Medicine and Health Sciences Commons^™

A Case Study Assessing The Integration Of Nuclear Safety And Security In Facilities Using A Monte Carlo Simulation Aided Analytical Hierarchy Process, Theodore A. Thomas, Shraddha Rane, Jason Timothy Harris

International Journal of Nuclear Security

Nuclear safety and security are essential in all operations using nuclear and radioactive materials. Even though both elements are important, the evolution of these programs has not developed at the same rate. As such, their integration has been met with challenges. This study analyzed the potential for synergy across different criteria and settings when integrating nuclear safety and security. The criteria included eight points where overlap could be identified between nuclear safety and security. Three work settings—industrial, medical, and research—were evaluated. Responses were collected from nine individuals who worked with nuclear materials in various capacities and different nuclear work settings. …

Effects Of The U.S. Veterinary Feed Directive Final Rule On The Prevalence Of Violative Antibiotic Residues And Antibiotic-Resistant Bacteria In Animal Products, Md Shamim Sarkar

Doctoral Dissertations

Antibiotic-resistant is a public health concern. The dissertation objective was to assess the effect of the implementation of the Veterinary Feed Directive (VFD) rule changes on the prevalence of violative antibiotic residues and antibiotic-resistant bacteria in food-animal tissues, retail meats, and cecal samples from food animals compared to the pre-VFD rule change period in the U.S. To understand the effect of implemented VFD rule changes on violative antibiotic residues in food-animal tissues, inspector-generated sampling (IGS) data from the U.S. National Residue Surveillance Program (NRP) was analyzed. An important observation was that implementing VFD rule changes was associated with the decreased …

Prior Authorizations And Addiction Treatment, Channie Cretsinger Mph, Jeremy C. Kourvelas Mph, Jennifer G. Tourville Dnp

SMART Policy Briefs

Key Points

• Concerns about prior authorizations have grown given research demonstrating inconsistent coverage and review policies across insurers, interruptions to care, high provider burden and higher healthcare costs.
• Tennessee policymakers and insurers have recently taken appropriate measures to ease the concerns and minizine unnecessary barriers. TennCare changed their policy on buprenorphine allowances in May 2023, essentially removing the prior authorization barrier for buprenorphine/naloxone preferred products.
• This is a significant step for Tennesseans given that the research shows that once the prior authorization process was removed for medications for opioid use disorder (MOUD), patients with opioid use disorder …

Spatial Epidemiology Of Prediabetes And Diabetes In Florida, Md Marufuzzaman Khan

Doctoral Dissertations

The burden of diabetes and diabetes-related Emergency Department (ED) visits has increased in Florida. However, Diabetes Self-management Education (DSME) Program participation remained considerably low. Little is known about disparities of DSME participation, diabetes complications, and ED use by diabetes patients in Florida and yet this information is important for guiding health programs aimed at reducing diabetes burden. Therefore, the objectives of this study were to investigate: (a) disparities of diabetes prevalence and DSME participation; (b) disparities of diabetes-related ED visit risks; and (c) prevalence and predictors of stroke among persons with prediabetes and diabetes.

Behavioral Risk Factor Surveillance System and …

Advanced Air Quality Management With Machine Learning, Cheng-Pin Kuo

Doctoral Dissertations

Air pollution has been a significant health risk factor at a regional and global scale. Although the present method can provide assessment indices like exposure risks or air pollutant concentrations for air quality management, the modeling estimations still remain non-negligible bias which could deviate from reality and limit the effectiveness of emission control strategies to reduce air pollution and derive health benefits. The current development in air quality management is still impeded by two major obstacles: (1) biased air quality concentrations from air quality models and (2) inaccurate exposure risk estimations

Inspired by more available and overwhelming data, machine learning …

The Pink Tax: A Comparative Case Study Between Tennessee And Washington State, Megha Chitturi

Baker Scholar Projects

The imposition of an additional luxury tax on menstrual health products, otherwise referred to as the “Pink Tax” or the “Tampon Tax”, is present in some states while absent in others. The decision to repeal such a tax is one that has proven to be critical, as it removes the connotation that such products are of “luxury” and make them more accessible to menstruators throughout the state. As of 2023, twenty-three states have eliminated the tax. The state of Washington falls under that parameter while Tennessee does not. The purpose of this undergraduate honors thesis is to explore the potential …

