Medicine and Health Sciences Commons^™

Towards A Structural Understanding Of Spore Germination In Clostridium Difficile, Chloe M. Adams

Graduate College Dissertations and Theses

Clostridium difficile is a Gram-positive bacterium that causes a toxin-mediated disease, typically in individuals whose normal intestinal flora has been compromised by antibiotic therapy. C. difficile is naturally resistant to many antibiotics and produces spores that can withstand harsh environmental conditions and many disinfectants, making the infection difficult to clear and easy to spread. The infection begins when spores from the environment are ingested and germinate upon exposure to taurocholate and glycine in the digestive tract. This germination process is required to initiate infection and thus represents a good target for the development of novel therapeutics. Although spore germination is …

Multi-Sensory Stimulation Environments For Use With Dementia Patients: Staff Perspectives On Reduction Of Agitation And Negative Behaviors, Megan Houston

Graduate College Dissertations and Theses

Background: Dementia is a degenerative neurological disorder that afflicts a growing proportion of the global population. Complementary alternative medicine (CAM) modalities are under investigation for their therapeutic value in the management of dementia.

Purpose: Nursing care of dementia sufferers can include managing agitation and negative behaviors; this study investigates staff appraisal of the Multi-Sensory Stimulation Environment (MSSE) as an intervention for these nursing challenges.

Methods: A purposive sample of nursing staff employed in residential care for dementia patients were recruited 10 weeks after the initiation of an open-access MSSE at the facility to complete a confidential self-administered questionnaire.

Results: 79% …

A Prelimary Study Of Differences Between Voluntary And Involuntary Retirement From Driving: Quality Of Life And Depression In A Rural Population, Elizabeth Ann Pruitt Saxton

Graduate College Dissertations and Theses

Research has revealed a variety of negative health consequences for older adults who stop driving, and with the "graying of America," this will be a frequently encountered issue for healthcare providers. The purpose of this study was to determine if there are differences in quality of life and depressive symptoms between former drivers who made the decision to stop driving voluntarily and former drivers who made the decision involuntarily (either in a resistant or in a reluctant manner). In this cross-sectional cohort comparison study, community dwelling older adults were asked to complete questionnaires of depression (using the Geriatric Depression Scale), …

Reverse Engineering The Human Brain: An Evolutionary Computation Approach To The Analysis Of Fmri, Nicholas Allgaier

Graduate College Dissertations and Theses

The field of neuroimaging has truly become data rich, and as such, novel analytical methods capable of gleaning meaningful information from large stores of imaging data are in high demand. Those methods that might also be applicable on the level of individual subjects, and thus potentially useful clinically, are of special interest. In this dissertation we introduce just such a method, called nonlinear functional mapping (NFM), and demonstrate its application in the analysis of resting state fMRI (functional Magnetic Resonance Imaging) from a 242-subject subset of the IMAGEN project, a European study of risk-taking behavior in adolescents that includes longitudinal …

The Health Care Provider's Experience With Fathers Of Overweight And Obese Children, Eliza Weston Anti

Graduate College Dissertations and Theses

The purpose of this study was to uncover the experience of health care providers (HCPs) as they work with fathers of children who are overweight and obese in the outpatient setting. Interpretative phenomenological analysis was used for data collection and analysis in this study. Seven HCPs were interviewed about their experiences. Two major themes emerged from the experiences of these HCPs: "dad in the backseat," and "paternal resistance." The theme of "dad in the backseat" captured to the HCPs' perception of parental roles and related stereotypes with respect to fathers' lack of presence in the health-care setting, family roles that …

Inhibitory Control Efficiency In Successful Weight Loss Participants, Kathryn Curran Olds

Graduate College Dissertations and Theses

Eating unhealthy foods and eating past satiety are inappropriate behaviors that promote obesity. The ability to effectively inhibit an inappropriate behavior is a key component of cognitive restraint and its impairment has been previously linked to obesity. In this study, a Go/No-Go fMRI task was completed by a cohort of adult women that had experienced initial weight loss followed by various levels of weight regain or continued weight loss. Region of interest fMRI analysis revealed that greater total weight loss was significantly related to decreasing activation in the right inferior frontal gyrus and the right superior frontal gyrus. These results …

Fnirs Measures Of Prefrontal Cortex Lateralization During Stuttered And Fluency-Enhanced Speech In Adults Who Stutter, Danra M. Kazenski

Graduate College Dissertations and Theses

The present study compared lateralization of cortical activation patterns in the prefrontal cortex (PFC) of adults who stutter (AWS) and typical speakers (TS) as measured with functional near infrared spectroscopy (fNIRS) in habitual and fluency-enhanced speaking conditions.

