Medicine and Health Sciences Commons^™

Lightweight Break-Glass Access Control System For Healthcare Internet-Of-Things, Yang Yang, Ximeng Liu, Robert H. Deng

Research Collection School Of Computing and Information Systems

Healthcare Internet-of-things (IoT) has been proposed as a promising means to greatly improve the efficiency and quality of patient care. Medical devices in healthcare IoT measure patients' vital signs and aggregate these data into medical files which are uploaded to the cloud for storage and accessed by healthcare workers. To protect patients' privacy, encryption is normally used to enforce access control of medical files by authorized parties while preventing unauthorized access. In healthcare, it is crucial to enable timely access of patient files in emergency situations. In this paper, we propose a lightweight break-glass access control (LiBAC) system that supports …

Trusting Artificial Intelligence In Healthcare, W. Wang, Keng Siau

Research Collection School Of Computing and Information Systems

Artificial Intelligence (AI) is able to perform at humans and even surpass human’s performances in some tasks. Recent cases about self-driving cars, cashier-free supermarket Amazon Go, and virtual assistants such as Apple’s Siri and Google Assistant have illustrated the current and future potential of AI. AI and its applications have infiltrated human’s work and daily life. It is inevitable that humans need to build a working relationship with AI and its applications. On one hand, humans can benefit from this new technology, for instance, a home robot can release housewife from mundane and monotonous tasks (Siau 2017, Siau 2018). On …

“Our Lab Is The Community”: Defining Essential Supporting Infrastructure In Engagement Research, Donald E. Nease Jr., Dee Burton, Sarah L. Cutrona, Lauren Edmundson, Alex H. Krist, Michael Barton Laws, Montelle Tamez

Publications and Research

Introduction: Effective patient engagement is central to patient-centered outcomes research. A well-designed infrastructure supports and facilitates patient engagement, enabling study development and implementation. We sought to understand infrastructure needs from recipients of Patient-Centered Outcomes Research Institute (PCORI) pilot grant awards. Methods: We surveyed recipients of PCORI pilot project awards on self-perceived strengths in engagement infrastructure through PCORI’s Ways of Engaging-Engagement Activity Tool survey, and interviewed leaders of 8 projects who volunteered as exemplars. Descriptive statistics summarized the survey findings. We conducted a thematic analysis of the interview transcripts. Results: Of the 50 surveyed pilots, 22 answered the engagement infrastructure questions …

The Effect Of Alpha-Linolenic Acid (Ala) On Endothelial Cell Expression Of Connexin43, Benjamin Pichette

Masters Theses

Atherosclerosis is the leading cause of cardiovascular diseases like myocardial infarctions and strokes. The formation of these atherosclerotic plaques occurs through localized inflammatory responses in blood vessels. Epidemiological evidence suggests omega-3 fatty acids (FAs) decrease vascular inflammation. The omega-3 FAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduce inflammation through pathways that may include the free fatty acid-4 (FFA-4) receptor. While EPA and DHA are well studied, less is known about the essential omega-3 FA from which they are synthesized: alpha-linolenic acid (ALA). Thus, this study will investigate whether ALA can activate the FFA-4 receptor and thereby contribute to anti-inflammatory …

Effects Of Eicosapentaenoic Acid (Epa) On Mouse Endothelial Cell Health, Spencer C. Pageau

Masters Theses

Cardiovascular disease is the number one killer of adults in the US (~800,000 lives every year:1 in 3 deaths). Evidence suggests omega-3 fatty acids like eicosapentaenoic acid (EPA), found in fish oils, reduce the risk of developing cardiovascular diseases. Many of these diseases are caused by atherosclerotic plaque development in vessels due to endothelial cell damage initiating inflammatory responses. Recent work argues omega-3 fatty acids stimulate anti-inflammatory responses by binding to Free Fatty Acid (FFA) receptors. Inflammatory responses in endothelial cells alter the expression of many proteins that affect the function of those cells. In particular, gap junction protein (connexin: …

