Medicine and Health Sciences Commons^™

Perioperative Experience Of Adolescents, Janean Carter Monahan

Wayne State University Dissertations

Research has shown that preoperative stress is associated with poorer health outcomes in adults and young children, but there is little in the literature about the stress experienced by adolescents. Clinical experience, however, has shown that adolescents behave differently throughout the perioperative experience than either adults or children. For example, common behaviors of adolescent's emerging from anesthesia include combativeness, thrashing, and crying. To promote adolescent health and to provide adolescents with appropriate interventions that will support a positive surgical outcome, research is needed to discover the perceptions and meanings adolescents attribute to the perioperative experience.

The purpose of this hermeneutic …

Patients' And Caregivers' Inside Perspectives: Living With A Left-Ventricular Assist Device As Destination Therapy, Linda Marcuccilli

Wayne State University Dissertations

Left-ventricular assist devices (LVADs) have improved the quality of life for many patients with advanced heart failure. Past research focused on technology issues and survival rates, but patients' and caregivers' perspectives of living with an LVAD as a destination therapy (e.g., permanent alternative to transplant) was not explored. Roy's adaptation model provided a framework to guide an understanding of how participants adjusted and accepted living with destination therapy. A hermeneutic-phenomenology as described by van Manen was used to explore and describe the essence of destination therapy from patients' and caregivers' perspectives in order to understand the meaning of this experience. …

A Role For Reactive Oxygen Species In Photodynamic Therapy, Michael Price

Wayne State University Dissertations

Photodynamic therapy (PDT) is based on the ability of certain photosensitizing agents to selectively localize in neoplastic cells and their vasculature. Subsequent irradiation at a wavelength corresponding to a photosensitizer absorbance band excites the photosensitizer molecules, leading to energy transfer reactions and fluorescence. It was initially concluded that the phototoxic effect occurred when energy from the excited state of the photosensitizer was transferred to dissolved oxygen to form singlet oxygen. This product has a very brief half-life and will cause cellular damage only in the immediate vicinity of its formation. But an excited-state photosensitizer can also interact with oxygen to …

The Proton-Coupled Folate Transporter: Biology And Therapeutic Applications To Cancer, Sita Desmoulin

Wayne State University Dissertations

Folates are essential cofactors of tumor cell proliferation and survival required for nucleotide biosynthesis and amino acid metabolism. In cancer therapy, inhibition of folate-dependent metabolic pathways has been achieved through the use of antifolates. Unfortunately, the efficacy of many clinically approved antifolates is limited by a lack of tumor selectivity. Facilitative transport of folates into mammalian cells is achieved by the reduced folate carrier (RFC) and proton-coupled folate transporter (PCFT). As PCFT is a folate-proton symporter with an acidic pH optimum, PCFT may provide a mechanism for targeting cytotoxic antifolates to tumors, based on their acidic microenvironments. To establish the …

Identification Of Transcriptional Mechanisms Downstream Of Nf1 Gene Defeciency In Malignant Peripheral Nerve Sheath Tumors, Daochun Sun

Wayne State University Dissertations

Malignant peripheral nerve sheath tumor (MPNST) is a type of soft tissue sarcoma that occurs in carriers of mutations in the neurofibromatosis type I gene (Nf1) as well as sporadically. Plexiform neurofibromas in NF1 patients have a significant risk of developing into MPNSTs leading to increased morbidity and mortality from this syndrome. Surgery is the primary intervention but it is not always effective due to the tendency of MPNSTs to infiltrate the surrounding tissue or grow in an inoperable location. Neurofibromin, the protein coded by the Nf1 gene, functions as a GTPase activating protein (GAP) whose mutation leads to constitutive …

Longitudinal Outcomes Of Distortion Product Otoacoustic Emissions And Wideband Reflectance In Infants, Virginia Ramachandran

Wayne State University Dissertations

Clinical practice has shown that some infants are born with, or develop a temporary conductive hearing loss characterized by the absence of measurable otoacoustic emissions (OAEs) but normal sensorineural hearing. This transient situation interferes with the process of universal newborn hearing screening and identification.

