Medicine and Health Sciences Commons^™

Bomb Blast Injuries: An Exploration Of Patient Characteristics And Outcome Using Pakistan National Emergency Departments Surveillance (Pak-Neds) Data., Irum Qamar Khan, Nadeem Ullah Khan, Rubaba Naeem, Salima Kerai, Kate Allen, Nukhba Zia, Sana Shahbaz, Shiraz Qayoom Afridi, Emaduddin Siddiqui, Uzma Rahim Khan, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries.

METHODS:

Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated.

RESULTS: …

Overcrowding In The Emergency Departments: Challenges And Opportunities For Improvement, Muhammad Akbar Baig, Asad Mian, Fatima Najeeb, Hira Shahzad

Department of Emergency Medicine

With the advent of Emergency Medicine, one can observe an increase in the number of Emergency Departments (ED) across the country. However, most EDs struggle due to an overwhelming number of patients. Overcrowding can lead to delays in patient care. For a city like Karachi which is an active disaster zone, preemptive preparedness is required in the face of terror threats and such overcrowding needs to be decreased to a bare minimum. The most frequent causes of prolonged length of stay (LOS) in the ED include non-availability of in-hospital beds, delays in response to subspecialty consultations and escalating medical expenses. …

Developing Paediatric Emergency Medicine—An Opinion From A Developing Country Tertiary Care Center, Emaduddin Siddiqui, Shahan Waheed, Irum Qamar Khan

Department of Emergency Medicine

No abstract provided.

Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum And Extensive Subcutaneous Emphysema In A Patient With Ulcerative Colitis: A Case Report., Usman T Siddiqui, Hira Shahzad, Asad Raja

Department of Surgery Docs

Abstract

INTRODUCTION:

Pneumo-mediastinum and subcutaneous emphysema are rare presentations of lower gastrointestinal tract perforation.

PRESENTATION OF CASE:

We are presenting the case of a middle aged man diagnosed with UC who presented with dyspnea and subcutaneous emphysema, attributed to multiple perforations including the stomach and colon.

CASE DISCUSSION:

Patients with ulcerative colitis (UC) are at an increased risk of perforations due to friability of colonic mucosa given the chronic inflammation and relapsing flares. Chronic use of steroids further predisposes to stress ulcers. These pathologies sometimes coexist and identification of each is crucial for the appropriate treatment plan.

CONCLUSION:

The case …

A Delphi Method Analysis To Create An Emergency Medicine Educational Patient Satisfaction Survey., Kory S London, Bonita Singal, Jennifer Fowler, Rebecca Prepejchal, Stefanie Simmons, Douglas Finefrock

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Feedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician's promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity.

METHODS: We used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from …

Barriers For Immunization Against Hpv In Developing Countries (India), Sandhya Ghanta

Master's Theses and Doctoral Dissertations

Cervical cancer is one of the most common cancers in women. Incidence and mortality rates of cervical cancer are high in less developed and developing countries. In some countries, the acceptance of the HPV vaccine to prevent cervical cancer is low. Previous studies revealed that lack of awareness, income, and education were major barriers for accepting the HPV vaccine. Apart from the above-mentioned barriers, some socio-cultural barriers for accepting the HPV vaccine exist in less developed and developing countries. This study surveyed 250 women in India of age groups 18 years and above. The sample population for the study was …

Prevalence Of Tick-Borne Pathogens In Small Mammals And White-Tailed Deer In Southeast Nebraska, Tim M. Hotaling

School of Veterinary and Biomedical Sciences: Dissertations, Theses, and Student Research

The prevalence of tick-borne diseases has been increasing in the United States for the past couple decades. Studies have been conducted throughout the US identifying tick-borne disease pathogens as well as their hosts and prevalence. Research was conducted in Nebraska to determine the presence of some tick-borne disease pathogens, their vectors, and their hosts, with emphasis made on Borrelia spp., Rickettsia rickettsii, and Ehrlichia chaffeensis.

