Medicine and Health Sciences Commons^™

Risk For Cardiovascular Diseases In Prostate Cancer Patients Treated With Androgen Deprivation: A Population-Based Cohort Study, Lei Jiang

Public Health Theses

Background: Previous studies evaluating the risk of cardiovascular diseases (CVD) in prostate cancer patients receiving androgen deprivation treatment (ADT) often did not distinguish different types of ADT.

Methods: We conducted a large, retrospective cohort study using the linked Surveillance, Epidemiology and End Results - Medicare database, including patients with primary localized prostate cancer diagnosed in 2007--2013 and followed through the end of 2014. Time dependent multivariable Cox proportional hazards models with death as the competing risk were used to evaluate the association between ADT (overall, and two subtypes: gonadotropin-releasing hormone [GnRH] agonists and oral antiandrogens) and incidence of CVD. …

Improved Cognitive Outcomes In Patients With Relapsing-Remitting Multiple Sclerosis Treated With Daclizumab Beta: Results From The Decide Study., Ralph Hb Benedict, Stanley Cohan, Sharon G Lynch, Katherine Riester, Ping Wang, Wanda Castro-Borrero, Jacob Elkins, Guido Sabatella

Articles, Abstracts, and Reports

BACKGROUND: Cognitive impairment is common in multiple sclerosis (MS), with cognitive processing speed being the most frequently affected domain.

OBJECTIVE: Examine the effects of daclizumab beta versus intramuscular (IM) interferon (IFN) beta-1a on cognitive processing speed as assessed by Symbol Digit Modalities Test (SDMT).

METHODS: In DECIDE, patients with relapsing-remitting multiple sclerosis (RRMS) (age: 18-55 years; Expanded Disability Status Scale (EDSS) score 0-5.0) were randomized to daclizumab beta ( n = 919) or IM IFN beta-1a ( n = 922) for 96-144 weeks. SDMT was administered at baseline and at 24-week intervals.

RESULTS: At week 96, significantly greater mean improvement …

Ganglioglioma Masked As Migraines., Kyle Kreitman Do

Department of Medicine

No abstract provided.

Physical Therapy Review Of Best Practices Based On Psychology, Bethany Painter

Honors Projects

Physical therapy is a field that is growing and changing constantly. For so long, it was assumed that physical healing should be the sole focus of physical therapy. While this is an important aspect of the rehabilitation process, there is so much more to it than that. The psychological trauma a person may experience following an injury can be just as challenging, if not more challenging to overcome than the physical repercussions of the injury. For this reason, it is important to take psychological healing into consideration, as well as physical healing when creating best practices for physical therapists. The …

The Impact Of Diabetes Mellitus On Burns And Standard Burn Treatments, Emma Shepard

Senior Honors Theses

Burns are complex injuries that trigger the stress response and result in increased blood glucose. Diabetes mellitus, an endocrine disorder with abnormal glucose regulation, can significantly alter the risk for burns and the treatment of burns. Pre-existing diabetes mellitus complicates burn treatments and healing ability. Diabetes mellitus may also develop directly from an unregulated stress response to the burn. The consideration of diabetes mellitus affects wound care, medications, and nutrition for burn patients. As patient advocates, nurses are responsible for caring for burn patients with awareness of endocrine complications. This paper provides a detailed overview of the pathophysiology, complications, and …

Infections Not Fought: Antibiotic Resistance In Underserved Communities, Derek Lillestolen

Senior Honors Theses

In 1928, the profound effects of penicillin were discovered and antibiotic treatments became extremely popular. Broad-spectrum antibiotics, like tetracyclines, have been since branded as cure-all prescriptions and used profusely in the Western World and abroad. Due to ignorance of specific biochemical mechanisms and the misuse of antibiotics these drugs inadvertently allowed the rise in prevalence of antibiotic resistant strains of certain bacteria as the century progressed. Now, the specific genetic causes and mechanisms of antibiotic resistance are being understood, but the fight against antimicrobial resistance is far from over. In the United States, thousands of fatalities are caused annually by …

Supplemental Training And Injury Prevention In The Sport Of Ultra-Running, Jessica M. Heidebrink