Serving American Veterans: A Review And Analysis Of Gaps In Service In The Needs Of Veterans, Mary Elisabeth Germann

Baker Scholar Projects

The United States Department of Veterans Affairs is the agency of the federal government that is responsible for providing benefits, health care, and cemetery services to US military Veterans and their families. About a quarter of the nation’s population, approximately 70 million people, are potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans. Due to this expansive demand, the United States has developed the most comprehensive system of Veterans assistance programs in the World. But many argue that the US VA still falls short of expectations and fails to fulfill the needs …

The Development Of Health System Resiliency: How Kenya's Experience With Malaria Impacted Its Reaction To The Covid-19 Pandemic, Zoe A. Ward

Baker Scholar Projects

Public health scholars have recently focused on health system resiliency to explain how previous experiences dealing with public health crises impact the healthcare sector, public behavior, and policy response to novel crises. However, it is unclear how resiliency develops. This study contributes by testing whether a health system’s experience with a health emergency and significant interventions impacts the response to a novel crisis. This research asks, “How has Kenya’s experience with malaria impacted its response to COVID-19?” Using the United States Agency for International Development (USAID) Malaria Indicator Survey (MIS), I develop a malaria adherence score to measure county-level compliance …

Ballad Health: Understanding Appalachia’S Regional Healthcare Monopoly, Meredith A. Bailey

Baker Scholar Projects

The Ballad Health merger of 2018, which combined the now 21 hospitals in the region under one organization, has impacted the healthcare landscape in Northeast Tennessee and Southwest Virginia. Historically, Appalachia has had to persevere through primary physician shortages, a lack of specialty care, geographic obstacles to accessing healthcare, challenges related to substance abuse, and much more. Since the merger of Mountain States Health Alliance and Wellmont Health System, little research has been done to assess the perceived impact the aggregation of providers has had on the population it serves. This study utilizes an online survey to better understand the …

Leptospira Seroprevalence In Companion Animals In Tennessee, Kellie Anne Mccreight

Masters Theses

Leptospirosis is a re-emerging zoonotic disease in humans and animals. The bacteria Leptospira spp. causing this disease is maintained in the kidneys of animals such as rodents and cattle as well as in the environment. Animals harboring Leptospira spp. in the kidneys frequently shed the bacteria in their urine, contaminating the environment. Contact with contaminated soil and water may result in infection. Animals and humans may develop serious life threatening disease from Leptospira infection. Approximately 1 million new human cases and over 50,000 deaths are reported worldwide. Numerous animal species including rodents, cattle, and dogs may serve as reservoir …

Ballad Health: Understanding Appalachia's Regional Healthcare Monopoly, Meredith A. Bailey

Chancellor’s Honors Program Projects

No abstract provided.

Healthcare Disparities And Hispanic Immigrants: A Systematic Review Of The Literature, William C. Greenman Iii

Chancellor’s Honors Program Projects

No abstract provided.

When The Rural Hospital Closes: An Analysis Of Acute Health Impacts Following Closure Of Rural Hospitals In Appalachia, Bret M. Berry

Chancellor’s Honors Program Projects

No abstract provided.

A Machine Learning Approach For Predicting Clinical Trial Patient Enrollment In Drug Development Portfolio Demand Planning, Ahmed Shoieb

Masters Theses

One of the biggest challenges the clinical research industry currently faces is the accurate forecasting of patient enrollment (namely if and when a clinical trial will achieve full enrollment), as the stochastic behavior of enrollment can significantly contribute to delays in the development of new drugs, increases in duration and costs of clinical trials, and the over- or under- estimation of clinical supply. This study proposes a Machine Learning model using a Fully Convolutional Network (FCN) that is trained on a dataset of 100,000 patient enrollment data points including patient age, patient gender, patient disease, investigational product, study phase, blinded …

Addressing Adolescent Sexual Health Through An Educational Toolkit For Providers In Rural Alaska, Anna M. Martin, Tracy L. Brewer, Hannah E. Warren

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

Introduction. Adequately addressing an adolescent’s sexual health is essential during the child’s development yet, 33% of adolescents have health visits with no mention of sexual health. On average, primary care providers spend approximately thirty-six seconds discussing sexual health topics with adolescents despite recommendations for comprehensive education. Alaska Native youth face significant disparities regarding sexual and reproductive health care. Implementation and evaluation of a comprehensive educational toolkit regarding various sexual health topics for rural healthcare providers in Alaska revealed positive outcomes in discussing sexual health with an adolescent.

