Develop, implement, and evaluate obstructive sleep apnea screening protocol in neuro patients

Purpose: The quality improvement (QI) project instituted an early identification of obstructive sleep apnea (OSA) and referral process among patients in the outpatient neurology clinic. Obstructive sleep apnea carries an increased morbidity and mortality risk and is one of the most prevalent and underdiagnosed sleep-related breathing disorders. According to the American Academy of Sleep Medicine, 24.9 million people suffer from OSA, and approximately 80% are underdiagnosed in the United States. Obstructive sleep apnea is more common in the neurology population. The project site does not currently have a standard patient OSA screening protocol. Methodology: Population: Patients 18 or older visited a neurology clinic for appointments under the neurology team in an outpatient neurology clinic. Interventions: The STOP-BANG questionnaire (SBQ) will be used to screen for OSA over 4 weeks with sleep medicine referrals for positively screened patients. The STOP-BANG questionnaire was identified as an evidence-based screening tool with high sensitivity and specificity to identify individuals at risk for OSA. Results: Of 27 patients visited during the 4 weeks of implementation, 25 patients were screened. Of the total 25 patients, 68% (n=17) screened positive, and 41% (n=7) of screened positive patients received referrals. Implications of practice: The results of this project showed an improvement in early identification and referral of OSA, which signifies the importance of OSA screening among patients with neurological disorders. Therefore, the co-investigator recommended incorporating the OSA screening tool and referral as standard practice at the neurology clinic.D.N.P.Includes bibliographical reference

Expedited partner treatment for sexually transmitted infections: chlamydia and gonorrhea

Purpose of Project: The purpose of this quality improvement project was to determine the rates of EPT and its correlation to re-infection rates, specifically for patients who test positive for Chlamydia and Gonorrhea. Methods: A secondary analysis via a retrospective chart review was conducted for patients who tested positive for chlamydia and gonorrhea during January 2023 and February 2023. Results: A total of 33 patient charts were evaluated. Patient demographics were collected including age, race, insurance status, and educational background. A total of 33 patients tested positive for chlamydia and gonorrhea. Of the 33 patients, 66.67% (n=22) patients were offered EPT; of those 22.73% (N=5) patients were reinfected. Of the 33 patients, 33.33% (n=11) patients were not offered EPT; of those 9.09% (n=1) patients were reinfected. Regardless of whether EPT was provided, 42.42% (n=14) of patients did not have follow-up cultures, and therefore re-infection status could not be determined for those patients. Implications for Practice: Implications of these results involve practice change initiatives including the implementation of clinical practice guidelines, increased patient education, annual provider training, and reduced health-care economic burdens. Overall, expedited partner treatment and follow-up cultures are important in the reduction of reinfection rates.D.N.P.Includes bibliographical reference

Simulating a frustrated Ising system using a programmable quantum computer

Quantum spin systems that exhibit geometric frustration have highly degenerate ground states that can be lifted in the presence of thermal and quantum fluctuations. A well- known example of this is the antiferromagnetic Ising model on the Kagome lattice. This differs from the same model on the triangular lattice, in that the triangular lattice orders at zero temperature under a small transverse field, whereas the Kagome lattice does not. In this work, we simulate this model on a D-Wave quantum computer. We first embed this model on the D-Wave Advantage2 Prototype, whose qubits are arranged according to the Zephyr graph; our embedding of the Kagome lattice consists of 231 sites and periodic boundary conditions in one direction. We then use calibration techniques to further improve the embedding. Preliminary forward annealing experiments show a 1/3 average magnetization plateau, which is characteristic of a spin ice. We then use an anneal-pause quench annealing schedule in order to sample the ensemble of states of the model in the presence of finite transverse field. Our results from this experiment show a departure from the spin ice state under finite transverse field.M.S.Includes bibliographical reference