The purpose of this prospective, longitudinal study was to describe outcomes of distortion product OAE (DPOAE) screening in infants at birth, and one, four, eight, and twelve weeks of age. In addition, wideband reflectance (WBR) measures, which have the potential to help characterize outer-ear canal and middle-ear function, were examined to determine their potential utility in …

The Effects Of Two Group Counseling Interventions On Arab-American High School Students' Perceptions Of Their Primary Relationships (Parent, Teacher, Peer), Nuzmeya Bader Elder

Wayne State University Dissertations

This study specifically investigated the effects of two group counseling interventions on Arab-American high school students' perceptions of the strength of their primary relationships (parent, teachers, and peers). It was designed to help high school students increase their acceptance of the culture of their host society and develop a sense of comfort so they can retain some of their own culture and Arab identity without feeling they will totally lose them. One approach was Choice group theory grounded in the reality of making choices concerning thoughts and behaviors. Choice Theory is described as the idea that people have mental images …

It's A Birth Not A Procedure: An Ethnographic Study Of Intrauterine Fetal Death In A Labor And Delivery Unit Of An American Hospital Setting, Catherine Mcleod Griffin

Wayne State University Dissertations

Life transitions such as birth and death constitute a significant area within anthropological studies of ritual. It is important to investigate how individuals, groups, and communities organize around these events. Birth and death can be considered as rites of passage that mark key life transitions (van Gennep 1909/1960). Thus birth and death related rituals need to be investigated within the social and cultural context of American hospital settings to better understand the social organization of life, death, and personhood. In the American hospital setting, a reproductive loss at any gestational age receives the medical diagnostic label of an intrauterine fetal …

An Examination Of The Effects Of Medicare Part D On Racial/Ethnic Disparities, Elham Mahmoudi

Wayne State University Dissertations

This dissertation seeks to evaluate whether Medicare Part D has reduced racial/ethnic disparities in prescription drug utilization and spending among Medicare seniors. Using nationally representative data on White, African-American, and Hispanic Medicare seniors from the 2002-2009 Medical Expenditure Panel Survey, this dissertation analyzes eight measures of access and utilization related to prescription medications. This dissertation applies the Institute of Medicine's definition of a racial/ethnic disparity, and adopts a difference-in-differences quasi-experimental design, using a multivariate regression framework. It finds strong evidence that Medicare Part D reduced ethnic disparities in prescription drug use, total prescription drug cost, out-of-pocket prescription drug cost, and …

Perceived And Functional Disability In Adults With Chronic Pain: What Accounts For Discrepancies?, Dana Catharine Nevedal

Wayne State University Dissertations

Disability among patients with chronic pain can be assessed functionally (behaviorally) or subjectively (self-report). However, discrepancies--including low or zero correlations--between these methods are commonly reported. Research suggests that subjective disability may be more influenced by psychosocial factors than disability measured during functional tasks, leading to under/over reporting, but further investigation is needed. This study sought to identify correlates of discrepancies between subjective and functional disability in two samples of patients with chronic pain.

Retrospective data was compiled from clinical records of 389 patients evaluated at a university multidisciplinary chronic spinal pain treatment program (52.7% men; 88.9% White, 9.8% Black; spinal …

Operating Room Utilization And Turnover Behavioral Study, Jihan Wang

Wayne State University Dissertations

Operating Rooms (OR) are the most expensive care units in health care systems. In order for OR theatre to operate in cost efficient way, it is desirable that the ORs exhibit high utilization, while at the same time, maintain a low-level over-utilized OR time. At the operational level, there are many factors that could influence the OR utilization performances. The objective of this study is to develop effective approaches focusing on the most important factors that influence OR utilization to assist OR management in decision making to achieve better utilization and cost efficiency. In the study, model selection and cross-validation …

Understanding The Gender-Based Mechanism Of Mso In Als Mice: A Metabolic Characterization Of The Sod1-G93a Mouse Model, Monica Ann Bame

Wayne State University Dissertations

Amyotrophic Lateral Sclerosis (ALS) is a devastating neurodegenerative disease characterized by motor neuron death and a corresponding loss of neuromuscular connections resulting in muscle atrophy. Patients become paralyzed shortly after symptom onset and typically die within one to five years of pulmonary complications. ALS is a relatively rare disease, with an overall incidence of approximately 2 in 100,000 people per year and a prevalence of about 5 in 100,000 people. It is typically associated with increasing age and has a slight male prevalence, with a male to female ratio of approximately 3:2. ALS is classified as either familial (the less …

A Novel Interaction Between 12-Lipoxygenase And Β4 Integrin Plays A Role In Cancer Progression, Sangeeta Joshi

Wayne State University Dissertations

No abstract provided.

