Medicine and Health Sciences Commons^™

Central Activation Of Orl-1 Receptors In Heart Failure Models, Jeffrey Angell

Theses & Dissertations

Heart failure is a prevalent and debilitating disease associated with high morbidity and mortality rates worldwide and is the leading cause of death in the United States. While various therapeutic strategies have been developed and approved to manage heart failure, exploration of novel targets and mechanisms are essential for improving patient outcomes. This thesis investigates the therapeutic potential of the central activation of opioid receptor-like 1 (ORL-1) by nociceptin in a rodent heart failure model.

Furthermore, this study aims to elucidate the central mechanisms underlying nociceptin induced cardiovascular and renal effects in heart failure. This involves investigating neuronal pathways and …

The Importance Of Contrast Sensitivity, Color Vision, And Electrophysiological Testing In Clinical And Occupational Settings, Frances Silva

Theses & Dissertations

Visual acuity (VA) is universally accepted as the gold standard metric for ocular vision and function. Contrast sensitivity (CS), color vision, and electrophysiological testing for clinical and occupational settings are warranted despite being deemed ancillary and minimally utilized by clinicians. These assessments provide essential information to subjectively and objectively quantify and obtain optimal functional vision. They are useful for baseline data and monitoring hereditary and progressive ocular conditions and cognitive function. The studies in this dissertation highlight the value of contrast sensitivity, color vision, and cone specific electrophysiological testing, as well as the novel metrics obtained with potential practical clinical …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Medicare Shared Savings Performance: Three-Year Pandemic Analysis, Bryan Adams

Theses & Dissertations

The Centers for Medicare and Medicaid's (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality …

How To Collaborate And Not Just Coexist: An Explanatory Sequential Mixed Methods Study On The Impact Of A Physician And Nurse Interprofessional Education Program On The Development Of Early Career Pediatrician Communication Skills And Collaborative Behaviors Once In Practice, Elizabeth L. Wueste

Theses & Dissertations

Healthcare organizations are challenged to build and develop interprofessional (IP) teams capable of delivering effective patient care (Tang et al., 2018). Historically, these multiple professional roles are not formally educated together but are all expected to work in unison once they enter practice (El-Hanafy, 2018). This lack of relational foundation has led to age-old conflict between the physician and nurse roles on the care team (Stein et al., 1990). This conflict has been attributed to a lack of role definition or an overemphasis on hierarchical structures, poor communication, and the inability of physicians to collaboratively work with their nurse counterparts …

Nursing Students' Knowledge Of And Attitudes Towards Near-Death Experiences, Laura Lee Varela

Theses & Dissertations

Incidence of reported near-death experiences (NDEs) has increased over decades; however, they continue to be inappropriately pathologized or dismissed. These types of responses to disclosures of NDEs by patients can potentially lead to them having problems integrating the experience into their lives. The purpose of this study was to assess undergraduate nursing students’ levels of accurate knowledge of and attitudes towards NDEs and to determine the predictors of nursing students’ knowledge of and attitudes toward NDEs. Additionally, I explored the sources in which nursing students acquire NDE knowledge. I accomplished this by using a cross-sectional, correlational research study design. I …

U.S. Army Physician Assistant Retention: A Latent Class Analysis, Robert Greener

Theses & Dissertations

Introduction: Retaining employees is crucial to the success of organizations. While significant effort has been made to model employee retention, models have been unable to significantly predict retention. The purpose of this quantitative, non-experimental, cross-sectional study was to develop an improved employee retention model which could be used as a practical guide to improve employee retention. Materials and Methods: The study analyzed a survey created, implemented, and collected by the Statistical Cell at the U.S. Army Center of Excellence. In September of 2020, all 864 active-duty PAs were sent a link to the survey and 290 completed the survey, …

Basic And Applied Studies Of Human Visual Function: Implications For Visually Demanding Occupations, Julie Lovell

Theses & Dissertations

Color vision is a complex process providing important information about objects within our environment. Color vision deficiency either congenital or acquired can impact real world performance. Current working environments either require normal color vision or utilize color as a tool to highlight critical information. The use of color in the workplace provides several advantages. Hence, color vision screening is required for entry into professions and occupational certifications. Acquired color vision deficiency may also impact job performance requiring clinical screening. The present dissertation focused on the considerations outlined by the Commission on Behavior and Social Sciences when choosing a clinical test …

Effect Of Protein, Fat, And Both Protein And Fat On The Glycemic Response Of A High Glycemic Index Meal, Muhammed Taai

Theses & Dissertations

Research Focus: Elevated blood glucose (BG) levels from a diet high in refined carbohydrates, even in the absence of diabetes, may increase the risk for chronic diseases including cardiovascular disease, type 2 diabetes, and obesity. The purpose of this study was to determine if supplementation of a high glycemic load breakfast with protein, fat, or a combination of the two attenuates the glycemic response in non-diabetic subjects.

