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OpenBU is Boston University’s digital institutional repository for scholarly articles, theses and dissertations, preprints, and grey literature. This repository enables BU researchers to share, disseminate, and preserve their scholarship, and makes their research more accessible
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Recent Submissions
The life situation-approach in the curriculum of religious education
(Boston University, 1933) Croy, Oakley Easley
The cost efficiency of semaglutide in patients with obesity
(2024) Luo, Andrew; Offner, Gwynneth; Gong, Haiyan
The number of Americans who are diagnosed with obesity and type 2 diabetes mellitus has been on a steady incline for at least the past 20 years. An increase in the number of patients struggling with these diseases comes with what seems like a correlating increase in the costs of healthcare. Significant innovations have been improving the quality of life and treating obesity and diabetes since the 1960s. However, with the increases in costs of care, it is important to understand the cost efficacy of newer medications periodically to gain a comprehensive understanding of the cost efficacy of these medications in improving the quality of life and health of these patients. Therefore, this paper will focus on the cost efficacy of Semaglutide, a new drug that functions as a glucagon-like peptide-1 (GLP-1) agonist. Other drugs and procedures on the market, such as Liraglutide, Contrave, Orlistat, phentermine-topiramate, and gastric bypass surgery, will be used as a comparison for Semaglutide. Based on a year's supply of the drug and the percentage of weight lost, the cost to lose weight was found. Then, based on the percent weight lost, the projected savings in medical care expenditure were calculated. This results in a ratio that compares the benefits to the cost of the medication. As a result, Semaglutide was effective in reducing weight; however, the price of the drug makes it less cost-efficient than other options on the market. However, it still has its place as it is still more cost-efficient than other medications, and it also has a different mechanism of action, which helps prove useful for certain types of patients.
Healthcare professional student integration into inpatient smoking cessation programs
(2024) May, Rachel; Gallardo Foreman, Alexis; Kathuria, Hasmeena
Smoking cessation counseling is an important aspect of preventative care in the United States, as smoking has numerous detrimental effects on health. Many hospital systems, such as Boston Medical Center, have begun to integrate programs in the inpatient setting to help with helping admitted patients to quit smoking. This thesis examines the current state of smoking cessation in the United States, especially with focus on the inpatient setting, as well as explores the current smoking cessation education in healthcare professional programs and related student interventions. This thesis reviewed numerous inpatient smoking cessation programs and identified areas for improvement, including the volume of patients counseled, and identified students as an untapped potential resource for helping to increase the number of patients that can be counseled. A study proposed will integrate Boston University Physician Assistant students into Boston Medical Center’s inpatient smoking cessation programs, and investigate whether hands-on experience with counseling patients leads to improved confidence and knowledge for students. The intervention will consist of interactive lectures about smoking cessation and available pharmacotherapy, followed by small group discussions, and finally opportunities to counsel patients in the inpatient setting. Study variables and measures will include comparison of pre- and post-test scores, as well as self-reported confidence scores before and after the intervention. This study will provide important information for educators about whether hands-on experience in smoking cessation counseling can better prepare healthcare professional students for clinical practice. Additionally, future studies are needed to further build on this framework and explore if students can help to expand volumes of patients counseled in the inpatient setting.
Assessing genitourinary and gastrointestinal toxicities in men with localized prostate cancer post high dose rate brachytherapy boost
(2024) Liang, Karren; Gong, Haiyan; Baine, Michael J.
Prostate cancer (PCa) remains one of the top leading cancer in the United States, with more advanced prostate cancer cases being diagnosed. While traditional curative treatments are limited in treating these aggressive cases, advancements in technology have pioneered modern radiotherapy techniques to address this issue, specifically high-dose rate brachytherapy boost (HDR-BTb). With level 1 evidence demonstrating higher efficacy than traditional techniques, however, it remains unconvinced that this technique could be offered to this cohort and able to produce tolerable toxicity profiles based on previous parameters. The aim of this study was to assess the incidence and extent of acute and chronic genitourinary (GU) and gastrointestinal (GI) toxicity profiles in men with high- or intermediate- unfavorable prostate cancer cases after HDR-BTb treatment in a single institution. It was found that both acute GU and GI toxicities were well tolerated, with 12.5% and 4.4% reporting CTCAE Grade 2+, respectively. In addition, reported CTCAE Grade 2+ rates for chronic GU and GI toxicities were 2.5% and 0%, respectively. Further, we found that previous factors associated with these toxicity profiles, such as increased prostate volume and baseline American Urological Association (AUA) score, are not relevant in a clinical setting when offering this treatment option.
The fate of vascular smooth muscle cells in Marfan aortic aneurysm
(2024) MacPhee, Jillian; Seta, Francesca; Young, Aaron
Vascular smooth muscle cells (VSMCs) function in the aortic vasculature as contractile units, regulating vessel diameter and blood flow, in a complex dynamic with the extracellular environment. Upon vascular injury, and in response to various physiological mediators, VSMCs de-differentiate to a non-contractile synthetic phenotype, that displays an array of physiological properties including increased proliferation rate, matrix metalloprotease (MMP) secretion, and extracellular matrix (ECM) production. These synthetic functions can lead to VSMC apoptosis, maladaptive ECM remodeling, or vessel hyperplasia, respectively, and contribute towards aortic pathogenesis. Aortic aneurysm (AA) is the most clinically fatal manifestation of the autosomal dominant genetic disorder Marfan Syndrome (MFS), which is characterized by medial degeneration, vessel thickening and weakening, and increased risk for aortic dissection. Mutations of fibrillin-1 (Fbn1) are widely understood to be the primary genetic contributor to MFS. Fbn1 is a microfibrillar protein that plays an important role in elastic lamellae formation and overall medial structure and function. Given the limitations and barriers to genotherapy, research on other medicinal and therapeutical treatments targeting the mechanism of MFS AA pathogenesis is warranted. Understanding VSMC switching or other concurrent disease processes, such as inflammatory mediators, and structural degeneration, a primary contributer to medial degeneration, is crucial to develop novel therapies. In this study, I sought to explore the morphological and structural features of the aneurysmal aorta of a mouse model of MFS when compared to wildtype (WT) aortas by staining with Hematoxylin and Eosin (H&E). I further sought to analyze the pathophysiological features of model MFS AA and other related models (MFS mice lacking anti-oxidant enzymes situin-1 or glutaredoxin-1), that exhibit exacerbated aneurysm, by immunofluorescence (IF) staining using primary antibody markers for contractile VSMCs (calponin), macrophages (F4/80), and proliferating VSMCs (KLF4).The H&E staining results showed minimal visual differences in WT and MFS structural integrity, besides mild VSMC disorganization, which infers a level of elastic lamellae disruption. Moreover, there were significant differences in the tissue quality and structural integrity of the medial layer when comparing more severe forms of MFS AA to WT aortas, revealing elastin fragmentation, cellular disorganization, and medial degeneration in the Fbn1-/- and Glrx-/- Fbn1-/- groups. The IF staining results showed limited variability in the average calponin fluorescence intensity per area of aorta between genotypic groups, which indicates that there is little contractile VSMC loss in MFS and related models of AA when compared to WT. Futhermore, there was a significant increase in the average F4/80 fluorescence intensity per area of aorta in MFS model mice, and especially MFS mice with VSMC specific Sirtuin-1 (SirT1) knockout (KO), when compared to WT aortas. Variability in the KLF4 flourescence intensity per area results between groups highlights the complexity of VSMC phenotypic switching. In conclusion, these results seem to indicate that macrophages play a more significant role in MFS and related AA pathogenesis, rather than the loss of contractile VSMCs due to phenotypic switching, however further trials are needed to increase the sample size and external validity of the study. The pathophysiological mechanism of MFS AA should be further exploited to reveal new targets for therapeutic intervention.
Vaccine hesitancy: a systematic literature review on the rationale behind parental vaccine hesitancy and its effects on pediatric medicine
(2024) Lavache, Dorine S.; Barnett, Elizabeth
Vaccine hesitancy remains a constant threat to global health despite the release several public health initiatives aimed at targeting and reducing vaccine hesitancy. The aftermath of the COVID-19 pandemic and rapid release of the SARS-CoV-2 vaccine resulted in increased vaccine hesitancy amongst individuals. Within pediatric medicine, concerns over the doubt and efficacy of vaccines has led to a significant decrease in the number of children receiving vaccines. Parental delay or refusals of vaccines, termed vaccine hesitancy, has resulted in a recurrence of vaccine preventable diseases such as measles, pertussis, and diphtheria. This review of the literature attempts to understand the parental reasons for continued vaccine hesitancy, examine the effects of the COVID-19 pandemic on vaccine hesitancy, and examine how continued vaccine hesitancy is affecting healthcare. An analysis of the literature revealed that health education, geographic location, and economic status are all contributing factors of vaccine hesitancy. More information is needed on this topic to better address and education vaccine hesitant parents.
The effect of smoking status and smoking cessation therapy on pseudarthrosis rates in spinal fusion
(2024) Norton, Brittany; Weinstein, John; Vu, Thai
Cigarette smoking is a public health crisis in the United States and poses an increased risk for postoperative complications across many surgical specialties. The pathophysiologic effects of nicotine on bone health have been well elucidated and have led to an interest in the effects of smoking status and smoking cessation on procedures involving bone fusion, such as spinal fusion. Lumbar degenerative disc disease is the most common indication for this procedure, which serves to stabilize the spine and can be performed using different surgical approaches. Pseudarthrosis is a potential complication of spinal fusion that may be associated with smoking status and can lead to increased postoperative pain, disability, and reoperation. Although the relationship of nicotine on bone integrity has been established, the application of this knowledge to patients specifically undergoing spinal fusion who currently smoke or have a significant smoking history is still underway. In recent studies evaluating the effects of smoking status on fusion rate and clinical outcomes after lumbar spinal fusion, postoperative smoking cessation was found to significantly decrease nonunion rates compared to active smokers. Additional studies showed that the use of any form of nicotine replacement therapy was associated with significantly decreased odds of developing any postoperative complication, but not pseudarthrosis specifically. Only one study to date has utilized an animal model to evaluate the independent effects of varenicline, a nicotine replacement, on spinal fusion outcomes and demonstrated that varenicline does not negatively interfere with the process of bone fusion. The proposed retrospective cohort study aims to analyze the development of radiographic pseudarthrosis following lumbar spinal fusion for the treatment of degenerative disc disease in nonsmokers, smokers treated with varenicline perioperatively, and active smokers not treated with varenicline perioperatively. If the results of this study demonstrate a decreased rate of pseudarthrosis in patients receiving varenicline perioperatively, perioperative guidelines for providers to prescribe appropriate smoking cessation therapy to patients undergoing spinal fusion may be better defined and healthcare costs associated with the treatment of pseudarthrosis will be improved. This study also has the potential to guide further research prospectively evaluating the use of varenicline and other smoking cessation therapies in patients undergoing spinal fusions.
Mineralocorticoid treatment and quality of life in primary adrenal insufficiency
(2024) McIntosh, Elise; Weinstein, John; Knapp, Philip
BACKGROUND: Patients with Primary Adrenal Insufficiency (PAI) report reduced quality of life. The existing research on clinical outcomes in patients with PAI has primarily focused on glucocorticoid (GC) replacement with inadequate analysis of outcomes related to fludrocortisone treatment (mineralocorticoid management). The aim of this study is to implement a nonpharmacologic intervention associated with fludrocortisone replacement to improve Health-Related Quality of Life (HRQOL).