Senior Honors Theses

By definition, ultra-marathon running is a sport that covers any distance above the 26.2-mile marathon distance in a single race. The mountains of Virginia host many ultra-marathon races that attract endurance runners from all over the nation to participate. Training is an essential component of running an ultra. Although there is not one specific way to train for an ultra, there is research that correlates the success of the top ultra-runners and their training preferences regarding supplemental training and injury prevention. To gain a more complete understanding of how to prepare for a successful ultra-marathon, an online survey was created …

Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin

Senior Honors Theses

The structures of the spinal cord and vertebral column are designed to provide flexibility, while still providing ample protection for the spinal cord deep within. While it does offer remarkable protection against most routine trauma, the spinal cord is still vulnerable to high-force etiologies of trauma and may become damaged as a result. These events are referred to as primary injury. Following the initial injury, the body’s own physiological responses cause a cascade of deleterious effects, known as secondary injury. Secondary injury is a major therapeutic target in mitigating the effects of spinal cord injury (SCI), and much research is …

Children’S Perspectives Of Their Psychosocial Wellbeing In Tanzanian Orphanages, Agnes Msoka, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

The aim of this study was to explore factors affecting the wellbeing of institutionalized orphaned children in Dar es Salaam, Tanzania. A descriptive qualitative study was used to collect data from Tanzanian orphaned children receiving orphanage care. Purposive sampling was employed to select 10 orphanage centers from which 123 orphaned children were recruited. A semi-structured interview guide relevant to the study objectives was developed from the literature and was used to guide the focus group interviews. Data was analysed by way of thematic analysis. There were 76 male and 47 female orphans; orphans without one or both parents were 87 …

Developing Certification Exam Questions: More Deliberate Than You May Think, Cheryl (Cheri) L. Marcham, Treasa M. Turnbeaugh, Susan Gould, Joel T. Nader

Publications

For more than 40 years, the multiple-choice examination has been the standardized assessment tool used in the certification process of OSH professionals (Wright, Turnbeaugh, Weldon, et al., 2015). The use of a multiple-choice exam to award a credential, however, has been criticized by many OSH professionals. This may be primarily due to a perception that relates to their previous academic experience with multiple-choice exams and a misunderstanding of the science behind the development of such exams.

The use of standardized tests clearly ensures a consistent and rapid method of scoring, but the use of such tests is legally defensible only …

Current Genetic Counseling Practice Following Positive Non-Invasive Prenatal Testing For Sex Chromosome Abnormalities, Lauren Fleddermann

Dissertations and Theses (Open Access)

The purpose of this study was to describe current prenatal and pediatric genetic counseling practice following a non-invasive prenatal testing (NIPT) result positive for a sex chromosome abnormality (SCA). The positive predictive value for SCA with NIPT is lower than seen for Trisomy 21 due to natural loss of the X chromosome from maternal cells during aging, confined placental mosaicism, and undiagnosed maternal sex chromosome abnormality. Except for 45,X, individuals with SCA usually have no ultrasound or postnatal findings. This makes follow-up for unresolved positive NIPT necessary; however, there are currently no clinical guidelines. This study used a prospective anonymous …

Functional Heterogeneity Of Fibroblasts In Dermal Wound Healing, Ehsan Ehsanipour

Dissertations and Theses (Open Access)

Impaired wound healing can lead to excessive scarring, dehiscence, chronic ulcers, and infection, which have adverse impact on the quality of life and pose a significant economic burden on the health care system. Thus, new therapeutic approaches are critically important. Dermal fibroblasts are critical players in cutaneous wound healing, possibly lending their contractile properties and extracellular matrix (ECM) remodeling functions to promote effective tissue repair. Dermal fibroblasts are also postulated to orchestrate tissue repair by interacting with and controlling other cell types in the wound microenvironment. It has become increasingly clear that the generic term “fibroblast” encompasses a diverse cell …

The Epithelial To Mesenchymal Transition In Breast Cancer Induces Alterations In Metabolism, Esmeralda Ramirez-Peña

Dissertations and Theses (Open Access)

Metastasis is currently incurable. Recent studies suggest that metabolic reprogramming significantly impacts metastatic progression. Understanding the underlying biology of how metabolic reprogramming influences metastasis will shed light on developing novel ways to treat metastasis and is of urgent clinical need. A potent mediator of metastatic potential in breast cancer is the winged helix/Forkhead domain transcription factor FOXC2. We have previously shown that FOXC2 is necessary and sufficient to promote metastasis through induction of the epithelial to mesenchymal transition (EMT). EMT is a latent embryonic program that is aberrantly induced in breast cancer cells conferring migratory and invasive capabilities in addition …

