The Roles Of Inhibition In C. Elegans Locomotion, Lan Deng

Dissertations

Inhibition plays important roles in modulating neural activities at different levels from small synapses to brain regions, and different systems from sensory to motor. To achieve translocation, locomotor systems produce alternation of antagonist muscles, including axial posture and limb movement and alternation. In the nematode C. elegans, a cross-inhibition circuit, involving excitatory cholinergic and inhibitory GABAergic motoneurons, is believed to generate the dorsoventral alternation of body-wall muscles that supports backward undulatory locomotion. This dissertation challenges this prevalent hypothesis, delves into studying different roles of inhibition, and depicts the expression pattern and functional role of ionotropic GABAA receptor, UNC-49, in motoneurons …

Neurobiological Markers For Remission And Persistence Of Childhood Attention-Deficit/Hyperactivity Disorder, Yuyang Luo

Dissertations

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in children. Symptoms of childhood ADHD persist into adulthood in around 65% of patients, which elevates the risk for a number of adverse outcomes, resulting in substantial individual and societal burden. A neurodevelopmental double dissociation model is proposed based on existing studies in which the early onset of childhood ADHD is suggested to associate with dysfunctional subcortical structures that remain static throughout the lifetime; while diminution of symptoms over development could link to optimal development of prefrontal cortex. Current existing studies only assess basic measures including regional brain activation …

Schwann Cells In Combination With Gag-Mimetic Scaffolds For Spinal Cord Repair, Sharareh Hashemi

Dissertations

Spinal cord injury (SCI) being a devastating neurological dysfunction can cause extensive irreversible neuronal loss and axonal damage. Fifty-four cases of spinal cord injury per million people occur annually in the United States. Due to the loss of glial cells and demyelination of axons, the neuronal function of surviving neurons is disrupted leading to permanent loss of sensory and motor functions. The glial scar formed by astrogliosis at the chronic stage protects undamaged tissues, but it is known to be a major barrier for axonal regeneration. The limited regeneration capacity of spinal cord makes it challenging to successfully treat the …

Effects Of A Primary Blast-Induced Traumatic Brain Injury On The Susceptibility To Behavioral And Neuronal Deficits On A Susequent Blunt Trauma, Aswati Aravind

Dissertations

Soldiers are often exposed to more than one traumatic brain injury (TBI) event over the course of their service. In recent years, more attention has been drawn to the increased risk of neurological deficits caused by the 'blast plus' polytrauma, which typically is a blast trauma combined with other forms of TBI. The objective of this dissertation is to investigate if exposure to a blast TBI predisposes the brain to increased neurological deficits when followed with a second blunt head trauma. The behavioral and neuronal deficits resulting from a blast plus injury involving a mild-moderate blast followed by a mild …

Syndemic Conditions And Medication Adherence In Older Hiv-Positive Men Who Have Sex With Men, Roland Zepf

Dissertations

For people living with HIV, lack of adherence to medication regimen is a significant problem with serious deleterious outcomes. Reasons for non-adherence are co-concurring psychosocial health conditions—also known as syndemic conditions—such as symptoms of depression, post-traumatic stress disorder (PTSD), past physical or sexual abuse, intimate partner violence (IPV), stimulant use, and binge drinking. Majority of all new HIV infections in the United States are among men who have sex with men (MSM). This dissertation reports on a secondary analysis of cross-sectional data from older MSM living with HIV receiving treatment at two outpatient HIV clinics in San Francisco.

Consensus In Anesthesia Handoff Reporting, Robin L. Groves Anselm

Dissertations

Despite some improvement, no consensus exists to perfect quality in anesthesia handoff practice and policy. This quality improvement project was designed to assist a local anesthesia and perioperative workforce questioning the quality of its current handoff. Theories and models used to inform the project included the Inter-Professional Team Collaborative, Lewin's change theory, the continuous quality improvement theory, and the knowledge to action model. The communication assessment tool (CAT) functioned as a needs assessment yielding a gap in handoff practice of 25 participants. The CAT also served as the post project evaluation survey. The situation, background, assessment, and recommendation (SBAR) tool …

