Medicine and Health Sciences Commons^™

Collaboration Occurring Between Professionals In Today's Schools, Kara Lynn Doglio

Theses and Dissertations

The collaborative service delivery model is beneficial in its approach as it allows educators and SLPs to work together to address communication impairments in naturalistic settings in order to maximize the functional potential of all students. The current utilization of collaboration as a viable service delivery option is unknown. The purpose of this study was to identify whether collaboration was occurring and with whom it was occurring. This study also sought to identify similarities and differences across four participant groups regarding perceived beliefs and reported practices in professional collaboration. While administrators took a separate survey than educators (general and special …

Analyzing The Leadership Skills Of Nurses Through Mentoring Relationships, Barbara Jean Siwula

Theses and Dissertations

Mentoring relationships have the ability to create healthier working environments for nurses by encouraging better communication, teaching necessary leadership skills, and creating unity among nurses. In the same respect, mentoring relationships can instill negative habits, creating a cycle of ineffective leadership. Therefore, it is vital mentoring relationships be analyzed to ensure that nurses are being taught effective leadership skills that will lead to a healthy workplace environment. The purpose of this study is to analyze the leadership skills of nurses though mentoring relationships. Data collection consisted of a mixed methods study completed by student, certified and registered nurses from various …

Recruitment And Retention Of Hispanic Nursing Students: Through The Lens Of Associate Degree Nursing Program Administrators And Hispanic Nursing Students, Debra Jean Handlos Devoe

Theses and Dissertations

The Hispanic population in the United States is changing and will constitute 30% of the population in 2050; however, the Hispanic registered nurse population is less than 3%. Cultural differences between patients and nurses may cause harm and a mistrust that can affect patient outcomes. A mixed methods convergent research study was done by an electronic survey, non-electronic surveys, telephone interviews, and focus groups to compare the perceptions of nursing program administrators at seven community colleges in a Mid-Atlantic state, in the United States, and the perceptions of 15 Hispanic nursing students regarding the challenges, barriers, and obstacles of Hispanic …

A Model Of Children's Acquisition Of Grammatical Word Categories From Adult Language Input Using An Adaption And Selection Algorithm, Emily Marie Berardi

Theses and Dissertations

Previous models of language acquisition have had partial success describing the processes that children use to acquire knowledge of the grammatical categories of their native language. The present study used a computer model based on the evolutionary principles of adaptation and selection to gain further insight into children's acquisition of grammatical categories. Transcribed language samples of eight parents or caregivers each conversing with their own child served as the input corpora for the model. The model was tested on each child's language corpus three times: two fixed mutation rates as well as a progressively decreasing mutation rate, which allowed less …

The Effect Of Age, Noise Level, And Frequency On Loudness Matching Functions Of Normal Hearing Listeners With Noise Masking, Linda Titera Parrish

Theses and Dissertations

Loudness recruitment is an abnormally rapid growth of perceived loudness above the hearing threshold that slows to normal growth as the intensity of the signal increases. Recruitment is common in sensorineural hearing loss and in simulated hearing loss with noise masking. This study looked at possible differences in loudness recruitment with age, noise level, and frequency. Participants from two age groups were tested. Group A included participants aged 18 to 30 years and Group B included participants aged 50 to 75 years. Participants practiced the Alternate Binaural Loudness Balance (ABLB) test without noise present. They then repeated the tests with …

Effects Of Sepsis Protocols On Health Outcomes Of Adult Patients With Sepsis, Monika U. Mróz

Theses and Dissertations

Sepsis is a condition that arises from the host’s own exaggerated response to an infection, directed towards pathogens, but causing multiple organ failure. Sepsis is one of the most common causes of death, and a considerable absorber of healthcare resources. This frequently fatal condition, despite progress in technology and improving knowledge of pathophysiology, is still poorly understood, carries high mortality and morbidity rates, and survivors are often left with permanent disabilities and poor health outcomes.