Epithelial To Mesenchymal Transition As A Predictor Of Response To Polo-Like Kinase 1 Inhibition-Induced Apoptosis In Non-Small Cell Lung Carcinoma, Pavitra Viswanath

Dissertations and Theses (Open Access)

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide. Outcomes are poor for patients with recurrent, advanced or metastatic NSCLC. Polo-like kinase 1 (PLK1), involved in the regulation of mitotic processes and the response to DNA damage, is overexpressed in NSCLC. Inhibiting PLK1 may be an effective treatment for NSCLC patients as it is involved in the mechanisms of resistance to several chemotherapy drugs. PLK1 inhibition or knock-down has various effects in cancer cells, including mitotic arrest, apoptosis, and senescence. Predictive biomarkers have not been identified to select those patients who are likely to respond to …

Investigating The Impact Of Intragenic Dna Methylation On Gene Expression, And The Clinical Implications On Tumor Cells And Associated Stroma, Michael Mcguire

Dissertations and Theses (Open Access)

Investigations into the function of non-promoter DNA methylation have yielded new insights into epigenetic regulation of gene expression. Previous studies have highlighted the importance of distinguishing between DNA methylation in discrete functional regions; however, integrated non-promoter DNA methylation and gene expression analyses across a wide number of tumor types and corresponding normal tissues have not been performed. Through integrated analysis of gene expression and DNA methylation profiles, we uncovered an enrichment of DNA methylation sites within the gene body and 3’UTR in which DNA methylation is strongly positively correlated with gene expression. We examined 32 tumor types and identified 57 …

Development And Characterization Of A Bi-Specific Antibody Targeting Hla-A2/Pr1, Amanda Herrmann

Dissertations and Theses (Open Access)

Despite substantial advances in the treatment of acute myeloid leukemia (AML), only 30% of AML patients survive more than 5 years. Therefore, new therapeutics are much needed. Here, we present novel therapeutic strategy targeting myeloid leukemia antigen, HLA-A2 restricted peptide PR1.Previously, we have conducted pre-clinical development and humanization of a T cell receptor-like monoclonal antibody (h8F4) that targets PR1/HLA-A2 and eliminates AML xenografts by antibody-dependent cellular cytotoxicity (ADCC) following repeat dosing. To improve the potency of h8F4, we have developed a bi-specific T cell-engaging antibody that targets PR1/HLA-A2 on leukemia and CD3 on neighboring T cells. Here we demonstrate successful …

Nanoscale Organization Of The Small Gtpase Rac1, Kelsey Maxwell

Dissertations and Theses (Open Access)

Rac1 is a small, guanine-nucleotide binding protein that cycles between an inactive GDP-bound and active GTP-bound state to regulate actin-mediated motility, migration, and adhesion. Plasma membrane (PM) localization is essential for its biological activity. Rac1 PM targeting is directed by a C-terminal membrane anchor that encompasses a geranylgeranyl-cysteine-methyl-ester, palmitoyl, and a polybasic domain (PBD) of contiguous lysine and arginine residues. Using high-resolution imaging combined with spatial mapping analysis, I found that Rac1 forms nanoclusters on the PM. Cycling between the GTP- and GDP-bound states, Rac1 forms nanoclusters that are non-overlapping, consequently undergoing guanine nucleotide-dependent spatial segregation. I further found that …

Examining The Relationship Between Genetic Counselors’ Implicit Attitudes To Ward Disability And Their Practice Methods, Helen W. Gould

Dissertations and Theses (Open Access)

Genetic counselors serve as a link between the medical community and the disability community as they are regularly the first exposure families have following a new diagnosis in a pregnancy, infant or child. This role requires genetic counselors to be responsible and compassionate when approaching conversations about disability. With a lack of research on how the specific attitudes of genetic counselors toward disability impact clinical practice, we aimed to understand these attitudes, what factors affect implicit attitudes toward disability, and how these attitudes affect counseling. Case scenarios involving disability were used to examine different counseling content preferences within a genetic …

Genetic Testing Practices Of Genetic Counselors, Geneticists, And Pediatric Neurologists With Regard To Childhood-Onset Neurogenetic Conditions, Sara Wofford

