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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 …

An Ethical Framework For Organizational Resource Allocation For Patient Services In Health Care, Natalie Dick

Electronic Theses and Dissertations

Unanswered questions on how to allocate scarce resources in health care settings are often left to either bedside decision-making or, at best, the organizational policy level. Yet, there is little attention and no consensus on how organizational policy should address resource allocation in health care. An ethically sound framework is needed to guide policy development for resource allocation within health care organizations. In addition, a more comprehensive study of concepts tied to moral obligations of health care organizations is needed in terms of human rights, health disparities, and patient care quality. Until now, human rights literature has largely focused on …

Enhancing Quality Ethics Consultations In Pediatric Medicine, Ariel Clatty

Electronic Theses and Dissertations

Medical ethics consultations occur predominantly in the adult realm of medicine, alternatively in Pediatric Medicine there is a widespread lack of training and skilled professionals to service these requests. Most of the literature in pediatric ethics consultations revolves around mirroring adult ethics consultations. This dissertation seeks to identify and address the issues related to quality of ethics consultations in a clinical setting regarding the organizational and research settings for Pediatric Medicine, and how adopting and applying the guiding standards for ethics consultation using the Core Competencies of the American Society of Bioethics and Humanities will better assist all parties to …

An Ethical Framework For Communication Of Prognosis In Pediatric Critical Care Medicine, Amanda Mattone

Electronic Theses and Dissertations

The focus of this dissertation is to create an ethical framework for communication of prognosis in the pediatric critical care setting. This dissertation argues that an ethical framework for communication of prognosis in the pediatric critical care setting is necessary because ethical communication transactions lead to better care for pediatric patients in critical care by enabling surrogate decision makers to make well-informed decisions. Moreover, a lack of effective communication skills can be detrimental to the patient. The need for such a framework is revealed by research indicating that physicians often lack the necessary education and skills for effective communication transactions …

Synthesis Of 2,4,6-Substituted Pyrrolo[2,3-D]Pyrimidines As Potential Anticancer Agents, Si Yang

Electronic Theses and Dissertations

This thesis mainly focuses on the introduction of the background and work have been done in the areas of antifolates development, such as folate function, its three uptake mechanisms inside human cells, antifolates’ role in chemotherapy, et. al. In addition, the Structure-Activity-Relationship design rationale for the series of antifolates will also be discussed. Nevertheless, the details of synthesizing these pyrrolo[2,3-d]pyrimidines as potential antifolates have been described, including chemistry reviews on the pyrrolo[2,3-d]pyrimidine scaffold, and the challenges encountered and the solutions how to solve or improve in order to achieve better yield.

Retention And Attrition In Bariatric Surgery Research: A Qualitative Study, William F. Gourash

Electronic Theses and Dissertations

Problem: Longitudinal bariatric surgical research studies often lack information on retention and attrition of study participants and the strategies utilized to optimize these. The potential for attrition bias with adverse effects on validity, reliability, and generalizability increases over time. The many factors potentially affecting retention and attrition in research, have been under studied.

Purpose: The purpose was to explore factors affecting research participation of bariatric surgical patients who are subjects in the Longitudinal Assessment of Bariatric Surgery (LABS) study. The research questions explored research participants’ perceptions, motivations, and attitudes concerning participation in the study, specifically participation in annual in-person visits …

Burden Of Illness And Pharmacoeconomic Evaluation Of Lumacaftor/Ivacaftor In Cystic Fibrosis, Pratyusha Vadagam

Electronic Theses and Dissertations

Objectives: (1) To estimate the burden of illness in cystic fibrosis (CF) using 2010-2014 Medical Expenditure Panel Survey (MEPS) data, and (2) to conduct a pharmacoeconomic evaluation of lumacaftor/ivacaftor in the treatment of CF.

