Medicine and Health Sciences Commons^™

Patient Satisfaction With Substance Use Disorder Rehabilitation Services, Trupti Dhumal

Electronic Theses and Dissertations

Background: Patient satisfaction is considered as an important indicator in the evaluation of healthcare quality across an array of treatments and services. It is deemed vital especially in the field of substance use disorder (SUD) research due to an increased emphasis on understanding patients’ perceptions regarding their treatment and the attributes that drive their progress towards recovery. Despite the potential value, gaps have been recognized in the exploration of these satisfaction-related assessments among patients undergoing SUD treatment in residential rehabilitative settings. Thus, there is a need for understanding the dimensions contributing to satisfaction which would facilitate the development of …

Determining Nurse Practitioner Core Competencies Utilizing A Delphi Approach, Tracey Chan

Electronic Theses and Dissertations

Background: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined.

Purpose: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies,(AACN, 2017a) …

Characterization Of The Effect Of Exercise Dose And Integrative Nonpharmacological Therapies In The Treatment Of Chronic Pain, Anna M. Polaski

Electronic Theses and Dissertations

Chronic pain includes debilitating conditions affecting large populations of people throughout the world. These diseases are further complicated by comorbid psychological disorders which make chronic pain conditions difficult to treat. Nonpharmacological treatment options have more recently become an important mainstay of effective therapies and are currently being used to supplement or replace traditional pharmacological treatment methods. Exercise-based therapies in particular are of interest due to their demonstrated success in reducing pain symptoms as well as improving psychological outcomes. Dose is an important factor in being able to effectively prescribe treatments in the context of specific exercise interventions and specific pain …

The Ethical Justification Of Increasing Awareness Of Preventive Medicine Among Healthcare Professionals, Patients And The General Public In The United States, Karishma Ether Moazzam

Electronic Theses and Dissertations

While practiced for centuries, preventive medicine has received increased attention during the recent times. Preventive medicine has a distinct mission to protect, promote, and maintain health as well as to prevent diseases, disabilities, and premature deaths. It aims to fulfill its mission through the combined form of clinical intervention and health promotion. In the recent years, preventive medicine has begun to lean more towards the clinical interventions, taking away from the health promotion. This imbalance has caused preventive medicine to lose its effectiveness in fulfilling its mission. One of the leading causes for such imbalance is the lack of proper …

The Potential For Dickeya Dianthicola To Be Vectored By Two Common Insect Pests Of Potatoes, Jonas K. Insinga

Electronic Theses and Dissertations

Dickeya dianthicola (Samson) causing blackleg and soft rot was first detected in potatoes grown in Maine in 2014. Previous work has suggested that insects, particularly aphids, may be able to vector bacteria in this genus between plants, but no conclusive work has been done to confirm this theory. In order to determine whether insect-mediated transmission is likely to occur in potato fields, two model potato pests common in Maine were used: the Colorado potato beetle (Leptinotarsa decimlineata Say) and the green peach aphids (Myzus persicae Sulzer). Olfactometry and recruitment experiments evaluated if either insect discriminates between infected and …

Evaluating The Occurrence Of Age-Related Peripheral Neuropathy In Het3 Mice And Development Of A Whole Tissue Imaging Technique For Analyzing Total Innervation In The Subcutaneous Adipose Depot, Jake Willows

Electronic Theses and Dissertations

Adipose tissue can be characterized as either being a white (energy storing) depot or a brown (energy expending) depot and both have been found to contain dense networks of neural innervation. This adipose nerve supply regulates numerous metabolic functions and likely plays an important role in the function of adipose blood vessels. Recently our lab has shown in the C57BL/6 mouse model that peripheral neuropathy, or the dying back and dysfunction of the nerves in the superficial tissues such as the skin, can extend into the subcutaneous adipose tissue in conditions commonly associated with the neuropathic phenotype (i.e. diabetes, obesity, …

Design, Synthesis, & Biological Evaluation Of Novel Het-Aromatic/Aromatic Analogs For The Treatment Of Hiv, Cancer, & Cognitive Dysfunctions, Mohit Gupta

Electronic Theses and Dissertations

Cyclophilin A are a class of peptidyl-prolyl isomerases that catalyzes isomerization of the proline residue within a protein. Cyclophilin A plays an instrumental role in the pathogenesis of HIV and HCV virus. Using structure-based drug we designed and synthesized small molecule inhibitors of cyclophilin A. These inhibitors were biologically evaluated for their ability to inhibit WT HIV-1 inhibition.

