Digital Commons Network^™

Determinants Of Financial Success Of Large Law Firms, James Xu

Dissertations

Prior research has established that leadership characteristics, job equity perception, and client satisfaction are all associated with a firm’s financial performance. This study tested hypotheses about these variables based upon Upper Echelons Theory, Adams Equity Theory, and Stakeholder Theory, in the context of 110 large U.S. law firms. The analysis revealed that (1) the racial diversity of the firm’s management committee is positively associated with the firm’s financial performance; (2) the average employee salary has a positive and U-shaped relationship with the firm’s financial performance; (3) the average employee salary has a positive relationship with the firm’s client satisfaction; (4) …

Utilization Of Asthma Guidelines In Primary Care, Kate R. Miller

Dissertations

Background: Chronic lower respiratory disease, including asthma, is the fourth leading cause of death in the U.S. Financially, asthma accounts for approximately 54 billion dollars in healthcare spending annually. The National Heart Lung and Blood Institute [NHLBI] established guidelines to reduce impairment and to reduce future asthma attacks.

Purpose: This Quality Improvement (QI) pilot implemented the Asthma Control Test (ACT) and the Asthma Action Plan (AAP) per NHLBI guidelines. This project aimed to increase provider use of the ACT and AAP to 50% in patients with a diagnosis of asthma over one month.

Methods: A convenience sample of six adult …

Community Health Nurse Educators And Disaster Nursing Education, Jody Spiess

Dissertations

Abstract

The world is struggling with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the need for disaster nursing education has never been more clear. Recently, the American Nurses Association reported that of the over 32,000 nurses surveyed; only 11% felt well prepared to care for a COVID-19 patient (ANA, 2020). Community health nurse educators are tasked with educating future nurses on disasters, yet, little is known about this population’s perceived competence in disaster preparedness. The purpose of this study is to describe community health nurse educators' perceived competence in disaster preparedness.

The study is a descriptive, correlational …

Synthesis Of Phosphonomethyl Tetrahydrofurans And Phostones, Rishi Paudel

Dissertations

This work has been divided into two major projects:

1) Synthesis of phosphonomethyl tetrahydrofurans by using the Mori-Tamaru reaction: The Mori-Tamaru reaction of phosphonate-substituted dienes is unexplored, and the directing effects of the phosphono-group are uncertain. The objectives of this research are to develop the homoallylation of phosphonodienes with different aldehydes, followed by their cyclization to phosphonomethyl tetrahydrofuran ring systems through an oxa-Michael reaction. This method has also been applied for the synthesis of 3-hydroxy substituted phosphonomethyl tetrahydrofuran rings (9) which might lead to the synthesis of 2’deoxy C-nucleosides.

2) Synthesis of vinyl phosphonates and phostones: Synthetic …

Dual Disadvantage: An Examination Of Racial Disparities In Victim And Suspect Criminal Justice Treatment, Paige Vaughn

Dissertations

During the past several decades, American criminal justice legal systems appear to have been over-punishing Black individuals as perpetrators of crime, and neglecting them as violent crime victims, perpetuating disparities that simultaneously repress and alienate Black citizens. Such complex processes of racial inequality are difficult to capture in studies that focus on single criminal justice stages and limited sets of variables. After presenting a working conceptualization of case processing that can be used across criminal justice systems, the current study uses data from the St. Louis Metropolitan Police Department, St. Louis Circuit Attorney’s Office, and U.S. Census to assess racial …

Demystifying First-Time Mothers’ Postpartum Mental Health: A Phenomenological Study Of The Transition To Becoming A Mother, Megan Dooley Hussmann

Dissertations

Becoming a mother is a significant life event that can greatly impact maternal mental health. Understanding maternal mental health is an important interdisciplinary goal because it could lead to mother’s receiving better care and support from both mental health and medical professionals. Seven first-time mothers with a baby under the age of one were interviewed for a phenomenological qualitative study, which investigated first-time mothers’ postpartum mental health experiences. This study was guided by two research questions: How do new mothers experience their postpartum mental health in comparison to how they experienced their mental health before having their baby, and how …

