Medicine and Health Sciences Commons^™

Investigating The Pi3k/Akt/Atm Pathway, Telomeric Dna Damage, T Cell Death, And Crispr/Cas9-Mediated Gene Editing During Acute And Chronic Hiv Infection, Sushant Khanal

Electronic Theses and Dissertations

Human Immunodeficiency Virus (HIV) infection initiates major metabolic and cell- survival complications. Anti-retroviral therapy (ART) is the current approach to suppress active HIV replication to a level of undetected viral load, but it is not a curative approach. Newer and sophisticated gene editing technologies could indeed be a potent antiviral therapy to achieve a clinical sterilization/cure of HIV infection. Chronic HIV patients, even under a successful ART regimen, exhibit a low-grade inflammation, immune senescence, premature aging, telomeric DNA attrition, T cell apoptosis, and cellular homeostasis. In this dissertation, we investigated CD4 T cell homeostasis, degree of T cell apoptosis, an …

Prevalence And Predictors Of Polypharmacy In Adolescents Who Have Engaged In Sexually Abusive Behaviors, Rebecca Gilley

Electronic Theses and Dissertations

Polypharmacy, or the concurrent use of multiple medications, is associated with detrimental outcomes for patients and has gathered increasing attention within the scientific clinical literature. Pediatric populations warrant special consideration for the practice of polypharmacy, as medication effects are more pronounced in youth and adverse effects may have a lasting impact on development. This dissertation study examined psychotropic prescribing practices in a sample of adolescents who have engaged in sexually abusive behaviors, a subset of justice-involved youth who are at risk for polypharmacy. General prescribing trends were examined, and a principle components analysis involving variables associated with risk of polypharmacy …

When The Costs Outweigh The Benefits: Examining Variations In Nulliparous, Term, Singleton, Vertex And Elective Cesarean Delivery Rates Across The United States, 2016-2020, Kathleen Tatro

Electronic Theses and Dissertations

The overutilization of cesarean deliveries is a major public health issue in the United States (U.S.). The rates of cesarean deliveries have increased substantially from the mid 1990s. Low-risk, defined as nulliparous, term, singleton, vertex (NTSV) pregnancies with no medical indication of need, and elective cesarean deliveries have been implicated as drivers of these increases. Elective cesarean deliveries are NTSV cesarean deliveries in which no trial of labor was attempted. There is a lack of clear rationale as to the noted increases in cesarean delivery rates as the evidence shows that these procedures provide no additional health benefits to mothers …

Cyclic Di-Gmp Regulates Motility, Biofilm Formation, And Desiccation Tolerance In Acinetobacter Baumannii, Garrett Reynolds

Electronic Theses and Dissertations

Acinetobacter baumannii is an increasingly multidrug-resistant pathogen contributing to hospital-acquired infections necessitating the discovery of novel treatments. A bacterial second messenger, cyclic diguanosine monophosphate (cyclic di-GMP), can regulate various persistence factors that are potentially advantageous for survival in hospital environments. Cyclic di-GMP–modulating enzymes and cyclic di-GMP–binding effectors predictively are encoded in the Acinetobacter baumannii genome. I hypothesized that cyclic di-GMP controls motility, biofilm formation, and desiccation tolerance in Acinetobacter baumannii. Disrupting cyclic di-GMP–modulating enzymes or cyclic di-GMP–binding effectors should alter the regulatory effectiveness of these phenotypes. I tested the multidrug-resistant isolate Acinetobacter baumannii strain AB5075 and identified several transposon …

Cognitive Preference And Skill Acquisition: The Relationship Between Student Nurse Anesthetists And Certified Registered Nurse Anesthetists Thinking Styles, Thomas Diller

Electronic Theses and Dissertations

Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making.

