AN ABSTRACT OF THE DISSERTATION OF Wendi Krista Middleton, for the Doctor of Philosophy degree in Health Education, presented on April 15, 2015 at Southern Illinois University Carbondale TITLE: TICK-BORNE DISEASES: ASSESSING THE KNOWLEDGE, ATTITUDES, AND BEHAVIORS OF COLLEGE STUDENTS. MAJOR PROFESSOR: Dr. Dhitinut Ratnapradipa Within the last few decades, the prevalence of tick-borne diseases (TBDs) has dramatically increased. Symptoms of TBDs are very similar to other illnesses and are often referred to as flu-like in nature. TBDs could be easily prevented, however, if people used proper prevention methods. If not treated early in the course of illness, tick-borne infections have the potential to cause serious health problems and even death. It is, therefore, extremely important that individuals use proper prevention strategies in order to reduce the risk of contracting TBDs. This research focused on the college population because these individuals represent one of the most active adult outdoor populations. While many students know that ticks carry diseases, it is thought that they have a poor understanding of the extent to which TBDs affect human health. Additionally, many experts believe that knowledge of health-related topics plays a major role in determining how individuals behave in regard to those concerns. Furthermore, a person's behavior strongly influences their risk of contracting a TBD. Information collected allowed for determining whether or not a person's knowledge and perceptions of tick-borne diseases have an influence on their prevention practices. As expected there was a lack of knowledge regarding tick-borne diseases. College students who volunteered to participate in this study indicated that they are unaware of the proper methods to use in order to prevent contracting TBDs. Thus, it was not surprising that they do not utilize correct prevention strategies. Additionally these students stated that more information about TBDs should be added to the curricula in college health courses. This research aimed to improve the psychometric properties of a newly created survey and assess college students' knowledge, attitudes, and associated behaviors regarding TBDs. Discovering the current knowledge of college students regarding TBDs has helped researchers in determining the effect that individual knowledge of TBDs has on a person's attitudes, and behaviors regarding prevention.

Doctor of Philosophy / General Summary: 1. The mechanisms involved in the pathogenesis of tick paralysis have been investigated in vivo in paralysed dogs and in vitro using nerve-muscle preparations removed from paralysed mice. 2. Neurologic and electromyographic examination of paralysed dogs indicated that tick paralysis involved a failure of neuromuscular transmission* No abnormality of conduction in the nerve trunk could be demonstrated and it was considered that the lesion was likely to be at or near the neuromuscular junction. 3. Nerve-muscle preparations from affected mice were found to be paralysed when examined in vitro. The paralysis was found to be temperature dependent. Results of these experiments supported the contention that the lesion was near the neuromuscular junction. 4. Neuromuscular transmission was examined in preparations from paralysed mice. No abnormality of nerve conduction could be demonstrated. The release of acetylcholine in response to nerve stimulation was depressed due to a reduction in quantal content rather than quantal size. Lowering the temperature of the preparation partially reversed this effect. These results indicated that tick paralysis is due to an abnormality in the mechanism which couples nerve terminal depolarisation and acetylcholine secretion. 5. There is some indication that crude toxin extracted from partially engorged ticks could affect nerve-muscle preparations incubated in it. 6. Apart from some secondary changes no significant morphological abnormalities could be demonstrated in nerve fibres, muscle fibres or neuromuscular junctions from tick paralysed mice.

256 leaves : ill. ; 26 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.) from the Dept. of Entomology, Waite Research Institute, University of Adelaide, 1973

Doctor of Philosophy / General Summary: 1. The mechanisms involved in the pathogenesis of tick paralysis have been investigated in vivo in paralysed dogs and in vitro using nerve-muscle preparations removed from paralysed mice. 2. Neurologic and electromyographic examination of paralysed dogs indicated that tick paralysis involved a failure of neuromuscular transmission* No abnormality of conduction in the nerve trunk could be demonstrated and it was considered that the lesion was likely to be at or near the neuromuscular junction. 3. Nerve-muscle preparations from affected mice were found to be paralysed when examined in vitro. The paralysis was found to be temperature dependent. Results of these experiments supported the contention that the lesion was near the neuromuscular junction. 4. Neuromuscular transmission was examined in preparations from paralysed mice. No abnormality of nerve conduction could be demonstrated. The release of acetylcholine in response to nerve stimulation was depressed due to a reduction in quantal content rather than quantal size. Lowering the temperature of the preparation partially reversed this effect. These results indicated that tick paralysis is due to an abnormality in the mechanism which couples nerve terminal depolarisation and acetylcholine secretion. 5. There is some indication that crude toxin extracted from partially engorged ticks could affect nerve-muscle preparations incubated in it. 6. Apart from some secondary changes no significant morphological abnormalities could be demonstrated in nerve fibres, muscle fibres or neuromuscular junctions from tick paralysed mice.

