16484 research outputs found
Sort by
Examining the Implementation of Outpatient Palliative Care and its Influence on Quality of Life in Patients with a Life-Limiting Condition
No full textBackground: Incorporating home-based palliative care is a new frontier within health care.Many health systems do not have patient access to such services. The need for comprehensive palliative care is inevitable with the aging population. Benefit of initiating palliative medicine for patients with life-limiting illness is known within present literature. The practice gap that exists within palliative medicine is well supported by existing evidence, as is the need to improve access to this style of care. Purpose: The purpose of this study is to embed outpatient palliative care services within the visiting nurses association (VNA) within Wellspan Health. By embedding this service as a needs assessment project, the investigator attempts to demonstrate improved quality of life outcomes and overall improved symptom management. Methods: a pre-test and post-test survey method using a convenience sample within the VNA was conducted assessing symptom control, wellbeing and level of distress. Initial ratings of symptoms including pain, nausea, anxiety, depression, sleep wellbeing, and distress level was documented using the Edmonton Symptom Assessment System and the distress thermometer. Weekly surveys were provided to participants on week one through eight during home visits. Evaluation: Descriptive statistics was used to evaluate the data collected. A Wilcoxon Signed Rank test was used to compare pain, wellbeing and distress scores from initial home visit to the final visit at the end of three weeks. Results: A non-parametric Wilcox Signed Rank test was used to analyze symptom data. When comparing the mean rating from the ESAS from week one (M=35.20, SD= 20.85), to week three (M=30.30, SD= 17.84), overall improvement cannot be generalized with the implementation of palliative care within the home health model. No statistical significance was identified (z= -1.07,p= 0.284). The same was true for the NCCN Distress Thermometer at week one (M= 3.60, SD=2.80), as compared to the end of the study at week three (M= 2.69, SD= 2.69, z= -.049, p=0.623). Clinical Implications: Review of the results does demonstrate some improvement toward improved symptom management, but because of time constraints and limited participation, results were not supportive of the hypothesis of suggested improvement with implementation of outpatient palliative care services within the VNA. Results suggest increase support for completion of symptom management tools and increased study length to demonstrate a more generalizable finding.D.N.P., Nursing Practice -- Drexel University, 201
Navigating the Hallways: A Dance/Movement Therapy Method for Adolescents in Schools
No full textThis thesis will describe the development of a dance/movement therapy method catered towards adolescents in a school setting that experience anxiety and chaos while in the classroom. The literature review addresses adolescent development, adolescents "at-risk", anxiety, identity development, and applications for dance/movement therapists working with adolescents. The method itself is a multi-step, somatic experience to help mitigate the symptoms of anxiety. Often, chaos occurs in the classroom. For adolescents with added exposure to violence, aggression, and abuse, classrooms become undesirable environments and increase levels of student’s anxiety. The method, "Navigating the Hallways" begins with body awareness to identify triggers that lead to anxiety. It is followed by four pathways, co-created with the therapist, to support the student’s ability to emotionally regulate, and to calm down enough to return to the classroom. This author looks at ways to provide students with body-based techniques to reduce anxiety that can then be utilized more independently or in coordination with other students in need. This author reflects on the process of developing this method and how relationships with the students aided in her growth as a dance/movement therapist.M.A., Dance/Movement Therapy and Counseling -- Drexel University, 201
The Relationship of Dietary Intakes of Calcium, Magnesium, and Zinc on Body Composition in Female and Male Athletes of Various Sports
