Medicine and Health Sciences Commons^™

Reducing Copd Readmissions Through The Implementation Of A Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project, Hannah F. Hall, Allyson Neal, Samantha Bauer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm …

Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Significance/Background: Type II Diabetes Mellitus (TIIDM) is a growing epidemic in Belize. The prevalence is increasing yearly, responsible for considerable health complications and deaths. Rates are much higher in Belize than in any other developing Central American country, and many rural citizens are undiagnosed and untreated. Access to healthcare is complex, and travel is often required in rural areas. Primary care visits in Belize are significantly less than in surrounding North and Central American countries. As a result, chronic illnesses such as TIIDM often go undiagnosed among children, adolescents, and adults- leaving TIIDM a leading cause of death in Belize. …

Educating School Nurses To Improve Bowel Continence In Children With Spina Bifida, Mckinley J. Waugh, Tracy L. Brewer, Lisa Wagoner

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Children born with spina bifida, a neural tube defect, can have associated loss of bowel control resulting in bowel incontinence. The National Patient Spina Bifida Registry found that 87% of those living with spina bifida had bowel incontinence, and less than 30% were bowel continent (Sawin et al., 2015; Wiener et al., 2017). Unfortunately, providers may never start a child living with spina bifida on a bowel management program. Evidence suggests that children with spina bifida should begin a bowel management program early, using a stepwise approach. School nurses, who interact with children living with spinal bifida while attending school, …

Unraveling The Molecular Foundations Behind The Diverged Behaviors Of Mouse Insulin 1 And Insulin 2, Connecting Diabetes Risk With Glucocorticoid Treatment And Chronic Migraine Through The Analysis Of Islet Chemistry, And Capturing Key Posttranslational Modifications All Through The Application Of A Novel Lc-Ims-Ms Workflow, Connor Christopher Long

Select or Award-Winning Individual Scholarship

We display the capabilities of our established liquid chromatography-ion mobility spectrometry-mass spectrometry (LC-IMS-MS) workflow in the investigations of islet chemistry at the sub-single-islet level. We begin by characterizing the structural differences of Ins1 and Ins2 to present novel insights as to why their behaviors diverge. We then examine the effects of the stress hormone corticosterone, the rodent equivalent of human cortisol that is often used as a therapeutic, on pancreatic peptide hormone secretion. We also uncover the molecular connection behind the inverse relationship between type 2 diabetes (T2D) risk and chronic migraine via the neuropeptides CGRP and PACAP. Lastly, we …

Geographic Distribution Of Staphylococcus Spp. Infections And Antimicrobial Resistance Among Dogs From Gauteng Province Presented At A Veterinary Teaching Hospital In South Africa., Daniel Nenene Qekwana, James Wabwire Oguttu, Agricola Odoi

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

The objective of this study was to investigate spatial patterns of staphylococcal infections and resistance patterns of clinical isolates from dogs from Gauteng province in South Africa. Data from records of 1,497 dog clinical samples submitted to a veterinary teaching hospital between 2007 and 2012 were used in the study. Spatial empirical Bayesian smoothed risk maps were used to investigate spatial patterns of staphylococcal infections, antimicrobial resistance (AMR), and multidrug resistance (MDR). Moran’s I and spatial scan statistics were used to investigate spatial clusters at municipal and town spatial scales. Significant clusters of staphylococcal infections were identified at both the …

Urine Sodium Concentrations Are Predictive Of Hypoadrenocorticism In Hyponatremic Dogs: A Retrospective Pilot Study, Elizabeth More Lennon, Shelly L. Vaden

Faculty Publications and Other Works -- Small Animal Clinical Sciences

Abstract

OBJECTIVES:

To determine if a urine sodium concentration could be used to rule out hypoadrenocorticism in hyponatraemic dogs.

MATERIALS AND METHODS:

Medical records were reviewed for hyponatraemic dogs (serum sodium/L) that had recorded urine sodium concentrations. Twenty hyponatraemic dogs were included: 11 diagnosed with classical hypoadrenocorticism and nine with non-adrenal causes of hyponatraemia. A Wilcoxon rank-sum test was used to compare results between groups.

