The present study investigated the effects of viewing audio-visual presentations of stuttered relative to fluent speech samples on the ocular reactions of participants. Ten adults, 5 males and 5 females, aged 18-55 who had a negative history of any speech, language and hearing disorders participated in the study. Participants were shown three 30 second audio-visual recordings of stuttered speech, and three 30 second audio-visual recordings of fluent speech, with a three second break (black screen) between the presentation of each video. All three individuals who stutter were rated as ‘severe’ (SSI-3, Riley, 1994), exhibiting high levels of struggle filled with overt stuttering behaviors such as repetitions, prolongations and silent postural fixations on speech sounds, in addition to tension-filled secondary behaviors such as head jerks, lip protrusion, and facial grimaces. During stuttered and fluent conditions, ocular behaviors of the viewers including pupillary movement, fixation time, eye-blink, and relative changes in pupil diameter were recorded using the Arrington ViewPoint Eye-Tracker infrared camera and the system’s data analysis software (e.g., Wong & Cronin-Colomb & Neargarder, 2005) via a 2.8GHz Dell Optiplex GX270 computer. For all ocular measures except fixation time, there were significant (p<.05) differences for stuttered relative to fluent speech. There was an increase in the number of pupillary movements, blinks, and relative change in pupil diameter and a decrease in time fixated when viewing stuttered relative to fluent speech samples. While not significant, participants fixated or directed their attention for less time during stuttered than fluent conditions, indicating decreased attention overall during stuttered speech samples. Increases in eye-blink data and pupil-dilation data were also significant. Because both eye-blink, as a measure of the startle reflex, and pupil-dilation are resistant to voluntary control or are completely under the control of the autonomic nervous system, significant increases in both for stuttered relative to fluent speech indicate a visceral reaction to stuttering.

Safety of residents has gained increased popularity in recent years following a report from the Institute of Medicine attributing 98,000 hospital deaths each year to errors by staff. As a result, regulatory agencies, advocates, and health care providers have shifted their focus to understanding patient safety and developing a culture that promotes safety. However, nursing homes lag behind other health care providers in their adoption of a patient safety culture and understanding what factors affect safety in resident care. These insights are needed to ensure that nursing home residents receive the safe care. The purpose of this dissertation is to explore factors that influence the safety of residents in nursing homes by conducting three separate studies and using Donabedian's Structure Process Outcome (SPO) framework. The first study examines facility characteristics that predict higher patient safety culture scores given by top managers among a nationally representative sample of nursing homes. Using the same sample, the second study examines the relationships among the three components of Donabedian's SPO model as they relate to patient safety: structure (patient safety culture), processes of care (restraint use) and a common patient safety outcome, resident falls. The final study uses a sample of Florida nursing homes and the SPO model to examine the relationships between nursing staff turnover, processes of care, and patient safety outcomes in nursing homes. Findings from this dissertation can contribute to a greater understanding of what predicts higher levels of patient safety in nursing homes. In the first analysis, facility characteristics that are traditionally related to quality of care in nursing homes are predictive of higher patient safety culture scores. In the second analysis, higher ratings of patient safety culture are related to better processes of care and a decreased likelihood of resident falls. In the final analysis, results indicate that Certified Nursing Assistant (CNA) turnover had an independent effect on two patient safety outcomes, falls and UTIs, and that this effect is mediated by processes of care within the nursing home. Collectively, the findings from this dissertation may have important implications for policy makers, providers, and consumers of nursing home services.