Initial presentation of sepsis is often nonspecific, making diagnosis difficult, and causing lifesaving treatment delays. Sepsis guidelines are derived from emerging evidence-based research. While there …

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

Using Semiphysiologically-Based Pharmacokinetic (Semi-Pbpk) Modeling To Explore The Impact Of Differences Between The Intravenous (Iv) And Oral (Po) Route Of Administration On The Magnitude And Time Course Of Cyp3a-Mediated Metabolic Drug-Drug Interactions (Ddi) Using Midazolam (Mdz) As Prototypical Substrate And Fluconazole (Flz) And Erythromycin (Ery) As Prototypical Inhibitors, Mengyao Li

Theses and Dissertations

The purpose of the project was to investigate the impact of IV and PO routes difference for MDZ, a prototypical CYP3A substrate, and two CYP3A inhibitors (CYP3AI) -FLZ and ERY-, on the magnitude and time course of their inhibitory metabolic DDI.

Individual semi-PBPK models for MDZ, FLZ and ERY were developed and validated separately, using pharmacokinetic (PK) parameters from clinical/in-vitro studies and published physiological parameters. Subsequently, DDI sub-models between MDZ and CYP3AIs incorporated non-competitive and mechanism-based inhibition (MBI) for FLZ and ERY, respectively, on hepatic and gut wall (GW) CYP3A metabolism of MDZ, using available in-vitro/in-vivo information. Model-simulated MDZ …

A Mechanistic Study Of An Ipsc Model For Leigh’S Disease Caused By Mtdna Mutataion (8993 T>G), John P. Galdun

Theses and Dissertations

Mitochondrial diseases encompass a broad range of devastating disorders that typically affect tissues with high-energy requirements. These disorders have been difficult to diagnose and research because of the complexity of mitochondrial genetics, and the large variability seen among patient populations. We have devised and carried out a mechanistic study to generate a cell based model for Leigh’s disease caused by mitochondrial DNA mutation 8993 T>G. Leigh’s disease is a multi-organ system disorder that depends heavily on the mutation burden seen within various tissues. Using new reprogramming and sequencing technologies, we were able to show that Leigh’s disease patient fibroblasts …

Potential Treatments For Malformation Associated Epilepsy, Olivia M. Bowles

Theses and Dissertations

Epilepsy has been previously attributed to either increased excitation or decreased inhibition. With this closed frame of mind, modern medicine has been unable to develop a permanent treatment against the mechanisms of epilepsy. In order to treat patients with intractable seizures, especially those caused by developmental malformations, it is essential to understand the entirety of mechanisms that could possibly play a role in the abnormal cortical function. One such developmental malformation is known as polymicrogyria. Epileptogenesis occurs in an area laterally adjacent to this malformation known as the paramicrogyral region (PMR). Past studies have narrowed down the potential cause of …

Understanding And Targeting The C-Terminal Binding Protein (Ctbp) Substrate-Binding Domain For Cancer Therapeutic Development, Benjamin L. Morris

Theses and Dissertations

Cancer involves the dysregulated proliferation and growth of cells throughout the body. C-terminal binding proteins (CtBP) 1 and 2 are transcriptional co-regulators upregulated in several cancers, including breast, colorectal, and ovarian tumors. CtBPs drive oncogenic properties, including migration, invasion, proliferation, and survival, in part through repression of tumor suppressor genes. CtBPs encode an intrinsic dehydrogenase activity, utilizing intracellular NADH concentrations and the substrate 4-methylthio-2-oxobutyric acid (MTOB), to regulate the recruitment of transcriptional regulatory complexes. High levels of MTOB inhibit CtBP dehydrogenase function and induce cytotoxicity among cancer cells in a CtBP-dependent manner. While encouraging, a good therapeutic would utilize >100-fold …

Testing A Low-Intensity And Accessible Cognitive Behavioral Therapy For Insomnia (Cbt-I) Intervention In Individuals Newly Diagnosed With Cancer, Amma Agyemang

Theses and Dissertations

Insomnia is defined as difficulty initiating or maintaining sleep, or nonrestorative sleep that lasts for at least one month and is accompanied by significant impairment in daytime functioning including fatigue, irritability, and/or difficulty concentrating. It is one of the most common complaints reported by individuals with cancer, especially around the time of cancer diagnosis and treatment. Yet it is often unrecognized and untreated, leading to adverse health consequences and increased healthcare costs. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recommended as the gold standard for treating insomnia among individuals with cancer. Multiple studies have tested and proven the efficacy …

Stains Induce Apoptosis And Autophagy In Primary And Transformed Mast Cells, Patrick A. Paez

Theses and Dissertations

Statin drugs are widely employed in the clinic to reduce serum low density lipoproteins (LDLs) in patients with hypocholesteremia. In addition to their cholesterol-lowering effects through HMG CoA reductase antagonism, isoprenyl lipids necessary for membrane anchorage and signaling of small G-proteins are abrogated. We previously found that statins suppress mast cell activation in murine and human cells, suggesting these drugs might be useful in treating allergic disease. While mast cell function is critical to allergic inflammation, mast cell hyperplasia and survival also impact these diseases, and were not studied in our previous work. In this study, we describe Fluvastatin-mediated apoptosis …

Power Analysis In Applied Linear Regression For Cell Type-Specific Differential Expression Detection, Edmund Glass

Theses and Dissertations

The goal of many human disease-oriented studies is to detect molecular mechanisms different between healthy controls and patients. Yet, commonly used gene expression measurements from any tissues suffer from variability of cell composition. This variability hinders the detection of differentially expressed genes and is often ignored. However, this variability may actually be advantageous, as heterogeneous gene expression measurements coupled with cell counts may provide deeper insights into the gene expression differences on the cell type-specific level. Published computational methods use linear regression to estimate cell type-specific differential expression. Yet, they do not consider many artifacts hidden in high-dimensional gene expression …

The Effects Of Amixicile, A Pyruvate Ferredoxin Oxidoreductase Inhibitor, On Oral Treponemes, Lucas A. Reed

Theses and Dissertations

Periodontal disease (PD) is a polymicrobial infection characterized by inflammation of the gingiva, alveolar bone resorption, and tooth loss (edentulism). Treponema denticola along with Porphyromonas gingivalis and Tannerella forsythia are among the “Red Complex” and are main etiological agents in PD. Treponemes are a member of the Spirochaeta phylum and are obligate anaerobes, that express pyruvate ferredoxin oxidoreductase (PFOR). The enzyme catalyzes the oxidation of pyruvate to acetyl-CoA and reduced ferredoxin. Amixicile is a novel bacteriostatic derivative of nitazoxanide and an inhibitor of PFOR. In light of the fact that Treponemes express PFOR, this study was conducted to investigate the …

Investigation Of Anaplasma Phagocytophilum And Anaplasma Marginale Adhesin-Host Cell Interactions, Kathryn S. Hebert

Theses and Dissertations

Anaplasma phagocytophilum and A. marginale are the etiologic agents of bovine anaplasmosis and human granulocytic anaplasmosis, respectively. As obligate intracellular pathogens, binding and entry of host cells is a prerequisite for survival. The molecular events associated with these processes are poorly understood. Identifying the adhesins mediating binding, delineating their key functional domains, and determining the molecular determinants to which they bind not only benefits better understanding of Anaplasma spp. pathobiology, but could also benefit the development of novel approaches for protecting against infection. We previously demonstrated that A. phagocytophilum outer membrane protein A (ApOmpA) is critical for bacterial binding and …

Assembly And Regulation Of The Dream Complex, Jessica G. Felthousen

Theses and Dissertations

The DREAM complex assembles during G0/G1 when RB-like protein p130 recruits E2F4, DP1, and a core complex of five MuvB proteins to repress genes involved in cell cycle progression. In S-phase, the MuvB core dissociates from p130 and binds to BMYB transcription factor. Binding of the MuvB core to p130 requires phosphorylation of its subunit LIN52 at S28 residue by DYRK1A protein kinase. However, little is known about how the MuvB core interacts with p130 to form the DREAM complex, and how these interactions are manipulated throughout the cell cycle. In collaboration with Dr. Seth Rubin, we characterized the structural …

The Effects Of 7,8-Dihydroxyflavone On Hippocampal Neurogenesis Following Traumatic Brain Injury, Mary K. Wurzelmann

Theses and Dissertations

Following traumatic brain injury (TBI), the hippocampus is particularly vulnerable to damage, and BDNF, an endogenous neurotrophin that activates the TrkB receptor, has been shown to play a key role in the brain’s neuroprotective response. Activation of the TrkB signaling pathway by BDNF in the CNS promotes cell survival and aids in cell growth. However, due to its inability to cross the blood brain barrier (BBB), the therapeutic advantages of BDNF treatment following TBI are limited. 7,8-Dihydroxyflavone (7,8-DHF) is a flavonoid that mimics the effects of BDNF, is a potent TrkB receptor agonist, and can successfully cross the BBB. Our …

Characterizing The Oncogenic Properties Of C-Terminal Binding Protein, Evan T. Sumner

Theses and Dissertations

The paralogous C-terminal binding proteins (CtBP) 1 and 2 are evolutionarily conserved transcriptional coregulators that target and disrupt the expression of several genes essential for multiple cellular processes critical to regulating tumor formation. CtBP’s ability to govern the transcription of genes necessary for apoptosis, tumor suppression, invasion/migration and EMT gives rise to its oncogenic activities. Both isoforms of CtBP are found to be overexpressed in cancers including colorectal, pancreatic, ovarian, and breast, with higher levels correlating to lower overall median survival. Although multiple lines of evidence suggest CtBP plays a role in tumorigenesis, it has never been formally characterized as …

Sciatic Peripheral Nerve Blockade For Pain Control Following Hamstring Autograft Harvest In Adolescents: A Comparison Of Two Techniques, James Furstein

Theses and Dissertations

Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the …

Trabecular Bone Microarchitecture In Association With Systemic And Local Factors As Potential Predictors Of Implant Failure, Diego A. Camacho Dmd

Theses and Dissertations

Clinicians have described the success rates of dental implants. The use of implants is projected to increase in the future. With a 5-10% failure rate, it is unclear the exact factors that are associated with implant failures. To improve upon these success rates, it is critical to understand parameters associated with implant failure including: periodontitis, peri-implantitis, systemic diseases, site preparation, dental history of the implant site, bone quality, materials, occlusion, and treatment timelines. While bone quality is associated with failure, objective measures to assess bone quality and characteristics are scarce. Therefore, the aim of this study is to determine whether …

Tumor-Specific Cell Death Induction By Noxa Overexpression For Head And Neck Squamous Cell Carcinoma (Hnscc) Treatment, Nicolas T. Maxim Mr.

Theses and Dissertations

The primary focus of this research is the mechanisms of cell death in head and neck squamous cell carcinoma (HNSCC) treatment. These cancers typically originate in squamous cells that line the moist mucosal surfaces of head and neck. HNSCC is commonly treated with a platinum based agent, cisplatin. While the drug does offer strong antitumor effects, its prolonged use often results in tumor-acquired resistance, which limits treatment effectiveness. We have shown that cisplatin treatment induces the expression of a pro-apoptotic BCL-2 family member Noxa, which then initiates caspase- dependent apoptosis through its binding and sequestration of pro-survival protein MCL-1 for …

Pharmacological Inhibition Of Cyclophilin Ameliorates Experimental Allergic Encephalomyelitis, Zi L. Huang

Theses and Dissertations

A subset of cyclophilins have been implicated in mechanisms of neuroinflammation and neurodegeneration that contributes to the pathogenesis of Multiple Sclerosis. Mitochondrial dysfunction leading to mitochondrial permeability transition plays a pivotal role in axonal damage and disease progression in Multiple Sclerosis. Cyclophilin D (CypD) is a crucial regulatory component of the mitochondrial permeability transition pore and it was demonstrated that the cyclophilin D knockout animals showed reduced experimental allergic encephalomyelitis (EAE) clinical disease severity and axonal injury. We investigated the effect of N-methyl-4-isoleucine-cyclosporin (NIM811), a non-immunosuppressive and non-selective cyclophilin inhibitor, on the course and severity of EAE. EAE mice treated …

Regulation Of Chronic And Acute Inflammatory Disease By Microrna And Microbiota, Pegah Mehrpouya-Bahrami

Theses and Dissertations

Inflammation is implicated in cancer development, degenerative diseases, allergies as well as artherosecelorsis. Dysregulated immune responses lead to chronic inflammation and tissue damage. Finding the ways to terminate inflammatory responses when no longer needed, demands further investigation. Herein, we investigated the modulation of acute and chronic inflammatory disease models by inducing antiinflammatory state. Acute inflammatory model was induced with SEB, an enterotoxin produced by a ubiquitous Gram-positive coccus, Staphylococcus aureus (S. aureus), which exerts profound toxic effects on the immune system, which leads to the cytokine storm and adverse immune response. SEB is the main cause of nosocomial infections, acute …