The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher …

An Investigation Into The Use Of Biomechanical And Performance Data From Vertical Jump Testing To Monitor Competitive Weightlifters, Dylan Suarez

Electronic Theses and Dissertations

This investigation aimed to employ novel analyses to longitudinal jump testing data gathered from competitive weightlifters to identify how certain biomechanical and performance characteristics obtained from the countermovement jump (CMJ) relate to changes in weightlifting performance over time and if they can differentiate higher and lower performers. A linear mixed-effect model was used to assess and compare the ability of countermovement jump height and net-impulse to predict Sinclair weightlifting total. CMJ force-time waveforms were compared in cross-sectional and repeated measures analyses to distinguish the force application patterns of higher-performing weightlifters and if they change over extended periods of training. It …

Overview Of Transition Care Clinics And Patient No-Shows, Manul Awasthi

Electronic Theses and Dissertations

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC …

Investigating Force-Velocity Profile Alterations And Methodology After Traditional Resistance Training, Joseph D'Amato

Electronic Theses and Dissertations

The purposes of this dissertation were to examine the agreement the agreement between double integration using the trapezoidal method and measurements for push-off distance to create force-velocity profiles, examine the change in push-off distance between loading conditions when force-velocity profiling, and to observe the alterations in mechanical outputs of force-velocity profiles after 15-weeks of off-season training. The major findings are as followed. Using double integration with the trapezoidal method may be a reliable way to estimate push-off distance, despite a small systematic bias. This bias should have negligible effects on push-off distance and therefore not alter or effect calculations in …

Acute Effects Of Match Play Induced Fatigue On Jump Performance In Collegiate Women's Volleyball, Grayson Flora

Electronic Theses and Dissertations

This study investigated changes in maximal jump performance in response to match play induced fatigue. During six sets of tournament match play, seven National Association of Intercollegiate Athletics women’s volleyball athletes accumulated a mean Player Load of 758.6±216.89 au (measured via microsensor accelerometry), and mean session rate of perceived exertion of 1184.1±363.2. Repeated measures ANOVAs were used to identify change with Hedge’s g effect sizes used to assess magnitude of change. Short recovery stress scale results indicated elevated stress (ES=1.401 to 1.588) and decreased recovery (ES = -1.358 to -1.848) 24 hours post-match, trending towards baseline 48 hours post-match. Countermovement …

Positive And Negative Deviant Counties: Identification Of Factors Associated With Health Outcomes, Olivia Egen

Electronic Theses and Dissertations

Rural counties in the United States vary drastically on metrics related to socioeconomic status and dominant economic industry as well as health behaviors and outcomes. This study sought to understand the underlying structural reasons why some rural counties have better or worse than expected health outcomes using a positive deviance (PD) approach. The study aimed to: 1) create an area deprivation index and divide counties into quartiles using the index; 2) identify positive, negative, and non-deviant counties using health outcome metrics; 3) analyze differences between deviance on a variety of local public health system metrics; and 4) analyze differences between …

Review Of Effective Injury Preventing And Performance Enhancing Strategies For Runners, Jessica Dolinger

Undergraduate Honors Theses

The purpose of this research is to piece together proven techniques for injury prevention and rehabilitation in runners and use this information to outline the best techniques to make invulnerable the body of a runner and maximally enhance his or her performance. This review will cover the specific muscles that, when strengthened or stretched, are closest linked to improved performance when running. Furthermore, shared characteristics of specific running injuries will be made, as well as examinations of debates for effective running injury rehabilitation strategies. By doing this, an understanding of running related injuries, and the studied exercises and techniques that …

A Survey To Highlight Areas Of Focus For Patient Care In Settings Utilizing Medical Interpretation, Azayzel Deregis

Undergraduate Honors Theses

This thesis recounts my personal experience working as a volunteer medical interpreter for the Language and Culture Resource Center at East Tennessee State University. The result of my time spent volunteering as a medical interpreter, shadowing professional medical interpreters, and witnessing patient-provider interactions during interpreted sessions was an inspiration to study medical interpretation further and delve into the challenges faced by patients who require medical interpreters. During my time researching this topic, I found that the United States is severely lacking in Spanish medical interpreters—with some healthcare facilities employing no medical interpreters—even though the size of the Hispanic population is …

2-Day Vs. 4-Day Training Cessation Following A Step Taper In Competitive And Recreational Powerlifters, Benjamin Burke

