Sevoflurane: Practice Change Integration Quality Improvement For Pharmacoeconomic Accountability, Kelly Moore Meyers

Graduate Theses, Dissertations, and Problem Reports

Background: Pharmacoeconomic accountability is increasingly of concern to patients, institutions, and healthcare payors alike. Annual sevoflurane expenditure at a large university hospital exceeds $300,000 (personal communication, Eric Likar). Sevoflurane is a liquid, volatile anesthetic delivered from a vaporizer, through a breathing circuit to a patient. Multiple studies focused on reducing sevoflurane use note significant cost savings were attained with a variety of techniques. Moreover, using less sevoflurane reduces the environmental impact of volatile agents which are potent greenhouse gases. Through simple interventions, such as a brief staff education and reminders, Lethbridge et al. (2007) demonstrated over a fifty-percent reduction in …

Harnessing Acoustic Streaming For Bioanalysis In Microfluidics, Xiaojun Li

Graduate Theses, Dissertations, and Problem Reports

In the past few decades, microfluidic technology has been developed rapidly in both fabrication methods and multifunctionality integrations, making it a powerful tool for a wider variety of biological applications. The device fabrication method has expanded from conventional polymer-based micro devices to 3D-printed micro devices, and allows multiple functions such as electric, optic, magnetic and acoustic to be integrated on a single platform. This dissertation focuses on method development of acoustic streaming-based microfluidics in bioanalysis such as immunoassay, enzyme kinetics and DNA fragmentation analysis. In this dissertation, a micromixer was developed based on acoustic streaming generated from sharp-edge structure vibration …

Differences In Smoking Behaviors And Readiness To Change For Patients With Copd And Differing Categories Of Depression, Jessica M. Floyd

Graduate Theses, Dissertations, and Problem Reports

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Depression is a common comorbidity of COPD and affects patient outcomes and smoking cessation. The purpose of this study was to explore and describe factors influencing smoking behaviors and readiness to change in patients with comorbid COPD and depression.

Aims: The research question that guided this study was, “What are the relationships among smoking, COPD, and depression?” The following aims stemmed from the research question: to describe the characteristics of a convenience sample of people living with COPD and differing categories of depression who …

Targeting Calcium Homeostasis For The Treatment Of Multiple Myeloma, Osama M. Elzamzamy

Graduate Theses, Dissertations, and Problem Reports

Multiple myeloma (MM) is a hematological malignancy characterized by the neoplastic proliferation of the plasma cells. MM is a relatively rare cancer that accounts for about 1.8% of all cancers and is the second most common hematologic malignancies, and despite the advancement from untreatable to treatable malignancy, it is yet incurable. Calcium ions (Ca²⁺) play an important role as second messengers in regulating a plethora of physiological and pathological processes, hence cytoplasmic Ca²⁺ is tightly regulated with strict spatial and temporal control to initiate, maintain, and terminate appropriate signaling pathways and phenotypes including cellular proliferation, cell cycle …

A Short Film That Addresses Substance Use Disorders In Rural Communities And Strategies In Prevention And Treatment Of Addiction, Sarah R. Poteracki

Graduate Theses, Dissertations, and Problem Reports

This research paper and accompanying video (link to the short film is here: https://drive.google.com/drive/folders/1etDnUmEvkOds8J0EKnq1gnFO79-GggjY) offer insight into the current state of research collaboration surrounding substance use disorders in West Virginia. This professional project explores the importance of collaboration both in a research and clinical setting and in the social realm. The film was shown at the 2nd annual meeting for the Appalachian Node of the National Institute on Drug Abuse Clinical Trials Network on February 25, 2021. I interviewed 14 researchers and experts from a diverse range of disciplines who shared insights and strategies in the prevention and treatment of …

Reframing: A Grounded Theory Study Of Postmenopausal Women Following Osteoporotic Fracture, Ashley D. Barber

Graduate Theses, Dissertations, and Problem Reports

BACKGROUND: Osteoporosis is a chronic disease resulting in low bone mass and increased bone fragility. Most often seen in women age 65 and older, osteoporosis is usually diagnosed following osteoporotic fracture. Despite numerous treatment options many women continue to remain untreated for osteoporosis and are at increased risk for subsequent fractures and complications. PURPOSE: The initial purpose of this classic grounded theory study was to explore the decision-making process women aged 65 and older experience when considering osteoporosis treatment following osteoporotic fracture. Following the tenth participant interview the researcher discovered a new main concern that emerged from participant interviews. Participants …

