Medicine and Health Sciences Commons^™

Heart Failure 30-Day Readmission Frequency, Rates, And Hf Classification, Yolanda R. Brown, Twonia M. Goyer, Margaret C. Harvey

Doctor of Nursing Practice Projects

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure

Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who …

Increasing Nurse Knowledge Using A Formal Lung Transplant Education Program, Amy M. Stoddard, Donna Lynch-Smith, Kate Carlson Wrammert, Bobby Bellflower

Doctor of Nursing Practice Projects

This quality improvement project was completed to show that a formal lung transplant education course for nurses caring for lung transplant patients increased their knowledge. An eight-hour education course was developed by experts in the field of lung transplantation. A pretest was administered before the education course. A posttest was administered to determine if knowledge was improved. A three-month follow-up test was administered to determine knowledge retention. Based on the data analysis, nurse knowledge improved after formal education. Item analysis determined what areas of educational content need to be the focus of quarterly education. The education course was adopted as …

Systems Genetics And Systems Biology Analysis Of Paraquat Effects In Bxd Recombinant Inbred Mice, Carolina Del Valle Torres Rojas

Theses and Dissertations (ETD)

Paraquat (PQ) is a chemical herbicide that is used in many countries including the United States. It is also highly acutely toxic to humans and has been used as a means of suicide. As PQ is applied mainly in agricultural settings, it moves to soil and well water. Chronic low dose exposure via drinking water may have adverse effects on humans, including increased risk for sporadic Parkinson’s disease (sPD). The etiology of sPD is unclear and the most accepted hypothesis states it is the result of the interaction between environmental factors and genetic susceptibility. Increasing evidence led us to infer …

Using Preliminary Data And Prospective Power Analyses For Mid-Stream Revision Of Projected Group And Subgroup Sizes In Pragmatic Patient-Centered Outcomes Research, Elizabeth A. Tolley Md, Satya Surbhi Md, James E. Bailey Md

Faculty Publications and Presentations

Pragmatic clinical trials are commonly used in patient-centered outcomes research to assess heterogeneity of treatment effects. Patient-Centered Outcomes Research Institute (PCORI) methodology standards for assessing heterogeneity of treatment effects are extremely rigorous, but their implementation in real-world settings can be difficult. Predicting recruitment effectiveness and subgroup characteristics is often challenging and may require mid-stream revision of projected group and subgroup sizes. Yet, little real-world data are available to demonstrate methodologically valid approaches to address situations where such revisions are necessary. These data were used for mid-stream revision of group and subgroup sizes in the Management of Diabetes in Everyday Life …

Effect Of Sound Source Location And Spatial Hearing On The Vestibulo-Ocular Reflex (Vor), Mary Easterday

Theses and Dissertations (ETD)

Accurate measurement of the vestibulo-ocular reflex (VOR) is imperative in differential diagnosis of vestibular disorders and balance function. However, the assessment protocol faces a number of limitations, including the need to control for extra- vestibular sensory factors such as hearing. Previous research has shown that the use of an auditory stimulus can have a significant effect on functional measures of balance, and many have contributed effects to be the result of spatial hearing. However, no studies have directly assessed the effect of speaker location on the VOR nor investigated correlations of functional spatial hearing with the VOR. Therefore, the aims …

Early Diagnosis Of Alzheimer’S Disease In The Primary Care Setting, Raymond R. Romano

Theses and Dissertations (ETD)

The burden of Alzheimer’s disease (AD) affects not just the individual but also families, providers, and society. Early recognition and diagnosis of AD may reduce cost by reducing interaction with the health care system, earlier initiation of treatment, and prolonging time to long- term care. Primary care providers, the first contact for diagnosis of patients with AD, are not fulfilling the potential of early diagnosis for a variety of reasons. Biomarkers of AD emerge on average 15 to 20 years before clinical diagnosis, yet currently established biomarkers are not easily available in the primary care setting. A growing body of …

Considerations For Small Libraries In Adopting Virtual Reality Technology For Medical Education, Rachel Walden, Emily Weyant, Matthew Carroll

Southern Chapter/Medical Library Association Annual Conference

Objective: Describe considerations for small libraries considering the adoption of virtual reality technology as a resource for health sciences education.

