Medicine and Health Sciences Commons^™

Protein Aggregation Through Acoustic Cavitation, John A. Giarratano

Electronic Theses and Dissertations

Therapeutic proteins represent an essential piece of a health management plan for diseases such as diabetes, cancer, hemophilia, Crohn's Disease, and myocardial infarction. These proteins, however, must be maintained in their correct, biologically active conformation throughout processing, transportation, and delivery. This requirement poses serious engineering challenges because of a protein's susceptibility to thermodynamic instabilities resulting from the weak bonds driving the tertiary structure of the molecule. A particularly problematic type of protein degradation is aggregation. Administration of aggregated proteins, a particularly problematic degradation form, can have dire consequences, including blocking a patient's responsiveness to therapy, inducing immunogenicity, and even anaphylactic …

Healthcare Technology: A Strategic Approach To Medical Device Management, Chad A. Kinley

Electronic Theses and Dissertations

The constant evolution of medical technology has increased the demand for managing medical devices to ensure safety and effectiveness. In this paper I will investigate how biomedical engineering has addressed the issue of equipment management and identifies strategies to successfully maintain an inventory of medical devices. Through research, on-the-job experience, and in-depth discussions with various biomedical engineering managers, I have been able to document possible equipment strategies and best practices for managing medical devices. There is really no "one size fits all" to medical equipment management due to the various clinical environments, but there are many aspects that remain necessary …

A Measurement Of Readiness For Tennessee Hospitals To Implement “Meaningful Use” Criteria Resulting From The American Recovery And Reinvestment Act, 2009, Kathryn Wallin Wilhoit

Electronic Theses and Dissertations

In 2009, the American Recovery and Reinvestment Act was signed into law. This legislation provided for monetary rewards for those acute-care hospitals that meet "meaningful use" computerization and reporting criteria.

The study used a descriptive, nonexperimental design to answer three research questions (1) What is the level of readiness to meet "meaningful use" criteria in the Tennessee Hospital Association (THA) member hospitals; (2) What is the level of readiness to meet "meaningful use" criteria in the rural THA member hospitals; and (3) Is there a difference in the readiness to meet "meaningful use" criteria between rural and urban THA member …

A Consensus Model For Electroencephalogram Data Via The S-Transform, Andrew Coady Young

Electronic Theses and Dissertations

A consensus model combines statistical methods with signal processing to create a better picture of the family of related signals. In this thesis, we will consider 32 signals produced by a single electroencephalogram (EEG) recording session. The consensus model will be produced by using the S-Transform of the individual signals and then normalized to unit energy. A bootstrapping process is used to produce a consensus spectrum. This leads to the consensus model via the inverse S-Transform of the consensus spectrum. The method will be applied to both a control and experimental EEG to show how the results can be used …

The Effects Of Nicotine Administration On Behavior And Markers Of Brain Plasticity In A Rodent Model Of Psychosis, Marla K. Perna

Electronic Theses and Dissertations

Schizophrenia affects about 1% of the population. A hallmark of the disorder is increased dopamine D2 receptor sensitivity in the brain. Studies have shown that schizophrenics smoke cigarettes at approximately 4 times the rate of the general population. It has been suggested that nicotine use is a form of self-medication for symptoms in schizophrenia. Smoking behaviors typically begin in adolescence. We assessed effects of nicotine on behavior and brain plasticity in an adolescent rodent model of schizophrenia with the goal of identifying targets for smoking cessation. Methods: Rats were neonatally treated with quinpirole (a D2/D3 agonist) or saline and sensitized …

Effects Of Burn Injury On Biological Ethanol And Ethyl Glucuronide Concentrations, Trista Haupt Wright

Electronic Theses and Dissertations

Alcohol is the most abused drug in the United States and most frequently performed assay in forensic laboratories. Alcohol is routinely present in biological specimens from fatal residential fires and forensic toxicologists must interpret if these individuals are impaired by determination of their blood alcohol concentrations on post-incineration blood collected at autopsy. There is no known data available to confirm or refute blood alcohol concentrations and impairment in fire-related deaths. Ethyl glucuronide (EtG), a non-volatile minor ethanol metabolite, may provide a better biomarker for ethanol consumption prior to burn injury. The literature does not address the possibility that ethanol or …

Exploring The Unique Characteristics Of Cancer In Adolescents And Young Adults In Tennessee, Megan Quinn