Methods: The study was conducted in two parts. Part 1 involved a retrospective analysis using individuals in MEPS database with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 277.00 for a principal diagnosis of CF. Dependent variables were cumulative and out-of-pocket (OOP) expenditures and independent variables included patient demographics and clinical characteristics. Unweighted and weighted estimates of expenditure in CF group, …

Target Based Design And Synthesis Of Fused Pyrimidines In The Potential Treatment Of Cancer And Opportunistic Infection, Khushbu Shah

Electronic Theses and Dissertations

This dissertation describes an introduction, background and research progress in the areas of agents designed as (a) selective Pneumocystis jirovecii dihydrofolate reductase (pjDHFR) inhibitors for pneumocystis pneumonia (PCP) infection; (b) inhibitors of microtubule polymerization and multiple receptor tyrosine kinase (RTK) for potential treatment of cancer; and (c) substrates for tumor-targeted therapy for cancer.

PCP is a host species-specific infection. Most of the drugs, synthesized and evaluated so far, have been tested against Pneumocystis carinii dihydrofolate reductase (the causative organism in rats), which would not necessarily be effective against pjDHFR (the causative organism in humans). Trimethoprim-sulfamethoxazole (TMP-SMX) combination, which has been …

Discovery Of Pyrimidine-Based Heterocycles As Single Agents With Combination Chemotherapy Potential And As Inhibitors Of Purine Nucleotide Biosynthesis For The Treatment Of Cancer, Rishabh Mohan

Electronic Theses and Dissertations

This dissertation describes the design, synthesis and biological evaluation of monocyclic and bicyclic pyrimidine-base heterocycles as single agents with combination chemotherapy potential having both antiangiogenic effects and cytotoxic effects. This dissertation also describes selective tumor targeting with 5-substituted pyrrolo[2,3-d]pyrimidines analogs with heteroatom bridge substitution as GARFTase inhibitors.

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

Mammography Utilization In African American Women, April D. Kidd

Electronic Theses and Dissertations

Purpose: Breast cancer presents differently among women causing breast cancer health disparities with women of color disproportionally shouldering later-stage screening, incidence, and treatment, and greater mortality. This study assessed 10 predictors and rates of recent and long-term mammography utilization for women 43-79 years of age to better understand differences among age strata and races. This was the first study to use both the calculated Gail Risk scores (calculates absolute breast cancer risk over time intervals) from the 2010 National Health Interview Survey (NHIS) and a temporary homelessness variable in predicting mammography utilization using national-level data.

Theoretical Framework: A modified Behavioral …

Parents Of Children Who Had Hypoxic-Ischemic Encephalopathy: A Mixed-Methods, Exploratory Study, Natalene Kramer

Electronic Theses and Dissertations

Background: There is scant literature addressing the parents of children who had hypoxic-ischemic encephalopathy (HIE). therefore only inferences may be made as to issues of that experience affecting parents.

Purpose: The purposes of this study was to uncover the lived experiences of parents of children who had HIE, evaluate issues of stress, depression, coping, and impact of neurologic disability in order to better care for them and thus their families

Methods: A parallel, convergent mixed-methods design was used to explore experiences and perceptions of these parents regarding their experiences and life changes. The quantitative strand addressed four research questions which …

A Systems Approach To Moral Distress In Long Term Care, Margaret Lemley

Electronic Theses and Dissertations

Abstract: The question that this dissertation seeks to answer is whether or not a Systems Approach to Moral Distress can serve to positively address issues of moral distress within the Long-Term Care setting. Because moral distress has largely been understood as a phenomenon of the individual, efforts to address and reduce incidents of moral distress have focused almost entirely on the individual and his or her reaction to specific triggers. Building upon the existing literature this dissertation argues that previous efforts to understand moral distress within the healthcare setting have been limiting in two very important aspects. The first …

Phylogeny, Psychology, And The Vicissitudes Of Human Development: The Anxiety Of Atavism, Frank Pittenger

