Medicine and Health Sciences Commons^™

Testing Claims Of Efficacy And Mechanism Of Action For Emotion Focused Couples Therapy: A Dyadic Case Study Using Time-Series Design, Albert Jun-Wei Wong

Doctoral Dissertations

The overall purpose of this study was to test claims regarding both the efficacy and mechanism of change for Emotion Focused Couple Therapy (EFT). Although a number of treatment outcome studies have been conducted on EFT, the vast majority of these studies emanate from the research laboratories associated with the two founders of EFT. Additionally, most EFT research has examined treatment outcome rather than mechanisms of change. This study used a time-series single-case experimental design approach to examine both the efficacy and the mechanisms of change in EFT for couple distress. I systematically tracked the symptoms of couple distress across …

Absorption And Utilization Of Choline And Vitamin B12 In Lactating Dairy Cows Using Different Delivery Methods, Virginia Maria Artegoitia Etcheverry

Doctoral Dissertations

Choline and vitamin B12 are essential nutrients for growth and performances of production animals. However, both nutrients are extensively degraded during digestion in the rumen. This thesis comprised three experiments. First, four cows equipped with a rumen cannula and catheters in the portal vein and a mesenteric artery received a post-ruminal bolus of: 1) cyanocobalamin (CN-CBL) alone (0.1 g) [gram], 2) CN-CBL (0.1 g) + casein (10 g) or 3) CN-CBL (0.1 g) + whey proteins (10 g). After the bolus, blood samples were taken until 24 h [hour] post-bolus. The intestinal absorption of CN-CBL was greater when the vitamin …

The Green Staff Of Asclepius: Envisioning Sustainable Medicine, Jason Lee Fishel

Doctoral Dissertations

To make society sustainable our institutions must also become sustainable. As an institution, health care contributes to environmental degradation. While unsurprising, contributions to environmental degradation increase risk factors for disease and illness, effectively frustrating the goals of medicine. To find ways to make health care sustainable I begin by reviewing the literature on sustainability from within environmental ethics and two previous attempts at envisioning sustainable health care in order to learn what to include in a vision of sustainable health care. Then I examine problems specific to making medicine sustainable by investigating how sustainability might affect the principles of medicine. …

Effect Of Small Interfering Rnas On In Vitro Replication And Gene Expression Of Feline Coronavirus, Eman Ahmed Mohamed Anis

Doctoral Dissertations

Feline corononavirus (FCoV) infection is ubiquitous in domestic cat populations worldwide and is usually associated with subclinical or mild enteritis. However, in some cats infection may result in the development of a fatal progressive disease called feline infectious peritonitis (FIP). FIP is considered to be the major cause of infectious-related death in pet cats. Currently, there is no protective vaccine or curative treatment to this highly fatal disease. In this study, we evaluated the ability of small interfering RNAs (siRNAs) to inhibit the in vitro viral replication and gene expression of FCoV as a potential treatment for FIP.

Five synthetic …

Living With Hypertension: Experiences Of Black Men Related To Their Perceptions Of The Clinical Encounter At Diagnosis, Glenda Mccartney Feild

Doctoral Dissertations

Introduction: In the U.S., hypertension (HTN) is the most common primary diagnosis and HTN related illnesses are the number one cause of death. Being a member of the Black population increases the risk for developing HTN. Black males are reported to develop HTN earlier in life and have a high incidence of undiagnosed, untreated, and uncontrolled HTN. Sociocultural and gender barriers influence this population’s perceptions of medical experiences, which affects their participation in health-promoting behaviors such as eating a healthy diet, engaging in regular physical activity, avoiding tobacco, limiting alcohol consumption, and decreasing stress.

Purpose: The purpose of this study …

"I Saved The Iguana": A Mixed Methods Study Examining Responder Mental Health After Major Disasters And Humanitarian Relief Events, Suzanne Marie Boswell

Doctoral Dissertations

The purpose of this mixed methods study was twofold. The first was to use Hobfoll’s (1989) Conservation of Resources theory to predict psychological stress based on responders’ perceptions of resource adequacy. The second was to use qualitative interviewing to gain a more comprehensive understanding of the disaster/humanitarian responder experience.

