Digital Commons Network^™

Patient Satisfaction With Substance Use Disorder Rehabilitation Services, Trupti Dhumal

Electronic Theses and Dissertations

Background: Patient satisfaction is considered as an important indicator in the evaluation of healthcare quality across an array of treatments and services. It is deemed vital especially in the field of substance use disorder (SUD) research due to an increased emphasis on understanding patients’ perceptions regarding their treatment and the attributes that drive their progress towards recovery. Despite the potential value, gaps have been recognized in the exploration of these satisfaction-related assessments among patients undergoing SUD treatment in residential rehabilitative settings. Thus, there is a need for understanding the dimensions contributing to satisfaction which would facilitate the development of …

Determining Nurse Practitioner Core Competencies Utilizing A Delphi Approach, Tracey Chan

Electronic Theses and Dissertations

Background: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined.

Purpose: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies,(AACN, 2017a) …

Characterization Of The Effect Of Exercise Dose And Integrative Nonpharmacological Therapies In The Treatment Of Chronic Pain, Anna M. Polaski

Electronic Theses and Dissertations

Chronic pain includes debilitating conditions affecting large populations of people throughout the world. These diseases are further complicated by comorbid psychological disorders which make chronic pain conditions difficult to treat. Nonpharmacological treatment options have more recently become an important mainstay of effective therapies and are currently being used to supplement or replace traditional pharmacological treatment methods. Exercise-based therapies in particular are of interest due to their demonstrated success in reducing pain symptoms as well as improving psychological outcomes. Dose is an important factor in being able to effectively prescribe treatments in the context of specific exercise interventions and specific pain …

The Ethical Justification Of Increasing Awareness Of Preventive Medicine Among Healthcare Professionals, Patients And The General Public In The United States, Karishma Ether Moazzam

Electronic Theses and Dissertations

While practiced for centuries, preventive medicine has received increased attention during the recent times. Preventive medicine has a distinct mission to protect, promote, and maintain health as well as to prevent diseases, disabilities, and premature deaths. It aims to fulfill its mission through the combined form of clinical intervention and health promotion. In the recent years, preventive medicine has begun to lean more towards the clinical interventions, taking away from the health promotion. This imbalance has caused preventive medicine to lose its effectiveness in fulfilling its mission. One of the leading causes for such imbalance is the lack of proper …

Design, Synthesis, & Biological Evaluation Of Novel Het-Aromatic/Aromatic Analogs For The Treatment Of Hiv, Cancer, & Cognitive Dysfunctions, Mohit Gupta

Electronic Theses and Dissertations

Cyclophilin A are a class of peptidyl-prolyl isomerases that catalyzes isomerization of the proline residue within a protein. Cyclophilin A plays an instrumental role in the pathogenesis of HIV and HCV virus. Using structure-based drug we designed and synthesized small molecule inhibitors of cyclophilin A. These inhibitors were biologically evaluated for their ability to inhibit WT HIV-1 inhibition.

Mitogen-Activated Protein Kinase signaling cascades plays a critical role in cancer cell survival, metastasis, and chemo-resistance. The MEK5/ERK5 pathway, which is a member of MAPK signaling cascade, is involved in cell survival, anti-apoptotic signaling, angiogenesis, and cell motility. It is found to …

Emergency Department Nursing Psychological Care (Early Crisis Intervention) For Adult Victims Of Violent Crime: A Quantitative Study, Barbara Conn

Electronic Theses and Dissertations

Recognition of the significance of early interventions and the importance of addressing psychological trauma for the victim of violence is of utmost importance for quality of life and the victim’s future. The serious impact of psychological trauma on victims of violent crime supports further study to determine whether Emergency Department (ED) nurses assess this trauma and initiate early interventions and referral for ongoing psychological care. Nursing care, assessment and early intervention with victims of violent crime was the focus of this dissertation study.