Barriers Of Volunteerism For Coaches Of Collegiate Division I Swimming Programs, Richard Allen West

Graduate Theses, Dissertations, and Problem Reports

Barriers to volunteerism are not researched often or concretely in specific volunteer populations. The aim of this project was to find agreement among a group of potential executive level volunteers in coaching to identify the most impactful and prevalent barriers preventing them from volunteer service. A Delphi study was utilized to identify and find consensus for these barriers as identified by the 30 collegiate swimming coaches who participated. A verification interview was administered to add further clarity to the results and allow participants to speculate as to methods to overcome the barriers listed. Key findings included the themes of dedicated …

Manipulating The Perineuronal Net In The Deep Cerebellar Nucleus, Deidre E. O'Dell

Graduate Theses, Dissertations, and Problem Reports

Perineuronal nets (PNN) are a type of specialized extracellular matrix in the central nervous system. The PNN forms during postnatal development but the ontogeny of the PNN has yet to be elucidated. Studying the PNN in the rat brain may allow us to further understand the PNN’s role in development, learning, and memory. The PNN is fully developed in the deep cerebellar nuclei (DCN) of rats by post-natal day 18. By using enzymatic digestion of the PNN with chondroitinase ABC (ChABC), we studied how digestion of the PNN affects cerebellar-dependent eyeblink conditioning (EBC) and performed electrophysiological recordings from DCN neurons. …

Economic Burden Of Low-Value Healthcare On Patients With Localized Prostate Cancer: Statistical & Machine Learning Approaches, Ryan Fiano

Graduate Theses, Dissertations, and Problem Reports

Adults with incident localized prostate cancer represent a large, medically complex population at risk for low-value care. Evidence-based guidelines recommend conservative management (CM) for localized prostate cancer patients with multimorbidity and limited life expectancy, however, 2 in 3 still choose treatment. This dissertation pursued three Aims to address research gaps related to healthcare practices associated with significant morbidity and economic burden on older men with incident localized prostate cancer: 1) examine the leading predictors of low-value healthcare practice of prostate cancer treatment for low-risk prostate cancer; 2) assess the role of patient‐reported experience with care on high-value prostate cancer management; …

Targeting The Cerebrovasculature In Sepsis: A Focus On The Brain Microvascular Endothelium, Divine C. Nwafor

Graduate Theses, Dissertations, and Problem Reports

The blood-brain barrier (BBB) is a critical interface between the systemic circulation and the brain. It is a specialized multicellular unit composed of brain microvascular endothelial cells (BMECs), pericytes, a basement membrane, and astrocytic end foot processes. BMECs are a principal component of the BBB that provide the structural framework needed for the stringent transport of molecules into the brain. BMEC dysfunction permits the trafficking of neurotoxins from systemic circulation into the brain, which ultimately exacerbates BBB dysfunction and neuroinflammation. Studies have shown that BBB dysfunction is a key determinant of cognitive decline in sepsis. However, there are critical knowledge …

Mitochondrial Aspects Of Neuronal Pathology In Triple-Transgenic Alzheimer’S Disease Mice, John Zachary Cavendish

Graduate Theses, Dissertations, and Problem Reports

Alzheimer’s disease (AD) is a fatal, progressive neurodegenerative disease afflicting millions of people in the United States alone and is the only one of the top leading causes of morbidity and mortality with no effective disease-modifying therapies. It is the most common form of dementia, affecting one in three people over the age of 85. While the hallmarks of the disease include accumulation of beta-amyloid-based extracellular plaques and hyperphosphorylated tau-based intracellular neurofibrillary tangles, treatment strategies centered on removing or mitigating these components of AD have all failed in humans. Mitochondrial dysfunction has been increasingly recognized as an early and consistent …

The Appalachian Medical Student Experience: A Case Study, Jason Scott Hedrick

Graduate Theses, Dissertations, and Problem Reports

The Appalachian region is a rural swath of mountainous terrain home to a historically distinct culture. The region’s population suffers from a multitude of health issues and disparities. Notably, the region also experiences a major healthcare provider shortage despite the fact that states, like West Virginia, produce per capita, a high volume of physicians. Appalachia, and particularly West Virginia, also suffers from a number of educational disparities, which culminates into low numbers of college graduates within the population. There is a plethora of research that has explored the first-generation college student, students from rural and Appalachian backgrounds, first-generation and rural …

Hands And Health: Quantifying Occupational Exposures And Implications Of Disability, Sueann R. Woods

Graduate Theses, Dissertations, and Problem Reports

Introduction: Hand grip strength (HGS) has been negatively correlated with both biologic, cognitive, and mental health markers. Aim one investigated how occupational metabolic equivalents (OMETs), impacted HGS. Aim two investigated lost time from work and the association with HGS. Finally, aim three investigated the health outcomes of workers’ compensation claimants who have lost time from work, following diagnosis of CTS.

