Medicine and Health Sciences Commons^™

Characterization And Economic Burden Associated With Pediatric Opioid Exposures And Poisonings, Anisha M. Patel

Theses and Dissertations

Introduction

The main objectives of this study were: 1) to examine the prevalence and characteristics of opioid exposures, 2) to estimate the economic costs associated with opioid poisonings, and 3) to examine the characteristics associated with opioid poisoning-related health care resource use (HCRU) and costs in children.

Methods

Data from the National Poison Data System from January 1, 2010 to December 31, 2014 were utilized to examine the prevalence and characteristics of opioid exposures and poisonings in children <18 years. Economic costs were estimated using the 2012 Nationwide Emergency Department Sample, Kids’ Inpatient Database, Multiple Cause-of-Death file and other published sources, applying a societal perspective. Direct costs included costs associated with ED visits, hospitalizations and ambulance transports. Indirect cost included productivity costs due to caregivers’ absenteeism and premature mortality among children.

Results

There were a total of 83,418 pediatric opioid exposures and nearly half of them resulted in poisoning. The epidemiology of opioid …

Prevalence, Incremental Cost And Resource Utilization Associated With Opioid Overdoses, Batul Electricwala

Theses and Dissertations

Background –

An increase in opioid prescribing has led to an increase in opioid overdoses.^1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”.

Objectives –

The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated …

Emerging Pathogens In Cystic Fibrosis Patients At Virginia Commonwealth University Medical Center (Vcumc), Emily M. Hill

Theses and Dissertations

Cystic fibrosis (CF) is an autosomal recessive disorder affecting 70,000 individuals worldwide. This disease is characterized by the buildup of mucus in the airways leading to chronic lung infections resulting in pulmonary failure and death in 95% of CF patients. Routine surveillance of CF pathogens using traditional microbiology culture guides management and treatment of CF patients. Molecular profiling studies have revealed emerging pathogens that may play a role in CF lung disease by either directly causing infection or upregulating the virulence factors of classic CF pathogens, such as P. aeruginosa; however, routine CF culture protocols have not been modified …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Autotaxin In Central Nervous System Development And Disease, Natalie A. Wheeler

Theses and Dissertations

During development, oligodendrocytes (OLGs), the myelinating cells of the central nervous system (CNS), undergo a stepwise progression during which OLG progenitors, specified from neural stem/progenitor cells, differentiate into fully mature myelinating OLGs. This progression along the OLG lineage is characterized by well-synchronized changes in morphology and gene expression patterns. The studies presented in this dissertation identified the extracellular factor Autotaxin (ATX) as a novel upstream signal modulating HDAC1/2 activity and gene expression in cells of the OLG lineage. Using the zebrafish as an in vivo model system, as well as rodent primary OLG cultures, this functional property of ATX was …

Nest - Caring For The Caregiver, Ashley Whitehead

Theses and Dissertations

Today, more than ever, there exists an overlap between hospitality and healthcare industries; with the impact being felt in the way hospital interiors are designed. This influence impacts the patient’s experience but focuses very little on the experience of the caregiver. Caring for a sick child takes an emotional, mental, and physical toll on a family. It is especially challenging to care for a sick family member when away from the comfort and security of the family’s private home. This project explores that challenge through the interior design of a space that, for both patient and family, is restorative, healing, …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Development And Evaluation Of A Peer-To-Peer Intervention To Increase Self-Management Among Adult In-Center Hemodialysis Patients, Jennifer J. St Clair Russell

Theses and Dissertations

Background: Peer-to-peer (P2P) support programs have the potential to assist ESRD patients in managing their disease and improve outcomes. Yet, there is little research examining P2P programs’ impact on psychosocial outcomes and disease management behaviors.

