Medicine and Health Sciences Commons^™

Examining Potential Causal Associations Of Sedentary Time And Physical Activity With Heart Failure Using Subjective And Objective Measures: A Mendelian Randomization Analysis, Jessica Geller

UNF Graduate Theses and Dissertations

Purpose: The objective of this study was to assess the causal relationship between both subjectively and objectively measured sedentary time (ST) and physical activity (PA) with heart failure (HF) risk, utilizing Mendelian Randomization (MR) approach.

Methods: The present MR used genetic instruments identified for self-reported ST and PA extracted from 51 genome wide association studies (GWAS), encompassing data from 703,901 individuals. The GWAS identified 89 independent single nucleotide polymorphisms (SNPs) associated with leisure screen time. Eleven loci were reported to be associated with moderate to vigorous physical activity (MVPA). From another GWAS examining accelerometer-based activities, three loci were found to …

Sleep, Sedentary Time, And Physical Activity In Heart Failure Subtypes: Multi-Ethnic Study Of Atherosclerosis (Mesa), Demi M. Nott

UNF Graduate Theses and Dissertations

INTRODUCTION: Previous studies have examined the associations between physical activity (PA), sedentary time (ST), and sleep on the risk of heart failure (HF). The primary aim of this study was to examine PA, ST, and sleep quality (SQ) in those diagnosed with preserved ejection fraction HF (HFpEF) and reduced ejection fraction HF (HFrEF). The secondary aim of this study was to examine these relationships in those with and without HF, independent of sub-type.

METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) collected data from 6,814 adults from a diversified cohort who range in age from 45 to 84. Subjects were classified …

Does Ceo Education Matter? The Relationship Between Doctoral-Educated Hospital Ceos And Organizational Performance, Kofi Ali Cash

All ETDs from UAB

One of the most pressing issues in healthcare strategic leadership research is identifying which hospital chief executive officer (CEO) characteristics possess a significant and favorable relationship to organizational performance. However, little is known about the relationship between hospitals led by doctoral-educated CEOs and organizational performance. This study adds to our knowledge by examining the relationship between doctoral-educated hospital CEOs and selected financial and patient safety outcomes. UET served as the theoretical framework and guided the examination of the relationship between the selected dependent and independent variables. This study’s population included 509 acute-care hospitals across nine states, requiring a minimum four-year …

Impact Of Federally Qualified Health Centers (Fqhc) And Look-Alikes (Fqhc Lal) Participating In The 340b Drug Pricing Program, Shannon Burger

All ETDs from UAB

The 340B Drug Pricing Program intends to enable community health providers to deliver care more easily to vulnerable populations. Safety net providers were designated as eligible entities through an act of Congress and were allowed access to prescription drug savings. Existing studies have focused on hospital participation in the program, overlooking the impact of Federally Qualified Health Centers (FQHC) and FQHC Look-alikes (FQHC LAL) and legislative intent. This study aimed to fill this gap by comparing the effectiveness of FQHCs and FQHC LALs participating in the 340B Drug Pricing Program. Specifically, the study examined the influence of the status of …

Catecholamines And Catecholamine Resistance In Animal Models Of Metabolic Syndrome, Robert Follett Rosencrans

All ETDs from UAB

The sympathetic nervous system is a key regulator of energy homeostasis, in part, through the control of white adipose tissue lipolysis. Sympathetic nerves modulate adipose tissue physiology through the release of catecholamines, particularly norepinephrine, onto alpha- and beta-adrenergic receptors (a-AR; B-AR). Lipolysis refers to the breakdown of triglycerides into glycerol and free fatty acids, often in response to activation of B2/3-AR. Beta adrenergic activation of lipolysis is widely known to be impaired in patients with metabolic syndrome and animal models thereof (catecholamine resistance). Recent studies have demonstrated that catecholamine regulation of adipokine release is also disrupted, suggesting that catecholamine resistance …

The Co-Occurrence Of Past Year Major Depressive Episodes And Marijuana Use And Its Relation To Mental Health Resource Utilization, Suicidal Ideation And Planning, Rachel I. Miranda

Honors Program Theses and Research Projects

Depression is a mental health disorder found worldwide affecting all demographics and is a major cause of global disability. For youth, depression can be very serious as it is a leading contributor to suicide, a top three cause of adolescent death. When we examine the onset of depression in adolescence, we also must acknowledge that youth access and usage of mental health resources and interactions with their communities may influence their outlook. We set out to examine how the co-occurrence of past year marijuana use and major depressive episodes (MDE), the variable we use to measure youth depression in this …