Dissertations and Theses (Open Access)

Identifying genetic diagnoses for neurological conditions with a considerable hereditary component, such as autism spectrum disorder (ASD), intellectual disability, and epilepsy, is critical to providing proper medical management for these patients and their families. However, many patients with these conditions are not tested appropriately or receive no genetic testing at all. The current study was designed to characterize the genetic testing practices of the providers most likely to evaluate or order genetic testing for these patients: pediatric neurologists, geneticists, and genetic counselors. The study noted significant variance between the testing strategies selected by pediatric neurologists compared to those of geneticists …

Outcomes Of Genetic Testing In A Genitourinary Genetics Clinic, Annelise Pace

Dissertations and Theses (Open Access)

Several known hereditary cancer syndromes confer an increased risk for genitourinary (GU)related malignancies. Various guidelines indicate when to refer patients to genetic counseling for GU-related hereditary cancer syndromes but there is limited research on the clinical picture of these patients, including their cancerous and non-cancerous features, the genetic testing strategy for this population, and the probability of having a positive germline mutation if testing is performed. The purpose of this study is to determine the most common indications for ordering genetic testing in a GU Genetics Clinic and evaluate whether there is a relationship between the indication for genetic testing …

Identification Of Tissue And Circulating Biomarkers For Premalignant And Malignant Lesions, Shu-Hong Lin

Dissertations and Theses (Open Access)

Recent advancement in technologies including next-generation sequencing and production-scale throughput qPCR have revolutionized the identification of biomarkers in the epidemiology field. In response to the vast amount of data generated from high-throughput technologies, novel inventions in the computer sciences fields have been applied to analyze these data. The current study demonstrates the application of such technologies in a variety of scenarios.

I first described how targeted and whole-exome sequencing were used to identify somatic mutations which marked the differences between colorectal adenomas and adenocarcinomas. A statistical test based on the unique clustering pattern of tumor suppressor genes and oncogenes was …

Computational Insights Into The Generation Of Chromosomal Copy Number Changes, Yihua Liu

Dissertations and Theses (Open Access)

Deviations from a diploid configuration of the human genome, spanning single genes or entire chromosomes, can have wide-ranging impacts on the variation of human phenotypes, including Mendelian and complex forms of diseases. These chromosomal alterations — such as duplications, deletions or copy-neutral loss-of-heterozygosity — are thus important forms of genetic variation for phenotyping populations of individuals as well as populations of cells. Indeed, copy number variants (CNVs) serve as hallmarks of critical changes in the development of particular diseases such as cancer and thus may be used as biomarkers. These CNVs may be either inherited (transmitted by germ cells, originating …

Tumor Immunotherapy: Mechanisms Of Acquired Resistance And Characterization Of Immune Related To Xicities, Ashvin Jaiswal

Dissertations and Theses (Open Access)

Tumor immunotherapy has shown very promising clinical benefit across an array of cancers; however, two major challenges remain unresolved in the field. First, many patients do not respond to therapy at all or relapse after a period of remission. Second, there are often dose-limiting immune related adverse effects associated with immunomodulation.

In order to understand the mechanisms employed by tumors to evade immunotherapeutic responses, we established a murine model of melanoma designed to elucidate the molecular mechanisms underlying immunotherapy resistance. Through multiple in vivo passages, we selected a B16 melanoma tumor line that evolved complete resistance to combination blockade of …

Identifying Subunit Organization And Function Of The Nuclear Rna Exosome Machinery, Jillian Losh

Dissertations and Theses (Open Access)

IDENTIFYING SUBUNIT ORGANIZATION AND FUNCTION OF THE NUCLEAR RNA EXOSOME MACHINERY

Jillian Strother Losh, A.S., B.S.

