Thesis advisor: Thomas Stegman / Thesis advisor: Robert Imbelli / Thesis (STL) — Boston College, 2014. / Submitted to: Boston College. School of Theology and Ministry. / Discipline: Sacred Theology.

Objectives: To establish the health-related quality of life (HRQOL) of survivors of critical illness as a result of trauma six months after discharge from the intensive care unit (ICU) and to determine which HRQOL measurement tool is more suitable to use in this population. To relate demographic characteristics and other outcome measures to HRQOL as reported six months after ICU discharge with the Short Form-36 (SF-36) Medical Outcomes questionnaire and EQ-5D questionnaire respectively. Methods: A retrospective cross-sectional cohort study was conducted to assess HRQOL at six months after ICU discharge for survivors of trauma who were treated with mechanical ventilation. Twenty eight (n=28) subjects were recruited from two ICUs in Johannesburg, South Africa. Health-related QOL was assessed with the SF-36 English UK version and the EQ-5D questionnaires. Demographic (age, gender) and outcome measure [Acute Physiology and Chronic Health Evaluation (APACHE) II, Injury Severity Score (ISS), ICU and hospital length of stay (LOS)] information was related to HRQOL. Results: The HRQOL reported by subjects showed limitations when measured with the EQ-5D and SF-36. EQ-5D data revealed that 50% of subjects reported some problems in mobility, 35% in self-care and 67.9% in usual activities. Furthermore, 60.7% reported some problems in pain/discomfort and 7.1% reported extreme problems in this domain. With regard to the anxiety/depression domain, 46.4% reported some problems whilst 7.1% reported extreme problems. The mean score for the EQ-5D visual analogue scale (VAS) was found to be 68 (± 26.1). Statistical significance was found in the relationships between age and EQ-VAS (p = 0.05; r = -0.4) where a moderate correlation was observed, ICU length of stay (LOS) and the mobility domain (p = 0.01), hospital LOS and the mobility domain (p = 0.04), hospital LOS and the self-care domain (p = 0.04) and the APACHE II score and the usual activities domain (p = 0.05). With respect to the HRQOL as measured with the SF-36 questionnaire, subjects were found to have not achieved optimal HRQOL in any of the domains nor with regard to the summary scores. Lowest scores were found in the role physical (RP) [44.6 (± 41.6)] and role emotional (RE) [44.1 (± 45.4)] domains. The physical component summary score (PCS) [62.1(± 27.8)] was slightly higher than the mental component summary score (MCS) [58.7(± 20.1)]. Statistical significance and a strong correlation was found in the association of age and physical functioning (PF) (p = 0.00; r = -0.6). The association between age and general health (GH) (p = 0.02; r = -0.4) yielded a moderate correlation. The same can be said about the association between age and physical component summary score (PCS) (p = 0.01; r = -0.5). PF was also significantly associated with ICU (p = 0.03; r = -0.4) and hospital (p = 0.03; r = -0.4) LOS and a moderate correlation was shown between these variables. Conclusion: At six months after ICU discharge, HRQOL for these subjects was not optimal. Age, ICU and hospital LOS seemed to be associated with limitations in HRQOL related to function while severity of illness had a lesser effect. The EQ-5D questionnaire proved to be simpler and more user-friendly in ascertaining the HRQOL of trauma survivors; however the SF-36 gave more detailed information about HRQOL. Patients who experienced trauma might benefit from a rehabilitation programme after discharge from hospital to address the functional impairments in HRQOL observed with this study.