No full textBecause athletes often seek to enhance their performance and body composition through nutrition, researchers must continue to investigate the current dietary consumption and the relationship of diet to body composition to best individualize nutrition guidance for athletes. Exploration of sex differences and sport specific differences in dietary intake provides insight on possible nutrition trends in specific athlete populations and risks for deficiencies. Calcium, magnesium, and zinc affect physiological mechanisms and systems needed for athletic performance, such as calcium for bone health; magnesium for energy production; and, zinc for the function of hundreds of enzymes and proteins. One purpose of our research was to determine the dietary intake of calcium, magnesium, and zinc in female and male athletes, including runners, triathletes, rowers, CrossFit athletes, and General athletes, 18 years of age and older. We also investigated the presence of sex differences and sport specific differences in dietary intake of these minerals. Finally, we examined possible correlations among these mineral intakes and body composition (bone mineral density [BMD] and percent body fat) to determine the strongest predictors of body composition. We evaluated the dietary intake and body composition of 247 athletes, 129 women and 118 men, with a mean age of 34.86±11.38 years. The population included runners (n=90), General athletes (n=59), triathletes (n=43), rowers (n=34), and CrossFit athletes (n=21). Dietary intake was assessed via a 2005 Block Food Frequency Questionnaire (FFQ), which analyzes one’s annual macronutrient and micronutrient intake. Bone mineral density (total body, lumbar spine, and dual femoral neck) and percent body fat were measured using dual-energy x-ray absorptiometry (DXA). One sample T-tests were used to compare the dietary intake of calcium, magnesium, and zinc to the Recommended Dietary Allowances (RDA) in female and male athletes. A one-way analysis of variance (ANOVA) was used to determine differences in dietary intake between the sexes and among various sports. Multiple regression analyses were utilized to identify the strongest predictors for BMD and percent body fat. All data were analyzed using standard SPSS version 25 software, with the alpha a priori set at 0.05. We found that across all female athletes, dietary intake of calcium was significantly below the RDA of 1000 mg/day (801.3 mg/day ± 264.9, p < 0.001). In addition, we found that General athletes (753.5 mg/day ± 262.9, p < 0.001), female runners (860.1 mg/day ± 262.3, p = 0.001), female CrossFit athletes (690.9 mg/day ± 207.1, p = 0.001), and female rowers (748.1 mg/day ± 224.1, p < 0.001) all consumed significantly lower calcium intakes below the RDA. Magnesium intake in all female athletes was significantly above the RDA of 310-320 mg/day (358.7 mg/day ± 110.9, p < 0.001). Zinc intake in all female athletes was significantly above the RDA of 8 mg/day (10.3 mg/day ± 4.1, p < 0.001), which was observed in female General athletes (9.7 mg/day ± 3, p = 0.001), female runners (11.5 mg/day ± 5.1, p < 0.001), and female triathletes (10.9 mg/day ± 4.4, p < 0.05). In male CrossFit athletes, we observed dietary intakes of calcium (680.9 mg/day ± 411.8, p < 0.05) and magnesium (285.9 mg/day ± 78.9, p < 0.001) below the RDAs of 1000 mg/day and 420 mg/day, respectively. We also found that zinc intake in all male athletes were significantly higher than the RDA of 11 mg/day (13.2 ± 5.7, p < 0.001). Zinc intake above the RDA was observed in male triathletes (14.2 mg/day ± 5.8, p < 0.01), and male rowers (16.3 mg/day ± 7.1, p < 0.05). Male athletes in other specific sports (runners, general athletes, and rowers) were at or slightly above the RDA for calcium, magnesium, and zinc. We found a significant difference in dietary calcium (p<0.01), magnesium (p<0.05), and zinc (p<0.001) intakes between sexes, with Bonferroni adjustment applied. We utilized a factorial ANOVA to determine significant correlations between sex and dietary intake, and sport type and dietary intake. Sport type had the strongest correlation to calcium intake (p=0.021), followed by sex (p = 0.03). Sex was also significantly correlated with magnesium intake (p = 0.039) and zinc intake (p <0.001). Sex was significantly negatively correlated with total body BMD. Through multiple regression analysis, we determined sex, zinc intake, and magnesium intake (p<0.001) were the three greatest predictors in that order for total body BMD in all athletes. Sex (p<0.01) and sport type (p<0.05) were significantly correlated to lumbar spine BMD. The greatest predictors of lumbar spine BMD were, in order, magnesium intake, sex, and zinc intake (p<0.01). Sex was significantly negatively correlated with dual femur BMD. Magnesium intake, sex, and zinc intake (p<0.001) in this order were the three strongest predictors for dual femoral neck BMD. Sex was positively correlated with percent body fat, while calcium, magnesium, and zinc intakes were all negatively correlated with percent body fat (p<0.001). In female athletes, the strongest predictor of percent body fat was the combination of calcium, magnesium, and zinc intakes (p<0.04). In male athletes, the strongest predictor of percent body fat was calcium intake (p<0.01), followed by magnesium intake and sport type. Dietary intakes of calcium, magnesium, and zinc varied significantly between sexes and across sport types. In the female athlete population and some sports, such as CrossFit, more research is required to evaluate the effects of dietary intake on body composition in athletes.M.S., Nutrition Sciences -- Drexel University, 201