Electronic Theses and Dissertations

This cross-disciplinary dissertation provides a missing intellectual history of an ostensibly dead idea. Once widely held and no less elegant for its obsolescence, the principle of biogenetic recapitulation is best remembered by its defining mantra, “ontogeny recapitulates phylogeny.” Among psychologists and sociologists as well as embryologists, the notion that the development of any individual organism repeats in compressed, miniaturized form the entire history of its species enjoyed broad (if not uncontested) acceptance through the early twentieth century. The author reexamines the origins of this theory in the work of Charles Darwin and Ernst Haeckel, and traces its influence in psychology …

Occupational Profiles Of At-Risk Youth: A Multi-Case Study, Abigail Catalano

Electronic Theses and Dissertations

Occupational therapy’s work with at-risk and adjudicated youth is a practice area currently possessing a limited base of evidence. One significant need in this body of literature is for examination of evidence-based evaluation practices. This project describes implementation and results of an evaluation protocol, Primary Occupations for Work and Employment Readiness (POWER), designed to elicit comprehensive occupational profiles from participants. POWER consists of five assessment tools, supplemented by clinical observations and program data. The assessments included are the Occupational Self-Assessment (OSA), Model of Human Occupation Screening Tool (MOHOST), Double OT (DOT), Kawa River Model, and Role Checklist Version 3 (RCV3). …

The Challenge Of Enhancement & Adaptability In Healthcare: An Ethical Framework For Organizations, Gary Edwards

Electronic Theses and Dissertations

This work defends enhancements that aim at promoting adaptability and formulates a framework for how healthcare organizations can cope with these sorts of enhancements. It begins by defending explicit approaches to defining enhancements and sketches a tripartite conception of enhancements dependent on well-being, social, and perception approaches. After assessing several major arguments for and against enhancement, it defends an adaptability justification for enhancements. In light of this justification, the remaining sections explore the adaptability argument’s implications for healthcare, justify an organizational approach for dealing with these implications, and finally formulate an organizational ethics framework for coping with the adaptability argument’s …

Emotions, Intuitions And Risk Perception In Critical Care, Oleksandr Dubov

Electronic Theses and Dissertations

The theory of decision-making as it applies to bioethics and healthcare assumes a rational decision maker: someone who knows all his alternatives, has clear preferences, can rank and weigh risks and benefits of an intervention, and always acts in his own best interests. However, the growing body of research from the field of decision science shows that, in reality, such a purely rational decision maker does not exist. Instead, patients are rational within personal or environmental constraints such as uncertainty or ambiguity in which non-rational approaches such as emotion and intuition are instrumental. This issue is particularly important in critical …

An Organizational Ethics Framework To Balance Individual Privacy And Population Interests Regarding Genetic Technologies, Christine Trani

Electronic Theses and Dissertations

The American culture holds the right to privacy as one of the most esteemed rights for individuals. As such, the culture adamantly defends the right to privacy to ensure individuals have the opportunity to live freely. In the American healthcare system, the right to privacy is critical for individual autonomy. However, genetic science has pushed this boundary as it emphasizes the interdependency between individual and population health. Genetic technologies for healthcare have been increasing at an exponential rate since the early 2000s. Their implantation into clinical care has been a slower process due to ethical dilemmas. Specifically, ethical dilemmas revolve …

A Bioethics Tool For The Implementation Of Global Principles By The Pharmaceutical Industry, Daniel J. Hurst

Electronic Theses and Dissertations

Due to scandals of scientific misconduct, a climate of mistrust of science exists amongst the general public. This becomes of concern when we acknowledge that it is difficult for science and technology to flourish without broad societal trust. The pharmaceutical industry has often felt the brunt of such mistrust and has suffered many reputational setbacks over the past several years. Such reputational decline has a strong moral dimension, as it stems from issues such as the questionable conduct of clinical trials, pricing schemas, and access to medicines for low- or middle-income countries. The end product of such issues is the …