Participants were AWS (n = 11) and gender- and age-matched TS (n = 11) who completed speaking tasks in three condition blocks: (1) habitual speech using no speaking strategy (2) prolonged speech after receiving short-term training in fluency-shaping strategy-use (3) syllable-timed speech after being trained to speak in rhythm with a metronome at 92 beats per minute.

The three primary dependent variables were …

Mothers' Perceptions Of Workplace Breastfeeding Support, Katrina Marie Russo Burks

Graduate College Dissertations and Theses

Despite substantial evidence that breastfeeding is the optimal way to feed the healthy, full-term infant, data show that, although most mothers in the United States start out breastfeeding their infants, there are often barriers to continued breastfeeding beyond the first few weeks or months. Among the reasons cited are lack of support and the need to return to full or part time paid employment. As a result of the Surgeon General's 2011 Call to Action to Support Breastfeeding, many initiatives have been implemented on national, state, and local levels to improve support for breastfeeding in the workplace. The purpose of …

Screaming Behind A Door: The Experiences Of Individuals Incarcerated Without Opioid Maintenance Treatment, Shoshana Aronowitz

Graduate College Dissertations and Theses

Background & Purpose: Opioid maintenance therapy (OMT) is an effective method of treating opioid addiction. Of incarcerated individuals in the U.S., 50-85% have a history of substance abuse, and >80% of inmates with opioid addiction history do not receive treatment. The purpose of this study was to explore individuals' experiences after being tapered from OMT upon incarceration. Methods: Interpretative phenomenological analysis (IPA) was employed using in-depth interviewing of 10 participants. Results: Analysis identified six themes that captured the essence of the participants' experiences. Implications & Conclusion: Losing OMT upon incarceration was described as an extremely stressful experience for many individuals, …

Longitudinal Extension Of Primary Afferents Is Regulated By Spingosine 1-Phosphate Receptors And Tyrosine Kinase Receptor B In The Embryonic Spinal Cord Via A Brain Derived Neurotrophic Factor Related Mechanism, Michelle Mcnamara

Graduate College Dissertations and Theses

Primary sensory afferent outgrowth within the developing longitudinal pathway of the spinal cord is important for intrasegmental and intersegmental communication that underlies coordination and development of reflexes and contributes to sensory perception. The endogenous mechanisms that regulate primary sensory afferent extension are the primary focus of this dissertation.

This dissertation tested the hypothesis that primary sensory afferent extension in the longitudinal pathway is regulated by sphingosine 1-phosphate type 1 receptor (S1P1R) and tyrosine kinase receptor B (TrkB) through a brain derived neurotrophic factor (BDNF) related mechanism. To test this hypothesis we used embryonic day five (E5) chicken embryos, as this …

Health Care Provision To Transgender Individuals; Understanding Clinician Attitudes And Knowledge Acquisition, Leo Isaac Kline

Graduate College Dissertations and Theses

The Institute of Medicine report of 2011 defined Transgender Specific Health Needs as one of four priority research areas. While there is research asserting that health care providers (HCPs) do not have adequate training in providing competent care to transgender patients, there are no studies to date assessing HCPs' gender identity attitudes and their willingness to learn the Standards of Care (SOC) developed for this patient population. According to the Agency for Health Care Research and Quality, as of 2010, 52% of Nurse Practitioners (NPs) were practicing in primary care settings. As more than half of NPs practice in primary …

The Self-Perceived Impact Of An International Immersion Experience On The Cultural Competency And Professional Practice Of Recently Graduated Registered Nurses, Christopher Vaughn

Graduate College Dissertations and Theses

Significant health care disparities exist in the United States. Nurses can play an important role eliminating these disparities. International immersion experiences for undergraduate nursing students may provide long-lasting enhancements in cultural competency and improvements in professional practice. The purpose of this descriptive qualitative study is to explore how a faculty-led international immersion experience for undergraduate nursing students in public health nursing has influenced cultural competency and how this is perceived to have impacted the individuals' current professional practice. Campinha-Bacote's (2002) Process of Cultural Competence in the Delivery of Health Care Services served as a theoretical framework for the study. Participants …

A Study To Investigate The Significance Of Knowing One's Prognosis In People Diagnosed With Life-Limiting Illnesses, Erika Currier

Graduate College Dissertations and Theses

ABSTRACT

Background: For patients with life-limiting illnesses, having adequate knowledge of prognosis can strongly impact the choice between curative and supportive treatment.

