Medicine and Health Sciences Commons^™

Burnout Among Emergency Physicians Working At A Large Tertiary Centre In Ontario, Rushika Perera, Kristine Van Aarsen, Laura Foxcroft, Rodrick Lim

Journal of Wellness

BACKGROUND: Emergency medicine (EM) is a high-stress specialty. Work related stress and burnout have been reported to negatively impact physician-patient interactions, overall physician mental and physical health, and most importantly, patient outcomes. We assessed the rates of burnout among emergency physicians (EPs) at our centre.

METHODS: A local cross-sectional study to assess burnout among adult and pediatric EPs, fellows and residents was conducted at three Emergency Departments (EDs) at a single institution in Canada. The anonymous online survey encompassed demographics, the validated MBI tool (Maslach Burnout Inventory) and additional questions aimed at identifying determinants of EP burnout. Each respondent’s three …

Night Shifts, Salvator Vicario

Journal of Wellness

No abstract provided.

Metaphors We Think By, Aldis H. Petriceks

Journal of Wellness

N/A

Can We Actually Improve Resident Wellness? Pilot Data From A Longitudinal Wellness Curriculum For Emergency Medicine Residents, Anne M. Messman, Claire Min-Venditti, Elizebeth Dubey, Brian Reed, Hanhan Zhang, Hafez Bazzi, James Paxton

Journal of Wellness

Objectives/Background: The wellness of resident physicians, particularly in emergency medicine with its high rate of burnout, has become of paramount importance to residency programs. This study aims to evaluate the effects of the implementation of an evidence-based wellness curriculum on self-reported resident wellness across three emergency medicine residency programs.

Methods: This is a prospective, interventional study of the impact of a well-defined, longitudinal wellness curriculum administered to all categorical residents in three emergency medicine residency programs. Anonymous surveys incorporating the Perceived Stress Scale (PSS) and the Connor-Davidson Resilience Scale (CD-RISC) were administered before and after implementation of the …

They Shouldn't Get To Hurt You, Diann M. Krywko

Journal of Wellness

No abstract provided.

The Manipulation Of Host Transcription By The Ankh Effector Of Legionella., Juanita E. Von Dwingelo

Electronic Theses and Dissertations

Legionella pneumophila is a Gram-negative facultative intracellular bacterium that can be found dispersed throughout freshwater environments, where it primarily parasitizes amoebae and other protozoan species. Humans are an accidental host for L. pneumophila, and infection occurs upon inhalation of aerosolized water droplets that contain the bacteria. L. pneumophila is the causative agent of Legionnaires’ Disease, which is the result of intracellular proliferation within alveolar macrophages. Pathogenesis of L. pneumophila is dependent on the Dot/Icm type 4 secretion system (T4SS) apparatus, which is comprised of 27 proteins and is responsible for translocating over 330 effector proteins into the host cell. Many …

A Recombinant Cholera Toxin B Subunit Variant (Ctb-Kdel) Exhibits Unique Colon Mucosal Healing Effects That Have Therapeutic Implications For Inflammatory Bowel Disease., Joshua Mark Royal

Electronic Theses and Dissertations

This dissertation uncovers the mechanism and explores the utility of a recombinant cholera toxin B subunit (CTB) variant containing a KDEL endoplasmic reticulum (ER) retention motif (CTB-KDEL) as a drug candidate for the treatment of inflammatory bowel disease (IBD). CTB is a mucosal immunomodulatory protein that induces robust mucosal and systemic antibody responses. This well-known biological activity has been exploited in cholera prevention (as a component of Dukoral® vaccine) and vaccine development for decades. On the other hand, several studies have investigated CTB’s immunotherapeutic potential in the treatment of inflammatory diseases such as Crohn’s disease and asthma. Here, we reveal …

Exploring Normalization Of Deviance And Examining Factors That Predict Culture Of Safety In The Operating Room., M. Imelda Wright

Electronic Theses and Dissertations

Patient safety in the operating room is a prodigious responsibility of OR nurses as the OR environment is complex and laden with risk, which increases surgical patients’ risk for adverse events. The dissertation presents the topic of patient safety in the operating room (OR), the concept of normalization of deviance, and a mixed-methods study with an exploratory sequential design that involved three phases. The dissertation comprises of five chapters. Chapter One presents an introductory overview of the salience of patient safety as well as its relevance to the unique environment of the OR. Chapter Two presents a concept analysis of …

