Perivascular Waste Metabolites Clearance In Central Nervous System (Cns), Yiming Cheng

Dissertations

Efficient clearance of interstitial waste metabolites is essential for normal brain homeostasis. Such effective clearance is hampered by the lack of a lymphatic system in the brain, and the cerebrospinal fluid (CSF) is unable to clear large size waste metabolites in the brain. Here, a novel idea that brain arterial endothelium and smooth muscle cells reactivity regulates the clearance of these water-insoluble large size waste metabolites through the perivascular dynamic exchange, and that low dose ethanol promotes this perivascular clearance is proposed.

In Aim 1, the biodistribution of a large size waste metabolite (Amyloid-β protein mimic) in rat perivascular space …

Mitochondria Imaging And Targeted Cancer Treatment, Tinghan Zhao

Dissertations

Mitochondria are essential organelles as the site of respiration in eukaryotic cells and are involved in many crucial functions in cell life. Dysfunction of mitochondrial metabolism and irregular morphology have been frequently found in human cancers. The capability of imaging mitochondria as well as regulating their microenvironment is important both scientifically and clinically. Mitochondria penetrating peptides (MPPs), certain peptides that are composed of cationic and hydrophobic amino acids, are good candidates for mitochondria targeting. Herein, a novel MPP, D-argine-phenylalanine-D-argine-phenylalanine-D-argine-phenylalanine-NH₂ (rFrFrF), is conjugated with a rhodamine-based fluorescent chromophore (TAMRA). The TAMRA-rFrFrF probe exhibits advantageous properties for long-term mitochondria tracking of …

Exemplary Chief Nurse Executives Leading Through Storytelling, Tricia Kassab

Dissertations

Purpose: The purpose of this phenomenological study was to understand and describe how exemplary human resources administrators use storytelling to lead organizations using Denning’s (2011) model. In addition, it was the purpose to understand how they use storytelling to create transformational change. Denning’s The Leader’s Guide to Storytelling highlights eight storytelling narrative patterns: to ignite action, to communicate who you are, to build your brand, to transmit values, to foster collaboration, to share knowledge, to tame the grapevine, and to share vision.

Methodology: This phenomenological qualitative study described the lived experiences of exemplary elementary chief nurse executives in California. The …

Using Lifestyle Educational Intervention To Decrease Blood Pressure Reading Amongst African American Adults, Catherine Madu

Dissertations

Hypertension or high blood pressure is a global epidemic and a major public health challenge in the United States. Hypertension increases the risk of cardiovascular disease, stroke, and renal failure. The disease disproportionately affects African Americans (AAs) and is a leading cause of morbidity and mortality in this ethnic group. Effective management of hypertension decreases complications from the disease. The purpose of the clinical scholarly project (CSP) was to decrease blood pressure readings amongst AA adults, ages 18 to 65 years old using educational intervention on lifestyle modifications. A convenience sampling of 20 AA (n = 20) adult participants was …

Physical Activity Prevalence Among Migrants In United Arab Emirate, Rowaa Elhidia Elobaid Abd-Allatif

Dissertations

Insufficient physical activity is a leading risk for non-communicable diseases (NCDs). Few data were available on the physical activity levels of migrants in the United Arab Emirates (UAE). This study aimed to determine leisure time physical activity levels and their associated socio-demographic determinants and NCD risk factors among migrants in Al Ain, UAE. A random sample of male South Asian migrants (n=1375) (76.4% response rate) and female South Asian, Arab, and Philippines migrants (n=555) (75% participation rate) was recruited from the government Visa Screening Center in Al Ain, UAE. An adapted version of the WHO STEPS Survey with a short …

The Usage And Impact Of Outpatient Commitment Orders On Suicide And Suicide Attempt Rates In Mississippi, Sam Mauldin

Dissertations

Rates of self-harm and suicide in the United States have not decreased since 1980 and remained relatively constant through the start of the 21^st Century. The most recent data indicate that suicide rates in the United States have risen by about 2% a year from 2006 through 2016, although suicide rates have decreased in other countries during the same timeframe. Finding a viable intervention to slow rates of self-harm and suicide is needed in the United States. The need for closer patient observation has been cited as an underutilized intervention for the reduction of attempts of self-harm and suicide. …

Exploring Wheelchair Service Delivery In A Dedicated Seating Department, Cara E. Masselink

