The purpose of this study was to identify what high school principals indicate are effective strategies and interventions to reduce chronic student absenteeism. Research has shown chronic student absenteeism is highest among high school students (Stronge and Associates, 2019; U.S. Department of Education, n.d.), and effects may include low academic achievement, possible high school dropout, and poor outcomes in adulthood (Elias, 2019; Ready, 2010; Stronge and Associates, 2019; Virginia Department of Education [VDOE], n.d.). Chronic student absenteeism is one measure of school performance in Virginia and therefore, a responsibility of the school principal to monitor, maintain, or improve (VDOE, n.d). This study sought to answer the following research questions: 1. What strategies and interventions do high school principals indicate they utilize and implement to reduce chronic student absenteeism? 2. What are the perceptions of high school principals regarding the effectiveness of strategies and interventions they utilized and implemented in order to reduce chronic student absenteeism? This study included a survey of 8 Virginia high school principals whose school experienced a reduced rate of chronic absenteeism between 2016-2017, 2017-2018, and 2018- 2019. The Virginia Department of Education (VDOE) reported chronic absenteeism as a measure of school accountability beginning in 2016. Additionally, this study included semi-structured interviews with 3 of the high school principals. The survey and interview questions aimed to determine various strategies and interventions high school principals implement to reduce chronic student absenteeism, along with the effectiveness of each. Principals in this study reported communication, involving school stakeholders, creating a positive school culture, and utilizing accountability practices as means to reduce chronic student absenteeism. Principals perceived communication and engaging instruction to be effective strategies or interventions utilized in order to reduce chronic student absenteeism, while data collection and management were considered to be least effective. The study suggests principals could engage in those practices perceived as effective in reducing chronic student absenteeism, but also school divisions could provide job embedded professional development to enhance the knowledge and skills of principals related to the topic. / Doctor of Education / The purpose of this study was to identify what high school principals indicate are effective strategies and interventions to reduce chronic student absenteeism. This study also explored how effective principals perceived each strategy or intervention was in regard to reducing chronic student absenteeism. The study included Virginia high school principals whose school experienced a reduced rate of chronic student absenteeism between 2016-2017, 2017- 2018, and 2018-2019. Principals participated in a survey and individual interview; the survey and interview instruments were designed by the researcher (see Appendix G and Appendix H). The study results indicated high school principals are utilizing communication as a strategy or intervention to reduce chronic student absenteeism. Additionally, principals also reported involving various school stakeholders, creating a positive school culture, and utilizing accountability practices in order to reduce chronic student absenteeism. Principals perceived communication and engaging instruction to be effective strategies or interventions, while data collection and management was perceived to be least effective. Future actions could include principals' continued efforts to engage families in practices to reduce chronic absenteeism. Principals could also monitor and support teacher instruction for student engagement. Additional implications and future research to decrease chronic student absenteeism are shared.

