This thesis addressed gaps in the literature regarding the effects of Mindfulness-based interventions (MBIs) for Type 2 diabetes (T2D) and sought to investigate the acceptability and feasibility of an MBI for a group at high risk for T2D, South Asians. A mixed-methods approach was utilised to produce four studies: 1) a systematic review evaluating the psychological and physiological effects of MBIs applied to T2D; 2) a modelling phase to gauge interest in, and cultural considerations for, a modified MBI for young adult South Asians as a diabetes prevention strategy; 3) an examination of the acceptability and feasibility of a modified MBI; and 4) a comparison of the perceived and objective effects of the modified MBI. The review found evidence for psychological benefits and mixed results for physiological effects. The modelling phase indicated that Mindfulness is acceptable to young South Asians pending minor adaptations. The subsequent feasibility study found the modified MBI to be acceptable and feasible, warranting a future full-scale trial. Across these studies, Mindfulness bore psychological benefits, and to a lesser degree physiological and behavioural benefits. The final study’s triangulation approach (using quantitative and qualitative methods) suggests the intervention has a potential positive impact on stress, anxiety, energy levels, emotional wellbeing, and systolic blood pressure in this sample.

Serial peak expiratory flow measurements (PEF) are recommended as an initial investigation in the confirmation of occupational asthma. Plotting measurements in Oasys gives reproducible results and can be used by non-experts. I report a new analysis, the area between curves (ABC) score, which gives 72% sensitivity and 100% specificity using a cut off of 15 L/min/h. Two-hourly measurements of PEF require 8 work days and 3 rest days for sensitive and specific analysis. Serial PEF records with long periods off work (≥ 4 consecutive days) show improved sensitivity from 73% to 80%, implying that 7 more workers in every 100 would be diagnosed. In a comparison of forced expiratory volume in one second (FEV1) to PEF, PEF was more sensitive to diurnal changes than FEV1, although FEV1 was more reproducible. Exhaled breath nitric oxide (FENO) showed similar ABC scores between those with normal and raised FENO. FENO was significantly correlated to methacholine reactivity. In shift workers, mean ABC scores were increased on morning shifts compared to nights, but the cut off of 15 L/min/h would be applicable across all shift types. The ABC score is a new robust method of confirming occupational asthma requiring shorter records than the Oasys score.

Smokers attend preferentially to smoking-related cues in the environment, known as attentional bias. Evidence suggests that attentional bias is related to craving and relapse. Attentional retraining (AR) procedures have been used in laboratory studies to modify attentional bias and processes related to drug use, but investigations on the clinical value of AR in addiction are scarce. This thesis reports on two randomised controlled trials investigating the efficacy of AR with modified visual probe tasks in smokers. The first study explored the effects of varying the length of AR on attentional bias, craving, mood and withdrawal in current smokers. No retraining effects were observed after either a short, medium or long block of AR. The second study explored the efficacy of AR on attentional bias and smoking cessation outcomes in treatment-seeking smokers. While AR procedures were feasible to deliver within smoking cessation clinics, the intervention did not significantly reduce attentional bias, craving, withdrawal symptoms or the likelihood of relapse. These results and the literature in general show that there is no clear association between attentional bias and craving and relapse. Current AR procedures are not effective in smokers and should not be used in smoking cessation treatments, as they currently stand.

Purpose This study assessed ETSU dental hygiene students’ perceptions and attitudes toward their careers after graduation in relation to underserved populations’ lack of access to dental care and nontraditional roles for dental hygienists. Methods A voluntary simple survey was used to assess the following: dental hygiene students’ exposure to and knowledge about underserved populations and nontraditional roles for dental hygienists, students’ favor or opposition toward these nontraditional roles, students’ interest in nontraditional roles, and students’ perceived preparedness to work outside of a traditional dental office in nontraditional roles to provide care for underserved populations. The survey data was aggregated and analyzed within the general context of the ETSU Dental Hygiene Program, and differences in responses based upon student classification were investigated using an independent samples t test. Results Between classes, a significant difference was seen in the responses for seven questions, all of which addressed either students’ knowledge about underserved populations and corresponding solutions to the lack of access to care or students’ perceived preparedness for nontraditional roles after graduation. The majority of the dental hygiene students responded as being in favor or completely in favor of expanded or nontraditional roles for dental hygienists and as being interested or highly interested in functioning in such roles. However, 88.89% of participants reported that they were either likely or highly likely to choose private practice as their primary place of employment. Conclusion The senior dental hygiene students both possess higher levels of knowledge about underserved populations and nontraditional roles for dental hygienists and feel more prepared to function in nontraditional roles after graduation than do the junior dental hygiene students. The program could consider focus areas, such as the reason for students’ high interest in nontraditional roles and simultaneous high likelihood to work primarily in private practice and ways to address this discrepancy.

No description available.

Hydrogen sulfide (H2S) is a gas commonly produced in manure pits. When the manure is disturbed through manure handling activities such as pressure washing, agitating, and pumping out manure, H2S is released. During these activities H2S concentrations increase quickly and reach hazardous concentrations. Many fatalities from high H2S concentrations during manure handling activities have been reported internationally as well as in the Midwest. Occupations in general industry that have identified the potential for high H2S concentrations use monitors to warn worker of high H2S concentrations. However, in agriculture the adoption of H2S monitors is low. To encourage farmers to adopt H2S monitors, interactive training materials were created. Displays were deployed to locations that farmers frequent such as agricultural stores, extension offices, and cooperatives. Agricultural stores are defined here as locations that sell agricultural supplies wholesale, or retail, and services. These displays contained educational materials, two H2S monitors, and two types of bump testing gas for farmers to use. Along with the display passive trainings, six in-person trainings were completed where participants filled out surveys. The survey asked questions about the farmers knowledge and use of H2S monitors, likelihood of purchasing a H2S monitor in the future, easiest bump testing gas to use and the one preferred for future bump testing, and the location that farmers would prefer to go to for bump testing and monitor education. Survey participants were placed into two groups: livestock producers and commercial manure applicators. A total of 43 surveys were completed by these groups. The majority of both livestock producers and commercial manure applicators knew what H2S monitors were, but less than half of the participants actually used H2S monitors. Outreach focusing on H2S monitor use and maintenance should be continued. Hydrogen sulfide monitor use and maintenance training had the more attendance when added to an already existing training or meeting such as the manure applicator trainings or livestock producer meetings. In the survey, livestock producers and commercial manure applicators were asked the easiest type of bump testing gas where both groups chose that the calibration gas is easiest to use. When prices were included in the survey question for both bump testing gas systems, many more of livestock producers and commercial manure applicators responded that they could see themselves using neither in the future. Price of bump testing systems ($130-$220) can be a potential barrier for some farmers to not bump test their monitors, it would be beneficial for multiple farmers to share one bump testing system. Putting a bump testing system in at agricultural stores, cooperatives and extension offices would allow many farmers to use it. Commercial manure applicators reported that they had no preference in future locations for bump testing and monitor advice between the agricultural store, cooperatives, and extension offices. Livestock producers preferred agricultural stores a little more than cooperatives and extension offices, but all three locations should be used for continuing H2S monitor education. In our study agricultural stores had the most bump tests recorded, bump testing gas used, they purchased a bump testing system for their customers.

Norovirus is the most common pathogen to cause acute gastroenteritis in the world. Symptoms of acute gastroenteritis include vomiting and/or diarrhea, along with fever, abdominal pain, and malaise. Annually, norovirus causes 685 million cases of acute gastroenteritis and 200,000 deaths, worldwide. Among the 685 million cases occurring every year, 19-21 million occur in the United States. Norovirus can spread through direct or indirect contact (e.g., contaminated food or water). In addition, recent evidence has suggested that norovirus can also be spread via aerosolization. However, no study has determined an indoor generation source for aerosolized norovirus. Therefore, the goals of this study were to optimize sampling and quantification methods for the collection of aerosolized norovirus. Upon optimization, the last was to investigate a potential indoor generation source (i.e., toilet flushing) of aerosolized norovirus. To achieve this goal we devised three studies. In the first study, we optimized a sampling method for the collection of aerosolized norovirus using murine norovirus (MNV) as a surrogate. Optimization of the sampling method was performed using two bioaerosol samplers (SKC BioSampler and the National Institute for Occupational Safety and Health [NIOSH] Bioaerosol Cyclone Sampler 251) and two sampling media (Hanks Balanced Salt Solution [HBSS] and Phosphate Buffered Saline [PBS]). Murine norovirus was aerosolized in a bioaerosol chamber and later collected using the optimized sampler/media combination. After collection, viral RNA was extracted from MNV collected samples and quantified using quantitative polymerase chain reaction (qPCR). Intact capsids of MNV were assessed using propidium monoazide dye in combination with qPCR and confirmed with transmission electron microscopy. There were a total of 10 trials conducted, with each trial lasting for 30 minutes. The SKC BioSampler collected a significantly higher concentration of MNV than the NIOSH-251 sampler did (p-value < 0.0001). However, there were no significant differences in the relative percent of MNV that remained viable between both samplers (p-value = 0.2215). The use of HBSS sampling media yielded a higher concentration of MNV than PBS media (p-value = 0.0125). However, PBS media maintained viability at a significantly higher percentage than HBSS media (p-value < 0.0001). The results support the optimization of a sampling method for the collection of aerosolized MNV and possibly norovirus in different sampling environments. In the second study, we optimized the quantification method for MNV. A relatively new quantification system, droplet digital polymerase chain reaction (ddPCR), was evaluated using the same extracted samples collected in the first study to determine if the same overall outcome could be achieved. In addition, a MNV standard was directly compared between the qPCR and ddPCR. When comparing the same standard, the mean observed concentrations were similar to the nominal concentration. The limit of detection for both instruments was 5 copies per reaction. The coefficient of variation was lower across all ddPCR results than the qPCR results. The range of the R2 was larger for ddPCR compared to qPCR. As for the analysis of bioaerosol samples collected from the first study, the SKC BioSampler collected a significantly higher concentration of MNV compared to the NIOSH-251 sampler (p-value = 0.0002). However, there were no significant differences in the relative percent of MNV that remained viable in both samplers (p-value = 0.6734). The use of HBSS sampling media yielded a higher concentration of MNV than PBS media (p-value = 0.0190). However, PBS media maintained viability at a significantly higher percentage than HBSS media (p-value = 0.0004). The use of ddPCR allows for a simpler workflow and fewer samples and resources. These results support that both PCR systems yield similar results and overall outcomes, thus presenting an optimized quantification method for MNV. In the third study, we used the optimized sampling and quantification methods to conduct a field trial investigation of a potential indoor aerosolization source for norovirus (toilet flushing). To inform bioaerosol sampler placement, two optical particle counters monitored particle size and number distribution of aerosol produced from flushing a toilet across three variables (height, position, and side). The location with the highest mean particle concentration, and where bioaerosol sampling occurred, was behind the toilet and 0.15 m above the toilet bowl rim. A flushometer type toilet was seeded with 105 and 106 PFU/mL of MNV and then flushed. Upon flushing, a SKC BioSampler and Coriolis µ sampler were activated to collect aerosolized MNV. Samples were extracted and then quantified using RT-ddPCR, and viability was quantified using PMA: RT-ddPCR. The concentration of MNV collected after seeding the toilet water ranged from 2.18 x 105 – 9.65 x 106 total copies of MNV. Positive samples of airborne MNV were detected using the Coriolis µ sampler with collected concentrations ranging from 383 – 684 RNA copies/m3 of air. Sample viability for bioaerosol samples were unable to be quantified. The relative percent of MNV virions that remained intact in seeded toilet water was 37-79%. This study provides the first evidence that MNV, a NV surrogate, can be aerosolized when a toilet is flushed.

This research focuses on occupational exposures associated with Methicillin-resistant Staphylococcus aureus (MRSA) in modern pork production facilities. This dissertation is composed of three related parts. In Chapter II, "Methicillin-resistant Staphylococcus aureus in pork production shower facilities" we documented the presence of MRSA in shower facilities of conventional swine production systems where pigs were colonized with MRSA. We tested farms involved in different production phases (sow, nursery, and finisher) and geographical locations. In the two swine production systems studied, 3% and 26% of shower samples were positive for MRSA. Overall, the prevalence in showers was 19%. In Chapter III, "Methicillin-resistant Staphylococcus aureus in pork production shower facilities: Adapting interventions from athletic facilities," we searched the literature for interventions designed to decrease MRSA infections in athletes. We then evaluated these interventions for adaptability to the pork production environment, and composed swine-specific guidelines for MRSA prevention. We implemented our intervention in a pilot study to reduce MRSA in showers and locker rooms and results were mixed. We recommend repeating this study with a larger sample, and better intervention management and oversight. In Chapter IV, "Methicillin-resistant Staphylococcus aureus infection in pork production workers," we sought to determine if pork producers report veterinarian-diagnosed antibiotic-resistant skin infections in pigs, and physician-diagnosed antibiotic-resistant skin infections in workers (including MRSA). We then examined potential risk factors for infection associated with biosecurity, including shower and laundry procedures, farm-specific clothing use (clothing worn only while working on the farm), and personal hygiene. No significant risk factors were identified for either skin infections in pigs or skin infections in workers. These studies provide evidence that MRSA can be found in pork production shower facilities, and that occupational exposures occur due to components of the biosecurity protocol. We designed and implemented an intervention to decrease the level of MRSA in showers. Our pilot intervention suggested that the impact of showers as environmental reservoirs can be reduced. We also reported the first prevalence estimate of MRSA infection in pork production workers in the United States. Livestock-associated MRSA remains an emerging issue and requires further study to determine the true occupational and public health risks.

Exposure to noise in hospital intensive care units (ICUs) can disrupt patients’ sleep and delay their recovery. In this intervention study, noise levels were measured in eight patient rooms of a medical ICU (MICU) every minute with sound level meters for eight weeks before and after an intervention. Implemented over six weeks, the intervention was designed to educate nurses and other staff members to reduce noise levels through behavior modification, including instituting a “quiet time” in the afternoons, encouraging patients to keep televisions off or at lower volumes, and speaking more quietly during conversations. Sound equivalent levels (Leq) were calculated from one-minute measurements for each hour in each room. These hourly Leq (Leq-H) values were compared by pod (group of rooms within the MICU), room position (in proximity to a central nurses’ station), occupancy status, and time of day. Days with more than ten hours of one-minute noise levels above 60 dBA were flagged as the loudest time periods and compared to MICU activity logs. The intervention was ineffective with Leq-H values always above World Health Organization guidelines for ICUs (35 dBA in day; 30 dBA at night) before and after the intervention. Leq-H values frequently exceeded more modest project goals during the day regardless of the intervention (50% of Leq-H > 55 dBA both pre- and post-intervention) and at night (68% and 62% of Leq-H > 50 dBA pre- and post-intervention). Statistical analysis of the Leq-H suggests a general source is contributing to the high baseline noise in the MICU, most likely the heating, ventilation, and air-conditioning (HVAC) system. Our analysis of one-minute data indicated that high noise was often associated with high-volume respiratory-support devices. We concluded that our intervention focusing on administrative controls (e.g., education and training) was not enough to reduce noise in the MICU but that an intervention designed with engineering controls (e.g., shielding, substitution) would be more effective.

Previous research evaluating restaurant worker exposure used environmental sound levels, but this does not take into account the temporal variability of restaurant worker exposure. To determine the actual personal exposure of restaurant workers, Quest Noise-Pro or Quest Edge dosimeters were placed on restaurant workers at six downtown Iowa City restaurants. At each participating locally-owned restaurant, workers classified as cooks, counter attendants, bartenders, and waiters participated. A time-weighted average (TWA) exposure per participant per shift was computed using both OSHA and NIOSH criteria for a total of 180 full-shift exposure measurements. Exposures were evaluated by season (when school is in session or not), restaurant type (counter service versus sit-down with bar), job title (cooks versus others), and time of week (weekday versus weekend) to characterize factors associated with high personal noise exposures. This work focused on day time exposures of restaurant employees in locally owned restaurants in a college town and determined the risks of noise induced hearing loss (NIHL). The results determined if restaurant workers are exposed to hazardous noise and whether exposures differ by job title, season, day of week and restaurant type. No TWA measurements exceeded the OSHA 8-hr TWA permissible exposure limit (PEL) of 90 dBA. Restaurant worker NIOSH TWAs ranged from 69-90 dBA with a mean (SD) of 80 dBA (4 dBA). Only 7.8% of all full-shift exposure data exceeded the NIOSH 8-hour 85 dBA. The highest worker TWAs were recorded during the period when the local university was in session and at the full-service restaurants: these workers were cooks during the weekends. Fourteen TWA measurements exceeded the NIOSH 8-hr TWA REL of 85 dBA. The NIOSH TWA exposure estimates significantly increased for full-service restaurants (p<0.001), cooks (p=0.003), during the fall semester (p=0.003), and during the weekend (p=0.048). Multiple Linear regression analysis suggested that restaurant type, job title, and season have a significant effect on restaurant worker noise exposures (p<0.001). Although restaurant employee noise exposures are within the OSHA hearing conservation standard limits, this study demonstrated that 7.8% (approximately 733,200) restaurant workers might be at risk for overexposure to noise based on NIOSH criteria. Intervention studies for the prevention of NIHL need to understand the impact of job title, restaurant type, season, and day of week on restaurant worker noise exposure. Additionally, all sampling was completed during the daytime and future research should evaluate restaurant worker noise exposures into the night time and early morning hours.