A predictive study of selected biological, social, behavioral and environmental risk factors for low birth weight infant births to African-American women in Mississippi

Dollar, Carolyn Blalock The University of Mississippi Medical Center 2005 해외박사(DDOD)

There is considerable racial disparity between African-American and White low birth weight (LBW) infant births in Mississippi. Low birth weight statistics for Mississippi per 1000 live births for the year 2000 were: total 10.3, White infants 7.4, and African-American infants 13.8. National LBW statistics were: total 7.6, White infants 5.7, and African-American infants 13.1, and follow a similar pattern in terms of racial disparity. Birth weight is the greatest predictor of infant health. The purpose of this study was to identify and describe selected biological factors (age, parity, prior fetal loss, preexisting medical risk factors, and complications of pregnancy), social factors of marriage (proxy for social support), and education (proxy for socioeconomic status), behavioral factors (alcohol use, smoking, prenatal care, and weight gain during pregnancy), and environmental factors (unemployment, mean income, population, racial mix, and number of health care providers) for each Mississippi county, either alone or in combination, that were most predictive of LBW infant births in African-American women in Mississippi. The study sample of 3,950 live births was obtained from certificates of live births for all African-American singleton births in the year 2000 from the Mississippi State Department of Health (MSDH) Bureau of Vital Statistics. Environmental factors were obtained from the 2000 U.S. Census Records and the MSDH for Mississippi's eighty-two counties. A predictive correlational design with descriptive statistics, Pearson correlation coefficients, and forward stepwise logistic regression were used as methods of analysis. A model of risk factors most predictive of LBW infant births included: weight gain <25 pounds; lack of prenatal care below 50% expected visits and greater than 110% expected visits; pregnancy complications (any level); prior fetal loss (one or two); and smoking during pregnancy. Environmental factors significantly associated with LBW infant births were: unemployment, racial mix, and number of primary care providers in each county. A predictive model of risk factors for LBW infant births in African-American women in Mississippi will increase understanding and assist with development of culturally sensitive programs of assessment, intervention, education, prevention, and evaluation in order to improve infant health.

Investigating a Rural Rotation in the Mississippi Delta Utilizing Reflective Writings: A Qualitative Study

Smith, C. Cory The University of Mississippi Medical Center 2012 해외박사(DDOD)

Lack of access to health care coupled with a severe shortage of physicians is on the forefront of much debate national and internationally. The result is rural areas often suffering the worst. Mississippi is no stranger to this shortage of physicians as well as certain regions of the state such as the Mississippi Delta being affected more so than others. Innovations in medical education, such as the creation of rural immersion rotations, are attempting to solve this health crisis. The purpose of this study was to investigate and analyze the reflective writings of 36 fourth-year medical students and primary care residents that participated in a month long rural immersion rotation in the Mississippi Delta. Using a qualitative research design while incorporating a grounded theory approach led to the emergence of twelve themes: reflections & feedback of the rotation, professional growth & development, contrast from academic medicine, community & community health, patient-physician relationship, access to health care, chronic disease, non-compliance, racial awareness, poverty, public policy, and alteration of prior perceptions. The findings of this research provided rich data from the perspective of the medical student and resident. This study concluded that the use of reflective writings was beneficial within the rural rotation, and the experience positively influenced and impacted medical students and residents.

A Comparison of Patient Outcomes (Morbidity, Mortality, and Average Length of Stay) Among Academic Medical Centers (AMCs) With and Without Value Analysis Programs Using Three Service Lines

Murray, Adrienne S The University of Mississippi Medical Center 2012 해외박사(DDOD)