Methods: A small academic medical library obtained grant funding to implement a virtual reality pilot project to support anatomy coursework.

Results: Observations were made related to the technology selection and purchasing process, space and safety requirements for implementing VR, student patterns of use, supplementary VR programs of interest to medical students (including gaming and meditation programs for stress relief), and staffing/scheduling/maintenance of the system.

Conclusions: Virtual reality technology is compelling for medical education; implementation resulted in increasing the library’s engagement …

An Analysis Of Patient-Generated Health Data In Assisting Nurses And Physicians To Better Treat Patients With Hypertension, Diana Chaparadza

Applied Research Projects

Patient Generated Health Data (PGHD is not new but it has gained more attention these past years due to the advent of smart devices, remote monitoring devices and many applications on various smart devices. PGHD reflects medications and treatment, lifestyle choices, and health history. Unlike traditional medical visits, where clinicians collect and manage data within their offices, PGHD is collected by patients throughout the course of their day and provides an insight of how they are responding to treatments or lifestyle choices. Examples include blood glucose monitoring or blood pressure readings using home health equipment, exercise and diet tracking using …

What Medical Students Want: A Ten Year Library Survey At A New Medical School, Luda Dolinsky, Francisco Fajardo, Rebecca Roth

Southern Chapter/Medical Library Association Annual Conference

Objective: To assess and evaluate the past and current performance of library services, resources, and space with the purpose of informing decisions in designing a library serving a new medical school.

Methods: The Herbert Wertheim College of Medicine (HWCOM) at Florida International University opened its doors to its first class in 2009. Shortly after, the medical library began seeking student feedback by administering a 15-question survey to each class. The inaugural Class of 2013 and other cohorts were queried at various points in their curriculum. Starting with the Class of 2017, the library began consistently administering its survey to students …

Library Engagement In Exploring Stories Of Polio Survivors In North Central Florida, Nina Stoyan-Rosenzweig

Southern Chapter/Medical Library Association Annual Conference

Introduction/background: This project seeks to record stories of individuals who survived polio in the 1940s and 1950s in order to capture a unique moment in history, both in how polio impacted society- uniquely and similar to other disease outbreaks, and how individuals with polio negotiated their polio identity and told their story (or remembered through stories told by others).

For the former, infectious diseases can have a tremendous impact on culture, psychology, and the physical structure of society during the course of outbreaks and epidemics. Indeed the form of response often is similar from outbreak to outbreak, as people respond …

Rapid Response: Librarian Integration Into An Expedited Pandemic Medicine Elective, Gail Kouame, Jacob Gallay

Southern Chapter/Medical Library Association Annual Conference

Objective: Describe how two librarians contributed to a new graduate medical school elective course developed dynamically in the midst of the COVID-19 pandemic.

Methods: Shortly after the COVID-19 outbreak, the Assistant Director for Research & Education Services attended a clerkship curriculum committee meeting for the medical college where a four-week Pandemic Medicine elective was proposed. Clerkship rotations were canceled due to the pandemic, so the elective would provide opportunities for graduate medical students to participate in service learning and contribute to pandemic response efforts. The leaders and faculty members who proposed the elective suggested five areas of focus: information services; …

Open For Business: Offering Physical Library Spaces In The Covid Era, Katie Sparks, Hannah Rogers

Southern Chapter/Medical Library Association Annual Conference

Objective: Our goal was to safely reopen physical library spaces at the Woodruff Health Sciences Center Library for use by various Emory University user groups including students, faculty, and staff during the COVID pandemic of 2020. Because our university brought a subset of students back to campus, we felt it was important to offer safe, socially distanced seating and workstations in the library.

