Browsing by Subject "Patients"

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    Asymmetry assessment using cone-beam CT: a class I and class II patient comparison
    (2010-06) Sievers, Matthew Michael
    Introduction: Asymmetry assessment is an important component of orthodontic diagnosis and treatment planning. Before the advent of three-dimensional imaging, orthodontists relied on two-dimensional headfilms to diagnose asymmetry. Cone beam computed tomography (CBCT) allows for assessment of asymmetry on a dimensionally accurate volumetric image. This study aims to determine if there is a difference in skeletal asymmetry between patients with a skeletal class I ANB angle compared to patients who have a skeletal class II using CBCT images. Methods: CBCT images were examined from 70 consecutive patients who presented for routine orthodontic care and fit inclusion criteria. Asymmetry was analyzed using an asymmetry index developed by Katsumata et al.18 Anatomic landmarks were defined and reference planes were established to determine the variance of the landmarks using a coordinate plane system. 30 randomly selected patients were reanalyzed to assess reliability of the method. Results: Statistical analysis demonstrated no significant relationship between asymmetry and ANB angle for any of the landmarks. Asymmetry index scores were reproducible within a certain range of agreement for each landmark. Conclusions: Based on this study, the differential in jaw proportion common for class II skeletal patterns results in no more skeletal asymmetry than class I skeletal patterns. Altman-Bland agreement plots suggest that some modification may be indicated to the system proposed by Katsumata et al18 to improve asymmetry diagnosis.
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    Characterization of viral mutants for the functional analysis of ppUL69 during human cytomegalovirus replication.
    (2009-11) Kronemann, Daniel Aaron
    Human cytomegalovirus (HCMV) is a β-herpesvirus that infects over 80% of the human population. Although disease is rare in immunocompetent individuals, severe disease is common in immunocompromised patients, including neonates, transplant recipients and acquired immunodeficiency syndrome (AIDS) patients. HCMV UL69 is a viral protein packaged in the tegument of the virion and, as such, is present from the earliest moments of infection. Using transient transfection assays, UL69 has been shown to bind the cellular splicing and mRNA export factor U2AF65 associated protein 56 (UAP56), shuttle between the nucleus and the cytoplasm, and bind the cellular chromatin remodeling and transcriptional elongation factor Suppressor of Ty 6 (Spt6). In previously published work, these characteristics were shown to be required for transactivating the major immediate/early promoter (MIEP) and promoting the export of an intron-containing chloramphenicol acetyltransferase (CAT) reporter transcript. These results, in addition to the fact that most herpesviral transcripts are intronless, have led to a model for UL69 function during HCMV infection as a viral mRNA export factor. However, recently published work using a UL69 deletion viral mutant, termed TNsubUL69, has demonstrated that during viral infection, UL69 is not required for expression of immediate/early (IE) or early (E) genes. In contrast, deletion of UL69 results in a severe defect in late (L) gene expression. Additionally, the UL69 deletion mutant exhibits a defect in viral DNA replication and a MOI-dependent replication defect. These results demonstrate the importance of examining the functional role of UL69 in the context of a viral infection, in the presence of a full complement of viral factors at physiologically relevant levels. The goal of this thesis is to characterize viral mutants that contain mutations in the UL69 open reading frame (ORF) which have been previously described to abolish either binding to UAP56 (UL69mUAP), nucleocytoplasmic shuttling (UL69P603 or UL69E618), or binding to Spt6 (UL69C496). We demonstrate our own ΔUL69 viral mutant exhibits a similar replication phenotype, consistent with previously published results. We demonstrate that the UL69mUAP mutation abolishes UL69 binding of UAP56 but does not affect viral replication. The UL69P603 mutation, but not the UL69E618 mutation, abolishes UL69 shuttling and results in a defect in viral replication similar to the deletion mutant virus. However, the UL69P603 viral mutant is also defective for every other UL69 characteristic for which we have assayed, suggesting the UL69P603 mutation affects a core domain in the UL69 ORF and results in a global UL69 defect during viral infection. A similar result has been obtained for the UL69C496 viral mutant, which is defective for UL69 binding of Spt6, but also results in a defect in other UL69 functions. Using an shRNA strategy to further examine the role of Spt6 during HCMV replication, we demonstrate that partial knockdown of Spt6 negatively affects WT HCMV replication. Taken together, we conclude that UL69 binding of UAP56 is not required efficient HCMV replication, but are unable to make strong conclusions about UL69 shuttling or binding of Spt6 during viral replication. Since both UL69 shuttling and UL69 binding of UAP56 are required for export of an introncontaining transcript, and given that UL69 binding of UAP56 is not required for efficient viral replication, we predict that UL69 shuttling is also not important for efficient viral replication. Thus we propose three models for UL69 function, which center on UL69 binding of Spt6. Through its interaction with Spt6, UL69 functions as either a viral mRNA export factor, a chromatin remodeling factor, or a transcriptional elongation factor.
