chart data were compared to three groups separately of the 2018 Behavioral Risk Factor Surveillance System (BRFSS) …

Genetic And Immunologic Predictors Of Genital Chlamydia Reinfection In African American Women Using Bayesian Hierarchical Models, Kristin Olson

All ETDs from UAB

Chlamydia trachomatis (CT) infection is the most common sexually transmitted infec-tion. The burden is greatest in young, African American women. CT reinfections are common and increase risk for reproductive morbidity. Why some women are more sus-ceptible to reinfection is not well understood. Emerging evidence suggests immunologic and genetic variants may predict reinfection susceptibility. The primary goal of this dissertation is to evaluate immunologic and genetic vari-ants as predictors of CT reinfection in young, African American women using different modeling approaches, which has never been reported previously. To evaluate a much larger number of potential predictors than our sample size (a …

Noninvasive Neuromodulation Using A Benchtop Approach To Mri-Guided Focused Ultrasound Blood Brain Barrier Opening, Megan Rich

All ETDs from UAB

Fundamental neuroscience research has provided a deeper understanding of the genes, molecules and cellular circuitry involved in neurological disorders, however translating discovery into clinical application remains a major challenge. This bench to bedside gap is in part due to the discrepancy in techniques used in the laboratory vs. the clinic for targeting the mechanisms that underlie disease. Ideally this discrepancy would be resolved not only by implementing novel clinical techniques to provide more precise targeting of disease foci, but also by using the same techniques in the clinic that are used at the lab bench to provide a direct bench …

Bond Of Resin Cements Through Three Ceramics At Varying Thickness, Po-Hsu Chen

All ETDs from UAB

The purpose of this study was to determine the bond strength of a light cured resin when cured through 3 different types of dental ceramics (traditional zirconia with 3 mol% yttria, translucent zirconia with 5 mol% yttria, and lithium disilicate) at 2 different thicknesses. A total of 135 specimens were prepared from traditional zirconia (IPS e.max ZirCAD LT, Ivoclar Vivadent, Liechtenstein), translucent zirconia (IPS e.max ZirCAD MT, Ivoclar Vivadent, Liechtenstein), and lithium disilicate (IPS e.max CAD LT, Ivoclar Vivadent, Liechtenstein) into a plate shape, but in different thicknesses (1mm and 1.5mm). Ceramic buttons were fabricated by pressed lithium disilicate (IPS …

Examining The Impact Of Baldrige On Hospital Performance, Jennifer O. Strahan

All ETDs from UAB

The national Baldrige program has supported performance excellence within healthcare for over twenty years, yet it has seen recent declines in the number of applications despite Baldrige award recipients claiming noteworthy improvements across operational, clinical, and financial outcomes. Previous studies have compared Baldrige hospital recipients to non-recipients, but no studies have empirically investigated the value of pursuing the Baldrige award, regardless of award recognition or not. Furthermore, it is unclear if specific categories of the Baldrige Excellence Framework (BEF) are associated with standardized industry performance outcomes. This study used propensity score matching with linear and quantile regression techniques to understand …

Circadian Clock And Lipid Metabolism Disruption In Fatty Liver Disease, Jennifer Valcin

All ETDs from UAB

Hepatic Steatosis, characterized by the accumulation of triglyceride (TG) in the liver is the first stage of Alcoholic Liver Disease (ALD) and Nonalcoholic Fatty Liver Disease (NAFLD). Many metabolic pathways, including lipid metabolism, are regulated by the molecular circadian clock. Importantly, alcohol consumption and obesity induce circadian clock disruption, a risk factor for many diseases, including liver disease. In our first study, we investigated the combined effect of clock disruption and alcohol feeding on liver pathology, and diurnal rhythms in the liver molecular clock and lipid metabolism. Male liver-specific Bmal1 knockout (LKO) mice and control littermates were fed a control …

Dna Methylation: A Mechanism For Sustained Alteration Of Kir4.1 Expression Following Central Nervous System Insult, Jessica Boni

