Doctor of Nursing Practice, Mount St. Joseph University , 2024, Department of Nursing

Chronic Obstructive Pulmonary Disease (COPD) remains a significant public health challenge and a leading cause of hospital readmissions in the United States, imposing substantial financial and quality-of-life burdens. Global guidelines have advocated early initiation of pulmonary rehabilitation (PR) as an effective intervention to mitigate these readmissions. This Doctor of Nursing Practice (DNP) project aimed to evaluate the impact of early initiation of PR on the 30-day readmission rates for patients discharged with an acute exacerbation of COPD. A comprehensive evaluation was conducted on a cohort of 129 patients admitted with COPD across four months from October 2023 to January 2024. The project tracked 30-day readmission rates, PR referrals, and PR enrollment rates. These were compared against the same period from the previous year to gauge the effectiveness of the intervention. The initiative included inpatient PR consults, patient education, and scheduled PR intake evaluations post-discharge. Early findings indicate a decrease in the 30-day readmission rates, from an initial readmission rate of 14.71% in October 2023 to 12.82% in January 2024. The observed-over-expected readmission ratios demonstrated improvements, particularly notable in January 2024, with a ratio of 0.70. Additionally, there was a notable increase in PR referrals and significant improvement in staff knowledge about PR, indicating successful implementation of the initiative. The early initiation of PR post-discharge for patients with COPD may contribute to reducing 30-day readmission rates.

Committee: Sandra Curtis (Advisor) Subjects: Health Care; Nursing; Rehabilitation

MA, Kent State University, 2022, College of Arts and Sciences / Department of Psychological Sciences

Depression and anxiety are common, debilitating comorbidities in chronic obstructive pulmonary disease (COPD) that are associated with poorer medical and psychological outcomes, but early evidence suggests that this population largely does not receive appropriate psychological treatment. The present study examines prevalence of depression and anxiety among individuals with COPD in the general United States population and their patterns of mental healthcare utilization. Cross-sectional data from 14,784 individuals in the 2019 National Health Interview Survey were analyzed. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder Scale (GAD-7). Hierarchical linear regression was used to predict PHQ-8 and GAD-7 scores based on COPD diagnosis. Chi-square tests were used to compare group differences in clinically significant depression and anxiety, mental healthcare utilization, and type of mental health intervention used. Significant findings were further analyzed using exploratory logistic regression. After controlling for covariates, COPD diagnosis was associated with higher depression and anxiety. In individuals with clinical depression and anxiety, COPD diagnosis was associated with greater mental healthcare utilization compared to those without COPD, with individuals with COPD using antidepressants and anti-anxiety medications at higher rates than talk therapy. The present study adds to the current literature noting high levels of depression and anxiety among individuals with COPD, drawing from a large community sample. Findings suggest, given the high levels of psychological comorbidities in COPD, a need for psychological screening and intervention as part of COPD treatment, as well as evaluation of the efficacy of psychopharmacological and psychotherapeutic interventions in COPD. Further study of patterns of mental healthcare utilization in COPD is also required, particularly with attention to how diseas (open full item for complete abstract)

Committee: Joel Hughes (Advisor); John Updegraff (Committee Member); Jennifer Taber (Committee Member); William Lechner (Committee Member) Subjects: Clinical Psychology; Epidemiology; Health Care; Mental Health; Psychology

Doctor of Philosophy in Urban Education, Cleveland State University, 2021, College of Education and Human Services

Background: Several attempts have been made to examine factors that influence 30-day readmissions in a hospital setting to ensure that inpatient care is accompanied by an effective post-discharge plan that can decrease 30-day readmissions to guide hospitals to use practices that increase hospitals `quality implications (Shah et al., 2015; Kripalani et al., 2007; Rinne et al., 2017, Jenks, Williams and Coleman, 2009, Shah, Press, Husingh-Scheetz & White, 2016; Sickler et al., 2015; Pruitt, 2018; Hansen et al., 2013; Simmering et al., 2016; Alper, O'Malley, & Greenwald, 2019). Purpose: To determine the role of post-discharge care in 30-day readmissions along with the typical clinical outcomes identified, we examined a small urban hospital population and the patient characteristics in each post-discharge care setting (HSC, HHC, LTAC, and SNF). Patients and Methods: A retrospective study was conducted in patients with COPD hospitalizations using the data from a small urban community hospital from 2014 to 2019, n = 1,008. Results: Home health care was identified as having the highest readmission rate in this small urban community hospital using a test of proportions. The weighted variables from a researcher-developed covariate scoring table were analyzed using a Chi-square analysis. The findings provided a reference framework for a systemized discharged planning process according to how the variables/groups were scored.

