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The increasing aging population and the prevalence of chronic diseases among lower socioeconomic groups have led to higher healthcare spending on chronic care management. In this paper, the study revolves around the utilization of Information and Communication Technology (ICT) for the management of chronic diseases, with a particular focus on the elderly population. The study examines various digital health interventions, including eHealth, mHealth, electronic health records, remote monitoring, wearable devices, clinical decision support systems, telehealth, and telemedicine, in the context of chronic disease management. The opportunities, strengths, and weaknesses of digital technology are discussed, highlighting the potential benefits of ICT in improving healthcare outcomes and reducing the severity of chronic conditions. The paper also addresses the barriers to the adoption of digital health interventions, such as lack of skills, privacy concerns, limited access to high-quality healthcare, and disparities in internet connectivity. Despite these barriers, the integration of ICT in healthcare has shown promising results, empowering patients, enhancing self-management, reducing relapse, and increasing patient participation. The study concludes by emphasizing the significance of digital health technology in addressing the challenges posed by the aging population and chronic diseases, while also acknowledging the need for further research and policy considerations for effective implementation.

PURPOSE: The primary purpose of this paper is to review the current available evidence on benefits and risks of intensive blood pressure control (< 120 mmHg systolic) in the greater than 75-year-old population. The secondary purpose will focus on discussion of general recommendations for blood pressure treatment in non-diabetics in this population. METHOD: A PubMed and NEJM literature search was directed towards search terms: hypertension, intensive, standard, older, and elderly, as well as search terms surrounding risk: adverse event, fall, fracture, syncope, AKI, and mortality. Fourteen articles are used for the basis of this paper, six of which are large scale RCTs. RESULTS: Though there has been a general lack of consensus on appropriate hypertensive management in the elderly, data has increasingly shown that lower blood pressure goals continue to demonstrate benefits on cardiovascular and cerebrovascular morbidity and mortality, as well as all-cause mortality in populations greater than 75 years old. However, with intensive management comes the concern for risk of morbidity from falls, syncope, AKI, cognitive decline and other laboratory aberrations, which impact patients of this population more severely. These risks are proven to be present with all levels of blood pressure management, and when comparing standard to intensive blood pressure goals, neither the frequency nor the severity of these risks seem to rise with more aggressive treatment. Simply, the intensive blood pressure target demonstrates continued benefits across a spectrum of morbidity and mortality causes, while the frequency of adverse events appears to plateau early. However, most of the trials focused on this cohort excluded some major comorbidities, including diabetes, prior stroke, and residence in a care facility. Intensive blood pressure targets are appropriate for ambulatory patients over the age of 75, but discussion of the risks and benefits should be weighed on a case-by-case basis and tailored to individual patient comorbidities and values. CONCLUSION: Overall, intensive blood pressure management should be considered in patients greater than 75 years old in order to mitigate morbidity and mortality associated with hypertension. Shared decision-making conversations and recommendations should be made with patients individually based on comorbidities, symptoms, and personal values.

Bronchopulmonary dysplasia (BPD) is a chronic neonatal lung disease that occurs in over 50% of premature infants. BPD is characterized by damage to the alveoli and bronchioles and improper vasculature formation. It is primarily caused by overexposure to oxygen through mechanical ventilation, but there are other risk factors that make infants more susceptible to BPD. Microbial composition impacts risk for developing BPD, and research is ongoing about the effects of the microbiome on BPD pathogenesis; this information is also valuable for preventative treatment. This paper reviews the normal function of the lungs, pathogenesis of BPD and how it affects normal lung function, and the current and ongoing research concerning the effects of the microbiome on BPD.

Oral hormonal birth control is frequently used by women for the regulation of medical conditions or as a contraceptive method. However, many women are dissatisfied with the side effects they experience while taking birth control, such as mood changes or oligomenorrhea. The primary objective of this paper is to conduct a scholarly literature review of the side effects caused by oral hormonal birth control, including an explanation of the mechanism of action of these contraceptives on the female reproductive system. The results of this review showed that some perceived side effects, such as weight gain, have little scientific basis, while other side effects, such as stroke, myocardial infarction, and mood changes, are significantly affected by risk factors women may possess.

Infection control practices (ICPs) are crucial for maintaining the health and safety of residents in a residential care community (RCC). This paper examines the differences in COVID-19 infection rates and cases based on the characteristics of RCCs, such as ICPs, personal protective equipment (PPE) shortages, ownership type (for-profit vs. nonprofit), census regions, and RCC size. While ICPs contribute significantly to preventing and controlling the highly contagious virus, a comprehensive program is encouraged to provide a targeted intervention based on RCC’s environmental factors. The importance of the characteristics of the RCCs must be considered in combing with the ICPs to enhance the impact of the infection practices, which will substantially improve the overall success of the infection control and prevention in COVID-19 outcomes. Systems Theory offers the lens for researchers to evaluate, examine, and compare various factors that are associated with the outcome of disease transmission and how those factors are related in certain settings. It facilitates the components such as census region, PPEs, size of the facility, and ownership type (for-profit vs. nonprofit) that are closely linked and provides feedback in a more accurate way to improve the overall success of the process. The study employed ANOVA to test the mean difference between each characteristic, revealing that for-profit and larger organizations tend to have higher infection rates in terms of the ICPs outcomes. However, there were contradictory results concerning other variables for PPE shortages and geographical variations (p>0.05), calling for more diverse explorations regarding the prevalence of ICPs and characteristics of RCCs in the future research.

Objective To discuss rural-urban disparities of adolescent unplanned pregnancies and sexual education availability. The potential of virtual sexual education programs are discussed by examining two studies that have used technology-based interventions to assess variables related to pregnancy prevention. Data Sources A review was conducted by gathering randomized controlled trials and systematic reviews utilizing databases such as ScienceDirect, PubMed and Wiley Online Library. Research articles included in this paper were from 1995 to present day and are inclusive of all races. Study Eligibility Criteria Studies were included if the interventions worked with young adolescents ages 13-24 year old, utilized technology-based interventions for sexual education and were conducted in the United States. Study Appraisal and Synthesis Methods The first meta-analysis examined 16 studies that were experimental designs and measured condom use or abstinence as outcomes. The studies chosen were rated for quality and risk of bias using the Cochrane Collaboration’s tool of assessing risk of bias. The second source was a study that looked at two rural Appalachian high schools that were similar demographically and were statistically identical on all but one variable (refusal self-efficacy). The schools were randomly assigned to either the control or experimental group to participate in a seven week program. The surveys pre- and post-intervention evaluated condom negotiation self-efficacy, attitudes toward abstinence and situational self-efficacy. Results The meta-analysis concluded that there was a small but significant effect on condom use and a significant effect on abstinence over time with technology-based interventions. The second study with the Appalachian high schools concluded that the experimental school had greater knowledge, greater condom negotiation self-efficacy, more favorable attitudes toward waiting to have sex and greater situational self-efficacy compared to the control school. There were no significant differences in regard to condom self-efficacy or refusal self-efficacy. Conclusion The higher rates of unplanned pregnancies in the rural areas of the United States can be associated with the lack of sexual education available. Technology-based programs hold the potential to close this gap based on several of the studies that have been conducted that have shown to have significant effect on variables of safer sex practices. Ultimately, more studies and research is needed to evaluate the short-term and long-term effects of virtual sexual education.