<p><em>Background & Rationale</em>: Early mobilization (EM) can minimize intensive care unit aquired weakness (ICUAW) among survivors of critical illness. Clinician awareness of ICUAW, perceived barriers to EM, and acute rehabilitation in Canadian ICUs have not been well described.</p> <p><em>Objective:</em> To assess (1) awareness of ICUAW and EM, (2) perceived institutional, clinician, patient level barriers to EM, (3) stated practice of acute rehabilitation in Canadian ICUs.</p> <p><em>Design</em><strong>:</strong> A cross-sectional, self administered postal survey</p> <p><em>Setting:</em> Academic Intensive Care Units (ICUs) in Canada</p> <p>Subjects: 134 physiotherapists and 302 critical care physicians</p> <p><em>Interventions & Measurements:</em> Item generation followed a review of relevant literature and discussion with 26 content experts. We reduced the survey to 10 domains and 29 specific questions. The survey intrument was piloted and evaluated for clinical sensibility and intra-rater reliability. Up to 3 surveys were mailed to potential respondents. Descriptive statistics were reported as proportions, means (+/- SD) or mode, as appropriate. We used the chi-squared test to compare proportions and multi-variate logisitc regressions to test for association between independent and dependent variables. <em></em></p> <p><em>Main Results:</em> The survey instrument had excellent clinical sensibility and good intra-rater reliability (Cohen’s kappa > 0.4). The overall response rate was 71.3% (311/436) including 87.3% (117/134) of physiotherapists and 64.2% (194/302) of physicians. The incidence of ICUAW in the general medical-surgical population was under-recognized by 68.8% of clinicians and 59.8% of clinicians stated they were either insufficiently trained or informed to mobilize mechanically ventilated patients. Excessive sedation and medical instability were perceived as the most important patient barriers. Limited staffing, safety concerns (by nurses) and delayed clinician recognition to initiate EM were key provider barriers to EM. Important institutional barriers to EM included insufficient guidelines and equipment. Only 19.9% of clinicians stated that patients with suspected ICUAW were referred to an out-patient clinic after ICU discharge for long term rehabilitation.</p> <p><em>Conclusions</em>: Over 60% of respondents to this national survey underestimated the incidence of ICUAW and do not feel adequately trained to mobilize mechanically ventilated patients. Multiple patient, provider and institutional barriers may also contribute. Clinical leaders and administrators should consider these modifiable factors when designing EM programs in the ICU.</p> / Master of Science (MSc)

Functional MRI technique is vital in investigating the effect of an intervention on cortical activation in normal and patient population. In many such investigations, block stimulation paradigms are still the preferred method of inducing brain activation during functional imaging sessions because of the high BOLD response, ease in implementation and subject compliance especially in patient population. However, effect of an intervention can be validly interpreted only after reproducibility of a detectable BOLD response evoked by the stimulation paradigm is first verified in the absence of the intervention. Detecting a large BOLD response that is also reproducible is a difficult task particularly in olfactory Functional MRI studies due to the factors such as (a) susceptibility-induced signal loss in olfactory related brain areas and (b) desensitization to odors due to prolonged odor stimulation, which is typical when block paradigms are used. Therefore, when block paradigms are used in olfactory interventional Functional MRI studies, the effect of the intervention may not be easily interpretable due to the factors mentioned above. The first task of this thesis was to select a block stimulation paradigm that would produce a large and reproducible BOLD response. It was hypothesized that a BOLD response of this nature could be produced if within-block and across-session desensitization could be minimized and further, that desensitization could be minimized by reducing the amount of odor by pulsing the odor stimulus within a block instead of providing a continuous odor throughout the block duration. Once the best paradigm was selected, the second task of the thesis was to select the best model for use in general linear model (GLM) analysis of the functional data, so that robust activation is detected in olfactory related brain areas. Finally, the third task was to apply the paradigm and model that were selected as the best among the ones tested in this thesis, to an olfactory interventional Functional MRI study investigating the effect of food (bananas) eaten to satiety on the brain activation to the odor related to that food. The methods used in this thesis to ensure valid interpretation of an interventional effect, can serve as a template for the experimental design of future interventional Functional MRI studies.