All ETDs from UAB

Astrocytes are the most numerous cells in the brain and play a critical role in maintaining homeostatic extracellular potassium ([K+]e). Maintaining low [K+]e is essential for many cellular functions including maintenance of intensely negative resting membrane potentials in the central nervous system. This process is mediated, in part, by a glial-specific, inwardly rectifying potassium channel, Kir4.1. Underscoring the role of Kir4.1 in CNS functioning, genetic mutations in Kcnj10, the gene which encodes Kir4.1, causes seizures, ataxia and developmental disability in humans. Notably, loss of Kir4.1 protein and mRNA are consistently observed after CNS injury, and in a number of neurological …

Distinct Tissue Specific Functions Of Bone Marrow Regulatory T Cells, And Their Therapeudic Applications In Myeloid Neoplasms, Virginia Camacho

All ETDs from UAB

In the bone marrow, Regulatory T cells (Tregs) constitute nearly 30% of CD4+ T cells, a significantly higher ratio than other tissues. Although a few of the mechanisms by which Tregs regulate normal hematopoiesis have been elucidated, our understanding of this process during leukemogenesis is ex-tremely limited. In this work, we define how Tregs maintain and support the bone marrow microenvironment. We propose that the role of Tregs extends be-yond their canonical immuno-suppressive function and that these cells are re-quired to maintain healthy hematopoiesis. We have defined tissue-specific roles for Tregs in the bone marrow including the maintenance of hematopoietic …

From Pathology To Circuits: Loss Of Pink1 Function In Parkinson’S Disease, Rose Berthe Creed

All ETDs from UAB

Parkinson’s disease (PD) is the most common neurogenerative motor disorder, affecting over 10 million people worldwide. Clinically, PD is diagnosed by presentation of hypokinetic movements such as bradykinesia, rigidity, and resting tremor. Additionally, PD patients have non-motor symptoms that include anosmia, constipation, and hypophonia. Current therapeutics have been successful in treating many of the locomotor symptoms, however no therapies stop or slow disease progression and the effectiveness of current medications diminishes as the symptoms invariably become more severe over the course of many years. Histopathologically, PD diagnosis is confirmed postmortem by two pathological hallmarks: 1. loss of dopaminergic neurons in …

Developing An Assessment Of Reading Impairment And Its Impact On Occupational Performance In Older Adults With Glaucoma In A Metropolitan Area Of The Southeastern Us: A Mixed Methods Approach, Robin Deacy

All ETDs from UAB

According to the United States Administration on Aging (AOA, 2014), the population of individuals over 65 will be 98 million by the year 2060, doubling its 2014 estimates. As our population ages, the prevalence of glaucoma increases. Vision loss resulting from glaucoma can limit participation in valued occupations including engagement in reading. It has long been thought that mobility issues and glare sensitivity were the main factors that characterized glaucoma. In the late 1990s and early 2000s researchers began to examine quality of life (QoL) in those with glaucoma. It was during these early QoL studies that the first reports …

Alabama's Acute Care Registered Nurse Workforce: A Study In Supply And Demand, Tracey Dick

All ETDs from UAB

Background/Significance: Nurses comprise the largest sector of the total health care workforce. Acute care hospitals have historically been major employers of registered nurses (RNs). What is currently known about Alabama’s acute care RN workforce supply is limited. Additionally, a paucity of data is available to describe employer demand. Alabama’s aging population, chronic disease burden, and health care system reforms suggest that the demand for RNs will continue to grow. Data are needed to provide a greater understanding of current and future RN supply and demand to inform workforce planning, educational investment, and state health policy. Purpose: To characterize the current …

Novel Mechanisms Of Nitric Oxide Activation In The Kidney, Randee Sedaka

All ETDs from UAB

Globally, adult sodium consumption has far exceeded daily intake recommendations, leading to one in ten cardiovascular deaths. Given the rise in hypertension prevalence, uncontrolled hypertension with antihypertensive medication use, and significant associations between high salt intake and high blood pressure, there is a need to better understand the mechanisms involved in hypertension. Nitric oxide synthase 1 (NOS1) is a well-established regulator of fluid and electrolyte balance in the renal collecting duct (CD) with highest activity in the inner medulla (IM). We previously reported that high salt (HS) intake stimulates CD endothelin B receptor (ETBR)/NOS1-dependent generation of NO, thereby inhibiting the …

Diurnal Dysfunction In Control Of Sodium Excretion In Diet-Induced Obesity, Reham Soliman

