Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons™

Open Access. Powered by Scholars. Published by Universities.®

All ETDs from UAB

Discipline
Keyword
Publication Year

Articles 931 - 960 of 2525

Full-Text Articles in Medicine and Health Sciences

Effect Of Antihypertensive Drugs On Left Ventricular Traits In Africam American, Anh N. Do Jan 2017

Effect Of Antihypertensive Drugs On Left Ventricular Traits In Africam American, Anh N. Do

All ETDs from UAB

The purpose of this dissertation is to evaluate the association of antihypertensive treatment as well genomic variants with left ventricular (LV) hypertrophy (LVH) -related traits among African Americans (AAs) in five cross-sectional epidemiology cohorts from the United States. AAs especially those with hypertension, are overburdened by left ventricular (LV) hypertrophy (LVH) compared to other ethnic groups. LVH is associated with increased risk for cardiovascular morbidity and mortality. Antihypertensive treatments have been found to improve LVH and related echocardiographic measures (i.e. LV traits) among hypertensive patients. However, the effect of antihypertensive treatments on LVH and related traits in AAs has not …


O-Acetyltransferase Functionality Mediates Pneumococcal Capsular Diversity, Brady Spencer Jan 2017

O-Acetyltransferase Functionality Mediates Pneumococcal Capsular Diversity, Brady Spencer

All ETDs from UAB

Streptococcus pneumoniae (pneumococcus) is an important human pathogen that asymptomatically colonizes the nasopharynx but can disseminate opportunistically to cause diseases such as otitis media, pneumonia, septicemia, or meningitis. The pneumo-coccal capsular polysaccharide is necessary to prevent opsonophagocytosis as nonencap-sulated pneumococci are largely avirulent. Currently, 98 antigenically distinct capsule types (serotypes) have been identified, which vary in virulence. O-acetylation, a subtle capsular modification, contributes to pneumococcal capsular diversity and modulates capsular physicochemical properties and interaction with innate or vaccine immunity. Replacement serotypes (and future vaccine types) 33F and 15B have O-acetylated capsules due to membrane-bound O-acetyltransferases (MOATs). We hypothesize that future …


Diabetes Risk In Women: Pschosocial And Lifestyle Determinants, Sarah Katherine Sweatt Jan 2017

Diabetes Risk In Women: Pschosocial And Lifestyle Determinants, Sarah Katherine Sweatt

All ETDs from UAB

Type 2 diabetes (T2D) is a major public health concern. Physical inactivity, poor diet, and psychosocial distress have emerged as factors contributing to T2D. Women may be uniquely affected by these factors as obesity, physical inactivity, and the prevalence of psychosocial distress are higher in women. Additionally, polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and increases the risk of both T2D and psychosocial distress. However, the relationship between physical activity (PA), psychosocial distress, and metabolic health is not fully understood, particularly in at risk populations such as minorities and women with PCOS. Therefore, the goal …


The Role Of Adipocytes And Osteocytes In Multiple Myeloma Progression, Timothy Nathan Trotter Jan 2017

The Role Of Adipocytes And Osteocytes In Multiple Myeloma Progression, Timothy Nathan Trotter

All ETDs from UAB

Multiple myeloma (MM) is a hematological malignancy of plasma cells that is intrinsically tied to the bone marrow (BM). Many cells in the BM microenvironment have been studied in MM, yet there is still much progress to be made. Recent work has revealed two new potential cellular targets in MM: adipocytes and osteocytes. Both are endocrine cells and secrete many molecules that regulate other cells proximally and systemically. Our lab previously showed that MM cells shift osteoblast precursor cells towards adipogenesis through soluble molecules alone. Recent findings also revealed that osteocyte apoptosis is enhanced in MM patients compared to healthy …


Statistical Tests For Confounding, Falynn Cartmill Turley Jan 2017

Statistical Tests For Confounding, Falynn Cartmill Turley

All ETDs from UAB

The use of propensity score methods have increased tremendously in the last several years. Propensity scores are used as a tool to correct the effects of confounding that can result in biased estimates of treatment effects. However, there is more than one method that employs propensity scores, and there is no guide in choosing the optimal method, in terms of Type I error and statistical power. This research aims to assess these attributes through a complex simulation study of a five variable model. The results of the simulations indicate performance of a particular propensity score method is dependent


