Medicine and Health Sciences Commons^™

Person-Centered Decision-Making And Socio-Cultural Contexts Influencing Cesarean Deliveries: A National Analysis., Alice M. Story

Electronic Theses and Dissertations

The cesarean delivery rate has increased and accounts for a third of pregnancies in the U.S., especially among marginalized women. This study applied a newly developed conceptual model to identify potential areas of influence that could reduce rates of cesarean deliveries. The Giving Voice to Mothers - United States data was used for analyses to predict covariates associated with having a cesarean delivery vs. spontaneous vaginal delivery (n=1,876). Significant covariates were determined and included the following: having a prior cesarean delivery (OR: 14.11, 95% CI: 7.99 - 24.90); more than one child (OR: 0.21, 95% CI: 0.13 - 0.35); elevated …

The Role Of Obesity In Macrophage-Mediated Mechanisms Promoting Early-Onset Colon Cancer., Katharina Marietta Scheurlen

Electronic Theses and Dissertations

Early-onset colon cancer (EOCC) is a leading cause of cancer death among people younger than 50 years of age in the United States and is associated with metabolic dysfunction and obesity. Anti-inflammatory tumor-associated macrophages (TAM) and low Peroxisome Proliferator Activated Receptor Gamma (PPARγ) gene expression in colon cancer (CC) tissue promote tumor progression and decreased patient survival. Obesity-related hormones, such as leptin and adiponectin, have the potential to affect gene expression in TAM to promote CC progression and thereby link obesity and EOCC. The aim of this project was to identify target genes in human CC and to investigate the …

Motivations Of Division I Student-Athletes To Participate In Strength And Conditioning Programs., Liza Reader

Electronic Theses and Dissertations

The purpose of this study was to understand the motivations of Division I collegiate athletes to participate in strength and conditioning programs as a part of their sports performance program. Specifically, this study examined what the motivations were and whether there were any differences between the athlete subpopulations of age group, gender, sport played, sport type, and injury status. In contrast to existing sport participation motivation research, this study focused on the participation of strength and conditioning as a part of sport participation, an area barren of motivational understanding and literature. This study utilized Self-Determination Theory (SDT) and Achievement Goal …

The Experience Of Scanxiety In Survivors Of Pancreatic Cancer: A Phenomenological Study., Susan Winebrenner

Electronic Theses and Dissertations

Surveillance scans can signify a crisis point in a cancer patient’s life, provoking fear and anxiety that negatively impact quality of life. Scan-related anxiety or scanxiety has been briefly discussed in the literature among lung cancer and lymphoma populations, but relatively few investigations have studied the psychological impact of routine surveillance scans during cancer survivorship. The purpose of this study was to illuminate the lived experience of scanxiety in survivors of pancreatic cancer who have undergone curative surgical resection. Hermeneutic phenomenology as applied by Heidegger provided the philosophical underpinnings for this study and van Manen’s methodological approach was used to …

Structural And Functional Myocardial Adaptations To Task-Specific Epidural Stimulation In Chronic Spinal Cord Injury., Harley D. Ledbetter

Electronic Theses and Dissertations

Cardiovascular disease is a leading cause of mortality, and this is especially true in individuals with spinal cord injury. Decreased systemic blood pressure leads to cardiac deconditioning, thought to be related to the increased cardiovascular morbidity and mortality in this population. This study investigates effects of myocardial loading from epidural stimulation in a group of individuals with spinal cord injury to understand how changes in preload and afterload could lead to beneficial myocardial remodeling. The study conducted echocardiograms to describe the myocardial changes after training with two different types of epidural stimulation intervention: one designed to facilitate movement (Voluntary) and …

Critical Thinking Or Critical Creativity: Applying De Bono's Six Thinking Hats To Speech-Language Pathology Education And Practice., Samantha Hahn