Human neutrophils are the most abundant type of white blood cell and provide the body with a line of defense against foreign, infectious microorganisms. Contained within the azurophilic granules in the cytoplasm of neutrophils are three serine proteases, Human Neutrophil Elastase, Cathepsin G, and Protease 3. Once a foreign bacterium is engulfed by white blood cells, these enzymes attack and degrade the invading body, thus killing it (Reeves et al., 2002). The focus of this research is centered on the production of one of the serine proteases, human neutrophil elastase (HNE), and while the importance of HNE can be seen, genetic mutations or improper regulation can compromise a person’s immunity. Neutropenia (a low neutrophil count) is one such disease caused by a genetic mutation of HNE that results in susceptibility to infection (Li and Horwitz, 2001). Additionally, HNE is a powerful enzyme that can attack the elastin of the lung if not properly controlled. Consequently, genetic deficiencies of alpha-1 proteinase inhibitor protein in the blood can result in emphysema because active HNE released from neutrophils is free to degrade lung tissue (Laurell and Eriksson, 1965). Recombinant HNE is not currently available, and the enzyme must be isolated from human blood cells, which has inherent hazards. Additionally, the lack of recombinant HNE has prevented studies involving site–directed mutagenesis to study the intracellular processing of HNE near its C-terminal end where mutations have been found to result in neutropenia. Kinetic studies of the full-length HNE might shed some light on why its C-terminal region is removed before storage in cytoplasmic granules. The HNE DNA sequence was first codon optimized for yeast and commercially synthesized. It was then fused with DNA for eGFP (enhanced green fluorescent protein) via an enterokinase cleavage site (D4K). This DNA construct (eGFP-D4K-HNE) was then inserted into the Kluyveromyces lactis (K. lactis) pKLAC1 vector, downstream of the alpha mating factor which directs proteins for secretion. Then, chemically competent GG799 cells (a strain of K. lactis) were transformed with the linearized pKLAC1-eGFP-D4K-HNE insert through a protocol from New England Biolabs. Theoretically, the gene integrates into the yeast genome upon transformation via sequences within the pKLAC1 vector that are homologous with the LAC4 gene promoter that allows for galactose utilization (Colussi 2005). Acetamide was used as a selectable marker because wild type K. lactis cells are not able to use acetamide as a nitrogen source. The pKLAC1 vector, however, contains the Aspergillus nidulans gene acetamidase (amdS) that allows only transformants to grow on plates with acetamide as the sole nitrogen source (Read 2007). Selected colonies were transferred to both liquid and agar-based synthetic media with galactose to induce transcription and translation of the HNE gene to produce the eGFP-D4K-HNE fusion, and screened via fluorescence microscopy for production of eGFP. None of the screened colonies tested positive for the presence of the fusion protein.

Neutrophils and cytokines present during an inflammatory response produce oxidants, such as reactive oxygen species (ROS) or reactive nitrogen species (RNS). These oxidants act as free radicals, a highly reactive species that steal electrons from nearby molecules to satisfy their valence electron needs. The removal of electrons by free radicals produces damage within the healthy cells of tissue. Antioxidants can be used to reduce this oxidative stress and reestablish the necessary environment for wound healing by donating electrons to the free radicals, sparing the damaging effects oxidation causes to other molecules. The standard procedure for administering supplemental antioxidants is through enteral delivery. However, the inflammation and vascular damage experienced with a burn wound produces a notable decrease in the blood profusion to the damaged tissues. In contrast, this research focuses on a topical antioxidant treatment applied directly to the surface of the wound. By applying the gel topically, a higher concentration of antioxidants will be able to permeate the damaged tissue and quench enough free radicals to provide a therapeutic effect. Additionally, the gel developed by this research is comprised of a large percentage of Vitamin E-TPGS. This is a product capable of stabilizing moisture at the wound site; drawing fluid from the moist center and redistributing it to the drier perimeters of the wound. It is hypothesized the need for surgical debridement may decrease as a result of use of this topical application. Antioxidants often referred to in literature discussing nutrition and wound care include the following: Vitamin E, α-Lipoic Acid, Vitamin C, Grape Seed Extract, Coenzyme Q10, Glutathione, and Lutein. These antioxidants were incorporated into a gel formula, using a factorial method, based on their antioxidant potential as evidenced by the existing literature. In order to identify the most effective combination of these antioxidants, one-, two-, three-, four-, and five-component antioxidant gels representing every combination of the test antioxidants were produced. This resulted in a compilation of 35 gels for comparison. Each gel was tested on the basis of viscosity, pH, and antioxidant capacity. Antioxidant capacity was determined using the Ferric Reducing Antioxidant Plasma (FRAP) Assay, a spectrophotometric evaluation. A three-antioxidant gel composed of α-Lipoic Acid, Coenzyme Q10, and Mixed Tocopherols (with and without micronized silver) was chosen as the final formulation. The storage stability of the final formulation was then evaluated once per week (over a total of 7 weeks) by measuring changes in pH, viscosity, and FRAP assay. In collaboration with Dr. Joseph Molnar at Wake Forest School of Medicine, an animal model trial will be conducted in the Spring Semester 2013 to determine the viability of the gel in comparison to a negative control and silver sulfadiazine, the current standard treatment protocol.