Investigating The Roles Of Tap63 And Tap73 In Cutaneous Squamous Cell Carcinoma And Lung Adenocarcinoma, Andrew J. Davis

Dissertations and Theses (Open Access)

TP63 and TP73 (which encode p63 and p73, respectively) are highly conserved transcription factors with important roles in development and tissue homeostasis. Similar to their homolog, p53, both p63 and p73 have been shown to mediate tumor suppression in multiple tissue types. Interestingly, however, both genes are expressed as multiple isoforms, which appear to have different and, in many cases, antagonistic functions. Through the use of isoform-specific null alleles of p63 and p73 our lab and others have shown that the full-length N-terminal isoforms of p63 and p73 (referred to as TAp63 and TAp73, respectively) exhibit distinct functions in development, …

Trichuris Muris Whey Acidic Protein Induces Type 2 Protective Immunity Against Whipworm, Neima Briggs

Dissertations and Theses (Open Access)

Human whipworm (Trichuris trichiura) infects approximately 1 in 15 people worldwide, representing the leading infectious cause of colitis and subsequent, inflammatory bowel disease (IBD). Current control measures focused on mass deworming have had limited success due to low drug efficacies. Vaccination would be an ideal, cost-effective strategy to induce protective immunity, leading to control of infection and transmission. Here we report the identification of whey acidic protein, a whipworm secretory protein, as a strong immunogen for inducing protective efficacy in a surrogate mouse T. muris infection model. The near full-length recombinant WAP protein (rTm-WAP49), as well …

Ube4b Levels Determine The Efficacy Of Egfr And Stat5 Inhibitors In Treatment Resistant Neuroblastoma, David James Savage

Dissertations and Theses (Open Access)

Neuroblastoma is the most common malignancy in infants. Overexpression of the epidermal growth factor receptor (EGFR) in neuroblastoma tumors can result in enhanced EGFR signaling, uncontrolled proliferation, and may provide a mechanism for chemotherapy resistance. UBE4B, an E3/E4 ubiquitin ligase, ubiquitinates the EGFR and promotes its lysosomal degradation ultimately attenuating EGFR signaling. Interestingly, the UBE4B gene lies in a chromosomal region (1p36) whose loss is correlated with poor patient outcomes due to inefficient EGFR degradation and enhanced cell proliferation. We examined whether depletion of UBE4B in a chemoresistant neuroblastoma cell line would affect tumor responses to drugs that specifically target …

Identification Of Intracranial Lesions With Dual-Energy Computed To Mography And Magnetic Resonance Phase Imaging, Megan C. Jacobsen

Dissertations and Theses (Open Access)

On conventional Single-energy Computed Tomography (SECT), lesions with an attenuation greater than 100 Hounsfield Units (HU) can be definitively diagnosed as calcification. However, low-density calcifications and hemorrhage may have overlapping attenuation ranges between 40 and 100 HU and, therefore, cannot be differentiated with SECT alone. On T2*-weighted Gradient Recalled Echo (GRE) MRI, these lesions appear as “foci of susceptibility” in which their signal is hypointense due to the magnetic susceptibility of the lesions differing from that of the background tissue.

Dual-energy Computed Tomography (DECT) and Phase-Sensitive Magnetic Resonance Imaging (PS-MRI) represent two new imaging paradigms which both have the potential …

Aging Exacerbates Neutrophil Pathogenicity In Ischemic Stroke, Meaghan Roy-O'Reilly

Dissertations and Theses (Open Access)

Ischemic stroke is a major cause of disability and mortality worldwide. As most patients cannot receive the currently approved therapies for ischemic stroke, novel treatments are critically needed. Cerebral ischemia causes irreversible tissue damage, referred to as the “tissue core”, which is surrounded by a salvageable penumbral region. Excitotoxicity, oxidative stress and inflammation can further damage this “tissue-at-risk”, resulting in even greater functional loss and poorer injury outcomes.

