• The Influence of type of healthcare provider on clinical practice guideline adoption

      Hooper, Vallire Davis; School of Graduate Studies (2009-11)
      Postoperative/postdischarge nausea and vomiting (PONV /PDNV) impacts onethird of surgical patients annually. Evidence-based clinical practice guidelines have been developed to guide the prevention and/or management of PONV/PDNV; however, degree of adoption and common factors impacting the adoption of these guidelines is not ·known. Characteristics influencing guideline adoption include Rogers' Diffusion of Innovations_ l theoretical constructs of perceived guideline characteristics, individual, and organizational innovativeness. A cross-sectional, descriptive exploratory design employing a web-based survey technique was used to explore differences in perianesthesia/anesthesia healthcare provider guideline preferences and attitudes as they relate to the degree of adoption of PONV /PDNV guidelines. A random sample of 3267 perianesthesia nurses, nurse anesthetists, and anesthesiologists were invited to participate. Data analysis techniques included analysis of variance, chi-square (x2) analyses, ordinary least squares regression, and ordinal logistic regression. Survey response rate was 11.2%. Degree of overall guideline adoption was higher than expected at 59.6%. Rogers' theoretical assumptions were supported, with certain caveats. Individual innovativeness scores differed significantly among providers (F(2,324) = 16.75,p = 0.000), but the relationship of individual innovativeness to guideline adoption did not differ by group~ Degree of guideline adoption differed by type of provider with regards to organizational innovativeness and perceived guideline characteristics. Every one unit increase in interconnectedness, the only organizational innovativeness characteristic making a significant contribution (p < 0.00) to adoption, increased the odds of adoption by a factor of 1. 7 5 for perianesthesia nurses, 1.21 for anesthesiologists, and 1.08 for nurse anesthetists. The most influential construct in the overall model, however, was the perianesthesia/anesthesia healthcare provider's perception of guideline characteristics, particularly the observability of guideline related outcomes (p < 0.000). Every one unit increase in observability increased the odds of adoption by a factor of 3 .29 for perianesthesia nurses, 2.05 for nurse anesthetists, and 1.25 for anesthesiologists., The perception of observability of guideline outcomes, in this case, the obvious reduction in the incidence of PONV /PDNV, may influence guideline adoption more than other guideline characteristics. Organizational characteristics should be considered within the context of the adopting unit and the innovation of interest, as the interaction of these variables may fluctuate.
    • Inherent Gene Expression and Protein Profile Differences Between Alveolar and Basal Bone

      Alotaibi, Fawwaz; Alotaibi, Fawwaz; Department of Oral Biology (5/1/2015)
      The mandible is composed to two bone types: alveolar and basal. Previous studies on the mandible have shown that the alveolar bone resorbs more than the basal bone after tooth extraction or as a result of tooth movement. Reasons for why the resorption rates are different is not well understood. This research begins exploring the differences of the alveolar and basal bone by using comparison characteristics such as bone mineral density (BMD), gene expression, protein profiles, and number of osteocytes. The research investigates these characteristics by using Real time RCR to study the differences in gene expression and protein profiles of the alveolar and basal bone. Micro-CT was used in comparing density and bone architecture characteristics of the alveolar and basal bone. Immunohistochemistry was used to better understand how osteocytes are different between the two bone types in hopes of later being able to understand the differences in resorption rates. The real time PCR showed that four genes are expressed significantly higher in basal bone than alveolar bone: SOST, E-11, DMP-1, MEPE. Three of which are associated with mature osteocytes indicating that basal bone has more mature osteocyte phenotypes. Micro-CT data indicated that the basal bone is denser and less porous than alveolar bone. There was no significant difference in immunohistochemistry and further quantitative testing is needed to draw and significant correlation.
    • Inheritance of nocardial mating factors

      Williams, Karol Kelly; Department of Cell and Molecular Biology (1970-06)
    • Inhibition and killing of staphylococcus aureus by [beta]-lactam antibiotics

      Schilhab, John Charles; Department of Cell and Molecular BIology (1977-09)
    • The Innate Immune System Regulates Stem Cell Responsiveness During Zebrafish Retinal Regeneration