Development And Initial Psychometric Evaluation Of A Culturally- Sensitive Beliefs About Personal Weight Survey, Stephanie Pickett

Wayne State University Dissertations

ABSTRACT

DEVELOPMENT AND INITIAL PSYCHOMETRIC EVALUATION OF

A CULTURALLY-SENSITIVE BELIEFS ABOUT PERSONAL WEIGHT SURVEY

by

STEPHANIE PICKETT

December 2012

Advisor: Dr. Rosalind Peters

Major: Nursing

Degree: Doctor of Philosophy

The purpose of this study was to develop and perform initial psychometric evaluation of an instrument that measures beliefs about personal weight in young African American women. Beliefs about personal weight were defined as a multidimensional concept consisting of the convictions regarding the descriptive characteristics, causal attributions, and consequences of one's personal weight. The theory of self-care (Orem, 2001) was used to conceptualize concepts and conceptual relationships.

The Beliefs about Personal …

Using The Protection Motivation Theory To Examine The Effects Of Obesity Fear Arousal On The Physical Activity Of Young Adult Female College Students, Bibia Renee Redd

Wayne State University Dissertations

The national rate of physical activity has been consistently declining while obesity and obesity-related illnesses are on the rise (French, Story, & Jeffrey, 2001; James, Leach, Kalamara, & Shayeghi, 2001; Malnick & Knobler, 2006). The current study employed a 2 (severity) x 2 (susceptibility) x 2 (intention implementation plan) x 3 (time) longitudinal within subject design examining the effects of the Protection Motivation Theory (Rogers, 1975, 1983) on the physical activity among 87 overweight young adult college females. A main effect was hypothesized for short-term severity, personal susceptibility, and the development of an intention implementation plan messages and an interaction …

Exploring Cervical Cancer Treatments, Coping And Sexual Self-Concept After Cervical Cancer, Barbara Hollie

Wayne State University Dissertations

ABSTRACT

EXPLORING CERVICAL CANCER TREATMENTS, COPING ADAPTATION AND WOMEN'S SEXUAL SELF-CONCEPT AFTER CERVICAL CANCER

By

BARBARA G. HOLLIE

Cervical cancer survivorship is increasing as a result of improved biomedical science and health care. Due to the nature of cervical cancer treatments most cures are not without consequences. Despite the progress in cancer treatments, associated side-effects persist and it is well established that sexual problems result from most of the available treatment options. Subsequently, cervical cancer treatment alters how women cope and experience their sexual self-concept after treatment. Poor coping and a non-adaptive sexual self-concept following cervical cancer treatment can result …

Nurse Beliefs And Other Influencing Variables On Nurses' Intentions And Decisions Regarding, Beverly Jones

Wayne State University Dissertations

Despite decades of compelling evidence regarding patient and family interest to be with loved ones or the lack of detrimental effects from being together, some nurses are not convinced of the merits of family presence (FP). Implementation of family presence in adult ICUs remains controversial for nurses. The feelings of many nurses, who are gate keepers related to patient visitation, continue to influence restrictions and/or inconsistent visiting practices for patients and families. Some hospitals have begun to permit relatives to be present during cardiopulmonary resuscitation (CPR) of adult loved ones, yet the availability of unrestricted access beyond official ICU visiting …

Preterm Birth And The Perception Of Risk Among African Americans, Gwendolyn Simpson Norman

Wayne State University Dissertations

Background: African American women deliver preterm at a rate that is two to three times that of their white counterparts, and after decades of research, this disparity in birth outcomes still remains unexplained. While factors including income, education, neighborhood conditions, infection and stress have all been associated with prematurity, no combination of these factors has explained why the disparity persists. Recently, however, racism-specific stress has emerged as a possible factor contributing to this disparity. This study was designed to learn how preterm birth was explained by African Americans directly impacted by prematurity. Methods: Interviews were conducted with African American women …

