Lung Resident Memory B Cells Maintain Allergic Ige Responses In The Respiratory Tract, Alexander James Nelson

Dissertations

Immunoglobulin E (IgE) is the primary cause of allergic asthma. Allergen-specific IgE can be detected in the airway of allergic asthma patients even in the absence of circulating IgE, suggesting that IgE can be synthesized locally in the respiratory tract. However, the source of IgE-producing B cells, as well as how IgE responses arise and persist at mucosal sites are not fully understood. To address these questions, we modeled allergic asthma in mice by repeated intranasal administration of ragweed pollen and ovalbumin (OVA). We found that allergen exposure induced the production of local IgE in the airway and formation of …

Identification Of A Potential Pr50gag Binding Site Critical For Selective Encapsidation Of Feline Immunodeficiency Virus (Fiv) Genomic Rna, Anjana Krishnan

Dissertations

Feline immunodeficiency virus (FIV) is an important lentivirus that causes acquired immunodeficiency syndrome (AIDS) in cats, making FIV a potential small animal model for studying the pathogenesis of human AIDS. Furthermore, due to its phylogenetic distance from primate retroviruses like human immunodeficiency virus (HIV) and its ability to infect non-dividing cells, FIV is also being exploited for the development of vectors for human gene therapy. Therefore, it is of paramount importance that pertinent steps in the life cycle of FIV, such as genomic RNA (gRNA) packaging, are delineated at the molecular level. The process of retroviral gRNA packaging relies on …

Impact Of Physical Inactivity On Glucose Metabolism And Skeletal Muscle Secretions In Healthy Trained Rats And Potential Counteracting Effect Of Exercise And Protocatechuic Acid, Hira Shakoor

Dissertations

Modern societies have significantly transformed people's lifestyles, leading to a substantial increase in physical inactivity, which concerns 23% of adults and 81% of adolescents worldwide. Physical inactivity is a major factor contributing to the emergence of chronic diseases, most prominently Type 2 Diabetes (T2D), which exhibits a high prevalence in many countries. T2D is characterized by elevated blood glucose levels due to cells’ responsiveness to insulin. The shift towards inactivity likely occurred more rapidly than the genome's capacity to adapt, resulting in the metabolic dysfunctions underlying the development of T2D. Skeletal muscle is crucial in the onset of these metabolic …

Apoe Risk Disclosure: A Review Of Positive And Negative Outcome, Stacey Rowcliffe

Dissertations

Two of this century’s most significant healthcare challenges are Alzheimer’s disease and mild cognitive impairment, with 40 million people suffering from the diseases. In fact, a conservative estimate projects that both conditions will double every 20 years until 2050. Alzheimer’s disease involves memory impairment, disorientation, confusion, and various problematic behaviors. Presently, no prevention method or cure has been discovered for Alzheimer’s. Mild cognitive impairment typically includes problems with memory, language, thinking, and judgment beyond those typical of one’s age. Usually, these symptoms do not interfere with daily activities but do not improve and have been linked with a risk of …

Predictors Of Chronic Traumatic Encephalopathy In Nfl Players: A Meta Analysis Review, Eisha Vora

Dissertations

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that emerges as a result of repetitive mild traumatic brain injury and has been studied within athletes of all sports. Repetitive blows to the brain are associated with many pathological changes and an emergence of tau pathology, all of which can lead to presentation with cognitive dysfunction, behavioral changes, and further motor decline in the later stages. After passing the inclusion criteria, a meta-analysis comprising four articles was computed using Comprehensive Meta-Analysis Version 3. Two hypotheses were examined: (a) the earlier the age of exposure to football, the greater the likelihood …

Computational And Experimental Investigation Of Elemental Sulfur And Polysulfide, Jyoti Sharma

