Medicine and Health Sciences Commons^™

The Ethics Of Involuntary Psychiatric Hospitalization: A Comprehensive Analysis Of Policies, Practice, And Ethical Oversight, Mariah Chobany

Electronic Theses and Dissertations

As a specialized field of medicine, psychiatry presents unique ethical challenges and dilemmas distinct from other medical disciplines. A particularly complex aspect of psychiatric care involves the involuntary treatment of patients who may be unable to make informed decisions about their care or participation in research due to the debilitating effects of their psychiatric condition. This presents a significant challenge for providers and researchers, particularly concerning capacity issues and the informed consent process. Despite the intricacies and complexities of ethical dilemmas in psychiatric treatment and research, there is a notable lack of comprehensive guidance in policies and practices on addressing …

From Policymaking To Legislation, The Need For A Secular Turn In Bioethics Discourse To Uphold, As A Function Of The Greater Good, Policy For Legislation Of Medically Aided Dying In The United States Of America, Scott Dyer

Electronic Theses and Dissertations

A person’s right to self-determination is a central aspect of living in a democratic nation. Similarly, decisions regarding medical care are generally left up to the patient to determine what treatment is or is not appropriate. The same should apply to end-of-life care as well, especially when a patient desires to hasten his or her death via medically aided dying. However, due to the illegality of medically assisted dying in most of the United States, the right to a self-determined death is not possible for the majority of American citizens. One of the main reasons for this is due to …

The Ethics Of Vulnerability In Health Care, Hannah Dieterle

Electronic Theses and Dissertations

This dissertation seeks to address vulnerability within clinical healthcare settings. Currently, clinical vulnerability is underrecognized and insufficiently researched which leads to the perpetuation of negative health outcomes for vulnerable populations. Specifically, there is a lack of a consistent and universal definition of vulnerability which has built a shaky foundation on which to discuss vulnerability. This dissertation begins to address these issues and increase awareness on clinical vulnerability due to some populations experiencing the devastating effects of vulnerability at a higher and disproportionate rate when compared to other populations. There is a clear need for increased attention from ethicists and medical …

Access To Health Care And Glycemic Control: The National Health And Nutrition Examinations Survey (Nhanes) 2005-2018., Mohamed M. Ali

Electronic Theses and Dissertations

Background and Purpose: Diabetes mellitus is a chronic metabolic condition associated with numerous medical and financial sequences. In 2018, 34.1 million adults aged 18 years or older had diabetes in the U.S. Access to Care for diabetic Americans remains a public healthcare concern. This study aims to examine the relationship between access to healthcare and selected diabetes indicators. Methods: A quantitative, repeated cross-sectional study uses four of the National Health and Nutrition Examinations Survey's (NHANES) access measures (insurance, the number of times of annual healthcare visits, routine place for healthcare, and type of place) and four diabetes indicators (Hemoglobin A1C …

Impact Of Human Immunoglobulin Genetic Variants On The Expressed Antibody Repertoire., Eric Engelbrecht

Electronic Theses and Dissertations

B cells produce immunoglobulins (IGs; antibodies), which are critical protein components of the immune system. Human IGs are composed of two pairs of identical ‘heavy’ chains and ‘light’ kappa or lambda chains, encoded by genes located at three loci in the genome: the IG heavy chain locus (IGH, chromosome 14), and the IG lambda (IGL, chromosome 22) and kappa (IGK, chromosome 2) loci. Each locus spans ~920-100 kilobase pairs (Kbp) of DNA and harbors families of gene segments that are somatically rearranged during B cell development. The IG loci collectively harbor >180 functional genes, many of which are part of …

Comparison Of The Effect Of Heavy Pulls Vs Light Powers On A Subsequent Clean In Trained Athletes, Luke Devirgiliis

Electronic Theses and Dissertations

The sport of weightlifting has been competed since the first modern Olympiad. Competition in weightlifting consists of 3 attempts the snatch and clean and jerk declared by the athlete and their coach prior to the starting of the lift. While waiting for the athlete’s lift, waiting periods can change and warm up attempts may need to be adjusted. Often, coaches prescribe either a complete “light power” or partial “heavy pull” repetition of the competed movement during a long wait. Previous literature indicates that a heavier stimulus may cause a “post-activation potentiation”, or “post-activation performance enhancement” effect on the subsequent lift. …

Self-Rated Interprofessionalism Between Allied Health Professionals, Courtney Andrews