Acute And Chronic Regulation Of Skeletal Muscle Mitochondrial Function, Jonathan Lund Warren Jan 2017

Acute And Chronic Regulation Of Skeletal Muscle Mitochondrial Function, Jonathan Lund Warren

All ETDs from UAB

Obesity and type 2 diabetes (T2D) represent a growing global burden on healthcare and financial resources. One hypothesis for the onset and exacerbation of these diseases is related to the role of mitochondria as the end users of products of the metabolism of the nutrients we consume and in mediating the oxidative state of the body through the production of reactive oxygen species (ROS). In order to meet the demands of a metabolic challenge and prevent excessive ROS production, there appear to be adaptations to mitochondrial physiology and morphology that can occur and we hypothesize that the ability of the …


Comparative Analysis Of New Techniques For Hearing Conservation Program Selection, Laura Hurst Jan 2017

Comparative Analysis Of New Techniques For Hearing Conservation Program Selection, Laura Hurst

All ETDs from UAB

Hazardous noise is a widespread problem in industry and recreation. Noise induced hearing loss is one of the most frequently reported occupational health claims worldwide. While there has been much research on noise, its effects, and how to prevent hearing loss in industry, there is limited research available to help quantify the difference that monitoring noise at a lower threshold might create in the measured exposure estimate. Additionally, the studies involving the use of different noise monitoring settings do not attempt to explain how the results might change the outcomes when using data and statistical techniques to classify similar exposure …


Alternative Methodological Approaches For Quantifying Dental Caries And Non-Water Beverage Consumptions For The Improvement Of Caries Risk Analyses In Children, Kelsey Harris Jordan Jan 2017

Alternative Methodological Approaches For Quantifying Dental Caries And Non-Water Beverage Consumptions For The Improvement Of Caries Risk Analyses In Children, Kelsey Harris Jordan

All ETDs from UAB

Researchers assume caries progress constantly, all crowned/extracted tooth surfaces are carious, and non-water beverage consumption (NWBC) habits are similar by relying on increments, dmfs scoring, and consumption frequencies, respectively. These assumptions are likely inaccurate. The purpose of this research was to evaluate and modify the use of 1) longitudinal caries disease assessment, 2) the dmfs score and 3) NWBC variables to more accurately estimate disease and identify risk factors. To investigate, young (8-18 months at baseline), healthy, poor, rural, African American, Alabamian children were observed annually for five years. Three calibrated dentists performed oral examinations (without radiographs), calculating the number …


Bioactive Materials: Ion Release, Flexural Strength, Secondary Caries Depth And Elemental Analysis Of Surrounding Tooth Structure, Prajakta Shreeram Kulkarni Jan 2017

Bioactive Materials: Ion Release, Flexural Strength, Secondary Caries Depth And Elemental Analysis Of Surrounding Tooth Structure, Prajakta Shreeram Kulkarni

All ETDs from UAB

ABSTRACT Objectives: Bioactive materials release calcium, phosphate, and fluoride which may increase tooth remineralization. But limited data is available demonstrating the superiority of bioactive or ion releasing materials compared to fluoride or no ion releasing materials. The aims of the present study are to measure and compare the calcium, fluoride, and phosphate ion release at different pH, flexural strength and caries protecting ability of the materials including the ion uptake of surrounding tooth structure. Methods: Activa, Cention N, Fuji LC II and Filtek Supreme Ultra were the restorative materials tested. Firstly, the fluoride and calcium release of these materials was …


Teleexercise For People With Disabilities, Byron Lai Jan 2017

Teleexercise For People With Disabilities, Byron Lai

All ETDs from UAB

Exercise is recognized as a method of improving health and function and preventing deconditioning for adults with neurological disabilities. However, they experience a multitude of barriers that prevent them from regular participation in exercise. To address these barriers, the goal of this dissertation was to explore the use of monitoring technology as a means for delivering exercise to adults with neurological disabilities at home. This pursuit involved three studies. The first study reviewed the extant literature for current trends in exercise interventions for people with disabilities. Regarding technology, the review indicated that technology is rarely used to deliver one-on-on supervised …