Dissertations

This study is a series of three studies aimed at exploring wheelchair service delivery in a department of physical and occupational therapists dedicated to wheelchair seating. The three studies utilized a retrospective analysis to investigate the clinical documentation written by the practicing clinicians between 2007 and 2017. The first study aimed to describe the wheelchair and accessory recommendations made in the 11-year period, in relationship to age and gender. The majority of recommendations in the dedicated seating department were for complex wheelchairs. The results indicated the ratio between standard and complex power mobility devices and four complexities of cushions changed, …

A Quality Improvement Study On Missed Appointment Management In Primary Care, Aunye' Dina Amos

Dissertations

Abstract

Problem: Patients who miss appointments have poorer health outcomes and increase costs for medical care. The purpose of this quality improvement study was to evaluate the effects of missed appointments on patients’ outcomes for diabetes mellitus, and resulting financial losses to a private primary care practice.

Method: A quality improvement initiative with a retrospective review of patients over a six-month period in 2018 (before) and 2019 (after a missed appointment fee was implemented). All adult patients, aged 18-92 years, were included. For those with diabetes, a HbA1c for each patient who kept or missed their appointment was recorded.

Results: …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Impact Of A Web-Based Instructional Module Of Alzheimer’S Disease Within Seven Content Knowledge Domains, Joyce Haynie

Dissertations

Abstract

Alzheimer’s Disease (AD) has been classified as the most common form of dementia. Primary health care providers are usually the first clinicians to whom individuals present with symptoms of dementia. By 2050, it is expected that as many as 13.8 million Americans will be living with AD, and millions more will be placed in the challenging role of providing care for these individuals. However, studies continue to show that dementia is often underdiagnosed and under detected. The purpose of the study was to systematically inquire about the impact of AD education on level of knowledge about AD among primary …

Evaluating Controlled Substance Documentation In An Electronic Medical Record, Delora Brooks

Dissertations

The Centers for Disease Control and Prevention (CDC) directives issued in 2016 gave guidelines for safely prescribing opiates; however, primary source discussions about methods used for documenting opioid and controlled substance monitoring within an electronic medical record (EMR) are limited (Hussain, Nelson, Polston & Zheng, 2019). This leaves individual providers to determine the appropriate way to document. Inconsistent documentation may not protect providers or organizations from regulatory, civil or criminal liability. As stated by Raveesh, Nayak & Kumbar (2016), “The best way to handle medico-legal issues is by preventing them”. Even with the advent and widespread use of EMRs, documentation …

Fathers' Experiences With Their Premature Infants Or Unhealthy Neonates, Lisa Cummings

Dissertations

Author: Lisa Cummings PhD RN

Fathers’ Experiences with Their Premature Infants or Unhealthy Neonates

Purpose and Background/Significance: Fifteen million babies worldwide are born prematurely each year, impacting a multitude of fathers. The importance of an early close father-infant relationship has been identified as central for the development of the child. Fathers influence on a child’s emotional and cognitive development and their physical well-being and health. Many times, the Neonatal Intensive Care Unit (NICU) is the initial contact environment between a father and his premature infant. Studies have shown that the NICU can be a stressful environment for parents, producing emotional …

Estimation Of Infectious Intestinal Disease Burden And Description Of The Infectious Disease Surveillance System In Ras Al Khaimah, United Arab Emirates, Fatema Hamdan Saif Al Alkeem Al Zaabi

Dissertations

Introduction: Infectious disease (ID) is an ongoing problem worldwide. In order to manage this problem, it is important to have an integrated and effective surveillance system that can be used to estimate the burden of ID. There is a scarcity of studies published on the prevalence of IDs in the United Arab Emirates (UAE), both in hospital settings and in the community. Infectious Intestinal Disease (IIDs) have been one of the most commonest IDs that have been studied in the community around the world, there are no studies on the prevalence of IIDs in Ras Al Khaimah (RAK). Furthermore, while …

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

Developmental And Sex Modulated Neurological Alterations In Autism Spectrum Disorder, Azeezat Azeez

Dissertations

Autism Spectrum Disorder (ASD) was first described in 1943 by Dr. Leo Kranner in a case study published in The Nervous Child. It is a neurodevelopment disorder, with a range of clinical symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used by clinicians to diagnose mental disorders, a child needs to have persistent social deficits, language impairments, and repetitive behaviors, that cannot be explained by neurological damage or intellectual disability. It is known that children diagnosed with ASD are often are developmentally delayed therefore alterations in the typical developmental trajectory should be a major factor in …

Modelling In Vitro Dissolution And Release Of Sumatriptan Succinate From Polyvinylpyrrolidone-Based Microneedles Aided By Iontophoresis, James Paul Ronnander

