Individual Characteristics And Shared Decision Making For Stroke Prevention In Atrial Fibrillation, Patricia Nadraus

Theses & Dissertations

With the advent of patient-centered care, individuals with Afib are asked to participate in the shared decision-making (SDM) process. Choosing therapies in thromboembolic risk reduction is complex, involves trade-offs along with considering risks and benefits of therapeutics. Afib affects between 2.7 million and 6.1 million American adults (January et al., 2014), and with the growing elderly population that number is expected to double by 2030 (Colilla et al., 2013). In 2016 Medicare required a SDM process for individuals considering left atrial appendage for stroke prevention. There have been no studies reported examining individual characteristics and participating in SDM in individuals …

A National Study Of Undergraduate Nursing Students' Early Consideration Of Doctoral Education: What Characteristics Predict Students' Report Of Intention And Readiness To Continue Graduate Education Toward The Doctorate?, Renee Lynn Buonaguro

Theses & Dissertations

Statement of the Problem The looming nursing faculty shortage has already had a direct effect on schools of nursing. With our current understanding about enrollments needed to meet the demands of an adequately prepared healthcare workforce, attention needs to be directed toward the preparation of an adequate educator workforce. A consequence of not having doctorally prepared nursing faculty would result in an inadequate number of professors to accommodate the 70,000 applicants who are desiring to pursue their nursing degrees. One solution to the faculty shortage is to vastly increase the number of doctorally prepared faculty earlier in their careers. This …

The Neural Oscillatory Dynamics Underlying Motor And Cognitive Abilities In Children And Adults With Cerebral Palsy, Rashelle M. Hoffman

Theses & Dissertations

Cerebral palsy (CP) is the most common neuromotor developmental diagnosis that can result in a myriad of activity impairments. The literature has primarily explored motor impairments in children with CP. Additionally, there is evidence of CP impacting several cognitive domains in children and adults with CP. Very little literature has explored if these impairments persist into adulthood, and the underlying neurophysiology serving these functions in individuals with CP is unknown.

The first purpose of this dissertation was to quantify the cortical oscillations serving hand movement with magnetoencephalography (MEG) and determine if differences were present as a function of age between …

Exploring Paramedic Students’ Level Of Preparedness For Disaster Response In Hajj 2019, Nawaf Albaqami

Theses & Dissertations

Objectives: 1) to gain further understanding of the paramedic students' level of preparedness before their clinical training at Hajj. 2) To shed more light on what paramedic students need when responding to a disaster. 3) To determine the need to recommend a change in the current practice with respect

Method: The data collection for this study was a cross-sectional survey using the REDCap electronic data capture tools. It was a convenience sample of 40 respondents. For the analyses, descriptive statistics, including frequencies and percentages, were used, and the Mann Whitney U test.

Results: The main findings in this study were …

Effects Of Liquid Viscosity And Food Texture On Swallowing Sounds, Chun Feng

Theses & Dissertations

Cervical auscultation (CA) is a technique of monitoring swallowing performance according to swallowing acoustic signals utilizing a stethoscope or other measurement devices such as a microphone and an accelerometer. In the past few years, doctors have utilized the stethoscope to identify the swallowing sounds, which resulted in an inability to accurately diagnose the aspiration/penetration in patients with dysphagia when compared to the gold standard. A digital CA assessment records swallowing acoustic signals and extracts the specific features from the recordings. It has been proven that digital CA as a promising portable and low-cost tool can be used for identifying patients …

Effects Of Acute Intracranial Pressure Changes On Optic Nerve Head Morphology In Humnans And Pig Model, Sachin Kedar

Theses & Dissertations

The optic nerve head (ONH) is located at the interface of intracranial and intraocular compartments. It is comprised of lamina cribrosa (LC), a fenestrated connective tissue tethered to the posterior sclera across the scleral canal. Since LC is exposed to intraocular pressure (IOP) anteriorly and intracranial pressure (ICP) posteriorly, it is an ideal site for noninvasively detecting intracranial pressure (ICP) fluctuation. We hypothesized that the pressure differential between IOP and ICP across LC, will determine LC position and meridional diameter of scleral canal (also called Bruch’s membrane opening- BMOD). We tested our hypothesis in 19 human subjects undergoing medically necessary …

