Medicine and Health Sciences Commons^™

Effective Risk-Based Decision Making In Quality Risk Management, Valerie Mulholland

Dissertations

Patients expect safe, effective, high-quality medicines that are available when needed. Meeting these expectations is increasingly challenging in a global pharmaceutical supply chain, as evidenced by persistent product quality and supply issues. A key contributory factor to these issues is disruptions in manufacturing operations, which in turn are often caused by a hesitancy to change and to continuously improve approved processes. Regulatory agencies repeatedly indicate that they will consider increased autonomy for post-approval changes, if pharmaceutical manufacturing operations can demonstrate the effectiveness of Quality Risk Management (QRM) within the Pharmaceutical Quality System (PQS). Thus, the question was posed by Dr …

Enhancing Organisational Performance Through Patient-Focused Learning Excellence In The Biopharmaceutical Industry, Lori Richter

Dissertations

Drug shortages, quality defects and challenges regarding innovation within the biopharmaceutical industry pose significant risks to patient safety and organisational performance. These problems persist despite the many scientific, technological and economic advances over the past several years in a well-funded, high-revenue industry operated by highly qualified personnel. Evidence suggests that the industry has yet to fully realise the potential for building organisational capabilities to enable learning from mistakes to enhance performance outcomes. This research study explored how biopharmaceutical companies can learn from their mistakes and embrace a culture of learning in order to reduce quality defects and drug shortages by …

Cbct Perceptions Of Radiology Leaders In The Midwest Dental Schools: A Qualitative Study, Tenzin Dadul

Dissertations

Problem

The integration of Cone Beam Computed Tomography (CBCT) in dental education is hindered by a lack of formal training among radiology leaders, insufficient institutional support, and financial constraints. Despite the proven efficacy of CBCT in enhancing diagnostic accuracy and treatment planning, its adoption in pre-doctoral curricula remains limited. This gap in education poses significant challenges for dental graduates, who are increasingly expected to utilize advanced imaging technologies in clinical practice.

Purpose of Study

This qualitative study aimed to explore the perceptions of radiology leaders in Midwest dental schools regarding the integration of CBCT education into pre-doctoral curricula. The objectives …

Employees' Perception Of The Management Of The Covid-19 Crisis At Najran University, Saudi Arabia, Noora Nasser Alsuhaibani

Dissertations

Problem

During the COVID-19 crisis, particularly in the context of Saudi education, the ability to physically attend schools and colleges was greatly hindered due to the widespread transmission of the virus and the resulting obstacles. The issues necessitated the use of crisis management strategies. Some Saudi universities are capable of implementing an organized plan both before to and during crisis management, whereas others lack this competence. This is a substantial problem. Several universities in Saudi Arabia effectively managed the COVID-19 epidemic, whereas others did not. Furthermore, prior studies on crisis management indicate that administrators exhibit diverse responses. By participating in …

Understanding Emerging Adult Mental Health And Attachment: The Roles Of Parental Factors In Childhood, Trauma, And Gender, Christiana A. Howell

Dissertations

Problem

The experience of the parental environment growing up, parental psychopathology in childhood, exposure to trauma throughout the lifespan, insecure adult attachment, and social support have been established as factors that influence mental health in adulthood. These factors have not yet been studied together as a complex model of emerging adult mental health and attachment. The purpose of this study was to develop a theoretically and empirically supported model of these factors to understand how these factors interact to influence mental health in emerging adulthood. Additionally, the purpose was to understand if these factors interact differently based on gender.

Method …

Quantifying Non-Muscle Myosin 2 Filament Dynamics, Melissa Ann Quintanilla

Dissertations

Non-muscle myosin 2 is a motor protein that, when assembled into filaments, works on the actin cytoskeleton to produce contractile forces within cells. This type of myosin dynamically assembles within cells to exert forces necessary for a wide variety of functions including cell division, migration, and multicellular movement. The ability to dynamically assemble contractile networks, and the ability to control the assembly and placement of these myosin filaments in both space and time, is therefore required throughout cell physiology. We used a suite of dynamic, quantitative imaging approaches to identify deterministic factors that drive myosin filament appearance and amplification as …

