Medicine and Health Sciences Commons^™

African Americans Navigating Through Relationships Towards Marriage: A Grounded Theory Study, Moosgar Yrveens Borieux

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to explore if and how early parent-participant relationships affect subsequent intimate relationships among African American couples. Given the clear gap between African Americans’ attitudes about marriage and the data that show them to be the least likely to be married among other racial or ethnic groups in the United States of America, a unique conceptualization [Life Course Developmental framework, Object Relations theory, Symbolic Interactionism perspective] was used to explore the role that early key figure-child social interactions potentially have in influencing young African Americans interactions with their significant others. To carry out the research …

Resilience And Complicated Grief, Les Bishop

Loma Linda University Electronic Theses, Dissertations & Projects

This study surveyed 155 family members or caregivers of patients who had died between twelve and thirty months prior to this study. These patients had been on hospice at the time of their death. The purpose of the study was to assess the prevalence of hospice defined risk factors for complicated grief. Medical records provided patient demographics information and a verbal (telephone) survey was used to measure the following risk factors: lack of social support, lack of expression of faith, lack of adequate coping skills, multiple losses, substance use, and relationship to the person who died. Descriptive statistics were used …

Microgravity Exerts An Age-Dependent Effect On Cardiovascular Progenitor Cell Development, Jonathan Baio

Loma Linda University Electronic Theses, Dissertations & Projects

The heart and its cellular components are profoundly altered by missions to space and injury on Earth. Increasing evidence has identified that one such alteration induced by spaceflight is the promotion of the efficacious use of stem cells in therapies on Earth. For this reason, neonatal and adult human cardiovascular progenitor cells (CPCs) were cultured aboard the International Space Station (ISS). Subsequently, we assessed the effects of mechanical unloading on developmental properties and signaling. Spaceflight induced the expression of genes that are typically associated with an earlier state of cardiovascular development. In particular, in neonatal CPCs, we measured increased expression …

Neurocognitive And Psychosocial Effects Of Repeated Concussions In Children And Adolescents, Shina Halavi

Loma Linda University Electronic Theses, Dissertations & Projects

In the United States, an estimated 1.7 million people sustain a traumatic brain injury (TBI) annually. About 75% of these TBIs are mild, which are referred to as “concussions.” This study assessed the neurocognitive and psychosocial effects of repeated concussions in children and adolescents and their interactions with age and gender. It also assessed the correlation between psychosocial functioning and neurocognitive functioning. Given the paucity of research on the effects of concussion in the developing brain, the current study characterized the neurocognitive and psychosocial effects of concussion in young populations. The overarching hypothesis stated that repeated concussions would induce more …

Accreditation Perceptions And Involvement In Saudi Arabian Schools Of Nursing, Amal Abdul Aziz Alaskar

Loma Linda University Electronic Theses, Dissertations & Projects

“Accreditation is a voluntary program in which trained external peer reviewers evaluate an academic institution and compares it with pre-established performance standards” (Alkhenizan & Shaw, 2012, p. 407). Those standards need to be applied by the faculty and administrators working at institutions of higher education. To understand, evaluate, and improve the quality of higher education, it is crucial to explore and examine how those implementing accreditation perceive the process of accreditation and whether it has any association with their motivation and involvement.

This quantitative descriptive correlational study used a survey method to examine whether there is a relationship between perceptions …

Risk Markers Associated With Caregiver Elder Abuse: A Meta-Analytic Study, Annie Johansson

Loma Linda University Electronic Theses, Dissertations & Projects

Elder abuse is a significant public health problem affecting approximately 10% of the US population, with international prevalence rates ranging from 3% to 30% (e.g. Burnes et al., 2015; Melchiorre, Penhale, & Lamura, 2014; Roepke-Buehler & Dong, 2015; Selwood, Cooper, & Livingston, 2007). A quantitative meta-analysis was performed to assess risk markers associated with caregivers who abuse the elderly. This dissertation will identify background information specific to this study, discuss specific objectives of the study, and explain the rationale for why this study is being done. Two theoretical frameworks will be discussed and linked with caregiver elder abuse: Bronfenbrenner’s ecological …

Gene Delivery Of Adenoviral-Tmbim6 Vector Protects The Neonatal Brain After Hypoxic-Ischemic Injury, Desislava Doycheva