Electronic Theses and Dissertations

Preventable deaths due to medical errors are a significant cause of death in the United States. Decreased communication and collaboration has been cited as a potential reason for these preventable medical errors. Interprofessional practice (IPP) is a service delivery method where medical professionals from different disciplines intentionally work together in order to provide collaborated and collective care for patients. Interprofessional education (IPE) training programs are becoming more common in healthcare education, and have been cited as one way to improve IPP among healthcare providers. However, gaps exist in the literature regarding how to best structure and implement these programs so …

Service Provider Perceptions Of Systems Serving Individuals Experiencing Homelessness: A Needs Assessment And Strategic Plan In Johnson City, Tn, Opal Frye-Clark

Electronic Theses and Dissertations

This Integrated Learning Experience (ILE) investigates service providers' perceptions of Johnson City, Tennessee's homelessness services, aiming to inform a city-wide strategic plan for reduction. Employing a mixed-methods approach, the study gathered qualitative data through in-depth interviews with service providers in 2022 and quantitative data via a 2024 survey. The research focused on those directly involved in serving or significantly influencing the lives of individuals experiencing homelessness (IEH). Three key aims guided the investigation: (1) To analyze provider perspectives to identify community assets, opportunities, barriers, and unmet needs, informing a comprehensive needs assessment; (2) To refine these findings through SWOT analysis …

Proteolytic Manipulation Of Neutrophil Responses And The Efferocytic Synapse By Porphyromonas Gingivalis., Kelley N. Cooper

Electronic Theses and Dissertations

Porphyromonas gingivalis (Pg) is etiologically associated with chronic periodontitis, a highly prevalent chronic inflammatory disease characterized by the destruction of hard and soft tissues of the periodontium. Pg is adapted to live in the human oral subgingival niche, a hostile environment dominated by excessive numbers of activated neutrophils and antimicrobial mediators. Its survival is contingent upon prompt and effective inactivation of neutrophil effector functions. In this dissertation, I uncover a novel pathogenic mechanism employed by Pg that disarms the antimicrobial capacity of live neutrophils and simultaneously sequesters them within macrophages. Mechanistically, RgpB, a cysteine protease produced by Pg …

Defining The Peripheral Plasticity Of Nociceptive Afferents Following Spinal Cord Injury And Physical Therapy Intervention., Morgan Julianna Forston

Electronic Theses and Dissertations

The focus of this dissertation is to explore the peripheral plasticity of nociceptive afferents following spinal cord injury (SCI) and whether it is exacerbated or induced when physical therapy-based muscle stretching, a therapy we have shown to be detrimental to locomotor recovery in rodents, is implemented post-SCI. Chapter I provides a brief introduction on sensory afferents with particular emphasis on nociceptive afferents and their multifaceted role within the peripheral and central nervous systems. Chapter II describes SCI epidemiology and common sensory related complications that occur in patients as well and pharmaco- and physical therapies that are employed post-SCI. Chapter III …

Patient, Provider, And Health System Characteristics Leading To The Delivery Of Low Value Health Care Services And Outcomes Of An Intervention For Mitigating Low Value Care., Philip Ray Rohrer

Electronic Theses and Dissertations

The United States spends more on health care than any other country, and Medicare accounted for nearly one-quarter of total personal health care spending in 2019. Waste within the health care system in the United States is estimated to represent approximately 25% of total U.S. health care expenditures. Low value care includes health care services that provide little or no benefit to patients, have potential to cause harm, incur unnecessary costs to patients, or waste limited healthcare resources. Low value care is estimated to represent roughly 10% of total health care waste, or between $75.7 billion and $101.2 billion dollars …

Understanding Carceral Pathways And Outcomes Of Marginalized Adults Who Use Drugs., Carmen Renee Mitchell

Electronic Theses and Dissertations

This dissertation is an examination of outcomes among substance users at various stages of the incarceration process divided among five chapters. Chapter One provides an overview of substance use disorder (SUD), incarceration, and wider justice system-involvement, and explores how the political economy of health theoretical framework can be applied to examine how the criminal justice system creates and perpetuates inequality among marginalized people who use substances. Chapter Two examines post-release health outcomes among the population of incarcerated people who use substances using a scoping review and finds that people in reentry with SUD have poorer overall outcomes that without transitional …

Plasma Resuscitation Attenuates Hemorrhage-Induced Glomerular Barrier Damage And Dysfunction., William Byron Risinger

