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The key question not addressed by the hierarchical model (Shavelson et al., 1976) is whether academic self-concept is reflected in relations with non-academic self-concept components (i.e. a between-network issue). The present study investigated the significance of physical self-concept, as a proposed mediator variable, to assess the relationship between anxiety/depression and school absence in children with chronic illness, which was hypothesized as Model A. Additionally, this research examined proposed mediator of absence in order to assess the relationship between physical self-concept and academic achievement, after controlling for academic self-concept, which was hypothesized as Model B. This study included participants from a comprehensive database of the Study of Early Child Care (SECC), by the National Institute of Child Health and Human Development (NICHD). This study will examine the health status, psychosocial factors, attendance, and academic functioning of children in the sixth grade at the time of data collection. Findings, related to Model A, suggest that when children, regardless of whether or not they are chronically ill, experience higher degrees of anxiety/depression, they are more likely to report having higher levels of negative physical self-concept and higher levels of school absence. Findings for Model B suggested that once academic self-concept was controlled, physical self-concept, while statistically significant, accounted for little actual variance in the number of days a student was absent from school. This finding was true among all students as well as those who were not chronically ill . Specifically, this finding did not hold true for chronically ill students.

The accumulation of pro-inflammatory macrophages in the inflamed vascular wall is a critical step in atherogenesis. The mechanism of macrophage retention within the site of inflammation is not understood yet. High adhesion that prevents macrophage migration is one of the potential mechanisms. Previous research in our laboratory showed that integrin αDβ2 is upregulated on pro-inflammatory macrophages, promotes macrophage retention, and contributes to atherogenesis. However, a key ligand for αDβ2 within the tissue is yet to be identified, since αDβ2 does not interact with major ECM proteins, collagens, and laminins. We recently found that during acute inflammation, the oxidation of docosahexaenoic acid (DHA) leads to the generation of end product carboxyethylpyrrole (CEP), which forms an adduct with fibrinogen and albumin via ε-amino group of lysines. There is evidence that macrophages adhere to CEP-modified albumin in αDβ2-dependent manner. We continued the advancement of the proposed hypothesis that non-conserved, basic amino acids of integrin αDβ2 located near the MIDAS site of the I-domain are responsible for binding to CEP. αD I-domain and generated I-domain mutants: H272(D), K297(Q) and K309(N) were used to map the ligand binding site between integrin and CEP. Using site-directed mutagenesis, mutant αD I-domains were generated with minimal amino acid substitutions. Protein-protein binding reveals that the generated mutation of K297(Q) on the I-domain demonstrates the strong reduction of binding, while H272(D) and K309(N) did not have a significant effect on integrin binding properties. Therefore, lysine 297 located in I-domain of integrin αD, is a critical amino acid for αDβ2 binding to CEP-modified proteins. The identification of a binding site for CEP-modified proteins within αDβ2 will help to develop a blocking reagent for the treatment of the inflammatory component of atherosclerosis.

Thesis (M.S.)--Boston University / The chronically ill patient in a general hospital designated for the treatment of the acutely ill presents serious problems to the medical team. With the advancements made in the medical profession, together with improved hospital facilities, more people today can benefit from hospitalization. Because of this fact, more people utilize hospital facilities today than in the past, with the results that hospitals are often overcrowded and cannot accommodate all who require treatment. Consequently, it is extremely important that the period of hospitalization be as short as possible, and consistent with the patient's condition, both for the chronically and the acutely ill if these services are to be available to all.

Adolescents in the United States continue to exhibit epidemic proportions of obesity and overweight, contributing to significant morbidity and mortality rates. Obesity and overweight are also found to be associated with other unhealthy behaviors in adolescents, such as physical inactivity and smoking. The Center for Disease Control and Prevention (CDC) reports the annual rates of adolescent obesity in the U.S.; however, comparative trends for the past two decades and comparisons of rates between general U.S. and Tennessee, a tobacco-producing state in the stroke belt, are not available. To compare trends in rates of BMI percentile, overweight, and obesity among adolescents, grades 9th through 12th, between the U.S. and Tennessee during 2003-2017 and identify critical factors associated with them. Both national and Tennessee BMI trends show different patterns from 1999 to 2017; further analysis of covariate factors will provide more information on this difference in trends. We expect to find little variation between the United States and Tennessee when comparing the age of high school obesity rates. However, previous trends in racial and ethnic disparities for BMI percentiles, obesity, and overweight suggest there will be differences among these variables. Preventable chronic diseases should not affect children. The outcomes of childhood obesity are too severe to ignore. Understanding the risk factors, risk behaviors, and prevalence of adolescent obesity is the first step in addressing this public health crisis.

