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Modulation Of Corticospinal Excitability Induced By Paired Associative Stimulation Combined With Movement, Ahmad O. Alokaily

Dissertations

An essential feature of the brain is its capacity to undergo long-lasting morphological or functional changes in response to experiences or trauma. Advances in noninvasive brain stimulation techniques have led to increased interest in understanding neural mechanisms of neuroplasticity at the network level. Paired associative stimulation (PAS) is one of the most commonly used applications for noninvasive brain stimulation because of its clinical potential as an adjuvant rehabilitative intervention. However, the optimal method for incorporating PAS into rehabilitative activities remains unknown. This dissertation explores different approaches to combining PAS with movement and investigates the enhancement of the specificity of conventional …

Modelling In Vitro Dissolution And Release Of Sumatriptan Succinate From Polyvinylpyrrolidone-Based Microneedles Aided By Iontophoresis, James Paul Ronnander

Dissertations

A novel dissolving microneedle array system is developed to investigate permeation of a sumatriptan succinate formulations through the skin aided by iontophoresis. Three formulations consisting of hydrophilic, positively charged drug molecules encapsulated in a water-soluble biologically suitable polymer, polyvinylpyrrolidone (PVP), have been accepted by the U.S. Food and Drug Administration (FDA). The microneedle systems are fabricated with 600 pyramid-shaped needles, each 500 µm tall, on a 0.785-cm² circular array. In vitro transdermal studies with minipig skin and vertical Franz diffusion cells show > 68% permeation of sumatriptan over a 24-hour period. A combination of microneedle and electrical current density ranging …

Engineering Of Escherichia Coli 2-Oxoglutarate Dehydrogenase Complex With Mechanistic And Synthetic Goals, Joydeep Chakraborty

Dissertations

The Escherichia coli 2-oxoglutarate dehydrogenase complex (OGDHc) compromises multiple copies of three enzymes - 2-oxoglutarate dehydrogenase (E1o), dihydrolipoyl succinyltransferase (E2o), and dihydrolipoyl dehydrogenase (E3). OGDHc is found in the Krebs cycle and catalyzes the formation of the all-important succinyl-Coenzyme A (succinyl-CoA). OGDHc was engineered to understand the catalytic mechanism and optimized for chemical synthetic goals.

Succinyl-CoA formation takes place within the catalytic domain of E2o via a transesterification reaction. The succinyl group from the thiol ester of S8-succinyldihydrolipoyl-E2o is transferred to the thiol group of CoA. Mechanistic studies were designed to investigate enzymatic transthioesterification. His375 and Asp374 was shown to …

Roles Of Surfactant And Binary Polymers On Dissolution Enhancement Of Bcs Ii Drugs From Nanocomposites And Amorphous Solid Dispersions, Md Mahbubur Rahman

Dissertations

Drug nanocomposites and amorphous solid dispersions (ASDs) are two major formulation platforms used for the bioavailability enhancement of BCS Class II drugs. The major drawback of nanocomposites is their inability to attain high drug supersaturation during in vitro (<50% relative supersaturation) and in vivo dissolution. On the other hand, formulating an amorphous solid dispersion (ASD) with high drug loading (>20%) that releases drug rapidly, while generating and maintaining high supersaturation over at least three hours is challenging. The goal of this thesis is to develop a fundamental understanding of the impact of anionic surfactants–polymers on in vitro drug release from nanocomposites and ASDs, while addressing the above challenges. To achieve this goal, the following objectives are set: (1) compare griseofulvin …

Impact Of The Bar Code Medication Administration (Bcma) System On Medication Administration Errors, Mary P. Davis

Dissertations

Medication errors are the second most frequent cause of injury among all types of medical errors (Leape, et al., 1991). Of concern to nursing practice, medication administration errors (MAE) are second only to ordering errors (Bates, Cullen, et al., 1995). The introduction of information technology designed to promote safe medication practice, such as the Bar Code Medication Administration (BCMA) system, offers new opportunities for reducing MAE. BCMA was developed to improve patient safety, improve documentation of medication administration, decrease medication errors, and capture medication accountability data. The overall goal of this study was to evaluate the impact of BCMA on …

Physiologic And Behavioral Responses To Acute Myocardial Ischemic Pain In Mexican Male Patients, Marilyn Kuhel Douglas

Dissertations

The verbal, non-verbal and physiologic responses of Mexican male patients to the pain of acute myocardial ischemia were studied as a basis for subsequent comparison with other cultural groups. A sample of 57 patients was studied in the Emergency Department (ED) of a federal, tertiary health care facility in urban central Mexico. Inclusion criteria were: chief complaint of non-traumatic chest pain and subsequent admission to the Coronary Care Unit with a suspected acute myocardial infarction (AMI); Mexican birth and residence; male gender; 35 years or older; and, 12 or less years education. At the time of ED admission, a 12-Lead …