Electronic Theses and Dissertations

Introduction: Acute renal dysfunction following traumatic injury and hemorrhagic shock carries significant morbidity and mortality. Despite an extensive understanding of renal tubule damage after injury, less is known regarding early alterations to the glomerular filtration barrier following hemorrhagic shock and resuscitation. Previously, our lab and others have demonstrated improved hepatic and intestinal microcirculatory parameters when resuscitation strategies incorporate fresh frozen plasma. In addition to improving end-organ perfusion, plasma reconstitutes the endothelial glycocalyx, an essential regulator of vascular permeability and microcirculatory function. However, the impact of plasma resuscitation on the glomerular glycocalyx and barrier following hemorrhage remains unknown. We hypothesized …

Implementation Of A Transition-Of-Care Model For Adult Ischemic Stroke Survivors, Megan Akacsos

Electronic Theses and Dissertations

The lasting physical and cognitive deficits associated with the complexities of newly acquired

disabilities resulting from an acute ischemic stroke (AIS) may lead to hospital readmissions. The

participating healthcare facility on the U.S. West Coast reported a hospital readmission rate for

AIS survivors of 24.29% within 30 days of discharge. This doctoral nursing project aimed to

determine if implementing the Comprehensive Post-Acute Stroke Services (COMPASS) model

would reduce 30-day readmission rates compared to no standardized transition-of-care model in

adult AIS survivors over 30 days. Implementing the COMPASS model in this patient population

was expected to better educate and support stroke …

Factors Impacting Ehr Implementation: A Case Study In Belize, Jessica Y. Resendiz

Electronic Theses and Dissertations

Electronic health record systems are a tool used throughout healthcare organizations to provide safe and efficient patient care. They are used to record and retrieve patient information related to health history, diagnostics, and treatment plans. Electronic health records have become increasingly integrated into healthcare practice and are demonstrative of safe and quality care. Healthcare organizations that do not have electronic health record systems in place jeopardize safe and efficient patient care. In addition, access and financial means to implement electronic health record systems in developing countries are challenging as resources are often restricted. This project aims to identify factors that …

General Sport Skills Performance Following The Combined Use Of Accentuated Eccentric Loading And Cluster Sets During A Strength-Endurance Training Phase, David Nelson

Electronic Theses and Dissertations

The purpose of this study aimed to evaluate the efficacy of resistance training with accentuated eccentric loading (AEL) and cluster sets (CS) versus traditional resistance training (TRAD) on general sports skills and power performance in recreationally trained individuals. Seventeen subjects (11 males, 6 females; mean age 23.2 ± 4.1 years; body mass 81.3 ± 22.2 kg; height 172.1 ± 10.0 cm; relative 1 RM back squat 1.5 ± 0.3) were randomly assigned to AEL (n = 9) or TRAD (n = 8) groups. After an initial familiarization and baseline testing, both groups underwent a four-week strength-endurance training regimen. The AEL …

Evaluating Trauma-Informed Design In A Mental Health Setting: A Community-Based Research Case Study, Marie Spence

Electronic Theses and Dissertations

This case study utilized a community-based research framework to explore how the Trauma-Informed Design framework can be implemented in a mental health setting. This study focused on the site of Empower Therapy Practice, a private mental health practice in the Denver Metro Area, to engage clients and staff to participate in advisory boards and inform the interior design of a new office space. To explore the application of Trauma-Informed Design, participants engaged in a variety of research activities, including an evaluative questionnaire, Photovoice, and focus group. Advisory board members identified various aspects of Trauma-Informed Design which meaningfully translate to therapeutic …

The Impact Of Cumulative And Acute Loading On Achilles Tendon Health, Performance, And Reported Pain In Collegiate Gymnasts, Julio Serrano Samayoa

Electronic Theses and Dissertations

Gymnasts are at a high risk of Achilles tendon (AT) injuries due to intense loads during takeoffs and landings. To better understand better the relationship between impact loading and its effects on tendon adaptation and athletic performance, this study uses Inertial Measurement Units (IMUs) to track AT loading across a collegiate gymnastics season. This data were compared against physiological and athletic performance metrics, obtained through force plates and ultrasound imaging, to explore how mechanical load influences reported pain and athletic performance. Results varied, with cumulative impacts being correlated with improved jump height (Spearman 0.362, Pearson 0.348), while peak power and …