Effect Of Patient Handoff Methods On Nurse Self-Efficacy, Christopher Scott Guelbert

Dissertations

Patients experience multiple transitions in care between nursing providers (handoffs) during hospitalization. Handoffs are opportunities for communication errors to occur. Patient handoffs between the post-anesthesia care unit (PACU) to the nursing division is a frequent event within hospitals. Methods of handoff vary in practice from face-to-face, telephone, or written report. Nurses receiving patient handoff may experience varying degrees of self-efficacy levels in providing care to the newly acquired patient from the PACU. Self-efficacy levels can be measured utilizing the Nursing Care Self-Efficacy Scale (NCSES). Variances in nursing self-efficacy scores among the methods of face-to-face and telephone patient handoff were analyzed …

Substance Use And Hiv Among Young Black Men Who Have Sex With Men (Msm), Raymond Austin Nation

Dissertations

In the United States, young Black men who have sex with men (MSM), between the ages of 13 and 29 years have the highest rates of new HIV infections. The prevalence of HIV among this population is three to four times higher than their White MSM counterparts. Research indicates substance use is strongly associated with HIV infection among young Black MSM. Twelve HIV-negative and HIV-positive participants from the Bay Area were recruited for this qualitative narrative study to explore the following three aims: (a) describe the role substance use plays in the lives of young Black MSM, (b) describe their …

How Does Standard Use Of A Rectal Acetaminophen/Intravenous (Iv) Opioid Combination Compare To Iv Opioid Alone In Improved Comfort Levels And Decreased Overall Opioid Use In Full-Term Infants Post Open Heart Repair?, Jacqueline M. Ochsenreither

Dissertations

Pediatric cardiothoracic surgical patients experience varying degrees of pain in the immediate post-operative period. Multiple analgesic modalities can be utilized to effectively manage pain in this specific patient population. Routinely, IV opioid only is prescribed post-operatively to manage acute pain needs in this select group of patients. However, standard use of rectal acetaminophen as an adjunct to IV opioid to improve comfort levels and decrease overall opioid use in the immediate post-operative period in this select population has not been examined. This retrospective, 18-month, quantitative study was conducted at a large urban children's teaching hospital incorporating electronic medical inpatient chart …

The Nursing Practice Environment And Job Outcomes In Saudi Hospitals, Zainab Ambani

Dissertations

The nursing shortage is a challenging problem globally. In Saudi Arabia, the nurse shortage continues to be a critical problem in all healthcare sectors. International nursing research has shown strong relationships between poor practice environments and unfavorable nurse job outcomes, including job dissatisfaction, burnout, and intention to leave, which often precedes turnover, a leading cause of shortage. However, there is scarcity in this area of research in Saudi Arabia. This study aims to describe and compare the nursing practice environments and nurse job-related outcomes of nurses in two types of hospitals in Saudi Arabia. Additionally, the study aims to test …

Comparing Teaching Strategies Utilized To Enhance Self-Confidence Among Novice Nursing Students, Ashley N. Carter

Dissertations

Faculty play a considerable role in positively impacting the development of a novice nursing student's self-confidence through contemporary, innovative, and meaningful teaching practices that are data-driven. Employing effective confidence-building teaching strategies early in the curriculum supports the development of confidence as a professional attribute and is critical to student success, patient safety, and patient comfort (Blum et al., 2010; Bulfone et al., 2016; Lundberg, 2008; White, 2009). This prospective, cross-sectional, quantitative, comparison pilot study compared the effectiveness of a role-play (RP) physical assessment simulation with a new teaching strategy, an individual high-fidelity physical assessment simulation (HFS), to determine the impact …

Correlates Of Fatigue In Lymphoma Patients Undergoing Autologous Peripheral Blood Stem Cell Transplantation, Majeda M. El-Banna

Dissertations

Fatigue is the most prevalent and disturbing symptom in cancer patients; however, little research explains the correlates and predictors of fatigue. The purposes of this study were to describe the fatigue patterns in lymphoma patients undergoing autologous peripheral blood stem cell transplantation (APBSCT) and to examine the relationships among these fatigue patterns and the changes in the patterns of melatonin, depression, pain, nausea, hemoglobin level, total sleep time within 24 hours, and number of awakenings at night that contribute to the changes in fatigue during the baseline, chemotherapy and recovery periods. The conceptual framework of this prospective, descriptive, correlational, and …

