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The goal of this staff education project is to increase patient awareness of early detection and self-management of cardiovascular disease (CVD) through the education of staff in an Arkansas cardiovascular clinic. Heart disease is the leading cause of death in Arkansas and the fourth highest in the country. The practice-focused question was: Does effective education for nursing staff regarding early detection and self-management of heart disease in adults help improve staff knowledge and willingness to educate patients as measured by pretest and posttest? Increasing patient knowledge in improving modifiable factors (e.g., physical activity, nutrition, monitoring of BMI, and cholesterol) can improve the condition of the patient living with heart disease. Assisting patients to adopt lifestyle changes can improve quality of life, reduce rehospitalizations, and minimize eventual complications. A pretest was given to nurses to measure their knowledge prior to the educational presentation. After the presentation, a posttest was given with the same questions. In the pretest, 61% (20 out of 33) of nurses correctly answered questions that assessed general CVD knowledge. After training, 91% (30 out of 33) of nurses correctly answered the questions. Personalized patient educational materials must be readily available for patients to take home. Books containing pictures will allow patients to easily understand complex concepts. Education personalized to each patient can achieve a more diversified and inclusive approach and deliver positive social change. Informed individuals often share what they learn with family and friends, creating ripple effects. This peer-to-peer influence can encourage communities to prioritize health and adopt healthier lifestyles, reducing morbidity and mortality.

Context: Endodontically treated premolars are currently restored with direct bonded techniques in conservative manner enabling them to bear functional stresses homogeneously. Aim: The study aimed to evaluate the effect of placement of compactable glass fibers in reinforcing the endodontically treated teeth in a novel conservative manner. Settings and Design: Research laboratory, in vitro study. Materials and Methods: Seventy-five extracted maxillary premolars were procured. Fifteen teeth were left untreated (Group A) and the remaining teeth were endodontically treated followed by standardized mesio-occluso-distal preparation and randomly assigned to experimental groups (n = 15) as follows: (B) no restoration, (C) restoration with composite, (D) EverStick® POST followed by composite, and (E) vertical glass fibers within 3 mm of the coronal root canal space and buccopalatal flaring of the coronal fibers followed by composite. After conditioning and thermocycling, specimens were loaded under a universal testing machine to evaluate fracture resistance and fracture pattern of specimens. Statistical Analysis Used: Obtained scores were statistically analyzed using one-way analysis of variance test for stress analysis, post hoc Tukey's test for intergroup comparison, and Chi-square test for analysis of favorable and unfavorable fracture. Results: The fracture resistance was highest to lowest as follows: Group A > E > C > D > B (P < 0.001). Conclusion: EverStick®POST used in conservative manner improved fracture strength of teeth significantly.

Rhabdomyosarcoma (RMS) is a childhood cancer originating from skeletal muscle, and patient survival is poor in the presence of metastatic disease. Few determinants that regulate metastasis development have been identified. The receptor tyrosine kinase FGFR4 is highly expressed in RMS tissue, suggesting a role in tumorigenesis, although its functional importance has not been defined. Here, we report the identification of mutations in FGFR4 in human RMS tumors that lead to its activation and present evidence that it functions as an oncogene in RMS. Higher FGFR4 expression in RMS tumors was associated with advanced-stage cancer and poor survival, while FGFR4 knockdown in a human RMS cell line reduced tumor growth and experimental lung metastases when the cells were transplanted into mice. Moreover, 6 FGFR4 tyrosine kinase domain mutations were found among 7 of 94 (7.5%) primary human RMS tumors. The mutants K535 and E550 increased autophosphorylation, Stat3 signaling, tumor proliferation, and metastatic potential when expressed in a murine RMS cell line. These mutants also transformed NIH 3T3 cells and led to an enhanced metastatic phenotype. Finally, murine RMS cell lines expressing the K535 and E550 FGFR4 mutants were substantially more susceptible to apoptosis in the presence of a pharmacologic FGFR inhibitor than the control cell lines expressing the empty vector or wild-type FGFR4. Together, our results demonstrate that mutationally activated FGFR4 acts as an oncogene, and these are what we believe to be the first known mutations in a receptor tyrosine kinase in RMS. These findings support the potential therapeutic targeting of FGFR4 in RMS.

The postcolonial momentum around nation-building, along with the transnational sentiment on decolonisation and development ensured a rhizomatic use of the photographic medium in India in the 1950s and 1960s. Considering the enormous production and dissemination of repetitive, mundane and largely unspectacular official photographs in state archives, and national and transnational bureaucratic networks, this dissertation is a focused study of the photographic vision of the postcolonial state. At a time when the nation was riding high on utopian futuristic aspirations, curating and managing 'optics' was central to the formation of the new nation and the consolidation of the postcolonial state. To add to this, an increasingly insecure Cold-War context and an emerging transnational network formed by seeing (and hiding from) each other, constantly interrupted and constituted the state's optical frame. The chapters explore photography as an expansive medium beyond the photograph-photographer binary and attempt to write histories situated in the functional presence of photography within the exhibition space, in official albums and archives and diplomatic exchange. In doing so, the dissertation interrogates the postcolonial state's caste-blind modernity and displacement-led development from a critical subaltern lens, puncturing official projections which have had the power to dictate the optics of inclusion and exclusion. This dissertation argues that there is value in complicating photography's relationship to seeing, deconstructing its evidentiary potential and questioning photographs as historical knowledge, to write a history of seeing and unseeing through the photographic medium. This dissertation contributes to postcolonial writing, photographic histories and visual culture studies, by attempting to reformulate our ways of seeing and unseeing through the 'language of rights', thereby asking questions about knowledge and power embedded into the photographic vision.

Aim: The study evaluated the effectiveness of three intermediate endodontic irrigating solutions in eliminating the residual sodium hypochlorite (NaOCl), thus preventing the formation of the orange-brown precipitate when 2% chlorhexidine (CHX) is used as the final irrigant. Materials and Methods: A total of 40 extracted human maxillary anterior teeth were selected, disinfected, and decoronated to obtain a standardized length of 10 mm. The teeth were prepared with Protaper universal rotary files until size F4 using 2.5% NaOCl as an irrigant during instrumentation. The teeth were then randomly divided into four groups of 10 samples each based on the irrigating solutions used during final wash sequence as follows: Group A - (2.5% NaOCl and 2% CHX), Group B - (2.5% NaOCl followed by 70% Isopropyl Alcohol and 2% CHX), Group C - (2.5% NaOCl followed by 6.25% sodium metabisulfite and 2% CHX), and Group D - (2.5% NaOCl followed by 3.86% sodium Thiosulfate and 2% CHX). The roots were sectioned longitudinally and the canal surface was evaluated under dental operating microscope (×16) for the presence of orange-brown precipitate. The results were tabulated as per scoring criteria and statistically analyzed. Statistical Analysis Used: One-way ANOVA test and post hoc Tukey's test. Results: The lowest mean score was observed in Group C, followed by Group D and Group B, respectively. In comparison, there was a statistically significant (P

Background: The nutrition support of children with biliary atresia after liver transplant is affected by multiple factors, and a connection between these factors and conditions present before transplant can potentially make the nutrition support more challenging. We aim to assess the adequacy of nutrition support, specifically energy and protein, during the first week of admission to the Pediatric Intensive Care Unit (PICU) in children after liver transplant secondary to biliary atresia. Methods: We performed a retrospective cohort study of 138 patients [13.9 median (9–33.4) IQR months; 62% female] with a diagnosis of biliary atresia admitted to the PICU after liver transplantation at Texas Children’s Hospital over a 14-year study period. We obtained nutrition adequacy of enteral and parenteral nutrition support for the first week after transplant during their PICU admission. Results: Goal adequacy was reached at the end of the first week of admission when combined enteral and parenteral nutrition support was provided (median 98% for energy and 101% for protein). Infants achieved significantly higher adequacies than older children during the first week (136% < 1 year vs. 0% > 1 year, p < 0.001 for calories, and 157% < 1 year vs. 0% > 1 year for protein; p < 0.01). Conclusions: These findings highlight the complex nutritional challenges faced by this population, and strategies are needed to meet the unique needs of children after liver transplantation.

