Medicine and Health Sciences Commons^™

Examination Of Birth Outcomes With Mode Of Delivery For Breech Presentation, Kelly Marie Arey

Theses and Dissertations

Introduction: Approximately 3% to 4% of all pregnancies at term will have a fetus with a breech presentation. Studies have shown that the US has almost completely abandoned vaginal delivery for breech presentation through the influence of the "Term Breech Trial" (TBT) which concluded that a policy of planned caesarian section would reduce perinatal mortality, late neonatal mortality, and serious neonatal morbidity by approximately two-thirds for term fetuses. However, the recommendations are still being challenged by others.Objectives: The purpose of the study was to describe who in Virginia is having a vaginal delivery for a breech presentation and to determine …

An Invitro Leakage And Viscosity Analysis Of Root End Filling Materials, Paul D. Clark

Theses and Dissertations

The purpose of this study was to determine if the viscosity of MTA Angelus Fluid is lower than that of Pro Root MTA and MTA Angelus; and to compare the viscosity, leakage and particle size of these materials to determine whether a relationship exists between these properties. The viscosity of each material was measured and compared with the Student's t test. MTA Angelus Fluid's viscosity was significantly lower than the other two materials tested. Microleakage of root end fillings was assessed in a passive diffusion model. Leakage groups were compared with a one-way ANOVA (p < 0.05). No significant difference was found. Particle size and shape were evaluated with the SEM. MTA Angelus Fluid has a lower viscosity than the other materials tested. There was no significant difference in the sealing ability of the three materials tested and there was no apparent variation in each material's particle size or shape.

Children With Special Needs Oral Health Quality Of Life Survey, Kristin Elizabeth Nelson

Theses and Dissertations

Purpose: The purpose of this study was to asses the oral health quality of life of children with special health care needs. This study examined the effects of oral health conditions on general well-being and family life of these children. A secondary aim of the study was to investigate correlations between specific health care conditions, gender, and age of these children and their global ratings of oral health and well-being.Methods: This study was a cross-sectional design with subjects who are members of the Virginia Care Connection for Children program, based at Virginia Commonwealth University. The oral health quality of life …

The Role Of Inhibitory Interneurons In A Model Od Developmental Epilepsy, Patrick James Wolfgang

Theses and Dissertations

Epilepsy, defined by recurrent seizures, is the one of the most prevalent neurological disorders worldwide (World Health Organization 2007). While many forms of epilepsy are well-controlled by anti-epileptogenic medications, a significant portion of patients have intractable, i.e. untreatable, seizures. The etiology of these seizures is varied, but a significant cause, particularly for patients with intractable epilepsy is developmental malformation. In these cases, an error or interruption during the development of the neocortex produces a structural alteration. Such patients may have other neurological problems, but seizures are the most common symptom. The neuronal mechanisms that link malformation and cortical hyperexcitability are …

The Effect Of Income Level On The Relationship Between The Personal Support Matrix And Sustained Breastfeeding, Sandra Mann Gossler

Theses and Dissertations

The Healthy People 2010 Objectives for the population of the United States include the objective for women to sustain breastfeeding at a higher rate than they are currently.The American Academy of Pediatrics (AAP) now recommends that all infants be fed human milk for the first year of life instead of the previously recommended first six months of life. Breastfeeding initiation rates are rising, but breastfeeding duration rates continue to fall. It was hypothesized that the support system of the women may play a role in the duration of breastfeeding. The purpose of this research study was to investigate the support …

Changes In Energy Expenditure With Ingestion Of High Protein, High Fat Versus High Protein, Low Fat Meals Among Underweight, Normal Weight, And Overweight Females., Amy Jo Riggs, Sareen S. Gropper, Barry D. White

Health Sciences & Kinesiology: Faculty Publications

Background: Metabolic rate is known to rise above basal levels after eating, especially following protein consumption. Yet, this postprandial rise in metabolism appears to vary among individuals. This study examined changes in energy expenditure in response to ingestion of a high protein, high fat (HPHF) meal versus an isocaloric high protein, low fat (HPLF) meal in underweight, normal weight, or overweight females (n = 21) aged 19–28 years.

