Medicine and Health Sciences Commons^™

Decreasing Primary-Care-Related Emergency Department Visits In The Hispanic Population Using Patient Navigators, Arthur Dominguez Jr.

Walden Dissertations and Doctoral Studies

Primary-care-related emergency department (PCR-ED) visits by Hispanic patients enrolled in a not-for-profit Medi-Cal and Medicare health plan resulted in longer wait times in the emergency department (ED) at a regional medical center in Southern California. This congestion decreased access for those with true emergencies, created capacity issues, increased ED length of stay, and resulted in potential safety risks. This project focused on decreasing PCR-ED visits in the Hispanic population using patient navigators in Southern California. Applying the health belief model and Lippitt's theory of change, this doctoral project involved the creation and implementation of a culturally appropriate, population-specific patient navigator …

Impact Of The Affordable Care Act On The Hiv Care Continuum, Ebere Erugo

Walden Dissertations and Doctoral Studies

People living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS; PLWHA) are at increased risk of insufficient medical care due to lack of insurance. Inadequate medical care for PLWHA contributes to increases in HIV transmission rates. The U.S. Surveillance Report noted that in 2015, over 1.2 million people were living with HIV infection, and there were approximately 50,000 new infections every year. The report further stated that about 675,000 people have died from HIV-related illnesses since its discovery in 1981. The implementation of the Affordable Care Act (ACA) in 2014 was intended to provide Americans, including people at …

Postpartum Mothers' Attitudes Toward Breastfeeding, Jackie Denise Jones

Walden Dissertations and Doctoral Studies

Breast milk is the optimal source of nourishment for babies, providing positive nutritional and psychosocial benefits for infants' growth and development. Rates for initiation of breastfeeding and exclusive breastfeeding at 6 months in the United States are well below the target rates for the Healthy People 2020 Maternal, Infant, and Children's Health objectives. Using Ajzen's theory of planned behavior, the purpose of this project was to ascertain how knowledge and attitudes influenced a mother's intent to breastfeed during her hospital stay and the likelihood of exclusive breastfeeding continuing after discharge. A convenience sample of 68 postpartum mothers was recruited from …

Hpv Vaccination, Sociodemographic Variables, And Physician Recommendation In Select U.S. Areas, Rebecca Marie Jungbauer

Walden Dissertations and Doctoral Studies

Human papillomavirus (HPV) is the most common sexually transmitted virus, and is causally related to several cancers. HPV vaccination rates are far below HealthyPeople 2020 targets and vary across geographic, socioeconomic, and demographic populations. The purpose of this research was to test the relationships among socioeconomic and demographic variables, HPV vaccination, social vulnerability, and physician recommendation within select local areas in the United States. Fundamental cause theory and behavioral economics informed this quantitative secondary analysis of National Immunization Survey-Teen and Social Vulnerability Index data (n = 43,271). Statistical analyses included chi-square and binomial logistic regression. Teens whose mothers had less …

Faculty Competence In Facilitating Clinical Simulation, Rose Kronziah-Seme

Walden Dissertations and Doctoral Studies

Clinical simulation is a teaching strategy to assist nursing students to connect classroom knowledge to the clinical setting. Teaching clinical simulation requires special training, but many nursing faculty who teach clinical simulation do not receive clinical simulation training. The purpose of this study was to determine if the effects of formal versus informal simulation training impacted nursing faculty's self-ratings of their competency in facilitating simulation and identify areas for needed educational support. A quantitative descriptive approach was used and grounded in the National League for Nursing and Jefferies (NLN/JSF) theoretical framework. This framework focuses on the relationship between teacher, student, …

The Association Between Child Abuse And Attempted Suicide In Hong Kong, Hing Sang Wilfred Wong

Walden Dissertations and Doctoral Studies

Children are the cornerstone of the community as well as the future of society. Child abuse and suicide among the young population is a serious and prevalent problem. Through a number of survey studies undertaken in other countries including Canada, United States, and Australia, researchers demonstrated that child abuse was related to suicidal behavior. However, this association had not been examined in Hong Kong. However, the number of hospital admissions for child abuse in Hong Kong had increased from 15.6 to 61.9 per 100,000 between 1995 and 2015 and 3.7% of child abuse cases had previously recorded suicide attempts. This …

