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    Observing the prevalence of Wolbachia found in tick species from the central Virginia region

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    Research has found that ticks are considered the second highest global vector of disease. Ticks can serve as a vector for pathogens such as Rickettsia rickettsii (Rocky Mountain Spotted Fever), Borrelia burgdorferi (Lyme Disease), Borrelia miyamotoi (B. miyamotoi disease) and Borrelia hermsii (tick-borne relapsing fever). Tick species such as Dermacentor variabilis (American Dog ticks), Amblyomma maculatum (Gulf Coast ticks), Amblyomma americanum (Lone Star ticks), Ixodes scapulari (Black legged ticks), and Ixodes affinis can be found within the southeastern Virginia region. Arthropod hosts that possess Wolbachia can have their reproduction negatively impacted through methods such as Parthenogenesis, Male Killing, Feminization, and Cytoplasmic Incompatibility. Currently, there are efforts to decrease mosquito populations by utilizing Wolbachia, which have shown effectiveness, but there is need for further research examining how this bacteria could decrease tick populations. To better understand Wolbachia infection rates within ticks, a survey of the frequency of Wolbachia found in tick species within Central Virginia was performed. Ticks used in the study were collected from the Central Virginia region. DNA extraction and isolation of each tick was performed, and then tick DNA (CO1), microbial DNA (16s rRNA), and potential Wolbachia DNA (WSPEC) were amplified by polymerase chain reaction (PCR). Lastly, 1.7% agarose gels were used to perform gel electrophoresis on amplified CO1, 16s rRNA, and WSPEC DNA. Through the amplification of CO1, 16s rRNA, and WSPEC, results demonstrated that Wolbachia was unable to be detected in the Central VA ticks. The observed results better highlight the relationship between Wolbachia infection rate and tick species. Additionally, success in the optimization of tick DNA extraction, PCR, and gel electrophoresis is important for future research testing for Wolbachia 1 infection in ticks. Lastly, success in extracting tick larvae DNA is useful for further Wolbachia-infection testing within tick larvae as well. Further research is needed to determine the possible application of Wolbachia to reduce tick populations

    Innovation in Active Learning: Evaluating the Flipped Classroom Method in Physician Associate Education

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    Stellate Ganglion Blockade Treatment for Posttraumatic Stress Disorder

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    Organizational Interventions to Reduce Burnout in Healthcare Providers

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    Ketogenic Diet and Intermittent Fasting as a Treatment for Metabolic Syndrome

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    This clinical review examines the evidence for the efficacy of using a ketogenic diet (KD) in combination with intermittent fasting (IF) as a diet and lifestyle intervention for the treatment of Metabolic syndrome (MetS). MetS is a phenomenon that currently affects more than one billion people, an increase of more than 35% in the last 30 years. The primary causes are unhealthy diet and lifestyle choices, leading to substantial increases in obesity, high blood pressure, hyperinsulinemia, elevated triglycerides, and low high-density lipoprotein (HDL) cholesterol. People with MetS have a significantly increased risk of cardiovascular disease, type 2 diabetes, stroke, and other chronic illnesses. Clinical guidelines recommend dietary and lifestyle interventions as the primary treatment. Mounting clinical evidence supports the use of the KD and IF for the treatment of multiple chronic diseases, including the underlying conditions of MetS. Long used for treating obesity and neurological disorders, the KD’s beneficial effects on insulin resistance, high blood pressure, triglycerides, overall lipid profile, and the suppression of oxidative stress and inflammation have also been substantiated. When used in combination, their symbiotic relationship enhances their effects on the body’s physiology and composition. Though some effects overlap, their synergistic relationship markedly improves cell and mitochondrial function and resilience as well as insulin and leptin sensitivity. The findings support a KD and IF regimen as a viable and cost-effective treatment option for patients with MetS. Concerns exist regarding adherence to the regimen and which of the numerous variations produce the best results both in the near and long term. The relatively low number of comprehensive clinical trials/studies, especially on IF, makes establishing consensus guidelines difficult. The need for Standardized protocols is essential not only for research and the relevant clinical data but for implementation as a treatment. Topic searches used PubMed, Elsevier, and Google Scholar and focused on data from humans aged 19 and over, collected within the last 5 years. Six articles were used as primary source material

    Clinical Review on Linking High Fructose Corn Syrup and Non-Alcoholic Fatty Liver Disease

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    ABSTRACT Excessive dietary fructose intake is increasingly recognized as a critical driver of metabolic disorder and chronic liver disease. Evidence from experimental and clinical studies links fructose consumption to hepatic steatosis, insulin resistance, and non-alcoholic fatty liver disease (NAFLD). This review synthesizes findings from key studies and recent narrative reviews to elucidate the metabolic, microbiota-mediated, and clinical pathway by which fructose, more specifically high fructose corn syrup (HFCS), contributes to liver pathology and discusses implications for prevention and management. Methods used to obtain the information included using databases such as PubMed (MEDLINE), Cochrane Library, Clinicaltrials.gov, and Google Scholar. Medical subject headings (MeSH) terms such as “Fructose/adverse effects”, “High Fructose Corn Syrup”, “Non alcoholic liver disease”, and “High Fructose Corn Syrup contributing to Non Alcoholic Liver Disease” were used. The Boolean operators used were “and/or.” Results indicated that currently, NAFLD has become the most common cause of chronic liver disease worldwide, paralleling the epidemics of obesity and metabolic syndrome. Fructose, unlike glucose, is metabolized primarily in the liver, bypassing key regulatory steps of glycolysis and promoting de novo lipogenesis (DNL). This unique metabolic fate makes fructose a potent driver for hepatic fat accumulation and inflammation. Public health policies to reduce fructose consumption, patient education by healthcare providers, including Physician Assistants, and developing targeted therapies to interrupt fructose-driven metabolic and inflammatory pathways are critical to curbing the global burden of metabolic liver disease. Future research is needed to clarify the dose-response relationship between HFCS and NAFLD. KEYWORDS: High fructose corn syrup, non alcoholic liver disease, metabolic disorders, APPENDIX Teng ML, Ng CH, Huang DQ, et al. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29(Suppl):S32-S42. doi:10.3350/cmh.2022.0365 Huang T (Dazhong), Behary J, Zekry A. Non-alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management. Intern Med J. 2020;50(9):1038-1047. doi:10.1111/imj.14709 Li C, Li M, Sheng W, et al. High dietary Fructose Drives Metabolic Dysfunction-Associated Steatotic Liver Disease via Activating ubiquitin-specific peptidase 2/11β-hydroxysteroid dehydrogenase type 1 Pathway in Mice. Int J Biol Sci. 2024;20(9):3480-3496. doi:10.7150/ijbs.97309 Coronati M, Baratta F, Pastori D, Ferro D, Angelico F, Del Ben M. Added Fructose in Non-Alcoholic Fatty Liver Disease and in Metabolic Syndrome: A Narrative Review. Nutrients. 2022;14(6):1127. doi:10.3390/nu14061127 White JS. Straight talk about high-fructose corn syrup: what it is and what it ain’t. Am J Clin Nutr. 2008;88(6):1716S-1721S. doi:10.3945/ajcn.2008.25825

    A Review of Adverse Patient Care Outcomes Associated With Delayed Transfers from Rural Hospitals

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    Management of Electrolyte Abnormalities in the Emergency Department

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