Molecular Mechanisms Of Manganese Porphyrin Compounds In The Prevention Of Radiation-Induced Fibrosis, Shashank Shrishrimal

Theses & Dissertations

Radiation therapy is frequently used as a treatment strategy for prostate cancer patients, which leads to several side effects due to damage to health tissue around the tumor and the development of radiation-induced fibrosis (RIF). Manganese (III) meso-tetrakis (N-ethylpyridinium-2-yl) porphyrin (MnTE-2-PyP or T2E or BMX-010) and other similar manganese porphyrin compounds that scavenge superoxide molecules have been demonstrated to be effective radioprotectors and prevent the development of RIF. However, understanding of the radioprotective molecular pathway associated with these compounds remains limited. Recent RNA-sequencing data from our laboratory revealed that MnTE-2-PyP treatment may activate the nuclear factor erythroid 2-related factor 2 …

Novel Detection And Treatment Strategies For Pancreatic Ductal Adenocarcinoma, Joseph Carmicheal

Theses & Dissertations

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with an estimated 5-year survival rate of less than 9%. The high lethality of PDAC is due to two primary reasons: the discovery of PDAC at later stages, with locally invasive or metastatic disease present at the time of initial diagnosis as well as the lack of efficacious therapeutic interventions that significantly impact survival. In this dissertation, we sought to discover and test novel detection and treatment strategies for PDAC. Firstly, serum EVs were investigated as potential non-invasive liquid biopsy biomarkers, to serve as a means of early cancer …

Integrating Geriatric Assessment And Genetic Profiling To Personalize Therapy Selection In Older Adults With Acute Myeloid, Vijaya R. Bhatt

Theses & Dissertations

Integrating geriatric assessment for patient profiling and genetic profiling of leukemic cells represents an innovative approach to personalize therapy selection in older adults with acute myeloid leukemia (AML). We report results of a pre-planned interim analysis of a pragmatic phase II trial that utilized this strategy to personalize therapy. Patients ≥60 years with a new diagnosis of AML underwent geriatric assessment prior to initiation of treatment. Geriatric assessment of physical function, cognitive function and comorbidity burden were used to determine fitness for chemotherapy. Patients with good or intermediate-risk AML received intensive chemotherapy such as anthracycline and cytarabine (7+3) if determined …

The Escape Pod: Utilizing Escape Room Methodologies To Train Public Health Volunteers On Open Point-Of-Dispensing Operations, Melanie R. Thompson

Theses & Dissertations

Mobilizing Points-of-Dispensing (PODs) during a mass dispensing of medication event at a local health department will require a large amount of personnel, both staff and volunteers. Training the volunteers prior to this type of event is ideal to ensure that POD operations flow quickly and properly. This project aimed to create an affordable and fun training that engaged volunteers and other interested stakeholders while increasing their knowledge of POD operations. Methodologies used in commercial escape rooms were employed in this training to enhance the participants’ understanding of POD operations. Participants to worked in groups to solve puzzles and challenges in …

Self-Management For Individuals Using Long-Term Urinary Catheterization, Lisa Krabbenhoft

Theses & Dissertations

Many individuals with adult neurogenic lower urinary tract disorder require long-term urinary catheterization for bladder management. The daily use of urinary catheterization increases the risk for chronic complications including catheter associated urinary tract infections. Previous studies have used self-management interventions to reduce chronic complications in the community setting. However, there are limited intervention studies focused on reducing chronic complications after discharge from a rehabilitation hospital. The purpose of this dissertation study is to examine the feasibility and impact of a self-management intervention on individuals after leaving rehabilitation hospital for home within the community.

