Medicine and Health Sciences Commons^™

Stepped Care For Smoking Cessation: A Cost-Effectiveness Analysis And Simulation Of Future Outcomes, Brandi E. Franklin

Theses and Dissertations (ETD)

It has been well established that smoking is the leading avoidable cause of premature morbidity and mortality in the United States and abroad. Smoking is attributable to over 400,000 annual deaths, and $193 billion in healthcare costs and lost productivity. Despite the apparent dangers and tremendous costs of tobacco use and dependence, smokers find difficulty quitting. Recently, stepped care has been proposed as a viable intensive approach for achieving long-term cessation. This research sought to evaluate cost-effectiveness of stepped care in a diverse population of smokers and analyze future health outcomes of smoking cessation.

Cost-effectiveness analysis was conducted from an …

Impact Of Parent’S Hiv Status On Their Uninfected Child—A Comparative Analysis Of The Child’S Healthcare Utilization, Access And Health Outcomes, Arijit Ganguli

Theses and Dissertations (ETD)

With the advent of effective antiretroviral medication and increased expectancy of life span among HIV-infected individuals has lead to an increase in the at-risk population of uninfected children living with their HIV-infected parent(s). The purpose of this study was to investigate the impact of parent’s HIV status on their child’s access to healthcare resources, healthcare utilization and health outcomes.

This was a cross-sectional study in which the information on the children of HIV seropositive parent(s) was collected through a face-to-face interview of the HIV-infected parents having children currently residing with them. The comparative group comprising of children of HIV seronegative …

Preferences And Willingness To Pay For Osteoarthritis Treatments Among The Medicare Population, Meghan Alexis Hufstader

Theses and Dissertations (ETD)

The design of this study is a non-random cross sectional survey to determine Medicare beneficiaries’ preferences and willingness to pay for osteoarthritis (OA) treatments. The population of interest in this study is the Medicare eligible (over age 65) population in Memphis, TN, and surrounding cities. Data were collected at Senior Centers and one internal medicine practice. The sample size was 181.

Choice-based conjoint analysis technique was utilized. The preferences and willingness to pay were determined using choice-based conjoint analysis, advanced design module with a dual-response none option. Choice-based conjoint analysis uses computer guided surveys to elicit patient preference for a …

Structural Characterization Of The C-Terminus Of The Cochlear Motor Protein Prestin: Intrinsic Disorder Linked To Voltage Sensor Function, Michael S. Podgorski

Theses and Dissertations (ETD)

The sensitivity of mammalian hearing relies upon the ability to amplify sound. Outer hair cells (OHCs) in the cochlea have motile properties that support this function. The motor protein called prestin resides in the lateral wall of the OHCs. Prestin undergoes voltage-dependent conformational changes, which correlates to the movement of charge through the membrane or non-linear capacitance (NLC). This property underlies OHC electromotility. A mechanistic understanding of prestin’s function remains unknown. Previous research has tied prestin’s C-terminus (residues 499-799) to the voltage-dependent events that occur in the membrane. The folding and biochemical properties of prestin’s C-terminus were characterized. This information …

Application Of Different Bioanalytical Workflows For Proteomics Of Prostate Cancer, Li Chen

Theses and Dissertations (ETD)

In the current dissertation, we focused on the development and application of multiple mass spectrometry-based bioanalytical platforms for phosphoproteomic characterization in cell culture and clinical specimens of prostate cancer; and on the application of optimized methods to analysis of differential protein expression to reveal molecular mechanism of drug action in animal model of prostate cancer.

Characterization of the phosphoproteome in prostate cancer

Our study in phosphoprotein signatures on a large scale in prostate cancer focused on the LNCaP human prostate cancer cell line, and on human prostate cancer tissue.

For the LNCaP prostate cancer cell line, we applied a combination …

Identification Of The Downstream Effector Genes Involved In Hoxb4-Induced Expansion Of Hematopoietic Progenitor Cells, Jie Jiang

Theses and Dissertations (ETD)

Overexpression of HOXB4, a member of Homeobox transcription factor family, promotes expansion of hematopoietic stem and progenitor cells bothin vivo and in vitro. However, the molecular mechanisms underlying this effect are not well understood. In order to identify direct target genes of HOXB4 in primary murine hematopoietice progenitor cells, we induced HOXB4 function in lineage-negative, murine bone marrow cells, using a tamoxifen-inducibleHOXB4-ER^T2fusion protein. Seventy seven genes with differentially changed expression in early response to HOXB4 have been identified as candidate target genes. Among them, we show that Hemogen (Hemgn), encoding a nuclear protein specifically …

