Recent advancements have uncovered environmental contributions to obesity and diabetes etiology. In fact, perinatal malnutrition resulting in low birth weight (LBW) has been shown to correlate with later life obesity and impaired glucose tolerance in aged offspring. LBW can result from a myriad of developmental perturbations including macronutrient restriction, hypoxia, maternal stress and toxin exposure. Polychlorinated biphenyls (PCBs) are ubiquitous environmental pollutants that bioaccumulate in the food chain resulting in dietary exposure in humans. Maternal and cord blood PCB levels are inversely associated with birth weight, and recent studies indicate that perinatal exposures to PCBs contribute to gender-specific obesity development in children. PCBs have also been shown to enter breast milk resulting in direct exposure in early postnatal life. Therefore, we hypothesized that perinatal PCB exposure cause developmental blight resulting in decreased birth weight and increased adiposity and glucose intolerance with aging. We found that mice perinatally exposed to PCBs did not differ in birth weight, but exhibited sex-specific effects on adiposity. Females perinatally exposed to PCBs were significantly more obese at 7 weeks of age while male offspring exhibited no difference in fat mass but had decreased lean mass compared to controls. With aging, the differences in females dissipated while the male offspring decreased lean mass persisted. Male offspring perinatally exposed to PCBs displayed impaired glucose tolerance at 7 weeks of age but normalized over time, while the females were glucose intolerant only after 6 months of age. This impairment of glucose tolerance was not attributed to insulin resistance. These data illustrate time-dependent and sex-specific perturbations of maternal PCB exposure on offspring body composition and glucose homeostasis. As the liver is a major facilitator in glucose homeostasis and xenobiotic detoxification, we investigated PCB-induced alterations in hepatic gene expression and found attenuated expression of glycolytic genes and increased expression of detoxifying and antioxidant genes in both PCB-exposed maternal and offspring livers. Taken together, these data demonstrate a role for perinatal pollutant exposure in the etiology of glucose intolerance. Further studies are required to elucidate the mechanisms causing sex-specific modulation of body composition and glucose intolerance.

In order to evaluate the short-term educational and behavioral impact of the American Heart Association's "Face the Fats" web application had upon college students, a study involving 116 Utah State University undergraduate students was conducted. A one-group pre-posttest design was utilized to answer eight research questions focusing on: health risks associated with trans fat, general trans fat knowledge, ability to identify foods containing trans and saturated fats, food label information, healthy alternatives to trans fat, and readiness to change trans fat intake. Participants completed an online pretest survey and then viewed the "Face the Fats" website at their own pace. After viewing the website, participants completed an online posttest survey. Data were analyzed using Microsoft Excel. Statistical analysis of a paired sample t test revealed that "Face the Fats" was successful in changing the general trans fat knowledge of participants (p = < 0.00). Results also showed participants increasing their knowledge of health risks associated with different types of fat (p = < 0.00). Knowledge of trans fat nutritional information on food labels also significantly increased (p = < 0.00) and participants were more able to name foods containing trans fat, although some confusion remained among foods that contained both saturated and trans fat. Using a chi-square test, it was found that participants were more likely to state they were seriously considering reducing trans fat intake within the next 30 days after viewing "Face the Fats" (p = < 0.00). Results of a paired sample t test also showed an increase in the impact that trans fat information had on participants' decision to purchase and consume food (p = < 0.00).

Background: Cervical cancer is reportedly the easiest gynecologic cancer to prevent, and measures that have the most impact are regular screening and timely follow-up. Although the Papanicolaou (Pap) test used to screen for cervical cancer has been recognized as one of the most valuable clinical preventive service for women, variation in screening and tracking remain a barrier for some women achieving optimal health. Missed opportunities for care in the form of inadequate follow-up is a patient safety and quality of care issue that can be appropriately addressed through implementation of a tool to be used as a component of a cervical cancer surveillance program. Purpose: The purpose of this quality improvement (QI) project was to develop an evidence-based, tracking tool for cervical cytology screening to facilitate surveillance measures in a community health center. Theoretical Framework: The theoretical framework applied was Donebedian’s quality of care framework that incorporates the Structure-Process-Outcome model. Methods: The study was conducted in five phases over a period of 14 months. After permission was granted to implement the study, the tracking tool was developed with input from the mentor. The final two phases consisted of training, implementation, and evaluation of tool’s effectiveness towards improving practice. A survey questionnaire measuring the staff’s opinion of the tool was administered and verbal feedback regarding perception of the tool’s capability to impact clinical practice was collected. Results: Informal surveys were performed by asking stakeholders to share their attitudes and opinions of the surveillance tool. Conclusion: Consistent evidence-based practice among those charged with providing care is paramount to helping patients achieve their best outcome. Surveillance is an internal process and improving surveillance is pivotal to the goal of optimizing outcomes. The findings of the QI project indicate that through the provision of this evidence-based practice, clinical resource, quality of care will be improved. Additionally, the surveillance tool will be incorporated into clinical practice and used as the official method for tracking abnormal cervical cancer screenings, scheduling follow up care, and tracking patients until resolution of cervical pathology.