Reproductive Decisions In Carriers Of Genetic Disease: A Survey Of Parents Of Children With Inborn Errors Of Metabolism, Catherine Yetter Read

Dissertations

This study explained reproductive decisions among parents who have already given birth to a child with an inborn error of metabolism (IEM). Two hundred thirty parents (65% response rate) completed a telephone survey which addressed biologic, psychological and sociocultural variables relative to five reproductive decision making outcomes (receptivity to prenatal diagnosis, likelihood of pregnancy termination, impact on future reproductive plans, measures taken to prevent future pregnancies, and birth of subsequent children). Using a combination of logistic and multiple regression, five models, derived from the Interaction Model of Client Health Behavior (IMCHB), were constructed to explain both the direct and indirect …

Development And Testing Of A Text Messaging Educational Intervention For Pregnant Adolescents, Rhonda R. Martin

Dissertations

This study developed a literature based educational text messaging intervention, utilizing professional and adolescent subject matter experts (SMEs) to assess the content validity of the intervention, and pilot test the intervention for effect on pregnant adolescents' knowledge of nutrition and physical activity. Pregnant adolescents tend to utilize prenatal care inconsistently and have problems with weight gain during pregnancy. Questions have arisen regarding whether pregnant women are receiving education needed to eat healthy and be active during pregnancy. Several studies identified that women know to eat healthy and exercise but not specifically what to eat, what kind of activity to perform, …

What Is The Bsn Student's Perception Of Why A Nursing Course Was Failed?, Amy M. Owen

Dissertations

Nursing student success is important to students, faculty, institutions of higher education, and the healthcare needs in Texas. Despite recent research showing that cognitive indicators can predict student success, the use of these factors has not significantly decreased the number of courses failed in nursing school. The purpose of this study was to explore the Bachelor of Science (BSN) nursing student perception of why a nursing course was failed.

The Relationship Between Recurrent Placental Pathology And Recurrent Poor Pregnancy Outcome, Cara Krulewitch

Dissertations

Poor pregnancy outcome (PPO) is a top agenda item in health and political arenas. Most prominent PPOs are low birth weight (LBW) and preterm delivery (PTD). Effective interventions to maximize pregnancy outcome will diminish their negative impact. The placenta is a diary of the infant's prenatal experiences. Changes in the placenta provide clues to the uterine environment during the pregnancy. Each placental pathology represents a different insult, including severity, duration and type. The Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke was a longitudinal study of obstetric outcomes in women. The study was conducted …

Describing Nursing Effectiveness Through Standardized Nursing Languages And Computerized Clinical Data, Cindy Ann Scherb

Dissertations

The purpose of this descriptive exploratory study was to analyze patient data from a computerized clinical documentation system using the standardized languages of the North American Nursing Diagnosis Association, the Nursing Interventions Classification, and the Nursing Outcomes Classification. This study investigated the relationships between nursing diagnoses, interventions, and outcomes for the patient populations of Pneumonia, Congestive Heart Failure (CHF), and Total Joint Replacement (TJR).

Using The Revised Wilson And Cleary Model To Explore Factors Affecting Quality Of Life In Persons On Hemodialysis, Daria L. Kring

Dissertations

The purpose of this study was to describe the quality of life in persons with end stage renal disease and examine factors that may affect quality of life. A revised version of Wilson and Cleary's model for health-related quality of life was used to guide the study. Biological factors (serum albumin and serum hemoglobin), symptoms (dialysis symptoms, anxiety, depression, and fatigue), functional status, general health perception, characteristics of the individual (age, gender, race/ethnicity), and characteristics of the environment (time on dialysis, marital status, and socioeconomic status) were examined to determine their potential impact on overall quality of life. A cross-sectional, …

Effects Of Anxiety Reducing Interventions On Performance Anxiety In Graduate Nurses, Georgita L. Tolbert Washington

Dissertations

Every new nursing graduate is challenged to successfully transition from student to professional nurse. The stress involved in that transition can manifest itself as performance anxiety, a type of anxiety occurring when someone is the focus of attention and is fearful of interactions or of being humiliated or embarrassed. It occurs only in specific situations. The new graduate's performance is the focus of attention and evaluation. Further, the need to interact with other professionals, patients, and families can create anxiety about performance. No studies have examined performance anxiety in graduate nurses. Use of cognitive behavioral therapy, progressive muscle relaxation, and …

Perceptions Of Patients' Post Coronary Artery Bypass Grafting Surgery Related To Health Related Quality Of Life And Satisfaction When Nurse Practitioners Are Active Participants In Care, Patricia D. Sweeney