Applications Of Computer Vision In Biomechanics And Orthopaedics, William Stewart Burton Ii

Electronic Theses and Dissertations

Machine learning has emerged as a key technology for enabling advanced computer vision systems. These systems now permeate many industries, and have enhanced traditional processes through autonomous interpretation of visual data. In the field of orthopaedics, the increasing prevalence of imaging highlights a need for similar tools. In many cases, however, direct translation of available frameworks fails to resolve the complex problems currently facing this field. Stringent performance requirements, complex visual environments, data scarcity, and implications for patient safety represent domain-specific factors which pose unique challenges to proven techniques. Novel approaches are needed to realize the full benefits of visual …

Impact Of Diabetes Self-Management Education On Hemoglobin A1c Levels In The Rural Patient Population, Barbara Adomakomensah Sarpong

Electronic Theses and Dissertations

The global prevalence of type 2 diabetes is one of the greatest health threats in society, especially in the rural population. Rural healthcare data analysis has proved a need for type 2 diabetes control education. Despite the existence of helpful diabetes control interventions, rural diabetes patients still struggle to maintain healthy behaviors, with about 60% of the patients recording hemoglobin A1c levels above 9. Many suffer severe conditions (e.g., stroke, kidney failure, and heart attacks) because of poor management of the condition. The project examined the impact of diabetes self-management education on hemoglobin A1c levels in the rural patient population. …

Implementing Bedside Shift Report In The Home Health Care Pediatric Setting, Ruth Elena Ramos-Ardila

Electronic Theses and Dissertations

Developing and maintaining good communication is central in nursing because the goal is to achieve the best outcomes for the patient. In the past, written handover reports have been the standard way nurses communicate with each other, especially in the hospital and in home-based practice. Despite this rationale, this approach has considerable weaknesses: its high risk of mistakes and misunderstanding could negatively influence patient outcomes. In light of these concerns, this project examines the role of bedside shift reports in pediatric home care and the patient readmission rate. This project employed a quantitative, cross-sectional research approach involving 32 pediatric home …

Transgender Education In School Nursing To Decrease Stigma And Promote Self-Efficacy, Brandy Shannon-Loyola

Electronic Theses and Dissertations

This Doctor of Nursing Practice project evaluated whether transgender education provided to school nurses and healthcare technicians decreased stigma and promoted self-efficacy. Concerns that transgender individuals have voiced were that they felt healthcare professionals could not effectively care for transgender patients, which may be due to personal or religious beliefs or lack of knowledge concerning the lesbian, gay, bisexual, transgender, and queer community. Participants included credentialed school nurses and healthcare technicians in secondary education settings. The method consisted of a presurvey, education in the form of a handout, followed by a postsurvey to determine if education was successful. The Wilcoxon …

Rural Cervical Cancer Survivors’ Experiences Of Gender Roles: An Application Of Social Constructionism, Olivia K. Pointer

Electronic Theses and Dissertations

Rural cervical cancer survivors, or individuals with a form of cancer that originated in the cervix of the reproductive system, may be uniquely impacted by socially constructed gender roles. The present study utilized the term “females” to describe those who self-identify as having a cervix, which may include cisgender, transgender, intersex, and non-binary gender identities. Rural females have been indicated to hold salience in traditional gender expectations as partners, mothers, community members, and more, which may add survivorship complexity for cervical cancer survivors within this population by to attempting to fulfill gender roles to the pre-cancer level. Moreover, rural cervical …

A Phenomenological Examination Of The Perception Of Psychopathological Misdiagnosis In Gifted Men, Tina Glass

Electronic Theses and Dissertations

While the exact prevalence of psychopathological misdiagnosis in gifted children is unknown, it is an occurrence within the gifted population (Amend & Beljan, 2009; Batstra et al., 2012; Bishop & Rinn, 2019; Bishop & Rinn, 2020; Coon, 2014; Webb et al., 2016). However, there is a gap in the literature related to psychopathological misdiagnosis specific to gifted males. (Desmet & Pereira, 2021; Ecklund et al., 2014; Eren et al., 2018; Neu & Weinfeld, 2007; OECD, 2015; Preckel et al., 2015; Watts, 2022). This transcendental phenomenological study leveraged Bronfenbrenner’s Bioecological Model for Human Development (Bronfenbrenner & Morris, 2006) as a theoretical …

Baby Dust: A Narrative Analysis Of Infertility Journeys On Youtube, Patricia Carrillo