The purpose of this study was to assess radiography faculty perceptions of the effectiveness of asynchronous online courses. Learning effectiveness in a web-based virtual learning environment (VLE) was the conceptual framework for this project (Piccoli, Ahmad, & Ives, 2001). For the purposes of this study, learning effectiveness was defined as the quality of learning being comparable between online and traditional courses (Moore, 2011). Ten research questions were used to guide this study, and statistical tests were conducted to evaluate 17 null hypotheses. The statistical tests included use of one-way analysis of variance (ANOVA), Pearson correlations, and single-sample t-tests. Ten of the 17 null hypotheses were rejected. Research findings indicate that the effectiveness of online courses is not significantly affected by faculty position, type of institution, faculty age, or years of teaching experience. Faculty perceptions of the effectiveness of online courses increase with years teaching online courses, number of online courses taught in the past 5 years, and perceived competence with use of technology.

Antimicrobial resistance is becoming an increasingly serious problem accompanied by relatively few studies examining the relationship between use and resistance. The present study undertakes a twenty year analysis of antimicrobial production and factors affecting antimicrobial use for a particular microorganism (Stp. faecalis)/antimicrobial agent (Cephalothin) combination. The period is inclusive of the market introduction of the agent and considerate of prescribing practices to the present time. The accumulated data reveal that there is indeed a relationship between total drug availability (medicinal, agricultural) and increased antimicrobial resistance. The data also suggest that national (or global) use changes would likely have a long term beneficial effect on the deteriorating circumstances surrounding microbial resistance to antimicrobial chemotherapeutic agents The methodology utilized includes analysis of primary historical data and graphical representation of indices derived from these data. A literature review examines the impact on antimicrobial resistance by historical duration of use, various mechanisms of resistance, non-medical uses of antimicrobial agents and clinical misuse.

Due to the demanding structure of caring for a child with a life-threatening disease (LTD), parents experience psychosocial distress. Studies have shown that stress in parents of children with LTDs can be increased by unmet needs or fragmented care and may be mitigated by coordinated and comprehensive care. Limited literature exists about unmet needs of parents of children with LTDs and the barriers they encounter to accessing mental health resources within pediatric palliative care (PPC) programs. This research study applied quantifiable descriptive methods including a purposive sample of ninety-eight (98) PPC and other pediatric practitioners through the distribution of anonymous online surveys in order to examine unmet needs for mental health resources as they relate to parents of children with LTDs who experience psychological distress exacerbated from psychosocial stressors of care giving. Influenced by Andersen’s predisposing, enabling, and need factors, this study found that PPC practitioners perceived parents encountering waitlists and/or denials when referred to community mental health resources as demonstrating resistance against seeking help.

ABSTRACT Background Private Emergency Medical Services serve a vital role in the community, as such they are subject to job related stress. Currently, there is a limited amount of research related to the stressors related to the job. Objective The purpose of this study was to define the type of daily stressors faced by Private EMS personnel and investigate how they impact their Sense of Coherence. Study Design A mixed methods approach was used in this study to obtain the necessary data. Semi-structured one-on-one interviews were conducted with current employees of an EMS agency that provides 911 service in their area. After the interviews, the participants were administered a survey. Participants/setting Current EMS employees were invited to participate in an interview, in a location and time of their choosing. Both Paramedics and Emergency Medical Technicians (EMT) were invited to participate. Results Critical call incidents, while impacting the mental health of EMS provides, it does not impact them with the same magnitude of operational stress. Operational stress originates from the daily task, interactions and availability of resources. Operational stress was demonstrated to have a large impact on Sense of Coherence. Conclusion Operational stress can have a larger impact on Sense of Coherence of EMS personnel. Research is needed to determine which EMS model helps mitigate the impacts of operational stress on the EMS personnel.