Electronic Theses and Dissertations

Decision-making is a fundamental skill that health care professionals use daily which involves the interaction of many cognitive systems. Critical and lateral thinking are two approaches to decision-making often cited in literature. Critical thinking emphasizes reasoning and systematic analyzation, while lateral thinking encompasses imagination and creativity. Speech-language pathology (SLP) is a prime example of a profession that amalgamates creative processes with organized methodologies. Edward de Bono described six styles of lateral thinking – each style is equated to a colored “hat”. This study sought to determine if an association exists between a given SLP student’s level of clinical experience and …

The Effect Of Telepractice On Vocal Interaction Between Provider, Deaf And Hard-Of-Hearing Pediatric Patients, And Caregivers., Abigail Betts

Electronic Theses and Dissertations

The purpose of this thesis is to examine how telepractice affects a vocal interaction between a speech-language pathologist (SLP), deaf and hard-of-hearing children who received cochlear implants (n = 7), and caregivers as they engage in speech-language interventions conducted in-person and via telepractice (tele). Frequency of vocalizations, vocal turns, pause duration, fundamental frequency (F0) mean and range, utterance duration, syllable rate per utterance duration, and mean length of utterance (MLU) were examined. The SLP vocalized more during in-person than tele-sessions, opposite result for the mother. There were more SLP-child turns during in-person sessions than tele-sessions; opposite result for mother-child turns. …

The Impact Of Volume Of Tissue Activation On Cortical-Striatal Networks And Verbal Fluency Declines In Post-Deep Brain Stimulation Parkinson's Disease Patients., Alexander Luke Alley

Electronic Theses and Dissertations

This study investigated the cortical-striatal networks of verbal fluency declines in 6-month, post-operative, deep brain stimulation Parkinson’s Disease patients. Nine Parkinson’s disease participants with implanted STN or GPi DBS systems were recruited for this study. Verbal fluency data was obtained from each patient preoperatively and 6- months post implantation. The stimulation-based volume of tissue activated area (VTA) of each target site (STN or GPi) was analyzed using Lead-DBS and Lead-Group. The white matter tracks intersecting each patient’s VTA, terminating in the pre-SMA, SMA, caudate nucleus, and anterior cingulate were investigated and correlated with verbal fluency declines. We found statistically significant …

Positive And Negative Deviant Counties: Identification Of Factors Associated With Health Outcomes, Olivia Egen

Electronic Theses and Dissertations

Rural counties in the United States vary drastically on metrics related to socioeconomic status and dominant economic industry as well as health behaviors and outcomes. This study sought to understand the underlying structural reasons why some rural counties have better or worse than expected health outcomes using a positive deviance (PD) approach. The study aimed to: 1) create an area deprivation index and divide counties into quartiles using the index; 2) identify positive, negative, and non-deviant counties using health outcome metrics; 3) analyze differences between deviance on a variety of local public health system metrics; and 4) analyze differences between …

Examining The State Of Substance Use Treatment Among Youth And Adults In The United States, Esther Adejoke Adeniran

Electronic Theses and Dissertations

In the United States (US), substance use, misuse, and substance use disorders are significant public health problems. Additionally, the difference between needing substance use treatment (SUT) and receiving treatment is becoming more pronounced. Therefore, the aims of this dissertation include, 1) to synthesize evidence of barriers and facilitators to integrating SUT into mainstream health care (MHC) after the Affordable Care Act was nationally implemented in 2014, 2) to examine the rate of treatment completion and dropout, along with its associated factors, among youth who received Medication-Assisted Opioid Therapy (MAT), 3) to determine the relationship between prior treatment episodes and length …

Perceptions, Knowledge, And Attitudes About Long-Acting Reversible Contraceptives (Larcs) Among Women In Appalachian Tennessee, Fenose Osedeme

Electronic Theses and Dissertations

In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Although long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework.