Committee: Kenneth Sparks Dr. (Committee Chair); Douglas Wajda Dr. (Committee Member); Emily Kullman Dr. (Committee Member); Amanda Penko Dr. (Committee Member) Subjects: Adult Education; Bioinformatics; Communication; Cultural Resources Management; Education Philosophy; Health Care Management; Health Education; Information Science; Instructional Design; Literacy; Management; Medicine; Minority and Ethnic Groups; Multicultural Education; Nursing; Organizational Behavior; Public Health; Systematic; Urban Planning

Doctor of Nursing Practice, Mount St. Joseph University , 2020, Department of Nursing

Executive Summary Chronic Obstructive Pulmonary Disease (COPD) affects millions of Americans and is a leading cause of death in the United States (US). The cost burden and penalties for hospitals associated with COPD readmissions continues to rise, challenging hospitals to find effective ways to reduce COPD readmissions. There have been numerous studies published regarding methods to reduce COPD readmissions. Common elements associated with reducing COPD readmissions included self-management education with individualized care plan, appropriate inhaler technique, assessment/ referral for pulmonary rehabilitation, arrangement for outpatient follow-up, and referral to a smoking cessation program. Given the current challenges with COPD readmissions at a 257-bed community hospital in Ohio, this DNP project included the education of nurses and respiratory therapists on a cardiac intermediate unit regarding evidence-based methods to reduce COPD readmissions. The purpose of this DNP project was to compare how the use of evidence-based COPD education compared to typical education for adult COPD patients affected the 30-day COPD readmission rate. The results were variable in support of the evidence that COPD readmissions could be reduced with the implementation of evidence-based COPD education. Results did demonstrate a significant improvement in participants' self-rated knowledge and skill in the use of the EMMI program for assignment of COPD education as well as documentation of COPD education following the educational session. The lack of participation and compliance with implementation of the evidence-based elements may have contributed to the variability of 30-day COPD readmission rates on the project unit. Other variables that may have contributed include a surge in patient volumes as well as the onset of the Covid-19 pandemic crisis.

Committee: Nancy Hinzman Dr. (Committee Chair) Subjects: Education; Health Care; Nursing

PHD, Kent State University, 2019, College of Public Health

African Americans have a high burden of respiratory disease and are three times more likely to be hospitalized, visit emergency departments, or die from asthma compared to non-Hispanic whites, while those with chronic obstructive pulmonary disease (COPD) experience worse quality of life. Community-based interventions have shown great potential in addressing health issues within the African American community. Integrated interventions though beneficial, have limited feasibility and sustainability, mainly due to associated costs. Inexpensive strategies that require fewer resources should be explored further and evaluated for effectiveness. A low-cost strategy that continues to receive much attention is the use of mobile communication technology, mHealth, to monitor and provide support for chronic disease management. Technological interventions in African Americans with asthma have been conducted mainly in younger populations, while those for older adults with COPD are lacking. The purpose of this research was to form a partnership to assess burden and risk of asthma and COPD and to evaluate the feasibility of implementing an educational and text-messaging intervention in an urban African American Church community. The first aim described the process of establishing a partnership for a community-based intervention, and to assess the feasibility of using a two-step case finding technique to estimate the prevalence of asthma, COPD and smoking. Prevalence was estimated at 25.9% for asthma, 13.9% probable asthma, 9.6% for COPD, 23.1% probable COPD, and 31.9% for smoking. It was feasible to estimate prevalence and define an asthma and COPD cohort to recruit participants for the subsequent intervention study. The second aim evaluated disease and management knowledge and found it to be low. An increase in proportion of participants that answered questions correctly was noted post educational intervention, more so in those with asthma. The educational intervention increa (open full item for complete abstract)

Committee: Melissa Zullo PhD (Committee Chair); Vinay Cheruvu PhD (Committee Member); Peggy Stephens PhD (Committee Member); Darrick Willis B.S. R.S. (Committee Member) Subjects: African Americans; Epidemiology; Health Education; Public Health