Mitogen-Activated Protein Kinase signaling cascades plays a critical role in cancer cell survival, metastasis, and chemo-resistance. The MEK5/ERK5 pathway, which is a member of MAPK signaling cascade, is involved in cell survival, anti-apoptotic signaling, angiogenesis, and cell motility. It is found to …

Hosptial Preparedness For An Internal Mass Casualty Event, Jason Farr

Electronic Theses and Dissertations

The purpose of this study was to determine hospital preparedness for an internal mass casualty/active shooter event at Tennessee hospitals. Data were collected during May of 2019 by surveying the CEOs of the 86 acute care hospitals in Tennessee. The survey solicited responses about training, preparedness, and internal evaluation of procedures. CEOs of 28 (32.5%) of Tennessee’s acute care hospitals responded to the survey. Just over half (53.6%) of those responding indicated that they believed their facility was prepared or well prepared for an active shooter event. The mean responses of CEOs who had experienced an active shooter event were …

An Exploratory Study Of Duty-Related Stress Among Conservation Officers, Logan Ledford

Electronic Theses and Dissertations

Research relating to police stress has typically focused on officers working in urban areas, neglecting their rural counterparts. This is especially true of conservation officers, who are tasked with enforcing laws in state parks and other recreational areas. To date, only a handful of studies have sought to better understand their experiences and perceptions. The current study seeks to further our understanding of conservation officer stress in three unique ways: (1) via applying McCreary and Thompson’s (2006) operational police stress scale (PSQ-Op) to the population, (2) determining whether officer characteristics (e.g., age, education, length of service) affect perceived stress, and …

The Manipulation Of Host Transcription By The Ankh Effector Of Legionella., Juanita E. Von Dwingelo

Electronic Theses and Dissertations

Legionella pneumophila is a Gram-negative facultative intracellular bacterium that can be found dispersed throughout freshwater environments, where it primarily parasitizes amoebae and other protozoan species. Humans are an accidental host for L. pneumophila, and infection occurs upon inhalation of aerosolized water droplets that contain the bacteria. L. pneumophila is the causative agent of Legionnaires’ Disease, which is the result of intracellular proliferation within alveolar macrophages. Pathogenesis of L. pneumophila is dependent on the Dot/Icm type 4 secretion system (T4SS) apparatus, which is comprised of 27 proteins and is responsible for translocating over 330 effector proteins into the host cell. Many …

A Recombinant Cholera Toxin B Subunit Variant (Ctb-Kdel) Exhibits Unique Colon Mucosal Healing Effects That Have Therapeutic Implications For Inflammatory Bowel Disease., Joshua Mark Royal

Electronic Theses and Dissertations

This dissertation uncovers the mechanism and explores the utility of a recombinant cholera toxin B subunit (CTB) variant containing a KDEL endoplasmic reticulum (ER) retention motif (CTB-KDEL) as a drug candidate for the treatment of inflammatory bowel disease (IBD). CTB is a mucosal immunomodulatory protein that induces robust mucosal and systemic antibody responses. This well-known biological activity has been exploited in cholera prevention (as a component of Dukoral® vaccine) and vaccine development for decades. On the other hand, several studies have investigated CTB’s immunotherapeutic potential in the treatment of inflammatory diseases such as Crohn’s disease and asthma. Here, we reveal …

Exploring Normalization Of Deviance And Examining Factors That Predict Culture Of Safety In The Operating Room., M. Imelda Wright

Electronic Theses and Dissertations

Patient safety in the operating room is a prodigious responsibility of OR nurses as the OR environment is complex and laden with risk, which increases surgical patients’ risk for adverse events. The dissertation presents the topic of patient safety in the operating room (OR), the concept of normalization of deviance, and a mixed-methods study with an exploratory sequential design that involved three phases. The dissertation comprises of five chapters. Chapter One presents an introductory overview of the salience of patient safety as well as its relevance to the unique environment of the OR. Chapter Two presents a concept analysis of …

Coordination Of Airway Protective Behaviors And Swallow: Effects Of Afferent Feedback And Sex., Alyssa D. Huff

