Medicine and Health Sciences Commons^™

Illness Perceptions And Health-Promoting Behaviors: The Buffering Role Of Resilience In Adults With Congenital Heart Disease, Taylor Rose Eldridge

Electronic Theses and Dissertations

Congenital heart defects (CHD) are one of the most prevalent genetic abnormalities, impacting the lives of millions of children, teens, and young adults. Conservative diagnoses estimate that 2.4 million children and adults are living with CHD in the United States (Gilboa et al., 2016). CHD requires consistent cardiac support with multiple surgeries and hospitalizations expected throughout the lifetime, which significantly impacts psychological health. Specifically, patients present with a host of extra-cardiac conditions that impact their quality of life. With advancements in medical technology, mortality rates continue to improve for this population; however, individuals face a number of consequences that impact …

Coping Strategies And Stress Of The Undergraduate Nursing Student In The Clinical Setting: An Evidence Based Practice Quantitative Study, Ashley Calverley

Electronic Theses and Dissertations

The assessment of perceived stress and coping behaviors related to first-semester clinical might benefit students in nursing education. The assessment of most common coping behaviors and perceived stress related to the clinical setting is essential due to difference in personalities, learning abilities, and coping behaviors among nursing students today. Previous research has suggested the initial clinical period results in adverse outcomes, such as poor academic performance, elevated burnout levels, and diminished personal well-being. These factors are detrimental to academic success in nursing programs. Evidence supports that helping students develop positive stress/coping abilities will aid in adapting in both the academic …

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Faust

Electronic Theses and Dissertations

This quantitative correlational study explored the relationships between perceived psychological safety, conflict management styles, and perceived conflict management success among nurse practitioners (NPs) operating in interprofessional acute or critical care teams in the United States. Despite existing literature on conflict management and psychological safety, there is a noticeable gap concerning the interplay of these factors, specifically among NPs. A multi-item survey was developed from validated measures to assess psychological safety, conflict management success, and conflict management style. The final sample included 944 NPs. The findings revealed a statistically significant difference in the scores of perceived psychological safety, depending on the …

A Quantitative Visualization Tool For The Assessment Of Mammographic Risky Dense Tissue Types, Margaret R. Mccarthy

Electronic Theses and Dissertations

Breast cancer is the second most occurring cancer type and is ranked fifth in terms of mortality. X-ray mammography is the most common methodology of breast imaging and can show radiographic signs of cancer, such as masses and calcifcations. From these mammograms, radiologists can also assess breast density, which is a known cancer risk factor. However, since not all dense tissue is cancer-prone, we hypothesize that dense tissue can be segregated into healthy vs. risky subtypes. We propose that risky dense tissue is associated with tissue microenvironment disorganization, which can be quantified via a computational characterization of the whole breast …

An Existential Punchline: How Humor Functions In A Young Adult Friendship Facing Advanced Cancer, Megan E. Solberg

Electronic Theses and Dissertations

Young adults (i.e., age 18-39) only comprise 4% of the total cancer population, yet cancers in this group are commonly found at more advanced stages due to situational factors influencing delayed diagnosis including access to healthcare, quality health insurance and competing life demands that may hinder prioritization of healthcare. Young adults with cancer also face unique challenges including higher rates of psychological distress, which may contribute to increased risk of social disconnection in response to cancer. Research suggests that humor may be a helpful coping approach and communication mechanism for mitigating distress and discussing difficult topics. Grounded within the frameworks …

Novel Insights Into Oligodendrocyte Biology From Developmental Myelination Studies In Autophagy Deficient Mice And Analysis Of Oligodendrocyte Translatome Response To Contusive Spinal Cord Injury., Michael David Forston

Electronic Theses and Dissertations

Loss of myelin causes severe neurological disorders and functional deficits in white matter injuries (WMI) such as traumatic spinal cord injury (SCI). This dissertation is focused on autophagy in OL development and the OL translatome after SCI. Chapter I describes the history of myelin, OL development, and their involvement in neurodegenerative diseases and SCI. The proteostasis network, in particular autophagy, and its contributions to white matter pathology is discussed. It concludes examining advantages and disadvantages of unbiased omics tools, like RiboTag, to study transcriptional/translational landscapes after SCI. Chapter II focuses on autophagy in OPC/OL differentiation, survival, and proper myelination in …

Incidence And Determinants Of Hypertensive Disorders Of Pregnancy In The Us: Hospitalization Discharge Rate For Preeclampsia, Eclampsia, And Gestational Hypertensions, 2016-2018., Kahir S. Jawad

Electronic Theses and Dissertations

Background: Hypertension remains one of the most prevalent medical issues in pregnancy. It contributes considerably to maternal and fetal morbidity and mortality, making it one of the most significant public health problems. Although various epidemiological studies have been conducted over the past decades to assess the disease incidence and key risk factors associated with hypertensive disorders of pregnancy, current incidence rates and trends are lacking. This is a novel and significant study because there are no current population-based incidence estimates of hypertensive disorders of pregnancy and their subtypes and very few studies with the power to explore a wide range …

On-Campus Mental Health Service Use Among College Students With Autism: A Case Study Applying The Andersen Behavioral Model Of Health Services Use, Estella C. Lilyquist

Electronic Theses and Dissertations

The unique set of impairments and limitations presented by students with autism spectrum disorder (ASD) make the accessing of campus-based nonacademic resources more difficult and complicated than their typically developed peers. Each year, the rate of students entering college with disabilities continues to grow, but their mental well-being is relatively poor. The purpose of this qualitative case study was to apply the conceptual framework of the Andersen behavioral model of health services use (ABMHSU) to the experiences of college students with ASD to understand and predict their utilization of campus-provided mental health resources. The participants were seven college students with …

The Influence Of Administrative Timing In Triple-Negative Breast Cancer Treatments, Emily Mailloux

Electronic Theses and Dissertations

Breast cancer accounts for 25% of all cancers in Canadian women, and 15-20% of these are triple-negative breast cancers (TNBC), which have a poorer prognosis than other breast cancer subtypes. TNBC lacks expression of the estrogen receptor, progesterone receptor, and the human epidermal growth factor receptor 2 (HER2), which are common therapeutic targets in breast cancer. Due to the lack of target therapy, generalized chemotherapy treatments are used instead. The standard of care for treatment of TNBC instead consists of doxorubicin (A), cyclophosphamide (C) paclitaxel (T), and carboplatin (Carbo), that target various aspects of the cell cycle to induce cell …

Metabolic Foundations Of Exercise-Induced Cardiac Growth., Kyle Fulghum

Electronic Theses and Dissertations

Regular aerobic exercise promotes physiological cardiac growth, which is an adaptive response thought to enable the heart to meet higher physical demands. Cardiac growth involves coordination of catabolic and anabolic activities to support ATP generation, macromolecule biosynthesis, and myocyte hypertrophy. Although previous studies suggest that exercise-induced reductions in cardiac glycolysis are critical for physiological myocyte hypertrophy, it remains unclear how exercise influences the many interlinked pathways of metabolism that support adaptive remodeling of the heart. In this thesis project, we tested the general hypothesis that aerobic exercise promotes physiological cardiac growth by coordinating myocardial metabolism to promote glucose-supported anabolic pathway …

Labeling Melanoma Cells With Black Microspheres For Improved Sensitivity In Detection Via Photoacoustic Flow Cytometry, Tori Kocsis

Electronic Theses and Dissertations

Melanoma is an aggressive form of skin cancer known for developing into metastatic disease. Current clinical diagnostics, including medical imaging and tissue biopsy, provide a poor prognosis since the cancer is in the late stages of disease progression. In recent years, photoacoustic flow cytometry has allowed for the detection of circulating melanoma cells within patient blood samples in vitro. Although this method exploits the naturally-produced melanin within the cells, it has only successfully detected highly-pigmented melanoma cell lines. Since various forms of melanoma exist, each with varying melanin concentrations, this research aims to provide a novel method for detecting lightly-pigmented …

Overview Of Transition Care Clinics And Patient No-Shows, Manul Awasthi

Electronic Theses and Dissertations

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC …

Primary Cilia Of The Cardiac Neural Crest & Hedgehog-Mediated Mechanisms Of Congenital Heart Disease, Lindsey A. Fitzsimons

Electronic Theses and Dissertations

Elimination of primary cilia in cardiac neural crest cell (CNCC) progenitors is hypothesized to cause a variety of congenital heart defects (CHDs), including atrioventricular septal defects, and malformations of the developing cardiac outflow tract. We present an in vivo model of CHD resulting from the conditional elimination of primary cilia from CNCC using multiple, Wnt1:Cre-loxP, neural crest-specific systems, targeting two distinctive, but critical, primary cilia structural genes: Intraflagellar transport protein 88 (Ift88) or kinesin family member 3A (Kif3a). CNCC loss of primary cilia leads to widespread CHD, where homozygous mutant embryos (MUT) display a variety of outflow tract malformations, septation …

The Experience Of Scanxiety In Survivors Of Pancreatic Cancer: A Phenomenological Study., Susan Winebrenner

Electronic Theses and Dissertations

Surveillance scans can signify a crisis point in a cancer patient’s life, provoking fear and anxiety that negatively impact quality of life. Scan-related anxiety or scanxiety has been briefly discussed in the literature among lung cancer and lymphoma populations, but relatively few investigations have studied the psychological impact of routine surveillance scans during cancer survivorship. The purpose of this study was to illuminate the lived experience of scanxiety in survivors of pancreatic cancer who have undergone curative surgical resection. Hermeneutic phenomenology as applied by Heidegger provided the philosophical underpinnings for this study and van Manen’s methodological approach was used to …

The Role Of Obesity In Macrophage-Mediated Mechanisms Promoting Early-Onset Colon Cancer., Katharina Marietta Scheurlen

Electronic Theses and Dissertations

Early-onset colon cancer (EOCC) is a leading cause of cancer death among people younger than 50 years of age in the United States and is associated with metabolic dysfunction and obesity. Anti-inflammatory tumor-associated macrophages (TAM) and low Peroxisome Proliferator Activated Receptor Gamma (PPARγ) gene expression in colon cancer (CC) tissue promote tumor progression and decreased patient survival. Obesity-related hormones, such as leptin and adiponectin, have the potential to affect gene expression in TAM to promote CC progression and thereby link obesity and EOCC. The aim of this project was to identify target genes in human CC and to investigate the …

The Impact Of Volume Of Tissue Activation On Cortical-Striatal Networks And Verbal Fluency Declines In Post-Deep Brain Stimulation Parkinson's Disease Patients., Alexander Luke Alley

Electronic Theses and Dissertations

This study investigated the cortical-striatal networks of verbal fluency declines in 6-month, post-operative, deep brain stimulation Parkinson’s Disease patients. Nine Parkinson’s disease participants with implanted STN or GPi DBS systems were recruited for this study. Verbal fluency data was obtained from each patient preoperatively and 6- months post implantation. The stimulation-based volume of tissue activated area (VTA) of each target site (STN or GPi) was analyzed using Lead-DBS and Lead-Group. The white matter tracks intersecting each patient’s VTA, terminating in the pre-SMA, SMA, caudate nucleus, and anterior cingulate were investigated and correlated with verbal fluency declines. We found statistically significant …

The Impact Of Disruptive Physician Behavior On Support Staff And Patients: A Quantitative Secondary Analysis, Michael C. Marino

Electronic Theses and Dissertations

In this quantitative secondary analysis, the purpose was to examine the nature of disruptive physician behavior (DPB) from the support staff and patient perspectives. Healthcare staffing shortages existed prior to the global pandemic and have increased, creating importance for employee retention and recruitment. I wanted to understand the impact of physician behavior on staff turnover rates in a private oncology practice, its effect on patient satisfaction rates, and to compare these rates of physicians that display DPB with physicians that do not display this behavior in a private hematology oncology community outpatient setting in the Southwest United States. To answer …

The Intersection Of Traumatic Brain Injury And Homelessness, Stephanie A. Chassman

Electronic Theses and Dissertations

The rates of TBI are significantly higher among individuals experiencing homelessness compared to the general population. Up to half of individuals experiencing homelessness may have a TBI. Accurate prevalence rates of TBI among individuals experiencing homelessness are difficult to obtain due to different methods of sampling participants and differing definitions of TBI; therefore, estimates may be underrepresented. Despite past research that has examined the relationship between TBI and homelessness, there are specific gaps in knowledge such as correlates and risk factors of TBI among individuals experiencing homelessness. This three-manuscript dissertation attempts to address these gaps in knowledge.

The first manuscript …

Organellar Zn2+ Homeostasis And The Role Of Trpml Channels In Neuronal Lysosome Physiology And Axonal Transport, Taylor Franklin Minckley

Electronic Theses and Dissertations

Zinc (Zn²⁺) is crucial for proper cellular function, and as such it is important to measure and track Zn²⁺ dynamics in living cells. Fluorescent sensors have been used to estimate Zn²⁺ content of subcellular compartments, but little is known about endolysosomal Zn2+ homeostasis. Similarly, although numerous sensors have been reported, it is unclear whether and how Zn²⁺ can be released from intracellular compartments into the cytosol due to a lack of probes that can detect physiological dynamics of cytosolic Zn²⁺. My dissertation started with comparing and characterizing different Zn²⁺ sensors including the …

Antioxidant Biomarkers And Nutraceutical Therapeutics In Neurodegeneration And Neurotrauma, Lilia A. Koza

Electronic Theses and Dissertations

Mild traumatic brain injury (mTBI), yielding a Glascow Coma Scale of 13-15, is the most commonly occurring severity of TBI. Pathology from mTBI consists of blood brain barrier disruption, neuroinflammation, oxidative stress, excitotoxicity, mitochondrial dysfunction, protein aggregation, axonal degeneration, and resulting neuronal death. These processes deplete the body’s endogenous antioxidant system. We report a retrospective analysis of antioxidant blood biomarkers in patients with a history of mTBI from a local sports medicine clinic, Resilience Code. We found persistent sex-specific antioxidant depletions in mTBI patients associated with worsened symptomology.

Certain populations, such as athletes, are at high risk for repetitive mTBI …

Experiences And Perceptions Of Female Athletic Trainers Working With Male Coaches In Male Sports, Sierra Hobday

Electronic Theses and Dissertations

Context: Female athletic trainers are making great strides in a previously male-dominated profession and are also becoming more prevalent in working with male sports teams. Female athletic trainers working within male sports often face gender bias and discrimination which has been found to come from male coaches of these sports. While previous studies have shown male coaches may demonstrate practices of gender bias towards female athletic trainers working in male sports, no studies have focused directly on the male coach and female athletic trainer relationship. Purpose: To examine the experiences and perceptions of female athletic trainers currently working with male …

Factors Associated With Intention To Disclose Concussive Symptoms In Active Duty Soldiers, Carly Beck

Electronic Theses and Dissertations

Background: Concussion disclosure is a heavily researched topic, and while previous literature has explored predictors of concussion disclosure in numerous populations, research within the active duty Soldier population is limited. This study further explored predictors of concussion disclosure to a medical professional or leadership in the active duty Solider population through the lens of the Theory of Planned Behavior. Methods: A cross-sectional electronic survey was distributed to 181 active duty Soldiers. Descriptive statistics were used to report frequency of high intention to disclose concussive symptoms among demographics, and a multivariate regression model was used to assess significant predictors of intention …

Role Of Meibum And Tear Phospholipids In The Evaporative Water Loss Associated With Dry Eye., Samiyyah M. Sledge

Electronic Theses and Dissertations

It is generally believed that the tear film lipid surface film inhibits the rate of evaporation (Revap) of the underlying tear aqueous. It is also generally believed that changes in the composition of the tear film lipid layer is responsible for an increase in Revap in patients with dry eye. Both of these ideas have never been proven. The purpose of the current studies was to test these ideas. Revap was measured in vitro gravimetrically. Lipid spreading was measured using Raman spectroscopy and microscopy. The influence of the following surface films on the Revap of the sub phase of physiologically …

The Role Of The Circadian Clock In The Intestinal Epithelium During Health, Regeneration, And Tumourigenesis, Kyle Stokes

Electronic Theses and Dissertations

The Earth’s axial rotation subjects its surface to constant periods of light and dark, this is known as photoperiod. Many organisms have adapted their physiology in accordance with this environmental constant by generating 24h rhythms in their physiological functions; these are known as circadian rhythms. Circadian rhythms are controlled by an endogenous time-keeping mechanism known as the circadian clock. Over 40% of the genome in mice and over 80% of the genome in primates has been shown to have 24h rhythms in transcription. The disruption of circadian rhythms through shiftwork, jetlag, or exposure to light at night is associated with …

Nursing Perceptions For Utilizing Essential Oil Application In Labor And The Effect Of Targeted Education, Joni R. Beckham

Electronic Theses and Dissertations

This Doctor of Nursing Practice project was implemented to determine how a nurse’s perception of aromatherapy influences their decision to provide aromatherapy for patients during labor and the effect of targeted education on a nurse’s perception. The purpose of this project was to determine how nurses view the use of aromatherapy resources at their disposal and the likelihood that they would offer the intervention to their patients. This project provided education to increase nurses’ confidence in providing optimal care to patients using a traditional and holistic avenue of aromatherapy while determining if education can positively influence nurses to support essential …

Improving Sexually Transmitted Infection Knowledge In Community College Students: A Path To Prevention, Rebecca F. Halford

Electronic Theses and Dissertations

This DNP project was conducted to identify gaps in knowledge focusing on sexually transmitted infections within Texas and Region one. The research study gathered data from first-year nursing students who have chosen to participate in a sexually transmitted infection-focused educational module. Participants were first-year nursing students and understood the research study was strictly voluntary with no forms of compensation. Currently, the curriculum in the nursing program at which the study took place does not focus on sexually transmitted infections and is directed to speak minimally on the subject. This is a contributing factor to why the rise in sexually transmitted …

The Role Of The Nkr-P1b:Clr-B Inhibitory Axis In Nk Cell-Mediated Tumour Immunosurveillance, Abd El Aziz Hendy

Electronic Theses and Dissertations

Natural killer (NK) cells are lymphocytes of the innate immune system which do not require prior priming to target infected or altered-self cells, such as tumour cells. The basic functions of NK cells include cytotoxicity and cytokine production. These cells possess numerous activating and inhibitory receptors which regulate their function based on a signalling balance. In mice, NK cells possess NKR-P1B inhibitory receptors which recognize the C-type lectin-related protein-b (Clr-b) ligand. This ligand is present on healthy self cells and may be used by cancer cells to evade NK cell effector functions. The disruption of the NKR-P1B:Clr-b axis has been …

An Enhancement To Cnn Approach With Synthesized Image Data For Disease Subtype Classification, Narider Pal Singh

Electronic Theses and Dissertations

The introduction of genetic testing has profoundly enhanced the prospects of early detection of diseases and techniques to suggest precision medicines. The subtyping of critical diseases has proven to be an essential part of the development of individualized therapies and has led to deeper insights into the heterogeneity of the disease. Studies suggest that variants in particular genes have significant effects on certain types of immune system cells and are also involved in the risk of certain critical illnesses like cancer. By analyzing the genetic sequence of a patient, disease types and subtypes can be predicted. Recent research work has …