RESULTS:

No dog with hypoadrenocorticism had a urine sodium concentration less than 30 mmol/L. Urine sodium concentration in dogs with hypoadrenocorticism was significantly higher (median 103 mmol/L, range: 41 to 225) than in dogs with …

Physical Activity And Its Effect On Reducing Disease: A Literature Review Of The National Runner's Health Study, Graham William Edson

Kinesiology, Recreation, and Sport Studies Publications and Other Works

In 1996, Dr. Paul Williams began The National Runner’s Health Study. The study had over one hundred thousand respondents who were questioned about their physical activity habits (walking or running), diet, weight, height, and use or previous use of tobacco and alcohol. Some of the participants were involved in case studies of several years. Primarily, the study tested the effects of vigorous physical activity and its ability to reduce disease. For close to twenty years, Dr. Williams has continued an impressive amount of research on various topics in the health and exercise field. The study is one of the most …

Sp526-A Do You Know How To Lower Your Risk For Cancer?, Bobbi P. Clarke

Health, and Fitness

No abstract provided.

Sp728: Hpv - What Teens Should Know, Barbara Bobbi Clarke, Laura L. Jones

Family

No abstract provided.

Neighborhood Disparities In Stroke And Myocardial Infarction Mortality: A Gis And Spatial Scan Statistics Approach, Ashley Pedigo, Tim Aldrich, Agricola Odoi

Faculty Publications and Other Works -- UT Graduate School of Medicine

Background

Stroke and myocardial infarction (MI) are serious public health burdens in the US. These burdens vary by geographic location with the highest mortality risks reported in the southeastern US. While these disparities have been investigated at state and county levels, little is known regarding disparities in risk at lower levels of geography, such as neighborhoods. Therefore, the objective of this study was to investigate spatial patterns of stroke and MI mortality risks in the East Tennessee Appalachian Region so as to identify neighborhoods with the highest risks.

Methods

Stroke and MI mortality data for the period 1999-2007, obtained free …

The Spatial Epidemiology And Clinical Features Of Reported Cases Of La Crosse Virus Infection In West Virginia From 2003 To 2007, Andrew D. Haddow, Danae Bixler, Agricola Odoi

Entomology & Plant Pathology Publications and Other Works

Background

La Crosse virus (LACV) is a major cause of pediatric encephalitis in the United States. Since the mid-1980s, the number of reported cases of LACV infection in West Virginia has continued to rise and the state currently reports the most cases in the United States. The purpose of this study was to investigate and describe the spatial epidemiology and clinical presentation of LACV infection cases reported in West Virginia, as well as to provide a description of the environmental conditions present at the residences of the LACV infection cases.

Methods

Descriptive and spatial analyses were performed on LACV infection …

Naïve T Cells Re-Distribute To The Lungs Of Selectin Ligand Deficient Mice, Thandi M. Onami, John R. Harp

Microbiology Publications and Other Works

BACKGROUND: Selectin mediated tethering represents one of the earliest steps in T cell extravasation into lymph nodes via high endothelial venules and is dependent on the biosynthesis of sialyl Lewis X (sLe(x)) ligands by several glycosyltransferases, including two fucosyltransferases, fucosyltransferase-IV and -VII. Selectin mediated binding also plays a key role in T cell entry to inflamed organs.

METHODOLOGY/PRINCIPAL FINDINGS: To understand how loss of selectin ligands (sLe(x)) influences T cell migration to the lung, we examined fucosyltransferase-IV and -VII double knockout (FtDKO) mice. We discovered that FtDKO mice showed significant increases (approximately 5-fold) in numbers of naïve T cells in …

Model Or Meal? Farm Animal Populations As Models For Infectious Diseases Of Humans, Cristina Lanzas, P Ayscue, R Ivanek, Y T. Grohn

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

In recent decades, theory addressing the processes that underlie the dynamics of infectious diseases has progressed considerably. Unfortunately, the availability of empirical data to evaluate these theories has not grown at the same pace. Although laboratory animals have been widely used as models at the organism level, they have been less appropriate for addressing issues at the population level. However, farm animal populations can provide empirical models to study infectious diseases at the population level.

Development Of A Mechanistic Model To Represent The Dynamics Of Particle Flow Out Of The Rumen And To Predict Rate Of Passage Of Forage Particles In Dairy Cattle., S Seo, Cristina Lanzas, L O. Tedeschi, A Pell, D G. Fox

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

A mechanistic and dynamic model was developed to represent physiological aspects of particle dynamics in the reticulo-rumen (RR) and to predict rate of passage out of the RR (Kp) of forage particles quantitatively. The model consists of 2 conceptual pools with 3 spatial compartments of particles; the compartment the particle enters is based on functional specific gravity (FSG). The model assumes 2 major pressure gradient-driven flows of particles out of the RR through the reticulo-omasal orifice between 2 consecutive primary reticular contractions. One is associated with the second phase of primary reticular contraction and involves propulsion of particles in the …

