Digital Commons Network^™

Increasing Cms Sepsis Core Measure Adherence Rates Through Virtual Consultation, Angela Cann

Dissertations

Problem: According to the Centers of Disease Control and Prevention (CDC, 2016), it is estimated that sepsis affects around 1.5 million individuals in the United States annually, causing the death of 250,000 individuals and being responsible for one out of three hospital deaths. One-fourth of patients who develop severe sepsis will die during their hospital stay. Delays in sepsis treatment contribute significantly to increased morbidity, mortality, and length of stay in the hospital. The Centers for Medicare and Medicaid (CMS) sepsis bundle guideline adherence rate in the Emergency Department of a Level III Trauma Center was stagnant at 55% through …

Optimizing The Effectiveness Of Peripheral Intravenous Catheters, Carrie Kollar

Dissertations

Problem Hospitalized adult patients require more than one short peripheral catheter (SPC) to complete the prescribed intravenous (IV) therapy due to catheter failure and the practice of resiting. The purpose of this quality improvement initiative was to increase the rate of SPCs remaining in situ for the entire duration of the IV therapy for hospitalized adult patients.

Methods Application of an engineered securement device (ESD), an educational program pertaining to modifiable risk factors, and changing the practice to removal upon clinical indication were methods utilized to reduce the number of SPC insertions and catheter failures. This study was conducted at …

Social Patterns And Pathways Of Hiv Care Among Hiv-Positive Transgender Women, Dana D. Hines

Dissertations

Transgender women have the highest HIV prevalence rates of all gender and sexual minorities, yet are less likely to enter and be retained in HIV care. As a result, they are at high risk for HIV-related morbidity and mortality. This study aimed to describe the illness career of transgender women living with HIV and to describe how interactions with health care providers and important others influenced their illness trajectory.

Mechanical Characterization Of Animal Derived Starting Materials For Tissue Engineering, Bin Zhang

Dissertations

Animal derived starting materials are well established in the production of Tissue Engineered Medical Devices. Porcine specifically can be found in products ranging in application from hernia repair to breast reconstruction. Although this material has been largely accepted in the Tissue Engineering industry, little is known of its material properties and mechanical characteristics. A review of the scientific literature describes limited mechanical measures only on uncontrolled research grade material. The objective of this work is to mechanically characterize porcine starting material used in the medical device industry. Porcine skin is provided by Midwest Research Swine, LLC (MRS) an established supplier …

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 …

Engagement Of Primary Stakeholders To Tailor A Comprehensive Transitional Care Model For Persons Who Have Experienced A Stroke And Their Caregivers, Lorre Laws

Dissertations

Stroke is the leading cause of disability in the US, affecting approximately 795,000 persons annually. Stroke care is delivered across multiple settings from hyperacute care in a hospital through chronic stroke management in the community. Considerable advancements have been made in the delivery of hyperacute and acute stroke care. Science and practice gaps exist in providing stroke transitional care across multiple providers and settings once an individual is discharged from an in-patient care facility to home.

Using a qualitative descriptive design, this study engaged and elicited descriptions from stroke survivors and caregivers affected by stroke to inform the refinement and …

Moral Development And Public Health Nursing, Margaret Avila

Dissertations

Public health nurses (PHNs) have the opportunity and professional obligation to be at the forefront of the fight to eliminate health disparities based on the practice principle of social justice. The overall purpose of this descriptive study was to explore the stage of the moral development in a convenience sample of practicing public health nurses (PHNs) and the differences in moral development stage across selected demographic variables (age, gender, race/ethnicity, level of entry into professional nursing, highest level of education, years practicing as an RN, years practicing in a public health department, self-identified political views, primary language, and region of …

The Effects Of Therapeutic Back Massage On Psychophysiologic Variables And Immune Function In Spouses Of Cancer Patients, Linda M. Goodfellow-Kruth

Dissertations

Scant attention has been given to help spouses of cancer patients reduce stress associated with their partner's illness. Stress-induced immune function change may be the link between stress and illness. A significant decrease in natural killer cell activity (NKCA) and a high incidence of stress-related disorders, depression, loneliness, and marital disruption have been reported in spouses of cancer patients. Therapeutic back massage (TBM) is an intervention that may be beneficial in reducing stress in spouses of cancer patients. TBM is a systematic form of touch that manipulates soft tissues of the body to promote relaxation. Interventions that induce relaxation have …

Antibiotic Resistant Bacteria, Antibiotic Resistance Genes And Potential Drivers In The Aquatic Environments, Shuo Shen

