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Bridging the Gap in Type 1 Diabetes Care: The Role of Clinical Pharmacists
No full textBackground: The management of type 1 diabetes mellitus (T1DM) has traditionally been led by endocrinologists. However, a growing T1DM population, coupled with a declining number of endocrinologists, has shifted much of the responsibility to primary care providers (PCPs), many of whom report low confidence in managing T1DM and evolving insulin delivery technologies. While pharmacist involvement in type 2 diabetes mellitus (T2DM) care is well established, their role in T1DM management remains underexplored. This study evaluates the impact of clinical pharmacists on glycemic control in T1DM patients. Methods: A retrospective chart review was conducted using data from the State of Franklin Healthcare Associates electronic health record (EHR) portal in Johnson City, TN. Patients included were adults (≥18 years) with T1DM, referred by their PCP to a clinical pharmacist between January 1 and December 31, 2023. Clinical pharmacists were responsible delivering patient education and adjusting insulin delivery. Eligibility required at least two medical evaluations per year and at least one pharmacist consultation. The primary outcome was the change in glycated hemoglobin (A1c) following an initial pharmacist visit, analyzed using a paired t-test in SPSS. Results: Of 84 patient charts reviewed, 47 met inclusion criteria. The mean baseline A1c was 8.8%, decreasing to 8.2% at 3–6 months post-consultation, with a mean reduction of 0.6% (95% CI: 0.12–1.00, p = 0.013). Conclusion: Pharmacist-led interventions in T1DM care were associated with statistically significant A1c reductions, highlighting the potential role of clinical pharmacists in addressing gaps in diabetes management. Expanding pharmacist involvement may improve outcomes for this growing patient population
Cranial Ontogeny of the Extinct Dwarf Tapir Tapirus polkensis; with Comparison to that of the Extant Tapirus bairdii (Tapiridae, Perissodactyla)
Get PDFTapirus polkensis is the smallest known species of tapir to ever live, and the largest deposit of their fossils is currently located at the GFS in Gray, TN. Phylogenetics suggest that the extant T. bairdii may be the sister taxon to T. polkensis, although they differ greatly in their morphology. Variation exists among adult T. polkensis specimens, with patterns not present in T. bairdii. For this study, as series of 2D GMAs, with TPSs, were rendered on 10 skulls of T. polkensis and 48 skulls of T. bairdii, across both species’ ontogenetic series. Analyses confirmed that growth patterns of T. polkensis and T. bairdii are significantly different, including a telescoping effect seen only in T. bairdii, while patterns in T. polkensis depict a widening of the frontals, orbits, zygomas, and possible paedomorphism. While the phylogenetic positioning remains uncertain, this study provides morphological evidence to support a reexamination of those relationships
Neuroplasticity of Sympathetic and Serotonergic Pathways to Improve the Recovery of Cardiovascular Activity after Spinal Cord Injury
Get PDFSpinal cord injuries (SCI) can severely impair bodily function, making early intervention crucial for recovery and preventing further damage. Injuries at or above the sixth thoracic (T6) vertebra impair neural cardiovascular regulation, leading to bradycardia, reduced blood flow, and hypotension. This is important because early intervention and participation in physical therapy are critical for recovery of motor function after SCI, and impaired cardiovascular regulation limits participation. Brainstem regions, including the raphe nuclei, contain serotonergic neurons with axons that project to the spinal cord and release serotonin (5-HT), a neurotransmitter essential for regulating heart rate, blood pressure, and motor control. SCI disrupts descending pathways, reducing 5-HT availability below the injury site. Because 5-HT regulates spinal neuronal excitability and promotes neuroplasticity, restoration of 5-HT pathways around the injury site can improve SCI recovery. Our study aims to investigate the effect of stimulating sympathetic preganglionic neurons, essential in cardiovascular regulation and signaling, on recovery after SCI. To determine the technique that best identifies preganglionic sympathetic neurons, we used immunohistochemistry (IHC) to compare Fluoro-Gold neuronal identification with Choline Acetyl Transferase (ChAT), a marker for sympathetic preganglionic neurons. We then validated 5-HT IHC to determine the extent of recovery after stimulation of sympathetic preganglionic neurons. To exclusively stimulate sympathetic neurons, we generated a transgenic rat model (ChAT-cre) that expresses cre recombinase enzyme within only ChAT-expressing neurons. We then injected a retrograde viral vector (pAAV-hSyn-DIO-hM3D(Gq)-mCherry) containing floxed designer receptors exclusively activated by designer drugs (DREADDs) into the adrenal gland to chemogenetically stimulate sympathetic preganglionic neurons after SCI. Studies will be conducted to optimize the dose of chemogenetic stimulant and the effect of chronic stimulation on spinal 5-HT neuroplasticity. These findings will provide insights into neuroplasticity after SCI and help develop targeted therapies to improve recovery of cardiovascular regulation and quality of life after SCI
Car Price Prediction Using Machine Learning: Analyzing the DVM-CAR Dataset
Get PDFThe objective of this study is to predict car prices using machine learning models and the DVM-CAR dataset, which includes over 1.4 million images and car specifi- cations from 899 car models. Key factors such as mileage, engine power, and year of registration were analyzed for their correlation with car prices. Extensive data cleaning was performed, including filling missing values, identifying outliers, and normalizing numerical variables. Discrete variables like car make and body type were encoded using one-hot encoding. Linear relationships were analyzed with Multiple Logistic Regression, and Random Forest models were used for nonlinear patterns. Model performance was evaluated using Mean Squared Error (MSE) to assess fit and Mean Squared Error of Prediction (MSEP) to test generalization. The findings enable the development of an automated system for car price estimation, benefiting both buyers and sellers
Encouraging Engaging Gameplay Through Zoologically Based Creature Design
Get PDFThis culminating experience project showcases a full understanding of the process for making game ready creature models. By designing three creatures meant to provide unique challenges in their creation, the author demonstrates understanding and flexibility in the skills of 3D modelling, digital sculpting, UV unwrapping, and texturing. Each creature is meant to, in its own way, encourage engaging gameplay in the hypothetical video game they belong to
A Fond Retrospective: A Personal Journey into the Worlds of Professional Videography, Editing, and Motion Graphics Preview Image
No full textPreview image from Ben Caroll-Garrett\u27s A Fond Retrospective: A Personal Journey into the Worlds of Professional Videography, Editing, and Motion Graphics.https://dc.etsu.edu/digitalmedia-culminating-experience-gallery/1004/thumbnail.jp
A Fond Retrospective: A Personal Journey into the Worlds of Professional Videography, Editing, and Motion Graphics
Get PDFIn this paper I recount my beginner journey into the worlds of professional videography, editing, and motion graphics without a formal portfolio. This is a personal paper, lightly academic in nature, and mostly diaristic. There is some technical discussion around camera and software usage, as well as navigating freelance client acquisition. I recommend it for anyone looking to decide if they want to swap career paths and explore an artistic field for the sake of financial or, perhaps more profoundly, personal fulfillment
2025 Spring - Afternoon Commencement Ceremony Video Recording
No full textThe 2:30 p.m. ceremony includes graduates of the Clemmer College of Education and Human Development, the College of Business and Technology, and the College of Nursing