Medicine and Health Sciences Commons^™

Perceptions And Experiences Of Adopting A Technology Based Intervention For Alcohol Screening And Referral To Treatment In Primary Care, Sonya L. Lachance

Doctoral Dissertations

Alcohol abuse is a significant concern in the United States. Today in the U.S., 15.1 million adults ages 18 and older, have been identified as having an alcohol use disorder. Alcohol abuse and binge drinking are highest amongst college students. More than 58.0 percent of college students admit to regular binge drinking or heavy alcohol use every month. Left unaddressed, this leads to negative health consequences later in life. The United States Preventive Services Task Force states that there is strong evidence that screening patients in primary care can reduce alcohol use disorder. Though screening, brief intervention, and referral to …

Older Women’S Experiences Of Intimate Partner Violence: A Phenomenological Study, Lourdes Irene

Doctoral Dissertations

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. Despite the growing number of women over age 60 in Puerto Rico, knowledge is lacking about culturally specific IPV in women of this age group. This lack of knowledge is problematic because women experiencing abuse often do not report it, health professionals are not educated to identify cases of abuse in older women, and researchers often includes IPV with other types of abuse, such as negligence by families. Therefore, the purpose of this study was to explore and describe the experiences and …

A Co-Parent Intervention To Reduce Prenatal Depression In Low-Income Couples: A Pilot Study, Rachel J. Herman

Doctoral Dissertations

Significant health disparities in the U.S. place low-income and racial and ethnic minority families at greater risk for parental depression, stress and poorer outcomes for children. The goal of this quasi-experimental pilot study was to assess the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing stress and depression in a sample of low-income expectant parents early in pregnancy. Twenty-four couples (48 participants) were assigned to the 6-week PREParing for Parenthood (PREP) intervention and 22 couples (46 participants) were assigned to a treatment-as-usual comparison group. The group intervention consisted of six sessions during pregnancy and was taught by …

An Eye Tracking Investigation Of The Pragmatic Language Comprehension Abilities Of Children With Autism, Kristina Curro

Doctoral Dissertations

Autism is a disorder of the comprehension and use of pragmatic language. Children with autism often display heterogeneous patterns of language ability even when language is considered a strength. This real-time analysis is a partial replication of Sedivy et al. (1999) who found evidence for incremental processing of pragmatic language in real-time with adults. This investigation focused on prosodic focus and scalar adjective comprehension in children with and without autism. Results show that children with autism successfully interpret prosodic focus when interpreting intersective adjectives but show processing delays in interpreting scalar adjectives. Implications for pragmatic language processing differences between children …

Prevalence Of Rats And Rodent Borne Pathogens Across Post-Katrina New Orleans, Bruno Marco Ghersi

Doctoral Dissertations

Disasters are happening at an increasingly higher rate and intensity a trend that is expected to continue as more humans migrate to coastal urban areas. Disasters, and as importantly, disaster recovery can affect how native and pest populations will recover. My aim was to improve understanding of disease risk by evaluating the socioecological conditions that have shaped commensal rat recovery and distribution, as well as the pathogens they carry, across New Orleans after Hurricane Katrina. I first estimated relative abundance and distribution of commensal rats from rodent trapping conducted between mid-2014 and early-2017 across 96 sites in 10 areas of …

A Review Of Horticultural Therapy And Horticultural Therapy Education In The United States: Addressing Challenges And Opportunities, Derrick R. Stowell

Doctoral Dissertations

The Horticultural Therapy (HT) profession has been formally organized in the United States since 1973. Despite the long history of horticulture being used as therapy, the profession of HT in the United States has not advanced as quickly as other allied healthcare professions. This study will review the current challenges and opportunities for HT and HT education in the United States.