MS, University of Cincinnati, 2018, Medicine: Clinical and Translational Research

Importance: Although COPD readmissions adversely affect patient outcomes and health care costs, effective interventions to reduce readmissions often elude large health systems. Objectives: i) To identify care delivery failures for COPD patients readmitted within 30 days and create a COPD care bundle to reduce these failures. ii) To achieve 90% adherence to the bundle through improvement science to decrease COPD readmissions. Setting: University of Cincinnati Medical Center is an 800-bed academic regional referral health center and a safety net hospital. The COPD 30-day all-cause readmission rate was 22.7% per month from August 2013 to September 2015. Method: We performed a cross-sectional study of COPD 30-day readmissions from 10/2014 to 3/2015 to identify failures in care delivery. To identify needs at discharge, we interviewed readmitted COPD patients. We reviewed published literature to identify best practices. Then, we formed a multidisciplinary team to create a 5-element COPD care bundle designed to mitigate system failures and meet patient needs. Using quasi-experimental study design and `Model for Improvement', we redesigned care delivery through sequential Plan-Do-Study-Act cycles to improve adherence to the bundle. Interrupted Time-series analysis was performed using statistical process control (SPC) chart. Measures: Bundle compliance and all-cause 30-day readmissions. Results: In cross-sectional review, 27 patients had 44 readmissions. Median time to readmission was 7 days. COPD was the most common readmission diagnosis (55%). 42 system-level failures were identified during the index admissions. The most prevalent failures were inappropriate inhaler regimen at discharge, late or nonexistent follow-up appointments, and sub-optimal discharge instructions. Patient interviews revealed confusing discharge instructions, especially regarding inhaler use. The COPD care bundle elements were: i) appropriate inhaler regimen, ii) 30-day inhale (open full item for complete abstract)

Committee: Erin Haynes Dr.P.H. (Committee Chair); Evaline Alessandrini M.D. (Committee Member); Mark Eckman M.D. (Committee Member); Ralph Panos M.D. (Committee Member) Subjects: Surgery

Doctor of Philosophy, The Ohio State University, 2017, Psychology

Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible medical condition associated with decreased quality of life (QoL), psychological functioning, and exercise capacity. Research indicates that COPD patients with negative illness perceptions are more likely to report poorer psychological well-being and lower QoL. Caregivers of patients with COPD also may have an influence on psychological functioning and quality of life of patients. However, few studies have examined the impact of caregiver illness perceptions on patient outcomes, and no study has examined the influence of caregiver perceptions in the context of a behavioral intervention. Preliminary evidence suggests that illness perceptions among other patient groups are modifiable. This exploratory study evaluated changes in illness perceptions and the moderating effect of patient and caregiver illness perceptions on patient psychological and somatic QoL, and exercise capacity following a telephone-based coping skills training (CST) intervention. The current study included 39 COPD patients (84.6% Caucasian, 53.8% female, mean age = 64.1 years, mean FEV1% predicted = 43.1, caregiver identified = 82.1%) and 32 caregivers (81.3% Caucasian, 68.8% female, mean age = 58.4%). Participants were randomized to a 14-week telephone-based CST group (n = 20) or COPD education (COPD-ED) group (n = 19). Patient and caregiver illness perceptions, generic and disease specific QoL, depression, anxiety, perceived dyspnea, exercise capacity (as indicated by six-minute walk distance [6MWD]), and lung function were assessed at baseline and post-intervention. Repeated measures analysis of variance (ANOVA), regressions, and estimation of conditional effects were the primary modes of data analysis. Results indicated that perceived concern decreased in the CST group compared to COPD-ED. There was no difference between groups on the other dimensions of illness perceptions. Participants in CST exhibited no change in ps (open full item for complete abstract)

Committee: Charles Emery PhD (Advisor); Julian Thayer PhD (Committee Member); Michael Vasey PhD (Committee Member) Subjects: Psychology

PHD, Kent State University, 2015, College of Arts and Sciences / Department of Psychological Sciences

