Medicine and Health Sciences Commons^™

Spatiotemporal Analysis Of Neuronal Activity During The First Second Of Visual Conscious Perception, Anusha Raja

Yale Medicine Thesis Digital Library

Visual conscious perception occurs in less than one second. Using cerebral cortex electrical readings from human subjects during a behavioral visual task, we studied the spatiotemporal sequence of these events. Nine subjects, implanted with 100-300 subdural and depth electrodes in both hemispheres, were enrolled to complete the threshold perception task. The analysis investigated the role of broadband gamma power changes in electric potential in the range of 40-115 Hertz (Hz). In addition to implementing the behavioral task with the research subjects, my contribution focused on using clustering algorithms to analyze the broadband gamma power time-series to visualize the “switch and …

Patient Versus Physician Perceptions Of Prognosis And End-Of-Life Outcomes In Acute Leukemia, Sophia Elana Shimer

Yale Medicine Thesis Digital Library

PATIENT VERSUS PHYSICIAN PERCEPTIONS OF PROGNOSIS AND END-OF-LIFE OUTCOMES IN ACUTE LEUKEMIA.

Sophia Shimer and Kerin Adelson. Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.

Background: Acute leukemia poses unique challenges for prognostication. In many cases, cure is possible but unlikely and treatment is risky. Little is known about how patients perceive their prognosis. The purpose of this study was to assess prognostic understanding and end-of-life outcomes in patients with acute leukemia.

Methods: In this observational study, we surveyed patients admitted with acute leukemia and their treating hematologists. We elicited patient preferences for …

Contributors To The Development Of Intercultural Competence In Nursing Students, Esther Zazzi

Walden Dissertations and Doctoral Studies

Nurses deal more effectively with cultural diversity when they have an ethnorelative orientation toward cultural difference and commonality on the Intercultural Development Continuum, which was the theoretical framework of this study. Scholarly literature shows limited knowledge on what fosters nurses' intercultural development. Thus, this quantitative, retrospective study was the first investigation in health care in Switzerland conducted on nursing students' orientation on the Intercultural Development Inventory (IDI) and the relationship to student demographic variables. The sample for this secondary data analysis consisted of the IDI results from nursing students enrolled between 2010 and 2016 at the largest nursing college in …

Education Program For Critical Care Nurses On Preventing Catheter-Associated Urinary Tract Infections, Olatunde Olatunji

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles's adult learning theory. The theoretical model was based on 4 fundamental assumptions …

A Conflictive Triuvirate Consruct Of Epidemiologic Systems Failure, Ngozi Lois Ulinwa

Walden Dissertations and Doctoral Studies

Epidemiologic systems failure (ESF) is a major hurdle in minimizing the spread of infectious diseases during outbreaks. The reasons for ESF include the technical limitation of personnel handling epidemic crises, strictly defined health policies that limit the actions of epidemiologists, and personal perspective's reservations towards the intentions of health agencies. The purpose of this triumvirate mixed-methods case study was to examine factors of infectious disease control mechanisms useful for determining ESF. Three juxtaposed pre-emptive factors (technical [T], organizational [O], and personal [P] perspectives were used to determine how the multiple perspectives inquiring systems and fuzzy logic revealed factors causing ESF …

Effects Of Medical Professionals' Communication With Men Sleeping With Men And Hiv/Aids, Dawne D. Dickerson

Walden Dissertations and Doctoral Studies

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) initially emerged in the 1980s and ever since, a battle has been underway with regard to understanding some of the root issues attributed to behavior and HIV/AIDS. AIDS is prevalent in the men sleeping with men (MSM) community. There is lack of studies evaluating the quality and quantity of communication between MSM and medical professionals, which can be a catalyst to help reduce HIV/AIDS within this community. The aim of this quantitative study was to evaluate the relationship between quantity and quality of medical professionals' communication and regular HIV …

Parent/Patient Satisfaction And Physician/Nurse Interaction At A Children's Hospital, Veronica L. Givan

Walden Dissertations and Doctoral Studies

Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Veronica Laviece Givan

has been found to be complete and satisfactory in all respects,

and that any and all revisions required by

the review committee have been made.

