Digital Commons Network^™

Urban Dwellers Experiences Regarding Loss Of Natural Environments Due To Rapid Urbanization, Erica Montanye

Walden Dissertations and Doctoral Studies

Little is known about how residents of rapidly growing cities are impacted by the loss of natural environments. Large cities are expanding at an exponential rate, reducing the presence of, and access to, natural environments for urban dwellers. Many benefits to human health regarding the presence of natural environments near where people live and work are known, but impacts of the loss of natural environments for urban dwellers are unknown. The purpose of this qualitative investigation was to understand residents' experiences regarding the loss of natural environments and related impacts. Attention restoration theory and place attachment were the theoretical lenses …

Determinants Of Switching From Peritoneal To Hemodialysis In Preserving Residual Renal Function, Mohamed Katerji

Walden Dissertations and Doctoral Studies

There are more than 2 million end stage renal disease (ESRD) patients in the world. ESRD is becoming more manageable with the advent of competent therapies such as peritoneal dialysis (PD) and hemodialysis (HD). While recent evidence suggests that switching from PD to HD may preserve residual renal function longer than either PD or HD alone as an alternative approach, little is known about the optimal timing and the long-term efficacy of switching dialysis modes. The purpose of this quantitative retrospective study, based on the bio-psychosocial model, was to investigate the optimal timing and determinants of the effectiveness of switching …

Hiv Testing Practices And Provider-Identified Barriers In The Acute Care Setting, Alex Ariri

Walden Dissertations and Doctoral Studies

Despite the Centers for Disease Control and Prevention recommendations to test patients ages 13 to 64 years for HIV at health care settings, routine HIV testing is lacking. As a result, many people are unaware of their HIV seropositive status. The purpose of this quantitative cross-sectional study was to examine relationships between HIV testing and provider type, knowledge, attitudes, and behaviors regarding HIV testing in the acute care setting. The study was informed by social cognitive theory. Using a convenient sampling method, a questionnaire derived from previous surveys (Society of General Internal Medicine and University of Washington) was sent to …

Educational Advocacy And The Foster Child, Jennifer Loetzerich

Walden Dissertations and Doctoral Studies

In Georgia, there are high rates of instability in foster care, and each time a child changes placement, his or her support networks are gone until he or she can rebuild them. The purpose of this case study was to explore if current stakeholders provide effective support and assistance to professionals and others who assist foster students with their educational needs. This case study used a conceptual framework based on Rankism, in which students move up and down the rungs of the ladder of their social system. Data were collected via interviews with a Court Appointed Special Advocate (CASA) worker, …

Assessment Of Postoperative And Postdischarge Wound Infection After Abdominal Hysterectomy, Jinni J. Amin

Walden Dissertations and Doctoral Studies

Surgical site infection (SSI) is the most common healthcare-associated infection. Approximately 2% to 14% of surgical patients are diagnosed with SSI, which may extend length of stay in the hospital or lead to readmission and may necessitate another surgical procedure. Patient readmission due to SSI costs health care industries about $3,000 to $29,000 per case and a total of $10 billion per year. The purpose of this quantitative cross-sectional retrospective study was to examine the association between SSI and teaching status, hospital ownership, and number of beds in the hospital. The epidemiological triad was used as a framework to describe …

Examining The Barriers To The Continuing Education Of Early Childhood Teacher Assistants, Colleen Louise Wright

Walden Dissertations and Doctoral Studies

The Improving Head Start for School Readiness Act of 2007 required teacher assistants (TAs) to obtain their child development associate (CDA) credential by September of 2015. TAs who had not obtained their CDA within the required timeframe were either demoted or terminated from their positions. However, with the increase of working parents, the need for quality early childhood education has risen. In this project study, the barriers TAs confront in regards to their decision to continue their schooling to obtain a CDA credential were examined, as were the factors that deterred or prevented them from enrolling in or completing a …

Barriers Cardiac Nurses Face In Addressing Psychosocial Issues Of Heart Failure Patients, Debra Kay Disbrow