Thesis (Ph.D.) from the Dept. of Entomology, Waite Research Institute, University of Adelaide, 1973.

Thesis (Ph. D.)--University of Sydney, 1977. / Title from title screen (viewed April 1, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Department of Veterinary Pathology and Bacteriology, Faculty of Veterinary Science. Degree awarded 1997; thesis submitted 1976. Includes bibliographical references. Also available in print form.

Thesis (Ph.D.)--Aberdeen University, 2009. / Title from web page (viewed on Mar. 3, 2010). Includes bibliographical references.

<p>More than 15 tick-borne diseases have been recognized in the United States (US) (Eisen (2020). Collectively, TBDs have been linked to seven different tick species in the US. Climate change, urbanization, and host migration exacerbate the threat of increasing TBD incidence and the expanding geographic distribution of ticks. Furthermore, data suggests that less than a tenth of the reportable TBDs were reported to the CDC annually. Studies from a national survey and high incidence states for Lyme disease provided evidence that healthcare providers have knowledge gaps about TBD epidemiology and diagnostics, which has yet to be examined in Indiana to our knowledge.</p><p></p><p>An anonymous survey of 597 Indiana healthcare providers was conducted between February 28^th and April 10^th,2020 to assess knowledge about ticks and tick-borne diseases (TBDs). The survey comprised 22 discrete and ordinal questions and one open-ended question. The study revealed that 92% of the respondents reported Doctor of Medicine (MD) (71%), Doctor of Osteopathic Medicine (DO) (8%), Physician Assistant (PA) (12%) and Registered nurse (RN) (1%) as their highest level of training and practiced in a diversity of settings including Primary care office (28%), Specialty care office (23%) and Hospital (inpatient) (20%). Analyses revealed that 39% of respondents had practiced for more than 25 years, consulted between 1-25 patients with confirmed or suspected TBD per year, and predominantly served both rural and urban communities (62% respondents). Seventy percent of respondents recognized the clinical signs and symptoms of TBDs endemic to Indiana and 96% of DOs, 94% of PAs, and 91% of MDs were aware of the limitations of the erythema migrans (EM) rash as a diagnostic criteria for Lyme disease (LD), the most common TBD in Indiana and the U.S. The majority of respondents (75%) reported using fine tip tweezers, considered best practice for the removal of an attached tick. Among respondents who used online resources to obtain information regarding diagnostic and treatment guidelines, 25-45% visited federal (CDC) and state (Indiana Department of Health, IDOH) websites. </p><p>Survey data revealed several potential knowledge gaps among Indiana state providers. Respondents reported that they were unsure about the following topics: (1) the tick species capable of disease transmission in IN (47% unsure), (2) the geographic distribution of the black legged tick, <i>Ixodes scapularis, </i>the vector of LD in the U.S. (56% unsure), (3) northwest Indiana as the region of the state associated with highest LD risk (49% unsure), and (4) May-July as the months considered highest risk for TBD transmission (48% unsure or answered incorrectly). These findings provided evidence to support the hypothesis under investigation in the present study that Indiana healthcare providers lack knowledge of tick vectors and TBDs risks specific to the state. </p>Qualitative analysis was conducted for open-ended question (Q23) and resulted in coding of 597 responses into six major categories (Healthcare provider, Healthcare system, Patient Knowledge, Disagreement, Education and Not applicable) and 15 associated subcategories. Coding analyses revealed that healthcare providers are aware of their shortcomings and are receptive to online interventions. Here we present the first focused study to assess provider knowledge of ticks and TBD in Indiana. Taken together, the survey findings provide information to guide development of region-specific educational material and guidelines about ticks and TBDs for healthcare providers. We provide evidence to suggest that a continued provider education program may improve diagnosis and treatment of TBDs.

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