Rapidly Dissolving Polymeric Microneedle Skin Patch of Naloxone for Opioid Overdose Treatment Tijani Akeemat1, Maria J. Peláez2, Prashant Dogra2,3, Ashana Puri1 1 Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614. 2 Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA 3 Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA Worldwide opioid abuse affects over 16 million people. A major cause of death in abusers is overdosing. Naloxone (NAL) is an opioid inhibitor that reverses its respiratory depressing effect. The use of this drug is limited mostly to invasive delivery: intravenous (IV), intramuscular (IM) and subcutaneous (SC) due to its significant hepatic clearance and poor oral bioavailability (2%). These routes are painful and worse still is the need for frequent injections for patient stabilization due to the short half-life of NAL. Non-invasive intranasal forms exist but this is fraught with a couple of limitations such as nasal damage and epistaxis. The need for alternatives without these limitations is thus evident. The feasibility of the use of metal microneedles (MNs) for the transdermal delivery of NAL was demonstrated in-vitro and through in-vitro in-vivo correlation modeling in our lab. The goal of the current study was to design a rapidly dissolving polymeric MN patch with delivery and pharmacokinetic (PK) properties comparable to that seen with the commercially available NAL products, eliminating their highlighted limitations. NAL loaded rapidly dissolving polyvinyl pyrrolidone-based MN arrays (500 µm, 100 needles) were fabricated by the mold casting technique. The permeation profile of fabricated MNs over a predetermined time were assessed via an in-vitro permeation set up using porcine ear skin. Samples were analyzed via HPLC. To improve on drug flux and amount permeated, the effect of increasing MN length and density (no. of needles/unit area) were assessed by fabricating MNs 300 µm longer and those with density double that of the initial array. Factors such as drug load and polymer strength influenced the needle fabrication. Compared to passive permeation, a reduced lag time of about 15 min was observed with a significant drug flux of 15.09 ± 7.68 g/cm2/h seen in the first 1 h (pin-vitro in-vivocorrelation we were able to predict an optimized design of the patch that can reproduce the clinical PK of NAL obtained with commercial devices. Increasing needle density and/or patch area was found to be of greater significance. Overall, drug flux seen over 1 h depicts the applicability of fabricated needles in opioid overdose emergencies with delivery properties comparable to that with IM and IN delivery.

Exposure to Poaceae airborne pollen (PAP) has been shown to induce allergic reactions in individuals sensitive to PAP. Patient care for individuals sensitive to PAP can be aided by knowledge of PAP profiles. Air samples were collected using a Rotorod M40 rotation impact sampler from February 2005 to September 2017. Air samples were collected daily, excluding weekends and winter months, and are expressed in grains per cubic meter (g/m3). Light microscopy at 400x magnification was used to analyze samples. Pollen was classified according to the classifications provided by the American Academy of Allergy Asthma and Immunology and the National Allergy Bureau. Detection of PAP onset averaged on day 84 (March 25th); end day averaged on day 285 (October 12th); average duration was 202 days; average peak level onset was on day 146 (May 26th) and the average peak level was 135 g/m3. Average number of days during Poaceae season with 1 to 19 g/m^3 detected was 95; with 20 to 39 g/m^3 was 7; with 40 to 59 g/m^3 was 4; and with 60 g/m^3 or more was 2. Day of onset of PAP trended to be 1.6 days earlier in the year over the course of our data collection, with R2= 0.3476. Poaceae airborne pollen in Johnson City, Tennessee was noticeable for almost 7 months out of the year. We can assume the riskiest months of the year are from March to October with the highest risk period being the end of May.