Electronic Theses and Dissertations

This dissertation represents a series of studies describing mechanisms related to breathing, upper airway behaviors and their coordination in man and animal. Chapter two transformed the cough swallow aspiration protocol from the cat (previous work) to the human introducing a new strategy, volume targeting, in swallow breathing coordination. Chapter three evaluated swallow breathing coordination at increasing altitudes. As respiratory drive altered due to hypoxia and hypocapnia, swallow breathing coordination shifted toward inspiration occurring during the transition from inspiration and expiration. The collection of the two previous studies led to development of an animal model to evaluate volume targeting and …

Characterization Of The Impact Of Prenatal Cigarette Smoke Exposure On Age- And Sex-Specific Sirt1-Mediated Hepatic Molecular Phenotype In C57bl/6 Mice., Kendall S. Stocke

Electronic Theses and Dissertations

In the U.S., 7.2% of women still report having smoked at some point during pregnancy despite known risks to fetal health. Prenatal cigarette smoke exposure (CSE) in children puts them at risk for low birth weight, premature birth, and other adverse impacts on developmental and postnatal health. Children subjected to prenatal CSE have a higher risk of adulthood metabolic disease predicted by the Barker Hypothesis. The hepatic molecular phenotype associated with this risk is unknown. This dissertation characterizes the prenatal CSE-induced hepatic molecular phenotype during three key life stages. We used a murine model of prenatal CSE utilizing a Teague …

Addressing The Problem Of Sterile Drug Injecting Supply Acquisition For People Who Inject Drugs., Barbra Ann Cave

Electronic Theses and Dissertations

This dissertation contains five chapters, including three manuscripts, covering harm reduction and some of the challenges people who inject drugs (PWID) face in their effort to reduce the risk of injection drug-related harms through sterile injecting supply acquisition and use. Chapter One discusses some background related to PWID and provides an overview of the issues addressed in this dissertation. Chapter Two includes a literature review covering the harm reduction concept, important aspects of syringe exchange programs as a harm reduction tool, and the social determinants of health model as a potential tool for future research. Chapter Three is a two-phase …

Design And Development Of A Comprehensive And Interactive Diabetic Parameter Monitoring System - Betictrack, Nusrat Chowdhury

Electronic Theses and Dissertations

A novel, interactive Android app has been developed that monitors the health of type 2 diabetic patients in real-time, providing patients and their physicians with real-time feedback on all relevant parameters of diabetes. The app includes modules for recording carbohydrate intake and blood glucose; for reminding patients about the need to take medications on schedule; and for tracking physical activity, using movement data via Bluetooth from a pair of wearable insole devices. Two machine learning models were developed to detect seven physical activities: sitting, standing, walking, running, stair ascent, stair descent and use of elliptical trainers. The SVM and decision …

Automatic Exposure Control During Computed Tomography Scans Of The Head: Effects On Dose And Image Quality, Stephen D. Osborne

Electronic Theses and Dissertations

Automatic exposure control (AEC) is effective at reducing potentially harmful radiation doses without sacrificing image quality for many types of computed tomography (CT) scans. However, there is a need for more information regarding the use of AEC for CT head scans. This study was conducted at Johnson County Community Hospital in Mountain City, TN. Preexisting adult CT head scans (n)60 were randomly selected to form 2 stratified samples, (n)30 each. One sample used a standard protocol, and the other used a protocol with a mA-modulated AEC system, Siemens CARE Dose 4D. Causal-comparative analyses were conducted, and …

Structure Elucidation Of A Pyrrolobenzodiazepine Alkaloid And A Biologically Active Polyketide Produced By Rhodococcus Sp. Mtm3w5.2 Via Two-Dimensional Nmr Spectroscopy, Garrett Johnson

Electronic Theses and Dissertations

As the battle against ever-increasing drug resistence bacteria rages on, novel and sometimes more complex natural products can be used to combat this. In this study, two-dimensional NMR techniques were utilized to collect a complete spectral data set for two natural products. The first structure, a synthesized Pyrrolobenzodiazepine alkaloid natural product was confirmed through these methods. The second, a strain of Rhodococcus, MTM3W5.2, produces a novel antibacterial molecule in broth cultures and the active compound was fractionated using a Sephedex LH-20 column. Chromatographic purification yielded a pure sample at 58.90 minutes, RT.58. HRMS data deduced an exact mass of …

