<p>Direct VIP-nerve and indirect ICC-mediated inhibitory control of colon motility were studied using biochemical techniques. In order to define a basis for VIP action in colon, longitudinal muscle, ICC-poor circular muscle and ICC-rich layers separated by dissection were characterized by electron microscopy and subcellular fractionation using markers for synaptosomes, smooth muscle membrane and mitochondria. Synaptosmal, mitochondrial and smooth muscle enriched membrane fractions were isolated but a putative ICC membrane enriched fractions has the highest 5'nucleotidase, Mg2+ATPASE activities and density of 125 I-VIP binding followed by synaptosome and smooth muscle membranes. High VIP binding density can be used as a marker for ICC membrane.</p> <p>The study of nitric oxide production in fractions from ICC-rich and-poor preparation by measuring nitrite levels showed that mitochondrial, synaptosome and ICC-rich membrane fractions produced nitric oxide but greater levels were seen in the ICC-membrane rich fraction. Nitric oxide synthase activity on ICC membrane was constitutive and calcium-dependant. VIP increased (2-fold) nitric oxide production in ICC-rich strips which was inhibited by L-NAME, reduced by EGTA and increased by exogenous calcium. Partial inhibition of VIP-induce nitric oxide production by ω-Conotoxin GVIA was recorded in the absence (22%) and presence (32%) of L-arginine suggesting that the source of nitric oxide was in large part non-neural, from ICC.</p> <p>I conclude that direct nerve-mediated control of longitudinal and circular muscle occurs through VIP binding on membrane receptors while indirect control of circular muscle occur through VIP-nerve induced production of nitric oxide from ICC to cause smooth muscle relaxation.</p> / Doctor of Philosophy (PhD)

<p>Many people suffer from some form of low back pain during their lifetime. A well designed morbidity study of general practice in England; using data collected from over 100 general practices, showed the incidence to be 1.6% per year and the prevalence to be 17.5% (62). Severe back pain may necessitate job changes or even job loss.</p> <p>Forty-two million dollars were spent on industrial back injuries during 1974 in Ontario (86).</p> <p>Review of the literature is hampered by the fact that only in a minority of cases can a diagnosis be made with any degree of certainty based on knowledge of pathophysiological mechanisms. Perhaps even less relisble is the chance that the doctor may know some therapy which will actually be superior to the spontaneous recovery rate. The spontaneous recovery rate is estimated at 70% after three weeks of symptoms (76). Because of the lack of progress in the area of diagnosis and treatment many studies lack methodological rigor.</p> <p>This thesis attempts to examine and summarize some of the physiological, anatomical and mechanical factors that may be implicated in the etiology of low back pain and serve as a basis for rational therapy. It also reviews the encouraging advances in basic research which have taken place in the last decade.</p> <p>In an effort to determine whether proven clinical outcomes occur, with certain standard treatment regimes, a randomized clinical trial is proposed to test the effectiveness of four different programs in a two by two factorial design. All participants will receive analgesics and/or anti-inflammatory agents at the discretion of their family physician. One group will receive no further treatment. The remaining three groups will have bed rest alone, bed rest with physiotherapy, or physiotherapy alone.</p> <p>Baseline measurements will be obtained by objective methods of assessing spinal flexion, pain, and activities of daily living.</p> <p>Prior to the commencement of the trial the study population will be divided into two prognostic groups by the method center based on the decision of the family physician to give the patient either major anti-inflammatory medication or minor analgesics.</p> <p>It is expected that about 260 subjects suffering from low back pain will be identified by five groups of family physicians within a period of six months. For the patients receiving physiotherapy the same physiotherapist will visit each of the five groups two half-days a week in order to supervise the treatment. Compliance with medication will be assessed by pill counts.</p> <p>Assessment of bed rest compliance will be measured by self-reporting, reports from a friend and a home visit.</p> <p>One month after treatments begin, another family physician who is blind as to which group the patient is in will perform some of the outcome measures. Outcome results will consist of relief of pain, return to work, return to normal activities, and relapse rate up to three months.</p> / Master of Science (MS)

