Medicine and Health Sciences Commons^™

Improving The Diagnostic Accuracy Of Failure-To-Rescue, Amelia Marie Joseph

Theses and Dissertations

The ability to successfully rescue patients from complications has been shown to be a good measure of quality care processes in hospitals. Failure-to-rescue (FTR) has been defined using secondary International Classification of Disease (ICD-9 CM) codes. Studies of FTR using these codes have demonstrated satisfactory accuracy when compared to clinical events documented in the medical record. However, a subset of the original codes for FTR, thought to be sensitive to nursing care, have failed to show the same level of accuracy. This study examined the possibility of using clinica lpredictors to identify failure-to-rescue.

Secondary analysis of a previous dataset was …

Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation And Measurement Issues In Rural Pakistan, Zaeem Haq

Theses and Dissertations

Appropriate nutrition and psychosocial stimulation during the first three years of life can have long-lasting effects on a child's health and development. However, not all children in the world receive adequate nutrition and psychosocial stimulation during this period. There has been enormous interest in developing the evidence on the most effective ways of implementing and assessing early childhood development (ECD) promotion interventions in resource poor settings. Despite the interest, the integration of ECD interventions into pre-existing public health programs, and assessment of these interventions in extended family, rural household environment have not been addressed.

The dissertation research presented here was …

Emergency Department Triage Acuity Ratings: Embedding Esi Into The Electronic Medical Record, Candace Whitfield

Theses and Dissertations

A need for improvement in the triage process was identified in the ED of a southeastern healthcare facility. Lewin's Change Theory guided the implementation of an evidence-based quality improvement project (QIP) to improve the efficiency of the triage process using and embedded Emergency Severity Index (ESI) triage acuity-level assistant template in the electronic medical record (EMR). The target interventions were ED throughput times, the number of patients left without being seen (LWOT), and RN satisfaction.

Methods included the implementation of education interventions for all ED RNs that included a presentation, use of ESI algorithm badges for each nurse, and weekly …

The Effect Of Radiation On Myofiber Properties In Mouse Skeletal Muscle, Dennis K. Fix

Theses and Dissertations

Radiotherapy has been proven as an effective and necessary treatment for cancer. The dose given is dependent on cancer type and location. It has been previously established that skeletal muscle is the most radiation tolerant tissue in the body. With that being said there is a current gap in the literature that is missing the effect of radiation doses on the histological properties of skeletal muscle. The overall purpose of this study is to determine the effect that a single unfractionated dose of 16Gy radiation has on histological properties of myofibers when compared to 4 fractionated doses of 4Gy . …

Postnatal Depression In Mexico: Healthcare Provider Conceptualizations And Policies In The Public Health Sector, Jean Marie Sims Place

Theses and Dissertations

Background: The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) highlight education and training for healthcare providers and the development of a policy framework as core strategies to address maternal mental health in low- and middle-income countries. This research critically examines these strategies with respect to postnatal depression in Mexico. The research 1) addresses how healthcare providers in Mexico conceptualize postnatal depression, and 2) assesses the policies that exist in Mexico regarding postnatal depression, which will inform the next steps for policy development. The research informs appropriate healthcare provider education and training, as well as the next …

Narrative Discourse In Aphasia: Main Concept And Core Lexicon Analyses Of The Cinderella Story, Emily Patricia Dillow

Theses and Dissertations

Discourse is a highly individualized and complex speech act essential for effective communication in daily life. Individuals with language disorders demonstrate impaired narrative ability and a resultant decline in functional communication (Webster, Franklin, & Howard, 2007). Discourse analysis is often time-consuming and impractical for everyday clinical use. Most informative discourse measures require specialized training to perform and are time-consuming. A clinically practical measurement is lacking. Standardized core lexicon and main concept lists for discourse tasks could allow clinicians to efficiently assess discourse skills and predict activity and participation limitations. This study presents the development and application of a core lexicon …

Race, Ethnicity, And Differential Perceptions Of Sexual Victimization (Assault), Kaleea Regina Lewis

