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- Genre: Doctoral Dissertation
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Purpose: The purpose of this study was to examine the acute effects of two novel intermittent exercise prescriptions on glucose regulation and ambulatory blood pressure. Methods: Ten subjects (5 men and 5 women, ages 31.5 ± 5.42 yr, height 170.38 ± 9.69 cm and weight 88.59 ± 18.91 kg) participated in this four-treatment crossover trial. All subjects participated in four trials, each taking place over three days. On the evening of the first day, subjects were fitted with a continuous glucose monitor (CGM). On the second day, subjects were fitted with an ambulatory blood pressure monitor (ABP) and underwent one of the following four conditions in a randomized order: 1) 30-min: 30 minutes of continuous exercise at 60 - 70% VO2peak; 2) Mod 2-min: twenty-one 2-min bouts of walking at 3 mph performed once every 20 minutes; 3) HI 2-min: eight 2-min bouts of walking at maximal incline performed once every hour; 4) Control: a no exercise control condition. On the morning of the third day, the CGM and ABP devices were removed. All meals were standardized during the study visits. Linear mixed models were used to compare mean differences in glucose and blood pressure regulation between the four trials. Results: Glucose concentrations were significantly lower following the 30-min (91.1 ± 14.9 mg/dl), Mod 2-min (93.7 ± 19.8 mg/dl) and HI 2-min (96.1 ± 16.4 mg/dl) trials as compared to the Control (101.1 ± 20 mg/dl) (P < 0.001 for all three comparisons). The 30-min trial was superior to the Mod 2-min, which was superior to the HI 2-min trial in lowering blood glucose levels (P < 0.001 and P = 0.003 respectively). Only the 30-min trial was effective in lowering systolic ABP (124 ± 12 mmHg) as compared to the Control trial (127 ± 14 mmHg; P < 0.001) for up to 11 hours post exercise. Conclusion: Performing frequent short (i.e., 2 minutes) bouts of moderate or high intensity exercise may be a viable alternative to traditional continuous exercise in improving glucose regulation. However, 2-min bouts of exercise are not effective in reducing ambulatory blood pressure in healthy adults.
ContributorsBhammar, Dharini Mukeshkumar (Author) / Gaesser, Glenn A (Thesis advisor) / Shaibi, Gabriel (Committee member) / Buman, Matthew (Committee member) / Swan, Pamela (Committee member) / Lee, Chong (Committee member) / Arizona State University (Publisher)
Created2013
Description
During the past five decades neurosurgery has made great progress, with marked improvements in patient outcomes. These noticeable improvements of morbidity and mortality can be attributed to the advances in innovative technologies used in neurosurgery. Cutting-edge technologies are essential in most neurosurgical procedures, and there is no doubt that neurosurgery has become heavily technology dependent. With the introduction of any new modalities, surgeons must adapt, train, and become thoroughly familiar with the capabilities and the extent of application of these new innovations. Within the past decade, endoscopy has become more widely used in neurosurgery, and this newly adopted technology is being recognized as the new minimally invasive future of neurosurgery. The use of endoscopy has allowed neurosurgeons to overcome common challenges, such as limited illumination and visualization in a very narrow surgical corridor; however, it introduces other challenges, such as instrument "sword fighting" and limited maneuverability (surgical freedom). The newly introduced concept of surgical freedom is very essential in surgical planning and approach selection and can play a role in determining outcome of the procedure, since limited surgical freedom can cause fatigue or limit the extent of lesion resection. In my thesis, we develop a consistent objective methodology to quantify and evaluate surgical freedom, which has been previously evaluated subjectively, and apply this model to the analysis of various endoscopic techniques. This model is crucial for evaluating different endoscopic surgical approaches before they are applied in a clinical setting, for identifying surgical maneuvers that can improve surgical freedom, and for developing endoscopic training simulators that accurately model the surgical freedom of various approaches. Quantifying the extent of endoscopic surgical freedom will also provide developers with valuable data that will help them design improved endoscopes and endoscopic instrumentation.