Small rodents in southeast Nebraska were trapped and sampled at eight study sites using live capture traps. Captured rodents were assessed for active parasitism by ticks which were collected and placed in alcohol. …

Integrated Dual Disorder Treatment: Co-Occurring Evidence-Based Practice Implementation, Alteration, And Fidelity Over Time, Jennifer Harrison

Dissertations

Individuals with co-occurring illnesses are at risk for poor outcomes related to criminal justice, hospitalization, housing, and employment. High fidelity evidence-based practice models, including Integrated Dual Disorder Treatment (IDDT), are associated with significant improvements in outcomes. Although IDDT has been well-researched in small scale clinical trials, the implementation, alteration, and sustainability in real world applications over time has not been well-researched or understood. Initially, a descriptive analysis of a secondary dataset including the full population of 68 IDDT fidelity teams from 2006–2012 evaluated by the Michigan Fidelity and Assessment Team (MiFAST) in one state was completed. IDDT fidelity significantly improved …

Methylseleninic Acid Promotes Antitumour Effects Via Nuclear Foxo3a Translocation Through Akt Inhibition, Míriam Tarrado-Castellarnau, Roldán Cortés, Miriam Zanuy, Josep Tarragó-Celada, Ibrahim H. Polat, Richard Hill, Teresa W-M Fan, Wolfgang Link, Marta Cascante

Toxicology and Cancer Biology Faculty Publications

Selenium supplement has been shown in clinical trials to reduce the risk of different cancers including lung carcinoma. Previous studies reported that the antiproliferative and pro-apoptotic activities of methylseleninic acid (MSA) in cancer cells could be mediated by inhibition of the PI3K pathway. A better understanding of the downstream cellular targets of MSA will provide information on its mechanism of action and will help to optimize its use in combination therapies with PI3K inhibitors. For this study, the effects of MSA on viability, cell cycle, metabolism, apoptosis, protein and mRNA expression, and reactive oxygen species production were analysed in A549 …

Endoplasmic Reticulum Stress And Ethanol Neurotoxicity, Fanmuyi Yang, Jia Luo

Pharmacology and Nutritional Sciences Faculty Publications

Ethanol abuse affects virtually all organ systems and the central nervous system (CNS) is particularly vulnerable to excessive ethanol exposure. Ethanol exposure causes profound damages to both the adult and developing brain. Prenatal ethanol exposure induces fetal alcohol spectrum disorders (FASD) which is associated with mental retardation and other behavioral deficits. A number of potential mechanisms have been proposed for ethanol-induced brain damage; these include the promotion of neuroinflammation, interference with signaling by neurotrophic factors, induction of oxidative stress, modulation of retinoid acid signaling, and thiamine deficiency. The endoplasmic reticulum (ER) regulates posttranslational protein processing and transport. The accumulation of …

Chronic Systemic Immune Dysfunction In African-Americans With Small Vessel-Type Ischemic Stroke, Candice M. Brown, Cheryl D. Bushnell, Gregory P. Samsa, Larry B. Goldstein, Carol A. Colton

Neurology Faculty Publications

The incidence of small vessel-type (lacunar) ischemic strokes is greater in African-Americans compared to whites. The chronic inflammatory changes that result from lacunar stroke are poorly understood. To elucidate these changes, we measured serum inflammatory and thrombotic biomarkers in African-Americans at least 6 weeks post-stroke compared to control individuals. Cases were African-Americans with lacunar stroke (n = 30), and controls were age-matched African-Americans with no history of stroke or other major neurologic disease (n = 37). Blood was obtained > 6 weeks post-stroke and was analyzed for inflammatory biomarkers. Freshly isolated peripheral blood mononuclear cells were stimulated with lipopolysaccharide …

A Clinical Trial To Validate Event-Related Potential Markers Of Alzheimer's Disease In Outpatient Settings, Marco Cecchi, Dennis K. Moore, Carl H. Sadowsky, Paul R. Solomon, P. Murali Doraiswamy, Charles D. Smith, Gregory A. Jicha, Andrew E. Budson, Steven E. Arnold, Kalford C. Fadem

Neurology Faculty Publications

INTRODUCTION: We investigated whether event-related potentials (ERP) collected in outpatient settings and analyzed with standardized methods can provide a sensitive and reliable measure of the cognitive deficits associated with early Alzheimer's disease (AD).

METHODS: A total of 103 subjects with probable mild AD and 101 healthy controls were recruited at seven clinical study sites. Subjects were tested using an auditory oddball ERP paradigm.

