Health and Medicine

Taylor Colvin, Utah Valley University Health Introduction: There are millions of people in need of prosthetics worldwide and only a very small percentage currently have access to appropriate prosthetic care. As amputees are unable to afford a prosthetic, they are often incapable of maintaining many social interactions and provide for their basic needs. Utah Valley University’s Mobility Mission traveled to Guatemala to manufacture prosthetic limbs for those individuals in need. Our research can also encourage manufacturers to continue developing a better affordable prosthetic that can be donated to those amputees in need to restore quality of life to those individuals.

Josh Lee, Dixie State University Health According to the World Health Organization (2012), health care systems in Central America rank in the top 50% of the 190 ranked countries in the world, yet thousands of people are in need of simple medical attention and supplies every day in these areas. Countries such as Honduras lack virtually all access to health services, with 83% of the country’s population without health insurance, and 30% with no health care access at all (Pearson et al., 2012). To address this issue, a 2013 Dixie State University study conducted by the author, an Integrated Studies major with disciplinary emphases in Spanish and Biology, interviewed fifty adult Central American immigrants at a Southern Utah health care facility with the aim to providing student groups embarking on health service projects a researched list of vitally needed medical supplies. Participants in the study were asked to provide information regarding their health care experiences in their countries of origin and draw upon their comparative experiences with health care in the United States in order to determine areas of need. The forty individuals in this study represented a total of seven Central American countries and the interviews were conducted in Spanish and translated into English. The interviews were conducted over an 8-week period of time and results suggested that diabetes, cold, flu, antibiotics, and anti diarrhea medicines and supplies are a few of the needed health care items in these neighboring countries. Although statistical significance was not a feature of this study due to the number of participants, significant consistencies in responses by former residents of a variety of Central American countries suggested that some medical needs are regionally shared and that larger scale follow-up studies may reliably identify these as key resources for student medical delegations traveling to Central America.

Stephen Clarkson, Brigham Young University Health While there is an abundance of mobile health apps for weight management on the market today, almost all focus entirely on net caloric intake (exercise minus calories consumed). Recording daily caloric intake can be cumbersome, inefficient and inaccurate. One rising suggestion in the health field for reaching weight goals is objectively recording hand-to-mouth movements (HTMMs) during meals throughout the day. This method focuses entirely on portion control and if any improvements are to be made in this area, an effective method of activity recognition must be developed. In this paper, we report our efforts to classify HTMMs and non-HTMMs in an effort to automate counting the number of HTMMs during meals throughout the day. We also report on the performance of several base-level classifiers such as k-NN, Naive Bayes and Decision Trees as well as meta-level classifiers (Voting, Bagging and Boosting).

McKay Frandsen, Utah Valley University Health INTRODUCTION

Charity Anne Rowley, Brigham Young University Health In 2010, The Office of the Inspector General of the U.S. Department of Health and Human Services reported that adverse events during hospitalization contribute to the deaths of 180,000 patients each year! The purpose of this study is to improve patient safety in the hospital by understanding the role of the charge nurse(the 24/7 nursing supervisor in hospital units).

Jennifer Orton, Brigham Young University Health In contrast to the success of America’s vaccination rates among children, adult vaccination rates remain suboptimal. Some adults, such as school employees, are in a position where they can easily contract and spread vaccine-preventable communicable diseases, yet mandatory vaccinations are usually lacking in this population. Schools may easily become communicable disease outbreak centers, especially for highly contagious diseases such as measles and influenza. The purpose of this study was to evaluate why rural Utah school employees remain vaccinated for measles and influenza, as well as to discover the perceptions of these school employees regarding mandatory vaccination policies. Of the 835 respondents, 71.7% reported they received the measles vaccination as a child, although only 26.9% reported having a measles booster vaccine as an adult. When asked why they had not received the measles booster, 46% of participants stated they were unsure if they needed one. Other participants also reported lack of an adult measles booster vaccine because it was not required by the school district (5%) and that they did not perceive the need because they were healthy (5%). Even more concerning, over half of the school employees (51%) had not received their influenza vaccine for the current year. When questioned about their lack of influenza vaccination, 26.4% believed the vaccine was ineffective and 25.4% were noncompliant because they did not have the time to get the vaccination. When questioned about their perceptions regarding mandatory vaccine policies for school employees, four major themes emerged: 1) adults should retain agency; 2) vaccine effectiveness was not guaranteed; 3) adults do not need vaccinations; and 4) cost of vaccines. Further education is needed regarding the need for adult vaccinations, especially among school employees in rural Utah. To control the spread of communicable diseases, school districts may consider mandatory vaccination of school employees.