Theses and Dissertations

The purpose of this pilot study is to ascertain how a sample of female college students perceives a hypothetical victim of a fabricated sexual assault. Participant perceptions of the sexual assault were explored through three distinct parameters: (1) victim responsibility attributes, (2) levels of trauma suffered due to the experience, and (3) levels of social support. This study addressed the two following research questions: (1) how does the hypothetical sexual assault victim's race and ethnicity affect how the study parameters are assessed and (2) how do participants perceive a hypothetical sexual assault victim, when presented in different races and ethnicities, …

The Impact Of Imprecision In Hcv Viral Load Test Results On Clinicians’ Therapeutic Management Decisions And On The Economic Value Of The Test, Roberta M. Madej

Theses and Dissertations

Clinical laboratory test results are integral to patient management. Important aspects of laboratory tests’ contributions are the use of the test information and the role they have in facilitating efficient and effective use of healthcare resources. Methods of measuring those contributions were examined using quantitative HCV RNA test results (HCV VL) in therapeutic management decisions as a model. Test precision is important in those decisions; therefore, the clinical use was evaluated by studying the impact that knowledge of inherent assay imprecision had on clinicians’ decisions. A survey describing a simulated patient at a decision point for HCV triple-combination therapy management …

The Ticking Of The “Biological Clock”: Worry About Future Fertility In Nulliparous Women, Karen E. Kersting

Theses and Dissertations

Abstract

Title: The Ticking of the “Biological Clock”: Worry about Future Fertility in Nulliparous Women

By: Karen Kersting, M.A., M.S.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University.

Virginia Commonwealth University, 2013.

Major Director: Kathleen M. Ingram, J.D., Ph.D.

Associate Professor of Psychology

Department of Psychology

Modern women are waiting until later in their lives to have children than women of previous generations, a trend influenced by a number of factors including financial stability, dating norms, and career goals and responsibilities. As women age, their fertility may decline …

Prevalence Of Anti-Diabetic And Antilipidemic Medications In Children And Adolescents Treated With Atypical Antipsychotics In A Virginia Medicaid Population, Della Varghese

Theses and Dissertations

Objective: To determine if the prevalence of anti-diabetic and antilipidemic medication use among children treated with atypical antipsychotics is higher than those not treated with antipsychotics. Methods: Virginia Medicaid beneficiaries (2-17 years) continuously enrolled from August 1, 2010 to July 31, 2011 with at least two prescription claims for atypical antipsychotics were the exposed group. All other subjects during the study period were the non-exposed group. Prevalence of anti-diabetic and antilipidemic medication use in both groups were computed and compared using Chi-square test (α=0.05). Results: A total of 299,593 and 4,922 subjects were identified as the non-exposed and exposed groups, …

Early Adolescent Nicotine Exposure Has Long-Lasting Effects On Cocaine-Induced Behaviors In Mice, Mai Alajaji

Theses and Dissertations

Nicotine is one of the most commonly used drugs among adolescent populations. Given the fact that adolescence is a unique developmental stage, during which nicotine has long-term effects on future drug-taking behavior, it is essential to understand how early exposure to nicotine during adolescence may affect the abuse liability of other drugs. We hypothesize that repeated exposure to low doses of nicotine in adolescence induce age-specific enhancement of the rewarding effects of several drugs of abuse in the conditioned place preference (CPP) test. Furthermore, we predict that these changes in behavioral responses are mediated by nicotine-induced brain region-specific increases in …

Kinetics And Mechanisms Of Accumulation For Liposomal Ciprofloxacin Into Rat Alveolar Macrophages, Sayeed Mossadeq

Theses and Dissertations

The kinetics and mechanism of accumulation for liposomal ciprofloxacin (Lipo-CPFX) into the rat alveolar macrophage NR8383 cells were studied in vitro, in comparison to unformulated ciprofloxacin (CPFX). Upon incubation with CPFX or Lipo-CPFX, cellular drug accumulation was determined from the cell lysates or efflux was from the extracellular media by fluorescence-HPLC. The accumulation for Lipo-CPFX reached the asymptotic values at ≥ 2 hours, which was a result of uptake and efflux. The uptake appeared to be due to liposomes, mediated via cellular energy-independent mechanism like lipid fusion. In contrast, the efflux appeared to be due to ciprofloxacin, partly cellular energy-dependent, …