A qualitative study of the status of the profession was conducted to determine what challenges and opportunities the profession of HT currently has and how the profession can meet those challenges and opportunities. The study sample was recruited from …

Emerging Zoonotic Pathogens At The Human-Wildlife Interface In Protected Areas: Game In The Southeastern United States And Bushmeat In Northern Uganda, Breeanna M. Dell

Doctoral Dissertations

The emergence of zoonotic pathogens through contact with animal reservoirs is a well-documented phenomenon and growing concern for public health. Particularly in light of the ongoing Ebola epidemic in the Democratic Republic of the Congo and the coronavirus pandemic, the need to understand mechanisms of contact and disease transmission at the human-wildlife interface and to understand which infectious agents may reside within wildlife reservoirs crucial. In this project, we investigated the potential introduction of zoonotic cestode Echinococcus canadensis to public lands in Tennessee subsequent to elk translocation effort and aimed to identify whether a transmission cycle was established in this …

Fall Risk Factors Among Hospitalized Older Adults With Alzheimer’S Disease And Related Dementias, Jean Bettencourtt Sconza

Doctoral Dissertations

Falls are a common and devastating complication of hospital admission for older adults. Falls are especially significant for those with Alzheimer’s Disease and related dementias (ADRD) as they are at high risk to fall and to suffer injuries from falling. Despite the large body of research on falls in hospitals, less is known about fall risk factors among patients with ADRD. The purpose of this retrospective case-control study was to determine which risk factors are predictors of falls among hospitalized older adults with Alzheimer’s disease and related dementias (ADRD) by comparing those who fell with those who did not fall. …

The Lived Resettlement Experience For Single Refugee Mothers From The Democratic Republic Of Congo, Lauren Michelle Mefford

Doctoral Dissertations

At least 72% of the 50,000 Congolese refugees resettled in the USA in the last 5 years are women and children. Many are single refugee mothers (SRM) disadvantaged by obstacles (i.e., childcare) that hinder them from becoming self-sufficient within the required timeframe post-resettlement. Published research on resettlement has focused general challenges, but an understanding of the unique needs and perspectives of SRMs is lacking. This phenomenological, qualitative study provides insight into the lived resettlement experience for SRMs from the Democratic of Congo (DRC). Participants (n=7) were recruited from a refugee resettlement agency in East Tennessee and partook in open-ended, unstructured …

Exploring The Geography Of Neighborhood Mental Health Vulnerability In The Context Of Racial/Ethnic Residential Segregation, Donghee Koh

Doctoral Dissertations

Mental health matters because it affects all aspects of our lives. There is a growing body of literature about neighborhood effects on mental health. These studies argue that individuals living in socioeconomically disadvantaged neighborhoods are more likely to suffer from mental illnesses due to the higher prevalence of chronic stressors and their inability to cope with such problems. A neighborhood, however, is much more than just the sum of its socioeconomic characteristics, and I argue that there are many other important contextual factors that need to be considered to better understand the impact of neighborhood environment on mental health. Hence, …

Examination And Validation Of The Fundamental Lower Extremity Mobile Testing System, And Identification Of Best Practice To Mount Synthetic Turf To A Force Platform, Sean Quisenberry

Doctoral Dissertations

Annually, over 4 million high school and college athletes participate in competitive sports played on turf surfaces. Since the introduction of synthetic turf in the 1970s, it has become a common alternative to natural grass playing surfaces. However, athletes playing on synthetic turf has been found to have an increased incidence of lower extremity injury compared to natural grass.

Mechanical surface testing has found that synthetic turf exhibits significantly higher rotational and translational tractions compared to natural grass. The cleat-turf interface is often examined using a force platform, an instrument commonly used in a biomechanical laboratory. Mobile surface testing instruments …

Examining The Physical Activity Levels Of Youth With Intellectual And Developmental Disabilities During Physical Education And Recess, Vincenzo Nocera

Doctoral Dissertations

Introduction: It is currently believed that children with intellectual and/or developmental disabilities (IDD) are less physically active than their peers. The school setting may offer a promising solution to allow children with and without IDD to engage in physical activity (PA). However, the current school-based PA levels of this population remain unclear. Therefore, the purpose of this investigation was to compare the PA levels and related context of youth with and without IDD during the total school day, physical education, and recess. Methods: A total of 13 children (n = 3 with IDD) enrolled in first- and second grade participated …

Adverse Childhood Experiences And Health Related Quality Of Life As Well As Cognitive Decline In Adult Population In Tennessee, Pragya Poudel

Doctoral Dissertations

Adverse childhood experiences (ACEs) have been linked to increased risk of negative health outcomes in later life. At least half of the population in Tennessee experience one ACE. Further, Tennessee ranks amongst the top five states in terms of cognitive decline in adult populations age 45 and above. To our knowledge, there is yet no study that has explored ACEs and adult health outcomes (health-related quality of life (HRQOL) and cognitive decline) in Tennessee.