The eukaryotic RNA exosome processes and degrades many classes of RNA. It is present in the nucleus and the cytoplasm, highly evolutionarily conserved, and essential for viability. Since the RNA exosome is such a significant component of the RNA degradation machinery, it is unsurprising that even single point mutations in a few of its subunits have been linked to human disease. For example, at least eight point mutations in a single subunit of the RNA exosome have been linked to pontocerebellar hypoplasia subtype 1b …

Sphingosine Kinase 1 Regulates Fascin Expression To Promote Metastasis In Triple Negative Breast Cancer, Sunil Acharya

Dissertations and Theses (Open Access)

Distant metastasis is the primary cause of breast cancer–related mortality. To date, effective therapeutic drugs that target metastasis are still lacking. Triple negative breast cancer (TNBC) occurs in high frequency in young women and are more likely to recur and metastasize than are other breast cancer subtypes. Also, TNBC patients cannot benefit from currently available hormonal or targeted therapies, as they lack estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2. Thus, understanding the signaling pathways that promote TNBC metastasis and developing novel therapeutic approaches to target them are critical, in order to prolong the survival and improve …

Genomic Evolution Of Chemoresistance In Triple-Negative Breast Cancer Delineated By Single Cell Sequencing, Charissa Kim

Dissertations and Theses (Open Access)

Triple-negative breast cancer (TNBC) is an aggressive subtype that displays extensive intratumor heterogeneity and frequently (46%) develops resistance to neoadjuvant chemotherapy (NAC). Currently, the genomic basis of chemoresistance remains poorly understood. An important question is whether resistance to chemotherapy is driven by the selection of rare pre-existing subclones with genomic mutations and transcriptional programs that confer resistance to chemotherapy (adaptive resistance) or by the spontaneous induction of new mutations and expression changes that confer a resistant phenotype (acquired resistance). To investigate this question we applied single cell DNA and RNA sequencing methods and deep-exome sequencing to longitudinal time-point samples collected …

Somatostatin Receptor 2 Regulation By C-Terminal Motifs And Pdz Domain Proteins, Courtney Olsen

Dissertations and Theses (Open Access)

Somatostatin receptor 2 (sst2) is a Gi-coupled G-protein coupled receptor that mediates many of somatostatin’s neuroendocrine actions. Sst2 is a clinically important GPCR as it is the drug target of somatostatin analogs such as octreotide, lanreotide, and pasireotide. Treatment with these agonists is the main medical approach to controlling excessive hormone secretion from neuroendocrine tumors. Activation of sst2 decreases hormone secretion by inhibiting cAMP production and decreasing intracellular calcium concentrations. In addition, treatment with somatostatin analogs has been shown to decrease tumor growth. Unfortunately, many patients will fail to respond to somatostatin analogs despite sst2 being present on their tumors. …

Bayesian Designs For Early Phase Clinical Trials With Novel Target Agents, Heng Zhou

Dissertations and Theses (Open Access)

My dissertation mainly focus on Bayesian designs for early phase clinical trials with novel target agents. It includes three specific topics: (1) reviewing novel phase I clinical trial designs and comparing their operating characteristics; (2) Proposing a Bayesian optimal phase II clinical trial (BOP2) design with simple and complex endpoints under a unified framework; and (3) extending the BOP2 design to incorporate the durable clinical response as a primary endpoint.

A number of novel model-based and model-assisted designs have been proposed to find the maximum tolerated dose (MTD) in phase I clinical trials, but their differences and relative pros and …

Identifying Molecular Targets And Validating Novel Therapies For Ovarian Cancer, Alejandro Villar-Prados

Dissertations and Theses (Open Access)

Re-purposing of targeted therapies for additional tumor types is a promising avenue for expanding treatment options for cancer patients, however accurately predicting what re-purposed targeted therapy will be effective remains challenging. To address this need, we developed a Therapy Predicting Tool (TPT) that accurately predicts the beneficial therapeutic effect of clinically relevant targeted therapies and the downstream pathways they may impact in the cancer of interest. Using ovarian cancer as a model to biologically validate our tool, we determined that Bromodomain and Extra-Terminal motif inhibitors (BETis), which target proteins such as BRD4, held the greatest promise to produce therapeutic effects …

Trim24 As An Oncogene In The Mammary Gland, Aundrietta Duncan

Dissertations and Theses (Open Access)

Despite the many advances made in breast cancer research and treatments, breast cancer remains one of the deadliest diseases plaguing women worldwide. While many findings on genetic mutations and their role in predisposing people to breast cancer have been uncovered, we are just beginning to understand the extent to which epigenetic regulators promote tumorigenic phenotypes, metastasis, and chemotherapeutic resistance. Moreover, new experimental tools offer the ability to address questions we were previously unable to assess. My project takes advantage of a new mouse model to understand the role of a proto-oncogenic, transcriptional co-regulator, TRIM24, in mammary gland development and disease. …