The Association Between Neighborhood Factors And Mexican Americans’ Mental Health Outcomes: A Systematic Review, Kai Wei, Jaime Booth

The Journal of Sociology & Social Welfare

This systematic review seeks to elucidate the association between neighborhood factors and Mexican American mental health outcomes. We searched PsycINFO and Academic Search Premier for studies related to neighborhood factors and mental health. Google Scholar was used to identify additional studies, followed by a manual inspection of the related work. Eleven studies were identified. Nine studies found that neighborhood factors had a significant impact on mental health among this group. Neighborhood compositional factors influenced mental health directly, among which minority concentration was found to be protective for Mexican American mental health. Neighborhood contextual factors influenced mental health directly and indirectly …

When ‘Places’ Include Pets: Broadening The Scope Of Relational Approaches To Promoting Aging-In-Place, Ann M. Toohey, Jennifer A. Hewson, Cindy L. Adams, Melanie J. Rock

The Journal of Sociology & Social Welfare

Aging-in-place is a well-established concept, but discussions rarely consider that many older adults live with pets. In a ‘pet-friendly’ city, we conducted semi-structured interviews to explore perspectives of community-based social support agencies that promote aging-in-place, and those of animal welfare agencies. Applying a relational ecology theoretical framework, we found that pets may contribute to feeling socially- situated, yet may also exacerbate constraints on autonomy experienced by some older adults. Pet-related considerations at times led to discretionary acts of more-than-human solidarity, but also created paradoxical situations for service-providers, impacting their efforts to assist older adults. A shortage of pet-friendly affordable housing …

Hygiene Beliefs, Attitudes, And Practices Of Suya Producers In Nigeria, Vivian Iwar

Walden Dissertations and Doctoral Studies

The street food sector continues to grow in Nigeria in a largely unregulated environment. The lack of regulation poses a significant public health risk for consuming unsafe street foods such as suya. Quantitative research has revealed high levels of microbiological contamination of suya, despite qualitative findings that suggest that food handlers are knowledgeable about safe food handling practices. This discrepancy reveals a gap in understanding about what influences safe food handling practices besides knowledge. This qualitative study was therefore designed to gain a deeper understanding of the beliefs and attitudes that influence hygienic practices among suya producers. Guided by the …

The Meaning Of Feeling Fearful For New Community/Public Health Nurses, Demetrius Ann Jones

Walden Dissertations and Doctoral Studies

This study examined the meaning of feeling fearful for nurses entering community/public health (C/PH) nursing. Nurses are entering the C/PH workforce with less experience and education than ever before, and may feel afraid or fearful in their jobs. Additionally, the autonomous nature of C/PH nursing poses significant challenges for this population such as fear of isolation and/ or abandonment. Therefore, the purpose of this qualitative descriptive study was to explicate the meaning of feeling fearful for new C/PH health nurses. Ten nurses with up to 2 years of C/PH experience volunteered for this study. The research questions were guided by …

Translation And Validation Of The Spanish Version Of The Rapid Estimate Of Adult Literacy In Dentistry-30, Wilma Luquis

Walden Dissertations and Doctoral Studies

Low or marginal health literacy affect nearly 90 million citizens in the United States, compromising health outcomes, including oral health. Oral health literacy has been studied in diverse populations, yet the assessments used were developed and validated for English-speaking populations. A validated Spanish-language oral health literacy assessment was needed to help researchers and practitioners evaluate oral health literacy in the Hispanic population. Using the oral health literacy framework, the purpose of this study was to translate, culturally adapt, and validate a Spanish version of a previously validated English-language oral health literacy. A translation-back-translation process was applied to the English version …

Temporary Restaurant Closures And Food Handling Violations: Inspection Reports In British Columbia, Pam Mandarino