The Role Of Klotho In Adult Neurogenesis, Ann Laszczyk Jan 2017

The Role Of Klotho In Adult Neurogenesis, Ann Laszczyk

All ETDs from UAB

Klotho is an anti-aging protein that when upregulated, extends lifespan and enhances cognition. Klotho knockout mice age prematurely and die by ~8 weeks of life after developing cognitive impairment. Klotho function outside of the brain is well established but the protein’s action within the brain remains unknown. As klotho regulates peripheral stem cell populations, I sought to determine whether klotho contributes to cognition through a role in the maintenance of the adult hippocampal neurogenic niche. I examined adult mouse neurogenesis using global klotho-deficiency or global klotho overexpression models. Klotho knockout brains show reduced progenitor proliferation and granule cell production while …


Sample Size Re-Estimation For Confirmatory Two-Stage Multi-Arm Trials With Normal And Binary Outcomes, Yan Li Jan 2017

Sample Size Re-Estimation For Confirmatory Two-Stage Multi-Arm Trials With Normal And Binary Outcomes, Yan Li

All ETDs from UAB

Multi-arm clinical trials comparing several treatments against a common control are more efficient than traditional multiple two-arm trials. Several flexible multi-arm designs which utilize the closed test procedure for strong familywise error rate control have been proposed to allow treatment selection and sample size re-estimation (SSR) at the interim analysis. Because of the interdependence among hypothesis tests for each treatment induced by the closed test procedure, SSR methods for two-arm trials are not directly applicable to multi-arm trials. Further, there is limited literature on methods for SSR in multi-arm trials. In paper 1, we derive SSR procedures based on the …


A Statistical Approach To Computed Tomography Perfusion, Seth Thomas Lirette Jan 2017

A Statistical Approach To Computed Tomography Perfusion, Seth Thomas Lirette

All ETDs from UAB

Stroke is, and will continue to be, a pervasive problem in the both the United States and across the world, and computed tomography (CT) perfusion scanning will continue to be a first-line diagnostic tool to quantify where and how much blood flow occlusion is present in the brain. CT perfusion maps displaying several scalar perfusion parameters for each brain voxel will continue to be used by radiologists and other clinicians. The goal of this dissertation is to examine and improve upon current standards of practice concerning CT perfusion. We first exhibit how software that constructs perfusion maps can be implemented …


Univariate Frailty Model For Competing Risks Data Analysis, Yuliang Liu Jan 2017

Univariate Frailty Model For Competing Risks Data Analysis, Yuliang Liu

All ETDs from UAB

Unobserved individual heterogeneity, that is frailty, is a major concern in the application of analysis for competing risks data. Unlike the study of clustered competing risks data using multivariate frailty models, we have not found a study of non-clustered competing risks data using univariate frailty model. This dissertation focuses on developing frailty models for the analysis of non-clustered competing risks data. The estimation of the effects of covariates by a parametric univariate frailty model could be a useful approach when heterogeneity must be considered in the non-clustered competing risks setting. In paper 1, we compared the performance of the Cox, …


Circulating Mirnas And Human Insulin Resistance, Elizabeth Ma Jan 2017

Circulating Mirnas And Human Insulin Resistance, Elizabeth Ma

All ETDs from UAB

Insulin resistance (IR) is central to the pathophysiology of Type 2 diabetes (T2DM), and is a risk factor for cardiovascular disease. The mechanisms behind IR are not clear, but microRNA (miR; short, non-coding RNA strands that base-pair with mRNA to modify gene expression) have garnered interest as potential contributors. miRs have recently been shown to be detectable in the circulation, and can be taken up and regulate target genes within recipient cells. Our primary objective was to identify circulating miRs (c-miRs) that play a role in regulating systemic metabolism and participate in the pathophysiology of IR and cardiometabolic disease. Three …


Formaldehyde Emissions From Laminate Flooring, Stephanie Latisha Marzette Jan 2017

Formaldehyde Emissions From Laminate Flooring, Stephanie Latisha Marzette

All ETDs from UAB

In recent years, several incidents have caused public concern about the levels of formaldehyde present in residential homes. It is one of the most prevalent and regularly detected pollutants in an indoor environment. This is due to the presence of formalde-hyde in many common products, such as household cleaners and paints, as well as build-ing materials. Formaldehyde exposure can lead to sore throat, coughing, eye and airway irritation, and increased occurrences of asthma symptoms. Due to the public health con-cerns, this research was designed to investigate the distinctive nature of formaldehyde emissions from laminate flooring and test the reliability of …