Type 2 Diabetes And Insomnia: Impact On Metabolic Control, Cheryl Lee Tannas

Wayne State University Dissertations

Diabetes is one of the most serious health challenges in the United States, affecting nearly 21 million Americans. The goal of diabetes management is to maintain the blood glucose close to normal to prevent diabetic complications and therefore extending life expectancy and improving quality of life. Research now indicates a relationship of the quantity and quality of sleep to glycemic control in type 2 diabetics. No research on the impact of insomnia on diabetes prevention and/or management was found in the literature. The purpose of this 11 week intervention study was to examine the effects of participation in Cognitive Behavioral …

Predicting Vision Loss In Healthy Aging With Manganese-Enhanced Mri Of The Rat Eye, David Bissig

Wayne State University Dissertations

In healthy aging, visual function declines throughout adulthood. Age-related changes in neuronal ion homeostasis -- specifically, increased Ca2+ influx through L-type voltage gated calcium channels (L-VGCCs) -- are believed to contribute to certain functional declines, but this possibility has not yet been tested in the neural retina. In young, mid- and old adult Long-Evans rats, we compared visual function (optokinetic tracking), as well as retinal physiology and eye morphology (Mn2+-enhanced MRI (MEMRI), which uses neuronal Mn2+ uptake as a marker of Ca2+ influx). We documented significant age-related decreases in visual performance and increases in retinal ion influx. We confirmed that …

Substance P And The Host Immune Response, Megan Elizabeth Foldenauer

Wayne State University Dissertations

This body of work examined the mechanism by which SP regulates host immunity, specifically, its control of growth factors and TLR expression in the P. aeruginosa-infected cornea. The role of mTOR and VIP in corneal infection and inflammation also was tested.

SP has a dual role in bacterial infection, unexpectedly upregulating growth factor production. This was accompanied by macrophage-specific upregulation of pro-inflammatory cytokines, downregulation of anti-inflammatory cytokines, and upregulation of anti-apoptotic genes, as well as a decrease in arginase-producing macrophages (M2 cells), important in stromal healing in these mice. All of these lead to worsened disease, despite the stimulatory effects …

The Relationship Of Rehabilitation Counselors' Knowledge Of The Americans With Disabilities Act 1990, Attitudes Toward Reasonable Accommodation, And Job Development Efficacy, Joy Elizabeth Inniss-Johnson

Wayne State University Dissertations

The purpose of this research was to evaluate the relationship between the rehabilitation counselors' level of knowledge, attitudes towards reasonable accommodations and job development efficacy. The more knowledgeable rehabilitation counselors are about ADA, reasonable accommodations, and their attitude toward job development, the less likely their attitudes will be expected to fluctuate. In addition, there has been very little research in terms of evaluating rehabilitation counselor's level of job placement efficacy. A survey-based design was utilized to create both a quantitative description of knowledge of the ADA, beliefs about reasonable accommodations and job placement efficacy and qualitative information concerning the barriers …

Cellular Plasticity In White Adipose Tissue: In Vivo Identification Of Bipotent Adipocyte Progenitors In Adult White Adipose Tissue, Yun-Hee Lee

Wayne State University Dissertations

Nutritional and pharmacological stimuli can dramatically alter the cellular composition and phenotype of white adipose tissue (WAT). Nonetheless, the identity of progenitors that contribute to this cellular plasticity in vivo remains poorly understood. Utilizing genetic lineage tracing techniques in combination with in situ imunohistochemical analysis, we demonstrate that brown adipocytes (BA) that are induced by beta3-adrenergic receptor activation (ADRB3) in WAT arise from the proliferation and differentiation of cells that express platelet-derived growth factor receptor alpha (PDGFRA), CD34 and Sca1 (PDGFRA+ cells). PDGFRA+ cells have a unique morphology in which extended processes contact multiple cells in the tissue microenvironment. Surprisingly, …

Itch Occurring With Chronic Wounds, Julia Claire Paul

Wayne State University Dissertations

Abstract

Vip And Host Immunity, Xiaoyu Jiang

Wayne State University Dissertations

The purpose of the current dissertation was to examine how VIP regulates host immunity and corneal healing, specifically, its control of growth factors and TLR expression in the P. aeruginosa infected cornea. Firstly, VIP treatment increased growth factor expression (EGF, GHF, FGF and VEGF) in infected cornea. Notably, treatment with a mixture of EGF, FGF and HGF prevented corneal perforation, reduced pro-inflammatory cytokines and bacterial plate count, while increasing anti-inflammatory cytokines and antimicrobials such as murine beta-defensin2 and 3.

