Medicine and Health Sciences Commons^™

Curricular Influence On Professional Formation In Physical Therapy Students, Chad W. Jackson

Electronic Theses and Dissertations

Professionalism is needed from each healthcare professional to meet the needs of patients, society, and the expectation that the profession has for its members. Professionalism comprises many attributes and is developed explicitly and implicitly over time through a variety of influential factors. Professional formation education should be an intentional emphasis in any professional program. However, in the academic preparation of healthcare professionals, including physical therapists, a lack of consistency exists in professionalism curricula. It does not appear there are published studies that have specifically compared the effect of curricular approaches in physical therapy education on students’ professional formation. The purpose …

A Program Evaluation Of A Rural Nursing Academic Partnership, Meagan A. Spencer

Electronic Theses and Dissertations

As the American Association of Colleges of Nursing and Commission on Collegiate Nursing Education continue to promote the implementation and creation of literature on academic partnerships, a Christian university, sought to evaluate its academic partnership with a for-profit hospital for the first time in regard to student perspectives. The purpose of this mixed-methods program evaluation was to describe the student perceptions of the academic partnership in trusting, collaborating, and engaging nursing students and recruiting and retaining nursing graduates to rural hospitals and health care facilities. Measurable impacts included both qualitative and quantitative coding of the levels of trust, collaboration, and …

Use Of The Cameo Ii Acuity Tool To Decrease Burnout For Nurses Working In A Pediatric Intensive Care Unit, Frances Lynn Feria-Clement

Electronic Theses and Dissertations

The World Health Organization (WHO) reported registered nurse burnout is an occupational hazard resulting in serious consequences for patients, healthcare organizations, and individual registered nurses (Woo et al., 2020). The purpose of this project was to see if the Complexity Assessment and Monitoring to Ensure Optimal Outcomes II (CAMEO II) Acuity Tool, used as an intervention for staffing and scheduling, would have a positive effect against nurse burnout in a pediatric critical care setting in a pediatric medical center. Maslach’s Burnout Inventory- Human Services Survey for Medical Personnel (MBI-HSSMP) was used as a pre- and postsurvey to measure the emotional …

Stroke Preventive In African American Women Ages 20-40 That Are Using Or Have Used Oral Contraceptives, Ashanti L. N. Coleman

Electronic Theses and Dissertations

This Doctor of Nursing Practice project will inform the audience of stroke awareness as it pertains to oral contraceptives. The study’s focus was to enhance the knowledge of African American women ages 20–40 that have used or are currently using an oral contraceptive. It has been identified that this patient population lacked the knowledge regarding stroke and oral contraceptives, and African American women continue to have the highest incidence of stroke. African American women also make up more than half of the consumers utilizing oral contraceptives. An oral contraceptive knowledge questionnaire was utilized from previous research to determine if any …

Determining The Effectiveness Of A Peer Support Person In Individuals With Depression Symptoms, Donna K. Reeves

Electronic Theses and Dissertations

Abstract

This study’s aim was to evaluate the effectiveness of an existing peer support program as an adjunct treatment for patients with depression. This retrospective evaluation analyzed the total scores of 110 patients with depression on the PHQ-9 questionnaire at the initial assessment (Time 1), at 6-weeks (Time 2), and then at 12-weeks (Time 3). The participants were divided into two groups, those who enrolled in a peer support program (n = 55) and those without peer support (n = 55). PHQ-9 total scores for each time interval were compared for the two groups utilizing independent sample t-tests …

Lowering Perceived Stress Levels In Undergraduate Nursing Students, Caitlin Dodd

Electronic Theses and Dissertations

This project analyzed the effects of guided meditations and a stress management class on undergraduate, prelicensure nursing students’ perceived stress levels. College students and professional nurses are both susceptible to having high stress levels. Mindfulness activities have been shown to lower stress levels. Undergraduate, prelicensure nursing students participated in this project determining the effects of guided meditations and a stress management class on perceived stress levels in a quantitative, pre- and postinterventional study. Participants in the project completed a stress management class and 18 guided meditation sessions in an undergraduate classroom setting. The researcher used the Perceived Stress Scale-10 (PSS-10) …

The Integration Of Primary Care And Psychiatry For Adults With Schizophrenia, Yvonne C. Cobbs Dr