A quantitative study, with a non-experimental, descriptive design employed retrospective chart reviews to determine whether ED nurses …

A Quantitative Study Of Drug Recrystallization In Drug-In-Adhesive Transdermal Patches Using Vibrational Spectroscopy, Yi Li

Electronic Theses and Dissertations

Drug-in-adhesive (DIA) transdermal patches are an important type of transdermal drug delivery system (TDDS). The drugs used in the DIA system are frequently present in metastable forms, such as amorphous solids or supercooled liquids. These drug states are thermodynamically unstable and tend to undergo recrystallization. Recrystallization of the active pharmaceutical ingredient can adversely affect the efficacy of transdermal products. This dissertation demonstrates a systematic approach to quantify the crystalline content of the API in DIA systems. This approach uses a novel method of preparing calibration standards and a spectroscopic method to reliably predict crystalline content in DIA patches. Spectroscopic tools, …

Carer Information Needs Following A Family Member's Right Hemisphere Stroke, Christyn Davidson

Electronic Theses and Dissertations

Background: Previous studies have explored information needs for carers of persons with aphasia; however, there is minimal research on information needs of carers with right hemisphere disorder (RHD). RHD describes cognitive and communication impairments a person experiences following a right hemisphere stroke or brain injury. Carers have an important role in rehabilitation and the long-term quality of life of a person with RHD. This study explores the information needs for carers following a family member’s right hemisphere stroke throughout different periods of recovery.

Methods/Procedures: Participants completed online surveys and a semi-structured phone interview. Analysis of the interviews revealed four major …

Humeral Retroversion, Range Of Motion, And Strength Adaptations In Tennis Players, Daniel Hannah

Electronic Theses and Dissertations

Purpose: This study aimed to develop an understanding of humeral retroversion (HRV) asymmetries in tennis players and its impact on physical and performance characteristics of the shoulder.Participants: Healthy tennis players were categorized into 3 groups: younger juniors (n=11, age=14.5±0.5 years), older juniors (n=12, age=17.1±0.9 years), and collegiate (n=16, age=19.6±1.2 years). Methods: HRV, internal rotation (IR), and external rotation (ER), total arc of motion (TAM), HRV-corrected IR (HRVcIR), and HRV-corrected ER (HRVcER) were measured and calculated bilaterally using a digital inclinometer and ultrasonography. Bilateral differences (Δ) were calculated (dominant minus nondominant) for HRV and ROM variables. Isometric ER:IR strength ratios …

Cultural Aspects Of End Of Life Advance Care Planning For African Americans: An Ethnonursing Study, John Collins

Electronic Theses and Dissertations

Introduction: Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are impacted by demographic variables, cultural distinctives related to patient autonomy, mistrust of the healthcare system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. End of Life (EOL) advance care planning (ACP) promotes patient and family centered care. The purpose of this study was to identify culturally based meanings, expressions, and traditions of EOL ACP and decision making among African Americans, to better understand and provide culturally congruent nursing …

Dual Inhibition Of The Pi3k/Akt And Mek5/Erk5 Pathways For The Treatment Of Breast Cancer, Thomas Douglas Wright

Electronic Theses and Dissertations

Breast cancer is a heterogeneous disease state with several challenging frontiers. In particular, aberrations in the Phosphoinositide-3-kinase (PI3K) and Mitogen Activated Protein Kinase (MAPK) pathways have been linked to increased breast cancer proliferation and survival. It has been proposed that these survival characteristics are enhanced through compensatory signaling and crosstalk mechanisms. New evidence suggests that MEK5/ERK5, a member of the MAPK family, is a crucial component in the proliferation and survival of several aggressive cancers. We hypothesize that inhibiting both PI3K/Akt and MEK5/ERK5 pathways will decrease cell viability while maintaining limited collateral toxicity. In this study, we examined the effects …

Design And Synthesis Of Pyrimidine Based Heterocycles As Potential Anti-Cancer Agents With Combination Chemotherapeutic Potential Or Targeted One Carbon Metabolism Inhibition And Anti-Opportunistic Agents, Arpit Doshi

Electronic Theses and Dissertations

This dissertation describes the design, synthesis and biological evaluation of monocyclic, bicyclic and tricyclic pyrimidine-based heterocycles as a) single agents with combination chemotherapy potential having dual antiangiogenic effects and cytotoxic effects or b) one-carbon metabolism inhibitors for targeted tumor therapy; or c) selective Pneumocystis jirovecii (pj) dihydrofolate reductase (pjDHFR) inhibitors for pneumocystis pneumonia (PCP) infection.

