Over 43.5 million Americans provide informal care to a fast-growing elderly population in the United States. Informal care allows care-recipients to remain functional members of society. However, research suggests that the demands of informal care can negatively impact the health of caregivers. For example, caregiver burden increases the risk for poor health in caregivers compared to non-caregivers. Caregiving research is on the rise, but the dynamics of informal care in active retirement communities remains widely unexplored. To provide adequate services to lessen caregiver burden and improve the Quality of Life (QoL) of informal caregivers, the various settings in which informal care is delivered must be evaluated. Aiming to understand the needs of informal caregivers and the protective factors against caregiver burden in active retirement communities, data from the USF Health and The Villages study, conducted from October 2011 and March 2013, were analyzed. Data from twenty-nine focus groups (N=144) was used to explore the challenges faced by seniors in a caregiver role and the availability of resources that decrease caregiver burden. The primary focus was informal care and the challenges associated with the caregiver role; findings revealed a great need for caregiver relief and limited information on existing resources is available to informal caregivers. Consistent with existing literature on caregiver burden, having no personal time, financial burden, physical demands, and poor health were commonly identified as the biggest caregiving challenges. However, findings strongly suggest that the unique structure of The Villages community encourages high social support that may be the strongest protective factor against caregiver burden in the community.

Person-centered care is important to the quality of life of nursing home residents with dementia. Preference assessments enable person-centered care by documenting residents’ preferred activities. Residents with severe dementia are less likely to have a role in preference assessment due to communication challenges associated with the disease. External supports (visual and text cues) are effective in improving the communication of residents with dementia, but these cues are often not used in practice. Standard assessment (verbal questioning) places greater demands on short-term memory and attention, which are known deficits in dementia. Applying a within-subjects design, this study evaluated two conditions (standard and supported) for assessing preferences of residents with severe dementia (N=21). This study examined the effect of these conditions on residents’ consistency over time (1-week) and utterance types in response to preference questions. Naïve judges (N=10) listened to the interviews and rated residents’ communication clarity and their confidence with understanding residents’ preferences. Results show that residents with severe dementia can report preferences with similar consistency in both assessment conditions; however, residents may comprehend the assessment better when provided in a supported format. In addition, residents successfully engaged in preference interviews without proxy participation. Anecdotally, many residents demonstrated an accurate understanding of their environment and how they would prefer to spend their days. Future studies will optimize visual stimuli, choice options, staff training components, efficiency measures, and examine acceptability by nursing home staff.

This study sought to explore the utilization and perception of best practices by community-based technology training programs when instructing older adults to become technologically literate. The target population included adults age 55 years and older of the Baby Boomer generational cohort who ranged academically from possessing a high school diploma or General Education Diploma (GED) through a college degree and had enrolled in a local technology training program to improve their technological skill level with the goal of obtaining employment and/or to remain functionally independent. This study was conducted at three community technology training centers located in the southeast that offered computer training classes for both civilian and ex-military older adults and employed a mixed methods research design. Data was collected through a series of participant interviews, surveys, and class observations to establish an understanding of current participant computer literacy status, demographic details and experiences, class structure, the computer curriculum, and training execution. It was the intent of this study to help maintain increased focus on the necessity of reducing the present digital divide that exists between younger and older adults by highlighting the importance of designing technology training programs that incorporated both expert recommended best practices for instructing older adults, as well as the expressed benefit and personal needs of the Baby Boomer population being served by local technology training centers.

The purpose of this thesis is to examine familial hypercholesterolemia (FH) and emerging pharmacogenomics therapies that propose to lower serum low density lipid (LDL) levels. The search of various data bases resulted in nine research articles being selected for review. Syntheses of the articles suggest emerging phamacogenomic drug therapy can improve treatment outcomes for individuals with a diagnosis of FH. The Human Genome Project (HGP) has had far reaching applications for genomic technologies and pharmacagenomic interventions, tailored to human conditions associated with select genomic traits. Synthesis of nine research articles demonstrate that little is known on the topic and reveals extensive gaps in the evidence. This thesis concludes with implications for nursing education, practice, policy and research along with limitations are noted.

