On July 27th, 1990, the U.S. Centers for Disease Control reported that a Florida dentist had transmitted the human immunodeficiency virus (HIV) to five of his patients. These incidents raised many, previously unaddressed, questions regarding the ethical obligations of the HIV-infected health care worker (HCW), as well as the ethical responses to this difficult situation by patients and society. / This paper attempts to address these questions from an ethical viewpoint examining risk of harm and the individual duties of the HCW, the patient and society as well as through analysis of policies regarding HIV-infected HCWs. These policies were written by the federal U.S. and Canadian governments as well as state and provincial health departments and registrars of medical associations in the U.S. and Canada. / The policies were analyzed for five categories of requirements or recommendations with respect to: (1) notification of government and professional organizations or health care institutions and notification of patients of the HCW's HIV status, (2) mandatory HIV testing of HCWs, (3) work restriction for the HCW, (4) retrospective notification of the patient, and (5) monitoring compliance with the policy. / It was found that, in their practical interpretation, the policies left room for a wide spectrum of interpretation possibly due to poorly defined risk of individual invasive procedures. This indicates the need to accurately determine the risks of HIV transmission, from HCW to patient, during specific medical interventions. / It was concluded that certain policies, such as Health and Welfare Canada's Laboratory Centre for Disease Control (LCDC), policy and New York State Department of Health's policy allow enough flexibility to minimize risks of harm as well as to provide the possibility of a balance of the interests of all involved. (Abstract shortened by UMI.)

<p> HIV infections rates for African American females in the United States remain disproportionately high with no significant evidence that the current trend will change in the near future. For 17 consecutive years, HIV related illnesses continues to be the leading cause of death for African American females ages 25-34, creating additional social and economic burdens for families and communities who have been devastated by this epidemic. This qualitative phenomenological heuristic study was conducted using focus group interviews, journal entries, and letters to explore the lived experiences of nine courageous HIV/ positive African American females, ages 39 to 78, living in the Metropolitan area of Orlando, FL. Additionally, over 2 years of the researcher&rsquo;s journal entries were added to the richness of the collected data. Findings included four core themes that emerged from the data analysis: (a) lack of knowledge about HIV/AIDS and related issues; (b) low self-worth, poor self-acceptance, and lack of responsibility for self; (c) personal, familial, and social conflicts; and (d) stigma, fear, shame, and guilt that contributed to the HIV seroconversion in nine African American females. The following three themes may be used potentially to develop prevention programs for generalized populations throughout the United States: (e) spiritual and faith based initiatives of shared core beliefs; (f) empowerment and advocacy groups based on attributes of women as healers; and (g) peer campaigns strategies.</p>

<p> Coping with chronic illness often takes place within the context of the marital relationship. Among married couples, collaborative efforts to cope with one partner's chronic health condition have been linked to a range of positive outcomes, including better disease management among patients and greater emotional and interpersonal adjustment among patients and their spouses. Theory suggests that dyadic forms of coping with disease, such as collaboration, may be more beneficial when they are consistent with, or match, partners' appraisal of who is responsible (couple vs. patient) for managing the patient's disease. Very few studies, however, have examined this possibility. The current study of couples coping with one partner's diabetes addressed this research gap by investigating whether disease-related collaboration was more strongly related to better adjustment among partners who view diabetes management as their shared responsibility compared to those who view diabetes management as the patient's responsibility alone. Three major areas of adjustment were examined: 1) patients' disease management; 2) patients' and spouses' emotional well-being; and 3) patients' and spouses' relationship quality. Participants were 126 married couples in which one partner (the patient) was at least 55 years old and had been diagnosed with type 2 diabetes for at least one year and the other partner (the spouse) did not have diabetes. Patients and spouses separately completed a baseline interview and 24-day electronic daily diary. Predictor variables were derived from interviews; outcome variables were derived from daily diary records, and daily assessments of outcomes were aggregated across the entire diary period. Study hypotheses were tested using regression analysis and dyadic multilevel modeling. Results indicated that disease-related collaboration was linked to more positive psychosocial outcomes among patients in "shared responsibility" couples compared to patients "patient responsibility" couples. In contrast, collaboration had mixed associations with spouses' psychosocial outcomes, and none of these associations depended on partners' appraisal of responsibility for diabetes management. Overall, findings suggest that match between partners' collaborative efforts to cope with diabetes and their appraisal of disease management is important for the daily psychosocial adjustment of patients, but not for that of spouses. Implications for theory and intervention are discussed.</p>