Dissertations

A novel dissolving microneedle array system is developed to investigate permeation of a sumatriptan succinate formulations through the skin aided by iontophoresis. Three formulations consisting of hydrophilic, positively charged drug molecules encapsulated in a water-soluble biologically suitable polymer, polyvinylpyrrolidone (PVP), have been accepted by the U.S. Food and Drug Administration (FDA). The microneedle systems are fabricated with 600 pyramid-shaped needles, each 500 µm tall, on a 0.785-cm² circular array. In vitro transdermal studies with minipig skin and vertical Franz diffusion cells show > 68% permeation of sumatriptan over a 24-hour period. A combination of microneedle and electrical current density ranging …

Roles Of Surfactant And Binary Polymers On Dissolution Enhancement Of Bcs Ii Drugs From Nanocomposites And Amorphous Solid Dispersions, Md Mahbubur Rahman

Dissertations

Drug nanocomposites and amorphous solid dispersions (ASDs) are two major formulation platforms used for the bioavailability enhancement of BCS Class II drugs. The major drawback of nanocomposites is their inability to attain high drug supersaturation during in vitro (<50% relative supersaturation) and in vivo dissolution. On the other hand, formulating an amorphous solid dispersion (ASD) with high drug loading (>20%) that releases drug rapidly, while generating and maintaining high supersaturation over at least three hours is challenging. The goal of this thesis is to develop a fundamental understanding of the impact of anionic surfactants–polymers on in vitro drug release from nanocomposites and ASDs, while addressing the above challenges. To achieve this goal, the following objectives are set: (1) compare griseofulvin …

The Underlying Psychophysiology Of Pedophilic Disorder And The Implications For Treatment Approaches, Tonise Florexil

Dissertations

Sexual crimes are a persistent and significant social dilemma that continues to plague our society (Lee, Jackson, Pattison, & Ward,2002). Past research has made considerable advancements in terms of the types of interventions that clinicians can utilize when they work with individuals who have a history of child sexual offenses. However, current literature lacks an understanding of the risk factors that influence the development of Pedophilic Disorder. A history of sexual trauma also affects families. The children of traumatized individuals have more adjustment difficulties than their counterparts who did not have a parent(s) with a sexual trauma history. This clinical …

The Relationship Between Frequency Of Yoga And Meditation On Ptsd Symptoms In Individuals Who Have Experienced Intimate Partner Violence, Kimberly Polignani

Dissertations

Intimate partner violence (IPV) has become a growing phenomenon in the United States,

affecting nearly 13% of the population. The adverse mental health outcomes from people who experience IPV are prevalent and more than half have a diagnosis of posttraumatic stress disorder (PTSD). Therefore, therapeutic techniques for PTSD appear to be feasible for IPV survivors and their mental health issues. Complementary and alternative medicine has become a widely accepted approach for PTSD. Being two complementary and alternative medicine techniques, yoga and meditation are effective forms of therapy in many diagnoses, including PTSD. This study utilized a not-for-profit organization called the …

The Diffusion Of Telehealth: System-Level Conditions For Successful Adoption, Danika Tynes

Dissertations

Telehealth is a promising advancement in health care, though there are certain conditions under which telehealth has a greater chance of success. This research sought to further the understanding of what conditions compel the success of telehealth adoption at the systems level applying Diffusion of Innovations (DoI) theory. System-level indicators were selected to represent four components of DoI theory (relative advantage, compatibility, complexity, and observability) and regressed on 5 types of Telehealth (Teleradiology, Teledermatology, Telepathology, Telepsychology, and Remote Monitoring) using multiple logistic regression.

Analyses included data from 84 states leveraging data from the World Health Organization, World Bank, ICT Index, …

From The Boots On The Ground: A Comparison Of The Attitudes And Beliefs Of Military Members And Mental Health Professionals Regarding The Moral Injury Construct, Karis L. Callaway

Dissertations

An increasing amount of research conducted in recent years indicates that, in addition to Posttraumatic Stress Disorder, moral injury is a key concept to recognize when considering the deployment experiences of service members. Although related to Posttraumatic Stress Disorder, which is a fear-based mental health diagnosis, moral injury is a distinct concept. It acknowledges the possible prolonged negative psychological, social, and spiritual consequences that may occur after experiences that challenge and transgress one’s deeply held moral beliefs. Events such as perpetration of harm, failing to protect or prevent harm, and witnessing or learning about distressing acts committed by influential others …

A Phenomenological Investigation Of Women’S Infertility And Miscarriage Grief Experiences, Tristan Mcbain

Dissertations

Infertility and miscarriage are reproductive losses that often produce grief reactions in affected women. This phenomenological study investigated the grief experiences of infertility and miscarriage through the ambiguous loss and disenfranchised grief frameworks in order to better understand both the obscurity of reproductive loss and how the resulting grief may be invalidated.