Modeling On-Farm Escherichia Coli O157:H7 Population Dynamics, P Ayscue, Cristina Lanzas, R Ivanek, Y T. Grohn

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

Escherichia coli O157:H7 is a potentially fatal foodborne pathogen with a putative reservoir for human infection in feedlot cattle. In order to more effectively identify targets for intervention strategies, we aimed to (1) assess the role of various feedlot habitats in E. coli O157:H7 propagation and (2) provide a framework for examining the relative contributions of animals and the surrounding environment to observed pathogen dynamics. To meet these goals we developed a mathematical model based on an ecological metapopulation framework to track bacterial population dynamics inside and outside the host. We used E. coli O157:H7 microbiological and epidemiological literature to …

The Generation Of Influenza-Specific Humoral Responses Is Impaired In St6gal I-Deficient Mice., Thandi M. Onami, J Zeng, H. M. Joo, B. Rajini, J. P. Wrammert, M. Y. Sangster

Microbiology Publications and Other Works

Posttranslational modification of proteins, such as glycosylation, can impact cell signaling and function. ST6Gal I, a glycosyltransferase expressed by B cells, catalyzes the addition of alpha-2,6 sialic acid to galactose, a modification found on N-linked glycoproteins such as CD22, a negative regulator of B cell activation. We show that SNA lectin, which binds alpha-2,6 sialic acid linked to galactose, shows high binding on plasma blasts and germinal center B cells following viral infection, suggesting ST6Gal I expression remains high on activated B cells in vivo. To understand the relevance of this modification on the antiviral B cell immune response, we …

Role Of Chromodomain Helicase Dna-Binding Protein 2 In Dna Damage Response Signaling And Tumorigenesis., Thandi M. Onami, P. Nagarajan, S. Rajagopalan, S. Kania, R. Donnell, S. Venkatachalam

Microbiology Publications and Other Works

The chromodomain helicase DNA-binding proteins (CHDs) are known to affect transcription through their ability to remodel chromatin and modulate histone deacetylation. In an effort to understand the functional role of the CHD2 in mammals, we have generated a Chd2 mutant mouse model. Remarkably, the Chd2 protein appears to play a critical role in the development, hematopoiesis and tumor suppression. The Chd2 heterozygous mutant mice exhibit increased extramedullary hematopoiesis and susceptibility to lymphomas. At the cellular level, Chd2 mutants are defective in hematopoietic stem cell differentiation, accumulate higher levels of the chromatin-associated DNA damage response mediator, cH2AX, and exhibit an aberrant …

Improved Feed Protein Fractionation Schemes For Formulating Rations With The Cornell Net Carbohydrate And Protein System, Cristina Lanzas, G A. Broderick, D G. Fox

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

Adequate predictions of rumen-degradable protein (RDP) and rumen-undegradable protein (RUP) supplies are necessary to optimize performance while minimizing losses of excess nitrogen (N). The objectives of this study were to evaluate the original Cornell Net Carbohydrate Protein System (CNCPS) protein fractionation scheme and to develop and evaluate alternatives designed to improve its adequacy in predicting RDP and RUP. The CNCPS version 5 fractionates CP into 5 fractions based on solubility in protein precipitant agents, buffers, and detergent solutions: A represents the soluble nonprotein N, B1 is the soluble true protein, B2 represents protein with intermediate rates of degradation, B3 is …

The Risk And Control Of Salmonella Outbreaks In Calf-Raising Operations: A Mathematical Modeling Approach, Cristina Lanzas, L D. Warnick, R Ivanek, P Ayscue, D V. Nydam, Y T. Grohn

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

Salmonellosis in calves has economic and welfare implications, and serves as a potential source of human infections. Our objectives were to assess the risk of Salmonella spread following its introduction into a herd of pre-weaned calves and to evaluate the efficacy of control strategies to prevent and control outbreaks. To meet these objectives, we developed a model of Salmonella transmission within a pre-weaned group of calves based on a well documented outbreak of salmonellosis in a calf-raising operation and other literature. Intervention scenarios were evaluated in both deterministic and stochastic versions of the model. While the basic reproduction number (R0) …

The Effect Of Heterogeneous Infectious Period And Contagiousness On The Dynamics Of Salmonella Transmission In Dairy Cattle, Cristina Lanzas, S Brien, R Ivanek, Y Lo, P P. Chapagain, K A. Ray, P Ayscue, L D. Warnick, Y T. Grohn

