Medicine and Health Sciences Commons^™

Factors Associated With Influenza & Tdap Vaccine Uptake In Pregnant Patients At The Ut Family Medicine Clinic In Memphis, Rachel Woods, Alison Zhong, Madelyn Vincent

Longitudinal Scholar's Project

INTRODUCTION: Given the increased risk for infections among pregnant patients and newborns, vaccination against influenza (>50,000,000 annual US cases affecting all ages) and pertussis (>15,000 annual US cases disproportionately affecting newborns) are recommended among pregnant patients in order to protect them and their babies via passive immunity to cover a newborn’s window of vaccine ineligibility. Though flu and Tdap vaccination rates among pregnant patients have been trending upwards nationally, there is still room for improvement to achieve optimal rates.

OBJECTIVES: The primary objectives were to study factors that affect the vaccination rates at the University of Tennessee Family …

Computer-Assisted Coding: Post Icd-10 Implementation, Teresa C. Allen

Applied Research Projects

Computer-assisted coding (CAC) has been around since the 1950s and is projecting to reach $4.75 Billion by 2022. However, it has not been on the hospitals’ priority list until 2014 before the implementation of ICD-10 in 2015. Computer-assisted coding is a technology software that helps streamline the coding workflow, reduce backlogs by increasing productivity, and help coders navigate through more extended, more complex charts more quickly. The technology is a type of artificial intelligence. The idea of computer-assisted became more front-line with the implementation of electronic health records (EHRs) and the demands of a more restrictive reimbursement from payers. Accuracy, …

Mean Arterial Pressure In Acute Ischemic Stroke Study, Mary Angela Grove

Theses and Dissertations (ETD)

Background. There is little, if any, evidence available on the validation of blood pressure (BP) measurements obtained in the acute care setting. Despite this, acute stroke practitioners trust and rely on non-invasive blood pressure (NIBP) devices to guide acute ischemic stroke (AIS) patients’ treatment. Although systolic blood pressure (SBP) has been found to be the most unreliable measurement displayed on NIBP devices, treatment decisions for AIS are based on them. Today, 25 years after the FDA’s approval of alteplase, practitioners continue to use BP parameters of 185/110 and 180/105 to guide the initiation of alteplase bolus and infusion, although the …

Renal And Cardiovascular Outcomes Associated With Cannabis Use In Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Praveen Kumar Potukuchi

Theses and Dissertations (ETD)

Background: Legalization of cannabis and its constituents may lead to increased exposure of a higher number of consumers to cannabis use, including those with chronic kidney disease (CKD). We expect increase in cannabis use, especially, in patients with compromised kidney function. However, there is sparse literature on the effects of cannabis use on cardiorenal and mortality outcomes among patients with advanced CKD. Objectives: The main goal of the current study was to examine the effect of cannabis use on renal and cerebrovascular outcomes as well as mortality in patients with advanced CKD. Using a nationwide cohort of US veterans with …

Mechanisms Of Bak Activation In The Initiation Of Mitochondrial Apoptosis, Geetika Singh

Theses and Dissertations (ETD)

Mitochondrial apoptosis is crucial for normal mammalian development and adult homeostasis being regulated by B-Cell Lymphoma-2 (BCL-2) proteins. Deregulation of BCL-2 proteins form the basis for myriad of human pathologies including cancer and autoimmune diseases. Therefore, BCL-2 proteins are considered key therapeutic targets. BCL-2 homologous antagonist/killer (BAK) is an effector of outer mitochondrial membrane (OMM) pemeabilization or mitochondrial poration. Despite progress in understanding BAK-mediated mitochondrial poration, the underlying multi-step mechanism is not clearly defined. Here, we provide mechanistic details on the early steps in this process related to BAK activation, including transient direct activation and autoactivation. We demonstrate for the …

Selective Targeting Of Cyp3a5 Through Chemical And Genetic Approaches, William C. Wright

Theses and Dissertations (ETD)

Cytochrome P450 enzymes function to catalyze a wide range of reactions important for various biological processes. In humans, the CYP3A subfamily is particularly critical for drug response. Within this family are CYP3A4 and CYP3A5, which collectively metabolize greater than half of all currently prescribed drugs. These promiscuous enzymes can bind a broad and structurally diverse array of compounds, in turn leading to an increased risk of their modulation via small molecules. In the case of CYP3A5, which is over-expressed in some cancers, this leads to chemoresistance. Such aberrant expression and corresponding drug resistance merit a need to selectively target CYP3A5. …