Methods. Larrabee's Model for Evidence-based Practice Change guided the development, implementation, and …

The Need For Point-Of-Care Testing Of All Illicit Substances, Channie Cretsinger, Jeremy Kourvelas Mph, Jennifer G. Tourville Dnp, Julia Van Zyl Md

SMART Policy Briefs

An estimated 107,477 overdose deaths occurred in the United States within the last year, with about 4,000 of those deaths being Tennesseans. Over 80 percent of these deaths are attributable to opioids such as fentanyl, for which there does not exist tests approved by the Food and Drug Administration (FDA) for point-of-care testing (POCT). POCT is intended to be used near or at the site of the patient and is performed outside of a physical clinical laboratory, usually at the bedside. A classic example of this is a bedside glucose test in the hospital. Tests for fentanyl and other illicit …

Genealogy Tells: Informing Health And Aging Policies Using East Tennessean Older Women's Family Histories, Perceptions, And Experiences Of Health Inequity, Heather Davis

Doctoral Dissertations

Older women face unique health inequities challenges. This study aims to provide an understanding of older women’s perceptions and situated experiences regarding the gendered health inequities they face and the social determinants (SDH) thereof. It examines how these health inequities are situated in older women’s genealogical (familial) and geographical health and mortality outcomes histories and how their perceptions and experiences of health inequities and their familial mortality outcomes histories are characterized by the geopolitical and social norms in which they live. The purpose of this project is to present policy and decision-makers with insights about and recommendations from older women …

Healthcare Service Utilization And Life Satisfaction In South Africa, Tamara Chavez-Lindell

Doctoral Dissertations

South Africa has achieved improvements in many health measures over the past 30 years, yet significant disparities in healthcare utilization and health outcomes persist. There is evidence that healthcare utilization has a strong influence on health outcomes and life satisfaction. Unfortunately, rural areas tend to have poorer accessibility and utilization of health services, leading to disparities in health outcomes. In rapidly urbanizing countries such as South Africa, identification of disparities and predictors of public healthcare utilization and life satisfaction may provide information that can be used to guide development of programs aimed at improving population health outcomes, quality-of-life, and overall …

Perinatal Health In North Dakota: Emerging Issues, Grace N. Njau

Doctoral Dissertations

Preterm birth, newborn screening refusal, and postpartum depression represent three emerging areas of concern that have not been previously investigated in North Dakota. Their potential impact creates significant social, behavioral, and economic burdens. Although various studies have investigated preterm birth and postpartum depression, to the best of my knowledge, newborn screening refusal in the United States has not been previously investigated. In alignment with the role of Title V of the Social Security Act (Maternal and Child Health) Programs to conduct ongoing statewide needs assessments, the objectives of this study was to investigate and identify predictors of preterm birth, newborn …

Design And Development Of The Urban Population Health Observatory To Improve Disease Surveillance And Response, Whitney Brakefield

Doctoral Dissertations

Chronic and infectious diseases have a profound impact on the quality and length of life of populations that suffer from these conditions. Scientists, physicians, and health officials are seeking innovative approaches to decrease the morbidity and mortality of deadly diseases. Incorporating artificial intelligence and data science techniques across the health science domain could improve disease surveillance, intervention planning, and policymaking. In this dissertation, we describe the design and development of the Urban Population Health Observatory (UPHO), an explainable knowledge-based multimodal big data analytics platform. A common challenge for conducting multimodal big data analytics is integrating multidimensional heterogeneous data sources, which …

Agent-Based Dynamics Of A Spahr Opioid Model On Social Network Structures, Owen Queen, W. C. Strickland, Leigh B. Pearcy

Chancellor’s Honors Program Projects

No abstract provided.