Perceived Power By Nurse Managers In Dialysis Units: A Qualitative Case Study, Janie Griner

Dissertations

Nurses comprise the largest workforce in health care but lack power despite their numbers. Nurses have suffered short-staffing, burnout, job dissatisfaction, unsafe work settings, and cumbersome technology for decades. The dialysis nurse manager is an important component of the dialysis unit and plays a role in the retention and recruitment of nurses. Using a case study approach this qualitative, thematic analysis described dialysis nurse managers’ perception of power in dialysis units. A review of the current research revealed a gap involving dialysis nurse managers’ perception of power in the dialysis unit. The following research question was developed: • How do …

Perceptions Of Stress In Community Clinic Nurses During The Covid-19 Pandemic, Jomeka Smith

Dissertations

The COVID-19 pandemic is one of the largest healthcare crises that has affected the entire healthcare industry. Community health nurses in the front-line roles are greatly threatened by the COVID-19 pandemic that has decimated healthcare systems. The well-being of nurses is vital to perform their full potential of adequate patient care. Increased demands and pandemic related stressors can increase the risk of mental health problems. Nurses work in a variety of healthcare settings, however, the expectations, the fear of the unknown, and changes in demands have largely contributed to the unprecedented stressors that accompany nurses in clinical settings. Stress among …

The Leadership Experience Of Academic Chief Nurse Administrators In The State Of Georgia During The Covid-19 Pandemic Upon Return To Campus After Full Virtual Instruction: A Qualitative Study, Susie Jonassen

Dissertations

The impact of the COVID-19 global pandemic has been rated as the highest factor of intent to leave the profession in nurses serving in a leadership role. During the pandemic, crisis leadership swept across academia partly because nursing academia was not prepared for the rapid transition to virtual instruction. The reopening of nursing programs, while pandemic restrictions were still required, caused unprecedented disruptions and stress for academic leaders. One-third of nursing faculty anticipate retirement within the next two years. With the present burnout and shortage of nursing academia leaders, there was a need to explore the lived experience of academic …

Cross-Cultural Adaptation And Validation Of The Emirati Version Instrument That Assesses Cognition Problems Among The Uae Population: The Subjective Scale To Investigate Cognition - Emirates (Sstic-E), A Cross-Sectional Study, Fadwa Elgid Babikir

Dissertations

This dissertation focused on exploring the subjective complaints of cognition problems among the United Arab Emirates (UAE) population using a validated and adapted Arabic Emirati language version of a subjective scale that assesses cognition problems, -The Subjective Scale to Investigate Cognition - Emirates (SSTIC-E). Cognitive complaints and lack of cognitive insights are not specific to schizophrenia. It could be related to depression, mild cognitive impairment, dementia, or Alzheimer's. Hence, scales in this field can be very useful to assess and collect data for populations at risk of developing cognitive decline. The study aims to translate, adapt, and validate the SSTICS …

The Effect Of Maternal Obesity On The Regulation Of Gene Expression And Cell Fate During Embryonic Cortical Neurogenesis, Thilina Thejinda Alawathugoda

Dissertations

Neurodevelopmental disorders have their roots in multifaceted origins that manifest during the earliest stages of embryonic growth, often linked to sophisticated gene regulation dynamics. A perturbed metabolic environment, specifically owing to maternal obesity, can lead to dyslipidemia, subsequently threatening the optimal development of the embryonic central nervous system. Growing evidence suggests that such metabolic irregularities during pregnancy can alter neurogenesis pathways, thus predisposing the developing fetus to neurodevelopmental disorders. One of the primary avenues through which these disruptions may occur is through alterations in histone modifications resulting from fluctuations in the expression of histone modifying enzymes or the availability of …

National Emergency Department Sample In Geriatric Subsequent Mild Traumatic Brain Injury Visits And Associations With Sex, Falls, Payor, And Discharge Outcomes, Carrie Ann Barrett

Dissertations

The purpose of this study was to explore the variables of sex (male, female), fall mechanism of injury, payor source, and emergency department (ED) discharge outcomes in patients aged >65 who presented with mild traumatic brain injury (mTBI) subsequent ED visits.