Walden Dissertations and Doctoral Studies

Heart failure is a chronic disease and a common cause of hospitalizations and readmissions within 30-days of discharge. To decrease the cost of care for patients with heart failure, the Centers for Medicare and Medicaid Services initiated the Readmissions Reduction Program that reduces payment to hospitals with preventable readmissions. Among the causes for readmissions of patients with heart failure are concurrent behavioral health issues that can lead to decreased medication compliance and increased risk for disease progression. The prevalence of comorbid depression is as high as 77% among patients with heart failure and may be an important factor in readmissions. …

Understanding The Importance Of Culturally Appropriate Patient-Provider Communication In Diabetes Self-Management, Anita Mwalui

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, 29.1 million people in the United States have diabetes. Among those 29.1 million people, 21 million have been diagnosed, but 8.1 million have not. Changing demographics in the United States and the prevalence of diabetes are projected to be burdens on the health care system through 2050. Guided by the social cognitive theory, the purpose of this qualitative case study was to understand the importance of culturally appropriate patient-provider communication to the self-management of Type 2 diabetes by patients who are African immigrants. Culturally based health care has unique challenges when …

Contributing Factors Of Obesity Among Over-The-Road Truckers, Shari Weiss

Walden Dissertations and Doctoral Studies

Obesity among over-the-road truckers (OTRs) is an epidemic creating significant public health issues among this population. The consequences of obesity (hypertension, diabetes, heart disease) put both truckers' health and their medical clearance at significant risk. The purpose of this study was to examine the impact of gender, physical activity, diet, and sleep on obesity among OTRs. Through a socioecological lens, this study examined whether obesity is significantly impacted by gender, physical activity, nutrition, and sleep. This study also examined the impact of the trucking environment on obesity. The study used a quantitative research design and data were collected through a …

The Predictive Relationship Between Naturopathic Basic Science Curriculum And Nplex I Performance, Tammy Marie Aragon

Walden Dissertations and Doctoral Studies

Naturopathic medical schools are concerned with low first-time pass rates on the Naturopathic Physicians Licensing Exam Part I (NPLEX I) that may impact schools' accreditation with the Council on Naturopathic Medical Education (CNME). At a North American school of naturopathic medicine first-time pass rates have been a concern for 3 of the last 5 years. The purpose of this quantitative study was to determine whether students' naturopathic basic science content area scores predict NPLEX I scores at this this school. Grounded in general systems theory, a predictive correlational research design utilizing multiple logistic regression analyses was used. Archival data were …

An Evaluation Of An Innovative Weight Management Program In A Primary Care Setting, Susan Peak

DNP Projects

Background- Kentucky ranks third in the nation for childhood overweight and obesity. . Consumption of high dietary fat, excessive use of electronics, low levels of physical activity and consumption of sugar filled drinks are modifiable behaviors believed to be the biggest culprits behind these statistics.

Purpose- The purpose of this evaluation was to assess the implementation of the 5-2-1-0 plan in the management of childhood overweight or obesity within an urban primary care clinic.

Methods- After initiation of the program by the clinic focused interviews with the primary care providers were conducted to evaluate barriers and benefits to …

Evaluation Of A Nurse Navigator Program On The 30-Day Readmission Rate In Heart Failure Patients, Katie A. Winiger

DNP Projects

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure …

Evaluation Of A Primary Care Based Diabetes Education Program, Claire Pfister

DNP Projects

The improved management of diabetes is a critical clinical and economic challenge facing our healthcare system. Educating patients with diabetes to self-manage their disease is a vital component of diabetes care. The purpose of this DNP practice improvement project was to evaluate an innovative health care delivery method of individualized diabetes self-management education (DSME) in primary care. The approach combined individual DSME with a registered dietician and routine diabetes care with the primary care provider into one patient appointment. System data was reviewed to compare referral and attendance patterns of group and individual methods. Changes in clinical indicators of A1C, …

Evaluation Of An Enhanced Recovery After Surgery (Eras) Pathway In Two Hospitals, Jennifer A. Janes

DNP Projects

OBJECTIVE: The purpose of this study is to evaluate the Enhanced Recovery After Surgery (ERAS) pathway utilized at two Norton Healthcare facilities for colorectal and gynecological surgeries. The specific aim is to examine the impact on patient outcomes, clinical effectiveness, and costs.