Dissertations

Petroleum processing results in the generation of significant quantities of elemental sulfur (S₈), leading to a surplus of sulfur worldwide. Despite its abundance and low cost, the use of sulfur in value-added organic compound synthesis is limited due to its unpredictable and misunderstood reactivity. This dissertation aims to address this issue by tackling it from two angles. Firstly, by utilizing Density Functional Theory (DFT) calculations, the reactivity of sulfur in the presence of nucleophiles is studied. This facilitates the identification of organic polysulfide intermediates that can be generated under different conditions, as well as the corresponding reactivity for …

Role Of Ripk3 In The Pathogenesis Of Tet2 Mutant Hematopoietic Malignancies, Kanak Joshi

Dissertations

Hematopoiesis is dynamically controlled by an epigenetic landscape that regulates gene transcription. Ten-eleven translocation 2 (TET2) is a Fe2+ and α-ketoglutarate (α-KG)-dependent dioxygenase that regulates the transcriptional status of genes associated with hematopoietic stem cell self-renewal and multiple stages of lineage commitment and differentiation. TET2 mutations are commonly detected in almost all types of hematopoietic malignancies, including myeloproliferative disorder, acute myeloid leukemia, and peripheral T-cell lymphomas. In most cases, TET2 is a founder mutation that occurred in hematopoietic stem/progenitor cells (HSPCs). The mutant HSCs undergo clonal expansion and evolution with the accumulation of additional mutations for malignant transformation. Microbial-stimulated inflammatory …

Atrial Fibrillation Management In Hispanic Adults, Tania Borja

Dissertations

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. …

The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

Effects Of A Self-Forgiveness Intervention On Recovery From Substance Use Disorders, Michael Saltzman

Dissertations

Previous research has highlighted the relationship between shame, guilt, and problematic substance use (Gueta, 2013; Luoma et al., 2019; McGaffin et al., 2013; Rahim & Patton, 2015). Self-forgiveness has been associated with positive outcomes for individuals in recovery with substance use disorders (SUDs), though only one prior study has explored the effects of a selfforgiveness intervention for individuals in treatment (Scherer et al., 2011). This study examines the effects of a self-forgiveness intervention on state shame and guilt, state self-forgiveness, and drug avoidance self-efficacy, and it is the first intervention study to focus on self-forgiveness for individuals with SUDs receiving …

The Correlational And Predictive Ability Of Pre-Season Risk Screenings On Hip And Groin Problems In Competitive Male Ice Hockey Players, William Suits

Dissertations

Background

Symptoms and disability due to conditions affecting the hip and groin are common in competitive male ice hockey players and can lead to long-term adverse health consequences. It is common practice for injury risk screenings at the beginning of the competitive season (preseason) to identify those with hip and groin symptoms and disability and guide primary and secondary prevention strategies. Commonly cited risk factors include total hip rotation range of motion (ROM), hip adductor strength, and the ratio of hip adductor to abductor strength. However, there is conflicting research regarding the utility of these preseason risk screenings, and the …

A Review Of The Role Of Anxiety In Diagnosis Of Children And Adolescents With Autism Spectrum Disorder: A Paradigm Shift In Conceptualization And Diagnosis, Evan Wahlquist

Dissertations

Early evidence of co-occurring anxiety symptoms in children and adolescents with autism spectrum disorder (ASD) dates back to the first descriptions of ASD by Leo Kanner (1943) and Hans Asperger (Frith & Mira, 1992). While current research has identified anxiety disorders as one of the most prevalent co-occurring disorders in children and adolescents with ASD, little is known about the nature of the relationship between these disorders. In an effort to explain these high prevalence rates, recent research has started to investigate the relationship between these two disorders. To join these efforts, this clinical research project explored the role of …

Cancer-Related Cognitive Impairment: Examining The Perspectives Of Survivors And Speech-Language Pathologists, Patricia Lynn Geels