Diabetes is the seventh leading cause of death in the United States. With the population rapidly aging, it is expected that 1 out of 3 Americans will have diabetes by 2050. Mobile devices and mobile applications have the potential to contribute to diabetes self-care by allowing users to manage their diabetes by keeping track of their blood glucose levels. Usability is important for systems that help people self-manage conditions such as diabetes. Age and diabetes-related cognitive decline might intensify the impact of usability issues for the users who need these mobile applications the most. As highlighted by usability researchers, the context of use (i.e. environment, user, task, and technology) has a significant impact on usability. The environment (lighting, temperature, audio and visual distractions, etc.) is of special interest to the mobile usability arena since in the case of mobile devices, is always changing. This dissertation aims to support the claim that context and more specifically environmental distraction such as semantic auditory distractions impact the usability of mobile applications. In doing so, it attempts to answer the following research questions: 1) Does semantic auditory distractions reduce the effectiveness of a blood glucose tracking mobile application? 2) Does semantic auditory distractions reduce the efficiency of a blood glucose tracking mobile application? 3) Does semantic auditory distractions reduce the user satisfaction of a blood glucose tracking mobile application? To answer the study research questions, a true experimental design was performed involving 30 adults with type 2 diabetes. Participants were paired based on their age and experience with smartphones and randomly assigned to the control (no semantic auditory distractions) or experimental (semantic auditory distractions) group. Research questions were tested using the general linear model. The results of this study confirmed that semantic auditory distractions have a significant effect on efficiency and effectiveness, and hence they need to be taken into account when evaluating mobile usability. This study also showed that semantic auditory distractions have no significant effect on user satisfaction. This dissertation enhances the current knowledge about the impact of semantic auditory distractions on the usability of mobile applications within the diabetic senior population.

Parkinson's Disease affects more than 1 million people in the United States with 60,000 new cases being diagnosed each year. Currently, there is no cure for Parkinson's Disease, but there are several treatment options available. Currently the most popular surgical option is Deep Brain Stimulation. Microelectrode recording helps identify nuclei as the microelectrode passes through them. While the firing frequencies of the target nuclei are well defined, other nuclei are not. This study will attempt to characterize the Zona Incerta, which is the structure directly above the Subthalamic Nucleus, a target nucleus. Characterization of the firing frequency of the Zona Incerta will help aid Deep Brain Stimulation procedures. Looking at the Interspike Intervals for 25 files showed that the average firing frequency is 11.6Hz. A file recorded in the STN was used for comparison and to validate the methods used. This yielded an average firing frequency of 37.5Hz.

ABSTRACT Hospice and Dementia Special Care Units (DSCUs) have been shown to be gold standards of care for individuals who are dying and for those with dementia in nursing homes. Using a retrospective administrator and family survey, this study investigated whether the processes of care used in hospice and DSCUs are associated with increased quality of end of life (EOL) care for individuals with dementia. A convenience sample of 17 facilities in four states (FL, PA, MD and MA) was included in the study. Nursing home administrators were surveyed between September 2008 and October 2009. The administrators identified 116 family members of decedents with dementia who were surveyed with the End-of-Life Dementia (EOLD) scale as the outcome. The Donabedian Structure-Process-Outcome theory was used to test the hypothesis that the process characteristics of hospice and DSCU will be associated with higher EOLD scores. Hierarchical regression models were conducted for two of the three subscales of the EOLD. The resident risk characteristics (decedent length of stay and resident immobility), the structure characteristics (profit status, percent Medicaid and presence of other palliation), and the process characteristics (hospice, DSCU, dual, and traditional enrolled, and strength of inter-disciplinary team (IDT)] were entered into the model to determine their association with Satisfaction With Care and Comfort At Death. Strength of the IDT was included as a moderating factor of this association. Only DSCU enrollment was associated with increased Satisfaction With Care (SWC; DSCU: b = .31, p < .01). The moderation analysis showed that strength of IDT did significantly moderate the association between DSCU enrollment and increased SWC (DSCU: b = -.09, p < .05). Study implications include the need for more research into DSCUs and Strength of IDT as best practices in EOL care. This study contributes to an expanding body of research on the extra value of enrollment in a DSCU and the role of IDT in quality of EOL care for individuals with dementia in nursing homes.