The study is significant given the expanding role of nurses within disaster/humanitarian response organizations. Furthermore, psychological stress results in increased turnover of human resources in these organizations. This turnover is detrimental to humanitarian systems that already lack adequate coverage and sufficiency because funding and human/material resources grow at a slower pace …

Dissociation And Sexual Trauma: The Moderating Role Of Somatization, Amineh Abbas

Doctoral Dissertations

This study examined various types of trauma, with an emphasis on sexual trauma across the lifespan, in a clinical sample of male and female adult outpatients assessed for trauma, somatization, and dissociation. Two hundred forty-five adult outpatients at the University of Tennessee Psychological Clinic were administered the Dissociative Experiences Scale (DES), the Traumatic Experiences Checklist (TEC), and Symptom Checklist-90-Revised (SCL-90-R), as part of the routine intake procedure. Of those individuals, 200 patients completed the questionnaires correctly and were included in the final study sample. The experience of sexual trauma indeed accounted for additional variance in somatization scores over and above …

Protecting The Skin Of Older Adults Through Surveillance And Pressure Ulcer Prevention Beginning In Emergency Services, Jennifer L. Zoeteman

Doctoral Dissertations

ED (emergency department) personnel are admitting to inpatient services increasing numbers of elderly clients who are at risk for skin breakdown. The ED environment is designed for short term care in response to emergent situations. Pressure related injuries originating in the ED lead to both physical suffering and financial burdens. Pressure relief strategies have been actively employed on an inpatient basis without translation to the ED environment. Evidence for best practice in PUP (pressure ulcer prevention) in the ED is not widely embraced. Prevention of PUs is primarily within the scope of nursing practice and amenable to improvements in the …

Perceptions Of Residential Elders Following Facilitated Advance Care Planning, Teresa M. Boersma

Doctoral Dissertations

The purpose of this project was to explore the perceptions of residential elders following a facilitated advance care planning (ACP) conversation. While literature is available regarding ACP and advance directives (ADs), there is minimal knowledge of first hand experiences from those who complete ACP and live in a residential or retirement community. Five residents of a retirement community who participated in facilitated ACP conversations also participated in a focus group interview to explore their perceptions of facilitators of and barriers to ACP and completing an AD. The interview was audio recorded and transcribed verbatim. Then the transcript was reviewed for …

An Evidence-Based Evaluation Of Medication Barcode Scanning Acceptance In A Community Hospital, Marie M. Vanderkooi

Doctoral Dissertations

Barcode scanning during medication administration is a powerful tool to prevent errors and support patient safety. In spite of the significant patient safety benefits, there is a lack of adoption and acceptance of barcode scanning. The purpose of this project was to implement an evidence-based assessment, utilizing a survey instrument based on the technology acceptance model, to understand adoption and acceptance of barcode scanning at a community hospital. Forty-four people, 38 nurses and 8 respiratory therapists, participated in the survey. Data analyses were performed using descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Spearman's rho tests. The subscales for the intention to …

The Effectiveness Of A Psychoeducational Intervention On Health Promoting Behaviors And Physical Health Of Adult Patients (18 And Over) On Antipsychotic Medications, Alice O. Mwanda

Doctoral Dissertations

Individuals on antipsychotic medications have been found to be disproportionately affected by overweight and obesity which increases their cardiometabolic risk. Psychoeducation has been found to be an effective strategy for risk reduction of cardiometabolic risks. This intervention examined the effectiveness of a psychoeducational intervention in adults (aged 18 and above) with severe mental illness. The four session, 8 week intervention encouraged an increase in fruit and vegetable intake and engagement in physical activity. The conceptual frameworks included the Health Promotion Model and Chronic Care Model. Outcome measures included nutrition, physical activity and health promoting behaviors. Biological outcomes included weight, BMI, …

The Influence Of Supportive Nursing Leadership In Staff Nurse Retention, Theresa L. Dawson

Doctoral Dissertations

Based on the increasing need to retain healthcare’s greatest assets, work environments must provide positive relationships and RN empowerment in an effort to improve staff nurse retention. A variety of factors can influence a registered nurse’s intent to stay, however supportive nursing leadership is thought to have the greatest impact on improving work environments resulting in greater job satisfaction. The purpose of this organizational assessment was to determine the current culture of supportive nursing leadership, RN perceptions of supervisory support, and themes that appeared to require nursing leadership development intervention. Based on these findings a series of leadership development workshops …

Primary Care Assessment And Interventions To Improve Physical Activity Among Insufficiently Active Adults Ages 18 Through 64 Years Old, Thomas A. Sanchez

