A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Background: Therapeutic management of bone loss in the craniofacial region as a consequence of trauma, surgery or congenital malformations presents a clinical challenge. Mesenchymal stem cells (MSCs), due to their inherent plasticity, are potential candidates for cell based therapies for the repair and reconstruction of craniofacial bone tissue. Guided differentiation of stem cells to osteogenic precursors is marked by spatio-temporally regulation of gene expression profiles including that of transcription factors, cytokines, extracellular matrix proteins, enzymes and several signaling pathways. Cytokines, produced by both immune and non-immune cells can influence both immuno- modulatory responses in the host and also affect cell physiology. Understanding the cytokine expression profiles will be of great advantage in developing methods for effective bone regeneration with minimal immunological insults either on the graft or on the host. Objective: The objective of the present study is to investigate the gene expression profiles of the various cytokines of HGMSCs in normal and osteogenic conditions. Methodology: HGMSCs were isolated from gingival tissues by standard enzymatic methods. HGMSCs were guided to osteogenic precursor cells and the differentiation process was monitored by measuring stage specific expression of genes and proteins. Mineral nodule formation of osteogenic differentiation was analyzed by using Alizarin red and Von Kossa Staining methods. Gene expression profiles of various pro- and anti-inflammatory cytokine profiles of HGMSCs were investigated using quantitative real time PCR at 1, 2 and 3 weeks post-induction with osteogenic medium. Results: The osteogenic differentiation of HGMSCs was confirmed by alkaline phosphate enzyme activity assay, gene and protein expression studies of osteogenic markers. Mineral nodule formation was observed after 4 weeks ofosteogenic induction. The results of cytokine profile expressions revealed that there was a significant upregulation in the expression of TGF-β at all-time points. The gene expression of IL-10 was more or less consistent with an overall increase of 40% over that of controls at all time points studied. We observed a significant decrease in the mRNA expression of IL-6 and IL-1? with respect to their control group (P<0.05) and the expression of IL-8 was upregulated significantly. Conclusion: There is an overall enhancement in the expression of anti-inflammatory cytokines IL-10 and TGF-β during the osteogenic differentiation of HGMSCs that indicates a potential shift of cytokines to dampen immune responses. The reduction of IL-6 and IL-1β expression is an added advantage to reduce the acute phase and inflammatory responses, favoring HGMSCs to be cells of choice for repair and regeneration of craniofacial bones. A beneficial combination of the cytokines expressed by HGMSCs during osteogenic differentiation to reduce acute phase and long term immune responses will facilitate the achievement of our long term goal.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objective: The objectives of this study were 1) to evaluate the effect of enamel deproteinization on the shear bond strength(SBS) of orthodontic brackets bonded with a resin modified glass-ionomer (RMGI) adhesive and a composite resin, 2) to determine the mode of bond failure according to the adhesive remnant index (ARI) and 3) to evaluate the effect of these adhesives in the prevention of white spot lesions (WSLs). Background: WSLs are a concern for orthodontic patients. RMGI orthodontic adhesives are capable of absorbing fluoride from the oral environment and releasing it continuously over time, however, they are not frequently used as they exhibit low SBS. Techniques such as non-invasive enamel deproteinization with 5.25% sodium hypochlorite prior to acid etching rid the surface of organic components and have the potential to enhance the etching pattern. Methods: Eighty-eight extracted bovine incisors were randomly divided into two groups. 48 incisors in group (A) underwent SBS testing, through debonding of brackets with the Universal Testing Machine and subsequent measurement of the ARI. 40 incisors in group (B) underwent demineralization testing by measuring the depth of WSLs formed after exposure to an acidic challenge for 96 hours. In groups A and B, the teeth were divided to have brackets bonded with GC Fuji ORTHO™ LC adhesive or Transbond™ XT adhesive and a self-etching primer. Each adhesive group had an experimental group receiving the intervention of enamel deproteinization prior to etching and bonding and a control group. Results: The highest mean SBS was observed in the Transbond™ XT control group (12.48 ± 6.23 MPa) and the lowest mean SBS was observed in the Fuji ORTHO™ experimental group (5.49 ± 2.97 MPa). ANOVA and Post-Hoc Tukey tests revealed statistically significant differences (p<0.05) in the SBS of both Fuji ORTHO™ groups compared to the Transbond™ XT control group. A significantly greater percentage of Transbond™ XT control teeth had an ARI score of 0 and a greater percentage of Fuji ORTHO™ experimental teeth had an ARI score of 3. The Transbond™ XT experimental group had the largest average demineralization lesions (62.97 ± 10.95 micrometers). The smallest lesion depths were found in the Fuji ORTHO™ groups, with an average of 7.74 micrometers in the experimental group and 6.57 micrometers in the control group. ANOVA and Post-Hoc Tukey tests revealed significant differences (p<0.001) in the depth of white spot lesions when comparing both composite resin groups to each other, and when each glass ionomer group was compared to each composite resin group. Conclusions: Enamel deproteinization did not increase the SBS of orthodontic brackets bonded with either Fuji ORTHO™ adhesive or Transbond™ XT adhesive. However, according to the ARI, more bond failures occurred at the bracket-adhesive interface in the Fuji ORTHO™ experimental group. Also, both Fuji ORTHO™ adhesive groups showed greater protection against enamel demineralization, when compared to the Transbond™ XT adhesive groups.

