<p> Mobile medical applications are emerging as a significant part of the healthcare industry. Despite this popularity, mobile medical application development has proven difficult due to several factors. Moreover, the U.S. Food and Drug Administration's (FDA) 2013 publishing of strict regulatory requirements has further complicated development efforts.</p><p> Consequently, this thesis addresses the market need to design mobile medical applications in a manner that simultaneously ensures conformance to regulatory requirements and facilitates commercial success. Thoroughly analyzed as a solution is the integration of Agile tools, practices, and principles with the Waterfall model for software development to develop a quality system that delivers safe and effective mobile medical applications in a manner that promotes commercial success.</p><p> Specifically, this thesis provides an Agile augmented Waterfall model for mobile medical application development that ensures conformance with regulatory requirements and responds to unique market development needs, thus orienting the organization towards commercial success.</p>

<p> Manufacturers, specifically small machine shops, find it difficult to compete with the capabilities of large manufacturers. If these small shops are not certified to a recognized standard such as AS9100, sales become even harder.</p><p> Small businesses need assistance in understanding and achieving the certifications requirements for a quality management system (QMS), which requires management's commitment and total buy-in for a proper implementation plan that involves the entire staff.</p><p> The objective of this project is to develop a quality manual that outlines the total process for the implementation of an AS9100 QMS. The author has researched various guidance documents that provide an understanding of the requirements, ownership, targets, and steps for applying appropriate resources. </p><p> A Gap analysis has been completed to determine the status of the QMS and identify what actions should be taken. Documents and processes have been developed with input from the management team, leading to a successful certification process.</p>

<p> Suicide is a tragic, complex phenomenon experienced by individuals of all ages, genders and cultures. Given its widespread occurrence, it is important to identify predictive and risk factors in order to develop efficacious prevention and intervention strategies. One factor that has been consistently identified as increasing risk for suicide is being diagnosed with schizophrenia. Persecutory delusions have been most prominently researched in relation to outcome in schizophrenia; however, few studies have investigated the relationship between persecutory delusions and suicide risk for those with this diagnosis. Furthermore, studies that have been conducted are largely quantitative in nature, and therefore are limited by their ability to offer explanations for their results. Understanding quantitative relationships through a theoretical perspective focused on choice and meaning making, such as existential psychology, may increase the specificity and effectiveness of preventative programs and intervention approaches, ultimately leading to more saved lives. This dissertation therefore used archival data from participants in the Chicago Follow-Up Study diagnosed with schizophrenia or schizoaffective disorder to explore the relationship between the course of suicidality and persecutory delusions in schizophrenia through an existential lens. Locus of control and self-esteem were included in the analysis as possible mediating variables. Those with high self-esteem endorsed higher suicidal activity, and those with persecutory delusions endorsed higher suicidal activity and a more external locus of control. Implications of these results suggest both self-esteem and locus of control should be addressed as possible mediating factors in the relationship between persecutory delusions and suicide for those diagnosed with schizophrenia.</p>

<p> The purpose of this study is to assess the attitudes towards individuals with mental illness among the healthcare providers of a long-term care facility. It takes a quantitative, non-experimental, cross-sectional, descriptive approach to view relationships. Minimal research exists in this subject matter, and literature reviews suggest that negative attitudes toward mental illness exist among healthcare providers (Ahmead et al., 2010; Aydin et al., 2003; Bjorkman et al., 2008; Rao et al., 2008; Reed &amp; Fitzgerald, 2005; Ucok, 2008; Ross &amp; Goldner, 2009; Smith et al., 2011; Zolnierek &amp; Clingerman, 2012). The Community Attitudes toward the Mentally Ill (CAMI) questionnaire was given to a sample of 51 long-term care employees. Data was analyzed by using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0, focusing on significant results concerning t-test, chi-square, and correlations in order to answer the research questions. Findings suggest a majority of the employee's attitudes in this long-term care facility were nonauthoritarian, nonsocial restrictive, and nonbenevolent. While there was no significant empirical support for differences in attitudes among RNs, LPNs, and CNAs, certain questions on the CAMI did provide significant results. Related to this there was also no empirical evidence for differences among the attitudes of departments, except when individual analysis of each question was complete. Correlational analysis showed relationships between various variables: education and seeking treatment for oneself, race and previous work experience, department and previous work experience, authoritarian views and gender, authoritarian views and education, nonsocial restrictive view and age, community mental health ideology and age, and community mental health ideology and department. Implications on future research and a discussion of recommendations to further decrease stigma in the long-term care environment are completed.</p>

<p> Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.</p>

<p> The purpose of this quantitative ex-post facto study was to determine if the level of satisfaction is increased over hospitals that do not incorporate PCC services. The study involved the use of archival data from HCAHPS (n.d.) satisfaction surveys analyzed during the first quarter of 2013. The respondents of the study included using archival patient satisfaction survey data from 113 hospitals within the State of Michigan. Fifty-two of these hospitals were identified as providing some level of PCC services to patients, and 61 of the hospitals were identified as not providing PCC services to patients. For each of the research questions, a two-sample t-test was used to compare the mean percentages between hospitals that have implemented PCC services and hospitals that have not implemented PCC services. The use of a two-sample test with all of the research variables did not reject any of the hypotheses for this study. This outcome could indicate that HCAHPS (n.d.) patient satisfactions scores may not be directly linked to PCC services. Although the results for this study did not demonstrate a favorable outcome regarding HCAHPS (n.d.) satisfaction scores and PCC services, the literature review for this study validates the importance for leaders within the health care community who have established PCC services to find other measurements to assess the effectiveness of PCC services, and those who do not to consider the implementation of Patient-Centered Care (PCC) services within their hospitals.</p>