Methods: Energy expenditure, measured using indirect calorimetry, was assessed before and every 30 minutes for 3.5 hours following consumption of the meals on two separate occasions. Height and weight were …

A Comparision Of Delta-9-Tetrahydrocannabinol Dependence In C57bl/6j Mice And Fatty Acid Amide Hydrolase Knock Out Mice, Brittany Leigh Alice Carlson

Theses and Dissertations

The idea that humans and laboratory animals can become physically dependent on marijuana or its primary psychoactive constituent, delta-9-tetrahydrocannabinol (THC), is gaining acceptance. However, there are no currently approved pharmacotherapies to treat cannabinoid withdrawal. The objective of this thesis was to evaluate whether elevating endogenous anandamide levels using mice lacking fatty acid amide hydrolase (FAAH), the enzyme responsible for anandamide metabolism, would ameliorate THC dependence. Mice were treated subchronically with a low or high THC dosing regimen and challenged with the CB1 receptor antagonist, rimonabant, to precipitate withdrawal. Following subchronic THC treatment, rimonabant precipitated a significant increase in paw flutters …

Oral Health Services In A Medical Setting, Robert William Mansman Ii

Theses and Dissertations

Purpose: The purpose of this study is to examine the baseline oral health status of infants and the level of their caregiver's oral health knowledge for families who received preventive oral health services in a medical setting. Methods: Using a prospective cohort study, children 0-3 years of age received an oral health screening, risk assessment, caregiver education, and a fluoride varnish treatment in an ambulatory pediatric medical clinic. A 16-item oral health knowledge and socio-demographic questionnaire was delivered to the caregiver of child. This questionnaire included knowledge, behavior and opinion items on risk factors for dental diseases, care of child's …

Has Richmond, Virginia Become Safer In The Past Five Years (2002-2006)?: An Analysis Of Ambulance Data Regarding Penetrating Trauma Incidents, Ashleigh K. Mccabe

Theses and Dissertations

Introduction: The World Health Assembly declared violence as a worldwide public health problem. Homicides have been identified as a leading cause of death in the United States across all age groups. The national homicide rate for 2004 and 2005 are 5.5 and 5.6 per 100,000 population, respectively. The reported rates for Virginia are 5.2 (2004) and 5.6 (2005) per 100,000 population, showing a 16.9% increase. Richmond has been ranked as high as the sixth most dangerous among similar cities in the United States. This study examines penetrating trauma injuries identified through 9-1-1 calls as an indicator of the incidence of …

Analysis Of Mouse Eklf/Klf2 E9.5 Double Knockout: Yolk Sac Morphology And Embryonic Erythroid Maturation, Tina Kathy Lung

Theses and Dissertations

Krüppel-like factors (KLFs) are a family of transcription factors with 3 Cys2/His2 zinc fingers that regulate cell differentiation and developmental processes. EKLF is involved in primitive and definitive erythropoiesis; KLF2 is implicated in the development of primitive erythroid and endothelial cells of the vasculature. Using light and electron microscopy, the yolk sacs and dorsal aortae from EKLF/KLF2 double knockout (KO) E9.5 (embryonic day 9.5) were examined to determine whether these KLFs have compensatory functions in morphology of blood cells and vessels. EKLF/KLF2 double KO E9.5 erythroid, endothelial, and mesothelial cells had more severely abnormal morphology than WT and KLF2-/-. Flow …

Breast And Cervical Cancer Screening In Virginia: The Impact Of Insurance Coverage And The Every Woman's Life Screening Program, Kamila Somayaji

Theses and Dissertations

Background: Screening for breast and cervical cancers is important because early detection increases cancer survival. Since 1991, the U.S. government has helped finance a national early detection program for breast and cervical cancer among uninsured low-income women, known in Virginia (VA) as Every Woman's Life (EWL).Objectives: This study aims to determine whether there are differences in the prevalence of breast and cervical cancer screening based on insurance coverage, assess the prevalence of screening by health district, and evaluate the ability of EWL to effectively reach its target population.Methods: Cross-sectional data from the 2005 Behavioral Risk Factor Surveillance System survey were …

The Relapsing Fever Spirochete, Borrelia Hermsii, And Complement Regulatory Proteins, Kelley M. Hovis