Dissertations

The issue of quality health care has a renewed focus since the Institute of Medicine's 2000 report and has become a primary concern for patients, providers, and payors. Quality needs to be addressed from the perspective of the patient, incorporating patient-centered preferences in all areas where care is received; with special attention for high frequency, high cost, high-risk populations that evaluates all types of providers. The primary aim of this study is to describe patient perceptions of health related quality of life (HRQOL) and satisfaction for patients hospitalized for coronary artery bypass grafting (CABG) surgery when Nurse Practitioners (NP) are …

Attitudes, Subjective Norms, And Perceived Behavioral Control: Critical Care Nurses' Intentions To Provide Culturally Congruent Care To Arab Muslims, Stephen R. Marrone

Dissertations

The purpose of this study was to investigate the relationships among critical care nurses' attitudes, subjective norms, perceived behavioral control, and intentions to provide culturally congruent care to Arab Muslims. A purposive convenience sample of 208 critical care nurses participated in this investigation. Data were collected using four Likert-scale instruments. Each subject received an attitude score, subjective norms score, perceived behavioral control score, and intention score.

An Examination Of The Relations Amongst Power, Uncertainty, Self-Transcendence, And Quality Of Life In Breast Cancer Survivors, Arlene T. Farren

Dissertations

The investigator examined the relations amongst Power, Uncertainty, Self-transcendence, and Quality of Life in breast cancer survivors. The theoretical rationale linked the theories of Barrett, Mishel, and Reed with Ferrans' conceptual model of Quality of Life from the perspective of Rogers' Science of Unitary Human Beings (SUHB). The variables were operationalized using: Quality of Life Index-Cancer Version (QLI-CV), Power as Knowing Participation in Change Tool, Version II (PKPCT), Mishel's Uncertainty in Illness Scale-Community Form (MUIS-C), and the Self-Transcendence Scale (STS). Following human subjects protection approvals, a correlational, cross-sectional study with purposive sampling was conducted and 104 women participated.

Differences In The Frequency Of Use Of Breast Cancer Control Methods In Black And White Women: An Application Of The Health Belief Model, Merrian E. Douglass

Dissertations

The purposes of this study were to describe differences in the frequency of use of breast cancer control methods (mammogram (MAM), clinical breast examination (CBE), and breast self-examination (BSE)) and health beliefs about breast cancer and breast cancer control methods, and to assess the usefulness of health beliefs about breast cancer and breast cancer control methods in predicting use of breast cancer control methods among black and white women.

Attitudes Of Nurses Toward Children With Disabilities, Kathleen A. Marsala-Cervasio

Dissertations

The attitudes of U.S. nurses toward children with disabilities have not been adequately measured over time and after an educational intervention. Disability content has not been a priority in nursing education and, if present, the focus has been on adults with disabilities. The attitudes of nurses play a significant role in the provision of quality healthcare services they provide for children with disabilities. This quantitative, experimental research measured the attitudes of graduating nursing students (N= 88) toward children with disabilities utilizing the Attitudes Towards Disabled Persons Scale (ATDP-B) before and after disability education.

The Training Of Elementary Assistant Principals, Nailya Jarocki

Dissertations

Purpose: The purpose of this Delphi study was to identify the most important professional development topics and practices for preparing teachers to become elementary assistant principals, as perceived by panel of experts. An additional purpose was to identify strategies for implementing the most important practices for the preparation of teachers to become elementary assistant principals.

Methodology: A classical Delphi method was utilized to collect perceptual data from a panel of California elementary school principals and administrators at county, district offices of education, and at the university level in California that met specific criteria regarding their education, years of experience, completion …

Comparison Of Telemedicine To Traditional Face-To-Face Care For Children With Special Health Care Needs: Analysis Of Cost, Caring, And Family-Centered Care, Mary A. Hooshmand

Dissertations

It is estimated that one out of every five household with children in the United States includes a Child with Special Health Care Needs (CSHCN). Families of CSHCN face many challenges including financial burdens beyond that of other families and difficulty accessing much needed pediatric specialty care. Telemedicine provides a potential solution or, at the least, an alternative to the traditional system of care, for health care providers and communities to address access and financial concerns of families of CSHCN. A quasi-experimental research design was used in this study to examine the differences in cost, caring, and family-centered care in …

Concept And Process Of Attaining And Maintaining Health For A Selected Vietnamese Immigrant Population, Louise Dean-Kelly

Dissertations

Nursing theorists have proposed that health is a concept central to nursing, yet the concept is surrounded by confusion and ambiguity because the word has had varying interpretations applied to it over time by both professionals and the lay public. A limited number of studies have been done to determine what professional's and lay persons' believe about health and how important it is to them. While Leininger (1985) has noted that health is both culturally defined and expressed, only a few studies have attempted to determine what difference a person's cultural background might have on his or her interpretation of …

Exemplary Leadership: A Mixed-Methods Case Study Discovering How Special Education Administrators Create Meaning, Julia Vandervennet

Dissertations

Purpose: The purpose of this mixed-methods case study was to identify and describe the

behaviors that exemplary Special Education administrators use to create personal and organizational meaning for themselves and their followers through character, vision, relationships, wisdom, and inspiration. In addition, it is the purpose of this study to determine the degree of importance to which special education teachers perceive the behaviors related to character, vision, relationships, wisdom, and inspiration help to create personal and organizational meaning.