The Effects Of Nurse-Manager Relationships And Nurse-Physician Collaboration On Nurse Intent To Leave, Phillip John Mazzuca Jan 2017

The Effects Of Nurse-Manager Relationships And Nurse-Physician Collaboration On Nurse Intent To Leave, Phillip John Mazzuca

All ETDs from UAB

ABSTRACT Aim. The aim of this study was to determine whether two relational aspects of the nurse work environment – perceived quality of the nurse-supervisor relationship and nurse-physician collaboration – might reduce nurse intent to leave the hospital. Background. There is a documented global shortage of nurses which is a pressing issue in U.S. hospitals. The nursing shortage has been exacerbated by a high rate of voluntary nursing turnover in U.S. hospitals which is costly and has previously been found to negatively impact patient care. Factors associated with the nursing work environment have been found to be important predictors of …


The Association Between Cancer And Risk Of Sepsis Among Whites And Blacks In The Regards Cohort, Justin Xavier Moore Jan 2017

The Association Between Cancer And Risk Of Sepsis Among Whites And Blacks In The Regards Cohort, Justin Xavier Moore

All ETDs from UAB

Cancer is the second leading cause of morbidity and death in the United States corresponding to more than 1.7 million incident cases and responsible for more than 550,000 deaths annually. In addition, hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to participants with no cancer history. As treatments and therapies for cancer continue to improve, the average 5-year survival is approaching 70% overall among the US population; however, to date there is very limited research that has examined the association between patients with a history of cancer and future risk of sepsis among a …


Alterations In Ubc9 Substrate Specificity Affect The Cellular Response To Dna Damage, Joshua Enyeribe Onuiri Jan 2017

Alterations In Ubc9 Substrate Specificity Affect The Cellular Response To Dna Damage, Joshua Enyeribe Onuiri

All ETDs from UAB

This dissertation seeks to uncover the impact of a post-translational modification, the small ubiquitin-related modifier (SUMO), on the cell response to DNA damage. Covalent modification of cellular proteins by SUMO occurs through an enzymatic cascade involving an E1 activating enzyme, an E2 conjugating enzyme, and a ligase (E3). Eukaryotic cells possess a single E1 and a single E2 for SUMO conjugation. The E2 for SUMO, Ubc9, is able to recognize and modify substrates on its own, although substrate recognition and modification are enhanced in the presence of the E3. Two independent genetic screens carried out in the budding yeast Saccharomyces …


The Role Of Macrophages In Pressure-Overload Induced Cardiac Remodeling, Bindiya Dinesh Patel Jan 2017

The Role Of Macrophages In Pressure-Overload Induced Cardiac Remodeling, Bindiya Dinesh Patel

All ETDs from UAB

Cardiac pressure-overload is a state of increased hemodynamic load and is initially characterized by concentric left ventricular (LV) hypertrophy, but can transition to eccentric hypertrophy and adverse LV remodeling leading to heart failure (HF). Cardiac remodeling during pressure-overload is accompanied by dysregulated collagen deposition, cardiomyocyte hypertrophy, and increased inflammatory signaling. Both clinical and preclinical studies have documented increased expression of inflammatory cytokines and leukocyte infiltration in the pressure-overloaded heart, indicating inflammatory mechanisms are active during cardiac remodeling. Despite the well-known link between leukocyte infiltration and exacerbated tissue injury, the role of innate immune cells, particularly monocytes, macrophages and dendritic cells, …


Investigating Phenotypic Severity Associated With Sister Chromatid Cohesion Defects In Human Disease, Stefanie Marie Percival Jan 2017

Investigating Phenotypic Severity Associated With Sister Chromatid Cohesion Defects In Human Disease, Stefanie Marie Percival

All ETDs from UAB

INVESTIGATING PHENOTYPIC SEVERITY ASSOCIATED WITH SISTER CHROMATID COHESION DEFECTS IN HUMAN DISEASE STEFANIE M. PERCIVAL GRADUATE BIOMEDICAL SCIENCES ABSTRACT Sister chromatid cohesion (SCC) is a process that utilizes a proteinaceous ring, cohesin, for accurate chromosome segregation. An essential process in S phase termed cohesion establishment is necessary to stabilize cohesin rings around sister chromatids. Mutations in establishment of cohesion homolog 2 (ESCO2), a protein essential for cohesion establishment, cause a developmental disorder called Roberts Syndrome (RBS). Cytogenetic analysis in patients reveals heterochromatic repulsion (HR), a centromeric puffing, indicative of cohesion defects. The severity of phenotypes varies from preterm lethal to …