<p> Commercial sexual exploitation affects young people all over the United States. Yet minimal services are available to restore, and reintegrate this population. One of the challenges involves assessing and training parents as mentors to provide round-the-clock care for their unique needs. This curriculum serves as a guide for agencies using the Child Welfare League of America PRIDE Model of Practice curriculum and is an adaptation of the original curriculum, which primarily focuses on neglected children.</p><p> The purpose of this curriculum is to provide child welfare agencies and prospective mentor parents with the tools to make an informed decision regarding their ability, willingness, and resources to support commercially sexually exploited youth. The curriculum also seeks to equip mentor parents with the skills to provide a safe and nurturing environment for these youth to develop healthy relationships, expand their social skills, increase cognition, and function as positive members of their communities.</p>

<p> Behavioral complications, such as Inappropriate Sexual Behavior (ISB), are developed in many cases of dementia. Sex, even for those with dementia, is a primary need, but supporting this need in an appropriate manner may overwhelm caregivers. The purpose of this project was to create a curriculum for Dementia Friendly Community (DFC) residential caregivers on the topic of sexual expression among older adults with dementia. By offering training on sexuality and dementia it is expected that caregivers can increase the DFC's provision of quality of life. This project presented an assessment tool and plan on how to manage ISB, activities relevant to the discussed topics, and curriculum evaluation forms. Expert reviewers offered recommendations to further improve the curriculum's quality.</p>

abstract: "Too often, people in pain are stuck in limbo. With no diagnosis there is no prognosis. They feel that without knowing what is wrong, there is no way to make it right" (Lewandowski, 2006, p. ix). Research has shown that environmental factors, such as views of nature, positive distractions and natural light can reduce anxiety and pain (Ulrich, 1984). Patients with chronic, painful diseases are often worried, anxious and tired. Doctor's appointments for those with a chronic pain diagnosis can be devastating (Gilron, Peter, Watson, Cahill, & Moulin, 2006). The research question explored in this study is: Does the layout, seating and elements of positive distraction in the pain center waiting room relate to the patients experience of pain and distress? This study utilized a mixed-method approach. A purposive sample of 39 individuals participated in the study. The study employed the Positive and Negative Affect Schedule (PANAS), the Lewandowski Pain Scale (LPS) and a researcher developed Spatial Perception Instrument (SPI) rating the appearance and comfort of a pain center waiting room in a large metropolitan area. Results indicated that there were no significant correlations between pain, distress and the waiting room environment. It is intended that this study will provide a framework for future research in the area of chronic pain and distress in order to advance the understanding of research in the waiting area environment and the effect it may have on the patient. / Dissertation/Thesis / M.S.D. Design 2012

abstract: Parkinson's disease, the most prevalent movement disorder of the central nervous system, is a chronic condition that affects more than 1000,000 U.S. residents and about 3% of the population over the age of 65. The characteristic symptoms include tremors, bradykinesia, rigidity and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients' motor performance but often leads to levodopa-induced complications, such as dyskinesia and motor fluctuation. With the disease progress, clinicians must closely monitor patients' progress in order to identify any complications or decline in motor function as soon as possible in PD management. Unfortunately, current clinical assessment for Parkinson's is subjective and mostly influenced by brief observations during patient visits. Thus improvement or decline in patients' motor function in between visits is extremely difficult to assess. This may hamper clinicians while making informed decisions about the course of therapy for Parkinson's patients and could negatively impact clinical care. In this study we explored new approaches for PD assessment that aim to provide home-based PD assessment and monitoring. By extending the disease assessment to home, the healthcare burden on patients and their family can be reduced, and the disease progress can be more closely monitored by physicians. To achieve these aims, two novel approaches have been designed, developed and validated. The first approach is a questionnaire based self-evaluation metric, which estimate the PD severity through using self-evaluation score on pre-designed questions. Based on the results of the first approach, a smart phone based approach was invented. The approach takes advantage of the mobile computing technology and clinical decision support approach to evaluate the motor performance of patient daily activity and provide the longitudinal disease assessment and monitoring. Both approaches have been validated on recruited PD patients at the movement disorder program of Barrow Neurological Clinic (BNC) at St Joseph's Hospital and Medical Center. The results of validation tests showed favorable accuracy on detecting and assessing critical symptoms of PD, and shed light on promising future of implementing mobile platform based PD evaluation and monitoring tools to facilitate PD management. / Dissertation/Thesis / Ph.D. Biomedical Informatics 2013