Coordination Of Airway Protective Behaviors And Swallow: Effects Of Afferent Feedback And Sex., Alyssa D. Huff

Electronic Theses and Dissertations

This dissertation represents a series of studies describing mechanisms related to breathing, upper airway behaviors and their coordination in man and animal. Chapter two transformed the cough swallow aspiration protocol from the cat (previous work) to the human introducing a new strategy, volume targeting, in swallow breathing coordination. Chapter three evaluated swallow breathing coordination at increasing altitudes. As respiratory drive altered due to hypoxia and hypocapnia, swallow breathing coordination shifted toward inspiration occurring during the transition from inspiration and expiration. The collection of the two previous studies led to development of an animal model to evaluate volume targeting and …

Characterization Of The Impact Of Prenatal Cigarette Smoke Exposure On Age- And Sex-Specific Sirt1-Mediated Hepatic Molecular Phenotype In C57bl/6 Mice., Kendall S. Stocke

Electronic Theses and Dissertations

In the U.S., 7.2% of women still report having smoked at some point during pregnancy despite known risks to fetal health. Prenatal cigarette smoke exposure (CSE) in children puts them at risk for low birth weight, premature birth, and other adverse impacts on developmental and postnatal health. Children subjected to prenatal CSE have a higher risk of adulthood metabolic disease predicted by the Barker Hypothesis. The hepatic molecular phenotype associated with this risk is unknown. This dissertation characterizes the prenatal CSE-induced hepatic molecular phenotype during three key life stages. We used a murine model of prenatal CSE utilizing a Teague …

Addressing The Problem Of Sterile Drug Injecting Supply Acquisition For People Who Inject Drugs., Barbra Ann Cave

Electronic Theses and Dissertations

This dissertation contains five chapters, including three manuscripts, covering harm reduction and some of the challenges people who inject drugs (PWID) face in their effort to reduce the risk of injection drug-related harms through sterile injecting supply acquisition and use. Chapter One discusses some background related to PWID and provides an overview of the issues addressed in this dissertation. Chapter Two includes a literature review covering the harm reduction concept, important aspects of syringe exchange programs as a harm reduction tool, and the social determinants of health model as a potential tool for future research. Chapter Three is a two-phase …

“Pissing In The Wind”: Racially Discriminatory Economic Policies’ Impact On Today’S Banking Status, Use Of Alternative Financial Services And Health Outcomes., Gaberiel Jones Jr

Electronic Theses and Dissertations

Centuries of discriminatory policies and practices in the United States have created racially segregated, resource-poor urban communities. Differential benefits of banking and housing legislation were among the consequences of these policies as they contributed to drastic racial inequities in wealth. Today, racial differences in banking status and financial practices persist. However, a void exists in the literature exploring what alternative financial services (AFS) are used in lieu of banks by Black Americans, why those services are used, the thoughts and beliefs of Black Americans about the use of those services, the impact of bank locations on financial behavior patterns, and …

The Identification Of Long Non-Coding Rna Zfas1 Through An Exploratory Rna-Sequencing Analysis And Its Association With Epithelial-To-Mesenchymal Transition In Colon Cancer Adenocarcinoma., Stephen J. O'Brien

Electronic Theses and Dissertations

Colorectal adenocarcinoma is the fourth most common cancer diagnosed worldwide and is a significant cause of morbidity and mortality. This dissertation performed an exploratory RNA-sequencing analysis comparing gene expression between colon adenocarcinoma tissue and paired normal colon epithelium. After identification of a number of lncRNAs that were increased in expression in colon adenocarcinoma compared to normal colon epithelium, we aimed to validate the expression and investigate their function in vitro. Specifically, we focused on the lncRNA ZFAS1 and its association with epithelial-to-mesenchymal transition. These studies found the following: 1. Seven candidate lncRNAs were identified from the exploratory RNA-sequencing analysis to …

The Effects Of Nicotine And Cigarette Smoking On Cardiac Electrophysiology., Affan B. Irfan