Walden Dissertations and Doctoral Studies

Unsafe food handling practices are implicated in many restaurant-associated foodborne disease outbreaks. Factors that contribute to unsafe food handling in restaurants include inadequate food safety knowledge, employees who perceive that safe food handling is not under their control, and restaurant cultures that do not prioritize food safety. The purpose of this study was to determine whether temporary restaurant closures were associated with reduced food handling violations after closure in restaurants from the Vancouver Coastal Health Authority and the Fraser Health Authority, in British Columbia, Canada. The theoretical foundations used were the health action process approach and the theory of planned …

School Nurses' Role In The Management Of Children With Type 2 Diabetes, Rosaline Jane Martinez-Culpepper

Walden Dissertations and Doctoral Studies

An estimated 215,000 children and adolescents younger than 20 years old were diagnosed with Type 1 or Type 2 diabetes in 2011. Management of children with Type 2 diabetes requires 24-hour care provided by health care providers, parents, and school nurses. Guided by the health belief model (HBM), the purpose of this qualitative case study was to explore and describe beliefs, attitudes, and practices of school nurses who manage children with Type 2 diabetes. A pilot study with 2 nurses was conducted to finalize interview guide. Volunteer school nurses were recruited through an e-mail announcement from their school district. Face-to-face, …

Gender Differences In Health Service Utilization Among Veterans With Acute Kidney Injury, Freneka Fronsha Minter

Walden Dissertations and Doctoral Studies

The U.S. Department of Veterans Affairs (VA) studies on acute kidney injury (AKI) have focused on defined procedures and outcomes but not on gender differences. The purpose of this study was to investigate differences in health services utilization by gender and other predisposing factors (age and race) among hospitalized veterans with AKI during a 5-year period from 2008 to 2013. The study included a retrospective cohort design and the behavioral model of health services utilization as the underlying theoretical framework. Secondary data were collected from an existing VA cohort. Data from 1,636 hospitalized AKI veterans were subjected to t tests …

Improving The Nursing Practice Environment With Point Of Care Specimen Collection, April Marie Saathoff

Walden Dissertations and Doctoral Studies

Specimen collection and identification errors are a significant problem in healthcare, contributing to incorrect diagnoses, delayed care, lack of essential treatments, patient injury or death, increased length of stay and increased healthcare costs, and decreased patient satisfaction. The purpose of the project was to evaluate the implementation of specimen collection technology with barcode scanning and bedside label printing in the maternal child health division of a community teaching hospital. The project was driven from Donabedian's quality framework for healthcare implementations, indicating that evaluating the quality of health care can be drawn from the categories of structure, process, and outcomes. The …

Leadership Strategies For Addressing U.S. Pharmaceutical Drug Shortages And Supply Chain Disruptions, Adrian Grant Scioli

Walden Dissertations and Doctoral Studies

Health care providers in the United States expend more than $400 million in unnecessary direct costs annually managing the effects of widespread drug shortages. Based on the theory of complexity and complex adaptive systems, the purpose of this exploratory multiple case study was to identify the strategies that health care pharmaceutical procurement leaders from the Eastern region of the United States use to address widespread drug shortages. Data were collected from 5 semistructured interviews with pharmaceutical procurement leaders, recorded field notes, and a review of public documents from company websites. Data analysis included deductive and open coding techniques. Emergent themes …

Infant Mortality Among African American Women Compared To European American Women In New York City, Marian Taylor

Walden Dissertations and Doctoral Studies

The birth of low weight babies in the United States has not had a meaningful decline for the last 10 years.It continues to be a major predictor of fetal-infant mortality. In addition, the rate of low birth weight infants among African American women continues to be twice that of European American women. Low birth weight babies may experience breathing problems, vision problems, diabetes, hypertension, and cerebral palsy. The purpose of this study was to examine why the high infant mortality rate persist among the African American communities of Southeast Queens, New York City as compared to European American communities in …

African American Pastors' Perspectives On Health Promotion Ministries, Brenda Ivy Watson

Walden Dissertations and Doctoral Studies

The centrality of the church in African American communities makes it a culturally compelling sponsor for health promotion activities targeting health disparities among the medically underserved. Pastoral support is critical in determining whether a church initiates or supports a health promotion agenda, but there is little understanding of the variables that influence this decision. The aim of the qualitative study was to investigate the perceptions of African American pastors regarding the decision to incorporate health promotion programs in their churches. This study was guided by the health belief model using a phenomenological approach. Data were collected using both semi-structured and …