We also investigated the expression of TLR-signaling pathways in P. aeruginosa infected corneas with or without VIP treatment. PCR array and …

Identifying Sm22 As A Key Player In Arterial Diseases, Jianbin Shen

Wayne State University Dissertations

Background : Expression of vascular smooth muscle cell (VSMC) cytoskeleton markers including SM22 is down-regulated in arterial diseases including atherosclerosis where inflammation and osteochondrogenesis are present. However, the role of this downregulation in arterial pathogenesis is unknown. Hypothesis : Downregulation of SM22 may actively contribute to arterial pathogenesis. Methods : Five Sm22 knockout (Sm22^-/-) mice and their wild type littermates were subjected to carotid artery denudation, an artery injury model. Analyses were conducted on carotid arteries 2 weeks after injury. Primary VSMCs were isolated from mouse aortas and investigated individually at passage 2 to 4. Sm22 knockdown was …

Motivating Adolescents To Chat For Health (Match): Improving Nutrition And Physical Activity In Urban Youth, Jaclyn Beth Issner

Wayne State University Dissertations

Adolescence represents a unique period of development that is filled with both opportunities and challenges. Choices and health patterns, such as sedentary activity or poor dietary intake, which are established during adolescence can set the stage for adulthood. Obesity in youth has emerged as a major health problem in the United States and across the globe (American Academy of Child and Adolescent Psychiatry, 2012). One way to help prevent obesity is by incorporating preventive intervention services into primary care health systems. The current study, therefore, evaluated the effects of a brief 1-session intervention delivered in a primary care setting in …

Role Of Thromboxane Receptor-Alpha In Prostate Cancer Progression, Prasanna Ekambaram

Wayne State University Dissertations

Thromboxane A2 (TXA2) is a major arachidonic acid metabolite that signals through TXA2 receptors (TP) to induce platelet aggregation and smooth muscle contraction. TXA2 receptors are expressed as two different isoforms in humans, namely TP-alpha (TPα) and TP-beta (TPβ), which have common and distinct signaling pathways. Of the two TP receptor isoforms, studies have shown that TPα impacts tumor growth and progression of lung cancer. Previously our studies demonstrated that activation of Thromboxane receptor by TXA2 agonists could regulate prostate cancer (PCa) cell motility and cytoskeletal reorganization through activation of Rho-A. The primary objective of this study is to investigate …

"Still Here, Trying To Find My Way": Understanding The Experiences Of Hiv Disruption And Reorganization Among Older African Americans In Detroit, Andrea Nevedal

Wayne State University Dissertations

Adults aged fifty and older are the fastest growing age group with HIV/AIDS. Research on older adults with HIV has focused primarily on health status and physiological changes that occur as people age with HIV. However, little is known about the socio-cultural consequences that occur when older adults are diagnosed with HIV and as they age with HIV. Drawing from an anthropological approach to the life course and Becker's (1997) framework of life disruption, this dissertation research explored to what extent people experienced disruption from living with HIV and reorganized their lives after experiencing disruption.

The specific aims included identifying …

Hdm2 Small-Molecule Inhibitors For Therapeutic Intervention In B-Cell Lymphoma, Angela Sosin

Wayne State University Dissertations

Lymphomas frequently retain wild-type (wt) p53 function but overexpress HDM2, compromising p53 activity. Therefore, lymphoma is a suitable model for studying therapeutic value of disrupting HDM2-p53 association by small-molecule inhibitors (SMIs). HDM2 SMIs have been developed and are currently under various stages of preclinical and clinical investigation. This study examined various molecular mechanisms associated and biological effects of two different classes of HDM2 SMIs: the spiro-oxindoles (MI-219) and cis-imidazoline (Nutlin-3) in lymphoma cell lines and patient-derived B-lymphoma cells. Surprisingly, results revealed significant quantitative and qualitative differences between these two agents. At the molecular level, effect of Nutlin-3 was generally more …