Medicine and Health Sciences Commons^™

Implementation Of Sleep Problem Screening In A Pediatric Primary Care Office, Jennifer Erin O'Donnell

Dissertations

Sleep problems, a major problem for children and their parents, are the most common complaint brought to pediatric clinicians (advanced practice nurses and other healthcare providers) attention but are often ignored and underdiagnosed in the pediatric population (Faruqui, Khubchandani, Price, Bolyard, & Reddy, 2011). “Sufficient amounts of good quality sleep are necessary for healthy development in childhood” (Bordeleau, Bernier, & Carrier, 2012, p. 254). Inadequate sleep in children has been linked to numerous adverse outcomes psychologically as well as physically (Owens, Jones, & Nash, 2011). The American Academy of Pediatrics (AAP), issued recommendations in 2002 stating screening for snoring, one …

Onsite Integrative Clinics: Acupuncture, Positive Patient Outcomes, And Frequency Of Provider Office Visits, Sherry Shoemaker Phd

Dissertations

Purpose and Aims. There is limited information about outcomes of care, resource utilization, and associated costs for patients who receive acupuncture in integrative health settings. The purpose of this study was to address this gap through the following aims: To examine: (1) changes in patient pain levels pre/post acupuncture treatments; (2) relationships between receiving acupuncture treatments (number of treatments, length of time, select demographic factors, (age, gender), pain level pre and post acupuncture treatments; (3) relationships between number of treatments, length of time, age, gender, pain level (pre/post acupuncture treatments) and provider visits (pre/post acupuncture treatments); and (4) relationship between …

Exploring A Diabetic Registry For Cardiovascular Risk Factors, Mary C. Anziano Phd

Dissertations

Background: Cardiovascular disease is the leading cause of death in the United States. There were over 18 million people diagnosed with diabetes in 2002. These disease processes together combine for significant health burden on society (American Diabetes Association, 2008). The purpose of the study was to describe the relationship between select demographics, and clinical characteristics to determine risk factors for cardiovascular disease in a diabetic population. Methods: A retrospective descriptive study was conducted using a diabetic registry database containing patients diagnosed with diabetes from January 1, 2011 to December 31, 2012. Study variables included age, gender, socio-economic status, glycosylated hemoglobin …

The Case Of Reintegration Of Women Post Incarceration, Deana Raley Noble Phd

Dissertations

Women released from prison or jail face particular obstacles and challenges on reentry to the community, many of which are related to their childhood and to gender roles as women and mothers. This study relates the lived experience of one woman's successful transition to economic and mainstream societal reintegration and family reconnection after release from prison and the insights gained by the researcher. Case study methodology congruent with Miller's Relational-Cultural Theory philosophical framework was utilized in this in-depth, single case design and represents a unique case. The overall purpose of this descriptive and explanatory research was to explore precursors to …

Tuning Responsiveness Of Polypeptide Based Block Copolymers For Drug Delivery, Ashley J. Johnson

Dissertations

The goal of this dissertation was to tune the pH response and self-assembled morphologies of amphiphilic polypeptide block copolymers for use as drug delivery vehicles. Poly(L-lysine) and poly(L-glutamtic acid) are responsive, ionizable polypeptides that undergo secondary structure transitions, from α-helix to random coil, whereby the change in conformation of the peptide chain results in changes to the global morphology of a self-assembled system. The main focus of this work was to understand how changes in the polymer composition and the local environment can lead to control over the behavior of the overall system. First, the responsive behavior of poly(L-lysine) block …

Relationship Between Age And Pre-End Stage Renal Disease Care In Elderly Hemodialysis Patients, Rubette Harford Phd, Msn, Rn

Dissertations

Purpose: The primary purpose of this dissertation was to examine the relationship between age and receipt of three components of pre-end stage renal disease care prior to first initiation of hemodialysis, and to explore the implications of differences in interpretation of funding policies for dialysis services in Puerto Rico and the U.S. mainland. Background: The growing burden of chronic kidney disease (CKD) is a national public health concern, particularly within the aged population. It is estimated that more than 25 million Americans are living with some level of kidney disease, with an increasing prevalence noted with increasing age (Coresh et …