Methodology: The current mixed-methods study obtained in depth qualitative data through interviews from 3 exemplary special education administrators. Following the qualitative interview …

Distributive Justice And Social Policy: A Case Study, Susan Swider

Dissertations

This research focused on explicating the conceptions of just distribution of resources underlying one example of health policy. The policy used as a case study was federal funding of home health care under Medicare, during the period 1965-1984. The data consisted of the public records of debate on federal policy for home health care during this period.

Coping With Acute Myocardial Infarction, Kathryn Ambur Scherck

Dissertations

This study examined how acute myocardial infarction (AMI) patients cope during the first three days of illness. Although the ability of patients to cope has been previously studied, there has been little investigation of coping efforts other than denial. Using the theory of coping explicated by Lazarus and colleagues, this study examined patients' appraisals and use of various behavioral and cognitive coping strategies. This study used a descriptive, exploratory design. The nonrandom sample consisted of 30 acutely ill AMI patients.

Predictors Of Hospitalized Patients' Access To Post-Discharge Home Health Services, Jeanne A. Matthews

Dissertations

An ex post facto study was conducted to identify factors associated with diabetic patients' access to home health services following hospital discharge. The Andersen (Aday, Fleming, & Andersen, 1984) model of access served as the conceptual framework for the study which examined the relationship between the predisposing, enabling, and need characteristics of the sample, and the realized access indicators of referral to, and acceptance for post-discharge home health services.

Organic Buildup And Residual Blood On Clean Infant Stethoscopes Used In Maternal-Infant Areas, Jan Marie Nick

Dissertations

Since the mid 1980s, health care workers have attempted to eliminate contact with blood and other body via primary or secondary exposure. At delivery, stethoscopes used on newly born infants come in direct contact with blood and body fluids from the skin of the infant. If contaminants such as blood and body fluids still remain on stethoscopes despite cleaning, an environmental risk may exist.

Using a naturalistic setting, a non-experimental, two group post-test design was implemented to investigate the occurrence of organic buildup and residual blood on clean stethoscopes used on infants in the delivery and/or nursery areas. Eleven hospitals …

Prenatal Breastfeeding Education: An Intervention For Pregnant Immigrant Hispanic Women, Jane W. Schlickau

Dissertations

This experimental study tested a one-to-one Prenatal Breastfeeding Education (PBE) intervention for primigravid immigrant Hispanic women who received prenatal care at a public health clinic. The study framework was derived from the Health Promotion Model. Specific aims were: (a) to test if the intervention increased breastfeeding initiation, (b) to test if the intervention increased breastfeeding duration and (c) to discover if breastfeeding self-efficacy mediates the effect of the intervention on breastfeeding initiation and duration.

Adult Patient Perceptions Of Nurse Listening Behaviors In An Acute Care Setting, Nancy E. Loos

Dissertations

Good listening is fundamental to effective nursing practice, critical to a healthcare professional's competence, and essential for patient satisfaction and experience. Because nurse listening has been linked to an enhanced patient experience and improved patient outcomes, it has been considered important enough that the U.S. Centers for Medicare or Medicaid Services have solicited patient perception as part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (CMS, n.d.). However, little can be found in the literature that describes which nursing behaviors are perceived by patients as listening behaviors. Via face-to-face interviews, this study sought to discover, describe, …

Down Home: An Ethnography About Community Process And Health Of Older Persons In A Rural Setting, Carol A. Craig

Dissertations

The purpose of this study was to understand how rural-dwelling elderly people describe their health and to gain an understanding of rural community processes as they relate to the health of older residents. Although community health nursing practice supports community-level interventions, the influence of communities upon the health of older community members is not well known. Ethnographic design and methods were employed to study the health of older residents in a Western Plains farming community of about 500 people.

Acuity-Based Staffing In Long Term Care: Does It Influence Quality?, Kathy Diane Gray-Siracusa

Dissertations

Long-term care settings have frequently been targeted as environments prone to deficiencies in quality and resultant negative effects on resident safety. The use of minimum nurse staffing ratios has been proposed as a way to improve the quality of care for long-term care residents. However, the American Nursing Association has criticized the appropriateness of ratios for the determination of staffing needs. A more appropriate staffing methodology is one that is based on a measure of intensity that takes into consideration the aggregate population of patients and the associated roles and responsibilities of the nursing staff. The purpose of this study …