The contents of this article are the author’s original unpublished findings. Background: Each year, approximately 6 million Americans are treated for skin cancer, resulting in a total annual medical expense of $8.9 billion 1. The two most common types of skin cancer are basal cell carcinoma (BCC) followed by squamous cell carcinoma (SCC)2. The metastatic potential of these cancers is minimal; however, their treatment may involve severe scarring and disfigurement2. In contrast, melanoma is an aggressive skin malignancy that grows rapidly and can metastasize in a quick manner2. Risk factors of these skin cancers include UV exposure, fair skin complexions, and family history2. To prevent skin cancer, emphasis is placed on sun protection; however, this approach is suboptimal within the population. To combat this, alternatives such as niacinamide, a form of vitamin B3, may be used to reduce the risk of skin malignancies. Objectives: To evaluate the mechanisms and effects of oral niacinamide in the risk reduction of skin cancers among individuals with a history of sun exposure. Methods: A review was conducted by gathering randomized controlled trials and systematic reviews utilizing databases such as ScienceDirect, PubMed, Wiley Online Library, and SpringerLink. Research articles included in this paper have been published within the last eleven years and are inclusive of all races. Results: Niacinamide was associated with a significant reduction in the occurrence of BCCs and SCCs. However, concerning melanoma, its preventive effects were solely investigated through in vitro and in vivo studies. The lack of clinical trials makes it challenging to evaluate its effectiveness for melanoma. Conclusion: The research presented found compelling evidence supporting the potential of niacinamide in reducing the incidence of nonmelanoma skin cancers, particularly basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Such results yield to the significance of larger clinical trials aimed at replicating the results obtained from the ONTRAC trial regarding SCCs and BCCs. Despite promising outcomes against nonmelanoma skin cancers, the evidence regarding niacinamide's efficacy in preventing melanoma remains inconclusive. While in vitro and in vivo studies suggest positive effects on melanoma cells, the lack of robust clinical trials specifically evaluating niacinamide's impact on melanoma prevention necessitates further investigation.

For Black American mothers, postpartum stressors are magnified as about half of this population are single mothers, and many suffer from inadequate social and healthcare needs. Expected postpartum stressors, coupled with social stressors that Black American mothers face, can mask or influence patient reporting of early postpartum hypertensive crisis symptoms. Patients diagnosed with preeclampsia risk developing even more severe complications, such as cardiovascular disease, which is the leading cause of pregnancy-related deaths in the United States. Black American women face the challenge of inadequate communication with their healthcare providers, medical mistrust, and perceived discrimination when accessing health care. Pregnant women, in general, report informational needs and relationships as highlighted factors when exploring patient-clinician communication. Therefore, this dissertation research aimed to understand Black American mothers' perceptions of care and communication with their clinicians after being diagnosed with an acute hypertensive crisis and the findings will provide knowledge that will improve maternal outcomes for this population. Three projects were conducted: a manuscript consisting of a literature review, a methods manuscript, and a convergent mixed-methods study. The first manuscript consisting of the literature review revealed that early detection of acute hypertensive crisis among the postpartum mother’s interdisciplinary care team improves maternal neonatal outcomes. This manuscript proposes an example protocol for facilitating emergency care to those. symptomatic postpartum mothers who are visiting their neonate in the neonatal intensive care unit (NICU). Also in this manuscript, a literature review was conducted on the etiology, pathophysiology and treatment recommendations for acute hypertensive crisis. The findings of this review led to the importance of investigating those diagnosed with acute hypertensive crisis, specifically those who were most at risk- Black Postpartum Mothers. The next project, a methods paper on qualitative interview techniques, was written to inform qualitative researchers on how to amplify the voices of Black postpartum mothers diagnosed with an acute hypertensive crisis during qualitative interviews. Techniques were shared based on lessons learned during qualitative data collection. The third project, a convergent mixed-methods study, was conducted to explore the perceptions of care and patient-clinician communication from Black postpartum mothers diagnosed with an acute hypertensive crisis in the Mississippi Delta region of the United States. Findings from this study revealed that most participants rated higher satisfaction with their doctor-patient communication during their outpatient prenatal visits and hospital stay, but still voiced repeated experiences of being dismissed and their symptoms being minimized by their obstetric clinicians. To meet the needs of Black postpartum mothers who experience high risk disorders such as acute hypertensive crises, obstetric clinicians must understand their experiences with patient-clinician communication and the adjustive communicative behaviors they adopt to navigate healthcare spaces. Obstetric clinicians must be intentional about providing detailed information early in pregnancy and establish a trusting relationship in order to improve their perceptions of care and patient-clinician communication.

Additive manufacturing (AM) is an emerging technology with diverse areas of application. In this paper we explore a new application of AM that uses a subset of AM known as 3D printing, to create real life models of the human connectome. The human connectome is a color coded map of the connections in the human brain where directions are indicated by colors and the density of connections are indicated by color intensity. There are several different algorithms for mapping the connections and describing the output. The Neu- roImaging Tools and Resource Collaboratory (NITRC) provides one such algorithm. It uses probabilistic mapping on an MRI to identify neural pathways and averages these identified connections from many MRI’s to create a standard atlas of the adult human brain. Currently AM files for 3D printing rely on a surface triangulation mesh to describe the model. This mesh consists of a series of vertices and faces, each one describing the location of a triangle in 3D space. Each triangle shares two vertices with another triangle. A continuous mesh is created by combining a set of such triangles that can represent irregular surfaces. These meshes however do not allow for interior points or interior color data. In this work we describe a novel solution for creating voxels from surface triangulation that allows the atlas to be directly translated to an accurate 3D printed model.

Home exercise programs (HEPs) are a foundational component of physical therapy (PT). However, the majority of patients are not compliant with their HEP; they lack the motivation and habits necessary to be compliant. The transtheoretical model (TTM) is a framework for understanding the decision-making of the individual and is a model of intentional change. When properly understood and applied, the TTM can improve a physical therapist’s ability to help patients to change their behavior and to become HEP compliant. This paper seeks to address patient exercise noncompliance by educating and instructing physical therapists in the application of the TTM, which includes the stages of change, processes of change, decisional balance, self-efficacy, initial stage assessment, mutual goal setting, verbal communication, nonverbal communication, and the proper utilization of the intimate patient-provider treatment setting.

PURPOSE Community-based breast cancer support agencies who address non-medical, social determinants of health needs that serve as barriers to maximizing breast health outcomes may play a vital role in mitigating breast cancer mortality. They share a common emphasis on addressing social, economic, and psychological needs of breast cancer survivors and those at risk of breast cancer. This paper is third in a series of papers exploring why the rate of breast cancer mortality is two times higher for African American women than white women in Memphis. We sought insights from community-based breast cancer support agencies because they have a close-up view of circumstances and decision-making among women at risk of and surviving breast cancer, and a close view of primary care, surgical, and insurance environments impacting these women. METHODS For this qualitative descriptive research study, data were collected using semi-structured in-depth focus groups with five breast cancer support agencies in Memphis. Categories and patterns were established using thematic analysis and a deductive a priori template of codes. RESULTS The main themes identified within support agencies were barriers to the use of services, education, health system support, and emotional support. Numerous sub themes included medication costs, support group supplemental programming, eligibility for mobile services, patient/provider communication, optimism, and family advice. Procrastinating, fearfulness, insurance, childcare, and transportation were barriers to care. Support agencies noted that one unique barrier that African American women who live in underserved areas of Memphis face in maintaining breast health is poor physician’s office management; in fragmented health care systems, information and patients can be lost to follow-up. DISCUSSION/CONCLUSIONS Community-based breast cancer support agencies, who focus on social determinants of health, play a critical role as connectors for women with breast cancer who live in medically underserved areas and must find their way within a fragmented medical system. GRANT SUPPORT This research was funded by the Tennessee Department of Health, grant number A17-1251.