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    Dosimetry of a next generation i-CAT CBCT machine as compared to a digital panoramic and lateral cephalogram in patient diagnosis and treatment at the University of Minnesota Division of Orthodontics.
    (2010-11) Schieck, Jacquelyn Rae Kolbeck DDS
    Background: Three-dimensional cone-beam computed tomography (CBCT) has rapidly gained prominence and exposure in the dental community over the last few years, and is quickly becoming the routine imaging modality for many orthodontic clinics. However, questions remain about the amount of radiation patients are exposed to during the multiple scans needed for the associated advanced diagnostic and treatment techniques. Objective: To determine the amount of radiation potentially absorbed by a patient during routine orthodontic imaging with the Next Generation i-CAT® cone-beam computed tomography machine with various scan settings. Also, to evaluate the amount of radiation patients at the University of Minnesota Division of Orthodontics are exposed to during a routine two-year treatment including cone-beam scans for diagnosis and for SureSmile® treatment. Methods: Twenty-four thermoluminescent dosimeters placed at anatomic sites inside a RANDO® phantom were scanned using various scan protocols on a Next Generation i- CAT machine and digital panoramic and cephalometric xray machine. Effective doses were calculated using the 2007 International Commission on Radiological Protection recommended tissue weighting factors. Results: The effective doses ranged from 108-129mSv for standard resolution CBCT scans at various voxel size and field of view settings; 196-212mSv for enhanced or highresolution full field of view scans; and measured 252mSv for a high-resolution landscape scan as would be used for SureSmile® therapy. Digital panoramic xray dose was 39mSv and lateral cephalogram was 25mSv. Discussion: Cone-beam CT, while providing proven diagnostic and therapeutic benefits, also exposes patients to a higher level of radiation than with standard digital 2D examinations. It is important for the clinician to weigh the benefits against the risks when determining their imaging protocol.
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    Evaluating the implications of stigma-induced identity threat for health and health care.
    (2010-12) Phelan, Sean Michael
    Introduction: Individuals with a stigmatized social identity may experience identity threat in the form of discrimination, prejudice, stereotype threat or internalized prejudice. Identity threat is a stressor that can contribute to physiological and psychological outcomes. In a health care setting, increased vigilance for identity threat can affect communication and impede individuals' ability to attain high-quality health care. Methods: This dissertation consists of three manuscripts that examine the implications of stigma and identity threat in the health care domain for three sets of stakeholders: patients, caregivers, and providers. The first manuscript assesses whether perceived discrimination as well as other facets of expected stigma are associated with mental and social health outcomes in a sample of 70 individuals who provide care for veterans with a traumatic brain injury. The second manuscript uses a sample of 1109 men who have been diagnosed with colorectal cancer to assess whether stigma related to cancer and self-blame or the perception that others blame them for the disease are associated with depressive symptoms. The third manuscript explores the theoretical underpinnings of identity threat as it relates to the medical encounter, provides several examples of how identity threat may affect the quality and substance of a medical encounter, and suggests evidence-based strategies to ameliorate the effects of the threat. Results: In manuscript 1, perceived discrimination and other facets of stigma were associated with strain, depressive symptoms, anxiety symptoms, and social isolation in multivariable models. In manuscript 2, cancer stigma and self-blame for acquiring cancer were associated with greater depressive symptoms, after adjustment for several known clinical and non-clinical stressors. In manuscript 3, several evidence-based strategies are presented which providers may use to communicate to clients and patients that identity threats are non-normative and individuals with stigmatized identities are safe and welcome. Conclusions: Having a stigmatized social identity and experiencing behavioral reactions to that identity has potentially numerous negative health and health behavior consequences for patients and caregivers. Health care systems and providers can create clinical environments that communicate safety for all social identities, and may improve care outcomes for several marginalized and stigmatized social groups.
