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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 …

Evaluation Of Data Collection Operations For Real-Time Influenza Surveillance During An Emergency, Yuwen Gu

Dissertations

It is unclear how data collection operations for surveillance alter the disease portrayal that influenza reported trends attempt to provide during an emergency. This study developed a model that simulates the collection and testing of influenza specimens after an outbreak is declared in Michigan. It performed simulation based optimization to understand which operational factors affect the biases between the growth rates of original and observed influenza incidence trends, and to quantify the predictive power of the influenza incidence trends at different points of data collection. The results show that emergency driven high risk perception increases the reporting, which leads to …

A Quality Initiative To Reduce Pneumonia Readmissions And Mortality In Older Adults, Terri Morris

Dissertations

The United States (U.S.) healthcare system journey for making improvements in the quality and value of healthcare continues. Hospital organizations are required to compose and make publically available their health quality outcome data. The publication transparency and increased availability of local, regional and national health quality metrics, including readmission and mortality rates, to governmental agencies, health plans, investors, other hospitals, providers and potential patient and families’ knowledge, creates a competitive pressure for a hospital to assure their quality outcomes data are the best. Despite breakthrough improvements using innovative care models that target vulnerable and potentially high cost of care areas …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

Reducing Cautis In A Neurological Icu, Claire Mckee

Dissertations

Catheter-associated urinary tract infections (CAUTIs) are the primary source of infection in patients with urinary catheters and are the fourth leading cause of healthcare-associated infection. Because indwelling urinary catheters are not completely avoidable in hospitalized patients, it is crucial to utilize evidence-based research to prevent CAUTIs. A urinary catheter maintenance bundle is one way to reduce CAUTI rates in hospitalized patients. This quality improvement project utilizes a catheter maintenance bundle with seven elements with the aim of reducing CAUTI rates. The project takes place in a 20-bed neurological intensive care unit (ICU) in a larger tertiary care medical center. Prior …

A Behavioral Weight Loss Program For Low-Income Adults With Obesity And Hiv, Sophai Thach

Dissertations

Problem: Obesity, having a body mass index (BMI) of 30 kg/m² or greater, increases the risk for cardiovascular disease. For people living with HIV (PLWH), this increases their risk for myocardial infarctions by 50% and causes this life-threatening event to occur at a younger age compared to those who are not diagnosed with HIV.

Methods: With obesity disproportionately affecting people with low income, this study aims to evaluate the effects of a 12-week behavioral weight loss program that utilizes journaling as a self-monitoring tool, weekly educational classes, and individualized goal-setting on PLWH with obesity who live in …

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …

A Grounded Theory Study Exploring Lesbian Patient Self-Disclosure Of Sexual Orientation In Acute Care, Margaret Ruth Neese

Dissertations

The purpose of this study was to develop a grounded substantive theory to describe the process involved in lesbian self-disclosure of sexual orientation in acute care settings. Philosophical Underpinning: The philosophical underpinning was grounded theory as described by Strauss and Corbin (1998).

Essays In The Application Of Machine Learning In Development Economics, Dweepobotee Brahma

Dissertations

This dissertation comprises four essays which apply Machine Learning (ML) techniques to examine India’s progress towards meeting several child-health targets under United Nation’s “Sustainable Development Goals (SDG) 2030”. The application of novel ML techniques unmasks certain detailed empirical aspects of the road to meeting specific indicators of SDG - child mortality, malnutrition, immunization coverage and health-expenses.

The first essay employs multiple parametric and non-parametric Machine Learning (ML) techniques (LASSO, Classification Random Forest, Boosted Logistic Regression, Boosted Classification Trees) to build predictive models for the incidences of neonatal and infant mortality. A large national level household survey dataset is used. All …

The Influence Of Behavioral Cues On Immunization Practices Of Elders, Lynn A. Chilton

Dissertations

A quasi-experimental intervention study was designed to compare the influence of behavioral cues on immunization practices of elders. Elders also were surveyed to determine immunization practices related to influenza and pneumonia and to ascertain reasons for under-immunization among this age group. The Neuman Systems Model and the Health Belief Model were used as conceptual frameworks to guide the study. Data were collected utilizing a Demographic Survey (DS) and an Immunization Survey (IS).

Policy Alternatives That Provide California School Districts With The Policy Options Necessary To Develop Facilities To Enhance Student Learning Opportunities And Optimize Financial Resources, Brett Mitchell

Dissertations

Purpose: The purpose of this study was to develop policy alternatives by the years 2019 to 2025 that would assist state policy makers, legislators, and advocates in adding definition to California school facility development and funding.