The goal of this study was to examine the relationship between ACEs [by overall, individual, type/domain, and dose-response effect of ACE] and HRQOL as well as …

Clinical Work With Adult Male Incest Survivors: Therapeutic Themes And Perspectives, Kathryn B. Rosenberg

Doctoral Dissertations

For psychotherapists, encountering clients who have experienced sexual trauma or abuse is inevitable, whether or not the abuse is disclosed to the therapist; however, mental health professionals receive extremely limited (if any) training on how to identify or effectively support adult clients who are survivors of childhood sexual abuse (CSA). Many people who experienced CSA, especially those who identify as male, remain isolated and invisible in their suffering as adults even within therapeutic spaces, facing what feel like insurmountable barriers – both internal and external – to getting help. When sexual abuse is intrafamilial, these barriers are both amplified and …

Mediation And Moderation Of Sleep In Arthritis Fatigue, Jean L. Cody

Doctoral Dissertations

Fatigue is a highly prevalent symptom for older adults with arthritis. Fatigue is a concerning symptom as it is associated with decreased activity and exacerbates co-morbid conditions. Physical activity and sleep quality have been shown to influence arthritis fatigue. However, the relationship between physical activity and sleep quality over time has not been clearly identified. The purpose of this pilot study was to examine the relationship between physical activity, sleep and arthritis fatigue. This study examined the direct effects and the mediation and moderation of sleep upon fatigue. The study utilized an experimental, longitudinal repeated measures design using mediation and …

Core Content Items And Constructs To Inform Student Nurse Handoff Communication, Kelley Mcafee

Doctoral Dissertations

This study describes nurse educators’ perceptions of content items for a high-risk, high frequency process essential for entry as a nurse generalist into clinical practice. The process of interest is student nurse handoff communication. Research Questions:

1. What do nurse educators identify as core content for successful student nurse handoff communication?
2. Do nurse educators identify with one handoff communication tool for student use?
3. Are student nurses expected to engage in nurse handoff communication during simulation experiences and/or clinical experiences?
4. What educator characteristics are associated with his/her perceptions of the core content?

Geographical Disparity Of Adverse Childhood Experiences And Chronic Diseases In Saudi Arabia, Fahad Alhowaymel

Doctoral Dissertations

Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings. Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship. Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program …

Redox Signaling In The Zebrafish Embryo And Implications For Endocrine Pancreas Morphogenesis, Archit Rastogi

Doctoral Dissertations

The glutathione (GSH) system evolved to combat oxygen toxicity in nearly all living organisms, and serves as the predominant cellular redox buffer in vertebrates. This dissertation explores the roles of GSH during embryogenesis using the zebrafish (Danio rerio). The first agnostic in vivo characterization of GSH utilization in the embryo revealed strict spatiotemporal GSH profiles in developing organ systems. Interruption of these GSH profiles by exogenous xenobiotics led to organ specific adverse developmental outcomes; pancreatic β-cells were found to be especially susceptible and developed atypical morphologies following redox active xenobiotic exposures. Pancreatic β-cells lacked expression of Nrf2a (Nuclear …

Use Of Stay S.A.F.E. Strategy During Medication Administration In Reducing Errors, Cidalia J. Vital

Doctoral Dissertations

Healthcare related medical errors are the third leading cause of death in the United States. Interruptions and distractions can lead to an increased risk of nurses making errors in healthcare, particularly during medication administration. Student nurses should receive education during their prelicensure period on the management of interruptions especially before being given the responsibility of performing high risk tasks such as medication administration. Using a novel interruption management strategy called Stay S.A.F.E., nursing students were interrupted during a simulated medication administration. Students were evaluated on the time spent on the task and if errors were committed. Lastly, perceived workload was …

Structural Analysis Of Protein Therapeutics Using Covalent Labeling – Mass Spectrometry, Patanachai Limpikirati