Electronic Theses and Dissertations

Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the medical and health fields, resulting in a lack of progress for this age group. Little is known about the unique biologic, epidemiologic, and psychosocial issues that play an integral role in the AYA cancer journey. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine 1) the main types of cancer that affect AYAs in TN, 2) the predictors of late-stage diagnosis of melanoma, and 3) the factors that predict a total thyroidectomy …

Stabilization Of The Cardiac Nervous System During Cardiac Stress Induces Cardioprotection, David D. Gibbons

Electronic Theses and Dissertations

The cardiac nervous system consists of nested reflex feedback loops that interact to regulate regional heart function. Cardiac disease affects multiple components of the cardiac nervous system and the myocytes themselves. This study aims to determine: 1) how select components of the cardiac nervous system respond to acute cardiac stress, including myocardial ischemia (MI) and induced neural imbalance leading to cardiac electrical instability, and 2) how neuromodulation can affect neural-myocyte interactions to induce cardioprotection. Thoracic spinal cord stimulation (SCS) is recognized for its anti-anginal effects and ability to reduce apoptosis in response to acute MI, primarily via modulation of adrenergic …

Approaches In The Treatment Of Parkinson's Disease : A Focus On Stem Cell-Based Therapies., Tareq Al-Maqtari 1979-

Electronic Theses and Dissertations

Parkinson's disease (PD) is a hypokinetic movement disorder resulting from the progressive neurodegeneration of the dopaminergic nigrostriatal system in the brain and the resulting imbalance between dopamine and acetylcholine in the basal ganglia motor circuitry. Although drug-based therapy approaches have shown dramatic symptomatic improvement in patients, they do not halt the progressive nature of the disease and their long-term use is associated with distressing adverse side effects. Consequently, several studies have aimed at discovering effective non-pharmacological strategies to reduce or to eliminate the need for drugs and possibly to halt or to reverse the neurodegenerative process in PD. Surgical deep …

Prelamin A Influences A Program Of Gene Expression In Regulation Of Cell Cycle Control, Christina N. Bridges

Electronic Theses and Dissertations

The A-type lamins are intermediate filament proteins that constitute a major part of the eukaryotic nuclear lamina—a tough, polymerized, mesh lining of the inner nuclear membrane, providing shape and structural integrity to the nucleus. Lamin A (LA) filaments also permeate the nucleoplasm, providing additional structural support, but also scaffolding numerous tethered molecules to stabilize, organize, and facilitate molecular interactions to accomplish critical functions of cellular metabolism. Over the past 2 decades, much attention has been focused on roles of LA in maintenance of nuclear structural integrity. Only since the late 1990s have scientists discovered the devastating effects of LA gene …

Influence Of Soil Microorganisms On Plant Growth And Fitness, Benjamin Jayne

Electronic Theses and Dissertations

Most terrestrial plants benefit from symbiosis with soil microorganisms. Symbiotic bacteria and fungi have wide-ranging effects on host plants, including improved nutrition, disease resistance, and drought tolerance. Association with Arbuscular Mycorrhizal Fungi (AMF) can enhance growth and protect plants from environmental stressors while they share products of photosynthesis with the resident fungi. Scores of studies indicate that mycorrhizal plants are more resistant to drought stress than their non-mycorrhizal counterparts. Use of microbes as a plant and soil supplement in home gardens represents a sustainable alternative to resource-intensive inputs and may allow for reduced water use. I investigated the effects of …

The Self-Described Experience Of Coping And Adaptation Associated With Workplace Stress Of Registered Nurses In The Acute Care Setting In Florida: An Ethnographic Study, Joyce Burr

Electronic Theses and Dissertations

Little is known about how nurses learn and use coping and adaptation skills in the workplace. Quantitative studies have identified the factors, nature, and outcomes of nursing stress. However, qualitative studies describing the human experience associated with workplace stress are lacking. The phenomenon of interest for this study using focused ethnographic method is the self-described experience of coping and adaptation associated with workplace stress of registered nurses working 12-hour shifts employed in acute care hospital facilities in east central and central Florida. Three aspects of the phenomena were examined: the self-described experiences of stress, the manner in which coping skills …