Electronic Theses and Dissertations

In this project, the investigator used the Integrated Primary Care Consulting Psychiatry Toolkit (IPCCPT) to assist with an integrated primary care and psychiatric clinic’s operations through a virtual educational intervention to minimize care fragmentation for adults with schizophrenia. Mortality rates for adults with schizophrenia at this urban outpatient mental health clinic rose in patients with schizophrenia. From March to September 2020, there were 45 patient deaths not related to COVID-19. The investigator conducted a virtual educational webinar on the integration of primary care and psychiatry using the IPCCPT with 37 full-time employees in the clinic. The investigator measured the knowledge …

The Interaction Of Adversity, Hope, Social Support, And Academic Resilience In Emerging Appalachian Adults, Daniel Joseph Gottron Jr.

Electronic Theses and Dissertations

The negative impact of adverse childhood experiences on both short-term and long-term wellbeing has been repeatedly validated across multiple populations. While adverse childhood experiences have been thoroughly researched in many contexts, this is not the case for Appalachia, which has often been relegated to the fringe of scholarly research, resulting in an overall lack of research on Appalachia. Further lacking is research into how protective factors might be utilized to help overcome adversity. While some recent research on the relationship between adverse childhood experiences, hope, and resilience has been conducted, it too has been limited to select populations. It is …

From Case Study As Symptom To Case Study As Sinthome: Engaging Lacan And Irigaray On "Thinking In Cases" As Psychoanalytic Pedagogy, Erica Freeman

Electronic Theses and Dissertations

This dissertation accomplishes two goals. First, this dissertation articulates a Lacanian account of the epistemological and historical presuppositions of the psychoanalytic case study genre, while engaging reflexively with extant Foucauldian scholarship on this genre as well as feminist psychoanalyst Luce Irigaray’s criticisms of Lacan. Irigaray’s critique is engaged in order to tarry with its implications for a Lacanian approach to the psychoanalytic case study genre. Second, this dissertation critically examines the significance of Lacan’s (re)reading, in Seminar V, of Joan Riviere’s (1929) “Womanliness as Masquerade” in the midst of his oral teachings on the psychoanalytic concepts of castration and …

Aphasia Friendly Medication Instructions: Effects On Comprehension In Persons With And Without Aphasia, Anna Saylor

Electronic Theses and Dissertations

Accessible health information supports people to understand and manage chronic medical conditions and is frequently presented via text. Comprehension of written health information becomes more difficult for people with language impairments, such as aphasia. Nine people with aphasia (PWA) and nine people without aphasia (PWoA), participated in this study. Each participant reviewed two unmodified medication instructions and two modified medication instructions using aphasia-friendly principles, then answered eight multiple choice questions and provided their preferences. Results showed that PWA demonstrated improved comprehension given modifications, but PWoA’s comprehension did not improve with modifications. Group comparison in the modified condition demonstrated that PWoA …

A Bioethical Paradigm For Enhanced, Post Or Transhumans In Medicine And Biological Research, Roderick Williams

Electronic Theses and Dissertations

In this dissertation the question addressed is the ethical protocol that should be used when enhanced, post or transhumans present themselves as patients to hospitals, or as subjects for scientific research. With the advent of the birth of four children who were genetically engineered in China to be resistant to HIV, I contend that transhumans are already here, and the prevailing Western paradigm of principlism, while good, is not adequate to the task. I explore the basic religious argument that can be used against or in favor of what I call human-directed human evolution. I show how the fears of …

Without Words: Relational Neuropsychology And Creative Arts Therapies With People Managing Aphasia, Autumn Marie Chilcote

Electronic Theses and Dissertations

Aphasia describes the broad experience of disrupted language production or comprehension acquired after structural changes in the brain. These changes, usually associated with stroke, tumor, or cortical degeneration, are often co-occurring with other symptoms, such as emotional dysregulation, partial paralysis, and difficult social, occupational, and community relationships. Common approaches to research and rehabilitation with persons managing aphasia highlight conversation and semantic retrieval, with a lack in literature considering the diversity of symptoms and responses. Questions arise as to the ways that psychotherapies, typically language- centered, can be adapted to collaborative, low-verbal approaches that attend to the range of individual symptoms …

Soluble Epoxide Hydrolase Inhibition: A Novel Therapeutic Strategy In Alcoholic Liver Disease., Jeffrey Barr Warner