Interactions Of The Nlrp3 Inflammasome Complex, Nyasha Makoni

Dissertations

The innate immune system is the first line of defense in response to invasion by pathogens. One of the major pathways in the innate immune system involves a three-protein complex known as the NLRP3 inflammasome. This complex comprises of NLRP3, ASC, and procaspase-1. In response to stimuli, the inflammasome assembles to activate caspase-1 which subsequently facilitates production of interleukin-1β (IL-1β), an inflammatory cytokine. The NLRP3 inflammasome has been implicated in a variety of inflammatory disorders including Alzheimer’s disease (AD). Amyloid beta (Aβ) is the protein that causes AD and Aβ deposits in the brain activate microglia resulting in chronic inflammation. …

Screening And Referring For Postpartum Depression In Pediatric Primary Care, Melissa Harkins

Dissertations

Problem

Postpartum depression (PPD) can lead to increased risk of child abuse, delays in infant development, and increased medical costs (Earls et al., 2019). The American Academy of Pediatrics (AAP) recommends all mothers of infants 0-6 months be screened for PPD during well-child visits. Despite these recommendations, many pediatric offices have no PPD screening process.

Methods

This quality improvement project utilized a standardized tool to screen mothers of infants 0-6 months for PPD during their infants’ well-child visits. Mothers who screened positive for PPD were offered referrals to treatment resources and given the opportunity to participate in two follow-up telephone …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Missed Appointment Rates And The Implication On Primary Care Practice, Kelly Martin

Dissertations

Problem: Missed appointments cost primary care facilities money and resources through lack of utilization. When patients fail to attend their scheduled appointment the providers are non-productive when they could be seeing other patients that are potentially moved to other days, sending patients to other providers, or worse sending patients to the prompt care or the Emergency Department for care. The missed appointment rate at Office A Primary Care is approximately ten percent, while Office B has a nearly 11% missed appointment rate. Both facilities make reminder calls to patients the day before their appointments to remind them of their appointment …

Sustainability Of An Outpatient Antibiotic Stewardship Program, Kristin Smith

Dissertations

Abstract

Problem: Antibiotic stewardship is an effort to evaluate and improve the use of antibiotics by providers and patients. Antibiotic stewardship programs (ASPs) promote the appropriate use of antibiotics. There is increasing evidence that supports the use of antibiotic stewardship programs in reducing antibiotic prescribing rates while continuing to maintain safe patient care. Research supports approaches with multiple interventions and ongoing commitment to antibiotic stewardship. However, information regarding long-term sustainability of antibiotic stewardship programs is lacking. The purpose of this quality assurance project was to assess long-term sustainability of a previously implemented ASP promoting appropriate prescribing of antibiotics for the …

Tailoring Violence Prevention Programming To A Critical Care Area, Jaime Campbell

Dissertations

Abstract

Problem: Rising rates of violence in health care environments signal a need for health care workers, specifically frontline nurses, to be trained in effective de-escalation management skills. Since January 2017, there has been an increase in the number of patients categorized as aggressive with more violent patient events taking place at a selected midwestern hospital facility in the critical care department, particularly the intensive care and transitional care units.

Methods: Using a pre-post design, this project compared nurses’ verbal de-escalation skills using the English Modified De-escalating Aggressive Behaviour Scale (EMDABS) to determine effectiveness of de-escalation strategies in simulated scenarios …

Effect Of Standardized Nurse Teaching On Patient Experience Using Cahps®, Julie Hake

Dissertations

Abstract

Purpose: This quality improvement (QI) project aimed to determine if a standardized nurse teaching approach improved patient understanding of diagnosis and treatment as it relates to women diagnosed with a pelvic floor disorder (PFD) after receiving a standardized nurse education (SNE) session in an urban tertiary care Urogynecology practice.

Methods: Females aged 18 and older with a newly diagnosed PFD and prescribed PFPT for the first time who agreed to receive the SNE and complete the CAHPS® survey were included in the project. Patient perception of PFPT was assessed via phone interview utilizing the Consumer Assessment of Healthcare …

Implementing A Three-Minute Foot Exam For Diabetic Patients In Primary Care, Emilee Laster

Dissertations

Problem- One in four U.S. Veterans have Diabetes Mellitus, and one in four U.S. Veterans with diabetes will develop a diabetic foot complication. There is currently no protocol for healthcare providers to perform foot screenings on diabetic patients at each visit. Utilizing a foot screening at each visit for high risk diabetic patients may help to recognize problems sooner, making treatment easier and less aggressive.

Methods- This quality improvement initiative was a retrospective and prospective record review before and after evidence based three-minute foot exams were implemented. A convenience sample of 50 patient medical records were reviewed to collect demographical, …

Comorbidity And Quality Of Life Of Hiv-Positive Adults Living In Supportive Housing, Rose Sharp

Dissertations

Problem: Life expectancy for people living with HIV significantly increased with widespread use of antiretroviral therapy, resulting in population increases in comorbidity prevalence. The increased burden of living with both HIV and comorbidities lowers health-related quality of life (HRQoL).

Methods: Using a descriptive, correlational, cross-sectional design, a convenience sample of HIV-positive adults was selected from seven supportive housing communities. Comorbidities were assessed using a modified Self-Administered Comorbidity Questionnaire, and HRQoL using the Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health.

Results: A sample of 17 (N = 17) adults reported a mean of 4.2 (SD = …

Social Support Following Pregnancy Loss And Its Implications For Women’S Experiences Of Posttraumatic Growth, Agata Freedle

Dissertations

The available literature suggests that social support can contribute to individuals’ positive psychological changes following a traumatic event. However, the effects of the social milieu following pregnancy loss on women’s post-loss adjustment continues to be vastly unexplored. This dissertation explores a gap in the literature surrounding the relationship of interpersonal and intrapersonal social factors on women’s posttraumatic growth (PTG) after miscarriage or stillbirth via three studies. Specifically, the following factors were investigated in relation to PTG: 1) Adult attachment and women’s experiences of dyadic coping; 2) self-disclosure, positive social reactions and deliberate rumination; 3) empathy and prosocial behaviors. Women who …

Applications Of Nanoporous Gold To Drug Release And Glycoscience, Dharmendra Neupane

Dissertations

Nanoporous gold (NPG) is a versatile material because of its three-dimensional nanoscale network, facile surface functionalization, biocompatibility, and potential usage in biotechnology applications. The field of glycoscience is growing in significance as the importance of glycans in human health and disease becomes more fully understood at the molecular level. NPG can be applied to several needs in the field of glycoscience. Our lab has applied NPG to applications in glycoscience including the capture and release of glycoproteins, and the detection of glycoprotein interactions by using either electrochemical methods or localized surface plasmon spectroscopy (LSPR). The capture of glycoproteins onto high …

A Quantitative Assessment Of The Effectiveness Of A Global Online Professional Development Course To Enhance 21st Century Skills In Stem Instructional Design, Chris Link

Dissertations

Science, technology, engineering and mathematics (STEM) disciplines are becoming increasingly important in the 21st century workforce, but there is currently a shortage of STEM professionals around the world. Even when students graduate with STEM degrees, many lack basic interpersonal skills such as communication and problem solving that would position them for success in the marketplace. The New York Academy of Science developed the STEM Education Framework to help ensure that STEM curricula teach the Essential Skills that students need in order to thrive in the modern workplace. In order for educators to proficiently utilize the STEM Education Framework, they must …

Peace At Last Or Just A Piece Of Paper? Assessing The Utilization Of Civil Protection Orders And Reported Violations, Jennifer Medel

Dissertations

Over the past 50 years, attention to domestic violence as a social problem has grown substantially. With this heightened interest, remedies available to survivors have evolved in both scope and access. One popular avenue of help-seeking concerns civil protection orders (POs), which attempt to prevent subsequent abuse by setting conditions that regulate future interaction between abusers and survivors. Abusers, unfortunately, often violate POs with estimates of cases with violations ranging from 40 to 60%. Relatively little research, however, has examined the nature and determinants of PO violations using court records.

This dissertation addresses these little-studied issues by exploring variations in …

Uncertainty In The Context Of End-Of-Life Communication In Heart Failure, Caleb Pardue

Dissertations

End-of-life communication between patients, their family members, and healthcare providers is essential to quality care at the end-of-life. Advance care planning is increasingly utilized to facilitate end-of-life communication, but heart failure patients in particular face numerous challenges to achieving adequate end-of-life communication. Extant literature has highlighted the inherent uncertainty in heart failure as a barrier to end-of-life communication as well as the role of time perspective on the experience of heart failure patients, but little empirical research has been conducted to examine the impact of these constructs. The sample included 168 participants with heart failure who were recruited online through …

Hope, Acculturation, And English Language Proficiency In The Career Decision Self-Efficacy Of East Asian International Students, Yang Ai

Dissertations

The present study explored the predictive abilities of hope, acculturation to American culture, acculturation to the home culture, and English language proficiency to career decision self-efficacy for East Asian international students in the United States who are originally from China, South Korea, and Japan. A total of 167 international students from China, South Korea, or Japan participated in this study. This study used a correlational design to measure the relationship between four predictor variables, including hope, acculturation to American culture, acculturation to the home culture, and English language proficiency and an outcome variable, career decision self-efficacy, among East Asian international …

Diet Behaviors, Physical Activity, And Sociodemographic Factors In A Sample Of Racially Diverse Adults: A Secondary Analysis Of Nhanes (2017-2018) Data, Fatemeh Choupani

Dissertations

Background: The prevalence of obesity is increasing among adults in the United States and is related to a high risk to health. Obesity has been linked to lifestyle behaviors such as diet behaviors and physical activity.

Purpose: This study aimed to determine if an association exits between foods prepared outside of the home, walking or biking, vigorous/moderate recreational activities, sociodemographic factors and the outcomes, body mass index, percentage of body fat, and waist circumference.

Method: A secondary analysis was conducted using data from 3942 adults from the U.S. aged 20 years, as recorded in the National Health …

Elitnauristet Yuutllu Calillgutkut Elitnaurluki Elitnaurat: Yup’Ik Peoples And Public-School Principals In Southwestern Alaska, A Quantitative Survey Of Cultural Values, Anthony Graham

Dissertations

This dissertation explores the alignment between local school principals’ values and ideas about what should be taught in their public schools and the values of the local Yup’ik communities in which those principals serve. A review of scholarly literature served as a basis for identifying Yup’ik values and a survey which measured principals’ beliefs about the importance and priority of those values was used to collect a variety of data. Findings showed both differences and similarities between principals’ priorities and Yup’ik values and was clear that the similarities and differences were predominantly related to the number of years of a …

A Spectroscopic And Photometric Survey Of The W4 Hii Region And Its Young Stellar Population, Matt Wentzel-Long

Dissertations

The W4 HII region is home to a large number of O and B-type stars as well as the young open cluster IC 1805. OB-type produce intense photoionizing radiation and stellar winds that can induce star formation in surrounding molecular clouds and sometimes carve out large regions of decreased particle density called superbubbles. During the star formation process, young stellar objects (YSOs) are initially surrounded by circumstellar disks made of gas and dust which naturally dissipate after several million years. The dissipation of the disk is thought to occur for a variety of reasons, including photoevaporation by the encompassed protostar …

Do User-Generated Ratings Affect Hotel Valuations? – An Analysis Of The Chicago Hotel Market, Shailesh Patel