Subclinical endotoxemia (low levels of circulating bacterial endotoxin) has been observed in patients suffering from chronic inflammatory diseases such as atherosclerosis, diabetes, and obesity. However, the link between this condition and chronic inflammation is poorly understood. Previous work from our lab has shown that chronic exposure to super-low doses of bacterial endotoxin (LPS) aggravates atherosclerosis resulting in increased plaque size and instability in a macrophage-dependent manner in a mouse model of atherosclerosis. Further, we showed that super-low dose LPS (SLD-LPS) treatment was able to inhibit lysosomal fusion in immortalized macrophages. However, this was done under more acute treatment conditions. The aim of this project was to examine the molecular mechanisms by which chronic SLD-LPS may polarize macrophages to a non-resolving pro-inflammatory state consistent with chronic inflammation. This was carried out in two projects, the first a more broad phenotypic paper showing the disruption in homeostasis by chronic SLD-LPS in immortalized macrophages, while the second uses primary bone marrow-derived mouse macrophages to identify specific molecular signaling pathways used by chronic SLD-LPS. Here we show that chronic SLD-LPS led to the novel upregulation of pro-inflammatory mediators p62 and ccl2 with simultaneous downregulation of homeostatic mediators Nrf2 and slc40a1 in immortalized wild-type mouse macrophages. Further we showed this effect was reversed using the homeostatic restorative agent sodium phenylbutyrate (4-PBA), a newly reported activity for this reagent in mouse macrophages. This indicated that a disruption in homeostasis, possibly involving autophagy, may be responsible for the non-resolving pro-inflammatory polarization of macrophages. Therefore, in our second project, we further explored the effect of chronic SLD-LPS treatment on the homeostatic arm of the response by focusing on the Nrf2 inhibitor Keap1. Here we show that chronic SLD-LPS results in an accumulation of Keap1 in mouse bone marrow-derived macrophages, an effect specific to chronic SLD-LPS, as high doses of LPS failed to induce Keap1. We suggest that this effect may be related to a disruption in lysosomal fusion as evidenced by accumulation of autophagy flux markers MLKL and p62. Further, we show that these effects are dependent on the non-traditional TLR4 adaptor TRAM, suggesting an alternative dose-dependent signaling pathway for LPS. Together this work identifies novel signaling mechanisms involved in non-resolving pro-inflammatory polarization of murine macrophages, providing new insight behind how chronic super-low dose LPS exposure may lead to chronic inflammation. / Doctor of Philosophy / Inflammation is the body's natural response to injury or insult and can be beneficial in certain contexts such as pathogen clearance. However, left un-checked, chronic inflammation can exacerbate or even lead to disease pathology, such as is the case with modern diseases such as atherosclerosis, obesity, diabetes, etc. Despite the high prevalence of these diseases, effective treatments and therapies are still lacking. Recently it was discovered that many patients suffering from chronic inflammatory diseases had low levels bacterial endotoxin (LPS) in their circulation, a condition referred to as subclinical endotoxemia. However, possible links between this condition and chronic inflammatory disease remain poorly understood. Using a mouse model of atherosclerosis, previous research from our lab showed that persistent exposure to super-low doses of bacterial endotoxin (similar to those observed in humans) lead to aggravated atherosclerosis with both increased plaque size and instability. Further, we showed that this effect was primarily mediated by pro-inflammatory polarized immune cells called macrophages, but the molecular mechanism behind this polarization is still unclear. Further research into these molecular mechanisms may provide better targets for the development of future chronic inflammatory disease treatments. Here using a combination of mouse cell line and primary cell cultures, we discuss how chronic exposure to super-low doses of bacterial endotoxin leads to the chronic non-resolving pro-inflammatory polarization of macrophage immune cells, with particular emphasis on the distinct molecular signaling mechanisms induced by chronic super-low dose LPS.

In writing this autoethnography, I invite you to enter into my world. It is not a world that is easy, or altogether happy. In the end, though, it is a story of survival and of perseverance. Trauma touches almost every person in some way. War, sexual abuse, physical and emotional abuse, death, and difficult life events color how we make sense of the world. Trauma may happen in one blinding moment or slowly eat away at us for years. Writing is often a way to cope with that trauma. This dissertation represents a small portion of my traumatic lived experiences that led me up to the doctoral process, and those that occurred in the ten years it took me to complete my dissertation. / Doctor of Philosophy / In writing this autoethnography, I invite you to enter into my world. It is not a world that is easy, or altogether happy. In the end, though, it is a story of survival and of perseverance. Trauma touches almost every person in some way. War, sexual abuse, physical and emotional abuse, death, and difficult life events color how we make sense of the world. Trauma may happen in one blinding moment or slowly eat away at us for years. Writing is often a way to cope with that trauma. This dissertation represents a small portion of my traumatic lived experiences that led me up to the doctoral process, and those that occurred in the ten years it took me to complete my dissertation.

The nutritional needs of the renal patient vary as the renal function decreases. Little information exists concerning energy requirements for patients on hemodialysis. Renal failure has been called a wasting disease as evidenced by decreased body weight, body fat, arm circumference and serum proteins. This research was designed to help precisely define energy requirements for the hemodialysis subject. Resting energy expenditure (REE) was measured by indirect calorimetry in 17 male hemodialysis subjects whose mean age was 55 years at the Veterans Administration Medical Center in Hampton, Va. The Beckman MMC Horizon System, a portable device which permits the determination of heat production from gas exchange, oxygen consumption and carbon dioxide production was used. By regression analysis, the measured REE was compared to the basal energy expenditure (BEE): the ideal weight based on the Metropolitan Life Insurance tables, the current weight taken on day of indirect calorimetry, a non-dialysis day, and the post dialysis weight taken immediately after dialysis. A correlation analysis of the dependent variable, IEE, with the current, ideal and post dialysis BBE variable resulted in correlation coefficients of .3783, .0003, and .3946 respectively. None of these correlation coefficients were significantly correlated with the REE. The post dialysis variable had the highest correlation coefficient, and thus the strongest relationship to the REE. While any of the weights studied could be used to determine energy needs for the hemodialysis subject, post dialysis weight may be the most desirable choice. / M.S.