Review Committee

Dr. Diana Naser, Committee Chairperson, Health Services Faculty

Dr. Nicoletta Alexander, Committee Member, Health Services Faculty

Dr. Michael Brunet, University Reviewer, Health Services Faculty

The Office of the Provost

Walden University

2019

Parent/patient satisfaction surveys are important tools used to measure quality of health care provided by physicians, nurses, and hospitals. Research has been conducted …

Exploring The Challenges Non-Clinical Departments Encounter During Eden Alternative Implementation, Keith George

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services recommends new guidelines that shift healthcare delivery in nursing homes and long-term care facilities from an institutional model to a person-centered care model. Although clinical outcomes are measured and tracked, there was limited literature about the challenges non-clinical departments face in a nursing facility during implementation of a person-centered model. The purpose of this qualitative study was to explore the challenges non-clinical staff experience while transitioning to an Eden Alternative philosophy, a person-centered care model. The theoretical foundation of this study relied upon Bressers' Contextual Interaction Theory. The research questions for this study …

Development And Evaluation Of A Long-Term Care Skills Simulation Program, Tina Marie Gerovac

Walden Dissertations and Doctoral Studies

New graduate nurses often lack clinical skill competency. In a single year, a long-term care facility located in the midwestern region of the United States reported 25 clinical errors, each costing the facility approximately $10,000. Root-cause analysis revealed 85% of those errors were made by nurses in their 1st year of practice. The increase in clinical errors were attributed to insufficient clinical preparation prior to independent practice. A review of the current scholarly literature suggested simulation had demonstrated efficacy in the development and maintenance of clinical nursing skills and answered the practice-focused question: Development of a skills simulation program for …

Leadership Development In Physical Therapy: Moving Toward A Community Of Transformative Practitioners, Kerry Cronin Mallini

Theses and Dissertations--Educational Leadership Studies

Physical therapy as an emerging profession is committed to establishing its identity and solidifying its role as a leader in health care. With expertise in human movement, wellness, and disease prevention, physical therapists possess invaluable knowledge and skill to influence public health and enhance patient recovery without increasing cost. Physical therapists have the opportunity to transform the delivery of public health services to meet current and future needs. A major challenge, however, is a dearth of leadership development in preparation programs. Because most physical therapists have not received formal education or explicit training in leadership, a problem of practice exists. …

Factors That Influence Maternal Feeding Decisions For Toddlers: Extending The Theory Of Planned Behavior, Elizabeth Lucas Combs

Theses and Dissertations--Kinesiology and Health Promotion

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.

The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using …

Chronic Low Intensity Continuous And Interval Training Prevent Heart Failure-Related Coronary Artery Stiffness, An Ouyang

Theses and Dissertations--Kinesiology and Health Promotion

Heart failure (HF) induced by aortic pressure over-load is associated with increased coronary artery stiffness. Perivascular adipose tissue (PVAT) and advanced glycation end products (AGE) both promote arterial stiffness. However, the mechanisms by which coronary PVAT promotes arterial stiffness and the efficacy of exercise to prevent coronary stiffness are unknown. The present study hypothesized both chronic continuous and interval exercise training would prevent coronary artery stiffness associated with inhibition of PVAT secreted AGE. Yucatan mininature swine were divided into four groups: control-sedentary (CON), aortic-banded sedentary heart failure (HF), aortic-banded HF continuous exercise trained (HF+CONT), and aortic-banded HF interval exercise trained …

Susceptibility To Ankle Sprain Injury Between Dominant And Non-Dominant Leg During Jump Landings, Riley Pashak

Theses and Dissertations--Kinesiology and Health Promotion

Ankle sprains are one of the most common injuries within athletics in the United States with approximately one-million student athletes experiencing ankle sprains each year. Studies argue excessive or rapid ankle inversion occurring from jump landings may cause ankle sprains. Also, the effect of limb dominance on risk of ankle sprain is not well documented.

The aim of this study was to determine if there is an affect of leg dominance on landing mechanism of the ankle joint that predisposes either ankle joint to greater risk of ankle sprain.