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

The objective of this study was to address the impact of heterogeneity of infectious period and contagiousness on Salmonella transmission dynamics in dairy cattle populations. We developed three deterministic SIR-type models with two basic infected stages (clinically and subclinically infected). In addition, model 2 included long-term shedders, which were defined as individuals with low contagiousness but long infectious period, and model 3 included super-shedders (individuals with high contagiousness and long infectious period). The simulated dynamics, basic reproduction number (R0) and critical vaccination threshold were studied. Clinically infected individuals were the main force of infection transmission for models 1 and 2. …

Gene Alterations By Peroxisome Proliferator-Activated Receptor Gamma Agonists In Human Colorectal Cancer Cells, Maria Cekanova, X Li, J Yuan, K B. Kim, Seung J. Baek

Faculty Publications and Other Works -- Biochemistry, Cellular and Molecular Biology

The peroxisome proliferator-activated receptor gamma (PPARgamma) is a nuclear transcription factor that controls the genes involved in metabolism and carcinogenesis. In the present study, we examined the alteration of gene expression in HCT-116 human colorectal cancer cells by PPARgamma agonists: MCC-555 (5 microM), rosiglitazone (5 microM), and 15-deoxy-Delta12,14-prostaglandin J2 (1 microM). The long-oligo microarray data revealed a list of target genes commonly induced (307 genes) and repressed (32 genes) by tested PPARgamma agonists. These genes were analyzed by Onto-Express software and KEGG pathway analysis and revealed that PPARgamma agonists are involved in cell proliferation, focal adhesion, and several signaling pathways. …

Systemic And Mucosal Infection Program Protective Memory Cd8 T Cells In The Vaginal Mucosa., Thandi M. Onami, P. K. Suvas, H. M. Dech, J. Zeng

Microbiology Publications and Other Works

Whether mucosal immunization is required for optimal protective CD8 T cell memory at mucosal surfaces is controversial. In this study, using an adoptive transfer system, we compare the efficacy of two routes of acute lymphocytic choriomeningitis viral infection on the generation, maintenance, and localization of Ag-specific CD8 T cells in tissues, including the vaginal mucosa. Surprisingly, at day 8, i.p. infection results in higher numbers of Ag-specific CD8 T cells in the vaginal mucosa and iliac lymph node, as well as 2-3x more Ag-specific CD8 T cells that coexpress both IFN-gamma and TNF-alpha in comparison to the intranasal route of …

Development Of A Mechanistic Model To Represent The Dynamics Of Liquid Flow Out Of The Rumen And To Predict The Rate Of Passage Of Liquid In Dairy Cattle, S Seo, Cristina Lanzas, L O. Tedeschi, D G. Fox

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

A mechanistic and dynamic model was developed to represent the physiological aspects of liquid dynamics in the rumen and to quantitatively predict liquid flow out of the reticulorumen (RR). The model is composed of 2 inflows (water consumption and salivary secretion), one outflow (liquid flow through the reticulo-omasal orifice (ROO), and one in-and-out flow (liquid flux through the rumen wall). We assumed that liquid flow through the ROO was coordinated with the primary reticular contraction, which is characterized by its frequency, duration, and amplitude during eating, ruminating, and resting. A database was developed to predict each component of the model. …

Evaluation Of Protein Fractionation Systems Used In Formulating Rations For Dairy Cattle, Cristina Lanzas, S Seo, L O. Tedeschi, D G. Fox

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

Production efficiency decreases when diets are not properly balanced for protein. Sensitivity analyses of the protein fractionation schemes used by the National Research Council Nutrient Requirement of Dairy Cattle (NRC) and the Cornell Net Carbohydrate and Protein System (CNCPS) were conducted to assess the influence of the uncertainty in feed inputs and the assumptions underlying the CNCPS scheme on metabolizable protein and amino acid predictions. Monte Carlo techniques were used. Two lactating dairy cow diets with low and high protein content were developed for the analysis. A feed database provided by a commercial laboratory and published sources were used to …

Digestion Kinetics Of Dried Cereal Grains, Cristina Lanzas, A N. Pell, D G. Fox

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

Grain fermentability largely determines the feed value of grains for ruminants. Our objective was to evaluate the variation in kinetics of gas production of cereal grains and the relationship among gas production, chemical composition and feed value. Eighteen barley, 99 corn, 23 sorghum, and 57 wheat samples were fermented in vitro for 48 h. Gas production was measured with a computerized system and an exponential model was fitted to the data. The impact of the variation in composition and kinetics on the feed value of grains in feedlot rations was assessed with the Cornell Net Carbohydrate and Protein System (CNCPS). …