Aging represents the single strongest risk factor for high mortality and poor outcome after stroke in patients. This phenotype is also seen in animal models, with aged mice experiencing higher mortality and …

Auto-Delineation Of Oropharyngeal Clinical Target Volumes Using Deep Learning Techniques, Carlos Eduardo Cardenas

Dissertations and Theses (Open Access)

Head and neck intensity modulate radiation therapy allows for the delivery of high-precision radiotherapy by conforming radiation dose to the defined treatment targets achieving more accurate target dose distribution and better sparing of normal tissues. However, producing very precise treatment plans may be ineffective if the target volumes are not defined accurately. Furthermore, there are several reports of significant inter-observer variability when delineating these target volumes for head and neck cancers making this variability one of the largest sources of uncertainty in head and neck radiation therapy.

The purpose of this study was to develop algorithms to automate target delineation …

The Role Of Perivascular Fibrosis In Post-Stroke Glymphatic Impairment And Cerebral Amyloid Angiopathy, Matthew D. Howe

Dissertations and Theses (Open Access)

In healthy brain tissue, toxic amyloid-β (Aβ) proteins are transported by the pulsatile flow of cerebrospinal fluid (CSF) along perivascular drainage pathways. Ischemic stroke may disrupt this process, leading to a perivascular build-up of Aβ, termed cerebral amyloid angiopathy (CAA). I hypothesize that an abnormal pattern of extracellular matrix deposition within the vascular basement membrane, termed fibrosis, impairs Aβ drainage from the aged brain after stroke. I further hypothesize that inhibition of astrocytic transforming growth factor-β (TGF-β) signaling can reverse these phenotypes. Finally, I also hypothesize that serum biomarkers of perivascular fibrosis can be used to diagnose CAA following intracerebral …

Changes In The Testes Following Spinal Cord Injury And The Attenuating Effects Of Licofelone, Ryan Fortune

Dissertations and Theses (Open Access)

Spinal cord injury is a devastating disease that researchers have had very limited success in treating. In addition to interrupted innervation, spinal cord injury causes pathologic changes in a multitude of organ systems. Male infertility is one such complication that is particularly devastating because the patient population is predominantly young men. Our lab has previously shown that the blood testis barrier breaks down after spinal cord injury. This dissertation shows the local metabolomic and mRNA changes that spinal cord injury causes within the testes using a Sprague Dawley rat model, including the elevation in eicosanoids, increased oxidative stress, chronically elevated …

Microrna Functions In Uv-Induced Cutaneous Squamous Cell Carcinoma, Tran Nguyen

Dissertations and Theses (Open Access)

Cutaneous squamous cell carcinoma (cuSCC) is the second most common skin cancer, for which long term UV exposure and chronic wounding are the dominant risk factors. Despite these clinically established connections, little is understood about the early molecular response of human skin to UV exposure and its connection to acute wounding and cuSCC. Thus, our goal is to find common and specific signatures driven by UV-exposure and wounding as a means of developing new approaches for treating and preventing cuSCC.

Here, we perform integrated analyses of RNA-seq and miR-seq on 3 datasets: (1) UV-unexposed and acute UV-exposed human skin, (2) …

Genomic And Transcriptomic Landscape Of Colorectal Premalignancy, Kyle Chang

Dissertations and Theses (Open Access)

Colorectal cancer (CRC) is the third most commonly diagnosed cancer among men and women in the United States, with 3 to 5 percent of the cases diagnosed in the background of a hereditary form of the disease. Biologically, CRC is divided into two groups: microsatellite instable (MSI) and chromosomally unstable (CIN). Genomic and transcriptomic characterization of CRC has emerged from large-scale studies in recent years due to the advancement of next-generation sequencing technologies. These studies have identified key genes and pathways altered in CRC and provided insights to the discovery of therapeutic targets. Despite the wealth of knowledge acquired in …

