Medicine and Health Sciences Commons^™

Developing Outpatient, Clinic-Based Education For Patients With Diabetes And Prediabetes, Ruth Ann Slayton

Electronic Theses and Dissertations

Abstract Education and support provided to the newly diagnosed prediabetic or Type 2 Diabetic are inadequate in the outpatient arena. In rural areas, instruction for diabetes is minimal to nonexistent, and patients are paying for this with their health and lives many times. The financial burden of diabetes in the United States is astronomical. The loss of life and life quality is significantly high as well. A systems-based approach to education in the rural health clinic would be of great benefit and has proven to be enough to reverse or avoid the progression of the disease. A clinic or field-based …

An Evaluation Of Cancer Nurse Providers’ Implementation Of The 2018 Commission On Cancer Survivorship Care Plan Requirement, Angelia Natascha Drake

Electronic Theses and Dissertations

There are apparent problems and fragmentation in the health care delivery system across all specialties, specifically oncology. Oncology is an area within the health care system that has an exponential growth of patients. The incidences of newly diagnosed cancer patients are increasing annually, and the improvements in cancer treatments allow patients to live beyond cancer, resulting in an increased volume of survivors annually as well. These increases place an incredible demand on our health care system, including, but not limited to, primary care physicians and specialists such as medical oncologists. With these increases, there is still an evident gap within …

Policy Development: Stress Management And Critical Incident Debriefing, Karen Loraine Hasie Rowland

Electronic Theses and Dissertations

Abstract Workplace stress and associated disorders (occupational burnout, compassion fatigue, secondary traumatic stress, critical incident stress, posttraumatic stress disorder, etc.) disproportionately affect healthcare workers, especially those working in critical care and emergency environments. The financial cost of stress related after-effects experienced by health care workers exceeds $191 billion each year and includes the cost of associated decreased quality of patient care, missed diagnoses, medical errors, and sentinel events leading to patient disablement or mortality. Mental health interventions such as stress management education and critical incident debriefings have been proven effective in reducing workplace stress and building personal resilience. A gap …

Use Of The Prescription Drug Monitoring Program For Substance Abuse Monitoring And Pain Management, Crystal P. Beddard

Electronic Theses and Dissertations

Abstract

The United States is in an opioid epidemic. The comitant use of opiates and benzodiazepines can ultimately result in death. This project consisted of a quality improvement approach addressing the continued need to educate prescribers on coprescribing benzodiazepines and opioids to the adult population. A qualitative and quantitative descriptive analysis was utilized for data collection. The results will assist in determining if accessing the Prescription Drug Monitoring Program (PDMP) and utilizing evidence-based guidelines before prescribing treatment compared to the nonutilization of the PDMP and evidence-based guidelines aid in the reduction of mortality and overdose rates within a three-month period. …

Clinical Pharmacy Services And Medication Utilization In Hospice Care, Aishwarya Kulkarni

Electronic Theses and Dissertations

Background: As discussed within the guidelines from the American Society of Health-System Pharmacists (ASHP), pharmacists are an integral part of the hospice multidisciplinary team involved in optimizing the treatments. Methadone, a long-active opioid, is particularly useful in this population but may be clinically underutilized. Additionally, the cost share of medication utilization in hospice and palliative care is shifting towards hospice providers. The assessment of medication utilization and methadone use in this setting can help develop overall cost/clinical optimization strategies. Thus, there is a need to understand the use and expenditure of various medications and pharmacists' role in providing methadone …

Predicting Covid-19 Behavior: Is It All Due To Political Orientation?, Caleb Potts

Electronic Theses and Dissertations

ABSTRACT

Adherence to COVID-19 preventing measures is becoming increasingly important as governments across the world realize COVID-19 is not an acute, but a chronic problem. There is, however, disagreement over to what extent COVID-19 is a problem. In the United States, the division appears to be primarily along party lines (Democrat and Republican[1]), though even within parties there is division. This division might be explained by differences in: the behavioral immune system and trust in government. Additional factors to examine include: personality, fear of COVID-19, and religious beliefs. The present study used previously validated self-report measures to assess …

Clash Of Titans: An Ethical Framework Towards Limitations In Religious Accommodation Within Healthcare, Yoelit Lipinsky