The study comprised six …

Dental Students' Perceptions Of Dental Hygienists' Education And Scope Of Practice, Cynthia Metzger

Electronic Theses and Dissertations

Oral health is strongly correlated to systemic health in the United States. Dental professionals play a significant role in addressing the oral health and prevention of disease for populations in the United States. Because many areas in the United States lack access to dental care, the federal government considers dental hygienists part of the solution. It is now paying attention to restrictive dental hygiene scope of practice rules in each state. State dental boards, comprised mainly of dentists, make these rules based on their perception of dental hygienists' lack of education. This study explored fourth-year dental students' perceptions of the …

Assessing Best Practices, Perceptions, And Barriers To Breastfeeding In The Appalachian Region, Melissa White

Electronic Theses and Dissertations

Background: Breastfeeding protects against a variety of adverse health outcomes for mothers and babies. Global best practices, known as the Baby-Friendly Hospital Initiative (BFHI), have been developed to support the initiation and exclusivity of breastfeeding during the post-delivery hospital stay. The aims of this study were to explore the literature related to the impact of the BFHI on breastfeeding disparities in the U.S.; compare the impact of exposure to these best practices on exclusive breastfeeding rates in Appalachian and non-Appalachian hospitals; and to understand knowledge, perceptions, and barriers to breastfeeding of postpartum mothers receiving care in a Northeast Tennessee OB/GYN …

Knockdown Of C. Elegans Nad Kinases Nadk-1 Or Nadk-2 Induces An Antioxidant Response Without Affecting Lifespan, Henry Gong

Electronic Theses and Dissertations

Nearly all multicellular organisms show changes in redox balance with aging leading to oxidative damage of macromolecules. This study investigated the role of the [NADP⁺]/[NADPH] redox couple in aging. This redox couple plays an important role in maintaining tissue redox balance and becomes slightly more oxidized in aged tissues. NADPH is a major source of reducing equivalents for enzymes that detoxify hydrogen peroxide. However, catalase detoxifies hydrogen peroxide independently of NADPH. But catalase is absent from mitochondria, a major source of hydrogen peroxide, where instead glutathione plays the major role in hydrogen peroxide detoxification in an NADPH-dependent manner. …

Self-Measured Blood Pressure Monitoring In Hypertension Control: The Role Of Social Determinants Of Health, Current State In The United States, And Future Directions, Adekunle Oke

Electronic Theses and Dissertations

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide …

Effect Of Chemical And Physical Enhancers On The Skin Permeation Of Cromolyn Sodium, Miranda Holman

Electronic Theses and Dissertations

Cromolyn sodium (CS) has clinically shown to be an effective topical remedy for atopic dermatitis, however its physiochemical properties prevent efficient passive drug delivery beyond the outermost skin layer. This project aimed to optimize CS gel formulations and applications to improve drug delivery to the dermis of skin by examining various topical enhancement strategies. Oleic acid, salcaprozate sodium, and microneedles were investigated as enhancers for their effect on skin permeation of CS. In vitro permeation studies across dermatomed porcine ear skin tested CS gels to determine 24-hour drug permeation profiles and skin layer distribution of drug. Further, extraction method efficiency, …

Early Detection Of Atypical Motor And Neurobehavior Of Infants At Risk Secondary To Opioid Exposure: A Prospective Study, Kara Boynewicz

Electronic Theses and Dissertations

Prenatal opioid exposure has been studied in relation to infants' medical outcomes. However, large gaps exist in the literature supporting early identification of atypical neurobehavior and motor development of infants with prenatal opioid exposure. The purpose of the study was to investigate whether prenatal opioid exposure has a negative influence on a newborn infant’s neurobehavior and motor development to aid in the early identification of potential delays. Using a prospective quasi experimental design, infants motor development using the Test of Infant Motor Performance (TIMP) and neurobehavior using the NICU Neonatal Network Scale (NNNS) was assessed on 58 infants in a …

2-Day Vs. 4-Day Training Cessation Following A Step Taper In Competitive And Recreational Powerlifters, Benjamin Burke

