Medicine and Health Sciences Commons^™

Pre-Treatment Hiv-Drug Resistance Associated With Virologic Outcome Of First-Line Nnrti-Antiretroviral Therapy: A Cohort Study In Kenya, Ingrid A. Beck, Molly Levine, Christine J. Mcgrath, Steve Bii, Ross S. Milne, James M. Kingoo, Isaac So, Nina Andersen, Sandra Dross, Michael Chung

Internal Medicine, East Africa

Background: Pre-treatment HIV-drug-resistance (PDR) to WHO-recommended 1st-line non-nucleoside reverse transcriptase inhibitors (NNRTI)-based antiretroviral treatment (ART) is increasing in low-resource communities. We evaluated the risk of PDR on treatment failure if detected at single or multiple codons, at minority (2–9%) or higher (≥10%) frequencies during efavirenz- vs. nevirapine-ART.

Methods: We conducted a pooled analysis across three cohorts of Kenyans initiating 1st-line NNRTI-ART between 2006 and 2014. Mutations K103N, Y181C, G190A, M184V and K65R were detected by an oligonucleotide ligation assay (OLA) and confirmed by Sanger and next-generation sequencing (NGS). PDR was defined as detection of any mutation by OLA when confirmed …

Revisiting Caroli Syndrome In A Tanzanian Patient, Casmir Wambura, Munish Sharma, Salim Surani

Internal Medicine, East Africa

Caroli disease and Caroli syndrome are two rare congenital diseases of the intrahepatic bile ducts. Caroli syndrome is characterized by the saccular dilatation of intrahepatic bile ducts associated with congenital hepatic fibrosis. It is rarely diagnosed in childhood. We hereby describe a case of Caroli syndrome in a young Tanzanian female who had abdominal pain and distension since childhood. Her history suggested the presence of portal hypertension possibly from congenital hepatic fibrosis. The diagnosis was reached based on ultrasound, computed tomography (CT) scan of the abdomen, and magnetic resonance cholangiopancreatography (MRCP)

Association Of Common Chronic Pain Conditions To Incident Alzheimer’S Disease And Related Dementias In Two Cohorts Of Older Medicare Beneficiaries, Sumaira Khalid

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objective: The purpose of this research was to study the collective and incremental association of common non-cancer chronic pain conditions (NCPC) to risk for Alzheimer’s disease and related dementias (ADRD); to explore the potential mediating influence of mood and sleep disorders; and to assess the potential synergistic effects of NCPC’s and multimorbidity on ADRD risk. This research also aimed to study the contribution of NCPC to ADRD risk in poor, rural, underserved United States populations who suffer a disproportionate burden of ADRD risk factors. To achieve these goals, this dissertation pursued three specific aims: 1) assess the association of …

Integrating The Natural Healing Process For Post-Traumatic Stress Disorder Treatment In Veterans Through A Healing Garden., Taiwo A. Ajibade

Graduate Theses, Dissertations, and Problem Reports (ETD)

In 2002, several ex-service personnel brought a court case against the Ministry of Defense for the inability to identify PTSD issues at an early stage and to provide support and effective treatment (Langston et al. 2007). Also in recent times, reports have suggested that US marine and army infantry units returning from duty in Iraq and Afghanistan have a higher level of expected proportions of mental disorders and that about 10% of personnel are returning home are with symptoms of post-traumatic stress disorder (Smith et al., 2008). This discovery made it pertinent to look for natural ways to assist veterans …

Structural Transformations Of Synaptic Partners During Growth And Competition Of The Giant Nerve Terminal, The Calyx Of Held, In The Medial Nucleus Of The Trapezoid Body In The Developing Postnatal Mouse, Dakota Richard Jackson

Graduate Theses, Dissertations, and Problem Reports (ETD)

Across many parts of the nervous system, initial neural circuit assembly involves stereotyped stages of early axonal proliferation within target territories, selective reinforcement of a subset of inputs and the removal of exuberant or unneeded connections via either activity or experience-dependent mechanisms, in a process referred to as synaptic competition. The mechanisms and associated structural transformations that underlie and define these stages of neurodevelopment have been examined in a variety of brain regions including the peripheral neuromuscular junction, the central climbing fiber innervation of cerebellar Purkinje cells and retinal ganglion cell innervation of the thalamic lateral geniculate nucleus. Each of …

Wv Dental Hygienists' Knowledge And Educational Approach For Pregnant Women, Isabella Hope Mcdaniel