Background: Although the Accreditation Council for Graduate Medical Education (ACGME) has provided educational directives on health disparities education during residency program for the medical residents, there is paucity of curricula focused on disparities education within the graduate medical education. Objective: The purpose of this study was to evaluate a Health Disparities Curriculum (HDC) that was delivered to twelve residency programs at a College of Medicine. Methodology: The study employed a cross-sectional study design. Stufflebeam’s Context-Input-Process-Product (CIPP) model was utilized as theoretical framework to assess whether the curriculum achieved its stated goals and objectives, the teaching and learning processes, and the outcomes of the health disparities curriculum through the feedback received from medical residents who participated in the electronic and paper-based surveys. Results: The response rate for the study was 46.68%. Context evaluation showed that there was agreement among the residents on the curriculum meeting its stated goals and objectives. In input evaluation, the residents expressed the need for community engagement opportunities, interactive content, and actional strategies. Time constraints were identified as one of the barriers to attending the sessions and for curricular incorporation. A unique attitudinal barrier was identified where residents perceived lack of control in addressing disparities. Findings of process evaluation indicated statistically significant difference in the proportion of residents attending the sessions by race, specialty, and year in the residency program. The medical residents reported favorable perceptions on the relevance of content and the instructor’s competence. Residents from the non-primary care specialties reviewed the learning resources statistically significantly more as compared to the residents in the primary care specialties. Findings of product evaluation showed statistically significant increase in self-efficacy after curriculum participation, increased awareness, statistically significant increase in disparities discussions and community partnerships, and favorable perceptions on curricular utility. There was no difference in inclination to incorporate cultural humility among residents and no change in scholarly activity development. INDEX WORDS: Graduate Medical Education, Health Disparities Curriculum, Context-Input-Process-Product, CIPP, Evaluation

Fall risk among older adult is a worldwide public health problem. As the older adult population is continuing to increase, addressing this issue is critical. Several fall risk assessment tools have been designed to help predict various risk factors. Among these assessment tools is the Hendrich II Fall Risk Model (HIIFRM). This tool uses evidence-based risk factors including mental status, sex, functional status, and whether the patient is taking antileptics and/or benzodiazepines. The purpose of this paper is to validate the HFRM, explore additional variables that increase the likelihood of falling including both past falls and the number of prescription medications a patient is taking. Our findings validate the HFRM; with each additional point on the HFRM score, holding all other explanatory variables constant, the odds of having multiple previous fall-related admissions increased by 38.3% (P < 0.001). The strongest predictor of future falls was previous falls. With confounders held constant, each additional previous fall predicted a 3.9-fold increase in the odds of experiencing a future fall (p < 0.001; 95% CI of OR: 3.131 to 4.961). When looking at prescription medications, for each additional increase in prescription medications, we observe a 11.8% increase in the number of falls experienced during the tracking period (p

For decades, people have prophylactically used aspirin (ASA), or acetylsalicylic acid, to mitigate their risk for cardiovascular disease (CVD). The role of ASA as a means of secondary prevention for CVD is well established, however there are conflicting schools of thought as to whether or not it should be used as primary prophylaxis. While this indication has been studied for more than 30-years, questions remain pertaining to the risk of bleeding that is associated with ASA usage, which ranges from mild epistaxis to life threatening hemorrhage.1 Lifestyle and behavioral factors play a large role in a person’s CVD risk, however individuals are often resistant to making said changes and instead prefer to use medications in hopes that they will have the same protective effects as altering daily habits. Thus, this paper will provide a summary of the six current literature articles that addresses the issue of prophylactic ASA as a means of primary CVD prevention in adults over the age of 40 with modifiable risk factors.

Objective: To find simple, fast, and easy ways to assess library users’ needs and to get real-time responses in order to shorten the interval between deploying surveys, gathering responses and implementation of solutions. In the past the library employed email surveys to assess user needs but the process was inefficient and ineffective due to low response rates and time spent creating online surveys. Methods: The library team began using paper “micro-assessments” to understand users’ needs. Short paper surveys of no more than five questions, were deployed at three different times throughout the academic year: (1) Medical students were handed surveys during one of the library’s weekly events about their use of library-issued iPads; (2) Surveys were left on each study space in the library quiet room over the course of one week asking about students’ opinions on food being allowed in the library quiet room; (3) Faculty were handed surveys during departmental meetings to assess their interest in scholarly publishing topics. Completed surveys were collected and results were tabulated the same day. Results: Results of the student iPad micro-assessment helped librarians understand students’ use of library-issued iPads. Feedback from the second student survey informed policy decisions in regards to allowing food in the library quiet room. Finally, results of the faculty micro-assessments led to the development of short presentations on scholarly communication topics, delivered by librarians during faculty departmental meetings, as well as one-on-one EndNote training sessions and a Getting Published Workshop.

Objective: To provide an overview of evaluating scientific scholarly impact among researchers in the health sciences. Librarians, as department liaisons, are a natural choice for guiding faculty, students, and tenure and promotion committees in understanding and responsibly applying altmetrics and bibliometrics, including the Relative Citation Ratio (RCR), to evaluate the impact of contemporary health sciences scholars. Background: Scholars in the health sciences, particularly clinician-researchers, who divide their time among patient care, education, as well as academic service, have less time for research than other scientists. Thus, citation patterns vary across the disciplines, possibly placing clinicians at a disadvantage when traditional bibliometrics are used to determine scholarly, as well as societal impact. Judicious use of altmetrics can complement bibliometrics and citation analysis to provide a clearer picture of the scholarly and societal impact of clinician-researchers. The RCR can be a helpful counterpart to altmetrics, because it normalizes across the disciplines, compensating for differences in citation patterns and is easily calculated using NIH’s iCite. Design: Discussion Paper. Data sources: Published literature in the health, information sciences, communications, and informatics disciplines. Implications for Health Sciences Librarians: Health sciences librarians can consult with faculty, students, and committees on best practices for using altmetrics to help determine scholarly impact. This paper will illustrate various means of using social media and incorporating altmetrics into clinicians’ curriculum vitae and grant proposals. It will also review the strengths, limitations and implications of using them. In addition, librarians can introduce the RCR to their departments and demonstrate iCite in calculating the RCR. Conclusion: Both altmetrics and RCR have great potential for showing a more complete and accurate picture of the scholarly and societal impact of researchers who work in the health sciences and librarians can take the lead in managing this evolution.

