Medicine and Health Sciences Commons^™

Education Program To Increase Nurses' Knowledge Of Faith Community Nursing, Lovell Thurmon Sweeten Cartwright

Walden Dissertations and Doctoral Studies

AbstractThe practice problem was a group of nurses practicing as faith community nurses (FCNs) who had no training in FCN practice, a specialty recognized by the American Nurses Association. This problem was important to address within the context of nursing practice because the nurses could have acted outside of their scope of practice and caused harm. The practice-focused question addressed whether a staff education program for FCNs would increase their knowledge of their role in a church setting with the goal of developing independent FCNs. The model guiding the project was the health promotion model. Eleven registered nurses were recruited …

Educating Nurses To Implement Serious Illness Conversations, Colleen Patricia Desai

Walden Dissertations and Doctoral Studies

AbstractAs part of investigating staff nurses’ reluctance to have serious illness conversations (SIC) at a local hospital, an educational deficit was noted. Nurses articulated they felt uneducated about how to have a SIC with a patient in need and questioned if the practice of conducting SICs was part of the nurses’ scope of practice in the New England State where they were employed. The purpose of this project was to create an educational tool and have it validated by a multidisciplinary group of experts. Once validated, the goal will be to educate nurses, raise awareness on the topic of SICs, …

Staff Education To Promote Probiotic Breastfeeding Therapy, José Diaz

Walden Dissertations and Doctoral Studies

Preterm birth is the leading cause of death in children under 5. In addition, there are 22 million babies born underweight each year which also contributes to the infant mortality rate. Some reasons for the inability to thrive and survive are the infants' immature system, allostatic load inadaptability, and undiversified and underdeveloped microbiota. Human breast milk (HBM) provides lifesaving nutrients, which prevents necrotizing enterocolitis and mortality. In addition, probiotic supplementation helps reduce late-onset sepsis, morbidities, and mortality. A literature review provided substantial evidence that HBM and probiotics can improve an infant's microbiota, thus improving thrivability and survivability. Probiotics offset the …

Facilitating Staff Education To Improve Effective Styles Of Nursing Leadership In An Orientation Setting, Tammy Melinda Finney

Walden Dissertations and Doctoral Studies

Nursing leadership is the cornerstone of the ever-changing landscape of healthcare. Minimal courses are included in nursing curriculums to prepare nurses to become proficient and develop knowledge of nursing leadership styles. There is a direct correlation of evidence-based leadership styles that impact effective communication, improved patient outcomes, succession planning, nursing retention, and relationship management. In an effort to bridge the gap of knowledge, an educational face-to-face training was developed and presented to new nursing staff in an orientation setting. The project practice question focused on commitment from nursing staff to implement increased knowledge of nursing leadership styles into their practice. …

Food Environment As A Moderator In The Relationship Between Ultra-Processed Food Intake And Mortality In The United States, Brandon Jerod Grandy

Walden Dissertations and Doctoral Studies

According to recent studies, the consumption of ultra-processed food is a major issue that leads to fatal outcomes within the United States, which is relevant because this type of food has become more accessible over the years. Using data from the National Health And Nutrition Examination Survey III (NHANES III), previous researchers found that frequent consumption of ultra-processed foods was associated with greater chances of all-cause mortality in U.S. adults, but little research has focused on factors that can impact ultra-processed food consumption, such as food environment. The purpose of this quantitative longitudinal study was to examine the effect of …

Clinicians' Perceptions Of Telehealth Services During The Covid-19 Pandemic In Virginia, Johnetta Hill Guishard

Walden Dissertations and Doctoral Studies

The onset of COVID-19 introduced unprecedented changes to how U.S. public health services were delivered. Many public and private agencies faced mandatory closures, social distancing mandates, and rapid transitions to telehealth interventions and treatment. Mental health clinicians witnessed disruptions in continuity of care and an increase in mental health risks overall. Although some studies have been conducted to survey clinicians’ perceptions of the usefulness and ease of use of technology-based interventions, knowledge about mental health clinicians’ experiences and perceptions in Virginia was sparse. The purpose of this generic qualitative study was to explore how mental health clinicians in Virginia described …

Traditional Healing And Biomedicine Use In Urban American Indians Living With Diabetes, Elin Elise Kambuga