abstract: Health and healing in the United States is in a moment of deep and broad transformation. Underpinning this transformation is a shift in focus from practitioner- and system-centric perspectives to patient and family expectations and their accompanying localized narratives. Situated within this transformation are patients and families of all kinds. This shift's interpretation lies in the converging and diverging trails of biomedicine, a patient-centric perspective of consensus between practitioner and patient, and postmodern philosophy, a break from prevailing norms and systems. Lending context is the dynamic interplay between increasing ethnic/cultural diversity, acculturation/biculturalism, and medical pluralism. Diverse populations continue to navigate multiple health and healing paradigms, engage in the process of their integration, and use health and healing practices that run corollary to them. The way this experience is viewed, whether biomedically or philosophically, has implications for the future of healthcare. Over this fluid interpenetration, with its vivid nuance, loom widespread health disparities. The adverse effects of static, fragmented healthcare systems unable to identify and answer diverse populations' emergent needs are acutely felt by these individuals. Eradication of health disparities is born from insight into how these populations experience health and healing. The resulting strategy must be one that simultaneously addresses the complex intricacies of patient-centered care, permits emergence of more localized narratives, and eschews systems that are no longer effective. It is the movement of caregivers across multiple health and healing sources, managing care for loved ones, that provides this insight and in which this project is keenly interested. Uncovering the emergent patterns of caregivers' management of these sources reveals a rich and nuanced spectrum of realities. These realities are replete with opportunities to re-frame health and healing in ways that better reflect what these diverse populations of caregivers and care recipients need. Engaging female Mexican American caregivers, a population whose experience is well-suited to aid in this re-frame, this project begins to provide that insight. Informed by a parent framework of Complexity Science, and balanced between biomedical and postmodern perspectives, this constructivist grounded theory secondary analysis charts these caregivers' processes and offers provocative findings and recommendations for understanding their experiences. / Dissertation/Thesis / Ph.D. Healthcare Innovation 2013

Master of Science / Department of Kinesiology / Timothy I. Musch / Aged rats exhibit a decreased muscle microvascular O[subscript]2 partial pressure (PO[subcript]2mv) at rest as well as during contractions compared to young rats and this may contribute to their reduced exercise tolerance. Age-related reductions in nitric oxide (NO) bioavailability due, in part, to elevated reactive O[subscript]2 species (ROS) constrain muscle blood flow (Qm). Therefore, antioxidants may restore NO bioavailability, Qm and ameliorate the reduction in PO[subscript]2mv and hence the decrease in exercise tolerance seen in aged rats. PURPOSE: To test the hypothesis that antioxidants would elevate Qm at rest and during contractions and therefore PO[subscript]2mv in aged muscle. METHODS: PO[subscript]2mv and Qm were measured in the spinotrapezius while muscle oxygen consumption (VO[subscript]2m) was estimated in 20 anesthetized male Fisher 344 x Brown Norway hybrid (F344xBN) rats at rest and during 1 Hz contractions before and after antioxidant intravenous infusion (76mg/kg vitamin C and 52mg/kg tempol). Moreover, muscle force production was measured in a subset of animals. RESULTS: Before infusion, contractions invoked a biphasic PO[subscript]2mv that fell from 30.6 [plus or minus] 0.9 mmHg to a nadir of 16.8 [plus or minus] 1.2 mmHg with an 'undershoot' of 2.8 [plus or minus] 0.7 mmHg below the subsequent steady-state (19.7 [plus or minus] 1.2 mmHg). Antioxidants elevated baseline PO[subscript]2mv to 35.7 [plus or minus] 0.8 mmHg (P<0.05) and reduced or abolished the 'undershoot' (P<0.05) without changing the steady-state contracting PO[plus or minus]2mv. Antioxidants did not change Qm at rest but during contractions Qm was reduced from 157 [plus or minus] 28 to 91 [plus or minus] 15 ml min[superscript]-1 100g[superscript]-1 (P<0.05). Antioxidants produced no significant effect on VO[subscript]2m. However, antioxidant supplementation produced a 16.5% decrease (P<0.05) in muscle force production that occurred within the first contraction and remained throughout the duration of stimulation. In addition, the ratio of muscle force production to VO[subscript]2m (F/VO[subscript]2m) actually increased from 0.92 [plus or minus] 0.03 to 1.06 [plus or minus] 0.6 (P<0.05) following infusion of antioxidants. CONCLUSION: Antioxidant supplementation significantly alters the balance between muscle O[subscript]2 delivery and VO[subscript]2 at rest and during contractions, which modifies the microvascular PO[subscript]2mv profile. Specifically, antioxidants elevate PO[subscript]2mv, which improves the potential for diffusive blood-myocyte flux. This effect arises, in part, from the unanticipated fall in muscle force production consequent to antioxidant supplementation.

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