Sometimes referred to as “the stethoscope of the future,” ultrasound has many advantages over other imaging techniques which make it ideal for use in primary care. With a unique combination of portability, dynamic imaging, affordability, and real-time interpretation point of care ultrasound (POCUS) is ideal for use in many practice settings. The use of POCUS as the primary imaging modality for many diseases can drastically shorten the time to definitive treatment, and as such is the preferred modality for some presentations. The purpose of this project was to investigate means to improve resident physician knowledge of POCUS and to evaluate if increased knowledge would lead to increased utilization in our outpatient clinic. We started with a pre-test survey covering basic POCUS knowledge as well as a question concerning current utilization of ultrasound imaging in the clinic. We followed that with an educational lecture about the basics of POCUS and some hands-on practice. Afterward a posttest survey was conducted. We found that there was a significant increase in both basic knowledge and the number of residents who intended to use POCUS in the clinic compared to the pre-test. These findings confirm that education on point of care ultrasound can increase both knowledge and utilization in the outpatient clinic. Further education and research could be done to see if there is an actual increase in utilization with continued education.

Omega-3 Fortification of Marinara Sauce Hannah Collie, Mary Andreae, MS, RD, LDN, W. Andrew Clark, PhD, RD, LDN, Department of Rehabilitative Science, College of Clinical and Rehabilitative Health East Tennessee State University, Johnson City, Tennessee In westernized culture, there is a deficit of healthy fats in the average person’s diet. This is evidenced by many different conditions such as cardiovascular disease, cancer, and chronic inflammatory issues. The “Mediterranean Diet” has been shown as an ideal way to combat these health issues.The diet promotes fish as a protein source and a way to consume essential polyunsaturated fatty acids. Due to location and trends, fish is less often a main component of the western diet.This study investigated ways to fortify a more commonly consumed food in western culture, marinara sauce, with flaxseed oil, walnut oil, and anchovies. These fortified marinara sauces were compared to a commercial sauce, Paul Newman’s Marinara for nutritional content. We hypothesize that adding omega-3 rich ingredients to a base marinara sauce recipe will significantly vary the fatty acid profile and increase the amount of omega-3 fatty acids as well as decrease the omega-6 to omega-3 fatty acid ratio. Sauces were prepared and analyzed for nutrient content using proximate analysis methods. Preparation included cooking and freeze drying the variants. Nutrient content tests performed included: bomb calorimetry, Kjeldahl protein analysis, Soxhlet fat analysis, ash inorganic analysis, FRAP Assay for antioxidant content, and gas chromatography to characterize fatty acid composition. Each variant sauce had a fatty acid profile that was unique. Two of the three variants showed a better omega-6 to omega-3 fatty acid ratio than the (control) Paul Newman’s sauce. Samples with the highest to lowest omega-6 to omega-3 ratio were respectively, flaxseed oil, Paul Newman’s commercial sauce, walnut oil, and anchovy. From gas chromatography, omega three fatty acid composition as a percentage of total fatty acids were approximately in the flaxseed oil variant, 21% in the Paul Newman’s sauce, 30% in the walnut oil variant, and 81% in the anchovy variant. Two of three variant sauces, walnut and anchovy, when compared to the commercial Paul Newman's sauce, showed more favorable omega-3 fatty acid content and lower omega-6 to omega-3 fatty acid ratios. Unexpectedly, the flaxseed oil variant had less omega three fatty acids and a higher omega-6 to omega-3 fatty acid ratio than the commercial sauce. In conclusion, simple additions of omega-3 ingredients to marinara sauce can decrease the omega-6 to omega-3 fatty acid ratio in the diet.