Cannabinoid Modulation Of Hiv-1 Tat-Stimulated Adhesion Of Macrophage-Like Cells To The Extracellular Matrix, Johnathan Drevik

Theses and Dissertations

HIV-Associated Neurocognitive Disorders (HANDs) are becoming one of the largest problems in patients infected with HIV-1. The ability of infected cells such as monocytes and microglial cells to act as viral reservoirs causes extreme inflammation in the CNS and has led to several different types of neurocognitive problems. Specifically these HIV-1 infected monocytes are able to secrete inflammatory factors such as the regulatory protein Tat which acts as a chemoattractant for monocytes while also promoting the adhesion of leukocytes to the extracellular matrix (ECM). We have shown that one of the major features of the Tat protein is that it …

In Vitro Lung Epithelial Cell Transport And Anti-Inflammatory Activity For Liposomal Ciprofloxacin, Ruba Darweesh

Theses and Dissertations

Liposomal ciprofloxacin (Lipo-CPFX) is being developed for inhalation, with a goal of sustaining the therapeutic activity, compared to unformulated ciprofloxacin (CPFX). However, the kinetics and mechanism of its sustained local lung retention and pharmacological activity are yet to be fully characterized. This project hypothesized that Lipo-CPFX enables slower and sustained lung epithelial transport and uptake, compared to CPFX, thereby producing prolonged local pharmacological actions. The human bronchial epithelial Calu-3 cells were used as monolayers to characterize the kinetics and mechanism of transport and/or uptake, and to assess the effects of such slow kinetics for Lipo-CPFX on its inhibition against lipopolysaccharide …

Regulation Of The Mouse And Human Β-Globin Genes By Krüppel Like Transcription Factors Klf1 And Klf2, Yousef N. Alhashem

Theses and Dissertations

Krüppel-like factors KLF1 and KLF2 are closely related transcription factors with three zinc finger domains in their carboxy-termini. KLF1 (erythroid Krüppel-like factor, or EKLF) plays essential roles in embryonic and adult erythropoiesis. KLF2 is a positive regulator of the mouse and human embryonic β- globin genes. KLF1 and KLF2 have overlapping roles in embryonic erythropoiesis, as demonstrated using single and double knockout (KO) mouse models. Ablation of the KLF1 or KLF2 gene causes embryonic lethality, and double KO embryos are more anemic and die sooner than either single KO. We have shown that KLF1 and KLF2 positively regulate the human …

Noun Clauses In Clinical Child Language Samples, Christine Beate Scoville

Theses and Dissertations

Noun clauses are grammatical constructions that are of relevance both to typical language development and impaired language development. These clauses have been part of published techniques for the clinical analysis of language samples, and computer software for the automated analysis of clinical language samples has attempted to identify noun clauses, with limited success. The present study examined the development and clinical use of noun clauses as well as the automated identification of these clauses. Two sets of language samples were examined. One set consisted of 10 children with specific language impairment (SLI) whose age ranged from 7;6 to 11;1 (years;months), …

From Linkage To Gwas: A Multifaceted Exploration Of The Genetic Risk For Alcohol Dependence, Amy Adkins

Theses and Dissertations

Family, twin and adoption studies consistently suggest that genetic factors strongly influence the risk for alcohol dependence (AD). Although the literature supports the role of genetics in AD, identification of specific genes contributing to the etiology of AD has proven difficult. These difficulties are due in part to the complex set of risk factors contributing to the development of AD. These risk factors include comorbidities with other clinical diagnoses and behavioral phenotypes (e.g., major depression), physiological differences that contribute to the differences between people in their level of response to ethanol (e.g., initial sensitivity) and finally the large number of …