Integrating controls and CFD for the satellite sloshing problem

Spacecraft dynamics and controls is a vast field with a great deal of invested research and resources. Computational engineering provides an unparalleled tool for design when experimental data is difficult to obtain and analytical solutions do not yet exist. One application of this is novel spacecraft and mission design. Two broad areas of study that have benefited from the use of computational resources are control theory and fluid mechanics. Through the development of a computational tool, a higher fidelity model for spacecraft dynamics and controls can be produced. The problem of interest is the satellite sloshing problem, and it is shown that the knowledge from analysis greatly enhances the understanding of the spacecraft dynamics and controls. The primary goal is to combine control theory and computational fluid dynamics in a cohesive manner without neglecting the extensive research done for either.M.S.Includes bibliographical reference

Bidirectional influences in mother-infant dyads: advanced HRV analysis in naturalistic settings

In the realm of neurodevelopment, rapid postnatal changes present a complex tableau of growth and adaptation. Amidst this dynamic process, heart rate variability (HRV) of infants, modulated by the autonomic nervous system, offers an early glimpse into their developing physiological landscape with potential impacts in the mother-infant relationship. This research offers the dyadic heart rate fluctuation dynamics as a barometer for the neurodevelopmental conditions that begin to shape the earliest chapters of the human social life. This thesis presents an analytical exploration of dyadic HRV dynamics as a potential biomarker of mutually experienced autonomic regulation in mother-infant dyads. The study utilized a unique dataset of naturalistic HRV recordings, approached initially without extensive background information. The dataset comprised 18 mother-infant pairs with recordings spanning 3-8 hours, capture the day-to-day variability in autonomic regulation. The exploratory nature of this work required the use of established techniques to validate the data, followed by the application of new lab-developed methods to analyze micro-fluctuations in inter-beat intervals. We then introduce an information theoretical approach to assess the dynamic, causal bidirectional influence within the dyads. The findings reveal a complex interplay between maternal and infant HRV, that automatically breaks the group into different self-emerging clusters of activity patterns. Furthermore, they reveal a predominant infant-led influence on maternal autonomic state. The research highlights the potential of HRV as an indicator of early development amenable to understand the physiological underpinnings of early mother-infant interactions. These insights contribute to the field of developmental psychophysiology and may inform intervention strategies promoting optimal early development of basic building units of synchrony and social rapport. Overall, this thesis underscores the utility of integrating traditional cardiac analytic techniques with innovative approaches to enhance our understanding of neurodevelopmental dynamics within the naturalistic settings of home environments.M.S.Includes bibliographical reference

A behavioral and physiological analysis of the modulatory role of the N/OFQ system in neuroinflammation

It is well established that the brain and the immune system communicate bidirectionally to influence behavior. This is exemplified by studies showing that environmental and psychological processes affect immunity, and in turn, immune-mediated inflammatory stressors affect central nervous system (CNS) function and behavior. In this context, the purpose of the current dissertation is to investigate the potential role of the neuropeptide Nociceptin/OrphaninFQ (N/OFQ) and its receptor NOP in the regulation of sickness behavior and associated neuroinflammatory signals. The overarching hypothesis was that the N/OFQ system serves to regulate the effects of inflammation on the CNS, limiting disruption of ongoing behavior. This was investigated using motivational, exploratory, and consummatory behavioral assays paired with ELISA and qPCR immunoassays to determine proinflammatory cytokine profiles in wildtype and NOP receptor (NOP KO) deficient mice challenged with the endotoxin LPS. The results of delivering LPS either systemically or centrally revealed major differences in the magnitude and pattern of expression in cytokine mRNA within the hypothalamus and hippocampus, as well as in the peripheral inflammatory response. Furthermore, it was found that in wildtype C57/BL6 mice, systemic LPS did not alter peripheral splenic proinflammatory cytokines in NOP KO mice compared to WT. However, when LPS was administered centrally, IL-6 was only elevated in WT LPS-treated mice, but not in mice with inhibited NOP function. After systemic LPS challenge, il1 and tnf mRNA transcripts were elevated in the hypothalamus in LPS-treated mice regardless of genotype, yet after central LPS, il1 and tnf were elevated 5-fold in the hypothalamus of NOP-inhibited mice when compared to saline controls. Behaviorally, NOP KO mice showed decreased neophobia in both exploratory and consummatory behaviors, although in a progressive ratio task for sucrose reward they showed greater persistence in responding. These results suggest a complex modulatory role of the N/OFQ system in neuroinflammation and related exploratory and motivational behaviors.Ph.D.Includes bibliographical reference