Physical And Functional Coupling Of Cftr And Pde3a, Himabindu Penmatsa

Theses and Dissertations (ETD)

Formation of multiple-protein macromolecular complexes at specialized subcellular microdomains increases the specificity and efficiency of signaling in cells. In this study, we demonstrated that phosphodiesterase type 3A (PDE3A) is physically and functionally coupled to cystic fibrosis transmembrane conductance regulator (CFTR). PDE3A inhibition increases cyclic adenosine 3′, 5′-monophosphate (cAMP) levels in a compartmentalized manner at the plasma membrane, which potentiates CFTR channel function and further clusters PDE3A and CFTR into microdomains. Actin skeleton disruption reduces PDE3A-CFTR interaction; segregates PDE3A from its interacting partners thus compromise the integrity of the macromolecular complex. Consequently, PDE3A inhibition no longer activates CFTR channel function in …

Discovery And Validation Of New Regulatory Rna Elements In Chlamydia Trachomatis, Yasser Mohammed Elsayed Metwally Abdelrahman

Theses and Dissertations (ETD)

Chlamydia trachomatis is an obligate intracellular bacterium that exhibits a unique biphasic developmental cycle that can be disrupted by growth in the presence of IFN-g and b-lactams, giving rise to an abnormal growth state termed persistence. Relatively little is known about the regulatory mechanisms that control temporal gene expression during the developmental cycle or the control of persistence and reactivation. Here we have examined the expression of a newly defined family of non-coding RNAs (ncRNAs) that are differentially expressed during the developmental cycle and the induction of persistence and reactivation (Using IFNγ and Carbenicillin). Non-coding RNAs were initially identified using …

Function And Pain In Community-Dwelling, Adult Mid-Southerners With Limb Loss, Cecile B. Evans

Theses and Dissertations (ETD)

Background: Limb loss affects about 1 in 190 people in the US. Risk factors for limb loss include diabetes, obesity, smoking, minority race, and poverty, which are all common in the Mid-South population. Function is impaired by limb loss, and pain associated with limb loss may further impair function.

Purpose: Describe the function, pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss. Estimate the relationship between function and pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss. Estimate the joint influences on function by pain, health status, and demographics of community-dwelling, adult Mid-Southerners with …

Chitosan/Ellagic Acid Composite Materials For Local Cancer Therapy, Sung Woo Kim

Theses and Dissertations (ETD)

Current advances in the drug delivery have improved the therapeutic efficacy of the drug and minimized risks of side effects associated with toxicity of the drug. Implantable polymeric delivery system has gained increasing attentions for controlled drug release and localized treatments. In comparison to conventional chemotherapy, polymeric delivery systems are implantable at a local targeted site and biodegradable after a sufficient therapeutic span. The objectives of this project were to fabricate and characterize an implantable polymeric vehicle for a local chemotherapy and investigate its biological properties against cancer cells including human WM115 melanoma, human U87 glioblastoma, and rat C6 glioma …

Pandemic Potential Of Reassortant Swine Influenza A Viruses, Christy Brockwell Staats

Theses and Dissertations (ETD)

Influenza A viruses are capable of causing disease in several species, including birds, humans and swine. Host specificity of the viruses is not absolute, and is influenced by a range of factors. Swine play a pivotal role in the interspecies transmission of influenza A viruses, as they are susceptible to infection with both human and avian strains and have been implicated as a “mixing vessel” for the reassortment of influenza A viruses from different species. The reassortment of influenza A viruses of human and avian origin led to human influenza pandemics in 1957 and 1968.

The dynamics of swine influenza …

Contribution Of The Membrane-Proximal Region Of The Vesicular Stomatitis Virus Glycoprotein To Host Cell Entry And Membrane Fusion, Elizabeth Lane Matheny

Theses and Dissertations (ETD)

Vesicular stomatitis virus (VSV) is an enveloped, nonsegmented, negative-sense, RNA virus belonging to the Rhabdoviridae family. VSV is considered the prototypic Rhabdovirus due to its simple genetic organization, broad host cell tropism, and ability to be easily grown in cell culture. Therefore, VSV has been used as the prototype to study viral entry, transcription, replication, and assembly. Viral entry, a critical step in the lifecycle of the virus, is mediated by the outer surface protein, G and will be the focus of this dissertation.