This dissertation comprises two studies, the first …

Smart Delivery Of Genes And Drugs For Treatment Of Cancer, Feng Lin

Theses & Dissertations

The ineffective delivery of genes and drugs have become a big obstacle for the treatment of cancer, due to either poor stability or low aqueous solubility. In the first part, A ROS responsive polymer named poly(ethylene glycol)–poly[aspartamidoethyl(p-boronobenzyl)diethylammonium bromide] (PEG-B-PAEBEA) was developed for codelivery miR-34a mimic and small molecule PLK1 inhibitor volasertib (BI6727) for the treatment of pancreatic ductal adenocarcinoma (PDAC), since tumor suppressor microRNA-34a (miR-34a), which targets many oncogenes related to proliferation, apoptosis, and invasion is significant downregulated while Polo-like kinase 1 (PLK1) closely associated with short survival rates of pancreatic cancer patients is remarkably upregulated . In part 2, …

Characterization Of Novel Animal Models For Parkinson’S Disease, Mohannad Almikhlafi

Theses & Dissertations

Parkinson’s disease (PD) is neurodegenerative disorder characterized by dopaminergic neuronal loss in the substantia nigra (SN) pars compacta. Mutations in DJ-1, PINK1 and Parkin lead to PD in humans; however, in mice, mutations or knockout of these genes do not lead to disease. Development of small animal models mimicking PD pathogenesis would enable better understanding of the disease. Here, we examined two approaches using laboratory rats. First, DJ-1 knockout rats have been reported to develop movement disorders and loss of neurons similar to human PD. Comprehensive analysis of mitochondrial proteomic alteration in isolated synaptic mitochondria from DJ-1 knockout rats using …

Development Of Fluorescent Hyaluronic Acid Nanoparticles For Intraoperative Tumor Detection, Nicholas E. Wojtynek

Theses & Dissertations

Surgical resection remains to be the primary treatment for the majority of solid tumors, including breast cancer. The complete removal of the primary tumor, local metastases, and metastatic lymph nodes dramatically improve a patient’s treatment outcome and prognosis. Nevertheless, surgeons are limited to tactile and visual cues in distinguishing malignant and healthy tissue. This can result in a positive surgical margin (PSM), which occurs when tumor goes undetected and is left behind in the surgical cavity. PSMs decreases a patient’s prognosis and necessitate additional treatment in the form of surgery, radiation, and chemotherapy. An emerging imaging modality, known as fluorescence-guided …

Ocular, Neural, And Cellular Biodistribution Of Multifunctional Antioxidants, Damian Daszynski

Theses & Dissertations

Aging is a complex biological process which stems from a growing imbalance between the regenerative capacity of an organism and endogenous as well as exogenous damaging factors. This imbalance leads to the slow deterioration of individual cells, organs, and eventually the entire organism. The free radical theory of aging combines the evolutionary and mechanistic aspects of aging, postulating that the innate process is caused by deleterious, irreversible, and inevitable changes in biological systems caused by oxidative damage that accumulates over the lifespan. Evidence of this phenomenon is supported by the pathogenesis of age-related diseases, such as age-related macular degeneration and …

The Role Of Extracellular Vesicles In Cancer-Related Fatigue And Its Co-Occurring Symptoms, Dilorom M. Sass

Theses & Dissertations

Cancer survivors report many debilitating symptoms associated with cancer and its treatments. About 30% will report long-term cancer-related fatigue (CRF) which often co-occurs with depressive symptoms, sleep disturbances, cognitive fatigue, and poor overall health-related quality of life. The underlying causes of these co-occurring symptoms have been related to systemic processes such as inflammation. Extracellular vesicles (EVs) contain systemic markers such as genetic and protein materials that inform about cell-to-cell interactions that influence immune signaling and inflammatory processing. No study to date has explored the associations of EVs with cancer-related symptoms. So, the purpose of this dissertation was to investigate the …

The Role Of Central Ace2 And Nrf2 In Sympatho-Excitation: Responses To Central Angiotensin Ii, Anyun Ma

Theses & Dissertations

Sympatho-excitation is a key characteristic in cardiovascular diseases such as chronic heart failure (CHF) and primary Hypertension (HTN). Evidence suggests that increased sympathetic tone is closely related to activation of the Renin-Angiotensin-Aldosterone system (RAAS) in the central nervous system. An underlying mechanism for sympatho-excitation is thought to be oxidative stress resulting from Angiotensin II (AngII) type 1 receptor (AT1R) activation. Over the past several decades, pharmacological targeting of components of the RAAS have been used as standard therapy in CHF and HTN. However, additional therapeutic strategies are necessary to control these diseases. Oxidative stress is regulated, in part, by the …