Emily Matson, Brigham Young University Health Cancer, despite its common association with old age, is a leading cause of death for children age 1-14, second only to unintentional injuries. Improvements in diagnosis and treatment are increasing childhood cancer survival, and more research is needed on the risk of subsequent cancer following an initial diagnosis, of either the same or another site. Research on associations between childhood and secondary cancers may improve patient follow-up by providing health professionals with information about which subsequent cancers are likely to occur, which screenings to conduct and what symptoms to look for.

Wesley Tietjen, Dixie State University Health High risk sexual behaviors, such as having unprotected sex, are a community health concern because of the heightened susceptibility to sexually transmitted diseases. An estimated 19.7 million people are newly infected with a sexually transmitted disease annually. Young people (ages 15-24) account for nearly half of all new incidences (CDC, 2008). Considering these statistics, the author, a Dixie State University Integrated Studies undergraduate student, conducted an interdisciplinary study to determine the correlation between the degree of self-reported religious devotion of Latter Day Saint (LDS) singles and their likelihood of purchasing or using protection during premarital intercourse. Seventy five students attending Dixie State University in Saint George, Utah participated in this study. Participants completed a 15-item survey consisting of questions inquiring how religious they consider themselves and their feelings towards premarital sex. Of the non-married participants who engage in sex, only 28% (n=4) of LDS respondents reported consistent use of birth control, compared to 84% (n=16) of non-LDS individuals. These results are suggestively significant and are consistent with findings from studies conducted by Douglas Kirby (2007) and others who have demonstrated that teaching abstinence, without providing education about birth control methods other than abstinence, leaves individuals unprepared to practice safe sex if the occasion arises. The relevance of the Dixie State University study to previous more broadly conceived research will be presented along with recommendations for future research.

Elise Corbett, Brigham Young University Health Background

Paydon Newman, Dixie State University Health Several studies (Shepley, 2012; Sherman-Bien, 2011; Walch, 2010) have found that sunlight has a stress-reducing effect on those who are exposed to it. An innovative new design of artificial lighting known as RaLight is proposed to reflect light with a color rendering index nearly identical to natural sunlight. This study will examine the relationship between exposure to RaLight (as a substitute for sunlight) and levels of stress. RaLight is predicted to decrease levels of stress in test subjects. In several hospice facilities, test subjects will consist of an estimated 100 patients both male and female with ages ranging from 65 to 85 years. This research is designed as a single subject experiment (ABA). The initial control condition will be the common indoor environment which exposes patients to standard fluorescent lighting. Replacing light fixtures with RaLight will then establish both the second phase of the experiment and the independent variable. A follow up re-installment of the initial fluorescent lighting will be conducted post-RaLight phase. Throughout each phase, questionnaires regarding the overall well-being of patients will be completed by hospice staff.

Tim Smith, Brigham Young University Health Previous research studies have confirmed that life-threatening illness adversely impacts psychosocial well-being, from feelings of isolation and embarrassment to the onset of psychotic episodes and suicidality. To help patients cope with chronic and/or terminal symptoms, many healthcare providers advocate the benefits of social support groups as a palliative measure, such as weekly meetings of cancer patients. The rapid proliferation of such programs, as well as associated “survivor groups,” has attracted research attention, and the number of research studies on the topic is now substantial. The field would currently benefit from a quantitative synthesis of the extant findings. To systematically quantify the effect of such intervention groups on mortality (i.e., death rates), we undertook a meta-analysis of the research literature, comparing patient survival rates as a function of social interventions. Across 27 studies examined thus far, we encountered a surprising variability of intervention success in prolonging life. Although most intervention provided demonstrated evidence of increased survival rates among participants, several studies did not. Our presentation will discuss the implications of our findings for healthcare providers and pose questions that will need to be addressed in future research.

Rhett Thomson, Utah Valley University Health Previous studies have shown high-frequency (HF) ultrasound may be sufficiently sensitive to detect and differentiate between both the histopathology and molecular subtypes of breast cancer. The goal of this study was to test the boundaries of HF ultrasonic testing methods. The parameter of interest was the effect of formalin fixation on tissue samples. Formalin has been found to stiffen tissues. Since ultrasound is sensitive to histological properties such as stiffness and adhesion factors, stiffening caused by fixation may compromise the results of the HF ultrasound analysis. This study monitored potential changes to HF measurements caused by tissue fixation. The fixation solution used was 10% neutral buffered formalin. The same formalin solution is used by hospitals after breast conserving surgery (BCS) to prepare and preserve excised tissue specimens for pathology. If no change in HF ultrasound analysis is detected in tissue samples before or after fixation, prepared tissue specimens from BCS patients may be used as viable samples for HF ultrasonic testing. Twenty tissue samples were used in this study. All samples were excised from the cortex, medulla, or ureter of a fresh cow kidney. Samples were tested with HF ultrasound. Testing conditions and procedures were identical to previous breast cancer tests. HF ultrasonic testing was completed at the zero hour mark and then repeated at five successive time intervals during fixation. Data collected from each sample was compared across all time intervals to detect any changes caused by fixation. Analysis of the data showed no significant changes in HF readings before, during, or after fixation up to 17 hours. Any variations observed were within experimental error. These findings demonstrate that formalin fixation does not affect the accuracy of HF ultrasonic testing techniques on bovine tissue samples. To reinforce the findings, this study will be repeated using different types of tissues.

