35989 research outputs found
Sort by
Double Trouble: Acquired QTc Prolongation in a Patient on Denosumab and Amiodarone
No full textIntroduction Denosumab is a monoclonal antibody used to treat osteoporosis. Due to its impact on bone metabolism, it can precipitate hypocalcemia potentially leading to QTc prolongation on electrocardiogram (EKG), increasing the risk of life-threatening arrhythmias. Amiodarone, a Class III antiarrhythmic, is also known to prolong QTc via its effects on cardiac conduction. We present a unique case of acquired QTc prolongation in a patient on concurrent Denosumab and Amiodarone therapy. Case Presentation A 70-year-old female with atrial fibrillation on Amiodarone and osteoporosis on Denosumab, presented to ED complaining of dizziness without syncope, palpitations, or chest pain. She was hemodynamically stable with negative orthostatic vitals. Neurologic examination revealed a positive Romberg without other cerebellar deficits. MRI showed an incidental vascular loop within the internal auditory canal without acute ischemic changes. Benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, and giant cell arteritis were ruled out based on history and physical examination. Laboratory tests revealed hypocalcemia (8.3 mg/dL) with reduced ionized calcium (1.05 mg/dL). EKG showed a QTc interval \u3e550 ms, suggesting acquired long QT syndrome due to hypocalcemia. Given the patient\u27s recent Denosumab infusion (administered less than a week before presentation) and ongoing Amiodarone use, drug-induced QTc prolongation was suspected. She was treated with IV calcium gluconate, leading to symptomatic improvement and calcium normalization. Amiodarone was replaced with metoprolol. Following these interventions, QTc improved to 486 ms. The patient was advised to transition from Denosumab to an alternative osteoporosis therapy during outpatient followup. Discussion Denosumab inhibits RANKL, disrupting osteoclast and osteoblast maturation and leading to hypocalcemia in 3–10% of patients, with severe cases occurring in \u3c1–3%. Hypocalcemia-induced QTc prolongation is rare, but can be exacerbated by concurrent medications such as Amiodarone, which prolongs QTc through potassium channel blockade. This case highlights the importance of evaluating side effect profiles in polypharmacy patients, particularly those on multiple QT-prolonging agents
Characterization of a bacteriocin with effectivity against Klebsiella
No full textWithin the last century, antibiotics have been discovered and proved to be successful in killing or inhibiting growth of bacteria. However, in its short history, antibiotics have been overprescribed and misused, which has caused many species of bacteria to become resistant to its effects. This has led to a dramatic increase in infections that cannot be resolved with antibiotics. Therefore, antimicrobial research has turned to finding new ways to counter bacterial infections such as understanding and utilizing polymicrobial interactions. Previous research in our laboratory has found that Klebsiella pneumoniae, a Gram-negative, rod-shaped bacterium that can cause pneumonia, possess inhibitory properties that reduce the growth of certain bacterial genus including Enterobacter, Citrobacter, and even other Klebsiella species. In the current research, our lab has demonstrated that supernatant from a specific strain of K. pneumoniae, which includes the bacteria’s metabolites and proteins without cells, have antimicrobial properties that inhibit growth of other strains of K. pneumoniae including K. Pneumoniae 9997 in both planktonic and biofilm growth. Development of a treatment that delivers the antimicrobial compound from K. pneumoniae to those with drug resistant infections could become an alternative treatment to antibiotics that have failed in treating infections
Investigating Historical Wildfire Trends and Forecasting Future Events in Colorado, Montana, Utah, and Wyoming through Advanced Spatio-Temporal Analysis
No full textAcute Metabolic, Physiological, and Perceptual Responses to Different Set and Rep Schemes in the Back Squat
No full textThe purpose of this study was to examine the acute effects of ecologically valid schemes of sets and repetitions in the back squat during the bout and into recovery. Such understanding is expected to contribute to knowledge of the strength-endurance continuum and differential responses to various training emphases in practical settings. Eleven participants completed back squat protocols consisting of a warm-up followed by either 3 x 2 at 90% of 1RM, 3 x 5 at 82.5% of 1RM, and 3 x 10 at 62.5% of 1RM in a randomized and counterbalanced design. VO2, heart rate (HR), lactate, and RPE were collected at baseline, during exercise, and into 10 minutes of recovery. A mixed ANOVA using linear mixed-effect model was used to examine the effects of protocol, time, and sex for VO2 and HR. A repeated measures ANOVA was used to examine the effects of protocol and time for lactate. RPE was analyzed using an ordinal mixed effect model for the effects of protocol and time. The critical alpha was set at 0.05. For HR, lactate, and VO2, post hoc testing was performed using either Tukey’s HSD (pairwise comparisons) or Scheffe’s adjustment (simple contrasts), and the associated Cohen’s d was calculated with 95% confidence intervals. There were statistically significant main effects of condition and time for lactate, VO2, and heart rate (p ≤ 0.05). There was a statistically significant effect of time for RPE (p ≤ 0.05). The post hoc pairwise comparisons revealed that lactate was statistically higher in the tens compared to sets of fives and twos across all time points measured but rest (p ≤ 0.05). The physiological and perceptual differences between conditions appear negligible by five minutes into recovery with the exception of lactate values. Sets of ten are likely to produce the highest glycolytic stress, however, as a possible result of greater intensity in the sets of five, the peak VO2 and HR responses may be similar. Practitioners looking to induce large amounts of metabolic stress during training sessions to develop anaerobic capacity should opt for higher repetition sets, however, these training sessions may lead to higher perceived exertions
Analysis and Promotion of Mental Health Services for Unhoused Individuals
No full textUnhoused individuals in Northeast Tennessee experience significant barriers to accessing mental health services despite the availability of resources. Factors such as inadequate communication, lack of transportation, and inefficiencies in service delivery contribute to these challenges. Additionally, the prevalence of co-occurring homelessness and mental illness is rising. This evidence-based project investigates the accessibility and effectiveness of mental health services for unhoused individuals by identifying service gaps and enhancing communication among providers. The project employs a three-phase approach. The first phase consists of a literature review on mental health, homelessness, and supportive services; this informs the development of an interview guide, to be used in the second phase. In this phase, semi-structured interviews are conducted with local service providers to assess resource availability, service limitations, and areas for improvement. Data analysis identifies key patterns and actionable insights from the interviews. In phase three, findings are synthesized and referenced to develop reporting tools for case management meetings. These forms are developed under the guidance of a community partner to enhance interprofessional communication. By bridging research and practice, this project contributes to the existing literature and offers practical strategies to improve service coordination. The results aim to inform future community-based interventions, promoting a more integrated and accessible mental health care system for unhoused individuals
Healthcare Access Barriers Among Sexual Minority Peripregnant People in the Appalachian Highlands
No full textBackground: Sexual minority peripregnant people (SMPPs) face unique barriers to healthcare access during peripregnancy, which spans preconception care through postpartum. These include a lack of social support, difficulty obtaining relevant health information, and discrimination from healthcare providers. Similarly, Appalachians – particularly rural Appalachians – also face unique barriers to peripregnancy care, including cultural stigma surrounding sexual and reproductive health and maternity care deserts. However, there is a dearth of research on peripregnancy experiences, barriers, and facilitators of healthcare access among peripregnant people who are both sexual minorities and Appalachian.
Methods: A quantitative analysis and qualitative analysis were performed independently to examine healthcare access barriers in three Appalachian states: Pennsylvania; Tennessee; and Virginia. For the quantitative analysis, secondary data from the 2022 Pennsylvania LGBTQ Health Needs Assessment were used to assess the relationship between healthcare access barriers, healthcare access intermediaries, and self-reported health levels among Appalachian and non-Appalachian people capable of pregnancy using bivariate analyses and logistic regression. For the qualitative analysis, semi-structured, in-depth interviews were conducted with SMPPs in the Appalachian Highlands region of Northeast Tennessee and Southwest Virginia, recruited through a venue-based sampling scheme. Interview transcripts were analyzed by two coders using a rapid coding methodology.
Results: With regard to the quantitative analysis, Appalachian and non-Appalachian subsamples did not significantly differ. The selected financial barrier, cognitive barrier, decreased prevention intermediary, and decreased care intermediary were significantly associated with health level. With regard to the qualitative analysis, eleven SMPPs participated in semi-structured, in-depth interviews focused on healthcare access barriers and intermediaries. Major themes that emerged included: lack of health education surrounding peripregnancy; ease of contraception access; and the importance of social support throughout peripregnancy.