Objective: LGBTQ+ people experience health disparities compared to heterosexual, cisgender peers. Individual and systemic barriers produce these disparities. One barrier is informational, as LGBTQ+ people experience challenges when learning about their health needs, navigating the healthcare system, and overcoming obstacles to care. This paper investigates the future of libraries and the health sciences by exploring how they can address these informational barriers. Methods: This paper reports on ~30 ongoing interviews with LGBTQ+ community leaders from South Carolina (SC) using a semi-structured protocol. The protocol asked participants to discuss their community’s health questions and concerns, how the community addresses them, and the barriers experienced along the way. Qualitative data analysis of interview transcripts and drawings from an information worlds mapping exercise is iterative and inductive. The researchers employ the constant comparative method to generate open codes and then organize them into broader thematic categories. Results: Findings denote that SC LGBTQ+ communities are keenly aware of their health information needs, however, they perceive a lack of institutional knowledge to address them. Moreover, participants mistrust experts like medical practitioners due to their perceived lack of cultural competence when serving LGBTQ+ communities. In turn, participants orient themselves and their communities through and around barriers to health information and resources via defensive and protective information practices. Conclusions: Implications suggest that LGBTQ+ people do not view themselves as experiencing deficits regarding how they engage with health-related information. Therefore, it is not the job of librarians to “correct” information practices that they may find to be risky or problematic. Instead, it is their duty to provide systems and services to meet the health needs of LGBTQ+ people, which may include reorienting their own approaches to information provision and assessment. This reorientation can be accomplished by leveraging defensive and protective information practices in which SC LGBTQ+ communities already engage.

Objective: The objective of this paper is to discuss information seeking behavior of digital-native students verses librarians and how this affects the design, layout, and content of effective library guides. Topics covered will include effective content curation for guides, web-user’s behavior patterns, design consistency, and tips & tricks for integrating design and content best practices across a library guide system. Methods: Springshare’s LibGuides is a platform that allows librarians to create and design topic-centered web pages called Library Guides which contain curated content; including library resources. While librarians generally follow webpage design best-practices in their library guides to increase their usage, these efforts may be undermined by the content that is later added to the guide. According to Sinkinson et al, most library guide content reflects the information seeking behavior of librarians instead of the information seeking behavior of their students. This leads to guides that students found “overwhelming and cluttered” despite librarians recognizing that students have different user behaviors and needs when designing their guides (Portal Libr Acad. 2012; 12(1):63-84. doi:10.1353/pla.2012.0008). This paper will discuss how librarians can use basic web-user behavior patterns, such as page scanning, viewing patterns, satisficing, and scrolling, to help them step into a student mindset to better curate their guide content and reinforce its use with their guide design. Basic strategies for implementing these changes across large library guide systems will also be covered. Results: A comparison of guide content clicks from Springshare’s LibGuide statistics platform, before and after the adoption of student-centered, best-practices guide design layout and content curation, shows a significant increase in the use of guide content. Conclusions: Using basic web-user behavior patterns, librarians can create best-practices for guide development that contain student-centered content along with guide layouts that assist students in finding convenient, curated, library resources.

Objective: The objective of this paper is to discuss and share some of the successes and challenges of manually tagging all first- and second-year (M1/M2) curriculum course sessions over the course of five academic years (2014 - 2019). Methods: As part of the Liaison Committee on Medical Education (LCME) accreditation process, all US medical schools are required to maintain a curriculum database that tracks the number of course hours spent on a selected set of topics outlined in the LCME Functions and Structures of a Medical School; this is usually achieved by building a controlled vocabulary based on Standard 6 and Standard 7. The created vocabulary is then applied to the corresponding course sessions in a process known as curriculum tagging or curriculum mapping. The health sciences library provides this service for the college in accordance with the requirements outlined by the LCME. Results: In 2014, the health sciences library began manually tagging all course sessions from the M1/M2 curriculum. This paper describes the challenges and successes encountered manually tagging the curriculum over five academic years. The challenges include taking over the tagging mid-project, not being able to participate in the creation of the controlled vocabulary tags, extremely limited feedback on the completed tagging and overall project, and finally the amount of time required to manually tag all course sessions. Some of the successes discussed are making a case for full access to all course content, a new page layout in the curriculum database to facilitate tagging, and finding, then applying, word frequency analysis software to course content to better determine tag selection. Conclusions: The curriculum database and course session tagging received a rating of Satisfactory from the LCME Committee after the LCME Site Survey during the accreditation process.

The opiate epidemic has had an impact on the lives of millions of people in this county. As we explore ways to address this issue, it is important to consider the long-term consequences that the epidemic will have. One long-term consequence is the spread of the hepatitis C virus (or HCV). Approximately 3.2 million people in the United States are chronically infected with this virus. Without consideration about ways to treat this virus and prevent its transmission, there will be large numbers of people who will die from complications of HCV in the future. These losses will contribute to the tragedies already sustained from the opiate epidemic. The following paper examines trends among individuals with a self-reported HCV positive status upon admission to Milestone Recovery, an acute detox facility in Portland, Maine. Findings include: that there were more male clients than female clients who presented with HCV in 2017, the median age of clients was 37 years, and there were high rates of both opiate and poly substance abuse among those with HCV. Also, there were high rates of needle sharing, lack of insurance coverage, high unemployment rates, and most clients were not connected with a primary care provider. Additionally, most of these clients reside in Cumberland County and had engaged in injection drug use in the past six months. An intervention is proposed at the end of this paper with a goal to connect hepatitis C positive clients from Milestone Recovery to healthcare and to treatment for HCV. This is a step towards reducing rates of HCV among high-risk and vulnerable individuals and a step towards reducing transmission of the disease to others.

Healthcare-associated infections (HAI) are a major cause of morbidity and mortality and a public health priority. However, standard procedures and comprehensive guidelines for HAI outbreak detection and response are still needed. This hybrid thesis describes what is known about HAI outbreaks in the introduction, reviews the HAI outbreaks reported to New Mexico Department of Health (NMDOH), in the first paper, and then in the second paper examines how established methods for detecting infectious disease outbreaks perform in identifying Clostridium difficile infection (CDI) outbreaks in long-term care facilities (LTCF) in Bernalillo County, New Mexico, and finally, it closes with our overall conclusions at this time from this work. Our main findings are that gastrointestinal illness, most commonly norovirus, in LTCFs is most likely to be reported and that in LTCFs the least complex threshold method performs with the highest sensitivity and specificity in detecting possible CDI outbreaks.

The paper entitled “DNA Breathing Dynamics in the Presence of a Terahertz Field” written by Alexandrov, Gelev, Bishop, Usheva, and Rasmussen that was posted on the Physics ArXiv on October 28, 2009, dealt with the effects of terahertz electromagnetic radiation on the DNA molecule. Figure 4 of the paper indicates that a segment of DNA that is between 60 and 70 base pairs in length will develop a “bubble” (i.e. separation of the hydrogen bonds between base pairs) at a location of about 45 base pairs, when exposed to 2 THz electromagnetic radiation for a time period of at least 40 picoseconds. Based upon assumptions regarding the model of biological quantum logic in DNA, some rapid calculations might provide insight into why such a specific change in the conformation of DNA occurs.