Understanding Human Astrovirus From Pathogenesis To Treatment, Virginia Hargest

Theses and Dissertations (ETD)

While human astroviruses (HAstV) were discovered nearly 45 years ago, these small positive-sense RNA viruses remain critically understudied. These studies provide fundamental new research on astrovirus pathogenesis and disruption of the gut epithelium by induction of epithelial-mesenchymal transition (EMT) following astrovirus infection. Here we characterize HAstV-induced EMT as an upregulation of SNAI1 and VIM with a down regulation of CDH1 and OCLN, loss of cell-cell junctions most notably at 18 hours post-infection (hpi), and loss of cellular polarity by 24 hpi. While active transforming growth factor- (TGF-) increases during HAstV infection, inhibition of TGF- signaling does not hinder EMT induction. …

Black Women Survive Breast Cancer With Community-Based Care, Shelley I. White-Means, Jill Dapremont, Barbara D. Davis, Tronlyn Thompson

Faculty Presentations

PURPOSE Community-based breast cancer support agencies who address non-medical, social determinants of health needs that serve as barriers to maximizing breast health outcomes may play a vital role in mitigating breast cancer mortality. They share a common emphasis on addressing social, economic, and psychological needs of breast cancer survivors and those at risk of breast cancer. This paper is third in a series of papers exploring why the rate of breast cancer mortality is two times higher for African American women than white women in Memphis. We sought insights from community-based breast cancer support agencies because they have a close-up …

Effectiveness Of Splinting In Adults With Radial Nerve Palsy, Laurel Jeanette Pitman, Logan Buckner, Logan Stem, Sarah Grace Rogers, Emylee Williams

Master of Occupational Therapy Student Critically Appraised Topics

The final portfolio contains 5 research articles from national and international journals. The study designs included in this portfolio are one small-scale RTC, one retrospective pretest posttest design, and three case studies. The studies included help answer our PICO question and help draw conclusions about how to care for adults with radial nerve palsy in regards to splinting. Three of the articles compared static splinting and dynamic splinting in regards to improvements in hand function. Two of the articles focused on dynamic splinting as a means of treatment for adults with radial nerve palsy.

Infant Massage And Bonding, Aly Blumenberg, Samantha Davis, Ali Graham, Rachel Medina, Emily Rayder

Master of Occupational Therapy Student Critically Appraised Topics

This project aims to appraise evidence of the effectiveness of infant massage for increasing social-emotional bonding. In our research, we focused on two studies considered Level I evidence and three studies considered Level II evidence. Study designs include quasi-experimental and randomized controlled trials. Strong evidence supports that infant massage increases social-emotional bonding and attachment. Based on the evidence, implementation varied from once per day for 10 minutes to 2-3 times per day for 15 minutes. It is recommended to use infant massage in an acute care setting and in the home to increase social-emotional bonding and attachment.

Long-Term Functional Effects Of Medulloblastoma Treatments, Serena Khiantani, Pamela Ponce, Bailey Diprima, Sarika Maymoundok, Leah Murray

Master of Occupational Therapy Student Critically Appraised Topics

All studies relate directly to components of the evidence-based practice question and were used to understand the possible long-term effects of treatment for clients diagnosed with medulloblastoma cancer. This Critically Appraised Topic (CAT) contains 6 research articles from both national and international journals. Study designs include two cohort studies with a control group, 1 cross sectional study with a control group, 1 retrospective cohort study without a control group, 1 descriptive report on a Randomized Control Trial (RCT), and 1 descriptive study. Through these studies, we found that radiation treatment is associated with impaired IQ and academic achievement and that …

The Effects Of Dual-Tasking On Fall Risks In Adults With Brain Injury, Kaley Campbell, Anayston Casey, Madison Culpepper, Elizabeth Denton, Katie Morgan