Electronic Theses and Dissertations

Cigarette smoking is a leading cause of preventable disease and premature death worldwide. The adverse effects of cigarette smoking, including proarrhythmia, are related to the mixture of chemicals, including nicotine (which sustains tobacco addiction). However, it remains unclear which individual tobacco smoke constituents and biological pathways mediate this increased risk. The purpose of this research was to explore the chronic effects of cigarette smoking, as well as compare the acute effects of nicotine and cigarette smoking, and the possible role of β-adrenoreceptors, on human cardiac electrophysiology. Chapter 1 is a comprehensive literature review of (a) the ex vivo and in …

Electrospun Fibers And Nanoparticles For The Prevention Of Sexually Transmitted Infections., Kevin Michael Tyo

Electronic Theses and Dissertations

Human immunodeficiency virus-1 (HIV-1) and herpes simplex virus 2 (HSV-2) affect hundreds of millions of people worldwide, with women disproportionately impacted by these infections. Currently, only oral pre-exposure prophylaxis (PrEP) is approved specifically for the prevention of HIV-1, but is challenged with adverse side effects associated with long-term use. Topical delivery platforms, such as gels and films, deliver agents directly to the female reproductive tract, but are limited in providing transient-release. The technology of polymeric electrospun fibers may serve as alternative topical delivery platform to the female reproductive tract. In these studies, we fabricated electrospun fibers comprised of different polymers …

Wellness Domains For Residency Training Programs, Danielle Hart, Glenn Paetow, Ramin Tabatabai, Rochelle Zarzar, Arlene S. Chung

Journal of Wellness

In this editorial, we describe a residency-specific wellness framework that residency leadership can utilize in developing their local wellness programs.

Sustainable Solutions, Fall/Winter 2020, Issue 41

Sustain Magazine

No abstract provided.

Developments For The Treatment Of Invasive Infections Due To Multidrug-Resistant Acinetobacter Baumannii, David Laurent, Richard Drew, Dustin Wilson

The University of Louisville Journal of Respiratory Infections

Acinetobacter baumannii is a significant pathogen in healthcare settings (specifically prominent in healthcare- and ventilator-associated pneumonia) due primarily to its virulence and resistance to a wide variety of antimicrobial drug classes, including carbapenems (CRAB). Existing therapies (notably polymyxins, minocycline, tigecycline, amikacin, and sulbactam) often result in suboptimal tissue concentrations, high rates of toxicity, and increasing rates of resistance. Although utilizing combinations of antibiotics (specifically those containing colistin) have been employed, results have been mixed, and control trials are lacking. Eravacycline is a novel tetracycline with an improved pharmacokinetic profile and more potent activity against A. baumannii relative to tigecycline. Cefiderocol …

Electronic Data Capture And Study Management, William A. Mattingly

Division of Infectious Diseases

Electronic Data Capture (EDC) is the process of recording data from a primary data source into a computerized system for improved reliability, security, and convenience. Data stored in EDC systems are used for analysis and, in the case of clinical studies, are an important part of the development pipeline for new drugs and medical devices. This text provides an introduction to data capture and the management of a scientific study using the popular EDC solution REDCap.

Community-Acquired Pneumonia Pathogenesis In Patients With Chronic Obstructive Pulmonary Disease, Julio A. Ramirez, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Plasma Cysteine/Cystine And Glutathione/Glutathione Disulfide Redox Potentials In Hiv And Copd Patients., Walter H. Watson, Jeffrey D. Ritzenthaler, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Tom J. Burke, Yuxuan Zheng, Julio A. Ramirez, Jesse Roman

Faculty Scholarship

Chronic obstructive pulmonary disease (COPD) is prevalent in patients infected with HIV. The purpose of this study was to test the hypothesis that systemic oxidation correlates with loss of lung function in subjects with COPD, and that HIV infection can contribute to creating such an environment. Subjects were recruited at the University of Louisville in the following groups: HIV-infected (n = 36), COPD (n = 32), HIV and COPD (n = 28), and uninfected controls with normal lung function (n = 34). HIV infection was assessed by viral load and CD4 cell counts. Pulmonary function was determined by spirometry …

Wellness Review 2019, Part 1, Martin Huecker, Brian A. Ferguson

Journal of Wellness

Welcome to the first Journal of Wellness review of recent literature. Wellness leaders are aware that a literature search yields thousands of articles on burnout, less on wellness, and no consistent, reliable source of publication. This validates the mission of JWellness, to collect editorials and research in one location, free for all to read and publish, allowing dissemination to all healthcare professionals.