Electronic Theses and Dissertations

Emerging evidence suggests that soluble epoxide hydrolase (sEH) inhibition is a valuable therapeutic strategy for the treatment of numerous diseases. sEH rapidly degrades cytochrome P450-produced epoxygenated lipids (epoxy-fatty acids, epFAs), which generally exert beneficial effects on several cellular processes. sEH hydrolysis of epoxy-fatty acids produces dihydroxy-fatty acids which are typically less biologically active than their parent epoxide. sEH inhibition has shown efficacy in treating numerous pathologies associated with non-alcoholic liver disease, yet no efforts to date have tested the efficacy of sEH inhibition in alcoholic liver disease (ALD). Herein, we measured the levels of sEH expression and epFAs in human …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Epithelial Responses To Porphyromonas Gingivalis In The Community Context., Zackary Ray Fitzsimonds

Electronic Theses and Dissertations

Porphyromonas gingivalis, a keystone pathogen for periodontal disease, initiates a complex molecular dialogue with gingival epithelial cells, leading ultimately to disruption of host signaling pathways. Dysbiotic host responses are also thought to contribute to the initiation and progression of oral squamous cell carcinomas. Recently, the homeostatic commensal Streptococcus gordonii has been shown to antagonize P. gingivalis-induced epithelial cell signaling events in host cells, such as proliferation and migration. The aim of this study was to characterize pathways that P. gingivalis targets to disturb host signaling, with a specific focus on pathways that S. gordonii can restore to homeostatic …

Qualifications Of Executive Nurses For Service On Hospital Boards, Michelle Lee Foxx

Electronic Theses and Dissertations

Abstract Healthcare governing boards have responsibility for the legal and financial stability of the organization. They are assuming more responsibility for quality care and outcomes. Nurse leaders have valuable insights into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight. Yet, only 5% of the 3.2 million nurses in the U.S. health workforce hold a seat on hospital governing boards in the United States. The purpose of this study was to explore how nurses with executive experience perceive their own leadership qualities in the context of established requirements for executive hospital boards. Fifty …

Serious Mental Illness And Rural Primary Care: Provider Training, Attitudes, And Opinions, Lydia Eisenbrandt

Electronic Theses and Dissertations

Healthcare resources are especially limited in rural regions of the US. The lack of Primary Care Providers (PCPs) and mental/behavioral health services is problematic, as there are high rates of behavioral and medical concerns within rural populations. Special populations, such as rural persons with Serious Mental Illness (SMI), are medically complex and represent a vulnerable and underserved population. Healthcare outcomes for persons with SMI are poor compared to the general population and commonly lead to premature death. Various barriers prevent this population from accessing optimal healthcare, especially in rural areas, due to negative perceptions/stigma, a lack of understanding from PCPs, …

N-Acetyltranserase 2 (Nat2) Genotype Polymorphism In Cryopreserved Human Hepatocytes And Chinese Hamster Ovary (Cho) Cells., Mariam Refaat Zaky Habil

Electronic Theses and Dissertations

Arylamine N-acetyltransferases, NAT1 and NAT2, catalyze the detoxification and/or activation of drugs and aromatic amine carcinogens. Single nucleotide polymorphisms or SNPs result in different human NAT2 genotypes thus dividing the population into rapid, intermediate, and slow acetylators. We hypothesize allelic variants of NAT2 genotype will decrease levels of N-acetylation, cytotoxicity, oxidative stress, DNA adduct formation, and mutagenesis compared to the reference allele NAT2*4. Cryopreserved human hepatocytes expressing different NAT2 genotypes and NER-deficient Chinese hamster ovary (CHO) cells transfected with human CYP1A2 and human NAT2*4, NAT2*5B or NAT2*7B have been used to investigate N-acetylation of different xenobiotics. In …

Modulation Of Inflammatory Pathway By Inflammatory Inhibitor Jsh-23 Mitigates Diabetic Retinopathy., Rubens Petit Homme

Electronic Theses and Dissertations

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). Its pathology is consisted of the breakdown of the blood-retinal barrier (BRB), particularly the inner blood-retinal barrier (iBRB). The exact mechanism that leads to the iBRB impairment and the development of DR has not been elucidated yet. However, chronic inflammation that is hallmark of the type I DM has recently become a key focus in DR study. Hyperglycemia causes dysregulation of nuclear factor-kappa B (NF-kB); and its constant activation increases the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and intercellular adhesion molecule-1 (ICAM-1) in the …