ContributorsElhadi, Ali M. (Author) / Preul, Mark C (Thesis advisor) / Towe, Bruce (Thesis advisor) / Little, Andrew S. (Committee member) / Nakaji, Peter (Committee member) / Vu, Eric T (Committee member) / Arizona State University (Publisher)
Created2014
Description
This dissertation focuses on the connections between childbirth and spirituality in fourteenth- and early fifteenth-century England. It argues that scholastic interest in conception and procreation led to a proliferation of texts mentioning obstetrics and gynecology, and that this attention to women's medicine and birth spread from the universities to the laity. This dissertation contends that there is interdependence between spiritual and physical health in late medieval English religious culture, correlated with and perhaps caused by an increasing fascination with materialism and women's bodies in religious practices and rhetoric. The first chapter provides an analysis of birth in medical and pastoral texts. Pastoral works were heavily influenced by the ecclesiastical emphasis on baptism, as well as by scholastic medicine's simultaneous disdain for and reluctant integration of folk medicine. The second chapter examines birth descriptions in narratives of saints' miracles and collections of exempla; these representations of childbirth were used in religious rhetoric to teach, motivate, and dissuade audiences. The third chapter turns to the cycle play representations of the nativity as depicting the mysteries of human generation and divine incarnation for public consumption. The fourth chapter analyzes the abstract uses of childbirth in visionary and other religious texts, especially in descriptions of spiritual rebirth and the development of vice and virtue in individuals or institutions. By identifying their roles as analogous with the roles of midwives, visionaries authorized themselves as spiritual caretakers, vital for communal health and necessary for collective spiritual growth. These chapters outline a trajectory of increasing male access to the birthing chamber through textual descriptions and prescriptions about birth and midwifery. At the same time, religious texts acknowledged, sought to regulate, and sometimes even utilized the potential authority of mothers and midwives as physical and spiritual caretakers.
ContributorsSwann, Alaya (Author) / Voaden, Rosalynn (Thesis advisor) / Newhauser, Richard (Committee member) / Sturges, Robert (Committee member) / Arizona State University (Publisher)
Created2014
Description
Medical practice surrounding tuberculosis (TB) treatment in two nineteenth-century Scottish charitable hospitals reveals that in developing empirically-positioned constructs of this and related diseases, medical practitioners drew upon social assumptions about women and the working classes, thus reinforcing rather than shedding cultural notions of who becomes ill and why. TB is a social disease, its distribution determined by relationships among human groups; primary among these is the patient-practitioner relationship, owing to the social role of medical treatment in restoring the ill to both health and society. To clarify the influence of cultural context upon the evolution of medical constructs of TB, I examined Glasgow Royal Infirmary (GRI) and Royal Infirmary of Edinburgh (RIE) ward journals, admissions registers, and institution management records from 1794 through 1905. Medical practice at the turn of the nineteenth century was dominated by observation and questioning of the patient, concordant with conceptions of physicians' labor as mental rather than physical. This changed with the introduction of the stethoscope in the 1820s, which together with the dissection of the poor allowed by the 1832 Anatomy Act ushered in disease concepts emphasizing pathological anatomy. Relationships between patient and practitioner also altered at this time, exhibiting distrust and medical dominance. The mid-Victorian era was notable for clinicians' increasing interest in immorality's contributions to ill health, absent in earlier practice and linked to conceptions of women and the working classes as inherently pathological. In 1882, discovery of the tubercle bacillus challenged existing nutritional, hereditary, and environmental explanations for TB. Although practitioners utilized bacteriological methods, this discovery did not revolutionize diagnosis or treatment. Rather, these older models were incorporated with perceived behavioral, environmental, and biological degradation of the working classes, rendering marginalized groups "soil" prepared for the "seeds" of disease -- at risk, but also to blame. This framework, in which marginalized groups contribute to their increased risk for disease through refusal to accord with hegemonically-established "healthy" behavior, persists. As a result, meaningful change in TB rates will need to address these longstanding contributions of social inequality to Western medical treatment.
