Medicine and Health Sciences Commons^™

Adults With Cystic Fibrosis: Self-Management And Health Outcomes, Amanda Rose Lambie

Theses and Dissertations

This dissertation is comprised of three manuscripts for publication reporting on adults living with cystic fibrosis, self-management behaviors and health outcomes. Chapter I explores what is known about adults living with cystic fibrosis (CF) and the factors impacting their self-management, including the complexities of a health maintenance regime required for survival while integrating and balancing the realities of adulthood. The review of literature provides direction for future research and implications for adult-focused CF studies. Chapter II is a manuscript describing the characteristics of prognostic survival models utilized in adult CF research and provides an overview of their development, validation, predictive …

Understanding The Experiences Of Adjunct Nursing Faculty In The Curriculum Development Process: A Qualitative Case Study, Laurie Ann Colborn

Theses and Dissertations

This qualitative case study examines the experiences of adjunct nursing faculty within the curriculum development process at universities granting a bachelor's degree in nursing within the Philadelphia five-county region, and the state of New Jersey. Seven adjunct nursing faculty members participated in this study providing detailed input of their experiences in this process. Five themes were uncovered during analysis including: assembling a critical foundation, value added, incidental collaboration, a seat at the table, and trial by fire. These themes helped to provide a deeper understanding of the opportunities, rewards, and challenges experienced by these adjunct nursing faculty members in the …

Disordered: Conversations About Mental Health And Society, Rachel Brown

Theses and Dissertations

Disordered is a collaborative, participatory street art project designed to destigmatize mental health challenges like depression and anxiety, and reframe health as a societal issue. Through social practice and guerrilla strategies, Disordered intervenes in public spaces, creating conversations, stickers and metal signs to inspire personal, social and political transformations.

A Qualitative Case Study On Delegation Of School Nursing Practice: School Nurses, Teachers, And Paraprofessionals Perspectives, Sharon L. Schofield

Theses and Dissertations

For the past decade, there have been many changes to school nursing with the implementation of unlicensed assistant personnel now known as paraprofessionals. This process has brought about several concerns such as mode of delegation, education, training, ability to monitor health-care needs, and organizational effects that trended downward without direction. This qualitative inquiry gave an interpretative meaning to the process of delegation in school nursing, the factors that hinder the delegation process as well as components that are needed to effectively delegate and utilize support staff (paraprofessionals) without detrimental effects to students. This study interviewed 20 participants.

Results of this …

Is Self-Interest At The Root Of Political Behavior? An Examination Of The Effects Of Dark Personality And Demographics On Political Beliefs And Actions, Nathan A. S. Frishberg

Theses and Dissertations

Prediction of political behavior is of interest to scientists in the fields of psychology, sociology, and politics, as well as to the lay public. Previous research has connected personality to broad political leanings, but little if any published research has examined how personality relates to voting behavior. The current study built on earlier work by examining the connections among the Dark Triad of personality (psychopathy, narcissism, and Machiavellianism), demographics, specific political beliefs, and political behaviors. We hypothesized that dark personality would relate to political beliefs such that those higher on the Dark Triad would show stronger support for policies that …

Comparative Effectiveness Of Conventional And Novel Sampling Methods For The Recruitment Of Sexual Minority Identified Women, Sarah M. Piperato

Theses and Dissertations

Sexual minority identified (SMI) women have an amplified risk for risky health behaviors and chronic health conditions. Current research on mechanisms related to health disparities in SMI women is limited. Research targeting SMI women has relied on small, convenience samples to address health disparities. Due to the nature of this population, probability sampling methods are ineffective and inefficient and cost prohibitive. The purpose of this dissertation was threefold. First, we examined the current state of literature to gain insight on prevalent sampling strategies used to access SMI women for health-related research. Second, we compared the efficacy of two sampling strategies, …

Structural Stress And Otherness: How Do They Influence Psychological Stress?, Christine Dewilde

