Diabetes is now considered a major risk factor for cardiovascular disease, particularly ischemic heart disease. Although restoration of coronary blood flow is prudent in order to salvage the region of the myocardium at risk, reperfusion is also associated with an additional injury to the heart. This is known as myocardial ischemia-reperfusion (I-R) injury. The diabetic heart appears to be more susceptible to I-R injury compared to non-diabetic hearts when blood is used as the perfusate suggesting that components within diabetic blood may play a role in exacerbating the damage to the diabetic heart upon reperfusion. In a series of experiments, we tested the hypothesis that leukocytes are retained in the coronary microcirculation to a significant extent early in reperfusion following ischemia. We also examined if diabetic PMNs are hyperactivated, and are able to respond to exogenous inflammatory stimuli. Since diabetic blood is known to be hypercoagulable, we tested the hypothesis that platelet activation adhesion protein expression is increased in diabetic blood. Finally, we examined if platelet-PMN interactions are increased in diabetic blood. Our results indicate that, early in reperfusion following ischemia, leukocyte retention in the coronary capillaries and post-capillary venules is significantly increased in diabetic hearts compared to non-diabetic hearts. Our findings also indicate that PMNs from diabetics are hyperactivated compared to nondiabetic PMNs suggesting that, once sequestered, PMNs in the diabetic coronary microcirculation are able to initiate an exaggerated inflammatory response, which may exacerbate the reperfusion injury. We also found that platelet adhesion protein expression was enhanced in diabetics, an effect that was partially attenuated by aspirin usage. Platelet-PMN conjugate formation was increased in diabetic blood and appeared to enhance ROS production in diabetic PMNs since blockade of these aggregates attenuated PMN ROS production in diabetic blood. The results from these experiments indicate that both hyperactivated PMNs and platelets in diabetic blood likely contribute to exacerbated ischemia-reperfusion injury in the diabetic heart. Once the mechanisms of myocardial reperfusion injury in diabetes are known, therapeutic interventions can be introduced with the hope of attenuating the increased morbidity and mortality associated with ischemic heart disease in the diabetic population.

<p> Background: Sepsis is one of the most lethal and expensive in hospital conditions in the Unites States and around the world. International consensus guidelines for the diagnosis and management of sepsis have been established. Compliance with these guidelines has been demonstrated to substantially improve outcomes such as hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. However, there are significant delays in timely and appropriate recognition of sepsis, as well as delays in timely and appropriate treatment after diagnosis. </p><p> Objective: To develop and implement a sepsis detection and alert system for use in the ICU setting. Several knowledge gaps must be closed to achieve this goal. </p><p> Methods: First, an optimal electronic medical record (EMR)-based algorithm for the detection of failure to recognize severe sepsis was developed. An algorithm for the detection of failure of timely and appropriate treatment of severe sepsis was also developed. Second, the best method of alert delivery for failure to recognize and treat severe sepsis was developed. This process was performed in the context of alert fatigue, interruption, human error, and information overload. Third, to demonstrate efficacy, this surveillance system for the detection of failure to recognize and treat severe sepsis was implemented in the ICU setting. </p><p> Results: A failure to recognize and treat severe sepsis detection and alert system was successfully developed and implemented in the ICU setting. </p><p> Conclusion: The work presented in this thesis proved the feasibility of iterative development, testing, and real-world implementation of electronic surveillance of sepsis resuscitation. This research paves the way for meaningful EMR use to enhance the safety of hospitalized patients.</p>

A quasi-experimental study was conducted to compare preoperative and postoperative postural responses to position change. A convenience sample of 30 men and women admitted for elective coronary artery bypass graft (CABG) surgery performed supine to sitting and supine to standing position changes prior to surgery and on postoperative day two or three. An ANOVA with repeated measures compared the responses of systolic blood pressure, diastolic blood pressure and heart rate. Systolic blood pressure exhibited a significant change from preoperative to postoperative measurements. Diastolic blood pressure remained the same; heart rate changed over time, but no significant preoperative to postoperative changes occurred. Comparison of normotensive and hypertensive subjects revealed reduced postoperative responsiveness in the hypertensive subjects for systolic blood pressure and heart rate. Nurses caring for postoperative CABG patients should anticipate a reduction in blood pressure and an increase in heart rate upon standing.