A secondary data analysis was performed to assess the relationship among the independent and dependent variables listed above. The independent variables were dichotomous for age (>65, < 65), sex (male, female), and fall mechanism of injury (yes, no), and categorical for payor source (Medicare, Medicaid, Private, Other). The ED discharge dependent variables were categorical [home; healthcare services (including skilled nursing facility, home care, and intermediary care)]. Logistic regression analyses were performed to evaluate specific variables that increase the probability of affecting ED discharge outcomes. The software, SPSS v. 28 was used in the statistical calculations. The study was approved by the Western Michigan University Human Subjects Internal Review Board.

An Analogue Study Of Expected Working Alliance And Hope With Victims Of Military Sexual Trauma Among Civilian And Military-Oriented Therapists, Alishia D. Salyer

Dissertations

Victims of military sexual trauma (MST) face unique challenges as they pursue mental health treatment and supportive care. Understanding what factors impact potential treatment outcomes is critical in aiding in their recovery (Castro et al., 2015; Kroviak, 2020). Although a substantial amount of research has been conducted to evaluate prevalence and client factors associated with treating victims of MST (Teit et al., 2015; Turchik & Wilson, 2010), little is known about therapists’ factors including therapists’ expectations working with such clients. The purpose of this study was to examine the relationships between therapist type (military-affiliated versus civilian), therapist gender, client gender, …

The Effect Of A Specialized Training Program On The Knowledge And Attitudes Of First Responders About People With Communication Disabilities, Mariesa Rang

Dissertations

Individuals with disabilities experience emergencies more often than those without disabilities, and individuals with complex communication needs (CCN) are even more likely to have these experiences. As a result of experiencing both medical and legal emergencies, individuals with CCN have frequent encounters with emergency first responders (i.e., firefighters, EMS, and police officers; EFR). Despite being well-trained in many facets of their occupation, EFRs are not adequately trained for working with this vulnerable population. This may lead to less-than-optimal outcomes for individuals with CCN.

To better equip EFRs in their efforts to assist individuals with CCN, a 90-minute training session was …

Chronic Stressors, Obesity Pathogenesis, And The Moderating Effect Of Internalized Weight Stigma; A Quantitative, Illinois Study, Karyn Byrne

Dissertations

The obesity epidemic is a ‘wicked’ problem with a complex web of determinants and outcomes. While generally higher for minoritized populations, prevalence rates manifest in surprising, nonlinear patterns. There is no consensus regarding treatment protocols or mitigation efforts, except that current efforts remain largely ineffective. Much research evidence that a profusion of determinants of health support obesity pathogenesis through various physiological processes and mechanisms, including the allostatic load, mitochondria functioning, the gut microbiome, and epigenetics. Intervening to support markers of the allostatic load (immunity, inflammation, and metabolic health) may provide a more effective treatment outcomes than traditional approaches, which tend …

The Effects Of Mindfulness And Exercise On Symptoms Of Parkinson’S Disease: A Systematic Review, Collin Tyler Garner

Dissertations

Parkinson’s Disease (PD) is the second most common neurodegenerative disease affecting which affects motor control, emotional regulation, cognition, and sleep through degradation of dopaminergic neurons. As of 2019, PD affects approximately 8.5 million individuals worldwide, with prevalence estimated to increase to between 8.7 and 9.3 million by 2030. The primary therapeutic approach to PD management is pharmaceutical, relying on dopamine replacement therapy. However, recent research has identified promising complementary therapies such as exercise and mindfulness training.

This review was conducted to compile and present evidence related to the efficacy of exercise, mindfulness, and combined exercise and mindfulness protocols as complementary …

Binding Interactions Of Biologically Relevant Molecules Studied Using Surface-Modified And Nanostructured Surfaces, Palak Sondhi

Dissertations

This research focuses on the field of surface nanobioscience, wherein different nanosurfaces that will be used as working electrodes in the electrochemical cell are manufactured and surface modified to understand the critical binding interactions between biologically significant molecules like proteins, carbohydrates, small drug molecules, and glycoproteins. This research is essential if we are to determine whether a synthetic molecule can serve as a therapeutic candidate or diagnose a disease in its early stages. In order to fully understand the binding interactions, the study begins with defining some of the fundamental concepts, principles, and analytical tools for biosensing.