Value analysis (VA) is the methodical review of the value of goods and services. It converges on quality and patient outcomes such as morbidity, mortality, and average length of stay. The objective of this study is to compare average length of stay, morbidity, and mortality in the academic medical centers (AMCs) with value analysis programs (VAPs) and those without value analysis programs using three service lines (Cardiovascular, Neuroscience and Orthopedics). The UHC Clinical Data Base/Resource Manager (CDB/RM) was utilized as secondary data for this study, which represents 90 % of AMCs in the country. The CDB/RM data was imported to SPSS, for analysis. The Mann-Whitney non-parametric statistical test was used to test for significant differences with respect to the measurement on the three outcomes average length of stay, morbidity, and mortality between AMCs with and without value analysis programs, across the three selected service lines. The differences between AMCs, with and without VAPs, were not found to be significant regarding patient outcomes (average length of stay, morbidity, and mortality). Trends in patient outcomes were found to be somewhat similar between the two VAP groups. The results demonstrate a significant difference among the service lines with respect to average length of stay, morbidity, and mortality. However, the neuroscience service line consistently demonstrated higher average length of stay, morbidity, and mortality, with the cardiovascular service line trailing. The orthopedic service line steadily revealed the lowest average length of stay, morbidity, and mortality. Even though the difference between the two VAP groups was not significant with respect to average length of stay, morbidity, and mortality, a negative impact on patient outcomes was not noted. It has been demonstrated that VAPs have saved healthcare organizations valuable dollars to be reinvested in clinical programs and equipment. Since 1997, the UHC Value Analysis Program has documented more than $500 million in savings for participating organizations, assisted members in realizing more than $2 million in cost savings annually, and delivered a return on investment of 10:1 for many members, including UMHC. It is possible to maintain quality patient outcomes while decreasing costs. Several case studies denote the savings VA can generate while simultaneously weighing patient outcomes and quality care. Further studies are needed to explore the benefits of VA and its effect on patient outcomes.

Mothering an extremely low birth weight infant

Schenk, Laura Kearney The University of Mississippi Medical Center 2005 해외박사(DDOD)

Women experiencing a difficult pregnancy and subsequent very early birth of an extremely low birth weight (ELBW) infant suffer from guilt and grief as they try to gather themselves together to learn to mother their ELBW infant. The neonatal intensive care unit (NICU) course is tortuous and long. Attachment theories commonly describe the attachment process of mothers and newborns as the relationship grows and matures rapidly through pregnancy and birth. Mothering theory describes how mothers transition into that role in a newborn and premature infant domain. Most of the literature on mothers of premature infants describes situations involving infants most often born at greater than 1500 grams. There is a dearth of literature describing the mothering journey of mothers of ELBW infants. The purpose of this interpretive phenomenological study was to explore the lived experiences of mothers of ELBW infants who are born at or less than 900 grams and usually at 27 weeks gestation or earlier. In-depth interviews were conducted with nine mothers initially on the eve of their discharge from the NICU. A subsequent phone interview was obtained some months after discharge to seek clarity and agreement of the preceding interview content. Narrative analysis was facilitated with the use of the QRS Nvivo2(c) computer program to aid narrative manipulation and coding. The results of this study revealed two major and many minor themes. The mothers clearly uncovered what it was like to experience the phenomenon of mothering an ELBW infant and gave insight into what was important to them in their effort to learn their role of being this kind of mother and maintain their commitments. The mother-nurse relationship was uncovered, and these mothers told of what was important to them and was necessary for them to have to ease the way through their NICU experience. These mothers unveiled the importance of making connections to facilitate their journey. One important connection revealed was their need for prayer and the maintenance of their spiritual self. Other connections valued were between family, community, physicians and the nurses. Through all of their trials in the NICU these mothers never gave up "Being the Mama" and "Making Connections".

The effects of estrogen, progesterone, and cortisol, with and without challenging antioxidants, on the viability and proliferation of SW 756, HeLa, and ECT 1/E6E7 cells in culture

Daniel, Melissa The University of Mississippi Medical Center 2005 해외박사(DDOD)