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Adverse pregnancy outcomes have become a concern for dental professionals caring for pregnant women with poor oral health. Pregnant women may not be aware of their increased risk of bacterial infections in their oral tissues and how it could relate to adverse pregnancy outcomes such as pre- term birth (PTB) and low birthweight babies (LBW). Dental healthcare professionals need to be well informed of risk related to poor oral health and have confidence to effectively educate pregnant women. PTB and LBW babies account for 1 million infant deaths annually. It is the responsibility of dental healthcare professionals to be …

Cerebrovascular Dysfunction And Degeneration In Alzheimer’S Disease Pathophysiology, Dominic Dimitri Quintana

Graduate Theses, Dissertations, and Problem Reports (ETD)

Alzheimer’s disease (AD) is a terminal illness and the most common form of dementia, which disproportionately affects the aged population. The pathophysiology of AD is characterized by neurodegeneration that slowly progresses, affecting regions of the brain that are involved in learning, memory, language, and executive function. In patients with the disease, early symptoms include non-disruptive forgetfulness that evolves into the inability to form new memories and ultimately the loss of autonomy at late stages. Histopathological hallmarks in the brain from patients with AD is the presence of amyloid-β (Aβ)-plaques and neurofibrillary tangles (NFT) deposited in the parenchyma. Since the discovery …

Effect Of Western Diet And Caloric Substitution With Apple Pomace On Fatty Acid Composition And Gene Expression In The Hypothalamus Of Growing Female Sprague-Dawley Rats, Ayad Abdulhamid Alawadi

Graduate Theses, Dissertations, and Problem Reports (ETD)

The hypothalamus plays a major role in regulating food-intake and energy-expenditure. Hypothalamic dysfunction implicated in neurodegenerative diseases is characterized by diet-induced neuroinflammation and energy dysregulation. Apple pomace, a waste byproduct of processing, is rich in polyphenols and soluble fibers, has the potential to ameliorate diet-inducing inflammation. The objective of this study was to determine the effects of Western diet and caloric substitution of Western diet with 10% apple pomace on brain fatty acid composition and gene expression related to hypothalamic function and health in growing female rats. Growing female Sprague-Dawley rats (age 22-29 days) were randomly assigned (n=8 rats/group) to …

Fracture Resistance Of Simulated External Cervical Resorption In Anterior Teeth Restored With And Without A Fiber Post., Michelle M. Romeo

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: External cervical resorption (ECR) is a destructive type of external resorption that can be difficult to treat. ECR usually begins subgingival at the cementoenamel junction of teeth and continues apically and circumferentially. This substantial loss of tooth structure may make these teeth more prone to fracture and should be addressed when treatment planning teeth with ECR. The aim of this in vitro study was to evaluate the fracture resistance of treated and non-treated teeth with simulated ECR using two different treatment modalities.

Materials and Methods: Forty-eight extracted human permanent mandibular central incisors were selected. Teeth were randomly divided into …

The Pattern Of Odontogenic Referred Pain, James J. Poulos

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Referred odontogenic pain (RP) is a phenomenon that is seen regularly in dentistry and it is not extensively understood. It can make formulating a proper diagnosis difficult and its presence can lead to inappropriate treatment.

Methods: 250 patients experiencing odontogenic pain within the dental clinics of West Virginia University were surveyed. The survey inquired about the patient’s biographical information, medical history, characteristics of the pain, the presence and location of RP, and the psychosocial effects of the pain. Additionally, the endodontic diagnosis of the offending tooth was determined by a member of the endodontic department. The collected …

The Interplay Of Progestins, Matrix Metalloproteinases, And The Aging Brain, Keyana Nicole Porter

Graduate Theses, Dissertations, and Problem Reports (ETD)

Progestins are synthetic hormones that are designed to mimic the biological actions of progesterone. They, however, possess other pharmacological actions and properties, in addition to their progestational activities. Medroxyprogesterone Acetate (MPA) is a progestin used globally in the hormonal contraceptive, Depo Provera®, by women in their reproductive prime and is a major compound found in hormone therapy (HT) formulations used by menopausal women. MPA is used by approximately 1 in 5 adolescents and adult women in the United States who are sexually active. Globally, nearly 48 million women utilize injectable contraceptives to prevent pregnancy, with most users utilizing MPA as …

Green Completion As A Mitigation For Btex Exposure In Gas Flaring: Nigeria Case Study (Exposure Assessment And Cost Model), Akintunde S. Akinyemi

Graduate Theses, Dissertations, and Problem Reports (ETD)