Loma Linda University Electronic Theses, Dissertations & Projects

Neonatal hypoxia ischemia (HI) is an injury caused to the immature brain due to reduced cerebral blood flow which is associated with life-long neurological impairments. HI causes oxidative protein folding in the endoplasmic reticulum (ER), which results in ER stress. Generation of reactive oxygen species (ROS), from cytochrome P450 members (CYP) and NADPH-P450 reductases (NPR), in combination with activation of the unfolded protein response (UPR) are two major consequences of ER stress that cause oxidative damage and cell death. Herein we identified the role of Bax Inhibitor-1 (BI-1), an evolutionary conserved protein encoded by the Transmembrane Bax inhibitor Motif Containing …

The Design Of Complex Weapons Systems In Scorpions: Sexual, Ontogenetic, And Interspecific Variation, Gerard A. A. Fox

Loma Linda University Electronic Theses, Dissertations & Projects

Scorpions possess two integrated multifunctional weapons systems. Anteriorly, they maintain a grasping system comprised of a pair of pedipalps ending in chelae that seize and manipulate prey, ward off predators, and secure mates. Posteriorly, they wield a venom delivery system consisting of a tail-like metasoma with a stinger at the tip of the terminal segment (telson) that can be thrust into prey, predators, or mates to inject venom. Given the complexity of these systems, I hypothesized that weaponry design is subject to selective forces arising from differences in usage between the sexes, during ontogeny, and among closely-related species occupying different …

Changes In The Morphology Of Hypoglossal Motor Neurons In The Brainstem Of Developing Rats, Paul Allen Williams

Loma Linda University Electronic Theses, Dissertations & Projects

The autonomic brainstem generates and modifies breathing rhythm by integrating inputs from chemo- and mechanosensors in the viscera while coordinating descending outputs from higher CNS structures. Hypoglossal motoneurons (XII MNs) receive inputs from respiratory premotor neurons in the medulla. Previous studies in rodents have demonstrated significant changes in breathing control during the first three weeks of life, with a sensitive period at 10 to 13 days post-birth (P10–P13) characterized by pronounced changes in neurotransmitters, receptors, excitation-inhibition balance, and breathing. However, age-dependent morphological changes of XII MNs during the first three weeks post-birth and especially during this sensitive period, have not …

Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised In Asian Americans, Dean Lim

Loma Linda University Electronic Theses, Dissertations & Projects

Prior research has indicated that the prevalence of eating disorders, which are recognized as one of most lethal psychological disorders with an approximately 20% mortality rate, are increasing among Asian Americans with rates comparable to those of the general population in the United States. However, research has also suggested that Asian Americans may not be fully reporting symptoms related to eating disorders because of sociocultural stigma and the desire to uphold cultural values, such as interdependence, harmony within the community, humility, and emotional restraint. The SATAQ-4R is a widely-used measure of sociocultural influences on body image and eating disturbance, which …

The Relationship Between Plantar Fascia Thickness, Metatarsophalangeal Joint Position And Gender, Michael J. Granado

Loma Linda University Electronic Theses, Dissertations & Projects

Ultrasound is a widely used diagnostic tool for patients with plantar fasciitis. It provides an inexpensive and noninvasive method for quantifying the plantar fascia with accuracy levels comparable to magnetic resonance imaging (MRI). However, some researchers have criticized the lack of standardization in the ultrasound measurement process for plantar fascia thickness as it calls into question the validity of the final measures. One critical component lacking any standardization during the procedure is metatarsophalangeal (MTP) joint position as ultrasound examiners often extend the toe position during the process. This variation has made it difficult to understand the etiology of plantar fasciitis …

Epidemiological, Environmental, And Biological Risk Factors For Gastroschisis, Arti Ketan Desai

Loma Linda University Electronic Theses, Dissertations & Projects

Gastroschisis, a congenital defect of the abdominal wall, manifests as external herniation of viscera, most commonly the fetal bowel. The worldwide prevalence of gastroschisis continues to rise, and this increase can also be seen in California with an overall birth prevalence of 2-3 per 10,000 births. While the etiology and pathogenesis of gastroschisis remains unknown, previous studies indicate several risk factors including young maternal age, nulliparity, and low maternal body mass index, in addition to environmental factors and exposure, given the increase in global prevalence with a predisposition of cases to occur in clusters, and absence of a genetic link. …

Secukinumab Versus Adalimumab For Psoriatic Arthritis: Comparative Effectiveness Up To 48 Weeks Using A Matching-Adjusted Indirect Comparison., Peter Nash, Iain B Mcinnes, Philip Mease, Howard Thom, Matthias Hunger, Andreas Karabis, Kunal Gandhi, Shephard Mpofu, Steffen M Jugl

Articles, Abstracts, and Reports

INTRODUCTION: Secukinumab and adalimumab are approved for adults with active psoriatic arthritis (PsA). In the absence of direct randomized controlled trial (RCT) data, matching-adjusted indirect comparison can estimate the comparative effectiveness in anti-tumor necrosis factor (TNF)-naïve populations.