Screening For Novel Inhibitors Of Αlpha-Ynuclein Seeded Nucleation-Dependent Aggregation And Toxicity As A Potential Therapeutic Strategy For Parkinson’S Disease, Mustafa Taleb Ardeh

Dissertations

α-Synuclein aggregation is the key pathogenic event in several important neurological disorders including Parkinson’s Disease, dementia with Lewy bodies and multiple system atrophy, giving rise to a distinct group of neurodegenerative diseases known as synucleinopathies. Although the molecular basis of α-syn toxicity has not been precisely elucidated, recent studies indicate that α-syn toxicity is mediated by a nucleation-dependent aggregation process. To elucidate the structural basis of α-synuclein mediated toxicity, we developed various methods to prepare different α-synuclein species of a defined size and morphology distribution, and we investigated their toxicity in different human dopaminergic cell lines. We observed that crude …

Meeting The Needs Of Students With Traumatic Brain Lnjury, Heather K. Koole

Dissertations

School reintegration following pediatric traumatic brain injury (TBI) presents a number of challenges. This dissertation comprises three studies exploring common themes of best practice, training, and supporting success for students with TBI in school settings.

Study 1 reports the results of a survey of 70 speech-language pathologists (SLPs) who responded to questions about their use of clinical activities that described more or less contextualized services. Current literature supports contextualized service delivery as best practice. Findings indicated that 98% of participants reported using at least one contextualized practice. Higher use of contextualized practices was associated with working in schools (compared to …

Assessing The Monitoring And Management Of Overweight And Obesity In Children Hospitalized For Asthma, Anne E. Borgmeyer

Dissertations

Asthma and overweight are two of the most common chronic health problems in children. Data support a relationship between the two health issues. Although asthma is one of the top reasons for hospital admission for children, little is known about the prevalence of overweight and obesity or clinical practice related to weight in children hospitalized for asthma. The purpose of this project was to assess weight characteristics of children admitted with asthma, as well as the current practices of monitoring and management of overweight and obesity in children hospitalized with asthma. A retrospective review of medical records was conducted. The …

Patients With Advanced Lung Cancer: Quality Of Life And Perception Of Dyspnea, Barbara A. Roces Phd, Msn, Np, Rn

Dissertations

Background: Dyspnea perception can be defined as a multidimensional experience of breathing discomfort, influenced by physiological, psychological, social, and environmental factors, that includes secondary psychological and behavioral responses and cannot be defined only by physical objective abnormalities (Mularski et al., 2010). Dyspnea is the most common and distressing symptom in patients with advanced lung cancer and decreases one's quality of life (QOL) (Smith et al., 2001). Furthermore, dyspnea has been found to interfere with physical activities such as walking, work, and psychological activities such as disposition, taking pleasure in life, relationship with others, and sleep (Tanaka, Akechi, Okuyama, Nishiwaki, & …

Depressive Symptomatology And Perceived Social Support In Adolescents With Type 2 Diabetes, Kristiana Gay Huffman Cullum Phd, Cpnp

Dissertations

Type 2 diabetes has increased dramatically in the pediatric population in the last decade. One of the comorbidities of diabetes is depression. In the presence of depression, diabetes may be mismanaged by patients and lead to a decline in health. Diabetes with comorbid depression may have better disease management outcomes in the presence of higher levels of social support. Defining childhood depression, which encompasses adolescence, and the subtleties of this disorder compared to the adult counterpart, was needed to better delineate important variables for this research study. There are several instruments that evaluate adolescents' perceived social support, but a fairly …

Symptom Burden And Healthcare Utilization In Pulmonary Arterial Hypertension, Catherina Anne Madani Phd

Dissertations

Background: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease. There is currently no cure; thus treatment is aimed at prolonging survival, improving functional status (FS), and symptom mitigation. Symptom burden (SB) can impact quality of life (QOL), and lead to increased healthcare utilization. Palliative care (PC) has been associated with higher QOL, decreased depression, aggressive care, and mortality. The Institute of Medicine's (IOM) recent report supports earlier integration of PC for people living with serious illness. Detection of patients at high risk for heavy SB may help to identify patients who could benefit from earlier integration of PC into …