<p>There is evidence that a number of psychiatric disorders, particularly depression and schizophrenia, are frequently associated with lateralized disturbances of brain function, or alterations in normal patterns of lateralized function. It is also known that many such disturbances, especially in schizophrenia, involve central dopamine (DA) systems. Several studies in recent years have established that lower animals often exhibit lateralization of brain function, both on the neurochemical and behavioral level. Central DA systems appear to be particularly asymmetrical. Left/right hemispheric asymmetries in rats have been reported at the population level for a variety of DA-modulated behaviors which may variously reflect motor, sensory, spatial, or stress/arousal processes. However, the directions of reported population asymmetries can vary across studies, depending in part upon the particular processes predominantly reflected in the measured behavior, and consequently leading to difficulties in interpretation. Given the potential relevance to both normal and abnormal brain function in humans, it is of much interest to determine what paraliels exist between lateralization in humans and lower animals.</p> <p>The objectives of the present thesis were twofold. First, we sought to determine which DA-mediated behaviors exhibit left/right hemispheric asymmetries at the population level in rats, by employing specific paradigms to measure motor, sensorimotor, spatial and stress-related processes. The basic approach was to compare the effects of unilateral DA-depleting lesions (with 6-hydroxydopamine), in left or right brain structures of male rats. Behavioral and neurochemical asymmetries were also examined in nonlesioned controls. A second objective was to study the role of interhemispheric connections in the expression of behavioral asymmetries characteristic of rats with unilateral lesion-induced DA depletion. Specifically, we describe the effects of sectioning the corpus callosum in unilaterally lesioned (6-OHDA) rats, on motor and sensorimotor asymmetries.</p> <p>Regarding the first objective, hemispheric population asymmetries were not found for any of three measures of motor activation, in rats with left or right lesions of the substantia nigra. These measures included ipsiversive turning behavior in response to amphetamine, contraversive turning in response to apomorphine and spontaneous locomotor measures in activity monitors. Similarly, groups did not differ in a measure of sensory/spatial bias, namely the orientation to edges during exploration of a large openfield. The same animals did differ however, in the performance of the Morris water maze task for spatial localization, suggesting that right brain mechanisms may be preferentially involved in successful task performance. A follow-up study with the water maze paradigm, using nonlesioned rats distinguished by the preferred direction of amphetamine-induced turning (and by inference the hemisphere of greater DA activity), further supported a preferential role for right brain DAergic mechanisms in this task. An additional test of population hemispheric asymmetry which focused on stress mechanisms, compared the effects of mesocortical DA depletion (left, right or hilateral) on the development of restraint stress-induced gastric pathology. Rats depleted of DA in the right anterior midline cortex, developed significantly more severe stress pathology than did nonlesioned controls. In contrast, left or bilateral cortical DA depletion resulted in nonsignificant trends for increased pathology. All three lesion types resulted in significant and unique effects on DAergic systems in subcortical brain structures, which may have in part contributed to the asymmetric effects on development of stress pathology.</p> <p>Regarding the second objective of the study, it was found that corpus callosum section eliminated the asymmetrical orientation to openfield edges in unilaterally lesioned rats. Conversely, there was no effect of callosotomy on asymmetries in direction of turning behavior, either drug-induced or externally cued in the behavioral competition for food. Taken together with the report that callosal section potentiates lateralization of emotional expression, the findings emphasize the anatomical dissociability of these functional asymmetries, despite their mediation by DAergic systems at various levels.</p> <p>Based on these and other literature reports, it is proposed that the most fundamental processes exhibiting consistent left/right hemispheric population biases in rats, are those related to stress. The greatest degree of functional asymmetry is found in the cortex, which modulates sutcortical structures in a highly asymmetrical manner. The data extend recent suggestions that the right cortex is preferentially involved in the mediation of high arousal states (such as uncontrollable stress). Other studies have shown that activation of mesocortical DA by stress initially favors the left brain, and later predominates in the right brain as stress is prolonged. Given the evidence that cortical DA facilitates coping ability, and based on a variety of neurochemical and behavioral reports of DAergic asymmetries, it is suggested that a normal left brain DAergic dominance may exist at the population level, for both rats and humans. Such an asymmetry is proposed to confer an adaptive advantage in the rapid execution of responses to minor stressors. Finally, it is proposed that disturbances in patterns of cortical activity may lead to (psycho)pathological states which are associated with vulnerability to stress.</p> / Doctor of Philosophy (PhD)