Research has shown that the rate of depression in patients with COPD is higher than in other chronic diseases and that depression in this population negatively impacts self-care (Qian et al., 2013). Unfortunately, depression is poorly managed in COPD patients (Norwood & Balkissoon, 2005); thus necessitating the development of alternative ways to manage COPD in the home. Often the burden of COPD management falls on an informal caregiver, who is expected to provide instrumental support by assisting with activities of daily living (Gardiner et al., 2010). Unfortunately, many informal caregivers lack the mental and physical capacity necessary to perform these activities. The aim of this investigation was to identify whether mental and physical morbidity in the informal caregivers of depressed patients with COPD influenced healthcare utilization in this population. Participants for this study were 50 COPD patients and their caregivers who were recruited from the pulmonary physicians' practices, pulmonary function testing laboratories, and pulmonary rehabilitation programs associated with a single, multi-center health system. The patients were asked to complete an in-home interview that addressed questions related to symptomology, adherence, healthcare utilization, and depression. In addition, presence of anxiety, depression, and physical morbidity were addressed during the caregiver interview. A moderated mediation analysis was conducted using structural equation modeling. Results of the analysis showed that patient depression was related to increased self-report of symptoms related to shortness of breath, decreased willingness to adhere to health behaviors, and increased healthcare facility admissions. Unexpectedly, the presence of physical morbidities in the caregiver attenuated the positive relationship between patient depression and healthcare utilization, although this became non-significant after controlling for patient age and COPD severity. In conclusion, results (open full item for complete abstract)

Committee: Joel Hughes PhD (Advisor); John Gunstad PhD (Committee Member); John Updegraff PhD (Committee Member); Barbara Drew PhD (Committee Member); Wendy Umberger PhD (Committee Member) Subjects: Experimental Psychology; Health

PHD, Kent State University, 2015, College of Arts and Sciences / Department of Psychological Sciences

The management of chronic obstructive pulmonary disease (COPD) involves complex medical regimens and the majority of patients manage their illness at home. Treatment typically requires the use of inhalers and improper usage can impact treatment effectiveness. Several factors have been found to be associated with lower disease knowledge and worse inhaler technique, potentially decreasing treatment effectiveness. Little is known about the impact of two such factors, health literacy and health numeracy, on patients' ability to effectively manage their COPD. The current investigation consisted of 50 patients with COPD. Participants completed questionnaires and demonstrated how they use their inhalers. A chart review of the prior 12 months checked for healthcare utilization and COPD severity. Adequate levels of health literacy ranged from 75-80% of patients, with 30% having adequate health numeracy. Knowledge of COPD was low. Twenty percent of patients were able to correctly complete all eight inhaler steps. No relationship was detected between health literacy or health numeracy and healthcare utilization. Health literacy and numeracy were not found to be related to errors in inhaler use. Health literacy significantly predicted knowledge of COPD, controlling for cognitive functioning, level of education, and general literacy. Additionally, health literacy was found to mediate the relationship between general literacy and knowledge of COPD. Results indicated that health literacy may impact patients' ability to learn vital information regarding COPD management. Future efforts should focus on developing patient education protocols that take into consideration patients' health literacy.

Committee: Joel Hughes PhD (Advisor); Katherine Rawson PhD (Committee Member); Karin Coifman PhD (Committee Member); Ann Jacobson PhD (Committee Member) Subjects: Psychology

Doctor of Philosophy, The Ohio State University, 2014, Integrated Biomedical Science Graduate Program

Chronic obstructive pulmonary disease (COPD) is a complex respiratory disease primarily caused by cigarette smoking. Cadmium (Cd), a toxic metal abundantly present in cigarette smoke, has been implicated in the development of disease, and accumulates in the bodies of smokers. It was recently discovered that a zinc (Zn) transporter, SLC39A8 (ZIP8), is responsible for the primary import of Cd into cells. Our lab discovered ZIP8 is under the transcriptional regulation of the central inflammatory NF-kappaB pathway. We hypothesize that inflammation in the lung created by smoke exposure increases the expression of ZIP8 thereby facilitating Cd uptake and pathology associated with COPD. The first aim of our work addressed the role of ZIP8 in Cd-mediated epithelial cell toxicity using the adenocarcinomic alveolar epithelial A549 cell line. Cd-induced toxicity was enhanced by TNF-alpha in an NF-kappaB-dependent manner, which stimulated expression of ZIP8. Use of an NF-kappaB (p65) inhibitor (Bay11-7082) or ZIP8 siRNA resulted in a significant decrease in cell toxicity. Cell death was also reversible with increasing concentrations of the micronutrient Zn. Immunohistochemical analysis of primary human upper airway epithelial cells revealed preferential ZIP8 expression on the environmentally-facing apical membrane. Analysis of lung tissue from GOLD stage 0 cigarette smokers and non-smoking controls revealed ZIP8 mRNA and protein to be significantly increased in the lungs of smokers. We translated these findings into a mouse model of chronic cigarette smoke exposure using a transgenic ZIP8 overexpressing mouse line. ZIP8 overexpression dramatically increased emphysematic pathology, compared to smoke exposed C57/Bl6 control mice. In line with previous studies, our epidemiologic analysis of the 2011-2012 National Health and Nutrition Examination Survey revealed blood Cd levels of smokers correlated with lower Zn serum levels. Based on our findings, we contend ZIP8 (open full item for complete abstract)