Elucidating The Physiologic And Prognostic Significance Of N-Myc And Stat Interactor Using Models Of Mammary Development And Metastasis, Hawley Christine Pruitt Jan 2017

Elucidating The Physiologic And Prognostic Significance Of N-Myc And Stat Interactor Using Models Of Mammary Development And Metastasis, Hawley Christine Pruitt

All ETDs from UAB

Distant metastasis of breast carcinoma reduces the five year survival rate of patients from 90% to a dismal 25%. Although the metastatic cascade has been extensively studied for decades, players that influence the progression of metastatic disease remain elusive. N-MYC and STAT Interactor (NMI) is a gene previously demonstrated by Devine et. al. to be downregulated with metastatic progression of breast cancer. However, due to the lack of a relevant genetic model, details of biological consequence of the loss of expression of this gene were unknown. We have constructed and characterized a mammary specific Nmi knock out mouse to elucidate …


Structure/Function Studies Of Yersinia Pestis Metal Transport Systems, Christopher David Radka Jan 2017

Structure/Function Studies Of Yersinia Pestis Metal Transport Systems, Christopher David Radka

All ETDs from UAB

The largest market sector of the global antibiotics industry is on the verge of becoming obsolete because the incidence of β-lactam antibiotic resistance in the clinic continues to rise. Therefore, we are in dire need of new therapeutics to address the increasing threat of antibiotic resistance. Novel targets that could lead to a new drug class are ABC (ATP-binding cassette) importers, which are only found in bacteria. The substrate-binding protein (SBP) components of these transporters present an intriguing subject of study because of their abundance in the cell and potential roles in infection. As a contribution to the scholarship of …


Effective Recruiting For Subgroups In The Systolic Blood Pressure Intervention Trial (Sprint), Thomas Marshall Ramsey Jan 2017

Effective Recruiting For Subgroups In The Systolic Blood Pressure Intervention Trial (Sprint), Thomas Marshall Ramsey

All ETDs from UAB

EFFECTIVE RECRUITING FOR SUBGROUPS IN THE SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL (SPRINT) THOMAS MARSHALL RAMSEY HEALTH EDUCATION / HEALTH PROMOTION ABSTRACT Background: The Systolic Blood Pressure Intervention Trial (SPRINT) recruitment focused on participants > 50 years old with systolic blood pressure of > 140 mm Hg (hypertension) with no evidence of diabetes or previous stroke. Priority participants were targeted in non-clinical subgroups (women and minorities) as well as three clinical subgroups (pre-existing cardiovascular disease, pre-existing chronic kidney disease, > 75 years old). Objective: The objective of this secondary analysis is to determine which of the five recruiting strategies was most effective? Which recruitment …


Uncovering The Role Of Common Gamma-Chain Cytokines In Aspergillus Fumigatus Associated Diseases, Kristen Marie Reeder Jan 2017

Uncovering The Role Of Common Gamma-Chain Cytokines In Aspergillus Fumigatus Associated Diseases, Kristen Marie Reeder

All ETDs from UAB

Fungal pathogens contribute to a wide range of diseases that are largely dependent on the host’s immune state. In the case of immune suppression, Aspergillus fumigatus is the causative agent of invasive aspergillosis. Furthermore, asthmatics sensitized to fungi such as Aspergillus fumigatus are reported to have more severe asthma. We have previously described a role for IL-22 in mouse models of invasive aspergillosis and fungal asthma. IL-22 was found to play a protective role in invasive aspergillosis, while it was found to play an immunopathogenic role in asthma. Here we describe the cell sources of IL-22 in both models. We …


Striatal Acetylcholine And Dopamine Modulation In A Mouse Model Of Dyt1 Dystonia, Chelsea Zimmerman Jan 2017

Striatal Acetylcholine And Dopamine Modulation In A Mouse Model Of Dyt1 Dystonia, Chelsea Zimmerman