Doctoral Dissertations

A number of chronic and debilitating conditions such as cardiovascular disease, stroke, hypertension, anxiety, depression, pain, osteoporosis, and falls are known to be delayed, improved, or prevented by increasing physical activity (PA) levels. The numbers of those affected form a substantial portion of the US population. As of 2011, for example, 26 million adults in the U.S. were diagnosed with diabetes mellitus (DM) alone. Another 79 million people had elevated blood glucose measurements putting them at risk for DM. Despite knowledge of the connection with chronic disease, PA levels are not consistently and quantitatively assessed during primary care office visits. …

Enhancing Communication, Satisfaction, And Self Efficacy In High-Risk Prenatal Women Using ‘Ask Me 3’, Cynthia A. Betterly

Doctoral Dissertations

Despite the recent advances in health care related to the patient-centered medical home, meaningful use, and the Affordable Care Act, the health care system has failed the vast number of patients who do not understand basic health information providers or educational materials designed to communicate to them. For the purpose of this project, low health literacy is framed as a barrier to patient and provider communication. Unfortunately, low health literacy often leads to adverse outcomes. These poor outcomes make improving health literacy a priority by acknowledging and evaluating health literacy interventions. The purpose of this project is to evaluate the …

Use Of The Cope Intervention For Depressed Adolescents, Lindsey R. Jelsma

Doctoral Dissertations

Depression disorders often present during adolescence. Depression can lead to difficulties with relationships, problems in school, and associated high risk behaviors. The goal is to identify and treat depression as soon as possible. The purpose of this project is to implement a cognitive– behavioral based intervention called Creating Opportunities for Personal Empowerment (COPE) to depressed adolescents. Previously, the COPE program has been implemented in outpatient and school settings. This intervention was implemented to adolescents in an inpatient psychiatric hospital. Effectiveness, acceptability, and feasibility were evaluated.

Twenty-five adolescents, majority female, ages 12-18 participated in this project. The participants completed all seven …

School-Based Nurse Managed Health Centers, Sylvia J. Simons

Doctoral Dissertations

School-based health centers (SBHCs) are a directed approach for providing health services to students who may otherwise lack them. Over the past 40 years, the number of SBHCs has olved from targeting public health concerns to the development of a specific collaborative model of care that is responsive to the unique needs of children. The purpose of this project was to develop a sustainable model for the creation and implementation of a school-based nurse-managed health center (SB-NMHC) with the capacity to improve health access and quality, and to reduce cost, while also mitigating present and future health disparities within a …

Elucidating Cellular Signaling Pathways That Contribute To The Immunopathogenesis Of Aplastic Anemia, Christina M. Kuksin

Doctoral Dissertations

Aplastic Anemia is a rare immune mediated bone marrow failure disease that is mediated by autoreactive T cells that cause destruction to the stem, progenitor, and stromal cells in the bone marrow. Because little is known about the etiology of the disease, our lab has developed a major MHC mismatch GVHD model to examine cellular pathways in autoreactive T cells that contribute to disease. We examined three pathways that are important in T cell activation and differentiation and asked if they were important in the development of Aplastic Anemia. First, we were able to show that expression of active PKCθ …

Relational Coordination: The Perception And Experiences Of Student Nurses And Nursing Faculty In A Hospital Setting, Clare Lamontagne

Doctoral Dissertations

The purpose of this study was to describe and measure student nurses’ and nursing faculty experiences and perceptions of relational coordination during their most recent clinical experience in a hospital setting. The complexity of healthcare settings in the United States necessitates a coordinated approach to patient care in order to meet the divergent needs of its citizens. Healthcare students and professionals need to be prepared to work collaboratively and communicate proficiently and effectively. The theory of relational coordination states that, in a well-functioning organization, members of the healthcare team engage in frequent, timely, accurate, and problem-solving communication and have high …

Stress And Depression During Pregnancy Among Hispanic Women: Risk For Adverse Birth Outcomes And The Role Of Physical Activity, Kathleen Szegda

Doctoral Dissertations

Preterm birth and low birth weight are among the leading causes of infant mortality and morbidity in the United States. Puerto Rican women are at increased risk for these adverse birth outcomes and elevated levels of depression and psychosocial stress during pregnancy when compared to non-Hispanic Whites. Therefore, it is important to understand whether these psychological factors increase risk for these adverse birth outcomes and mechanisms to prevent/reduce depression in this high-risk population. The first study of this dissertation examined associations between perceived stress during pregnancy and preterm birth, low birth weight, and birth of a small-for-gestational age infant (SGA) …