Many individuals, especially those in rural areas, experience barriers to accessing medical care. Some barriers are attitudinal and represent perceived quality of care, such as patient satisfaction; however, some rural residents report elevated patient satisfaction scores, regardless of limited access to these services. Identifying how perceived need for medical care is related to patient satisfaction has not been previously explored. Using an online survey to collect data from a national sample (n=535), the current study used the Patient Satisfaction Questionnaire-Short Form (PSQ-18) and a single-item measure of perceived need to examine the association between these two variables, and further, whether rural status, measured by a single-item measure, moderated this association. Results indicated a significant negative correlation between patient satisfaction and perceived need, r(423)=-.12, p=.012. Although the overall moderation model was significant, F(5, 388)=7.10, p<.001, perceived need was not significantly associated with patient satisfaction, b=-.14, p=.20, and rurality status did not significantly moderate the relationship, F(1, 388)=.44, p=.51, ��R2=0.01. However, the covariates of income, b=.11, p<.001, and sexual orientation, b=.23, p=.01, significantly predicted patient satisfaction. This study identified an association between patient satisfaction with perceived need for medical care that has not been previously explored, although this relationship was no longer significant in a larger model, indicating other important factors likely influence this relationship and contribute to the elevated satisfaction scores identified in some rural areas. The lack of moderation by rurality may be due to consistently high barriers to accessing care across all regions of the United States; while rural areas certainly experience unique barriers to care, the barriers present in urban environments may be significant enough that level of rurality in itself does not significantly affect the relationship between perceived need and patient satisfaction. Furthermore, this study highlights the importance of social determinants of health in patients’ perceptions of quality of care. Sexual orientation and income emerged as significant predictors of patient satisfaction, in that higher satisfaction was associated with those who identified as heterosexual and had higher income, consistent with previous literature. Further investigation is necessary to determine the reasons why these relationships exist; however, it is important to acknowledge that individuals with low-income and who identify as sexual minorities experience stigma and discrimination in healthcare settings. These negative experiences with healthcare likely influence perceptions and health disparities that exist within these individuals and may directly impact patient satisfaction levels, which may be influential to these findings.

Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Previously known as Munchausen syndrome, this term is now reserved for severe, chronic, or dramatic cases. Multiple theories for the pathogenesis of FD have been proposed, but most studies point to the behaviors exhibited as a coping mechanism to address emotional stress and resolve unmet psychosocial needs. This case report describes a 31-year-old male who frequently presented to several Emergency Departments at hospitals within the Appalachian region with intentional ingestion of foreign objects. These scenarios ultimately required the patient to undergo approximately 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over the course of two years. The patient also had a significant history of suicide attempts by prescription medication overdose, although clinical workup and laboratory confirmation of such ingestion was varied. After two years of these frequent ED presentations, the patient was evaluated for FD upon voluntary admission to an inpatient psychiatric facility. Due to the need for anesthetic agents in the frequent EGD's performed on this patient, the possibility of drug-seeking as the motivating factor for this patient’s behavior and the possibility of a co-occurring substance use disorder were considered. Suicidality in FD and the lack of case reports and reliable research on the topic makes a challenging diagnosis and clinical course even more complex. Additionally, the clinical management of FD is unique, and no reliable studies have detailed an effective treatment plan. Thus, to add to the literature, the treatment and outcome to date for the patient presented here and the suicidal ideation and intentional overdoses complicating this case are discussed. Continued research and reporting of FD cases will help guide clinicians in the treatment and management of this challenging diagnosis.

Objective: Voice defines a person’s identity. Teachers are professional voice users and about 10-18% experience a voice disorder at any given time. Voice disorder negatively impacts listener perceptions. The current study aims to identify student attitudes towards teachers with voice disorders. Specifically, the aims include: (a) if a voice disorder will lend to a negative perception towards individuals with voice problems, and (b) if the perception of individuals with a voice disorder will be different between a teacher and a non-teacher. Methods: Six voice samples, each lasting a minute long was obtained for three different female speakers to represent non-dysphonic, mildly dysphonic and a moderately severe dysphonic voice. Twenty-six high school students (including males- 4, females- 22) in the 9th and 10th grades served as participants. All participants listened to two different sets of voice recordings. During each set, participants listened to three randomized voice types. For the second set of recordings, the participants were asked to imagine the voice was that of their teacher. For each voice recording in each set, the participants completed a semantic differential questionnaire to rate the personality of the speaker based on the voice they heard. The semantic differential questionnaire included 12 differential rates on a 100mm visual analog scale. Additionally, for the second set of recordings, participants completed a series of open-ended questions to assess the ease of listening to and the perceived approachability of the voice. Results and Conclusions: Descriptive data analysis indicated a general difference in listener perceptions between a mild and moderately severe voice sample. Participants perceived the moderately severe voice sample to be a sick, boring, sad, quiet and scared irrespective of a teacher or non-teacher. The data were consistent for the moderately severe sample on open-ended questions as well. Participants reported they would not feel comfortable approaching the teacher or asking the teacher to repeat information; additionally, the students reported the sample as difficult to listen to. Preliminary descriptive analysis of the data revealed that the teachers’ voice quality influences students’ perceptions of their teacher. Data from this study can lead to identifying appropriate measures in the preventive care of a teacher’s voice.