Theses and Dissertations

Background: The Theory of Cultural Distress offers a framework for understanding the potential outcomes in patients who do not receive care that incorporates their cultural beliefs (DeWilde & Burton, 2017).This study represents initial steps in researching the theory byexploring the layering of stressors that place the patient at risk for Cultural Distress. Methods: Utilized aCross-sectional descriptive correlational analysis of intersecting identities (Structural Stressors), ethnicity-related stressors (Otherness) and ethnic-identity (Otherness) to develop understanding of the potential effects of these variables on psychological stress. Independent variables included intersecting identities, perceived ethnic discrimination, concern for stereotype confirmation, own group conformity pressure, and …

Galantamine's Deconstruction In The Quest Of A Pam Pharmacophore, Malaika Argade

Theses and Dissertations

Alzheimer’s disease is a progressive neurodegenerative disorder generally affecting people above the age of 65 years. Even though the pathophysiological hallmarks of AD were established more than a hundred years ago, there is yet to be a drug that can stop its characteristic neuronal damage. Of the five currently FDA-approved drugs, galantamine has a unique mechanism of action. Apart from being an AChE inhibitor, galantamine can effectively potentiate (positive allosteric modulator) the effect of agonists at nAChRs at concentrations lower than those required for its action as an AChE inhibitor. Perhaps the clinical benefits observed with galantamine are associated mainly …

The Role Of Ceramide In Neutrophil Elastase Induced Inflammation In The Lungs, Sophia Karandashova

Theses and Dissertations

Alterations to sphingolipid metabolism are associated with increased pulmonary inflammation, but the impact of inflammatory mediators, such as neutrophil elastase (NE), on airway sphingolipid homeostasis remains unknown. NE is a protease associated CF lung disease progression, and can be found in up to micromolar concentrations in patient airways. While sphingolipids have been investigated in the context of CF, the focus has been on loss of cystic fibrosis transmembrane conductance regulator (CFTR) function. Here, we present a novel observation: oropharyngeal aspiration of NE increases airway ceramides in mice. Using a previously characterized mouse model of NE-induced inflammation, we demonstrate that NE …

Exogenous Fniii 12-14 Regulates Tgf-Β1-Induced Markers, Hilmi M. Humeid

Theses and Dissertations

The extracellular matrix protein Fibronectin (FN) plays an important role in cell contractility, differentiation, growth, adhesion, and migration. The 12th -14th Type III repeats of FN (FNIII 12-14), also referred to as the Heparin-II domain, comprise a highly promiscuous growth factor (GF) binding region. This binding domain aids in cellular signaling initiated from the ECM. Additionally, FN has the ability to assemble into fibrils under certain conditions, mostly observed during cell contractile processes such as those that initiate due to upregulation of Transforming Growth Factor Beta 1 (TGF-β1) [1], [2]. Previous work from our lab has shown that self-assembly of …

Molecular Brain Adaptations To Ethanol: Role Of Glycogen Synthase Kinase-3 Beta In The Transition To Excessive Consumption, Andrew D. Van Der Vaart

Theses and Dissertations

Alcoholism is a complex neuropsychiatric disease that is characterized by compulsive alcohol use and intensifying cravings and withdrawals, often culminating in physiologic dependency. Fundamental alterations in brain chemistry underlie the transition from initial ethanol exposure to repetitive excessive use. Key mediators of this adaptation include changes in gene expression and signal transduction. Here we investigated gene expression pathways in prefrontal cortex and nucleus accumbens following acute or chronic ethanol treatment, to identify genes with potentially conserved involvement in the long-term response of the corticolimbic system to repeated ethanol exposure. We investigated Gsk3b, which encodes glycogen synthase kinase 3-beta, as a …

The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor

Theses and Dissertations

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection

David C. O’Connor, Ph.D., DNAP, CRNA

A dissertation submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2018

Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA

Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of …

Inpatient Utilization Of Computed Tomography: The Influence Of Market, Hospital, And Patient Characteristics, Michael Hanshew