Theses and Dissertations

Borrelia hermsii, the primary etiological agent of tick-borne relapsing fever in North America, binds the complement regulatory protein factor H (FH) as a means of evading opsonophagocytosis and the alternative pathway of complement. The sequence of the gene encoding the FH-binding protein has been determined. The protein is unique to B. hermsii and has been designated FhbA. Analyses of B. hermsii isolates revealed that FhbA is expressed by 24 of the 25 isolates tested. fhbA was demonstrated to be a single genetic locus through pulsed-field gel electrophoresis, restriction digest, and hybridization analyses, and all isolates possessing fhbA carry it on …

The Association Between Adult Self-Reported Asthma & Potential Exposures To Asthma Triggers In Virginia Workplaces: An Ecological Study, Jeanette R. Bowman

Theses and Dissertations

Introduction: Work-related asthma (WRA) is thought to be the most common occupational lung disease in the U.S., but there is no standard case definition of WRA. Most states, including Virginia, do not require WRA diagnoses to be reported to health departments. At present, there is too little epidemiological data on WRA in Virginia to direct public health planning efforts. Objectives: The first objective of this study was to estimate potential exposure to workplace asthma triggers in each of Virginia's 35 health districts. The second objective was to examine associations at the health district level between workplace asthma triggers, other asthma …

Relationship Between Facial Attractiveness And Occlusal Treatment Outcomes: A Retrospective Study, Chad Eric Fowler

Theses and Dissertations

The goal of this study was to determine if a relationship exists between pretreatment facial attractiveness and posttreatment occlusal outcome in orthodontic patients. A randomized sample of forty-seven patients (26 males, 21 females) was selected for inclusion in this study. Orthodontic evaluators rated pretreatment patient photographs (frontal smile, frontal, profile) using a 100 mm visual analog scale (VAS). Occlusal outomes were evaluated using percentage reduction in weighted Peer Assessment Rating (PAR) index scores and the American Board of Orthodontics objective grading system (ABO-OGS). Spearman correlation coefficients were calculated to assess the relationship between pretreatment VAS attractiveness ratings and posttreatment occlusal …

The Effect Of Pediatric Hospital Specialization On Patient Safety And Effectiveness Of Care, James Mitchell Harris Ii

Theses and Dissertations

Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess …

Prediction Of In-Vivo Antimuscarinic Activity (Ama) By In-Vitro Receptor Binding Assessment And Pk/Pd Modeling For Prototypical Drugs, Taghrid Y. Obied

Theses and Dissertations

Purpose: To establish a tool, termed as antimuscarinic activity (AMA), to predict the incidence of antimuscarinic adverse events (AMAEs).Methods: A literature review, focused on drugs having off-target interaction with muscarinic receptors, was performed. Prototypical drugs olanzapine, diphenhydramine, paroxetine were selected for the analysis. Scopolamine and darifenacin were included as positive and negative controls, respectively. Physiochemical properties, pharmacokinetic data, and clinical incidence of AMAEs for the selected drugs were collected from reported literature. Extrapolation of literature data was carried-out to obtain exposure data. To determine the drugs muscarinic affinity (Ki values), experiments were performed using 3H-QNB and membrane suspensions of M1, …

Disparities In The Use Of Emergency Contraceptives, Rebecca Dallman

Theses and Dissertations

Purpose: Unintended pregnancies are often a burden to pregnant women and to the health care system. The rates of unintended pregnancies have decreased since the wide use of contraceptives has increased; however, young women, women with low income, and racial/ethnic minorities are more likely to use contraceptives inconsistently, which increases the risk of an unintended pregnancy. This risk could be reduced with the proper use of emergency contraceptives (ECs).Methods and Analysis: A cross-sectional study was conducted using the data from the female respondents of the 2002 Cycle 6 NSFG. Logistic regression was used to determine rates of use of ECs …

Outcomes Of Status Epilepticus In The Elderly, Alan R. Towne

Theses and Dissertations

Background: Status epilepticus (SE) is a serious medical condition associated with significant morbidity and mortality. Few studies have addressed this condition in the elderly. The present study examines predictors of SE mortality in this growing population.Methods: SE patients visiting the Virginia Commonwealth University Medical Center from July 1, 1989, to June 30,2006 were included in the study. Data on demographic characteristics, SE type, etiology, time to treatment and mortality were collected. Logistic regression analysis was conducted to examine the determinants of mortality due to SE. Data was stratified by age to examine the characteristics of SE among the elderly population.Results: …