Methodology: This study involved descriptive statistics using a Delphi study method. Within the theoretical framework established for policy analysis, this Delphi study was inclusive of the knowledge and expertise of an expert panel that was nominated through peers. The Delphi panel consisted of 24 experts knowledgeable about statewide school facilities policy in California. The Delphi study was comprised of 3 rounds of electronic questionnaires …

A Grounded Theory Approach To Explore The Experience Of Involuntary Childlessness In Couples With Infertility, Taylor L. Grube

Dissertations

Couples who experience involuntary childlessness as a result of infertility are challenged to manage the biological, sociological, and psychological implications of the situation. Furthermore, they are confronted with a variety of options regarding infertility management and resolution of involuntary childlessness. Nurses play a key role in supporting couples as they manage infertility and involuntary childlessness. Since infertility and subsequent involuntary childlessness is a couple's experience, nursing care should aim to meet the needs of both partners. However, there is a lack of evidence to suggest how couples experience and manage this phenomenon. Therefore, the purpose of this study was to …

The Role Of Plasmids And Clones In The Emergence Of Carbapenem Resistant Enterobacteriaceae In The United Arab Emirates, Shaimaa Fekry Mahmoud Mouftah Ali

Dissertations

Resistance to carbapenems, the ultimate beta-lactam antibiotics used to treat life-threatening Gram-negative infections associates with very high mortality. Consequently, carbapenem-resistant Enterobacteriaceae (CRE), which are usually multi- or extremely drug-resistant, is considered a critical pathogen. To help to control their spread, we investigated the molecular epidemiology of CRE in the United Arab Emirates (UAE) and its neighboring countries. CRE isolated in the UAE were screened for IncX3 incompatibility type plasmids carrying carbapenemases. The complete sequence of the IncX3 plasmids identified was established. Thirty CRE carried blaNDM-1, blaNDM-4, blaNDM-5, blaNDM-7, blaOXA-181, and blaKPC-2 on IncX3 plasmids. …

Perioperative Antimicrobial Prophylaxis In Vascular Surgery: A Quality Assessment And Improvement Project, Brian Torres

Dissertations

Introduction: Prophylactic antimicrobial selection and administration for the prevention of surgical site infections in vascular surgery is a recommended best practice. Non-adherence to published guidelines on the selection and administration of antimicrobials has been observed and may lead to reduced efficacy of antimicrobial prophylaxis.

Methods: An observational, descriptive design was used to study clinician knowledge and behavior and included a retrospective patient record review and provider knowledge survey. A clinical education intervention targeting providers responsible for the selection and administration of antimicrobial prophylaxis was conducted. A repeat patient record review and knowledge survey was completed following the education intervention.

Results: …

The Perception Of Physical Activity And Social Support For Physical Activity Among Native Hawaiians 55 Years And Older, Verna Hanashiro

Dissertations

The benefits of physical activity on healthy aging and longevity have repeatedly been identified. Despite these known benefits, sedentary living is a serious and pervasive health problem among older adults throughout the United States, including the Native Hawaiian older adult population in Hawaii. Previous research has identified social support as a major facilitator for participation in physical activity.

The purpose of this study was to examine the perception of physical activity and social support for physical activity among Native Hawaiians 55 years of age and older.

How Professional Physical Therapist Education Programs Develop Cultural Competence Within Their Students: An Exploratory Concurrent Mixed Methods Study, Dustin E. Domingo

Dissertations

Purpose: The purpose of this exploratory concurrent mixed methods study was to describe experiences that shape the factors of cultural intelligence (CQ) as perceived by students of professional physical therapist education programs. In addition, it was the purpose of this study to determine whether any particular factor of cultural intelligence influenced one’s overall cultural competence according to the cultural competence continuum by Cross et al. (1989).

