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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Therapeutic Uses of Antioxidant Liposomes

Stone, William L., Mukherjee, Shyamali, Smith, Milton, Das, Salil K. 01 January 2002 (has links)
No description available.
32

Diagnosis and Management of Anxiety in Adolescents in Primary Care

Wood, David L., Tolliver, Matthew 01 January 2019 (has links)
Anxiety and fear are normal responses to human events and do not require clinical intervention unless the fear is of unusual duration, intensity, content or frequency, according to the DSM-V criteria. There are several types of anxiety disorders according to the DSM-V: Generalized anxiety disorder, panic disorders, phobias and separation anxiety. The DSM-V separates out anxiety from obsessive-compulsive disorders and trauma and stress related disorders such as PTSD. The prevalence of anxiety disorders across all of adolescence approaches 36%. Youth experiencing anxiety may have a strong physiologic reaction to the stress that reinforces the feelings of anxiety. The effects of anxiety on adolescent well-being and function depend on the level of severity of the anxiety, from mild to severe, which can debilitate the adolescent in many areas of his/her life. Longitudinal data suggest that anxiety disorders in youth predict a range of psychiatric disorders later in life, including other anxiety disorders, substance use disorders and depression. The primary care provider has a very important role to play in screening for, diagnosing and treating anxiety in adolescents. Validated clinical screening tools exist and can help the clinician make a diagnosis. For mild anxiety, reassurance, encouragement and follow-up may be sufficient to address the anxiety. For moderate to severe anxiety, both evidence-based counseling, such as cognitive behavioral therapy (CBT) or action and commitment therapy (ACT) and anti-anxiety medications (primarily the SSRIs) can effectively treat anxiety. ACT, with its mindfulness approach and use of metaphors, may be easier to integrate into primary care.
33

Assessing and Treating ADHD in Integrated Primary Care

Tolliver, Matthew, Wood, David L. 01 January 2019 (has links)
Attention deficit hyperactivity disorder (ADHD), one of the most commonly diagnosed behavior disorders in childhood, is frequently encountered by providers in primary care. While medications are the first line treatment for adolescents with ADHD, there are significant advantages to patients and providers when ADHD assessment and treatment occurs in a setting where behavioral health providers are fully integrated. Well thought out clinical pathways that specify roles and responsibilities between providers can help make ADHD assessment and management more efficient. Effective treatment of ADHD relies on integrated medical and behavioral treatment plans.
34

Maternal Drug Use and the Severity of Neonatal Abstinence Syndrome

Agarwal, Pratibha, Bailey, Beth, Hall, Jesi, Devoe, Michael, Wood, David 01 January 2018 (has links)
East Tennessee and Middle Appalachia is the epicenter of the prescription drug epidemic, with approximately 15% of women giving birth at our institution documented as suffering from drug addiction. Objective: In this chapter we describe our sample of women giving birth to infants who were drug exposed and experienced Neonatal Abstinence Syndrome (NAS) and to determine the maternal and neonatal factors associated with the severity of NAS as measured by the length of stay (LOS) in the Neonatal Intensive Care Unit (NICU). Methodology: This was a retrospective chart review of 73 infants diagnosed with NAS and treated in the NICU. We conducted bivariate analyses and multivariate modeling (least squares regression with backward elimination) of the significant variables (p <.10) against the infant’s LOS. Results: The mean LOS for infants with NAS was 17.7 days (sd = 11.6); 75.3% received nonpharmacological and 86.3% received pharmacologic (morphine) treatment. Of 73 women, 53.4% had a history of mental illness; 53.4% smoked >5 cigarettes per day in last trimester; 89% were taking buprenorphine, 9.6% had cord tissue positive for benzodiazepine. Term infants had 2.3 day longer LOS on average (p = 0.027) compared to preterm infants; infants exposed to benzodiazepines had 12.7 day longer LOS on average (p = 0.07) and prenatal exposure to >5 cigarettes per day in last trimester increased the hospital stay by 6.4 days (p = 0.022). Conclusion: We found that exposure to benzodiazepines and cigarette smoking were associated with an increased LOS.
35

Identifying Gaps in the Performance of Pediatric Trainees Who Receive Marginal/Unsatisfactory Ratings