Spirituality Among African American Christian Women Who Have Contemplated, Marilyn Wiley

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention reported that African American women had the lowest recorded number of suicide completions among all ethnic and gender groups in the United States. In addition, the number of suicides among African American women continued to soar without a clear reason or understanding of their lowest completion rates. Further research in the area of spirituality among African American women may be critical in understanding why African American women's rates of completed suicides are statistically lower than other ethnic groups and how to prevent future rate increases. A phenomenological framework was used to examine the …

Leadership Attributes And Behaviors As Predictors Of Organizational Resilience In Academic Health Care Systems, Patti Lynn Besuner

Walden Dissertations and Doctoral Studies

Research intentionally addressing how leadership attributes and behaviors collectively contributed to the socioecological perspective of organizational resilience were not found. This is a problem for organizations who must hire without benefit of how a collective leadership effect might influence their psychological capital. The purpose of this study was to explore whether or not self-efficacy, psychological empowerment, personal resilience, and leadership style were associated with or predicted organizational resilience among clinical managers in an academic medical center setting. Metatheory of resilience and resiliency was used to frame the study. A quantitative correlational design was used. Self-reported data was collected via the …

Examining The Relationship Between Exercise Induced Fatigue And Postural Stability Among Geriatric Patients With Vestibular Disorders, Alexis Christine King

University of the Pacific Theses and Dissertations

Purpose: This study examined: (1) the relationship between exercise induced fatigue and postural balance amongst geriatric patients with vestibular disorders. (2) Assessed the duration for postural stability to return to baseline measurements upon induced fatigue.

Methods: A controlled pre-post test experimental design method was used during this study. This study incorporated a quantitative analysis to explore the relationship between exercise induced fatigue and postural balance with a sample of 24 subjects. The subjects were randomly assigned to either an experimental or control group. Baseline postural stability measurements were conducted prior to all subject testing and were accounted for again once …

Fragment-Based Excitonic Coupled-Cluster Theory For Large Chemical Systems, Yuhong Liu

University of the Pacific Theses and Dissertations

Accurate energetic modeling of large molecular systems is always desired by chemists. For example, ligand-protein binding simulations and enzymatic catalysis studies all involve with a small energy difference. The energetic accuracy depends largely on a proper handling of electronic correlations. Molecular mechanics (MM) methods deliver a parameterized Newtonian treatment to these problems. They show great capability in handling large calculations but give only qualitatively good results. Quantum mechanics (QM) methods solve Schrödinger equations and exhibit much better energy accuracy, though the computational cost can be prohibitive if directly applied to very large systems.

Fragment-based methods have been developed to decompose …

Investigating Secondary Structure Features Of Yap1 Protein Fragments Using Molecular Dynamics (Md) And Steered Molecular Dynamics (Smd) Simulations, Ferdiemar Cardenas Guinto Jr.

University of the Pacific Theses and Dissertations

Molecular dynamics (MD) is a powerful tool that can be applied to protein folding and protein structure. MD allows for the calculation of movement, and final position, of atoms in a biomolecule. These movements can be used to investigate the pathways that allow proteins to fold into energetically favorable structures. While MD is very useful, it still has its limitations. Most notable, computing power and time are of constant concern.

Protein structure is inherently important due to the direct link between the structure of a protein and its function. One of the four levels of protein structure, the secondary structure, …

The Rational Investigation Of Anti-Cancer Peptide Specificity Using The Knob-Socket Model, Shivarni Patel

University of the Pacific Theses and Dissertations

Cancer has been a pervasive and deadly problem for many years. No treatments have been developed that effectively destroy cancer cells while also keeping healthy cells safe. In this work, the knob-socket construct is used to analyze two systems involved in cancer pathways, the PDZ domain and the Bcl-BH3 complex. Application of the knob-socket model in mapping the packing surface topology (PST) allows a direct analysis of the residue groups important for peptide specificity and affinity in both of these systems. PDZ domains are regulatory proteins that bind the C-terminus of peptides involved in the signaling pathway of cancer progression. …

Solubility Enhancement Of Model Compounds, Lavanya Pitani

University of the Pacific Theses and Dissertations

Solubility is the amount of solute in the solvent system at phase equilibrium with certain temperature and pressure. Many of the new chemical entities are lipophilic molecules that require techniques to enhance solubility. Solubility enhancement can be achieved by either physical and/or chemical modification of the drug. Various techniques are available for solubility enhancement of poorly soluble drugs include particle size reduction, salt formation, solid dispersions, use of surfactants, prodrug, crystal modification, etc.