As community pharmacy transitions from a fee-for-service model to a focus on value-based care, the desired skills of pharmacist graduates in contemporary practice is an evolving paradigm. Meanwhile, most student pharmacists pursuing a career in community pharmacy upon graduation rely solely upon their pharmacy school training as preparation for entering practice. Community pharmacy preceptors are stakeholders in a unique position to compare the dichotomy of the current climate of community practice with the preparedness of graduating students to enter this field. Therefore, these preceptors’ perceptions of contemporary practice services and skills essential for new graduates may be useful in identifying methods of educating and assessing PharmD candidates in their preparation to enter the evolving landscape of community practice. The objective of this research was to identify essential skills for new graduates in contemporary community pharmacy as perceived by these current practitioners. To accomplish this, researchers developed an anonymous web-based survey using REDCap which was emailed to active Advanced Pharmacy Practice Experiences (APPE) community preceptors. The survey included 3 sections: (1) preceptor demographics; (2) perceptions of “contemporary” services and an evaluation of services offered at their sites; and (3) essential skills for graduates entering contemporary community practice. Following a 30-day window of the survey being open, 25% of preceptors responded (n = 42). Survey responses provided clarity in comparing the proportionality in services offered versus services viewed as contemporary. This information may be useful in identifying transformations that have already seen implementation in practice compared to emerging areas yet to be implemented. We also found broad consensus in the perceived importance of most skill areas offered in the survey with just a few showing broader discrepancies with a minority of respondents suggesting skills which held less importance. Monitoring fluctuations of these parameters over time may disclose trends in community pharmacy practice transformation, further delineating service areas that are trending toward adoption in contemporary practice. Therefore, continued use of preceptor surveys may offer insights on the incremental progression of community pharmacy curricula.

BACKGROUND AND SIGNIFICANCE. Various studies have identified physical risk factors for musculoskeletal disorders (MSDs) associated with hand harvesting of crops, due to repetitive motions, lifting or carrying of heavy loads, and working in flexed trunk postures. A paucity of research exists on ergonomic risks to tomato farmworkers. The available studies have estimated risk based on self-reports of injury and semi-quantitative measures. METHODS. A partnership between East Tennessee State University (ETSU) and a migrant health center (Rural Medical Services) has identified some of the occupational health needs of this population. With the aid of surface electromyography (sEMG), an objective-quantitative tool, a more refined understanding of ergonomic health risks for this population will be developed. The purpose of this study is to evaluate the muscle load and fatigue induced on the anterior deltoid and upper trapezius muscles during three tasks: driving stakes into the ground, tying of tomatoes to stakes, and hoisting of a 35-pound bucket full of tomatoes. Space for a mock test plot, where the study will be conducted, is available at the ETSU’s Valleybrook facility. Muscle activity recordings will be obtained from 15 tomato farmworkers. Spectral analysis and the amplitude probability distribution function (APDF) will be used to assess fatigue and muscle load respectively. A repeated measures ANOVA will be employed in the study. ANTICIPATED RESULTS. Findings of this study should show that localized muscle loading increases muscle fatigue. Neuromuscular demand should vary, depending on the type of task performed. Stake pounding may show a higher neuromuscular demand than the other tasks. AIM 1. Evaluate the magnitude of muscle activity during three simulated tomato-field tasks and measure the intensity of movement during the stake pounding task. AIM 2. Compare estimates of muscle fatigue and muscle load induced on the anterior deltoid and upper trapezius muscles during three simulated tomato-field tasks.

Several studies have found that learning styles differ based on gender, but others found no differences. There are no previous studies on gender differences in intentional learning styles. The purpose of this study, therefore, was to evaluate intentional learning style differences based on gender, demographics, and psychological characteristics. The participants were junior level nursing students in a research course in two different semesters. The Learning Orientation Questionnaire of Martinez (2006) was administered in February of 2018 and 2019 to participants (n=198) and analyzed using ANOVA. The LOQ score was significantly different between males and females (p= 0.013). Males had a mean of 2.76 + .89 SD (N=26) but females had an LOQ score of 2.40 + .52 SD (N=169). The LOQ score was not significantly different for students seeking different degrees (p= 0.16). 2nd Degree-seeking students had a mean of 2.43 + 0.37 SD (N=25), LPN-BSN students had a mean of 2.63 + 0.35 SD (N=2), Main BSN students had a mean of 2.44 + 0.62 SD (N=163), RN-BSN students had a mean of 2.5 + 0.70 SD (N=6). Other types of degrees had a mean of 3.5 + 0.35 SD (N=2). The LOQ score was not significantly different for distances that students had to travel to the nearest hospital (p=.54) Students with a distance of 15-30 minutes from their house had a mean of 2.5 + 0.67 SD (N=75). A distance of 30-45 minutes had a mean of 2.62 + 0.63 SD (N=15). A distance of 5-15 minutes had a mean of 2.42 + 0.54 SD (N=86) A distance of less than 5 minutes had a mean of 2.31 + 0.55 SD (N=12). A distance of greater than 45 minutes away had a mean of 2.29 + 0.45 SD (N=9). The LOQ score for the age of responders was not significantly different (p=0.71). Students who were 23 or less had a mean of 2.45+ 0.66 SD (N=103), students who are between 24-29 had a mean of 2.35 + 0.34 SD (N=15), students who are between the ages 30-39 had a mean of 2.63 + 0.38 SD (N=6), students who are older than 40 had a mean of 2.13 + 0.37 SD (N=4), students who preferred not the answer had a mean of 3.0 + SD not available (N=1). The conclusion is that males and females have varied intentional learning styles. This supports previous studies that found differences in learning style in medicals students and practicing nurses.