Twelve recreationally active subjects were recruited and completed four maximal vertical …

Longitudinal Descriptive Profile Of Collegiate Pitchers Participating In A Summer Baseball League, Isabelle Leslie Gillis

Theses and Dissertations--Kinesiology and Health Promotion

The purpose of this study was to provide a longitudinal profile of pitching performance in a cohort of pitchers over two collegiate seasons and a summer league. Thus, this study utilized a longitudinal design to evaluate the impact of summer league participation on subsequent collegiate regular season pitching performance. Specifically, the performance of a cohort of Division 1 collegiate baseball pitchers during the 2018 Spring collegiate season, 2018 Summer League season, and the 2019 Spring collegiate season was evaluated and stratified by pitcher designation, arm dominance, and academic status. Analyses of variance were used to identify main and interaction effects …

The Effects Of Curcumin And Fenugreek Soluble Fiber On The Physical Working Capacity At The Fatigue Threshold, Peak Oxygen Consumption, And Time To Exhaustion, Lauren Herrick

Theses and Dissertations--Kinesiology and Health Promotion

Curcumin, a polyphenol, has been suggested to improve metabolic byproduct clearance and increase nitric oxide production in working muscle. These purported effects may delay neuromuscular fatigue. Therefore, the purpose of this study was to examine the effects of curcumin in combination with fenugreek (CUR) or fenugreek soluble fiber alone (FEN) on the neuromuscular fatigue threshold (PWC_FT), time to exhaustion (T_lim) on a graded exercise test (GXT), and O₂peak in untrained subjects.Forty-seven,college-aged, aerobically untrained individuals were randomly assigned to one of three supplementation groups; placebo (PLA, n=15),curcumin + fenugreek, CurQfen® (CUR, n=18), or fenugreek soluble …

Effects Of Curcumin And Fenugreek Soluble Fiber Supplements On Submaximal And Maximal Aerobic Performance Indices In Untrained College-Aged Subjects, Jensen Goh Zhong Sheng

Theses and Dissertations--Kinesiology and Health Promotion

Submaximal exercise performance is, in part, limited by the accumulation of metabolic byproducts and energy system capacities. Curcumin and the combination of curcumin and fenugreek soluble fiber (CurQfen^®) have been shown to increase endogenous antioxidants and metabolic byproduct clearance as well as reduce inflammation and lipid peroxidation, and therefore, may enhance submaximal aerobic thresholds. In addition, there is evidence that the galactomannan component of fenugreek, used to enhance bioavailability of curcumin, may also have potential physiological effects related to the up regulation of free fatty acid oxidation Therefore, the purpose of this study was to examine the effects …

Calibrated Short Tr Recovery Mri For Rapid Measurement Of Brain-Blood Partition Coefficient And Correction Of Quantitative Cerebral Blood Flow, Scott William Thalman

Theses and Dissertations--Biomedical Engineering

The high prevalence and mortality of cerebrovascular disease has led to the development of several methods to measure cerebral blood flow (CBF) in vivo. One of these, arterial spin labeling (ASL), is a quantitative magnetic resonance imaging (MRI) technique with the advantage that it is completely non-invasive. The quantification of CBF using ASL requires correction for a tissue specific parameter called the brain-blood partition coefficient (BBPC). Despite regional and inter-subject variability in BBPC, the current recommended implementation of ASL uses a constant assumed value of 0.9 mL/g for all regions of the brain, all subjects, and even all species.

The …

The Influence Of Patient-Provider Interaction, Self-Concept, And The Socio-Physical Environment On Pelvic Exam Seeking Behavior, Anxiety, And The Health Care Experience, Julie Lasslo

Theses and Dissertations--Education Sciences

Regular gynecological screenings are critical for women in promotion of health and preventing diseases like cervical cancer. Despite the importance of such examinations, many women fail to adhere to recommended screening protocols. As a result, women experience an increased disease risk. The current study examined the relationship between patient-provider communication quality, skill, and empathy on pelvic exam seeking behavior and exam-related anxiety and satisfaction. Additionally, negative self-concept, perceived poor genital self-image, and various elements of the socio-physical clinic environment were explored to better understand their impact on a women’s care seeking behavior.