Electronic Theses and Dissertations

In late October 2017, a young Canadian Jewish man was at the center of a storm that involved ethics, religion, law and policy He had been unconscious for a month and doctors deemed him brain dead. The Jewish community, and his family, wished to keep him on life support, since their religion did not consider brain death to be ‘death.’ This clash between medical and religious perspectives poignantly illustrates the unique and growing challenges posed by religious observance in Canada’s secular healthcare system. A similar story is found in America. In December 2019, a story was published demonstrating fears that …

Machine Learning Applied To Colloidal Properties Of Perfluorocarbon Nanoemulsions For Imaging In Ards/Ali, Marco Hosfeld

Electronic Theses and Dissertations

Acute Respiratory distress Syndrome (ARDS) and Acute Lung Injury (ALI) are inflammatory lung pathologies consisting of non-hydrostatic pulmonary edema leading to hypoxia and impaired gas exchange in the lungs. ARDS/ALI is both difficult to study and treat as it is not in itself a specific pathology but rather a syndrome consisting of many pathologies that vary case by case. It is, however, consistently characterized by an explosive acute inflammatory response in the lung parenchyma leading to hypoxia. Although time has seen to an increase in the understanding of ARDS/ALI, the mortality rate remains in the range of 30-50%. For these …

The Feasibility Of A Music Listening Intervention On The Incidence, Severity, And Duration Of Delirium In The Older Acute Care Patient: A Feasibility Trial, Mary Kovaleski

Electronic Theses and Dissertations

Background.Delirium is an acute change in cognition in response to some form of noxious insult whichhas been shown to last for up to one year post occurrence and may lead to permanent cognitive decline.As a non-pharmacological treatment, music may aid in improving patient engagement and attention. Method. An integrative review (IR) was used to synthesize current literature examining the effectof a musicinterventionon delirium in older acute care patients. Results. Systematicdatabase searches (2000-2019) yielded fourstudies that included a music listeningintervention.This IR found that collaborative music listening interventions (not music therapy), have been shown to decreasedelirium in the older acute care patient, …

Professional Ethics For College Health Services, Dessa Mrvos

Electronic Theses and Dissertations

College health services provide a crucial resource for campus communities in the United States, substantially affecting student health, safety, and wellbeing. The impact and quality of campus clinical services impact student life through varied approaches to the delivery of services, health innovations, and business models. The role that campus health services plays in dealing with risk mitigation is essential: well-established public health principles of disease prevention, health promotion, and health education are sustained and advanced by campus clinical health services. Despite the widely recognized importance of college health services, there is very little literature on the contribution of ethics related …

Subepidermal Moisture Measures And Their Relationship To Early Identification Of Pressure Injuries In Both Dark And Light Skin Tones In The Acute Care Setting, Cecilia Zamarripa

Electronic Theses and Dissertations

Background: Pressure injuries are an important quality measure. Most are avoidable and can be prevented by implementing nursing care strategies early. Pressure injury prevention is significant to nursing practice. There is a gap in the ability to detect early skin damage through standard visual skin assessment in dark skin toned individuals. Subepidermal moisture (SEM) values have been shown to detect early tissue damage in people with dark skin, prior to it being detected through standard visual skin assessment.

Objectives: This study sought to explore the relationship between visual skin assessment and SEM as indicators of pressure injury and …

An Ethical Foundation For Genetic Therapy And Gene Editing (Crispr), Nikolija Lukich

Electronic Theses and Dissertations

There are many steps involved in the process of introducing CRISPR-Cas9 into the current health care system. This dissertation provides an ethical foundation for the uses of CRISPR-Cas9 genetic therapies and editing techniques, which organizations can utilize when implementing these new technologies. Multiple components must be examined, including the practical application of the concept of autonomy, which benefits from the inclusion of personalism and care ethics as it aims to provide a more effective method upholding the right to independent decision-making. In addition to individual considerations, population-based decisions and public health tools are explored, connecting the human right to health …

Effects Of Carbohydrate Mouth Rinsing Plus Ingestion On Cycling Time Trial Performance, Henry D. Gebhardt