Methods: In collaboration with Emory University’s environmental and safety health officers, we made determinations of the number of seats that could safely be offered. Seating was removed or cordoned off or otherwise signposted. We implemented a reservations …

Eukaryotic Initiation Factor 5a2 (Eif5a2) Contributes To Ovarian Tumor Growth And Metastasis, Guannan Zhao

Theses and Dissertations (ETD)

Ovarian cancer has the highest mortality rate among all gynecological malignancies due to lack of effective biomarkers for early diagnosis. The majority of ovarian cancer patients are already at an advanced stage when diagnosed. In addition, ovarian cancers often become chemoresistant and metastatic, and recur following initial chemotherapy.

Audiovisual Integration During Novel Word Learning Among School-Aged Children With Cochlear Implants, Kristen Elizabeth Thompson Thornton

Theses and Dissertations (ETD)

Objective. It is well established that being able to see someone’s mouth move as they speak boosts speech perception for children with cochlear implants (CIs). Thus, children with CIs are often instructed to orient themselves toward the person they are listening to, to gain access to visual speech cues. Children with CIs who are better “audiovisual integrators,” or those who experience an auditory-visual (AV) enhancement effect (higher performance for AV information than auditory-alone (AO) or visual-alone (VO)), are more likely to have better speech and language outcomes after receiving their CI than children with poorer AV integration skills. While AV …

Dissecting Drivers Of Basal Immunity And Acute Responses To Viral Infection, Aisha Nadia Hegab Souquette

Theses and Dissertations (ETD)

Heterogeneity in the human immune system can lead to limited vaccine efficacy, poor response to therapeutics, increased susceptibility to immune mediated diseases, and differential outcome to infection. Studies to date have suggested a role for biological, environmental, and genetic factors in immune variation; however, they are often focused on a specific subset of the population (e.g. ancestral group, age range) which can exclude phenotypes unique to a diverse population and bias results. To address this gap, we have utilized samples from healthy or influenza virus infected subjects from 8 distinct populations in 5 countries to conduct an integrative analysis of …

Model-Based Dose-Exposure-Response Assessment For Lead And Backup Spectinamide In A Mouse Model Of Tuberculosis, Santosh Janardan Wagh

Theses and Dissertations (ETD)

Despite decades of research, tuberculosis remains the oldest pathogen-based disease that is the leading cause of death from a single infectious agent. Among many anti-tubercular therapies under investigation, the semisynthetic compounds spectinamides are a promising novel class of anti-tuberculosis agents. One such lead candidate, spectinamide 1810, and backup spectinamide 1599 have demonstrated excellent efficacy, safety, and drug-like properties in various in vitro and in vivo assessments. The dose-ranging and dose fractionation studies were designed to characterize the dose-exposure-response relationship for lead and backup spectinamide in a mouse model of Mycobacterium tuberculosis infection. In this current study, we used 26 and …

Vitamin D Levels Affect Survival In A Bcr-Abl Acute Lymphoblastic Leukemia Mouse Model But Do Not Cause Vitamin-Drug Interactions, Kavya Annu

Theses and Dissertations (ETD)

It is a well-established phenomenon that dietary components containing CYP3A inducers or inhibitors if co-administered with drugs that are CYP3A4 substrates lead to marked drug-drug interactions. Because vitamin D is known to regulate intestinal CYP3A expression and gut CYP3A expression plays an important role in pre-systemic metabolism of CYP3A drugs, we determined the impact of vitamin D (VD3) status on systemic exposure and efficacy of chemotherapeutic agents that are CYP3A substrates. We employed VD3 sufficient and deficient mice to perform pharmacokinetics (PK) and anti-leukemic efficacy studies.

First, using hCYP3A4 transgenic mouse model we evaluated the intestinal, hepatic and renal expression …

Role Of Cerebral Vasculature And Effect Of Circulating Exosomes In Propagation Of Systemic Inflammatory Responses Into The Central Nervous System, Mahesh Chandra Kodali

Theses and Dissertations (ETD)

Sepsis-associated encephalopathy (SAE) is an acutely progressing brain dysfunction induced by systemic inflammation. The mechanism of initiation of neuroinflammation during SAE, which ultimately leads to delirium and cognitive dysfunction, remains elusive. The goal of this project was to study the molecular events of SAE to capture its onset and progression into the central nervous system (CNS), and further identify the cellular players involved in mediating acute inflammatory signaling. Gene expression profiling on the cerebral vessels isolated from the brains of the mice treated with peripheral lipopolysaccharide (LPS) revealed that the cerebral vasculature responds within minutes to acute systemic inflammation by …