Sixteen women volunteered to participate in this study and each fell into one of the following three categories: women affected by infertility without miscarriage (4); women affected by miscarriage without infertility (4); and women affected by infertility and miscarriage (8). A phenomenological hermeneutic approach was utilized to uncover …

Comorbid Symptom Treatment In Parkinson’S Disease Using Neurofeedback, Joanne Mcfarland O'Rourke

Dissertations

The purpose of this research was to determine the impact of neurofeedback (NFB) on Parkinson’s symptoms that patients identify as priorities. First, a focus group of patients helped identify priority symptoms, then a pilot study tested protocols resulting from the focus group, and finally, an intervention study using a single subject design was conducted.

In the focus group, tremor and activity planning were identified as issues affecting every group member. The pilot study was conducted with three mid-stage Parkinson’s patients, who received a sensory motor (SM) protocol to address tremor, a SM plus cognition protocol (SM+Cog) for tremor and planning …

Same-Sex Sexual Coercion Among Women: The Impact Of Minority Stress On Perpetration And Victimization Experiences Of Women Of Diverse Sexual Identities, Allison Kirschbaum

Dissertations

The purpose of the current study was to investigate women’s experiences with same-sex sexual coercion perpetration and victimization. Specifically, I sought to explore the role that the stress of living as a sexual minority plays in these experiences as well as to determine whether the psychological variables of perceived powerlessness, psychological distress, social support, and alcohol use mediate the relationship between minority stress and perpetration and victimization experiences. Data were collected online from self-identified women and individuals assigned female at birth who reported experiencing genital sexual contact with another woman (N=339). Of the cisgender women in the sample, 31.6% reported …

A Survey Of Healthcare Workers On Safe Patient Handling And Mobility Resource Availability, Utilization, And Adherence, Kimberly Waltrip

Dissertations

The purpose of this study was to examine the current status of safe patient handling and mobility—specifically resource availability, utilization, and adherence to established safe patient handling and mobility standards—and measure any relationships among these factors. This study builds on the reliability and validity of the adapted American Nurses Association’s (2016) Safe Patient Handling and Mobility Self-Assessment Resource. Responses came from a one-shot survey of healthcare workers in direct patient care across several private and Veterans Health Administration healthcare organizations in the Midwestern United States. The risk of injury is higher in patient handling than in many other professions; …

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

Dissertations

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

Education-Based Interventions Effects On 30-Day Readmission Rates For Patients With Copd, Gina Hand-Eoloff

Dissertations

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing education-based program for Chronic Obstructive Pulmonary Disease (COPD) and its effect on 30-day readmission rates in one hospital in rural Missouri.

Method: A retrospective chart review was completed on 493 patients with an inclusive diagnosis of COPD from June 1, 2018, to March 31, 2019, using a cohort study design and a two-sample t-test analysis. Additional variables were analyzed to determine if there were predictive factors of an elevated risk of readmission.

Results: The two-sample t-test reveals there is no statistically significant difference between the rates of readmission …

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

Dissertations

Abstract

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

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

Barriers To Mental Health Treatment In Patients Referred By Primary Care, Rebecca Palmer

Dissertations

Problem: Limited access to mental health treatment is one of many potential barriers to treating mental illness in the United States. Where resources are readily available, reportedly high no-show rates for established mental health appointments suggests further investigation is necessary to identify frequent barriers within that population. This was a quality improvement project to identify common themes in patient-reported barriers to care.

Methods: A 4-question phone survey was offered to individuals that did not appear at their mental health appointment. Data was analyzed to identify the most commonly reported barriers to mental health treatment. Additional data collected includes reported history …

Nitrous Oxide Use For Minor But Painful Pediatric Procedures, Samantha Kremer

Dissertations

Problem: Nitrous oxide (N₂O) is used for mild to moderate pain control and anxiolysis. Registered nurses (RN) as providers of N₂O administration may decrease the number of missed opportunities for pain control or anxiolysis. The purpose of this quality improvement initiative was to evaluate the type of procedures and rate of N₂O administration by providers, and cost difference between them.

Method: A descriptive, cohort-design for pediatric patients in the Imaging and Sedation Department between October through November of 2017 and 2018. Data was compared between physicians in 2017 and either a physician or RN …