RESULTS: Subjects with mild AD showed lower amplitude and increased latency for ERP features associated with attention, working memory, and executive function. These subjects also had decreased accuracy and longer reaction time in the target detection task …

Development Of A Vascularized, Induced Pluripotent Stem Cell-Derived Liver-Tissue Mimic For Therapeutic Applications., Venkat Madhav Ramakrishnan

Electronic Theses and Dissertations

This dissertation describes the incorporation of several technologies (stem cells, gene therapy, tissue engineering and regenerative medicine) into a single project that aims to produce a liver-tissue mimic for therapeutic applications. The liver is arguably one of the most complex organs in the body. In addition to its remarkable capacity to regenerate, it performs a host of vital functions. As a result, its impairment has widespread systemic consequences. The work described herein focused on the liver in the context of cardiovascular disease and used the heritable disorder Familial Hypercholesterolemia (FH) as a clinical disease model. As (a) the only definitive …

The Relevance Of Client-Healthcare Provider Communication To The Appraisal Of Illness Uncertainty In Women With Fibromyalgia Syndrome., Melody Dawn Reibel

Electronic Theses and Dissertations

Illness uncertainty and impaired client-healthcare provider (HCP) communication are critical healthcare problems for women with fibromyalgia syndrome (FMS). However, the relationship between illness uncertainty and client-HCP communication has not been previously examined. The purposes of this dissertation were to (a) gain a deeper understanding of the lived experiences of women with FMS, (b) to examine the relationships among client-HCP communication, illness uncertainty, helplessness, and subjective well-being (SWB) in women with FMS, and (c) evaluate the psychometric properties of the patient-HCP communication scale (PHCPCS) in women with FMS. A mixed-methods design enhanced validity of the findings. The qualitative pilot study showed …

Circulating Angiogenic Stem Cells In Diabetes., Nagma Zafar

Electronic Theses and Dissertations

Circulating angiogenic stem cells (CACs) are rare cells found in peripheral blood that have been shown to contribute to endothelial repair and new blood vessel formation. These cells could be biomarkers and/or therapeutic targets for the assessment and prevention of cardiovascular disease (CVD), which is the leading cause of mortality globally and in the United States. Diabetes is an independent risk factor for CVD, and there are inconsistent reports on the role of CACs in diabetic vasculopathy. To study this further we tested the hypothesis that diabetes depletes circulating levels of CACs, due to hyperglycemia or insulin resistance and that …

A Phenomenological Study Of Anticipated Intimacy And Sexual Expression Needs Of Aging Male And Female Baby Boomers., Charles Shawn Oak

Electronic Theses and Dissertations

The purpose of this study was to understand the phenomenon of how heterosexual Baby Boomers define and understand intimacy, sexual expression, along expectations and desires relating to their respective expressions across the lifespan through their individual experiences and reflections. A set of guiding questions were used in a hermeneutic phenomenological qualitative research design. Data was gathered from thirteen subjects (n=13) using the Rappaport Time Line (RTL) that was used to develop individualized semi-structured interviews and follow-up interviews that were professionally transcribed. These were coded to identify emergent themes. Results of the study provided insight into the phenomenon of how heterosexual …

Immunomodulation Of Myeloid-Derived Suppressor Cells By Particulate B-Glucan In Cancer., Sabrin Husein Albeituni

Electronic Theses and Dissertations

Myeloid-derived suppressor cells (MDSC) are a heterogeneous population of immature myeloid cells that promote tumor progression. In this study, we investigated the effect of dectin-1 stimulation by yeast-derived particulate β-glucan in MDSC function and differentiation in cancer. In vivo treatment of mice bearing lewis lung carcinoma and mammary cell carcinoma with particulate β-glucan decreased tumor weight and splenomegaly, and reduced the accumulation of polymorphonuclear-MDSC (PMN-MDSC) but not monocytic-MDSC (M-MDSC) in the spleen and tumor. In addition, particulate β-glucan differentially modulated the function of different MDSC subsets; it enhanced PMN-MDSC respiratory burst and apoptosis, and induced the differentiation of M-MDSC into …

Evaluation Of Liver Transplant Prioritization Methods For Hepatocellular Carcinoma Patients Using Multistate Models., Sarah Katharine Alver