Objectives: The purpose of this research study is to explore patient understanding of prognosis and to illuminate the experience of having or not having prognostic information in people diagnosed with life-limiting illnesses. This study aims to investigate the patient's understanding of the term "prognosis", the significance of the term "prognosis" to the patient, and how prognosis may or may not affect future treatment choices. In addition, this study aims to further understand the experience of prognostic communication between …

Mechanisms Of Seizure During Pregnancy And Preeclampsia, Abbie Chapman Johnson

Graduate College Dissertations and Theses

Eclampsia is defined as de novo seizure in a woman with the hypertensive complication of pregnancy known as preeclampsia (PE), and is a leading cause of maternal and fetal morbidity and mortality worldwide. The pathogenesis of eclamptic seizure remains unknown, but is considered a form of hypertensive encephalopathy where an acute rise in blood pressure causes loss of cerebral blood flow (CBF) autoregulation and hyperperfusion of the brain that results in vasogenic edema formation and subsequent seizure. However, eclamptic seizure can occur during seemingly uncomplicated pregnancies, in the absence of hypertension and PE, suggesting that normal pregnancy may predispose the …

Transient Ischemic Attack (Tia) Guideline Knowledge And Perceived Barriers To Implementation Amongst Emergency Department Health Care Providers In A Rural State, Christopher T. Ingvoldstad

Graduate College Dissertations and Theses

Transient Ischemic Attack (TIA) is a prominent risk factor for subsequent stroke, and its associated morbidity, mortality, and health care costs. Studies have demonstrated up to 80% reductions in subsequent stroke rate with prompt, optimized protocols for rapid TIA evaluation and treatment. National Stroke Association (NSA) and American Heart Association (AHA) guidelines have recommended institution of protocols assuring timely completion of the recommended testing, and evaluation by a stroke expert within 48 hours. However, limited literature exists on the implementation of guideline-based care in rural regions, and the few studies related to TIA suggest that barriers including difficulty accessing services …

The Lived Experience Of Transgender College-Aged Students Receiving Healthcare, Lisa Schaffer

Graduate College Dissertations and Theses

Background

There is a relative dearth of information regarding transgender patient perceptions of healthcare provider interactions and experiences. Previous studies have examined the experiences of transgender patients across multiple generations.

Purpose

This research focuses on understanding the lived experience of transgender college-aged students receiving healthcare. The goal of this research is to help inform the practices of healthcare providers in order to improve care experiences.

Methods

Hermeneutic phenomenology was utilized to illuminate the lived experiences of three college-aged transgender patients receiving healthcare. Interviews were conducted with research participants. After transcription, interview content was read and re-read for significant statements. Significant …

From Dar Es Salaam To Dartmouth: A Case Study Of The Experiences Of Fogarty Aids International Training And Research Program Fellows At Dartmouth College, Lisa Anne Purvis

Graduate College Dissertations and Theses

From Dar es Salaam to Dartmouth: A Case Study of the Experiences of Fogarty AIDS International Training and Research Program Fellows at Dartmouth

Lisa Purvis, EdD Candidate, MPH, MBA

Background

The United States (US) is a major host nation to international college students and scholars who study a variety of disciplines (Farrugia & Bhandari, 2014). Beginning in the last decade, the demand for global health training has risen (Kanter, 2008; Kerry, Ndung'u, Walensky, Lees, Kayanjas, & Bangsberg, 2011).

Since 2000, Geisel School of Medicine at Dartmouth has been one of 26 US universities participating in a global health training program, …

A Comparative Examination Of The Safety Programs At Ucla, Umn, And Uvm In Response To Recent Chemistry Laboratory Incidents, Victoria Carhart

Graduate College Dissertations and Theses

Laboratory safety has recently become more of an imperative in research laboratories than it has ever been in the past. Recent accidents at several universities have escalated the awareness of safety concerns in laboratory workspaces among the general public and created a greater need for a stronger culture of safety in chemistry research overall. Historically, results and publications have been the top priority of most researchers, not laboratory safety.

This thesis discusses a number of laboratory accidents. The first happened in December of 2008 at the University of California, Los Angeles (UCLA) and resulted in the death of a graduate …

Ubiquitin Ligase Trim32 And Chloride-Sensitive Wnk1 As Regulators Of Potassium Channels In The Brain, Eugene Miler Cilento

Graduate College Dissertations and Theses

The voltage-gated potassium channel Kv1.2 impacts membrane potential and therefore excitability of neurons. Expression of Kv1.2 at the plasma membrane (PM) is critical for channel function, and altering Kv1.2 at the PM is one way to affect membrane excitability. Such is the case in the cerebellum, a portion of the brain with dense Kv1.2 expression, where modulation of Kv1.2 at the PM can impact electrical activity of neurons and ultimately cerebellum-dependent learning. Modulation of Kv1.2 at the PM can occur through endocytic trafficking of the channel; however mechanisms behind this process in the brain remain to be defined.