Creating A Backyard Buzz: Evaluating The Effectiveness Of Using A Video Infographic To Increase Knowledge About Mosquito Populations And Diseases In Tn, Caroline M. Barnes, Rebecca T. Trout Fryxell, Cristina Barroso, Julie Andsager

Chancellor’s Honors Program Projects

No abstract provided.

Moms And Vaccines: A Cross-Sectional Survey Assessing Covid-19 Vaccine Acceptance Among Pregnant People In East Tennessee, Sara Burnette

Chancellor’s Honors Program Projects

No abstract provided.

Tennessee’S Covid-19 Response: The Relationship Between Case Numbers And Public Opinion, Chandni Naidoo

Chancellor’s Honors Program Projects

No abstract provided.

Nuclear Security Awareness Survey At A University, Marcia P. Robinson, Naomi German, Destiny B. White, Shraddha V. Rane, Jason Timothy Harris

International Journal of Nuclear Security

The concept of assessing safety culture in an organization emerged with its application at the nuclear power industry and has expanded since then. An assessment of nuclear security, on the contrary, is still under-developed, especially at non-nuclear facilities, such as academic institutions and medical facilities. To identify the level of the awareness and understanding of credible nuclear and radiological threats, response preparedness, security culture, and the integrity of nuclear security systems among non-radioactive material users at a university setting; a campus-wide survey was deployed. A total of 3,336 non-radioactive material users, including students, faculty, and staff participated in the survey. …

A Game Theoretical Model Of Radiological Terrorism Defense, Shraddha Rane, Jason Timothy Harris

International Journal of Nuclear Security

Radiological dispersal devices (RDD) pose a threat to the United States. Healthcare facilities housing high-risk radioactive materials and devices are potentially easy targets for unauthorized access and are vulnerable to malevolent acts of theft or sabotage. The three most attractive candidates for use in RDD considered in this study are: ⁶⁰Co (radiosurgery devices), ¹³⁷Cs (blood irradiators) and ¹⁹²Ir (brachytherapy high dose radiation device). The threat posed by RDDs has led to evaluating the security risk of radioactive materials and defending against attacks. The concepts of risk analysis used in conjunction with game theory lay the foundations of …

An Epidemiologic Study Of Vaccination Exemptions And Pertussis Risk, Corinne B. Tandy

Doctoral Dissertations

The incidence of pertussis, a vaccine-preventable disease that can have severe complications in infants, has been increasing in the United States over the past three decades. Vaccine hesitancy and refusal have also increased and are associated with vaccination exemptions, which in turn are associated with outbreaks of vaccine-preventable diseases, including pertussis. Understanding attitudes towards vaccinations and identifying geographic disparities of vaccination exemptions and pertussis risks is useful for guiding control programs. Therefore, the objectives of this study were to: (i) investigate attitudes towards vaccinations; (ii) identify county-level geographic disparities and sociodemographic predictors of vaccination exemptions in Florida; (iii) investigate county-level …

Educating School Nurses: Returning To School During The Covid-19 Pandemic, Kelle Flynn-Gulley

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

As schools began reopening, following government mandated school closure early on during the COVID-19 pandemic, new safety measures and protocols were put in place to keep students and staff safe. School nurses have become essential to ensuring schools reopen safely. However, as school nurses were forced to adapt to their increasing roles and responsibilities, a method for providing continuing education to school nurses within an East Tennessee school district did not exist. The goal of this evidence-based practice project was to provide continuing education to school nurses on COVID-19 return to school guidelines via an e-learning modality. Larrabee’s Model for …

The Medicaid Expansion: Modeling Of Important Factors In State Decision Making, Augustus M. White

Haslam Scholars Projects

No abstract provided.

Medical Illustration As A Tool For Health Literacy, Courtney Anne Wombles

EURēCA: Exhibition of Undergraduate Research and Creative Achievement

Health literacy is most commonly described as the ability of an individual to obtain, comprehend, and utilize information related to their health. Including the ability to read, write, speak, and display numeracy in medical situations, rates of health literacy impact the ability of an individual to navigate the healthcare system and make informed decisions. As reported by the National Assessment of Adult Literacy, only 12% of individuals have the proficiency to understand and manage their health. This research identifies problems existing in health literacy and doctor-patient communication, with an emphasis on consumer health information. It explores resources used for science …