Mechanisms Of Chromate-Induced Suppression Of Rad51: A One Environmental Health Approach., Rachel M. Speer

Electronic Theses and Dissertations

Lung cancer is the leading cause of cancer death. Lung cancer is commonly associated with smoking, however, 1 in 5 women and 1 in 12 men who develop lung cancer are never-smokers. Environmental exposures, therefore, account for a significant portion of lung cancer cases. Hexavalent chromium [Cr(VI)] is a global environmental contaminant and known human lung carcinogen. Cr(VI) and other carcinogenic metals induce chromosome instability, an early event in lung cancer. Structural chromosome instability arises in part due to failed DNA repair. Particulate Cr(VI), the most potent form of Cr(VI), induces DNA double strand breaks and inhibits the high-fidelity DNA …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Tissue-Resident Myeloid-Derived Suppressor Cells Modulate Immune Homeostasis In Healthy Adipose., Katlin Brooke Stivers

Electronic Theses and Dissertations

Our goal with this study was to gain insight into the homeostatic immune cell network in healthy adipose tissue. Specifically, we sought to determine if the immature myeloid cells found in healthy and inflamed adipose were, in fact, tissue-resident myeloid-derived suppressor cells (MDSCs). Using various in vitro and in vivo methods, we have uncovered a population of CD11b^Hi Ly6C^Hi Ly6G^- MDSCs resident in healthy adipose tissue. To the best of our knowledge this is the first time that these cells have been investigated and described in healthy adipose tissue. Systemic MDSC depletion lead to the accumulation of …

Plasmodium Impairs Antibacterial Innate Immunity To Systemic Infections In Part Through Hemozoin-Bound Bioactive Molecules., Christopher Lynn Harding

Electronic Theses and Dissertations

Despite efforts to decrease the global health burden of malaria, infections with Plasmodium species continue to cause over 200 million episodes of malaria each year which resulted in 405,000 deaths in 2018 [1]. One complication of malaria is increased susceptibility to invasive bacterial infections. Plasmodium infections impair host immunity to non-Typhoid Salmonella (NTS) through activities of heme oxygenase I (HO-I) )-induced release of immature granulocytes and myeloid cell-derived IL-10. Yet, it is not known if these mechanisms are specific to NTS. We show here, that Plasmodium yoelii 17XNL (Py) infected mice had impaired clearance of systemic Listeria monocytogenes (Lm) during …

Application Of Machine Learning Technologies For Detection Of Proximal Lesions In Intraoral Digital Images: In Vitro Study., Rohit Vadlamani

Electronic Theses and Dissertations

Background: Interpretation of bitewing radiographs is influenced by factors such as acquisition parameters (e.g. exposure, type of sensor), clinical technique, visualization (e.g. monitor type and calibration) and the observer (e.g. experience and fatigue bias). We hypothesized that the use of artificial intelligence (AI) will reduce visualization and observer factor in bitewing interpretation and improve diagnostic accuracy. Objective: The purpose of the present study was to evaluate the use of AI in the form of a machine-learning algorithm to detect and quantify proximal lesions compared with human trained observers. Methods: 16,000 anonymized, digital bitewings of patients were hand searched and non-bitewing, …

Identification And Structural Characterization Functional Motifs In The Porphyromonas Gingivalis Mfa1 Short Fimbria., Mohammad K. Roky

Electronic Theses and Dissertations

Porphyromonas gingivalis is a causative agent of periodontal disease, initially colonizes the oral cavity by adhering to commensal streptococci. Adherence requires the interaction of the minor fimbrial protein (Mfa1) of P. gingivalis with streptococcal antigen I/II (Ag I/II). A peptide derived from Ag I/II peptide has been well characterized and shown to significantly reduce P. gingivalis colonization and bone loss in vivo, suggesting that this interaction represents a potential target for therapeutic intervention. However, the functional motifs of Mfa1 involved in the interaction with Ag I/II remain uncharacterized. A series of N- and C-terminal peptide fragments of Mfa1 were …