Assessing the Prevalence of and Risk Factors for Disordered Eating Behaviors in Adolescents with Inflammatory Bowel Disease
No full textBackground: Diet-related chronic health conditions (DRCHCs) are a category of diseases that include Type I Diabetes, Cystic Fibrosis, Celiac Disease, and Inflammatory Bowel Disease (IBD) and revolve around food, diet, and weight. IBD is an umbrella term for Crohn’s Disease and ulcerative colitis, both of which are chronic, autoimmune conditions that primarily affect the gastrointestinal system. Although previous research has demonstrated that adolescents with DRCHCs are vulnerable to disordered eating behaviors, the prevalence and risk factors of such concerns within a pediatric IBD population has yet to be explored. This study investigated the prevalence of, and risk factors for, disordered eating behaviors in adolescents with IBD. Methods: This cross-sectional, multi-site survey study recruited via three outpatient pediatric IBD clinics in the ImproveCareNow research collaborative and ImproveCareNow social media postings. Interested pediatric patients with IBD between 12 and 22 years of age were electronically consented to the study and completed the online survey study. Survey study measures included the EDE-Q, IMPACT-III, and the RCADS-25, which assessed disordered eating behaviors, pediatric IBD-specific quality of life, and internalizing symptoms, respectively. Results: Approximately 34% of participants reported clinically significant shape concerns (i.e., discomfort with body shape) and more than 17% reported clinically significant EDE-Q total scores. No differences were found by gender between adolescents with IBD and established norms for healthy individuals. Lower body image, higher anxiety, and lower quality of life were found to significantly predict disordered eating behaviors in this population. Small effect sizes were identified for several medical variables, including diagnosis subtype, surgery history, and previous steroid use, on disordered eating behaviors. Conclusions: Over one third of the study sample endorsed clinically significant shape-related disordered eating thoughts and nearly 20% endorsed symptoms that suggest clinically significant disordered eating, consistent with findings from other DRCHCs research. These findings suggest that pediatric patients with IBD are more likely to identify concerns with thoughts related to disordered eating than disordered eating behaviors. Medical variables may be related to disordered eating thoughts and behaviors. Future research should seek to assess if these findings are replicated with a large sample size. Given the relatively high prevalence, findings suggest that clinicians and researchers should continue to assess body image concerns and disordered eating behaviors in adolescents with IBD in the medical and psychosocial care for this population.Ph.D., Psychology -- Drexel University, 201
Exploring interactions between the parasite plasma membrane and the parasite vacuolar membrane of Plasmodium falciparum
No full textMalaria poses a large health and economical threat to 40% of the world’s population. Treatment and prophylaxis with antimalarials remain a mainstay to control malaria. However, drug resistance remains a constant threat to these efforts. It is hoped that with the approval of new antimalarials and their proper distribution to endemic populations, the disease will stay contained and resistance to currently implemented drugs can be suppressed. Understanding the biology of the Plasmodium parasites that cause malaria infection will greatly aid in the hunt for potential antimalarials. Here, we study a series of compounds from the Medicines for Malaria Venture by monitoring their ability to induce lipid dysregulation within the parasites’ plasma membranes (PPM). Saponin sensitivity was measured in this newly developed assay via release of parasite cytosolic proteins after their exposure to drug. Proteins that contribute to lipid dynamic movement in P. falciparum are under investigation in our laboratory. Specifically, Niemann-Pick type C1-related protein (PfNCR1) and oxysterol-binding protein (PfOSBP) influence lipid movement across the PPM within an infected red blood cell. Though, we have shown PfOSBP not