Results:HGS was positively associated with OMET (rs = 0.078, p = 0.009). Linear regression model demonstrated a statistically significant association between HGS and OMETs, F(1, 31) = 9.735, p = .001. Aim two found that all occupation groups had …

An In-Depth Exploration Of Hospital-Based Physical And Occupational Therapists’ Needs, Perceptions And Participation In A Safe Patient Handling And Mobility Program, Kimeran W. Evans

Graduate Theses, Dissertations, and Problem Reports

Introduction - Patient mobility performed in the hospital setting places healthcare workers at high risk for WMSDs. The healthcare industry has responded through the creation of SPHM programs that are successful in reducing work-related injuries broadly. However, less is known about the distinct experiences of rehabilitation professionals. Therefore, an in depth exploration of the perceptions, participation, and needs pertaining to lift equipment usage among rehabilitation professionals was performed.

Methods – A qualitative case study approach explored this bounded system. Six focus groups were conducted with 25 members of the rehabilitation team and three interviews were conducted with key administrative personnel. …

Evaluation Of Dental And Skeletal Changes With Sequential Distalization Of Maxillary Molars Using Clear Aligners: A Preliminary Study, Minh Phi Nguyen

Graduate Theses, Dissertations, and Problem Reports

Introduction: Class II malocclusions can be treated with appliances such as the pendulum appliance or distal jets to distalize maxillary molars to achieve a Class I molar relationships. It is not clear in the literature whether these clear aligners can distalize maxillary molars, dental tipping, or translation. The objective was to evaluate the dental and skeletal changes in three planes spaces using CBCT scans and compare the treatment changes with a control group of subjects. Methods: Eight Class II division 1 malocclusions patients treated with maxillary molar distalization using clear aligners. Twelve molars were evaluated for tooth movement in three …

Janus Kinase 1 Drives Endoplasmic Reticulum Stress-Induced Transcriptional Reprogramming In Astrocytes, Savannah Graham Sims

Graduate Theses, Dissertations, and Problem Reports

Neurological and neurodegenerative diseases are heterogenous and devastating diseases with limited therapeutic options and no cures. The broad, long-term goal of this project was to elucidate therapeutic targets for neurodegenerative conditions that attenuate damaging inflammation while leaving the beneficial immune response intact and avoiding broad immunosuppression. Inflammation and the accumulation of misfolded proteins are associated with a wide variety of neurological diseases. Here, we have examined how the accumulation of misfolded proteins shapes inflammatory signaling in the glial cell population astrocytes. Astrocytes are the most populous cell in the central nervous system (CNS) and provide physical and trophic support to …

Understanding The Variable Drivers Of Toxicity For The Broad Class Of Carbon Nanotubes And Nanofibers From U.S. Facilities, Kelly E. Fraser

Graduate Theses, Dissertations, and Problem Reports

Pulmonary exposure to carbon nanotubes or nanofibers (CNT/F) is known to induce inflammation, toxicity, or tumorigenesis, and is a concern in the occupational setting. U. S. facility employees are at risk of inhalation exposure of multi-walled carbon nanotubes and carbon nanofibers during primary and secondary manufacturing. To date, only one MWCNT, Mitsui-7 has been classified as possibly carcinogenic to humans (Group 2B), while all other materials were subsequently categorized as unclassifiable (Group 3). This class of material has recently been listed as a high priority to the International Agency for Research on Cancer due to this significant knowledge gap. Furthermore, …

Novel Mechanisms Of Neuronal And Hormonal Regulation Of Large Intestinal Electrolyte Transport, Andrew John Nickerson

Graduate Theses, Dissertations, and Problem Reports

The mammalian colon plays a vital role in maintaining overall electrolyte and fluid homeostasis in the body, and it possesses the ability to either secrete or absorb water depending upon the needs of the organism. Secretion or absorption of electrolyte ions, such as Na⁺, Cl^- and K⁺, drives the movement of water across the colonic epithelium – the inner gut lining where all transport takes place. Aberrant absorptive and/or secretory activity within the colonic epithelium is central to the pathogenesis of many gastrointestinal diseases, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), constipation …

Association Of Incident Cancer To Low-Value Care And Healthcare Cost Burden Among Elderly Medicare Beneficiaries, Chibuzo Iloabuchi