Electronic Theses and Dissertations

The Model for End Stage Liver Disease (MELD), used for prioritizing liver transplantation, predicts mortality from liver disease. Patients with hepatocellular carcinoma (HCC) risk disease progression not reflected in their MELD score. Exception scores prioritize HCC patients higher than their MELD scores, but advantage them over non-HCC patients. To address this, a delay of six months for using exception scores has been implemented, and alternative HCC-specific scores have been developed. Using multistate models, this study projects waitlist dropout and transplant probabilities under the delay and under two alternative scores. The delay improves equity between HCC and non-HCC patients for the …

The Pedagogy Of Medical Humanities : Using Literature And The Visual Arts To Help Future Caregivers Maintain Their Compassion And Resilience., Lisa Higgins Shugoll

Electronic Theses and Dissertations

This dissertation argues that medical humanities education for students considering careers in healthcare should begin at the general undergraduate level and should have two primary objectives, (1) providing tools that will help students foster therapeutic, compassionate relationships with their patients, and (2) providing strategies that will help students maintain healthy habits of mind that afford resilience against compassion fatigue. I assert that in order for students to practice compassion for themselves and others three core objectives must be met. (1) Students must be exposed to the fundamentals of bioethics in order to understand the virtue of compassion itself, (2) they …

A Comparative Analysis Of Data Collection Systems Used In Radiography Educational Programs And The Role Mobile Electronic Devices Play, Robin S. Garner

Electronic Theses and Dissertations

Each radiography program has a system to collect important data from didactic and clinical settings in order to accurately assess the progress and success of students, provide the needed student intervention, and provide accreditation agencies with appropriate documentation that demonstrates student success in reaching program learning outcomes. The purpose of this research study was to determine the method of data collection and documentation used by radiography programs to evaluate student progress and to examine if MEDs play a role in evaluating and documenting student skills at the point of care.

The majority of radiography programs in this study were using …

Effects Of Agitation And Storage Temperature On Measurements Of Hydration Status., Heather M Adams, Lindsey E Eberman, Susan W Yeargin, Andrew J Niemann, Heather L Mata, David J Dziedzicki

Ambulatory and Primary Care Articles

BACKGROUND: Hypohydration can have significant implications on normal physiological functions of the body.

OBJECTIVES: This study aimed to determine the impact of agitation, storage temperature, and storage time on urine osmolality compared to the criterion control.

PATIENTS AND METHODS: We used a descriptive diagnostic validity test design. To investigate agitation, we recruited 75 healthy individuals (males = 41, females = 34; mean age = 22 ± 5 years; mean self-reported height = 172 ± 23 cm and mass = 77 ± 17 kg) who provided one or more samples (total = 81). The independent variables were agitation (vortex, hand shaken, …

Mechanisms By Which Dietary Ellagic Acid Attenuates Obesity And Obesity-Mediated Metabolic Complications, Inhae Kang

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Ellagic acid (EA) is a polyphenol found in various fruits and plants, such as berries, pomegranates, muscadine grapes, nuts and bark of oak tree. EA has been known to exhibit anti-inflammatory and anti-proliferative effects in various types of cancer. However, little is known about the effects of EA on obesity. Herein, 1) the lipid-lowering role of EA was identified in primary human adipose stem cells (hASCs) and human hepatoma Huh7 cells; 2) the molecular mechanisms by which EA attenuates adipogenesis by epigenetic modification were identified; 3) the effects of EA on high fat and high sucrose-mediated obesity was …

An Evaluation And Exploration Of Nutrition Education In Elementary Schools, Elisha M. Hall

Department of Nutrition and Health Sciences: Dissertations, Theses, and Student Research

Childhood obesity is a significant problem in the United States. Obese children suffer from a variety of physical, emotional, and social consequences. To curb or reduce this problem, school-based nutrition education interventions have become more common. However, little research has been conducted concerning nutrition-related socioeconomic disparities in behavior change constructs for low and high income children, which is integral to forming appropriate theory-based interventions and allocating resources appropriately. Research into classroom teachers’ perspectives is also an area in need of strengthening to better inform interventions. Finally, the School Enrichment Kit Program (SEKP), a current interactive, classroom-based, nutrition and physical activity …

Analysis Of Changes In Muscle Architecture And Explosive Ability In Ncaa Division I Volleyball Players, Caleb D. Bazyler, Jacob R. Goodin, Conrad Rapp, Mark Disanto, Frank Smith, Michael H. Stone

ETSU Faculty Works

Abstract available in the 10th Annual Coaches and Sport Science College .

Application Of Principal Components Analysis In Kinetics Study For Isometric Squat, Junshi Liu, Caleb D. Bazyler, Christopher B. Taber, Tony Pustina, Satoshi Mizuguchi

ETSU Faculty Works

Abstract available in the 10th Annual Coaches and Sport Science College .

Prenatal Exposure To Perfluoroalkyl Acids And Serum Testosterone Concentrations At 15 Years Of Age In Female Alspac Study Participants, Mildred Maisonet, Antonia M. Calafat, Michele Marcus, Jouni J.K. Jaakkola, Hany Lashen

ETSU Faculty Works

Background: Exposure to perfluorooctane sulfonic acid (PFOS) or to perfluorooctanoic acid (PFOA) increases mouse and human peroxisome proliferator–activated receptor alpha (PPARα) subtype activity, which influences lipid metabolism. Because cholesterol is the substrate from which testosterone is synthesized, exposure to these substances has the potential to alter testosterone concentrations.

Objectives: We explored associations of total testosterone and sex hormone–binding globulin (SHBG) concentrations at age 15 years with prenatal exposures to PFOS, PFOA, perfluorohexane sulfonic acid (PFHxS), and perfluoronanoic acid (PFNA) in females.

Methods: Prenatal concentrations of the perfluoroalkyl acids (PFAAs) were measured in serum collected from pregnant mothers at enrollment (1991–1992) …

The Regulation Of Hpv Late Gene Expression And The Potential Role Of Inkt Cells In Cervical Cancer, Patrice Nolan

Masters

Human papillomaviruses (HPVs) are ubiquitous, sexually transmitted viruses present in 99.7% of all cervical cancers, the second most common cancer in females worldwide. Expression of HPV L1 and L2 late genes is found only in terminally differentiated epithelial cells. As L1 and L2 proteins are highly immunogenic, it is suggested that their suppression may prevent detection of the virus by the immune system, thus acting as a prerequisite for persistence of infection. Therefore, if expression of these proteins in the lower cervical layers was induced, it could lead to clearance of the virus. One aim of this thesis was to …

Effects Of Expected Service Life Exposures On The Functional Properties And Impact Performance Of An American Football Helmet Outer Shell Material, David E. Krzeminski

Dissertations

The purpose of this dissertation is to gain a greater scientific understanding of the changes in functional material properties and impact performance of an American football helmet outer shell material under expected service life exposures. The research goals are to (i) quantify chemical, physical, thermal, and mechanical degradation of an American football outer shell material under expected environmental conditions and (ii) develop a linear drop test impact protocol to employ expected on-field impact conditions to American football helmet components and a plaque-foam (i.e., shell-liner) surrogate. Overall, a step-wise progression of analysis was demonstrated to concurrently quantify and understand changes in …

Olfactory Enrichment In California Sea Lions (Zalophus Californianus), Mystera M. Samuelson

Dissertations

In the wild, California sea lions (Zalophus californianus) are exposed to a wide array of sensory information at all times. However, it is impossible for captive environments to provide this level of complexity. Therefore unique procedures and practices are necessary for the maintenance of physiological and psychological health in captive animals (Wells, 2009). This project aims to explore the behavioral effect of scent added to the environment, with the goal of improving the welfare of captive sea lions by introducing two scent types: 1.) Natural scents, found in their native environment, and 2.) Non-natural scents, not found in …

Hospital Practices Related To Breastfeeding In Mississippi: A Socio-Ecological Approach, Amir Alakaam

Dissertations

Mississippi continues to have one of the lowest rates and the weakest support in respect to breastfeeding in the nation (Centers for Disease Control and Prevention, 2014a). Hospital practices supporting breastfeeding such as the Ten Steps to Successful Breastfeeding (TSSB) can dramatically increase breastfeeding rates and duration (Rosenberg, Stull, Adler, Kasehagen, & Crivelli-Kovach, 2008). The aim of this study was to explore breastfeeding practices in Mississippi hospitals based on two levels of the Socio-Ecological Model: the organizational level (phase I) examined the hospital practices based on the level of implementation of the TSSB; the individual level (phase II) examined knowledge …