Master of Occupational Therapy Student Critically Appraised Topics

Clinical Scenario: Dual-tasking combines both physical and cognitive components into one therapeutic intervention. There has been limited research on the benefits of dual tasking in relation to fall risks in adults with brain injury. Currently, it is common for various therapy interventions to spend the majority of time targeting physical or cognitive components, but not both at once. After appraisal, a total of five articles were used. These included two level I studies involving a high-quality randomized control trial and a meta-analysis, two level II studies that were both small-scale randomized control trials, and one level IV study that was …

Effects Of Occupational Therapy Intervention In Low Vision, Zach Harrington, Juliana Crossett, Carlie Carter, Baleigh Gooch, Liberty Harris

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of this CAT is to investigate therapeutic intervention and its effects for improving independence in occupational performance, overall health, quality of life, and mental health in adults over 40 with acquired low vision. This CAT contains nine peer-reviewed research articles from national journals. Study designs include one randomized controlled trial, seven systematic reviews, and one non-randomized controlled trial. All studies relate directly to the components of our evidence-based practice question and will be used to support further research on the optometry and occupational therapy collaboration. All of the articles specifically describe various interventions used in the low vision …

Group Therapy Versus Individual Therapy For Older Adults With A Cerebrovascular Accident, Montana R. Bawcum, Jessica Sorrell, Kaleigh Stevens, Caitlyn Strietelmeier, Madeline Young

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to synthesize the best current evidence regarding the feasibility of group occupational therapy and outcomes related to ADL performance. The final portfolio contains a total of five research articles. Study designs include two pre-post single group designs, two case studies, and one non randomized pilot trial with a control group. All studies related directly to the PICO question and were used to determine best evidence for the feasibility of group therapy of the older adult population in a rehabilitation setting.

Effectiveness Of Aerobic Exercise For Adults With Leukemia, Jalin Davis, Summer Hood, Alex Miller, Sam Stein, Kaylee Stem

Master of Occupational Therapy Student Critically Appraised Topics

We wanted to look at the most effective interventions for increasing strength and endurance in clients with Leukemia experiencing functional decline.

2020 County Health Rankings Tennessee Data And Updated Substance Abuse 2005-2019, Kelsey L. Grabeel, Jenny Moore

Faculty Publications

No abstract provided.

Mental Health Assessments In Icu And Acute Care, Carolynn M. Keane, Megan Altom, Taylor Harrell, Erica Smith, Danielle Woodward

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to provide a brief summary of assessments that may be relevant to the burn unit or ICU setting, including their validity, reliability, specificity, sensitivity, and limitations. We had a total of eight articles with the following study designs: Systematic Review (2 articles), Longitudinal Study (1 article), Comparative Analysis (1 article), Correlational Analysis (2 articles) and Methodological (2 articles). These articles looked at the reliability, validity, specificity, and sensitivity of the following assessments: Abbreviated Burn Specific Anxiety Scale (A-BSPAS), Beck Depression Inventory-II, Brief Coping Orientation to Problems Experience (B-COPE), Concise Mental Health Checklist …

Vestibular Evoked Myogenic Potentials And Postural Control In Adults With Age-Related Hearing Loss, Steven Michael Doettl

Theses and Dissertations (ETD)

It is well-documented that auditory thresholds decrease with age, which can be referred to as Age-related hearing loss (ARHL). ARHL is one of the most common conditions affecting older adults and is associated with several conditions including decreased postural stability and falls. Age-related changes to auditory function have been attributed to, through histopathological study, specific degradation of the sensory, supporting, and afferent structures of the cochlea. Vestibular function, as measured through vestibular evoked myogenic potentials (VEMPs) also show decreases with age. VEMPs are a measurement of evoked potentials generated by auditory stimulation of the utricle and saccule measured through a …

Characterization Of Novel Cb2 Agonist Smm-295 And Its Effects In Ischemia/Reperfusion Injury, Jeffrey D. Pressly

Theses and Dissertations (ETD)

Acute kidney injury (AKI) is a major problem clinically affecting up to two-thirds of intensive care unit patients, and results in increased hospitalization time, the risk of developing chronic kidney disease, and mortality. Hallmarks of AKI include tubular cell death and a decrease in renal perfusion which leads to decreases in renal function following injury. For 20 years the pathophysiology of AKI has been well established. However, therapies for AKI have shown minimal to no success clinically. The work here describes our efforts to further categorize the effects of CB2 activation, a possible novel therapeutic target in AKI.