We hypothesize that the highly conserved residues in the membrane-proximal region of VSV G protein are …

Symbiotic Caregivers: A Qualitative Case Study Of African American Custodial Grandparents And Their Grandchildren, Stella Enyichi Nwokeji

Theses and Dissertations (ETD)

Data from the U.S. Census Bureau’s 2005-2007 American Community Survey show that there are 11,436 grandparents in Shelby County, Tennessee, who are responsible for grandchildren. In Memphis only, there are 9,213 grandparents who are responsible for their grandchildren (U.S. Census Bureau, 2000). The Child Welfare League of America (CWLA) 2003 report (2003) showed that 42% of Tennessee grandparents who were responsible for grandchildren who are living with them live in households where the children’s parents are not present. Casper and Bryson (1998) noted that grandparent-headed households are more prevalent in African American communities and are at high risk for poverty. …

The Role Of Inflammation In The Early Radiation Response, Christy Marie Wilson

Theses and Dissertations (ETD)

Radiation is one of the principal treatments for adults and children with brain tumors, and is one of the oldest established treatments for tumors of all types. Currently, the limiting factor for the use of radiation is the effect on normal tissue adjacent to the tumor. Toxicity, including early and late effects from radiation, limits the dose administered to the tumor and reduces the probability of cure. This work has three aims in its attempt to understand and limit early radiation damage: characterize the role of the inflammatory molecules tumor necrosis factor alpha (TNF) and intracellular adhesion molecule-1 (ICAM-1) in …

A Pharmacokinetics And Pharmacodynamics (Pk/Pd) Guided Approach To Lead Optimization Of Nitrofuranylamide Anti-Tuberculosis Agents, Nageshwar Rao Budha

Theses and Dissertations (ETD)

Currently used treatment strategies for tuberculosis (TB) involve administration of multiple drug combinations for a minimum of 6-9 months. However, these prolonged regimens do not always achieve sterilization, as evidenced by post-therapy relapse in a subgroup of treated individuals. In an effort to develop novel therapeutic agents for TB a new class of chemical agents, nitrofuranylamides, is being developed at the University of Tennessee Health Science Center. We hypothesized that the application of an iterative pharmacokinetics and pharmacodynamics (PK/PD) guided approach would facilitate the optimization of nitrofuranylamide lead compounds suitable for further development.

First, we examined the biopharmaceutic properties and …

Immediate Effect Of Complete Denture Occlusal Errors On Masticatory Muscle Emg Activity In Denture Wearers: A Pilot Study, Swati Ahuja

Theses and Dissertations (ETD)

In the last three decades, little scientific progress has been seen in relation to the occlusal aspects in complete dentures. Equal distribution of loading forces to the edentulous denture foundation is an important factor affecting stability, patient comfort and acceptance of complete dentures. Also, understanding the functional behavior of masticatory muscles for complete denture wearers is important for diagnosing and planning the clinical treatment.

The purpose of the present study was to determine the effect of unilateral and bilateral occlusal interferences on the masticatory muscle activity in edentulous patients, and how patients respond to occlusal interferences both physiologically and psychologically …

Effect Of Methamphetamine On Gingival Fibroblast Production Of Matrix Metalloproteinase (Mmp)-2 And -9 And Tissue Inhibitor Of Metalloproteinase (Timp)-1 And -2 In Vitro, Owais Ali Farooqi

Theses and Dissertations (ETD)

Methamphetamine (METH) abuse is associated with "METH mouth" characterized by rampant caries and periodontitis. Matrix metalloproteinases (MMPs) produced by gingival fibroblasts degrade the extracellular matrix (ECM) and play an important role in periodontitis and oral cancer metastasis. There is no information on effects of METH on fibroblast MMP production, or its role in periodontitis or tumor metastasis.

Objective: Determine effect of METH on gingival fibroblast MMP production and activity.

Methods: A human gingival fibroblast cell line was used. METH cytotoxicity was determined by measuring its effects on activity of a mitochondrial enzyme. Cells were cultured ± METH (1x10^-6- …

The Influence Of Biofilm On The Antifungal Activity Of Amine Oxide, Jonathan Michael Hart

Theses and Dissertations (ETD)

Denture-related stomatitis (DRS) is the most common oral disease affecting denture wearers today, and is characterized by inflammation of the denture bearing mucosa. In a search through historical dental literature for the most often suspected culprit of DRS, one will repeatedly find first listed the fungus Candida albicans. While C. albicans can be isolated from the fitting surfaces of dentures, and the supporting mucosa of patients suffering from DRS, it is also found in the oral cavity of 65% of the human population—most of which is free from oral disease. A truth puzzling to investigators, the discovery of a self-produced, …