Immersive Virtual Reality Training Improved Upper Extremity Function In Patients With Spinal Cord Injuries: A Case Series, Anqi Zhang

Theses & Dissertations

Virtual reality (VR) is an emerging treatment tool to engage people in environments that appear and feel similar to real-world objects and events.¹ There are various levels of evidence that VR can potentially promote functional activity and neuroplasticity in patients with neurological disorders like spinal cord injury (SCI).^2,3

In this case series, we explored the feasibility of using commercially available immersive VR technology as an augmented treatment in the SCI population and compare participant’s suitability for this intervention. Three male SCI participants were recruited in a subacute inpatient rehabilitation facility and participated in VR intervention twice a week …

Development Of Hyaluronic Acid-Derived Macromolecular Agents For Multimodal Imaging Probes And Nanomedicine, William M. Payne

Theses & Dissertations

Cancer, one of the most challenging maladies facing modern medicine, is a complex family of diseases that requires a multifaceted treatment regime. In recent years, increased research effort has been placed on the development of nanoscale formulations as a potential method to improve therapeutic efficacy and offer better treatment. Both drug formulation and biomedical imaging has benefitted from the development of new, nanoscale agents. Hyaluronic Acid (HA), a naturally occurring glycosaminoglycan, is a promising platform for the development of new drug delivery systems. Furthermore, hyaluronic acid is the principal ligand for the cell surface receptor CD44, which is overexpressed on …

Delivery For Hydrophobic Drugs For Treating Pancreatic Cancer, Saud Almawash

Theses & Dissertations

Purpose The aim of this study was to determine whether coadministration of hedgehog (Hh) pathway inhibitor cyclopamine (CYP) and microtubule stabilizer docetaxel (DTX) as polymer-drug conjugates, methoxy poly(ethylene glycol)-block-poly(2-methyl-2-carboxyl-propylenecarbonategraft- dodecanol-graft-cyclopamine) (P-CYP) and methoxy poly(ethylene glycol)-block-poly(2-methyl-2-carboxyl-propylene carbonate-graft-dodecanol-graft-docetaxel) (P-DTX) could synergistically inhibit orthotopic pancreatic tumor growth in NSG mice.

Methods P-DTX and P-CYP were synthesized from mPEGb- PCC through carbodiimide coupling reaction and characterized by 1H–NMR. The micelles were prepared by film hydration and particle size was measured by dynamic light scattering (DLS). Cytotoxicity, apoptosis and cell cycle analysis of P-DTX and P-CYP were evaluated in MIA PaCa-2 cells. In vivo efficacy …

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

Planning And Facilitating The Training Of Emergency Medical Services On The Safe Transport Of Patients With Highly Infectious Diseases, Mohammed Alhallaf

Theses & Dissertations

Emergency Medical Services (EMS) personnel are the first line of treatment and are the first exposed health care workers to infectious diseases (IDs). Consequently, the EMS setting is a relatively vulnerable environment for disease transmission and cross-contamination. Also, serious and emerging IDs, such as highly pathogenic viral hemorrhagic fevers and novel Coronaviruses, in a time of increased globalization, require comprehensive EMS training and preparedness. This project had the objective of identifying best practices for the EMS transport of patients with IDs. The methods for this project were done in two phases. In the first stage, we …

The Relationahips Between Health Behaviors Of Women And Health Locus Of Control Among Black Caribbean Women And Black American Women With Hypertension, Camelle Charles

Theses & Dissertations

Background

Millions of Caribbean women have migrated to the United States, and a sizeable number of these women and Black American women suffer from hypertension and other cardiovascular health problems. This research showed the comparison of health behaviors of both groups of women and the difference in their health outcomes. Today, there are more migrants in the world than ever before; an estimated 272 million international migrants in 2019, which is an increase in 51 million since 2010 (United Nations, 2019) and Caribbean migrants are a substantial portion of this pool. Approximately 4.4 million Caribbean immigrants reside in the U.S. …