Development, Expansion And Role Of Myeloid-Derived Suppressor Cells In Post-Sepsis Immune Suppression, Tuqa Alkhateeb

Electronic Theses and Dissertations

Myeloid-derived suppressor cells (MDSCs) numbers increase significantly in sepsis and are associated with high mortality rates. These myeloid cell precursors promote immunosuppression, especially in the late (post sepsis) stage. However, the mechanisms that underlie MDSC expansion and programming are not completely understood. To investigate these mechanisms, we used a cecal-ligation and puncture (CLP) mouse model of polymicrobial sepsis that progresses from an early/acute proinflammatory phase to a late/chronic immunosuppressive phase. Previous studies in our laboratory showed that microRNA (miR)-21 and miR-181b elevate levels of the transcription factor nuclear factor 1 (NFI-A) that promotes MDSC expansion. We report here that miR-21 …

The Relationship Between Cell-Free Dna And Resistance Training, Henry Lang

Electronic Theses and Dissertations

The primary purposes of this dissertation were to explore relationship between cell free DNA (cf-DNA), creatine kinase (CK), C-reactive protein (CRP), vertical jump testing delayed onset muscle soreness (DOMS) in response to a high-volume resistance training protocol, and to assess the sensitivity of cf-DNA to different resistance training volume loads. The secondary purpose was to examine the relationship between cf-DNA and relative strength. Study 1 was an exploratory attempt to discover relationships between cf-DNA, CK, CRP, delayed onset muscle soreness, and performance variables. Seventeen resistance trained males were recruited, 9 were randomly assigned to receive BCAAs while 8 received a …

The Effects Of Increasing Running Speed On Vgrf And Asymmetry, Kaela M. Hierholzer

Electronic Theses and Dissertations

Biomechanical and physiological parameters related to running performance are usually studied separately. However, evaluating both aspects together could be beneficial in improving athletic performance. The purpose of this study was to observe the change in peak vGRF and asymmetry as speed increases, while observing physiological responses during a O_2maxtest. Data from athlete monitoring of 12 cross-country and triathlon athletes were analyzed. The athlete monitoring protocol included three unweighted countermovement jumps and a O_2maxtest performed by the athletes. The athletes had an average O_2maxof 53.4 ± 7.7 mL/kg/min, while their average vGRF asymmetry throughout the …

Tumor-Derived Exosomes Drive Immunosuppressive Macrophages In A Pre-Metastatic Niche Through Nf-Kβ Dependent Glycolytic Metabolic Reprogramming., Samantha M. Morrissey

Electronic Theses and Dissertations

The formation of a pre-metastatic niche is a fundamental requirement for primary tumor metastasis. One of the defining characteristics of a pre-metastatic niche is infiltration of immunosuppressive macrophages. However, how these macrophages acquire their immunosuppressive phenotype remains largely unexplored. Here, we demonstrate that tumor-derived exosomes (TDE) polarize macrophages towards an immunosuppressive phenotype characterized by increased PD-L1 expression through NF-kB-dependent metabolic reprogramming in mice and humans. While NF-κB has previously been shown to act as a direct transcription factor for PD-L1, we report a novel mechanism where TDE-induced NF-κB activation drives PD-L1 expression by augmenting the glycolytic capacity of macrophages through …

Investigation Of Factors Affecting The Hiv Continuum Of Care In Tennessee, Elaine Loudermilk

Electronic Theses and Dissertations

Introduction: Factors contributing to the HIV continuum of care (HCC) for adults in Tennessee (TN) have not been studied in depth with known predictors for HIV risk, specifically adverse childhood experiences (ACEs), among low annual income or sexual minority groups [lesbian, gay, bisexual, or transgender (LGBT)].

Methods: A mixed methods study design was used to assess factors related to the HCC. Quantitative analysis used the TN Behavioral Risk Factor Surveillance System data to examine at risk and ever tested for HIV, to (1) investigate ACEs among adults with low-income (<$25,000 annually) in 2016-2017 and (2) among LGBT in 2018. Descriptive statistics and multiple logistic regression (MLR) analysis stratified by TN grand division were performed. Qualitative analysis included 11 interviews with persons living with HIV (PLWH) receiving care at a local clinic to evaluate surveillance questions related to ACEs and the HCC to develop a culturally appropriate survey.

Results: Quantitative results found that among LGBT (N=262) and low-income …