      White, David Thomas; Department of Neuroscience and Regenerative Medicine (2015-10)
      Zebrafish replace lost retinal cells via activation of a potentially conserved vertebrate retinal stem cell type, Müller glia. We hypothesize that the innate immune system plays a key role in regulating Müller glia responsiveness to retinal cell death, as occurs during degenerative disease, thereby impacting the regenerative potential of retinal stem cells. To test this, we visualized immune cell subtypes via intravital imaging following induction of selective rod photoreceptor loss. Time-lapse imaging and immunolabeling showed that macrophages and microglia showed immune cell hallmarks consistent with reactivity to rod cell death. However, whereas microglia acted within the retina directly, macrophages were restricted to the extraocular space. Microglia activation was characterized by translocation toward the rod cell layer, proliferation, and phagocytosis of dying rod cells. To test the role of microglia during regeneration, we co-ablated microglia/rod cells or applied immune suppression, and characterized the kinetics of: (1) rod cell clearance, (2) stem cell proliferation, and (3) rod cell regeneration. The data revealed that the rate of stem cell proliferation and rod cell replacement were dependent on the presence of microglia, establishing a role for this innate immune cell subtype in regulating retinal regeneration. Additionally, characterization of the retinal milieu following rod cell ablation indicated a complex inflammatory response. Determining how innate immune cells shape retinal stem cell responsiveness will help to inform therapeutic strategies—e.g., modulating cytokine signaling to promote stem cell proliferation—aimed at reversing vision loss caused by degenerative retinal conditions.
    • The innervation of human fetal muscle spindles

      Dissin, Jonathen; Department of Anatomy (1973-06)
    • Insights into the Arginine Paradox and the Role of Arginase in Diabetic Retinopathy

      Elms, Shawn; Vascular Biology Center (2012-12)
      Reduced production of nitric oxide (NO) is one of the first indications of endothelial dysfunction and precedes the development of many cardiovascular diseases. Arginase has been shown to be upregulated in cardiovascular disease and has been proposed as a mechanism to account for diminished NO production. Arginases consume L-arginine, the substrate for nitric oxide synthase (NOS), and L-arginine depletion is thought to reduce NOS-derived NO. However, this simple relationship is complicated by the L-arginine paradox. The paradox addresses the phenomenon that L-arginine concentrations in endothelial cells remain sufficiently high to support NO synthesis yet increasing Larginine externally drives increased production of NO. One mechanism proposed to explain this is compartmentalization of intracellular L-arginine into distinct pools. In the current study we investigated this concept by targeting eNOS and arginase to different locations within the cell. We first showed that supplemental L-arginine and L-citrulline dose-dependently increased NO production in a manner independent of the location of eNOS within the cell. Cytosolic arginase-1 (ArgI) and mitochondrial arginase-2 (Argil) inhibited eNOS activity equally regardless of where in the cell eNOS was expressed. Similarly, targeting ArgI to different regions of the cell did not modify its ability to inhibit NO formation. These results argue against compartmentalization as the mechanism by which arginase inhibit eNOS. Further studies showed that arginasedependent inhibition of NO formation was prevented pharmacologically with arginase inhibitors. Also, arginase inhibition of NO production was absent in a catalytically inactive arginase mutant. Arginase did not co-immunoprecipitate with eNOS and the metabolic products of arginase or downstream enzymes did not contribute to reduced NO formation. Because of previous studies in animals and cell culture supporting the role of ArgI specifically in vascular dysfunction, we aimed to investigate the role of ArgI in the retinal vascular dysfunction of diabetic retinopathy (DR). Our hypothesis was that ArgI could be a mediator in the vascular dysfunction associated with DR. While using a mouse funduscope to image the retinal vasculature, we infused acetylcholine or sodium nitroprasside intravenously into diabetic or normoglycemic control mice and measured vessel relaxation. Endothelium-dependent retinal vasorelaxation was impaired in diabetic mice (40% of control). Diabetic mice hemizygous for arginase-1 (Argl+/") had improved function of the retinal vessels (71% of control). Endothelium-independent vasorelaxation was similar in diabetic and control, Argl+/' and wild type mice, indicating that the diabetes effect was specifically an endothelial issue and not one of smooth muscle dysfunction. Arginase inhibitors were shown to be effective in improving vascular function and reducing arginase activity. Further experiments were conducted in isolated central retinal arteries of diabetic and control rats, which recapitulated the results found in the mouse. We found that pharmacologic inhibition in both mice and rats or partial knock out of ArgI in mice resulted in improvement in the retinal vascular dysfunction associated with DR. We conclude that ArgI is a potential player in the retinal vascular dysfunction of DR.
    • Institutional ethics committees : what is the nurse's role?