Alexis Holman, Utah Valley University Health

Arlene Johnston, Brigham Young University Nursing Description:

Edie Kieu-Mi Nguyen and Cassandra Nguyen, University of Utah Nursing Home hospice care is a growing area within the health care system. However, because of the difficulty in gaining access to these patients and caregivers in the home, research findings have been slow to keep pace with this growth. While hospice has been at the forefront of family-centered care, explicitly stating that the unit of care is the family, there has been little empirical research to show who is actually involved in this care in the home on a regular basis. Hypothesis: Our goal of this project was to describe who is present at the nurse home visit with the patient. Research Method: This research, part of a larger intervention study, involved reviewing audio recordings of home hospice visits to set up a coding system for future communication coding. During this review, we also identified and documented those present during the visit. Results: In our sample of 115 home hospice visits, 12 nurses caring for 13 patients spent an average of XXX minutes each (SD=XXX) in the home. We have found that caregivers are present 80% of the time. Our data shows that a spouse is present in 28% of visits. In 58.3% of visits, a daughter is present, while sons are present in only 3.1% of visits. Implications: It is important to know who is present at the visit and how long they spent with the patient to increase our understanding of what goes on in home hospice care. This research has implications for improving patient care. For example, in order to promote a more family orientated home care; more family members should participate in nurse visits. This descriptive research can be used in practice for hospices to know who to expect during patient home visits, as well as to incorporate the family members better into the patient care plan.

Xin Wan, University of Utah College of Health, and Department of Endocrinology, Metabolism, and Diabetes We hypothesized that PP2A activation is required for lipid-induced, ceramide-mediated arterial dysfunction. Mice haploinsufficient for dihydroceramide desaturase (des1+/-) and their wild-type littermates (des1+/+) were infused (iv) for 6 h with lard-oil (LO) or vehicle (veh). Subgroups of LO and veh mice were treated (1.5 mg/kg IP) for 3 days prior to infusion with the PP2A inhibitor LB1 (Lixte Biotechnology, NY). LO increased ceramide accrual in arteries from des1+/+ but not des1+/mice. Palmitate (3 h x 500 uM) increased (p<0.05) PP2A activity, and impaired (p<0.05) insulin-stimulated p-eNOS(S) 1177 to eNOS in endothelial cells, and these responses were negated by LB1 (4 uM; n=5-8). Endothelium-dependent and -independent relaxation of femoral arteries (~ 150 um i.d.) was assessed using acetylcholine (ACh) and sodium nitroprusside (SNP), respectively (n=3 mice / group, 3 vessels / mouse). ACh-mediated (2×10-8, 3×10-8, and 6×10-8 M) relaxation (%) was less (p<0.05) in LO des1+/+ (30±2, 41±3, and 61±4, respectively) vs. veh des1+/+ mice (48±4, 67±6, and 73±6, respectively). Endothelial dysfunction observed in LO des1+/+ mice was less severe when ceramide accrual (i.e. LO des1+/mice) or PP2A activation (i.e., LB1 +LO des1+/+ mice) were prevented. SNP-evoked vasorelaxation was intact among groups. LO-induced ceramide accumulation induces endothelial dysfunction that is dependent upon PP2A activation. ADA1-12-BS-208, 2R15HL091493

Nicole Kelbert, University of Utah Nursing Introduction:

Darien Shapiro, University of Utah Pharmacology and Toxicology Exposure to wood smoke particulate matter (WSPM) has been linked to exacerbation of asthma, development of chronic obstructive pulmonary disease (COPD), and premature death. Combustion-derived PM (cdPM) such as cigarette smoke (CS), diesel exhaust (DEP), and WSPM, activate transient receptor potential ankyrin-1 (TRPA1) which promotes neurogenic inflammation/edema and airway irritation/cough. The mechanism of TRPA1 activation by DEP and CS involves the electrophilic/oxidant binding (3CK) and menthol-binding (ST) sites, and a novel mechanosensitive site. We hypothesized that WSPM would activate TRPA1 through one or more of these sites similar to other cdPM. Pine and mesquite PM were generated in the laboratory. Both types of WSPM particles activated TRPA1 in human TRPA1 over-expressing HEK-293 and primary mouse trigeminal (TG) neurons. WSPM also activated TRPA1 in A549 cells, a human alveolar adenocarcinoma cell line, which has recently been shown to express TRPA1. HC030031, a TRPA1 specific antagonist, attenuated the calcium flux due to WSPM treatment in both human A459 cells and mouse primary TG neurons. Differential activation of TRPA1, as a function of particle size, demonstrated that PM2.5 m were most potent. Several known chemical components of WSPM, including 3,5-ditert-butylphenol and agathic acid were TRPA1 agonists. Both WSPM and agathic acid activated TRPA1 primarily via binding the 3CK site, based on inhibition of calcium flux by glutathione and mutation of the 3CK site. Conversely, 3,5-ditert-butylphenol activated TRPA1 through the ST site. This study established the mechanism by which WSPM and associated chemical components activated TRPA1 which may help tailor effective therapeutic treatments for WSPM pneumotoxicity. Support: NIEHS ES017431 and the University of Utah Undergraduate Research Opportunities Program.

Elizabeth Johnson, University of Utah College of Health, and Division of Endocrinology, Metabolism, and Diabetes Constant-flow left ventricular assist devices (LVAD) are implanted in heart failure patients to assist the heart in pumping blood through the body either temporarily as a “bridge” mechanism until a heart transplant or permanently as a destination therapy. The blood flows constantly with an LVAD contrary to the natural pulsatile flow of the human heart. We wanted to determine if this constant flow attenuated the function of the arteries. A transmural biopsy was taken from seven male patients (52±6 years old) when the LVAD was implanted (pre) and again 142±2 days later upon LVAD explant (post). Arteries were obtained from the pre and post tissue biopsies. Vessel function was assessed using isometric tension techniques. After Lmax tension was determined for each vessel, the contraction-response curve of each vessel was tested using potassium chloride (KCl, 10-100 mM). Next the vessels were pre-contracted to ~65% maximal tension and treated with bradykinin (BK, 10-6 to 10-10 M) and sodium nitroprusside (SNP, 10-4 to 10-9 M) to determine, respectively, endothelium-dependent and -independent vasorelaxation. Maximal KCl-evoked contraction (0.99±0.22 and 0.69±0.14 mg tension development / μm vessel length), maximal BK-evoked vasorelaxation (64±13% and 80±7%), and maximal SNP-evoked vasorelaxation (92±3% and 92±4%), was similar in arteries obtained from pre (n=13 arteries, 206±40 μm i.d.) and post (n=14 arteries, 288±24 μm i.d.) transmural biopsy samples, respectively. These preliminary data indicate that coronary vascular function is not attenuated by LVAD implantation.

Israel Worthington, Utah Valley University Science and Health The Nation and world’s dependency on fuels has steadily grown over the last several decades. The world’s consumption of oil dramatically increases in the United States and peaks at approximately 20 million barrels of oil each day. Predictions of decreasing fuel reserves and increasing costs have made the development of a renewable fuel source increasingly appropriate. Much research has been done using the fermentative process to produce biofuels as an alternative fuel source, but the research attempting to utilize photosynthetic bacteria as a producer of alternative fuels is relatively undeveloped. In this research, it was attempted to transform cyanobacteria with the gene necessary to produce the enzyme methyl-butenol synthase, which catalyzes the production of the biofuel methyl-butenol. The gene for methyl-butenol was successfully transformed into cyanobacteria on a plasmid, and production of the enzyme methyl-butenol synthase was successfully detected via western blotting. The production of an alternative fuel source using photosynthetic bacteria could create a cheap, renewable, and more environmentally friendly source of fuel.

Mikaelyn Miles, University of Utah Pediatrics Altering myocardial growth interferes with hemodynamic parameters such as blood flow or pressure, and subsequently alters vascular development. We hypothesized that experimentally increasing hemodynamic stress by conotruncal banding during early heart development would result in a remodeling of the arterial wall. The outflow tract of a stage-21 (3_-d) chick embryo was constricted with an overhand knot of a 10-0 nylon suture, and the embryo was returned to the incubator. Normal embryo was not operated. We harvested the embryo at stage-34 (8-d), and fixed the heart in diastole with 0.025 μg/Kg diltiazem in 4% paraformaldehyde. Transverse sections of the carotid artery were stained with H&E staining, and the dorsal aorta was treated with rhodamin-phalloidin-smooth muscle antibody staining. En face sections of the aorta were examined under confocal microscopy. Morphometric analysis was quantitated using customized MatLab software for filament-actin alignment and density. Data are presented as mean±SEM, and analyzed by Student’s t test and ANOVA with statistical significance defined as a p value of less than 5%. Both right and left carotid arteries in the conotruncal banded heart had a thinner vessel wall when compared to the arteries of the normal embryos. Some vessels in the conotruncal banded hearts displayed dilation and variation in size between the right and left coronary arteries. The overall filament length in the dorsal aorta between the normal and banded hearts (39.8±4.3 vs. 29.6±2.7 μm, respectively) was statistically different (p<0.05). The filaments were also widely spaced in the conotruncal banded hearts. Altered growth in the developing heart caused by altering the hemodynamics results in secondary abnormalities in development due to abnormal vascular architecture. These factors may be important in the understanding of myocardial development with defects such