Electronic Theses and Dissertations

Due to limited glycogen stores, carbohydrate (CHO) consumption during exercise is effective at improving performance in endurance events lasting longer than 90 minutes in duration. Recent research has established that CHO mouth rinsing may improve performance over shorter durations, independent of actual consumption. However, research is lacking in determining if an extended period of mouth rinsing has any additive benefit in conjunction with typical CHO beverage consumption over longer competition durations, where CHO ingestion/consumption is likely warranted. PURPOSE: Determine the effects of CHO mouth rinsing combined with consumption compared to CHO consumption alone on cycling performance. METHODS: Following …

Harnessing The Power Of Trained Immunity In The Setting Of Pancreatic Cancer: A Novel Mechanism Of Immune Trafficking And Tumor Control., Anne Elena Geller

Electronic Theses and Dissertations

Despite the success of immunotherapy in many types of cancer, pancreatic adenocarcinoma (PDAC) has yet to benefit. Innate immune cells are critical to antitumor immunosurveillance and recent studies have revealed that these populations possess a form of memory, termed trained innate immunity, which occurs through transcriptomic, epigenetic, and metabolic reprograming. Though trained innate immunity has mostly been investigated in the context of infection, the induction of trained innate immunity could also protect against tumors, and specifically pancreatic tumors. Here, we demonstrate that yeast-derived particulate β-glucan, a known inducer of trained immunity, traffics to the pancreas following IP administration. This causes …

Identifying The Cardiovascular Effects Of Multiple Pollutants., Katlyn Elizabeth Mcgraw

Electronic Theses and Dissertations

Cardiovascular disease (CVD) is the leading cause of death from environmental exposures. Although exposure to PM_2.5 is an established risk factor for CVD, the contribution of other hazardous pollutant exposure to CVD is less clear. Overall, this work aimed to examine the effect of pollutants with lesser documented effects on cardiovascular disease using a multi-pronged approach to exposure assessment. The three aims were to examine the relationship between county-level toxic chemical releases and CVD mortality in the contiguous United States between 2002 and 2012, to assess the relationship between individual-level VOC metabolites and vascular function, and to build multipollutant …

Pde4 Inhibition: A Novel Therapeutic Strategy In Liver Fibrosis., Mohamed Elnagdy

Electronic Theses and Dissertations

Background: Liver fibrosis is accumulation of extracellular matrix (ECM) proteins due to chronic liver injury. Chronic hepatic damage can occur due to multiple causes including, alcohol, non-alcoholic steatohepatitis and chronic viral hepatitis. Liver fibrosis is a critical problem worldwide due to the extremely high incidence of alcohol associated liver damage and chronic viral hepatitis. Moreover, there is no FDA approved therapy for liver fibrosis. Activation and transdifferentiation of quiecent hepatic stellate cells (HSCs) to myofibroblasts (MFBs) is the main event contributing to liver fibrosis. This process involves two phases, the initiation and the perpetuation phases. Hepatocyte injury and inflammatory response …

Heterocyclic Amines And Arylamine N-Acetyltransferase 2 Polymorphism In Pathogenesis Of Insulin Resistance., Kennedy M. Walls

Electronic Theses and Dissertations

Heterocyclic amines (HCAs) are formed when cooking meats at high temperatures or for long periods of time, and their major metabolic pathway includes hepatic N‑hydroxylation by CYP1A2 followed by O-acetylation by N-acetyltransferase 2 (NAT2). NAT2 is a highly polymorphic gene involved in metabolism of drugs and xenobiotics, and its single nucleotide polymorphisms (SNPs) produce phenotypes characterized as slow, intermediate, or rapid acetylator. Recent studies have documented associations between HCAs and insulin resistance and between certain NAT2 phenotypes and insulin resistance. In this study, we demonstrated that NAT2 activity and exposure to certain HCAs may alter cellular glucose …

Particulate Matter Exposure And Community-Acquired Pneumonia Mortality Among Hospitalized Adults With Pneumococcal Pneumonia: Incidence Study (Happi) Participants., Jack Anthony Pfeiffer

Electronic Theses and Dissertations

The role of air pollution as an agent of elevated morbidity and mortality has come under increasingly intense scrutiny in recent years. As the body of literature grows, so too does our understanding of how extensive the harm of such pollutants can be. Particulate matter (PM) particularly harmful due to its small size, ability to travel great distance while airborne, and capacity to infiltrate numerous bodily systems, often to the detriment of those exposed. Besides being associated with increased mortality risk in more heavily exposed populations, PM exposure has also been associated with complications in the respiratory, cardiovascular, and nervous …