A total of 350 women 19 through 80 …

Improving Safety Performance Of Highway Maintenance Crews Through Pre-Task Safety Toolbox Talks, Zamaan Al-Shabbani

Theses and Dissertations--Civil Engineering

The dangerous work environment in the construction industry and the inherent high risks associated with construction work make it the focus of safety training and regulations. Highway construction and maintenance has unique hazards but seemingly less directly applicable safety standards, regulations, and programs. Department of Transportation (DOT) employees working in highway maintenance are exposed to a variety of unique hazards specifically associated with their work and not relating to the adjacent traffic. Yet, highway construction and maintenance work has not received sufficient attention in terms of safety research and programs. The lack of safety training and education in highway construction …

Madness Narratives: Victorian Textual Responses To The Insanity Diagnosis, Jonathan Glenn Tinnin

Theses and Dissertations--English

In Madness Narratives, I examine four understudied texts at the intersection of Victorian asylums, patients’ lack of voice, and resistance narratives. I argue that these texts all reject the silencing power of the insanity diagnosis as they represent patients, former patients, and asylum reformers creating counternarratives that call for recognition of the patients’ humanity and right to be heard. In my first chapter, “Narrating Insanity: Constructing the Madness Narrative in Charles Reade’s Hard Cash,” I assert that Reade’s 1863 novel proposes a nuanced understanding of the insanity diagnosis as a collaboratively-composed story that justifies the confinement of the …

The Stimulation Of Dendritic Cells By Cationic Lipids, John Peyton Bush

Theses and Dissertations--Medical Sciences

The discovery that cationic lipids can independently stimulate the immune system has generated interest in their potential as vaccine adjuvants. Here, we show that the cationic lipid R-DOTAP can independently stimulate type 1 interferon production in dendritic cells in both primary culture and immortalized cell culture. Levels of type 1 interferon production are cell line-dependent and limited in vitro by lipid-induced cell death. We show that cationic lipids can independently activate TLR-7 and TLR-9, suggesting a mechanism for type 1 interferon induction. This TLR-stimulatory activity is not restricted to R-DOTAP and can be extended to other similar cationic lipids in …

Integrin Α5Β1 As A Novel Target With The Small Peptide, Atn-161, In The Treatment Of Ischemic Stroke, Danielle Nichele Edwards

Theses and Dissertations--Neuroscience

Stroke is the 5^th leading cause of death and the leading cause of disability in the United States, but there are only two available therapies, tissue plasminogen activator and endovascular thrombectomy. As both therapies focus on removal of the clot, the subsequent pathologic processes, i.e. inflammation, cerebrovascular breakdown, ATP depletion, etc. are left untreated, contributing to worsened patient outcome. Many clinical trials have unsuccessfully attempted to address these mechanisms. The blood-brain barrier (BBB), a system of non-fenestrated endothelial cells, extracellular matrix, and astrocytic endfeet, is significantly impacted after ischemic stroke in its role of preventing the free movement of …

The Role Of Cd8 T Cell Immunodominance And Regulatory T Cells In Neonatal Immunity To Influenza Virus, Luke Heil

Theses and Dissertations--Microbiology, Immunology, and Molecular Genetics

Neonates are more susceptible to influenza virus infection than adults, resulting in increased morbidity and mortality as well as delayed clearance of the virus. Efforts to improve influenza infection outcomes in neonates typically center on prevention, although current vaccines fall short of complete protection and can only be administered in humans after 6 months of life. We propose that as the neonatal immune system responds differently than the adult immune system, interventions that are efficacious or tolerable in adults cannot be guaranteed to perform the same in neonates. T cell vaccines that target conserved influenza virus epitopes have been proposed …

Neuroprotective Strategies Following Experimental Traumatic Brain Injury: Lipid Peroxidation-Derived Aldehyde Scavenging And Inhibition Of Mitochondrial Permeability Transition, Jacqueline Renee Kulbe

Theses and Dissertations--Neuroscience

Traumatic brain injury (TBI) represents a significant health crisis. To date there are no FDA-approved pharmacotherapies available to prevent the neurologic deficits caused by TBI. Following TBI, dysfunctional mitochondria generate reactive oxygen and nitrogen species, initiating lipid peroxidation (LP) and the formation of LP-derived neurotoxic aldehydes, which bind mitochondrial proteins, exacerbating dysfunction and opening of the mitochondrial permeability pore (mPTP), resulting in extrusion of mitochondrial sequestered calcium into the cytosol, and initiating a downstream cascade of calpain activation, spectrin degradation, neurodegeneration and neurologic impairment.