The work in this dissertation is centered on identifying structural features that are necessary for inhibition of tubulin polymerization or thymidylate synthase as well as for inhibition of one or more of the receptor tyrosine kinases (RTKs)- vascular endothelial growth factor receptor-2 (VEGFR2), epidermal growth …

The Development Of Hybrid Process Control Systems For Fluidized Bed Pellet Coating Processes, Hanzhou Feng

Electronic Theses and Dissertations

The conventional basic control for pharmaceutical batch processes has several drawbacks. The basic control often uses constant process settings discovered by trial and error. The rigid process operation provides limited process understanding and forgoes the opportunities of process optimization. Product quality attributes are measured by the low efficient off-line tests, therefore these cannot be used to monitor and inform the process to make appropriate adjustments. Frequent reprocessing and batch failures are possible consequences if the process is not under effective control. These issues raise serious concerns of the process capability of a pharmaceutical manufacturing process.

An alternative process control strategy …

The Effect Of Functional Movement Control On Patient-Reported Outcomes In Individuals With Non-Arthritic Hip Pain, Ryan Mcgovern

Electronic Theses and Dissertations

Purpose: Both the single leg squat test and step-down test assess for deficiencies relating to the hip and surrounding musculoskeletal structures and could be useful in the evaluation of functional movement control for individuals with non-arthritic hip pain. The purpose of this study is to determine if individuals with non-arthritic hip pain that improve functional movement control during the single leg squat test and step-down test have better patient-reported outcomes than those that do not improve, following the implementation of a rehabilitation intervention and a standardized home-exercise program.

Subjects: Forty-six individuals (31 females; 15 males) with a mean age of …

Exploring Maternal Factors Linked To Weight Status In Salvadorian Infants, Carmen M. Kiraly, Melanie Turk, Melissa Kalarchian, Cheryl Shaffer

Electronic Theses and Dissertations

Background: Obesity rates in the US have risen dramatically, especially among Hispanic adults and children. Because of the high prevalence of overweight and obesity in Latino children by preschool age, it is prudent to examine maternal factors potentially linked to weight status during an infant’s first year of life. The literature on risk factors of child obesity has focused primarily on children of Mexican descent, and little research exists for other Latino populations, such as Salvadorans. Objective: To investigate maternal physiologic and infant feeding factors associated with infant overweight and/or obesity in a sample of Salvadoran mother-infant dyads. Methods: A …

The Lived Experience Of Recovery Following Transoral Robotic Surgery (Tors) For Head And Neck Cancer, Katharine Mahalik

Electronic Theses and Dissertations

Abstract

Ongoing advances in minimally invasive surgical techniques, such as transoral robotic surgery (TORS), has enabled select patients with head and neck cancer to receive treatment that results in less disfigurement and dysfunction compared with traditional approaches. While TORS research has focused mainly on functional surgical outcomes, a need exists to understand recovery following TORS from the patient perspective. A hermeneutic phenomenological approach was used to recruit patients who had recently undergone TORS at a major academic health system in northeastern US. Data were collected using audio-recorded telephone interviews and field notes and analyzed concurrently. Participants included 17 HNCS (12 …

The Effects Of Learning Mindfulness Based Stress Reduction On Psychosocial Variables And Hba1c In Adolescents With Type 1 Diabetes, Denise Van Sant - Smith

Electronic Theses and Dissertations

ABSTRACT

THE PHYSIOLOGICAL AND PSYCHOSOCIAL EFFECTS OF AN ONLINE MINDFULNESS BASED STRESS REDUCTION INTERVENTION ON ADOLESCENTS WITH TYPE 1 DIABETES

By

Denise E. Van Sant – Smith

Date: 4-5-2019

Dissertation Supervised by Linda Goodfellow, PhD, RN, FAAN

Background: Stress has been shown to increase glucose levels through a sympathetic physiological response resulting in a release of chemicals such as adrenalin and cortisol, a response which results in an even greater need for insulin. Adolescents with Type 1 Diabetes may not be able to change or decrease the amount of stress in their lives but they may be able to …