Dissertations

Scientific advancements have led to significant improvements in cancer treatment and increased survival rates. However, cancer survivors often experience long-term effects, including cognitive impairments known as cancer-related cognitive impairment (CRCI). CRCI is a common and distressing side effect that affects affected individuals’ quality of life. The discipline of speech-language pathology (SLP) is well-positioned to assess and treat CRCI. Still, there is a gap in determining the most effective support for cancer survivors with CRCI. This mixed methods, three-paper dissertation implements exploratory, cross-sectional survey design to examine how speech-language pathologists and survivors view CRCI symptoms, its impact on daily functioning, and …

What Covid-19 Tweets Reveal About Risk Perception And Safety Preventative Measures And Behaviors Two Years Into A Pandemic, Elizabeth Vargas

Dissertations

The purpose of this study was to examine individuals Covid-19 risk perceptions two years into a long running pandemic. Data was collected analyzing risk perception and safety preventative measures to understand how individuals communicated risk in a health crisis that lasts more than two years. 116,401 tweets were collected from March 7-18, 2022, and analyzed utilizing a qualitative content analysis design. Four main classes were identified from the data which looked at how individuals perceived risk, how individuals determined risk from information that was shared, what preventative measures individuals were utilizing, and how individuals were living after the SARS-CoV-2 pandemic …

Allied Health Faculty Members’ Perspective On Interprofessional Collaborative Practice: A Hermeneutic Phenomenological Study, Prajakta Khare-Ranade, Margaret Newsham Beckley, Mary Geders Falcetti

Dissertations

A framework for interprofessional collaborative practice (IPCP) was developed by the World Health Organization (WHO) (WHO, 2010) in response to the need to address the complicated conditions that exist in today’s health systems. Much of the focus of today’s health service delivery is predicated on the social determinants of health (Barzansky et al., 2019), which refer to the environmental conditions associated with where people are born, live, go to school, work, play, age, and worship that have an impact on health, function, quality of life, and risks (Healthy People 2030, n.d.). IPCP is thought to be the only approach effective …

Daily Sbar Sheet For Pediatric Patients With Central Lines, Jordan M. Enzwiler

Dissertations

Problem: The patient’s daily central line Theraworx baths were not being documented and completed at a mid-Missouri teaching hospital. After completing a retrospective chart review for 2022, 8.35% (n=90) of daily central line Theraworx baths were documented. Daily central line baths decrease central line-associated bloodstream infections (CLABSI), prolonged hospital stays, and costs.

Methods: The quality improvement (QI) project utilized a pilot retrospective and prospective pre-post-design. A retrospective chart review on daily central line Theraworx baths was conducted on patients two years and older within the pediatric service line who had a central line. A situation, background, assessment, and recommendation (SBAR) …

Vaccine Hesitancy, Provider Time, And Decision To Vaccinate, Kenneth Shackelford

Dissertations

Problem: To date, there is a significant gap in the literature involving studies evaluating the time healthcare providers spend educating vaccine-hesitant caregivers about the necessity for their child’s immunizations. Due to alarming resurgence rates of vaccine-preventable diseases in children, this project aimed to answer the following question: In vaccine-hesitant caregivers of newborns through six months of age, what is the effect of provider discussion time on vaccine administration (item) at well-child visits during the child’s first six months of life?

Methods: Using a descriptive observation design, pre-collected data on provider discussion time and vaccine administration was evaluated retrospectively from …

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

Evaluation Of Dirfloortime® On Mother’S Depression, Anxiety, And Stress, Hailey Vanderleest

Dissertations

This paper reports the results of a retrospective record review and qualitative questionnaires of mothers of children with neurocognitive disorders such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The aim was to examine the relationship between DIRFloortime® use in children with ASD and ADHD and PHQ-8 scores for depression, GAD-7 scores for anxiety, and PSS-10 scores for perceived stress among the children’s mothers. The results showed no statistical significance between DIRFloortime® use in children and PHQ-8, GAD-7, and PSS-10 scores for mothers. Qualitative questionnaires did report improvements in quality of life. Implications for the need of evidence-based developmental …

Intimate Partner Violence Screening In The Emergency Department, Rebecca Stuerman