Self-Care And Quality Of Life In Patients With Heart Failure, Chantira Chiaranai

Theses and Dissertations

Although it is well known that self-care reduces the frequency of hospital admissions and exacerbations and enhances quality of life (QOL) in heart failure (HF) patients, little is known about self-care in this population. Therefore, the study purpose was to examine relationships among selected individual characteristics (demographics, severity of illness, comorbidities, and social support), self-care strategies, and QOL using Reigel's Model of Self Care in Patients with Heart Failure as the guiding framework. In this descriptive correlational study, self-care was measured using the Self-Care of Heart Failure Index (SCHFI), which measures self-care maintenance (SC-Mt), self-care management (SC-Mn), and self-care self-confidence …

Visual Contributions To The Vestibulo-Ocular Reflex During Balance Recovery Tasks, Mark D. Diehl

Theses and Dissertations

Introduction: The Vestibulo-ocular reflex (VOR) is quantified by computing the ratio of head angular velocity and eye angular velocity (VOR Gain). This measure only includes head angular movements; linear translations are not accounted for. These investigations postulate an alternative method of VOR quantification, one that assesses retinal image stability during head angular and linear movements (Foveal fixation (FF)). This method was used to assess the role of vision in balance reactions. Methods: Experiment 1 : Ten Young subjects were fitted with an eye tracker linked to an EM kinematic recording system. This allowed for the recording of head, trunk and …

Cd23'S Role As A Negative Regulator Of Allergic Disease: In Vivo Effects Of Murine Cd23 Destabilization And Allelic Mutations, Jill Wallace Ford

Theses and Dissertations

Through underexpression and overexpression studies, CD23 has been shown to negatively regulate IgE production. To investigate CD23 destabilization and its effects on CD23 shedding and IgE synthesis in vivo, we utilized an anti-CD23 stalk monoclonal (19G5) which has previously been shown to enhance proteolysis of CD23 in vitro. Compared to isotype control-treated mice, mice injected with 19G5 displayed enhanced serum soluble CD23 and IgE. Because 19G5 injection substantially enhanced CD23 shedding, it was useful in investigating the identity of the CD23 sheddase. 19G5 enhanced CD23 shedding in ADAM8-/-, ADAM9-/-ADAM15-/-, and ADAM9-/-ADAM12-/-ADAM15-/- mice, ruling out these ADAMs as candidate CD23 sheddases. …

Resilience And Risk-Taking Behavior Among Thai Adolescents Living In Bangkok, Thailand, Patcharin Nintachan

Theses and Dissertations

The major purposes of this study were to determine the relationships among resilience, risk-taking behavior and personal characteristics of Thai adolescents living in Bangkok and to examine the differences in risk-taking behavior by school grades or gender. To accomplish these, a cross-sectional correlational research design was conducted. Resilience was measured by using the State-Trait Resilience Inventory developed by Hiew, Mori, Shirnizu and Torninaga.Risk-taking behavior was measured by the Risk-taking Behavior Questionnaire for Thai Adolescents which is a modified version of the 2003 Youth Risk Behavior Survey (YRBS) originally developed by the U.S. Centers for Disease Control and Prevention. In order …

Concurrent Whitening And Orthodontic Treatment, Jason Thomas Gladwell

Theses and Dissertations

The aim was to evaluate whether a whitening system, when used during the final stages of orthodontics, would yield results comparable to whitening alone. Patients were assigned to either the control (n=20) or experimental (n=26) groups. At T1, patients were given a ten day supply of Trèswhite™ by Opalescence®, instructions on use, and initial shade determination was made and photographs were taken. At T2 and T3, shade determination was accomplished and updated photographs were taken. Whitening of the teeth occurred in both groups on average, but significantly more whitening was experienced in the experimental group (p < 0.004). An average of 87% of teeth whitened during orthodontic treatment compared to 97% of control teeth (p < 0.01) were judged to be uniform in appearance. In conclusion, the data do not contraindicate the concurrent accomplishment of teeth whitening during orthodontic treatment.