Discussion: SMPPs in the Appalachian Highlands face unique barriers to high-quality care access across the peripregnancy care spectrum. Recommendations for addressing these barriers to care include expansion of coverage for prenatal services, incorporation of principles of trauma-informed care, health sensitivity training for providers, and increased social support opportunities for SMPPs in the Appalachian Highlands. More research is needed across Appalachia in order to understand and improve healthcare access during peripregnancy for sexual minorities throughout the region
Capturing Women\u27s Birth Experiences through Photos
No full textPurpose: Each year 3.5 to 4 million women give birth in the United States. Childbirth is a life-changing event that induces various emotions in women. Many women report having a negative experience due to short staffing, inadequate care, and a loss of autonomy. Aims: The aim of the study was to understand what factors contribute to a positive or negative birth experience.
Methods: A descriptive qualitative study was conducted using photo elicitation. Photos were collected from participants and included a description of how the photo represented the participant’s experience. Demographic data were collected through a survey. Participants were requested to submit up to five photos that represented how they felt during or immediately following giving birth. Content analysis was used to identify patterns and themes among the photos and descriptions. This project was approved by the IRB.
Results: Childbirth takes an emotional toll on mothers, but despite its challenges, it is a radiant and embodying experience that women go through. Data analysis is in progress.
Limitations: some women did not understand the type of photos to submit, so it may be that some of the instructions were not clear.
Conclusions: The findings from this study allow researchers to better understand the personal experiences and needs of women during childbirth, offering valuable insights for healthcare clinicians to be better equipped to provide improved patient care. This study has the potential to improve patient-centered care by promoting compassion and support during labor, delivery, and the immediate postpartum period
A jewel in the crown is better than money in the pocket : Historical Data on the Role of Midwives in Caring for Families in Southern Appalachia
No full textBackground: Midwives have provided care to women since the beginning of time. Early midwives had little training but learned their craft from experienced women. Later, formal training became available. Midwives have a rich history in Appalachia.
Purpose: to explore the rich history of all types of midwives in Appalachia.
Methods: Materials from the Archives of Appalachia were reviewed. Both written and oral materials were evaluated. This included a review of the document, identification of themes, and then comparing those themes with previously identified themes. Documents were reviewed in a random order by two researchers who met to discuss results.
Results: The individual themes seemed to be either positive or negative and were divided into 2 main categories based on similarities: Caring for Women, Families, and Communities and Midwifery Challenges in Caring for the Community. Main theme 1: Caring for women, families, and communities included the following themes: Need for Midwives, Granny Midwives and Community Presence, Caring for the Community, Religion and Spirituality, Superstitions in Caring for Women, Herbal Remedies, and No Charge or Bartering for Services. Main theme 2: Themes related to midwifery challenges in caring for the community included the following subthemes: Community Support Decreases for Midwives, Legal Issues, Education, Dangers in/for the Midwifery Community, and the Demise of Lay Midwifery.
Conclusion: Midwives provided care to families of Appalachia in a variety of ways including labor and birth, wellness, and supporting families and communities
Finding an Effective Measure of Religiosity and Substance Use Levels for the Deaf: An Attempted Pilot Study
Get PDFThe Deaf often lack access to health-promoting services (Meador & Zazove, 2005), though they have an increased risk of developing substance use disorders (Hommes et al., 2018). Communication has been a prominent barrier to the accessibility of healthcare services and participation in research for the Deaf (McKee et al., 2012). Literature has shown multiple methodological challenges when conducting research with the Deaf (Napier et al., 2018). This pilot study used Jones et al.’s (2001) cross-cultural translation model to translate two measures into American Sign Language (ASL). Six bilingual experts in ASL and English translated the RSAS-5 and the TAPS into unstructured ASL Gloss. Due to the small sample size (n= 3), the analyses were not run. Instead, incidents that occurred are discussed from a qualitative perspective. This study suggests that a prominent barrier to conducting research with the Deaf is the lack of trust between hearing researchers and the Deaf