BACKGROUND: Super-utilizers are individuals with disproportionately high inpatient and emergency department (ED) use, and mostly have multiple chronic conditions and use multiple concurrent medications. They place a substantial burden on the U.S. healthcare system and have become the focus of policy initiatives aimed at reducing their disproportionate inpatient and ED use. Medication management is critical for these patients since nonadherence to essential chronic medications is associated with poor health outcomes, and higher health care utilization and costs. OBJECTIVES: This dissertation employed a three empirical research papers approach to study the following aims: (1) the prevalence and patterns of medication nonadherence to essential chronic medications in Medicare super-utilizers with chronic conditions, and to identify the factors associated with medication nonadherence, with special emphasis on factors including mental illness and use of opioid medications, (2) examine associations between medication nonadherence, and inpatient and ED use, and to evaluate other risk factors associated with health care utilization in Medicare super-utilizers with chronic conditions, and (3) examine the impact of the SafeMed Program, a care transitions program with a focus on medication management, on medication use and adherence among publicly insured super-utilizers with chronic conditions. METHODS: This dissertation was based on patients eligible for the SafeMed Program, a care transitions program with a focus on medication management. The SafeMed Program targeted publicly insured super-utilizers with chronic conditions who were admitted to three hospitals that were part of a non-profit hospital system in Memphis, TN. The study sample included Medicare or TennCare insured adults who met the SafeMed Program eligibility criteria, had continuous medication coverage, and filled at least one of the drug classes used to treat hypertension, congestive heart failure, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), or asthma. Papers 1 and 2 were retrospective panel data analyses of the 2-year baseline data for Medicare Part D beneficiaries meeting the SafeMed Program eligibility criteria. Association between various factors and medication nonadherence was examined using random effects models with a binary distribution. Association between medication nonadherence and inpatient and ED utilization was examined using fixed effects negative binomial analyses. Paper 3 used a prospective quasi-experimental study design to examine the effectiveness of the SafeMed Program on medication use and adherence among SafeMed participants compared with patients in a control group using a difference in differences (DID) approach. RESULTS: Paper 1 demonstrated that the proportion of patients who were nonadherent to their essential chronic disease medications ranged from 45.7% to 58.4%, with the highest rate for COPD/Asthma medications (54.3% to 64.4%). In the multivariate analysis examining predictors of medication nonadherence, we found that compared with patients who did not use any opioid medication in the previous period, patients using >4 opioid medications had higher odds of medication nonadherence. Other risk factors for nonadherence included age years, dual beneficiaries receiving low income subsidy, and higher number of unique prescribers. Factors associated with lower odds of nonadherence included number of different medications filled and >1 physician office visits in the previous period. When examining the associations between medication nonadherence, and inpatient and ED use in Paper 2, we found that among elderly Medicare beneficiaries, nonadherence was significantly associated with a 57% increase in inpatient hospitalizations, and among non-elderly Medicare beneficiaries, nonadherence was significantly associated with 41% increase in inpatient stays and 25% increase in ED visits. Similar associations were found across all therapy classes examined (diabetes, cardiovascular, and COPD/asthma) in both age groups. However, nonadherence to diabetes and COPD/asthma drugs was not significantly associated with ED visits. Among other factors, mental illness, substance use disorder, non-Hispanic blacks and dual low-income subsidy status were associated with higher inpatient and ED use. Finally, the DID analyses in paper 3 showed that SafeMed Program did not improve medication adherence in vulnerable super-utilizers with chronic conditions. However, for some sub-group populations including Medicare only beneficiaries, patients >65 years of age, and patients with lower number of comorbidities, the intervention may have ensured that the decline in the probability of being adherent was not as low as it would have been in the absence of the intervention. Additionally, for patients diagnosed with COPD/asthma and diabetes, there were positive medication use trends in favor of enrollees, however, these associations were not statistically significant. CONCLUSIONS: This study is the first to our knowledge to demonstrate the magnitude and importance of medication nonadherence in vulnerable super-utilizers with chronic conditions. The study findings show that medication nonadherence is a significant problem among super-utilizers with chronic conditions and is associated with high inpatient and ED utilization. Furthermore, the findings suggest that medication management interventions during care transitions may not be sufficient for these high-risk patients and other alternative strategies such as addressing social risk factors, and removing cost barriers may be needed to improve adherence, especially among low-income dual beneficiaries, Medicaid enrollees, and patients with higher comorbidity.

Introduction. Coronavirus Disease 2019 (COVID-19) poses a major global threat to human beings, which has caused devastating consequences of population health, political, and economic crises in many countries. This dissertation was composed of three research activities to study the following aims: (1) review the existing literature focusing on political factors and health outcomes of COVID-19; (2) assess the relationship between democracy and case fatality rate of COVID-19 by controlling for the effect of age, comorbidity, health expenditure, healthcare workforce, and population density; and (3) identify the trajectory pattern cases peak days, deaths peak days, and peak periods. Methods. We accessed data from the World Health Organization (WHO), World Bank, Johns Hopkins University, and the Democracy Index 2019 database. First, we conducted a systematic review that searched three databases and synthesized the articles about democracy and health outcomes of COVID-19. Second, we analyzed data from 148 countries with at least 2,000 confirmed cases of COVID-19 by October 25, 2020. Multiple linear regression was used to examine the association between the Democracy Index and case fatality rate of COVID-19 while controlling for other variables, most notably the age distribution of the population. Lastly, we used the patterns of data at the early onset of COVID-19 from seven countries to estimate the time lag between peak days of cases and deaths. Results. Our first research found that of 170 publications in the databases search, 12 publications were screened for systematic review. Among them, one study reported no association between democracy and health outcomes of COVID-19. Eleven articles claimed there was a relationship between democracy level and outcomes of COVID-19. Two papers reported negative associations between democracy and adverse outcomes of the population, while the other nine articles claimed there were positive associations between democracy and the poor health status of populations. When examining the relationship between democracy and health outcomes of COVID-19, the second research demonstrated that the number of hospital beds, the proportion of population above age 65, and current health expenditure as a percentage of the gross domestic product (GDP) are significantly related to the case fatality rates of COVID-19 across 148 countries (p < 0.05). The Democracy Index was not statistically related to the case fatality rates of COVID-19 when considering all 148 countries analyzed but was negatively associated with case fatality rates among 47 high-income countries. In addition, the healthcare workforce, population density, and comorbidity were not statistically significant among the 148 countries. Finally, the findings in the last research suggested that comparative analyses of data from different regions and countries reveal the differences between peaks of cases and deaths caused by COVID-19 and the incomplete and underestimated cases in Wuhan. Different countries may show different patterns of cases peak days, deaths peak days, and peak periods. Error in the early COVID-19 statistics in Brazil was identified. Conclusions. This research is the first to our knowledge to study the relationship between democracy and health outcomes of COVID-19 across countries with large sample sizes. According to the multicountry data, the cross-sectional study suggests that enhancing healthcare system facilities is vital to improving clinical outcomes. Protecting the population older than 65 and adjusting the health expenditure budget may need to be considered. The findings suggest that in high-income countries the higher democracy index is associated with more deaths from COVID-19, perhaps due to the decreased ability of the government to control the movement and behavior of its citizens. Besides, the simulated graphical trajectory method identifies statistical biases in surveillance data. This approach incorporates all sources of available data and provides a robust method to characterize the time course of an infectious disease. Regions and countries beginning with high mortality rates from the COVID-19 epidemic will suffer a long, painful period of the disease epidemic. Where the mortality rate is relatively high, healthcare professionals should prepare for a longer period of fighting this pandemic. Data quality is key to case fatality rate estimation which is needed by policymakers to make correct and timely critical decisions.

The elder population in our country is growing at an exponential pace. Studies have shown that elders who are aged 80 years and older are projected to suffer from age related issues such as Alzheimer’s, dementia, and osteoporosis and will need assistance with Long Term Services and Support (LTSS). Additionally, many elders are also projected to suffer from more severe chronic illnesses such as diabetes, cancer, and heart related illnesses. Because many of these elders are aging in place, residing in their own homes, they will require the services of at home assistance, which high probability will be a neighbor, friend, or family member, serving in the role as an informal caregiver. As the pace of elders increasingly outnumbers informal caregivers, strategic methods must be evaluated, researched, and implemented to ensure caregivers are not becoming overwhelmed and contributing to our chronic health population due to caregiver burden, and to also ensure informal caregivers have the appropriate level of holistic support (emotionally, physically, financially, and spiritually) needed to provide adequate care to our aging population. This paper will focus on the emergence of digital health technology and how it can be beneficial to informal caregivers and care recipients.