A Preliminary Model Of Dignity Management In Hospice, Qiaohong Guo

Doctoral Dissertations

This study aims to develop a preliminary model of dignity management (MDM) in hospice describing the social process used by the interdisciplinary team to support the dignity of the patient-family unit in hospice. A qualitative, grounded theory methodology was used to achieve this goal. Research samples, including dying patients, their families and hospice staff, were recruited from a residential hospice in North Amherst, Massachusetts. Data collection methods included interview, observation, and document review. Symbolic interactionism and pragmatism provided the philosophical basis for this study. Thematic analysis was used to explore the definitions of dignity; and grounded theory analytic techniques for …

Needs Of Patient’S Families In The Hospital Tele-Intensive Care Unit, Mary L. Jahrsdoerfer

Doctoral Dissertations

Purpose: To explore, identify and describe the perceptions of family members of a patient admitted to a telemedicine intensive care unit (tele-ICU); and to determine if these needs differ from those established by the Critical Care Family Needs Inventory (CCFNI) in the traditional ICU setting. Background: The tele-ICU is a new care modality in which offsite nurses provide consultation to bedside clinical staff at geographically-dispersed ICUs. The last decade demonstrates a growing existence of tele-ICU’s in our healthcare culture. ’Information’, ‘close proximity’, ‘assurance’, ‘support’ and ‘comfort’ have been identified as the top five needs of family members in the traditional …

Dried Whole Plant Artemisia Annua As A Novel Antimalarial Therapy, Mostafa A. Elfawal

Doctoral Dissertations

Dried Whole plant Artemisia annua as a novel antimalarial therapy September 2014 Mostafa Ahmed Elfawal Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Stephen M. Rich Malaria is one of the worst vector-borne parasitic diseases in the developing world. The World Health Organization (WHO) estimated that 215 million cases of malaria occurred, with >655,000 deaths; half the world’s population is at risk of contracting the disease. Drugs are primary weapons for reducing malaria in human populations. Successful drugs are highly efficacious and inexpensive to manufacture synthetically. However, emergence of resistant parasites has repeatedly curtailed the lifespan of each drug that …

Longitudinal Trajectories And Predictors Of Functional Impairment In Mild Cognitive Impairment, Alzheimer’S Disease, And Vascular Dementia, Lauren Z. Chisholm

Doctoral Dissertations

Functional disability in older persons with cognitive impairment is associated with reduced quality of life and greater mortality, health care utilization, and caregiver burden. Episodic memory, executive function, apathy, depressive symptoms, and medical burden have been identified as cross-sectional predictors of functional disability but have received little longitudinal investigation in a way that explicates how changes in these variables relates to functional disability. Functional disability also drives the distinction between the diagnoses of Mild Cognitive Impairment (MCI) and dementia; however, little is known about the rates of functional decline in these groups over time. This study utilized multi-level modeling to …

Nutritional, Hormonal, And Psychological Risk Factors For Breast Cancer, Susan Nicole Boyer Brown

Doctoral Dissertations

Over the course of a lifetime, one in eight women will develop breast cancer. To date, 30-40% of breast cancer cases can be attributed to established risk factors, which supports the need for identification of additional modifiable risk factors. Therefore, we conducted three epidemiologic studies to examine the associations between nutritional, hormonal, and psychological risk factors and breast cancer risk. In our first study, we examined the relationship between urinary melatonin levels and the risk of breast cancer in a nested-case control study within the Nurses’ Health Study II. While limited in some respects, experimental and epidemiologic evidence support the …

Associations Between Vitamin D Status, Adiposity, And Inflammatory Biomarkers In Young Women (18 – 30 Years), Adolphina Addo-Lartey