Enhancing Radiation Sensitivity In Non-Small Cell Lung Cancer, Yifan Wang

Dissertations and Theses (Open Access)

Lung cancer is the leading cause of cancer-related death. While radiation therapy is one of the standard treatments for lung cancer, the disease outcome after radiotherapy is still far from satisfactory despite ongoing advances in radiation techniques. Enhancing the radiosensitivity of lung cancer has the potential to improve the disease outcome of radiation treatments. Using a novel high throughput radiation sensitizing screen, previous work in the lab has identified several potent radiation sensitizers. The focus of my dissertation is on two of the identified pathways, HSP90 and MEK, using the potent and clinically relevant inhibitors ganetespib and trametinib. Using both …

The Cross-Talk Between Neurons And Microglia Through Interleukin-4 After Ischemic Injury, Shun-Ming Ting

Dissertations and Theses (Open Access)

After ischemic stroke, the loss of blood supply to the affected region of the brain leads to a series of pathological events known as ischemic cascades, that include excitotoxicity and microglia/macrophage over-activation resulting in damaging inflammatory responses. Studies from our research group suggest that the viable neurons in the ischemic penumbra (location receiving less profound damage, as compare to ischemic core) produce and release a potent anti-inflammatory cytokine, interleukin(IL) -4. We propose that this neuronal response to sublethal ischemia is designed to guide surrounding microglia/macrophages to a reparative and anti-inflammatory (M2) phenotype.

The research included in this study is designed …

The Protective Effects Of Memantine On The Morphology And Activity Of Irradiated Dendritic Spines, Thanh Lam

Dissertations and Theses (Open Access)

Abstract: The Protective Effects of Memantine on the Morphology And

Activity of Irradiated Dendritic Spines

Thanh T. Lam, M.S.

Advisory Professor: David R. Grosshans, M.D, Ph.D.

Although radiotherapy is an effective treatment for brain tumors, the adverse effects of such treatments may result in a decline in cognitive functioning. To prevent or reverse such radiation-induced cognitive dysfunctions, it is critical to understand the cellular and subcellular effects of radiation. In this study, both Thy-1 YFP mice and cultured cortical neurons were used to investigate changes in dendritic spines after cortical neurons were irradiated. The results indicated that irradiation has long-term …

Improved Target Coverage Of Spinal Metastases Through The Use Of Flattening Filter Free Beams, Laura Bennett

Dissertations and Theses (Open Access)

Of the patients that are diagnosed with metastatic disease, up to 40% will develop vertebral osseous metastases. These metastases tend to be located in close proximity to the spinal cord itself, making it difficult to achieve the recommended minimum dose of 14 Gy for single fraction SBRT or 21 Gy¹ for three fraction SBRT while maintaining acceptable doses to the cord and cauda equina. This proximity of the target to critical structures has the potential to compromise the efficacy of the radiation treatment plan in favor of reducing normal tissue dose, resulting in poor local control and tumor recurrence …

Mir-484 Functions As An Onco-Mir In Triple Negative Breast Cancer, Nashwa Kabil

Dissertations and Theses (Open Access)

Triple negative breast cancer (TNBC) is a highly aggressive subtype of breast cancer (BC), with a poor prognosis with currently used therapies, and thus represents an unmet therapeutic challenge. Lack of molecular targets (i.e. ER, PR, HER2) and significant genetic heterogeneity are the major reasons contributing to early relapse and high mortality rates. Numerous studies have indicated that microRNAs (miRs) have an important role in BC progression, invasion, angiogenesis, and metastasis. We analyzed miRNA expression profiles of BC patient data bases and identified that miR-484 is highly upregulated in all subtypes of BC patients, with the highest expression in TNBC …

Design, Fabrication, And Validation Of 3d Printed, Patient-Specific Compensators For Postmastectomy Radiation Therapy, Daniel Craft

Dissertations and Theses (Open Access)

The purpose of this study was to use 3D printed, patient-specific tissue compensators to overcome the 3D planning limitations for postmastectomy radiation therapy (PMRT). Tissue compensators can be used to reduce dose heterogeneity, hot and cold spots at field junctions, and treatment complexity, but are currently seldom used due to the difficulty in designing, fabricating, and validating them.