Syphilis, a systemic sexually transmitted disease, is on the rise in the US, with infection rates the highest recorded since 1994 according to the CDC. Useful laboratory testing is an important diagnostic tool for determining individual syphilis infection and preventing community-wide disease spread. The purpose of this study was to determine the usefulness of a specific automated treponemal test method, the CaptiaTM Syphilis IgG EIA, and the syphilis reverse algorithm interpretation for detecting syphilis infection among patients seeking care in a public health clinic. The study employed a retrospective, nonexperimental descriptive correlational design with data collected between 2012-2013 from 4,077 public health clinic patients with 21% of the patients diagnosed with syphilis infection. There was a statistically significant difference between the CaptiaTM Syphilis IgG and the Fujirebio Serodia TP-PA test results; between the CaptiaTM Syphilis IgG Signal to Cutoff (S/CO) and the MacroVue RPR titer continuous variables; and between the reverse and traditional syphilis interpretation algorithms. The reverse algorithm using the CaptiaTM Syphilis IgG test method provided more useful performance measures with a sensitivity of 82%; specificity of 99%; accuracy of 95%; positive likelihood ratio of 63.06 and negative likelihood of 0.18 than the traditional algorithm using the MacroVue RPR test method. Statistical comparison of the area under the curve (AUC) for the continuous variables, CaptiaTM Syphilis IgG S/CO and RPR titer, concluded that the Syphilis IgG AUC (0.9500) was higher than the RPR titer (0.8155) indicating greater accuracy for detecting syphilis infection. This was the first study to determine that the CaptiaTM Syphilis IgG, the S/CO value, and reverse algorithm are useful diagnostic predictors of syphilis infection among public health clinic patients. The data from this study can be utilized by future researchers and scientists who are developing or improving syphilis detection methods.

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical. Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity and mortality is on the horizon unless aggressive measures are taken at mitigating risk. Similarly, as the obesity epidemic expands, obesity-related comorbid conditions including obstructive sleep apnea (OSA) are likely to grow. The purpose of this research was to explore the relationship between ambulatory orthopedic patient-reported activities (quality of life metrics) and diagnostic factors (physical and perioperative care data) in the immediate postoperative period that are predictive of arterial oxygen desaturation. Data was obtained using a novel patient journal exploring sleep, pain, nausea, tobacco use, alcohol use, and appetite in conjunction with a valid and reliable portable, wrist-worn pulse oximeter. Additional assessment data was taken from the preanesthetic assessment. All participants were scored according to the STOP-Bang questionnaire, an accepted survey of OSA risk. Patients were recruited from a busy metropolitan ambulatory surgery center in Richmond, Virginia that sees approximately 500 cases monthly, and a 309-bed tertiary care hospital in West Burlington, Iowa. The target sample included 52 individual patients with data collected over the first two post-operative nights following discharge. Two patients were excluded. Negative binomial regression, log10 transformation, and least-squares regression examined the relationships the STOP-Bang questionnaire, quality of life data, and physical perioperative data had on postoperative desaturation events. Results suggested the STOP-Bang score predicted desaturation events and that age and BMI were significant individual predictors. Opiate pain medication treatment, a happy mood, and home CPAP use were associated with decreased events. This study provided a unique perspective in patient safety research, relating human behaviors and experiences with postoperative oxygen desaturation. Future research projects aligned with postoperative monitoring, pulse oximetry, patient safety, and obstructive sleep apnea are potential following the findings of this study.

This thesis focuses on the Blood Drive which takes place during the spring Greek Week event at Western Kentucky University. I primarily investigate the varying methods of negotiating issues of altruism and egoism in terms of the Blood Drive as well as way that the Blood Drive fits into the WKU Greek yearly cycle. I focus on issues of the process of identity in social Greek-letter organizations and how the process of this identity is renegotiated during the Blood Drive and other Greek events. I interviewed people from several groups for this paper. Initially, I interviewed Blood Donor Recruitment Representatives from the American Red Cross, WKU students associated with the social Greek-letter system and the Blood Drive of Greek Week, and employees of WKU associated with the social Greek-letter system and the Blood Drive of Greek Week. At the event itself I widened my scope to include information provided by Mobile Unit Assistants (MUAs) and other employees of the American Red Cross. Key conclusions of this paper include that while people may all participate or be involved in the same event, their methods of understanding concepts of altruism and egoism vary with their kinds of association. In turn, their conceptualizations mirror those developed by social scientists in the last two hundred years. Also, the issues of separation and integration, processes to do with identity, are central to the events of the Greek calendar year and the Blood Drive event in particular.