<p>This thesis examines the sensitivity and specificity of manometry and defecography assessments; the relationship between function and symptoms; and the relationship between age and parity and patient assessments.</p> <p>The manometry assessments of 72 incontinent and 50 constipated female patients were compared to 86 healthy volunteers using discriminant function and classification analysis (DFA). The defecography assesssments of a subset of these patients, 21 incontinent and 25 constipated, were compared to 22 healthy female volunteers. These data were used to examine the factors age, parity, severity of symptoms and rectal wall morphology on function.</p> <p>The results show that the variables of total squeeze pressure and resting pressure have a sensitivity of 79% for the incontinent patients and 32% for the constipated patients. The specificity was 87%. The manometry variables resting pressure, squeeze pressures, volume to urgency were significantly different in the patient groups. Aging was a significant factor for lower resting pressures and increased parity was a significant factor for lower squeeze pressures in the patient groups.</p> <p>The sensitivity of the combination of the defecography variables, lift and strain angles and junction levdls, was 90% for the incontinent patients and 88% for the constipated patients. The specificity was 95%. The defecography variables were not significantly different in the patient groups. Rest and lift angles were significantly wider with increased age and parity.</p> <p>Neither the defecography and manometry variables nor rectal wall morphology changes were associated with varying severity of either constipation or incontinence.</p> <p>The manometry and defecography assessments are presented in graphs, which may enhance the dinical usefulness of the assessments by demonstrating the difference between patient values and healthy controls. The manometry data are also presented in an index which makes areas of specific impairment more obvious.</p> <p>DFA of the manomeby and defecography variables provides probability rates which may be useful in predicting patient outcomes. The discriminant scores from the analysis of the defecography and manometry variables can be used to develop a continuum from health to incontinence.</p> / Doctor of Philosophy (PhD)

Menopause, a natural transition for women, often brings about a multitude of physical, psychological, and emotional challenges. As life expectancy rises, a significant portion of a woman's life is spent post-menopause. This thesis explores the potential of yoga therapy as a complementary approach to enhance well-being and improve quality of life during this significant phase. It describes IRB research about Yoga Therapy for Menopause- a salutogenic program that aims to create a safe and educational platform for women who are navigating the changes that menopause brings. This research underscores the effectiveness of yoga therapy as a complementary approach to coping with menopausal symptoms. It further emphasizes the importance of creating supportive spaces for women navigating this transition.

Pediatric palliative care has recently become a priority in the healthcare field and is implemented at the time of diagnosis rather than days or weeks before the child's death. Social constructivism theory in which humans generate meaning from their experiences was utilized as a general framework to determine the impact of pediatric palliative care on close relatives. The purpose of this grounded theory study was to generate a substantive theory that explains how close relatives such as grandparents, aunts, and uncles of a child with cancer experience palliative care. The participants of the study included close relatives of children in palliative care. Semi-structured interviews and journaling were used to collect data. Initial, focused, and selective coding procedures were used to manage the data and a content analysis of the textual data was performed. Findings from the data suggested a process of surrendering to the journey in which close relatives learn to let go of what they cannot control while holding on to what they can control. Social change implications of this study may include improving healthcare programming for close relatives utilizing supportive-expressive measures. This programming may promote mental health of the close relatives who will learn to deal with their adjustment difficulties and improve their coping skills.