Theses and Dissertations

The use of computed tomography (CT) in the care of patients has grown dramatically since its introduction over 30 years ago. The vast majority of the utilization research has focused on factors associated with the variable use in the outpatient and emergency department settings. This has left much of the inpatient use and variation understudied. This study has multiple aims. The first is to characterize the inpatient variation across multiple states and markets. The second is to evaluate the relationship between inpatient CT use and commercial payers across these areas. The third is to develop a model to evaluate the …

Impact Of Sensory Adapted Dental Environment On Children With Developmental Disabilities, Gail Kim

Theses and Dissertations

Purpose: This was a pilot study assessing the impact of a sensory adapted dental environment (SADE) on children with developmental disabilities (DD) receiving routine dental care.

Methods: A crossover study of 22 children with DD, aged 6 through 21, was conducted at Virginia Commonwealth University Pediatric Dental clinic. Each participant was randomized to a sequence of two dental cleanings, one regular dental environment (RDE) and one SADE with a 3-4-month recall. Outcomes included physiological measures (heart rate and oxygen saturation) and cooperation (Frankl scores).

Results: Study subjects completed a total of 36 visits. None of the physiological measures differed at …

Directing Mesenchymal Stem Cells For Periodontal Regeneration, Charles Stoianovici

Theses and Dissertations

Background: Directing autogenous Mesenchymal Stem Cell (MSC) to defect sites has a great promise in bone regeneration. We designed a MSC specific, bone affinity peptide (E7HA7) by conjugating E7 with a polyglutamate hydroxyapatite (HA) binding motif. We sought to characterize the in-vivo releasing pattern and bioactivity of E7HA7. Methods: HA discs were coated with fluorescent labeled peptides E7HA7, E7HA2 or E7 were subcutaneously implanted in Sprague Dawley rats. In an ectopic bone formation model was used to test the in-vivo bioactivity of E7HA7 conjugated to DBM. Results: E7HA7 showed slower peptide release from scaffolds in comparison to other groups, being …

Usefulness Of The Captia Syphilis Igg Eia Test Method And Reverse Algorithm For Detection Of Syphilis Infection In A Public Health Setting, Patricia Armour

Theses and Dissertations

Syphilis, a systemic sexually transmitted disease, is on the rise in the US, with infection rates the highest recorded since 1994 according to the CDC. Useful laboratory testing is an important diagnostic tool for determining individual syphilis infection and preventing community-wide disease spread.

The purpose of this study was to determine the usefulness of a specific automated treponemal test method, the Captia^TM Syphilis IgG EIA, and the syphilis reverse algorithm interpretation for detecting syphilis infection among patients seeking care in a public health clinic. The study employed a retrospective, nonexperimental descriptive correlational design with data collected between 2012-2013 from …

The Effect Of Instrumentation Taper On Dentin Conservation, Megan E. Green

Theses and Dissertations

Introduction: The aim of this in vitro study was two part. The first being to assess and compare the amount of dentin removed by an instrument with a taper of 0.04 versus an instrument with a taper of 0.06 using the Edge Evolve® file system at different increments within the canal system. Secondly, this study evaluated whether instrumentation with either taper resulted in a remaining dentin thickness (RDT) of less than 0.3mm. If this RDT was imposed upon, fracture resistance was compromised. Both pre and post instrumentation measurements were taken of samples instrumented with the 0.04 and 0.06 tapered files. …

The Cognitive And Functional Impact Of Open Heart Surgery: A Pilot Study Including Three Common Procedures (Coronary Artery Bypass Graft, Heart Valve Replacement, And Left Ventricular Assist Device), Robert Fix

Theses and Dissertations

This study investigated the impact of open heart surgery (Coronary Artery Bypass Graft, Heart Valve Replacement, or Left Ventricular Assist Device placement) on cognition, functional performance, and mood in the three months following surgery. The Montreal Cognitive Assessment (MoCA), Kettle Test (KT), Physical Self Maintenance Scale (PSMS), and Hospital Anxiety and Depression Scale (HD) measured global cognition, functional cognition, functional performance, and mood states, respectively.

