Browsing by Author "Crack, Laura Elizabeth"
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- ItemEmbargoBone Loss and Fracture Risk Following Spinal Cord Injury: Patient Priorities and Treatment Options(2024-04-22) Crack, Laura Elizabeth; Edwards, W. Brent; Gabel, Leigh; Kline, GregRapid and profound bone loss is a well-known secondary complication following spinal cord injury (SCI), occurring primarily below the level of neurological lesion due to mechanical disuse. The greatest loss of bone is experienced during the acute phase of injury, and established osteoporosis often persists into the chronic phase, with no current standard care plan for patients. The main goals of this thesis were to: (1) explore patient knowledge and awareness regarding bone loss, fracture risk and treatment options following SCI, and (2) to investigate pharmaceutical treatment options to prevent bone loss in acute SCI, as well as treat established osteoporosis in chronic SCI. Three independent studies were carried out and are presented in Chapters 3-5, respectively. Survey results demonstrated that while more than half of participants with SCI were able to correctly answer knowledge-based questions regarding bone health, less than one-fifth had received education on the topic, and approximately three-quarters were interested in learning more about treatment options. Our clinical trials demonstrated the efficacy of zoledronic acid (antiresorptive therapy) to mitigate loss of bone mineral and strength at the hip in acute SCI, regardless of one’s ability to regain ambulation following injury, and the efficacy of romosozumab (anabolic and antiresorptive monoclonal antibody therapy) to increase bone mineral and strength at the hip, but not the knee, in women with chronic SCI. These findings add to the existing body of literature suggesting zoledronic acid is a strong candidate for standard of care to mitigate bone loss during acute SCI, and indicating that further investigation is required to find a treatment that can increase bone mineral, and reduce fracture risk, at both the hip and knee during chronic SCI for those with established osteoporosis.
- ItemOpen AccessCHESS: Changes in Hormones with Exposure to Student Stress(2019-08-20) Crack, Laura Elizabeth; Doyle-Baker, Patricia K.; Murias, Juan M.; Lebrun, Constance MarieSalivary cortisol levels measure the acute stress response and this daily measurement occurs in two phases: the cortisol awakening response (CAR; 30 minutes after waking) and the diurnal cortisol response (the slope of the trend line associated with the remaining periodic samples throughout the day). Progesterone, one of two female sex hormones associated with the menstrual cycle (MC) is not well documented in terms of the stress cycle. The primary objective of the CHESS study was to prospectively investigate the impact of chronic stress (measured by the Student-Life Stress Inventory) on salivary cortisol and progesterone levels among female undergraduate students (N=19), while controlling for MC phase. Participants displayed blunted CAR, possible hypothalamic-pituitary-adrenal axis dysregulation manifested in irregular diurnal cortisol patterns, and changes in progesterone levels in response to academic stress. This finding provides a foundation for future studies to examine the relationship between cortisol and progesterone during times of stress.