Electronic Theses and Dissertations

The purpose of this study was to compare differences in maximal strength, perceived recovery and stress state, and body composition alterations in powerlifters undergoing a 2-day or 4-day period of training cessation following a step taper. Ten participants completed a 6-week powerlifting specific training protocol. Body composition, perceived recovery and stress state, and maximal strength in the back squat (BS), bench press (BP), and deadlift (DL) were assessed prior to the overreach week (week 5) and either 2-days or 4-days after the taper. Alpha criterion was set at p≤0.05. There were statistically significant increases in BP (pp=0.03) …

Assessing Best Practices, Perceptions, And Barriers To Breastfeeding In The Appalachian Region, Melissa White

Electronic Theses and Dissertations

Background: Breastfeeding protects against a variety of adverse health outcomes for mothers and babies. Global best practices, known as the Baby-Friendly Hospital Initiative (BFHI), have been developed to support the initiation and exclusivity of breastfeeding during the post-delivery hospital stay. The aims of this study were to explore the literature related to the impact of the BFHI on breastfeeding disparities in the U.S.; compare the impact of exposure to these best practices on exclusive breastfeeding rates in Appalachian and non-Appalachian hospitals; and to understand knowledge, perceptions, and barriers to breastfeeding of postpartum mothers receiving care in a Northeast Tennessee OB/GYN …

Knockdown Of C. Elegans Nad Kinases Nadk-1 Or Nadk-2 Induces An Antioxidant Response Without Affecting Lifespan, Henry Gong

Electronic Theses and Dissertations

Nearly all multicellular organisms show changes in redox balance with aging leading to oxidative damage of macromolecules. This study investigated the role of the [NADP⁺]/[NADPH] redox couple in aging. This redox couple plays an important role in maintaining tissue redox balance and becomes slightly more oxidized in aged tissues. NADPH is a major source of reducing equivalents for enzymes that detoxify hydrogen peroxide. However, catalase detoxifies hydrogen peroxide independently of NADPH. But catalase is absent from mitochondria, a major source of hydrogen peroxide, where instead glutathione plays the major role in hydrogen peroxide detoxification in an NADPH-dependent manner. …

Cyclic-Di-Gmp-Binding Proteins Regulate Acinetobacter Baumannii Motility, Gabriel Smith

Undergraduate Honors Theses

Acinetobacter baumannii is a prevalent nosocomial pathogen where, like many other infectious bacteria, A. baumannii is increasingly considered a multi-drug resistant pathogen. This research study was designed to find a way to affect the persistence of A. baumannii such that it can be applied to a hospital setting to prevent further nosocomial infections. One regulatory mechanism potentially used by A. baumannii to persist on hospital surfaces is through the use of the bacterial second messenger cyclic-di-GMP (c-di-GMP). This nucleotide signal is regulated in response to environmental conditions, and then activates c-di-GMP-binding proteins that induce phenotypic changes. One c-di-GMP-regulated phenotype is …

The Impact Of Covid-19 On The Opioid Epidemic, Hailey Stewart

Undergraduate Honors Theses

The COVID-19 pandemic adversely affected the lives of most Americans. People with Substance Use Disorder (SUD) were particularly vulnerable to the negative effects brought on by the pandemic. This study explored the increase in deaths due to opioid overdose during the pandemic exacerbated by factors such as increased stress, decrease in treatment options due to social distancing requirements and facility closures, social isolation, and an increase in spare time. Access to treatment for opioid use disorder (OUD) was interrupted by the measures meant to mitigate the spread of COVID-19. Through a systematic review of current literature, it was demonstrated that …

Evaluating The Effectiveness Of Restorative Justice Rehabilitative Services Available In Northeast Tennessee For Mothers Diagnosed With Substance Use Disorder, Claire Roberson

Undergraduate Honors Theses

Substance Use Disorder (SUD) has plagued families of rural Appalachia for many years, perpetuating involvement in the criminal justice system as well as generational trauma for people diagnosed with SUD and their children. This points to the necessity of a trauma-informed, restorative-justice based framework for rehabilitative services to most effectively heal families, address trauma, and re-integrate people diagnosed with SUD into society. A restorative justice-based program would provide health care services for addiction and any comorbid mental health disorders as well as teach parents how to properly provide for themselves and their families, manage finances, obtain employment, and further education. …