Veru-111 As An Oral Tubulin Inhibitor Suppressing Triple-Negative Breast Cancer And Evaluation Of Novel Tubulin Inhibitors For Cancer Therapy, Shanshan Deng

Theses and Dissertations (ETD)

Triple negative breast cancer (TNBC) has aggressive clinical features strongly associated with poorer overall prognosis and higher mortality rates relative to other molecular subtypes. FDA-approved drugs, such as paclitaxel, are effective in treating TNBC. Yet, treatment failure is commonly observed due to the development of acquired chemoresistance, which remains a clinical challenge for TNBC therapy.

Attenuation Of Interferon Responses In The Obese Host And Ramifications For Influenza Virus Evolution, Rebekah Reed Honce

Theses and Dissertations (ETD)

The most insidious pandemic of modern life does not arise from an infectious agent but rather from malnutrition. With its global incidence tripling over the past three decades, obesity is a major public health concern. Obesity’s rising prevalence has also illuminated its impact on communicable diseases. Following the 2009 H1N1 influenza A virus pandemic, obesity was identified as a risk factor for increased disease severity and mortality in infected individuals. Obesity causes a chronic state of meta-inflammation with systemic implications for immunity, including delayed antiviral responses to influenza virus infection, poor recovery, and impaired immunological memory. However, the majority of …

Genetic Variation And Sex Mediate Differential Responses To ∆-9-Tetrahydrocannabinol Among Inbred Mice, Cory Parks

Theses and Dissertations (ETD)

The plant Cannabis sativa has been used by people for both recreational and medicinal use for thousands of years, but scientific investigation of the plant and its components didn’t begin until the early nineteen hundreds when Cannabis components known as phytocannabinoids were characterized and later isolated. In the 1970’s, ∆9-tetrahydrocannabinol (THC) was isolated and recognized as the major constituent responsible for the psychoactive and intoxicating effects associated with consumption of cannabis. This opened the door for intensive research in the field that lead to the discovery of the endogenous cannabinoid system and its associated receptors, effectors of signaling, and biosynthetic …

An Unexpected Outcome Of A Pediatric Simulation Encounter For Occupational Therapy Students., Anne H. Zachry, K. Booker, S. B. Lancaster

Faculty Presentations

This presentation reviewed how to plan and implement a pediatric simulated educational experience to align with the targeted course learning objective(s). Participants learned how to incorporate best practices into simulation education in order to advance occupational therapy education.

Characterization Of Genome-Wide Binding Of Nuclear-Factor I-X In Hematopoietic Progenitor Cells, Megan J. Walker

Theses and Dissertations (ETD)

We report that ectopic expression of Nfix in primary mouse HSPC extended their ex vivo culture from 20 to 40 days. HSPC overexpressing Nfix displayed hypersensitivity to supportive cytokines and reduced apoptosis when subjected to cytokine deprivation compared to controls. Ectopic Nfix resulted in elevated levels of c-Mpl transcripts and cell surface protein on primary murine HSPC as well as increased phosphorylation of STAT5, which is known to be activated down-stream of c-MPL signaling. Blocking c-MPL signaling by removal of its ligand, thrombopoietin (TPO), or addition of a c-MPL neutralizing antibody negated the anti-apoptotic effect of Nfix overexpression on cultured …

Validation And Application Of A Novel Target-Based Whole-Cell Screen To Identify Antifungal Compounds, Christian Alexander Dejarnette

Theses and Dissertations (ETD)

Traditional approaches to drug discovery are inefficient and have several key limitations that constrain our capacity to rapidly identify and develop novel experimental therapeutics. To address this, we have devised a second-generation target-based whole-cell screening assay based on the principles of competitive fitness, which can rapidly identify target-specific and physiologically-active compounds. Briefly, strains expressing high, intermediate, and low levels of a preselected target protein were constructed, tagged with spectrally distinct fluorescent proteins (FPs), and mixed together. The pooled strains were then grown in the presence of various small molecules, and the relative growth of each strain within the mixed culture …