Local Anesthesia Before Intravenous Cannula Insertion: Recommendations For Registered Nurses In Practice, Vera Campbell-Jones

Electronic Theses and Dissertations

Abstract

Administering local anesthetics, such as intradermal, should become standard practice for RNs in pretreatments for pain control prior to intravenous insertion. Peripheral venous cannulation has provoked the most fear and anxiety in adult patients about everyday practice in hospitals. Adult patients often state that this procedure causes considerable discomfort. Local anesthesia for cannulation is usually not offered to adult patients who are on general medical units. Evidence has indicated inconsistency in the use of pain management strategies during these procedures. The researcher’s goal in this project was to educate RNs about the intradermal pretreatment procedure, provide education on the …

The Impact Of Direct Nursing On Patient Engagement To Improve Medication Adherence, Shelley Moore

Electronic Theses and Dissertations

This study examined the impact of direct nursing care on patient engagement and medication adherence within the practice setting of specialty pharmacy. It investigated the problem statement, “Among patients with specialty pharmacy dispensed medications, will direct interaction with nurses impact patient engagement and improve medication adherence?” Patient engagement in healthcare is a growing area of knowledge for the effectiveness of care. The research uncovered patient engagement as a predictor of improved medication adherence through effective direct nursing involvement. Methods to measure engagement were the utilization of the ACE™ Altarum Consumer Engagement (ACE) Measure™. By using a proven, researched tool to …

“Pissing In The Wind”: Racially Discriminatory Economic Policies’ Impact On Today’S Banking Status, Use Of Alternative Financial Services And Health Outcomes., Gaberiel Jones Jr

Electronic Theses and Dissertations

Centuries of discriminatory policies and practices in the United States have created racially segregated, resource-poor urban communities. Differential benefits of banking and housing legislation were among the consequences of these policies as they contributed to drastic racial inequities in wealth. Today, racial differences in banking status and financial practices persist. However, a void exists in the literature exploring what alternative financial services (AFS) are used in lieu of banks by Black Americans, why those services are used, the thoughts and beliefs of Black Americans about the use of those services, the impact of bank locations on financial behavior patterns, and …

The Identification Of Long Non-Coding Rna Zfas1 Through An Exploratory Rna-Sequencing Analysis And Its Association With Epithelial-To-Mesenchymal Transition In Colon Cancer Adenocarcinoma., Stephen J. O'Brien

Electronic Theses and Dissertations

Colorectal adenocarcinoma is the fourth most common cancer diagnosed worldwide and is a significant cause of morbidity and mortality. This dissertation performed an exploratory RNA-sequencing analysis comparing gene expression between colon adenocarcinoma tissue and paired normal colon epithelium. After identification of a number of lncRNAs that were increased in expression in colon adenocarcinoma compared to normal colon epithelium, we aimed to validate the expression and investigate their function in vitro. Specifically, we focused on the lncRNA ZFAS1 and its association with epithelial-to-mesenchymal transition. These studies found the following: 1. Seven candidate lncRNAs were identified from the exploratory RNA-sequencing analysis to …

The Effects Of Nicotine And Cigarette Smoking On Cardiac Electrophysiology., Affan B. Irfan

Electronic Theses and Dissertations

Cigarette smoking is a leading cause of preventable disease and premature death worldwide. The adverse effects of cigarette smoking, including proarrhythmia, are related to the mixture of chemicals, including nicotine (which sustains tobacco addiction). However, it remains unclear which individual tobacco smoke constituents and biological pathways mediate this increased risk. The purpose of this research was to explore the chronic effects of cigarette smoking, as well as compare the acute effects of nicotine and cigarette smoking, and the possible role of β-adrenoreceptors, on human cardiac electrophysiology. Chapter 1 is a comprehensive literature review of (a) the ex vivo and in …

Electrospun Fibers And Nanoparticles For The Prevention Of Sexually Transmitted Infections., Kevin Michael Tyo

Electronic Theses and Dissertations

Human immunodeficiency virus-1 (HIV-1) and herpes simplex virus 2 (HSV-2) affect hundreds of millions of people worldwide, with women disproportionately impacted by these infections. Currently, only oral pre-exposure prophylaxis (PrEP) is approved specifically for the prevention of HIV-1, but is challenged with adverse side effects associated with long-term use. Topical delivery platforms, such as gels and films, deliver agents directly to the female reproductive tract, but are limited in providing transient-release. The technology of polymeric electrospun fibers may serve as alternative topical delivery platform to the female reproductive tract. In these studies, we fabricated electrospun fibers comprised of different polymers …