Our laboratory has integrated the use of a human-derived, in vitro model of airway mucociliary tissue. We isolate human nasal epithelial cells (HNECs) from the nasal mucociliary tissue of donors with a small brush and expand the airway progenitor cells in culture. The HNECs are then seeded onto semi-permeable transwell inserts. The inserts are in contact with the media in the lower chamber but don’t contain media in the upper chamber therefore the cells are exposed to the air while drawing nutrients from the media below, this is called the Air-Liquid Interface (ALI). HNECs cultured at the ALI initiate a differentiation program and the progenitor cells regenerate fully functioning airway mucociliary tissue that maintains the morphology and cell types of mucociliary tissue located in the lung, bronchus, and nasal passages. This model system allows for investigations in the regenerative ability of HNECs, and fully differentiated ALI-tissue can be maintained in culture for weeks at a time for long-term experiments in the homeostatic maintenance of mucociliary tissue. At the conclusion of experiments ALI tissue can be harvested for analyses including histology, immunohistochemistry, gene expression studies, western blotting, and other molecular techniques. We identified an opportunity to write a comprehensive methods paper containing all protocols necessary to implement the ALI model system and perform histological analyses. The complete method manuscript can be found in Chapter 1 of this dissertation. Upon implementation of the ALI model system our laboratory launched multiple lines of investigation into the biology of airway mucociliary tissue. Chapters 2, 3 and 4 are each unique research projects and all three utilized the ALI model system. Chapter 2 is an investigation into the roles of vitamin D (VD) and the vitamin D receptor (VDR) in ALI tissue. Chapter 3 is an examination of angiotensin converting enzyme 2 (ACE2) in ALI tissue. Chapter 4 combines the ALI model system with a novel vaporizing research device (VRD) created by the laboratory to investigate the impact that vape-pen vapor has on airway mucociliary tissue.

The United States generated 251 million tons of municipal solid waste in 2012, half of which ended up in landfills; paper and paperboard make up the largest portion. Although the effects of antecedent and consequent manipulations on recycling are fairly well understood, with few exceptions (e.g., Trudel & Argo, 2013), the effect of stimulus characteristics on recycling has not been evaluated. Using a between subjects experimental group design, Trudel and Argo (2013) found size, and for cans, condition, affected recycling, such that more participants recycled large pieces of paper and large undented aluminum cans and fewer participants recycled small pieces of paper and small dented and undented aluminum cans. However, Trudel and Argo’s (2013) data provide little information regarding how context or group sessions affect recycling or whether the condition of paper might differentially affect recycling, as it did with cans. The present study used individual sessions, controlled for contextual variables (i.e., participant viewed all sizes of paper), and examined the effect of both size and condition of paper (i.e., crumpled or smooth) on recycling. Participants ( N = 60) were told this was a study about memory. They were instructed to complete a set of sorting tasks twice (for a total of two trials) with four different pieces of paper (standard-size smooth, standard-size crumpled, half-size, eighth-size), and, after each sorting task, to dispose of a piece until all four pieces were disposed. Results indicated neither size nor condition affected recycling; nearly all participants (90%) recycled all the paper. Factors other than paper size or condition (e.g., participant reactivity, geographic differences, exposure to all types of paper) may explain why results of the current study differed from previous research.

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is centered on how to prevent complications and improve the quality of life of those living with type 2 diabetes. This paper will focus on the longitudinal association between these social determinants and how they may predispose to the progression to Type 2 diabetes.

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.

Objective: To assess and evaluate the past and current performance of library services, resources, and space with the purpose of informing decisions in designing a library serving a new medical school. Methods: The Herbert Wertheim College of Medicine (HWCOM) at Florida International University opened its doors to its first class in 2009. Shortly after, the medical library began seeking student feedback by administering a 15-question survey to each class. The inaugural Class of 2013 and other cohorts were queried at various points in their curriculum. Starting with the Class of 2017, the library began consistently administering its survey to students at the end of their second year. Most questions were multiple-choice, but some gave students the option to choose “other” and provide free responses. In 2018, the library began administering the survey electronically using Qualtrics. Later, the pen and paper responses were transcribed to that software. The library now has data from all seven classes that have graduated plus two more classes yet to graduate in 2020 and 2021. Results: The survey indicated the following: online resources are used far more than the facility, the hours were mostly adequate, and that more than half preferred a combination of print and electronic textbooks. For those who did not use the library, the major reasons they gave were because either (a) they preferred to study at home, or (b) the library was too far from the buildings where they attended classes. When it came to overall satisfaction, more than three-quarters of respondents indicated they were in the satisfied range. The greatest need for improvement lay with the facility and amenities. Conclusion: After analyzing the data collected, librarians were able to determine students’ preferences for library space, services, and resources, as well as how those preferences have changed with the increasing class sizes over time. As the medical school continues to grow, and the idea of a new medical library becomes a reality, this data will inform the design of the structure, collection, and services that librarians will provide. Even though students were satisfied with our services and resources, in regards to the facility, there are aspirations for group study spaces, various furniture, more space, and more windows to provide natural light.

Lung Cancer is the leading cause of cancer related death in both men and women in the United States (Bray et al., 2018). Cancer treatments are often non-specific and kill many dividing cells within a patient causing unwanted side effects. Norcantharidin (NCTD) is a synthetic FDA approved treatment for cancers including non-small cell lung cancers (NSCLC). NCTD suppresses cell proliferation by inhibiting cells from exiting the G2 phase of the cell cycle. Aptamers are short single-stranded DNA or RNA molecules with ligand directed self-annealing capabilities allowing selective binding to specific targets. This paper will discuss the hypothesized effects of using a single-stranded DNA aptamer bound to NCTD to reduce proliferation of A549 cells, an adenocarcinoma cell line often used to study NSCLC (Foster et al., 1998 & Giard et al., 1973).

This research paper focuses on the barriers that parents and caregivers of special-needs children patients face with leveraging technology and informatics as they attempt to communicate with their child’s healthcare specialists regarding specialized and critical oversight and management of complex medical conditions and the need for empowerment for this population of parents and caregivers. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of electronic applications. A review of the literature showed that the special needs population has not been represented. This study surveys a range of parents and caregivers to include a various age ranges, genders, education and socioeconomic statuses to identify the barriers this unique population has encountered.

Intermittent fasting has been instructed in the Bible as an implied part of daily living. This paper has reviewed the physical benefits of intermittent fasting. In healthy test subjects, it has led to higher levels of autophagy, gut health, and lifespan. In non-healthy test subjects, it has proven beneficial in cancer treatment, as well as in protection against and/or attenuation of the effects of neurodegeneration, metabolic disorders, and cardiovascular diseases. The possible mechanisms underlying these benefits have been discussed in this review.

Health information management (HIM) staffs in health care facilities have a long history of managing medical records in a paper format. Since 2009, with the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), health care facilities have been rapidly changing from a paper medical record system to an electronic system. The adoption of electronic record systems has reduced or eliminated paper medical record forms which consequently changed many HIM staff’s jobs. A survey of HIM professionals was conducted in two southeastern states to determine any increase or decrease in HIM staff numbers and to identify any changes in required HIM skill levels. While the response rate of the survey was low, the survey results yielded much information about the actual changes HIM staffs are experiencing with the adoption of electronic record systems in their health care facilities. This information will be valuable to HIM professionals by aiding them in developing realistic strategic plans for the future of their HIM departments.