Wildlife diseases often occur under quantifiable and consistent patterns, which can be understood to statistically predict their occurrence and spread across landscapes. Chronic wasting disease (CWD) is a neurodegenerative disease in the deer family Cervidae caused by a prion, a pathogenic and misfolded variant of a naturally occurring protein. Managing and controlling CWD is imperative for conservation of ecologically and economically important cervid species, but unclear transmission mechanisms within landscapes complicate evidence-based management. Gaps of information in the landscape ecology for CWD are particularly pronounced for areas with recent disease emergence and spread, such as within the CWD cluster in the Mid-Atlantic United States. Thus, I identified current gaps in information and sought to fill neglected areas of research, specifically focusing on landscape determinants for CWD occurrence and spread in the state of Virginia. In chapter 2, I conducted a scoping study that collected and synthesized decades of CWD research and identified trends with respect to statistical and mathematical modeling methods used, connectivity within the CWD research community, and the geographic areas from which studies were performed. In chapter 3, I investigated landscape determinants for CWD in Virginia using remote sensing landscape data and an epidemiological dataset from Virginia Department of Wildlife Resources (DWR) using diverse algorithms and model evaluation techniques. Finally, in chapter 4, I modeled landscape connectivity between confirmed CWD cases to examine potential paths and barriers to CWD spread across landscapes. My results indicate that landscape ecology was rarely incorporated throughout CWD's 50+ year history. I provide evidence that remotely-sensed landscape conditions can be used to predict the likelihood of CWD occurrence and connectivity in Virginia landscapes, suggesting plausible CWD spread. I suggest areas of future work by explicitly identifying gaps in CWD research and diagnostic methods from which models are based, and encourage further consideration of host's ecology in modeling. By integrating remotely-sensed data into my modeling framework, the workflow should be easily adaptable to new study areas or other wildlife diseases. / Master of Science / Understanding why diseases occur in some locations and not others can be a critical challenge for disease ecologists. One disease that has received significant attention from the media and scientific community is chronic wasting disease (CWD), which is caused by a misfolded protein called a prion. Virginia Department of Wildlife Resources (DWR) has identified a stark increase in the number of CWD cases since first discovered in 2009, which threatens white-tailed deer populations and a 500 million dollar industry used for conservation of Virginia wildlife species. Previous research found that CWD does not occur randomly on the landscape, but otherwise little is known about the landscape ecology of CWD. To provide insight on Virginia's CWD outbreak, I assessed methods used to investigate other CWD outbreaks in both space and time. Also, I used landscape data collected from satellites and data from CWD cases in Virginia, and applied statistical tools to identify patterns in the landscape that were linked with CWD cases. My results suggest that landscapes were rarely examined to understand CWD, and instead, researchers focused on understanding how populations will respond to the disease. I also provide evidence that, at least in Virginia, researchers can use satellite information with disease data to predict CWD on the landscape and estimate its spread. This information can be used by wildlife managers to control the disease. For example, disease surveillance can be increased in areas where CWD has been predicted, or herd sizes can be reduced in areas likely to promote disease spread. This information could also be used to tailor wildlife health regulations aimed to minimize the risk of other deer populations acquiring the disease. Ultimately, the landscape plays an important role in CWD, but research on this topic is limited; therefore, additional research is needed to understand and eventually control this disease affecting ecologically and culturally important game species.

The relationships between marital communication of later-life couples coping with chronic, physical illness, caregiver depression and marital satisfaction were examined in this study of 25 patients and their spouse caregivers. Guided by Bowen Theory, lag sequential analyses and sequence repetition analyses were conducted on observational data to determine the effects of open communication, closed communication, and pursuer-distancer communication on caregiver depression and marital satisfaction. The findings indicate that reciprocal closed communication between caregivers and spouses was positively related to caregiver depression, reciprocal open communication between caregivers and spouses was negatively related to marital satisfaction, and reciprocal pursuer-distancer communication was negatively related to marital satisfaction. Further, sustained pursuer-distancer communication was related to higher caregiver depression. Communication patterns were found to be related to family of origin relationships. Possible explanations for these findings and implications for family therapy and future research are discussed. / Ph. D.

This study was conducted to analyze various objective measures of treatment outcome among patients that participated in a multidisciplinary chronic pain treatment program and to compare these measures to the absence or presence of antidepressant medication, the level of depression, and the quality of pain and depression reported. In addition, this study examined whether there are certain patient characteristics that are related to treatment outcome measures. Data was collected from the medical records of 232 patients who were admitted to and treated for various chronic pain syndromes at the Lewis-Gale Hospital Pain Center in Salem, Virginia. Results of the study indicate that when chronic pain patients are subdivided into groups based on antidepressant drug use, depression level, reported quality of pain, and depressive symptomatology, there are distinct and significant differences before treatment when between-group comparisons are made. Within-group comparisons revealed significant differences between pre and post test measures for most groups studied, however, those with the most significant changes in scores included those patients on antidepressant medication, those patients with greater cognitive symptoms of depression, and those patients who were non-depressed. Patient characteristics that were significantly related to outcome included age, gender, duration of pain, employment, workers compensation, and litigation status. / Ph. D.

