Digital Commons Network^™

Clabsi Prevention In The Icu-A New Approach, Shannon M. Hicks

Master's Projects and Capstones

Abstract

The Center for Disease Control and Prevention (CDC) emphasizes that the primary cause of preventable deaths and disabilities among hospitalized patients in the United States are hospital-acquired infections (HAIs). Based on the CDC surgical site infection monitoring, common infections include central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia, and catheter-associated urinary tract infections. This paper primarily focuses on the problem of CLABSI, with an aim to reduce the net occurrences of CLABSIs in the intensive care unit (ICU) through the interventional use of SecurePortIV skin adhesive during the insertion of central lines. Although few researchers have examined the implication of …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Post Cesarean Surgical Site Infection Reduction Through Vaginal Preparation, Jennifer M. Jaime

Master's Projects and Capstones

Abstract

Problem: The increasing rates of surgical site infections (SSIs) after cesarean delivery have a negative impact on patient morbidity, mortality, postoperative fevers, trauma, and hospital costs.

Context: Interventions are a necessity for this population however, there is lack of preventative practice utilized in the labor and delivery unit to reduce the rates of post cesarean SSIs.

Interventions: The preventative evidenced based practice of vaginal preparation with 10% povidone-iodine was implemented on women in the operating room before their cesarean procedure. Educational materials such as informative presentations, videos, and posters were created to educate nursing staff on the implementation of …

Reducing Maternal Falls On A Postpartum Unit Through Staff Education, Kathleen Benjamin

Master's Projects and Capstones

There have been 23 documented falls on the maternity unit at Hospital A over the past three years. This fall rate is above the national average, making the reduction of falls on the postpartum unit a priority to maintain the hospital’s Magnet status and improve patient safety. Data analysis related to contributing factors of falls and staff education on best ambulation practices has the potential to decrease the number of maternal falls on the targeted microsystem population of the postpartum unit. This quality improvement project conducted a fall audit on each documented fall case, performed an environmental survey of the …

Evidence Based Repositioning Strategies To Improve Pressure Injury Rates, Ivan E. Dorsey

Master's Projects and Capstones

Pressure injuries (PI) affect approximately 1-3 million people in the United States annually, and amount to 3-11 billion dollars in yearly healthcare costs (Mondragon et al., 2021; Padula & Delarmente, 2019). In veterans who seek care, especially the elderly (>65 y/o), pressure injuries are particularly devastating because they increase hospital costs and lengthen stays (Stroupe et al., 2011). In light of these statistics, the aim of this project was to decrease PI rates in veteran patients through the implementation of evidence-based practice. This project was conducted on a medical/surgical telemetry unit with 18 beds at a Northern California hospital …

Reducing Hospital Readmission Rate In Chf Patients Through Early Individualized Patient Discharge Education, Anthony Ensah

Master's Projects and Capstones

The term congestive heart failure (CHF) is a chronic condition that occurs in a person when the heart stops doing its normal activity of pumping blood to the rest of the body for the body. Heart failure normally occurs when the heart can no longer pump (systolic) or fills (diastolic) pressure adequately to the body. Because heart failure is one of the leading causes of death in the United States this project was conducted on one of the Northern California San Francisco Bay- Area hospitals to assess patients understanding and knowledge on the presenting signs and symptoms of heart failure …

Coyote Management In San Francisco, Matthew Greer

Master's Projects and Capstones

As cities in North America grow, coyotes have become progressively more important species in urban ecosystems. Moreover, as coyotes increasingly use these urban spaces, human-coyote conflicts have become more common, creating a need for new management strategies. This paper will explore how the city of San Francisco could create a new coyote management plan for its highly visible coyote population. San Francisco has had a persistent coyote population since the early 2000s (Todd, 2018). Currently, the coyote population is close to 100 individuals and is still growing (J. Young, Presidio Trust, pers. comm.). To explore this topic a literature review …

Discharge Nurse Role Implementation: Improving Discharge Timeliness And Patient Outcomes, Diamond Faith Chu

Master's Projects and Capstones

Problem: The Discharge Nurse (DN) Role Implementation project aims to reduce the delay in the discharge process and patient length-of-stay. With the current microsystem discharge process, there are observed barriers to timely discharge related to various discharge tasks and interdisciplinary communication methods.