Objective: The objective of this study was to determine the effect of pulsating vibration on the sliding resistance between orthodontic brackets and stainless steel wires. Brackets were placed at two different angulations (0° and 5°) to simulate leveling of a tipped tooth during tooth movement. Pulsating vibration was delivered via the AcceleDent device. Background: Friction is defined as a force that retards or resists the relative motion of two objects in contact, and its direction is tangential to the common boundary of the two surfaces in contact. This has been of interest to the orthodontist since the mid-20th century. Since the time of Stoner’s paper in 1960, the orthodontic literature has been full of studies done on friction in orthodontics including: friction with different ligation methods, friction among different arch wire materials, friction and different bracket materials, and friction with various slot designs. Understanding friction has led to the emergence of new technologies in orthodontics. One of the most popular is the self-ligating bracket. This popularity arose from claims that they reduce friction during treatment. Other innovations have been introduced in the field of orthodontics to help accelerate tooth movement. Among these innovations is the application of a pulsating vibration during active orthodontic treatment. Such pulsating vibration can be delivered during orthodontic treatment by AcceleDent, which is a hands- free device designed by OrthoAccel Technologies, Inc., Bellaire, TX. The company claims the output force helps accelerate bone turnover. The following study investigated whether it could decrease treatment time via a different mechanism: decreasing frictional resistance to tooth movement along the arch wire. Methods: A paper template was made of a typodont tooth with a bracket window cut out. The bracket cut out was made with the bracket window angulated 0° and 5°. 0.022” x 0.028” standard prescription edgewise brackets (American Orthodontics, Sheboygan, WI) of ceramic, twin and self-ligating design were bonded to 3 maxillary 1st premolar typodont teeth using the template. The teeth were leveled with a 0.019” x 0.025” SS arch wire and placed in a metal scaffold. They were held in place with Aquasil Ultra XLV wash material PVS (DENTSPLY Caulk, Milford, DE.). Only the middle bracket was adjusted for angulation and accuracy was checked with the iPhone 6 level. The AcceleDent Aura device (OrthoAccel Technologies, Inc., Bellaire, TX). was attached to the occlusal surface of the teeth via cable ties. The AcceleDent Aura device provided 30 Hz of pulsating vibration. All tests were performed with a 0.019” x 0.025” SS arch wire pulled through the brackets via a Universal Testing Machine (Instron, Grove City, PA) at a crosshead speed of 2.5mm/min for 30 seconds. Frictional resistance was measured by averaging 6 recordings every 5 seconds. Results: The pulsating vibration provided by the AcceleDent device significantly reduced the resistance to sliding for each bracket type at both 0° and 5° (p<0.05). Ceramic brackets had the highest resistance to sliding of all bracket types. Conclusions: Pulsating vibration via the AcceleDent Aura device reduces the resistance to sliding between a bracket and arch wire in vitro. This may potentially decrease overall treatment time but more in vivo studies need to be done to evaluate this.