to be essential for asexual blood stage growth, this protein plays a notable role in sexual stage development and functionality. Additionally, [delta]PfOSBP transgenic parasites display altered PPM composition, which may link PfOSBP’s function with the lipid transfer pathway in P. falciparum as was shown with PfNCR1. We have proposed cholesterol to transfer from the parasite vacuolar membrane (PVM) inward, to the PPM upon drug exposure. The PPM and PVM are in proximity to one another, especially at the parasite’s cytostome which forms a site for lipid movement between membranes. To investigate proteins involved in cytostome development, we looked to analogous proteins found in a ciliate, Tetrahymena. A citrate synthase protein is involved in this ciliate’s oral apparatus formation. We show P. falciparum citrate synthase-like protein (PfCSL) to be an essential protein. In analogy with citrate synthase in Tetrahymena, we propose PfCSL to contribute to parasite cytostome function.Ph.D., Microbiology and Immunology -- Drexel University, 201
Teacher and Parent Perceptions Of The Effectiveness of a Summer Reading Program Engaging Urban Low-Income Elementary Students
No full textOver the summer months students forfeit their reading skills when not engaged in literacy activity. This loss of reading skill is much more pronounced in poor children, especially from minority communities. This loss has been dubbed "summer slide." "Summer slide" is synonymous with the ethnic achievement gap. This gap expands over the summer. Summer reading loss studies have also found that there is no real variance in literacy gains between rich and poor children during the school year, yet every summer poor children drop two to three months in reading skills while their higher-income classmates make modest gains. Researchers recommend interspersing literacy activity throughout a family's summer vacation, so their children will return to school reinvigorated, enthusiastic, and motivated to pick up where they stopped in June. This study explored the following questions, "What are the teacher and parent perceptions of the effectiveness of a summer reading program on underprivileged youth?," and "How did the summer reading program artifacts function as a set of systematic processes to interact with the mission of the program?" This case study, which is a multi-method qualitative approach to research involved the study of a case within a real-life, contemporary context or setting. The goal of this study was to analyze the teacher and parent perceptions of the effectiveness of a summer reading program engaging urban low-income elementary students. This study found that, in the eyes of parents and teachers, this summer reading camp overall was successful in bolstering campers' literacy skills over the summer, less some minor issues that needed to be improved in the area of discipline techniques.Ed.D., Educational Leadership and Management -- Drexel University, 201
Viral and Lipid Regulation of Hepatocyte Signaling Pathways
No full textPrimary liver cancer is the sixth most common cancer and the third highest cause of cancer-related deaths, globally. Hepatocellular carcinoma (HCC) is the predominate form of primary liver cancer, comprising 75-85% of the cases. Approximately 60% of HCCs are associated with a chronic hepatitis B virus (HBV) infection. Additionally, the increasing number of obese individuals in the United States has been linked to an increase in obesity-associated liver diseases such as non-alcoholic fatty liver disease (NAFLD). In Western countries, the incidence of NAFLD associated HCC is also on the rise and has been linked to 4–22% of HCC. In studies described here, we examined whether localization of the Hepatitis B Virus (HBV) HBx protein with mitochondria affects HBV replication and separately analyzed the interplay of changes in the gut microbiome and the liver transcriptome in the context of NAFLD development. HBx is required for efficient HBV replication and is thought to contribute to the development of HBV-associated HCC. Several studies have shown that a fraction of cytosolic HBx localizes to mitochondria in established cell lines and primary hepatocytes. Numerous studies have shown that HBx localizes to mitochondria and affects mitochondrial physiology. However, prior to our study, it was not known whether HBx affects on mitochondria or on HBV replication requires HBx localization to mitochondria. We now report that HBx localization to mitochondria is associated with efficient HBV replication in HepG2 cells and cultured primary rat hepatocytes. We also show that HBx localization to mitochondria is associated with activating signaling pathways directly or indirectly linked with HBx-induced elevation of cytosolic