Electronic Theses and Dissertations

The purpose of this study was to compare differences in maximal strength, perceived recovery and stress state, and body composition alterations in powerlifters undergoing a 2-day or 4-day period of training cessation following a step taper. Ten participants completed a 6-week powerlifting specific training protocol. Body composition, perceived recovery and stress state, and maximal strength in the back squat (BS), bench press (BP), and deadlift (DL) were assessed prior to the overreach week (week 5) and either 2-days or 4-days after the taper. Alpha criterion was set at p≤0.05. There were statistically significant increases in BP (pp=0.03) …

Nurses Leading In Bridging The Culture Gap: Communicating With The Deaf Community, Veronica C. Leftridge

Electronic Theses and Dissertations

Nurses provide patient care in clinics, hospitals, homes, churches, schools, communities, and military, as well as on emergency medical helicopters. When a nurse is assigned to care for a patient, the patient expects the nurse to be culturally competent, communicate effectively, and provide safe quality care. However, cultural incompetence is observed when nurses provide care for Deaf patients, but they are unfamiliar with Deaf culture. In addition, communication is a fundamental skill nurses learn in nursing school, but course content in nursing programs rarely touches on how to communicate effectively with Deaf patients. Of the approximately 325 million people in …

Double Consciousness And Unhealthy Weight Control Behaviors In Young Black And White Adults, Priscillia Ihionkhan

Electronic Theses and Dissertations

The present study examined the previously understudied notion that Black individuals are buffered against being dissatisfied with their bodies and in turn developing unhealthy eating and weight control behaviors. Double consciousness, a racially/ethnically sensitive measure of body dissatisfaction, was tested as a mediator of the relation between ethnic identity and unhealthy eating and weight control behaviors in Black and White adults. It was anticipated that unhealthy weight control behaviors would be more common in Black women compared to White women and that double consciousness would mediate the association between ethnic identity and unhealthy weight control behaviors among Black women, but …

Understanding How To Promote Healthy Dietary Habits Among Parents Of Adolescents, Jazmine D. Collins

Electronic Theses and Dissertations

Adolescents in the United States today have record-high prevalence rates for childhood obesity and overweight, which are conditions that have lifelong negative health consequences for individuals, and also carry high financial and social costs for the entire nation. The disproportionate burden of obesity and associated health conditions falls on adolescents of racial and ethnic minority group identities and from lower-income households. The increased risk that adolescents have for developing conditions like childhood obesity is closely associated with youth having diets that are unhealthier than in the past. Parents have a large influence on the eating habits and preferences of their …

Diabetes Education With A Focus On Blood Glucose Self-Management: Impacting The Frequency Of Glucose Monitoring, Jennifer M. Young

Electronic Theses and Dissertations

This quality improvement project was conducted to evaluate whether a focused educational session on self-management of blood glucose monitoring increased the frequency of monitoring for adult type II diabetics who were not taking insulin therapy. The purpose of this improvement project was to add to the body of research from this project. Currently, there are no recommendations for people with type II diabetes who are not taking insulin therapy regarding monitoring their blood glucose. This quantitative project was conducted online to reduce face-to-face contact during the COVID-19 pandemic. It was conducted online through diabetes support groups found on Facebook. Permission …

Facilitators To Becoming And Remaining Open Defecation Free In Uganda: Implications For Community-Led Total Sanitation Programming, Danette Lee Cagnet

Electronic Theses and Dissertations

Poor sanitation behaviors, including open defecation, present risks for diarrhea, which is credited with 600,000 deaths a year in children under age five. Although CLTS is a solution to ending open defecation, more than half of the investment in producing open defecation free (ODF) communities is lost during the maintenance phase. The purpose of this qualitative, case study was to understand stakeholder perceptions of the facilitators and hindrances to becoming ODF certified and maintaining ODF status and sanitary behaviors in a small village community located in Uganda, East Africa. The researcher held individual interviews and in-person focus group discussions to …

