Digital Commons Network^™

The Association Between Depression, Anxiety And Clinical Outcomes For Type 2 Diabetes Mellitus, Elham Heidari

Electronic Theses and Dissertations

Objective: To evaluate the impact of depression and/or anxiety on clinical outcomes of diabetes, including glycosylated hemoglobin (HgA1c), blood glucose, blood pressure, total cholesterol, weight and LDL among patients with incident type 2 diabetes mellitus (T2DM).

Method: A retrospective cohort study utilizing electronic medical record (EMR) data from a primary care physician (PCP) group practice was conducted to identify patients newly diagnosed with T2DM with at least 6 months pre-diagnosis and 12 months post-diagnosis of EMR data using International Classification of Disease 9th edition Clinical Modification (ICD-9-CM) coding. The presence of comorbid depression and anxiety was identified to identify four …

Community Pharmacists And Substance Use Disorders: Attitudes, Knowledge And Practices, Deepika Rao

Electronic Theses and Dissertations

Background: Substance use disorder (SUD) is a serious health concern affecting a large proportion of the US population. Community pharmacists are well-positioned to prevent, screen, and provide appropriate treatment for SUD. Stigma towards these patients and SUD results in reduced quality of care as well as poor treatment outcomes. It is imperative that pharmacists have the appropriate knowledge of and attitude towards prevention, harm reduction and treatment to develop therapeutic relationships and improve their delivery of pharmacy services

Objective: To assess knowledge, practices (with an emphasis upon screening), stigma and general attitudes of community pharmacists towards SUD and evaluate the …

Access To Care And The Use Of Healthcare Services By Women In Rural Cameroon: A Participatory Action Research Study, Grace Tadzong-Awasum

Electronic Theses and Dissertations

Women in rural Cameroon do not access health care as timeously and as often as they should. They fail to get screened for common diseases, with the consequence that such diseases are often diagnosed at a very advanced stage. This accounts for the high morbidity and mortality rates as well as low life expectancy recorded among women. The purpose of this study was to explore and understand the health access experiences of women in rural Cameroon. Methodology: Participatory action research was used guided by a Focused ethnography in phase one. Twenty-five women aged 21-77 years were recruited through local the …

Take Charge For Therapy Discharge: Outcomes Of A Patient Education Program Applying The Co-Op Approach, Kathryn Westley

Electronic Theses and Dissertations

A thorough needs assessment at HealthSouth Rehabilitation Hospital of Largo revealed slight dissatisfaction scores on the Press Ganey survey for both the occupational therapy department and discharge planning processes. This quality improvement project, Take Charge for Therapy Discharge, implemented a two-session patient education protocol using the Cognitive Orientation to Occupational Performance (CO-OP) approach. Using the Patient-Specific Functional Scale (PSFS), participants identified and prioritized three therapy goals and rated their perceived current performance. Results demonstrated a significant difference between the participants’ PSFS pre and post-intervention scores. Patients’ improved self-perceived goal attainment scores served as evidence that, in addition to using …

Probiotic Use In Trauma Patients: A Pathway To Determining The Standard Of Care To Improve Outcomes, Heather Vitko

Electronic Theses and Dissertations

The gut microbiome consists of normally non-pathogenic bacteria, viruses, and fungi. These friendly microbes serve to maintain GI barrier function and integrity, play a role in host nutrient and drug metabolism, immunomodulation, and prevent pathogenic bacteria from colonizing or causing disease. The importance of a healthy microbiome for the overall health of the host is just recently being appreciated within the medical and science communities. Disruption of the microbiome places one at greater risk for illness and infection. Patients who suffer a traumatic injury are among those at highest risk for complications associated with microbial imbalance, or dysbiosis. In addition …

Using An In Vitro-In Vivo Correlation For The ‘Bioequivalence By Design’ Development Of An Immediate Release Carbamazepine Product, Douglas Steinbach

Electronic Theses and Dissertations

The quality of a drug product may be characterized by the consistency with which its indicated clinical effect, and safety profile, is experienced by the patient. The concept that such quality should be built into a product is at the core of the United States Food and Drug Administration’s (FDA) quality by design (QbD) initiative. This vision for pharmaceutical product development emphasizes the risk-based identification of critical quality attributes (CQA) which summarize a product’s performance, the efficient refinement of critical product/process parameters (CPP) that can affect such attributes, and the systematic development of CPP limits, which assure appropriate performance of …