Walden Dissertations and Doctoral Studies

The purpose of this interpretative qualitative study was to describe influences that affect the use of traditional healing and biomedical health services for type 2 diabetes to help health educators develop more culturally competent diabetes education programs for urban American Indian/Alaska Native (AI/AN) communities in the United States. The theoretical framework used for this study was the social ecological model (SEM). Using the SEM, the research questions were crafted to explore experiences of participants connected to personal, interpersonal, community, institutional, policy, and educational factors that influenced the use of traditional healing and biomedical health services. Urban AI/AN adults living in …

The Association Between Working Habits And Hypertension Among First Generation African Immigrants, Olalekan Kilo

Walden Dissertations and Doctoral Studies

Even though hypertension affects people of all races, it is more prevalent among African Americans. However, recent research has revealed that the prevalence of hypertension is progressively increasing across Africa. African immigrants in the United States are the least-studied immigrant group prone to health inequalities when compared to their African American counterparts. To help bridge this gap, a secondary data analysis of a cross-sectional study was conducted to investigate the association between working habits (hours worked, diet at work), length of stay in the United States, and hypertension rates for first-generation African immigrants residing in the United States. The study …

Discipline Without Punishment For African American Male Juveniles: From The Eyes Of A Mental Health Professional, Mia Nichole Lee

Walden Dissertations and Doctoral Studies

Juvenile rehabilitation and incarceration among African Americans are not equal and up to the standards and recommendations of society. This study focused on identifying the differences between the juvenile rehabilitation and incarceration punishment among African American offenders, with the goal of helping improve the way that the society looks at African Americans. The paper followed qualitative research methodology, which provided social evidence and helped in breaking down information. Data were collected from focus groups, observations, questionnaires, and interviews. The research highlights issues regarding juvenile rehabilitation and incarceration of African Americans, which can encourage change.

Examination Of Physiological And Perceptual Responses During Sustained, Isometric, Fatiguing, Handgrip Exercise Anchored To Ratings Of Perceived Exertion, Minyoung Kwak

Theses and Dissertations--Kinesiology and Health Promotion

The purposes of this study were to: 1) Examine the patterns of force responses relative to critical force (CF) during submaximal, fatiguing, isometric handgrip exercise anchored to different rating of perceived exertion (RPE) levels (RPE=3, 5, and 7); 2) assess the loss of force during the task and the level of performance fatigability after each RPE hold; 3) examine the time course of changes and patterns of neuromuscular [electromyography (EMG) amplitude (AMP), mean power frequency (MPF), mechanomyography (MMG) AMP and MPF, and neuromuscular efficiency (NME) (i.e. force/EMG AMP)] and muscle oxygen saturation (% SmO₂) responses during each RPE …

Investigation Of Lower Extremity Neuromuscular Function In Individuals With And Without Diabetes, Roya Hoveizavi

Theses and Dissertations--Kinesiology and Health Promotion

Background: Diabetes mellitus is associated with notable neuromuscular and motor dysfunctions that could lead to an increased risk of plantar ulcers and amputations. Several contributing factors, including increased muscle-tendon stiffness and abnormal muscle activation pattern may influence the kinematics and kinetics of walking in people with diabetes and promote formation of plantar ulcers. Hyperglycemia and the resultant accelerated rate of glycation have been recognized as the leading cause of muscle and tendon degeneration, yet the precise mechanisms by which diabetes affects the biomechanical properties of the muscle-tendon unit remains unclear. Altered muscle activity during gait is observed in people with …

Reliability And Validity Of A Commercial Running Power Meter To Indicate Metabolic Workload During Endurance Running, James Harris Hudgins Iii

Theses and Dissertations--Kinesiology and Health Promotion

Commercial running power (RP) meters may provide endurance runners and coaches with improved precision for monitoring running intensity. Cyclists rely upon the relationship between cycling power and metabolic demand to regulate physiological intensity during training and racing, independent of changes in the physical environment (e.g., terrain, wind). Research demonstrates strong reliability and validity for a specific RP meter to indicate metabolic demand within controlled running conditions. However, several potential influences on this relationship have not been investigated. Therefore, four studies were conducted with the following aims:

- Study 1: Determine the inter-limb reliability and validity of a single-limb-based RP meter …

Sensory Marketing For Consumer Wellbeing, Josh Lundberg

Theses and Dissertations--Marketing and Supply Chain

Chapter 1. Many consumer decisions – from trying a new brand to trying a new recipe – involve some risk. However, although consumers’ appetite for risk has received over fifty years of investigation, the impact of situational variables (e.g., atmospherics) on consumer decision making involving risk remains relatively unexplored. To address this gap, the current work examines the influence of temperature, a ubiquitous situational influence, on consumers’ inclination toward risk. Across four studies, we find evidence for a positive relationship between temperature and risk taking, using multiple manipulations of temperature and measurements of risk. Evidence suggests that this effect is …