Cervical cancer is a major health threat to women worldwide and the role of steroid hormones, antioxidants, and combinations thereof, on cervical cancer cells, is not clearly defined. This study investigated the effects of steroid hormones estrogen, progesterone, and cortisol, antioxidants vitamin E and selenium, and combined effects of vitamin E and estrogen on the viability and proliferation of cervical tumor cell lines, SW 756 (HPV negative) and HeLa (HPV-18 positive), and normal ectocervical cells, Ect 1/E6E7 (HPV-16 transformed), in culture. All cell lines were treated with physiological and supraphysiological doses of all agents and examined biochemically (MTS, Total Protein, MDA, and LD Assays) and morphologically (Papanicolaou and H & E stains) at 24, 48, and 72 hours of time. Physiological doses of estrogen (1.0 nM) either matched the control or had a positive effect on all cell lines. Supraphysiological doses of estrogen (1.0muM) caused less damage in the HPV-positive cell lines. Estrogen behaved as a tumor promoter by enhancing proliferation in the HPV-positive cell lines. The effects of progesterone (1.0 nM and 0.1 muM) were phasic. Progesterone did not behave as a tumor promoter. Supraphysiological doses of cortisol (0.5 muM) produced significant decreases in cell proliferation at all time periods (p < 0.05) in all cell lines, while physiological doses (0.05 muM) matched or superseded the controls. Physiological doses of vitamin E (0.02 muM) had a protective effect on all cell lines at all time periods. SW 756 cells were adversely affected by supraphysiological doses of vitamin E (0.04 muM). Both doses of selenium had damaging effects on all cell lines (31.87 muM and 318.7 muM). The combined agents had the greatest protective effects on Ect 1/E6E7 cells. Morphologically, Papanicolaou stain was superior to H & E stain due to increased nuclear crispness and enhanced cytoplasmic detail. Data obtained from this project provided the literature with significant information regarding the exposure of steroid hormones alone, or in combination with free radical scavengers, to transformed and nontransformed cervical cell lines. The data demonstrated that cervical cell line type has to be taken into consideration in designing or developing an effective therapy or intervention against the progression of cervical carcinoma.

Manipulation of RC/4B pituitary cells exposed to sustained and conventional levels of glucocorticoids

Haynie, Lisa A The University of Mississippi Medical Center 2005 해외박사(DDOD)

Pituitary adenomas are benign tumors that arise exclusively within the anterior pituitary. Many of these tumors can be successfully treated. Surgical removal of the tumor is generally the first line of treatment. In addition, HRT is used to return the body to normal hormone production; however, HRT regimen is the most cumbersome and often leads the patient at serious risk for peaks and valleys in hormone levels as well as an increase in stress levels. Without the hypothalamic-pituitary-adrenal axis (HPA) the patient's ability to produce an anti-stress effect may be altered. The objective of this study is to determine what happens to the pituitary cells at cortisol levels indicating hypocortisolism, normal cortisol, and hypercortisolism alone or at different points of endotoxin administration. The experimental design consisted of four phases. The results of this investigation yielded: (a) proliferation rates of RC/4B cells demonstrated a decline in cell number as early as 24 and 72 hours and a rebound to control levels by 96 hours throughout the study; (b) TCPL drug delivery system was capable of providing sustained release of cortisol, as evidenced by survival of the cells in all experimental groups; (c) regardless of the cortisol dose + the pre or post exposure to LPS, RC/4B cells were viable throughout all experimental periods; (d) the use of sustained delivery of supraphysiological dose of cortisol provided an ideal means of steroid delivery in the in vitro environment; (e) exposure of RC/4B cells to various levels of glucocorticoids 30 minutes post exposure to LPS (conventional) does not inhibit IL-6 secretion in all treated groups; however, over time the amount of IL-6 is decreased in the cortisol treated groups compared to the control group; (f) exposure of RC/4B cells to various levels of cortisol 30 minutes post exposure to LPS (conventional) suppressed FSH levels at all time periods; conversely, positive levels of LH were noted by 72 hours, and then decreased levels were noted in the cortisol treated groups over time. Overall, the results of this study provided the literature for the first time, with preliminary findings regarding the effects of conventional and sustained delivery of cortisol on the RC/4B cell line.

Effects of thymoquinone, lycopene, and selenium in the presence of estrogen on the viability, biochemical markers and morphology of SiHa cells in vitro

Brewer, Joyce The University of Mississippi Medical Center 2005 해외박사(DDOD)

