Do Clinical Exercise Tests Permit Exercise Threshold Identification In Patients Referred To Cardiac Rehabilitation?, Randi R. Keltz

Electronic Thesis and Dissertation Repository

The purpose of this thesis was to quantify the proportion of patients whose clinical cardiopulmonary exercise test (CPET) permitted identification of estimated lactate threshold (θ_LT) and respiratory compensation point (RCP) and to characterize the variability at which these thresholds occur to evaluate the feasibility of “threshold-based” aerobic exercise prescription. We retrospectively analyzed CPET data of 1102 patients (65±12 yrs; 306 females) referred to cardiac rehabilitation. θ_LT and RCP were identified and reported as oxygen uptake (V̇O₂), heart rate (HR), %V̇O_2peak, and %HR_peak. Patients were grouped by threshold identification: group 0) neither …

Incorporating Poi As A Therapeutic Modality For Preschool Aged Children In The Care Clinic, Danielle Zirkle

Department of Occupational Therapy Entry-Level Capstone Projects

No abstract provided.

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

Implementation Of An Educational Teach-Back Program For Patients With Hypertension, Lakesha Hill

Dissertations

Implementation of an Educational Teach-back Program for Patients with Hypertension

Abstract

Problem: To improve health literacy and provide adequate health care to patients and their family, clear and effective dialogue is essential. The teach-back method is a technique utilized to confirm a patient’s level of understanding of care instructions done by relaying patient directions, and then confirming the patient understands by asking the patient to reiterate those directions. The purpose of this quality improvement project was to assess the effectiveness of using the teach-back method by health care professionals with their patients who have a diagnosis of hypertension or high …

Pediatric Streptococcal Pharyngitis Testing And Treatment Practices, Amanda Welch

Dissertations

Objective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.

Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Improving Initial Lactic Acid Compliance Of Suspected Septic Adults In A Rural Emergency Department, Nataleigh Jones

Doctor of Nursing Practice Projects

Background: Sepsis remains one of the leading causes of death in hospital settings. The doctor of nursing practice (DNP) project demonstrated areas that the hospital is doing satisfactorily with compliance and many areas for improvement within the organization regarding sepsis compliance. The DNP project demonstrated the effectiveness of the sepsis best practice advisory (BPA) tool in increasing sepsis bundle compliance in the emergency department (ED).

Purpose: The purpose of this DNP project is to help aid in the early recognition of sepsis and improve initial lactic acid compliance in a local emergency department. Many tools help with the early recognition …

Improving Door-To-Balloon Times In Adult Patients With St-Elevation Myocardial Infarction By Utilizing A Stemi-Rn, Amanda Hunter

Doctor of Nursing Practice Projects

Background: Heart disease is the leading cause of death in Alabama. The national estimated annual incidence of myocardial infarction (MI) is 605,000 new and 200,000 recurrent attacks, of which approximately 170,000 are silent (Tsao et al., 2022). Roughly every 40 seconds, an American will have an MI (Tsao et al., 2022). An ST-elevation myocardial infarction (STEMI) occurs when one or more of the coronary arteries supplying the heart with blood occlude, leading to myocardial injury (Akbar et al., 2021). Clinical practice guidelines for STEMI recommend Door to Balloon (D2B) intervention in 90 minutes or less (O'Gara et al., 2013), while …

Low-Incidence Special Education Teachers Lived Experience Teaching During Covid-19, Christina Samone Hatcher

Graduate Student Dissertations, Theses, Capstones, and Portfolios

This study's purpose is to identify how the shift has impacted low-incidence special education teachers to remote learning during the COVID-19 pandemic. There is minimal research regarding the lived experiences of how low-incidence special education teachers teach remotely during the COVID-19 pandemic. This study will consist of evaluating how prepared low-incidence special education teachers felt they were for the demands of remote learning, how they mitigated the demands, what resources and support were received that were helpful, as well as what resources and support low-incidence special education teachers feel they still need to continue to teach remotely, and how their …

Complement System In Multiple Sclerosis: Its Role In Disease Course And Potential As A Therapeutic Target, Michael R. Linzey

Dartmouth College Ph.D Dissertations

Multiple sclerosis (MS) is a clinically heterogeneous neurological condition characterized by neuroinflammation and neurodegeneration. Relapsing-remitting MS, defined by inflammatory attacks, is the most common initial form of MS and there are currently 23 FDA-approved treatments for these patients. These therapies work primarily by reducing inflammation in the CNS; they do not work well in progressive disease. Therefore, an unmet medical need exists for effective therapeutic options to treat progressive MS (PMS).