All ETDs from UAB

The renal endothelin system plays a key role in sodium excretion, particularly under high salt (HS) diet. HS stimulates renal endothelin-1 (ET-1), which binds and activates the endothelin receptor B (ETB) to excrete the excess salt. Loss of ETB receptor is linked to the development of hypertension under HS. Central clock genes are important in maintaining rhythmic patterns of sodium excretion and ET-1 is identified as a target for clock genes, including Period and Bmal1. ET-1 excretion follows a diurnal rhythm along with sodium excretion. Sexual dimorphism is evident in the diurnal regulation of endothelin-mediated natriuresis and its downstream targets. …

Mitochondrial Priming Of Tumor Initiating Cells Involves Repression Of Mitochondrial Fission Activity Towards Redox Regulation Of The Cell Cycle Regulator Cyclin E, Brian Spurlock

All ETDs from UAB

Mitochondrial dynamics primarily refers to the opposing fission or fusion events between individual mitochondria, which maintains steady-state mitochondrial morphology in cells. Fission and fusion activities maintain the energetics of normal and neoplastic stem cells. We developed the novel approach mito-SinCe2 to study the bidirectional relationship between mitochondrial dynamics and energetics. Application of this method led to the hypothesis that mitochondria-dependent ovarian tumor initiating cells interconvert between 3 states with distinct mitochondrial energetics/dynamics relationships. Cells in one state, characterized by high mitochondrial ROS and low fission activity, appear to be primed for self-renewal by mitochondria. We call these cells mitochondria-primed stem …

Exploring The Roles Of Long Non-Coding Rnas In Glioblastoma Tumor Recurrence And Therapy Resistance, Christian Tyler Stackhouse

All ETDs from UAB

ABSTRACT Glioblastoma (GBM) is the most common and devastating primary CNS brain tumor with a median survival time of around 14 months. Most patients succumb to re-current disease which is often more malignant than the primary tumor and is frequently therapy resistant. There have not been significant advances in the treatment of GBM despite decades of research. This is partly due to the lack of accurate preclinical models and of the focus on primary rather than recurrent tumors. We created a 350 gene custom GBM-specific panel which contains 16 molecular signatures including molecular sub-typing signatures. We have demonstrated concordance of …

Role Of Endogenous Tau In Lewy-Like Pathology, Lindsay Stoyka

All ETDs from UAB

Lewy Body Diseases (LBDs) are a group of disorders characterized by intracellular inclusions of misfolded alpha-synuclein (α-synuclein). Of these, Parkinson’s Disease (PD) is the most common neurodegenerative movement disorder, and Dementia with Lewy Bodies (DLB) is the second most common neurodegenerative dementia. PD is characterized clinically by bradykinesia, resting tremor, rigidity, and postural instability. In addition, up to 80% of patients eventually develop dementia, termed Parkinson’s Disease Dementia (PDD). DLB is characterized by onset of dementia before or concurrently with parkinsonism. Currently, no disease-modifying therapies exist for either of these diseases. Lewy pathology is found in regions important for cognition …

Pheochromocytoma: A Systematic Review Of The Diagnosis, Treatment, And Risk Factors, Brandon A. Singletary

All ETDs from UAB

ABSTRACT Pheochromocytomas and extra-adrenal paragangliomas (PGLs) are forms of neuroendocrine tumors which when left untreated lead to debilitating complications of cerebral hemorrhaging, stroke, and death. Typically, the tumors present with symptoms of episodic headaches, sweating, and palpitations, however hypertension is considered one of the more predominant signs. As a result of the rarity of the disease and wide range of symptoms, there are often difficulties in screening and diagnosis to identify these tumors. While there are many case studies and results in small populations, large epidemiologic driven studies are limited. To date the majority of large-scale studies exist in countries …

Toxin Secretion By Mycobacterium Tuberculosis, Uday Tak

All ETDs from UAB

Mycobacterium tuberculosis (Mtb) is a highly infectious airborne bacterial pathogen, and the causative agent of human tuberculosis. Mtb infects approximately one-third of the human population, and is responsible for more deaths than any other infectious disease in the history of mankind. Mtb is an intracellular pathogen and primarily infects myeloid cells, such as macrophages in the human lung. In macrophages, Mtb establishes a replication niche within membrane-bound vacuoles named phagosomes, while subverting immunity. The intracellular survival of Mtb depends on manipulation of host cellular processes through secreted effector proteins. Ultimately, this intracellular vacuole is ruptured by the type VII secretion …