Dissertations

Problem: Intimate partner violence [IPV] is a public health concern that affects one in three women worldwide. IPV can be addressed through identification and early intervention with minimal risk to the patient. The emergency department is an important setting for screening given the frequency with which people who experience abuse may present with IPV-related injuries and other related concerns (depression, suicidality, etc.). Successfully implementing a validated tool for screening and providing early access to resources and referrals may help to mitigate the longterm negative impacts of IPV. The need for increased staff education was a major barrier to screening for …

Implementing Trauma-Informed Care Curriculum In A Doctoral Nursing Program, Mary D. Brown

Dissertations

Purpose: Trauma is highly prevalent with 70% of individuals encountering at least one traumatic event during their lifetime and approximately 30% experiencing four or more events (Wheeler & Phillips, 2021). Despite the dramatic impact of trauma, there is minimal literature to assist nurses in caring for patients with a trauma history. The purpose of this project was to evaluate the implementation of a virtual, asynchronous trauma-informed care (TIC) educational program for Doctor of Nursing Practice (DNP) students at a midsized, Midwestern public university using knowledge, attitudes, and competency scores as outcome measures.

Methods: This program evaluation (PE) project was an …

Evaluation Of Simulation On Medication Errors In The Pediatric Intensive Care Unit, Carrie Clark

Dissertations

Problem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.

Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).

Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Acute Agitation Intervention Tool For Reduction Of Polypharmacy, Brooks J. Propst

Dissertations

Introduction: Patients with behavioral health diagnoses are among the highest risk for
aggression. For pediatric patients with behavioral health needs, urgent treatment is
needed for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guide
pharmacological intervention for mild and moderate to severe agitation in pediatric
patients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.

Methods: This QI included …

Pediatric Streptococcal Pharyngitis Testing And Treatment Practices, Amanda Welch

Dissertations

Objective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.

Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Implementation Of An Educational Teach-Back Program For Patients With Hypertension, Lakesha Hill

Dissertations

Implementation of an Educational Teach-back Program for Patients with Hypertension

Abstract

Problem: To improve health literacy and provide adequate health care to patients and their family, clear and effective dialogue is essential. The teach-back method is a technique utilized to confirm a patient’s level of understanding of care instructions done by relaying patient directions, and then confirming the patient understands by asking the patient to reiterate those directions. The purpose of this quality improvement project was to assess the effectiveness of using the teach-back method by health care professionals with their patients who have a diagnosis of hypertension or high …

Implementation Of A Situation, Background, Assessment, Recommendation (Sbar) Patient Handoff Tool In The Electronic Medical Record (Emr), Kristen L. Chandler

Dissertations

Abstract

Purpose and Problem: Handoffs that are poorly conducted are implicated in 80% of preventable adverse events in healthcare facilities. Within a Pediatric Rehabilitation Facility in Maryland Heights, Missouri it was observed that nurse handoffs were not conducted and lacked the use of a standardized evidence-based tool, resulting in nurse dissatisfaction with the handoff process and miscommunication. Recognized by the World Health Organization, The Joint Commission, and Agency for Healthcare Research and Quality, the Situation, Background, Assessment, Recommendation (SBAR) evidence-based tool is effective in improving handoff communication, improving nurse satisfaction, reducing adverse events, and promoting patient safety. The purpose of …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Improving Postpartum Depression Screening Practices In The Postpartum Setting, Courtney Lynn Cole

Dissertations

Abstract

Problem: Postpartum Depression (PPD) is frequently undetected in women due to barriers that limit effective recognition and diagnosis. Depression screenings and treatment referrals improve outcomes in the immediate postpartum period. Follow-up methods for positive depression screens are often missed by postpartum care teams.

Methods: A descriptive, observational design was used for this quality improvement project. A formalized depression screening protocol was created to help guide nursing staff on a Postpartum Unit when detecting a positive depression screen. Convenience sampling was utilized and the sample included patients aged 18-45. Data collected throughout this quality improvement project included Edinburgh Postnatal Depression …