There is …

Forecasting The Essential Chemotherapy Needed For Treatment Of Children With Acute Lymphoblastic Leukemia In Low- And Middle-Income Countries, Brian T. Lewis

Theses and Dissertations (ETD)

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with contemporary therapy resulting in a 90% survival in high-income countries (HIC). However, an estimated 89% of the world’s children live in low- and middle-income countries (LMIC) where survival is much lower. Lack of access to essential chemotherapy contributes significantly to the decreased survival rates for LMIC, and inaccurate forecasting of chemotherapy needed may lead to stockouts or oversupply. This chapter describes a simple forecasting system with population and patient-based multipliers for each drug used in the treatment of pediatric ALL, thus estimating the essential chemotherapy quantities needed for a …

Development And Characterization Of Selective Cb2r Inverse Agonists As A Novel Anti-Inflammatory Therapy For Neuroinflammation – Mechanisms Of Action In Murine And Human Microglia Models Provide Valuable Insights Into Their Therapeutic Potential, Sahar Saleh Alghamdi

Theses and Dissertations (ETD)

Introduction: Recently, research has revealed the presence of cannabinoid receptor 2 (CB2R) in the central nervous system (CNS); since then, the receptor has emerged as a promising therapeutic target for treating multiple neurodegenerative diseases (NDD) such as Alzheimer’s (AD), Parkinson’s (PD), Human Immunodeficiency Virus (HIV) and Multiple Sclerosis (MS). The restricted and upregulated expression of CB2R in activated microglia and lack of psychotropic activity make this receptor an attractive target for discovering novel therapy to treat neuroinflammatory diseases for which there is currently no curative treatment. Methodology: A library of compounds were synthesized and evaluated in ACTOne and TANGO-bla functional …

Survey Of Client Perspective On The Use Of Veterinary Telemedicine For Chronic Disease Management, Nathan Jay Matlock

Applied Research Projects

Veterinary Telehealth is a rapidly growing sector of Veterinary Medicine. Technological advancements have allowed for vast changes in the way chronic disease states can be managed. There are many facets of telemedicine that must be researched to determine the productiveness of such technological advances. The first step in determination of implementation is that of community acceptance and likely utilization. This project’s scope is to determine client perspective on the use of veterinary telemedicine for chronic disease state(s) management.

Health Information Management Careers: The Importance Of Skillset And Location On Salary, Danielle Sager

Applied Research Projects

Health information management is an engaging and dynamic occupational field that employs thousands of individuals throughout the United States across the spectrum of health care providing organizations. The ability to navigate these opportunities is influenced heavily by the location of available positions and the skillsets desired by employers. Through study of workforce development data and research in health information management one is able to determine the location and skillset of positions that will help distinguish oneself in a competitive marketplace that values not only education and experience, but the ability to lead in a field that is rapidly changing and …

Biochemical And Structural Characterization Of The Atg8/Lc3 Lipidation Pathway, Yumei Zheng

Theses and Dissertations (ETD)

Atg8 and its eukaryotic orthologues LC3 and GARBARAP family proteins (referred here to Atg8 family proteins) play crucial roles in autophagy through their covalent ligation to lipids, typically phosphatidylethanolamine (PE), in a process known as lipidation. Lipidation of Atg8 family proteins regulates numerous facets of the autophagy process, including regulating expansion of the phagophore membrane, recruiting selected cargoes for degradation, and providing an autophagosome membrane-bound platform mediating dynamic interactions with other regulatory proteins. Atg8 family proteins are ubiquitin-like proteins (UBLs), and their lipidation involves a divergent UBL conjugation cascade including Atg7, Atg3, and Atg12–Atg5-Atg16 acting as E1, E2, and E3 …

Novel Paclitaxel Nanoparticles For Enhanced Therapeutic Effects In Breast Cancer, Pallabita Chowdhury

Theses and Dissertations (ETD)

Drug delivery to triple negative breast cancer (TNBC) remains a formidable challenge. Given the lack of expressions of estrogen (ER), progesterone (PR) and human epidermal growth factor receptor (HER2), there is no specific prognostic marker for targeting this aggressive cancer. In spite of rapid advancement in breast cancer with agents such as Trastuzumab in HER2 positive, chemotherapy with cytotoxic agents remains the mainstay treatment for TNBC. Although these cytotoxic agents are potent in managing the tumor progression, yet they pose adverse effects on healthy tissues. Paclitaxel (PTX) has been used as a gold standard chemotherapeutic agent for breast, ovarian, pancreatic …