Committee: Daren Knoell PharmD (Advisor); Estelle Cormet-Boyaka PhD (Committee Member); Mark Failla PhD (Committee Member); Joanne Turner PhD (Committee Member) Subjects: Biomedical Research

Master of Arts, The Ohio State University, 2013, Psychology

Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible disease and is the third leading cause of mortality. Past studies suggest that individuals with COPD have poorer quality of life and decreased psychological well-being compared to the general population. In addition, previous studies indicate that negative illness perceptions among patients with COPD are associated with psychological distress and poor quality of life. However, no prior studies have examined the relationship of caregiver illness perceptions to COPD patient outcomes. This cross-sectional study evaluated the relationship of illness perceptions with quality of life and psychological functioning among patients with COPD and extended the literature by examining the moderating effects of caregiver perceptions in the relationship of patient illness perceptions and patient outcomes. In addition, the current study examined relationship of caregiver illness perceptions and caregiver outcomes. The current study included 55 patients with COPD (85.5% Caucasian, 52.7% male, mean age = 63.5 years, mean FEV1 % predicted = 72.5%) and 36 caregivers (83.3% Caucasian, 72.2%, female, mean age = 58.1). Pearson correlations and hierarchical regression analyses were the primary modes of data analysis. Correlational analyses indicated that patient illness perceptions were associated with patient quality of life and psychological well-being, but not with functional capacity or disease severity. Caregiver perceptions of consequences were associated with poorer physical quality of life and increased burden. Hierarchical regression analysis of patient anxiety revealed an interaction between patient perceived consequences and caregiver perceived consequences. Thus, when caregiver perception of consequences for the patient and self are low, patient perceived consequences is associated with greater anxiety. Regression analyses revealed interactions of patient emotional representation (i.e., negative respons (open full item for complete abstract)

Committee: Charles Emery PhD (Advisor); Julian Thayer PhD (Committee Member); Michael Vasey PhD (Committee Member) Subjects: Psychology

Doctor of Philosophy, The Ohio State University, 2010, Psychology

Studies indicate that women may have a greater risk of diagnosis with chronic obstructive pulmonary disease (COPD) as well as poorer disease outcomes than men. Systemic inflammation has been hypothesized as a critical factor in this sex difference. This study evaluated sex differences in systemic inflammation among men and women with COPD (N=23) prior to and after participation in pulmonary exercise rehabilitation. Before and after rehabilitation participation, participants had blood drawn to measure serum interleukin-6 (IL-6), and participants completed self-report measures of depression, anxiety, quality of life, and dyspnea, as well as standardized assessments of physical fitness. It was hypothesized that women would have higher levels of systemic inflammation, psychological distress, and dyspnea, and lower levels of quality of life and physical fitness at baseline compared with men. In addition, it was hypothesized that men would experience significantly greater improvements on most outcome variables after participating in exercise rehabilitation. Further, it was hypothesized that age, sex, and psychological distress would moderate the relationship between changes in physical fitness and changes in systemic inflammation. Results indicated that women reported higher levels of psychological distress than men at baseline, but that men and women did not differ in terms of systemic inflammation at baseline. In addition, both men and women experienced improvements in multiple outcome variables following exercise rehabilitation. There was limited evidence of any additional improvement for men, beyond that experienced by women, and neither group experienced changes in systemic inflammation as a result of exercise rehabilitation. However, women experienced greater increases in inflammation associated with improvement in physical endurance. Pearson correlations revealed that IL-6 was positively correlated with weight and negatively correlated with pulmonary functioning. H (open full item for complete abstract)