Dissertations

As antibiotic resistance genes in aquatic environment have been increasing across the world, affecting water quality and public health, many studies documented concentrations of antibiotic resistance genes and some studies discussed their potential drivers. However, systematic and quantitative reviews that link antibiotic resistance genes (ARGs) to anthropogenic and environmental factors are limited. Nevertheless, this information will be important for developing regulation policy on controlling antibiotic use and therefore reducing potential risks to antibiotic resistance. I conducted meta-analysis of ARGs concentration at a global scale using Bayesian inference to explore climatic and socio-economic factors as drivers. I found local-scale climatic variables …

Comparative Host Response And Gene Regulation In Deer Mice And Syrian Golden Hamsters During Acute Infection With Modoc Virus, Tyler Sherman

Dissertations

Flaviviruses (family Flaviviridae, genus Flavivirus) comprise a diverse group of globally-distributed viruses that may specifically infect vertebrates, invertebrates, or both. Of those that can replicate in both invertebrates (such as ticks and mosquitoes) as well as vertebrates (such as mammals), many represent important human pathogens. Examples of these include dengue virus (DENV), which may cause severe hemorrhagic fevers, West Nile virus (WNV), Japanese encephalitis virus (JEV), and Zika virus (ZIKV), all of which may cause febrile illness with neurologic involvement, and yellow fever virus (YFV), which may induce hepatic dysfunction. Given that these viruses (among others) are carried and transmitted …

Hypertension Therapeutic Goal Attainment In Patients With Dual Diagnoses Of Hypertension And Diabetes, Susan Marie Harris

Dissertations

The purpose of this study was to evaluate the adequacy of blood pressure control and utilization patterns of antihypertensive agents among patients with dual diagnoses of hypertension and Diabetes Mellitus type 2 seen in a primary care clinic during the calendar year 2008.

Tattoo Adversity, Regret, And Removal: Constructivist Grounded Theory, Luis R. Esparza

Dissertations

To date, unique tattoo designs and inks have become a trend (Mao & De Joseph, 2012). Regrettably, trendy tattoos have brought many forms of tattoo adversity. Tattoo adversity can include tattoo regret, tattoo-related health complications, and tattoo artist -tattooed relational betrayal (Birrell & Freyd, 2006). The purpose of this study was to explore the events, circumstances, and experiences that comprise tattoo adversity to such a degree that an individual would seek tattoo removal. The researcher utilized constructivist grounded theory to understand participants’ experiences of tattoo adversity leading to tattoo removal. Interview data illuminated participants’ tattoo regret, pain, and aspirations while …

Contributions Of Three Nursing Leaders To The Development Of Registered Nursing Education In Jamaica, 1946-1986, Hermi Hyacinth Hewitt

Dissertations

The historical research design is used to document the contributions that Misses Ruth Nita Barrow, Gertrude Hildegarde Swaby and Julie Symes made in advancing the status of professional nursing education in Jamaica, between 1946 and 1986. Their roles in the Jamaica General Trained Nurses Association and the General Nursing Council of Jamaica in obtaining registration for nurses' education in Jamaica, reciprocal agreement with England and Wales and professional recognition from the International Council of Nurses are discussed. Since nearly two decades of Barrow, Swaby and Symes' contributions to professional nursing's development occurred while Jamaica was a British colony, the economic, …

Development And Testing Of A Measure Of Patient Satisfaction With Nursing Care, Lee A. Schmidt

Dissertations

The purpose of this research was to test an empirically derived measure of patient satisfaction with nursing care. Existing measures of this important phenomenon lack adequate validity and a strong theoretical base. A grounded theory study was completed with patients discharged from medical surgical units of a tertiary care facility.

Factors That Influence Health-Related Quality Of Life And Satisfaction With Care Among Adults At A Community-Based Aids Service Organization, Robert T. Dodge

Dissertations

The purpose of this study was two-fold: (a) to describe health-related quality of life and satisfaction with care among adults at a community-based AIDS service organization, and (b) to identify the socio-demographic variables that influence health-related quality of life and satisfaction with care. The theoretical frameworks that guided this study were the Wilson and Cleary's (1995) health-related quality of life conceptual model of patient outcomes and Ware's (1978) taxonomy of patient satisfaction. The research design consisted of a nonexperimental, descriptive and correlational study that was designed to describe health-related quality of life and satisfaction with care among adults at a …

Between This World And The Next: The Lived Experience Of Having A Life-Threatening Illness, Janna C. Roop