Exploring The Relationship Between Cold Medicine Abuse And Recreational Drug Use, Luis Barco

Honors Program Theses and Research Projects

Over-the-counter medicines such as cold and cough medications may be abused as an accessible alternative to other recreational drugs in order to obtain a desired ‘high.’ A lack of literature is currently present, with few studies specifically observing simultaneous drug use and cold and/or cough medicine abuse. Using publicly available data from the 2021 National Survey on Drug Use and Health (NSDUH), the researcher sought to help bridge this gap in knowledge by identifying any risk factor relationship that could exist between cold medicine abuse and commonly used recreational drugs. The observed frequency of recreational drug use (marijuana, phencyclidine, ecstasy, …

Clostridioides Difficile: Identification Of Rival Organisms & Evaluation Of Non-Antibiotic Treatment Implementation, Justin Davis

Honors Undergraduate Theses

Clostrioides difficile is a common cause of nosocomial (hospital-acquired) infections. Patients receiving antibiotic treatment experience dysbiosis of gut microbiota, and C. difficile, normally held in check by the various other organisms, takes this opportunity to propagate. Symptoms of infection generally include diarrhea, colitis, dehydration, and fever. Understanding that C. difficile generally only causes illness when it is the dominant bacterium (i.e. when growth is relatively unchecked by other microbes), it is appropriate to investigate potential competitive organisms that may be introduced after antibiotic courses or during active C. difficile infection to effectively displace it. Fecal samples from the University …

Tim/Tam Receptors: A Potential Biomarker For Predicting Sensitivity To Zika Virus-Induced Oncolysis In Non-Small Cell Lung Cancers, Shankari Somasekar

Honors Undergraduate Theses

Non-small cell lung cancers (NSCLC) constitute 80-85% of lung cancers and are the leading cause of cancer-related deaths globally. The most common cause is prolonged smoking. Current treatment options for NSCLC include surgery, radiation, chemotherapy, targeted drug therapy, and immunotherapy. Although these medications are effective in the short term, patients often face issues of drug resistance and debilitating side effects with prolonged use. Currently, the use of Zika virus (ZIKV) is being researched as a possible alternative treatment for cancer, which minimizes side effects and the risk of drug resistance. TIM/TAM proteins are identified as the putative ZIKV receptors on …

Serious Game-Based Training For Improved Utilization Of A Novel Temporalis Emg Interface For Controlling Powered Wheelchairs, Calvin Macdonald

Honors Undergraduate Theses

Amyotrophic lateral sclerosis (ALS) is a terminal neurodegenerative disease that leads to a lack of independent mobility. One solution uses a unilateral surface EMG (sEMG) interface on the temporalis muscle to provide autonomous control of a powered wheelchair. Limbitless Journey, an EMG-controlled serious game, intends to provide users with a virtual environment to train in before use in a real-world scenario. A recent study analyzed the effect of video game training on the use of sEMG systems on the forearm, showing significant improvement in the usage of the interface but no difference between Free Play and structured play. The study …

How Hormonal Contraceptives Influence Injury In Female Athletes: A Systematic Review, Ashley V. Malvita

Honors Undergraduate Theses

Research indicates that female athletes have a higher risk of musculoskeletal injuries. Hormone fluctuations throughout the different periods of the menstruation cycle impacts the risk of injuries for women. Contraceptive use, most used in the form of an oral contraceptive pill, directly effects hormones and menstrual cycle related symptoms, with evidence of ameliorating some symptoms. Oral contraceptive use is suggested to influence musculoskeletal injuries in female athletes. However, there is little research and data that explores the direct relationship between oral contraceptive use and the injury rates of female athletes. Within this systematic review, five articles investigating this relationship fulfilled …

Pupillometry As A Viable Augmentative And Alternative Communication Pathway: A Machine Learning Application, Kouadio Marc-Antoine Niamba

Dissertations and Theses

Every year, clinicians diagnose 5000 new Amyotrophic Lateral Sclerosis (ALS) cases in the United States (Mehta et al., 2018). ALS is a degenerative neuromuscular disease that prevents neurons from sending impulses to the muscles, thus resulting in paralysis and death. People with ALS (PALS) not only experience limited mobility but also lose their ability to communicate. Although the disease currently remains incurable, efforts to improve the patients’ communication are increasingly leading toward Augmentative and Alternative Communication (AAC) systems (Beukelman and Mirenda, 2013). AAC systems are assistive technologies that propose to counteract the defects resulting from ALS through non-verbal communication channels. …