Phytochemical Studies On The Medicinal Plant Sutherlandia Frutescens, Xiang Fu

Electronic Theses and Dissertations

Sutherlandia frutescens (L.) R. Br (Fabaceae) is a multipurpose medicinal plant with diverse biological activities, and has been widely used for the treatment of cancer, AIDS, diabetes, and infectious diseases in southern Africa. The primary goal of this study was to investigate the chemical constituents of S. frutescens and develop an analytical method to analyze this plant and the dietary supplements derived from this plant. The dissertation is composed of six chapters. Chapter 1 introduces the general background of S. frutescens, including traditional uses and chemical and biological studies on the plant. Chapter 2 describes the phytochemical studies that have …

Pharmaceutical Formulation Development Utilizing Hot Melt Extrusion And Other Techniques For Development Of Immediate And Controlled Release Dosage Forms, Noorullah Naqvi Mohammed

Electronic Theses and Dissertations

Hot melt extrusion (HME) was evaluated as a processing technology for the manufacture of immediate as well as controlled release formulations for oral delivery of two model compounds. For immediate release applications lower molecular weight grades of Hydroxypropyl cellulose polymers, EF and ELF, were utilized as carrier matrices to form solid solutions of a poorly soluble compound, Ketoprofen (KPR). Thermal characterization techniques were used to confirm thermal stability, miscibility and setting up processing conditions for extrusion. Extruded matrices were pelletized to be filled into pellets or further milled and compressed into tablets. Pellets exhibited a carrier dependent release with ELF …

Effects Of Off-Label Prescribing On Patient Decision Making, Douglas Paul

Electronic Theses and Dissertations

Objectives: Despite the comuse of off-label prescribing in the US, no research has been conducted to understand the impact of off-label prescribing on patient decision making. This study sought to measure the impact on trust in physicians, intentions of involvement in the decision making, beliefs about the drug, and initial compliance intentions in elderly and nonelderly populations. Methods. This study was designed to assess the effects of off-label prescribing using a 2 × 2 × 2 design. Using an online panel, 830 consumers were surveyed, 409 elderly and 421 nonelderly, using 8 different scenarios based on disease criticality, off-label use …

Functional Studies Of Novel Bioactives From Complex Host-Microbiomes As Drug Leads For Cancer, Infectious Disease, Depression And Pain, John Jason Bowling

Electronic Theses and Dissertations

The drug discovery process has become increasingly complex in comparison to early efforts particularly those involving diseases or conditions that affect large numbers of the human population. It is difficult to point directly to one factor leading evolution of the process but the definition of a mechanism of pharmacological action for a drug lead has noticeably become a higher priority. This evolution has helped diminish the stigma of natural products and compound supply issues. The issue of compound supply has also been addressed to some extent with the emergence of recombinant technologies and new synthetic methodology. With approximately 60 years …

The Effects Of A Multi-Component Wellness Program On Employee Biometrics, Jennifer Erin Patrick

Electronic Theses and Dissertations

Corporate wellness initiatives are gaining momentum as a critical indicator of business performance. Metabolic Syndrome is commonly used within corporations to assess the health of their employees and estimate potential healthcare costs. Using five risk factors (blood pressure, high density lipoprotein (HDL-C), triglycerides (TG), fasting blood glucose, and waist circumference) individuals with three or more risk factors are classified as having Metabolic Syndrome. Voluntary pre and post health screenings were conducted at a rural manufacturing plant. A multi-component wellness program was conducted over six months to determine if the program would have significant beneficial effects on employee biometrics and Metabolic …

An Evaluation Of Medicaid Programs Using Medication Use-Related Quality Measures, Vennela Thumula

Electronic Theses and Dissertations

Objective: To assess quality of care provided to Medicaid beneficiaries using medication use-related quality indicators. Methods: This study is a retrospective analysis of 2006 & 2007 Medicaid administrative claims data from 45 states and DC. Eleven medication use-related measures (adherence/persistence and standard of care) from the AHRQ initial core set were included. A composite measure of medication use-related quality was also created. Patient case-mix adjusted measure scores were computed using hierarchical logistic regression models. States were ranked on both case-mix adjusted and unadjusted scores and categorized into top (?20%), medium (60%) and bottom (?20%) performers. Agreement in rankings and groups …

The Effect Of Exercise On Mechanical Pressure Pain Threshold In The Presence And Absence Of Delayed-Onset Muscle Soreness, Brandon Tynes