Methodology: Students in a professional physical therapist education program completed a questionnaire, which included Likert scale questions, open ended questions, and a 37-item self-assessment based on the expanded cultural intelligence scale by Van Dyne …

The Experience Of Chief Nurses In Military Operations Other Than War, Martha H. Turner

Dissertations

The purpose of this research was to describe the experience of chief nurses in military operations other than war. The study is significant to the profession because nurses will continue to provide care in humanitarian operations, peacekeeping missions and disaster relief efforts. Inquiry into the experience will lead to an understanding of the foundations of the global caregiving community. Hermeneutic phenomenology provided a description and thematic interpretation of the meaning of the experience. Purposeful sampling yielded thirteen participants, eleven women and two men. Duration of the deployments ranged from 3-7 months. Sites included Saudi Arabia, Oman, Panama, Cuba, Somalia, Guam, …

The Experience Of Families When A Child Is Diagnosed With Cancer With A Favorable Diagnosis, Laura Clarke-Steffen

Dissertations

The major objective of this longitudinal, descriptive study was to describe the family transition to living with childhood cancer, from the family's point of view, when a child is diagnosed with cancer with a favorable prognosis. The major research question was: What is the experience of families when a child is diagnosed with cancer with a favorable prognosis? A convenience sample consisted of 40 members of 7 families with a child recently diagnosed with cancer with a favorable prognosis at a northwestern health sciences university hospital. Cancer with a favorable prognosis was defined to be any subtype of cancer with …

The Use Of Guided Imagery To Enhance Power For Smoking Behavior Change, Christine A. Wynd

Dissertations

Cigarette smoking is known to be a risk factor in several fatal disease syndromes. Despite increasing knowledge of the danger, thirty-one percent of all Americans continue to smoke (Thornberry et al., 1986). Individual responsibility for behavioral change is indicated for successful, long-term smoking abstinence. However, there is need for continued systematic study of interventions which assist clients in their pursuit of healthier lifestyle change. The purpose of this study was to determine the effectiveness of guided imagery for enhancing client power relevant to smoking behavior change.

Composure Behaviours Of Advanced Beginner Nurses And Their Effects On The Wellness Outcome Among Selected Orthopaedic Patients: Basis For Action Plans, Bea-Gracia M. Cruz

Dissertations

The study determined the effects of the COMPOSURE behaviours of advanced beginner nurses on the wellness outcome among selected orthopaedic patients and used quasi-experimental 2-group pretest posttest design.

Binge Alcohol Drinking Exacerbates Ulcerative Colitis Flare, Abigail Cannon

Dissertations

Inflammatory Bowel Disease (IBD) remains a prominent medical concern affecting over 1.4 million people in the U.S. One of the most common forms of the disease is ulcerative colitis (UC), and UC patients will often head doctor's advice to refrain from drinking alcohol. However, whether this phenomenon of alcohol exacerbating UC symptoms occurs is still unknown, which necessitated the generation of a mouse model of UC and binge alcohol. Therefore, we examined a range of DSS concentrations (2-4%) and 2 alcohol paradigms in C57BL/6 mice. Mice receiving 2% DSS ad libitum for five days with a three-day alcohol binge had …

Modulating The Tumor Microenvironment To Induce Cross-Priming For Cancer Immunotherapy, Erica Fleming-Trujillo

Dissertations

Adoptive cell transfer (ACT) using T cells engineered to express tumor-specific T cell receptors (TCR) holds great promise in treating cancer patients. ACT involves the in vitro generation of large numbers of tumor-specific T cells, which are then administered back to the patient, to establish an in vivo response and effective tumor control. Our lab conducted a phase I clinical trial in which metastatic melanoma patients received systemic infusions of autologous T cells transduced to express a tyrosinase-specific TCR (TIL 1383I). We observed tumor regression in one of seven patients and the development of vitiligo, indicative of T cell-mediated killing …

Assessing The Temporal Dynamics Of The Lower Urinary Tract Microbiota And The Effects Of Lifestyle, Travis Kyle Price

Dissertations

Urinary tract infections (UTIs) are among the most common bacterial infections in humans, accounting for $3.5 billion in health care expenditures yearly in the United States alone. Yet, treatments for UTI have seen little innovation over the past decade. As demonstrated in other body sites, such as the vagina and gastrointestinal (GI) tract, acute and infectious diseases often have indirect microbial contributions which serve as intriguing new targets for therapies. The recent discovery of the existence of a resident community of bacteria (i.e., microbiota) in the bladders of both women and men, represents a novel avenue for targeting UTIs. However, …

Structure-Guided T Cell Receptor Mutations That Alter Antigen Specificity, Cross-Reactivity, And Polyfunctional Phenotypes In Gene-Modified T Cells, Kendra Foley

Dissertations

Adoptive cell transfer of T cell receptor (TCR) gene-modified T cells targeting specific tumor antigens is currently in clinical trials for patients with advanced malignancies. Despite the clinical responses, there are still hurdles to be overcome in achieving an effective and safe therapy. One of the limitations in the success of this type of therapy is the potential for cross-reactivity and unanticipated off-target reactivity which could lead to autoimmunity. Adverse events encompassing these "off-target, off-tumor" cross-reactivities leading to autoimmunity have been seen in patients in different clinical trials. Here, we demonstrate a novel approach to improve antigen specific reactivity and …