As central mediators of the TBI secondary injury cascade, mitochondria and LP-derived neurotoxic aldehydes make promising …

Autologous Peripheral Nerve Grafts To The Brain For The Treatment Of Parkinson's Disease, Andrew Welleford

Theses and Dissertations--Neuroscience

Parkinson’s disease (PD) is a disorder of the nervous system that causes problems with movement (motor symptoms) as well as other problems such as mood disorders, cognitive changes, sleep disorders, constipation, pain, and other non-motor symptoms. The severity of PD symptoms worsens over time as the disease progresses, and while there are treatments for the motor and some non-motor symptoms there is no known cure for PD. Thus there is a high demand for therapies to slow the progressive neurodegeneration observed in PD. Two clinical trials at the University of Kentucky College of Medicine (NCT02369003, NCT01833364) are currently underway that …

Depressive Symptoms Among Farm Women Aged 50 And Older, Cheryl Dean Witt

Theses and Dissertations--Nursing

Alarming rates of suicide among production farmers have prompted researchers to investigate factors associated with depressive symptoms among this population. Aspects of farm life and farming can contribute to higher levels of depressive symptoms. Higher levels of depression can also increase an individual’s risk of injury and development of chronic disease, impacting overall quality of life. Despite the approximate 3.5 million farm women in the U.S., current research has focused on the male farmer.

Men and women have different responses to stressors, and women in general have a higher prevalence of depressive symptoms. Farm women can be further subjected to …

Neurochemical Factors Associated With The Initial Pathophysiological Reaction To Large Vessel Occlusion Stroke, Sarah R. Martha

Theses and Dissertations--Nursing

Ischemic stroke is the leading cause of disability world-wide and affects over 800,000 people per year in the United States. The majority of these strokes are ischemic due to a blockage of blood flow to the brain. Damage to the brain occurs at the onset of stroke, neuronal cell death is irreversible and therefore, quick treatment to remove blockage is critical factor in the recovery from stroke. Mechanical thrombectomy as a treatment for ischemic stroke provides an ideal opportunity to collect blood distal and proximal to the cerebral thrombus to examine neurochemical changes occurring during stroke.

The purpose of this …

End-Of-Life Decision-Making In Patients With A Cardiac Device, Jessica Harman Thompson

Theses and Dissertations--Nursing

Heart failure (HF) is one of the top causes of mortality in the United States and globally. In order to combat the high mortality rates of this disease, medical technology, including internal cardioverter defibrillators (ICD) and left ventricular assist devices (LVAD), have become one of the most common treatments. Over the past 10 years the utilization of these cardiac devices has increased exponentially, which has created a new phenomenon of how we discuss death with patients who have one of these devices. The purpose of this dissertation is to increase understanding of the end-of-life decision making processes and current experiences …

A Lifestyle Intervention To Decrease Risk Of Developing Type 2 Diabetes Mellitus In A Rural Population, Amanda Culp-Roche

Theses and Dissertations--Nursing

Individuals with type 2 diabetes mellitus (T2DM) are at risk for developing life-threatening comorbidities such as cardiovascular disease (CVD). As a consequence, T2DM is associated with increased morbidity and mortality and decreased quality of life, thus highlighting the importance of prevention of T2DM. Further, the prevalence of T2DM is substantially greater in rural populations compared to urban populations, making rural individuals particularly appropriate targets for T2DM prevention.

T2DM is a largely preventable disease that is associated with modifiable risk factors such as poor diet, sedentary lifestyle, and obesity. Lifestyle interventions to improve these modifiable risk factors have been used to …

Race-Based Discrimination, Occupational Stress, And Depression In Black Registered Nurses, Arica A. Brandford

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine depression, experiences of work-related racism, and occupational stress among black nurses. Nursing is a highly stressful and demanding profession that can negatively affect health. Underscoring this is the high rate of depression experienced by nurses. In fact, nurses experience depression at a rate twice that of individuals in other occupations. Examining depression in nurses can provide insights that can inform measures addressing the psychological health of this group. This may be particularly important in black nurses who, in addition to the already high occupational stress associated with nursing, may experience additional stress …