ContributorsFarnbach Pearson, Amy Walker (Author) / Buikstra, Jane E. (Thesis advisor) / Fuchs, Rachel G (Committee member) / Brewis Slade, Alexandra (Committee member) / Roberts, Charlotte A. (Committee member) / Arizona State University (Publisher)
Created2013
Description
Peptide microarrays are to proteomics as sequencing is to genomics. As microarrays become more content-rich, higher resolution proteomic studies will parallel deep sequencing of nucleic acids. Antigen-antibody interactions can be studied at a much higher resolution using microarrays than was possible only a decade ago. My dissertation focuses on testing the feasibility of using either the Immunosignature platform, based on non-natural peptide sequences, or a pathogen peptide microarray, which uses bioinformatically-selected peptides from pathogens for creating sensitive diagnostics. Both diagnostic applications use relatively little serum from infected individuals, but each approaches diagnosis of disease differently. The first project compares pathogen epitope peptide (life-space) and non-natural (random-space) peptide microarrays while using them for the early detection of Coccidioidomycosis (Valley Fever). The second project uses NIAID category A, B and C priority pathogen epitope peptides in a multiplexed microarray platform to assess the feasibility of using epitope peptides to simultaneously diagnose multiple exposures using a single assay. Cross-reactivity is a consistent feature of several antigen-antibody based immunodiagnostics. This work utilizes microarray optimization and bioinformatic approaches to distill the underlying disease specific antibody signature pattern. Circumventing inherent cross-reactivity observed in antibody binding to peptides was crucial to achieve the goal of this work to accurately distinguishing multiple exposures simultaneously.
ContributorsNavalkar, Krupa Arun (Author) / Johnston, Stephen A. (Thesis advisor) / Stafford, Phillip (Thesis advisor) / Sykes, Kathryn (Committee member) / Jacobs, Bertram (Committee member) / Arizona State University (Publisher)
Created2014
Description
During the nineteenth century, children's physical health became a dominant theme in France and Great Britain, two of Europe's pediatric pioneers. This dissertation examines how British and French doctors, legislators, hospital administrators, and social reformers came to see the preservation of children's physical health as an object of national and international concern. Medical knowledge and practice shaped, and was shaped by, nineteenth-century child preservation activities in France and Great Britain, linking medicine, public health, and national public and private efforts to improve the health of nations, especially that of their future members. Children's hospitals played a significant role in this process by promoting child health; preventing and combating childhood diseases; fostering pediatric professionalization and specialization; and diffusing medical-based justifications for child welfare reforms in the second half of the century. This deeply contextualized tale of two hospitals, Great Ormond Street Hospital for Children in London (1852) and Sainte-Eugénie in Paris (1855), traces a crescendo in the interest, provision, and advocacy for children's medical care over time: from foundling homes and dispensaries to specialized hospitals with convalescent branches and large outpatient clinics. As a comparative study of the medicalization of children's bodies between 1820 and 1890, this dissertation also investigates the transnational exchange of medical ideas, institutions, and practices pertaining to child health between France and Great Britain during a period of nation-building. Specialized pediatric institutions in Paris and London built upon and solidified local, national, and international interests in improving and preserving child health. Despite great differences in their hospital systems, French and British children's hospital administrators and doctors looked to one another as partners, models, and competitors. Nineteenth-century French and British concerns for national public health, and child health in particular, had important distinctions and parallels, but medical, institutional, and legislative developments related to these concerns were not isolated activities, but rather, tied to transnational communication, cooperation, and competition.