Synthesis Of Novel 6-Substituted And 5-Substituted Pyrrolo[2,3-D] Pyrimidine Antifolates As Targeted Anticancer Therapies, Xinxin Li

Electronic Theses and Dissertations

The dissertation will give an introduction, background and current research progress in the areas of antifolates and chemotherapy of anticancer. The design and synthesis of classical 6- substituted pyrrolo[2,3-d]pyrimidines and 5-substituted pyrrolo[2,3-d]pyrimidines as potential antifolates have been described. The design variations include: methylated thiophene regioisomers, fluorinated phenyl regioisomers, thionyl regioisomers on the side chain of pyrrolo[2,3-d]pyrimidines. As a part of this study, a series of new compounds have been synthesized and characterized. Of these, ten final compounds were submitted for biological evaluation.

Independence Through Patient Education In A Spinal Cord Injury Population, Justin Mctish

Electronic Theses and Dissertations

The Know More, Live Better program was developed because the population of people with Spinal Cord Injuries (SCI) includes a substantial number of young people, who often readmit into hospitals for preventable causes such as pressure ulcers, respiratory infections, and bowel/bladder infections. These complications can be avoided through patient education. A needs assessment was conducted at the SCI unit at Good Shepherd Rehabilitation Hospital in Allentown, PA. This assessment included structured observation of patient education in the therapy process, semi-structured interviews about site needs and patient education topics completed with patients and occupational therapists on staff, and surveys of multi-disciplinary …

Characterization Of G-Protein Coupled Receptors In Pain, Depression And Anxiety, Neil Lax

Electronic Theses and Dissertations

Chronic pain and major depressive disorder are widespread conditions in the world. Interestingly, these conditions often occur comorbidly, with each individual disease amplifying the symptoms of the other. A significant amount of preclinical research in pain and depression focuses on G-protein coupled receptors (GPCRs), implying that GPCRs may be useful in treating this comorbidity. Our efforts have sought to characterize several poorly understood GPCRs, including the serotonin receptor subtypes 2C and 7 (5-HT2CR and 5-HT7R) and metabotropic glutamate receptor 5 (mGluR5), along with more well-known GPCRs such as the mu opioid receptor (MOR), and the role that they play in …

Tumble Tots: Outcomes Of A Gymnastics Program For Children With Disabilities, Cayla Leichtenberger

Electronic Theses and Dissertations

Despite the benefits, children with disabilities do not participate in recreational activities as often as typically developing peers. The purpose of the program was to: 1) describe the benefit of a gymnastics program on a child’s development, and 2) identify the impact of a staff training program. Engagement in the proposed program aimed to ultimately contribute to a child’s involvement in recreational activities, health and quality of life (QOL). All participants in the gymnastics program demonstrated a positive change in motor and communication skills. Pre-test data from the staff training program indicated that none of the gymnastics staff members were …

Sensory-Based Programming In Mental Health: Sense Of Self, Nikki Yeckel

Electronic Theses and Dissertations

The doctoral experiential component (DEC) for this Capstone was completed at the Veterans Affairs Healthcare System (VA) in Pittsburgh, Pennsylvania. The program, called Sense of Self, was implemented with the Veteran mental health (MH) population in an inpatient psychiatric rehabilitation unit at the VA. Sense of Self was a three-day educational program that educated Veterans on the sensory systems and sensory processing, provided calming or alerting strategies with use of sensory materials, and assisted the Veterans in creating sensory home programs based on personal goals. The goals of this Capstone were to inform the staff of the Veteran demographic population …

The Influence Of Age, Gender, And Thiol Repletion In An In Vivo Model Of Lewy Body Disorders, Daniel Mason

Electronic Theses and Dissertations

Lewy body disorders are a family of neurological brain disorders associated with olfactory, motor, and cognitive deficits and are collectively defined as α-synucleinopathies, as they are characterized by hallmark “Lewy bodies” composed of aggregated, fibrillar α-synuclein. It is not certain but often posited that fibrillar α-synuclein seeds the progressive, self-propagating spread of Lewy pathology through neuroanatomical circuitry. Furthermore, the site of disease induction is still debated. In Aim I, we developed a novel protocol for generating reproducible and robust α-synucleinopathy in the limbic temporal lobe following infusions of preformed α-synuclein iv fibrils into the mouse olfactory bulb, which is frequently …