To produce compensators using 3D printing technology, suitable materials had to be found and characterized. Several materials were found to be promising, but previously unreported material uncertainties were also discovered that must be carefully controlled for in 3D printing studies. A new …

Omics Approaches To Uncover Germline And Somatic Variation Underlying Inherited Sarcomagenesis, Justin Wong

Dissertations and Theses (Open Access)

Sarcomas are rare mesenchymal tumors, making up 15% of all childhood and 1% of all adult tumors. They account for a disproportionate share of mortality in young adults, and if left untreated, are highly likely to metastasize. However, sarcoma etiology is poorly understood, and having numerous histological subtypes has complicated elucidation. To better understand factors underlying sarcomagenesis, we leveraged two rare inherited cancer predisposition syndromes, Li-Fraumeni Syndrome (LFS), and LFS-like (LFSL), both with a high incidence of sarcomas. LFS is caused by mutations in the tumor suppressor gene TP53 (p53), but has variable and incomplete penetrance, suggesting additional acquired …

Approaches To Carrier Testing And Results Disclosure In Translational Genomics Research, Ellen Wright Clayton, Kathryn M. Porter, Et Al.

Vanderbilt Law School Faculty Publications

Background: Clinical genome and exome sequencing (CGES) is primarily used to address specific clinical concerns by detecting risk of future disease, clarifying diagnosis, or directing treatment. Additionally, CGES makes possible the disclosure of autosomal recessive and X-linked carrier results as additional secondary findings, and research about the impact of carrier results disclosure in this context is needed.

Methods: Representatives from 11 projects in the clinical sequencing exploratory research (CSER) consortium collected data from their projects using a structured survey. The survey focused on project characteristics, which variants were offered and/or disclosed to participants as carrier results, methods for carrier results …

Comparison Of Muscle Physiology And Performance Outcomes From Either Relative Intensity Or Repetition Maximum Training, Kevin Carroll

Electronic Theses and Dissertations

The main purpose of this dissertation was to compare performance and physiological outcomes of between a repetition maximum (RM) and a relative intensity using sets-and-repetitions (RI_SR) resistance training (RT) program in well-trained lifters. Fifteen subjects underwent RT 3 d·wk^-1 for 10-weeks in either a RM group (n=8) or RI_SR group (n=7). The RM group achieved a relative maximum each day while the RI_SR group trained based on percentages. Testing included percutaneous needle biopsies of the vastus lateralis, ultrasonography, unweighted (g to assess within and between-group alterations. RI_SR from pre-to-post yielded statistically significant increases in …

Cluster Set Loading In The Back Squat: Kinetic And Kinematic Implications, Alexander Wetmore

Electronic Theses and Dissertations

The purpose of this study was to investigate the kinetic and kinematic implications of cluster loading as a resistance training programming tactic. Cluster loading involves introducing rest during a set which may allow athletes to train at higher absolute intensities. Eleven trained males were recruited for this study. Subjects completed two testing sessions consisting of three sets of five back squats at 80% of their one repetition maximum. Cluster loading included 30s of inter-repetition rest. All testing was done on dualforce plates with four linear position transducers. Paired sample t-tests were used to determine differences between conditions with Cohen’s d …

Do Healthcare Students Endorsing Stigma Of Mental Illness Screen For Suicidal Ideation? An Evaluation Of Knowledge, Attitudes, And Behaviors, Dannel K. Petgrave