A Revised Cncps Feed Carbohydrate Fractionation Scheme For Formulating Rations For Ruminants, Cristina Lanzas, C J. Sniffen, S Seo, L O. Tedeschi, D G. Fox

Faculty Publications and Other Works -- Biomedical and Diagnostic Sciences

Balancing ruminant diets for appropriate levels and types of dietary carbohydrates (CHO) is necessary to maximize production while assuring the health of the animals. Several feed fractions (i.e., volatile fatty acids (VFA), lactate, sugars, starch) are now being measured in some commercial feed laboratories and this information may assist in better formulating diets. A CHO fractionation scheme based on ruminal degradation characteristics needed for nutritional models is described and its impact on predictions with the Cornell Net Carbohydrate and Protein System (CNCPS) is assessed. Dietary CHO are divided into eight fractions: the CA1 is volatile fatty acids (VFA), CA2 is …

Lack Of Antigen-Specific Tissue Remodeling In Mice Deficient In The Macrophage Galactose-Type Calcium-Type Lectin 1/Cd301a., Thandi M. Onami, K. Sato, Y. Imai, N. Higashi, Y. Kumamoto, S. M. Hedrick, T. Irimura

Microbiology Publications and Other Works

Macrophage galactose-type C-type lectins (MGLs), which were recently named CD301, have 2 homologues in mice: MGL1 and MGL2. MGLs are expressed on macrophages and immature dendritic cells. The persistent presence of granulation tissue induced by a protein antigen was observed in wild-type mice but not in mice lacking an endogenous, macrophage-specific, galactose-type calcium-type lectin 1 (MGL1) in an air pouch model. The anti-MGL1 antibody suppressed the granulation tissue formation in wild-type mice. A large number of cells, present only in the pouch of MGL1-deficient mice, were not myeloid or lymphoid lineage cells and the number significantly declined after administration of …

Cd43 Modulates Severity And Onset Of Experimental Autoimmune Encephalomyelitis., Thandi M. Onami, M. L. Ford, A. Sperling, R. Ahmed, B. D. Evavold

Microbiology Publications and Other Works

Experimental autoimmune encephalomyelitis (EAE) is a mouse model of multiple sclerosis characterized by infiltration of activated CD4(+) T lymphocytes into tissues of the CNS. This study investigated the role of CD43 in the induction and progression of EAE. Results demonstrate that CD43-deficient mice have reduced and delayed clinical and histological disease severity relative to CD43(+/+) mice. This reduction was characterized by decreased CD4(+) T cell infiltration of the CNS of CD43(-/-) mice but similar numbers of Ag-specific T cells in the periphery, suggesting a defect in T cell trafficking to the CNS. The absence of CD43 also affected cytokine production, …

Primary And Secondary Immunocompetence In Mixed Allogeneic Chimeras, Thandi M. Onami, M. A. Williams, A. B. Adams, M. B. Walsh, N. Shirasugi, T. C. Pearson, R. Ahmed, C. P. Larsen

Microbiology Publications and Other Works

Targeted disruption of T cell costimulatory pathways, particularly CD28 and CD40, has allowed for the development of minimally myeloablative strategies for the induction of mixed allogeneic chimerism and donor-specific tolerance across full MHC barriers. In this study we analyze in depth the ability of mixed allogeneic chimeras in two strain combinations to mount effective host-restricted and donor-restricted antiviral CD4 and CD8 responses, as well as the impact of development of mixed chimerism on the maintenance of pre-existing memory populations. While antiviral CD8 responses in mixed chimeras following acute viral infection with lymphocytic choriomeningitis virus Armstrong or vaccinia virus are largely …

Tcr Signal Transduction In Antigen-Specific Memory Cd8 T Cells, Thandi M. Onami, Ellen N. Kersh, Susan M. Kaech, Miriana Moran, E. John Wherry, M. Carrie Miceli, Rafi Ahmed

Microbiology Publications and Other Works

Memory T cells are more responsive to Ag than naive cells. To determine whether memory T cells also have more efficient TCR signaling, we compared naive, effector, and memory CD8 T cells of the same antigenic specificity. Surprisingly, initial CD3 signaling events are indistinguishable. However, memory T cells have more extensive lipid rafts with higher phosphoprotein content before TCR engagement. Upon activation in vivo, they more efficiently induce phosphorylation of-LAT (linker for activation of T cells), ERK (extracellular signal-regulated kinase), JNK (c-Jun N-terminal kinase), and p38. Thus, memory CD8 T cells do not increase their TCR sensitivity, but are better …