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    Identification of TGF-Beta gene expression profiles in earlobe keloids using cDNA microarrays.
    (2009-12) Ho, Vu The
    Abstract summary not available.
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    A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a “Sandwich” method for stage III, IV, and recurrent endometrial cancer.
    (2010-10) Geller, Melissa Ann MD
    Purpose: To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer. Patients and Methods: Patients with surgically staged III-IV (excluding IIIA from positive cytology alone) endometrial cancer or biopsy confirmed recurrent disease were eligible. Treatment consisted of 3 cycles of docetaxel (75mg/m2) and carboplatin (AUC 6) on a q21 day schedule followed by involved field irradiation (45Gy) ± brachytherapy and 3 additional cycles of docetaxel and carboplatin. Kaplan-Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS). Results: Forty-two patients enrolled, 7 did not complete therapy. 95% (39/41) had primary disease. Median age = 58 years (range: 21-81). 78% (32/41) = endometrioid histology. Stages=10 IIIA, 21 IIIC, 1 IVA, 7 IVB, (recurrent=1 IC, 1 IIA). There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities. Five patients died following treatment with a median follow-up of 16.1 months (range: 5-51). KM estimates and 95% confidence intervals for OS at 1 year were=94.4% (79.5-98.6), at 2 years 90.9% (74.2-97.0)), and at 3 years 79.6% (45.4-93.6). Of the 39 with primary disease, 9 progressed or died within 3 years of study enrollment. KM estimates and 95% confidence intervals for PFS at 1 year were 85.7% (69.0-93.8), at 2 years 75.6% (56.8-87.1), and at 3 years=68.0% (44.6-83.2). Conclusions: “Sandwiching” radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS.
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    Quantitative digital assessment of periapical healing.
    (2011-08) Wiswall, Jeffrey Herbert
    Abstract summary not available
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    Severe peripheral artery disease: new observations from a community-based Minnesota Registry.
    (2010-06) Keo, Hak Hong
    This study assessed whether time serves as a previously undefined predictor of both limb and patient survival in individuals with acute limb ischemia (ALI) and critical limb ischemia (CLI). Patients with ALI or CLI referred to a single metropolitan tertiary care hospital were consecutively entered into the prospective “FReedom from Ischemic Events: New Dimensions for Survival” (FRIENDS) registry. Demographics, key time segments and short-term outcomes were evaluated for all patients. Key time segments were reported as median and interquartile range (IQR). Myocardial infarction (MI), stroke, amputation and all-cause mortality were collected at one month. From 2/07 through 12/09, 206 patients (75 ALI, 131 CLI) were enrolled in the FRIENDS registry. The median age was 76 (64, 84) years and 58% were male patients. Median time from symptom onset to admission was 19.2 hours (7.2, 79.2) for ALI and 59 days (24, 124) for CLI patients. Length of stay was 7.0 days (4.3, 10.4) for ALI and 6.1 days (3.1, 10.7) for CLI patients. Minor and major amputation was performed during the index hospitalization in 10 (13%) of patients with ALI and 34 (26%) of those with CLI. In ALI patients, amputation was significantly associated with increased duration of ischemia (P=0.015 for trend), but this trend was not observed in CLI patients. One month after discharge, a longer duration of ischemia was significantly associated with an increase in the quadruple endpoint of nonfatal MI, stroke, amputation or death in patients with ALI (P=0.007 for trend). No such association was observed in individuals with CLI. Amputation-free survival at one month was 78.7% and 71.8% for patients with ALI and CLI, respectively. In conclusion, these data suggest that expedited admission and treatment for ALI is associated with lower rates of in-hospital amputation and morbidity and mortality at one month. There was no association between the duration of ischemia and morbidity and mortality among the CLI patients. These data clarify a high incidence of ALI amongst patients with severe PAD; verify that length of stay remains long and major adverse outcomes remain common even within the first month of a severe PAD admission. Future research might investigate the biological mechanisms and processes of care that could link the long referral times and high rates of vascular ischemic events.