calcium levels, an essential function of HBx that is also required for HBV replication. Cumulatively, our research suggests that HBx association with mitochondria contributes to efficient HBV replication and is responsible for activating signaling pathways associated with HBx-induced elevation of calcium. NAFLD arises from the accumulation of lipids in hepatocytes, the major cell type of the liver, and the resulting liver inflammation as immune cells enter the liver in response to lipid accumulation. Recently, studies in mice and humans have shown that there are alterations in the composition of the gut microbiome in individuals with NAFLD as compared to healthy individuals. However, the mechanism by which the gut microbiome contributes to NAFLD is unclear. While previous studies characterized microbiome changes during NAFLD development, no previous studies have correlated changes in the gut microbiome with changes in liver gene expression. Feeding mice a high-fat diet (HFD) is a model system for studying obesity and associated metabolic disorders such as NAFLD. We characterized changes in gut bacteria and liver gene expression associated with the development of NAFLD in both male and female mice fed a HFD. We also analyzed the effect of non-fermentable fiber on the development of NAFLD. We analyzed the effect of supplementing the HFD and a standard diet (SD) with non-fermentable fiber on liver lipid content. Our research demonstrated that only SD supplemented with non-fermentable fiber resulted in decreased liver lipid content as compared to HFD, with or without non-fermentable fiber supplementation, and SD without non-fermentable fiber supplementation. While numerous studies have shown positive effects of supplementing diets with fiber, before our study, it was unknown whether supplementing diets with non-fermentable fiber could affect the accumulation of lipids in the liver and, consequently, the development of NAFLD. Our results suggest that fiber content, specifically non-fermentable fiber, in the diet is important in preventing the accumulation of lipids in hepatocytes and the development of NAFLD.Ph.D., Moecular and Cell Biology and Genetics -- Drexel University, 201
Accelerating Drug Development with Health-Consumer-Contributed Data and Heterogeneous Network Mining
No full textNew drug development is a time-consuming, high-investment, and high-risk process. It usually takes more than ten years to bring a new medication to market and costs the pharmaceutical companies an average of $1.2 billion during the procedure. As a result, taking drugs that have been developed for one disease and "repositioning" them to another disease is becoming more and more common and an increasingly important strategy in both industry and academia. Current drug repositioning researches can be categorized as biological experimental methods and computational methods. The fast development of biomedical knowledge bases and computational capabilities has elevated a number of computational drug repositioning approaches, with less investment in time and cost compared with experimental approaches. Additionally, another important starting point for drug repositioning is off-label drug use. The detection of off-label drug uses in clinical practice can provide relevant hypotheses for drug repositioning and drug development, meanwhile, the findings in drug repositioning also provide possible off-label use opportunities. In this dissertation, we focus on both off-label drug use and drug repositioning to accelerate the drug development. With consideration of the insufficient utilization of unstructured biomedical data especially the contents contributed by health consumers, we employed health-consumer-contributed data for the topics. Specifically, for off-label drug use, we develop an automated method to detect off-label drug use from the heterogeneous healthcare network based on meta-path mining. In order to find better ways to represent the relationships between medical entities, we improve the method by introducing word embedding models to measure those associations on the basis of association rule mining. In order to deal with the sparsity and missing data problem in user-generated contents, we furtherly employ tensor decomposition techniques for detecting off-label drug-disease relationships. Experiment results show that the proposed approaches could identify off-label drug uses from health-consumer-contributed data effectively and accurately. Especially, when incorporating word embedding models and tensor decomposition, the models achieve better results. For drug repositioning, we propose a systematic method to identify repositioning drugs from health-consumer-contributed data by using the adverse drug reaction (ADR)-based repositioning strategy and heterogeneous network mining approaches. Based on the constructed heterogeneous healthcare network, we develop path-mining approaches to extract the significant associations between ADRs and diseases and then identify the novel associations between drugs and diseases for repositioning opportunity. To better understand the repositioning results and examine the computational repositioning approach, we conduct detailed literature review and case studies for a specific disease, Parkinson’s Disease (PD). Additionally, in order to resolve the challenge of extracting ADR entities from health-consumer-contributed texts and improve the performance of drug repositioning detection, we utilize bidirectional long short-term memory (LSTM) models to recognize ADRs first and then use the expanded vocabulary to construct and mine the heterogeneous healthcare network. Experiment results show that ADRs are effective intermediaries to reveal drug-disease associations and the proposed approaches could suggest quite potential repositioning drug candidates.Ph.D., Information Studies -- Drexel University, 201
Incorporating Textual Information with Recommender Systems
No full textCollaborative filtering-based approaches typically use structured signals, such as likes, clicks, and ratings, and predict such signals via matrix factorizations. Collaborative filtering-based approaches have shown great performance with large datasets, but also suffer from the "cold-start" problem with small datasets, and are not easily interpretable and explainable. In the Meanwhile, more and more unstructured textual information becomes available nowadays, such as reviews, comments, and tags. How to incorporate textual information into collaborative filtering-based recommender systems is a non-trivial research question, presenting new opportunities and challenges. This thesis focuses on the overarching research question concerning how to incorporate textual information into recommender systems to improve system performance and enhance model explainability. More specifically, this thesis addresses four specific research questions to answer the overarching research question. The four research questions center around the effects of using (1) textual information alone; (2) structured textual information and ratings; (3) unstructured textual information and ratings, to improve recommendation performance. The fourth research question subsequently focuses on how visualization tools can assist in gaining insights and intuitions for recommendation tasks. Three recommendation frameworks are developed to tackle the first three research questions respectively. The first framework casts the problem as a joint-ranking problem between emotion and topic concentration in text streams. The second framework uses uncertainty signals extracted from text context as additional supervised signals for link prediction. The third framework uses both quantum-like language models and a mutual-attention layer to boost the performance of rating prediction. Extensive experiments show that proposed frameworks outperform corresponding baselines.Ph.D., Information Systems -- Drexel University, 201
Museums Leadership Traits and Sustainability Practices
No full textOur natural world is changing dramatically because of human activity (NASA, n.d.). As our natural world has changed, museums over the centuries have been adapting and providing space for difficult conversations to occur, for knowledge to be shared to understand our world, our humanity, and relationships. Museums, as institutions held in the public’s trust, have a responsibility to be leaders in creating and sharing the knowledge to make the world a healthier place. Museums have the unique ability and opportunity to help communities and individuals facilitate meaning and conversations. One critical discussion occurring now is about the climate crisis. The climate crisis is happening, and museums can help to facilitate purpose and action between the individual and our natural environment. Understanding leadership behavior, specifically how it relates to green organizational practices, will help the museum sector to confront our current climate crisis. The conducted research demonstrated that none of the studied museum leaders fully embodied being an environmental specific transformational leader within a green organization, but each exhibited a combination of traits both individually and organizational. Because of this, there is a significant opportunity for museums to become green leaders within Philadelphia through the development of environmental specific transformational leadership and strengthening of green organizational behavior.M.S., Arts Administration -- Drexel University, 201