Committee: Charles Emery Ph.D. (Advisor); Janice Kiecolt-Glaser Ph.D. (Committee Member); Michael Vasey Ph.D. (Committee Member); Timothy Buckley Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy, The Ohio State University, 2010, Psychology

Elevated levels of anxiety and high prevalence of anxiety disorders have been observed among patients with Chronic Obstructive Pulmonary Disease (COPD). Decreased heart rate variability has been associated with COPD and poor emotional regulation, but there have not been any prior studies investigating decreased heart rate variability (HRV) as an underlying mechanism that may partially explain the high levels of anxiety in COPD patients. The current study utilized a 2 (disease status) X2 (anxiety group) factorial design with four groups (COPD, COPD-ANX, HEA, HEA-ANX) examining heart rate variability associated with anxiety symptoms in COPD patients compared to healthy controls when exposed to a modified Trier Social Stress Task. Participants were evaluated with pulmonary function tests, HRV monitoring, and self-report questionnaires assessing health behaviors, psychological factors, and dispositional variables. 30 COPD patients were age- and gender-matched with 30 healthy controls. Mean age was 59.1 (±11.2) years and 50% of the participants were female. Participants with COPD presented with severe airway obstruction [mean forced expiratory volume in one second / forced vital capacity ratio (FEV1/FVC) = 0.63 (± 0.15)]. There were no significant differences in resting HRV between groups. Repeated measures ANOVA revealed that the COPD-ANX and HEA-ANX groups displayed a blunted response to a stressor. Although this study was unable to distinguish HRV differences unique to the COPD population, HRV responses to stress in anxious individuals with and without COPD were blunted. Future studies of COPD patients and healthy controls investigating HRV should measure anxiety to avoid the potential confound of high anxiety levels among patients with COPD. Results revealed that the COPD-ANX group had significantly lower psychological well-being and poorer sleep quality than the COPD group. Furthermore, individuals in the COPD-ANX group with pre-existing anxiety prior to their CO (open full item for complete abstract)

Committee: Charles F Emery Ph.D. (Advisor); Steven Beck Ph.D. (Committee Member); Julian Thayer Ph.D. (Committee Member); Michael Vasey Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy, The Ohio State University, 2003, Veterinary Biosciences

The respiratory system serves as a functional gas exchanger which, under neural control, contributes greatly to homeostasis. This study was designed to evoke tracheo-bronchoconstriction by different stimuli and to study the respiratory and hemodynamic effects of three bronchodilators. Tracheo-bronchoconstriction was induced in morphine/chloralose-anesthetized dogs by 5% CO2, 10% O2 or intravenous bethanechol (0.5 mg/kg). Hypercapnia caused no significant (p>0.01) respiratory or hemodynamic effects. Hypoxia significantly (p<0.01) increased heart rate (HR), pulmonary artery pressure (Pap), cardiac output (CO), and peripheral vascular resistance (PVR). No significant changes were observed in left ventricular end-diastolic pressure (LVEDP), tracheal pressure (Tp), airway pressure (Paw), bronchial pressure (Brp), and pulmonary compliance (PC) due to hypoxia. Changes due to gas mixtures were transient and returned to baseline upon normal respiration. In contrast, bethanechol caused significant increases in Pap, LVEDP, PVR, Tp and Paw with no significant changes in HR, CO or Brp. Compared to gas mixtures, bethanechol produced greater respiratory and hemodynamic effects that may resemble asthma and chronic obstructive pulmonary disease. Four groups of dogs were used to compare the respiratory and hemodynamic effects of aminophylline, atropine, terbutaline, or saline control on bethanechol-induced bronchoconstriction. Both atropine (0.04 mg/kg) and aminophylline (20 mg/kg) increased HR significantly (p<0.006) compared to control. Atropine, starting at 0.02 mg/kg, significantly decreased the bethanechol-elevated Pap, with no changes in the other groups. Atropine (0.02 mg/kg) and aminophylline (20 mg/kg) significantly decreased LVEDP after bethanechol. Atropine decreased 65% of the elevated Tp compared to 47%, and 12.6% for terbutaline, and aminophylline, respectively. Only terbutaline significantly decreased Paw and increased PC. No significant changes were observed in CO, PV (open full item for complete abstract)