Background: The National Institute Mental Health (2015) estimated there were about 44.7 million people diagnosed with a serious mental illness and 62.9% of those diagnosed were without mental health services. The loss of services was due to unemployment, reoccurring hospitalization, inabilities to care for themselves, and lack of participation in societal norms (World Health Organization [WHO], 2014). According to Insel (2011/2015), the U.S. cost of mental healthcare was an estimated $57.5 billion in 2006. This cost was not due to actual care but associated with the economic burden of job loss and the excessive use of community resources. The Affordable Care Act (ACA) and the Mental Health Equality and Parity Act (MHEPA) has positively influenced access to mental healthcare, but healthcare coverage continues to be deficient. Insufficient clinical documentation practices decrease insurance reimbursement potential. Purpose: The purpose of this quality improvement project was to enhance the current clinical documentation practices and policies and increase insurance reimbursement in an adult psychiatric inpatient unit in a private, non-profit mental and behavioral health organization. Theoretical Framework: The Kurt Lewin’s 3 Step Change Management Theory Methods: A quantitative design guided this project utilized an investigator-developed tool modeled from the CMS Inpatient Unit Worksheet as a data collection tool from the clinical chart documentation reviews. Results: Fisher’s Exact and Chi square tests measured the cross tabulation of pre and post comparison sample frequency of staff’s integration of an evidence-based descriptive documentation method into practice. The results presented with statistical significance of the progress narrative notes. The declined chart claims a p <0.001, and the numbers related to case scenario utilization of the documentation method was p = 1.00. Conclusion: The relationship between descriptive clinical documentation and insurance reimbursement was evident in the usage of the Data, Assessment/Action, Response, and Plan (DARP) method in the clinical documentation progress narratives notes. There was a 24% improvement in insurance reimbursement claims and a 17% decrease in charts declined for the study period.

There is a paucity of occupational therapy literature related to the professional development process that occurs when students participate in immersive, international servant leadership experiences in developing countries. A scarcity of literature exists on how such culturally rich experiences can influence the development of the participating students’ dispositional critical thinking and cultural competency skill sets. This mixed methods study depicts how a 3-week servant leadership experience in Zambia, Africa, measured the acquisition of dispositional critical thinking and cultural competency skill sets in novice to experienced occupational therapy students. Moreover, this study infuses a constructivist grounded theory approach to uncover a holistic understanding of the professional development process that occurred for the participating students over a 3-week immersion experience in Zambia. This study highlights how a hands-on servant leadership experience in Zambia contributed to the acquisition of professional development and problem-solving skills and cultural responsiveness for students who were trained in westernized health care practices. The participants demonstrated statistically significant increases in their critical thinking skills with medium effect sizes in truth-seeking, inquisitiveness, analyticity, systematicity, confidence, and maturity of judgment. In addition, the participants demonstrated statistically significant increases in cultural competency skills with medium to very large effect sizes in cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desires. The qualitative strand of the study revealed the professional growth of the students during the experience through the themes that emerged: “resilient occupational therapy lens” and “empowered occupational therapy students.” Furthermore, this mixed methods study provides a Servant Leadership Professional Development Model to illustrate the transformational professional development process that students underwent that is supported by the mixed methods data findings.