Impact Of Nurse-Initiated Intentional Rounding On Patient Satisfaction Scores On A Surgical Unit, Tina Eslinger-Vaughn

Dissertations

This project focused on nurse-initiated intentional rounding (NIIR) as a new nursing approach to patient care. NIIR anticipates the needs of patients as nurses perform hourly checks on their patients, thereby improving the overall patient experience, and increasing patient satisfaction. This DNP project included a summative program evaluation of the use of NIIR on a 33-bed surgical unit (N = 629 patients), guided by the John Hopkins Nursing Evidence-Based Model and Guidelines (JHNEBP). The program evaluation included comparisons of mean patient satisfaction scores 3 months prior to implementation of NIIR, and 3 months after implementation.

Physical Activity Improves Depressive Symptoms In Older Adults, Karen Lee Fahey

Dissertations

Engaging in physical activity can help older adults to take part in community activities, maintain relationships, and initiate new friendships, thus preventing loneliness and depression. The purpose of this quality improvement (QI) project was to evaluate whether participation in physical activity improved depressive symptoms in 15 older adults at a local senior center. Pender's health promotion model was used to determine nursing and behavioral science views on components that affect health behavior.

The Effects Of Art Therapy On Hypertension In Black American Women, Ellen Layton Mullarkey

Dissertations

70 million Americans have hypertension affecting one out of three Americans. Heart disease was the leading cause of death in America in 2015. The American Heart Association published an algorithm for implementing alternative approaches to treating hypertension. Creative art therapy was not included. Art therapy blends the therapeutic process of psychotherapy with the art of painting, drawing and sculpture to help express emotions and beliefs that are too difficult to convey in verbal and written communication. The health belief model is a framework that examines why people do not follow the recommendations of health care providers due to real and …

The Relation Between Patient Education And Picc Line Occlusion And Infection, Patricia L. Cameron

Dissertations

The purpose of this study was to test the feasibility of using an electronic tablet to supplement patient and caregiver education about PICC line maintenance and to compare the percentage of PICC line complications in the intervention group with national percentage rates for patients and caregivers.

Life Balance In Nurse Educators: A Mixed Methods Study, Joan M. Owens

Dissertations

The topic of nurse educator life balance is significant to the nurse educator community, which is facing a national nurse faculty shortage, challenges in producing enough new nurses, and a continuing shortage of nurses. This compromises patient safety and the quality of care. Major factors identified as contributing to the shortage of nurse educators are educator dissatisfaction with workload and work life balance. Life balance is described as an enjoyable array of daily activities that is meaningful and contributes to the individual's health. Professional quality of life is described as the quality one feels in relation to one's work as …

The Effectiveness Of A Chart Audit And Feedback Intervention To Improve Cardiology Provider Delivery Of Heart Failure Self-Care Education, Dorothy L. Murphy

Dissertations

Heart failure is a challenging disease process that presents a high risk of mortality, frequent hospitalizations, and an overwhelming economic burden to the health system. Patient self-care education has been shown to decrease unplanned hospitalizations, emergency room visits, hospitalized days, costs, and mortality rates. However, only 61% of adults with HF receive self-care education within a 12-month period. Under the framework of the Iowa Model for Evidence-Based Practice, the purpose of this project was to implement an electronic health record audit and written and verbal provider feedback intervention with the aim of improving provider delivery of heart failure self-care education …

Health Literacy Preparation Of Bsn Students: A Basic Qualitative Study, Robin E. Squellati

Dissertations

Understanding the complexity of multiple health conditions, treatment options, and medications requires a high level of health literacy. Yet, 88% of Americans have some deficiency in health literacy. The nursing literature is lacking in best practices for teaching nursing students how to address health literacy concepts with their patients. Therefore, this basic qualitative study explored Bachelor's of Science in Nursing (BSN) students' educational preparation to integrate health literacy in patient education. The primary research questions asked, How do BSN students describe their preparation to integrate health literacy in patient education?