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 …

Assessment Of Activity Levels And Perceived Barriers Or Facilitators To Physical Activity In Pregnancy At Aga Khan University Hospital, Nairobi, Kenya, Zoya Virji Lalani

Theses & Dissertations

Introduction: Physical activity (PA) during pregnancy significantly reduces the risk of pregnancy related complications and positively influences maternal health and wellbeing. The American College of Obstetricians and Gynaecologists (ACOG) recommends that pregnant women can exercise moderately for 30 minutes on most days of the week, however no study has ever examined the extent to which Kenyan women are meeting these recommendations. Furthermore, attitudes and perceptions of pregnant women towards PA shape their eventual behaviour. Whilst these influencing factors have not been explored, understanding them is essential for implementing effective interventions to improve exercise participation antenatally.

Objectives: This study examined …

Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis, Soraiya Manji

Theses & Dissertations

Background: Chronic kidney disease is highly prevalent in the world with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.

Objective: The primary objective of this study was to determine the association between the dialysate sodium concentration and interdialytic weight gain …

Temporal Pain Pattern Sequencing In The Older Adult After Joint Replacement Surgery, Jennifer B. Withall

Theses & Dissertations

Background

Large joint replacement surgery, including hip and knee arthroplasties, are two of the most common surgical procedures that American adults aged 65 years and older undergo annually. While postoperative pain is expected, if it is not properly managed, it can have deleterious effects on postoperative recovery, including an increased length of stay, increased risk for postoperative complications, and decreased patient satisfaction.

Problem

Postoperative pain is primarily managed pharmacologically, typically with opioid pain medications are administered as needed (i.e., pro re nata [PRN]). Patients request pain-relieving medications when they are experiencing escalating pain, which can be challenging to maintain comfort …

Neonatal Nurses' Perceptions Of Providing Palliative Care In The Neonatal Intensive Care Unit, Susan Di Nonno Chin

Theses & Dissertations

Although advances in neonatal medicine have greatly improved infant survival rates, there remains a significant number of infants admitted to the neonatal intensive care unit who will not survive. It is estimated that 50% of the 25,000 annual hospital pediatric deaths occur in the neonatal intensive care unit (NICU) (Conway-Oriel & Edlund, 2015). Despite widely supported guidelines endorsing neonatal palliative care (NPC), implementation has been sporadic and inconsistent (Kain & Wilkinson, 2013). Lack of palliative care protocols has been associated with negative impacts on infants, their families, and multidisciplinary team members. NICU nurses are uniquely positioned to influence end-of-life care …

Outcomes Of Inpatients Hospitalized With Community Acquired Pneumonia, Jamila Nambafu

Theses & Dissertations

Background: The morbidity from lower respiratory tract infections has varied between age groups and from region to region. In sub-Saharan Africa, pneumonia remains the most frequent reason for adult hospitalization, with approximately 4 million episodes and about 200,000 deaths every year. Some of the attributable factors have been HIV pandemic, pulmonary tuberculosis, and poor socio-economic status.

Objective: The main objective was to determine the morbidity of community-acquired pneumonia in patients admitted to a tertiary hospital in Nairobi, Kenya, between May 2019, and March 2020. The results are anticipated to help in informing protocols for the evaluation and treatment …

Prior Mammographic Screening: What Is Its Effect On The Clinical Stage In Newly Diagnosed Breast Cancer Patients At Akuhn., Jillo Bika

Theses & Dissertations

Introduction: Breast cancer is now the leading cancer amongst women in Kenya according to GLOBOCAN 2018. It is also a leading cause of cancer deaths in Kenya, after esophageal and cervical cancer. Mammography is the gold standard in the screening of breast cancer. For screening to be effective, however, it has to be offered to the right patients at the appropriate time and intervals. Up until February of 2019, there were no local guidelines to guide the screening of breast cancer in Kenya. The objective of this study is to assess if prior mammographic screening had an effect on the …