Graduate Theses, Dissertations, and Problem Reports

In the United States (US), 25% of healthcare spending is considered wasteful because it is spent reimbursing low-value care. Low-value care is the utilization of healthcare services, medical tests, and procedures that have unclear or no clinical benefit to patients but still exposes them to risk. World-wide, low-value care imposes a significant economic burden on patients, payers, governments, and society. Cancer care among older adults > 65 years is one of the biggest drivers of healthcare expenditure in the US and accounts for nearly 40% of all spending, and low-value care among cancer patients is prevalent and contributes to the financial …

Examining The Effects Of Background Noise On Contextualized Word Learning, Caitlin Alyssa Ross

Graduate Theses, Dissertations, and Problem Reports

Despite redundancy in the acoustic speech signal, both children and adults demonstrate difficulty listening and learning in noise. Research has shown that the acoustic parameters of classrooms and common study places, such as libraries and coffee shops, are often exposing students daily to unhealthy levels of background noise and distraction as they attempt to access and retain new information. While younger children may encounter new words via deliberate instruction in a classroom setting, older students are more likely to access new vocabulary indirectly via reading or self-study in noisy environments often of their own choosing. In both scenarios, accurate perception …

Does A Brief Mindfulness Induction Change Delay Discounting In Individuals With High Levels Of Obsessive-Compulsive Symptoms?, Cierra B. Edwards

Graduate Theses, Dissertations, and Problem Reports

Obsessive-compulsive disorder (OCD) is a mental illness characterized by obsessions and compulsions that cause significant distress and/or functional impairment. Delay discounting, the decline in value of a reward with the delay of its receipt, is linked to a range of maladaptive behaviors and mental disorders. Increased delay discounting is related to obsessive-compulsive disorder (OCD), reflecting that compulsive behaviors that aim to counteract obsessive thoughts are viewed as uncontrollable by the sufferer. We aimed to experimentally reduce delay discounting in individuals with high levels of obsessive-compulsive symptoms through a brief mindfulness induction. Eligible participants were randomly assigned to receive either a …

Accuracy Of Implant Placement Utilizing Stereolithographic Guides Printed With And Without Cross-Arch Stabilization Struts, Caitlin Libby Dds

Graduate Theses, Dissertations, and Problem Reports

Objectives: The purpose of this study was to assess the accuracy of implant placement using stereolithographic guides printed with and without stabilization struts by comparing the post-operative position to the planned implant position.

Methods: A pre-operative cone-beam computed tomography (CBCT) of a drillable maxillary model was obtained and data was uploaded into coDiagnostiX for preoperative planning. The implant position was planned in an edentulous space of #5 using a 3.3x10mm Bone Level Tapered (BLT) implant (Straumann). Ten surgical guides were designed utilizing a stabilization strut (Group A), while ten guides were designed without the stabilization strut (Group B). Twenty guides …

Pseudomonas Aeruginosa Vaccine Development Using Dual-Species Whole Cell And Subunit Vaccines, Catherine Bell Blackwood

Graduate Theses, Dissertations, and Problem Reports

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen which can cause severe, recurrent, and chronic infections. The pathogen is highly adaptable, and pneumonia caused by it is associated with high morbidity and mortality, especially in individuals with the genetic disorder cystic fibrosis. Antibiotic resistance amongst clinical isolates of P. aeruginosa is steadily increasing, and multi-drug resistant strains are prevalent. There is currently no vaccine available for commercial use against P. aeruginosa. For these reasons, we sought to understand the immunity to P. aeruginosa induced by whole cell vaccination and identify antigens for development of future subunit vaccines. In this dissertation, …

Perceptions Of Integrated Mental And Behavioral Health In Pediatric Specialty Care Settings: A Mixed-Methods Study, Desireé Nicole Williford

Graduate Theses, Dissertations, and Problem Reports

Pediatric patients are at an increased risk of experiencing mental and behavioral health concerns, which have direct associations with HRQOL, physiological health, and likelihood that youth will engage in health promoting behavior. Researchers and practitioners have increased their awareness of these concerns and identified strategies for improving the mental and behavioral health of these youth, specifically via implementing organizational efforts (i.e., task forces) and guidelines around integrating psychosocial screening and other services into routine practice. Despite this, there are several identified barriers to families receiving mental/behavioral health care in these settings. These barriers exist at all levels, including at the …

Mechanisms And Therapeutic Interventions For Breast Cancer-Induced Fatigue And Mitochondrial Dysfunction, David Andrew Stanton