Ultrasound Visual Biofeedback And Accent Modification: Effects On Consonant And Vowel Accuracy For Mandarin English Language Learners, Courtney Armstrong

Electronic Theses and Dissertations

The number of individuals in the United States who speak languages other than English continues to increase. With the increase of language diversity comes a potential rise in communication challenges for those who speak with non-mainstream American English accents as English language learners. A portion of these individuals may elect to seek accent modification services, perhaps due to decreased intelligibility or communication breakdowns. Thus, speech-language pathologists must research and provide effective techniques to enhance intelligibility of all American English speakers for optimal communication. Few approaches employ a variety of treatment methods to improve speech sound accuracy, naturalness and intelligibility to …

Effects Of Natural Antioxidants On Motor And Cognitive Deficits In An Animal Model Of Aging And Obesity And Dopaminergic-Like Sh-Sy5y Cell Line, Sneha Potdar

Electronic Theses and Dissertations

Aging is a universal phenomenon. One of the greatest challenges faced by the elderly population is to sustain a healthy standard of living. Advancing age is associated with increased motor and cognitive deficits. Loss of balance, falls, hip fractures, and poor memory all contribute to a decline in the quality of life of the aging population. While ongoing research is making advances to find therapeutic interventions for neurodegenerative disorders like Parkinson’s and Alzheimer’s diseases, there is a pressing need to address deficits associated with normal aging.

Increase in oxidative stress and a decline of antioxidant mechanisms with aging have been …

The Association Of Prescription Opioid Exposure And Patient Factors With Prolonged Postoperative Opioid Use In Opioid Naive Patients, Jennifer Lanzillotta

Electronic Theses and Dissertations

Background

Research suggests prolonged postoperative opioid use occurs in 4-13% of opioid naïve patients and is related to factors other than surgical pain. However, it is unclear which patient factors and prescribing practices are associated with prolonged use after surgery among opioid naïve patients.

Objectives

To identify factors associated with prolonged postoperative opioid use (refills 90-180 days after surgery) in opioid naïve patients in two domains: specific patient characteristics (demographics, smoking status, comorbidities, etc.) and exposure through postoperative opioid prescriptions (in oral morphine milligram equivalents [OME]).

Methods

An electronic medical record dataset analysis of inpatient and outpatient opioid naïve adult …

Workplace Bullying, Nurse Practice Environment, Patient Outcomes: A Descriptive Study, Noreen Houck

Electronic Theses and Dissertations

Better nursing practice environments are associated with improved patient safety, yet little is known about the nurse’s experiences of bullying or flourishing within the practice environment. This study described nurses’ experiences of workplace bullying and flourishing and identified associations with patient outcomes.

The study used an exploratory cross-sectional survey design following Donabedian’s Quality Framework of structure-process-outcome and informed through critical feminist theory. The study took place at a large medical facility in the northeastern United States. A multi-instrument survey included four sections. The demographic section and the Practice Environment Scale of the Nurse Work Index (PES-NWI) were used to measure …

The Effect Of The Movie Time Social Learning Method On The Emotional Inferencing Skills In An Adult With Autism Spectrum Disorder, Jenna Reade

Electronic Theses and Dissertations

Individuals with autism spectrum disorder (ASD) have difficulty finding employment and maintaining social relationships. Professional and personal interactions require individuals to make inferences, or read between the lines. Inferencing is a challenge for individuals with ASD because it requires complex information processing. More specifically, it involves the integration of cognitive and linguistic information. There is a lack of research using complex stimuli to treat inferencing. An A-B-A-B design with one adult with ASD was used to examine the effectiveness of a movie-based method, Movie Time Social Learning(Vagin, 2012), on improving the emotional inferencing skills of one young adult with …

Self-Assembling Bioaffinity Hydrogels For Localized Antibody Delivery, Wen Liu

Electronic Theses and Dissertations

The scope of illnesses that are being treated using monoclonal antibodies (mAbs) has been expanding from cancers to autoimmune diseases due to their high specificity to their molecular target. Because many of the new mAbs are aimed to modulate the immune system, an emerging concern is that patients with chronic illnesses are subjected to immune-related Adverse Events (irAEs). Loss of immunological tolerance to self-antigens or increased susceptibility to infections have been documented in some mAb treatments. Localized sustained release of mAb at disease sites might mitigate the risk of such toxicities. Antibody drugs are formulated typically for parenteral delivery because …