Calibration Of Periodontal Diagnosis Among Participants Of Various Dental Education Levels, Shadi Alkhoury

All ETDs from UAB

ABSTRACT: The purpose of this project is to assess the level of calibration among dental students of two different education levels and postgraduate students of two different dental specialties during diagnosis and treatment planning of clinical cases with various levels of periodontal involvement, using the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. Fifty-seven second year dental students (D2), 45 fourth year dental students (D4), 17 orthodontic postgraduate students (OS) and 12 postgraduate periodontology (PS) students were presented with an anonymous survey of 10 different cases, each with 5 choices of diagnosis and 7 therapeutic approaches. Consensus diagnosis was …

Exploring The Nursing Work Environment And Patient Outcomes Associated With Nurse-Reported Workplace Bullying: A Mixed Methods Study, Colleen Anusiewicz

All ETDs from UAB

Workplace bullying (WPB) in nursing is a workplace problem that can undermine the safety culture necessary to minimize adverse patient events and improve health care quality. Nurses continue to experience and report WPB despite a substantial and growing body of evidence reflecting the negative effects of WPB on nurses, published position statements and alerts, and the initiation of workplace violence policies and protocols. To decrease WPB and inform the development of effective anti-bullying interventions, there has been a shift in focus from individual factors and interpersonal relationships among nurses and health care workers to organizational factors that contribute to nurse-reported …

Understanding The Impact Of Diet And Obesity On Anti-Tumor Immunity And Therapeutic Efficacy In Kidney Cancer, Rachael Miller Orlandella

All ETDs from UAB

Obesity is regarded as a major risk factor for developing renal cell carcinoma (RCC). Advanced-stage RCC exhibits chemotherapeutic resistance, but is responsive to immunotherapies such as the immune checkpoint inhibitor anti-programmed cell death-1 (anti-PD-1). Despite some clinical successes, response rates remain low for anti-PD-1 monotherapy (20-30%). Preclinical evaluations of immunotherapeutic strategies typically use lean mice and do not account for patient comorbidities. This may explain the underwhelming success rates following clinical translation of new cancer treatments. Recent studies found that obesity was associated with favorable outcomes and responses to immunotherapy in melanoma. However, the effects of obesity on anti-tumor immunity …

Role Of Trib3 In Progression And Pathogenesis Of Diabetic Retinopathy, Priyamvada Milind Pitale

All ETDs from UAB

Diabetic retinopathy (DR) is reported to be one of the leading causes of blindness in the United States by Center for Disease Prevention and Control. As the estimated prevalence of the disease will likely triple by 2020, the research in this area should focus on identifying novel targets and therapeutic approaches. One of the therapeutic approaches for DR is the reprograming of retinal metabolism to delay the progression of the disease. The unfolded protein response (UPR) is recognized as a cellular pathway activated in diabetic retina which interacts with key transcription factors to physiologically regulate glucose, lipid homeostasis, and angiogenic …

Disease Specific Dysregulation Of Stat1 And Stat5 Activation In Mature Cd4+ And Cd8+ T Cells Influences Enhanced Kinetic Responses And Inflammation In Patients With Treatment-Naïve Relapsing Remitting Multiple Sclerosis (Rrms), Brandon Jay Pope

All ETDs from UAB

Autoimmunity is propagated through the lack of effective mechanisms of central and peripheral tolerance. In relapsing remitting multiple sclerosis (RRMS), dysregulated adaptive immune cells have been shown to contribute to disease morbidity through the influence of immune-modulating cytokines in the peripheral blood. Interleukin-2 (IL-2) is a cytokine with several key functions in regulating homeostatic mechanisms within the human immune system. Interferon gamma (IFNγ) is a type II interferon that is needed for an effective response to intracellular bacteria infection through the actions of Th1 cells. IL-2 and IFNγ signaling occurs primarily through signal transducer and activator of transcription (STAT) activation. …

