Digital Commons Network^™

An Outcome Assessment Of A Single Institution's Longitudinal Experience With Uveal Melanoma Patients With Liver Metastasis., Rino S. Seedor, David J. Eschelman, Carin F. Gonsalves, Robert D. Adamo, Marlana Orloff, Anjum Amjad, Erin Sharpe-Mills, Inna Chervoneva, Carol L. Shields, Jerry A. Shields, Michael Mastrangelo, Takami Sato

Department of Medical Oncology Faculty Papers

There is no FDA-approved treatment for metastatic uveal melanoma (UM) and overall outcomes are generally poor for those who develop liver metastasis. We performed a retrospective single-institution chart review on consecutive series of UM patients with liver metastasis who were treated at Thomas Jefferson University Hospital between 1971–1993 (Cohort 1, n = 80), 1998–2007 (Cohort 2, n = 198), and 2008–2017 (Cohort 3, n = 452). In total, 70% of patients in Cohort 1 received only systemic therapies as their treatment modality for liver metastasis, while 98% of patients in Cohort 2 and Cohort 3 received liver-directed treatment either alone …

Individual And Joint Effects Of Metformin And Statins On Mortality Among Patients With High-Risk Prostate Cancer., Xiang-Lin Tan, Jian-Yu E, Yong Lin, Timothy R Rebbeck, Shou-En Lu, Mingyi Shang, William K Kelly, Anthony D'Amico, Mark N Stein, Lanjing Zhang, Thomas L Jang, Isaac Yi Kim, Kitaw Demissie, Anna Ferrari, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

BACKGROUND: Pre-clinical studies suggest that metformin and statins may delay prostate cancer (PCa) metastases; however, data in humans are limited. To the best of our knowledge, this is the first human study aimed to quantify the individual and joint effects of statin and metformin use among patients with high-risk PCa.

METHODS: This population-based retrospective cohort study identified patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Exposure to metformin and statins was ascertained from Medicare Prescription Drug Event files. The association with all-cause and PCa mortality were evaluated using Cox proportional hazard model with competing causes of death, …

Treating Hematologic Malignancies During A Pandemic: Utilizing Telehealth And Digital Technology To Optimize Care., Adam F Binder, Nathan R Handley, Lindsay Wilde, Neil Palmisiano, Ana Maria Lopez

Department of Medical Oncology Faculty Papers

In late January 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) was reported as an outbreak in Wuhan, China. Within 2 months it became a global pandemic. Patients with cancer are at highest risk for both contracting and suffering complications of its resultant disease, Coronavirus 19 (COVID-19). Healthcare systems across the world had to adapt quickly to mitigate this risk, while continuing to provide potentially lifesaving treatment to patients. Bringing care to the home through the use of telehealth, home based chemotherapy, and remote patient monitoring technologies can help minimize risk to the patient and healthcare workers without sacrificing quality …

Retaining African American Male Sophomore Students At A Historically Black University, Gourjoine M. Wade

Walden Dissertations and Doctoral Studies

Retention rate sophomore to junior year among African American male students is low at Academia State University (a pseudonym), a public Historically Black College and University (HBCU) located in the Southern United States. The purpose of this qualitative case study was to explore the perceptions of African American male students regarding what influenced their persistence to the junior year at the study site. Schlossberg's transition theory was the conceptual framework used to guide the inquiry. The research questions for this study addressed perceptions of African American male students regarding what programs, services, or experiences may improve sophomore year success. Three …

Cybersecurity Using Risk Management Strategies Of U.S. Government Health Organizations, Ian Cornelius Wilkinson

Walden Dissertations and Doctoral Studies

Seismic data loss attributed to cybersecurity attacks has been an epidemic-level threat currently plaguing the U.S. healthcare system. Addressing cyber attacks is important to information technology (IT) security managers to minimize organizational risks and effectively safeguard data from associated security breaches. Grounded in the protection motivation theory, the purpose of this qualitative multiple case study was to explore risk-based strategies used by IT security managers to safeguard data effectively. Data were derived from interviews of eight IT security managers of four U.S. government health institutions and a review of relevant organizational documentation. The research data were coded and organized to …

Talent Retention Strategies For Service Industry Managers Within Rust Belts, Tunisha Foley

