Indiana University-Purdue University Indianapolis (IUPUI) / In 2017, the United States government declared that the opioid epidemic was a public health emergency. Among responses to address the epidemic, the Centers for Disease Control and Prevention released a set of opioid prescribing guidelines for primary care clinicians. Since their release, federal agencies and experts have been interested and concerned about their application in policy and clinical practice. This dissertation examines how some of these federal recommendations were implemented in clinic practice and state law, as well as the effects of related prescribing laws. This dissertation includes three studies 1) a qualitative analysis of clinician and patient discussions about opioid-related risks, benefits, and treatment goals, 2) a policy surveillance study of state tapering laws and their consistency with the CDC guideline’s opioid tapering recommendations, and 3) an empirical study of the effects of morphine milligram equivalent daily dose laws and acute opioid prescribing laws on pain medication prescribing for patients with Medicaid. Overall, this dissertation attempts to understand the translation of national opioid prescribing guidelines into policy and their effects on healthcare delivery. / 2021-02-28

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment for the Degree of Master of Medicine In the branch of Anatomical Pathology Johannesburg 2015 / Background: Mycobacterium tuberculosis (Mtb) poses a major global health problem. According to the World Health Organization, South Africa is a country with one of the highest reported incidence rates of this disease. Key to overcoming this preventable and treatable disease lies in establishing a reliable and rapid diagnostic approach. Aims and Objectives: This study aims to investigate the validity of the mycobacterium polymerase chain reaction (PCR) assay applied to formalin-fixed, paraffin-embedded tissue in which the histology showed granulomatous inflammation with no demonstrable acid-fast bacilli. Methods: A retrospective, cross sectional and non-interventional study was conducted on 121 histopathology cases showing granulomatous inflammation with a negative Ziehl-Neelsen (ZN) stain. The mycobacterium PCR results obtained in these cases were compared against the results of mycobacterium culture obtained from a specimen derived from the same or related site as the biopsy. Results: The mean age of the study population was 35.3 years and the study cohort included 63 males and 58 females. The sensitivity of nested mycobacterium PCR (detecting the 133 base pair product of the heat shock protein 65 kilo Dalton gene), was 64.1% and the specificity was 68.2%. The positive and negative predictive values were 49% and 80% respectively. Twenty six of the 121 cases studied had a false positive result (21.5%). CONCLUSION: There are many factors that may influence the result of a PCR assay and the interpretation thereof. Some of these factors include the inability of the test to distinguish between live and dead bacilli, the high risk of carry over contamination, and the paucibacillary nature of certain samples with an unequal distribution of the few bacilli that may be present. Although the sensitivity and specificity of mycobacterium PCR on paucibacillary, formalin-fixed, paraffin embedded tissue is suboptimal, the interpretation of these results must be performed in conjunction with the overall clinical presentation of the patient. / MT2016

Faculty of Health Sciences School of Therapectic Sciences 0213128j 0117899331 / The Pilates exercise method applies many of the principles of lumbar stabilisation that have been found to be effective in the treatment of chronic low back pain. Pilates has recently found its way into the physiotherapy setting, where it is being integrated into the rehabilitation of patients with low back pain. This study consisted of a randomised control trial using an intervention group that underwent a twelve-week Pilates programme, and control group that continued with standardised physiotherapy treatment as necessary. Baseline, three-week, and twelve-week scores for a Visual Analogue Scale for pain and the Roland Morris Disability Questionnaire were recorded and compared. The Pilates group showed significantly greater improvements in pain and functional disability mean scores when compared to the control group (p=0.059 and p=0.026 respectively). It therefore appears that Pilates can be recommended as an effective treatment modality for the reduction of pain and the improvement of functional disability for chronic low back pain sufferers.

Current research has demonstrated that stress is a contributing factor to many chronic disease states in our world today. Diabetes, hypertension, and high cholesterol are just a few health conditions in which stress can worsen these disease states in individuals. Stress is apparent in individuals with chronic disease but can also appear in those dealing with high-performance anxiety such as student-athletes. Stress does not discriminate in how it can affect people physically, mentally, and emotionally. Even though stress can affect a diverse range of people, there may be similarities among different groups affected by stress such that lessons can learn from each other. For example, research has shown the overwhelming benefits of exercise on physical health and mental health. Yet, even though athletes train consistently, they can still feel the adverse effects of stress on their mental well-being and emotional health. This feeling may be due to the pressure incited to perform at a high level during athletic events. Another adverse area of stress for athletes is the reality that their career will at some point end. This reality may be in their early 30s or 40s. The feelings of loss of purpose are common for many prior athletes and instills additional fear in navigating life direction after sports. In contrast, chronically ill patients go through different events because their stress is directly due to their illness. However, many studies reveal similarities between athletes and those who have a chronic disease regarding mental and emotional coping mechanisms for stress. This thesis addresses these similarities and discusses how both groups even though they have vital differences can learn from one another when dealing with stress.

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Abstract available in the Journal of Investigative Medicine.