Variation in state tax burden and family well-being

Although taxes in the United States are generally thought of as progressive, state sales taxes and many state income taxes are in fact regressive, further depleting the resources of low-income households. Accordingly, evidence suggests that state taxes are associated with increases in mortality, non-marital births, crime, and high school dropout. Between states, there is significant variation in tax policies and the resulting tax burden on low-income families. However, very little research has been done on the effect of these policies on the well-being of families and children, and even fewer studies examine these policies in combination. This dissertation aims to describe state tax policies over time and examine the effects of policies – singularly, in combination, and in totality – on two robust measures of family well-being, food insecurity and child birthweight. This dissertation leverages a new dataset, collected by the author, describing state tax policies over 20 years (1990 – 2019). Results from descriptive analyses of these policies demonstrate the significant variation in tax burden, such that a household at the Federal Poverty Line, in one state, could receive a refundable tax credit increasing their resources by 25%, while the same household, in another state, could lose 8% of their resources to state income and sales taxes. This policy dataset is next linked to individual-level data from two nationally representative datasets to examine the effects of tax policies on household food insecurity and child birthweight. To examine the relationship between state taxes and food insecurity, the state tax policy data are merged with the nationally representative Current Population Survey Food Security Supplement (2002-2019). Results indicate that state sales taxes are particularly detrimental for household food security, while state EITCs are protective against household food insecurity. To examine the relationship between state taxes and child birthweight, the state tax policy data are merged with the Pregnancy Risk Assessment Monitoring System (PRAMS). These results indicate that state sales taxes on food and overall tax burden are associated with increased risk of mothers having a low birthweight infant. Results are contextualized with simulations of the effects of policy changes on the well-being outcomes.Ph.D.Includes bibliographical reference

Design, 3D printing, and characterization of porous orthopedic fixation devices

This thesis begins with a review on the use of Laser-based Powder Bed Fusion (LPBF) to print metallic lattices for use in orthopedic applications. The benefits of such implants, including promoting osteointegration and limiting stress shielding, have been reviewed. A discussion of the specific implant geometries and materials utilized to achieve these benefits follows. Firstly, three lattice designs are optimized using the software package nTop for use in porous blanks. Theoretical porosity, mean pore size, min pore size, max pore size, and overall pore distribution data are calculated and analyzed. Secondly, porous blanks are printed using an LPBF machine, specifically the Aconity3D Mini. The blanks are then machined to create M7 threads, a thread analogous to those used in headless compression screws. Thirdly, a 2D characterization was performed using a Keyence VR-3100. A 3D characterization was performed using a Nikon 225KV industrial CT. The data gathered are compared to the theoretical nTop data. Surface and line roughness measurements are obtained from the as-printed and as-machined surfaces using a Keyence VR-3100. Finally, theoretical stiffness tensors are calculated for each lattice design and is compared to that of a theoretical solid sample.M.S.Includes bibliographical reference

Dietary animal fat disrupts gut microbiota and aggravates Graft-versus-host disease following hematopoietic stem cell transfer