      Srembo, Dorothy J.; School of Nursing (1985-12)
      The purpose of this descriptive survey was'to determine the existence, composition, and functions of Institutional Ethics Committees (IECs) in the Southeast. A subpurpose of the study was to describe the role of the nurse member of the IEC. The target population was all hospitals licensed and registered with the State Hospital Association in Georgia and Florida (N~464). A response rate of 41.4% (192} resulted. IECs were reported in 19.4% (37) of the hospitals. The IECs were most frequently found in the :urban and suburban communities and in the not-for-profit .hospitals having 350 or more beds. The membership .composition of the IECs ·was,; multidisciplinary and included physicians, nurses,.· administrators, theologians, lawyers, and laypersons.· Nurse members were reported on 95.2% of the responding IECs, had fu~~voting privileges and equal input in committee discussions. The primary functions reported by the IECs were education (establish clinical awareness of ethical decision making) , policy formulation and prospective consultation (consult with the physi~ian as the case progresses) • The research found similar trends to previous surveys, reported in 1983, in which IECs were located in an urban or suburban community, not-forprofit hospital with .over 350 beds. Two significant findings in this study were the wider representation of multidisciplinary membership of the IEC and an increase in the nurse members of the IEC to 95.2% from less than 50% in the pre~ious. studies.
    • Integrated Effects of Leptin in the Forebrain and Hindbrain

      Desai, Bhavna N; Department of Physiology (2014-11)
      Obesity develops because of a sustained positive shift in energy balance. The hormone leptin was identified as a key negative feedback signal in energy balance regulation, yet it has been ineffective in reversing human obesity. Leptin injection studies in experimental animals have identified leptin receptors (ObRb) in the forebrain and hindbrain as critical and independent mediators of leptin responses. We hypothesized that under near physiological conditions; activation of ObRb in both these areas is required to reduce body fat. We used a male Sprague Dawley double cannulation rat model (3rd and 4th ventricle) and infused either saline (S) or sub-threshold doses of leptin (L) for 12 days (0.1μg leptin/24h in 3rd, 0.6μg leptin/24h in 4th) in different combinations SS, SL, LS, LL (3rd-4th), to test for integration of forebrain and hindbrain responses. There was no effect of leptin in single ventricle infused groups (LS, SL) compared to controls (SS). Rats with sub-threshold leptin infusions into both ventricles (LL) showed a 60% reduction in energy intake that reversed after day 6 and a 20% weight loss which stabilized at day 6. Body fat of LL rats was decreased by 30% in 6 days, and 50% after 12 days despite correction of energy intake. LL rats displayed normal activity and maintained normal energy expenditure despite weight loss. We further investigated which brain nuclei are involved in this integrated response using phosphorylation of signal transducer and activator of transcription 3 (pSTAT3) as a marker of ObRb activation and delta FosB (ΔFosB) as a marker of chronic neuronal activation. The weight loss in LL rats was associated with a significant increase in pSTAT3 and ΔFosB within multiple hypothalamic nuclei, including the arcuate, ventromedial and dorsomedial nuclei, with no changes in activation of brainstem nuclei. Our results suggest that under near physiologial conditions, the simultaneous activation of both forebain and hindbrain ObRb is required for leptin to reduce body fat and this is facilitated by leptin in the hindbrain promoting activation of pSTAT3 in the hypothalamus. This provides a new perspective on the physiological role of leptin and could lead to new strategies to treat obesity.
    • The interaction of polycyclic hydrocarbons with nuclear macromolecules

      Vaught, Jimmie Barton; Department of Cell and Molecular Biology (1976-10)
    • An Interdisciplinary Team Approach to Decision-making About the Use of Psychotropic Medication for Individuals with Mental Retardation