Associations Between Physical Activity Levels And Physical And Mental Health In Military Veterans., Troy Hubert

Theses and Dissertations--Psychology

Research suggests that higher rates of health conditions are associated with lower levels of physical activity, but this association is not well characterized in U.S. Military Veterans. The current study utilized a sample of U.S. military veterans (n = 3,989) from the 2019-2020 National Health and Resiliency in Veterans Study (NHRVS). Physical activity levels (insufficient, moderate, and active), physical and mental health were evaluated with a variety of self-report questionnaires. After controlling for covariates, veterans with any disability, asthma, chronic pain, diabetes, high cholesterol, and stroke were significantly less likely to report sufficient physical activity compared to insufficient physical …

Student Academic Success System, Brandi Castle

Doctor of Nursing Practice Projects

This project aimed to enhance academic success and retention rates in a practical nursing program through the implementation of a Student Academic Success System (SASS), utilizing evidence-based teaching strategies. A quality improvement design using both the Iowa Model of Evidence-Based Practice and the Plan, Do, Study, Act (PDSA) framework was guided by Kolb’s Model. Nurse faculty saw a need for increased student retention among practical nursing students; the student then proposed a plan, translated evidence, created a pre- and post-survey, and carried out SASS with the use of trained nurse faculty coaches. The goal of the project was to reduce …

Occupational Therapy’S Role In Facilitation And Compliance With Clean Intermittent Self-Catheterization (Cisc), Abigail P. Hernandez

Occupational Therapy Doctorate Capstone Projects

Background: The Occupational Therapy Practice Framework (OTPF) (4th ed.) states that toileting and toilet hygiene includes management of continence needs, including catheters and the necessary equipment to maintain bladder control (American Occupational Therapy Association, 2020b). However, the overall perspectives of occupational therapy’s role are poorly understood.

Purpose: The study's purpose was to collect data about occupational therapy (OT) practitioners' practice trends in client management of clean intermittent self-catheterization (CISC), including perceived competency, education and training, and frequency and extent of involvement in supporting clients with CISC needs.

Theoretical Framework: The study is also supported by the American Occupational Therapy Association …

The Effectiveness And Feasibility Of Telehealth Occupational Performance Coaching With Young Adults With Intellectual Disabilities: A Case Study, Mara Sampson

Occupational Therapy Doctorate Capstone Projects

Background: College students with intellectual disabilities (ID) experience occupational performance barriers, impeding participation. Limited evidence-based techniques are available to therapists working with this population. Telehealth Occupational Performance Coaching (OPC) has been found to be an effective treatment technique for improving occupational performance and self-determination for populations outside of college students with ID.

Purpose: The purpose of this experimental case study was to test whether participation in a telehealth OPC program for college students with ID increases occupational performance, occupational satisfaction, and self-determination.

Theoretical Framework: Self-Determination Theory and the Canadian Model of Occupational Performance and Engagement (CMOP-E) provide for the theoretical …

Impact Of Iadl Interventions On Discharge Readiness: Musculoskeletal Conditions In Inpatient Rehabilitation, Kasi B. Gannon

Occupational Therapy Doctorate Capstone Projects

Background: Musculoskeletal conditions are the highest contributing cause of the need for rehabilitation globally, and are common conditions treated by occupational therapy in inpatient rehabilitation. Basic activities of daily living (BADLs) are the main focus of rehabilitation in these settings, which may leave clients unprepared to complete important higher level instrumental activities of daily living (IADLs) at home.