Samantha Webber, Brigham Young University Nursing Background: In November of 2012, a small group from BYU’s College of Nursing returned to Guayaquil, Ecuador to measure anemia indicators post interventions in school age children. In May of 2012 a larger group, including students, from BYU’s College of Nursing had visited Guayaquil for the fourth consecutive year to assess malnutrition and anemia rates in school age children. This multi-phase research project which began in May of 2009 found that nearly 41% of the children in this area suffered from anemia (below 11g/dl as per WHO guidelines). The adverse effects of anemia for these children can include: weakness, fatigue, shortness of breath, and poor concentration. Anemia may result from deficiencies of iron, B12, folic acid, and may also be the result of intestinal parasites. A nutrition survey conducted among these same school children showed that daily intake of iron, B12, and folic acid were below recommended levels. Intervention: In May of 2009 Hogar de Cristo (HDC), a non-profit organization, began distributing 6 to 8 ounce bottles of soy milk as a school snack for each school-aged child at a few of the schools in the area. A local pharmaceutical company who supplied vitamin and iron supplements during the first year of the soy milk distribution, reassessed anemia rates in those children in November of 2009. The BYU College of Nursing continued to assess school- aged children for measures of anemia and growth and development in 2010 and 2011 as directed by Hogar de Cristo. After 2011 it was difficult to correlate anemia and soy milk because of changes in the sample from year to year. In May of 2012 the BYU College of Nursing shifted their focus to four interventions with the aim of determining which one would best lower anemia rates. The study focused on students at four schools in the perimetral area, each school received one of the interventions as an adjunct to soy milk: vitamin supplements, antiparasites, vitamins and antiparasites, and a control group (soy milk only). Growth and development measures along with rates of anemia were reassessed in November 2012. Results: In May of 2012 the BYU College of Nursing tested 1041 school-ages children for growth and development and anemia. growth and development rate results spanning the four years of testing, and a comparison of anemia rates between intervention groups and control groups.

Ashlee Manwaring, Brigham Young University Nursing Purpose: To examine how the new policy of Medicare/Medicaid reimbursement being based on HCAHPS scores affects nursing care. Rationale: The Patient Protection and Affordable Care Act (PPACA) mandates that Medicare and Medicaid reimbursement be based on hospital performance and patient satisfaction. Patient satisfaction is measured nationally through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey was development in the early 2000’s to create a uniform measure for patient perspectives regarding their inpatient stay; however, with the HCAHPS scores being related to Medicare and Medicaid reimbursement, hospitals are required to reevaluate their quality of care from the patient, not medical, perspective. Van Empel et al. (2011) found that physicians and nurses primarily value medical outcomes of treatment. While, at the same time, patient’s value patient-centeredness, even if it means decreasing the desired outcome of treatment. Undertaking: A literature review was completed by searching in CINAHL and Medline. Preliminary research used HCAHPS and Medicare reimbursement as key words. Second, a search was completed using HCAHPS and nursing as key words. All results were published between 2008 and 2012. Outcomes: Kutney-Lee et al. (2009) reported that patient satisfaction was primarily linked with nurse-to-patient ratio, interdisciplinary collaboration and work environment. Research by Robinson and Watters (2010) found the main factor in patient dissatisfaction was feeling like the nurses were short staffed, task-oriented and rushed, leaving the patient lacking adequately communication to understand their situation. Van Empel et al. (2011) reported patients’ willingness to change providers and facilities to received patient-centered care. Conclusion: Nurses have the greatest potential to effect patient satisfaction. Therefore, with the new regulation of Medicare and Medicaid reimbursement based on patient satisfaction surveys, nurses have a greater responsibility to ensure patient satisfaction. From the research presented, the main nursing implication is to help each patient feel like their care is centered on what is important to that individual. This can most easily be accomplished by the nurse opening a line of communication with the patient, and then advocating for the patient’s wishes.