Research Methods: Thirteen healthy adults, age 24.7±4y, BMI 25.1±4.5 completed four trials, having fasted 8-12h for this randomized, double-blind crossover study.

Fasting BG was measured, then subjects consumed 2 slices of white …

Implementing The Patient-Centered Care Paradigm In An Academic Research Environment, Fernando Orgas

Theses & Dissertations

Research Focus. The healthcare landscape is transitioning from a provider-centered care model toward greater emphasis on patient-centered care (PCC). The shift to PCC reflects efforts to increase the quality of healthcare and the care experience. The current state of research within healthcare remains focused on how to provide high-quality and sound research that will bring new equipment, procedures, and verify strategies that may benefit healthcare globally. However, changes in the healthcare atmosphere bring a new perspective to research. How is the paradigm shift to patient-centered care implemented in an academic research environment? Does this holistic mindset fully cross into …

Affordable Care Act And Preventive Care Usage: A Mixed Method Analysis Of Cardiovascular Care, Brit Peek

Theses & Dissertations

It is a commonly held belief that access to health insurance affects the level of utilization of preventive care services, and thus plays a crucial role in the effective management of avoidable chronic illnesses, decreasing levels of premature mortality, and enabling individuals to live wholesome long lives. Based on this belief, among other goals, the Affordable Care Act (ACA) was designed to increase access to health insurance and related medical services for the population of the United States. This dissertation attempts to identify whether this belief is valid or not by testing whether the usage of preventive care changed between …

Preventive Healthcare Usage In The United States: Does Health Insurance Matter, Diane Rodriguez

Theses & Dissertations

The Centers for Disease Control in the United States has maintained that adults who avoid preventive care services are more likely to suffer from long term chronic diseases because they are not addressed or treated in a timely manner. Examining the effects of providing access to healthcare to uninsured adults and increasing preventive services can help in reducing chronic diseases and enable adults to live longer, healthier lives. The purpose of this study was to identify the relationship between the utilization of preventive health services and socioeconomic factors such as insurance status, race/ethnicity, household income, marital status, education, gender, age, …

Ozone Induced Effects On The Mammalian Visual System, Jordan Wetz

Theses & Dissertations

Research Focus. Millions of people who suffer from retinal disease live in air-polluted environments. The impact of the gaseous air pollutant ozone (O₃), a strong oxidant, on the retina is unknown. The aim of the present study is to compare the electroretinographic responses between control (no O₃ exposure) and O₃ -exposed rats and to better understand the effects of O₃ on retinal function.

Materials and Methods. Age-matched adult female rats were separated into two groups (N = 6), 3 control and 3 experimental. The experimental group was exposed to 0.4 ppm O₃ for …

Screening Of Crude Microalgal Extracts For Antimicrobial Activity, Patrick Matulich

Theses & Dissertations

Microbial biofilm associated infections are a significant threat to patients with medical devices and are partially responsible for the increased resistance seen in nosocomial infections. The biofilm chemical and physical properties restrict access of chemotherapeutic agents. Therefore, there is a need to enhance the antimicrobial effects of current chemotherapeutic agents. Microalgae live in competitive environments that include film-forming, opportunistic pathogens S. maltophilia and C. albicans. Extracts from 5 diverse species of microalgae were screened for antimicrobial enhancing effects against established biofilms with two different extraction solvents, 3:1 hexanes and isopropyl (HIPA) and 2-methyltetrahydrofuran (2-MTHF).

Three species, B. braunii, …

Nursing Leaders’ Ethical Decision-Making About Professional Boundaries And Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design, Pamela Scott

Theses & Dissertations

The purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ …

Early Oral Feeding After Bowel Resection, Jennifer Strang

Theses & Dissertations

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery.

Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients …

Primary Care-Related Emergency Department Use, Tiffany Wetz

Theses & Dissertations

Primary care-related emergency department use has become a focal point in the United States considering health reform and changes made to the delivery model and reimbursement mechanisms. Emergency departments serve as critical access points within the United States delivery system because important medical resources are made available for all members within the community. However, a gap in the literature exists due to a lack of consensus regarding factors that influence emergency department use for primary care-related health needs. The purpose of this study was to understand the relationship between demographic, social, economic, geographic, and need factors that influenced use of …

Dopamine Levels In The Brain Of Rat Models Of Human Rheumatoid Arthritis, Amelia Stinson

Theses & Dissertations

Research Focus. Rheumatoid arthritis (RA) is a chronic, debilitating, autoimmune disease that causes the destruction of bone tissue and the articular structures of joints. At least 30% of RA patient populations have cognitive impairment. Acidic dopamine (DA) is the principal neuroimmunotransmitter that links the central nervous system and peripheral nervous system together. The aim of the present study was to determine the levels of DA and its two acidic metabolites: 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in arthritic induced rats, and whether their levels vary across four different parts of the brain: amygdala (AMG), front cerebral cortex (CX), hippocampus …

An Investigation Of The Levels Of Pro-Inflammation Cytokines In The Brain Of Autoimmune Lewis Rats, Han Yang

Theses & Dissertations

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, which can cause cartilage and bone damage, as well as disability. A reported symptom of RA includes tissue inflammation disease and cognitive dysfunction. This study aimed to compare the concentration of selected cytokines in the cerebral cortex, hippocampus, hypothalamus, amygdala, and cerebellum of Lewis rats. Age and sex-matched Lewis rats were separated into two groups: control and adjuvant-induced RA. Twenty-eight days after the adjuvant injection, groups were sacrificed and brains dissected using the stereotaxic atlas of Paximos and Watson as a guide. Pro-inflammatory cytokines IL-1β, IL-6, and IL-23, plus the anti-inflammatory …

Added Sugar Consumption Among College Students, Maram Murad

Theses & Dissertations

Added sugar consumption has been increasing in all age groups in the United States and worldwide, with the greatest increase in young adults. College-age years are a critical period in the young adult's life where many habits develop, including nutrition and food choices. An understanding of college-age students’ attitudes and behaviors toward added sugar consumption might help predict added sugar consumption within this population. This was a quantitative study of traditional-aged college students' added sugar consumption through a convenience sample at a private university in San Antonio, TX. A survey was administrated to undergraduate students at different classes. Subjects were …

Teaching And Learning Courageous Followership: An Action Research Study, Karen Walker Schwab

Theses & Dissertations

Followership has been shown to be a developmental stage of leadership. Yet, there is a lack of followership theory in the health-care context. The purpose of this qualitative action research study was to explore how introducing Chaleff’s dimensions of courageous followership influences the undergraduate nursing students’ views of the follower role and informs their nursing practice. Secondary research questions asked how knowledge of these dimensions influences the nursing students’ views while advocating, collaborating, and addressing lateral violence. Using purposeful sampling, 12 participants were recruited for this study. After attending a followership seminar, they completed online reflections and participated in individual …

Effect Of Postprandial Walking On The Glycemic Effect Of A Meal: Type I Diabetes, Samantha L. Hinojosa

Theses & Dissertations

This study was conducted to determine if 15 minutes of postprandial light walking has an effect on the glycemic response to a Boost® beverage in individuals with type 1 diabetes. Seven participants, 22.3 + 4.3 yrs, with type 1 diabetes completed the two days of data collection. On day 1, participants measured baseline fasting blood glucose (BG) with a glucometer, consumed a Boost® beverage, and sat quietly, repeating BG measurements 15, 30, 60, 90, and 120 minute. On day 2, participants repeated the protocol, but walked 15 minutes at a light pace (50-60% max HR) immediately after beverage consumption. The …

Quality Improvement Programs’ Contribution To Successful Clinical Practice Changes, Erika O. Bowen

Theses & Dissertations

There is a great deal of healthcare literature on the importance of QI programs and the significant contributions they make toward patient safety and patient satisfaction; however, documentation of outcome measures and predictors of success remains challenging. This study examined the experiences of physician participants who attended a state supported South Texas medical school’s CSE course to gain an understanding of QI education, demonstrate the need for formal QI education, and determine if a change in clinical practice occurred as a result of attending a structured QI course. Kirkpatrick’s (1967) four-level evaluation model was used as a framework to guide …

Duty Hour Limitations And Educational Outcomes: Perspectives From A Community Hospital-Based Family Medicine Residency Program, Maria Eliza Marquise

Theses & Dissertations

In 2003, the Accreditation Council for Graduate Medical Education and the American Osteopathic Association introduced new models that established limits on residents’ duty hours in training programs across the United States (Miulli & Valcore, 2010; Philibert & Taradejna, 2011); more stringent limitations were implemented in 2011. If these physician training programs decreased the time residents’ spent in a formal learning environment and utilized experiential learning as one teaching method, did the duty hour limitations affect the residents’ learning outcomes? The purpose of this ex post facto, quantitative study was to determine if there were differences in ITE (In-Training Examination) scores …

Mentoring, Job Satisfaction, Job Dissatisfaction, And Organizational Commitment Among Graduate Nurses, Abisola Adeyomibo Santos

Theses & Dissertations

Shortage of bedside nurses has been researched for a long time. Many researchers have referred to different shortage percentages, but the American Nurse Association stated that the shortage of bedside nurses would increase in the range of 29% to 36% by 2020. It is also reported that a large number of newly graduated, newly hired nurses leave within one year as compared to newly hired experienced nurses. The purpose of this correlational study was to evaluate the influence of mentoring, mediating job satisfaction, job dissatisfaction, and, therefore, organizational commitment, on nurses who completed the nurse residency program between January 2010 …

Mental Health Clinical Managers And Their Multicultural Leadership Practices, Christie Marie Melonson

Theses & Dissertations

There is a general recognition that the United States has historically failed to provide adequate mental health services to ethnic minorities. The American Counseling Association has mandated multicultural competence of counseling professionals in today’s context of dramatic demographic change. Despite numerous studies on practitioners, organizations, models, and interventions geared toward minorities, disparities in access, usage, and outcomes in still exist. Simultaneously, counseling fields have emphasized leadership development as a key factor in improving services, yet training or research on leadership remains scarce. In response to these conditions, this basic interpretive qualitative study focused on exploring clinical managers’ perceptions of their …

Fall Prevention Among Older Adults Living In The Community, Clarissa Silva Lopez

Theses & Dissertations

Older adults are within the fastest population growth rate in the United States, and as the population ages, the potential for falls increases (DHHS, 2011). This was a mixed-method explanatory study that investigated the perceptions of older adults regarding the usefulness, adequacy, and positive experience of fall information among older adults living in the community when received from healthcare professionals during physician’s office visits. The research questions were: 1. What is the relationship among perceptions of usefulness, adequacy, and positive experience of fall information among older adults? 2. Is there a difference in the perceptions of usefulness and adequacy among …

An Assessment Of The Relationship Between The Hospital Chief Executive Officer’S Leadership Behaviors And Hospital Success, Newton J. Courtney

Theses & Dissertations

The health care delivery system in the United States has received increased attention over the last 2 decades. Concerns of access, choice, cost, and quality have been in the forefront. This study was conducted to assess the leadership behaviors of hospitals’ chief executive officers and how they impact the performance of hospitals. Two instruments were used to collect the data for the study: the Multifactor Leadership Questionnaire (MLQ-5X; Avolio & Bass, 2004) and a demographics questionnaire. A correlational research design was used to measure the degree of association between variables related to hospital CEOs, the hospitals they represented and hospital …

Correlating Coworker Relations, Employee Involvement, And Leadership With Associate Commitment In Select Healthcare Companies Using A Mixed Sequential Explanatory Design, Kimberly Ann Lee

Theses & Dissertations

Increasing patient demands and decreasing reimbursement require better efficiency and effectiveness in health care systems and, subsequently, in health care teams. These environmental and societal factors are further complicated by the complex initiatives set forth by the Affordable Care Act (2010). In this study, the researcher sought to examine and identify the strongest variables of health care teaming and to explore resulting themes through the perception of groups of health care associates. This mixed sequential explanatory design first examined the relationships between coworker relations, employee involvement, and leadership with associate commitment and with each other. An existing database of associate …

Homelessness: Relationships Between Program Completion At A Transformational Shelter And Mental Illness, Substance Abuse, And Trauma, Richard T. Mccutcheon

Theses & Dissertations

Each and every evening many people do not have a home to return to. Solving the epidemic problem of homelessness is an ongoing pursuit. Analyzing issues related to homelessness will help solve the problem of homelessness for some individuals and families. Data was gathered, prioritized and analyzed to determine correlations and relationships between completion of a transformational shelter’s program and mental illness, substance abuse, and trauma. Demographic variables were assessed as well. A person is more likely to complete the program if they have a substance abuse issue. Females are more likely than males to complete the program. Program completion …