Conditional Loss Of Engrailed 1/2 In Rhombic Lip-Derived Neurons Increases Intrinsic Rhythmicity And Decreases Overall Variability Of Eupneic Respiration, Angela P. Taylor

Theses and Dissertations (ETD)

Evidence for a cerebellar role during cardiopulmonary challenges has long been established, but investigation into cerebellar involvement in eupneic breathing has been inconclusive. Given the view of the cerebellum (CRB) as a temporally coordinating structure, any investigation into the CRB during respiration must evaluate rhythm and variability of the respiratory sequence. In this study, we chose an elegant model of cerebellar neuropathology, Atoh1-En1/2 CKO, where mutant animals have conditional loss of the developmental patterning gene Engrailed 1/2 in rhombic lip-lineage neurons and exhibit a proportional scaling-down of neuron number in hypoplastic lobules of the CRB. We utilized whole-body unrestrained plethysmography …

The Characterization Of Hematopoiesis In Murine Fetal Bone Marrow, Trent Daniel Hall

Theses and Dissertations (ETD)

Hematopoietic stem cells (HSCs) and their downstream progenitors are a heterogeneous population of cells that are indispensable for lifelong hematopoiesis and are often utilized in the clinic for the treatment of hematologic maladies via hematopoietic stem cell transplantation (HSCT). Over several decades, it has been discovered that HSCs arise in the dorsal aorta of the developing embryo, migrate to the fetal liver (FL), and undergo a large expansion before reaching their final resting place in the bone marrow (BM). Many resources have been invested in understanding the roles of the different niches HSCs encounter along their journey. A greater understanding …

Genomic Instability And The Oncohistone H3k27m Drive Gliomagenesis In A Murine Model, Lee J. Pribyl

Theses and Dissertations (ETD)

Maintaining genome stability is crucial for human health and it is of particular importance in neural cells during early brain development. Genome maintenance occurs at two broad stages; surveillance during DNA replication and DNA damage repair in differentiating and mature cells. Neural cells are particularly sensitive to DNA strand breaks and defective DNA damage responses can result in detrimental effects on the nervous system, including cancer. Multiple DNA repair pathways play critical roles in preventing DNA damage accumulation in stem and neural progenitor cells. The mechanisms that protect progenitor genomes also suppress DNA mutations that can result in cancer. A …

Leveraging Health Informatics And Parental Empowerment: Perspectives From Parents And Caregivers Of Medically Complex Children, Shazia Ashraf

Applied Research Projects

This research paper focuses on the barriers that parents and caregivers of special-needs children patients face with leveraging technology and informatics as they attempt to communicate with their child’s healthcare specialists regarding specialized and critical oversight and management of complex medical conditions and the need for empowerment for this population of parents and caregivers. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of electronic applications. A review of the literature showed that the special needs population has not been represented. This study surveys a range of parents and caregivers …

Investigation Of A Novel Mitophagy Regulatory Pathway And Chemical Inducer, Jane E. Craig

Theses and Dissertations (ETD)

Mitochondria are vital organelles that coordinate cellular energy homeostasis and also have important roles in cell death. Therefore, the removal of damaged or excessive mitochondria through autophagy, a process called mitophagy, is critical for maintaining proper cellular function. Much of the research elucidating the mechanism and regulation of autophagy was performed in yeast cells, so there is still a lot of mystery surrounding how mitophagy is promoted and regulated in mammals in general and in different tissues. The most well understood mechanism involved in mitophagy is the PINK1-PARKN pathway. However, studies often rely on severe mitochondrial damage using CCCP that …

Clinical And Socioeconomic Predictors Of Palliative Care Utilization, Rohan Reddy Tummala, Andrew Manuel De Jesus, Natasha Danielle Tillett, Jeffrey Scott Nelson, Christine Marie Lamey

Longitudinal Scholar's Project

INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service.

OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization.

METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), …