Austin Stevens, University of Utah Pediatrics Neurofibromatosis type 1 (NF1) is a common autosomal dominant genetic disorder. It affects 1/3500 individuals worldwide (Friedman, 2002). It is classically characterized as a neurocutaneous disorder, but osseous and spinal abnormalities are clearly associated with NF1. These complications are not well understood and rarely emphasized, even though as high as 38% have been reported to have osseous manifestations (Crawford and Schorry, 1999). In particular, the medical management of scoliosis in NF1 is problematic with no consensus on preferred treatment strategies. More information on the natural history and health-related quality of life are needed before effective therapies can be designed as assessment of treatment efficacy is complex and outcome measures difficult to define. Dr. Stevenson and Dr. Viskochil are part of an NF Consortium focused on developing clinical trials in NF1. However, specific outcome measures are needed for these clinical trials. In particular changes in quality of life are an essential part of clinical trials. Our objective is to determine if specific quality of life instruments can be utilized in the NF1 population for the skeletal manifestations. A battery of these instruments were used given that it was not known which instrument would be most appropriate for the various manifestations of NF1. A total of 129 patients were enrolled in this study, and the relevant questionnaires were administered and recorded. Categorical data of health status will be summarized as frequency distributions and differences among groups will be assessed using chi-square tests of proportions. Frequency distributions for interval-scale variables of health status (e.g., HUI single-attribute utility scores) and HRQL (e.g., HUI multi-attribute utility and PedsQL4.0 summary scores) will be summarized as mean, standard deviation, 95% confidence bounds, median, minimum and maximum. T-tests and analysis of variance techniques (including repeated-measures models) will be used to test differences in means between groups.

Deborah Nelson, University of Utah Pediatrics Families of pediatric cancer patients are presented with significant emotional, social, and financial challenges. Most children with cancer are treated in pediatric oncology centers located in urban areas and many must travel great distances for therapy. This study aims to evaluate the burden of care associated with pediatric cancer care and to determine the impact of the location of patients’ residence on those burdens. We administered a n=310 (48-item, English) and n=46 (72-item, Spanish) survey to the primary caregiver of patients, ages 0-18 years, diagnosed with a cancer between three to six months prior to the survey. Survey domains included measures of rurality, time from first symptoms to diagnosis, financial burden (travel costs and time, missed work, relocation) and missed school. Survey analysis suggests rural families and those traveling >2 hours to a pediatric oncology center took longer to obtain diagnosis, missed more work days, paid more in travel expenses and relocated more often than families living closer. Of the respondents, 18% were considered “rural” with 38% reporting greater than one-hour travel time and 25% reporting greater than two-hour travel time. Mean onset of initial symptoms to diagnosis was 11.4 weeks for rural and 7.6 weeks for urban patients. Mean out of pocket costs per clinic visit for rural were over three times that of urban patients. Twenty-nine percent (n=102) moved since diagnosis; of that 33% reported moving was directly due to cancer. Fifty-six percent of school-aged patients discontinued school; of those 28% were unable to “keep up” and 10% repeated a grade. Caring for a child with cancer places a significant number of burdens on the patient’s family. This burden appears greater for patients living in rural and distant areas and could effect patient care and access to treatment.

Jennifer Nhan, University of Utah College of Health, Division of Endocrinology, Metabolism, and Diabetes The overall goal of our laboratory is to elucidate mechanisms whereby endothelial nitric oxide (NO) synthase (eNOS) enzyme function and NO bioavailability are impaired in individuals with diet-induced obesity (DIO), type 2 diabetes (T2DM), and insulin resistance. This is a clinically relevant issue because all of these conditions are associated with poor vascular function that might be precipitated by disrupted eNOS enzyme function and NO bioavailability. To study this issue we use model systems including cell culture, isolated arteries, and rodents. It is important to have an accurate, reproducible, and sensitive method to detect NO in each of these systems. The purpose of my work was to optimize the technique of electron paramagnetic resonance spectroscopy (EPR) to assess NO in bovine aortic endothelial cells (BAECs). NO contains an unpaired electron. This structural feature facilitates the measurement of NO via EPR. NO is detected with a spin trap of FeSO4 and diethyldithiocarbamate trihydrate (DETC). In the presence of NO, the spin trap forms a NO-Fe(DETC) complex which is detected by EPR. BAECs were grown to 70-80% confluency in six-well plates, and treated with: (i) vehicle (buffer only), (ii) 600 uM of insulin (an NO agonist), (iii) 10 uM of NG-monomethyl-L-arginine acetate salt [LNMMA, an NO synthase (NOS) inhibitor], and (iv) three doses (1, 10, 100 uM) of diethylammonium (DEA) NONOate (an NO donor) to serve as a positive control. All treatments contained L-arginine [the substrate for endothelial NOS (eNOS)] and FeSO4 (the spin trap). After a 60-min incubation with treatments (i) (iv), cells were dislodged from each plate, collected, frozen in liquid nitrogen, and NO was detected using EPR. Relative to vehicle treatment, 1uM, 10uM, and 100uM DEA NONOate increased NO production by 50±8%, 150±2%, and 700±26% (p<0.05) respectively. Insulin increased (p<0.05) NO production by 73±4% vs. vehicle, and this response was prevented in cells treated with insulin + LNMMA. These results indicate EPR is a suitable method to detect cellular NO production. My next project is to optimize this technique for use in isolated arteries from experimental animal models.