Committee: Dr. Robert Hamlin (Advisor); Dr. S. Strauch (Other); Dr. Kathryn Meurs (Other); Dr. Roger Stradley (Other) Subjects:

Doctor of Philosophy, The Ohio State University, 2003, Psychology

Previous research suggests that marriage and marital satisfaction is associated with morbidity and mortality across various chronic diseases. However, no studies have examined marital adjustment in the context of patients with chronic obstructive pulmonary disease (COPD) participating in exercise rehabilitation, despite evidence suggesting that COPD may lead to marital distress. Fifty-two patients with COPD and their partners were evaluated on measures of marital adjustment before and after an 8-week exercise rehabilitation program. Patients were evaluated on measures of psychological well-being, pulmonary function, functional capacity, dyspnea, and quality of life. Specific hypotheses tested included: 1) marital adjustment and quality of life among COPD patients and their partners will be poor compared to a healthy normative sample, 2) depression and anxiety will mediate the relationship between marital adjustment and quality of life, 3) dyspnea will mediate the relationship between marital adjustment and quality of life, 4) marital adjustment will moderate the relationship between functional capacity and quality of life, 5) anxiety, depression, dyspnea, functional capacity, quality of life, and marital adjustment will improve over time among patients participating in an 8-week exercise rehabilitation program, and 6) baseline marital adjustment will predict changes in dyspnea, functional capacity, quality of life, depression, and anxiety over an 8-week rehabilitation program. Results indicated several findings including: 1) contrary to expectations, patient and partner marital adjustment was high, 2) socioeconomic status was associated with patient functioning but not marital adjustment, 3) marital adjustment was associated with psychological well-being, functional capacity, and quality of life, 4) depression and anxiety mediated the relationship between marital adjustment and quality of life except when controlling for social support, 5) quality of life, functiona (open full item for complete abstract)

Committee: Charles Emery (Advisor) Subjects:

Doctor of Philosophy in Biomedical Sciences (Ph.D.), University of Toledo, 2009, College of Medicine

COPD is characterized by chronic inflammation in the lung, and its severe stageexacerbation is one of the major burdens of healthcare, causing diminished quality of life and highly increased mortality rate. Most common treatments for COPD could only improve the symptoms, but do not suppress the undergoing inflammations. Our study based on understanding the molecular basis of M. catarrhalis-induced innate immune responses on pulmonary epithelial cells and monocytes would help to identify new therapeutic target for COPD. M. catarrhalis has been proved to be the third leading cause of COPD. We found that M. catarrhalis could induce CCL20/MIP-3α expression mainly through TLR2-MyD88-TRAF-6-NF-κB/MAPK signaling pathway on pulmonary epithelial cells. Only TLR2, but not TLR4 signaling pathway can be activated on those cells during M. catarrhalis infection. Study on stable transfected HEK293 cells suggested that CD14 and MD2 are critical to activate TLR4 signaling; and sCD14 could enhance TLR2-mediated inflammatory responses. Thus our hypothesis is that lack of CD14 and MD2 might contribute to the silence of TLR4 signaling; and sCD14 released from monocytes could modulate TLR2- and TLR4-mediated inflammatory responses on airway epithelial cells. Both mCD14 and sCD14 expression levels are very low on naive monocytic THP1 cells. 1α, 25-dihydroxy VD3 and specific ligands of TLR2 and TLR4 could increase mCD14 and sCD14 expression, which up-regulates both TLR2- and TLR4-mediated inflammatory responses on THP1 cells. Meanwhile, conditioned media from 1α,25-dihydroxy VD3 primed THP1 cells could activate TLR4 signaling pathway and enhance TLR2-mediated inflammatory responses on pulmonary epithelial cells under M. catarrhalis infection. Such amplified inflammatory responses could be abolished by CD14 antibody. All these data suggest that sCD14 could mediate a crosstalk between monocytes and pulmonary epithelial cells to mount an amplification loop through TLR2 and TLR4 during bacteri (open full item for complete abstract)