Methods: A 4-month P2P mentoring intervention was designed and piloted in a facility serving 249 in-center hemodialysis patients in Lynchburg, Virginia. Preceded by a social marketing effort, which included a program naming contest and participant recruitment, the intervention included: (1) mentor training, (2) pairing of mentees and mentors, (3) kick-off social mixers, (4) ongoing meetings between mentees and mentors, (5) mentor training booster, and (6) …

Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright

Theses and Dissertations

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the …

Multifunctional Nanocarriers For Cancer Therapy, Bei Cheng

Theses and Dissertations

Cancer is one of the leading causes of human mortality and mortality in all diseases. There has been a boost in developing nanocarrier-based therapies for treating cancer or other diseases during the past decade. One of the major advantages about nanocarrier (with the size range from 1-1000 nm) lies in its ability to specifically target tumor and maximize drug accumulation in tumor foci through the enhanced permeability and retention effect. Advancement in nanotechnology has opened a new paradigm in pharmaceutical field. But new challenges have to be overcome in order to fully exploit the technology and improve safety in clinical …

Comparison Of The Effects Of Energy Flux On Metabolic Conditions And Satiety In Young Adults, Molly Madison Demello

Theses and Dissertations

Within the United States, 68% of all adults have been classified as overweight to obese, as defined by 25 kg/m2 ≤ BMI ≤ 35 kg/m2. Research has shown that overweight/obese individuals can still gain health benefits through participation in aerobic activity without losing weight. These improvements include improved glucose control, CRF, HDL and quality of life. More research is necessary to understand the health benefits associated with a chronic aerobic intervention under weight stable conditions. We therefore examined the health benefits of an aerobic 6-month intervention under weight stable conditions on body composition, cholesterol and measurements of appetite and satiety …

Factors Influencing The Collagen Fiber Angle Distribution In The Mouse Aorta, Shana Roach Watson

Theses and Dissertations

The aortic extracellular matrix (ECM) consists of microstructural proteins, collagen and elastin, together with proteoglycans and other components. The matrix metalloproteinases (MMPs) are proteolytic enzymes that influence morphological and structural changes in the ECM and can degrade the matrix as it responds to cellular behaviors such as angiogenesis, apoptosis, proliferation, and migration. Collagen is the most important component among the extracellular proteins because it provides strength and stability to the tissue. Changes in collagen content play a major role in the development of atherosclerosis. These changes can be induced by increased or decreased proteinase activity. Therefore, we studied the collagen …

Progesterone-Only Oral Contraceptive Pill, Breast Cancer, Heart Disease, And Stroke, Marsha Ema Samson

Theses and Dissertations

There is evidence from earlier studies that oral contraceptive pills may be a risk factor for certain chronic diseases, including heart disease, stroke, and breast cancer. Previous studies mainly focus on the estrogen component of combined (estrogen+ progestin) oral contraceptives (COCs) due to their popularity. This focus limits our understanding of progestin-only contraceptives and its relationship to commonly occurring chronic diseases. To provide insight into alternative methods of oral contraception, this dissertation explores the relationship between progestin-only oral contraceptive (POC) pills and heart disease, stroke, and breast cancer. We hypothesize that women using POCs are less likely to have certain …

Social Capital And Social Networks: The Importance Of Social Ties For Health Among Residents Of Disadvantaged Communities, Stephanie Child

Theses and Dissertations

Access to social capital via social networks is important for health and may be linked with chronic disease, including obesity and hypertension. Socioeconomic status (SES) may influence access to social capital and social network characteristics, and may also moderate the relationship between social capital, social networks, and health. Yet few studies have explored relationships between social capital, social networks, and chronic disease among resource poor individuals.