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    Telehealth Use for HIV Care: Patients' and Healthcare Providers' Perceptions and Predictors of Intention to Use Among Adults Living with HIV in Kampala, Uganda
    (2023-08) Osingada, Charles
    Background and Purpose Human Immunodeficiency Virus (HIV) remains an enormous public health challenge globally. People living with HIV face considerable challenges in accessing HIV services. Telehealth has the potential to address some of the obstacles to HIV care. However, little is known about telehealth's feasibility, acceptability, and efficacy in caring for people living with HIV. In low-resource settings specifically, there is a limited understanding of the determinants of telehealth use, and little is known about patients' and health providers' perceptions of the use of virtual care for people living with HIV. Overall aims. This dissertation had three broad aims: 1) to describe the feasibility, acceptability, and efficacy of telehealth for HIV testing and care, 2) to determine predictors of intention to use telehealth among adults living with HIV, and 3) explore patients' and health providers' perceptions about the use of telehealth to provide follow-up HIV care. Methods Aim 1. This aim was accomplished by conducting a literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The literature search was conducted across Ovid Medline, PsycINFO, and CINAHL databases for articles published through July 2021. The search yielded 1394 titles and abstracts, and after the screening, 17 full-text articles were included in the review. Aims 2 and 3. The second and third manuscripts involved a mixed methods study conducted among people living with HIV and focus group discussions conducted with nurses and counselors engaged in caring for people living with HIV. The second paper was a sequential explanatory study that examined predictors of intention to use telehealth and perceptions of patients living with HIV. A survey was conducted among 266 patients, and one-on-one interviews were conducted with 12 participants. The third manuscript reports findings from a qualitative study that explored perceptions of health providers (nurses and counselors) about the use of telehealth to provide follow-up HIV care. Results Aim 1. Findings from the literature review showed that videoconferencing and video-based interventions are generally feasible and acceptable. Videoconferencing is effective in improving adherence to HIV treatment and in promoting HIV testing. In addition, video-based interventions were effective in promoting HIV testing, treatment initiation, and adherence to medication. Both modalities enhanced linkage and retention in treatment for HIV-positive patients. Aim 2. Results from the survey part of the study showed that for a unit increase in effort expectancy scores, the odds of a participant scoring high in intention to use telehealth were 1.26 (95% CI, 1.13-1.41) times the odds of obtaining a low score. Likewise, for a unit increase in facilitating conditions scores, the odds of a participant scoring high in intention to use telehealth were 1.44 (95% CI, 1.17-1.73) times the odds of recording a low score. Furthermore, compared to participants who earned 10,000 UGX monthly (about $2.70), patients who earned an estimated monthly income of 100,001-500,000 UGX (approximately $27-135) had increased odds of obtaining a high score on intention to use telehealth. Likewise, compared to participants who earned 10,000 UGX (about $2.70), patients who earned an estimated monthly income of 500,000 UGX or more (≥ $135) had excess odds of obtaining a high score on intention to use telehealth. Also, compared to patients with poor medication adherence, participants with good adherence had increased odds of getting a higher score of intention to use score. Aim 3. From one-on-one interviews conducted with people living with HIV and focus group discussions held with health providers, we found similarities in perceptions about the benefits of telehealth and possible barriers to the adoption of virtual care. Some of the benefits cited by the participants include reducing the cost of care, enhancing the quality of care, promoting patient-health provider relationships, reducing loss to follow-up, and improving medication adherence. Barriers to telehealth adoption include a lack of smartphones, low digital literacy, fears about the security of personal health information, and challenges in accessing the internet. Both patients and health providers believed that telehealth would be suitable for counseling services, monitoring medication adherence, providing health education, and triaging patients. While patients and nurses felt that telehealth would help address stigma, counselors thought the implementation of telehealth would promote stigma among people living with HIV. Additionally, nurses thought the implementation of telehealth would compromise the delivery of other health services, including early diagnosis of non-communicable diseases. Finally, the nurses and counselors provided suggestions about issues that need to be addressed before the implementation of telehealth, including issues related to cost and access to reliable internet, establishing measures to protect patient health information, improving infrastructure, and training health professionals. Conclusions Telehealth interventions are beneficial in HIV testing and treatment. However, the scarcity of primary studies employing these telehealth modalities means that there is a need for more research in these areas, particularly in resource-limited settings that bear a high burden of HIV and AIDS. In addition, telehealth has the potential to enhance patient-centered care, particularly for patients adhering well to their medication. However, its implementation should not exacerbate existing health disparities, particularly among individuals with low socioeconomic and literacy levels. More research is needed to examine ways of integrating telehealth into existing HIV care models and how this will influence health outcomes in people living with HIV as well as the delivery of other health services.