Adverse Childhood Experiences, Nicotine Dependence, And Depressive Symptoms Among A Community Sample Of People With Mental Illnesses, Bassema Abufarsakh

Theses and Dissertations--Nursing

Adverse childhood experiences (ACEs) pose a major public health issue as they are associated with poor mental and physical health outcomes. In the United States (US), more than 60% of adults report at least one ACE, and around 15% experienced four or more. Repeated exposure to ACEs stressors can convert ACEs to toxic stress by altering the brain's architecture and function. Evidence suggests that exposure to four or more ACEs, which are indicators of exposure to toxic stressors, is associated with nicotine dependence (ND) and depressive symptoms. Moreover, people with mental illnesses (MI) often have greater exposure to toxic stressors …

Investigating The Use Of Mpges-1 Inhibitors For The Treatment Of Abdominal Aortic Aneurysms, Lauren M. Weaver

Theses and Dissertations--Pharmacy

The cardiovascular field is still searching for a treatment for abdominal aortic aneurysms (AAA). This inflammatory disease is a deadly, permanent ballooning of the aortic artery. It often goes undiagnosed until a late stage where associated rupture has a high mortality rate. Surgery is the only option available to patients, but it is risky. There are currently no FDA-approved pharmacological treatments for AAA available. Historically, drugs that have been examined in interventional clinical trials for treatment of AAA were repurposed therapeutics. Novel treatments have been unable to reach the clinic, stalling out in pre-clinical studies. Exceedingly few murine studies have …

Effectiveness Of A Long-Acting Cocaine Hydrolase In Metabolizing Cocaine And Its Physiologically Active Metabolites, Linyue Shang

Theses and Dissertations--Pharmacy

Cocaine is a widely abused, hepatotoxic drug without an FDA-approved pharmacotherapy specific for cocaine addiction or overdose. Cocaine-induced toxicity in animals and humans is due to its multiple physiological effects on the central nervous system, cardiovascular system, etc. The toxicity of cocaine is highly complex, as its metabolites also contribute to the toxicity. Notably, the combination of cocaine and alcohol is common among drug users and can produce additional metabolites. Some of the metabolites are more toxic than cocaine itself. Hence, to develop an ideal therapeutic candidate, the candidate should not only account for cocaine but should also detoxify other …

Self-Assembled Ternary Polypeptide Nanoparticles With Improved Biostability For Drug Delivery In Cancer Therapy, Preye Mike Agbana

Theses and Dissertations--Pharmacy

Cancer remains a real and present threat to global health. In the United States, according to cancer statistics, almost 40% of people will be diagnosed with cancer at some point in their lifetime. Conventional chemotherapy has become the mainstay for cancer treatment option. However, chemotherapeutic agents are plagued with problems such as poor aqueous solubility, chemical degradation, Bio instability, and off-site toxicity due to non-specificity. New drug modalities are needed to tackle the ever-growing burden on cancer. In recent times, the promise of nanotechnology has aided to develop drug delivery vehicles to facilitate the administration of potent chemotherapeutics. Nanoformulations such …

Striving For Appropriate Antibiotic Use: A Biomarker Initiative, And Outcomes Associated With Azithromycin Exposure, Amanda Gusovsky

Theses and Dissertations--Pharmacy

The introduction of antibiotics into clinical practice is considered the greatest medical breakthrough of the 20^thcentury. However, the use of antibiotics can contribute to the development of resistance. In the United States (U.S.), approximately 2.8 million people are infected with antibiotic-resistant bacteria each year, and more than 35,000 people die as a result. Moreover, some antibiotics are known to cause cardiac side effects including QT prolongation, hypotension, and ventricular arrythmias. The U.S. Centers for Disease Control and Prevention (CDC) defines appropriate antibiotic use as the effort to use “the right antibiotic, at the right dose, for the right …

Optimization Of Orally Bioavailable Inhibitors Of Defective In Cullin Neddylation 1 (Dcn-1), Leah Kovalic

Theses and Dissertations--Pharmacy

Ubiquitin (UB) and ubiquitin-like protein (UBL) pathways have emerged as important targets for oncology drug discovery based on the success of proteasome inhibitors (bortezomib or carfilzomib), E3 inhibitors, and the NEDD8 E1 inhibitor pevonedistat (MLN42924). Chemical inhibitors have also proven to be useful probes for identifying and dissecting multifactor UB and UBL regulatory networks. Toward this end, we have pursued approaches to target NEDD8 ligation to Cullins, through developing small molecule inhibitors of DCN1 (defective in Cullin Neddylation 1). DCN1 was discovered as a potentiating RBX1-dependent NEDD8-ligation, through recognizing the acetylated N-terminal methionine of the NEDD8 E2s UBE2M and UBE2F. …