Gas flaring is an essential part of the oil and gas industry safety and waste management procedures; however, it presents a potential exposure to BTEX compounds, a group of Non-Methane Volatile Organic Compounds (NMVOC), within up to a 10-mile radius of the flare point. The physical and the psychological cost of the journey to work, make employees live close to the workplace. This study examined the perceived exposure of oil and gas industry workers to possible carcinogenic emissions outside the workplace. It looked at the outcomes of the exposure to BTEX through gas flaring drawing on archival data and using …

Applications Of Machine Learning Methods In Health Outcomes Research: Heart Failure In Women, Khalid Abdullah Alhussain

Graduate Theses, Dissertations, and Problem Reports (ETD)

There is robust evidence that heart failure (HF) is associated with substantial mortality, morbidity, poor health-related quality of life, healthcare utilization, and economic burden. Previous research has revealed that there are sex differences in the epidemiology, etiology, and disease burden of HF. However, research on HF among women, especially postmenopausal women, is limited. To fill the knowledge gap, the three related aims of this dissertation were to: (1) identify knowledge gaps in HF research among women, especially postmenopausal women, using unsupervised machine learning methods and big data (i.e., articles published in PubMed); (2) identify emerging predictors (i.e., polypharmacy and some …

Role Of Ciliary Proteins Adp Ribosylation Factor Like Gtpase 13b (Arl13b) And Bardet-Biedl Syndrome-8 (Bbs8) In Photoreceptor Outer Segment Morphogenesis, Maintenance, And Viability, Tanya L. Dilan

Graduate Theses, Dissertations, and Problem Reports (ETD)

Photoreceptor neurons are modified primary cilia with an extended ciliary compartment known as the outer segment (OS). The mechanisms behind the elaboration of photoreceptor cilia, OS morphogenesis, and maintenance remain poorly understood. In this work, we focused on dissecting the role of two ciliary proteins, the small GTPase ADP-ribosylation factor-like GTPase 13B (ARL13B) and Bardet-Biedl Syndrome-8 (BBS8) in the context of photoreceptor biology. Both BBS8 and ARL13B are linked to defects in ciliogenesis (cilia development) and Retinitis Pigmentosa (vision loss). ARL13B is implicated in regulating ciliary length, and BBS8 is part of the Bardet-Biedl Syndrome complex (BBSome); the BBSome is …

Asthma-Copd Overlap: Economic Burden And Medication Adherence, Mona Nili

Graduate Theses, Dissertations, and Problem Reports (ETD)

In many older adults, asthma and chronic obstructive pulmonary disease (COPD) coexist as “Asthma-COPD overlap” (ACO). This dissertation pursued three Aims: 1) estimate the economic burden of ACO and its contributory factors; 2) evaluate the association of ACO to “cost-related medication nonadherence” (CRN); and 3) identify adherence trajectory patterns and examine the impact of initial maintenance therapies (IMT) type (inhaled corticosteroids monotherapy (ICS) vs. fixed-dose combination of ICS and long-acting beta agonist (ICS/LABA)) on adherence trajectory patterns among older adults Medicare Beneficiaries. The first and second Aims were cross-sectional studies by using Medicare Current Beneficiary Survey data. For the third …

Evaluation Of The Impact Of An Educational Intervention Aimed At Improving Tuberculosis Infection Control Knowledge Among Health Care Workers In A Military Treatment Facility: A Quality Improvement Project, Allen C. Potter

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Florida (FL) is one of the top five states in the nation for Tuberculosis (TB) infections. A majority of new infections can be found in the minority populations which represents 78% of all TB infections in the state. A combination of TB rates in FL, Orlando located 60 miles away and a transient population who frequently deploys worldwide to austere locations may result in an increased risk of acquiring TB. Literature suggests Health Care Providers (HCPs) obtain training regarding TB Infection Control (TB-IC). The Patrick AFB Military Treatment Facility (MTF) lacked a TB Infection Control (TB-IC) plan. Objective: The …

Creating A Community-Based Protocol To Prevent Unintended Pregnancy In Homeless Women In Monongalia County, West Virginia, Jessica Eva Wukasch

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: At any given time, 10% of homeless women are pregnant, about twice the rate of all U.S. women of reproductive age (5%) (Healthcare for the Homeless, 2001). According to Healthcare for the Homeless Council ([HHC], 2012), approximately “73% of pregnancies among homeless women were unintended at the time of conception.” In addition, “about 12% of homeless children are placed in foster care compared to 1% of other children” (HHC, 2012). There is an evident need to address unintended pregnancy among homeless women.