The Role Of Interferon Gamma In The Regulation Of Il-18 Binding Protein And The Development Of Autoimmune Arthritis In A Genetically Non-Susceptible Mouse Strain, Timothy Daniel Kayes

Theses and Dissertations (ETD)

The etiology of the autoimmune disease rheumatoid arthritis (RA) is unknown, but the role of cytokines, including IFN-g, as effectors of immune cell function has been established by the examination of cytokine production in RA patients and through the use of animal models. C57BL/6 (B6) mice that express MHC class II molecules of the b haplotype (I-A^b) are not typically susceptible to collagen-induced arthritis (CIA), the most widely studied animal model of RA. When the gene encoding IFN-g is removed by genetic deletion, however, susceptibility to CIA is conferred. In addition, T cell responses against the immunogen that …

Multiscale Genomic Analysis Of The Corticolimbic System: Uncovering The Molecular And Anatomic Substrates Of Anxiety-Related Behavior, Khyobeni Mozhui

Theses and Dissertations (ETD)

Genetic diversity generates variation at multiple phenotypic levels, ranging from the most basic molecular to higher-order cognitive and behavioral traits. The far-reaching impact that genes have on higher traits is apparent in several neuropsychiatric conditions such as stress and anxiety disorders. Like most, if not all, neural phenotypes, stress, anxiety, and other emotion-related traits are extremely complex and are defined by the interplay of multiple genetic, environmental, experiential, and epigenetic factors.

The work presented in this dissertation is a multi-scalar, integrative analysis of the molecular and neuroanatomic substrates that underlie emotion-related behavior. The amygdala is a principle component of the …

Use Of Cvm Stages In Assessment Of Young Orthodontic Patients To Estimate Growth Potential, David Justin Sander

Theses and Dissertations (ETD)

Harnessing a patient’s growth to correct parasagittal discrepancies is an important part of Class II correction in orthodontic treatment; however, orthodontists rarely have the opportunity to choose when a patient is referred to them. Diagnostic records can assist the orthodontist in determining how much growth a patient has remaining. The purpose of this retrospective cephalometric study was to determine whether the amounts of in-treatment facial growth differ significantly by sex and by cervical vertebral maturation (CVM) stage. The sample consisted of 133 Class II division 1 patients from a single private practice office treated with a combination of a functional …

Impact Of Cost Sharing Levels On Adherence To Controller Drugs And Consequent Outcomes Among Asthma Patients, Varun Vaidya

Theses and Dissertations (ETD)

Prescription drug cost sharing is an effective tool to reduce the excessive drug consumption. However, many times it could have a negative impact on the drug utilization especially in case of chronic conditions. Chronic conditions such as asthma require appropriate utilization of controller medication to keep the inflammation and symptoms under control. Literature on asthma drug utilization has consistently reported underuse of controller drugs among asthma patients. The present study attempted to investigate the impact of prescription drug cost sharing levels on the controller adherence among the privately insured asthma population with moderate persistent asthma. The study also analyzed the …

Cost Burden Of The ‘Presenteeism’ Health Outcome In A Diverse Nurse And Pharmacist Workforce: Practice Models And Health Policy Implications, Carol L. Warren

Theses and Dissertations (ETD)

The complex phenomenon of presenteeism is an undesirable health outcome that occurs when employees remain present on-the-job with lowered work productivity caused by personal health conditions. The cost burden of presenteeism in healthcare professionals has been under-explored and the cost burden of presenteeism across racial and ethnic minority employees has been un-explored. Aims of this research were to describe presenteeism and its cost burden among nurses and pharmacists and to determine distinctness of differences across racial/ethnic groups within these professions. In exploring presenteeism, the focus was on recognizing it, characterizing it, and measuring it. In monetizing presenteeism, its costs burden …

Distinct Dna Damage Signaling In The Brain Distinguishes Atld, Nbs, And Atr-Seckel Syndrome, Erin Renee Phillips Shull

Theses and Dissertations (ETD)

DNA double strand breaks create a situation of extreme stress under which a cell must either be capable of repairing the lesions in order to continue replication or succumb to death. Not surprisingly, deficiencies in DNA repair genes often lead to human diseases frequently associated with genomic instability, cancer proneness, and neuropathology. Neurological consequences of aberrant DNA repair mechanisms vary depending upon the affected gene and the pathway in which it operates. Ataxia-telangiectasia (A-T) is the prototypical disease associated with DNA double strand break (DSB) repair deficiency and is characterized by severe neural pathology. A-T results from homozygous mutations that …