Patient Care Technology And The Nurse-Patient Relationship, Belinda M. Toole Phd, Msn, Rn

Dissertations

Background: Technological devices are increasingly used in healthcare and their proliferation has providers questioning the impact on the patient-provider relationship. Technological device integration has been studied in the primary care setting, less extensively in the acute care setting. The impact of device use on the nurse-patient relationship in acute care setting required further study, particularly with nursing's history of holistic practice incorporating caring and presence. Objectives: The study purpose was to explore the patient's perceptions of nurse caring and presence when technological devices were used in care delivery in the acute care setting. Specific aims were: 1) to describe the …

Skin Cancer Risk Perception And Sunscreen Use In Adolescent Female Soccer Athletes, Cheryl L. Butera Phd, Msn, Aprn, Fnp-Bc, Np-C, Phn

Dissertations

Over 3.5 million cases of skin cancer are diagnosed annually in the United States. In adolescent females ages 15-19, melanoma is the second most common form of cancer. The greatest risk factor for skin cancer is ultraviolet rays from the sun. Research has shown that sunscreen use is protective of all skin cancers, especially melanoma. The purpose of this study was to obtain perceptions about risk of skin cancer and sunscreen use among 13- to 18-year-old adolescent female club soccer athletes as a basis for effective interventions to improve sunscreen use in this population. The Health Belief Model was employed …

Provider Perception Of Patient Satisfaction If Antibiotics Are Not Given For Upper Respiratory Infection, Robyn Doniel Drake

Dissertations

The purpose of this project was to assess if advanced practice nurse practitioners perceived patient satisfaction of patients seen in Metropolitan Retail Clinics was improved after educational materials were given to explain when antibiotics work. I hypothesized that provider perception of patient satisfaction would decrease unnecessary prescribing of antibiotics after providing patient education? This project used questionnaires to collect data from control and intervention groups to demonstrate a gain in provider perception if patient satisfaction after education was given in the intervention group. The results of this project did not reveal to the primary investigator what was originally assumed, that …

Increasing Patients’ Knowledge In Transmission Of Bacterial Vaginosis And Its Treatment Regimens, Debra Garner

Dissertations

Research has shown bacterial vaginosis to be one of the most common vaginal disorders in women of child bearing age (Chen, Tian, & Beigi, 2009; Centers for Disease Control, 2012; Menard, 2011). Each year many women are seen by their gynecologist, sexually transmitted infection (STI) clinics, and emergency rooms (ER) for complaints of having malodorous discharge (Bradshaw, et al., 2005). Several STI’s and adverse pregnancy outcomes have been attributed to women having bacterial vaginosis (Bradshaw, et al, 2005; Chen, et al.2009; Elkins, & Mayeaux, 2010). Women are predisposed to bacterial vaginosis by the use of wearing non cotton underwear, douching, …

Nutrition, Appetite And Weight Loss In Elders Living In Long-Term Care Facilities, Karene Marie Goodman

Dissertations

Abstract Elders living in long-term care facilities often experience weight loss. Weight loss in elders has been shown to increase their risk of death. Existing research has identified numerous factors associated with appetite and weight loss in elders. Dementia, depression, acute and chronic illness, and medications have all been identified as potential causes of decreased appetite and weight loss in elders. Only a few nutritional and appetite assessment tools exist, and these tools are not widely used in long-term care facilities. The purpose of this descriptive study was to validate the Simplified Nutritional Appetite Questionnaire (SNAQ), an appetite assessment tool …

Dispositional Optimism: Modeling Cardiovascular Disease Mortality With Traditional Risk Factors And A Psychosocial Personality Trait, Kiana Ramisi Luckett Robinson

Dissertations

Despite increased awareness of clinical risk factors for cardiovascular disease (CVD), heart disease remains a physical and economic burden to African Americans. The aim of this study was to investigate the relationship between dispositional optimism, a psychosocial personality trait, and CVD mortality, based on immediate cause of death. A cross-sectional design was used to examine the predictive value of dispositional optimism in CVD mortality concomitant with traditional CVD risk factors. The traditional CVD risk factors of interest consisted of body mass index, waist circumference, systolic and diastolic blood pressures, total cholesterol, and C-reactive protein. Also, aggregated mortality data for optimists …