Text Messaging As Adjunct To Community Based Weight Management Program, Claudia Bouhaidar

Theses and Dissertations

Obesity ascending rates are still a public health priority. The primary aim of the study was to evaluate the effect of tailored text messages on body weight change in overweight and obese adults in a community based weight management program. A secondary aim was to detect behavioral changes in the same population. The study design was quasi-experimental with pre and posttest analysis, conducted over 12 weeks. A total of 28 participants were included in the analysis. Body weight, eating behaviors, exercise and nutrition self-efficacy, attitude toward mobile technology, social support and physical activity were assessed at baseline and at 12 …

The Economic Burden Of Opioid Poisoning In The United States And Determinants Of Increased Costs In Opioid Poisoning, Timothy Inocencio

Theses and Dissertations

Introduction: Opioid poisoning has been rapidly increasing in the past decade, and has been driven in large part due to increases in opioid prescribing. This has been accompanied by intervention efforts aimed at preventing and reversing opioid poisoning through naloxone prescription programs. Current literature have not quantified the economic burden of opioid poisoning. Understanding this information can help inform these efforts and bring light to this growing problem. In addition understanding various determinants of increased costs can help to identify the types of populations more likely to have greater costs. Main Objectives: The objectives are 1) to quantify the economic …

Medication-Related Problems Experienced By Patients During Transitions To Assisted Living, Deanna Flora

Theses and Dissertations

Medication reconciliation is a systematic and comprehensive review of medication regimens during care transitions aiming to prevent adverse drug events. Poorly executed transitions negatively impact patient welfare and cause financial burden. Medication-related problems (MRPs) experienced during transitions to an assisted living facility (ALF) were evaluated. Data was collected from pharmacy records for transitions to an ALF over three months, including demographics, medications, potentially inappropriate medications, and MRPs. MRPs were categorized and summarized using descriptive statistics. Forty-five patients (71% female) experienced 59 transitions. Average age was 85.6 years. Median length of stay away from the ALF was three days. There were …

Characterization Of The Expression Of The Intercellular Adhesin Locus In Staphylococcus Aureus, Jamie Brooks

Theses and Dissertations

Poly-N-acetylglucosamine (PNAG) is an important Staphylococcus aureus virulence factor. It is a major component of the extracellular polymeric matrix in biofilms, and contributes to resistance to the innate immune response. The proteins encoded in the icaADBC (intercellular adhesin) operon are responsible for PNAG production. Here, we present evidence of a new mechanism of phase variation for switching off PNAG production that involves slipped strand mutagenesis, along with further insight into the regulation and expression of the icaADBC operon. S. aureus strain MN8m (mucoid) is a spontaneous mutant of strain MN8 (non-mucoid). It is characterized by constitutive overproduction of PNAG, resulting …

The Role Of Megalin In The Transport Of Aminoglycosides Across Human Placenta, Amal Akour

Theses and Dissertations

Background: Intra-amniotic infections (IAIs) are common complications of labor and delivery. If inadequately treated, these infections can lead to significant morbidity and mortality in the mother and the fetus. Intrapartum aminoglycoside (AG) administration is recommended for the management of IAIs. AGs are known to cross the placenta and achieve bactericidal concentrations in fetal serum. However, the highest and most persistent fetal levels are achieved in renal tissue. So, the fetus may be vulnerable to the nephrotoxic effects of AGs. Megalin, a 600 kDaendocytic receptor, is responsible for the uptake of AGs into renal proximal tubular epithelial cells. This receptor is …

Diffuse Traumatic Axonal Injury Within The Visual System: Implications For Visual Pathway Reorganization, Jiaqiong Wang

Theses and Dissertations

Traumatic brain injury is a major health problem with much of its morbidity associated with traumatic axonal injury (TAI). To date, significant insight has been gained into the initiating pathogenesis of TAI. However, the specific anterograde and retrograde sequelae of TAI are poorly understood because the diffuse nature of TAI complicates data analysis. To overcome this limitation, we subjected transgenic mice expressing yellow fluorescent protein (YFP) within the visual system to central fluid percussion injury, and consistently generated diffuse TAI within the optic nerve that could easily be followed in the organized YFP positive fibers. We demonstrated progressive axonal swelling, …