Cervical cancer is a problem not only in the United States, but worldwide. Even though statistical rates of cervical cancer is decreasing in the United States, the incidence worldwide is not changing. Specific ethnic groups, lower socioeconomic income populations and areas with high incidences of sexually transmitted diseases still have a stable or increasing incidence of cervical cancer even in the United States. The increase in cervical cancer mirrors the increased rate of human papillomavirus, a sexually transmitted disease and a known precursor of cervical cancer. Antioxidants have been studied in relation to cardiovascular diseases, the aging process and cancers. This study investigated the antioxidants thymoquinone, selenium, and lycopene on SiHa, a cervical cancer cell line preinfected with human papillomavirus. The hypothesis was that the combination of thymoquinone, selenium, and lycopene would have a detrimental effect on the viability, biochemical analysis, and morphology of SiHa cells. The specific aims were (1) to study the effect of estrogen at different concentrations by conventional delivery vs. sustained delivery on the viability and behavior of SiHa cell line, (2) to establish the role of selenium, lycopene and thymoquinone on SiHa cells in the presence of, or in the absence of estrogen, (3) to determine if a combination of estrogen, lycopene, selenium, and/or thymoquinone are more effective in slowing the proliferation of SiHa cells then when used alone either with conventional delivery or drug delivery systems, (4) to evaluate the expression of epidermal growth factor in SiHa cells. Results indicated that Estrogen 10 pg was the optimal dose of estrogen to use with these cells. In the study of the antioxidants, selenium alone appeared to be chemoprotective, but when used in combination with estrogen, lycopene and TQ caused cellular damage as evidenced by decreased proliferation rate, increased glutathione levels, and increased MDA levels.

Ristocetin induces a conformational change in human von Willebrand factor that promotes its binding to platelet glycoprotein Ib-IX-V

강문규 University of Mississippi Medical Center 2002 해외박사

von Willebrand factor (VWF) does not normally interact with platelets in the bloodstream. Binding of VWF to exposed vascular subendothelium, however, enables it to interact with the platelet glycoprotein Ib-IX-V complex (Gplb-IX-V). This change in VWF function may reflect a change in conformation. The glycopeptide antibiotic ristocetin also mediates binding of VWF to GpIb-IX-V. Ristocetin thus provides a model for changes in VWF conformation and function that may occur in vivo. The influence of ristocetin on the fluid-phase conformation and function of VWF was evaluated through assessments of its susceptibility to proteolytic digestion, its binding to heparin and its binding to platelet GpIb-IX-V. Addition of ristocetin markedly altered the pattern of VWF digestion by trypsin, increasing the prevalence of 109 and 157 kDa tryptic fragments and decreasing that of 130 and 181 kDa fragments. Treatment with ristocetin also changed the pattern of VWF digestion by elastase, increasing the predominance of 76, 110, and 162 kDa elastase fragments and decreasing that of 98 and 192 kDa fragments. The pattern of VWF digestion by chymotrypsin was altered as the prevalence of 78, 82 and 128 kDa chymotrypsin fragments was increased and that of 142 and 170 kDa fragments decreased with ristocetin. Vancomycin, a structurally related antibiotic, did not affect VWF digestion by trypsin or elastase. However, it partially reversed the ristocetin-mediated change in VWF digestion by these proteases. Changes in the prevalence of the 109, 130, and 157 kDa tryptic fragments and the 98, 110, and 192 kDa elastase fragments correlated closely with changes in VWF binding to GpIb-IX-V. Interaction between VWF and heparin also increased appreciably in the presence of ristocetin. This finding suggests that interaction of ristocetin with VWF may cause a change in VWF conformation that exposes its heparin-binding domain, which is located near the putative GpIb-binding domain of VWF. These observations suggest that ristocetin may modulate the conformation of VWF in such a way as to unmask both its heparin-binding domain and its GpIb-binding domain. Such regulation enables VWF to interact with heparin and platelet GpIb-IX-V, and alters its susceptibility to proteolytic cleavage by trypsin, elastase, and chymotrypsin.

Effects of specific mutations in the copper binding site on the structure and function of amicyanin

Choi,moonsung University of Mississippi Medical Center 2011 해외박사

Enkephalins and neuropeptide Y in normal and catecholamine depleted pigs subjected to cerebral ischemia