The Effect Of Pre-Cure Bracket Movement On The Shear Bond Strength Of Metal Brackets, Thomas Luther Roberts Iv

Theses and Dissertations

The effect on shear bond strength of bracket movement after seating the brackets and before light curing has not been reported. The purpose of this study was to determine the effect of linear and rotational pre-cure bracket movement on the shear bond strength of orthodontic brackets. 100 extracted human maxillary premolars were divided into 5 groups of 20 teeth each. The control group was bonded with no pre-cure bracket movement, and test groups were bonded with pre-cure bracket movement of 2 mm, 4 mm, 45¢ª or 180¢ª. Debonding force was measured with an Instron universal testing machine. Results were analyzed …

The Impact Of Stress Management On Nurse Productivity And Retention, Tammi F. Milliken, Paul T. Clements, Harry J. Tillman

Counseling & Human Services Faculty Publications

Throughout the history of nursing there is a seeming legacy of personnel shortage, lack of funds, and, based on the nature of the role and related services, heightened levels of stress involved in patient care.

The future of the profession and more imminently, patient care and the health of nurses, may be significantly impacted by repeated challenges where current levels of stress and burnout are contributing to organizational problems, burnout, and attrition.

Employee stress and burn out commonly lead to myriad health-related problems that result in significant organizational consequences.

There are many methods of stress management, and sometimes the best …

Poor Glycaemic Control Is The Major Factor Associated With Increased Frequency Of Gastrointestinal Symptoms In Patients With Diabetes Mellitus, Shahab Abid, Wasim Jafri, Firdous Jahan, Fauziah Rabbani, Najmul Islam, Masood H. Khan, Rana Masood

Department of Medicine

Objective:To compare the GI symptoms in diabetic patients with controls and its relationship with the complications, duration of diabetes and glycaemic control. Methods:Consecutive patients were prospectively enrolled in to two groups. Group I (diabetic patients) and Group II (non-diabetic, Controls). Patient's characteristics, demographic profiles and GI symptoms were evaluated on a questionnaire. Groups were compared for differences in various GI symptoms. Group I was further analyzed for the relationship between GI symptoms with complications, duration of diabetes andglycaemic control.
Results:Atotal of 514 patients were enrolled 250 were diabetics (group I) and 264 were non-diabetics (groupII). Mean age …

Biliary Tract Obstruction In Chronic Pancreatitis, Abdallah Abdulkarim, Jake E. J. Krige, Philippus C. Bornman

General Surgery, East Africa

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible.

Initial conservative treatment is advised in …

Practical Approaches To Treating Patients With Bipolar Disorder, Jane E. Neu, Susan M. Denisco

Nursing Faculty Publications

Many patients present to a primary care setting with symptoms of a mood disorder. These symptoms may be indicative of an anxiety disorder or a depressive disorder, but they may also represent bipolar disorder, which is more common than many practitioners think. Correctly diagnosing bipolar disorder can be complex, because patients tend to seek treatment when they are experiencing the symptoms of depression or anxiety rather than mania or hypomania. Comorbid disorders such as substance abuse and anxiety disorders may complicate the clinical presentation. Failing to correctly diagnose bipolar disorder can have serious consequences in terms of patients' morbidity and …

Prevalence Of Self-Reported Overweight-Obesity And Its Association With Socioeconomic And Health Factors Among Older Mexican Adults, Liliana Ruiz-Arregui, Lilia Castillo-Martínez, Arturo Orea-Tejeda, Silvia Mejia-Arango Dr.

School of Medicine Publications

Objective: To investigate the prevalence of obesity and its association with socioeconomic factors and comorbidities in a population-based study.

Material and methods: Data were examined from 4,605 persons ages 60 and older that participated in the 2001 Mexican Health and Aging Study, conducted in rural and urban communities in Mexico. The prevalence of obesity (according to self-reported weight and height) was obtained, stratified by age, and logistic regression was used to study cross-sectional associations between obesity and socioeconomic factors.

Results: Of the population studied, 20.9% were classified as obese and the prevalence diminishes with age. Overall, women were more likely …

Book Review: Social Justice: The Moral Foundations Of Public Health And Health Policy, Robin West

Georgetown Law Faculty Publications and Other Works

This essay is a review of Social Justice: The Moral Foundations of Public Health and Health Policy by Madison Powers & Ruth Faden (2006).

In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate? In a world filled with inequalities in health and well-being, which inequalities matter most and are the most morally urgent to address? In order to answer these questions, Powers and Faden develop a unique theory of social justice that, while developed for the specific contexts of public health and health …