Epilepsy is one of the most common neurological disorders, affecting more than 2% of children and 1% of adults in the U.S. Emerging research has demonstrated that calcium, as a major second messenger system, underlies many of these injury-induced plasticity changes associated with the development of epilepsy. Recent evidence has suggested that long term elevations in neuronal resting calcium levels play a role in initiating and maintaining epileptogenesis (the development of epilepsy). Collaborations between our lab and others have produced microarray data that suggests that a major calcium-binding protein, calbindin D-28k, mRNA levels are decreased in epileptic rats even up to one year following pilocarpine treatment. The goal of this research effort was to determine if epileptogenesis alters basal calcium levels by producing a long-term change in the expression of the major calcium binding protein in neurons, calbindin D-28k. Immunohistochemistry (MC) and western blot experiments have been conducted to test the hypothesis that epileptogenesis produces a long lasting decrease in the expression of calbindin in the hippocampus in the rat pilocarpine model of acquired epilepsy. IHC experiments indicated that changes in calbindin expression occur gradually over a 2-4 week interval after the initial injury. Significant decreases in calbindin immunoreactivity are seen in the hippocampus of epileptic animals, at one month, four months, and six months post-pilocarpine treatment. However, these changes were not seen as early as 4 days post-status epilepticus. Western blots quantitated differences between epileptic animals and naive controls. Long lasting decreases in calbindin may play an important role in the altered calcium homeostatic mechanisms observed in epileptic neurons. These findings will help to elucidate one of many changes that occurs in epilepsy.

ABSTRACT PREDICTORS OF SITUATION AWARENESS IN GRADUATE STUDENT REGISTERED NURSE ANESTHETISTS Suzanne M. Wright, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2009 Major Director: J. James Cotter, Ph.D. Situation awareness (SA) is defined as one’s perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. Stated more simply, SA is knowing what is going on around you. The concept of SA is well known in the field of aviation which is characterized by complexity and dynamism. The discipline of anesthesia shares these same characteristics, yet the study of SA in this setting is in its infancy. Human error has been implicated in nearly 80% of all preventable medical errors. It is well documented that lack of SA frequently contributes to human error. Although the discipline of anesthesia has led the medical field in patient safety through rigorous study of human error and adverse events in the operating room, crises in anesthesia still exist. Nurse anesthetists should possess the ability to acquire and maintain SA at all times during clinical situations in the operating room, yet there are no studies examining SA in this population. Guided by Endsley’s theory of situation awareness, the purpose of this study was to provide nurse anesthesia educators with a best evidence predictor model of SA in GSRNAs for curricular implementation. The study objectives are to determine: a) the extent to which memory, cognition, and automaticity are related to situation awareness, b) the extent to which any relationship amongst memory, cognition, and automaticity mediates their relationship with situation awareness, and c) the extent to which Endsley’s theory of situation awareness is supported in the GSRNA population. After IRB approval, 71 GSRNAs were randomly selected from each of three universities chosen for this study. A non-experimental, correlational design was used to measure the relationship between memory, cognition, and automaticity and SA. Situation awareness was measured by the WOMBAT-CS, a computer-based assessment tool for evaluating SA in complex-system operators such as pilots, air traffic controllers, and anesthetists. A stepwise multiple regression was performed between the GSRNA attributes and SA scores. Beta-weights were used to identify the magnitude each relationship. Findings from this study revealed that cognition best predicts SA in the population of Graduate Student Registered Nurse Anesthetists, with the addition of memory and automaticity contributing no additional predictive value to the model. The results of this study have the potential to make a positive impact on the education and training of GSRNAs. Additionally, this study may provide foundational support for further research directed at assessing the effectiveness of high-fidelity simulated operating room environments in promoting SA in GSRNAs.

This correlational study explored the knowledge, perceived seriousness, and willingness to seek medical help for Alzheimer’s Disease (AD) among Ghanaian Immigrants currently residing in the Unites States. Study participants were 163 Ghanaian Immigrants between the ages of 45 and 90, attending Ghanaian community churches in Virginia and Maryland. Significant results include a positive correlation between knowledge and perceived seriousness of the disease, perceived seriousness of the disease was negatively correlated with caregiving experience. These results as well as several seemingly counterintuitive findings are discussed in terms of the Health Disparities and Psychometric challenges. Specifically, these results points to the necessity for future research and implication for action in the following areas: 1) Further qualitative exploration to develop a deep, rich understandings of the phenomenon of AD among Ghanaian Immigrants, 2) Improved cultural sensitivity in psychometric assessment with immigrant populations of AD knowledge, perceptions, and willingness to seek assistance, 3) Person Centeredness and Cultural Humility in Educational Interventions to empower individuals and parallel existing cultural beliefs rather than displacing them.