In MS, intrathecal immunoglobulins synthesis (IIgS) correlates with disease progression. My goals for this dissertation were to establish the pathological role of IIgS and identify new potential therapeutic …

Mining Sars-Cov-2 Phylogenetic Trees To Estimate Circulating Infections And Patterns Of Migration, Erin V. Brintnell

Electronic Thesis and Dissertation Repository

The SARS-CoV-2 pandemic led to the formation of very large databases of genomic viral data. These databases contain information on transmission dynamics, emergence and evolution of SARS-CoV-2. However, extracting this information from sequences is difficult, as most methods of analyzing viral genomes were developed for smaller data sets. Therefore, my objective was to develop new fast estimators of the number of infections (I) and the rate of migration based on simple features of SARS-CoV-2 phylogenies.

I simulated pathogen evolution using a susceptible-exposed-infectious-recovered (SEIR) model of pathogen spread, reconstructing evolution using CoVizu. For simulations of I, I varied the total number …

Bridging Empathy, Qianwen Lu

Masters Theses

As a jeweler, ally, and sympathetic witness to the traumatic stories of survivors, my work aims to support the process of reconstruction and reintegration for victims and the greater community. To move beyond isolation, resentment, and debilitating helplessness requires care and support. I want my jewelry to act as catalysts in the healing process by straddling both sides of the trauma-induced situation, to create greater awareness and empathy. National Coalition Against Domestic Violence shows that women are more likely to become victims of domestic violence, sexual assault, or other forms of physical and psychological abuse in unhealthy emotional relationships. These …

Role Of Chronic Stress-Induced Neuroinflammation In Rodent Locus Coeruleus Physiology And Anxiety-Like Behaviors, Arthur Anthony Alfonso Reyes

Graduate School of Biomedical Sciences Theses and Dissertations

The locus coeruleus (LC), the primary site of brain norepinephrine (NE), is a key anatomical brain region implicated in the stress response. Stress is a neuroendocrine physiologic response to a stressor that promotes organism survival through adaptive change and restoration of homeostasis. The central stress response, which drives behavioral and physiological change, is primarily mediated by activating the hypothalamic-pituitary-adrenal (HPA) axis. While advantageous in the short term, chronic stress exposure can lead to HPA axis and LC dysregulation, which are thought to contribute to the etiology of anxiety disorders. Previous studies demonstrate the effects of acute stress in increasing LC …

Impact Of Covid-19 On Latinx And Black Communities, Carolina Zuluaga

Dissertations

This critical literature review project explored the impact of COVID-19 on Latinx and Black communities. According to the Centers for Disease Control and Prevention, as of September 28, 2022, around 16% of COVID-19 cases in the United States were among Latinx people, and 14% of cases were among Black people (Centers for Disease Control and Prevention, 2022). Since COVID-19 began, clinicians have become more conscious of the effects of health disparities within racial and ethnic minorities, which has warranted increased advocacy by educating health and mental health providers and creating and providing resources to these communities and clinicians. The review …

Investigating The Mammillary Bodies As An Early Target Of Alzheimer's Disease, Cole Martinson

University Honors Theses

Alzheimer's disease (AD) is the most common form of dementia. With minimal treatment options and no cure, developing a deeper understanding of the pathology of the disease is crucial. For nearly four decades, the accumulation of beta-amyloid (Aβ) plaques has been correlated with the disease and its progression. Previous studies mapping this accumulation show that the mammillary bodies (MB) are an early target of the disease. Glutamatergic neurons are of key interest due to their prevalence in the central nervous system, specifically the MB. To understand the effects of AD on the glutamatergic system, we used vesicular glutamate transporter 2 …

Obesity Risk And Comorbidities Among Colombians In New York City And In Colombia, Carlos A. Devia

Dissertations and Theses

Introduction: The prevalence of obesity and overweight in adults and children continues to increase worldwide, accounting for the mortality and morbidity from several diseases. Obesity disproportionally impacts Latinos in the United States (U.S.), and despite their diversity in origins, ancestry, and culture, it is still unclear the burden of obesity by specific Latino groups. For example, little information is available about how obesity impacts Colombians in the U.S. (the largest South American population). New evidence also indicates that Latino immigrants may no longer be arriving with healthy weight status to the U.S. because Latin American countries are undergoing epidemiologic and …

Implementation Of The Generalized Anxiety Disorder 2-Item Screening Tool For Adult Patients In An Underserved Outpatient Cardiology Clinic, Leila Joint

Doctor of Nursing Practice Final Manuscripts

Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization …

Educating And Improving Collegiate Athlete Sunscreen Use, Julia Pederson

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to prospectively evaluate the ability to alter the behavior of young adults by providing sunscreen education and thereby reduce their risk of skin cancer from sun exposure. Twenty-three collegiate athletes ages 18 to 21 years old who were on the university softball team were enrolled. These student athletes were then educated about the impact of daily sun protection and risk factors. The goal was to observe an increase in sunscreen use and increase sun exposure awareness.