PROPOSED PROJECT: The study would include 320 participants with newly diagnosed PAI divided into two groups: experimental and control. Each group will receive standardized pharmacologic GC and MC treatment using a standardized algorithm for a three-month run-in period. The experimental group will receive a standardized educational video describing non-pharmaceutical techniques to manage salt/water intake in specific situations, such as during exercise or hot weather. Each group will complete the specific quality of life in Addison’s disease questionnaire (AddiQOL) at designated intervals. With a study population of 320, randomized into two groups of 160, the study will be powered to 80% to detect a standardized effect of 0.3. This constitutes an effective size of small to medium using Cohn’s kappa, signifying that a difference will be detected if there is one.
CONCLUSIONS: This study will assess whether an intervention aimed at strengthening patients’ knowledge regarding nonpharmacologic methods to augment their MC management can improve HRQOL as assessed by AddiQOL.
Drug-induced liver injury in selective Androgen Receptor Modulator users
(2024) Narravula, Raghav; Gong, Haiyan; Law, James
Selective Androgen Receptor Modulators (SARMS) were initially administered with the intention of preventing muscle-wasting in cancer patients. In the past couple of decades, with increased popularity in recent years, athletes and bodybuilders have used SARMS as an alternative to traditional Androgenic-Anabolic Steroids. SARMS are virtually unregulated and can be easily purchased online. This thesis reviewed and analyzed 17 case studies concerning adult males with Drug-Induced Liver Injury after using Ostarine, RAD-140, and Ligandrol. Cholestatic or Mixed Drug-Induced Liver Injury occurred in 16 of the cases, while Hepatocellular Drug-Induced Liver Injury occurred only once. The single case of Hepatocellular Drug-Induced Liver Injury was also the only case that was not accompanied by a hyperbilirubinemia. A standardized Roussel Uclaf Causality Assessment Method (RUCAM) showed SARMS to be the probable cause of 5 of the cases presented and possible cause in the remaining 12 cases. These results were often skewed because post-hospital laboratory testing was unavailable and RUCAM also factors in reoccurring exposures which did not occur in any of the cases. Little research has been conducted on side effects of SARMS and drastic policy changes are necessary to prevent a public health crisis.
The effects of transcranial direct current stimulation (tDCS) during sleep on affect and alertness
(2024) Nijhawan, Diya; Gobrogge, Kyle; Cunningham, Tony
BACKGROUND: Previous studies have identified how transcranial direct current stimulation (tDCS) treatment during sleep could be used in the management of psychiatric disorders. However, inconsistencies persist regarding changes in mood and alertness on participants resulting from administration of tDCS treatment.
METHODS: In this crossover, counter-balanced study, healthy participants were given both stimulation and sham tDCS treatment during two separate two-hour nap sessions as a part of a larger clinically-oriented trial. This pilot analysis tracked changes in mood and alertness based on scores from the Positive Affect and Negative Affect Scale (PANAS) and Stanford Sleepiness Scale (SSS), respectively. These were measured before and after completion of a two-hour stimulation nap and a two-hour sham nap.
RESULTS: Positive and negative affect scores on the PANAS both saw a significant decrease in the sham nap condition. There was no significant change in affect measures pre- to post-stimulation nap. However, stimulation nap sessions found a similar inhibition in positive and negative affect scores, as no significance in magnitude was found between the sham and stimulation nap sessions. There were no significant changes in alertness as measured by the SSS.
CONCLUSION: In summation, there was a significant reduction in positive and negative affect scores during the sham nap with no significant difference in magnitude found during the stimulation nap. While a sample size of fourteen participants limits generalizability, the within-subjects design provides a valid framework for data consideration from this pilot study. Therefore, more efforts should be directed towards investigating changes in mood and alertness resulting from tDCS treatment during sleep. Continued enrollment of both healthy and patient populations must be evaluated for shifts in positive and negative affect because of the application of tDCS during sleep.