METHODS: This was a multi-center, pre-post implementation retrospective study of the impact of ERAS pathways on colorectal surgery patients at Norton Audubon Hospital (NAH) and gynecological surgery patients at Norton Women’s and Children's Hospital (NWCH). The sample included 399 patients including patients from both hospitals, pre- and post-ERAS.

RESULTS: The ERAS pathway lead to a significant reduction in …

Evaluation Of Oral Nutritional Supplement Use In Elderly Patients Admitted With Heart Failure, Geri L. Sipe

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effects of enhanced ordering privileges among registered dieticians (RD) on oral nutritional supplement (ONS) ordering frequency and prevalence of oral nutritional supplement use among elderly patients admitted with heart failure (HF).

METHODS: This study was a single facility, retrospective pre-post implementation evaluation of the impact of expanded ONS ordering privileges among elderly patients (age ≥ 65 years old) hospitalized with heart failure at Frankfort Regional Medical Center (FRMC). The sample consisted of 105 patients for the pre-evaluation period and 259 for the post-evaluation period.

RESULTS: There were …

Assessing Provider And Staff Knowledge Of Health Literacy And Satisfaction With A Health Literacy Assessment Tool In A Primary Care Practice, Whitney J. Lynn

DNP Projects

PURPOSE: The purpose of this quality improvement project was to assess provider and staff knowledge about health literacy. Specifically, the knowledge of health literacy and perceived importance, current usage, and benefits of the use of a health literacy assessment tool at a primary care clinic was evaluated pre-intervention. The perceived importance of health literacy as well as satisfaction with, frequency of use, and recommendation of the chosen health literacy assessment tool for future use was evaluated post-intervention.

METHODS: This project used surveys pre- and post-intervention at an urban primary care clinic in the southeastern United States from January to March …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

Implementing & Evaluating A Nurse-Led Educational Intervention For Bone Marrow Transplant Patients In The Acute Care Setting, Tia T. Wheatley

DNP Projects

Objective: The Bone Marrow Transplant (BMT) Basics Class is a nurse-led educational program dedicated to preparing patients and their caregivers of the treatment outline and self-care behaviors associated with receiving a BMT. The purpose of this project is to evaluate the effectiveness of this intervention in order to support the needs of the BMT patient and promote patient-centered care.

Study Design: Retrospective review to evaluate a quality improvement project.

Participants & Methods: As of July 2016, the BMT Basics Class became a standard of care at an NCI-designated academic cancer center in the southeastern United States. Between July 20, 2016 …

Incidence Rate Of Delirium After Cardiac Surgery And Feasibility Of A Delirium Prediction Rule, Kelly Bohl

DNP Projects

Delirium is an acute, temporary cognitive disorder that is characterized by a change in mental status, altered level of judgement, and changes in perception and behavior. Elderly patients who undergo open cardiac surgery are particularly at risk for developing delirium postoperatively. Although it is a temporary disorder, there are many consequences associated with delirium after cardiac surgery, including a longer length of stay in the hospital, long term functional decline, a greater use of health care resources and an increase in mortality risk. The purpose of this project was to identify the one-year incidence of postoperative delirium after cardiac surgery …

Reducing Preoperative Anxiety In Adolescents Facing Spinal Fusion Surgery, Anna Gayle Parke

DNP Projects

Reducing preoperative anxiety for adolescents facing spinal fusion surgery for the treatment of scoliosis has significant implications for clinical practice and patient outcomes for this specific population. The reality of a pending surgery creates a difficult, uncomfortable, and exhausting state of being that can lead to increased postoperative pain, sleep disturbances, and maladaptive behaviors. This final capstone project inquiry report presents three manuscripts which focus on the reduction of preoperative anxiety in adolescents facing spinal fusion surgery. The first manuscript is a literature review examining current evidence related to preoperative anxiety, adolescents undergoing spinal fusion surgery, and teaching programs aimed …