Modeling And Prediction Of Amorphous Solid Dispersion Formation Using A Molecular Descriptor, Kevin Deboyace

Electronic Theses and Dissertations

Poor aqueous solubility of an active pharmaceutical ingredient (API) is a significant hurdle during drug development. Delivering a drug in its amorphous solid-state is a potential method to overcome this issue, since the amorphous form has increased apparent aqueous solubility. However, the amorphous state is only metastable, and is thermodynamically driven to recrystallize. As a result, pure amorphous drugs are seldom used in marketed products. Intimately mixing a drug in its amorphous form with a polymer, known as an amorphous solid dispersion (ASD), has the potential to significantly extend the physical stability of the amorphous form, while maintaining the benefit …

Public Health Policy: An Ethical Analysis Of Quarantine, Dina Alqahtani

Electronic Theses and Dissertations

As a public health measure quarantine has both historical and contemporary significance both in the United States and abroad. On the surface it represents a low-cost, low-tech way in which the spread of disease can be mitigated as its core requirement is that those who may have been exposed to an infectious agent are kept away from those who have not been exposed to that agent for enough time to determine whether or not infection has been spread. This has been utilized for centuries with both limited questions and scattered, inconsistent, or impossible to achieve oversight and goals. In understanding …

An Ethical Analysis Of Reproductive Justice In The Context Of The Egenics Movement In The United States, Bernetta Welch

Electronic Theses and Dissertations

The history of forced sterilization and the American cultural agreement with this practice robbed women of color of control of their own bodies, destinies, and communities. Negative eugenics as genetic proof of low intelligence, low possibility, and low productivity fed the system of compulsory sterilization even though the science proved faulty and incorrect. As advances in medical technology and genetic science increases, eugenics is making a return into the American psyche. Vulnerable populations which include women of color make reproduction and the subsequent control of their bodies vulnerable once again.

The Reproductive Justice Movement is a collaboration of organized women …

Precision Medicine And It's Ethical And Social Implications: Public Health And Gobal Persepctives, Evangel Sarwar

Electronic Theses and Dissertations

Ever since President Obama's launch of the Precision Medicine Initiative (PMI) in 2015, precision medicine (PM) has been anticipated as the new paradigm for healthcare with the capacity to “empower patients, researchers, and providers to work together toward the development of individualized care,” through research, technologies, and policies (President Obama, 2015). Precision Medicine (PM), in the form of genomics, offers unprecedented promise of providing new tools for improving health and reducing the burden of diseases, not just for the U.S. - but also globally. According to World Health Organization, genomics research and precision medicine will play a major part in …

The Ethical Challenge Of Conflicts Of Interest In Healthcare, Fahad Alhazmi

Electronic Theses and Dissertations

Conflicts of interest are prevalent across all walks of society, and unfortunately, the healthcare industry is not immune to these impediments. Conflicts of interest arise when the objective of upholding a patients’ interest collide with the physicians’ secondary goals and is mostly but not always related to monetary gain.

To avoid conflict of interest, it is advisable for medical practitioners to weigh the pros and cons that their actions would inflict. Medical practices whose benefits outweigh the associated risks are ethically upright hence avoid conflict of interest.

Each section proposes solutions for the conflicts of interest encountered at the disparate …

“I Do Have A Softer Side”: A Phenomenological Investigation Of The Prisoner-Dog Relationship In The Canine Partners For Life Training Program, Kathleen Kocherzat

Electronic Theses and Dissertations

This qualitative study investigated the relationship between incarcerated dog handlers and the service dogs they trained. Six men at a large northeastern prison were interviewed during the summer of 2017; all were current or former dog trainers in the Canine Partners for Life (CPL) training program. The men were serving prison sentences ranging anywhere from several years to life without parole. The interviews focused on their lived experience, rasing and training puppies for a period up to eighteen months. The qualitative data consisted of approximately thirteen hours of transcribed interviews, which were then interpreted using the phenomenological psychological method developed …