Title: Helping or Hovering: Examining Social Loafing and the Free-Rider Effect in Youth’s Transition Readiness Author: Mekyala Williams, East Tennessee State University Co-author(s): Kiana Johnson, MS, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Lindsay Ellis Lee, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Introduction Transition readiness in youth has been hard to study because parents and providers have served as managers rather than coaches hindering the process. Social loafing is a phenomenon that explains why people are more prone to exert less effort in group settings. We decided to observe the prevalence of social loafing in youth we examined if students knew how to perform specific transition readiness skills but allowed their support systems to do the task for them. This would be measured in opposition to them performing the tasks themselves since they do have the necessary skillset. The present study aims to validate the 4 domain subscales (i.e., managing medications, keeping appointments, tracking health issues, and talking with providers) found in the revised 20-item Transition Readiness Assessment Questionnaire (TRAQ). Additionally, the study will evaluate youth reliance on familial support systems for healthcare through the lens of the social loafing phenomenon. Methods To obtain demographic information, participants were asked on the survey to report their sex, age, ethnicity, and race (i.e., White, Black or African American, Asian, Native Hawaiian/Pacific Islander, Hispanic/Latino, American Indian, or Alaska Native, or other). Once all the surveys were completed, participants were categorized into white and non-white. We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories were whether they know how to do the specific task or not and whether youth perform the task themselves or if someone else does the task for them. Using confirmatory factor analysis, the revised 20-item version of the TRAQ will validate with the present sample. All statistical analyses will be conducted in R. Anticipatory Results and Conclusions Preliminary results based on the 161 participants found that youth can perform these tasks but very frequently allow someone else to do them. Out of the 20 items listed on the TRAQ, the endorsement rate of social loafing response varied between 10% and 52%. Fifteen out of the 20 items had a 30% response rate for social loafing. For the transition to adulthood to be successful for youth, they have to learn to accept different roles and responsibilities without the help of anyone else. This emphasizes the importance of shifting parents and providers to a coaching role rather than a managing role. Doing so will help enhance the youths’ ability and independence as they get older. This can also be applied to healthcare settings as using a coaching approach will minimize social loafing and allow more competence in managing their health.

Introduction and Background: Burnout is a syndrome that many health professionals are experiencing. It involves a state of emotional and mental exhaustion and professional fatigue that can impact the personal lives of these individuals leading to anxiety, depression, and discontentment. The impact may go further in the healthcare setting and lead to a decrease in patient safety and diminished quality of care for patients. Purpose: The purpose of this literature review is to systematically and critically appraise current literature to examine the associations between nurse burnout rates and poor patient outcomes. Literature Review: A total of thirteen articles, one literature review, and one meta-analysis were included in this review. Databases that were used to obtain these articles included PubMed, ScienceDirect, Scopus, and CINAHL. Findings: The related factors that were associated with nurse burnout included a high-stress work environment, lack of support, emotional exhaustion, depersonalization, and inadequate staffing. In situations where the staff was experiencing high levels of burnout, there was a correlation with decreased patient and family satisfaction and an increase in adverse events such as medication errors and missed care. Conclusion: Due to the COVID-19 pandemic, articles published within the past years have consisted of data collection through questionnaires and online surveys to limit the transmission of the virus. This technique could have led to a bias gap within the literature collected considering the lack of validity questionnaires yield due to the collection of information without further explanation. Despite this limitation, the data results still exposed that the presence of burnout among health professionals is associated with worsening patient safety. High levels of burnout are related to external factors, such as high workload, long hours, and interpersonal relationships. Avoiding professional exhaustion is an important strategy for improving patient safety.