Electronic Theses and Dissertations

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2D layout of bead based thioaptamer/aptamer selection platform for therapeutics and diagnostics
(2007-07-20) Xu Zhao; Bruce A. Luxon; William D. Willis; L.Lilian Chan
Nucleic acid research has expanded the way we can intervene with biological systems. Especially, oligonucleotide agents (ODN or aptamers) are believed to affect cell function via complementary recognition or binding to specific proteins by forming tertiary structure. This opens new ways in therapeutics and diagnostics. The phosphoro- mono-/di- thioate substitutions in the backbone (termed “thioaptamer”) grants ODN nuclease resistance and higher binding affinity. \r\nA bead-based combinatorial library, in which every bead contains a unique species of aptamers, provides a promising platform for selection of aptamers and thioaptamers. To successfully screen the bead-based library, 2D layout of beads in gel and on bead screening model is proposed. To develop the 2D layout of beads and its corresponding functional assays, a model system is first established: NF-kappa B proteins were expressed, purified and characterized. Thioaptamer XBY6, which specifically targets NF-kappa B protein, and its natural origin, I-kappa B were synthesized and verified. Thioaptamer purification using FPLC and HPLC was also investigated, and several 5’-funtionalized thioaptamers were successfully purified. Electrophoretic mobility shifting assay (EMSA) has been used to verify XBY6 binding, and ELISA assay has been used to verify I-kappa B binding towards human recombinant NF-kappa B protein. Preliminary study of bead in 2D gel showed applicability of bead-based selection and thus on bead functional assays were developed. Both double strand one species library with I-kappa B sequence and a 212=4096 different species beads library were constructed and verified. The library was then tested using on-bead EMSA like assay and ELISA assay. Both assays showed encouraging results for 2D layout selection and further enhancement of visualization (signal/noise improvement) is discussed. \r\nThe project suggested that 2D layout of beads in gel (PAGE) is well suited for parallel high-throughput selection of thioaptamers and aptamers, thus paving a new way for drug discovery and future therapeutics and diagnostics.\r\n
A 4-month randomized controlled clinical trial of adjuvant exenatide or pramlintide versus insulin alone in pediatric type 1 diabetes mellitus: Effect on glycemic control
(2010-07-29) Sarah Elizabeth Withycombe; Elena Volpi; Melinda Sheffield-Moore; Antonella Casola
This study investigates the effects of 16 weeks of treatment with adjuvant Exenatide or Pramlintide versus insulin alone on glycemic control, as measured by glycated hemoglobin (HbA1C) and 1,5-Anhydroglucitol (1,5-AG), or GlycoMark, in pediatric Type 1 Diabetes Mellitus (T1DM). We present here the preliminary results (n=24) of a Phase III randomized clinical trial designed to compare the glycemic effects of using adjuvant Pramlintide or Exenatide versus insulin alone in pediatric T1DM. Sample size calculations estimated 21 patients per treatment arm (63 total) are needed. So far, 24 patients have been recruited from Texas Children’s Hospital’s main Diabetes Care Center or its outlying clinics in the Houston, TX area. Recruited patients were randomized to one of 3 treatment arms (Pramlintide + insulin, Exenatide + insulin, or insulin alone) and completed 16 weeks of treatment. HbA1C and 1,5-AG levels were the primary endpoints analyzed as measures of glycemic control. All statistical analyses were\r\ndone using two-sample t-tests assuming equal variance and paired two-sample t-tests performed in Excel. No statistical differences in ΔHbA1C or Δ1,5-AG were observed between each treatment arm and the insulin control arm. Similarly, no statistical differences in HbA1C or 1,5-AG were reported within each group from baseline to 16 weeks. These preliminary data suggest that addition of Pramlintide or Exenatide to insulin regimen of pediatric T1DM does not improve glycemic control. However, reevaluation of the results upon study completion is warranted.
A Comparison Of Traditional Face-To-Face And Hybrid Pediatrics and Obstetrical Nursing Courses
Jammer, Veronica M.; Bishop, Sheryl L.; Hill, Alice S.; Richard, Patricia L.; Nieburh, Bruce R.; Fowler, Debra L.
Distance learning is rapidly spreading across various institutions as a main methodology in the delivery of curriculum. As schools of nursing are faced with mandates to increase enrollment to meet the demands of the nursing shortage with limited resources (financial and human capital) some institutions are offering complete programs online while others are gradually integrating this methodology through hybrid instruction (51% face-to-face and 49% online). Such a shift in educational modality brings with it a commensurate concern with equivalency of educational content. Is student performance equivalent or, perhaps even superior, in one modality versus another? Does content make a difference in the effectiveness of a particular modality? This study compared four groups of students who were enrolled in the Associate Degree in Nursing program at a community college in southeast Texas. Two courses, pediatrics and obstetrics (OB), were taught in the fall 2010 semester. Each had a section delivering course content in the traditional face-to-face lecture and a second via hybrid delivery. This was the students’ first experience with distance learning nursing courses. Historically, students have higher performance outcomes (grades) in pediatric courses compared to obstetric courses. Thus, an evaluation of modality across differing content was also important. The study was a descriptive comparative design of Content (2) x Modality (2) that examined student performance outcomes on unit exams, final exams, and the Health Education Systems, Inc. (HESI), a specialty test for pediatrics and OB. This design allowed an examination of the equivalence of the delivery methodologies across different nursing content and provided for the assessment of both content and modality contribution to educational performance outcomes. Results indicated clear equivalences across modalities for both content areas. Improvement across time was seen in the hybrid groups but not observed in the face-to-face classes within content areas, which essentially offset initial lower performance in hybrid courses. This finding suggests that the newer and more unfamiliar format of hybrid courses may pose an initial challenge for students, but students quickly adapt and perform at equivalent levels as their face-to-face counterparts by mid-semester with no significant differences in end-point or HESI performance.
A Correlational Study of the Relationship between Human Caring and Nursing Home Administrator Turnover
Norton, Lakeesha Patricia; Verklan, Terese; Rounds, Linda; Wiggs, Carol; Grumbles, Loretta; Jones, Jacqueline
Many nursing homes in the United States are experiencing a significant state of fluctuation in nursing home staff which is believed to have contributed to a “dysfunctional” crisis. There are reports of substantial nursing staff and administrator turnover rates in numerous nursing homes around the country. This is of significant concern as it is predicted that the U.S. will soon experience an explosion in its’ Baby Boomer population. This projected growth of the older population is expected to substantially impact American healthcare providers, especially those providing services for the elderly residing in nursing homes. Many nursing homes are in need of strong, reliable, and caring administrators to lead and deliver high quality healthcare services. There is a significant amount of nursing literature addressing how important human caring is to the development of transpersonal relationships, which is essential to the development of caring and healing environments. However, the nursing home administrator is not specially addressed. The purpose of this study was to develop an understanding of the relationship between human caring and nursing home administrator turnover. A correlational research design using a purposive sample of 144 licensed nursing facility administrators (LNFAs) in the state of Texas was used in this study. The data were collected from Caring Dimension Inventory (CDI) questionnaires mailed to subjects. The resulting dataset from the CDIs was analyzed by use of Pearson’s correlation and other statistical tests to examine associations, relationships, and differences between LNFA’s caring scores, turnover rates, and selected LNFA demographics. Additional analyses were conducted to determine caring scores and turnover rates of LNFAs who participated in this study. Findings revealed no significant association between human caring levels and turnover rates of LNFAs in this study. There was also no evidence indicating that higher level of human caring increases LNFA retention. However, all LNFAs in this study exhibited high levels of human caring. The overall mean caring level of LNFA’s was 4.39 and average LNFA turnover rate was 28%. Additionally, none of the statistical analyses detected any significant associations, relationships, or differences between LNFA’s caring levels, turnover rates, and selected demographics.
A descriptive epidemiological review of hospital admissions for UTI from long term care facilities and a systematic review of strategies to reduce the risk of catheter associated UTI in long term care facilities in order to reduce these admissions.
Han, Wei; Eschbach, Karl; Arcari, Christine; Kramer, George
Urinary tract infection (UTI) is a significant source of morbidity and mortality in the elderly. Urinary catheter use greatly increases the risk of contracting a UTI. Use of a urinary catheter has been shown to increase the risk of contracting a UTI-accounting for up to 40% of nosocomial infections in one (older) study. A number of studies and reviews of studies have been done to assess strategies for reducing the risk of such catheter associated UTI (CA-UTI) in the acute setting. However, there has been less work done in long term care facilities (LCTF), a setting where UTI incidence is already high and urinary catheter use is increasing. LTCF have a number of issues that increase the difficulty in applying strategies developed for more acute care settings, including higher percentage of comorbid conditions and reduced staffing and funding. This Capstone project has two aims. It will first examine the Texas Health Care Information Collection (THCIC) database to find the number and attributes of hospital admissions from LTCF for UTI in order to describe the epidemiology of the problem. Second, it aims to do a systematic review of the literature and assess strategies for reducing risk of CA-UTI in LTCF, especially in terms of feasibility and economic impact. The author will be initially using the PubMed database and concentrating on English language articles. Keywords include Long-Term-Care-Facility, UTI, and Urinary Catheter. Expansion into other databases will be done as needed.
A Naturalistic Inquiry into the Experiences of Emergency Medical Technicians and Paramedics Who Become Registered Nurses
Ford, Shiela R
The United States has been faced with a nursing shortage for many decades (ANA, 2017). The increasing age of nursing faculty, the aging population, and retirement of bedside nurses further diminish the nursing workforce in the United States (ANA). One potential nursing recruitment source is Emergency Medical Technicians and Paramedics (EMT-P). EMT-Ps can bring important skills and knowledge to nursing. Concern about attrition of EMT-Ps from pre-licensure nursing programs and the dearth of literature about EMT-Ps who are interested in becoming registered nurses led to this Naturalistic Inquiry study (Lincoln & Guba, 1985; Erlandson et al., 1993) that explored the experiences of EMT-Ps who become registered nurses. Twelve EMT-Ps who were registered nurses at the time of data collection participated in the study. Data consisted of demographic and interview data as well as the researcher’s observations. Study findings highlighted EMT-Ps’ motivations for becoming a nurse, the challenge of adapting to a nurse mindset, and the process of coming to terms with being a nurse. The study findings also provided information about how the EMT-P who became nurses identified themselves and some of the ethical dilemmas they face being EMT-Ps who are practicing as nurses.
A Naturalistic Inquiry Into the Lived Experience of Nurse Practitioners Who Have Full Practice Authority
(2023-05-01T05:00:00.000Z) Jenkins, Kimberly N 1979-; Dr. Linda Rounds; Dr. Mary O'Keefe; Dr. Carol Wiggs; Dr. Kathleen Pitts; Dr. Judith Aronson; Dr. Mary O'Keefe
Full Practice Authority (FPA) is one of three types of practice authority that a nurse practitioner (NP) can obtain through state licensure, depending on the state where the NP plans to practice. The American Academy of Nurse Practitioners (AANP) explains that FPA entails “…the authorization of nurse practitioners to evaluate patients, diagnose, order, and interpret diagnostic tests, initiate, and manage treatments - including prescribing medications – under the exclusive licensure authority of the state board of nursing” (AANP, 2022, Policy Briefs section). To date, there are 29 FPA states and territories, 16 reduced practice states, and 11 restricted practice states. The purpose of the study, “A Naturalistic Inquiry Into the Lived Experiences of Nurse Practitioners with Full Practice Authority,” was to explore the everyday experience of the FPA NP using Naturalistic Inquiry (NI). NPs were recruited through electronic mail (e-mail) requests using e-mail addresses obtained from the state Board of Nursing in FPA states. Eleven NPs were interviewed, and data collection followed a semi-structured interview format, with analysis resulting in the emergence of the following themes: (a) autonomy, (b) confidence, (c) collaboration/support system (d) standard credentialing/licensure process, (e) legislation, (f) accessibility and flexibility in patient care, (g) new FPA NP education and research, (h) limitations, (i) reimbursement. The participants indicated FPA is a positive experience in their practices, but limitations to practice and inconsistencies in regulation still exist as the United States, including the District of Columbia and U.S. territories. This study can offer information and insights about the experience of practicing with FPA to the NP who has yet to obtain FPA as all states progress towards FPA for NPs.
A Naturalistic Inquiry of Nigerian Immigrant Nursing Students’ Experiences in United States (U.S.) Baccalaureate Nursing Programs
(2020-05-01T05:00:00.000Z) King, Shatoi T
Nigerian immigrant nursing students have been identified in the literature as having difficulty in making a transition to the teaching methods used in nursing programs in the U.S. Among the problems they experience are understanding the vocabulary and terminology of the Western culture. Previous research suggests Nigerian students remain silent in seeking help regarding the challenges of their learning in part due to the isolation they face from peers and faculty (Sanner, Wilson and Samson, 2002). There is a paucity of research associated with Nigerian immigrant nursing students and how they acclimate to U.S. nursing programs. This study utilized Naturalistic Inquiry (Erlandson et al., 1993; Lincoln & Guba, 1985) to explore the perceptions and experiences of ten Nigerian immigrant nursing students. Study participants were Nigerian immigrant nursing students and the researcher recruited students enrolled in baccalaureate nursing programs in Texas. Interviews, face-to-face or by telephone, for the ten participants were conducted in a private, agreed upon place. Data were collected until reaching saturation, indicating data redundancy, and with no new themes evolving. Analyzed data used procedures described by Lincoln and Guba (1985) and Erlandson et al. (1993) to seek emerging patterns. Guided by Lincoln and Guba (1985) procedures, the five emergent themes included Stepping into America, Navigating the Rough Waters, Unexpected Changes, Searching for Consistency, and Hopes of Finding Clarity. Lincoln and Guba’s (1985) criteria were used to evaluate trustworthiness of the data. Study findings revealed that Nigerian immigrant nursing students experience positive and negative encounters with faculty and classmates, challenges and obstacles related to the American English language, their Nigerian accent, family expectations, and work obligations. The study findings may aid U.S. nursing schools and faculty to incorporate strategies in the learning environment to assist Nigerian immigrants and other international nursing students, to better acclimate to Western programs to achieve success.
A Recombinant Vesicular Stomatitis Virus Expressing the Junin Virus Glycoprotein for Arenavirus Countermeasure Development
(2019-12-01T06:00:00.000Z) Sorvillo, Teresa Eirena
Arenaviruses are pathogens of biodefense importance due to their potential for aerosol transmission and mortality rates reaching 30%. Here, we evaluated the use of a recombinant vesicular stomatitis virus expressing the Junin virus glycoprotein (rVSVΔG-JUNVGP) for the development of countermeasures against arenaviruses. First, we evaluated rVSVΔG-JUNVGP as a vaccine against lethal Junin virus (JUNV) challenge in a guinea pig model. Currently, there are no JUNV vaccines licensed by the United States Food and Drug Administration (FDA) for at-risk individuals. We demonstrated that rVSVΔG-JUNVGP generated 100% protective efficacy against lethal JUNV challenge using a single vaccine injection. We also showed that rVSVΔG-JUNVGP induced robust, high avidity IgG antibody titers as well as detectable neutralizing antibodies. We next evaluated the use of rVSVΔG-JUNVGP as a tool for the detection of JUNV neutralizing antibodies. Conventional methodologies for the detection and quantification of JUNV neutralizing antibodies have several limitations, including the length of time necessary to obtain results (6-8 days) and the requirement of a high containment (BSL-3/4) laboratory. In this study, we showed that rVSVΔG-JUNVGP could overcome these limitations, detecting neutralizing antibodies with the same sensitivity as currently available methods, but more rapidly (within 48 hours) and without the need for a high containment laboratory. Lastly, for biodefense and public health purposes the development of a cross protective arenavirus vaccine may be an important long-term research objective. We therefore developed a panel of chimeric glycoproteins which simultaneously express immunogenic epitopes from multiple arenavirus pathogens. We demonstrated that all chimeric GPs were adequately processed intracellularly, packaged into a rVSVΔG-GFP virion from the plasma membrane, and capable of cellular entry. Our findings suggest that these chimeric GPs may be good candidates to move forward into a rVSV vaccine vector for evaluation of protective efficacy in-vivo. Overall, the findings in these studies demonstrate that a rVSV vector system can be utilized to successfully advance arenavirus and JUNV-specific countermeasure development.
A Review of Associations Between Traumatic Brain Injury & Addiction and Therapeutic Interventions for Addiction in the Brain Injured Population
Wynne, Karon; Arcari, Christine; Seale, Gary; Baillargeon, Jacques
The research linking drug and alcohol use with increased risk of sustaining a traumatic brain injury (TBI) has been well established. There is some evidence suggesting that the inverse relationship exists; that sustaining a TBI increases the likelihood for developing a drug or alcohol abuse problem. However much less is known about the impact of TBI on substance use disorders (SUD) and many barriers exist in determining these links. Research also suggests that for individuals with previously existing drug or alcohol problems, sustaining a TBI increases the likelihood of relapse. SUD greatly impact recovery after injury and because this association between TBI and SUD is not well understood there is a need to address how to treat addiction in this population. This work reviews the body of literature about the links between TBI and addiction and strategies for improving SUD treatment in individuals with cognitive impairments. Using the existing body of literature we identified strategies for how SUD treatment can be modified to address the specific needs of individuals with a TBI.
A Review of the Government Sponsored Offensive Biological Programs, Weaponized Biological Pathogens and their Countermeasures
Patterson, Michael James; de Boer, Melanie A; Arcari, Christine; LeDuc, James
Since the beginning of the 20th century humanity’s capacity for warfare and death has evolved at an ever increasing rate. The horse was quickly replaced by the automobile and the rifle by the machine gun. The use of biological weapons (bioweapons) took the same leap forward from medics fighting battlefield illness to strategic weapons of mass destruction. The two largest research programs, the Soviet and United States of America (US), operated for decades at the height of their scientific fields developing and stockpiling biological weapons with the capability to kill thousands more cost-efficiently than any weapon previously designed. All of these weapons were developed from naturally occurring human pathogens and most of the research is still classified. Many of these pathogens account for only a minimal number, if any, of disease cases each year within the US. The rarity of many of these diseases makes it difficult for medical personnel to diagnosis. The delay in diagnosis and treatment can affect the outcome for the patient and drastically increase the risk of an outbreak. This capstone covered a selection of the bioweapons produced by these two programs, their historical importance, clinical symptoms, and the available countermeasures in the case of exposure. It then opened a discussion on the selection criteria modern bioweapons programs may utilize in the 21st century and the role many of these pathogens play as public health risks. Finally it addressed many of the new developments and policies implemented by the US to tackle and minimize these risks.
A Rhapsody on the Aryl Hydrocarbon Receptor: Molecular and Environmental Health Insights Through Novel and Canonical Signaling Pathways
Jackson, Daniel P; Sowers, Lawrence; Elferink, Cornelis; Kyumycu-Martinez, Neshilan M; Elferink, Lisa; Becnel, Lauren
The Aryl Hydrocarbon Receptor is a ubiquitously expressed, cytosolic transcription factor, which is activated by myriad structurally-diverse xenobiotic compounds, most notably 2,3,7,8-tetrechlorodibenzo-p-dioxin. In this role, the AhR is known to play a fundamental role in several physiological process, for example cell division. Pathologically, the AhR has been identified as a fundamental driver of the toxic effects of numerous persistent, potent, and commonly encountered environmental contaminants. As such, we have investigated the specific role of the AhR in cellular replication during liver regeneration. Based on our findings, we then set out to assess transcriptional targets of the AhR in the mouse liver following exposure to 2,3,7,8-tetrechlorodibenzo-p-dioxin. Finally, given the toxicities with which the AhR is associated, we undertook studies to quantify PAH contamination in Gulf of Mexico seafood as a result of two recent oil spills in an effort to assess safe seafood consumption levels, given the well-known link between the AhR and its toxic xenobiotic PAH ligands.
A Secondary Analysis of County Health Statistics for the Galveston County of Texas Report
Robbins, Esther Raney; Prochaska, John; Arcari, Christine M; Mutambudzi, Miriam
The health of Galveston County communities (as is common with many areas outside large urban cities) is not fully summarized in a single report; however, a descriptive analysis would benefit community partners such as the Research Education and Community Health coalition who are interested in developing community health plans and for setting goals aimed at improving community health. The objective of this analysis is to compare reported health measures for Galveston County to Texas and the United States to see the most pressing health problems and their determinants of health such as race, gender, age, education and income. The methods included collecting secondary data from the Texas Behavioral Risk Factor Surveillance System for 2010, the County Health Rankings and Roadmaps, the 2013 American Community Survey 5-Year Estimates, and mortality data through the CDC Wonder Query system for Galveston County, Public Health Administration region 6/5S, Texas and the United States. Differences were calculated for each indicator between PHA 6/5S, Galveston County and Texas and/or the nation (for certain measures). To focus on greatest health concerns, only the highest differences were presented. Results revealed that Galveston County’s leading cause of death is cancer compared to Texas and the US with cardiovascular disease as the leading cause. The greatest differences seen for health risks were in the health topics of Prostate Cancer Screening, Colon Cancer Screening, Immunizations, Tobacco Use, Alcohol Use, Mental & Physical Health, and Health Access. 25% of these differences were associated with black race and 20% were associated with no high school education. County Health Rankings differences showed that Galveston County’s premature death rate was higher than the state of Texas. For clinical care, the proportions of primary care providers and mental health providers are fewer patients per one provider compared to Texas. The conclusions of this report reinforce known health disparities such as minority status and lack of education. Cancer deaths as well and access to cancer screenings seem to be the greatest health problems in Galveston County; however, sub-county level data needs to be elucidated to understand more specific population health status.
A study of two interventions to increase adherence with oral contraceptives and condom use among adolescents and young adults
Berenson, Abbey; Freeman, Jean; Freeman, Dan; Wilkinson, Gregg; Barrett, Alan; Jamieson, Denise
A randomized, controlled trial was conducted to examine the effectiveness of two different interventions on adherence with oral contraception (OC) and their effect on dual use (oral contraception and condoms). A total of 1,155 women 16-24 years of age who requested oral contraception at one of five reproductive health clinics were recruited to participate and randomized to receive either (1) face-to-face behavioral counseling and education at their baseline clinic visit (C group); (2) this same intervention followed by monthly phone calls for 6 months (C+P group); or (3) standard care (S group). Phone interviews at 3, 6, and 12 months after the initial visit assessed whether women developed a cue (defined as use of an object or action to help them remember to take their medication), duration and correctness of contraceptive use, method satisfaction, clinic follow up, condom use with and without hormonal contraceptive use (dual use), and rates of pregnancy and sexually transmitted infections (STIs). Bivariate analysis demonstrated that women in the C+P group were more likely to use their pills correctly in only one out of the 12 months of follow up. Analysis using General Estimating Equations showed that those in the C group were actually more likely to switch brands of OC and less likely to recommend their method to a friend. Those randomized to C+P were more likely to report condom use at last intercourse, but not more likely to use condoms while taking OC. Furthermore, use of a cue was associated with a longer period of correct OC use, regardless of the intervention. No differences were observed between those in either intervention group and standard care in contraceptive discontinuation, satisfaction rates, correct use of their method, or STI rates. Finally, the Mantel Haenszel test revealed no differences in pregnancy rates between groups during the 12 months of follow up. In conclusion, this study demonstrated that clinic based education with or without phone follow up is not effective in helping young women use OC for a longer duration or more accurately. Furthermore, it does not increase rates of dual use.
A Systematic Review of the Psychological Effects of Heat Stress on Subjects in Uncooled, Sealed, Environment Suits
Levin, Dana Reed
This review was performed to determine if current literature is sufficient to understand the cognitive effects of heat stress for individuals in uncooled pressure suits and the timeline when these effects would occur. Recent growth in the commercial spaceflight industry has led to renewed interest in environment suits to protect against decompression events. Such suits impair the body’s thermoregulatory mechanisms leading to heat stress.22 Because of this, space suits incorporate cooling mechanisms to offload stored heat.22,32,44 However, coolant system failures have been a recurrent problem for spacecraft, particularly those affecting the systems in pressure suits.3,4 Events that force crew members to stay in suits for extended periods of time, such as off nominal landings with a delayed rescue, or coolant failures on orbit could expose crew members to significant heat stress. While the physiological effects are well documented, the cognitive effects of heat stress, which could impair one’s ability to perform critical spaceflight tasks, are less well understood. A systematic review was performed via Ovid, Pubmed, the Defense Technical Information Center, the Institute for Scientific Information Web Of Science, and Google Scholar. The aim was to identify English language studies measuring performance ability, body temperature, and time in individuals wearing uncooled, sealed environment suits and performing limited physical activity under hot environmental conditions. These criteria were used to ensure both space suit based and analogue based studies were detected. Twenty-eight studies representing data from five hundred fifteen individuals met inclusion criteria. The studies tested multiple variables across a range of conditions. The results show evidence for increased fatigue, increased depression, increased hostility, decreased cognitive capacity, decreased vigilance, worsened task performance, decreased psychomotor abilities, increased anxiety, decreased perception, and decreased memory. Application of the results from this review to the spacefaring population are limited because most of the reviewed studies are in analogue populations that do not match current astronauts or expected commercial spaceflight participants. Many factors, such as demographics, suit type, health status of individuals, environmental exposures and activities differ between the conditions in these studies and those expected to be experienced in spaceflight.
A Tale of Two States: Texas v. California Firearm Mortality, Legislation, and Policies to Reduce Firearm-Related Violence in the United States
Escobar, Betsy
Ninety Americans die every day due to gun violence. This violence is a public health burden resulting in thousands of injuries and deaths every year. The age-adjusted firearm mortality rate per 100,000 from 2000-2015 ranges from 10.14-11.01 and is trending up. States address gun violence differently, either by strengthening or deregulating existing firearm legislation. In Texas, the legislature passed an open carry law, enacted on January 1, 2016. Conversely, California has stricter firearm legislation and no open carry. These differences prompted the comparison of Texas and California gun laws following the methods of Kalesan et al. I reviewed the literature and evaluated firearm legislation comparing gun laws and firearm-related mortality rates. The goal was to propose evidence-based recommendations aimed at reducing gun-related mortality. There was an association between stronger gun legislation and lower firearm-related mortality. The most supported and effective legislation for reducing gun-related deaths is expanding universal background checks to private sales to keep guns away from criminals, domestic abusers, and severely mentally ill people. This paper is focusing on three impact areas to address gun violence: research, legislation, and public health campaigns. First, removing Dickey restrictions on CDC and NIH budgets to fund gun violence research. Second, legislating universal background checks to stop unauthorized people from buying guns. Finally, creating public health campaigns targeting the gun culture, social and mental health issues to address gun violence.
Acculturation and disability in Mexican American older adults
(2008-11-19) Mary Ellen E. Kuhlmann; Kenneth Ottenbacher, Ph.D.; Ronald Angel, Ph.D.; M. Kristen Peek, Ph.D.; Laura Ray, M.P.A.; Judith Drew, Ph.D., R.N.; Gayle Weaver, Ph.D.; Elbert Whorton, M.S., Ph.D.
Abstract: The purpose of this study is to examine acculturation and disability in Mexican American older adults living independently in the southwestern United States. Design: A prospective cohort study (1993-2005). Setting: Texas, New Mexico, Colorado, Arizona, and California. Participants: Participants in the Hispanic Established Population for Epidemiologic Studies of the Elderly (H-EPESE), a population-based sample of 3050 non-institutionalized Mexican-American men and women aged 65 and over. Measures: Variables included three measures of acculturation (English proficiency, English usage, and Mainstream contact), risk factors (age, gender, education, marital status, and BMI), disablement process factors (chronic pathology, cognitive status, and physical performance), and activities of daily living disability (ADLs), and instrumental activities of daily living disability (IADLs). Chi-Square, Chi-Square test for trends, ordinary least squares regression and discrete hazard analyses were used to identify associations of measures of acculturation with incidence of ADL and IADL disability. Results: There was a significant association between one measure of acculturation (English proficiency) and incidence of IADL disability, which remained after adding risk factors and Disablement process variables to the model. Conclusion: The findings support the importance of acculturation when examining ADL and IADL disability. Interventions that consider acculturation may be useful in reducing ADL and IADL disability in Mexican American older adults.
Acute febrile respiratory illness aboard ships in the US Navy
(2009-08-01) Jonathan F. Stinson; Christine Arcari, Ph.D.; Miriam Alter, Ph.D.; Laura Rudkin, Ph.D.
Acute Febrile Respiratory Illness (A/FRI) is a common but significant category of illness with world wide effect and impact on morbidity and mortality. In the shipboard environment the environmental, susceptibility and exposure factors that favor the spread of A/FRI are augmented. This paper assesses the risk of A/FRI aboard US Navy ships and compares that risk to preparations and policy already in place to reduce the risk of epidemics aboard ships. For ships to have the best chance at avoiding disabling epidemics, improvements are needed in the following five areas: 1) accurate and timely medical intelligence about A/FRI outbreaks worldwide, disseminated to all ships medical departments, as well as aggressive ship board surveillance programs with rapid testing Influenza kits and real time submission up the chain of command, 2) mandated education for all shipboard personnel about proper hygiene, the avoidance of disease, and self reporting of symptoms to facilitate early diagnosis and intervention if needed, 3) facilitation of early detection of outbreaks through the widespread availability and use of point of care rapid testing for influenza A & B with reflex testing to identify Avian Flu or novel strains, 4) early treatment with antiviral medications including keeping supplies aboard for ready use to avoid time delay in procurement, and 5) development of effective respiratory isolation methods and procedures standardized by ship class, established, in place and ready for immediate use. Improvements in these five critical areas are necessary to avoid the potential of an A/FRI epidemic aboard ship and its resultant impact on morbidity, mortality and operational readiness.
Acute Metabolic and Neuroendocrine Responses to Maximal Treadmill Exercise in Patients Recovering from Traumatic Brain Injury (TBI)
Amonette, William 1977-; Mossberg, Kurt; Masel, Brent; Paddon-Jones, Doug; Peres, Camille; Sheffield-Moore, Melinda; Urban, Randall
Public awareness of the incidence of traumatic brain injury (TBI) increased significantly throughout the past decade. The increased awareness is primarily the result of a heightened understanding of the impact of blast-related TBI in the wars in Iraq and Afghanistan and a renewed interest in sport-related concussion. A TBI can have devastating effects on an individual, yet many of the symptoms are subtle and may not be visibly evident. Impairments caused by TBI can lead to increased morbidity, decreased functional independence, and an increased reliance on the public health-care system. TBI can cause cognitive and behavioral impairments, reduced peak physical and metabolic work capacity, and endocrine irregularities. Chronic fatigue is one of the most common complaints in patients recovering from TBI and affects many facets of life, including the ability to return and contribute to the workforce. It has been documented that patients with a TBI have reduced peak aerobic capacities compared to sedentary controls and that growth hormone (GH) deficiency is associated with lower peak aerobic capacity. Moreover, research suggests that GH deficiency may be related to perceived fatigue. The hormonal response to exercise is predictable and well documented in apparently healthy controls (CON), but to date few if any studies have quantified the endocrine response to exercise in TBI. The series of studies in this dissertation demonstrate that (1) peak metabolic, ventilatory, and cardiovascular responses are lower than predicted in patients with a TBI, irrespective of gender; (2) peak metabolic and ventilatory anaerobic threshold (VAT) responses to exercise are lower in patients with a TBI compared to healthy, sedentary CON; (3) the GH/insulin-like growth factor-1 response to exercise is similar in patients with a TBI and sedentary CON, but there are marked differences in the responses of prolactin (PRO) and cortisol (COR); and finally (4) perceived fatigue is associated with lower resting insulin-like growth factor-I (IGF-1) levels and VAT responses, but not the exercising response of hormones. Together, the results strongly support the use of intense physical exercise in rehabilitation of patients recovering from a TBI.
Acute Neuropathological Alterations after Smoke Inhalation Injury, with and without Skin Burn
Randolph, Anita Christine
More than 23,000 smoke inhalation injuries are reported in the United States each year. While the pathophysiology of smoke inhalation-induced lung injury is well studied, little is known about the acute effects of smoke inhalation on the central nervous system (CNS). Tragic events, such as those of the nightclub fire in Brazil in 2013, suggest that neurological complications occur following smoke inhalation injury, with the most commonly reported symptoms being a persistent headache, memory loss, and paresthesia. Additionally, one case report described that smoke inhalation alone was associated with progressive cognitive and psychiatric impairments, lasting for years after the initial injury, with neurological dysfunctions starting within one-month post-injury and persisting for over 14 years. These reports lead to the conclusion that acute smoke inhalation injury results in a long-term global decrease in metabolic activity and deterioration of several areas of the brain. In this study, using a well-characterized ovine model, I aimed to characterize acute pathophysiological changes in the brain induced by smoke inhalation, with and without third-degree skin burn injury. My data showed that smoke inhalation, regardless of the presence of third-degree skin burn, leads to diffuse histopathological changes in the brain and loss of blood-brain barrier integrity resulting in dilated and congested blood vessels and micro-hemorrhaging. These findings provide important information that can be used to develop effective and novel treatment options for patients with smoke and burn injuries aimed at alleviating CNS dysfunction.

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