Exposing Second Year Medical Students To The Clinical Reasoning Process Prior To High Fidelity Simulation Learning, Phondie Simelane Simelane

Theses and Dissertations

Clinical reasoning is a highly complex process that is both difficult to impart and acquire (Bowen 2006, Custers 2005, Merriënboer 2010, Schmidt 2015). Second year medical learners appear to lack strategy to effectively step through the presented scenarios (Allen, personal communication, March 2, 2015). Though possessing a degree of background knowledge, immature clinical reasoning skills make data collection (focused history, focused review of systems and focused physical assessments) a challenge to efficiently navigate. As oppose to discriminating their line of questions, learners sweep through a wide range of information. Consequently, problem solving takes on a shot gun approach resulting in …

Comparison Of Treatment Planning Decisions When Combining Cbct And Digital Radiography Verses Digital Radiography Alone, Mckay Barlow Packer

Theses and Dissertations

Cone beam computed tomography (CBCT) is the recommended imaging modality of choice for evaluating previous endodontic treatment (1). The aim of this study was to compare treatment planning decisions made when evaluating previous endodontic treatment to determine if treatment planned and projected prognosis differs when digital radiography is used alone or in combination with CBCT. A retrospective chart review was conducted. Patients for whom a CBCT was taken were included in the study. Twenty-eight patients qualified. Patient’s periapical digital radiographs (Dexis©) were evaluated by 2 calibrated endodontists, a treatment plan was identified and a prognosis was projected. Later the same …

Influence Of Thyroid Disorders On Pregnancy Outcomes, Brittany Sullivan

Theses and Dissertations

Objective: The objective of this thesis is to investigate the effects of maternal thyroid dysfunction on maternal pregnancy outcomes.

Setting and Participants: The NICHD Consecutive Pregnancy data set contains information on a total of 114,679 pregnancies from 51,086 women who delivered ≥ 20 weeks of gestation. The data come from 20 different hospitals throughout the state of Utah and were collected between the years of 2002 to 2010.

Main Outcomes: Main outcomes of interest included: breech presentation, chorioamnionitis, gestational diabetes, gestational hypertension, hemorrhage, inductions, placental abruption, placental previa, preterm birth, premature rupture of membranes (PROM), preeclampsia, and …

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria, Dumbiri Joy Powell

Theses and Dissertations

Given poor maternal services utilization and associated high maternal mortality risk in Nigeria, we document policy-amenable supply and demand factors impacting women’ use of skilled ANC and institutional delivery services. Using a cross-sectional design, we analyzed data from the Nigeria State Health Investment Project health facility and household surveys on 418 health facilities and 3,726 women with a pregnancy within 24 months prior to survey living in 241 geographic wards of two states. Logistic regression was used to study associations of women’s use of each maternal service with ward facilities’ ANC outpatient satisfaction, healthcare staff job satisfaction, surveyorverified facility infrastructure, …

Selectivity Targeting Polo-Like Kinase 1 (Plk1) Using Novel Inhibitors Of The Polo-Box Domain, Merissa Lynnea Baxter

Theses and Dissertations

Polo-like Kinse 1 (PLK1) is a serine/threonine protein kinase that is expressed in dividing cells. It is a widely studied protein that plays an important role in regulating mitotic progression. PLK1 is over-expressed in several tumor types, and studies have shown that down-regulating PLK1 expression inhibits cancer cell proliferation, validating PLK1 as an oncotarget. Efforts to target this protein therapeutically has led to the development of several ATP-based inhibitors, although these are not exclusively specific. Because other PLK family members are tumor suppressors, it is important that PLK1 inhibitors selectively bind to PLK1 and not the other PLKs, particularly PLK3. …

The Involvement Of Estrogen Receptors In Astrocyte Survival, Lauren M. Johnson

Theses and Dissertations

Estrogens are a class of hormones that are demonstrated to be neuroprotective. The levels of estrogen in the body decline during menopause which can cause a variety of symptoms. Hormone replacement therapy (HRT) is a treatment option for menopause, however, it has been demonstrated to have adverse side effects. Of the treatment options for adverse side effects of HRT, Selective estrogen Down-regulators do not appear to have an agonist effects on estrogen receptors while Selective estrogen receptor Modulators do. The aim of this study was to determine the role that estrogen receptors play in the survival of astrocytes when placed …