The goal …

Promoting Time In Nature For Children: Investigating The Role Of Provider Nature Relatedness, Lindsey Gauderer

Graduate College Dissertations and Theses

Research has shown that time spent in and exposure to natural environments has numerous benefits for children, both physical and mental. At the same time, children face many barriers to obtaining time in the outdoors and today's youth spend less time outside than previous generations. Initiatives such as health care provider prescriptions for outdoor activity aim to encourage exposure to nature as a health intervention for children. In order to enhance the potential for success of programs such as these, factors influencing their implementation need to be assessed. This study aims to explore the impact that provider connectedness to nature, …

Glycogen Synthase Kinase-3Β: An Investigation Of The Novel Serine 389 Phosphorylation Site, Brendan Deegan Hare

Graduate College Dissertations and Theses

Stress associated psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder affect a large proportion of the population. Reductions in the complexity of neuronal morphology and reduced neurogenesis are commonly observed outcomes following stress exposure in rodent models and may represent a mechanism for the reduced brain volume in stress sensitive regions such as the hippocampus observed in individuals diagnosed with stress associated disorders. Multiple lines of evidence suggest that glycogen synthase kinase (GSK)-B may play a role in the neurodegenerative phenotype observed following stress exposure. GSK3B is atypical in that it is inhibited by phosphorylation. This inhibitory phosphorylation …

Traumatic Brain Injury Causes Endothelial Dysfunction In Mesenteric Arteries 24 Hrs After Injury, Ivette Ariela Nunez

Graduate College Dissertations and Theses

Traumatic brain injury (TBI) is the most frequent cause of death in children and young adults in the United States. Besides emergency neurosurgical procedures, there are few medical treatment options to improve recovery in people who have experienced a TBI. Management of patients who survive TBI is complicated by both central nervous system and peripheral systemic effects. The pathophysiology of systemic inflammation and coagulopathy following TBI has been attributed to trauma-induced endothelial cell dysfunction; however, there is little knowledge of the mechanisms by which trauma might impact the functions of the vascular endothelium at sites remote from the injury. The …

Modifiable Risk Factors For Cardiovascular Disease As Perceived By Women In Kenya, Catherine Wanjiru Lawrence

Graduate College Dissertations and Theses

Cardiovascular disease (CVD) worldwide has grown exponentially in the last two decades and while sub-Saharan Africa (SSA) has been grappling with the crippling effects of epidemic infectious diseases such as HIV/AIDS and malaria, cardiovascular disease is now emerging as a grievous concern. Research and resources have largely been directed toward understanding and curtailing infectious diseases in the African continent. But as the risk of cardiovascular disease reaching endemic proportions in sub-Saharan Africa becomes more evident, research is critically needed in order to understand how to manage it and more importantly to direct the development and implementations of culturally relevant prevention …

Defining Food Agency: An Ethnographic Exploration Of Home And Student Cooks In The Northeast, Maria Carabello

Graduate College Dissertations and Theses

According to popular and academic sources, home cooking is in decline. Nutrition and public health scholars concern that a loss of cooking abilities may diminish individuals' control over their food choices, thus contributing to poor health outcomes. Yet, there are still many unanswered questions. What skills, strategies, and knowledge sets are required to cook a meal on any given occasion? What capacity separates those who cook with ease from those who struggle to incorporate cooking into their daily routines? I propose that this difference is determined by an individual's capacity to employ a range of cognitive and technical skills related …

Physical Activity In Nature And Children's Mental Health, Stephanie Marcia Bless

Graduate College Dissertations and Theses

The aim of this study was to determine if there is a relationship between children's physical activity and wellbeing, and if that relationship is enhanced by physical activity in nature. This study was a non-experimental retrospective multi-informant data review conducted at an outpatient pediatric psychiatric clinic in the Northeast. The theoretical framework used to guide this study was the Health Promotion Model, suggesting Advanced Practice Nursing investigate the relationship between health promoting behaviors and personal factors that support mental wellness in children and protect against mental illness. Data collected included age, sex, and exercise and wellbeing subsections of the Vermont …

Living With Aortic Stenosis: A Phenomenological Study Of Patients' Experiences And Subsequent Health Choices, Gayle Ann Hagen-Peter

Graduate College Dissertations and Theses

Symptomatic aortic stenosis (AS) is an increasing phenomenon as more adults live longer. The gold standard for treating AS is surgical aortic valve replacement (SAVR). Frequently, as older individuals with AS often have multiple comorbidities, a SAVR is determined to be too high risk. Therefore, a less invasive treatment option is available, namely a transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR). Such biomedical procedures have encouraged life extension and the decision to intervene commonplace with the aging population. Without an intervention, significant debilitating symptoms affect a person's quality of life (QoL). Multiple quantitative studies evaluating QoL …