Objective: The overall objective was to create an accessible and useful community-based protocol to reduce the rate …

Clincial Translational Science Research Of The Functional Role Of Large Conductance Potassium Channels In Selective Destruction Of Triple Negative Breast Cancer Cells, Gina Sizemore

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

The preliminary background that puts this research into context is threefold; it is the aggressive nature of triple negative breast cancer (TNBC), the complexity surrounding its pathology, and the significant lack of targeted treatment for this disease. To clarify the focus of my research, I have concentrated on identifying a targeted treatment for TNBC. In the process, I have identified cycles of reciprocity between treatment, clinical diagnosis, staging, and pathology that will be addressed in smaller papers. However, the weight of this work is in the discovery of a novel target for triple negative breast cancer. The value of …

Evaluation Of Control Strategies For Overhead Work Using Electromyography Of Rotator Cuff Muscles, Hossein Motabar

Graduate Theses, Dissertations, and Problem Reports (ETD)

Work-related musculoskeletal disorders (MSDs) of shoulder have a significant impact on overall health and economics in the industrialized nations. Rotator cuff is the most frequently injured region in the shoulder complex. Overhead work is considered as one of the most predominant causes of rotator cuff injuries. The workers in construction, automotive, and aerospace industries are routinely exposed to overhead exertions. Elimination of overhead work is nearly impossible due to various task and technology constraints. Therefore, appropriate intervention strategies based on the engineering and administrative controls opt to be used to prevent the hazardous impact of overhead exertions. The objective of …

Therapeutic Approaches To Recovery In West Virginia, Rachel A. Wattick

Graduate Theses, Dissertations, and Problem Reports (ETD)

Substance use disorder (SUD) is a prevalent problem in the United States, with 19.7 million Americans aged 12 and older battling an SUD in 2017. Multiple factors influence the risk that someone will develop an SUD, including family history, childhood trauma, community factors, and poverty. West Virginia has the highest rate of overdose deaths in the nation, and individuals in WV are at high risk of SUD due to the aforementioned risk factors. There are a variety of treatment options available to someone with an SUD. These include outpatient or inpatient treatment, detoxification, therapeutic communities, and collegiate recovery programs. Despite …

Three Essays On Health Economics And Policy Evaluation, Shishir Shakya

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances …

Evaluation Of The Care And Communication Bundle To Improve Palliative Care In Intensive Care Units, Angela Susan Bohon

Graduate Theses, Dissertations, and Problem Reports (ETD)

Review of local data and concerns from nursing staff revealed the need to improve palliative care in a local, community hospital Intensive Care Unit (ICU). This effort was mobilized by implementing the Care and Communication Bundle within evidence-based time frames, into this local, community ICU, using Lewin’s Change theory as a guide for implementation. The Care and Communication Bundle is a grouping of nine palliative, quality measures found to improve palliative care in the ICU. A pre/post-educational intervention evaluated if the implementation of the Care and Communication Bundle in the ICU improved palliative care by reviewing the documentation of the …

Comparison Of Skeletal And Dentoalveolar Changes Between Two Bone-Borne Maxillary Expanders, Mohamad Sarraj

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Bone-borne maxillary expander (BBME) are designed to provide additional anchorage to widen the maxillary arch for patients who exhibit maxillary transverse deficiency. One form of BBME is the hybrid BBME which uses mini-implants (bone-borne) and posterior teeth (tooth-borne) as anchorage for maxillary expansion. The other form of BBME is absolute BBME which only uses mini-implants as anchorage. It is not clear in the literature if there is a difference in skeletal and dental changes with these two types of expanders. The objective of this study was to compare the skeletal, dentoalveolar, and periodontal changes between the hybrid and the …

Evidence Of Y Chromosome Long Non-Coding Rnas Involved In The Radiation Response Of Male Non-Small Cell Lung Cancer Cells, Tayvia Brownmiller

Graduate Theses, Dissertations, and Problem Reports (ETD)

Non-small cell lung cancer (NSCLC) is the number one cause of cancer related mortality in the United States and worldwide. Advanced and therapeutically resistant lung tumors contribute to the high rate of mortality from NSCLC, therefore there is a need for new methods of diagnosing and treating this disease. Long non-coding RNAs (lncRNAs) have been shown to be a crucial component of human molecular biology, regulating nearly every cellular pathway from chromatin condensation to transcription and translation. Furthermore, many lncRNAs have been classified as oncogenes or tumor suppressors, highlighting the various molecular mechanisms they are involved in regarding the formation …