Using Systematic And Engaging Early Literacy Instruction And Digital Books To Teach At-Risk Kindergarteners To Read Target Words, Audra Marie Hales

Theses and Dissertations

The purpose of this study was to examine the effects of using Systematic and Engaging Early Literacy (SEEL) intervention activities that incorporate digital books to teach kindergarteners to read. The study used a single-subject-multiple-baseline-across-behaviors design to compare kindergarten students' reading of comparable CVC words before and after intervention. Four students at-risk for reading difficulties were chosen for the study based on their performance on assessments and their teachers' recommendations. Students were divided into two dyads and received intervention three times a week for 25 minutes for approximately six weeks, or 18 total sessions. Baseline assessment data was collected prior to …

Ige Enhances B Cell-Derived Exosomal Induced T Cell Proliferation, Brooks Keith

Theses and Dissertations

For many years it has been known that the injection of antigen bound to an antibody leads to more than a 1000-fold increase in antigen specific antibody response. This observation holds true for IgE, which is dependent upon CD23 expression, as this enhancement is not present in mice deficient in CD23. It also has been shown that when mice are injected with IgE-antigen complexes also display an increase in antigen specific T cell proliferation. While there are published studies that demonstrate a role for B cell derived exosomes in the activation and proliferation of T cells, none have focused upon …

Perceived Stress And Surgical Wound Cytokine Patterns, Valentina Lucas

Theses and Dissertations

Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed …

Role Of Tyrosyl-Dna Phosphodiesterase (Tdp 1) On Repair Of 3′-Phosphoglycolate (3′- Pg) Terminated Dna Double-Strand Breaks (Dsbs) And In Response To Oxidative Stress, Tong Zhou

Theses and Dissertations

DNA DSBs are most toxic to cells because they can lead to genomic rearrangements and even cell death. Most DSBs induced by ionizing radiation or radiomimetic drugs such as calicheamicin and bleomycin, bear 3′-phosphate or 3′- PG moieties that must be removed to allow subsequent gap filling and ligation. DSBs can be repaired by two main pathways: the homologous recombination (HR) pathway and the non-homologous end-joining (NHEJ) pathway, NHEJ is the primary repair pathway in mammalian cells. While HR repairs single strand breaks (SSBs) or DSBs accurately by using an undamaged copy of the sequence mostly at late S phase …

Costs And Use Of Oral Anti-Cancer Medications Among Senior Medicare Part D Beneficiaries, Nantana Kaisaeng

Theses and Dissertations

Oral cancer drugs are branded and expensive medications that generally do not have generics available. The restrictions of the Medicare Part D program, including the coverage gap and high cost-sharing, and the high cost of oral chemotherapy may lead to patients’ non-adherence to medication. Few studies have examined the cost and utilization of oral anti-cancer medications. This study will be the first to examine the costs associated with the use of oral anti-cancer medications and the impact of cost-sharing and type of prescription drug subsidy on medication discontinuation in the Medicare Part D elderly population. Objectives: To determine the usage …

Investigating A Model For Fetal Alcohol Damage In Caenorhabditis Elegans, Lindsay Kondo

Theses and Dissertations

Alcohol use and abuse has many harmful effects, especially to children exposed prenatally, including fetal alcohol spectrum disorders (FASDs). The disabilities due to fetal alcohol exposure continue throughout life and cause major financial burdens to society. The molecular mechanisms underlying FASDs are not well understood. We have taken a genetic approach to characterize ethanol’s effect on changing a discrete cell fate decision during embryogenesis in the nematode, Caenorhabditis elegans (C. elegans). Our preliminary data suggest that ethanol can affect the development of AWC neurons, a pair of olfactory neurons in C. elegans. We suggest that lipids can protect AWC neurons …

"Being Certain": Moral Distress In Critical Care Nurses, Marian Baxter

Theses and Dissertations

Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.