Objective: Multiple sclerosis (MS) is one of the most common neurological diseases affecting adults of working age, and those of younger ages of onset have been increasingly recognized. Twenty-seven percent of people with MS (PwMS) are age 30 years old or younger. The burden of MS for young adults puts them at risk for poorer outcomes regarding their education, family planning, vocation, and social skills as they transition to adulthood. Fine motor (FM) skill impairment might impede performance within the daily occupations of young adults who are transitioning into adulthood. Few studies focus on the occupations and occupational performance of younger adults with MS. Method: Forty participants with MS between the ages of 18 to 30 were recruited to participate in a study. Two standardized measures were used to identify possible FM dexterity deficits and one standardized self-report was used to measure the perceived satisfaction and performance of occupations for this population. A semi-structured interview was conducted with a subgroup of 18 participants to understand the lived experiences of young adults with MS (YAwMS) and their FM performance during their occupations. Results: With quantitative and qualitative analysis, a relationship was suggested between FM scores and both perceived performance and satisfaction scores of an adapted performance measure. Conclusion: Young adults with MS perceive difficulties with occupations that are influenced by their FM status. It is recommended that occupational therapy professionals consider the motor skill needed to perform and complete occupations that specifically require FM skills.

The increased emergence of childhood chronic illnesses in the United States of America has created a need for educational support in this unique student population. Research trends have showcased how the child's emotional health and vacancies in legislation are some of the affecting factors when discussing the level of academic aid these children receive from the state. Some other factors that come into play when ensuring children with chronic illnesses are not excluded from receiving quality education are their learning environment, school reintegration process, and evaluating pre-existing hospital-school programs which are all themes covered in this narrative. Teacher preparation programs are the best way to tackle this issue early on. By providing aspiring educators training on how to help these students, they will ensure a successful school reintegration for the child once they return to the traditional schooling setting. Hence, why this research focuses on the PedsAcademy, a pioneer Florida hospital-school program, and the aspiring educators' perceptions of their academic and socio-emotional impact on the students. The research questions are synthesized into three main topics: social-emotional impact, influence on aspiring educators, and state regulations. Each of these themes encompass further descriptive terms based on the survey and interview results, which include: meaningful academic and socio-emotional student progress, flexible teaching, unique opportunity, life-changing experience, and knowledge of state regulations. Through the data collection of survey and interview responses, this thesis records the research findings and establishes concrete recommendations that contribute to the preexisting materials on the educational support available for children with chronic illnesses.

The purpose of the present cross-sectional study was to examine the effects of ambiguity of loss and type of caregiver-to-patient relationship on anticipatory grief, negative physical and psychological outcomes associated with grief, and boundary ambiguity in family caregivers of chronically ill patients. Questionnaires were completed by 23 parents of ill children and 30 spouses of ill mates. Using an original and a revised concept for level of ambiguity, partial support was found for the prediction that parents and spouses in high ambiguity of loss circumstances would report more anticipatory grief than those in low ambiguity ones. Contrary to prediction, a slight but nonsignificant trend occurred for parents and spouses in low ambiguity situations to report more negative physical and psychological effects associated with grief as well. Level of ambiguity was not found to impact boundary ambiguity as had been hypothesized. Spouses reported more boundary ambiguity than parents, regardless of level of ambiguity of the loss. Contrary to prediction that parents would report less anticipatory grief and more negative physical and psychological outcomes than spouses, generally, no significant differences were found between the two groups. However, using the original concept of ambiguity, parents did tend to recall more past grief than spouses. The study highlighted several methodological concerns which impact research on loss and grief, particularly the difficulty involved in recruiting participants with subsequent occurrence of sampling bias, rudimentary status of available measurement tools, and a host of potentially confounding personal and sociodemographic variables. The present study supports a view of the loss which occurs in families dealing with chronic illness as a complex process whose impact on grief, distress, and family upheaval is influenced by multiple factors. Such factors include both the ambiguity of the loss and the type of family relationship involved. Complex research of a longitudinal nature using psychosocial models of illness is needed to better delineate the impact of factors such as these.