Electronic Theses and Dissertations

The stigma of mental illness endorsed by healthcare professionals has been linked to adverse outcomes. This issue underscores the need for early anti-stigma interventions in the context of professional training. The present study measured stigma change and suicide screening behaviors among medical, nursing, and pharmacy students enrolled in an interprofessional Communication Skills for Healthcare Professionals course. The Mental Health Knowledge Schedule (MAKS; Evans-Lacko et al., 2010), Opening Minds Scale for Health Care Providers (OMS-HC; Modgill, Patten, Knaak, Kassam, & Szeto, 2014), and the Marlowe-Crowne Social Desirability Scale Form C (M-C SDS Form C; Reynolds, 1982) was administered at baseline (T …

Hiv Integrase Inhibitor Pharmacogenetics And Clinical Outcomes: An Exploratory Association Study, Derek E. Murrell

Electronic Theses and Dissertations

As HIV is now primarily a chronic condition, treatment is given life-long with changes as necessitated by alterations in tolerability and efficacy. Thus, personalized medicine may be useful in the prevention of unnecessary drug exposure and avoidable side effects. Three of the four currently available HIV integrase strand transfer inhibitors (INSTIs), raltegravir, elvitegravir, and dolutegravir, are widely utilized antiretrovirals in the USA and exhibit variations in outcomes among subjects. To interrogate differences among subjects receiving these drugs, we investigated the association of several single nucleotide polymorphisms (SNPs) with drug exposure, clinical outcomes, and subject-reported adverse events. HIV+ adults (≥18 years …

3d-Printed Fluidic Devices And Incorporated Graphite Electrodes For Electrochemical Immunoassay Of Biomarker Proteins, Abdulhameed Alabdulwaheed

Electronic Theses and Dissertations

Biomarkers are measurable indicators of health status or disease state that can be used for diagnosis and may help guide patient treatment strategies. Enzyme-linked immunosorbent assays (ELISA) and other many clinical techniques currently used for measuring biomarker proteins lack sensitivity, demand high analysis cost, are often not well-suited for measuring multiple biomarkers in a single sample, and require long analysis times. Here, we demonstrate simple, low-cost 3D-printed flow-through devices with integrated electrodes modified with gold nanoparticles (AuNPs) for electrochemical immunoassays of S100B, a biomarker protein related to conditions like skin cancer and brain injuries. Flow-through devices are fabricated from photocurable-resin …

A Glance At Imaging Bladder Cancer., Ebru Salmanoglu, Ethan J. Halpern, Edouard J. Trabulsi, Sung Kim, Mathew L. Thakur

Department of Radiology Faculty Papers

Purpose: Early and accurate diagnosis of Bladder cancer (BCa) will contribute extensively to the management of the disease. The purpose of this review was to briefly describe the conventional imaging methods and other novel imaging modalities used for early detection of BCa and outline their pros and cons.

Methods: Literature search was performed on Pubmed, PMC, and Google scholar for the period of January 2014 to February 2018 and using such words as "bladder cancer, bladder tumor, bladder cancer detection, diagnosis and imaging".

Results: A total of 81 published papers were retrieved and are included in the review. For patients …

Advances In Modern Clinical Ultrasound, Sriharsha Gummadi, Md, John R. Eisenbrey, Phd, Jingzhi Li, Md, Zhaojun Li, Md, Flemming Forsberg, Phd, Andrej Lyshchik, Md, Ji-Bin Liu, Md

Department of Radiology Faculty Papers

Advances in modern clinical ultrasound include developments in ultrasound signal processing, imaging techniques and clinical applications. Improvements in ultrasound processing include contrast and high-fidelity ultrasound imaging to expand B-mode imaging and microvascular (or microluminal) discrimination. Similarly, volumetric sonography, automated or intelligent ultrasound, and fusion imaging developed from the innate limitations of planar ultrasound, including user-operator technical dependencies and complex anatomic spatial prerequisites. Additionally, ultrasound techniques and instrumentation have evolved towards expanding access amongst clinicians and patients. To that end, portability of ultrasound systems has become paramount. This has afforded growth into the point-of-care ultrasound and remote or tele-ultrasound arenas. In …