Li, Su Ting, Tancredi, Daniel J., Schwartz, Alan, Guillot, Ann, Burke, Ann, Trimm, R. Franklin, Guralnick, Susan, Mahan, John D., Gifford, Kimberly A., Basila, Dennis, Dougherty, Katherine, Robus, Richard S., Matrone, Christa, Schumacher, Daniel J., Dewar, Stephanie B., Hofkosh, Dena, Lieberman, Rhett, Poynter, Sue E., Tuell, Dawn, Huff, Janara J., Rincon, Marielisa, Sease, Kerry K., Yeh, Sylvia H., McKenna, Michael P., Price, Laura, Donnelly, Kathleen M., Carter, Meredith L., Rappaport, David I. 01 January 2018 (has links)
Purpose To perform a derivation study to determine in which subcompetencies marginal/unsatisfactory pediatric residents had the greatest deficits compared with their satisfactorily performing peers and which subcompetencies best discriminated between marginal/unsatisfactory and satisfactorily performing residents. Method Multi-institutional cohort study of all 21 milestones (rated on four or five levels) reported to the Accreditation Council for Graduate Medical Education, and global marginal/unsatisfactory versus satisfactory performance reported to the American Board of Pediatrics. Data were gathered in 2013-2014. For each level of training (postgraduate year [PGY] 1, 2, and 3), mean differences between milestone levels of residents with marginal/unsatisfactory and satisfactory performance adjusted for clustering by program and C-statistics (area under receiver operating characteristic curve) were calculated. A Bonferroni-corrected significance threshold of.0007963 was used to account for multiple comparisons. Results Milestone and overall performance evaluations for 1,704 pediatric residents in 41 programs were obtained. For PGY1s, two subcompetencies had almost a one-point difference in milestone levels between marginal/unsatisfactory and satisfactory trainees and outstanding discrimination (≥ 0.90): organize/prioritize (0.93; C-statistic: 0.91) and transfer of care (0.97; C-statistic: 0.90). The largest difference between marginal/unsatisfactory and satisfactory PGY2s was trustworthiness (0.78). The largest differences between marginal/unsatisfactory and satisfactory PGY3s were ethical behavior (1.17), incorporating feedback (1.03), and professionalization (0.96). For PGY2s and PGY3s, no subcompetencies had outstanding discrimination. Conclusions Marginal/unsatisfactory pediatric residents had different subcompetency gaps at different training levels. While PGY1s may have global deficits, senior residents may have different performance deficiencies requiring individualized counseling and targeted performance improvement plans.
36

Inhibition of Inducible Nitric Oxide Synthase by a Mustard Gas Analog in Murine Macrophages

Qui, Min, Paromov, Victor M., Yang, Hongsong, Smith, Milton, Stone, William L. 30 November 2006 (has links)
Background: 2-Chloroethyl ethyl sulphide (CEES) is a sulphur vesicating agent and an analogue of the chemical warfare agent 2,2′-dichlorodiethyl sulphide, or sulphur mustard gas (HD). Both CEES and HD are alkylating agents that influence cellular thiols and are highly toxic. In a previous publication, we reported that lipopolysaccharide (LPS) enhances the cytotoxicity of CEES in murine RAW264.7 macrophages. In the present investigation, we studied the influence of CEES on nitric oxide (NO) production in LPS stimulated RAW264.7 cells since NO signalling affects inflammation, cell death, and wound healing. Murine macrophages stimulated with LPS produce NO almost exclusively via inducible nitric oxide synthase (iNOS) activity. We suggest that the influence of CEES or HD on the cellular production of NO could play an important role in the pathophysiological responses of tissues to these toxicants. In particular, it is known that macrophage generated NO synthesised by iNOS plays a critical role in wound healing. Results: We initially confirmed that in LPS stimulated RAW264.7 macrophages NO is exclusively generated by the iNOS form of nitric oxide synthase. CEES treatment inhibited the synthesis of NO (after 24 hours) in viable LPS-stimulated RAW264.7 macrophages as measured by either nitrite secretion into the culture medium or the intracellular conversion of 4,5-diaminofluorescein diacetate (DAF-2DA) or dichlorofluorescin diacetate (DCFH-DA). Western blots showed that CEES transiently decreased the expression of iNOS protein; however, treatment of active iNOS with CEES in vitro did not inhibit its enzymatic activity. Conclusion: CEES inhibits NO production in LPS stimulated macrophages by decreasing iNOS protein expression. Decreased iNOS expression is likely the result of CEES induced alteration in the nuclear factor kappa B (NF-κB) signalling pathway. Since NO can act as an antioxidant, the CEES induced down-regulation of iNOS in LPS-stimulated macrophages could elevate oxidative stress. Since macrophage generated NO is known to play a key role in cutaneous wound healing, it is possible that this work has physiological relevance with respect to the healing of HD induced skin blisters.
37

Comparative Effects of RRR-Alpha- and RRR-Gamma-Tocopherol on Proliferation and Apoptosis in Human Colon Cancer Cell Lines

Campbell, Sharon, Stone, William L., Lee, Steven, Whaley, Sarah, Yang, Hongsong, Qui, Min, Goforth, Paige, Sherman, Devin, McHaffie, Derek, Krishnan, Koyamangalath 17 January 2006 (has links)
Background: Mediterranean societies, with diets rich in vitamin E isoforms, have a lower risk for colon cancer than those of northern Europe and the Americas. Vitamin E rich diets may neutralize free radicals generated by fecal bacteria in the gut and prevent DNA damage, but signal transduction activities can occur independent of the antioxiclant function. The term vitamin E represents eight structurally related compounds, each differing in their potency and mechanisms of chemoprevention. The RRR-γ-tocopherol isoform is found primarily in the US diet, while RRR-α-tocopherol is highest in the plasma. Methods: The effectiveness of RRR-α-and RRR-γ-tocopherol at inhibiting cell growth and inducing apoptosis in colon cancer cell lines with varying molecular characteristics (SW480, HCT-15, HCT-116 and HT-29) and primary colon cells (CCD-112CoN, nontransformed normal phenotype) was studied. Colon cells were treated with and without RRR-α- or RRR-γ-tocopherol using varying tocopherol concentrations and time intervals. Cell proliferation and apoptosis were measured using the trypan blue assay, annexin V staining, DNA laddering and caspase activation. Results: Treatment with RRR-γ-tocopherol resulted in signi ficant cell death for all cancer cell lines tested, while RRR-α-tocopherol did not. Further, RRR-γ-tocopherol treatment showed no cytotoxicity to normal colon cells CCD-112CoN at the highest concentration and time point tested. RRR-γ-tocopherol treatment resulted in cleavage of PARP, caspase 3, 7, and 8, but not caspase 9. Differences in the percentage cell death and apoptosis were observed in different cell lines suggesting that molecular differences in these cell lines may influence the ability of RRR-γ-tocopherol to induce cell death. Conclusion: This is the first study to demonstrate that multiple colon cancer cell lines containing varying genetic alterations will under go growth reduction and apoptosis in the presence of RRR-γ-tocopherol without damage to normal colon cells. The amount growth reduction was dependent upon the molecular signatures of the cell lines. Since RRR-γ-tocopherol is effective at inhibition of cell proliferation at both physiological and pharmacological concentrations dietary RRR-γ-tocopherol may be chemopreventive, while pharmacological concentrations of RRR-γ-tocopherol may aid chemotherapy without toxic effects to normal cells demonstrated by most chemotherapeutic agents.
38

Amoebic liver abscess in Natal African children

Scragg, Joan Noelle 26 July 2017 (has links)
No description available.
39

An Examination of Lumbar and Ventricular Cerebrospinal Fluid Findings in Children with Tuberculous Meningitis and Hydrocephalus