Background: Skin cancer is the most frequently diagnosed cancer in …

How Alzheimer's Disease Is Taking Over (Your Brain), Hoda Aboueich

Honors Projects

As the population continues to age and the burden on our care system grows, it is urgent to understand, treat, and cure Alzheimer’s Disease (AD). Despite decades of research, there is currently no known cause for the development of dementia or AD. There are two prominent explanations currently dominant in neuroscience: amyloid plaques and neurofibrillary tangles. I will delve into the hypotheses and definitions of each of these pathologies and specifically address how they affect overall neural activity that is proposed to result in the neurodegenerative symptoms of AD. I will also discuss the recent research surrounding biomarkers, age-related neurodegeneration, …

Epidemiology Of Island And Mainland Populations: How Does Culture Influence Health Risk Factors Of Non-Communicable, Chronic, And Metabolic Diseases?, Jake Thomas D. Palisoc

Honors Projects

Non-communicable diseases (NCDs), including chronic and metabolic diseases, are responsible for 74% of global mortality and are strongly influenced by health risk factors. Geographical differences in NCDs have been identified in several countries but have not been completely explained through cultural factors, specifically island and mainland cultures. This study aimed to develop an epidemiological framework for determining diseases with the highest mortality for further investigation regarding different health risk factors rooted in a specific population’s cultural foundations. Preliminary findings indicated diabetes type II (D2) and CKD caused by hypertension and D2 to have the highest risk factor and mortality percentage …

Exploring The Hinterland: The Development Of A Person-Centered Music Therapy Method For A Hospice Patient With Lewy Body Dementia, Paige Chaplin

Expressive Therapies Capstone Theses

This thesis explores the development and implementation of a music therapy method with an individual diagnosed with dementia with Lewy Bodies (DLB) receiving home hospice services. There is very little known about the effect of music therapy on patients diagnosed with DLB. Informed by Tom Kitwood’s Person-Centered Care (PCC) philosophy for dementia care, Yumiko Sato’s Musical Life Review (MLR) model, and Lisa Kelly and Bill Ahessy’s Reminiscence-Focused Music Therapy (RFMT) model, a clinical method was developed to explore the effects of person-centered music therapy on reminiscence, caregiver connection, and identity. I drew inspiration from music therapy concepts by Tony Wigram …

The Role Of Complement In Stroke And Traumatic Brain Injury, Christine Couch

MUSC Theses and Dissertations

Brain and neural injury are a non-specific disease category that includes traumatic brain injury (TBI) and stroke. Both TBI and stroke are common, costly, and leading causes of severe disability in adults. Both stroke and TBI are responsible for substantial disability in working age adults, with stroke being the second leading cause of death worldwide [1] and TBI a major cause of disability in people younger than their 40's [2]. The immune response after brain injury is multifactorial and involves both local and systemic events at the cellular and molecular level. The complement system is a component of both the …

Development Of An Immunoblot Assay To Detect Antibodies To Sars-Cov-2 Spike And Nucleocapsid Antigens In Serum Of Covid-19 Patients, Christian Hollis

Honors Theses

The coronavirus disease (COVID-19) has created one of the most world-halting events in recent world history. Its effects have reached every corner of the globe and manifested problems within each country’s healthcare and social systems. During the pandemic, many researchers have searched to develop a more robust understanding of the novel virus’s genetic and structural material. In year three since the emergence of COVID-19, these researchers hope to implement new advancements in testing and detection for the presence of the virus.