Respondent-driven sampling was employed to recruit participants (n=430) from low-income communities in the US South for a household survey as part of the Greenville Healthy Neighborhoods Project. The survey collected information about participants’ SES …

Linking Obesity & Breast Cancer: Role Of Monocyte Chemoattractant Protein-1 And High Fat Diet-Induced Inflammation On Mammary Tumorigenesis, Taryn L. Cranford

Theses and Dissertations

More than two-thirds of the adult population in the United States is classified as overweight or obese. In order to fully comprehend this rapidly increasing dilemma, further understanding of the complex phenomena that are involved with obesity and its many comorbidities is necessary. Chronic inflammation represents a distinctive, recurrent feature of obesity and has been associated with an increased risk of breast cancer. Monocyte chemoattractant protein 1 is a crucial component of the inflammatory process and represents a potential therapeutic treatment target, not only in obesity but also in breast cancer. Using a monocyte chemoattractant protein deficient model, we examined …

The Incidence Of Root Dentinal Micro-Cracks Caused By Reciprocating And Continuous Rotary Instrumentation, Stephen N. Schroeder

Theses and Dissertations

The aim of this study was to compare the incidence of root canal dentinal micro-cracks after canal instrumentation using reciprocating files (WaveOne Gold® and Twisted Adaptive®) and continuous rotation files (Edge Evolve® and EndoSequence®) in an ex-vivo benchtop study. This project used a novel methodology of finding dentinal defects using the “K-cube”, which allows evaluators to visualize sectioned root surfaces before instrumentation and after instrumentation. Mesial roots from 40 human mandibular first molars were divided into 4 groups of 10 for each file type. Root section pictures were taken with a Zeiss Discovery V20 stereomicroscope before and after canal instrumentation. …

Motives For Participation In Triathlons Among Midlife To Older Black Women: A Mixed Method Study, Candace Brown

Theses and Dissertations

BACKGROUND: Research has established the positive link between physical activity and its impact on health among adults. Generally, as people get older, they are less likely to be active. Black women comprise 13% of the women in the US but constitute 52% of women who are inactive. Existing articles on exercise motivation among Black women have generally assessed sedentary individuals. Little research has examined the motivations to exercise among physically active Black women. METHODS: Guided by the regulators of the Self Determination Theory, the 56 item Motivations of Marathoners Scales for Triathletes (MOMS-T) was used to assess the motives of …

Obesity And Asthma: Adiponectin Receptor 1 (Adipo R1) And Adiponectin Receptor 2 (Adipo R2) Are Expressed By Normal Human Bronchial Epithelial (Nhbe) Cells At Air-Liquid Interface (Ali) And Expression Changes With Il-13 Stimulation, Jennifer L. Bradley

Theses and Dissertations

Obesity is recognized as an important risk factor for the development of many chronic diseases such as hypertension, Type 2 diabetes mellitus (T2DM) cardiovascular disease, cancer, renal disease, neurologic dysfunction, metabolic syndrome and asthma (3, 4). Circulating serum adiponectin levels in obese asthmatics have been reported to be low. Therefore, we aimed to investigate the role of adiponectin in a mucus hypersecretion model and hypothesized that adiponectin would decrease IL-13 induced MUC5AC expression from differentiated NHBE cells and that increasing concentrations of IL-13 would cause a decrease in Adipo R1 and Adipo R2 expression. MUC5AC expression with exposure to adiponectin …

A Study Of The Action Of Risperidone At 5-Ht2a Receptors, Supriya A. Gaitonde

Theses and Dissertations

Risperidone is an ‘atypical’ antipsychotic and is approved by the USFDA mainly for the treatment of schizophrenia and symptoms of bipolar disorder. Risperidone (an SDA or serotonin-dopamine antagonist) has ~20-fold higher affinity at 5-HT_2A receptors over dopamine D₂ receptors, which makes it more efficacious against the negative symptoms of schizophrenia and less liable to causing extrapyramidal side effects than ‘typical’ antipsychotics.