Purpose: The purpose of this study was to determine the impact that instrumental activities of daily living (IADL) intervention and training has on individuals’ perceived discharge readiness and quality indicator scoring for those admitted to an inpatient rehabilitation facility with a musculoskeletal …

When Divergent Worlds Collide: Dr. Santiago Ramón Y Cajal’S Influence On The Surrealism Movement, William J. Hardman Iii, Md

MA Theses

Dr. Santiago Ramón y Cajal’s drawings were created for the sole purpose of illustrating his newly discovered and earth-shattering revelations in the field of neuroscience culminating with his magnum opus: the “Neuron theory” and the “Theory of Dynamic Polarization.” For these discoveries and many others, he shared the 1906 Nobel Prize in medicine and physiology with his rival Dr. Camilo Golgi, an Italian pathologist. At no time did he envision that his drawings would capture the interest of artists as it did with members of the Surrealism Movement. This thesis will explore and present for the first time supporting evidence …

Impact Of An End-Of-Life Simulation On Nurses’ Attitudes, Self-Confidence, And Communication Skills, Amanda Scofield

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: New graduate nurses (NGNs) often lack exposure to end-of-life (EOL) care. Simulation experiences offer a safe place for learning and reflection. Implementation of an EOL simulation has the potential to increase NGNs attitudes, selfconfidence, and communication skills.
Methods: Forty-one NGNs in a nurse residency program participated in an EOL simulation. Attitudes toward EOL, self-confidence regarding EOL care, and EOL communication were evaluated using a pretest posttest format.
Results: Following the simulation, mean self-confidence scores increased, however the increase was not statistically significant (p = 0.53). Mean scores increased for 1 of 2 categories related to attitude toward EOL, however …

Implementation Of A Non-Pharmacological Cognitive Stimulation Therapeutic Activities Protocol As A Delirium Prevention Method For Adults, Jada Hieb

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background/Purpose: Delirium is a complex clinical syndrome comprising a constellation of symptoms, including acute onset, inattention, altered level of consciousness, and disorganized thinking or cognitive dysfunction. Delirium is a common complication often unrecognized, expensive, and preventable. This project's focus was further exploring non-pharmacological delirium prevention strategies (NDPS).
Methods: A NDPS program using a therapeutic activity book (TAB) was implemented in a Midwestern acute care hospital measuring the impact on the number of positive delirium screens, the number of delirium diagnoses, and hospital length of stay (LOS).
Results: A causative relationship or association between the TAB and outcomes could not be …

Improving Preventive Care Tasks In Adults Aged 50 And Older With Pre- Visit Planning In Primary Care: Review Of Literature, Destinee Rice

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: Primary care providers are seeing an increased number of elderly patients with several chronic health issues. The time required to address multiple chronic health issues during an appointment impedes timely completion of preventive care tasks. Previsit planning can aid in closing this gap in preventative care by having all necessary information prepared before a patient’s visit.
Evidence Summary: A literature search was conducted in Cumulative Index to Nursing and Allied Health Literature and PubMed using subject headings and MeSH terms. The search was refined to include articles within the last 10 years. Articles were further narrowed down by their …

Implementing The Teach-Back Method On Pessary Utilization In A Urogynecology Clinic, Marissa Eich

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The effectiveness of pessary patient education using the teach-back method and improving nurse confidence and conviction related to pessary use are essential in improving patient outcomes.
/="/">Local Problem: The current limitations in pessary education stem from constraints in nurse availability and workload distribution.
/="/">Methods: The quality improvement initiative involved conducting surveys to evaluate nurse confidence using surveys adapted from the Agency for Healthcare Research and Quality toolkit before the nurse education session, 1 month into the intervention, and at 3 months, when the implementation period ended. These surveys assessed the effectiveness of the teach-back method.
/="/">Intervention: …

Reduction Of Pressure Injury Development In Long-Term Care Residents Using A Pressure Injury Prevention Plan And Communication Alerts, Joseph Osazee

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Accurate communication of changes in residents' skin condition and the provision of appropriate intervention in long-term care is key to ensuring patient safety and well-being through the prevention of pressure injury (PI) development. Effective use of a PI prevention plan and communication tools by certified nursing assistants (CNAs) and nurses can help in this regard.
/="/">Methodology: Thirty-three nursing staff attended an initial I -hour education session on how to identify changes in skin conditions and report them using the as needed (PRN) skin check tool or custom alert tool and implement interventions to prevent PI progression. The Pieper-Zulkowski …

Impact Of Evidence-Based Interventions On Nurse Burnout Among Ambulatory Care Nurses, Haley M. Lupher

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The physical and emotional demands of the nursing profession often cause increased stress and burnout in nurses. If burnout is not addressed, the negative consequences of burnout are perpetuated by one another. Evidence-based interventions, such as meditation, yoga, and physical activity can help reduce nurse burnout.
Local Problem: This project was completed at an ambulatory dermatology clinic that sees approximately 300 patients a day. In recent years, this department has noticed increased nurse turnover and low nurse morale.
Methods: A convenience sample from approximately 30 nurses was utilized. Burnout was measured using the Maslach Burnout Inventory for Medical Personnel …

Nurses' Knowledge, Confidence, And Compliance With An Ambulatory Surgery Discharge Checklist, Heather Van Marion

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Preventable errors in healthcare are fueling the growth of patient safety cultures. Checklists have been found to increase discharge accuracy and efficiency and detection of patient safety concerns before discharge.
Local Problem: Oversight errors can be traced back to poor communication or outdated workflows. Ad hoc communication and knowledge of physician preferences are no longer sufficient for ensuring complete discharge instructions. Methods & Interventions: A discharge checklist was developed and implemented in an ambulatory surgery department to ensure discharge instructions were complete and accurate. Nurses completed a pre and 3-month post-checklist questionnaire assessing their knowledge and confidence in the …

Implementation Of An Induction Of Labor Protocol, Rebecca A. Erickson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Nationwide focus has been placed on the reduction of incidence of adverse maternal and neonatal outcomes in nulliparous, term, singleton, vertex (NTSV) patients.
Local Problem: Nursing leaders of a maternal child health unit in the upper Midwest recognized a need to reduce the rate of adverse maternal outcomes with evidence-based practice. The facility does not currently have an induction of labor (IOL) protocol.
Methods: The California Maternal Quality Care Collaboration Toolkit to Support Vaginal Birth and Reduce Primary Cesarean Sections was used to create an IOL protocol to prevent adverse maternal outcomes. Categorical outcome data was compared for 6 …

Implementation Of An Oral Sucrose Protocol For Advanced Practice Providers, Cori Shatto

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background/Purpose: Pain in infancy due to immunization administration often goes untreated. The pain infants experience leads to negative effects on neurodevelopment and pain response. Needle fear develops in infancy and can extend into adulthood, leading to vaccine avoidance and endemic outbreaks. Methods: In a family practice clinic in an upper Midwest state, an oral sucrose protocol was implemented for use by advanced practice providers (APPs). Prior to education on the protocol, a survey was administered to assess the providers’ knowledge, attitudes, and practice (KAP) in relation to oral sucrose. The providers were educated on the benefits and intended use of …

Implementation Of A Daily Protocol To Reduce Central Line Days On A Medical-Surgical Unit, Katherine Wickstrom

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Central line associated bloodstream infections (CLABSIs) are preventable healthcare associated infections (HAI) in the United States. CLABSIs are associated with increased length of hospital stays, mortality, and financial implications for both patients and hospital systems. Extensive research has shown implementing CLABSI prevention bundles can reduce infections and costs. These bundles are often misused, highlighting the importance of bundle compliance and education.
Local Problem: A medical surgical unit in the upper Midwest continues to have delayed central line removal despite a CLABSI prevention bundle. Efforts to decrease central line days were identified as a priority.
Methods: Staff completed education on …

Implementation Of A Prediabetes Risk Assessment And Motivational Interviewing In Adults Ages 35 And Older, Emma Lilleberg

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The American Diabetes Association (ADA) recommends screening for prediabetes using a validated assessment tool in asymptomatic adults starting at age 35. An effective process to raise screening numbers to identify those at risk of prediabetes and diabetes is needed to provide quality care.
Methods: Nursing staff were educated on use of the risk assessment tool and principles of motivational interviewing (MI). Utilizing the ADA risk assessment tool identified those at risk. Nursing staff completed MI with individuals who scored 5 or higher. A readiness for change survey was completed by patients after receiving MI. Additionally, individuals received education on …

Reducing Emergency Department Decision To Admit To Disposition Time Using The Sydney Triage To Admission Risk Tool, Jolyn Sackmann

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Long emergency department (ED) length of stay (LOS) is associated with increased mortality, delay in care, longer inpatient (IP) stays, readmission risk, poor patient satisfaction, and opportunity for error. Within the ED LOS is a quality indicator measuring the time a provider determines a patient will be admitted to the time the patient leaves the ED for an IP unit, called ED-2. Prolonged ED-2 indicates impaired ED output.
/="/">Local Problem: Despite previous interventions, the ED-2 at a rural Midwest hospital was about 63.5 minutes; the goal set forth by the Centers for Medicare and Medicaid is 35 minutes …