Electronic Theses and Dissertations

Research has shown decreased pain sensitivity (hypoalgesia) during and following maximal and sub-maximal isometric exercise (Koltyn, 2002). Research on fibromyalgia patients however has shown the same exercises increase pain sensitivity (hyperalgesia) (Staud, Robinson, & Price, 2005; Kosek, Ekholm, & Hansson, 1996). The purpose of the present study was to examine the effects of exercise on pressure pain thresholds (PPT) in the presence and absence of delayed-onset muscle soreness (DOMS) within the ipsilateral (contracting) and contralateral quadriceps muscle and plurisegmental finger. Data were collected using twenty-five male participants (aged 18-29) over five testing days: two days of familiarization, one day of …

Isolation, Structure Elucidation And Biological Evaluation Of Natural Products From Plants And Fungi, Xiaoning Wang

Electronic Theses and Dissertations

Natural products have provided considerable value for drug discovery over the past half-century. Nearly four fifth of drugs were natural products or inspired by natural compounds. Bioactive secondary metabolites isolated from natural source, either fungal or terrestrial, are relatively safer for human health and the environment and can serve as drug or as drug leads for the development of synthetic or semi-synthetic analogs. Natural products have also been successfully used in agriculture as plant growth regulators, signal transductions, fungicides, herbicides and tranquilizers. In our continued efforts to identify bioactive compounds, seventy-seven plant and fungal extracts were evaluated using a direct-bioautography …

Antileishmania Compounds From An Unidentified Endophytic Fungus And Biotransformation Of 5,7,2`,4`,5`-Pentahydroxyflavonol, Ahmed Idris

Electronic Theses and Dissertations

Leishmaniasis is a parasitic disease remaining a major public health problem. It causes illness and death especially in developing countries. Comchemotherapeutic agents currently used are often inadequate, requiring long courses of parenteral administration, having toxic side effects or becoming less effective due to the emergence of resistant strains. Thus, there is an urgent need for new, effective, and inexpensive drugs. In the fight against leishmaniasis, natural products are important sources of novel therapeutic agents. The goal of our research is to study secondary metabolites from endophytic fungi as a source of effective antileishmanial agents. Many crude extracts from endophytic fungi …

Discovery Of Novel Glycogen Synthase Kinase-3beta Inhibitors: Molecular Modeling, Virtual Screening, And Biological Evaluation, Gang Fu

Electronic Theses and Dissertations

Glycogen synthase kinase-3 (GSK-3) is a multifunctional serine/threonine protein kinase which is engaged in a variety of signaling pathways, regulating a wide range of cellular processes. Due to its distinct regulation mechanism and unique substrate specificity in the molecular pathogenesis of human diseases, GSK-3 is one of the most attractive therapeutic targets for the unmet treatment of pathologies, including type-II diabetes, cancers, inflammation, and neurodegenerative disease. Recent advances in drug discovery targeting GSK-3 involved extensive computational modeling techniques. Both ligand/structure-based approaches have been well explored to design ATP-competitive inhibitors. Molecular modeling plus dynamics simulations can provide insight into the protein-substrate …

Geographic And Host-Microbe Symbiotic Influence On Secondary Metabolism, Samuel Hamed Abbas

Electronic Theses and Dissertations

This thesis is composed of studies that regard the advancement to the Arctic region and the importance of host-microbe interactions in natural product discovery. Bioactive metabolites have been reported from a myriad of marine and terrestrial organisms around the world including plants, insects, sponges, tunicates, bacteria, and fungi among others. Many macroorganisms, of which the metabolites are found, depend on the symbiotic relationship of microorganisms for metabolite production. The scope of this work is to investigate secondary metabolism of both marine and terrestrial organisms from different areas of the world as well as search for the importance of host-microbe symbiosis …

Development And Comparative Predictive Validity Of An Outpatient Medication Exposure Measure For Risk Adjustment Using Retrospective Claims Data, Kyle Dennis Null

Electronic Theses and Dissertations

The purpose of this study was to develop and test a measure of outpatient prescription utilization (medication exposure measure, or MEM) that may be coupled with the CMS-HCC and CMS-RxHCC methodologies to improve risk-adjusted payments to Medicare Part C and Part D plans. Studies have identified prescription measures that predict future expenditures; however, many are easily manipulable by health plans or practitioners, thus limiting their utility as risk-adjusters. The addition of a non-manipulable prescription utilization measure to existing risk-adjustment models may improve prediction, reducing adverse risk selection incentives by health plans. A secondary objective of this study was to evaluate …