Hypertension affects as many as 50-70 million Americans; early and consistent compliance to hypertension guidelines is important to prevent heart attack and stroke, both leading causes of death in the United States. Despite the advances in medicine and health-care technology, the effectiveness with which hypertension is managed at the individual and community level is less than optimal. The research questions in this study addressed the lack of physician compliance to hypertension guidelines and why patients fail to follow guidelines. Improving hypertension management depends on bridging the gap between physician awareness of evidence-based guidelines and patient compliance. Grounded theory was used to understand and integrate the perspectives of a purposeful selection of nine physicians and seven patients regarding barriers to hypertension guidelines compliance. Theoretical perspectives used to frame this research were self-efficacy and the health-belief model for the patient and awareness to adherence and the dissemination model for the physician. Data analysis strategies included open/axial and in-vivo coding to assign and refine themes and discover key concepts. Themes for both physician and patient participants related to methods of compliance, the physician/patient relationship, awareness of theoretical models by both groups, and issues related to patient non-compliance. Eight key recommendations were developed, including: evidence and theory must coexist to increase compliance, health insurance practices must be reformed, and collaboration and communication between physicians and patients must improve. Implications for positive social change included reduced health care costs and improved outcomes for hypertensive patients.

Racial disparity is present in deaths attributed to sudden infant death syndrome (SIDS) and unintentional suffocation. The Back to Sleep Campaign that began in 1994 caused an overall decrease in SIDS rates, but the racial disparity has continued to increase. Researchers have analyzed and described various socio-demographic characteristics of SIDS and infant deaths by unintentional suffocation in urban areas yet have not simultaneously controlled for multiple risk factors that may contribute to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). The purpose of this study was to determine if there is a relationship between poverty, race, maternal education, parity, and infant sleep-related deaths in the African American population in an urban setting. This quantitative case-control study used secondary data collected from birth certificates and matched birth/death certificates by a Midwestern state health department between 2005 and 2009. The health belief model was used as a conceptual framework. To answer the research questions that asked if there was a relationship between infant sleep-related deaths (dependent variable) and race, poverty, maternal education, and parity (independent variables), chi-square analysis and logistic regression analysis were performed. These analyses suggested that race and poverty have significant relationships with infant sleep-related deaths. The analyses did not suggest a relationship between maternal education or parity and sleep related infant deaths. The social significance of these findings may be that the results could be useful for population-specific modifications of prevention messages that will reduce infant sleep-related deaths.

Obstructive sleep apnea (OSA), a disorder in which the airway intermittently collapses and obstructs during sleep, is associated with increased cardiovascular and cerebrovascular morbidity and mortality, increased risk of motor vehicle accidents, metabolic syndrome, hypertension, and depression. Treatment of OSA attenuates or reverses many of these associated risks. However, most cases of OSA are unrecognized and untreated. The two most recent studies using 1990s data found that only 6.5 - 15.4% of OSA cases, depending on severity, are clinically recognized in mixed gender populations. Based on a conceptual framework of improved physician awareness of OSA, and reduced diagnostic access bias with the increased availability of sleep laboratory services, increased OSA recognition since the 1990s was predicted. Study participants with clinically recognized OSA were identified using the resources of the Rochester Epidemiology Project, while the Berlin Questionnaire OSA high risk classification was used as a surrogate for prevalent OSA in this population. Analysis in a mixed gender population determined that OSA clinical recognition among those with prevalent OSA was 22.7 % (95% CI 19.6 - 25.8%) for mild or greater OSA severity leaving more than 75% of prevalent OSA clinically unrecognized and untreated in this population. Obesity and male gender were associated with increased likelihood of clinical recognition in bivariate and multivariate analyses, though even among obese men only 36.5% of OSA was clinically recognized. In order to support positive social change and address these inequities of OSA clinical recognition, strategies that enhance OSA recognition overall, and more specifically target recognition of OSA among women and the nonobese, should be developed and implemented. Further research regarding such strategies should consider whether they reduce OSA associated morbidity and mortality.

Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.