Graduate Theses, Dissertations, and Problem Reports

According to the latest statistics from the National Cancer Institute (NCI), about 1 in 8 U.S. women (~13%) will develop invasive breast cancer over the course of their lifetime. This translates to an estimated 268,600 new cases of breast cancer for the year 2019, and these diagnoses will collectively make up 15% of all new cancer cases across all cancer types. The majority of these women will experience the often-debilitating symptom of breast cancer-induced fatigue. these patients often have difficulty performing normal activities of daily living, have decreased tolerance to traditional tumor-directed therapies, and have higher rates of cancer recurrence. …

Observational Measurement Of Attachment In Toddlers With Disruptive Behavior Using The Strange Situation Procedure And Attachment Q-Set, Corey C. Lieneman

Graduate Theses, Dissertations, and Problem Reports

Child-caregiver attachment is an important factor in healthy child development and is often targeted by early intervention programs. To assess the efficacy of these interventions, attachment must be accurately measured across the toddler years in populations referred for treatment of externalizing behavior problems. The Strange Situation Procedure (SSP; Ainsworth et al., 1978) and Attachment Q-Set (AQS; Waters, 1987) are empirically-validated measures of child-caregiver attachment, each with unique strengths and weaknesses. Previous research has reached mixed conclusions on relations between the observer-report AQS and SSP, depending on sample and study characteristics, and a review of the literature did not produce any …

From Inner Segment To Outer Segment: Palmitoylation Of Photoreceptor Na+, K+-Atpase And The Importance Of Prcd In Photoreceptor Outer Segment Morphogenesis, Emily R. Sechrest

Graduate Theses, Dissertations, and Problem Reports

Photoreceptors are specialized neuroepithelial cells which are optimized for efficient capture of light and initiation of visual transduction. These cells have several compartments which are very important for proper visual function and segregation of cellular processes, including the outer segment (OS), inner segment (IS), nucleus, and synapse. The IS houses all of the cellular organelles and biosynthetic molecular machinery the cell requires and is the site of protein synthesis. The light-sensing OS is a highly modified, primary cilium, which contains many stacks of double membranous discs which house proteins required for formation and maintenance of OS structure, as well as …

Effect Of Pad Design And Bracket Manufacturing Method On Bracket Bond Strength, Dustin Osborne

Graduate Theses, Dissertations, and Problem Reports

Objective: The objective is to determine if there is a significant difference in shear bond strength and debonding characteristics between one-piece metal brackets made by metal injection molding (MIM) and multi-piece metal brackets made by machining then soldering/brazing with differing pad designs. Methods: A total of thirteen metal orthodontic brackets manufactured by 8 different companies were divided into two groups: one-piece MIM and multi-piece brackets. Each group consisted of 10 brackets for a total of 130 brackets. Brackets were bonded to stainless steel tubes with a universal bonding technique. Samples were tested on the universal Instron testing machine to measure …

Bypassing The Blood-Brain Barrier: A Physical And Pharmacological Approach For The Treatment Of Metastatic Brain Tumors, Samuel A. Sprowls

Graduate Theses, Dissertations, and Problem Reports

This dissertation (a) provided an in depth literature review of methods to disrupt the BBB/BTB and improve therapeutic distribution to brain tumors, (b) evaluated the use of azacitidine as a single agent therapy for the treatment of brain metastasis of breast cancer and a potential molecular mechanism by which brain tropic cells are sensitized to hypomethylating agents, (c) determined the impact cannabidiol has on P-glycoprotein mediated efflux at the blood-brain barrier and its potential for use as a single agent treatment for metastatic brain tumors, (d) developed a preclinical radiation therapy protocol for use in small animals and in vitro …

Nitrite Supplementation Restores Aortic Health In Chronically Stressed Mice, Tyler Coblentz

Graduate Theses, Dissertations, and Problem Reports

Chronic stress increases the risk of developing cardiovascular disease potentially via increases in elastic artery stiffness and endothelial dysfunction. Decreased bioavailability of the potent vasodilator nitric oxide (NO) describes a hallmark of endothelial dysfunction. Nitrite reduces into active NO, providing an alternative pathway of NO restoration. The effect of nitrite supplementation on aortic endothelial function has yet to be determined in chronically stressed mice. We hypothesized that nitrite supplementation would rescue chronic stress-attributed impairments in aortic endothelial function.

Mice at 18 weeks of age underwent an unpredictable chronic mild stress (UCMS; 5 days/week for 7 hrs/day) paradigm to elicit a …