The Purpose of this quasi-experimental study was to test the effects of a multidisciplinary team teaching program on state anxiety, satisfaction with care, and length of hospital stay in patients (N = 38) undergoing hip and knee joint replacement. A multidisciplinary team composed of nurses, a social worker, and a physical therapist presented an one-hour structured teaching program to groups of patients and family members prior to surgery in a 350 bed teaching facility. Control subjects did not receive the structured teaching program. No significant differences in state anxiety, satisfaction with care, or length of hospital stay were found between the experimental subjects (n = 23) who received the teaching program and the control subjects (n = 15) who did not. The project did however, stimulate the development of a formal group teaching program and encouraged collaboration and communication among members of a multidisciplinary team of care providers.

A descriptive study was conducted to explore whether or not there were any differences in perceptions of physicians, acute care nurses, long-term care nurses, and nurse practitioners associated with end-of-life decision making for people over 65 years of age. A convenience sample of 95 health care providers, all of whom were involved in direct patient care was used. Quantitative research techniques were employed for data collection and analysis. Statistically significant differences were found between four individual items on the CDMS and the health care providers. It was found that long-term care nurses believed items associated with pain and suffering, and culture to be more important than either physicians or acute care nurses, where as they found physicians input less important. A statistical significance was also found between the years spent in practice by health care providers and scores on the CDMS.

Pulmonary damage resulting from aspiration of gastric contents has been reported to be related to the acidity of the aspirate. The purpose of this research was to evaluate if Alka-Seltzer Effervescent and/or Bicitra, ingested preoperatively, increased gastric pH >2.5 and if so, which of the two products sustained the increase for the greatest length of time. Twenty-nine subjects ingested either Alka-Seltzer Effervescent (n = 15) or Bicitra (n = 14) during the immediate preoperative period. Gastric pH was analyzed at 30 and 60 minutes post-ingestion via oro- or naso-gastric tube. Repeated measures Analysis of Variance demonstrated that both antacids elevated gastric pH >2.5 at 30 and 60 minutes post-ingestion. However, Alka-Seltzer Effervescent produced a statistically significant greater (p =.032) increase in gastric pH than Bicitra at both 30 and 60 minutes post-ingestion.

<p> Duchenne muscular dystrophy (DMD) is a recessive genetic disease resulting from mutation in the dystrophin gene that causes loss of the <i>dystrophin </i> protein, which is known to be found in muscle and brain tissue. In muscle, dystrophin is located in the dystrophin-glycoprotein complex (DGC), which has been shown to aid in force transduction across the sarcolemma (Turrina <i> et al,</i> 2013). DMD patients suffer from a progressive degeneration of muscles leading to loss of ambulation, and a shortened lifespan. Dystrophic muscle is characterized by cycles of degenerating fibers, fibrosis, increased fat deposition, split fibers, and hyaline fibers. Glucocorticoids (GC) are the most effective treatment of DMD, but these drugs only slow the progression of the disease and are known for their severe adverse effects. Skeletal muscle regeneration has been shown to be a spatio-temporally regulated process. Our laboratory has developed the theory that the cause for the failure of regeneration in dystrophic muscle is the result of inappropriate cross-talk between areas that are at different stages of regeneration. Furthermore, we hypothesize that glucocorticoids are effective due to their ability to resynchronize gene expression. In order to test our theory, we have developed a model of asynchronous regeneration in healthy muscle by creating cross-talk using multiple injuries with myotoxins. We found that placing injuries 10 days apart produced muscle histology with many of the features of dystrophic muscle. In the future, we can use this model to test the effectiveness of glucocorticoid treatment in resynchronization. As glucocorticoids are also an endogenous hormone, we sought to determine if their secretion was inherently altered in mdx mice. We found that mdx mice have a significantly dampened circadian endogenous glucocorticoid rhythm of secretion compared to wildtype mice. We also found that administering glucocorticoids in line with circadian rhythm of the endogenous hormone improves muscle histology. In the future, we could use more animals in a longer trial to determine if a chronotherapeutic approach to treatment of dystrophin-deficiency improves efficacy and decreases side effects of glucocorticoids. As dystrophin is expressed in regions of the brain responsible for glucocorticoid regulation, it is possible that lack of dystrophin is directly responsible for the change in endogenous glucocorticoid secretion. This is an important novel hypothesis that should be examined in the future.</p>

The effects of therapist training techniques upon treatment outcomes in traumatic brain injury has not been widely studied. This study demonstrates that when therapists work on Functional Independence Measurement System (FIMS) related activities and use training methods identified in the applied behavioral literature to be effective, FIM scores are likely to increase. Seven therapists working with persons with traumatic brain injuries were subjects for this study. Six subjects were targeted because their clients were not making progress on the FIM. One subject was chosen because her clients consistently made progress on their FIM scores. Baseline data was collected from video tapes, targeting 14 training elements within the areas of the task, prompting, reinforcement and the clients behavior. Therapists were given feedback based upon the teaching diagnostic of the decision matrix. Feedback was delivered during the first week of intervention only. The results clearly show that diagnostic-based intervention with therapists can result in direct, immediate and obvious improvements in FIM scores across patients. / Source: Dissertation Abstracts International, Volume: 55-04, Section: B, page: 1658. / Major Professor: Jon S. Bailey. / Thesis (Ph.D.)--The Florida State University, 1994.

Since there is a sharp increase in the number of women approaching menopause, the purpose of this study was to investigate the role of family life changes and physiological/psychological stresses pertaining to menopause upon the coping, stress, perceived sexual satisfaction, and life satisfaction of menopausal women. Since recent research has indicated the beneficial effects of hormone replacement therapy (HRT) on the functioning of menopausal women, similarities and differences between women using HRT and women not using HRT were examined. / A survey research design was employed which utilized a national random sample of women (n = 346) between the ages of 45 and 60 who were members of an association of college educated women. The subsample used for this study was comprised of only perimenopausal and postmenopausal women (n = 283) who indicated whether or not they were using HRT. Research instruments included the Family Inventory of Life Events and Changes, Hunter Menopause Questionnaire, Family Crisis Oriented Personal Evaluation Scales, Index of Sexual Satisfaction, and Generalized Contentment Scale. / No significant differences were found between women using and not using HRT for the variables, family life changes, menopausal symptomatology, coping, stress, sexual satisfaction, and life satisfaction. A path analysis procedure was utilized on restricted and saturated models to determine the underlying relationships among the variables. In the restricted model, the greatest total effect on quality of life was stress for women using HRT and coping for women not using HRT. In the saturated model, menopausal symptomatology exhibited the greatest total effects on quality of life for both groups of women. In further analyses which utilized the total sample, respondents were categorized according to menstrual status: pre, peri, or postmenopausal. Differences were found among the three groups of women. Analyses indicated that overall level of stress and menopausal symptomatology was greatest for perimenopausal women. Menopausal symptomatology was found to be the major factor influencing life satisfaction for all three groups of women. / Source: Dissertation Abstracts International, Volume: 54-04, Section: B, page: 1928. / Major Professor: Carol Anderson Darling. / Thesis (Ph.D.)--The Florida State University, 1993.

In Study 1, normative data were collected on masseter muscle activity in 25 MPDS and 25 nonMPDS patients to determine if there were significant differences in overall EMG activity, and if there was a significant difference between left and right EMG activity in either or both groups. Data were collected using a Myotronics EM2 Electromyograph. Masseter EMG levels were in the predicted direction (MPDS $>$ nonMPDS), but the difference between the groups was not significant. There was a significant difference between left and right masseter activity for both groups. However, there was no difference between groups in the magnitude of the bilateral differential. In Study 2, the effectiveness of unilateral, bilateral, and false feedback in reducing masseter EMG activity were compared. Sixty-five subjects received 20 minutes of biofeedback during two training sessions. A follow-up session was conducted one week after treatment completion. Perceived jaw and general muscle tension were also assessed using a SUDS-type scale. Data were collected using a Cyborg Biolab and an Apple II plus computer. Results showed that for all groups, EMG activity decreased from session one to session two. There was no difference between the unilateral and bilateral group in the amount of EMG reduction across the two experimental sessions. The reduction of EMG activity across sessions one and two was significantly greater for the unilateral + bilateral group as compared to the false feedback group. Treatment effects maintained at the follow-up session for subjects in the bilateral + unilateral group, but not for the false feedback group. EMG activity in the unilateral + bilateral group decreased significantly from session two to the follow-up session, whereas EMG activity for the false feedback group increased from session two to the follow-up. For the subjective measures of jaw and / general muscle tension, the changes in ratings across sessions did not differ as a function of feedback group. There were no significant correlations between EMG activity and muscle tension ratings for the unilateral + bilateral group or for the false feedback group. / Source: Dissertation Abstracts International, Volume: 52-03, Section: B, page: 1726. / Major Professor: Jack G. May, Jr. / Thesis (Ph.D.)--The Florida State University, 1990.