Context: This project was implemented in a metropolitan hospital within Northern California, on a unit that serves medical-surgical, oncology, and geriatric patients. There are 35 registered nurses (RN’s), eight certified nursing assistants, one charge manager, one assistant charge manager, one clinical nurse leader, and four clinical nurse specialists (oncology).

Interventions: The intended aim of this project is to …

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …

Establishing Quiet Hours In Long-Term Care: A Quality Improvement Project, Heather Battaglia

Master's Projects and Capstones

Problem: Sleep disturbances in long-term care residents are associated with falls, behavioral problems, and increased mortality rates, yet long-term care facilities are traditionally noisy environments at night. Designated quiet hours have been shown to improve patient sleep as well as decrease stress levels in nurses.

Context: In a skilled nursing facility that provides care for military veterans with complex medical and psychosocial needs, signage exists that indicates to be quiet between 10:00 p.m. and 7:00 a.m., but no defined guidelines were available for staff to observe.

Interventions: Standards for quiet hours were established and posted throughout the microsystem. Lecture-style teaching …

The Feasibility Of Industrial Wastewater Reuse Onsite In The Tri-City Area, Shayla Bergeron

Master's Projects and Capstones

Industries typically discharge wastewater to a centralized wastewater treatment plant, but given ongoing water scarcity from repeated droughts, onsite wastewater reuse within the industrial facility’s plant is an attractive alternative. However, information on economic and technical feasibility on wastewater reuse onsite is limited. A literature review showed that membrane bioreactors are a promising wastewater reuse treatment technology due to their reduced footprint and high quality produced effluent. A watershed assessment of the Tri-City area was conducted to evaluate future water supply. A case study was then performed on industrial dischargers in the Tri-City area applying this technology. Finally, the costs …

Joint Management Of Upland & Aquatic Habitat For The California Red-Legged Frog & California Tiger Salamander, Kyle E. Verblaauw

Master's Projects and Capstones

As federally and state protected amphibians, the California tiger salamander (Ambystoma californiense) and the California red-legged frog (Rana draytonii) are recipients of ample management focus. Both species face a variety of threats, including habitat loss and alteration, introduction of non-native species, spread of disease, and effects of climate change. While management plans for the California tiger salamander and California red-legged frog exist, they frequently do not consider both species in tandem and often contain multiple shortcomings. This document aims to address the shortfalls of current management by providing practical recommendations for jointly managing the upland and …

Motivating Poetry In The Adult Esl Classroom, Lenore Marin Myers

Master's Projects and Capstones

Current research into motivation in second language acquisition, including Dörnyei (2005, 2009, 2015), offers compelling evidence that adult language learners who develop and habitually strengthen a vision of their future, linguistically capable selves using concrete, sensory imagery are more likely to sustain the necessary motivation to achieve their personal language-learning goals. My thesis proposes that poetry writing can be an effective medium for language learners to build facility in developing concrete, sensory imagery (tactile, visual, kinesthetic, olfactory, and auditory), including creating a motivating vision of their future, linguistically capable selves. Because poetry can directly support and build learner motivation, it …

Steroid Receptor-Coregulator Transcriptional Complexes: New Insights From Cryoem, Ping Yi, Xinzhe Yu, Zhao Wang, Bert W O'Malley

Faculty, Staff and Students Publications

Steroid receptors activate gene transcription through recruitment of a number of coregulators to facilitate histone modification, chromatin remodeling, and general transcription machinery stabilization. Understanding the structures of full-length steroid receptor and coregulatory complexes has been difficult due to their large molecular sizes and dynamic structural conformations. Recent developments in cryo-electron microscopy (cryoEM) technology and proteomics have advanced the structural studies of steroid receptor complexes. Here, we will review the insights we learned from cryoEM studies of the estrogen and androgen receptor transcriptional complexes. Despite similar domain organizations, the two receptors have different coregulator interaction modes. The cryoEM structures now have …

Residential Metals Abatement Program Quality Assurance Project Plan (Non-Residential Parcels - Indoor Dust), Environmental Resource Management (Erm), Elsie King, Christopher Berg, Thomas J. Beckman

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Factors Associated With Omani’S Schoolteachers’ Reporting Behavior Of Suspected Cases Of Child Abuse And Neglect, Zeinab N. Alazri

Theses & Dissertations

Child abuse and neglect is a global problem that can result in severe negative consequences for victims and their societies. Numerous initiatives have been launched by the United Nations Children's Fund (UNICEF) to combat this problem. Recently, Sultanate Oman, an Arab country, has mandated schoolteachers to report suspected abuse and neglect cases to comply with UNICEF's recommendations. As schoolteachers spend a great deal of their time with children, they are in a good position to recognize and report suspected abuse and neglect cases so the victims can get the needed help and treatment. There is a dearth of information about …

Development Of A Muc16-Targeted Near-Infrared Antibody Probe For Fluorescence-Guided Surgery Of Pancreatic Cancer, Madeline T. Olson

Theses & Dissertations

Pancreatic cancer (PDAC) is an extremely lethal disease with an overall survival rate of 10%. Surgery remains the only potentially curative treatment option, but resections are complicated by infiltrative disease, proximity of critical vasculature, peritumoral inflammation, and dense stroma. Surgeons are limited to tactile and visual cues to differentiate cancerous tissue from normal tissue. Furthermore, translating preoperative images to the intraoperative setting poses additional challenges for tumor detection, and can result in undetected and unresected lesions. Thus, PDAC has high rates of incomplete resections, and subsequently, disease recurrence. Fluorescence-guided surgery (FGS) has emerged as a method to improve intraoperative detection …

The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration, Xiping Jiang

Theses & Dissertations

Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area with a high prevalence for the elderly population. In addition, regeneration of the gradient structure of the enthesis is still a significant clinical challenge. Our studies aim to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging, and develop a novel therapeutic method using three-dimensional (3D) bioprinting technique to regenerate a functional enthesis. Striking variations of the entheses were observed both histologically and biomechanically during the maturation process. The histological features did not show many differences at the insertion site …

Probing The Role Of Astrocytes In The Pathology Of Fragile X Syndrome With Human Stem Cells, Baiyan Ren

Theses & Dissertations

Fragile X syndrome (FXS) is an X-linked neurodevelopmental disorder related to intellectual disability and the most common monogenic cause of autism spectrum disorder. FXS is mainly caused by an expansion of CGG repeats in the 5’-untranslated region of fragile X mental retardation 1 (FMR1) gene, leading to the loss of expression of fragile X mental retardation protein (FMRP). Astrocytes are the most abundant glial cells in the central nervous system (CNS). Loss of FMRP in astrocytes has been found to contribute to structural and functional synaptic deficits in the Fmr1-KO mouse model. The contribution of human astrocytes, however, to the …

Usp11 And Usp7 Deubiquitinases Regulate Sprtn Auto-Proteolysis And Sprtn-Mediated Dna-Protein Crosslink Repair, Megan C. Perry

Theses & Dissertations

DNA repair pathways that recognize and remove damaged DNA are vital for maintenance of genomic stability and prevention of tumorigenesis. Conversely, these pathways may be robust in tumor cells, thus diminishing the anti-cancer potential of available therapies. DNA-protein crosslinks (DPCs) are particularly deleterious DNA adducts that occur when proteins become irreversibly covalently bound to the DNA. DPCs represent a diverse group of lesions, as any protein can be crosslinked to the DNA duplex by non-specific crosslinking agents like reactive aldehydes and radiation. Additionally, functional DNA-binding proteins such as topoisomerases may become permanently crosslinked to DNA ends by abortive enzymatic processes …

Approximate Likelihood Based Estimations For Joint Models With Intractable Likelihoods, Karl Stessy M. Bisselou

Theses & Dissertations

This dissertation focuses on the development of approximation approaches for the joint modeling (JM) of repeated measures data and time-to-event data in the presence of analytically or numerically intractable likelihoods. Current likelihood-based inferences for JMs show several limitations including (i) intractability of integrals during marginal likelihood derivations due to the complexity in computations, and (ii) the large number of nuisance parameters (unobserved) posing a problem with convergence. The h-likelihood (HL) and synthetic likelihood (SL) are two computationally efficient estimation approaches that overcome these challenges.

In the presence of extremely high censoring rates, the HL can produce bias parameter estimates. We …

Glad To Be Out. I Was Running Out Of Womb: A Study Of Omega-6 And Omega-3 Fatty Acid Metabolites At Delivery And Their Relationship To Infant Growth, Prematurity, And Admission To The Neonatal Intensive Care Unit, Maranda Thompson

Theses & Dissertations

Normal pregnancy relies on inflammation for implantation, placentation, and parturition, but uncontrolled it can lead to poor infant outcomes. Maternal diet is one modifiable factor that can impact inflammation. Omega-3 and omega-6 fatty acids have been shown to be metabolized into bioactive metabolites that effect inflammation. The presence and importance of these metabolites at the time of delivery are not well understood. Therefore, the purpose of this dissertation was to first quantify omega-3 and omega-6 metabolites in maternal plasma, cord plasma, and placental tissue. Then the relationships between metabolites and infant outcomes, including birth weight percentile, length percentile, head circumferences …

Functional Characterization Of Cancer-Associated Dna Polymerase Ε Variants, Stephanie R. Barbari

Theses & Dissertations

Replicative DNA polymerases ε (Polε) and δ (Polδ) achieve high fidelity DNA synthesis through a precise balance of polymerization and exonucleolytic proofreading. Errors that escape proofreading are corrected by DNA mismatch repair (MMR). Ultramutated human cancers with proficient MMR carry alterations in the exonuclease domain of Polε, which were initially predicted to abolish proofreading. However, functional studies in yeast of the most recurrent Polε-P286R variant suggested defects beyond a loss of exonuclease activity. Indeed, biochemical analysis of the yeast Polε-P286R analog revealed increased polymerization capacity in addition to decreased proofreading, which enables efficient mismatch extension and bypass of replication-blocking non-B …

Integrative Analysis Of Multi-Omics Kinome Data And Virtual Screening Of Identified Targets With Pan-Cancer Application, Siddesh Southekal

Theses & Dissertations

Cancer is a heterogeneous disease characterized by the uncontrolled growth and dissemination of abnormal cells. Unfortunately, it is also challenging to treat due to the heterogeneous nature of the tumors and the lack of known drugs that are effective against all tumor subpopulations.

The human protein kinases represent an essential and diverse family of enzymes and are often dysregulated in cancer. The human kinome comprises only around 2% of all coding genes of the human genome but phosphorylates about 30% of cellular proteins critical for regulating various biological processes such as cell proliferation, cell cycle progression, apoptosis, motility, growth, differentiation, …

Understanding The Impact Of Chlamydia Trachomatis Infection On Host Vesicular Trafficking, Lisa M. Jorgenson

Theses & Dissertations

Chlamydia trachomatis is a highly evolved obligate intracellular bacterial pathogen. During infection, organisms reside within a host epithelial cell in a membrane-bound vacuole called the inclusion. The inclusion membrane contains both pathogen and host components, including unique chlamydial type III effector proteins called Incs and host lipids like cholesterol and sphingomyelin. The inclusion membrane serves as the main barrier between the bacteria and the host cytosol, and thus, functions as the platform supporting host-chlamydial interactions. Via the inclusion membrane, C. trachomatis intercepts components of host vesicular traffic including many host SNARE proteins, which are a conserved family of eukaryotic proteins …

Molecular Investigation Into The Biologic And Prognostic Elements Of Peripheral T-Cell Lymphoma With Regulators Of Tumor Microenvironment Signaling Explored In Model Systems, Tyler Herek

Theses & Dissertations

Peripheral T-cell lymphoma (PTCL) is heterogenous group of mature T-cell neoplasms characterized by distinctive transcriptional and genetic lesions. Herein, we investigated DNMT3A mutations in angioimmunoblastic T-cell lymphoma (AITL, n = 176) and novel molecular subtypes (i.e., PTCL-GATA3, n = 61 and PTCL-TBX21, n = 80) within PTCL- NOS and observed significant biological and prognostic differences associated with DNMT3A mutations. DNMT3A-mutated PTCL-TBX21 cases showed inferior overall survival (OS; p < 0.005), with DNMT3A mutations (DNMT3A-MT) skewed toward the methyltransferase domain and in the dimerization domain (S881-R887). Transcriptional profiling demonstrated significant enrichment of activated CD8⁺ T-cell cytotoxic gene signatures in the tumor microenvironment of DNMT3A-MT PTCL-TBX21 cases. Genome-wide methylation analysis of DNMT3A-R882/Q886 versus wild-type in PTCL-TBX21 cases demonstrated hypomethylation in target genes regulating T-cytotoxic genes, TCR …

Humanized Mice For Brain Infection Of Emerging Viruses, Edward Makarov

Theses & Dissertations

Studies on the pathogenesis of emerging viruses that present a global threat are critical for pathogen classification and therapeutic development. Humanized mice enable investigation of viral pathogens, including Human immunodeficiency virus (HIV-1), Zika virus (ZIKV), Coronavirus 2 (SARS-CoV-2), and Dengue virus (DENV), offering an advanced understanding into the mechanisms of viral perseverance in its natural human host cells and for therapeutic discovery. Realizing the diverse dynamics of various viral infections with the capacity to establish an innovative acuity for therapeutics and mechanics when utilizing humanized mice contributes a formerly inaccessible insight into human-specific viral pathogenesis and treatment. We recently developed …

Immunological Factors Associated With Siv/ Shiv Persistence In Diverse Tissue Niches, Omalla A. Olwenyi

Theses & Dissertations

The significant challenge towards a successful HIV cure lies in eradicating persistent viral reservoirs across diverse tissue niches. As a result, HIV-infected individuals have to resort to lifelong antiretroviral therapy. Recent news of supposed HIV eradication in a second patient has further re-invigorated the fields of HIV cure. However, a few barriers remain, such as the lack of currently available assays to accurately quantify viral reservoirs, limited information on cellular factors associated with persistence, and varied dynamics of the viral reservoir in various body compartments. Lastly, HIV-infected individuals live different lifestyles stemming from comorbid substance abuse including consumption of morphine, …

Metabolic Heterogeneity And The Roles Of Cody And Ccpa In Central Metabolism And S. Aureus Biofilm Formation., Logan L. Bulock

Theses & Dissertations

Staphylococcus aureus is a metabolically versatile human pathogen, causing disease in many areas of the body. Its versatility can be attributed to the fact that it utilizes a variety of tools to adapt to many different environments, including toxins to scavenge from the host and multiple transporters to compete for its preferred carbon sources. S. aureus can also survive in harsh conditions through biofilm development, which are notoriously recalcitrant to antibiotics and immune defenses. Biofilms exhibit marked heterogeneity, with division of labor for production of matrix components and differential gene expression among various niches within the biofilm.

In this study, …