In this study, the three model drugs belong to BCS class II and IV having low solubility with a certain range of physicochemical properties were studies in …

Clinical Factors Associated With Hepatitis C Treatment Selection In A Veterans Affairs Population, Carly Anne Ranson

University of the Pacific Theses and Dissertations

Background: Hepatitis C virus is currently the most common chronic blood borne pathogen in the United States, with only half of those infected aware of their condition. The cost for treatment is higher with Harvoni® (ledipasvir/sofosbuvir) than Viekira Pak® (ombitasvir/paritaprevir/ritonavir and dasabuvir). With finite resources available to treat patients, it is important to understand which clinical factors may influence treatment selection decisions.

Methods: The study is a 12-month medical record review within the Veterans Affairs (VA) system to evaluate significant relationships between selected clinical and sociodemographic factors and HCV treatment selection with either Harvoni® or Viekira Pak®. Clinical and demographic …

Liposome-Coated Magnesium Phosphate Nanoparticle For Delivery Of Cytochrome C Into Lung Cancer Cells A549, Weizhou Yue

University of the Pacific Theses and Dissertations

Proteins are large biomolecules that have great therapeutic potential in treating many human diseases. However, chemical/enzymatic degradation, denaturation, and poor penetration into cells are some of the challenges for clinical use of intracellular proteins.

Previously, our group has developed cationic lipid-coated magnesium phosphate nanoparticle (LP MgP NP-CAT) formulations to enhance the intracellular delivery of the negatively charged protein catalase. The goal of the current research is to develop a formulation to deliver cytochrome c (CytC), a positively charged protein into lung cancer cells A549. Specifically, this thesis research prepares and tests liposome-coated magnesium phosphate nanoparticle for delivery of cytochrome c …

Heart Failure Readmission Strategy Via Heart Failure Script, Michael Todd Williams

Walden Dissertations and Doctoral Studies

Hospital administrators strive to reduce readmission and over use of the acute care setting for chronic health conditions. Historically hospitals have focused on readmission prevention strategies to improve the transition of patients from the hospital to the community and although the causes of a hospital readmission may span multiple providers along the continuum of care, the hospital is currently the only provider being penalized. The project facility implemented a readmission reduction strategy, Re-Engineered Discharge (Project RED), as a means to reduce readmissions and yet continued to have high readmission rates for heart failure (HF) patients. The continued high rate of …

Evaluating The Impact Of A Smoking Cessation Program., Gideon Eke

Walden Dissertations and Doctoral Studies

Forty-six million individuals in the United States used tobacco products. People who use

tobacco products attempt numerous strategies before giving up smoking habit altogether. The goal of this project was to evaluate the impact of a tobacco cessation program by evaluating pre-and post-cessation program data, and hospital records of participants attending the hospital smoking cessation program over a 6-month period to ascertain the degree of reduction in tobacco use and hospitalization from smoking-related diseases. The population sample comprised of both men and women between the ages of 18 years and above. The project question addressed whether the smoking cessation program …

How Heroin-Addicted Offenders Experience Sobriety Upon Release From Jail, Rebecca Lynn Foster

Walden Dissertations and Doctoral Studies

Heroin addiction is a growing epidemic in the United States. The need for proper treatment programs accessible by heroin users who wish to or are mandated to participate in recovery programs is a growing need, and pathways to sobriety for ex-offenders have presented in literature as understudied. The purpose of this study was to examine heroin-addicted offenders' experiences prior to and after release on their paths to sobriety. This study followed a qualitative phenomenological approach based on the theory of personal causation, which posits that individuals see events in life as either driven by themselves or caused by others, both …