METHODS: Individual patient data from the FUTURE 2 RCT (secukinumab vs. placebo; N = 299) were adjusted to match baseline characteristics of the ADEPT RCT (adalimumab vs. placebo; N = 313). Logistic regression determined adjustment weights for age, body weight, sex, race, methotrexate use, psoriasis affecting ≥ 3% of body surface area, Psoriasis Area and Severity Index score, Health Assessment Questionnaire Disability Index …

Using A Model To Design Activity-Based Educational Experiences To Improve Cultural Competency Among Graduate Students, Yeon Bai, Kathleen D. Bauer

Department of Nutrition and Food Studies Scholarship and Creative Works

To improve the cultural competency of 34 students participating in graduate nutrition counseling classes, the Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Services was used to design, implement, and evaluate counseling classes. Each assignment and activity addressed one or more of the five constructs of the model, i.e., knowledge, skill, desire, encounters, and awareness. A repeated measure ANOVA evaluated pre- and post-test cultural competence scores (Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals). The overall cultural competence score significantly improved (p < 0.001) from “culturally aware” (68.7 at pre-test) to “culturally competent” (78.7 at post-test). Students significantly improved (p < 0.001) in four constructs of the model including awareness, knowledge, skill, and encounter. Factor analysis indicated that course activities accounted for 83.2% and course assignments accounted for 74.6% of the total variance of cultural competence. An activity-based counseling course encouraging self-evaluation and reflection and addressing Model constructs significantly improved the cultural competence of students. As class activities and assignments aligned well with the Campinha-Bacote Model constructs, the findings of this study can help guide health educators to design effective cultural competence training and education programs.

A Systematic Review Of The Efficacy Of Weighted Vests And Blankets On People With Asd Or Adhd, E. Denny, W. Folkes, I. Ghattas, H. Kaufmann, H. Williams, Marie-Christine Potvin

Student Papers, Posters & Projects

Sensory-based treatment methods are commonly used by occupational therapists and others working with individual with ADHD and ASD (Wan Yunus, Liu, Bissett, & Penkala, 2015). Weighted vests or weighted blankets are popular sensory-based interventions used with people with these conditions. Weighted vests and weighted blankets are widely reported to have various benefits and positive outcomes with children with these conditions (Shulman, 2018). They are thought of as providing deep pressure that is reported to help clients self-regulate, diminish episodes of maladaptive behavior and anxiety or stress, and improve attention, sleep, and mood (Shulman, 2018). A series of systematic reviews have …

Cognitive Orientation To (Daily) Occupational Performance (Co-Op) Approach And Children With Disabilities, E. Amidon, K. Matteo, K. O'Toole, C. Pistilli, A. Slomowitz, Marie-Christine Potvin

Student Papers, Posters & Projects

There is a growing body of research evidence for the CO-OP approach since first published in 2001. Individual studies such as single case designs have found positive outcomes using this approach, however, no prior systematic reviews exist. Therefore, this review aims to compile and evaluate the efficacy of the CO-OP approach in children with disabilities.

Use Of International Classification Of Diseases, Ninth Revision Codes For Obesity: Trends In The United States From An Electronic Health Record-Derived Database., Michelle Mocarski, Ye Tian, B. Gabriel Smolarz, John Mcana, Albert Crawford

College of Population Health Faculty Papers

Obesity is a potentially modifiable risk factor for many diseases, and a better understanding of its impact on health care utilization, costs, and medical outcomes is needed. The ability to accurately evaluate obesity outcomes depends on a correct identification of the population with obesity. The primary objective of this study was to determine the prevalence and accuracy of International Classification of Diseases, Ninth Revision (ICD-9) coding for overweight and obesity within a US primary care electronic health record (EHR) database compared against actual body mass index (BMI) values from recorded clinical patient data; characteristics of patients with obesity who did …

Monitoring Of Birth Registry Coverage And Data Quality Utilizing Lot Quality Assurance Sampling Methodology: A Pilot Study, Shiyam Sunder Tikmani, Sarah Saleem, Elizabeth Mcclure, Farnaz Naqvi, Farina Abrejo, Zahid Soomro, Dennis Wallace, Robert L. Goldenberg