Thirteen male participants (ages 38 – 75) completed assessments at four time points -- when they were scheduled for surgery, within one week prior to surgery, before hospital discharge after surgery, and three months after …

Investigating The Role Of Nicotinic Acetylcholine Receptors (Nachrs) In The Development And Maintenance Of Chemotherpy-Induced Peripheral Neuropathy In Mice, Wisam B. Toma

Theses and Dissertations

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a major dose-limiting side effect of several anticancer drugs. The prevalence of CIPN ranges from one-third to two-thirds of cancer patients. CIPN can persist for months to years after completion of chemotherapy. Despite the efficacious use of paclitaxel in the treatment of tumors, it can induce many sensory symptoms, such as paresthesia, numbness, tingling and burning pain, and mechanical and cold allodynia, which typically are present in the hands and feet. Similar to other types of chronic pain, paclitaxel-induced CIPN is comorbid with depression and anxiety in cancer survivors, and paclitaxel induces changes in affect-like …

An Innovative Use Of Technology And Associative Learning To Assess Prone Motor Learning And Design Interventions To Enhance Motor Development In Infants, Tanya Tripathi

Theses and Dissertations

Since the introduction of the American Academy of Pediatrics Back to Sleep Campaign infants have not met the recommendation to “incorporate supervised, awake “prone play” in their infant’s daily routine to support motor development and minimize the risk of plagiocephaly”. Interventions are needed to increase infants’ tolerance for prone position and prone playtime to reduce the risk of plagiocephaly and motor delays. Associative learning is the ability to understand causal relationship between events. Operant conditioning is a form of associative learning that occurs by associating a behavior with positive or negative consequences. Operant conditions has been utilized to encourage behaviors …

Shared Genetic And Environmental Influences On Fear, Anxiety, Posttraumatic Stress, And Brain Morphometry, Chelsea Sawyers

Theses and Dissertations

Anxiety disorders (ADs) and stress-related disorders are some of the most common psychiatric disorders in the United States. Like other c0mplex psychiatric illness, genetics and neuroimaging research has focused on understanding their underlying neurobiology. Areas within the fear-network play important roles in threat perception, fear conditioning/learning, cognitive processing, and modulation of fear responses including contextual modulation and extinction and have been implicated in ADs as well as stress disorders such as posttraumatic stress disorder (PTSD). The primary gap in the current search for underlying biological mechanisms is in whether biomarkers associated with disorders share genetic influences with the disorders they …

5-Ht2b Receptor-Mediated Cardiac Valvulopathy, Pallavi Nistala

Theses and Dissertations

5-HT_2B receptor agonism causes cardiac valvulopathy, a condition characterized by thickening of the heart valves and as a result, regurgitation of blood within the heart. The anti-obesity drug fenfluramine, which was originally prescribed as an anorectic, was withdrawn from the market due to causing cardiac valvulopathy. Fenfluramine, after metabolism by N-dealkylation, produces the metabolite norfenfluramine, which acts as a more potent valvulopathogen. The same was seen with MDMA (ecstasy), a popular drug of abuse, which is metabolized by N-dealkylation to produce MDA, a more potent valvulopathogen. Glennon and co-workers. studied a series of 2,5-dimethoxy-4- substituted phenylisopropylamines (DOX type) hallucinogens …

The Effects Of Stand-Alone Prescription Drug Plans On Health Care Utilizations, Expenditures And Medication Adherence Among Elderly Medicare Beneficiaries, Jing Yuan

Theses and Dissertations

Since the implementation of Medicare Part D in 2006, a growing body of evidence has shown that Medicare Part D might offset the total healthcare spending by improving the use of prescription drugs. However, little is known about the impact of different types of Part D plans – Stand-alone Prescription Drug Plan (PDPs) and Medicare Advantage Prescription Drug Plan (MA-PDs) – on health care utilizations and expenditures. This dissertation examined the association between the effect in PDPs on health care utilizations as well as expenditures, and medication adherence among elderly Medicare beneficiaries, compared to MA-PDs. Data was pooled from 2006-2010 …

Minimal Hearing Loss In School-Age Children: Prevalence And Relationship To Reading Impairment, Laura Peek

Theses and Dissertations

Purpose: The two-fold purpose of this study was to determine if a) students with reading impairments fail hearing screenings at higher rates than students without reading impairments and b) if the pattern of simple view of reading classification differs across hearing screening results.