Electronic Theses and Dissertations

Infertility is a distressing experience for those diagnosed and often exacerbated by engagement with biomedical treatments. This thesis is an exploration of infertility “journeys” posted on YouTube. Through a narrative analysis of 8 YouTube channels, several key themes were identified, specifically embodiment of the infertility label, barriers to treatment, and agency. This work uses the mindful body framework to look at how the individual body, social body, and body politic shape and reinforce these themes in the context of biomedical infertility treatment. These findings suggest infertility is a dynamic and distressing experience but by engaging in the narrative process, through …

Injectable Formulations For Localized Delivery Of Immunomodulators, Ketki Velankar

Electronic Theses and Dissertations

Dysregulation of immune homeostasis is fundamental to the development of autoimmune disorders. Fibroblastic reticular cells (FRCs) within lymph nodes play crucial roles in forming a microenvironment conducive to immune cell interactions and regulating autoreactive T cells driving autoimmune diseases. Studies have shown the potential of FRCs as a form of personalized cell therapy to correct dysregulated immune responses. Successful translational efforts, however, require the cells to be formulated as injectable suspensions while retaining their native architecture, which is essential for their regulatory functions. The main challenge resides in retaining the native reticular organization of FRCs lost in conventional monolayer cultures …

The Ethical Duty Of Care For Suicide Ideation, Tah Ngijoi Yogo

Electronic Theses and Dissertations

With suicide being a leading global cause of death, there is a need to explore the ethical complexities surrounding suicide and preventive measures. This dissertation questions the morality of suicide by examining the historical and philosophical dimensions across cultures and religions. The text argues for an approach that acknowledges rational suicide while developing the ethics of paternalistic measures for suicide prevention of vulnerable populations.

Considering the ethics of autonomy, the dissertation discusses the practice of nudging in healthcare to highlight the role of paternalism in supporting informed consent. The text proposes an enhanced autonomy model that balances trust, influence, and …

Uptake Of Extracellular Vesicles Into Brain Endothelial Cells And Development Of Motor Neuron-Derived Extracellular Vesicles For Amyotrophic Lateral Sclerosis, Jhanvi Rajan Jhaveri

Electronic Theses and Dissertations

Extracellular vehicles (EVs) are an emerging class of drug carriers and are primarily reported to be internalized into recipient cells via a combination of endocytic routes such as clathrin-mediated, caveolae-mediated and macropinocytosis pathways. In part one of this thesis, (1) we investigated potential effects of homotypic vs. heterotypic interactions by studying the cellular uptake of homologous EVs (EV donor cells and recipient cells of the same type) vs. heterologous EVs (EV donor cells and recipient cells of different types) and (2) determined the route of EV internalization into low pinocytic/hard-to-deliver cell models such as brain endothelial cells ( …

Delivery Of Mitochondria-Containing Engineered Extracellular Vesicles To The Blood-Brain Barrier For Ischemic Stroke Therapy, Kandarp Dave

Electronic Theses and Dissertations

Ischemic stroke is the second leading cause of death worldwide, and the lack of effective treatment options is an unmet clinical need for stroke survivors. Ischemic stroke-induced oxygen-glucose deprivation (OGD) in the affected brain tissue leads to mitochondrial dysfunction and adenosine triphosphate (ATP) depletion in the brain endothelial cells (BECs) lining the blood-brain barrier (BBB). ATP deprivation in the BECs dysregulates actin cytoskeleton dynamics, resulting in BBB breakdown. Restoration of blood flow (i.e., reperfusion) upon the first-line stroke treatment further leads to BBB breakdown and widens the paracellular spaces between BECs. …

Environmental Factors (Rurality, Distribution Of Prescribers, And Altitude) Of People Who Died By Suicide In Montana, 2013- 2022, Anne N. Brown

Electronic Theses and Dissertations

Introduction: Suicide is increasingly prevalent in rural areas across the United States, especially in the western Rocky Mountain states. The connection between suicide and rural residency is not well understood, nor is the relationship between the distribution of prescribers, altitude, and suicide. Purpose: This retrospective quantitative study aimed to describe the characteristics of individuals who died by suicide in Montana and investigate the associations among rurality, distribution of prescribers, altitude, and suicide rate. Methods: Montana suicide mortality data for 2013-22 was used to describe individual characteristics. A second dataset was created for each Zip Code Tabulation Area (ZCTA) level in …