ContributorsSchreiner, Stephanie (Author) / Fuchs, Rachel G. (Thesis advisor) / Green, Monica (Committee member) / Szuter, Christine (Committee member) / Thompson, Victoria (Committee member) / Arizona State University (Publisher)
Created2014
Description
The effects of a long-term combat deployment on a soldier's physical fitness are not well understood. In active duty soldiers, combat deployment reduced physical fitness compared to pre-deployment status, but no similar research has been performed on Army National Guard soldiers. This study is the first to identify physical fitness changes in Arizona National Guard (AZNG) soldiers following deployment to a combat zone and to assess the relationships between physical fitness and non-combat injuries and illness (NCII). Sixty soldiers from the Arizona National Guard (AZNG) completed a battery of physical fitness tests prior to deployment and within 1-7 days of returning from a 12-month deployment to Iraq. Pre and post-deployment measures assessed body composition (Bod Pod), muscular strength (1RM bench press, back-squat), muscular endurance (push-up, sit-up), power (Wingate cycle test), cardiorespiratory fitness (treadmill run to VO2 peak), and flexibility (sit-and-reach, trunk extension, shoulder elevation). Post deployment, medical records were reviewed by a blinded researcher and inventoried for NCII that occurred during deployment. Data were analyzed for changes between pre and post-deployment physical fitness. Relationships between fitness and utilization of medical resources for NCII were then determined. Significant declines were noted in mean cardiorespiratory fitness (-10.8%) and trunk flexibility (-6.7%). Significant improvements were seen in mean level of fat mass (-11.1%), relative strength (bench press, 10.2%, back-squat 14.2%) and muscular endurance (push-up 16.4%, sit-up 11.0%). Significant (p < 0.05) negative correlations were detected between percentage change in fat mass and gastrointestinal visits (r = -0.37); sit-and-reach and lower extremity visits (r= -0.33); shoulder elevation and upper extremity visits (r= -0.36); and cardiorespiratory fitness and back visits (r= -0.31); as well as behavioral health visits (r= -0.28). Cardiorespiratory fitness changes were grouped into tertiles. Those who lost the greatest fitness had significantly greater number of NCII visits (8.0 v 3.1 v 2.6, p = .03). These data indicate a relationship between the decline in cardiorespiratory fitness and an overall increase in utilization of medical resources. The results may provide incentive to military leaders to ensure that soldiers maintain their cardiorespiratory fitness throughout the extent of their deployment.
ContributorsWarr, Bradley (Author) / Swan, Pamela (Thesis advisor) / Lee, Chong (Committee member) / Campbell, Kathryn (Committee member) / Erickson, Steven (Committee member) / Alvar, Brent (Committee member) / Arizona State University (Publisher)
Created2011
Description
We propose a novel solution to prevent cancer by developing a prophylactic cancer. Several sources of antigens for cancer vaccines have been published. Among these, antigens that contain a frame-shift (FS) peptide or viral peptide are quite attractive for a variety of reasons. FS sequences, from either mistake in RNA processing or in genomic DNA, may lead to generation of neo-peptides that are foreign to the immune system. Viral peptides presumably would originate from exogenous but integrated viral nucleic acid sequences. Both are non-self, therefore lessen concerns about development of autoimmunity. I have developed a bioinformatical approach to identify these aberrant transcripts in the cancer transcriptome. Their suitability for use in a vaccine is evaluated by establishing their frequencies and predicting possible epitopes along with their population coverage according to the prevalence of major histocompatibility complex (MHC) types. Viral transcripts and transcripts with FS mutations from gene fusion, insertion/deletion at coding microsatellite DNA, and alternative splicing were identified in NCBI Expressed Sequence Tag (EST) database. 48 FS chimeric transcripts were validated in 50 breast cell lines and 68 primary breast tumor samples with their frequencies from 4% to 98% by RT-PCR and sequencing confirmation. These 48 FS peptides, if translated and presented, could be used to protect more than 90% of the population in Northern America based on the prediction of epitopes derived from them. Furthermore, we synthesized 150 peptides that correspond to FS and viral peptides that we predicted would exist in tumor patients and we tested over 200 different cancer patient sera. We found a number of serological reactive peptide sequences in cancer patients that had little to no reactivity in healthy controls; strong support for the strength of our bioinformatic approach. This study describes a process used to identify aberrant transcripts that lead to a new source of antigens that can be tested and used in a prophylactic cancer vaccine. The vast amount of transcriptome data of various cancers from the Cancer Genome Atlas (TCGA) project will enhance our ability to further select better cancer antigen candidates.