Association Of Urine Levels Of C-Reactive Protein With Clinical Outcomes In Patients With Pneumonia: A Pilot Study, Subathra Marimuthu, Vidyulata Salunkhe, Stephen P. Furmanek, Leslie A Wolf

The University of Louisville Journal of Respiratory Infections

Finding relevant biomarkers as a potential predictor of severity for patients hospitalized with community acquired pneumonia (CAP), in addition to the clinical scoring system, could advance progress towards more effective patient management. The inflammatory marker, C-reactive protein (CRP), which is elevated in the pathogenesis of many infectious diseases, may be a key biomarker target for CAP. Previous studies have shown that serum CRP may be a useful diagnostic marker for pneumonia in hospitalized patients with acute respiratory symptoms. The main aims of this study were to determine the correlation between serum and urine CRP levels in hospitalized patients with CAP, …

Health Benefits Associated With An Employer-Sponsored Health Promotion Program With Device-Reported Activity, Ian Duncan, Wade Herndon, Xiyue Liao

Journal of Wellness

Background: As interest has grown in the effect of healthy behaviors on health outcomes, programs have been developed to incent healthy behavior. The growth of devices able to transmit information about program participant activities has allowed researchers to analyze physical activity (PA). We analyzed the relationship between positive changes in device-reported physical activity levels and changes in health-related variables in a longitudinal cohort of US based employees.

Methods: Exercise levels were measured and recorded by a device (such as a pedometer or heart-rate monitor) or gym visit and recorded by the health promotion program provider, The Vitality Group. The devices …

Letter From The Editor-In-Chief: Journal Of Refugee & Global Health Volume 2, Issue 2, Ruth Carrico

Journal of Refugee & Global Health

No abstract provided.

Treatment Of Podoconiosis With Complicating Polyinfections Within Rural African Villages: A Case Study, Amanda R. Beering, Abigail R. Florence, Soon Bahrami Md

Journal of Refugee & Global Health

This case study aims to provide a treatment plan for the treatment of podoconiosis with complicating polyinfections in a resource poor setting. A second objective is to help healthcare providers teach preventive measures to villagers in affected regions.

Implementing A Clinical Research Program In Long Term Care Facilities: Experiences From The University Of Louisville Center Excellence For Research In Infectious Diseases [Cerid], Ruth Carrico, Dawn Balcom, Kuldeep Ghosh, Bilal Abaid, Vidyulata Salunkhe, Bibodh Jung Karki, Simra Kiran, Stephen Furmanek, Senen Pena, Julio A. Ramirez

Journal of Refugee & Global Health

Background: According to the US Census Bureau International Report, in 2015, almost nine percent of the world’s population was aged 65 and over. As the worldwide population ages, there is a need to understand how to best care for those individuals. Developing clinical research programs focusing on long term care (LTC) will be critical to defining best practice.

Objectives: The objectives of this manuscript are to: 1) outline the challenges identified in performing clinical research in long term care facilities (LTCF), and 2) offer solutions for future clinical research in the LTC environment based upon our experiences.

Methods: A research …

The Make ‘Em Well Project -Rewards And Recognition Phase, Diann M. Krywko

Journal of Wellness

The Make ‘EM Well Project- Rewards and Recognition

Background: Physicians report high burnout levels and difficulty finding joy in work, causing a healthcare system crisis. Our institution assessed burnout by administering the Areas of Work-life (AWS) and Maslach Burnout Inventory™ (MBI) Surveys. Emergency Medicine (EM) results were alarming. Effectively rewarding and recognizing employees requires understanding different appreciation languages. Administrators should understand what enhances and detracts from joy in the workplace. This study describes the “Make ‘EM Well Project” and its focus on Rewards and Recognition (RR).

Methods: Two surveys were sent to EM providers including faculty, residents, fellows, and advanced …

Environmentally Responsible Land Use, Spring/Summer 2010, Issue 22

Sustain Magazine

No abstract provided.

Sustainable Communities, Fall/Winter 2010, Issue 21

Sustain Magazine

No abstract provided.