Dissertations

Today’s travelers are increasingly relying on aggregated online opinions to make purchase decisions. One of the sectors most impacted by these online reviews is the hospitality industry, where consumer review websites such as TripAdvisor, Expedia, and Bookings.com play a critical role in influencing consumer's choice of hotel and the price they will pay for the room. Recently, there have been studies investigating the various aspects of user-generated online reviews and ratings. The purpose of this paper is to investigate the impact of user-generated ratings on hotel valuations. Our paper does this using regression analysis to study the impact of TripAdvisor …

The Experience Of Early Mobility After One Week Of Hospital-Acquired Deconditioning, Lila S. Moersch

Dissertations

Abstract

Older adults who are hospitalized spend most of their time in bed. Prolonged bed rest and immobility in older adults may result in deconditioning of the muscles, leading to a loss of muscle mass and strength. The loss of muscle mass results in weakness and reduced physiological functioning post-hospital discharge. Immobility is especially problematic in older adults who naturally lose muscle mass and strength due to the aging process. Older adults who experience weakness post-hospital discharge face challenges with mobility. The purpose of this study was to describe the early mobility experiences of adults who are 60 years old …

Help Seeking For Mental Health Problems In Mental Health Counselors: Prevalence, Barriers, And Predictors, Carol A. Miller

Dissertations

This study surveyed a sample of 255 mental health counselors in the United States and used descriptive statistics, chi-square tests, one-way ANOVA, and logistic regression analysis to investigate the prevalence of mental health problems and help seeking, the perceived barriers to, and predictors of help seeking for mental health problems among mental health counselors. In this sample, 62.6% (n = 159) reported they had experienced a mental health problem during the time since licensure. Of those, 13.2% (n = 21) reported they had not received treatment. “Handling the problem on my own” was the most cited barrier to help seeking, …

The Impact Of Medicare Insurance Plans Upon Healthcare Services Utilization Considering Patients' Characteristics And Their Access To Medical Care, Steven Stout

Dissertations

The annual average cost of healthcare for services utilization by a Medicare beneficiary is projected to grow from about $10,000 to over $16,000 by 2023. As an ongoing initiative to address this trend, the federal government contracts with private insurance companies and other entities, called Medicare Advantage Organizations (MAOs), to develop and administer alternative health insurance plans designed to contain service utilization and costs. One feature of some Medicare Advantage plans is the presence of risk-bearing contracts with primary care physician organizations that voluntarily accept financial responsibility for the overall cost of care for patients attributed to them. In this …

Investment Advisor Succession Planning: Attitudes, Norms, And Control, Don Mueth

Dissertations

This study investigated succession planning intentions of investment advisors who lead their small businesses. We employed the theory of planned behavior to better understand the attitudes, norms and perceptions of control that impact these business leaders’ intentions to plan. Our research included a pilot study of interviews with 10 investment advisors and a main study of advisor survey responses. With a sample size of 198 participants, we analyzed survey responses measuring traditional TPB constructs as well as involvement in outside activities. Using two-step structural equation modeling, our model fit was acceptable, and our results supported our hypotheses that beliefs, attitudes, …

Searching For A “Home”: Examining The Experiences Of Confucian Asian College Students With Third Culture Kid Backgrounds, Yuima Mizutani

Dissertations

Third culture kids (TCKs) spend their childhood and adolescence outside of their home countries. Because of their unique backgrounds, TCKs and adult TCKs face challenges including identity development, low self-esteem, lack of connection with their home countries, posttraumatic stress disorder, depression, adjustment disorder, and others. Although the number of TCKs is increasing due to globalization, this population has been understudied. Moreover, most existing research has focused on TCKs in Western countries. Few researchers have studied Confucian Asian adult TCKs; that is, adult TCKs from China, Hong Kong, Singapore, Japan, South Korea, Taiwan, and others. Confucian Asian countries have collectivistic cultures …