Mwenda, Lona Albertha 13 February 2020 (has links)
Background: Childhood tuberculous meningitis (TBM) has poor outcomes. These are often associated with delayed diagnosis because early diagnosis and treatment is challenging. Existing diagnostic criteria use CSF characteristics to suspect TBM. However, lumbar and ventricular CSF may differ. These differences have not been well characterised Sometimes only ventricular CSF is available and decisions about surgical treatment may be influenced by CSF characteristics. This study examined CSF parameters from lumbar and ventricular compartments in patients with TBM and hydrocephalus who required neurosurgical procedures, their CSF temporal profiles, differentials between compartments, and factors that may influence these results. Methodology: A descriptive cross-sectional study was conducted including data from two prospective TBM studies. Children treated for TBM and hydrocephalus at Red Cross War Memorial Children’s Hospital with lumbar and/ or ventricular samples were selected. Pooled lumbar verses ventricular samples and paired time-linked samples in individual patients were analysed. Differences in CSF cell counts and biochemistry parameters across compartments were analyzed using Wilcoxon signed rank test, and temporal profiles graphically presented. Associations between laboratory, clinical and radiological data were analyzed using Mann-Whitney’s U test. To test for associated factors, results of the nature of hydrocephalus (level of CSF obstruction) and spinal imaging were analyzed where available. Association between CSF parameters and morbidity was analyzed. Results: Eighty-one patients were studied, 29 had time-linked paired CSF. The mean patient age was 36 months (2- 156 months), 93% were HIV-uninfected, and the mortality rate was 13.6%. Seventy-two percent had communicating hydrocephalus, 16% non-communicating, and 12% uncertain (unable to demonstrate level of block). Medians of admission lumbar CSF showed low glucose (2.2 mmol/L), low chloride (112 mmol/L), raised protein (2g/L) and elevated white cell count (165 x 106 /L). Corresponding values for admission ventricular CSF were minimally affected glucose (3mmol/L), mildly low to normal chloride (114.5mmol/L), normal to mildly raised protein (0.5g/L) and less elevated white cell count (22 x 106 /L). In paired samples, all parameters were significantly different between lumbar and ventricular CSF. Ventricular CSF showed milder aberrations than lumbar CSF: lower protein and total white cell count, higher glucose and chloride. All paired samples showed higher lumbar CSF protein; lower lumbar CSF chloride in almost 80%; lower lumbar CSF glucose in 96%. Analysis of possible factors was limited by the small patient numbers who had full brain and spine imaging, and also paired CSF samples (n=17). However, maximum lumbar CSF protein was associated with severity of spinal disease on imaging. The lymphocyte ratio between lumbar and ventricular CSF was higher in patients with non-communicating and uncertain hydrocephalus. CSF parameters normalized slowly. White cell count and lymphocyte CSF differential were associated with favorable outcome in survivors. Conclusion: Lumbar CSF depicted a typical TBM pattern. Ventricular CSF differed: CSF parameters were less abnormal in both pooled analysis and across individual paired samples. Spinal disease severity and nature of hydrocephalus may affect this differential. The CSF compartment sampled is therefore clinically relevant when interpreting CSF characteristics for diagnostic and treatment decisions. Studies of TBM diagnosis, pathophysiology, biomarkers and drug concentrations should consider these differences.
40

Plasma-Vitamin E and Low Plasma Lipoprotein Levels in Sickle Cell Anemia Patients.

Stone, W. L., Payne, P. H., Adebonojo, F. O. 01 January 1990 (has links)
Increasing evidence suggests that in vivo lipid peroxidation may be an important factor in sickle cell anemia (HbSS). Vitamin E is the major lipid-soluble antioxidant in plasma, and this vitamin, as well as cholesterol, is transported in plasma almost exclusively by lipoproteins. The purpose of this investigation was to determine if vitamin E and plasma lipoprotein-cholesterol levels in sickle cell anemia (SCA) patients are interrelated. We found that low plasma-vitamin E levels in SCA patients were accompanied by low levels of plasma-cholesterol. The mean plasma-vitamin E/plasma-cholesterol ratio was similar in 12 SCA patients (6.1 +/- 0.7 micrograms vitamin E per mg plasma-cholesterol) and 21 controls (6.5 +/- 0.7 micrograms/mg). Our results suggest that the low levels of plasma-vitamin E in SCA patients may be related to decreased levels of lipoprotein carriers. The low plasma-cholesterol levels in SCA patients (139.1 +/- 9.9 mg/dL) were due to low levels of both high density lipoprotein-cholesterol (HDL-cholesterol of 35.0 +/- 1.0 mg/dL) and low density lipoprotein-cholesterol (LDL-cholesterol of 97.8 +/- 9.2 mg/dL). The "atherogenic index," defined as LDL-cholesterol/HDL-cholesterol, was similar in the SCA patients (2.9 +/- 0.2) and the controls (3.0 +/- 0.4).

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