Initiée dans les années 1960, la radiologie interventionnelle comprend les actes médicaux invasifs ayant pour but le traitement ou le diagnostic d’une pathologie réalisés sous guidage ou sous contrôle d’un moyen d’imagerie. L’enjeu de la thèse est de développer l’analyse sociohistorique de l’émergence d’une spécialité médicale – la radiologie interventionnelle – et d’en étudier les stratégies de légitimation. Trois axes d’investigation interdépendants sont plus particulièrement privilégiés. Le premier d’entre eux vise à comprendre comment est née cette pratique médicale en établissant l’archéologie des innovations dont elle résulte. Dans le deuxième, il s’agit d’analyser les stratégies de valorisation et les modes de faire-valoir de la radiologie interventionnelle. Les velléités d’autonomisation des radiologues interventionnels les ont ainsi conduits à mobiliser différents registres de légitimité (légitimité scientifique, légitimité professionnelle dans le champ médical, légitimité régulatoire). Le troisième axe permet quant à lui la prise en compte de la question de la démarcation sociale et des frontières. Étant porteuse d’une transgression de la dichotomie établie entre sphères diagnostique et thérapeutique, la radiologie interventionnelle a de fait entraîné une reconfiguration des relations entre spécialités. L’investigation s’appuie sur une méthodologie plurielle combinant entretiens semidirectifs, observations in situ (bloc opératoire, scanner, réunions de concertation pluridisciplinaire, consultations) et exploitation de données scientométriques. Une mise en perspective internationale avec la situation canadienne permet d’étudier l’impact des contextes nationaux sur la diffusion et la reconnaissance de la radiologie interventionnelle. / Introduced in the 1960s, interventional radiology includes invasive medical procedures for the treatment or diagnosis of a pathology performed under the guidance or control of an imaging device. The aim of the thesis is to develop the sociohistorical analysis of the emergence of a medical specialty – interventional radiology – and to study its legitimization strategies. Three interdependent lines of inquiry are privileged in particular. The first aims to understand how this medical practice was born by establishing the archaeology of the innovations that gave rise to it. In the second, it is a question of analyzing the strategies of valorization and the ways of valuing interventional radiology. The interventional radiologists’ desire for independence has led them to mobilize different registers of legitimacy (scientific legitimacy, professional legitimacy in the medical field, regulatory legitimacy). The third line of inquiry allows for the issue of social demarcation and boundaries to be taken into account. As it is a means of transgressing the established dichotomy between the diagnostic and therapeutic spheres, interventional radiology has in fact led to a reconfiguration of the relations between specialties. The investigation is based on a methodology combining semi-directive interviews, in situ observations (operating theater, multidisciplinary consultation meetings, consultations) and the use of scientometric data. An international perspective on the Canadian situation makes it possible to study the impact of national contexts on the dissemination and recognition of interventional radiology.