      Natvig, Deborah A.; Department of Biobehavioral Nursing (1993-05)
      The purpose of this study was to examine a decision-making model for developing psychotropic medication plans for individuals w ith mental retardation. The study examined relationships among medication knowledge, acceptance of the interdisciplinary team (IDT) process, leadership, consensus, and the quality of the psychotropic medication plan. The study w as conceptualized using Henderson's Model for Nursing. Henderson (19 6 6 ) identified the nurse as an active participant on the IDT who helps plan and implement care designed to m eet the needs of the individual. T w o hundred eight (N = 208) team members from 4 9 interdisciplinary psychotropic medication review teams participated in th e study. Team s from all four large regional Intermediate Care Facilities for the M entally Retarded (ICFs/MR) in one southeastern state participated. Multiple regression and hierarchical multiple regression analyses were performed to test the hypotheses. The first hypothesis, that consensus would be predicted by medication knowledge, acceptance of the IDT process, and leadership w as partially supported. Leadership w as a significant predictor of consensus. The second hypothesis, that the quality of the psychotropic medication plan would be predicted by medication knowledge, acceptance of the IDT process, and leadership was not supported. The third hypothesis, which added consensus to the model, did not explain any additional variance in the quality of the psychotropic medication plan. As part of this study, The Psychotropic Review for Interdisciplinary Decisions and Evaluation (PRIDE) scale w as developed to assess the quality of psychotropic medication plans. Several threats to statistical conclusion validity were identified, which may have Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. affected the results of the study. These included: small sample size, lack of independence of teams, low variability of responses to instruments, and multicollinearity. Psychotropic medication plans from some ICFs/MR were superior to those produced by others. Characteristics of the ICFs/MR, such as, the amount of guidance given to teams through written guidelines and policy, and the degree of administrative support reflected through availability of staff to participate in the review process, may have been the most significant factors influencing the quality of psychotropic medication plan produced.
    • Invasion of gingival tissues by bacteria in healthy and diseased states

      Silverstien, Lee Howard; Department of Oral Biology (1988-05)
    • Investigating Student and Faculty Perspectives Related to Predictors of Success: BSN Curriculum and NCLEX-RN Outcomes

      Cosper, Sharon M; Department of Advanced Studies and Innovation (Augusta University, 5/22/2018)
      The literature reports higher patient satisfaction when care is delivered from baccalaureate-prepared nurses (BSN); however, there is a significant shortage of BSN prepared nurses in the country (Schmidt & MacWilliams, 2015; Roa, Shipman, Hooten, & Carter, 2011). For institutions across the nation, there is a lack of understanding as to why certain students struggle academically throughout the program and on the board certification exam. In order to facilitate training, graduation, and success with NCLEX-RN outcomes for these critical healthcare providers, consideration for why students struggle with curriculum and passing the board certification examination is needed. This study utilized a concurrent embedded mixed methods design to gain a greater understanding as to what factors may be contributing to student difficulty. Participants included graduates (n = 75) and faculty (n = 25) within the College of Nursing in a university located in the southeast region of the United States. Data were collected through review of student records, survey responses, focus group participation, and use of the EQ-i 2.0 for descriptive purposes. Results indicate that the BSN GPA, HESI examination scores, and Adult Health II course grades were found to predict performance on the NCLEX-RN. The qualitative findings illuminate categories of external and interpersonal factors contributing to students’ success and first time pass rates on the NCLEX-RN. The themes of Curriculum, Test Methodologies and Preparation, Teaching and Instruction, Balance, Drive, Compassion and Respect, and Critical Thinking were all relevant for consideration to help nursing programs improve the first time pass rates of their graduates on the NCLEX-RN. Further research utilizing methods to understand emotional intelligence and implications for admission as well as successful outcomes on the NCLEX-RN are indicated based on the qualitative findings of this investigation.
    • Investigating Student and Faculty Perspectives Related to Predictors of Success: BSN Curriculum and NCLEX-RN Outcomes