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

The Role Of Socioeconomic Status And Prior Industry Exposure On The Attitudes, Career Goals, And Career Decision Self-Efficacy Of Undergraduates Studying Hospitality And Tourism Management, Laura Mckenzie Shroder

Dissertations

The hospitality and tourism industry struggles with high employee turnover, and many hospitality management students graduate and subsequently leave or choose not to enter the industry. Scholars have found it beneficial to study students’ industry attitudes, career goals, demographics, and career decision self-efficacy to further understand how these variables influence students’ perceptions, engagement, and retention. This quantitative study measured these variables as well as prior industry exposure, which is based on the Social Cognitive Career Theory. Results of an online survey of hospitality students in the Western United States (n = 315; response rate 79.9%) suggested that students’ prior industry …

Navy Seals - Crossing Cultures: Cross-Cultural Competence And Decision Styles, Robert Newson

Dissertations

U.S. military cross-cultural competence is currently deficient, as Special Operations Forces (SOF) personnel assessments fail to explicitly consider aspects related to cross-cultural competence and lack processes specifically tailored to cross-cultural personnel assignments. Researchers, however, have identified eleven attributes that contribute to military cross-cultural competence; this study uses these attributes to explore whether decision styles and demographics correlate with cross-cultural competence. Building on existing work on the attributes of military cross-cultural competence (defined in this study as the ability to quickly and accurately assess, then effectively act, in a culturally complex environment to achieve mission results), I first examined the attribute …

Leadership Adapted: Towards An Understanding Of How Western-Developed Leadership Theories Are Translated And Practiced In The Modern Arab Middle East, Derek R. Olson

Dissertations

The purpose of this study is to understand how western-developed leadership theories are translated and practiced in the Modern Arab Middle East (MAME). Over the past century the notion of leadership has progressed through phases of understanding, definition, and practice. This evolution continues today and is no longer contained to the academic and practice-oriented institutions of North America and Europe. Through western-styled educational institutions and professional industries, western-developed leadership theories have stretched around the globe, including the MAME. While this is known, what is much less understood is how these theories are adopted and adapted. This study’s objective is to …

Understanding The Barriers, Bridges And Bases To Inclusion Instruction For Secondary Students With Mild To Moderate Disabilities, Angela Renee Lyte Crowther

Dissertations

Inclusion is the practice of educating students with disabilities and students without disabilities in the same learning environment. For secondary students with mild/moderate disabilities, inclusion is rooted in the philosophical mindset of social justice, equity, and legislation. Inclusion is a complex and sometimes controversial topic few educational systems want to tackle. The purpose of this multi-method research was to gather and analyze secondary site administrators' and teachers’ opinions on the barriers, bridges, and bases needed for the furtherance of inclusion practices and the elimination of the segregated classrooms for students with mild-moderate disabilities. A plethora of research on this topic …

Expanding And Improving High-Quality Early Care And Education In California: Is There Alignment Between Policymakers And The Public?, Heidi Schmidt Emberling

Dissertations

Although there is widespread agreement about the life-long benefits of high-quality childcare and preschool, access for all children in California is limited. The negative effects of this inadequate landscape are borne predominantly by children living in poverty, and middle-income families who do not qualify for subsidies and cannot afford full-fee care. This mixed-methods study examines specific factors that impede expansion and improvement of childcare/preschool in California, from the perspective of five diverse policymakers. Findings reveal a variety of policy solutions in the areas of funding, teacher workforce, quality of care, policy development, and public perception of the importance of high-quality …

Examining The Effects Of A Peer-Mediated Social Skills Intervention On The Prosocial Behaviors Of Elementary Students With Emotional And Behavioral Disorders, Prabhjot Singh

Dissertations

Students with Emotional and Behavioral Disorders represent part of the population of students who receive special education services, and the social skill deficits that they present makes it so that they are less likely to pass their classes and more likely to drop out of school than their typical peers. The social skill deficits of these students often lead to a variety of negative factors including poor relationships and academic achievement. The purpose of this study was to examine the effects of a peer-mediated social skills intervention on fourth and fifth grade students in a public-school setting. The current study …