<p> Objective: This study was designed to evaluate the use of low dose vaginal estriol and low dose vaginal estradiol creams for the treatment of vulvovaginal atrophy. Methods: We designed a 12-week randomized double blinded pilot study. Participants applied the study cream daily (estriol 10mcg, estradiol 10mcg, or placebo) for 2 weeks and then twice weekly for a further 10 weeks. Results: Sixty three women were accrued, of whom 56 completed the study. There was no statistical difference between the three groups in improvement in the symptoms of vulvovaginal atrophy. There was a within group improvement for vaginal dryness and itch in all 3 arms. The within group improvement for vaginal dryness was greatest in the estriol group. Estriol levels remained &lt;25ng/ml at baseline, week 2 and week 12 for all participants except 1 (in the placebo group at week 2 when it rose to 29.8ng/ml). Estradiol levels at week 2 in the estradiol group were significantly higher than week 2 levels in the estriol or placebo group. Conclusions: Low dose vaginal estriol cream is a feasible alternative to low dose vaginal estradiol cream for the treatment of vulvovaginal atrophy. Further research should include a larger volume of base cream and an adequately powered clinical trial.</p>

<p> Low health literacy impacts an individual's ability to comprehend communication from healthcare providers, reduces access to healthcare, and contributes to increased mortality. The purpose of this study was to evaluate the impact of learning style on adult health literacy education. The health belief model, protection motivation theory, the transtheoretical model, and social cognitive theory were used to analyze the data in this study, and to further develop effective health literacy education. The research questions addressed the effectiveness of educational intervention adjusted to their appropriate learning style in comparison to a standardized health literacy intervention and potential difference, according to type of learning style, in the amount of changed performance between pretest and posttest. A sample of 80 adults in an urban community was recruited through organizations serving low-income individuals. The participants were assessed for baseline health literacy level, followed by identification of learning style, educational intervention, and posttest assessment, which led to determination by <i>t</i> test that changes between pretest and posttest scores were statistically significant between the control group and the study groups. This finding suggests that health education should be delivered to patients according to individual learning style in order for patients to comprehend and retain information provided. Social change implications include healthcare professionals appropriately addressing health literacy so that patients may participate more actively in their personal healthcare decisions to improve healthcare quality outcomes, decrease long-term costs of delivering healthcare services, and improve the general health of the community.</p>

This thesis argues that women's bodies are constituted by discourses about them. It explores the operations of power over women's bodies by analyzing the way in which the maternal body is constructed in the discourses of law, medicine and culture. Chapter One provides a theoretical context for this thesis. It examines the organization of knowledge and its relationship to power within the Western liberal tradition. Power is implicated in the production and dissemination of knowledge about the maternal body in two ways. First, scientific knowledge is privileged in legal and cultural discourses with the effect that knowledge claims based on experience are discredited. Second, scientific knowledge about the fetus, divined through the routine application of diagnostic technologies, has generated new opportunities for scrutinizing the maternal body. This information has been used to create expectations about which bodies are appropriate for reproductive purposes. These points are explored in Chapters Two and Three. Chapter Two is a study of cultural discourses about two women whose pregnancies were condemned on the basis that their bodies deviated from the ideal maternal body. In these stories, each woman was represented as a bad mother for pursuing her pregnancy against medical advice. Chapter Three is a study of the law's response to women who have failed to comply with medical advice deemed necessary for fetal well-being. It analyzes the strategies and implications of legally regulating pregnant women. Overall, this thesis poses a challenge to the way that the maternal body is represented by excavating the partial nature of the claims upon which these representations are based. Further, it argues for a re-conceptualization of the maternal body.

The aim of this thesis is to examine the concept of virtue ethics in Stanley Hauerwas's understanding of virtue and delineate how that contributes to his ethical reasoning and his comprehension of medical ethics. The first chapter focuses on the shift that occurred in moral theory under the stance of the Enlightenment that eroded the traditional idea of morality as the formation of the self, allowing space for new concepts that dismissed the importance of the agent in the ethical task of seeking the good. In the second chapter, the three main ideas (character, vision, and narrative) that make up Hauerwas' ethical theory are examined with a particular attention to the importance of agency in moral life. The third chapter describes how Hauerwas' medical ethics, informed by his moral theory based on character, vision, and narrative, is relevant to medical ethics. Hauerwas argues that because medicine is a form of human activity with internal goods and standards of excellence intrinsic to its practice, it requires taking into account the notion of agency in the healing relationship. Finally, in the last chapter the specific religious discourse of Hauerwas' ethics is discussed in relation to secular medical ethics. In other words, this thesis raises the question of whether the reduction of medical ethics to a set of principles, as it is mostly the case today, represents a suitable picture of the reality of moral life in medicine.