Method: This project included 19 students with reading impairments and 17 students with typically reading skills in grades 2 through 11. Each participant completed a hearing screening and a complete battery of language and literacy tests to determine their hearing screen status and simple view classification.

Results: Results of a chi square test comparing reading status and …

Intervention For Women In Costa Rica Who Are Discouraged And Have Food Insecurity And Excess Body Weight, Tatiana Martínez-Jaikel

Theses and Dissertations

ntroduction: The coexistence of food insecurity and excess body weight has been wellrecognized by researchers, and it has been documented in women, but not men. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these programs might contribute to excess body weight, particularly in adult women. Our previous in-depth qualitative research in Costa Rica showed that discouragement was the primary link in the coexistence of food insecurity and excess body weight among Costa Rican women, and that the family and existing gender …

Initiating The Loeb Criteria In Long-Term Care, Janice Khauslender

Theses and Dissertations

Urinary tract infections are one of the most commonly reported infections in long-term care. Current practices often rely on non-specific symptoms, rather than specific genitourinary symptoms, to aid in the decision to obtain a urine culture. The literature does not support this practice due to the high prevalence of asymptomatic bacteriuria among long-term care patients, which does not have adverse outcomes when untreated. Antibiotics do not eradicate asymptomatic bacteriuria and place patients at risk of adverse reactions and increased risk of multi-drug resistant organisms. This clinical improvement project applied the Loeb criteria in two long-term care facilities to reduce the …

High Fidelity Simulation Experience And Development Of Clinical Judgment: Recent Graduate Nurses’ Reflections, Martha Kay Lawrence

Theses and Dissertations

Introduction: Nurse faculty endeavor to educate future nurses who are able to effectively transition to competent practice after graduation. Shrinking clinical resources and shortages of qualified clinical faculty have contributed to the increasing utilization of high fidelity simulation (HFS) as a substitute for and enhancement of clinical practice in nursing education. The growing body of HFS research documents both student and faculty satisfaction and increased student self-confidence and self-efficacy. A significant gap in the literature is the lack of research on the translation of knowledge gained in HFS to practice. The aim of this research was to investigate recently graduated …

Motivators Impacting Employment After Disability Due To Injury Or Chronic Illness, Damion B. Jackson

Theses and Dissertations

Unemployment caused by the need to treat and recover from a disability due to injury or chronic illness is a common phenomenon. Research illustrates that absence from work damages organizational growth, employers, and employees. Employees often experience problems with their mental and physical health that affect their social identity and function. In the context of the recognized value of employment for human health and well being, policy-makers have implemented various programs and approaches to encourage re-employment of those unemployed due to required treatment and rehabilitation. Many of the approaches are driven by financial incentives to encourage individuals to rejoin the …

Perceptions Of The Nursing Faculty Shortage: A Case Study Of One College’S Adjunct Faculty’S Perception Of Doctoral Education, Donna Shaw

Theses and Dissertations

The problem addressed in this qualitative case study was the nurse faculty shortage and associated consequences of a shortage of nurses available to care for an aging population with multifaceted healthcare needs in a complex healthcare system. Because of the nurse faculty shortage, numerous qualified applicants are unable to enroll in nursing programs across the country. One of the key reasons for the nurse faculty shortage is a lack of nurse educators with doctorate degrees to fill the vacant positions. Adjunct nursing faculty were interviewed to ascertain their perceptions about the nurse faculty shortage and messages conveyed by full-time nurse …

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes, Duaa I. Aljabri

Theses and Dissertations

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain …