Medicine and Health Sciences Commons^™

An Evidence-Based Approach To Determine The Feasibility And Sustainability Of A Support Group For Vulnerable Populations With Diabetes In A Free Health Clinic, Shawn Hillman

Doctoral Dissertations

Purpose: People living with diabetes require the appropriate resources, education, and support to avoid long-term complications. Vulnerable people with diabetes are often lacking these vital components, resulting in higher rates of complications, and decreased quality of life. A support group for diabetes in a free health clinic is an effective venue to provide these resources. This project determined the feasibility and factors leading to the potential for sustainability of a diabetes support group for a vulnerable population in West Michigan by implementing a pilot support group. Determinants of feasibility and sustainability were participant and professional feedback, perceptions of value and …

“You Came To Not Normal Land”: Nurses' Experience Of The Environment Of Disaster: A Phenomenological Investigation, Stasia Elizabeth Ruskie

Doctoral Dissertations

Previous research suggests US nurses are unprepared for disaster, and suffer from adverse psychosocial outcomes following their disaster response. Current disaster preparedness focuses on providing hospital-centric trauma and acute care in fully resourced Western conditions, and does not include the environmental realities of the disaster setting. This study utilized an existential phenomenological approach to explore the meaning of the nurse’s experience of the disaster environment. Eleven nurses with broad disaster expertise and training levels participated in this research. The essence of their disaster experiences can be summed up by the central theme of “You came to not normal land.” Four …

Health Assessment Of Two Reintroduced Populations Of American Martens (Martes Americana) In Michigan, Maria Catherine Spriggs

Doctoral Dissertations

The American marten (Martes americana) was extirpated from Michigan during the early-20th century due to loss of vast areas of mature conifer forest and unregulated trapping. The species was reintroduced into the Upper Peninsula (UP) and Northern Lower Peninsula (NLP) during the mid-20th century. While the American marten population in the UP has grown and is doing well, the population in the NLP has been less successful. The reasons for the limited success of the NLP population are unknown, but may include lack of suitable habitat, limited reproductive success, poor genetic diversity, disease, or negative environmental impacts. American …

Characterization Of Hypothalamic Neuropeptides In Mammalian Reproduction, Valeria Tanco

Doctoral Dissertations

Understanding of regulation of reproduction at the level of the brain changed dramatically with the discovery of reproductive neuropeptides. To date there have been no studies to characterize the distribution of reproductive neuropeptides in the bovine hypothalamus at different stages of the estrus cycle or to determine the physiological effects of peripheral administration of Gonadotropin inhibiting hormone (GnIH) in intact female cattle and ovariohysterectomized bitches.

The goal of the first study was to determine distribution and connectivity of kisspeptin, dynorphin, and GnIH in the hypothalami of sexually mature female cattle during the estrous cycle. To this end, hypothalami of female …

Targeting Early Events In Herpetic Stromal Keratitis, Fernanda Giménez

Doctoral Dissertations

Herpetic stromal keratitis [HSK] is an immunoinflammatory corneal lesion caused by Herpes simplex virus type 1 [HSV] infection. SK is usually the consequence of virus reactivation from latency in the trigeminal ganglion. Studies in animal models have revealed that SK lesions are orchestrated mainly by CD4+T cells that infiltrate the corneal stroma. However, prior to this immunoinflammatory phase, multiple events occur that set the stage for subsequent pathology. These include production of cytokines and chemokines, infiltration of innate immune cells and neovascularization of the avascular cornea.

The first part of this dissertation reviews literature regarding the current understanding of human …

Examining The Relationships Between Gratitude And Readiness For Self-Directed Learning In Undergraduate Nursing Students, Kellee Renee Vess

Doctoral Dissertations

The purpose of this study was to explore the relationships between gratitude and readiness for self-directed learning among nursing students enrolled in a four-year baccalaureate nursing program. For this study a sample of 59 nursing students were selected from a four-year baccalaureate nursing program, situated in a private, faith-based college in the Southeast United States. During data collection, participants were asked to complete the Gratitude 6-item questionnaire [GQ-], the 40-item Self-Directed Learning Readiness Scale for Nursing Education [SDLRS-NE], and two demographic questions (i.e., age and class rank). Using both parametric and nonparametric statistics, this study examined eight research questions, and …

The Metastatic Receptor Status Impact On First-Line Treatment Plans And Outcomes For Recurrent Metastatic Breast Cancer, T. Allen Pannell

Doctoral Dissertations

Background: For more than two decades, breast cancer researchers have studied the benefits, risks and clinical importance of testing the receptor status of metastatic tumors. While there is a growing consensus that the status should be re-tested and under what circumstances that re-testing should occur, there is little to no evidence that utilizing test results for metastatic tumor receptor status improves the clinical outcomes of patients. In fact, there is evidence that changes to treatment plans based on this re-testing can be harmful to patient outcomes.

Objective: This dissertation evaluates the current state of evidence related to altering patient treatment …

Experiences Of Newly Licensed Registered Nurses Who Stay In Their First Jobs, Lisa D. Kirkland

Doctoral Dissertations

Most newly licensed registered nurses go to work in acute care hospitals, which means they enter an increasingly complex healthcare environment where they experience staffing shortages, high nurse-patient ratios, and workplace violence. The purpose of this study is to attempt to understand the experiences of newly licensed registered nurses who have endured the early years of bedside hospital nursing and continue to work in their first nursing job. The existential phenomenological philosophy of Merleau-Ponty serves as the guiding framework for this qualitative research study. Following IRB approval, criterion and snowball sampling were used to recruit newly licensed registered nurses who …

Brown And Beige Adipocytes: Effects Of Inflammation And Nutritional Intervention, Jiyoung Bae

Doctoral Dissertations

Recent findings of brown adipocytes and brown-like or beige adipocytes, capable of dissipating energy as heat, in adult humans have promised new hope for obesity treatment and prevention. Understanding of the regulation of brown and beige adipocytes will provide novel strategies to reach the goal. Pattern recognition receptors (PRR) are responsible for inflammation in adipose tissue, which leads to adipose dysfunction and obesity associated chronic diseases. It has been shown that PRR activation induces inflammation, leading to insulin resistance in white adipocytes and white adipose tissue (WAT). However, the roles of PRR activation in brown adipocytes and brown adipose tissue …

Epidemiology Of Select Species Of Filarial Nematodes In Free-Ranging Moose (Alces Alces) Of North America, Caroline Mae Grunenwald

Doctoral Dissertations

North American moose (Alces alces) are a culturally and economically valued species. Recent population declines raise concern for the survivability of this natural resource. The Minnesota population has experienced the most dramatic decline, with a 60% loss in total numbers since 2006. Nematode parasites, particularly some species of filarids, are important pathogens of moose and could be contributing to morbidity and mortality. This study investigates the eco-epidemiology of two filarial parasites of moose: Rumenfilaria andersoni and Elaeophora schneideri. By surveying cervid species from six U.S. states, we discovered R. andersoni was present in moose from all sample locations …

The Chemopreventive Effect Of Polymethoxyflavones: Targeting The Colorectal Cancer Stem Cells, Fei Xu

Doctoral Dissertations

Among all the cancers, the death rate of colorectal cancer is one of the highest. Evidence from both murine xenograft model and human trials have shown cancer stem cells (CSCs) are responsible for the initiation, metastasis and recurrence of multiple cancers therefore targeting colorectal CSCs would be a promising chemo-preventive/ therapeutic strategy. Polymethoxyflavones including nobiletin (NBT) and 5-demethylatednobiletin (5DN) are exclusively found in citrus peels and have been shown to have anti-cancer effects. Our previous studies in the biotransformation and tissue distribution of NBT and 5DN have shown that in order to fuller evaluate the biological impact of those two …

Economics Of Fixed-Dose Combination Drugs Approved In The United States, Jing Hao

Doctoral Dissertations

Patent is the most important form of intellectual property protection for new drugs. Patent extension and market exclusivity currently serve as major regulatory incentives to promote new drugs. Combination drug, or fixed-dose combination (FDC) are formulations that contain two or more active ingredients in a single pill. FDCs, especially combinations of singe drugs that are already in the market, are common strategy for brand-name drug companies to extent the patent and exclusivity life. The substitution of single drug products that soon have generic alternatives with newer, brand-name combinations lead to potential increases in pharmaceutical expenditures and raises concerns on economic …