Doctoral Dissertations

Using mass spectrometry (MS) to obtain information about a higher order structure of protein requires that a protein’s structural properties are encoded into the mass of that protein. Covalent labeling (CL) with reagents that can irreversibly modify solvent accessible amino acid side chains is an effective way to encode structural information into the mass of a protein, as this information can be read-out in a straightforward manner using standard MS-based proteomics techniques. The differential reactivity of proteins under two or more conditions can be used to distinguish protein topologies, conformations, and/or binding sites. CL-MS methods have been effectively used for …

Rare Diseases In The United States: Establishing Prevalence, The Insurance Experience, And Orphan Drug Expenditures In Medicare Part D, Tai Pasquini

Doctoral Dissertations

In the United States, there are an estimated 30 million people living with one or more rare diseases. Each rare disease impacts fewer than 200,000 people. Small patient populations create research and medical challenges. Patients and the healthcare system experience high costs. To adequately address patient needs and prepare our healthcare system, it is critical that we conduct research that contextualizes the U.S. rare disease experience. This dissertation includes three related studies that look at the U.S. rare disease experience. The first paper investigates the availability and data quality of rare disease prevalence estimates and the healthcare infrastructure that could …

Identity Development In Transgender Women Of Color: An Interpretative Phenomenological Analysis, Angel Tseng

Doctoral Dissertations

Transgender women of color have been at the forefront of LGBT rights moments in the U.S. and has been credited for leading the Stonewall resistance (Roberts, 2018). Though much has changed since Stonewall, transgender women of color still face harassment, discrimination, and many other barriers and health risks today. One of the many challenges faced by transgender women of color is identity conflict. The purpose of the study was to examine the identity development processes of transgender women of color. This qualitative research study utilized Interpretative Phenomenological Analysis to explore the lived experiences and narratives of individuals from this community …

Acoustic And Perceptual Characteristics Of Prosody In Autism Spectrum Disorder: The Impact Of Language, Motor Speech, And Auditory Processing, Colleen Gargan

Doctoral Dissertations

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition that affects an individual’s social communication, social interaction, and behavior (American Psychological Association, 2013). A striking feature that distinguishes some individuals with autism from their peers without autism is “atypical” prosody. A between-group study was conducted to investigate prosody, speech motor control, auditory processing of pitch, and trained listener ratings of prosodic “naturalness” among adolescents with ASD (n=17) compared to TD controls (n=17) matched for age, gender and language. The specific aims of this study were to: (1) determine if individuals with ASD have significant acoustic-perceptual differences in their receptive and …

Engineered Nanoparticles For Site-Specific Bioorthogonal Catalysis: Imaging And Therapy, Riddha Das

Doctoral Dissertations

Bioorthogonal catalysis offers a strategy for chemical transformations complementary to bioprocesses and has proven to be a powerful tool in biochemistry and medical sciences. Transition metal catalysts (TMCs) have emerged as a powerful tool to execute selective chemical transformations, however, lack of biocompatibility and stability limits their use in biological applications. Incorporation of TMCs into nanoparticle monolayers provides a versatile strategy for the generation of bioorthogonal nanocatalysts known as “nanozymes”. We have fabricated a family of nanozymes using gold nanoparticles (AuNPs) as scaffolds featuring diverse chemical functional groups for controlled localization of nanozymes in biological environments, providing unique strategies for …

Extraction And Analysis Of Data For Fragility Fracture Patients To Help Determine The Likelihood Of Follow-Up With A West Michigan Fragility Fracture Service, Michael Joseph Lamphere

Doctoral Dissertations

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture …

Investigation On Nanoparticle Based Combination Therapy For Targeted Cancer Treatment, Muhammad Raisul Abedin

Doctoral Dissertations

“The current treatment methods in cancer are associated with toxicity in healthy tissues, partial therapeutic response, drug resistance and finally recurrence of the disease. The cancer drugs are challenged by non-specific binding, undesired toxicity in healthy cells, low therapeutic index and finally poor therapeutic outcome. In this work, a targeted nanoscale therapeutic system Antibody Drug Nanoparticle (ADN) was engineered to selectively inhibit the breast cancer cell growth with reduced toxicity in healthy cells. The ADNs were designed by synthesizing rod shaped anoparticles using pure chemotherapeutic drug and covalently conjugating a therapeutic monoclonal antibody (mAb) on the surface of the drug …