Walden Dissertations and Doctoral Studies

Human capital flight jeopardizes the future of rust belt organizations. Service industry managers within rust belt cities are at high risk of failure. Framed by the talent management model, the purpose of this qualitative multiple case study was to explore strategies rust belt managers used to reduce human capital flight. Participants were 1 health care manager and 1 social assistance manager from Detroit, Michigan, and Flint, Michigan, respectively, who successfully implemented strategies to reduce human capital flight. Data were collected from semistructured interviews and business documents. Data were analyzed with inductive content analysis, word frequency searches, and theme interpretation. Three …

Alternative Therapy For Veterans Diagnosed With Post-Traumatic Stress Disorder, Shannon Rae Hill

Walden Dissertations and Doctoral Studies

An increasing number of veterans diagnosed with post-traumatic stress disorder (PTSD) has led to an increased demand for treatment within the Veteran Affairs health care system. Presently, veterans diagnosed with PTSD receive psychotropic medications and intermittent therapy sessions. Nurses are challenged to educate veterans about other health care issues based on verbalized side effects from prescribed PTSD medications limiting veterans’ ability to focus. Identifying alternative treatment options may improve treatment choices, reduce side effects, and promote positive outcomes for veterans with PTSD. This systematic review provided evidence-based practice information by addressing whether alternative therapy such as biofeedback would improve the …

Transformational Leadership Effects On Employee Engagement And Counterproductive Work Behavior's Influence As A Moderating Variable, Cybil M. Johnson

Walden Dissertations and Doctoral Studies

Many organizations have the daunting task of dealing with counterproductive work behavior (CWB) at various levels in the workplace. This study sought to examine if transformational leadership (TFL) has an impact on employee engagement (EE) and if CWB has a moderating influence on this relationship in the U.S. Postal Service. This study’s intent was to address a gap in the literature regarding CWB exhibited by employees and the positive intentions of TFL on EE. A quantitative study was conducted utilizing an anonymous online survey to assess the relationship among employees of the U.S. Postal Service. The study was conducted using …

The Influence On Employee Engagement Of Employee Negative Perceptions Of Leader Actions, Vickki Gamol Johnson

Walden Dissertations and Doctoral Studies

In 2018, only 34% of U.S. workers reported that they were engaged in their jobs, up from 31.5% just 4 years prior. Employee engagement, organizational well-being, and leader actions are significant to companies and brands in a highly competitive, modern business environment. The alarmingly low rate of employee engagement resulted from negative perceptions of leaders. The purpose of this qualitative study was to explore the phenomenon of disengagement through the lived experiences of employees in the public sector who had negative perceptions of their leaders. The conceptual lens was Herzberg’s theory mapped onto Maslow’s hierarchy to address the research question …

Stress And Coping Methods In Law Enforcement Personnel, Brandon M. Sheard

Walden Dissertations and Doctoral Studies

A notable problem exists within law enforcement due to the lack of mental health assistance offered for police officers, as well as little to no literature available pertaining to officers in law enforcement who may have mental health issues. Without proper coping methods, there is a higher possibility of suicide among police officers. Therefore, the purpose of this phenomenological qualitative study was to investigate why officers were choosing to not seek mental and behavioral health assistance, as well as determine factors that could both prevent as well as encourage officers to seek mental health assistance if needed. Grounded in the …

Human Resource Management Practices For Sustainability Of Ghanaian Small And Medium Enterprises, Charles Bandari

Walden Dissertations and Doctoral Studies

In 2018, the failure rate of small and medium enterprises (SMEs) in Ghana was approximately 75%. SME owners and managers who refuse to recognize HRM strategies as a way for business sustainability risk closure. Grounded in Blau's social exchange theory, the purpose of this qualitative multiple case study was to explore human resource strategies leaders of SMEs use to sustain their businesses. Participants were 4 SME leaders in the Tamale metropolitan area of Ghana who successfully used human resource management strategies to promote the sustainability of their businesses. Data were collected from semistructured face-to-face interviews, focus group discussions, and company …

Lived Experience Of Parenting Nurses Pursuing A Doctorate: A Phenomenological Inquiry, Jaimee Feldstein

Walden Dissertations and Doctoral Studies

The need for more doctoral prepared nurses is evident; data indicate that less than 1% of nurses hold doctoral degrees, yet, little is known about student persistence in doctoral nursing programs. Even less is known about doctoral nursing students navigating an online learning environment while balancing parenthood. The purpose of this phenomenological study, guided by Rovai’s composite persistence model, was to explore the embedded meanings in the experiences of parenting nurses pursuing their doctoral degrees at an online university. Ten female parenting nurses who completed a doctorate within the last 2 years were interviewed and shared the key factors that …

Strategies To Implement A Material Management Information System For Medical Device Recalls, Paul Leo Lafrance

Walden Dissertations and Doctoral Studies

Health care business executives lack strategies to implement material management information systems (MMIS) related to medical device recalls. Lacking sufficient MMIS, health care business executives face insufficient product tracking related to medical devices affecting operational efficiency. Grounded in the conceptual frameworks of the technology acceptance model and diffusion of innovation, the purpose of this qualitative single case study was to explore health care business executives’ strategies for implementing an MMIS related to medical device recalls. The participants were 6 health care executives who implemented an MMIS in an urban hospital in the northeast region of the United States. Data were …

Relationship Between Pm2.5 Levels And Cancer Incidences In Interior Alaska, Sandra G. Lewis

Walden Dissertations and Doctoral Studies

Exposure to high levels of ambient air particulates < 2.5 microns in diameter (PM2.5) in the Fairbanks North Star Borough (FNSB) and the resulting impact on cancer incidence is the focus of this study. Climate, geography, and culture influence PM2.5 levels, particularly during the long cold season. While this study considers lung cancer incidences from PM2.5 exposure, the primary focus of the study is the incidences of all other types of cancers from exposure to PM2.5, because of the limited research done on this topic. This quantitative, retrospective, cohort study considered the incidences of new cancer diagnoses in the population during a 10-year period (January 1, 2008-December 31, 2017). The 2 FNSB Zip Codes, designated “hot spots,” frequently see spikes in PM2.5 during the long cold season. These areas are densely populated and contain the EPA-regulated air quality monitors. Cancer diagnoses in the hot spot Zip Codes were compared to cancer diagnoses in outlying Zip Codes (non-hot spots) that experience less PM2.5 and are more consistently within the EPA air quality guidelines. EPA monitors are not yet located in the non-hot spots. Cancer patient data were obtained from the Fairbanks Memorial Hospital Cancer Center. The results demonstrated that a strong association was found between PM2.5 exposure and non-lung cancers (OR = 1.37; RR = 1.36; p < 0.001); and between PM2.5 exposure and lung cancer (OR = 1.87; RR = 1.88; p < 0.001). These findings may be used to promote an increased awareness among FNSB residents of the potential impact on cancer diagnoses from inhaling high levels of PM2.5, so residents may change their behavior in favor of alternatives to biomass burning to improve air quality.

Firearm Restriction And Its Impact In Reducing Violent Crimes In California, Sampson C. Onwuka

Walden Dissertations and Doctoral Studies

There have been recurring incidents of gun violence, murder, and mass shootings that have raised public concern on the dangers of guns, and people have demanded government regulation on firearms usage. Studies have attributed these incidents to non-strict laws on guns; however, it was unclear whether firearm restrictions affected California's violent crime reduction. This quasi-experimental, quantitative study was focused on finding out the impact of gun violence restraining orders (GVROs) on violent crime reduction in California. Four research questions addressed the changes in the variables after the establishment of the GVRO. Secondary data from the California Department of Justice were …

Understanding The Lived Experiences Of Traumatic Brain Injury Students In Online Courses, Rebecca Lynn Owens

Walden Dissertations and Doctoral Studies

Many combat veterans are returning with what has been labeled the signature injury of nearly 2 decades of wars, traumatic brain injury (TBI). TBI injuries can alter cognitive abilities, memory, behavior, and emotions, all of which can vary in intensity and can affect learning. The purpose of this phenomenological study was to gain additional insight from the perspective of the veteran student on the learning challenges experienced in online classrooms when suffering from TBI. The conceptual framework for this study was (a) Bandura’s theory of self-efficacy, (b) Zimmerman’s theories on the relationship between TBI and learning, and (c) Schlossberg’s transition …

Social Responsibility Perceptions Of Community Flood Resilience In Nigeria, Reginald Olisa Oranye

Walden Dissertations and Doctoral Studies

Flooding is a severe threat to livelihoods and socioeconomic development in Ogbaru riverine communities of Anambra State, Nigeria. Limited success in the traditional approach of using predominantly structural measures, such as flood channels, to manage floods makes it imperative to explore nonstructural resilience initiatives that would potentially better protect vulnerable flood-prone communities. This study contributes to addressing the problems of ineffective flood management by developing vital social responsibility (SR) data and information that can enhance community flood resilience through individual and collective responsibilities for resilient action. The purpose of this quantitative correlational study was to explore SR perceptions of flood …

Effect On Health Literacy On Medication Adherence In Older Latina Women With Type 2 Diabetes Mellitus, Cecilia S. Trinidad

Walden Dissertations and Doctoral Studies

The level of health literacy (HL) can have a significant impact on an individual's ability to understand how to care for themselves. Limited HL reduces access to healthcare having limited HL is associated with poor self-management of Type 2 Diabetes Mellitus (T2DM), which is common among vulnerable populations and further contributes to increased morbidity and mortality, especially in which is true in Latina/Hispanic adults who have T2DM. The purpose of the study, guided by the health belief model, was to determine what effect an educational intervention had on blood glucose levels, health literacy, and medication adherence in older Latina/Hispanic women …

Evaluating The Relationship Between Financial Inclusion, Social Inclusion And Multidimensional Poverty Reduction, Rotimi Mathew Nihinlola

Walden Dissertations and Doctoral Studies

The problems of high levels of poverty, financial exclusion and social exclusion are well documented in literature; a large population of poor people lack adequate access to financial services and social services including healthcare, electricity, education and water. Globally there are over 700 million people living in extreme poverty and in Ghana, over 6 million face this challenge. Progress is being recorded but there is no research that has examined the relationship between financial inclusion, social inclusion and poverty reduction in a country where multidimensional poverty is high. The purpose of this within-subject quasi-experimental correlational study is to determine the …

Demographic Factors Associated With Childhood Obesity Among Women, Infants, Children (Wic) Participants In 2014, Olukayode Wisdom Oduwole

Walden Dissertations and Doctoral Studies

In the past few years, there has been an alarming increase in childhood obesity in the United States and worldwide, however there is little consensus around how to respond to the problem. What has now become an epidemic, was uncommon decades ago. This study assessed the demographic factors associated with childhood obesity among WIC participants in 2014. The study utilized demographic data from 3,011,119 participants in 2014 nationally representative National Health and Nutrition Examination Survey, and social cognitive theory (SCT) to understand the demographical factors associated with childhood obesity. Adjusted odds of obesity were calculated to assess association between males …

The Politics Of Decentralizing Criminal Justice Systems In Postconflict Societies: Insights From Liberia (2011-2017), Samuel Opoku-Agyakwa

Walden Dissertations and Doctoral Studies

After the end of Liberia’s brutal 14 year civil war, the process of rebuilding Liberia has focused on a number of interventions including reforming the criminal justice system. In the current study, institutional, policy, legal reform, and infrastructure development were the approaches used to decentralize Liberia’s Criminal Justice System. Thirty experts were interviewed, and their responses coded using NVivo 12.0. Seven themes and 25 subthemes emerged from the data. It was that found that a top down internationally led approach with minimal involvement of local communities and the neglect of the traditional justice system characterized the decentralization process. Results also …

2019-2020 Oak Wilt Surveys, Cooperative Extension

UNH Cooperative Extension

No abstract provided.

The Cultural Construct Of Stress In Luganda-Speaking Women In Uganda, Courtney Skiera

Walden Dissertations and Doctoral Studies

Luganda, the primary language spoken in Uganda has no word for stress, but this does not necessarily preclude the Luganda-speaking population from experiencing stress. There is currently no research that reveals the stress phenomenon from a Ugandan’s perspective. The purpose of this study was to examine how Luganda-speaking Ugandans conceptualize stress. Two theoretical foundations formed the basis of this study: the cognitive appraisal of stress theory and the coordinated management of meaning. Using a qualitative interpretive design, this study examined the conceptualization of stress by Luganda-speaking women in terms of understanding, experiencing, and communicating the stress phenomenon. Participants were 7 …

Strategies For It Product Managers To Manage Microservice Systems In Enterprises, Walter Zrzavy

Walden Dissertations and Doctoral Studies

Many information technology (IT) product managers have experienced significant challenges in adopting microservice architecture (MSA) systems successfully in their organizations. Inefficiencies resulting from MSA system adoption are of concern to IT product managers as these inefficiencies increase the cost of maintenance and increase the time to deliver software updates to the business. Grounded in the technology-organization-environment theory, the purpose of this qualitative multiple case study was to explore the strategies used by IT product managers for the domain-driven design and development and operations practices to reduce the inefficiencies during the MSA system adoption. The participants were 18 IT product managers …

Staff Education On Fall Reduction Strategies For Residents Of A Long-Term Care Facility, Olivia C. Anaele-Nwogu

Walden Dissertations and Doctoral Studies

Fall-reduction programs are frequently ineffective in reducing falls among geriatric patients in long-term care (LTC) facilities. Multicomponent strategies have proved to be effective in reducing these falls. However, these strategies require staff education to ensure their success. The purpose of this project was to support the integration of multicomponent fall prevention strategies into practice by providing staff education focusing on the appropriateness use of hourly rounding and the 4Ps (pain, position, prompted voiding and placement) in addition to bed alarms to prevent falls among geriatric patients in the local LTC facility. The Johns Hopkins Nursing Evidence-based model was the conceptual …

Life In A Harsh Environment: The Effects Of Age, Sex, Reproductive Condition, And Season On Hair Cortisol Concentration In A Wild Non-Human Primate, P. A. Garber, A. Mckenney, Evelyn Elizabeth Bartling-John, J. C. Bicca-Marques, M. F. De La Fuente, F. Abreu, N. Schiel, A. Souto, Kimberley A. Phillips

Psychology Faculty Research

Hair cortisol concentration (HCC) provides a long-term retrospective measure of hypothalamic–pituitary–adrenal axis activity, and is increasingly used to assess the life history, health and ecology of wild mammals. Given that sex, age, season and pregnancy influence HCC, and that it may indicate ongoing stress, we examined HCC in common marmosets (Callithrix jacchus) naturally inhabiting a hot and dry semi-desert like habitat, Caatinga, in northeastern Brazil. We trapped, measured, weighed, marked and collected shaved hair from the back of the neck of 61 wild marmosets during the wet and dry seasons. Using enzyme immunoassay, we found that HCC was …

Food Insecurity And Eating Disorders: A Review Of Emerging Evidence, V. M. Hazzard, K. A. Loth, L. Hooper, Carolyn Black Becker

Psychology Faculty Research

Purpose of Review: This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice.

Recent Findings: Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date.

Summary: Emerging evidence consistently indicates that food insecurity …

The Executive Director Experiences Of African American Women In Mainstream Nonprofit Performing Arts Organizations, Davida S. Gobin

Walden Dissertations and Doctoral Studies

African American women are presently underrepresented in mainstream nonprofit performing arts organizations (PAOs) throughout the United States. Despite this inequality, a small number of African American women have overcome the odds and have productively earned senior leadership roles as executive directors in mainstream nonprofit PAOs. Using the conceptual frameworks of intersectionality and critical race feminism, the purpose of this study was to explore the shared lived experiences of African American women in executive director positions and the impact of race and gender on their leadership development and training for advancement in a mainstream nonprofit PAO. Four research questions explored the …

Recognition, Classification, And Help-Seeking Behavior Of Nigerian Immigrants In Minnesota, Frederick Nnabuchionye

Walden Dissertations and Doctoral Studies

Immigrants from non-Western cultures are known to underutilize mental health services in the United States. Part of the problem is in the way how cultures recognize and classify symptoms as a mental disorder. A report from the Minnesota Ombudsman's Office for Mental Health showed that out of every 6 suicide-related deaths in Anoka Regional Treatment Center in Minnesota, 4 are of African descent. The purpose of this quantitative study was to investigate the cultural view of depressive symptoms as possible predictors of attitude toward seeking professional psychiatric help. The theory of reasoned action/ theory of planned behavior provided the framework …

An Exploration Of The Gross National Happiness Approach To Assure Patient Safety And Healthcare Quality In Bhutan, Rinchen Pelzang, Alison M. Hutchinson

Journal of Sustainable Social Impact

Although the principles of Gross National Happiness (GNH) are currently being used as the overall framework for Bhutan’s development programs (including healthcare services), little is known about how Bhutanese healthcare professionals perceive the relationship between GNH and patient safety or how the GNH principles could help in improving patient safety in Bhutan’s healthcare system. The aim of this study was to explore how Bhutanese healthcare professionals, educators, managers, and policy makers perceive the relationship between GNH and patient safety and what they believe should be done to improve patient safety in Bhutan. A qualitative exploratory descriptive study using in-depth interviews …