How Early Education And Pet Therapy May Help Nurses With Compassion Fatigue, Katie E. Clark

Electronic Theses and Dissertations

Abstract

Although there is a great deal of research on the causes of compassion fatigue, there is little research on prevention techniques or ways to combat compassion fatigue. The purpose of this qualitative phenomenological study was to discover if nurses are prepared to cope with occupational stress and compassion fatigue. A secondary purpose was to examine the perceived benefit that pet therapy can have as a possible stress reduction technique to decrease the effects of compassion fatigue. This research was conducted by gathering data via semistructured interviews. The researcher interviewed nurses who were currently practicing patient care and scored as …

Utilizing Prams And Healthy People 2020 To Examine Black Women’S Breastfeeding Behavior In Louisiana Prior To The Onset Of The Covid-19 Pandemic, Almetra Amayá Granger

Electronic Theses and Dissertations

No abstract provided.

The Impact Of Disruptive Physician Behavior On Support Staff And Patients: A Quantitative Secondary Analysis, Michael C. Marino

Electronic Theses and Dissertations

In this quantitative secondary analysis, the purpose was to examine the nature of disruptive physician behavior (DPB) from the support staff and patient perspectives. Healthcare staffing shortages existed prior to the global pandemic and have increased, creating importance for employee retention and recruitment. I wanted to understand the impact of physician behavior on staff turnover rates in a private oncology practice, its effect on patient satisfaction rates, and to compare these rates of physicians that display DPB with physicians that do not display this behavior in a private hematology oncology community outpatient setting in the Southwest United States. To answer …

Improving The Competency Of Nurse Educators In The Use Of Simulation, Pricilla H. Wyatt

Electronic Theses and Dissertations

Simulation in nursing education programs is widely used as an active clinical learning strategy. This teaching methodology is a standard supplement to clinical experiences for nursing students to meet the requirements of clinical components within their degree program; however, the faculty of a small liberal arts-based Bachelor of Science in Nursing program was not using simulation to its fullest potential. Therefore, the purpose of this DNP project was to introduce the use of evidence-based practice simulation guidelines recommended by the National Council of State Boards of Nursing. The study sample of 16 included 10 full-time faculty, five part-time adjunct faculty, …

Exploring The Potential For Therapeutic Art-Making In School Psychology Practice: A Single Case Study Of A Training Experience, Alexandra G. Manion

Electronic Theses and Dissertations

The purpose of this study was to investigate the impact of a training experience on the use of therapeutic art-making for school psychologists, with a focus on how to incorporate these concepts into their school-based mental health practice. Therapeutic artmaking includes the use of visual art activities (drawing, painting, clay, and collage) with specific therapeutic intent. Although there are examples of art therapists providing inschool therapeutic art-making services to support the mental health needs of students, there is far less information regarding the use of therapeutic art-making by school-based mental health providers, including school psychologists. This single case study explored …

Exploring The Relationship Between Historical Redlining And Place-Based Reproductive Health Inequities: A Qualitative Gis Approach, Kristi L. Roybal

Electronic Theses and Dissertations

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences …

Perceptions Of Parental Care And Overprotection In Childhood: Influences On The Neurobiological Adaptation To Motherhood, Leah Grande

Electronic Theses and Dissertations

Recalled memories of caregiving in childhood are especially salient during the postpartum period and inform mothers’ conceptualization of her new parenting role. Positive perceptions of care received from one’s parents are related to improved maternal-infant bonding and positive parenting behaviors, whereas negative perceptions of care convey risk for maladaptive parenting. Few studies have investigated neural and biological mechanisms contributing to observed associations between childhood care and the adaptation to motherhood. The following studies address this gap by examining how perceptions of childhood parental care and overprotection are related to maternal behavior, oxytocin levels, and neural response. Methods: Perceived childhood maternal …