The Nurse As The Facilitator Of Patients' Narration: An Educational Intervention, Petra Stockman

Electronic Theses and Dissertations

More than one million resident patients live and receive care at certified long-term facilities in the United States, many of whom suffer from depressive symptoms and anxiety. Prior research recommended storytelling as a vibrant nursing intervention to assist long-term care residents in overcoming challenges and emotional pain. However, nurses frequently lack knowledge of successful planning and implementation of narrative reminiscence. This scholarly project was designed to increase nursing competence and confidence in using storytelling as a clinical tool to improve mental health in long-term care, using a quasi-experimental, nonrandomized pretest, intervention, and posttest study design. A convenience sample of 10 …

Chronic Kidney Disease: The Need To Increase Nurse Practitioner Awareness, Juan Hernandez

Electronic Theses and Dissertations

Abstract

Chronic kidney disease (CKD) has become a major issue in the United States. Individuals with chronic disease such as diabetes, cardiovascular disease, or hyperlipidemia are at higher risk of CKD. Risk factors include family history, age, obesity, and smoking. Kidney function decreases with age and other related conditions. It is critical to increase awareness, education, and prevention of CKD to advanced practice nurses. Nurse practitioners encounter and have the responsibility to be able to identify and manage patients in their primary practice. To address this issue, a sample of nurse practitioners in a local community health center was surveyed …

Examining Opportunities To Increase Flu Vaccine Uptake On College Campuses Through Pharmacy Partnerships, Kristi Hargrave

Electronic Theses and Dissertations

The purpose of this project was to examine a university health clinic’s influenza vaccination program in a suburban city in a western U.S. state, and to explore the effects of partnering with a local pharmacy to overcome billing issues. A program evaluation was conducted to identify the potential barrier of cost for students. The health clinic was not set up to bill private health insurance for students; therefore, if students wanted to get a flu shot, they had to pay out of pocket for it. A pilot program was created in conjunction with the program director, partnering with the local …

Std Education Among African American Women: An Educational Improvement Initiative, Marqueta V. Abraham

Electronic Theses and Dissertations

Research reveals there is a knowledge gap facing African American women regarding sexual health education, specifically sexually transmitted diseases. The Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ) was used to assess participants’ knowledge and attitudes regarding sexually transmitted diseases. The STD-KQ self-assessment was administered to African American women and utilized to develop a 45-minute education seminar to bridge the knowledge gap. After an education seminar was held, a posttest was administered to test the women’s knowledge and to determine their level of awareness. Using a paired-samples t test, the researcher found an overall increase in awareness of the types of sexually …

Emergency Department Nursing Psychological Care (Early Crisis Intervention) For Adult Victims Of Violent Crime: A Quantitative Study, Barbara Conn

Electronic Theses and Dissertations

Recognition of the significance of early interventions and the importance of addressing psychological trauma for the victim of violence is of utmost importance for quality of life and the victim’s future. The serious impact of psychological trauma on victims of violent crime supports further study to determine whether Emergency Department (ED) nurses assess this trauma and initiate early interventions and referral for ongoing psychological care. Nursing care, assessment and early intervention with victims of violent crime was the focus of this dissertation study.

A quantitative study, with a non-experimental, descriptive design employed retrospective chart reviews to determine whether ED nurses …

A Quantitative Study Of Drug Recrystallization In Drug-In-Adhesive Transdermal Patches Using Vibrational Spectroscopy, Yi Li

Electronic Theses and Dissertations

Drug-in-adhesive (DIA) transdermal patches are an important type of transdermal drug delivery system (TDDS). The drugs used in the DIA system are frequently present in metastable forms, such as amorphous solids or supercooled liquids. These drug states are thermodynamically unstable and tend to undergo recrystallization. Recrystallization of the active pharmaceutical ingredient can adversely affect the efficacy of transdermal products. This dissertation demonstrates a systematic approach to quantify the crystalline content of the API in DIA systems. This approach uses a novel method of preparing calibration standards and a spectroscopic method to reliably predict crystalline content in DIA patches. Spectroscopic tools, …