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The Role Of An Advanced Practice Provider (App) And Its Relation To Physician Shortages And Rural Healthcare Survival: A State-By-State Analysis, Allen Anderson

Dissertations, Theses, and Projects

The extent that Advanced Practice Providers (APPs) are able to practice independently with a full scope of practice varies state-by-state. The purpose of this paper was to review how APPs could help in a number of different areas of healthcare. This analysis examines the state of rural healthcare and reviews physician shortage statistics and hospital closures by state. In the examination, it also evaluates which states have full scope, reduced scope, and restricted scope of practice laws and cross-references that with states that have experienced a hospital closure. Through case studies, this research finds that APPs can be an alternative …

An Evaluation Of The Impact Of Medication On Behavioral Intervention Effectiveness For Adults With Traumatic Brain Injury, Sulay Martinez

Capstone Projects

A systematic search of the literature was conducted to identify articles implementing both pharmacological and behavioral interventions with subjects with traumatic brain injury (TBI). Limitations of pharmacological interventions were evaluated and compared to the implications for behavioral interventions for adults with TBI. Results of this study indicate further research is necessary to adequately evaluate the effects of medication on behavioral intervention effectiveness for adults with TBI.

Women Are Being Cut During Childbirth Without Need Or Consent, Molly Cora Enking

Capstones

An episiotomy, a surgical cut used to enlarge the vaginal opening during childbirth, can be extremely painful, hard to recover from and can increase the risk of severe complications. In 2018, episiotomies are rarely necessary, but at some U.S. hospitals they happen much more than they should. And in the course reporting this story, New York City News Service found that it is common for doctors to cut women without the mother’s consent.

https://medium.com/@mollyenking/women-are-being-cut-during-childbirth-without-need-or-consent-7677de7eddae

Use Of Telemedicine To Improve Cpap Non-Adherence In Patients With Obstructive Sleep Apnea, A Pilot Study, Kristin L. Hanger

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

The aim of this project is to improve continuous positive airway pressure (CPAP) non-adherence in patients newly diagnosed with obstructive sleep apnea. Obstructive sleep apnea (OSA) is caused by recurrent collapse of the upper airway during sleep. Untreated, OSA is associated with co-morbidity and decreased quality of life. The standard for OSA treatment is CPAP. Adherence to CPAP is not optimal. Applying telemedicine technology to monitor adherence of CPAP treatment, allows for early intervention. Prior research has shown mixed results with use of telemedicine on non-adherence rates.

This is a pilot study using telemedicine to monitor adherence data to …

Improving Breastfeeding In Rural Tanzania Using Bardach’S Policy Analysis Methodology, Katherine Skiff

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under five years (U5Y) compared to all other preventive interventions. The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. Shirati hospital, in rural Tanzania, does not have a breastfeeding policy. Bardach’s 8-Fold Pathway for policy analysis methodology (adapted by Collins for health policy) was used to evaluate three promising breastfeeding policies to improve compliance with this recommendation. They include …

The Role Of Apolipoprotein E In Regulating Tau Pathogenesis And Neurodegeneration In A Tauopathy Mouse Model, Yang Shi

Arts & Sciences Electronic Theses and Dissertations

APOE4 is the strongest genetic risk factor for late-onset Alzheimer's disease (AD). APOE4 increases brain amyloid-β (Aβ) pathology relative to other APOE isoforms. However, whether APOE independently influences tau pathology, the other pathological hallmark of AD and other tauopathies, or tau-mediated neurodegeneration, is not clear. By generating P301S tau transgenic mice on either a human APOE knock in (KI) or APOE knockout (KO) background, we show that the presence of human APOE, regardless of APOE isoforms, leads to various degrees of brain atrophy in 9-month old P301S mice, whereas APOE ablation strongly protects against neurodegeneration. In particular, P301S/E4 mice develop …

A Recombinant Virus And Reporter Mouse System To Study Chronic Chikungunya Virus Pathogenesis, Alissa Roxanne Young

Arts & Sciences Electronic Theses and Dissertations

Chikungunya virus (CHIKV) is an arthritogenic alphavirus that during acute disease causes fever as well as severe joint and muscle pain. Chronic joint and muscle pain persists in a significant subset of patients, yet we still have a poor understanding of what drives this chronic disease. While replicating virus has not been detected in the joints of patients with chronic arthritis or in various animal models at chronic time points, persistent viral RNA can be detected for months after acute infection.

To identify the cells that could be contributing to chronic CHIKV pathogenesis, we developed recombinant viruses that express Cre …

Sequence Analysis Methods For The Design Of Cancer Vaccines That Target Tumor-Specific Mutant Antigens (Neoantigens), Jasreet Hundal

Arts & Sciences Electronic Theses and Dissertations

The human adaptive immune system is programmed to distinguish between self and non-self proteins and if trained to recognize markers unique to a cancer, it may be possible to stimulate the selective destruction of cancer cells. Therapeutic cancer vaccines aim to boost the immune system by selectively increasing the population of T cells specifically targeted to the tumor-unique antigens, thereby initiating cancer cell death.. In the past, this approach has primarily focused on targeted selection of ‘shared’ tumor antigens, found across many patients. The advent of massively parallel sequencing and specialized analytical approaches has enabled more efficient characterization of tumor-specific …

A Tail Of Two Pancancer Projects: Somatic Variant Identification And Driver Gene Discovery Using Tcga, Matthew Hawkins Bailey

Arts & Sciences Electronic Theses and Dissertations

The implementation of next-generation genomic sequencing has exploded over the past dozen years. Large consortia, such as The Cancer Genome Atlas (TCGA); the International Cancer Genetics Consortium (ICGC); and the Pediatric Cancer Genome Projects (PCGP), made great strides in democratizing big data for the scientific community. These data sets provide a rich resource to build tools for somatic variant discovery and exploratory analysis. Public repositories hold the answer to many novel biological and clinical revelations i.e., the discovery of complex indels, splice creating mutations, alternative super enhancer binding sites, machine learning models to predict mutation impact, and cancer subtype classification …

The Role Of Fibrillin-1 In Eye Development And Disease, Wendell Brooks Jones

Arts & Sciences Electronic Theses and Dissertations

The ciliary zonule of the human eye consists of a circumferential array of fibers that connect the ocular lens to the nonpigmented ciliary epithelium (NPCE) located at the inner wall of the eye. Zonular fibers consist of bundles of beaded filaments called microfibrils. Microfibrils are major structural elements of the extracellular matrix and are present in pure form in the ciliary zonule. Microfibrils are composed principally of fibrillin-1 (FBN-1); a large extracellular matrix glycoprotein. In humans, mutations in FBN1 underlie Marfan syndrome; a pleiotropic connective tissue disorder that profoundly affects the eye. Ocular manifestations include ectopia lentis (dislocated lenses), cataracts, …

Towards An In Vitro Model Of Testing Osteoblast Cellular Function In Contact With Various Surfaces, Raheleh Miralami

Theses & Dissertations

Past studies have shown that the success of total joint replacements depends on the biocompatibility of orthopaedic materials, which can be improved by modifying the implant surface. However, the exact roles of these modifications and their effective mechanisms are poorly understood. The objective of this study was to develop and evaluate a model system to investigate the impact of nano-structured surfaces, produced by the ion beam-assisted deposition (IBAD) technique, on biomarkers of osteointegration using an in vitro model. The IBAD technique was employed to deposit zirconium oxide (ZrO₂), Titanium oxide (TiO₂), and Titanium (Ti) nano-films on …

Quantification Of Lutein + Zeaxanthin Presence In Human Placenta And Correlations With Blood Levels And Maternal Dietary Intake, Melissa Thoene

Theses & Dissertations

Lutein + zeaxanthin are carotenoids most recognized in eye health, but less is known about their status and transfer during pregnancy. While quantified in maternal and umbilical cord blood, they have never been analyzed in placenta tissue. Therefore, the purpose of this dissertation is to firstly quantify lutein + zeaxanthin concentrations in human placenta and to later correlate with levels in maternal dietary intake, maternal serum, and umbilical cord blood. Proportions of lutein + zeaxanthin will also be compared within diet, placenta, maternal serum, and umbilical cord blood among additionally analyzed carotenoids including lycopene, β-cryptoxanthin, α-carotene, and β-carotene. Lutein + …

Association Between Systemic Inflammation And Nutritional Compounds In Maternal-Infant Dyads, Jessica N. Snowden

Theses & Dissertations

Many events during pregnancy and early infancy can affect infant brain development. Inflammation during pregnancy, around delivery and during early infancy appears to adversely affect infant brain development. As the brain is rapidly growing and developing from conception through early childhood, it is particularly vulnerable during this time to inflammatory insults, which may be exacerbated or ameliorated by nutritional factors. Inflammatory compounds, as well as many nutritional compounds, can be either pro- or anti-inflammatory. These compounds are of particular importance in preterm infants, who are at risk of deficiency in anti-inflammatory micronutrients typically stored as a result of prenatal maternal …

Sleep Paralysis: Dreams, Demons And Rem-Atonia, Joshua G. Christensen

Capstones

Have you ever woken up from a dream only to find you can’t move? You’re paralyzed and, sometimes, you are even having vivid hallucinations. It’s terrifying, but harmless and very common. Regardless of it being so innocuous, Sleep Paralysis has inspired fear for centuries and many still believe it to be a supernatural phenomenon. This is, most likely, because most people who get Sleep Paralysis, don’t really know what it is. People just like me.

https://medium.com/@joshua.christensen/sleep-paralysis-dreams-demons-and-rem-atonia-27f46c2748cf

Surveillance, Prevention And Surgical Treatments For Hepatocellular Carcinoma, Kerui Xu

Theses & Dissertations

Liver cancer is the second-leading cause of cancer death, representing roughly 9.1% of all cancer mortality. Of all primary cancers of the liver, hepatocellular carcinoma (HCC) accounts for roughly 85%. HCC has been increasing in the U.S. and other countries. In particular, HCC places a huge burden on the Chinese population, as China alone consists of approximately 50% of the total HCC cases and deaths. In China, chronic hepatitis B virus (HBV) infection is the leading cause for developing HCC. The two challenges in prevention and control of HCC experienced in China are low rates of HCC screening among the …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Changes In The Transverse Dimension Of The Nasomaxillary Complex Following Rapid Palatal Expansion – A Post-Retention, Cbct Evaluation, Allison Schubert

Theses & Dissertations

Purpose: The purpose of this investigation was to evaluate the immediate and long-term effects of palatal expansion on the transverse dimension of the nasomaxillary complex.

Materials and Methods: Twenty-eight patients’ CBCTs were obtained at four time points: pre-expansion (T₁), post-expansion (T₂), pre-treatment (T₃), and middle or end of orthodontic treatment (T₄). The patients’ age, sex, cervical vertebral maturation stage, and the number of instructed expander turns were recorded. Measurements of the nasal floor, nasal passage, maxillary sinus, maxillary first molar mesiolingual cusp, maxillary first molar palatal cusp, maxillary first molar buccal cortical …

Dietary Polyunsaturated Fatty Acids Regulate Mammary Tumor Growth And Metastasis By Modulating Tissue Microenvironments, Saraswoti Khadge

Theses & Dissertations

Omega (ω)-6 and ω-3 polyunsaturated fatty acids (PUFAs) are essential fatty acids (FAs) and the precursors of pro- and anti-inflammatory mediators respectively. Epidemiological studies have shown a lower incidence of breast cancer (BC) in the countries where long-chain (LC)-ω-3FAs consumption is higher; however, the role of ω-3FAs in BC growth and metastasis is poorly understood. We used isocaloric, isolipidic ω-6 and ω-3 (contains LC-ω-3FAs) diets and a pair-fed model to evaluate the effects of dietary PUFAs in mammary tumor metastasis. Our studies have resulted in several novel observations including that dietary LC-ω-3FAs modulate mammary gland (MG) microenvironments in non-tumor bearing …

Evaluation Of Perioperative Peripheral Nerve Injury In Cardiac Surgery Using A Novel Automated Ssep Monitoring Device, Satoru Fujii

Electronic Thesis and Dissertation Repository

INTRODUCTION: The high incidence of peripheral nerve injury (PNI) in conventional cardiac surgery (CCS) is believed to result from mechanical injury during sternotomy and/or retraction of the sternum. Minimally invasive cardiac surgery (MICS) is a newly developed type of cardiac surgery which does not require sternotomy or retraction of the sternum. Since surgery related PNI can lead to serious problems for both the patients and care providers, the incidence and details of PNI in cardiac surgery needs to be investigated. OBJECTIVE: To compare the degree of nerve injury in MICS and CCS using somatosensory evoked potential (SSEP) signals. …

A Randomized Controlled Trial Of A Modified Cystoscopy Technique, Khalil Hetou

Electronic Thesis and Dissertation Repository

Introduction

Pain, anxiety and embarrassment are well documented feelings in patients undergoing ambulatory diagnostic cystoscopy. In this study, we explored utilizing Peak-end theory in improving pain perception in patients undergoing diagnostic cystoscopy.

Materials and Methods

We conducted a randomized clinical trial at the London Health Sciences Center for patients undergoing an ambulatory diagnostic cystoscopy for the first time. Males and females as well as allocation ratios were 1:1. The control arm received a standard cystoscopy. In the intervention arm the cystoscope was left for additional 2 minutes without further manipulation in the bladder before scope removal. The primary outcome was …

Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis

Doctoral Projects

The management of a difficult airway by anesthesia providers is a core component of providing safe care. Simulation provides an opportunity for the student to manage uncommon clinical scenarios without harm to an actual patient. This project aimed to determine if the use of simulation may be useful in training Student Registered Nurse Anesthetist in the management skills of a difficult airway. The proposed intervention of this project was the addition of simulation experience to didactic lecture covering difficult airway management techniques. As supported in the Adult Learning Principles of Medical Learners, by allowing the SRNA to actively participate in …

Best Practice Policy Recommendation For Neuraxial Anesthesia Skin Antiseptic Solutions, Kyle Adams

Doctoral Projects

A clinical affiliate hospital in Mississippi lacked a best practice clinical policy regarding the most appropriate skin preparation solution to use prior to neuraxial anesthesia. The evidence showed that alcoholic chlorhexidine is the optimal solution due to advanced characteristics which help reduce infection. Reducing infections can potentially reduce further complications for the patient, hospitalization length, and cost. Also, chlorhexidine was found safe to use for neuraxial anesthesia if cross-contamination is avoided and adequate drying time is allowed. Lastly, alcoholic povidone-iodine is an appropriate alternate if 0.5% chlorhexidine is unavailable.

A best practice clinical policy was formulated and presented to a …

Following Epidural Pca Use, Do Obstetric Patients Feel Satisfied With Their Pain Control, James Mcrae

Doctoral Projects

ABSTRACT

Pain is a source of anxiety for many patients, and uncontrolled pain can have deleterious effects on patient outcomes (Patak et al., 2014). Pain associated with labor is a particular concern of obstetric patients. Epidural analgesia is currently the frontline treatment for pain associated with labor, with epidural patient-controlled analgesia (PCA) often being utilized (Braveman, Scavone, Blessing, & Wong, 2013). Little evidence exists that details what factors of epidural PCA that patients considered important (Patak et al., 2014). In this project, a randomized questionnaire was administered to obstetric patients to assess satisfaction levels with their epidural PCA. The questionnaire …

Measuring The Efficiency Of The Living Kidney Donor Candidate Evaluation Process, Steven Habbous

Electronic Thesis and Dissertation Repository

Background: Living kidney donation is the ideal treatment for many patients with kidney failure. However, the living donor evaluation process has been criticized by patients and healthcare providers as inefficient. In the present research, we evaluated the inefficiency of the living donor evaluation process.

Methods: We conducted a scoping review of the literature and obtained data from large administrative datasets (1256 living donors) and medical chart review (849 prospectively recruited living donors across 12 transplant centres plus retrospective analysis of 1065 living donor candidates from a single centre).

Results: The median time to complete the entire evaluation was 9-11 months …

Acromial Insufficiency Fractures In Reverse Total Shoulder Arthroplasty: A Biomechanical Study, Alicia Kerrigan

Electronic Thesis and Dissertation Repository

Reverse total shoulder arthroplasty (RTSA) is increasingly utilized in the aging population, with a growing list of surgical indications including rotator cuff tear arthropathy, proximal humerus fractures, and revision arthroplasty. Acromial insufficiency fractures following RTSA are poorly understood, difficult to diagnose, and associated with inferior clinical outcomes. There is limited knowledge in the literature regarding the etiology of post-operative acromial fractures. The purpose of this study is to evaluate the role of implant parameters on acromial strain following RTSA.

Using a cadaveric model, a custom designed modular RTSA system was implanted that allowed for evaluation of modifiable parameters including glenoid …

The Role Of Tbx3 In Early Breast Cancer Progression, Milica Krstic

Electronic Thesis and Dissertation Repository

TBX3 is a transcriptional regulator involved in embryonic development and in tumorigenesis of several cancer types. There are two isoforms of TBX3 (TBX3iso1 and TBX3iso2) with different DNA binding domains. The large-scale functional roles of TBX3iso1 and TBX3iso2 were characterized in a breast cancer context. Both TBX3 isoforms induced invasiveness and an epithelial-to-mesenchymal (EMT) phenotype. Coupling data from genome-wide ChIP-array and RNA-Seq studies provided a novel list of genes regulated by each isoform. Both TBX3 isoforms regulate expression of several EMT-related genes, including SLUG and TWIST1. Importantly, TBX3 is a direct regulator of SLUG, and SLUG expression is required for …

The Tumor Microenvironment Regulates Retinoblastoma Cell Survival, Zachary K. Goldsmith

Theses and Dissertations (ETD)

Retinoblastoma (Rb) is the most common intraocular malignancy in children comprising 4% of all pediatric tumors. Early intervention increases survival rates up to 95% in developed countries; being survival rates associated to socio-economic status. Despite the high survival rates in developed countries, preservation of the eye and vision are continuing challenges in the management of Rb. Vitreous seeds constitute the greatest challenge in treatment of Rb. The unique location of these seeds within the vitreous makes them difficult to treat. Viable seeds showed reduced proliferative capacity and metabolism. making the majority refractory to current chemotherapeutics. This prompted the development of …

The Role Of Non-Neuronal Acetylcholine In Urogenital Chlamydial Infection, Jessica R. Lockhart

Electronic Theses and Dissertations

Chlamydia trachomatiscauses a bacterial sexually transmitted infection, Chlamydia, that is often chronic and casues reproductive complications in women. We hypothesized that Chlamydia infection increases local acetylcholine (ACh) production, which regulates the host’s inflammatory response to the infection. Female mice infected with C. muridarumwere sacrificed at days 3, 9, 15, and 21 post-infection, genital tract tissues harvested, and immunohistochemistry performed to enumerate ACh-producing cells. Infection increased the number of ACh-producing cells in cervical tissue at days 3,15, and 21 post-infection (pi), uterine tissue at day 3 and 9 pi, and ovarian tissue day 3, 15, and 21 pi. These …

Early Oral Feeding After Bowel Resection, Jennifer Strang

Theses & Dissertations

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery.

Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients …

The Impact Of Maternal Diabetes On Fetal And Infant Outcomes: A Secondary Analysis Of Peridata.Net® From 2013 To 2017, Christina Lynn Dzioba

Theses and Dissertations

ABSTRACT

THE IMPACT OF MATERNAL DIABETES ON FETAL AND INFANT OUTCOMES:

A SECONDARY ANALYSIS OF PERIDATA.NET® FROM 2013 TO 2017

Christina Dzioba, MS, ARNP, WHNP-BC, C-EFM

Background: Diabetes is a leading cause of morbidity and mortality for most of the developed world and is known to contribute to adverse maternal, fetal, and infant outcomes. The purpose of this study was to examine the relationship of maternal diabetes to fetal and infant outcomes for infants born in a small heterogeneous urban community with significant disparities in infant mortality using data in the PeriData.Net® database.

Methods: Women with diabetes were case matched …