      Callan, Richard S.; Department of Advanced Studies and Innovation (Augusta University, 5/22/2018)
      The literature reports higher patient satisfaction when care is delivered from baccalaureate-prepared nurses (BSN); however, there is a significant shortage of BSN prepared nurses in the country (Schmidt & MacWilliams, 2015; Roa, Shipman, Hooten, & Carter, 2011). For institutions across the nation, there is a lack of understanding as to why certain students struggle academically throughout the program and on the board certification exam. In order to facilitate training, graduation, and success with NCLEX-RN outcomes for these critical healthcare providers, consideration for why students struggle with curriculum and passing the board certification examination is needed. This study utilized a concurrent embedded mixed methods design to gain a greater understanding as to what factors may be contributing to student difficulty. Participants included graduates (n = 75) and faculty (n = 25) within the College of Nursing in a university located in the southeast region of the United States. Data were collected through review of student records, survey responses, focus group participation, and use of the EQ-i 2.0 for descriptive purposes. Results indicate that the BSN GPA, HESI examination scores, and Adult Health II course grades were found to predict performance on the NCLEX-RN. The qualitative findings illuminate categories of external and interpersonal factors contributing to students’ success and first time pass rates on the NCLEX-RN. The themes of Curriculum, Test Methodologies and Preparation, Teaching and Instruction, Balance, Drive, Compassion and Respect, and Critical Thinking were all relevant for consideration to help nursing programs improve the first time pass rates of their graduates on the NCLEX-RN. Further research utilizing methods to understand emotional intelligence and implications for admission as well as successful outcomes on the NCLEX-RN are indicated based on the qualitative findings of this investigation.
    • Investigating the Role of the Hdac3 Co-Repressor Complex in Glucocorticoid Signaling-Mediated Bone Marrow Lipid Storage with Age

      Pierce, Jessica Liane; Biomedical Sciences (Augusta University, 2019-12)
      Aging bone is characterized by loss of tissue density, marrow fat accumulation, and dysregulated bone marrow stromal cell (BMSC) differentiation. The contribution of the epigenetic regulator histone deactylase 3 (Hdac3) is of increasing interest in bone biology. Hdac3 expression decreases with aging, and the current model for conditional deletion of Hdac3 in Osterix-expressing osteoprogenitor cells (Hdac3-CKOOsx) exhibited an aged bone phenotype in young mice along with the novel finding of osteoblastic (Runx2+ osteogenic cells) lipid droplet storage. In addition, bone-specific loss of Hdac3 activity increases expression of the glucocorticoid (GC)-activating enzyme 11β-hydroxysteroid dehydrogenase type 1 (Hsd11b1), suggesting a mechanism for the increased lipid accumulation in aged and Hdac3-deficient BMSC-derived osteoblasts. The cofactor nuclear receptor corepressor 1 (NCoR1), which mediates Hdac3 enzymatic activity in a co-repressor complex (CRC), was proposed as a regulator of Hdac3 activity in bone. Both Hdac3 and NCoR1 expression decreased in aged osteoblasts, and the two factors exhibited synergy in downregulating the promoter activity of glucocorticoid-responsive elements. Because of the relationship between increased GC signaling and osteoporosis, the glucocorticoid receptor (GR) was investigated as a mediator of the marrow fat phenotype, with the hypothesis that loss of GR function in bone would be protective against common forms of osteoporosis. Chronic caloric restriction in WT and GR-deficient (GR-CKOOsx) mice was used as a short-term stressor to induce an osteoporotic phenotype, while aging of GR-deficient mice (where Hdac3 CRC expression naturally decreases) was used as a biologically-relevant model for dual loss of Hdac3 and the GR. Surprisingly, the loss of GR function in osteoprogenitors exacerbated bone loss and marrow fat accumulation in both models—and induced a chronic stress phenotype by increasing cellular bioenergetics and whole-body metabolic rate—providing evidence of a role for the GR in facilitating healthy bone maintenance as well as evidence for compensatory mechanisms that regulate bone biology through GC signaling. GR-deficient bone also induced changes to whole-body physiology (e.g., sarcopenia, decreased physical activity, metabolic dysfunction) that further demonstrate the intricacies of bone as an endocrine organ. The current study provides new avenues to investigate cell signaling, bioenergetics, and tissue crosstalk in osteoporotic bone.
    • Investigation of Rabbit Eye Anterior Segment Reducing Capacity: Interplay Between Hydrogen peroxide, Ascorbic Acid and Reductive Enzyme Systems