Submitted by Priscilla Araujo (priscilla@ibict.br) on 2018-03-06T19:26:36Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) IBICT - Dissertacao Andrea Penna - 8 de noembro.pdf: 5481178 bytes, checksum: b216396a750335e9e614b4a17f727c96 (MD5) / Made available in DSpace on 2018-03-06T19:26:38Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) IBICT - Dissertacao Andrea Penna - 8 de noembro.pdf: 5481178 bytes, checksum: b216396a750335e9e614b4a17f727c96 (MD5) Previous issue date: 2017-02-23 / Pesquisa exploratória sobre divulgação científica no Brasil, na área de Saúde, cujo objetivo principal foi identificar e analisar as ações de divulgação científica, no período de 2000 a 2016, empreendidas por Sociedades Brasileiras de Especialidades Médicas, cujos especialistas lidam com as doenças responsáveis pelos maiores índices de mortalidade no Brasil, a fim de verificar como estão sendo desenvolvidas essas iniciativas. As Sociedades Brasileiras de Especialidades Médicas, uma vez que constituem o ambiente da pesquisa, são apresentadas em um breve perfil. O quadro teórico é centrado em alguns aspectos da divulgação científica, como seu nascedouro, diferenças da comunicação científica, sendo ressaltada a contribuição da comunicação social para o tema, embora o enfoque da pesquisa seja a Ciência da Informação. É incluída uma questão polêmica, a discussão sobre quem deve assumir a divulgação científica, o pesquisador ou o jornalista, e ressaltada a dimensão social da área, finalizando essa fundamentação a Divulgação Científica no Brasil.A pesquisa empírica reuniu a análise dos portais das Sociedades Científicas selecionadas e entrevistas com diretores e jornalistas dessas instituições. Na primeira parte, os portais das Sociedades indicam riqueza de informações e a ênfase em materiais de prevenção de doenças e campanhas de promoção de saúde. As entrevistas demonstram, de um modo geral, pouca familiaridade com o conceito da Divulgação Científica, embora há esforço e investimento nessas ações. Os resultados em geral indicam que na Saúde e com base nas Sociedades Brasileiras de Especialidades Médicas, a Divulgação Científica avança e está em vias de consolidação, no Brasil. / Exploratory research on scientific divulgation in the area of Health, having as its main objective the identification and the analysis of actions of scientific divulgation, from 2000 to 2016, undertaken by the Brazilian Societies of Medical Specialties. Their experts deal with diseases that account for the highest rates of death in Brazil. The study aimed at verifying how these initiatives are being developed. The Brazilian Societies of Medical Specialties, as long as they make up the research environment, are briefly presented. The theoretical framework focuses on some aspects of scientific divulgation, like its beginnings, differences in scientific communication, enhancing the contribution of social communication in the area, though focusing this research on Information Science. A controversial issue is included: the discussion about who must assume scientific divulgation, researchers or journalists, and highlighting the social dimension in the area, concluding the theoretical foundation with Scientific Divulgation in Brazil. Empirical research gathered analysis from portals of the selected Scientific Societies and interviews with directors and journalists of such institutions. In the first part, Societies' portals indicate a wealth of information and an emphasis on materials to prevent diseases and health-promoting campaigns. The interviews generally demonstrated little acquaintance with the concept of scientific divulgation, although there is effort and there is investment in these actions. Results, in general, indicate that as far as Health is concerned, and based on the Brazilian Societies of Medical Specialties, Scientific Divulgation moves forward and is in the process of consolidation in Brazil.

Purpose: In an Orthopedic office in Northeast Tennessee clinical decision making about injection options for non-surgical candidates with knee osteoarthritis is unclear. Aims: This quality improvement project will develop a clinical guideline so that providers know criteria for choosing optimal knee alternative treatments for non-surgical knee patients. Outcome measures: An expert panel gave feedback and advice on the information presented for the injection types of Platelet Rich Plasma, Corticosteroids, Amniotic Allograft and Hyaluronic Acid. They edited the guideline then sent the edits back to be complied and edited using the Delphi method. Process and Methods: The expert feedback was then be collected in a non-identifiable fashion and the guideline was rewritten based on the panel advice. Then the guideline was then presented to the practice site and the site reviewed and rated the guideline on clarity, accuracy and ease of use. Results: The guideline was rated by the practice site as able to be adopted into practice and used at the site. Findings and Limitations: Limitations include the practice site is constantly changing and new implementations could be overlooked. The expert panel are all busy professionals and finding time to review and critique a guideline is extensive. Conclusions and Implications: This novel guideline will improve healthcare by eliciting an expert panel of orthopedics that perform injections to assist in compiling the most accurate up to date guideline through which will create enhanced decision making and overall better patient care when choosing knee injections for non surgical patients.