The Myth Of Promiscuity: Examining Black Male Sexual Narratives And Sexual Identity, Seth Young

Electronic Theses and Dissertations

Black masculinity and sexuality are common topics across areas of philosophy, psychology, cultural studies and others. Yet, these topics are dedicated to the racial narrative of hypersexual Black male, the sexual objectification of Black men, and their presumed promiscuity. While such topics are important, there is little qualitative research that looks at the complexity and emotionality of African American men’s sexual experiences. Using the theoretical research on black masculinity and sexuality as its backdrop, this dissertation explores how heterosexual, African American men experience their sexuality. The study incorporates narrative inquiry and in-depth, semi-structured interviews to gather stories of five African …

Macromolecule Loading On Plga Particles Through Surface Adsorption, Yiwei Wang

Electronic Theses and Dissertations

The advent of biotherapeutics have impacted the ways in which diseases are treated. In many instances development of recombinant proteins and oligonucleotides into therapeutics are slowed by poor stability of the candidate drugs. Progress has been made in using polymeric particles as carriers of macromolecule drugs. Historically the method is to encapsulate biological drugs into spherical polymeric matrices. Owing to its biocompatible and biodegradable nature, poly (d,l-lactic-co-glycolic acid) (PLGA) has been used extensively in formulating biological drugs into nano- and micro-sized particles. The development of PLGA biologic formulations, however, has been hampered by matrix acidification; the hydrolysis of the polymer …

The Association Between Medication Adherence In Mental Illness And Substance Use Disorder Relapse In Patients With Dual Diagnosis, Tyler Dunn

Electronic Theses and Dissertations

Objectives: The aims of the study were to (1) identify personal, social, and clinical history for patients with substance use disorder (SUD) and mental illness, (2) measure agreeance between patient self-report versus facility record history for mental illness, substance abuse, and psychotropic medication, (3) investigate the specific role of medication adherence and barriers to use for psychotropic medications upon SUD relapse, and (4) assess follow-up changes in mental illness severity and medication adherence in dual diagnosis patients enrolled in a substance abuse rehabilitation program.

Methods: The pilot study utilized a mixed methodology. Inclusion criteria included male patients at least 18 …

Synthesis Of Novel 5-Substituted Pyrrolo[2,3-D]Pyrimidine Antifolates As Selective And Potent Anti-Tumor Agents, Mohammad Karim

Electronic Theses and Dissertations

In last few decades many folate analogs have been discovered and several compounds are successfully being used as anticancer agents. Methotrexate (MTX), pemetrexed (PMX), raltitrexed (RTX): are a few examples of classical antifolates that are currently in clinical use. Although these compounds are widely used, all of them show dose limiting toxicity due to their non-specific transport into normal cells as well as malignant cells. Currently, clinically used classical antifolates suffer from this disadvantage because there is no way to selectively transport them into malignant cells. Currently available antifolates are transported via reduced folate career (RFC) as well as Folate …

The Logic Of Sexuation In Deleuze And Lacan, Matthew Lovett

Electronic Theses and Dissertations

In The Logic of Sexuation in Deleuze and Lacan, I argue for an account of sexual difference that responds to a tension in feminist philosophy, namely, the problem of the ontological status of the sexed body. In so doing, I turn to the work of Gilles Deleuze and Jacques Lacan. I argue that, rather than being antithetical, the two can be productively read together, in particular with regard to this very question. Ultimately basing my reading in the Deleuzian passive syntheses and dynamic geneses of Difference and Repetition and The Logic of Sense as well as in Lacan’s twentieth …

Key Components For An Ethics Consultation Curriculum, Joseph Bertino

Electronic Theses and Dissertations

Due to a lack of formal credentials for clinical ethics consultants, the professionalization of clinical ethics as a normative discipline in contemporary American health care is diminished amongst other health care professionals. While medical specialties, organizational leadership positions, and other miscellaneous health care occupations possess governing bodies that posit credentials that justify these roles, clinical ethics consultants lack a standard of competence. While this gap has been temporarily reconciled by individual employer criteria, a national standard that attempts to educate and demonstrate a clinical ethicist’s abilities does not exist. Still, various attempts have been made to establish a certification program …

The Effect Of A Mindfulness Intervention On The Depression Symptoms Of Mothers In Treatment For An Opioid Use Disorder, Karen Alexander

Electronic Theses and Dissertations

BACKGROUND: Mothers in treatment for an opioid use disorder experience a high prevalence of depression which may influence their relationship with their child. In the general population, mindfulness-based parenting intervention has been seen in the literature to have a clear positive effect on maternal depression. No research has been published regarding the effect of mindfulness intervention on maternal depression of women in treatment for an opioid use disorder.

