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- All Subjects: treatment
- Creators: Ankeny, Casey
- Creators: Stoll, Ryan
Description
Anxiety and depression are among the most prevalent disorders in youth, with prevalence rates ranging from 15% to 25% for anxiety and 5% to 14% for depression. Anxiety and depressive disorders cause significant impairment, fail to spontaneously remit, and have been prospectively linked to problematic substance use and legal problems in adulthood. These disorders often share a high-degree of comorbidity in both clinical and community samples, with anxiety disorders typically preceding the onset of depression. Given the nature and consequences of anxiety and depressive disorders, a plethora of treatment and preventative interventions have been developed and tested with data showing significant pre to post to follow-up reductions in anxiety and depressive symptoms. However, little is known about the mediators by which these interventions achieve their effects. To address this gap in the literature, the present thesis study combined meta-analytic methods and path analysis to evaluate the effects of youth anxiety and depression interventions on outcomes and four theory-driven mediators using data from 55 randomized controlled trials (N = 11,413). The mediators included: (1) information-processing biases, (2) coping strategies, (3) social competence, and (4) physiological hyperarousal. Meta-analytic results showed that treatment and preventative interventions reliably produced moderate effect sizes on outcomes and three of the four mediators (information-processing biases, coping strategies, social competence). Most importantly, findings from the path analysis showed that changes in information-processing biases and coping strategies consistently mediated changes in outcomes for anxiety and depression at both levels of intervention, whereas gains in social competence and reductions in physiological hyperarousal did not emerge as significant mediators. Knowledge of the mediators underlying intervention effects is important because they can refine testable models of treatment and prevention efforts and identify which anxiety and depression components need to be packaged or strengthened to maximize intervention effects. Allocating additional resources to significant mediators has the potential to reduce costs associated with adopting and implementing evidence-based interventions and improve dissemination and sustainability in real-world settings, thus setting the stage to be more readily integrated into clinical and non-clinical settings on a large scale.
ContributorsStoll, Ryan (Author) / Pina, Armando A (Thesis advisor) / MacKinnon, David (Committee member) / Knight, George (Committee member) / Arizona State University (Publisher)
Created2015
Description
Breast and other solid tumors exhibit high and varying degrees of intra-tumor heterogeneity resulting in targeted therapy resistance and other challenges that make the management and treatment of these diseases rather difficult. Due to the presence of admixtures of non-neoplastic cells with polyclonal cell populations, it is difficult to define cancer genomes in patient samples. By isolating tumor cells from normal cells, and enriching distinct clonal populations, clinically relevant genomic aberrations that drive disease can be identified in patients in vivo. An in-depth analysis of clonal architecture and tumor heterogeneity was performed in a stage II chemoradiation-naïve breast cancer from a sixty-five year old patient. DAPI-based DNA content measurements and DNA content-based flow sorting was used to to isolate nuclei from distinct clonal populations of diploid and aneuploid tumor cells in surgical tumor samples. We combined DNA content-based flow cytometry and ploidy analysis with high-definition array comparative genomic hybridization (aCGH) and next-generation sequencing technologies to interrogate the genomes of multiple biopsies from the breast cancer. The detailed profiles of ploidy, copy number aberrations and mutations were used to recreate and map the lineages present within the tumor. The clonal analysis revealed driver events for tumor progression (a heterozygous germline BRCA2 mutation converted to homozygosity within the tumor by a copy number event and the constitutive activation of Notch and Akt signaling pathways. The highlighted approach has broad implications in the study of tumor heterogeneity by providing a unique ultra-high resolution of polyclonal tumors that can advance effective therapies and clinical management of patients with this disease.
ContributorsLaughlin, Brady Scott (Author) / Ankeny, Casey (Thesis director) / Barrett, Michael (Committee member) / Barrett, The Honors College (Contributor) / Harrington Bioengineering Program (Contributor) / School for the Science of Health Care Delivery (Contributor)
Created2015-05
Description
The primary objective of this research project is to develop dual layered polymeric microparticles with a tunable delayed release profile. Poly(L-lactic acid) (PLA) and poly(lactic-co-glycolic acid) (PLGA) phase separate in a double emulsion process due to differences in hydrophobicity, which allows for the synthesis of double-walled microparticles with a PLA shell surrounding the PLGA core. The microparticles were loaded with bovine serum albumin (BSA) and different volumes of ethanol were added to the PLA shell phase to alter the porosity and release characteristics of the BSA. Different amounts of ethanol varied the total loading percentage of the BSA, the release profile, surface morphology, size distribution, and the localization of the protein within the particles. Scanning electron microscopy images detailed the surface morphology of the different particles. Loading the particles with fluorescently tagged insulin and imaging the particles through confocal microscopy supported the localization of the protein inside the particle. The study suggest that ethanol alters the release characteristics of the loaded BSA encapsulated in the microparticles supporting the use of a polar, protic solvent as a tool for tuning the delayed release profile of biological proteins.
ContributorsFauer, Chase Alexander (Author) / Stabenfeldt, Sarah (Thesis director) / Ankeny, Casey (Committee member) / Barrett, The Honors College (Contributor) / Harrington Bioengineering Program (Contributor)
Created2015-05
Description
There is a need to reinvent evidence-based interventions (EBIs) for pediatric anxiety problems to better address the demands of real-word service delivery settings and achieve public health impact. The time- and resource-intensive nature of most EBIs for youth anxiety has frequently been noted as a barrier to the utilization of EBIs in community settings, leading to increased attention towards exploring the viability of briefer, more accessible protocols. Principally, this research reports between-group effect sizes from brief-interventions targeting pediatric anxiety and classifies each as well-established, probably efficacious, possibly efficacious, experimental, or questionable. brief interventions yielded an overall mean effect size of 0.19 on pediatric anxiety outcomes from pre to post. Effect sizes varied significantly by level of intervention: Pre to post-intervention effects were strongest for brief-treatments (0.35), followed by brief-targeted prevention (0.22), and weakest for brief-universal prevention (0.09). No participant or other intervention characteristic emerged as significant moderators of effect sizes. In terms of standard of evidence, one brief intervention is well-established, and five are probably efficacious, with most drawing on cognitive and behavioral change procedures and/or family systems models. At this juncture, the minimal intervention needed for clinical change in pediatric anxiety points to in-vivo exposures for specific phobias (~3 hours), cognitive-behavioral therapy (CBT) with social skills training (~3 hours), and CBT based parent training (~6 hours, eight digital modules with clinician support). This research concludes with a discussion on limitations to available brief EBIs, practice guidelines, and future research needed to capitalize on the viability of briefer protocols in enhancing access to, and impact of, evidence-based care in the real-world.
ContributorsStoll, Ryan (Author) / Pina, Armando A. (Thesis advisor) / Gonzales, Nancy (Committee member) / MacKinnon, David (Committee member) / Perez, Marisol (Committee member) / Arizona State University (Publisher)
Created2019