Afterwards, we addressed …

Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

Problem: Loneliness related to social isolation among the older adult population has become an increasing health concern with few interventions available for the general population. Loneliness has been directly associated with depression, poorer physical health outcomes, and overall quality of life.

Methods: The purpose of this study is to evaluate loneliness in the older adult population residing in a senior living community in an urban area in Missouri. Weekly one-on-one socialization, ranging from 45-60 minutes, will be implemented over 6 weeks, with pre and post-intervention screening for loneliness with the 28-item Visit-A-Bit (VAB) screening tool. Approval was received by both …

Risk And Protective Factors To Well-Being In Foster Care Youth Prescribed Psychotropic Medication In A Wraparound Program Of Care, Ann Reali Stratton

Dissertations

Background: Youth in foster care are prescribed psychotropic medications at higher rates and are more likely to experience disruptions to their medical care. Wraparound models of care have been shown to improve outcomes for youths on psychotropic medications, however, these methods have proved difficult to replicate in the foster care population. Government policies have called for better oversight in the foster care population and in response programs have been implemented, however, there remains little research for these programs. Objective: This research will evaluate the characteristics of foster care youth as they enter a Wraparound model of care and the predictive …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Effects Of Adropin On Metabolic Parameters, Oxidative Stress, And Cell Proliferation In Animal Model Of Diabetes Mellitus, Ifrah Ismail Ali

Dissertations

Diabetes Mellitus (DM) is a major health condition that has reached alarming levels, affecting around 537 million of the global adult population. DM is a group of metabolic diseases characterized by hyperglycemia with disturbance in carbohydrate, fat, and protein metabolism. The proposed therapeutic options for DM are different according to their mechanism of action, and peptide therapy is one of these options. Adropin, a peptide hormone involved in energy homeostasis, has shown promising results in the treatment of diabetes by lowering fasting blood glucose, reducing insulin resistance, and minimizing fat storage. Moreover, it has been demonstrated that adropin is engaged …

Newer Insights Into Mmtv Replication: The Human Retroviral Proteins Hiv-1 Tat And Htlv-1 Tax Can Transactivate The Mmtv Novel 5’ Element, Thanumol Abdul Khader

Dissertations

The mouse mammary tumor virus (MMTV) is a prototypic betaretrovirus that causes breast cancer in mice. MMTV regulates its gene expression both at the transcriptional and post transcriptional levels. It has hormonally-regulated promoters controlled by negative regulatory factors in a tissue-specific manner. Recently, we identified a novel 24-nucleotide region at the 5' end of the MMTV genome crucial for MMTV gene expression. Its deletion resulted in disruption of MMTV transcript elongation and stability, leading to a complete loss of Gag gene expression. This conserved element is present within the bifurcated stem loop 4, responsible for gRNA dimerization and encapsidation, into …

Quad Bike Injuries In The United Arab Emirates: Evidence For Injury Prevention Strategies, Preetha Menon Karuveetil

Dissertations

Quad bikes, also known as All-Terrain Vehicles (ATVs), are versatile vehicles designed for navigating uneven terrain. Originally intended for agricultural purposes, they have gained popularity for recreational use, particularly in the middle east, notably the United Arab Emirates (UAE). While these vehicles offer health benefits, they are associated with substantial safety risks, resulting in injuries ranging from lacerations to severe traumatic injuries, imposing a significant economic burden on healthcare systems.

This research addresses a critical gap in the existing literature by focusing on quad bike injuries in the unique context of the UAE, taking into account its desert environment, rider …

Mixed-Method Study Of Relationship Satisfaction Among African American Males With Or Without History Of Childhood Sexual Abuse, Sandra Webster Brown

Dissertations

Relationship satisfaction among African American males is an important and feasible topic and underrepresented among scholarly literature. The purpose of this study was to explore relationship satisfaction and experiences among African American males who may be impacted by history of childhood sexual abuse. The study was guided by the theoretical frameworks of family systems theory. Using a concurrent mixed-methods triangulation design, the researcher collected data quantitatively and qualitatively from an online survey. Data were collected from 43 African American males recruited from Black organizations in the United States. The qualitative data collected by written narratives from the men were used …