Genetic And Pharmacogenetics Associations Of Cancer Disparities In Appalachia, Nan Lin

Theses and Dissertations--Pharmacy

Individuals residing in Appalachian regions have significant health disparities, including higher cancer incidence and mortality rates. Previous studies have addressed the impact of socioeconomic status and environmental risk factors on Appalachia cancer disparities, while few studies have evaluated genetic risk factors.

Germline whole exome sequencing samples from 7,078 individuals with cancer (759 Appalachians) were evaluated. Demographics and relatedness were assessed using KING. Ethnicity was verified by principal component analysis using TRACE, which included 6,034 individuals (85%) of European genetic ancestry. After QC filtering, 5,980 individuals were analyzed. To assess the overall predisposition of hereditary disease, gene level frequency of likely …

Bioinformatic Analysis Of Proteomic And Genomic Data From Nsclc Tumors On Prognostic And Predictive Factors Of Immunotherapy Treatment, Mark Wuenschel

Theses and Dissertations--Pharmacy

Recent lung cancer research has led to advancements in molecular immunology, resulting in development of small molecule inhibitors, or immune checkpoint inhibitors, that propagate an anti-tumor T cell response. Despite increased overall and progression-free survival with reduced adverse effects compared to traditional chemotherapy, treating advanced stage lung adenocarcinoma patients remains non-curative, and evidence of non-responders or tumor recurrence to immune checkpoint inhibitor therapy is growing. Also, compared to traditional chemotherapy, there is a lower percentage of patients who respond to small molecule inhibitors. In this analysis of proteomic and genomic data from The Cancer Proteome Atlas and Global Data Commons …

Population-Based Evaluation Of Treatment Patterns, Drug-Drug Interactions, And Cardiovascular Risk In Patients With Metastatic Castration-Resistant Prostate Cancer, Yue Cheng

Theses and Dissertations--Pharmacy

Prostate cancer has the highest increasing rate and new cases among all cancer in men in the United States and has a higher risk in elderly men. Metastatic castration-resistant prostate cancer (mCRPC) is the late stage of prostate cancer and associated with poor prognosis (median survival 13 months). Androgen deprivation therapy (ADT) use with novel hormone therapy or standard chemotherapy are recommended for mCRPC treatment. Although, the treatment options expanded significantly in recent years, new challenges are present because of the aging population, larger treatment spectrum and co-administrated medication use for other underlying medical conditions, especially for cardiovascular disease (CVD), …

Design And Synthesis Of Small Molecular Inhibitors Of Dcn1-Ube2m Interaction, Tucker J. Moseley

Theses and Dissertations--Pharmacy

Over the last century, advancements in medicine have been made to improve cancer patients' outcomes. The discovery of new druggable targets is essential to achieving this goal. Defective in Cullin Neddylation 1 is a proven oncogenetic driver that may lead to better clinical outcomes when targeted. In efforts to further improve a series of novel small molecular inhibitors of the DCN1 and UBE2M protein-protein interaction, the Guy lab has designed and synthesized 26 new compounds. These compounds were designed to specifically target the UBE2M N-Acetyl sub-pocket on DCN1 that was not occupied by compounds previously described in the literature.

Investigation Of Folate-Poly(Glutamic Acid)/Polyethylenimine/Dna Complexes For In Vitro Gene Delivery, Caleb Akers

Theses and Dissertations--Pharmacy

Gene therapy is currently being studied as a treatment for a variety of indications, including cancer, infectious disease, and cardiovascular diseases, among others. While many of the early treatments in the field involved the use of viral delivery methods, various safety, ethical, and financial concerns limit the potential uses of this methodology. As such, more recent research has focused on developing non-viral delivery platforms to alleviate some of the issues inherent in viral delivery. Recently, the release of the COVID-19 vaccines from Pfizer and Moderna represents a promising use of non-viral delivery as both utilized a lipid-based delivery vector.