ContributorsLee, HoJoon (Author) / Johnston, Stephen A. (Thesis advisor) / Kumar, Sudhir (Committee member) / Miller, Laurence (Committee member) / Stafford, Phillip (Committee member) / Sykes, Kathryn (Committee member) / Arizona State University (Publisher)
Created2012
Description
Aqueous solutions of temperature-responsive copolymers based on N-isopropylacrylamide (NIPAAm) hold promise for medical applications because they can be delivered as liquids and quickly form gels in the body without organic solvents or chemical reaction. However, their gelation is often followed by phase-separation and shrinking. Gel shrinking and water loss is a major limitation to using NIPAAm-based gels for nearly any biomedical application. In this work, a graft copolymer design was used to synthesize polymers which combine the convenient injectability of poly(NIPAAm) with gel water content controlled by hydrophilic side-chain grafts based on Jeffamine® M-1000 acrylamide (JAAm). The first segment of this work describes the synthesis and characterization of poly(NIPAAm-co-JAAm) copolymers which demonstrates controlled swelling that is nearly independent of LCST. The graft copolymer design was then used to produce a degradable antimicrobial-eluting gel for prevention of prosthetic joint infection. The resorbable graft copolymer gels were shown to have three unique characteristics which demonstrate their suitability for this application. First, antimicrobial release is sustained and complete within 1 week. Second, the gels behave like viscoelastic fluids, enabling complete surface coverage of an implant without disrupting fixation or movement. Finally, the gels degrade rapidly within 1-6 weeks, which may enable their use in interfaces where bone healing takes place. Graft copolymer hydrogels were also developed which undergo Michael addition in situ with poly(ethylene glycol) diacrylate to form elastic gels for endovascular embolization of saccular aneurysms. Inclusion of JAAm grafts led to weaker physical crosslinking and faster, more complete chemical crosslinking. JAAm grafts prolonged the delivery window of the system from 30 seconds to 220 seconds, provided improved gel swelling, and resulted in stronger, more elastic gels within 30 minutes after delivery.
ContributorsOverstreet, Derek (Author) / Caplan, Michael (Thesis advisor) / Massia, Stephen (Committee member) / Mclaren, Alexander (Committee member) / Vernon, Brent (Committee member) / McLemore, Ryan (Committee member) / Arizona State University (Publisher)
Created2012
Description
Heart failure is a major worldwide health concern and is the leading cause of hospitalization among elderly Americans. Approximately 50% of those diagnosed with heart failure have heart failure with preserved ejection fraction (HFPEF). HFPEF presents a therapeutic dilemma because pharmacological strategies that are effective for the treatment of heart failure and reduced ejection fraction have failed to show benefit in HFPEF. Long term moderate intensity exercise programs have been shown to improve diastolic function in patients HFPEF. High intensity interval training (HIIT) has been shown to improve diastolic function in patients with heart failure and reduced ejection fraction. However, the effects of high intensity interval training in patients with HFPEF are unknown. Fourteen patients with HFPEF were randomized to either: (1) a novel program of high-intensity aerobic interval training (n = 8), or (2) a commonly prescribed program of moderate-intensity (MOD) aerobic exercise training (n = 6). Before and after four weeks of exercise training, patients underwent a treadmill graded exercise test for the determination of peak oxygen uptake (VO2peak), a brachial artery reactivity test for assessment of endothelium-dependent flow-mediated dilation (BAFMD), aortic pulse wave velocity assessment as an index of vascular stiffness and two-dimensional echocardiography for assessment of left ventricular diastolic and systolic function. I hypothesized that (1) high-intensity aerobic interval training would result in superior improvements in FMD, aortic pulse wave velocity, VO2peak, diastolic function and, (2) changes in these parameters would be correlated with changes in VO2peak. The principal findings of the study were that a one month long high intensity interval training program resulted in significant improvements in diastolic function as measured by two-dimensional echocardiography [pre diastolic dysfunction (DD) grade - 2.13 + 0.4 vs. post DD grade - 1.25 + 0.7, p = 0.03]. The left atrial volume index was reduced in the HIIT group compared to MOD ( - 4.4 + 6.2 ml/m2 vs. 5.8 + 10.7 ml/m2, p = 0.02). Early mitral flow (E) improved in the HIIT group (pre - 0.93 + 0.2 m/s vs. post - 0.78 + 0.3 m/s, p = 0.03). A significant inverse correlation was observed between change in BAFMD and change in diastolic dysfunction grade (r = - 0.585, p = 0.028) when all the data were pooled. HIIT appears to be a time-efficient and safe strategy for improving diastolic function in patients with heart failure and preserved ejection fraction. These data may have implications for cardiovascular risk reduction in this population.
ContributorsAngadi, Siddhartha (Author) / Gaesser, Glenn A (Thesis advisor) / Mookadam, Farouk (Committee member) / Swan, Pamela (Committee member) / Vega-Lopez, Sonia (Committee member) / Lee, Chong (Committee member) / Arizona State University (Publisher)
Created2012