Molecular Mechanisms Underlying The Muscle Response To Exercise-Induced Muscle Damage In Chronic Cigarette Smokers, Nina Moore

Doctoral Dissertations

Smoking increases risk for musculoskeletal injury and protracts healing. The underlying mechanisms have not been explored, yet dysregulated inflammatory responses may contribute. To investigate these risks, Study 1 of this dissertation monitored typical responses to muscle damaging eccentric contractions (ECC) in smokers and nonsmokers. Smokers experienced greater muscle fatigue both during and immediately after ECC and greater delayed hyperalgesia, a phenomenon known as delayed onset muscle soreness (DOMS), than did non-smokers. DOMS (driven by inflammation) peaks 48h after ECC, when there is a shift from pro- to anti-inflammatory signaling; thus I chose to investigate this time further in smokers. The …

Engineering Novel Detection And Treatment Strategies For Bacterial Therapy Of Cancer, Jan T. Panteli

Doctoral Dissertations

Finding and treating cancer is difficult due to limited sensitivity and specificity of current detection and treatment strategies. Many chemotherapeutic drugs are small molecules that are limited by diffusion, making it difficult to reach cancer sites requiring high doses that lead to systemic toxicity and off-target effects. Tomographic detection techniques, like PET, MRI and CT, are good at identifying macroscopic lesions in the body but are limited in their ability to detect microscopic lesions. Biomarker detection strategies are extremely sensitive and able to identify ng/ml concentrations of protein, but are poor at discriminating between healthy and disease state levels due …

Impact Of A Preschool Workplace Intervention On Classroom Teachers’ Physical Activity Levels And Quality Of Life, Ogechi O. Nwaokelemeh

Doctoral Dissertations

PURPOSE: To examine the feasibility and efficacy of a three-month, cluster-randomized workplace PA intervention on PA levels and wellbeing measures in preschool classroom teachers. METHODS: Ten preschool centers were randomized into two groups; short-bouts of structured PA (SBS-PA, n=5) or traditional unstructured PA (TRAD-PA, n=5). The SBS-PA intervention consisted of 10-minute structured, teacher-led PA routines implemented within the classroom setting, followed by 20 minutes of unstructured playtime. The TRAD-PA intervention consisted of supervised 30-minute of unstructured free playtime. Both interventions were implemented during the morning and afternoon designated gross-motor playtime for 30 min/session, five days/week for three months. Participants’ …

Impact Of Exercise During Pregnancy On Maternal Outcomes Among A High-Risk Population, Carrie Nobles

Doctoral Dissertations

Prior observational research has suggested an association between increased physical activity during pregnancy and improved maternal outcomes including a reduced risk of gestational diabetes mellitus (GDM). Despite this, randomized controlled trials of prenatal exercise are sparse and only one had been conducted in a high-risk population. Therefore, we examined the association between physical activity during pregnancy and risk of adverse pregnancy outcomes in the Behaviors Affecting Baby and You (B.A.B.Y.) Study, a randomized controlled trial of a 12-week exercise intervention among a diverse group of inactive pregnant women at high-risk for GDM. The first project examined the effect of participation …

Factors Affecting The Quality Of Services Provided To Female Survivors Of Sexual Violence In Nairobi, Kenya: Perspectives From Health Practitioners, Leso Munala

Doctoral Dissertations

This study examined the experiences of practitioners facing the challenges of providing services to female survivors of sexual violence in Kenya. Specifically, the study examined how health practitioners understand their experience in responding to the needs of sexual violence survivors, how they view these women, in what ways they are helping them to heal, and in what ways the health system fails to help these women. In-depth interviews were conducted with 28 health practitioners, from eight post-rape care facilities located in Nairobi, Kenya. The questions focused on the practitioners’ workload, challenges and rewards, the emotional impact of working with survivors, …

Mimicking The Arterial Microenvironment With Peg-Pc To Investigate The Roles Of Physicochemical Stimuli In Smc Phenotype And Behavior, William G. Herrick

Doctoral Dissertations

The goal of this dissertation was to parse the roles of physical, mechanical and chemical cues in the phenotype plasticity of smooth muscle cells (SMCs) in atherosclerosis. We first developed and characterized a novel synthetic hydrogel with desirable traits for studying mechanotransduction in vitro. This hydrogel, PEG-PC, is a co-polymer of poly(ethylene glycol) and phosphorylcholine with an incredible range of Young’s moduli (~1 kPa - 9 MPa) that enables reproduction of nearly any tissue stiffness, exceptional optical and anti-fouling properties, and support for covalent attachment of extracellular matrix (ECM) proteins. To our knowledge, this combination of mechanical range, low …

Recognition And Comprehension Of Speech In Noise In School-Aged Children With Unilateral Hearing Loss, Amanda M. Griffin

Doctoral Dissertations

Sentence recognition and auditory comprehension abilities of young adults with normal hearing (NH) and school-age children with NH and unilateral hearing loss (UHL) were tested in a mixed design. In Experiment 1, subjects’ sentence recognition abilities were measured in the presence of speech spectrum noise (SSN) and two-talker child babble (TTB) in co-located and spatially-separated target and masker configurations. In all conditions, reception thresholds for sentences (RTS) improved with age from six-to 12 years. Speech spectrum noise proved to be a more effective masker than TTB in all listening conditions, suggesting subjects were able to take advantage of temporal and …

Injection Drug Users’ Perceptions Of Received Nursing Care: A Case Study, Kimberly Dion

Doctoral Dissertations

The primary aim of the exploratory case study was to explore the injection drug users’ experience with received nursing care while hospitalized on a medical unit. Data were gathered using semistructured interviews with nine injection drug users at two needle exchange services. Five men and four women were interviewed for 27–90 minutes. Travelbee’s (1971) interpersonal nursing model served as the theoretic framework for this study. Data were analyzed through the process of coding, pattern matching, and the convergence of emerging themes. For the rival case, the theme of Understanding Addiction emerged. For the comparison cases, the overarching themes of Marginalization …

Guidelines For Scheduling In Primary Care: An Empirically Driven Mathematical Programming Approach, Hyun Jung Alvarez Oh

Doctoral Dissertations

Primary care practices play a vital role in healthcare delivery since they are the first point of contact for most patients, and provide health prevention, counseling, education, diagnosis and treatment. Practices, however, face a complex appointment scheduling problem because of the variety of patient conditions, the mix of appointment types, the uncertain service times with providers and non-provider staff (nurses/medical assistants), and no-show rates which all compound into a highly variable and unpredictable flow of patients. The end result is an imbalance between provider idle time and patient waiting time. To understand the realities of the scheduling problem we analyze …

The Effects Of Electronic Treatment Reminder Cues On Relapse Prevention, Kathrin Ritter

Doctoral Dissertations

Substance use is highly prevalent in the United States, and although treatments designed to reduce substance use have shown promise, relapse rates between 40% and 70% following treatment have been reported in recent studies. Given the high rate and chronicity of relapse following substance abuse treatment, conducting research aimed to develop techniques to lower the risk of relapse following treatment is imperative. A promising option to reduce relapse is to use treatment reminder cues, or cues that are salient features of the treatment environment that can be used to extend the effects of treatment into non-treatment settings. This study investigated …

Developing An Optimal Model For Infant Home Visitation, Isaac Atuahene

Doctoral Dissertations

The United States, Great Britain, Denmark, Canada and many other countries have accepted home visitation (HV) as a promising strategy for interventions for infants after births and for their mothers. Prior HV studies have focused on theoretical foundations, evaluations of programs, cost/benefit analysis and cost estimation by using hospital/payer/insurance data to prove its effectiveness and high cost. As governments and private organizations continue to fund HVs, it is an opportune time to develop and formulate operations research (OR) models of HV coverage, quality and cost so they might be used in program implementation as done for adult home healthcare (HHC) …

Evaluating The Effects Of Standardized Patient Care Pathways On Clinical Outcomes, Anna V. Romanova

Doctoral Dissertations

The main focus of this study is to create a standardized approach to evaluating the impact of the patient care pathways across all major disease categories and key outcome measures in a hospital setting when randomized clinical trials are not feasible. Toward this goal I identify statistical methods, control factors, and adjustments that can correct for potential confounding in observational studies. I investigate the efficiency of existing bias correction methods under varying conditions of imbalanced samples through a Monte Carlo simulation. The simulation results are then utilized in a case study for one of the largest primary diagnosis areas, chronic …