Community Health Sciences

Background: Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan.
Methods: This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for …

The Project To Understand And Research Preterm Pregnancy Outcomes And Stillbirths In South Asia (Purpose): A Protocol Of A Prospective, Cohort Study Of Causes Of Mortality Among Preterm Births And Stillbirths, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Sangappa Dhaded, G. Guruprasad, Yogesh Kumar, Shiyam Sunder Tikmani, Muhammad Masood Kadir, Jamal Raza, Haleema Yasmin

Community Health Sciences

Background: In South Asia, where most stillbirths and neonatal deaths occur, much remains unknown about the causes of these deaths. About one-third of neonatal deaths are attributed to prematurity, yet the specific conditions which cause these deaths are often unclear as is the etiology of stillbirths. In low-resource settings, most women are not routinely tested for infections and autopsy is rare.
Methods: This prospective, cohort study will be conducted in hospitals in Davengere, India and Karachi, Pakistan. All women who deliver either a stillbirth or a preterm birth at one of the hospitals will be eligible for enrollment. …

Out-Of-School Children: Examining The Reasons In Semi- Urban Setting In Pakistan, Nousheen Pradhan, Tanzil Jamali, Shireen Shehzad Bhamani, Tazeen Saeed Ali, Rozina Karmaliani

Community Health Sciences

Globally, 57 million primary age children remain out-of-school. In South Asia, Pakistan has the highest (34%) out-of-primary school age children. This paper highlights the proportion of out-of-school children with reasons and children’s educational attainment in the semi-urban community of Pakistan. A cross-sectional survey was conducted by using systematic sampling in a semi-urban town in Karachi, Pakistan. Chi-square was used to describe the difference in the educational achievements with age and gender of the children with p-value < 0.05, considered as significant. Among 254 surveyed households, 22.9% of the children (age 3-15 years) were found out-of-school, with no significant gender difference among boys (11.6%) and girls (11.1 %). A large group of young children (3-6 years of age) were found out-of-school with boys 71.6% (n=68) and girls 67.03% (n=61). Children’s lack of interest in education was the major (42%) reason, followed by high school expenses (23%). Children’s educational attainment was significantly (p<0.000) related to age and gender. At the local community level, teachers and Taluka Education Officers have a pivotal role to play towards increasing primary school enrollment and mobilizing the resources to overcome financial hardships faced by the parents for their children’s education in early years. Nousheen Akber Pradhan is a Senior Instructor at the Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

Neuroimmunology Diagnostics, Mohammad Saeed, Tariq Gazdar, Nadir Ali Syed, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Neuroimmunology has led to advanced diagnostics of previously cryptic disorders, using autoantibody testing against neurological targets. Neuropsychiatric syndromes and autoimmune encephalitis can now be routinely diagnosed using specialized antibody tests such as immunofluorescence and immunoblot assays in specialized laboratories. This helps in early and accurate diagnosis, leading to favorable patient prognosis. Here, we briefly review the diagnostics for Neuroimmunologic and related disorders including autoimmune encephalitis, demyelinating diseases, neuropathies, paraneoplastic syndromes, stiffperson syndrome, inflammatory myopathies as well as Alzheimer’s disease.

Cerebral Venous Thrombosis Presenting As Subarachnoid Haemorrhage, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

We present a 31 years old lady who was 19 days postpartum who was admitted with fits and loss of consciousness. At presentation Glasgow Coma Scale was 8/15. No focal deficit. CT scan brain showed findings suggestive of subarachnoid haemorrhage(SAH) in left sylvian fissure along with few parenchymal haemorrhagic areas in frontal and parietal lobes. MRI brain and MRV confirmed superior sagittal sinus thrombosis, inferior sagittal, straight and right transverse and sigmoid sinus thrombosis. Patient was treated conservatively and was anticoagulated for 6 months and had a complete recovery. Further workup of thrombophilia was negative. Postpartum being the only risk …

Pattern Of Mental Health Disorders In Adult Population Attending A Tertiary Mental Health Care Setting, Nasir Mehmood, Uroosa Talib, Raza Ur Rehman

Pakistan Journal of Neurological Sciences (PJNS)

Mental health disorders contribute significantly to the global burden of disease (32.4%), . Mental health disorders are the 4th leading cause of disability in developed countries, and the most disabling disorders in low-income and middle-income countries (LAMIC). Over one third of people in most LIMIC fulfill sufficient diagnostic criteria for a mental health disorder at some point in their life.

Profile Of Dementia Patients From A Tertiary Care Center In Karachi, Pakistan, Qurat Ul Ain Khan, Sana Siddiqui, Mohammad Zaman, Abdullah Waqar, Sumera Aziz Ali

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: According to an estimate currently over 46 million people live with dementia worldwide and 58% reside in developing countries. However like some other developing countries, not much is known about the demographics, characteristics, and associated conditions of those suffering from dementia in Pakistan. OBJECTIVE: To study profile of dementia patients from a tertiary care hospital in Karachi, Pakistan.

Association Of Serum Albumin Levels And Guillain Barre Syndrome (Gbs) Outcome., Mazhar Badshah, Ghulam Shabbir, Sumaira Fazal Nabi, Daniyal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker …

Circadian Variation Of Brain Proteins: Importance In Experiments, Muhammad Rafiq, Zahid Mahmood, Sajed Ali

Pakistan Journal of Neurological Sciences (PJNS)

Circadian (from the Latin word circa, meaning 'about', and dies, meaning 'day') rhythms are the rhythms occurring within a period of 24 hours and are endogenously driven in biochemical, physiological or behavioral processes [1]. Circadian rhythms are also entrained by the external environmental cues called zeitgebers, the primary one of which is day light [2]. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria [3]. The study of the biological processes that vary during different time of the day, is called chronobiology. A number of studies on mammalian species have confirmed that the circadian pacemaker resides in …

Child Protection In Pakistan: Legislation & Implementation, Sana Younus, Aisha S Chachar, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Children are an integral part of any society. Their dependency on others for the fulfilment of their basic needs like food, shelter, education, safety and security makes them a vulnerable group. Society is judged on its ability to provide for the needs of the vulnerable. Provision of each of these needs is the responsibility of primary caregivers but requires assistance from multiple agencies working at the national level to ensure an effective delivery. Children’s rights can be defined as “the rights, which are concerned both with the protection of the individual child and with the creation of the conditions in …

Genetic Association With Subgingival Bacterial Colonization In Chronic Periodontitis, Franco Cavalla, Cláudia Cristina Biguetti, Jessica Lima Melchiades, Andre Pantenuci Tabanez, Michelle De Campos Soriani Azevedo, Ana Paula Favaro Trombone, Marcelo Faveri, Magda Feres, Gustavo P. Garlet

School of Podiatric Medicine Publications

Chronic periodontitis is the most prevalent form of inflammatory destructive bone disease and has been affecting humans since antiquity. Evidence suggest that genetic factors can highly influence periodontitis risk, modulating disease elements such as the susceptibility to microbial colonization and the nature of subsequent host-microbe interaction. Several single-nucleotide polymorphisms (SNPs) have been associated with the occurrence of periodontitis, but the full range of genetic influence in periodontitis outcomes remains to be determined. In this context, this study comprises an analysis of possible correlation between periodontitis-related genetic variants with changes in the subgingival microbiological pattern performed in a Brazilian population ( …

Spindle Cell Pseudotumor Mimicking Malignancy In An Immunocompetent Patient With A Left Ventricular Assist Device, Zahava C. Farkas, Lavneet Chawla, Shalom Frager, Edward Esses, Yasmin Yusuf, Brad Dworkin

NYMC Faculty Publications

Cytomegalovirus (CMV)-induced pseudotumors, or mass-like lesions in the colon, are a rare entity. We report a case of CMV-related spindle cell pseudotumor in an immunocompetent patient with a left ventricular assist device. This case highlights the importance of considering CMV-induced inflammatory pseudotumor when evaluating tumorous lesions in the colon, as well as the importance of appropriate diagnostic work-up, including proper biopsy technique and meticulous review of the pathology.

The Impact Of Comorbidities, Depression, And Substance Use Problems On Quality Of Life Among Older Adults Living With Hiv, Brett M. Millar, Tyrel Starks, Sitaji Gurung, Jeffrey T. Parsons

Publications and Research

Older adults living with HIV (OALWH) comprise a growing population with a range of complex and interconnecting medical and psychosocial needs. Based on the biopsychosocial model with its emphasis on a holistic approach to various aspects of people’s lives, the current study explored associations between physical health, psychological health, substance use, and overall quality of life. Drawing on data from 114 substance-using OALWH (aged 50 or older), we employed linear regression to show associations between the number of current comorbid health conditions on quality of life, over and above depression, substance use problems, and demographic characteristics (age, race/ethnicity, gender, sexual …