Despite …

An Epidemiological And Pharmacokinetic-Pharmacodynamic Investigation Into The Impact Of Carbapenem-Resistant Enterobacterales, Justin Clark

Theses and Dissertations--Pharmacy

Background: According to the 2019 CDC Antibiotic Resistance Threats Report, more than 2.8 million antibiotic-resistant infections occur in the United States each year, leading to more than 35,000 deaths. Among the most urgent threats identified by the CDC are carbapenem-resistant Enterobacterales (CRE). Despite efforts to control the spread of these organisms, the number of estimated cases between 2012 and 2017 remained stable. In 2017, an estimated 13,100 hospitalized cases of CRE led to approximately 1,100 deaths and $130 million attributable healthcare costs. This dissertation seeks to address this issue from both a pharmacokinetic/pharmacodynamic and epidemiological perspective.

Methods: We evaluated the …

Developing A Biocatalytic Toolbox To Aid In Understanding Nucleoside Antibiotics, Jasmine Brianna Woods

Theses and Dissertations--Pharmacy

Antibiotic resistance happens when bacteria develop the ability to survive medications that normally terminate them. Instead, these super germs are able to survive in the body and produce a community of antibiotic resistance germs which can cause human fatalities. It is important to discover and develop new compounds and molecules that will improve this clinical obstacle. This research focused on analyzing the biosynthesis that incorporates distinctive chemical characteristic of various nucleoside antibiotics, ß-hydroxy amino acids and α-methyl-amino acids. ß-hydroxy amino acids and α-methyl-amino acids are considered an important class of industrially useful compounds, particularly for pharmaceutical development, and are found …

New Tools For Biocatalysis: Studies On The Carminomycin 4-O-Methyltransferase Dnrk, Elnaz Jalali

Theses and Dissertations--Pharmacy

Methyltransferases (MTs) are ubiquitous enzymes commonly involved in biosynthesis and regulation. The fundamental goal of this thesis was to explore the permissive nature of methyltransferases and leverage this unique biocatalytic feature to develop a new platform for chemoselective intramolecular cyclization reactions. To realize this ambitious goal, this thesis project set out to probe the substrate specificity of multiple natural product tailoring enzymes (MTs and glycosyltransferases), identify model substrates common to multiple such tailoring enzymes and subsequently establish multi-enzyme tandem reactions that would set the stage for a subsequent chemoselective intramolecular cyclization reaction. Chapter One highlights current state of the art …

Mitochondria As Causes Of And Therapeutic Targets In Chronic Post-Sepsis Skeletal Muscle Weakness, Meagan Scott Kingren

Theses and Dissertations--Pharmacology and Nutritional Sciences

Sepsis, or the organ damage that ensues after the body fails to properly contain a local infection, is the leading cause of in-patient hospitalization in the United States. Advances in critical care medicine over the last 20 years have enabled most sepsis patients to survive the life-threatening dysregulated immune response. However, a majority of survivors report chronic weakness and fatigue years after sepsis, and the cause of this weakness remains largely unknown. This dissertation work focused first on elucidating the major causes of post-sepsis muscle weakness (Aim 1). This aim involved a time-course study to determine when muscle weakness was …

Studies Of Polypharmacy And Medication Therapy Management In Population-Based Cohorts, Ximena A. Oyarzun Gonzalez

Theses and Dissertations--Epidemiology and Biostatistics

According to the United States Census Bureau, 16.8% of the population was 65 years and older in 2021, and it is expected that by 2060 that number will increase to about 30% (about 114 million people). Aging is associated with physiological changes in all systems of the body. These changes impact the pharmacodynamics and pharmacokinetic characteristics of drugs. Furthermore, older adults usually have several chronic conditions, which increases their exposure to medications. Increased vulnerability combined with increasing exposure puts elderly people at higher risk for drug interactions and adverse events.

Charlesworth et al. (2014) found that the prevalence of polypharmacy, …

Clustering Hospital Performance Using Group-Based Multi-Trajectory Modeling With Singular Bayesian Information Criterion, Gaixin Du

Theses and Dissertations--Epidemiology and Biostatistics

Hospital performance is complex and patient-experience oriented. Currently, the Centers for Medicare and Medicaid Services (CMS) evaluate hospitals yearly with a single score of one to five ("Star Rating") using composite measures from five domains. However, a single composite score cannot fully describe it, and alternative measures should be considered. Healthcare quality improvement needs long-term data to validate effectiveness. Group-based multi-trajectory modeling (GBMTM) estimates probabilities of latent group membership based on longitudinal profiles from multiple outcomes. We use GBMTM to identify groups of hospitals with similar performance in SAS PROC TRAJ.

We downloaded Medicare-eligible hospitals (N=5,111) that provided patient care …