This paper will explore strategy for overcoming erroneous confirmation bias within the context of generalist versus specialist function as described in the paper entitled “Information Fusion and Quantum Logic in Family Medicine”.

Introduction The purpose of this paper is to make readers aware of the legal issues in the electronic health record (EHR) and the risks involved so they can be prepared. It is also to help provide solution to those who are already dealing with the risks. The goal of this Project is to reach out to health care facilities who are about to embark on a new chapter in health care that we call, the EHR. Everyone should know the risks of a product before purchasing and that is what my research will show. Method I used The Journal of American Health Information Management Association as a primary search engine for articles. I also used PubMed which comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books, and the Journal of American Medical Association. Results From doing the research, I have found that there are not as many legal issues within the electronic health record that most people think. According to an article in the Journal of American Medical Association, one research letter published online in Archives of Internal Medicine found that the rate of liability claims when EHRs were used was one-sixth the rate when EHRs were not used (Dolan, 2012). Conclusion The Electronic Health Record is still fairly new to some facilities so people may not know all the risks. People are misinformed about the risks of the EHR and this paper will hopefully educate readers on the topic. People will be surprised to learn the risks are not as many as they think, in fact, implementing and EHR may actually decrease the legal risks and improve patient care.

TITLE: Designing a Poster-to-Publication Campaign for Medical Residents OBJECTIVE: To describe the development of a campaign to improve medical residents’ knowledge of the research and publication process while providing support in transforming poster presentations into peer-reviewed publications. METHODS: Medical residents at a public research university complete poster presentation projects as part of the standard residency curriculum, but few go on to expand upon and publish this research in academic journals. This paper describes the development of a campaign intended to support residents as they expand poster research projects into publishable articles. A needs assessment will be developed to identify gaps in knowledge and other barriers to publication. Existing research support services in place at the university and one hospital site will be reviewed and summarized on a LibGuide. A series of workshops led by librarians and guest experts will be designed to address knowledge gaps and will be scheduled around key university and hospital research events. Participants who attend at least two workshops will receive follow-up emails from the graduate medical education librarian and will be eligible for assignment to an experienced research mentor. RESULTS: A post-assessment will evaluate the effectiveness of this campaign in increasing the research and publication competency of medical residents. At approximately six and twelve months after the final workshop, the number of resident publications will be compared to the number of resident publications prior to campaign execution. CONCLUSIONS: Pre- and post-campaign assessments and a poster-to-publication guide will be made available for librarians to adapt for their own institutions.

Objective: In medicine, numerous commentaries implore clinicians (e.g., physicians, physician assistants, nurse practitioners) to display more humility. However, given the complex power dynamics between patients and clinicians, one should not presume that patients desire and appreciate humble clinicians. This paper examines the relationship between clinician humility and patient outcomes, and aims to provide empirical evidence for the significance of clinician humility. Methods: In two studies, patients (N = 497) recalled their most recent visit to a clinician through an online survey platform (Qualtrics). Patients rated their clinician’s humility, their satisfaction and trust with their clinician, and their health status. They also provided demographic information (e.g., gender, race, subjective SES), details about their clinician (e.g., gender, race, professional status) and information about their last medical visit with this clinician (e.g., purpose of visit, wait time during visit). Results: Through hierarchical multiple regression, we demonstrated that clinician humility positively predicted patient satisfaction, trust, and self-report health (only in Study 2) above and beyond patient, clinician, and visit characteristics. Conclusion: The results demonstrated that clinician humility can predict important patient outcomes above and beyond objective characteristics of the medical interaction. Practice Implications: These findings may shape clinician-patient interactions by validating the pursuit of humility during medical encounters.

This paper focuses on the barriers that patients have as to why they do not use their electronic patient portal. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of the electronic portals. A review of the literature showed that all populations have not been represented. This study surveys a broader range of patients including all ages, genders, education and socioeconomic statuses to see what barriers that this broader range of patients has to using their electronic portals.

A solution to the Kaggle competition: Human Protein Atlas Image Classification. Using microscopic images of cells provided by the Human Protein Atlas, convolutional neural networks, CNNs, were used to analyze and predict the location of protein patterns. Challenges included working with an unbalanced dataset, finding a correct learning rate, and choosing a correct architecture to solve the problem. To learn how to overcome these challenges and gain more understanding of the problem, various kernels and discussion posts for the competition, as well as papers on different CNN architectures were used.

The Medical University of South Carolina (MUSC) Value Institute, which falls under the hospital’s Quality Department, has contributed to evidence-based practice (EBP) culture through education, evidence synthesis services, and the development of clinical decision support tools. Three members of the Value Institute -- a librarian, Clinical Evidence-Based Analyst, and Senior Value Specialist -- have taught a variety of EBP courses to clinicians over the years. However, because of increasing course dropout rates, the Value Institute conducted focus groups to identify ways to redesign the course. Two focus groups consisted of 6-8 previous course participants each. The focus groups started with an introduction, challenge statement, and problem statement. Participants silently brainstormed answers to four questions then posted answers to wall-mounted paper. A group discussion followed.

LEP or Limited English Proficiency patients across the United States are at higher risk for decreased quality of care because of their inability to communicate effectively with healthcare providers. Interpreters are not offered in a consistent manner due to many variables such as cost, availability of qualified interpreters, the time spent with patients due to an increased work-overload and clinician lack of knowledge into technologies available to use. Healthcare information technology such as video and telephone interpretation can bridge the gap between patients and medical personnel when a language barrier is present. At the pre-admission clinic, the Nursing personnel interviews the patient and assesses the need for an interpreter. All patients scheduled for an appointment at the pre-admission clinic will undergo a scheduled surgery or procedure that will require General Anesthesia, Epidural blocks or the administration of Local Monitored Anesthesia Care. The purpose of this paper is to determine the practices of Nurses in these initial interactions, regarding communication, technology, and documentation in the Electronic Health Record through a qualitative survey.

In today’s healthcare, intravenous (IV) therapy-related errors have become rampant and are responsible for a substantial portion of hospital injuries and deaths. In the last decade, however, since the development and implementation of “smart” IV pumps, a significant number of these IV medication errors have allegedly been reduced. The purpose of this paper is to discuss research surrounding an evaluation of the efficacy of smart IV pumps from a nursing perspective.

There is little data available on the complex cause and effect of delayed hospital discharge; however, some evidence suggests that long-stay patients tend to be complex, older, and sicker. In Maine, a 2014 Maine Health Association report found complex hospital patients were waiting weeks, months and sometimes over a year in Maine Hospitals before accessing long-term services and supports. In response to these concerns around delayed discharge from hospitals, the First Regular Session of the 127th Maine Legislature created the Commission to study Difficult to Place Patients. The Commission ultimately passed Legislation that gave the Maine Long- Term Care Ombudsman Program the ability to assist with delayed discharges to decrease these delays and free up hospital beds. This paper will share and analyze preliminary data from this innovative program (approx. 1.5 fiscal years).