The major goal of the current investigation was to study the structure of risperidone and to identify the minimum structural features required for 5-HT_2A receptor affinity that retain antagonist action. The structure of risperidone was systematically …

The Effect Of Pre-Deployment Physiology As A Predictor Of Post-Traumatic Stress Disorder Among A Sample Of United States Army National Guard And Reserve Soldiers, David J. Rothman

Theses and Dissertations

Potential risk factors for development of Post-Traumatic Stress Disorder (PTSD) are still unclear. One potential risk factor for the development of PTSD is an individual’s cardiovascular reactivity and recovery in response to stressor tasks. The current study was conducted with 763 Army National Guard and Army Reserve soldiers. Participants completed a stressful induction along with self-report measures prior to deployment. Post-deployment, self-report measures were completed to assess PTSD symptomatology and experiences related to deployment and combat. Multiple regression was used to determine the ability of blood pressure response to stress to predict PTSD symptoms immediately and one-year after return from …

N-Methyl 4-Methyl Amphetamine N-Alkyl Chain Extension Differentially Affects Ion Flux At The Human Dopamine And Norepinephrine Transporters, Alan C. Harris Jr.

Theses and Dissertations

Amphetamine (AMPH) and its derivatives embody a remarkable breadth of pharmacology. These molecules exert their effects, both therapeutic and pathological, at the human monoamine transporters, which tune synaptic dynamics by evacuating monoamine neuromodulators from the synapse subsequent to neuronal impulses. These transporters are electrogenic, and the transporter-mediated current can be correlated to a surrogate measure of the change in membrane voltage: Ca⁺⁺ currents from co-transfected L-type Ca⁺⁺ channels. The present work makes use of this assay, with which it is possible to derive pharmacodynamic metrics from both substrates and inhibitors. This work presents data on a heretofore-unstudied class …

Pharmacological Implications Of Adenosine 2a Receptor- Dopamine Type 2 Receptor Heteromerization, Candice N. Hatcher-Solis

Theses and Dissertations

G protein-coupled receptors (GPCRs) are heptahelical, transmembrane proteins that mediate a plethora of physiological functions by binding ligands and releasing G proteins that interact with downstream effectors. GPCRs signal as monomers, complexes of the same receptor subtype (homomers), or complexes of different receptor subtypes (heteromers). Recently, heteromeric GPCR complexes have become attractive targets for drug development since they exhibit distinct signaling and cell-specific localization from their homomeric counterparts. Yet, the effect of heteromerization on the pharmacology of many GPCR homomers remains unknown. Therefore, we have undertaken the task to examine the effect of heteromerization on G_s signaling through the …

Predictors Of Caffeine-Related Withdrawal Symptoms In College Freshmen, David J. Pomm

Theses and Dissertations

While caffeine withdrawal has been well-characterized, research on caffeine intake and factors associated with withdrawal has been limited. The present study examined prevalence rates of caffeine use and identified psychosocial factors associated with having caffeine withdrawal headaches (CWH). Participants were N = 1,989 college freshmen who participated in the 2011 Spit for Science project. Caffeine use was reported by 80% of the sample. Females were more likely than males to consume caffeine, and soda was the primary source of caffeine for both genders. As hypothesized, daily caffeine users were more likely to report CWH than non-daily users. When multivariable analyses …

Continuous Stationary Phase Gradients For Planar And Column Chromatography, Veeren Dewoolkar

Theses and Dissertations

Surfaces that exhibit a gradual change in their chemical and/or physical properties are termed as surface gradients. Based on the changes in properties they are classified either as physical or chemical gradients. Chemical gradients show variations in properties like polarity, charge, functionality concentration and have found potential applications in fields of biology, physics, biosensing, catalysis and separation science. In this dissertation, surface gradients have been prepared using controlled rate infusion (CRI).