All ETDs from UAB

DYT1 dystonia is a neurological movement disorder characterized by sustained muscle contractions causing twisting and repetitive movements or abnormal posture. While many movement disorders are due to loss of neurons, DYT1 dystonia does not present with any gross abnormalities. As of now, the most common form of treatment is anticholinergics. Since anticholinergic are the most effective pharmacotherapy and “paradoxical excitation” has been shown in when quinpirole, D2R agonist, is bath applied on cholinergic interneurons, we began by examining acetylcholine efflux in a DYT1 knock-in mouse model. Our studies provide evidence that at basal levels, there is a hypercholinergic state present …


Correlation Of Preoperative Analysis Of Cbct Gray Value With Implant Primary Stability, Luis Gerardo Guzman Suarez Jan 2017

Correlation Of Preoperative Analysis Of Cbct Gray Value With Implant Primary Stability, Luis Gerardo Guzman Suarez

All ETDs from UAB

Objective: This study aims to investigate the correlation between the gray values (GV) of Cone Beam Computed Tomography (CBCT) analyzed by two commonly used implant planning software (coDiagnostiX, and Simplant®) and the primary stability of dental implants by measuring insertion torque value (ITV) and Resonance Frequency Analysis (ISQ). Materials and Methods: Thirty-eight patients planned to receive a total of 102 dental implants (Straumann Bone Level Tapered) were enrolled in the study. At time of implant placement, ITV in Ncm with a Bien-Air iChiropro implant console, resonance frequency analysis (ISQ) with an Osstell device, and the surgeon’s estimated torque of placement …


Volumetric Analysis Of The Lips In Aging African American And Caucasian Males, Matthew Steven Leftwich Jan 2017

Volumetric Analysis Of The Lips In Aging African American And Caucasian Males, Matthew Steven Leftwich

All ETDs from UAB

VOLUMETRIC ANALYSIS OF THE LIPS IN AGING AFRICAN AMERICAN AND CAUCASIAN MALES DEPARTMENT OF ORTHODONTICS ABSTRACT The purpose of this cross sectional study was to analyze the volumetric changes in lip volume with respect to aging in a population of African American and Caucasian males using three-dimensional imaging technology. Materials and Methods: A sample size of 102 Caucasian males and 90 African American males with balanced faces divided into five age groups distributed as follows:[20-30], [31-40], [41-50], [51-60], [61-70[.Three-dimensional images were obtained using the 3dMDfaceTM camera system. The subjects were placed in front of the camera in natural head position …


Type I Myofiber Grouping: Myofiber Phenotype And Implications For Muscle Performance In Older Adults And Parkinson Disease, Kelley Grace Hammond Jan 2017

Type I Myofiber Grouping: Myofiber Phenotype And Implications For Muscle Performance In Older Adults And Parkinson Disease, Kelley Grace Hammond

All ETDs from UAB

Neuromuscular morphology and function undergo changes with increasing age and Parkinson disease (PD) pathology. Motor unit reorganization occurs by denervation-reinnervation events which lead to diminishing random distribution of myofibers and type I myofiber grouping. Grouped type I myofibers maintain type II features such as hypertrophic capacity and myonuclear addition, sarco(endo)plasmic reticulum Ca2+ ATPase 1 expression, and lower capillarization. Though age-related type I myofiber grouping has been qualitatively described in the literature, this was the first study to characterize the phenotype of grouped type I myofibers in older adults. Furthermore, we identified a magnified degree of type I myofiber grouping in …


Behavioral Markers Of Supraspinal Pain In Clinically Relevant Models Of Spinal Cord Injury, Kathryn Yamamoto Henley Jan 2017

Behavioral Markers Of Supraspinal Pain In Clinically Relevant Models Of Spinal Cord Injury, Kathryn Yamamoto Henley

All ETDs from UAB

The majority of people suffering from neuropathic pain as a result of a spinal cord injury (SCI) do not experience effective pain relief with currently available therapeutics. One aspect of preclinical studies that may be limiting the development of successful analgesics is the assessment of pain in animal models of SCI. Previous work has relied primarily on withdrawal reflexes to indicate pain; however, there is evidence that suggests this is an inadequate measure of pain sensation as spinal reflexes do not reflect the supraspinal processing of nociceptive information. The use of withdrawal responses is especially challenging in the context of …