Mesiodistal Crown Size In Relation To The Risk And Severity Of Malocclusion, Jon Robert Zang-Bodis

Theses and Dissertations (ETD)

From among numerous potential causes of dental malocclusion, tooth size has been implicated as one factor. Prior studies show that mesiodistally larger teeth increase the risk of malocclusion. The present report extends our understanding by testing for graded responses between crown size and the extent of dental malocclusion. Maximum mesiodistal crown dimensions of all 14 permanent tooth types (excluding third molars) were measured in 207 American white adolescents (routine orthodontic patients), and 10 measures of malocclusion (e.g., rotations, displacements, spacing) were recorded. Analysis of covariance (controlling for sexual dimorphism in tooth size) disclosed (1) significant positive associations between …

Effect Of Obesity On The Traditional And Emerging Cardiovascular Disease Risk Factors In African American Women, Queen Obiageli Henry-Okafor

Theses and Dissertations (ETD)

Background: Obesity is a growing health care concern with cardiovascular disease (CVD) implications. African American women (AAW) have the highest prevalence rate of obesity and highest CVD morbidity and mortality rate of all ethnic groups. The traditional CVD risk factors have not been sufficient to explain this disparity in disease prevalence and outcomes. Current knowledge is limited regarding the interaction between various levels of adiposity and both traditional and emerging CVD risk factors, particularly in AAW. This study sought to explore these interactions.

Methods: The study design was a cross-sectional, descriptive, correlational analysis of 48 AAW ages 18 to 45 …

Metabolic Syndrome, Inflammation, Heart Rate Variability, And Fitness In Obese African American Youth, Belinda J. Fleming

Theses and Dissertations (ETD)

Purpose. The purposes of this dissertation were to (1) explore the relationships among fitness, heart rate variability (HRV), inflammation and components of the Metabolic Syndrome in obese African American youth participating in a supervised weight management program, (2) examine the effect of change in severity of obesity on these variables, and (3) identify predictors of weight loss.

Method. This study consisted of a post-hoc analysis of existing pre and post-intervention data obtained from 50 African-American youth (70% female, aged 7-18 years). Anthropometric assessment of height, weight, waist circumference, systolic blood pressure, body mass index, body mass index percentile …

Generation And Characterization Of A Knock-In Allele Of Eklf: Probing The In Vivo Role Of The Chromatin Remodeling Domain In Definitive Hematopoietic Cells, Valerie Malyvanh Jansen

Theses and Dissertations (ETD)

The zinc finger-encoding transacting factor EKLF, or erythroid Krüppel-like factor, binds key regulatory elements of many erythroid-specific genes, and is essential for definitive erythropoiesis. Mice lacking this factor die of anemia by E15.5 of gestation, failing to activate β-globin gene transcription, and demonstrating a block in the erythroid differentiation program at the primitive erythroblast stage. In contrast, megakaryocytic progenitors are amplified in EKLF-null embryos, with increased Fli-1 gene expression, a marker of early megakaryocytic differentiation. These observations are consistent with the idea that EKLF modulates the megakaryocytic-erythroid (M-E) differentiation switch.

Our laboratory has previously demonstrated that an amino terminal sequence …

The Use Of Spectroscopic Techniques In The Characterization Of Mycobacterial Metabolites, Engy Abdelhameed Mahrous

Theses and Dissertations (ETD)

The mycobacterial cell wall metabolites have always imposed great challenges to researchers due to their unusual complexity and structural diversity. A lot of research efforts have been directed towards the evaluation of these metabolites and the role they play in the pathogenesis and virulence of different serious human pathogens including Mycobacterium tuberculosis the causative agent of tuberculosis (TB). In the genomic era, it is crucial to develop new methodologies to analyze these components from a global perspective in a comprehensive and well-validated manner.

Towards this end, we developed a rapid NMR-based approach to produce metabolic profiles in the form of …

Diffusion Tensor Imaging In Pediatric Brain Tumor Patients, Nicholas S. Phillips

Theses and Dissertations (ETD)

In this dissertation, we outline our efforts to introduce an advanced MRI imaging technique called Diffusion Tensor Imaging (DTI) to the pediatric brain tumor population. We discuss the theory and application of DTI as it was performed in a series of translational investigations at St. Jude Children’s Research Hospital. We present evidence of how the introduction of this technique impacted diagnosis, and treatment. And finally, we demonstrate how DTI was used to investigate cognitive morbidities associated with cancer treatment and how this research provided insight into the underlying pathophysiology involved in the development of these treatment sequela.

This research has …