Determination Of Transforming Growth Factor-Β Signaling Targets In Activated T Cells, Ramiah Jacks

Dissertations

T lymphocytes are a critical component of the adaptive immune system and their responses in pathogenic and steady state conditions require strict regulation. One mechanism involved in this regulation is Transforming Growth Factor-β (TGF-β) signaling. TGF-β can act on activated T cells to facilitate the differentiation of TGF-β dependent T helper subsets or the suppression of T cell activation and proliferation. However, the molecular mechanism(s) by which TGF-β signaling controls T cell differentiation vs T cell suppression remain poorly understood.TGF-β signaling is propagated by initially binding to the TGF-β type II receptor, which subsequently activates TGF-β type I receptor (TGF-βRI) …

Aerococcus Urinae: Establishing The Pathogenesis Of An Emerging Uropathogen, Evann E. Hilt

Dissertations

Urinary tract infection (UTI) is the world's most common bacterial infection. Much is known about the infectious process (pathogenesis) of a few of the bacteria that cause these infections, especially E. coli. Unfortunately, the pathogenesis of E. coli and other uropathogenic bacteria was explored almost exclusively in the belief that the bladder is supposed to be sterile. Our recent evidence, however, debunks this dogma. We used modern methods to reveal diverse bacterial communities in the bladders of adult women. These communities differ in women with and without lower urinary tract symptoms (LUTS), including UTI and urinary incontinence (UI). Many bacteria …

Predicting Decision-Making In Relation To Health-Risk Behavior In College Freshmen, Anne Bijumon Luckose

Dissertations

Method/Measurements: A cross-sectional correlational design explored the relationships between decision-making, health-risk behaviors and social support systems in college freshmen. The aims of the study were: 1) to explore the relationship between decision-making and health-risk behaviors among college freshmen; 2) to determine whether or not family support and social support jointly predict decision-making among college freshmen; and 3) to ascertain whether or not the effect of family support on decision-making is different for male and female college freshmen. Measurement was collected at one time-point and participants in this study completed on-line questionnaires through a web-based online survey software application with measures …

Protection From Staphylococcus Aureus Bloodstream Infection By Probiotic Exopolysaccharide, Wonbeom Paik

Dissertations

Staphylococcus aureus is known to cause severe systemic infection with high mortality rates. Antibiotics are the only approved therapy for patients, but the widespread prevalence of antibiotic resistant strains limits treatment efficacy, and many patients succumb to the disease. Many probiotic agents are commercially available, but the mechanisms by which they benefit are not known. Understanding these mechanisms will help develop novel therapeutics that can improve healthcare, including systemic infections by S. aureus. Bacillus subtilis is a probiotic bacterium that produces an exopolysaccharide (EPS) that induces anti inflammatory macrophages (MΦ). We tested if EPS could be used for systemic S. …

Yczr, A New Case Of Plp-Dependent Mocr/Gabr Type Transcription Regulator In Klebsiella Pneumonia, Yuanzhang Zheng

Dissertations

Increasing number of genes encoding PLP-dependent transcription regulators, MocR/GabR type regulators, have been identified in various bacterial genomes. However, only a handful of them, including MocR, PdxR and GabR have been studied experimentally. They control different aspects of the bacterial metabolism. Only GabR has reported crystallographic structures. MocR/GabR regulators possess a chimeric structure consisted of a WHTH DNA binding domain and an Aminotransferase-like regulation domain, which can bind PLP as an effector in transcription regulation. Such a chimeric construct presents an interesting case in molecular evolution. The regulation domains of All MocR/GabR type regulators loss their catalytic capacity during evolution …

Stakeholder Perspectives: Implementation Of Local School Wellness Policies In The Kent Intermediate School District, Adrienne A. Wallace

Dissertations

The purpose of this study was to explore attitudes and perception of stakeholders (teachers, principals, nutrition service directors, nutrition service supervisors, school nurses, nutrition specialists and administrators) toward the implementation of the local school wellness policy in public schools within Kent County, Michigan. The subjects of interest were stakeholders from more than 300 schools and 20 public school districts within the Kent Intermediate School District. Subjects responded to a survey assessing their perspectives regarding the implementation of the local school wellness policy pursuant to the Healthy Hunger-Free Kids Act of 2010 an Obama-era policy, the results were then examined using …