Asthma is a prevalent, costly, and potentially deadly disease. Despite advances in the pharmacological treatment of asthma, many asthma sufferers do not benefit from their medication the way they should because they fail to take it as prescribed. The noncompliance rate for asthma is about 30% to 40%. In this study, I describe the theoretical and practical rationale for, as well as the development of, a brief self-report measure (called the Multidimensional Asthma Questionnaire $\{$MAQ$\}$) for assessing medication compliance in asthma sufferers. Results of the study showed that the MAQ had adequate internal validity and a four factor structure that was designated belief, threat, use, and knowledge respectively. Although it was hypothesized that scores on the MAQ would correlate positively with an independent measure of compliance that was based on pharmacists' medication refill records, this hypothesis was not supported. Neither the MAQ, nor two other measures for assessing the attitudes and beliefs of asthma patients, had any relationship to medication compliance as estimated by pharmacists' refill records. In fact, when scores on the three questionnaires were entered into a multiple regression analysis, the results showed that minimal patient identifying information (gender, marital status, and SES) did a better job of predicting compliance. These results underscore the complexities of accurately assessing and measuring compliance in asthma sufferers. Suggestions for future research are described.

The "thin ideal" and its relationship to depression and eating disorders was investigated in a cross-sectional study of 599 students in the 5th, 8th, and 12th grades. Endorsement of the "thin ideal," socioeconomic status (SES), body image, depression, and eating disorders were measured to test McCarthy's (1990) model for eating disorders. An important variable in this model, SES, was unevenly distributed with an under-representation of high SES participants. Thus, the model was not fully tested. However, an important finding from this study was a "normative" body dissatisfaction and preoccupation with eating and weight concerns among the post-menarche, female participants. This suggests a pervasive condition that challenges the validity of McCarthy's model for eating disorders.

The present study sought: (a) to investigate differences in the type of stressors and level of job stress reported by nurses working in ICU/CCU, Medicine/Surgery, and other specialty areas; (b) to examine the relationship between perceived job stress and social support; and (c) to determine whether the demographic characteristics, age, sex, marital status, level of educational training, and military rank, had any moderating effects upon job stress. A sample of 231 military nurses completed a demographic inventory, the Nursing Job Stress Instrument, and the Social Support Questionnaire. Social support, clearly the most important variable examined by this study, was negatively correlated with job stress. All nurses seemed to experience the most stress as a result of inadequate staffing. However, no support was found for the idea that critical care nurses experience greater or different stressors than ward nurses. All of the demographic variables were unrelated to job stress.

Nonadherence with blood glucose testing is a prevalent and potentially dangerous problem for patients with diabetes. Unit dose packaging has been shown to increase medication adherence in several populations. However, this technique has not been applied to products other than pills, and has not been used with diabetes patients. The present study used unit dose packaged blood testing and injection materials and a brief telephone prompt to increase the frequency with which diabetes patients test their blood glucose. In a combined multiple baseline A-B-BC-A design, baseline was established for at least 3 weeks (A) followed by special packaging for at least 2 weeks (B) special packaging plus a telephone prompt (BC), and then a 3 week return to baseline (A). Adherence was measured with self-report forms, trace measures of used testing materials, and the Wagner's Blood Testing Questionnaire. Results show that overall, there was a difference between baseline and treatment, with treatment, either B or BC, yielding the highest overall adherence for all 5 participants.

The problem investigated by the researcher relates to the development of critical thinking knowledge and skill in nursing students. Traditional approaches to educating nursing students have been used in the past to educate nursing students, but newly licensed registered nurses still have difficulty with critical thinking knowledge and skills. The principal investigator evaluated the use of an alternative method of teaching learning to foster and develop critical thinking knowledge and skills. One suggestion for teaching learning methods is the use of human patient simulation. A pretest/posttest experimental design was used to investigate critical thinking knowledge and skills after using human patient simulation in second semester nursing students. Nursing students from a northern California university were approached to participate in the study in the fall of 2011 and spring of 2012. The WGCTA Form D and the Lasater Clinical Judgment Rubric were used as a method to determine any changes in critical thinking knowledge and skills. No simulation. This study adds to the body of knowledge relating to the use of human patient simulation.