Under dryland farming operations, the use of fertilizers is often restricted due to limited crop response arising from limited seasonal moisture. Once this dryland area is brought under irrigation, there is increased use of fertilizers and increased demands for greater exactness in amounts of fertilizers to apply, due to efforts which are made to increase the returns from the land by introduction of new farming techniques and crops.

In the last few years, much research has been done on lipid metabolism because of the possible involvement of lipids in atherosclerosis and coronary heart disease. These diseases appear to be related to abnormalities in lipid metabolism. Since sex differences have been noted in lipid metabolism, the role of steroid hormones has been under investigation in a number of laboratories. Coronary heart disease occurs only rarely in women during the reproductive phase. In men, the administration of estrogens results in a decreased serum cholesterol level while androgens tend to increase circulating cholesterol. Experiments on rats and chickens have indicated that both corticosteroids and sex hormones are involved in the regulation of lipid and cholesterol metabolism. In chickens, estrogens decreased the circulating cholesterol and prevented the coronary atherosclerosis that can be induced by feeding cholesterol. The effect of estrogens and androgens on the metabolism of essential fatty acids in rats is under investigation by Ostwald et al. (1965). Female or estrogen-treated rats maintained more arachidonic acid in their plasma phospholipids and cholesteryl esters than did their male counterparts even during acute and prolonged deficiencies of dietary linoleic acid. Adrenal cortex contains a number of potent hormones all of which are steroid derivatives having characteristic cyclopentanoperhydrophenanthrene nucleus. The corticosteroids are produced by the adrenal gland in both male and female. One measure of corticosteroids activity is the determination of urinary 17, 21-dihydroxy-20-ketosteroids. The androgens in female are produced by the adrenal cortex and in small amounts by the ovary; in the male by the testis and to a lesser extent in the adrenal cortex. Measurement of the urinary neutral 17-ketosteroids is becoming more frequently used as an index of androgenic activity but it should be borne in mind that the androgenic ptency of a given urine extract will not necessarily parallel 17-ketosteroid concentration. Until more is known about androgen and 17,21-dihydroxy-20-ketosteroids (DKS), male adrenals, as well as possible androgen secretion by the ovary, the significance of normal neutral 17-ketosteroids and 17,21-dihydroxy-20-ketosteroids determinations in urine are of considerable importance when measured regularly for long periods of time. The measurement of the output of these steroids during several menstrual periods would provide a biochemical index of androgen and corticosteroids secretion in women. Few, detailed studies of changes in urinary excretion of androgen and corticosteroid end products during the menstrual cycle in normal young women have been reported in the literature. Yu (1964) found that neutral 17-ketosteroids gradually increased from the 9 to 15 days. This increase was significant. However, she did not have values for the rest of menstrual period on her five subjects. Her results indicated that a more detailed study of changes occurring during the menstrual cycle was desirable. Then, if these changes were related to concentrations of the serum fatty acids during the menstrual cycle, basic information on relationships between steroid hormones and lipid metabolism might be obtained. The findings should be important because abnormal metabolism of lipids seems to be one factor involved in several of the degenerative diseases of old age such as atherosclerosis and cerebral hemorrhage. This study is a part of a larger problem to determine relationships that exist among serum cholesterol, serum fatty acids, and concentrations of estrogens and degradations products of the androgens and corticosteroids in urine in normal young women. The purpose of this study is to determine the changes in concentrations of neutral 17-ketosteroid and 17,21-dihydoxy-20-ketosteroid hormones in women's urine during specified days of the menstrual period, which would help to define the effect of ovulation on the urinary excretion of these hormones.