Anxiety And Self-Efficacy Related To Learning Neuroanatomy In An Integrated Medical Curriculum., Jessica S. Bergden

Electronic Theses and Dissertations

Medical student anxiety towards learning neuroanatomy — neurophobia, a key obstacle in medical education, is influencing medical student success and potentially swaying medical students away from neurology careers. This is particularly concerning with condensed neuroanatomy instructional hours from curriculum integration and the concurrent shortage of neurologists, combined with the rising prevalence of neurological disease, and medical students choosing neurological specialties at lower rates. Neuroanatomy education is one factor described in the literature as contributing toneurophobia, yet specific ways in which neuroanatomy education could be improved have not yet been explained. In this present work, we demonstrate four specific domains, namely …

Genetic And Functional Analysis Of Rat Mammary Cancer Susceptibility., Emily L Duderstadt

Electronic Theses and Dissertations

Breast cancer genetic susceptibility is modulated by high to low penetrance risk alleles. Population frequencies of high and moderate penetrant predisposing mutations are rare and responsible for a small percentage of population cases. Most genetic variation in breast cancer susceptibility is low penetrance common variants where causal genes and risk-associated mechanisms are largely unknown. Comparative genetics uses animal models to isolate and mechanistically evaluate genetic susceptibility to human disease. Rat strains have different susceptibility phenotypes to chemical-induced carcinogenesis. Selective breeding and genetic linkage analysis using a 7,12-dimethylbenz(a)anthracene (DMBA) rat mammary carcinogenesis model have identified Mammary carcinoma susceptibilityquantitative trait loci …

The Importance Of Noncapped Viral Genomic Rna To Alphaviral Infection And Pathogenesis., Autumn Lapointe

Electronic Theses and Dissertations

Alphaviruses are mosquito-borne arboviruses that have a positive sense, single-stranded RNA genome, which are capable of causing severe disease and thus pose a significant burden to public health. During alphaviral replication, significant quantities of viral genomic RNAs that lack the canonical alphaviral 5’ cap structure are produced and packaged into viral particles, despite the fact that these noncapped genomes cannot be translated and are essentially noninfectious. The production and packaging of the noncapped genomes has been found to be true for infections across multiple vertebrate and invertebrate cell lines and alphavirus species, although the proportion of ncgRNA produced differs. Despite …

Role Of Kvβ2 Subunits In Regulation Of Resistance Arterial Tone., Sean M Raph

Electronic Theses and Dissertations

Voltage-gated potassium (Kv) channels control vascular resistance and facilitate the augmentation of myocardial blood flow in response to increases in cardiac workload (i.e., metabolic hyperemia). Native sarcolemmal Kv1 channels in arterial myocytes associate with a heteromeric auxiliary complex consisting of intracellular Kvβ1 and Kvβ2 proteins. The Kvβ proteins differentially regulate the function of heterologously expressed Kv channels, as well as native Kv1 channels in excitable cells of the cardiovascular and nervous systems. The physiological importance of vascular Kvβ proteins in mediating vasodilation remains unknown. In this study, I tested the hypothesis that Kvβ proteins functionally regulate vascular tone in response …

Vitamin B12 Deficiency Does Not Stimulate Amyloid-Beta Toxicity In A Ceanorhabditis Elegans Model Of Alzheimer’S Disease, Opeyemi F. Showemimo

Electronic Theses and Dissertations

Alzheimer’s disease (AD) is symptomized by amyloid-beta plaques in the brain and accounts for more than 65 percent of dementia cases. Vitamin B12 (cobalamin) deficiency can result in similar cognitive impairment and roughly 15% of the elderly are vitamin B12 deficient. Vitamin B12 deficiency results in the accumulation of toxic methylmalonic acid and homocysteine. Hyperhomocysteinemia is a strong risk factor for AD. To test if vitamin B12 deficiency stimulates amyloid-beta toxicity, Caenorhabditis elegans expressing amyloid-beta in muscle were fed either vitamin B12-deficient OP50-1 or vitamin B12-rich HT115(DE3) E. coli bacteria. Increased amyloid-beta toxicity was found in worms fed the …

Covid-19 Serological Diagnostic Development Using A Sars-Cov-2 Rbd Foldon Fusion, Joey Emery Breckenridge Jr.