Cami Schiel, Brigham Young University Nursing 65 French hospital nurses in Avignon, France were surveyed about their opinions about healthcare. Survey results identified and described French nurses’ perceptions of their health care system as well as other systems. Access to care was a positive aspect of their healthcare system that was identified by a majority of the respondents. Abuse or lack of oversight, and budget deficit were major themes identified as negative aspects of the French healthcare system. The French nurses’ opinions about different countries’ health care systems were compared to World Health Organization [WHO] (2000) rankings. French nurses overwhelmingly ranked France’s healthcare system as number one, which matched the WHO (2000) ranking. 73% of respondents prioritized preventative care over acute treatment. Work and other professional peers were identified as the main sources of influence on French nurses’ perceptions of health- care both French and internationally. Nurses’ opinions heavily influenced other nurses in the workplace. An implication from this study is that nurses can have a powerful impact on others’ viewpoints about healthcare. They are also a valuable resource for identifying strengths and weaknesses of a healthcare system, given their lived experience working in the healthcare system.

Kara Vickers, University of Utah Nursing Symptoms related to cancer and its treatments are a significant source of distress for children and adolescents with cancer. Although children and adolescents may receive interventions aimed at alleviating symptoms, the hospital care environment itself may be one that adds to the overall symptom burden. The purpose of this study is to investigate relationships between symptoms experienced by hospitalized children and adolescents with cancer and the care environment on an inpatient pediatric oncology unit. This prospective, descriptive study uses use a repeated measure, within-group design to identify relationships between symptoms and the nursing care environment that can be used to guide future interventions. Participants are 50 children and adolescents (7 to 18 years of age) with cancer. Data collection is occurring over a 3-day and 3-night period. Children and adolescents’ symptoms are measured each shift using the Memorial Symptom Assessment Scale for patients aged 7-12 years. Participants also answer two open-ended questions about what has bothered them about the hospital environment and what they perceive could improve the hospital environment. Sound and light levels are measured continuously using a sound pressure level meter and data logger placed approximately 48 inches from the child’s bedside. Nursing care activities are measured through counts of care activities occurring during room entries by nursing staff. Room entries are identified using an Axis pan-tilt-zoom (PTZ) dome camera. A member of the research team reviews the child’s nursing flow sheet, medication administration record, acuity level, laboratory values, and medical orders each day. Data is presently being collected and will be analyzed using hierarchical mixed effects statistical models. Long-term goals of this project include improving symptom management in the inpatient setting, minimizing modifiable factors in the care environment that cause greater symptom burden, and lastly use the findings to inform hypotheses for a larger intervention studies. Hopefully these studies will target structuring the hospital care environment to minimize the symptom burden experienced by hospitalized children and adolescents with cancer and, ultimately, promote their quality of life.

Jordyn Whiting, Brigham Young University Nursing Purpose: To demonstrate use of a guide to help nursing students increase cultural competency gained during study abroad programs.Background/significance: In a world of increasing globalization, nurses are more likely to care for patients of a cultural background different from their own. To care for increasingly diverse patients, nurses need greater cultural competence to provide the safest and highest quality of care possible. Study abroad programs have been shown to be an excellent way to provide cultural education for students. The number of students choosing to participate in these programs has more than doubled in the last ten years. However, no research is available from a student perspective on how to plan for an optimum learning experience during study abroad. A research-based guide, from a student perspective, will help students take better advantage of experiences abroad to increase cultural competency. Methods: A literature review using online databases (including CINAHL and MEDLINE) was conducted using search terms such as nursing student, student, cultural competency, cultural sensitivity, cultural awareness, study abroad, international experience, and exchange program. Articles from the online search were used to compile a student guide. The guide includes competence-enhancing activities, formulated using brief anecdotal summaries and trending study abroad outcomes found in the articles. The guide’s framework came from Josepha Campinha-Bacote’s 2002 article, “The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care,” and its subsequently updated versions (2007 and 2011). With the original version of the guide, there were 16 activities in four categories: cultural awareness, cultural knowledge, cultural skill, and cultural desire. The guide also included 16 blank squares where students could create their own activities. The guide contains a small reflective writing portion where students can think about their experiences as a whole and how they can implement what they learned into practice. A total of 12 students, including the author, used the guide in two different study abroad programs, first while participating in a Global Health and Human Diversity program with the College of Nursing in Tonga in May 2012.