The Distribution Of Opioid Settlement Funds In Northeast Tennessee, Amani Patel

Undergraduate Honors Theses

Opioid Use Disorder is defined by the NIH as “the chronic use of opioids that causes

clinically significant distress or impairment.”1 Due to a number of factors, the overuse of opioids has become an epidemic in the United States. In recent years there have been a number of lawsuits against pharmaceutical companies and other parties who have benefitted from the proliferation of this issue. In most cases, it is up to the states or local governments who receive these funds to determine their best use. The purpose of this Thesis is to analyze the resources recommended by Ballad Health’s Community …

Nursing Students, Bullying, And Burnout: A Study On Bullying By Medical Staff Members Against Nursing Students In The Clinical Setting And Its Relation To Nursing Student Burnout, Kihley Bellamy

Undergraduate Honors Theses

The present study investigated the existence of bullying by medical staff members in the clinical setting as experienced by nursing students, the existence of burnout among these students, and if such students perceive feelings of burnout as directly related to experiences of bullying. Undergraduate main campus traditional Bachelor of Science in nursing students at East Tennessee State University in their second, third, fourth, or fifth semesters were invited to participate in the study. Participants (n=52) were required to complete an online survey that regarded bullying, burnout, and how participants perceive the relation between the two variables. The study shows that …

Covid-19 In Tennessee: Lessons Learned And A Tool For The Future, Allen Archer, Randy Wykoff, Megan Quinn

Undergraduate Honors Theses

Background: In late 2019, the SARS-CoV-2 virus was identified in Wuhan, China. Within a matter of weeks, the virus spread to the United States and many other countries around the world. By March 5, 2020, the first case of COVID-19 (the disease caused by the SARS-CoV-2 virus) was identified in the state of Tennessee, and the first known COVID-19 associated death in the state followed on March 20, 2020. In 2020 alone, there were 514,922 confirmed cases and 6,760 COVID-19 attributed deaths in the state of Tennessee. It is important to understand, however, that confirmed COVID-19 deaths do not accurately …

The Effects Of The Transition From Pre-Nursing To Nursing On Mental Health, Andrew J. Davis, Paige R. Mullins, Kimberly A. Sell

Undergraduate Honors Theses

Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression …

The Fecal Fermentation Profile Of Infants With Different Feeding Modalities, Willow Lewis, Michelle E. Johnson, William A. Clark, Amy Wahlquist

Undergraduate Honors Theses

Introduction/Background

Research indicates nutrition and environment in the first year of a child's life are crucial in their development and growth and can contribute to lower chances of developing obesity and other health concerns. Key factors that can determine these outcomes include the bacteria and resulting short chain fatty acids (SCFAs) present in the gut. This composition may be affected by feeding modality (formula feeding vs breastfeeding), exposure to the mother’s microbiota, weight status of the child, and type of delivery. This research aims to identify the impact of infant feeding modality on toddlers' fecal fermentation profile, and if there …

Comparison Of Short Chain Volatile Fatty Acids In The Breastmilk Of Normal And Overweight/Obese Mothers, Ellen Gaskill, W Andrew Clark, Kristy L. Thomas, Amy Wahlquist, Michelle E. Johnson

Undergraduate Honors Theses

INTRODUCTION: Health professionals emphasize the importance of breastfeeding in the development of children up to 6-months of age. It is known that short chain volatile fatty acids (SCVFAs) are a byproduct of nutrient fermentation by gut microbiome. These SCVFAs interact with the gut/brain axis and are known to influence infant development. Therefore, a reflection of maternal gut microbiome could likely be found in breastmilk (BM) due to diffusion of SCVFAs across the gut wall into the blood. Previous research in our laboratory has shown differences in the SCVFA fecal fermentation profile between individuals with normal (N) versus overweight/obese (OWOB) body …

Investigation On Bacterial Signaling Through Generation Of A Ppgpp Biosensor, Andrew Robinson