Newly Licensed Registered Nurses' Experiences With Clinical Simulation, Carrie Ann Bailey

Doctoral Dissertations

The purpose of this study was to understand how new graduate nurses perceive the value of simulation in making the transition into professional practice. This study will use a descriptive qualitative approach with a sample of first year nurses. Kolb’s Experiential Learning Model serves as this study’s conceptual framework. For the current study, the sample consisted of 10 newly graduated, female nurses with less than one year of experience working in the hospital setting were interviewed. Data analysis included interviews and transcription by the researcher. Finally, participants were asked about themes to increase rigor. Four themes emerged from this research: …

A Cyberbullying Needs Assessment In A Middle School Population: Identifying A Direction For Nurses, Ashley M. Eggleston

Doctoral Dissertations

Cyberbullying is a fairly new phenomenon that most adolescents will experience or be exposed to during their lifetime. It produces devastating outcomes on those who are victims and perpetrators of cyberbullying. There is a limited amount of research regarding the prevention of cyberbullying. The evidence that is available is mostly exploratory in nature. Currently, the literature recommends conducting a needs assessment to validate the problem, raise awareness, and identify potential solutions that are specific to a population and/or setting. Therefore, the purpose of this scholarly project was to administer a cyberbullying needs assessment at a local west Michigan middle school. …

Population Modeling For Resource Allocation And Antimicrobial Stewardship, Jason Bintz

Doctoral Dissertations

This dissertation contains two types of population models with applications in conservation biology and epidemiology. In particular, it considers models for resource allocation and antimicrobial stewardship.

In a population model with a parabolic differential equation and density dependent growth, we study the problem of allocating resources to maximize the net benefit in the conservation of a single species while the cost of the resource allocation is minimized. The net benefit is measured in terms of maximizing population abundance and the goal of maximizing abundance is divided between the goal of maximizing the overall abundance across space and time and the …

A Process Improvement Toolkit To Guide The Attainment Of Meaningful Use Stage 2 Requirements, Katie M. Alfredson

Doctoral Dissertations

Healthcare is evolving. Reimbursement is transitioning to a model based on quality and patient outcomes. To remain relevant and survive this transition, providers of care must adapt and implement new models of care delivery that account for these changes. This toolkit was created as a deliverable of a Doctor of Nursing Practice dissertation that explored a successful primary care delivery model of a Patient-Centered Medical Home that utilized an interdisciplinary team approach that included nurses. Through this model high quality care was delivered to achieve desired outcomes, specifically, successful attestation for Stage 2 of the Meaningful Use Incentive Program during …

The Evaluation Of Select Lifestyle Behavior Modification Following Participation In A Comprehensive Weight Management Clinic, Jennifer L. Bowling

Doctoral Dissertations

Over the last decades, obesity in the United States has reached epidemic proportion. Obesity rates have nearly doubled since 1960 when 43% of the United States population was overweight or obese and 1% was extremely obese. In 2012, approximately 69% of the US population was overweight or obese while 6.3% were extremely obese. Obesity rates are expected to progressively increase; therefore, interventions and guidelines are imperative in order to reduce the long term health risks of the Nation and to reduce overall health care costs (National Institute of Health [NIH], 2012).

Obesity increases morbidity resulting from associated hypertension, cardiovascular disease, …

An Interdisciplinary Team Approach To The Patient-Centered Medical Home As A Means Of Meeting Meaningful Use Stage 2 Requirements, Katie M. Alfredson

Doctoral Dissertations

In an attempt to address the shortcomings of the current U.S. healthcare system, reimbursement structure is changing from fee-for-service to a value-based model. This requires drastic change in how care is delivered. Therefore, care delivery models and reimbursement incentive programs are evolving to promote advancements in care delivery. This project examined an interdisciplinary team model utilized at a rural, privately owned practice that is a Patient Centered Medical Home (PCMH). This practice has incorporated unique structures and processes to attain Stage 2 Meaningful Use requirements in the first year attesting for this stage became available as a means of addressing …