The family Bunyaviridae is the largest of vertebrate diseases and includes the mosquito-borne disease La Crosse (LAC) virus. Vectors include the major vector Aedes triseriatus and two accessory vectors Aedes albopictus and Aedes japonicus. In the past several decades there has been an increase in the number of LAC cases, implication of new vectors, and the appearance of new foci of disease in the southeastern U.S. To better understand the vectors and the relationship between vectors and the virus, laboratory and field studies were conducted to determine oviposition preferences, effect of virus infection on blood-feeding behavior, and compare the efficacy of various methods to determine minimum infection rates of vectors. In laboratory studies of oviposition preference, only Ae. japonicus demonstrated a preference when presented with preexisting eggs. They deposited more eggs in cups containing either conspecifics or Ae. albopictus. The presence of 1st instar larvae Ae. albopictus larvae deterred oviposition by Ae. triseriatus and Ae. japonicus. Ae. japonicus and Ae. triseriatus preferred cups containing larval rearing water (LRW) of conspecifics and Ae. albopictus. Aedes albopictus preferred LRW regardless of species compared to control cups. Field experiments with fresh egg papers and preexisting eggs did not show significant differences, although the unequal population densities of species in the study area confounded the analysis. More work is needed to elucidate the interaction among these species and its effect on oviposition in the field. Blood-feeding experiments showed that LAC virus-infected Ae. triseriatus and Ae. albopictus imbibed significantly less blood compared to uninfected mosquitoes. Because blood meal size affects the subsequent inhibition of host seeking, experiments were done to ascertain the effect of virus infection on refeeding. Significantly more infected Ae. triseriatus mosquitoes refed but there was no effect on the refeeding rate of Ae. albopictus. Thus, the detrimental effect of virus infection, i.e., reduction in blood meal size, may lead to increased host exposure by Ae. triseriatus, enhancing horizontal transmission. Collecting adult mosquitoes was more efficient to detect virus in field populations than the collection of eggs. Maximum likelihood estimation-infection rates (MLE-IR) were calculated using bias-corrected maximum likelihood estimation. Adult collections yielded significantly more positive pools compared with egg collections. Virus was isolated from pools from Ae. canadensis, Ae. triseriatus, and Ae. albopictus. These results are comparable to other studies. / Ph. D.

Central line associated bloodstream infections (CLABSIs) are one of the most fatal types of healthcare associated infections (HAIs) and their economic impact is significant. Although some studies have found no signification reduction in CLABSI rates with chlorhexidine gluconate (CHG) bathing; good evidence exists to support the use of CHG bathing as an intervention to reduce CLABSIs (Bleasdale et al., 2007; Climo et al., 2009; Climo et al., 2013; Montecalvo et al., 2012). CHG bathing performance may influence the effectiveness of the CHG bathing protocol. The purpose of this study was to determine the effect of a targeted educational approach involving simulation on the delivery by nursing assistants of a CHG bathing protocol. The study aims were (1) to compare the effectiveness of removal of simulated skin microbes by nursing assistants who receive training for a CHG bathing protocol with simulation training to simulated skin microbe removal by nursing assistants who receive training for a CHG bathing protocol without simulation training and (2) to examine the influence of a demographic factor, years of practice as a nursing assistant on the percentage of simulated microbes present following performance of bathing. Thirty nursing assitant volunteered for this study and were randomized to either the intervention group (training for a 2% CHG cloth bathing protocol with simulation training) or the control group (training for a 2% CHG cloth bathing protocol without simulation training). For aim (1) an independent t-test (inferential tests of group differences) was used to examine if there was any difference between the intervention group and the control group on the percentage of microbes remaining on the mannequin post bathing. For aim (2) a Pearson correlation was computed to assess the relationship between years of practice as a nursing assistant and the percentage of microbes remaining post bathing. Results showed no statistically significant differences between the two groups on demographc factors. For aim (1) the t-test revealed a statistically significant (p < .001) difference between the intervention group and the control group on the percentage of simulated microbes remaining on the mannequin post bathing. For aim (2) there was no correlation between the years of practice as a nursing assistant and the amount of microbes left on the mannequin post bathing (p=.709). This study provided an innovative method of assessing the percentage of simulation microbes remaining on the mannequin and made it possible to quantitatively measure bathing performance. Monitoring the compliance with CHG bathing is an important component when evaluating the effectiveness of a CHG bathing protocol. The findings of this study suggest that simulation training was an added benefit to the nursing assistants who received it, as they performed better than those who did not receive simulation training.

Aim: To determine if a significant relationship exists between bloodless medicine practices and decreased infection rates in oncology patients following hematopoietic stem cell transplantation by performing a literature review. Background: It is not uncommon for healthcare professionals to encounter Jehovah's Witnesses (JW) seeking medical treatment in the acute care hospital setting and outpatient clinics alike. However, JW's pose a unique challenge to healthcare providers. Their refusal of blood transfusions makes them a population of interest within the medical community. The refusal of blood transfusions also poses a serious challenge to successful treatment in oncology JW patients, and many hospitals will refuse to perform a procedure as complex yet beneficial as a hematopoietic stem cell transplant in this population. Methods: An extensive electronic literature search in the CINAHL Plus database was completed and included the keywords infection, blood transfusion, stem cell transplant, bloodless medicine, Jehovah's Witnesses, and transfusion reactions. The available literature was carefully examined for interventions performed and compared for ultimate results to be finalized as a written report. Significance: The results of this research can not only optimize healthcare for the population of Jehovah's Witnesses, but also assist in reduced blood transfusions and improved cost management in all patients with a cancer diagnosis. Conclusions: All studies concluded that autologous hematopoietic stem cell transplantation can be performed safely without the use of blood products. Their conclusion was based off of the data they collected following patients post-stem cell transplant. More research is needed to explore outcomes in this population as a result of blood transfusion refusal following stem cell transplantation in comparison with those who receive blood transfusion support.