Laura Gilpin, Brigham Young University Nursing Purpose/Aims: The purpose of this pilot study was (1) to examine nursing students’ perceptions of their first experience with death in the clinical setting and (2) to determine if curricular changes are necessary to better prepare nursing students effectively cope with their first death experience as a nurse. Background: Death, particularly the unexpected death of a patient, is an emotionally charged, high-stress situation for any nurse. Nursing students encounter scenarios involving death and dying in simulation laboratories, as well as in the clinical setting. In simulation settings debriefing is routinely accomplished and is seen as a critical component of the learning experience. However, Leavy and colleagues (2011) found that even during formal simulation debriefing sessions nursing students were not able to fully process their emotions In real-life clinical settings, the stakes are even higher as nursing students must be able to effectively cope with the death of a patient. Unfortunately, research on students’ first experience with death is limited. Huang and colleagues (2010) found students may not receive adequate support from clinical nursing instructors during the dying process and after a patient’s death. Methods: This was a descriptive mixed methods pilot study. An online anonymous survey was sent to students in the Brigham Young University College of Nursing regarding their first experience with death in the clinical setting (N=306). Students were e-mailed a brief description of the research project and an invitation to participate in the study only if they had experienced the death of a patient. Completion of the online questionnaire implied consent. The participants answered 5 demographic questions and 11 survey questions with the estimated time commitment for each participant being 15 minutes. Results: The online questionnaire was sent to 306 BSN nursing students Approximately 10% initially responded (N=33). A smaller group (N=25) completed the entire survey. Qualitative comments from nursing students who experienced the death of their patient included feeling sad, shocked and uncomfortable. Fifty percent of the nursing students did not receive any debriefing from their clinical instructor following the event.

Jacqueline Rodriguez, University of Utah Health Promotion and Education This is the second phase of an anticipated multistage research study. The first phase was completed Spring of 2012 and data showed that drivers of personal vehicles were having a difficult time hearing Emergency Medical Service (EMS) vehicles when driving with their radio on or while operating a hands-free cell phone which may be a leading factor in many of the estimated 9,000 EMS accidents a year. Information will be collected from accident reports and personal interviews will be conducted with EMS personnel who have been involved in a vehicular accident while driving an EMS vehicle. Similarities found in the interviews and accident reports that may explain why vehicular accidents involving EMS occur will be recorded. The accident reports which will be analyzed will have occurred in the past five years and will have transpired within the State of Utah. One-on-one interviews will be conducted about the accident in the State of Utah and with EMS personnel that have been in a vehicular accident in the past 5 years while driving an EMS vehicle. It is hypothesized that many of the vehicular accidents involving EMS drivers occur due to drivers in personal vehicles not noticing EMS vehicles in enough time to clear the way. It is believe the results gathered from the interview and accident reports will show that drivers do not see/hear EMS vehicles very well when distracted. In the cases where the EMS driver was found at fault for the accident, it may be due to having to resort to unsafe driving practices because they are responding to an emergency and the drivers in personal vehicles are not moving out of the way in a timely manner or simply not at all. It is anticipated that the results of this study should be available late December.

Heather Peatross, Southern Utah University Agriculture and Nutrition Sciences Complementary and Alternative Medicine (CAM) is defined as any ingestible herb, supplement, or other substance used to increase one’s health or well-being both physically and mentally. National studies have examined the usage of CAM. In 2007, the latest year surveyed by the National Center for Complementary and Alternative Medicine (NCCAM), approximately 38% of adults in the U.S. were using some form of CAM with the greatest usage among women and persons with higher education and income levels. Non-vitamin/mineral natural products are the most commonly used CAM therapies. Americans spent $33.9 billion out-of-pocket on CAM over the previous 12 months. Little information regarding CAM use and knowledge in a rural college-age population is available. The purpose of this study is to examine the knowledge Southern Utah University (SUU) students have of CAM, usage by this population, and the reasons for using these products. Do SUU students typically use CAM therapies in their daily lives? Do SUU students use CAM primarily when ill? Are SUU students using CAM as a replacement for traditional (western) medicine? What types of CAM are being used (particularly herbal or dietary supplements)? It is hypothesized that the majority (>50%) of CAM users do not discuss their alternative therapies with a health care physician. Additionally it is hypothesized that students that have been diagnosed, or have a family member that has been diagnosed, with cancer are more knowledgeable/more likely to have used CAM therapies. Four hundred and eighty students were surveyed in a convenience sample of fourteen general education classes at SUU. The survey asked about usage of CAM therapies (including for health or sport performance), overall experience with CAM products used, sources of health advice, and any discussion with their medical physician regarding CAM use. Study results and conclusions are pending.

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