Development Of The Tagalog Version Of The Western Aphasia Battery-Revised, Carmina Ozaeta

Electronic Theses and Dissertations

There has been limited research done in the Philippines in the area of aphasia, a frequent concomitant symptom of strokes and presents as impairment in any area of the input and output of language. Diagnosis is generally conducted by clinicians based on sites of lesion of speakers with aphasia and clinical observations of language symptoms and unpublished translation of the WAB. The lack of relevant research and formal assessment tools in the Philippines motivated this current study. The development of this type of assessment battery for the Tagalog (pronounced /təˈɡɑːlɒɡ/ in English) speaking population will provide a means for differential …

Effects Of A Reading Strategy With Digital Social Studies Texts For Eighth Grade Students, Melissa Doan Malani

Electronic Theses and Dissertations

Recent data indicate that only 34% of American eighth grade students are able to demonstrate grade-level proficiency with academic reading tasks (NCES, 2011). The staggering nature of statistics such as this is even more profound when considering that high level literacy skills combined with mastery of digital texts have become practical requirements for success in secondary education, post-secondary education, and virtually all vocational contexts. Despite this incongruent scenario, little research has been conducted to evaluate instructional methods and reading comprehension strategies with digital texts. To address this critical issue, the present study examined the effects of a metacognitive reading comprehension …

Impact Of Cancer-Specific Advance Care Planning On Anxiety, Decisional Conflict, And Surrogate Understanding Of Patient Treatment Preferences, Lynn Waser

Electronic Theses and Dissertations

Patients with life-limiting cancer and their families face unique challenges that interfere with their ability to make decisions or adequately express their health care preferences about end of life (EOL) treatment. As a result, patients at EOL often receive aggressive unwanted treatment that nationally costs billions of dollars and results in surrogate distress about not honoring patient wishes. Respecting Choices® DS-ACP is a disease-specific Advance Care Planning (ACP) intervention that is designed to overcome barriers associated with ACP and potentially decrease the incidence of unwanted, overly aggressive treatments at EOL. The intervention is delivered to patient-surrogate dyads by a trained …

The Potential For Screening For Interpersonal Violence In Community Pharmacies: An Exploratory Study, Marie Barnard

Electronic Theses and Dissertations

Intimate partner violence (IPV) is a public health problem of epidemic proportion; the only known effective health care intervention is routine screening for IPV exposure. Despite professional guidelines for routine screening, this intervention has been poorly adopted. Expansion of screening efforts to the community pharmacy setting provides an opportunity to have a substantial impact on the health, well-being of pharmacy patients. This investigation is the first to examine IPV screening related to the pharmacy environment. An existing measure of physicians' readiness to manage IPV (PREMIS) was adapted for the community pharmacy environment and validated in a national random sample of …

Preformulation Characterization And Formulation Development Of Δ9-Tetrahydrocannabinol Prodrugs For Potential Treatment Of Glacuoma, Tushar Hingorani

Electronic Theses and Dissertations

Relationship between smoking marihuana and a drop in intraocular pressure (IOP) was first reported in 1971. Research efforts since then have identified a number of constituents that could be linked to this observation. Delta-9-Tetrahydrocannabinol (THC) was one of the ingredients identified. However, four decades and numerous research efforts since the first observation, it has still not been concluded whether THC is effective in the treatment of glaucoma or not. Current therapy for IOP control in glaucoma, though effective, cannot prevent vision loss completely. Thus, identification of agents that can lower IOP as well as protect the retinal ganglion cells from …

Design And Development Of Drug Delivery Systems For Immediate And Sustained Release Utilizing Hot Melt Extrusion, Abhilasha Singh

Electronic Theses and Dissertations

Polymers have indispensable role in pharmaceutical formulation development. Polymer choice is a critical factor to obtain the desired drug-release profile during formulation development for HME (Hot melt extrusion). Many commercially available, pharmaceutical-grade polymers can be used in HME formulations. The suitable polymer choice facilitates processing in the extruder. When choosing a polymer to use in a formulation, processing conditions and processing attributes of the active pharmaceutical ingredients (APIs) should be considered. The physicochemical and the mechanisms of drug release from drug delivery systems prepared by utilizing HME with various polymeric carriers were investigated. Amorphous forms of API can have as …