This thesis intends to produce evidence for the reliability of COVID-19 antibody tests using immunoblot assay detection. These tests …

Investigating The Relationship Between Ses And Fear Of Covid-19 In A Sample Of Adults With And Without Asthma, Margot Salsman

Psychology Theses and Dissertations

While health challenges introduced by the coronavirus-19 disease (COVID-19) pandemic impacted the general population, individuals living with both asthma and low socioeconomic status (SES) may have been particularly vulnerable to health-related stress. For example, the CDC announced that a diagnosis of asthma increased one's risk of severe COVID- 19, emergency room closures restricted access to reliable disease management resources, and many lost health insurance after losing employment. Further, many essential or blue-collar workers could not protect themselves from disease by isolating themselves or quarantining at home. For these individuals, the pandemic may have introduced or exacerbated feelings of being "out …

Evolution And Epidemiology Of Channel Catfish Virus (Ccv), Arun Venugopalan

Theses and Dissertations

Channel catfish virus disease (CCVD) is the principal viral disease in the United States catfish industry. The CCVD is caused by channel catfish virus (CCV), with mortality reaching up to 100% in fingerlings. CCV is assigned taxonomically to the family Alloherpesviridae, genus Ictalurivirus, species Ictalurid herpesvirus 1 (IcHV-1). To date, virulence, immunogenicity, and genome plasticity of the CCV field isolates have not been investigated. Three genotypes of CCV (IcHV-1A, IcHV-1B, and BCAHV) were identified using restriction fragment length polymorphism (RFLP) analysis. Virulence assessment of three representative isolates of RFLP groups suggests that IcHV-1B (pooled survival [mean ± SE]: 58.3% ± …

The Impact Of Sleep Quality Combined With Physical Activity On Autonomic Function (24-Hour Hrv) In College Students, Meghan Peterson, Trent Hargens, Elizabeth Edwards, Christopher Womack

Masters Theses, 2020-current

Long-term poor sleep quality is associated with health outcomes that can lead to autonomic nervous system dysfunction. Both cardiorespiratory fitness and physical activity (PA) are associated with improvements in autonomic function and heart rate variability (HRV). Markers of fitness and sleep were explored to determine the degree of contribution to autonomic dysfunction. A total of 15 subjects, (age = 20.6±0.5; BMI = 23.9±1.0) completed 7 days of physical activity and sleep assessment via accelerometry. Participants then completed a graded exercise test to determine cardiorespiratory fitness (VO_2max), followed by a 24-H HRV measurement. HRV through LF:HF ratio was negatively …

Early Onset Hypertension Objective Structured Clinical Examinations, Katrina Morace

Doctoral Projects

Hypertension is known as a condition in which raised blood vessel pressure persists. On a normal day, the pressure can rise and fall causing damage to the heart. When the pressure stays at higher readings, damage can be caused to the heart and can also lead to additional health problems. Another word for high blood pressure is hypertension. The blood is carried to all body parts from the heart by the arteries. The harder the heart pumps the higher the blood pressure (Centers for Diseases Control and Prevention [CDC], 2020). When hypertension is not diagnosed and treated at an early …

Genetic Influences On The Response To Neuromodulation In Craving Behaviors, Carly J. Haring

Honors Thesis

Obesity and eating disorders are highly prevalent in the United States. People who suffer from obesity and/or eating disorders face serious health consequences and even death. Current treatments are not effective as recovery rates are low, so there is a dire need for an effective treatment for obesity and eating disorders. There have been studies investigating the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) as a means of treatment for these people. While findings show promise, there is much variability. The goal of this study is to further prior …

Cystic Duct Morphology And Heister Valves: A Cadaveric Study, Cierra R. Goerish

Theses & Dissertations

Continued occurrence of cholelithiasis, gallstones, commonly results in cholecystectomy, removal of the gallbladder. Having a comprehensive anatomical, histological, and physiological knowledge of the biliary apparatus is imperative in clinical medicine today. Additionally, the functionality of cystic duct (CD) Heister valves (HV) has been speculatory since being reported in 1732. This study summarizes the morphology, orientation, and variability of the gross biliary system and provides data to help justify HV functionality.

Cadaveric dissection was utilized for gross observation and analysis of the biliary system. The angulation of the CD was found primarily as an acute angle; however, obtuse angulation could be …

Mechanisms Of Mutated Myosin Vb Mediated Cholestasis In Microvillus Inclusion Disease, Melissa S. Holzapfel

Theses & Dissertations

Microvillus inclusion disease (MVID) is a constitutive intestinal epithelial disease which causes definitive intestinal failure and cholestatic liver disease primarily caused by mutations in the Myosin Vb gene. Genotype-clinical phenotype associations suggest that the progression of liver disease can be predicted through a correlation between myosin Vb residual function and variable retention of bile salt transport machinery in intestinal enterocytes and liver hepatocytes. We proposed that aberrant distribution of bile salt transport proteins disrupts enterohepatic regulation of bile acids and contributes to the progression of cholestatic liver disease. To investigate the genotype-phenotype correlation, samples from MVID patients were evaluated for …