Electronic Theses and Dissertations

Serological tests are conducted to assess humoral response against viral protein antigens, to assess viral exposure and protection from pathogens. The rapid development and modularity of serological assays have proven critical to managing the current SARS-CoV-2 pandemic. The receptor binding domain of SARS-CoV-2 is within the trimeric Spike protein and serves as a highly immunogenic target for potentially neutralizing antibodies. Current receptor binding domain serological assays use recombinant monomers or dimers of the receptor binding domain. The receptor binding domain is presented to the immune system natively in the context of the Spike protein trimer. Therefore, a recombinant trimeric receptor …

Agreement Level Of Running Temporal Measurements, Kinetics, And Force-Time Curves Calculated From Inertial Measurement Units, Austin Smith

Electronic Theses and Dissertations

Inertial measurement units (IMUs) and wearable sensors have enabled athlete monitoring and research to become more ecologically valid due to their small size and low cost. IMUs and accelerometers that are placed on the body close to the point of impact and that record at sufficiently high frequencies have demonstrated the highest validity when measuring temporal gait event moments such as ground contact time (GCT) and flight time (FT) as well as peak forces (PF) during upright running. While the use of IMUs has increased in the sport performance and athlete monitoring realm, the potential of the technology’s ability to …

Rurality As A Moderator Of Perception Of Need For Medical Care And Patient Satisfaction, Kyndal Grammer

Electronic Theses and Dissertations

Many individuals experience barriers to accessing medical care, especially in rural areas. Some barriers are attitudinal and represent perceptions of quality care. Patient satisfaction and perceived need for medical care are two such attitudinal barriers related to health care utilization, yet the relationship between these variables has not been explored. Using data from an online survey, the current study examined the association between these variables, and further, whether rurality status moderated this association. Results indicated a significant correlation between patient satisfaction and perception of need. Although the overall moderation model was significant, perception of need was not significantly associated with …

The Role Of Src In Nsclc Cell And Lung Fibroblast Migration On 3d Cell-Derived Matrix., Austin M Krueger

Electronic Theses and Dissertations

Lung cancer is responsible for the most cancer deaths between males and females, with a 6% five-year survival rate. Cancer metastasis is one of the leading causes of lung cancer lethality. Our lab has developed a method to culture cells on cell-derived matrix (CDM) and study cell-ECM interactions. This study utilized multiple cell migration methods to investigate the migration of NSCLC cells and IMR90 lung fibroblasts, both together and independently, on 2D plastic and 3D CDM. Our results showed that inhibiting Src, a significant influencer of cell migration and member of integrin activation, blocked cancer cell migration on 2D and …

“I Done Been Through Hell”: An Existential Phenomenological Study Of The Lived Experience Of Fathers Who Have Lost A Child, Dynisha Wigginson

Electronic Theses and Dissertations

The rise in American pediatric death led to a shift in pediatric end-of-life care from focusing care only on the dying pediatric patient to include focus on the family. Most literature has focused only on mothers’ experiences or the combined experiences of mothers and fathers. Fathers’ experiences at their child’s end of life, as an individual phenomenon, is overlooked and ignored. Hence, significant knowledge gaps exist related to the repeated exclusion of fathers’ individual experiences. This study aimed to begin to fill this gap. Using the lens of Merleau-Ponty, this existential phenomenological study aimed to describe the lived experiences of …

How Nutrition Knowledge Of Coaches, Athletic Trainers, And Strength And Conditioning Specialists Translates To Their Athletes, Alexa Carbone

Electronic Theses and Dissertations

The basis of dietary habits is linked to an individuals’ nutrition knowledge; for collegiate athletes this is the difference between optimal performance and falling short. To understand how nutrition information is disseminated to student-athletes, this research surveyed the athletes themselves and their sports staff (coaches, athletic trainers, and strength and conditioning specialists) on their current knowledge. Sport staff and student-athletes at East Tennessee State University were given the opportunity to participate in a 52-question online survey that tested both their general and sports-related nutrition knowledge. While the study sample size did not allow for statistical analyses required to address all …

Sarcopenia Screening By Registered Dietitian Nutritionists (Rdns) In The United States (U.S.), Madison Marcom

Electronic Theses and Dissertations

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed …