BACKGROUND: The Appalachian Research Network (AppNET) was established in the Department of Family Medicine at East Tennessee State University (ETSU) as a network of community primary care preceptors focused on Quality Improvement (QI) in rural Appalachia. As the network has moved forward, following our established aims and priorities to improve the quality of healthcare in rural Appalachia, the importance of transitioning to an interdisciplinary network has emerged. METHOD: AppNET QI projects related to medication reconciliation and prescription drug monitoring led to the development of an AAFP Foundation grant focused on prescription drug abuse/misuse (PDA/M). AppNET approached two ETSU pharmacy faculty experienced in PDA/M research to join the team. Soon after, we were invited to collaborate on an NIH NIDA R-24 submission with the ETSU Bill Gatton College of Pharmacy (GCOP) and the ETSU College of Public Health: Diversity-promoting Institutional Drug Abuse Research Program (DIDARP). This colllaboration has contributed to a variety of AppNET interdisciplinary partnerships resulting in an expanding scope. RESULTS: AppNET’s interdisciplinary partnerships have resulted in several funded projects. In June 2013, we received funding from the AAFP Foundation to assess family physician knowledge, attitudes, and methods for effective and responsible prescribing of pain medication. The ETSU DIDARP grant was awarded in September 2013 with AppNET’s Network Director serving as CoInvestigator on one of three funded projects as well as an AppNET PEA joining the DIDARP team. AppNET is serving as the laboratory for the project, which requires input from providers and pharmacists, leading to the recruitment of pharmacists to the PBRN. In April 2014, through an interdisciplinary partnership of AppNET and GCOP, ETSU was awarded a contract from the Tennessee Department of Health to help combat the Neonatal Abstinence Syndrome (NAS) epidemic in the State. AppNET’s Research Director and a Pharmacy faculty member are leading a project to study the knowledge, attitudes, beliefs, and behaviors of prescribers and dispensers specific to substance use in pregnancy and NAS and evaluate the impact of a NAS primary prevention academic detailing intervention. CONCLUSION: Research in the major health issues facing rural Appalachia, such as PDA/M and NAS, has required an expansion of the research team to include other key professions such as pharmacy and public health. AppNET evolving into an interdisciplinary network has expanded our research scope, our success with obtaining funding, and increased the potential for future funding.

It is estimated that the divorce rate for marriages in which at least one party is a physician is 10-20% higher than the general population. Predicting the variables that contribute to marital satisfaction, identifying the skills associated with those behaviors and developing a residency curriculum to teach the skills to resident physicians is the focus of this study. Intimacy, conflict resolution and emotional expressiveness have all been identified as important aspects of marital satisfaction. We will determine how each of these variables contributes to marital satisfaction using multilevel logistic regression. The results will be used to develop a skills based training curriculum for residency to improve the lives and well-being of physicians and their families.

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Continuity of Care has long been known to be of critical importance in primary care and is a major component in the Patient Centered Medical Home. With the increasing importance of scheduling availability and Patient Centered Medical Home access requirements, it is important to determine to what degree patients are able to schedule appointments with Primary Care Providers (PCPs) - Family Physicians and Nurse Practioners - and what moveable barriers restrict access. Objectives: 1. Determine the frequency appointments are initially scheduled with Primary Care Provider. 2. Determine any systematic difference for patients unable to schedule with identified Primary Care Provider. 3. Use the findings of the study to plan a future intervention to increase access to PCPs. Human Subjects Review: Database analysis only, not considered human subjects research. Design: Clinic Electronic Health Record (EHR) review. Setting: appointments made in four rural South-Central Appalachian primary care clinics. Patients or Other Participants: all appointments recorded in clinic EHR databases for 2010 and 2011. Intervention/Instrument: database analysis from eClinical works, AllScripts, and Centricity EHRs. Outcome Measures: Summary assessment of Primary Care Provider accessibility. Anticipated Results: 1. It is expected that the frequency of appointments initially scheduled with PCP will be under 60% based upon preliminary data from one clinic. 2. It is anticipated that patients may have been unable to schedule with a PCP because appointments were not available or because there was no PCP identified. 3. Identification of systematic barriers to Primary Care Provider Access in order to improve same day appointment availability. Conclusions- An accurate picture of ability to schedule appointments with Primary Care Providers would be useful in ensuring continuity of care and success of a Patient Centered Medical Home.

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This study was designed to investigate the effects of acute eticlopride (0.02 mg/kg, D2 antagonist) treatment, given immediately before training, in rats neonatally treated with quinpirole, which has been shown to produce long-term D2 receptor supersensitization. Rats were given quinpirole (1mg/kg) or saline treatment from P1-21. Beginning on P22, rats were administered eticlopride or saline (i.p.) fifteen mins before each of seven days of training. Rats were tested on the Morris water task (MWT). For the first three consecutive days, rats were tested on the place version of the MWT with a stationary platform. Animals were given 24 training trials followed by a probe trial, and swim patterns were analyzed with platform removed. The next day, animals began testing on the match-to-place version for four consecutive days and two daily trials were given with the platform moved to a new location each day. On both the search time and target visit measures of the probe trial, animals neonatally treated with quinpirole demonstrated a deficit, and eticlopride eliminated this deficit. Interestingly, animals neonatally treated with saline but given eticlopride before training also demonstrated a deficit on both measures. On the match-to-place version, the difference in latency to locate the platform between the two daily trials served as the dependent measure. Similar to the MWT place version, eticlopride treatment eliminated deficits produced by neonatal quinpirole treatment on this task, and eticlopride produced a deficit in saline controls. This study demonstrates that in a model of dopamine D2 supersensitivity, it appears that the increased sensitivity of the D2 receptor is important for cognitive function.

In this experiment, rats were administered nicotine (0.3 mg/kg) for 11 consecutive days before and after an electrolytic medial frontal cortex lesion. After drug administration ceased, rats were tested on two spatial memory tasks, the radial arm maze (RAM) and the Morris water task (MWT). Behavioral testing was arranged so that rats were tested on the RAM 1 day after drug administration followed by behavioral testing on the MWT 19 days after drug treatment, or tested on the MWT 1 day after drug administration followed by testing on the RAM 4 days after drug treatment. Results of MWT testing showed that regardless of the drug/behavioral testing interval, lesioned rats given nicotine demonstrated enhancement relative to saline-treated lesioned animals, but the effects were more robust 1 day after drug treatment had ceased. Nicotine-induced behavioral compensation after medial frontal cortex lesions appears to be time-dependent in animals behaviorally tested on the MWT. Results of RAM testing showed that there were no significant differences between lesioned groups at the 1-day drug/testing interval, although nicotine improved performance in non-lesioned rats compared to non-lesioned rats given saline. Four days after drug administration, nicotine improved performance in lesioned rats to the levels of non-lesioned rats given saline or nicotine. This result suggests that previous training on the MWT may have primed behavioral compensation produced by nicotine in medial frontal cortex lesioned rats behaviorally tested on the RAM.

INTRODUCTION: Intrauterine devices (IUDs) and implants have been shown to decrease the rate of unintended pregnancies. These methods also known as Long Acting Reversible Contraceptives (LARCs) are considered the birth control of choice for women of childbearing age, including adolescents, from multiple professional medical associations. However, even with strong recommendations, LARCs are widely underused in the United States, especially in rural areas. This research is based in the Rural Health Services Consortium (RHSC) clinic in Rogersville, Tennessee. This research looks at knowledge and use of LARCs in this clinic before and after receiving training in IUD and implant insertion and removal. METHODS: The physicians, nurse practitioners and physician assistants affiliated with the Rural Health Services Consortium were invited to attend both an IUD and an Implant training. Those who agreed to participate in the study were asked to complete a survey, which addressed current knowledge of LARCs, contraceptive counseling practice and LARC referral practice. Surveys were de-identified and linked to each individual provider through a person specific randomized code. Providers were then trained and certified in the insertion and removal of both IUDs and Implants. Following training the providers provided a survey assessing any change in knowledge and intended practice. At three and six months the same providers will be given an additional surveys with their individualized codes. These surveys assessed the providers' knowledge of LARCs and current practice regarding contraceptive counseling and LARC referral. All survey data was compiled and analyzed for statistical significance using paired T tests. Data was analyzed to identify significant changes in knowledge or practice following training. RESULTS: A t-test revealed a statistically significant increase in provider comfort level with discussing the risks and benefits associated with both IUDs (pretest M=1.92, posttest M=2.92, t = -3.09, p<.01) and implants (pretest M = 1.83, posttest M = 2.83, t = -2.76, p< .05). Regarding practice behavior, a t-test found a statistically significant increase in provider recommendation/discussion of Mirena/Skyla (pretest M= 2.09, posttest M= 3.08, t = -2.14, p<.05) and implants (pretest M = 2.25,