Dissertations

Wonderings about hospice patients' experience of dying evolved into the question, "What is it like to have a life-threatening illness?" That question guided this interpretive phenomenological inquiry. Phenomenology is a philosophy that seeks to rediscover the rich meaning lying hidden beneath the surface of everyday. Phenomenology's quest is to coax that which has been concealed out into the light. It is a call to re-dis-cover what Martin Heidegger (1959/1966) might call the mystery of Being. What is it that anesthetizes us to the wonder of our everydays? What is it about the ordinary that blinds us to its depth? We …

Suffocated Cd8 T Cells In The Hypoxic Tumor Microenvironment, Lourdes Beatriz Plaza Rojas

Dissertations

Hypoxia is a common feature of solid tumors that plays an important role in angiogenesis, malignant progression and metastatic development. However, its impact on T cell anti-tumor responses is less known. We determined that CD8 tumor infiltrating lymphocytes (TILs) tend to localize to non-hypoxic tumor areas, suggesting a susceptibility to tumor-associated hypoxia. This led us to further study the effects of hypoxia in vitro by culturing spleen-derived mouse T cells in a humidified chamber at 0.5% O2, 5% CO2 and 37 °C. We found that T cell proliferation and effector function are reduced by hypoxia, severely affecting inflammatory cytokine production. …

Elucidating The Impact And Mechanism Of Hepatitis C Virus Cell-To-Cell Spread, Karina Durso-Cain

Dissertations

Virus cell-to-cell spread has been implicated in the establishment of persistent infection and has been shown to be involved in the transmission of antiviral resistant mutants. However, relatively little is known about how virus cell-to-cell spread impacts infection or the specific mechanisms by which cell-to-cell spread occurs. as such, this dissertation focused on investigating HCV cell-to-cell spread not only to learn more about this medically important virus, but also to determine the broader impact cell-to-cell spread has on viral infection dynamics, identify the cellular factors involved, and perhaps ultimately provide insight into antiviral strategies that might enhance the barrier to …

Developing Caspase-1 Biosensors To Monitor Inflammation In Vitro And In Vivo, Sarah Talley

Dissertations

Inflammation is central to the pathogenesis of numerous human diseases. in many contexts, inflammation drives immune responses which are critical to protection against many pathogens. However, uncontrolled inflammation can drive the pathology of numerous diseases, including neurodegenerative diseases, intestinal disorders, cancer, and autoimmune diseases. a primary mediator of inflammation is the inflammasome complex, which drives the release of inflammatory mediators through caspase-1 activation. Our goal was to develop a tool that would allow us to monitor caspase-1 activation in vitro and ultimately in vivo. to this end, we employed a circularly permuted form of luciferase in which the N- and …

Determining The Genetic And Phenotypic Profile Of Cord Blood Derived T Regulatory Cells And The Effect Of Calcitriol On Immune Suppression, Anya Nikolai-Yogerst

Dissertations

Recent outbreaks in vertically transmitted viruses, such as Zika virus and HIV, have rejuvenated interest in fetal and neonatal immune tolerance. Babies are susceptible to vertically transmitted viruses because fetal and neonatal immune systems are considered to be immune-privileged and will tolerate antigens presented to them by their mother. Thus, understanding the mechanisms of this tolerance is important to design effective treatments for infected mothers to protect their offspring. Here, I define a novel Treg, a type of T cell that mediates tolerance, named bidirectional T cells (BiT), found in human umbilical cord blood (UCB). These cells are induced by …

The Effects Of Health Beliefs, Acculturation, And A Culturally Appropriate Teaching Intervention On Parents' Knowledge Of And Compliance With Tuberculosis Treatment In A Mexican-American Population: A Preliminary Analysis, Renee P. Mcleod

Dissertations

The primary purpose of this research study, using a correlational and comparative descriptive design, was to examine the effects of health beliefs, acculturation, and a culturally appropriate Spanish-language audiotaped novena on knowledge of Tuberculosis (TB), and compliance with treatment and medications in Mexican-American parents' of a child with TB infection. Due to the limited number of subjects obtained (N = 31), the research data and analyses are presented as preliminary findings since meaningful hypothesis testing would be premature at this time.

Integrating Patient Safety In Nursing Education: An Analysis Of Pre-Registration Nursing Curricula In Kenya, Nickcy Nyaruai Mbuthia

Dissertations

The purpose of this research was to investigate the extent to which patient safety concepts were integrated in the Kenyan pre-registration Bachelor of Science in nursing curriculum, and to understand the issues that influence its delivery in the classroom and clinical settings, with the aim of developing strategies that will enhance the integration of patient safety concepts in the curriculum. In the first phase, a qualitative content analysis of the nursing curriculum documents was performed.