Beta-thalassemia (ß-thalassemia) is a frequently inherited monogenic disorder worldwide with severe physical and mental health comorbidities. The aim of this study is to evaluate the burden of psychiatric disorders in adult patients hospitalized with ß-thalassemia in the United States (US). We utilized the discharge data from the National Inpatient Sample (NIS) from 2010 through 2014 to identify hospitalized ß-thalassemia patients who are 18 years and older. We assessed categorical and continuous variables using chi-square test and Student’s t test respectively. The burden of psychiatric disorders was assessed using descriptive statistics and represented in terms of frequency (n) and percentage (%). A p value threshold of < 0.05 was considered clinically significant. All statistical analyses were performed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Of the 10,046 ß-thalassemia patients studied, 24.4% (n = 2448) reported psychiatric disorders. Mood disorders (15.2%; inclusive of 10.3% depression), followed by anxiety (9.4%), and substance abuse disorder (6.5%; 4.3% drug abuse, 2.2% alcohol abuse) were most prevalent. Comorbid mental illnesses increased the length of stay by 44.6% and total costs by 23.4%. All-cause mortality rate was reported at 1.9% in overall ß-thalassemia patients. This study highlights higher rates of psychiatric disorders such as depression and anxiety and correlated increases in length of stay and cost in hospitalized ß-thalassemia patients. To improve medical outcomes and curtail unnecessary health-care costs, implementation of an integrated care model can be considered.

Acute Myeloid Leukemia (AML) therapy continues to be a daunting challenge. Cytosine Arabinoside (Ara-C) is widely used to treat hematological malignancy in humans, but often becomes ineffective because of increased resistance to the drug which may lead to a worse prognosis. Therefore new strategies are needed to understand the mechanism responsible for drug resistance and to develop new therapies to overcome it. Research evidence based on natural compounds used alone or in combination with current chemotherapeutic agents proved their efficacy to treat and prevent cancer. Hesperidin and Silibinin displayed anti-cancer activity against various types of cancers and cell lines and can be used in combination with Cytarabine with the aim to increase cytotoxicy profile and reduction in drug resistance. Experimental Work: Primary cells obtained from AML patient's bone marrow were used to develop in-vitro model and further exposed to various concentration of Cytarabine (10 nM-5000 nM), Hesperidin (0.5 μM-100 μM) and Silibinin (0.5 μM-100 μM) alone and in combination with Cytarabine (Hesperidin-25 μM, Silibinin10 μM) to check cytotoxicity using MTT assay. Synergistic effect was evaluated by Combination Index method. In-vitro study of Hesperidin and Silibinin indicated their cytotoxicity at IC 50 value 50.12 μM and 16.2 μM, respectively. Combination Index study revealed Hesperidin and Silibinin both showed synergistic potential and decreased the IC 50 value of Cytarabine by ~5.9 and ~4.5 folds, respectively. Both natural compounds showed potential anti-leukemic activity hence may be used for AML therapy alone or in combination with other chemotherapeutic agents.

Despite the growing prevalence of adult congenital heart disease (ACHD), data on trends in prevalence of mental health disorders (MHD) among patients with ACHD remain limited. The National Inpatient Sample (2007 to 2014) was queried to identify the frequency and trends of MHD among ACHD hospitalizations (stratification by age, sex, and race); demographics and co-morbidities for ACHD cohorts, with (MHD+) versus without MHD (MHD-); the rate and trends of all-cause in-hospital mortality, disposition, mean length of stay, and hospitalization charges among both cohorts. A total of 11,709 (13.8%, mean age: 49.1 years, 56.0% females, 78.7% white) out of 85,029 ACHD patient encounters had a coexistent MHD (anxiety, depression, mood disorder, or psychosis). ACHD-MHD+ cohort was more often admitted nonelectively (38.1% vs 32.8%, p <0.001) and had a higher frequency of cardiac/extra-cardiac co-morbidities. The trends in prevalence of coexistent MHD increased from 10.3% to 17.5% (70% relative increase) from 2007 to 2014 with a consistently higher prevalence among females (from 13% to 20.3%) compared to males (from 7.6% to 15.5%) (ptrend <0.001). The hospitalization trends with MHD increased in whites (12.1% to 19.8%) and Hispanics (5.9% to 12.7%). All-cause mortality was lower (0.7% vs 1.1%, p = 0.002) in ACHD-MHD+; however, mean length of stay (∼5.7 vs 4.9 days, p <0.001) was higher without significant difference in charges ($97,710 vs $96,058, p = 0.137). ACHD-MHD+ cohort was less often discharged routinely (declining trend) and more frequently transferred to other facilities and required home healthcare (rising trends). In conclusion, this study reveals increasing trends of MHD, healthcare resource utilization and a higher frequency of co-morbidities in patients with ACHD.