Novel Hiv Adaptation Strategy Against Host Cd8 T Cell Immunity, Kai Qin

All ETDs from UAB

Since the 1980s, HIV infection has caused millions of death and tremendous economic losses worldwide. Despite great scientific advances, the only effective therapy to date, antiretroviral therapy (ART), merely delays disease progression yet cannot eradicate viral infection. Therefore, an effective HIV vaccine that can prevent the acquisition of infection would be a desirable alternative. The critical role of CD8 T-cell immunity in HIV infection has been well documented and therefore not surprisingly a great deal of effort has been focused on developing an effective CD8 T-cell based HIV vaccine. However, by far, such CD8 T-cell based HIV vaccine trials have …

Investigating The Roles Of The Renal Primary Cilium Through The Use Of Intravital Imaging, Dustin Zachary Revell

All ETDs from UAB

Primary cilia are small microtubule based appendages present on nearly every cell type in the mammalian body, and are highly conserved from organisms as simple as algae to humans. Cilia function as complex signaling centers integrating a variety of pathways and play critical roles throughout development and in maintaining homeostasis. Mutations to ciliary proteins in humans result in a wide array of diseases termed ciliopathies, which have a broad range of symptoms affecting nearly every organ in the body. Renal primary cilia are present on the apical side of tubular epithelium, where they project into the lumen and are thought …

Psychometric Evaluation Of A Perceived Barriers To Medication Adherence Instrument And Association Between Perceived Barriers And Patient Characteristics, Lynn Andreae

All ETDs from UAB

Medication adherence is an important component of diabetes management, yet nonadherence is common and has substantial patient and economic costs. In order to achieve meaningful improvements in medication adherence, clinicians and researchers need good ways of both identifying those at risk of nonadherence and ascertaining the specific reasons driving nonadherence in those patients. Current options for self-reported medication adherence are limited in their vulnerability to response bias, which may lead to overestimation of adherence. A measure that assesses perceived barriers to medication adherence may be a useful alternative, as it may identify patients at risk of nonadherence while reducing socially …

The Comparison Of Two Diabetes Self-Management Education Programs In The Reduction Of Patient A1c Levels, Edward Sharpless

All ETDs from UAB

This dissertation was a quasi-experimental research study exploring the effectiveness of two educational teaching methods with patients with diabetes. One teaching method utilized an education framework called the Conversation Map tools, a group-based, highly interactive learning experience using colorful visual tools, activity cards and sharing of real-life experiences. The other method was a traditional, lecture-style class taught by a health educator using overhead slides and handouts.

Secondary data from a regional health system in the Western U.S. was used to test the hypothesis that participants in the Conversation Map classes would report a larger drop in A1c levels compared to …

Assessment Of Emergency Department High Utilizer Program In Public Health System Setting, Michael Malaise

All ETDs from UAB

is study examined whether a case management model designed to reduce emergency department utilization among patients described as super-utilizers in a public health system could also reduce the per patient cost of those super-utilizers. The setting for this study was a large public health system in a major metropolitan area. The study focused on a low-income, urban population. Given the program’s stated desire to improve the self-efficacy of patients over time so that they could take more ownership of their own health status, this study reviewed the program within the framework of self-efficacy theory. This research predicted that the case …

Fixed And Variable Costs At Critical Access Hospitals, Jeremy J. Lyman

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Cost structures (the ratio of fixed to variable costs) vary across and within indus-tries. Hospital managers and policymakers can make better decisions when they under-stand cost structures, including marginal costs (the change in the total cost that arises when the quantity produced is increased by one unit). Although some studies have inves-tigated hospital cost structures, the results have been mixed and less than definitive, and very little attention has been given to critical access hospitals and marginal costs specifi-cally. Rural hospitals, including critical access hospitals, have increasingly experienced financial distress. Between 2005 and 2019, 159 rural hospitals closed across the …

Impact Of Ncqa Pcmh-Level On Low Income Diabetics In Louisiana, Michael G. Griffin

All ETDs from UAB

While past studies have examined the relationship between safety-net provider sites that are certified as Patient Centered Medical Homes (PCMH) and quality health care outcomes, no previous studies have evaluated the relationship between NCQA PCMH certification levels at primary care sites and quality health care outcomes. NCQA is the largest national certification program for PCMH, and for 10 years was the only national program that offered a tiered level of certification based on provider level of patient engagement and deployed resources. The Donabedian Model, which focuses on structure, process, and outcomes, was used to develop the theoretical framework to address …