The gut microbiome and dietary regimen are two modifiable variables that have been widely investigated as factors that can impact Graft-versus-host disease (GVHD) following allogeneic bone marrow transplant. The rise in fat content has been linked to a reduction in gut microbiome diversity and an aggravation of GVHD. However, the impact of the quality of dietary fat on both the gut microbiota and GVHD outcome remains elusive. Here, we developed two rodent diets with moderate fat, ensuring equivalent macronutrient composition while varying only in fat type—animal-derived versus plant-derived fat. We found that mice fed the animal fat diet (AFD) compared to a plant fed diet (PFD) exhibited worse outcomes in a model of chronic GVHD. The mice fed an AFD had an elevated serum cytokine response, more severe skin inflammation and more intestinal immune dysregulation, compared to mice fed a PFD. While both diets caused reductions of gut microbial diversity, the diets induced discrete gut microbial structures. Further, we identified two guilds consisting of 18 amplicon sequence variants (ASVs) that distinguished between AFD and PFD-fed mice and may contribute to disease severity in AFD group. Our data show that even short-term feeding of diets that are equal in macronutrient content but different in fat source can promote different gut microbiomes, alter intestinal homeostasis, and drive differential Scl-cGVHD outcomes.Ph.D.Includes bibliographical reference

Miocene paleoceanography at Rockall Plateau site 982

The Miocene Epoch contains two juxtaposed end-member climate states beginning with the Miocene Climate Optimum (MCO) (17-14.8 Ma), the most recent interval of ice-free or near ice-free conditions, and ending with the abrupt establishment of a permanent East Antarctic Ice Sheet during the Middle Miocene Climate Transition (MMCT) (14.8-12.8 Ma). The North Atlantic plays an important role in global ocean water circulation and Earth’s climate and yet, relatively few sea surface temperature (SSTs) records have been generated for the Miocene in the subpolar North Atlantic. Biomarker (UK’37, TEX86) SST records at subpolar Ocean Drilling Program (ODP) Site 982 (57.5°N) yield SST estimates which indicate that surface waters in the high latitudes remained warm (>20°C) until ⁓8 Ma when 4°C cooling occurred. In contrast, foraminiferal-based estimates from subtropical and transitional DSDP Sites 563, 558, and 608 (33.6-42.8°N) indicate that the largest cooling (4°C) occurred during the MMCT between 14.8-12.8 Ma, recording little to no cooling after 8 Ma. We analyzed planktonic (G. bulloides and G. praebulloides) and benthic foraminifera (P. wuellerstorfi, S. tenuicarinata) from the Early to Late Miocene (20 to 4.5 Ma) at Site 982 for δ 18O and δ 13C to evaluate SSTs, thermocline and deepwater evolutions, and to test the biomarker-based reconstructions of SSTs in the subpolar North Atlantic. Our results show that planktonic foraminifera from Site 982 record a 1.45‰ increase in δ18O values between 15-13.8 Ma, reaching modern values by 11.75 Ma (1.55‰ Modern for G. bulloides). Accounting for ice volume difference using Miller et al. (2020) ice volume estimates, SSTs varied between 15-17°C during the MCO and cooled to 11-13°C with the MMCT, in line with the modern seasonal SSTs in the region (Modern winter 9°C, Modern Summer 13°C). Our benthic foraminiferal δ18O values record a 0.5‰ increase reflecting a 2-3°C deep-water cooling following the MCO. In contrast, the UK’37 and TEX86 based SSTs recorded modest cooling (22°C) through the MCO and subsequent Antarctic Ice sheet growth. Resolving disparities between SST proxies is important because they present two different and possibly incompatible scenarios. The biomarker-based estimates require an asymmetry in cooling with the subpolar North Atlantic maintaining subtropical conditions while the southern subpolar region cooled dramatically. We favor the stable isotope SST reconstruction because 1) the cooling coincides with CO2 decreases and the growth of a large ice sheet on Antarctica and 2) the resulting SST estimates following the MCO are similar to the modern seasonal SSTs over Rockall Plateau (10-13°C) and supports the preferred temperature ranges for the faunal species found in that interval.M.S.Includes bibliographical reference