Zinc deficiencies occur in many fruit orchards in Utah even though the soil contains amounts of zinc that would normally be sufficient for good plant growth. The existing zinc problem in Utah is, therefore, one of availability.

The isothermal movement of liquid water in saturated soil has been intensively studied, and a sound theoretical basis has been intensively studied, and a sound theoretical basis has been developed. Considerably less is known about the flow of water in unsaturated soils, but a general theory based on Darcy’s law of flow is beginning to develop. A good theoretical basis exists for the vapor diffusion under isothermal conditions. Inconsistent data and theories are found in the literature concerning the movement of water in both the vapor and liquid phases, under the influence of thermal fields.

The purpose of this study was to determine if the complexity and surface area of a macrophyte’s structure has an influence on invertebrate colonization, and to determine the influence of two non-native species on invertebrate colonization. Three plant architectures were compared. Floating leaved plants were represented by the following species: Nuphar lutea, Nymphaea odorata, and Brasenia schreberi. Moderately dissected leaved plants were represented by Potamogeton natans, and highly dissected leaved plants were represented by two non-native species, Myriophyllum spicatum and Myriophyllum heterophyllum. The number of invertebrates/g dry biomass and the number of individuals/m², diversity, evenness, and richness were calculated for comparison. The density of invertebrates was significantly different among the different plant architecture types for both individuals per m² and individuals per/g dry biomass (ANOVA, F=33.53, p < 0.0001; ANOVA, F=194.41, p < 0.0001). The highly dissected milfoils had the greatest density of individuals per gram dry plant biomass compared to the moderately dissected plants, and the moderately dissected plants had a greater density of individuals per gram dry mass than floating leaved plant. There were also differences in terms of invertebrate community diversity (H'), (ANOVA, F=l7.08, p < 0.001), and richness (ANOVA, F= 35.52, p < 0.001), but not evenness (ANOVA, F = 1.83, p = .0961). When the number of invertebrates/g dry plant biomass was examined in lakes where the highly dissected plants were ”rare/not observed", there was a lower density of invertebrates per gram dry biomass. This was significantly lower than in lakes where the highly dissected plants were both ”common” and ”dominant” (ANOVA, F=3.31, p = 0.0393). Data analysis was strongly affected by the density of the oligochaete Sty/aria and the amphipod Hyallela azteca, as evident in the Principle Component Analysis. Parameters associated with the two axes, principle component 1 and principle component 2, explained 86% of the variation in epiphytic invertebrate density.

acase@tulane.edu / High-quality end-of-life cancer care supports patients' quality of life by providing care to maximize comfort and minimize the physical or psychological harm often caused by unnecessary aggressive treatments. There are recognized racial inequities in the aggressiveness of end-of-life care between Black and White adults, but these discrepancies have not been examined thoroughly in the Deep South. This study has two aims: (a) to test the feasibility of utilizing a novel database in the Deep South and (b) to examine the association between race and aggressive end-of-life cancer care. Retrospective administrative data were extracted from the Research Action for Health Network (REACHnet) database using their Common Data Model. Logistic regressions were used to analyze the relationship between race and each indicator of aggressive care (chemotherapy use, inpatient hospitalization, emergency department admission, intensive care unit admission, or mechanical ventilation in the 30 days before death). Additionally, ordinal regression was used to examine the relationship between race and a composite measure of all indicators of aggressive care. Utilizing the REACHnet database was successful to provide clinical health data. Results supported the omnibus hypothesis and partially hypotheses focused on specific indicators of aggressive care. Racial disparities in the Deep South exist which may impact a patient’s treatment and subsequent quality of life near death. The mechanisms driving such disparities deserve further attention to eliminate racial disparities in end-of-life care for patients with advanced cancer. / 0 / Leah Walsh