공재양 University of Mississippi Medical Center 1989 해외박사

건축, 토목 분야에서 폭넓게 사용되고 있는 에폭시 수지는 타의 폴리머에 비교하여 접착성, 내약품성, 역학적 성질등이 우수하기 때문에 시멘트 모르타 르 및 콘크리트에 혼입함으로서 철근 콘크리트 구조물의 보수재 및 마무리재 로서 보다 더 우수한 성능을 가진 폴리머 시멘트 모르타르 및 콘크리트를 제 조할 수 있게 되었다. 그러나 지금까지의 연구 개발되어 온 에폭시 수지 혼 입 폴리머 시멘트 모르타르 및 콘크리트에서는 폴리머 시멘트비가 타의 시멘 트 혼화용 폴리머와 비교하여 극히 높고, 더우기 에폭시 수지와 경화제의 두 성분을 필수적으로 혼합해야 하기 때문에 경제성 및 시공성의 면에서 문제점 을 내포하고 있다. 한편 경화제를 사용하지 않고 에폭시 수지만을 시멘트 모 르타르 및 콘크리트 중에 혼입 하기만 하여도 에폭시 수지는 시멘트 모르타르 및 콘크리트 중의 시멘트의 수화의 결과 생성되는 수산화물 이온의 작용에 의해 에폭시 수지를 개환시켜 경화할 수 있다는 사실을 발견하였다. 이러한 것은 철근콘크리트 구조물의 내구성 증진을 위한 에폭시 수지 혼입 폴리머 시 멘트 모르타르 및 콘크리트의 폴리머 시멘트비의 저감 및 기존의 두 성분의 혼합에 기인한 결점을 극복할 수 있는 가능성을 시사하게 되었다. 본 논문에서는 철근 콘크리트 구조물의 보수재 및 마무리재로서의 경화제 무첨가 에폭시 수지 혼입 폴리머 시멘트 모르타르 및 콘크리트의 개발을 목적 으로 배합을 변화시켜 기존의 경화제를 첨가한 것과 비교하면서 에폭시 수지 의 경화 기구 및 각종 성질을 실험 고찰하였다. 제1장에서는 본 연구의 목적과 배경 및 연구의 범위, 경화제 무첨가 에폭시 수지 혼입 폴리머 시멘트 모르타르 및 콘크리트의 개발의 필요성 및 기존의 연구에 대해 설명하였다. 제2장에서는 경화제 무첨가 에폭시 수지 혼입 폴리머 시멘트 모르타르중에 서의 에폭시 수지의 경화 기구에 대하여 검토하고 더우기 경화제 무첨가 에폭 시 수지 혼입 폴리머 시멘트 페이스트 및 모르타르 중에서 경화한 에폭시 수 지의 정량을 행하여 에폭시 수지의 경화의 정도를 해명하였다. 제3장에서는 경화제 무첨가 에폭시 수지 혼입 폴리머 시멘트 모르타르의 배 합을 변화시켜 그의 물리적 성질 및 내구성에 대해 검토했다 Enkephalin and neuropeptide Y (NPY) immunoreactivities (IRS) are often associated with noradrenergic fibers in peripheral tissues. Enkephalins and NPY are also co-stored at high concentrations with norepinephrine (NE) in large dense cored vesicles (LDVs) isolated from sympathetic nerves. However, differences in ratios and concentrations of neuropeptides and NE from tissue to tissue and the opposing effects on the smooth muscle tone raised the question of whether the two peptides are always co-stored with NE In this thesis, a combined physiological, biochemical and morphological approach was used to answer this question. The adrenal gland, middle cerebral artery and vas deferens of the domestic pig were chosen for detailed examination. Sympathetic responses to reserpine (0.05 mg/kg every other day) and acute CNS ischemia had very different, often opposite, effects on enkephalins and NPY. The results suggested differences in storage sites and regulation of release and metabolism of two neuropeptides. In the adrenal eland, most of the enkephalins were stored in the chromaffin granules of epinephrine (E) cells, while no chromaffin cell contained NPY. The NPY was found mainly in perivascular nerve fibers. In the middle cerebral artery, the identical distribution of enkephalin and dopamine-beta-hydroxylase (DBH) IRS and immuno-gold labeling of LDVs indicated the storage of enkephalins in noradrenergic terminals. The NPY-IR was very similar to DBH- and enkephalin-IRS. However, there were discrepancies in fibers and varicosities. Double immunofluorescence. and gold labeling showed that enkephalins and NPY were not commonly co-stored in the same noradrenergic neuron. In the vas deferens, the identical distribution of enkephalins- and DBH-IRS confirmed the storage of enkephalins in noradrenergic terminals. The NPY showed a different distribution from enkephalin and DBH. Double immunofluorescence and gold labeling confirmed that NPY and enkephalins were not commonly co-stored. The present study provides conclusive evidence to support the hypothesis that enkephalins and NPY are often associated with separate but parallel noradrenergic fibers in peripheral tissues of the pig. Moreover, NPY may co-exist with vasoactive intestinal polypeptide in non-noradrenergic, presumptive cholinergic, nerve fibers.