Multimorbidity, Immune Checkpoint Inhibitor Use, And Healthcare Expenditures Among Older Patients With Late-Stage Melanoma, Pragya Rai

Graduate Theses, Dissertations, and Problem Reports (ETD)

With decades of unchanged cancer care with no added survival benefit, immune checkpoint inhibitors (ICI) changed the treatment landscape of late-stage melanoma in 2011. A key factor in determining the use of ICIs is the presence of pre-existing chronic conditions, which can influence the outcome. However, the prevalence of multimorbidity (defined as presence of two or more chronic conditions) among older patients with late-stage melanoma remains unknown. It also remains unknown if the presence of multimorbidity factors into the use of ICIs. Hospital-related factors associated with ICI use have been studied. Yet, patient-level factors, such as age, sex, marital status, …

Women Veterans’ Descriptions Of The Patient-Provider Interaction With Civilian Providers, Billie S. Vance

Graduate Theses, Dissertations, and Problem Reports (ETD)

BACKGROUND: Women veterans require care for unique gender, and war-related health issues. Concerns exist regarding non-Veterans Health Administration (VHA), civilian healthcare providers’ preparedness to deliver care to the veteran population. Health outcomes are influenced by the quality of care provided to patients. There is a significant gap in the literature with regard to woman veterans’ perspectives about the quality of the patient-provider interaction between women veterans and non-VHA, civilian providers.

PURPOSE: The purpose of this study was to describe women veterans’ perspectives about interactions between themselves and civilian providers and to critically analyze the veterans’ data to further inform the …

The Visual And Spectrophotometric Effect Of External Bleaching On Omnichroma Resin Composite And Natural Teeth, Michael Brian Evans

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objective: To determine the visual and spectrophotometric effect external tooth bleaching has on natural tooth structure and OMNiCHROMA composite at various number of treatments. Variables were compared to determine if there is a detectable difference between the composite and the tooth before and after bleaching.

Methods: Preparation and restoration of 25 previously extracted teeth was completed. OMNiCHROMA composite was used. Each tooth was measured visually with a VITA shade guide and a colorimeter. Measurements were recorded before bleaching, after 5 and 10 treatments. Statistical analysis was completed and ΔE values between the composite and tooth were compared between the 3 …

Knowledge Of Content For Clinical Nursing Educators: An Ethnographic Investigation Of Clinical Experts Who Transition To The Role Of Novice Clinical Nursing Educator, Stacy Wheat Huber

Graduate Theses, Dissertations, and Problem Reports (ETD)

The purpose of this research study was to identify and describe the teaching practices and the grounding experiences of the teaching practices novice educators use when teaching undergraduate students in the clinical patient care area. The following research questions guided this investigation: What teaching practices and teacher knowledge do novice clinical nursing educators demonstrate or draw from when teaching undergraduate nursing students in the clinical patient-care area? In what ways do novice clinical nursing educators change or adapt their teaching behaviors as a response to the context of the teaching/learning environment? What grounding educational or professional experiences do novice clinical …

Cortical Neurophysiologic Correlates Of Auditory Threshold In Adults And Children With Normal Hearing And Auditory Neuropathy Spectrum Disorder, Garrett Cardon, Anu Sharma

Faculty Publications

Purpose: Auditory threshold estimation using the auditory brainstem response or auditory steady state response is limited in some populations (e.g., individuals with auditory neuropathy spectrum disorder [ANSD] or those who have difficulty remaining still during testing and cannot tolerate general anesthetic). However, cortical auditory evoked potentials (CAEPs) can be recorded in many such patients and have been employed in threshold approximation. Thus, we studied CAEP estimates of auditory thresholds in participants with normal hearing, sensorineural hearing loss, and ANSD. Method: We recorded CAEPs at varying intensity levels to speech (i.e., /ba/) and tones (i.e., 1 kHz) to estimate auditory thresholds …

Structural And Biophysical Investigations Into The Mechanism Of Hiv-1 Envelope Incorporation, Richard Elliot Murphy

All ETDs from UAB

Recent advancements in drug therapies and patient care have drastically improved upon the mortality rates of HIV-1 infected individuals. Many of these therapies were developed or improved upon using structure-based techniques, which underscores the importance of obtaining atomic level structural data critical to the understanding of essential mechanisms in the replication cycle of HIV-1. One such process which remains poorly understood on the structural level is the incorporation of the envelope glycoprotein (Env) into budding virus particles. The Env protein mediates viral infection of host cells, and there is strong evidence suggesting that incorporation of Env is mediated by an …