Happy Feet In A Rural Clinic: A Diabetic Foot Education Intervention, Carmencita S. Abood

Dissertations

Rural Healthy People 2010 report indicated that diabetes was more pervasive in non-metropolitan areas than in central cities and more commonplace in the Southeast and the Southwest regions of the United States due to complex set of factors such as low socioeconomic status among many rural residents, a high proportion of racial or ethnic minorities, and aging populations that were predominant in rural areas. The need for innovative, low literacy education material that type 2 diabetes mellitus (T2DM) patients in a rural clinic is imperative. The purpose of the capstone project was to determine the effectiveness of a patient-centered diabetes …

The Histoplasma Capsulatum Ddr48 Gene Is Required For Survival Within Macrophages And Resistance To Oxidative Stress And Antifungal Drugs, Logan Blancett

Dissertations

Histoplasma capsulatum(Hc)is a systemic, dimorphic fungal pathogen that affects upwards of 500,000 individuals in the United States annually. Hc grows as a multicellular mold at environmental temperatures; whereas, upon inhalation into a human or other mammalian host, it transforms into a unicellular, pathogenic yeast. The research presented in this dissertation is focused on characterizing the DNA damage-responsive gene HcDDR48. HcDDR48was originally isolated via a subtractive DNA library enriched for transcripts enriched in the mold-phase of Hcgrowth. Upon further analysis we found that HcDDR48is not just expressed in the mold morphotype, but both growth programs …

The Antimicrobial Activity And Cellular Targets Of Plant Derived Aldehydes And Degradable Pro-Antimicrobial Networks In Pseudomonas Aeruginosa, Yetunde Adewunmi

Dissertations

Essential oils (EOs) are plant-derived products that have been long exploited for their antimicrobial activities in medicine, agriculture, and food preservation. EOs represent a promising alternative to conventional antibiotics due to the broad-range antimicrobial activity, low toxicity to human commensal bacteria, and the capacity to kill microorganisms without promoting resistance. Despite the progress in the understanding of the biological activity of EOs, many aspects of their mode of action remain inconclusive. The overarching aim of this work was to address these gaps by studying molecular interactions between antimicrobial plant aldehydes and the opportunistic human pathogen Pseudomonas aeruginosa. We initiated …

When The Injured Nurse Returns To Work: An Institutional Ethnography, Laurie Clune

Dissertations

Nursing is a high risk profession for injury. A Canadian survey reports many nurses are in poor physical and emotional health; they sustain more musculoskeletal and violence related injuries than other occupational groups. In Ontario, an injury management approach called Early Return to Work (RTW) requires injured workers, including nurses, to go back to work before full recovery. The Workplace Safety and Insurance Board cite this approach as beneficial to both the employer and employee. This study uses an institutional ethnographic approach to examine critically the RTW process from the standpoint of injured registered nurses. Through interviews and mapping activities …

Implementation Of Oral Health Recommendations In Pediatric Primary Care, Kelly Lucash

Dissertations

Abstract

Problem: Early childhood caries (ECC) is the most common chronic disease of childhood and fluoride is key to prevention. A major barrier to dental care for children is lack of access to a dental provider. Current practice recommendations include the application of fluoride varnish (FV) in the primary care setting. The purpose of this quality improvement initiative was to evaluate the number of FV applications in a Midwestern, suburban pediatric primary care practice.

Methods: An observational, descriptive design utilizing retrospective medical record reviews for children aged 12-, 18-, 24-, and 36-months who experienced well-child visits between April 1^{st …}

Estimation Of Infectious Intestinal Disease Burden And Description Of The Infectious Disease Surveillance System In Ras Al Khaimah, United Arab Emirates, Fatema Hamdan Saif Al Alkeem Al Zaabi

Dissertations

Introduction: Infectious disease (ID) is an ongoing problem worldwide. In order to manage this problem, it is important to have an integrated and effective surveillance system that can be used to estimate the burden of ID. There is a scarcity of studies published on the prevalence of IDs in the United Arab Emirates (UAE), both in hospital settings and in the community. Infectious Intestinal Disease (IIDs) have been one of the most commonest IDs that have been studied in the community around the world, there are no studies on the prevalence of IIDs in Ras Al Khaimah (RAK). Furthermore, while …

Self-Efficacy, Social Support, Therapeutic Support And The Initiation And Duration Of Breastfeeding In Adolescent Mothers, Deborah L. Birk

Dissertations

This longitudinal investigation examines self-efficacy, social support and therapeutic support as predictors of initiation and duration of breastfeeding in adolescent mothers. It proposes that prenatal levels of self-efficacy, social support and therapeutic support are significant predictors of breastfeeding initiation in adolescent mothers. It also proposes that postpartum levels of these variables are significant predictors of the number of days breastfeeding after delivery in adolescent mothers.