Don’T Pull The Plug On Bioethics Mediation: The Use Of Mediation In Health Care Settings And End Of Life Situations, Amy Moorkamp

Journal of Dispute Resolution

A hefty decision, such as the life or death of a loved one, requires more than a few minutes of deliberation and a handful of outside consultations. Delicate, emotional, and potentially contentious medical decisions compel a structured, compassionate approach to produce quality and well-informed results. Due to the magnitude of the decision being made, as well as the abundance of other considerations, (emotional, religious, historic, financial, etc.) the case for a creative, problem-solving process of dispute resolution, such as mediation, is ripe.

This Comment will explore the use of mediation in bioethical disputes. In Part II, the Comment will give …

Increasing Renewable Oil Content And Utility, William Richard Serson

Theses and Dissertations--Plant and Soil Sciences

Since the dawn of agriculture man has been genetically modifying crop plants to increase yield, quality and utility. In addition to selective breeding and hybridization we can utilize mutant populations and biotechnology to have greater control over crop plant modification than ever before. Increasing the production of plant oils such as soybean oil as a renewable resource for food and fuel is valuable. Successful breeding for higher oil levels in soybean, however, usually results in reduced protein, a second valuable seed component. We show that by manipulating a highly active acyl-CoA: diacylglycerol acyltransferase (DGAT) the hydrocarbon flux to oil in …

Genotype × Environment × Management: Implications For Selection To Heat Stress Tolerance And Nitrogen Use Efficiency In Soft Red Winter Wheat, Kathleen Russell

Theses and Dissertations--Plant and Soil Sciences

The complex interaction of genetics, environment and management in determination of crop yields can interfere with selection progress in breeding programs. Specifically, the impact on selection for nitrogen use efficiency (NUE) in wheat (Triticum aestivum L.) under changing climatic conditions can be confounded by these interactions. Temperature increases for the southeastern United States are projected to range from 1-3°C by 2050 with nighttime temperatures increasing more rapidly than day temperatures. High temperatures are known to affect crop development and breeding for tolerance to heat stress is difficult to achieve in field environments. We utilized a multi-environment trial to assess …

Assessment Of Oil Quantification Methods In Soybean And Chia Seeds And Characterization Of Oil And Protein In Mutant Chia (Salvia Hispanica L.) Seeds, Ahmed N. Al-Bakri

Theses and Dissertations--Plant and Soil Sciences

This thesis includes two main parts:

I. Evaluation of techniques for oil (total lipid) quantification of chia and soybean seeds.

This study evaluated ten different methods of seed oil quantification, including some methods that have not been applied to oilseeds before. The main aim of this study was to find one or more techniques that are easy, inexpensive, safe and fast with a small amount of ground seeds. The Soxhlet method was used as a standard to compared between techniques of oil quantification. The oil extraction by the Soxhlet method was evaluated with two solvents petroleum ether and acetone. There …

Studies Relating Pqq Biosynthesis To Putative Peptidases And Operon Structure In Pseudomonas Species, Benjamin Diaz

Theses and Dissertations--Plant and Soil Sciences

Several bacteria isolated from the broccoli rhizosphere were assayed to compare their ability to solubilize phosphate and release pyrroloquinoline quinone (PQQ) into the surrounding media. Subsequently, their genomes were sequenced and analyzed for PQQ biosynthesis operon structure. PQQ biosynthesis genes pqqA-F were found in all isolates. The order of PQQ biosynthesis genes and predicted amino acid sequences were compared to each other and the host’s ability to solubilize phosphate and release PQQ. In all Pseudomonas species, two putative protease genes, pqqF, and pqqG, flanked the canonical pqqA-pqqE biosynthesis operon. No mechanistic studies have confirmed the function of …

Breeding For Biomass Yield In Switchgrass Using Surrogate Measures Of Yield, Michael D. Casler, Guillaume P. Ramstein

United States Department of Agriculture-Agricultural Research Service / University of Nebraska-Lincoln: Faculty Publications

Development of switchgrass (Panicum virgatum L.) as a dedicated biomass crop for conversion to energy requires substantial increases in biomass yield. Most efforts to breed for increased biomass yield are based on some form of indirect selection. The objective of this paper is to evaluate and compare the expected efficiency of several indirect measures of breeding value for improving sward-plot biomass yield of switchgrass. Sward-plot biomass yield, row-plot biomass, and spaced-plant biomass were measured on 144 half-sib families or their maternal parents from the WS4U-C2 breeding population of upland switchgrass. Heading date was also scored on row plots and …

Tracking Bacteria Through The Entire Gastrointestinal Tract Of A Beef Steer, Lisa M. Durso, Daniel N. Miller, Ty B. Schmidt, Todd Callaway

United States Department of Agriculture-Agricultural Research Service / University of Nebraska-Lincoln: Faculty Publications

Biological processes within beef cattle gastrointestinal tracts (GIT) influence animal health, and the output (feces) is an important vector for zoonotic pathogens and antibiotic resistant bacteria. Historically, outside of the rumen, little attention was paid to the bacteria along the GIT, despite their essential role in catabolizing feed into feces. Here we characterize bacteria from 15 GIT sites within a beef steer and examine the proportion of bacteria contributed by upstream compartments. This animal displayed characteristic differences between tissue and digesta communities in gastric and large-intestine, but not small-intestine, samples. The GIT sites shared between 50 and 80% of the …

Much Ado About The Tpp's Effect On Pharmaceuticals, Emily M. Morris

Faculty Publications

The Trans-Pacific Partnership Agreement’s many provisions that were beneficial to the pharmaceutical industry have caused a good deal of controversy. Specifically, critics allege that the TPP’s provisions requiring that member states expand patentable subject matter, adjust pharmaceutical patent terms, and link regulatory marketing approval to a drug's patent status would have raised drug prices and hindered access to medicines, particularly in developing countries. Closer examination of these provisions as well as the various ways in which member states can modify or ameliorate the effects of these provisions suggests that their potential effect on drug prices and access to health care …

Spatial And Temporal Changes In Maize And Soybean Grain Yield, Precipitation Use Efficiency, And Crop Water Productivity In The U.S. Great Plains, Meetpal S. Kukal, S. Irmak

Department of Agricultural and Biological Systems Engineering: Faculty Publications

Sustainable agricultural utilization of the limited water resources demands improvements in understanding the changes in crop water productivity (CWP) in space and time, which is often presented as a potential solution to relieve the growing pressure on fresh water resources. In addition, crop yield needs to be studied in relation to precipitation received annually and during the growing season for its contribution to reduce irrigation water requirements, which is quantified through precipitation use efficiency (PUE). Hence, systematic quantifications, mapping, and analyses of large-scale CWP and PUE levels are needed. This study aims to quantify long-term (1982-2013) information on grain yield, …

Effects And Mechanisms Of Porcine Reproductive And Respiratory Syndrome Virus (Prrsv) Type 1 And Type 2 On The Permeability And Viability Of Porcine Endometrial Epithelial Cells, Dran Rukarcheep

Chulalongkorn University Theses and Dissertations (Chula ETD)

Both PRRSV types 1 and 2 revealed the sign of reproductive disorders associated with a lesion at implantation sites. Impairment of maternal glandular endometrium cell integrity and function by PRRSV infection may impact a proper nourishing fetus. This research was aimed to examine the effects of PRRSV type 1 and type 2 directly on the viability and barrier function of the endometrium using porcine glandular endometrial epithelial cell culture (PEG). The comparison of the route and the strain of PRRSV infection coinciding with their virulent in reproductive epithelia were considered. PEG cells isolated from the 4-6 months old PRRSV-free-herd gilts …