OBJECTIVES: To describe the characteristics of mothers in treatment for opioid use disorder, including depression and adverse childhood experiences, and to evaluate the characteristics associated with participation in a mindfulness intervention. Lastly, …

The Relationship Between Perceptions Of Patient Safety Culture, Nurse Advocacy, And Nurse Sensitive Patient Outcomes, Margaret Dicuccio

Electronic Theses and Dissertations

The purpose of the study was to understand relationships between and among patient safety culture, nurse reported attitude toward patient advocacy and key patient outcomes. Nurses play an integral role in patient safety, providing care through constant interaction with the patient and clinical team. Advocating for patients is part of that role; however little research existed that explored how advocacy was related to the safety culture or specific patient outcomes.

A correlational cross-sectional design was chosen for this secondary data analysis. Correlation and regression models were applied to medical/surgical unit data from seven facilities within one hospital system. Sources of …

Melatonin-Micronutrients Osteopenia Treatment Study (Mots): A Translational Study Assessing The Effects Of Melatonin, Strontium Citrate, Vitamin D3 And Vitamin K2 On Bone Density, Bone Turnover Markers And Health-Related Quality Of Life In Postmenopausal Osteopenic Women Following A One-Year Double-Blind Randomized Placebo-Controlled Trial And On Osteoblast-Osteoclast Co-Cultures, Sifat Maria

Electronic Theses and Dissertations

Objective: The purpose of this study was to assess if a novel combination of melatonin and three other natural bone-aiding micronutrients: strontium citrate, vitamins D₃ and K₂ (MSDK) could improve bone health by modulating the activity of osteoblasts and osteoclasts in favor of balanced bone remodeling and by improving the overall health-related quality of life in postmenopausal osteopenic women.

Methods: The Melatonin-micronutrients Osteopenia Treatment Study (MOTS) is a translational research study that used both clinical and in vitro approaches to assess the efficacy of MSDK on bone health in women and to identify potential mechanisms for its effects. …

Designing A Calibration Set In Spectral Space For Efficient Development Of An Nir Method For Tablet Analysis, Md Anik Alam

Electronic Theses and Dissertations

Designing a calibration set is the first step in developing a spectroscopic calibration method for quantitative analysis of pharmaceutical tablets. This step is critical because successful model development depends on the suitability of the calibration data. For spectroscopic-based methods, traditional concentration based techniques for designing calibration sets are prone to have redundant information while simultaneously lacking necessary information for a successful calibration model. The traditional method also follows the same design approach for different spectroscopic techniques and different formulations, thereby lacks the optimizing capability to be technique and formulation specific.

A method for designing a calibration set in the Near …

Comparison Of Two Methods Of Pediatric Triage Education, Catherine Recznik

Electronic Theses and Dissertations

Introduction. The majority of pediatric emergency patients are seen in mixed-age emergency departments and triaged by general emergency nurses. Educational methods for teaching pediatric triage education to general emergency nurses have not been well studied, and previous studies of the use of the Emergency Severity Index in children have been performed primarily in centers that are high volume for pediatrics. Methods. A repeated measures, randomized crossover study comparing two different methods of pediatric triage education was conducted. Participants were general emergency triage nurses recruited from a general emergency department that is classified as low volume for pediatrics. Each participant was …

The Core Relation Between Hospitality (Philoxenia), Dignity And Vulnerability In Orthodox Christian Bioethics: A Contribution To Global Bioethics, Rabee Toumi

Electronic Theses and Dissertations

In a pluralistic world, reaching consensus in matters of bioethics has proved to be difficult, especially with the political polarization that nurtures inimical differences. This dissertation argues that a middle ground can be identified between the plurality of value systems in contemporary bioethics based on an anthropological approach. This middle ground that reflects commonalities of the human condition can be explored in relation to the foundational principles of Orthodox Christian anthropology. To identify this middle ground the analysis discusses the core relation between hospitality, dignity, and vulnerability as a contribution to global bioethics.

In general, based on Orthodox Christian theology …