Fluorine Containing Uv-Curable Materials For Advanced Transport Applications, James Thomas Goetz

Dissertations

The characterization of structure, thermal, gas transport, and free volume properties of two unique UV cured polymeric systems are studied and reported. In the initial pursuit of waterproof high water vapor transport membranes, it became apparent that the UV curing of fluorinated materials yielded routes to develop unique materials that fundamentally challenge conventional models for free volume and light gas transport behavior. UV-curing provides a means to rapidly “lock-in” morphologies that are accessible in the small molecule, monomer phase but rapidly become kinetically inaccessible when constraints such as covalent bonding and cross linking limit motion in the polymer system. This …

Influence Of Resources, Resource Loss, And Coping Response On Food Management Practices And Food Security, Simone Perette Camel

Dissertations

Food insecurity has been associated with compromised health and wellness. Current literature regarding coping strategies and practices employed by the food insecure often describes food management and acquisition practices, and/or the riskiness of these practices. Material and personal resources such as income, time, self-efficacy, and social support have been identified as predictors or influencers of food security status. In this study, the Conservation of Resources theory was used to conceptualize resources and resource loss as they relate to food practices and food security. It was hypothesized that the level of resources would influence food security status and the adaptive food …

Efficacy Of Parent-Child Interaction Therapy With The Use Of In-Room Coaching, Cassie Shacklett Reeve

Dissertations

One significant consequence of oppositional and defiant behavior is an increase in negative interactions between caregivers and the child exhibiting those behaviors (Greene & Doyle, 1999). Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment that targets the development of a nurturing parent-child relationship along with teaching effective discipline strategies to decrease child noncompliance (Bodiford-McNeil & Hembree-Kigin, 2010). The purpose of the present study was to evaluate the efficacy of PCIT when modified by utilizing strictly in-room coaching. This type of research would allow for expanded use of this empirically supported treatment into community agencies and clinics which do not …

The Counselor Experience In Counseling Clients Who Have Been Sexually Assaulted, Carrie J. Tremble

Dissertations

Despite sexual assault being the second highest reported violent crime in the United States, the literature regarding the experience of counselors who counsel clients who have been sexually assaulted is limited. This qualitative study explored and described the lived experiences of 9 counselors who, in the last five years, have provided counseling services to at least five clients who had been sexually assaulted when they were at least 18 years of age. The phenomenological data analysis approach of Moustakas (1994) was utilized to guide the data collection and analysis. Through in-depth, semi-structured interviews, the participants were able to share their …

Instituting A Behavioral Wellness Program And Updating A Clinical Pathway For Economically Disadvantaged Overweight And Obese Adults In A Community Health Center: A Clinical Scholarship Project, Kimberly D. Buck

Dissertations

This project is intentionally instituted in an underserved community in an attempt to bridge the gap of health disparities in a population that would otherwise not have access to such programs. The purpose of this clinical scholarship project is to work with the Midwestern health center to encourage weight loss as well as to promote healthy lifestyles and reduce risk factors among economically disadvantaged persons by: (a) starting a wellness program that incorporates both behavioral and physical health using principles of motivational interviewing and health coaching, and (b) updating a clinical pathway for persons with a body mass index twenty-five …

Nurse Practice Environment And Peripheral Intravenous Infiltrations In A Pediatric Hospital On The Magnet Journey, Jannise Topacio Baclig Phd

Dissertations

Background: Characteristics such as quality patient care, excellence in nursing, and innovations in professional nursing practice shape a health care organization into a "magnet" organization. Magnet designation is a key aspect of nursing, which places pressure on healthcare organizations to commit to nursing excellence and patient care should they take the challenge of attaining this prestige. With growing focus on quality and safety, nursing needs to remain diligent in ensuring a healthy work environment that not only supports the profession, but also sustains exceptional patient outcomes. The purpose of this research study was to describe the relationship of the nurse …

Spatial Mapping Of Macular Pigment Optical Density And Its Relationship To Contrast Sensitivity And Glare Disability, Christopher Michael Putnam

Dissertations

This dissertation explored the relationship of the macular pigment optical density (MPOD) spatial profile with measures of contrast sensitivity (CS), glare disability (GD), relative glare disability (RGD) and intraocular light scatter. A novel device capable of measuring MPOD across the central 16 degrees of retina along 8 principle meridians using customized heterochromatic flicker photometry (cHFP) at eccentricities of 0, 2, 4, 6 and 8 degrees was built. MPOD was calculated as both discrete and integrated values at all measured retinal loci. CS was measured using vertical grating stimuli of 3, 6 and 9 cycles per degree (cpd) also presented at …

Safety Hazards Education For Mothers Who Are Homeless: Target Teaching To Improve Knowledge Of Safety Hazards For Children Under Five Years Of Age, Susan Halpern Fliesher

Dissertations

The leading cause of morbidity and mortality in children in the U. S. is unintentional injury (Center for Disease Control Child Injury Report, 2000 to 2006), but there is little information about homeless mothers with children and child unintentional injury. Frencher et al. (2010) compared lower socioeconomic families with children with housing to homeless families with children, and found that unintentional injury was 13% higher among homeless children. Mothers who are homeless often need to navigate a variety of temporary housing and may lack understanding of child safety hazards in strange environments, limiting their ability to ensure their children’s safety …

Testing A Model Of Maladaptive Perfectionism And Depression Symptoms: The Roles Of Emotional Disclosure, Emotion Regulation Strategies, Adult Attachment, And Shame, Angela M. Garrison

Dissertations

Previous research has supported a link between maladaptive perfectionism and higher levels of depression symptoms. However, researchers have not yet investigated the ways in which emotion regulation processes may mediate this relationship. Therefore, the primary purpose of this study was to evaluate emotional disclosure, emotional avoidance, and rumination as mediators of the relation between maladaptive perfectionism and depression symptoms. Additionally, this study also investigated the role that insecure attachment orientations play in the relationship between maladaptive perfectionism and use of particular emotion regulation strategies. Further, the role of shame in the emotion regulation processes of individuals with higher levels of …

Biophysical Characterization Of The First Four Metal-Binding Domains Of Human Wilson Disease Protein, Alia V.H. Hinz

Dissertations

Wilson disease protein (WLNP) is a P_1b-type ATPase crucial for maintaining copper homeostasis in humans. Mutations in this protein result in the autosomal recessive disorder Wilson disease, a condition characterized by copper accumulation in the liver and brain. WLNP provides copper for incorporation into cuproproteins and exports excess copper into the bile for excretion. There are six metal-binding domains (MBDs) in WLNP, found within the first 650 amino acids of this 1,465 amino acid protein. Though each MBD has a different amino acid sequence, all MBDs possess a similar ferredoxin fold with a conserved hydrophobic core and a …

Breast Cancer Presentation Delay Among Women In The United Arab Emirates, Yusra E. Elobaid

Dissertations

Breast cancer is the commonest type of malignancy in the United Arab Emirates (UAE) with more than 65% of women diagnosed at an advanced stage. Routine clinical screening has aided in the early detection of breast cancer. However, more than 71% of breast tumors are self-detected. Therefore, exploring factors influencing delayed presentation to treatment after self-detection of breast tumors by Emirati and Arab women in the UAE is essential for improving the survival and the development of effective and targeted health intervention programs. This project explores the reasons behind delayed presentation to treatment by symptomatic women. It uses several approaches, …

Quantitative Measurement Of Reciprocal Social Behavior Among Toddlers Aged 18 To 24, Rebecca Sarah Light-Pearlman

Dissertations

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that starts in early childhood. It is characterized by impairments in reciprocal social behavior, impaired language, and stereotypic behavior/restricted interests (Pine, Luby, Abbacchi, & Constantino, 2006). One in 68 children is affected by ASD (Centers for Disease Control and Prevention, 2014). The prevalence of ASD is rapidly increasing. New estimates show a 23% increase in the number of cases since 2009 and a 78% increase in case numbers since 2007 (CDC, 2013). The purposes of this project were to: (a) establish normative parameters of reciprocal social behaviors, among toddlers aged 18 to …