The increased prevalence of chronic kidney disease (CKD) has become a major global health burden. This increase in CKD burden parallels the increase in hypertension prevalence. In addition, increasing evidence suggest that genetics play a strong role in the susceptibility for renal disease. Inbred mouse strains C57BL/6 and 129S6SvEv differ in their susceptibility to kidney disease when subjected to hypertension using the DOCA/salt uninephrectomy model of hypertension. Similar to others, we found the 129S6SvEv mice to be susceptible to develop severe glomerulosclerosis, whereas the C57BL/6 mice are comparatively resistant. To identify new candidate genes that are involved in the pathogenesis of glomerular disease, we used microarray technology to compare the glomerular transcriptome of both strains and determine changes in glomerular gene expression when subjected to the DOCA/salt uninephrectomy model of systemic hypertension. This approach was accompanied with ultrastructural analysis and glomerular stiffness measurements to identify corresponding structural changes. Here, we have identified novel genes associated with strain differences and hypertension, and we used immunohistochemistry to validate their expression in podocytes and glomerular arterioles in murine and human kidneys. The increased understanding of the molecular mechanisms underlying hypertension-associated podocyte injury and glomerular damage which will result from these studies, will ultimately lead to identification of novel pharmacologic targets or therapeutic strategies for patients with hypertension and renal disease. / 2017-11-02T00:00:00Z

Yes / Objectives: To explore experienced physiotherapists’ attitudes, beliefs and experiences regarding their personal role in contributing to effective therapeutic relationships when working with people with chronic musculoskeletal pain. Design: Descriptive qualitative design using semi-structured interviews. Setting: Within physiotherapy departments in two National Health Service acute secondary care trusts in the North West of England. Participants: Six experienced physiotherapists working with people with chronic musculoskeletal pain. Data Analysis: Thematic coding analysis of transcribed interview recordings Main outcomes: Four overarching themes emerged from the data: Listening to the person; a caring understanding of the person’s situation; engaging the person and coming together; and moving forwards. Results: Participants emphasized the importance of building effective therapeutic relationships when working with people with chronic pain, seeking to create these by engaging with the person, to promote a strong collaborative partnership. Participants highlighted the themes of listening to the person’s story and showing a caring understanding of their situation through empathy and belief with validation. The final theme of moving forward emphasized how positive therapeutic relationships aid the rehabilitation process in enabling people to make positive changes in their lives. Conclusions: A clearer understanding of how physiotherapists engender positive therapeutic relationships has the potential to improve training and service development priorities for physiotherapists working in the area of chronic musculoskeletal pain. Future studies should seek to further define the core dimensions impacting therapeutic relationships, from the perspectives of both physiotherapists and people with chronic musculoskeletal pain. / Health Education Yorkshire and the Humber

A silent pandemic, chronic, non-healing wounds are a major cause of morbidity, with treatment and management representing significant health burdens. The opportunistic pathogens Staphylococcus aureus and Pseudomonas aeruginosa are the most common species isolated from chronic wounds. Polydimethylsiloxane (PDMS), a biocompatible and, inexpensive to fabricate polymer, can undergo various modifications. The ability of the produced polymers to attract S. aureus and P. aeruginosa, either from the planktonic state, or while sessile in biofilms on ex vivo skin, was investigated using flat (FL) or patterned (PT) PDMS with or without 1% or 10% triclosan Patterned PDMS + 10% triclosan (PT 10%) attracted significantly more live S. aureus and P. aeruginosa, as determined using Colony Forming Unit (CFU) analysis (*p<0.01), Scanning Electron Microscopy (SEM) (*p<0.01) and Confocal Scanning Laser Microscopy (CSLM) (*p<0.01). The released triclosan was not cytotoxic against either bacteria or primary cultures of human dermal fibroblasts using Water Soluble Tetrazolium Salts (WST-1) assay. High performance liquid chromatography analysis highlights low level of triclosan release from the PDMS. Bacterial infection in co-culture using the Boyden chamber assay increased fibroblast viability in the presence of PDMS (*p<0.05). PT 10% demonstrated superior biofilm transfer from epidermis (*p<0.05), in comparison to all other analysed polymers. In summary, the unique topography of PDMS combined with triclosan attracted bacteria most efficiently. This promising data suggests potential for engineering a patterned polymer to physically transfer biofilms from wounds, and importantly lacks bactericidal properties which is vital in the quest to combat antimicrobial resistance.