      Csukas, Stephen; Department of Endocrinology (1987-06)
      Investigation of -'Rabbit Ey.e. Anterior Segment_ Reducing Capacity: Interplay Between Hydro·gen Peroxide, _Ascorbic Acid. and Reduc~ive Enzyme Systems (Under the Direction of KEITH- GREEN, Ph.D., D.Sc.) The experiments perfo~ed in this' body of work lay the. foundation. •. . for· describing the- sequelae_ .of an in vivo modification in. the reducing · ca.pacity. of the normal rabbit ocular ntilieu following the intro.ductiO? of an oxidative insult into the anterio·r- chamber .. of th~ rabbit eye. The· concentration of intracame:rally ·injected hydrogeri: peroxi-de (HP),. strong en~ugh to c·ause oxidative d~mage, ·and y~t not elicit a white cell response was first determined. The morp~ological and physiological responses to this. ·dose of HP were studied_ ·and described.~ · . - . Age related differences in response· to HP inj e_ction were manifested - ' - . between young and adult rabl:?its •.. Catala-se levels· were measured i~- i:r:i.s ~ ·. ciliary body, _cor~eal endothel-fum, liver ·and- lung. tfssues. Catalase · levels· ·were· demonstrated· to decrease with maturation. Values for ascorbate and HP in· aqueous-humor, an4 ascorbate ·in pla~ma were determined. ·.Ascorbate and HP levels. correlated in young and :adult anitnals •. -Corneal endothelia_l glutathione ·-redox state· ~as .. shifted . toward ·the heavily oxid:i.ze_d $tate ·.a.ftfiar_ intracameral hydrogen· peroxide . . . injectio? confirming 'that the· capacity for HP reduction of the_ . glutathione redox system wit~in the endothelium was being overwhelmed by-· the bolus. HP injection. ·Catalase levels were chemically inhibited by intravenous injection ·of· 3-aminotriazole (3AT) into adult ·animals to mimic the ·condition of a X diminished .ocular-· r~ducing _power. The dose_ response relationship was determined between the dose· ;of 3AT ·and the resultant catalase activ:i,tie~. : ... . . in ocular tissues. · The t~ Jo.r loss of HP from the aqueous humor was determined under control and.catalase inhibited-conditions,· and . ' demonstrated. a trend of fnGreasing length concurrent to increased catalase inhibition. The relationship between 'total ocular· reducing· power and.the t~ of,HP dissipation was determined by combining data ·from . . . . - the two experiments. Ocular. tissues exposed· to intracamerally injected I HPwhile· under 3AT inhibition of catalase activity demonstrated an exacerbated response compared with non-3AT treated· t:j_ssues •. These ' 'results suggest. 'an underlyin'g· r:elationship _between ~otal ocular reducing ' power and exte~t.of damag~ arising from contact with oxidants. 3AT was given orally ~o adult rabbits to determine _the .effects of long term-inhibition of catalase levels. These.animals were not . ' challenged. with in.tracamerally intro<iuced HP but rather were studied· to . ' ·determin~ the effects of 3AT on .endogenous.HP levels. Decreases were noted in levels· of qcular· ascorbate.· and HP but not in levels of plasma ascorbate. Concurrent morphological changes were also rioted in the- .posterior portion of the rabbit lens. These inclqded bleb bing and · · macuolization of· lens fibers~. The findings of thes·e studies witk rabbits suggest that: 1) . ' . catalase-activity decreases with_ maturation: in rabbits; 2) decreases in catalase activity can beachieved using 3AT; 3) challenging oculaJ; tissues with exogenous HP can expose the underlying relationship .. between .ocular reducing power _and· levels of oxidants under normal· conditions and during inflammatory .condi:tions; 4) und·er conditions of greater than· 50% inhibition of catalase levels, other reductive .systems such. as the glutathione redox cycle play. an increasingly important role; and 5) when catalase levels are inhibited for long periods of time without concurrent exogenous HP challenge, major morphological and chemical changes occur in the aqueous humor.