Undergraduate Honors Theses

Guanosine tetraphosphate (ppGpp) is a bacterial signaling molecule involved in activating the stringent response, a cellular reaction to environmental stress that downregulates cell division and metabolism processes to conserve nutrients. The stringent response is implicated in some instances of antibiotic persistence, so broadening the current understanding of ppGpp signaling is useful. This thesis seeks to generate a ppGpp biosensor that will bind ppGpp and emit fluorescent light in its presence, which will allow for improved research into the pathways and functions of the signaling molecule. To generate a novel ppGpp biosensor, I converted a biosensor previously used to detect cyclic …

Neuroanatomical Distribution Of Neurons Within The Hypothalamic Paraventricular Nucleus That Project To The Brainstem Rostral Ventrolateral Medulla, Nicolas Fuller

Undergraduate Honors Theses

The sympathetic nervous system is important in maintaining cardiovascular homeostasis. Elevated cardiovascular-related sympathetic activity can lead to neurogenic hypertension and a host of other serious cardiac-related abnormalities. The paraventricular nucleus (PVN) of the hypothalamus plays an important role in sympathetic cardiovascular regulation. Neurons from the PVN project to the rostral ventrolateral medulla (RVLM), which is the main brain stem sympathetic cardiovascular control center. While RVLM-projecting PVN neurons have been well characterized, the topographical organization within the PVN subnuclei is still not fully known. This neuroanatomical study aimed to map the topographical distribution of RVLM-projecting PVN neurons. Four different carboxylate FluoSphereTM …

An Assessment Evaluating The Possible Participation Of A Virtual Nutrition Education Program For Older Adults, Ashlyn Cobble

Undergraduate Honors Theses

The importance of proper nutrition education among older adults is crucial in promoting overall physical health and management of chronic health conditions. However, access to such education has been limited, especially during the COVID-19 pandemic. With the current boom in social media popularity, as well as virtual communication portals such as Zoom, the question must be asked if nutrition education could be effectively implemented for the use of older adults through these electronic channels. The study design for this particular research was a cross sectional survey to inform development of an online nutrition education program for older adults in Northeast …

An Exploration Of Low-Income Dental Services In The Tri-Cities, Macie Proffitt

Undergraduate Honors Theses

Dental care has great importance in the overall health of every individual. Many do not realize the effect oral health plays in their overall health and many areas in the United States do not have access to the dental care needed to obtain proper healthcare standards. In many of these areas, such as the Appalachian region, dental services for low-income citizens are limited. Specifically, in the Northeast Tennessee region, these dental services are severely limited. Washington County and Hawkins County of Northeast Tennessee are specific underserved areas in the Appalachian region. The purpose of this project was to explore the …

Severe Hypoxia Up-Regulates Gluconeogenesis In Daphnia, Morad C. Malek

Undergraduate Honors Theses

Hypoxia is a significant low oxygen state that has complex and diverse impacts on organisms. In aerobes, various adaptive responses to hypoxia are observed that vary depending on the level of oxygen depletion and previous adaptation, hence the continued attention to hypoxia as an important abiotic stressor. Adaptive responses to hypoxia are primarily governed by the hypoxia-inducible factors (HIFs), which activate downstream genetic pathways responsible for oxygen transport and metabolic plasticity. In aquatic habitats, oxygen availability can vary greatly over time and space. Therefore, aquatic organisms’ adaptation to hypoxia is likely pervasive, especially in genotypes originating from waterbodies prone to …

Long-Term Effects Of Estrogen Deficiency On Cardiac Systolic Function And Hypertrophy Following Chronic Sympathetic Stimulation, Pamela Avendano

Undergraduate Honors Theses

Cardiovascular disease (CVD) is the leading cause of death worldwide. Pre-menopausal women have a lower incidence and severity of CVD compared to age-matched men. However, at the onset of menopause, CVD increases. A central feature in patients with CVD is excessive chronic sympathetic stimulation (CSS) of β-adrenergic receptors (β-AR’s). Clinical and animal studies show estrogen deficiency and age exacerbate cardiac β-AR signaling and contractile function. This led to the hypothesis that prolonged estrogen deficiency followed by CSS worsens left ventricular cardiac function and hypertrophy in the aged female heart. Female mice underwent bilateral ovariectomy or SHAM surgery at 2.5 months …