CRI is a simple method in which a surface gradient is formed by carrying out the infusion of organoalkoxysilane in a time-dependent fashion using a set infusion rate. Depending …

The Identification Of The Direct And Indirect Pathways Through Which Leptin Facilitates Synaptic Plasticity In The Hippocampus, Catherine Van Doorn

Theses and Dissertations

Leptin, a peptide synthesized by adipocytes in the periphery, has been shown to play significant roles in feeding and energy expenditure mediated by the hypothalamus. Growing evidence supports the role of leptin in influencing synaptic plasticity in the hippocampus in that leptin dose-dependently enhances LTP, alters morphology and neurogenesis, facilitates spatial learning and memory, as well as memory retention. Models of leptin deficiency and resistance have further supported the importance of leptin in synaptic plasticity by exhibiting deficits in electrophysiological, morphological and behavioral tests that are improved after leptin restoration. The effects of leptin when applied directly into the hippocampus …

Towards Improving The Evaluation Of Speech Production Deficits In Chronic Stroke, Artemis Alexandra Basilakos

Theses and Dissertations

One of the most devastating consequences of stroke is aphasia - a disorder that impairs communication across the domains of expressive and receptive language. In addition to language difficulties, stroke survivors may struggle with disruptions in speech motor planning and/or execution processes (i.e., a motor speech disorder, MSD). The clinical management of MSDs has been challenged by debates regarding their theoretical nature and clinical manifestations. This is especially true for differentiating speech production errors that can be attributed to aphasia (i.e., phonemic paraphasias) from lower-level motor planning/programming impairments (i.e., articulation errors that occur in apraxia of speech; AOS). Therefore, the …

Neural And Behavioral Correlates Of Planning During Vocal Motor Control, Stacey Jean Sangtian

Theses and Dissertations

Speech is a goal-directed movement developed to serve the purpose of human communication. During speech, the brain simultaneously coordinates complex motor behavior and sensory information for planning, execution and online monitoring for error correction in order to ensure accurate delivery of the vocal messages. Models of speech production and voice motor control have adapted the principles of the internal forward model to explain that speech sound production is controlled by comparison of internal predictions with sensory feedback. Growing evidence from studies conducted in speech and limb motor movement indicate that these sensory predictions and responsive commands are loaded in anticipation …

Depression Among Pregnant Latinas In South Carolina, Andrew Fogner

Theses and Dissertations

The aim of the study was to determine the prevalence of depression among pregnant Latinas. To bring to light the importance of prenatal depression prevention, we assessed the effect of the quality of healthcare providers among South Carolina Latinas (n=171). Women answered a validated CES-D and were categorized as depressed (score >16). In multivariate analyses, good perception of quality of healthcare was more likely among women who were not depressed; adjusted odds ratio of 0.75, 95% confidence interval 0.37 – 1.55. The findings show the need for tailoring healthcare to Latinas with prenatal depression prevention. It is imperative to understand …

The Influence Of Fine Particulate Matter On Inflammatory Bowel Disease In South Carolina: An Ecological Analysis, Joshua Eric Sellner

Theses and Dissertations

Background. The Inflammatory Bowel Diseases, including both Ulcerative Colitis and Crohn’s Disease, are lifelong disorders of the Gastrointestinal tract. In recent years, both conditions have become much more prevalent and recognized as major public health issues. Environmental factors have become the focus of recent research around the cause of these diseases. Although shown to have detrimental effects on diseases similar to that of the Inflammatory Bowel Diseases, fine particulate matter’s role in these diseases has not been adequately investigated.

Aim. The purpose of this study was to test the relation of fine particulate matter with hospitalizations attributable to …

A Qualitative Study Of How Communities Think About And Act Upon Hunger In The Presence Of A Food Banking System, Eliza Miriam Fishbein

Theses and Dissertations

Hunger is often addressed by providing food directly to those experiencing symptoms of food insecurity and hunger. Even with the availability of government food assistance programs, food insecurity and hunger rates continue to rise. Many local community organizations (e.g., small food banks, faith-based organizations, schools) across the country have come together to create and implement a variety of nongovernment food programs. Although there is no evidence these programs lower food insecurity and hunger rates, community organizations appear to be strongly committed to sustaining these programs. Little is known about the basis for this commitment, i.e., “ the will to act …