The Influence Of Attachment Styles And Mental Health Symptoms On Marital Satisfaction Among Deployed Us Army Soldiers, Leo Mora

Dissertations

Since 2002, changes in the frequency, duration, and nature of military campaigns overseas have piqued efforts to understand the effects of deployment on the mental health of DoD service members, especially married Army soldiers. However, few studies have examined the influence of attachment styles on the emotional health of combat veterans and the wartime impact they have also imparted to their spouses. Thus, in the context of military deployments, this study examines how secure/insecure attachment styles, posttraumatic stress (PTS), and depressive symptoms significantly influence married soldiers and their perceptions of marital satisfaction. In addition, this study also examines pre-existent, internalized, …

The Caregiver Of The Child With Cerebral Palsy: The Unnoticed Victim, Taylor Tusinski

Dissertations

The purpose of this study was to better understand the overall quality of life (QoL) in the primary caregiver who provides care to the child or adolescent, aged 0-17 with mild, moderate, or severe Cerebral Palsy (CP). This study aligned with a nonexperimental or observational design and examined the severity level of CP and the QoL in the mother and/or father.

For research question 1, regression results indicated that the overall model did not significantly predict the mother’s and father’s QoL [R² = .000, R² _adj = -.012, F(1,80) = .003, p = .957]. Regression results indicated that …

The Effects Of Mindfulness On Depression In Dialysis Patients, Nakeia Saddler

Dissertations

Abstract

Problem: Depression is a prevailing global health issue and a typical complication of dialysis patients. This quality improvement project's purpose was to evaluate mindfulness on depression in dialysis patients, aged 18-93, who are on dialysis and participated in a mindfulness program over three months.

Methods: A descriptive, prospective, and retrospective design was used to assess depression pre- and post-implementation of a mindfulness telephone line over three months. A convenience sample of twenty adults aged 18-83 who use this hemodialysis center on Monday, Wednesday, and Friday was utilized. The Iowa Model is the framework selected to guide the implementation of …

Using Natural Language Processing To Evaluate Electronic Health Records Of Patients With Ovarian Cancer For Documentation Of Goals Of Care, Hillarie Elizabeth Joehl

Dissertations

Growing evidence supports the benefits of serious illness communication including goals of care (GOC) discussions and documentation in the electronic health record (EHR). Patients who discuss end-of-life (EOL) care with their clinicians are more likely to have positive outcomes including better-reported quality of life, less distress, and a higher likelihood of receiving care consistent with their preferences. Limited research suggests only a small fraction of ovarian cancer patients have such discussions with their clinicians. Using a novel natural language processing (NLP) methodology, this retrospective and descriptive study explores EHRs for patients with ovarian cancer to characterize documentation of GOC. Using …

Identifying Factors Affecting Saudi Nurses’ Intentions To Report Medication Errors In Arar Hospitals, Ohoud Aldughmi

Dissertations

Background: Medication errors are the most common safety issues in Saudi Arabia. To avoid medication errors, Saudi hospitals need to identify the causes of errors by encouraging reporting errors. Most Saudi nurses do not report errors because of the blaming culture. Therefore, Saudi nurses need a psychological safe environment that encourages nurses to admit and report errors. Even if establishing a good error reporting system is helpful, Saudi health organizations need to discover nurses' perceptions, attitudes, norms, behaviors, and intentions regarding medication error reporting. Purpose: The purpose of this study was to identify the factors affecting the intention of Saudi …

Cancer Survivor Empowerment Through Patient-Reported Outcomes, Mary Patricia Johnston

Dissertations

Background: Conventional approaches for assessing and managing symptoms in cancer survivors are unlikely to be effective in cancer survivorship care because clinician-driven assessment limits the voice of the cancer survivor while the burden and complexity of cancer care increases. Yet, cancer survivors are not prepared for the shift from clinician-driven assessment and management of symptoms to cancer survivor self-report of symptoms and self-management of their own care. There are gaps in clinician assessment, and no studies describe how patient empowerment may facilitate the cancer survivor’s ability to assume the responsibilities of monitoring, reporting, and managing symptoms as the cancer survivor …