Committee: Z. Kevin Pan M.D., Ph.D. (Committee Chair); Linyu Chen MD, Ph.D. (Committee Member); Randall Worth Ph.D. (Committee Member); Robert Blumenthal Ph.D. (Committee Member); James Trempe Ph.D. (Committee Member) Subjects: Biology; Biomedical Research; Health; Immunology; Microbiology; Molecular Biology

Doctor of Philosophy in Medical Sciences (Ph.D.), University of Toledo, 2007, College of Graduate Studies

Moraxella catarrhalis is a Gram-negative unencapsulated pathogen of the human respiratory system. This pathogen is responsible for ~20% of the otitis media cases and ~10% of all exacerbations of chronic obstructive pulmonary disease in the United States. To complicate matters, greater than 90% of all M. catarrhalis isolates examined to date are resistant to the a-lactam class of antibiotics, and therefore, a vaccine that elicits an immune response against this pathogen is highly desirable. To that end, the work presented here focuses on examining the feasibility of the Hag adhesin from M. catarrhalis as a vaccine antigen. Previous work has shown that Hag is a large, 2000 amino acid, autotransporter protein and that mediates M. catarrhalis attachment to A549 and human middle ear epithelial cells. Hag also has been shown to form oligomers and is responsible for lollipop like projections on the M. catarrhalis surface. In order to further explore Hag's characteristics, four M. catarrhalis strains were assayed for the ability to bind to pathogenically relevant cells, namely A549 (lung), NCIH292 (lung), HMEE (middle ear) and Chang (conjunctival) cell lines. This work revealed that Hag is necessary for attachment to all four of these cells lines. When Hag was expressed in non-adherent E. coli, it was able to mediate attachment to collagen as well as NCIH292 and HMEE cells. When the hag genes from seven M. catarrhalis isolated were analyzed, it was observed that the encoded protein products contained predicted motifs that were structurally similar to those found in YadA from Yersinia enterocolitica, the prototypical trimeric autotransporter. Previous work had shown that YadA forms lollipop like structure on the Y. enterocolitica surface and that attachment to epithelial cells and collagen is mediated through an N-terminal globular head. When Hag mutants lacking this head structure were expressed in E. coli, these bacteria were still able to bind to epithelial cells and coll (open full item for complete abstract)

Committee: Eric Lafontaine, Ph.D. (Advisor) Subjects: Biology, Microbiology

MS, University of Cincinnati, 2013, Pharmacy: Pharmaceutical Sciences

Objective: The objective of this study was to quantify associations between the use of long-acting beta agonists (LABAs) and health outcomes, including emergency-room (ER) visits, number of hospitalizations, total days spent in the hospital, and total direct medical costs, for patients with chronic obstructive pulmonary disease (COPD). Methods: The primary data source was a multistate Medicaid claims database, which covers 6 to 7 million enrollees from 9 or 10 state Medicaid programs depending on the year. The study period was from 2002 to 2007. A retrospective cohort study was conducted. Medication regimens examined were suggested by the 2004 Global Initiative for Chronic Obstructive Lung Disease Guidelines. Study drugs included LABAs, anticholinergics (including tiotropium), allergy medication, inhaled corticosteroids (ICSs), P.O. steroids, short-acting beta agonists (SABAs), and theophylline. Due to their similar patient profiles (both drug classes are presecribed for moderate or severe COPD patients), health outcomes were compared specifically between patients receiving LABAs and patients receiving tiotropium. Selection bias was controlled through the use of propensity scores. Student t-tests and chi-square tests were conducted to compare the initial amounts of bias between different groups. Poisson regression analysis was conducted to assess the risk of hospitalizations, number of days in the hospital, and ER visits, respectively,for study patients. A loglinear regression was performed to obtain an estimate of the total treatment costs for study patients. Results: Patients with a LABA only had a significantly higher number of hospitalizations compared to patients taking tiotropium only (p=0.038), although there were no statistically significant differences in ER visits, days in the hospital, or total treatment costs between the two groups. Patients with any LABA use had a lower risk of an ER visit (RR=0.932; 95% CI 0.925-0.938), but a higher risk of a hos (open full item for complete abstract)

Committee: Jianfei Guo Ph.D. (Committee Chair); Christina Kelton Ph.D. (Committee Member); Patricia Wigle Pharm.D. (Committee Member) Subjects: Pharmaceuticals