The world of technology in the twenty first century is forever expanding. In the healthcare field, patient data has transformed from paper charts into electronic health records. Electronic health records allow for organized patient information however, an enormous amount of information becomes available. Sometimes the massive amount of information is not always needed but important detail the medical chart is looked for by insurance companies for reimbursement. There is a special department in hospitals called the Clinical Documentation Improvement specialists who are made up of experienced medical coders, registered nurses, mid-level practitioners such as nurse practitioner’s s or physician’s assistants and physicians. This team focus on the pertinent clinician documentation while the patient is hospitalized looking for accurate information depending on the patients diagnose/s and reducing low quality clinical records. The importance of precise patient information leads to the point of this project to demonstrate the value of clinical documentation improvement.

Medial Tibial Stress Syndrome (MTSS) or more commonly referred to as “shin splints” is characterized as an overuse or repetitive stress injury that causes vague pain over and around the tibia. Researchers are yet to determine a definitive cause though numerous risk factors have been noted. They are as follows; over training,type of surface, poor footwear, muscular imbalances at the ankle, over tight or weak triceps surae muscles, imbalances at the thoracolumbar complex, other muscular imbalances and BMI above 30. Rehabilitation and treatment interventions often call for a pause in training entirely or at the very least an immediate scaling back of running or training. Most other interventions call for either a change in running or playing surfaces and a change or upgrade in footwear. For athletes competing at high levels, ceasing or lessening the workload can be detrimental to their seasons. Treatment interventions that call for rehabilitation plans that address the muscular imbalances are better suited for the competitive athlete. With this paper we intend to look at the rehabilitation plans for MTSS that address as many of the risk factors as possible. Once an ideal rehabilitation plan is drafted it would then be put it in to a preventative exercise plan that would hopefully minimize the risk of athletes and active people getting MTSS.

Purpose: The purpose of this project was intended to transform the outdated method of conducting debrief after simulation by implementing a good judgment model and integrating the concept of “advocacy-inquiry.” This implementation was expected to reduce demoralizing and anxiety producing debrief experiences and improve student reflection and learning in order for students to more deliberately link theory with practice. Significance: The debrief is often recognized as the component of simulation in which the most effective learning occurs. It is the time when students are provided opportunity to reflect on thoughts, actions and behaviors. Unfortunately, many nursing students often experience undue stress during simulation resulting in limited comprehension of how they did or did not meet outcomes. Students have expressed feeling judged during simulation thus; making it difficult to allow themselves to feel vulnerable enough to fully reflect on why they made mistakes. Methods: Realizing that a caring supportive model may improve student engagement and critical thinking Jean Watson’s Theory of Human Caring was recognized as a solid foundation in which to build this initiative. Utilizing best practices set forth by the Center for Medical Simulation (CMS) and INACSL (The International Nursing Association for Clinical Simulation and Learning) several new concepts and tools have been integrated into the simulation debriefing process. Importantly, faculty have been provided training in methods in which to successfully debrief so students are able to reflect on the simulation experience. The “debriefing with good judgment” model (Rudolph, Simon, Dufresne & Raemer, 2006) as well as the method of debriefing using “advocacy-inquiry” (Rudolph, Simon, Rivard, Dufresne, Raemer, 2007) are two such tools which guided the faculty to ensure a consistent reflection process. This process assisted students in recognizing and resolving clinical dilemmas identified during the simulation. Findings: Of 125 students in the spring 2017 cohort the vast majority identified positive changes in the simulation experience. Several students commented on “improved learning and insight” as well as an appreciation for the “focus on reflection.” Students also recognized that simulations were now “less judgmental than previous simulations” affirming the importance of integrating the “debriefing with good judgment” model (Rudolph, et al, 2006). The faculty identified that integrating the good judgment model and advocacy-inquiry tool into the debrief did result in improved student engagement. Overall students appeared to be less anxious and more reflective during the debrief process. Conclusion: This initiative proved to be a successful intervention in increasing student reflection and participant satisfaction. This paper will discuss the successful transformation of the simulation debriefing process at one academic institution.

The Palliative Players are screened and trained hospice volunteers who provide a low-cost, sustainable, role-playing resource for use teaching communication skills to healthcare workers who discuss serious illness with patients and their families. The Palliative Players project was conceived and developed in early 2017 by Dr. Lauren Michalakes, Medical Director of Palliative Care at Coastal Healthcare Alliance (CHA); Sarah Dwelley, RN; Flic Shooter, Director of Hospice Volunteers of Waldo County (HVOWC); and Eliza Eager, Project Coordinator; to provide believable, emotive simulated patients (SPs) for role-play in workshops teaching healthcare workers communication tools and skills for use in conversations with patients and families facing serious illness. Nationally, there are excellent tools and systems for teaching serious illness conversation skills to physicians and nurse practitioners, including VitalTalk (VitalTalk, 2017), and the Serious Illness Conversation Program (SICP) (Ariadne Labs, 2017). As designed, however, neither of these tools entirely fits all the needs and system constraints of rural Maine; nor were they designed for use teaching goals of care conversation skills to the nurses, social workers and other healthcare workers who can and do have these conversations with patients. The Palliative Players project adapts, expands, and combines existing tools, training hospice volunteers to be dynamic teaching resource for role-play of serious illness conversations. This capstone paper describes the development of the Palliative Players project, including training and management details and lessons learned in project implementation to date. Training materials used and developed are found in the Appendices.

John Wooden, former coach of the University of California, Los Angeles (UCLA) men’s basketball team, has won twice as many championships as the next most successful men’s collegiate basketball coach. This paper will examine the methods he used in his coaching, his leadership style, and how it compares with various leadership styles of other famous coaches and leaders, and other possible factors which may have led to his achieving such a high level of success. A thorough review of a wide variety of literature has been incorporated in the thesis, as well as a study comparing Wooden’s leadership style with those of some well-known leaders in sport, business, military, and government

Context: As a member of the sports medicine team, athletic trainers serve athletes through injury prevention, evaluation, and rehabilitation. While it is imperative for members of the sports medicine team to have knowledge of scope of practice of athletic trainers, it may also be important for athletes as well, so that the athletic trainers can be properly utilized by all parties. Although previous research has been completed on how athletes’ sport profile and satisfaction of care relate, no previous studies were identified that assessed athletes’ knowledge of athletic trainers’ scope of practice. Objective: Determine student-athletes’ knowledge of athletic trainers’ scope of practice. Design: Prospective sequential explanatory mixed methods design. Setting: Online survey delivered through university email system; paper-pencil survey distributed at pre-participation examinations (PPE). Participants: Convenience sample of 108 NCAA Division I student-athletes. Forty four total participants. Response rate: 41%. Groups were formed based on whether or not student-athletes had previous experience with an athletic trainer as well as sport profile. Interventions: Survey consisted of demographic information and knowledge sections. Independent variables: previous experience with an athletic trainer, sport profile. Main Outcome Measure: Demographic data were analyzed using descriptive statistics. Knowledge questions were scored based on correct responses and a total knowledge score was calculated. Independent t-tests were completed to compare knowledge scores between athletes with or without previous experience with athletic trainer and between high- and low-profile sport groups. Results: Approximately 91% of participants were 18 years old. 64% of participants had previous experience with an athletic trainer, while 36% had no previous experience. Independent T-tests revealed no significant differences in knowledge scores with regard to previous experience with an athletic trainer or sport profile. Conclusion: This study provides evidence that previous experience with an athletic trainer and sport profile do not have an effect on the athlete’s knowledge of athletic trainers’ scope of practice. Results indicated that athletes have a moderate level of knowledge in all domains, which established that athletes’ have a consistent knowledge level with physicians, administrators, and coaches. Future studies could be done to assess knowledge levels across all NCAA Divisions.