Doctoral Dissertations

We conducted a cross-sectional analysis among 270 (18- to 30-year old) female participants in the UMass Amherst Vitamin D Status Study (n = 270) to assess the extent to which dietary intakes of calcium and vitamin D are associated with obesity markers. We also evaluated the association between serum 25-OHD concentrations and both adiposity and inflammatory biomarkers. Study participants were mostly Caucasians (84.5%) with normal BMI, although about half of women had high adiposity (total body fat ‘TBF’≥ 32%). Women reporting adequate intakes of calcium (≥ 1000 mg/day) but low intakes of vitamin D (< 600 IU/day) were more than twice as likely to have a high percentage of TBF compared to women with adequate intakes of both calcium and vitamin D. In addition, women with lower calcium intake from supplements were twice as likely to have a waist circumference ≥ 80 cm (OR = 2.04; 95% CI: 1.04 – 3.99) compared to women in the highest tertile of calcium intake. The magnitude of this association is important since among young women 18-30 years old, a waist circumference greater than 80 cm indicates central obesity and suggests increased visceral adiposity, which contributes to hyperlipidemia and other obesity-related chronic conditions. Among all women, total vitamin D, food vitamin D, and supplemental vitamin D intake were not associated with serum 25-OHD concentration (P > 0.05). However, among supplement …

Nanotechnology And Additive Manufacturing Platforms For Clinical Medicine: An Investigation Of 3d Printing Bioactive Constructs And Halloysite Nanotubes For Drug Delivery And Biomaterials, Jeffery A. Weisman

Doctoral Dissertations

Personalized medicine requires the development of new technologies for controlled or targeted drug delivery. Three-dimensional (3D) printing and additive manufacturing techniques can be used to generate customized constructs for bioactive compound delivery. Nanotechnology in the form of nanoparticles, used as a stand-alone construct or for material enhancements, can significantly improve established biomaterials such as PMMA based bone cements or enable new technology to have enhanced capabilities. Combinations of the technologies can be used in such applications as infectious disease treatments, chemotherapeutic targeted drug delivery or targeted delivery of nearly any bioactive compound.

Chemotherapeutic or antibiotic enhanced 3D printing filaments were …

Psychosocial Factors Affecting Pregnant Hispanic Women, Marushka L. Silveira

Doctoral Dissertations

Prenatal psychosocial stress, anxiety, and depression are common, with higher rates among Hispanic women. While evidence supports an adverse effect of psychosocial factors on glucose intolerance and oral health, studies during pregnancy are sparse, particularly among Hispanic women. Therefore, we examined correlates of psychosocial factors and their associations with glucose intolerance and oral health among pregnant women. The first project examined correlates of high stress among 1,426 pregnant Hispanic participants in Proyecto Buena Salud, a prospective cohort study. Cohen’s Perceived Stress Scale was administered in early, mid- and late pregnancy. Using multivariable logistic regression, we found that increasing age, pre-pregnancy …

Evaluating Predictors Of An Individual’S Dietary Intake Latent Value Under Different Mixed Models, Shuli Yu

Doctoral Dissertations

The accurate estimation of an individual’s usual dietary intake is important since the estimates are essential to uncover the diet-disease relationships. This study explores a more accurate method to estimate an individual’s latent value of usual dietary intake when it is repeatedly measured using a 24-hour dietary recall (24HR) and seven day dietary recall (7DDR), accounting for random measurement error and bias. The performance of the (empirical) predictor of subject’s latent value obtained under the finite population mixed model (FPMM) framework is compared with those obtained under the usual mixed model and the measurement error model through a simulation study. …

Stochastic Models For Capacity Planning In Healthcare Delivery: Case Studies In An Outpatient, Inpatient And Surgical Setting, Asli Ozen

Doctoral Dissertations

U.S. healthcare system has become far too complex and costly to sustain and operations research has much to contribute in improving health systems by addressing a large spectrum of problems. We study capacity planning in healthcare while considering the case-mix of patients, using stochastic modeling in different application areas: primary care, inpatient bed allocation and (spine) surgery scheduling. This body of work was developed over four years of collaborative research with hospitals and healthcare providers. The main objective of our research in primary care is to optimize the patient mix of primary care physicians in a group practice to maximize …

Conversations With The Community: An Ethnography Of Two Case Studies Highlighting Community-Research Partnerships In Springfield, Ma, Vanessa Martinez

Doctoral Dissertations

This dissertation is both qualitative and collaborative. It emphasizes the participant observation and ethnographic documentation of two community-researcher partnerships on community-level health interventions in Springfield, MA. Drawing upon critical theories and reflexive methods, I explore and analyze the process of building and sustaining researcher-community partnerships in an era of limited funding. Two Springfield, MA-based projects – one on healthy cooking/eating, and the other on contingency management – serve as case studies to provide a concrete picture of the complex relationships of researcher-community collaborations. I use ethnographic storytelling to provide a multi-dimensional look at two different community-research partnerships on health disparities …