Although there have been numerous investigations of laryngeal muscle activity during phonation in the chest and falsetto/head registers in trained and untrained classical singers and non-singers, no research has been conducted examining laryngeal muscle activity during phonation in the chestmix register, a register used extensively by many female commercial singers, particularly for the production of higher frequencies. The purpose of this study was to test the hypothesis that commercial singers produce chestmix by maintaining or increasing adduction of the vocal processes and by engaging the thyroarytenoid muscle to a greater degree than they would to produce a head register sound. Simultaneous recordings of thyroarytenoid and cricothyroid muscle activity, videonasendosopy, and audio were obtained from seven female commercial singers (5 trained, 2 untrained) during sustained phonation and song phrases produced in chest, chestmix, headmix, and head registers. Thryoarytenoid and cricothyroid muscle activity was normalized to a percent of mean maximum activity and compared across registers and frequencies both within subjects and across subjects. Video stills of vocal processes adduction patterns were rated for degree of vocal processes adduction and also compared across register and frequency within and across subjects. All audio samples were rated for register by two singing teachers and audio samples of sustained phonation were analyzed via Fast Fourier Transform to measure the number and energy of the harmonics present in each sample. Interjudge and intrajudge reliability tests were performed for both the vocal processes adduction rating and audio sample rating tasks. Results from the study confirmed the hypothesis and showed that thyroarytenoid activity and adduction of the vocal processes was greater for chestmix than headmix or head, particularly during production of higher frequencies, but less than for chest productions. Cricothyroid activity was similar for chestmix, headmix and head during production of lower frequencies, but greater for chestmix during production of higher frequencies.

Over the next thirty years, Alzheimer’s disease rates will increase alongside global aging. To handle the anticipated increase in demand, knowledgeable and skilled dementia caregivers are in need throughout the long-term care spectrum. Online training programs have emerged as a viable and convenient platform to educate both formal and informal caregivers. The first and second study systematically reviewed online dementia training programs and evaluated the CARES® Dementia Basics Training Program among formal and informal caregivers. The first study is a systematic review of online dementia-based training programs for both formal and informal caregivers conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) method. Methodological quality of the final sample (N=15) was assessed by the Cochrane Collaboration Back Review Group criteria. Results of the systematic review suggests that online interventions improve the condition and preparedness of caregivers, but future evaluations should consider study designs with multiple time points, control groups, and content that is personalized and interactive. In the second study, an evaluation of the online CARES® Dementia Basics Program among formal and informal caregivers was performed. The sample (N=233) included respondents from the states of OR, WA, CA and IL over three time points. Results indicate baseline differences in education, race, and caregiver type and a modest improvement in knowledge among both formal and informal caregivers. Recommendations are provided for future development and evaluation of online interventions.

The purpose of this study was to determine the contamination level of Campylobacterjejuni in chicken quarters. Ninety-seven thigh and breast samples were purchased from thee supermarkets (Publix, Winn- Dixie, and Sedano's) in Miami-Dade County, Florida over an eight-week period. The bacteria were removed from the chicken skin by shaking the sample in a sterile bag containing nutrient broth. This extract was enriched in thioglycollate broth and subcultured onto selective media, which were incubated for 48 hours under microaerophilic conditions. Suspected colonies that were positive for the four biochemical tests performed were considered C. jejuni. The overall rate of contamination was 62%. Publix had the highest rate of contamination, 72%. Winn-Dixie had a contamination rate of 66%. Sedano's had the lowest rate of contamination, 48%. These findings show that the current methods used in preparing chicken for retail sale is not sufficient to eliminate pathogens, including Campylobacter jejuni.