Arid1a Haploinsufficiency Initiates Neural Crest Transformation In A Mouse Model Of Mycn-Driven Neuroblastoma, Kirby A. Wallace

Theses and Dissertations (ETD)

Mouse models of cancer are critical for developing therapeutic treatments for pediatric patients. Recent sequencing studies of neuroblastoma (NBL) patient tumors have uncovered precise deletions in the chromatin remodeler and tumor suppressor gene (TSG) ARID1A. Additional causal studies supported ARID1A’s candidacy as a putative 1p36 TSG in MYCN-driven NBL. This study aimed to causally test Arid1a loss during Mycn-driven NBL initiation through the development of a mouse model of high risk NBL.In this study, we modified a Mycn-driven mouse model of NBL to incorporate Cre mediated deletion of floxed Arid1a. Briefly, in freshly isolated embryonic day 9.5 primary trunk neural …

Muc13 Modulated Nanomechanical And Biophysical Responses In Pancreatic Cancer Cells, Andrew E. Massey

Theses and Dissertations (ETD)

Pancreatic adenocarcinoma is one of the deadliest forms of cancer. Even with recent advances in diagnostic tools, chemotherapeutic regimens, and biomarkers for earlier detection, it still has dismal survival rates. Part of the reason for this is the inherent difficulty in detecting and treating this disease. Recent findings suggest that the altered expression of mucins, including MUC13, may be useful molecular signatures for early disease diagnosis, chemotherapy response and predicting patient survival. MUC13, a recently identified transmembrane glycoprotein, is normally associated with forming a protective barrier on epithelial tissues. However, its overexpression/aberrant subcellular localization has been associated with cancer, disease …

Integrated Multimodal Genomic Analyses Reveal Novel Mechanisms Of Glucocorticoid Resistance In Acute Lymphoblastic Leukemia, Robert J. Autry

Theses and Dissertations (ETD)

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Much has been discovered in recent decades regarding ALL biology, and the outcome of patients with ALL has vastly improved, especially in pediatric ALL patients. Despite very promising overall cure rates, patients who relapse have a greatly decreased prognosis with survival rates ranging from 30-60%. These numbers stand to improve even further with new targeted therapies that seek to improve or maintain cure rates while reducing treatment related toxicities which affect patients both acutely and chronically. Glucocorticoids (GCs) are essential components of modern chemotherapeutic intervention for ALL. Resistance to glucocorticoids …

Design, Development And Evaluation Of Dual Drug Nanomedicine For Non-Small Cell Lung Cancer, Elham Hatami

Theses and Dissertations (ETD)

Resistance to conventional chemotherapy is a big challenge in the treatment of cancer including non-small cell lung cancer (NSCLC). A combination of natural chemo sensitizer agents with chemotherapy offers unique advantages over monotherapy alone. However, free unbound drugs, (in combination or as a single agent), lack tumor-targeted accumulation and therefore can be easily eliminated from the patient body. Moreover, some drugs are hydrophobic, and their organic solvents cause in vivo toxicity, thereby limiting their capability in clinical translation. Herein, dual loaded biocompatible and biodegradable nanoparticles (NPs) using Gemcitabine (Gem)a pyrimidine nucleoside antimetabolite and Gambogic acid (GA) (a highly hydrophobic chemo …

Unraveling Molecular Mechanisms Underlying The Development Of Unconventional T Cells, Daniel Eduardo Bastardo Blanco

Theses and Dissertations (ETD)

The thymus supports and guides the generation of a diverse repertoire of mature T cells from precursors derived from the bone marrow. In addition to conventional CD4 and CD8 T cells, innate-like T cells also develop in the thymus and share features of the adaptive and the innate immune system. These ‘unconventional’ T cells have emerging roles in tissue homeostasis and disease, but the molecular mechanisms underpinning their development remain elusive. In this study, we uncovered the roles of the molecules RAPTOR and PTEN in the thymic development of unconventional T cells. Capitalizing on genetic deletion of RAPTOR, we found …