xi, 62 p. : ill. (some col.) / This dissertation describes research into microbial influences on host signaling in the zebrafish intestine. Vertebrate organisms are consistently exposed to microbes, especially on epithelial tissues that are exposed to the environment, such as the skin and the gastrointestinal tract. The close association between these tissues and microbes over time has resulted in a symbiotic state, whereby microorganisms have gained the ability to utilize vertebrate epithelia as a niche for replication and the acquisition of nutrients. These associations run the gamut from beneficial to exceedingly pathogenic and often involve complex bidirectional signaling between microbe and host. Microbial signals can interact with host cell pathways involved in a wide range of cellular processes. Here, we describe our investigations into one such pathway, the Wnt signaling pathway, and how microbial activation of Wnt signaling can translate into alterations in cell proliferation and homeostasis in the intestinal epithelium of the teleost fish Danio rerio. We report that epithelial cell proliferation in the developing zebrafish intestine is stimulated both by the presence of the resident microbiota and by activation of Wnt signaling and demonstrate that resident intestinal bacteria enhance the stability of β-catenin in intestinal epithelial cells, promoting cell proliferation in the developing vertebrate intestine. We also describe how transgenic expression of the bacterial effector protein CagA from the human gastric pathogen Helicobacter pylori is capable of causing significant overproliferation of the intestinal epithelium and adult intestinal hyperplasia, as well as significant upregulation of the Wnt target genes cyclinD1 and the zebrafish c-myc ortholog myca. We show that co-expression of CagA with a mutant allele of the β-catenin destruction complex protein Axin1 resulted in a further increase in intestinal proliferation, while co-expression of CagA with a null allele of the essential β-catenin transcriptional cofactor Tcf4 restored intestinal proliferation to wild-type levels. These results suggest that CagA activates canonical Wnt signaling downstream of the β-catenin destruction complex and upstream of Tcf4. Our studies provide in vivo evidence of Wnt pathway activation by CagA and implicate this activation in CagA-induced epithelial overproliferation, an early step in gastrointestinal cancer development. This dissertation contains both my previously published and unpublished co-authored material. / Committee in charge: Dr. Judith Eisen, Chairperson; Dr. Karen Guillemin, Advisor; Dr. Tory Herman, Member; Dr. Hui Zong, Member; Dr. Kenneth Prehoda, Outside Member

Background: Journal writing is often used to gauge student skills and knowledge. There is disagreement as to whether journals should be graded because students may embellish experiences or write what the instructor wants to read. If students are not engaged in honest reflection, the benefit of reflective practice is reduced. Purpose: The purpose of this correlational non-experimental study was to examine if a relationship exists between the grading of reflective journals and student honesty in reflective journal writing. Theoretical Framework: The theoretical framework for this study was based on Schӧn’s reflective practice theory. This theoretical framework is suitable as students participate in reflective journal writing learning from experience and response to the situation, scaffolding on previous knowledge with the application of new knowledge. Methods: The correlational, non-experimental study was conducted at five Midwestern U.S. pre-licensure nursing programs. Data were collected using an anonymous survey. The non-probability sampling technique was used to examine the existence of a relationship between the grading of reflective journals and student honesty in reflective journal writing. Results: Findings indicated that a significant relationship exists between the grading of reflective journals and student honesty. The relationship between reflective journal writing and embellishment was negative and non-significant. Conclusions: This study revealed that a relationship exists between graded reflective journals and study honesty in reflective journal writing. Nurse educators and policy makers need to assess the process of reflection which involves critical thinking and problem-solving instead of grading the written component; possibly, changing to a complete/incomplete grade.

Man has always searched for greater understanding of himself and his environment. As a result, much scientific investigation has been directed towards the understanding of the life process. In recent years, such scientific inquiry has become increasingly focused on the fundamental biochemical events taking place at the cellular, subcellular, and molecular levels. In the course of investigation into the nature of living things, research has often necessitated the development of new techniques and investigational tools to serve as experimental systems. Very often such new methods have made possible the discovery of previously unknown processes. One very interesting and useful investigational tool which has been developed is the method by which cells and tissues are maintained in vitro.

Background: The need to control moisture and contamination is crucial in adhesive dentistry, especially when rubber dam isolation is not feasible. Hemostatic contamination can negatively affect adhesion to tooth substrate. To achieve better outcomes, hemostatic agents should be rinsed off properly using a method that will remove the contamination and will not affect the μ-SBS. Objective: To evaluate and compare the effect of three different aluminum chloride and ferric sulfate contamination removal methods on the μ-SBS of lithium disilicate glass-ceramic bonded to enamel and to compare the type of fracture between samples. Material and Methods: Lithium disilicate blocks (IPS e.max CAD) were cut into samples of 2 mm in diameter and 3mm in height. Thirty-five human molar teeth were collected and separated into seven groups (n=17) Groups: G1(control): No contamination. G2: Contamination with aluminum chloride and removal by 30 seconds water-rinse. G3: Contamination with aluminum chloride, removal by re-etching (37.5% phosphoric acid), water-rinse. G4: Contamination with aluminum chloride, removal with 18% EDTA G5: Contamination with ferric sulfate, removal with water-rinse. G6: Contamination with ferric sulfate, removal by re-etching (37.5% phosphoric acid), water-rinse and dried. G7: Contamination with ferric sulfate, removal with 18% EDTA. The enamel surface was etched, then contaminated with aluminum chloride and ferric sulfate, cleaned using 3 different methods, previously described. Ceramic samples were etched with HF acid, silanated then bonded to enamel surface using Optibond FL, Variolink veneer cement and the Elipar S10 curing light, to avoid oxygen inhibition restoration margins were cover with a glycerin to complete polymerization of 10 -30 seconds each side. Specimens were stored in deionized water for 7 days, then subjected to μ-SBS testing, fractured specimens were examined with a stereomicroscope to determine the type of fracture, and five sample of each group were selected for SEM. To compare differences for the outcome a general linear mode ANOVA was created, and data recorded. Results: There were statistically significant differences among the studied groups for the μ-SBS (p< 0.05). The G6 (Ferric sulfate- Re-etching) was the closest mean μ-SBS (10.75 MPa) to the G1(control group).μ-SBS (16.24 MPa), the lowest μ-SBS (6.13 MPa) for the G4 (Aluminum chloride-EDTA). The groups using ferric sulfate as a cleaning method presented higher μ-SBS MPa than the groups using aluminum chloride as a cleaning method. The type of fracture on groups with higher μ-SBS (MPa), G6 - 10.75 MPa (ferric sulfate-reetching), G5 - 9.21 μ-SBS(MPa) (Ferric sulfate-water) presented more cohesive fractures, while groups with lower μ-SBS(MPa), G4 – 6.13 MPa (Aluminum chloride- EDTA), G3 – 6.27 (aluminum chloride- re- etching) presented more mixed fractures. Conclusions: The present study sought to investigate the effect of three different contamination removal methods on bond strength of ceramic to enamel contaminated with aluminum chloride and ferric sulfate. Ferric sulfate hemostatic agent showed higher μ-SBS in all contamination removal methods when compare to aluminum chloride hemostatic agent. But all the contamination removal methods in both groups failed to increase the bond strength on enamel to the level of the control group. Further research is required before we can make definitive conclusions

Background: According to the World Health Organization (WHO), perinatal depression (PD) is the most common childbirth complication. About 10% of pregnant women and about 13% of postpartum women experience a mental health disorder, primarily depression (WHO, 2016). One of the WHO (2015 a) goals for maternal mental health includes providing strategies for the promotion of psychosocial well-being and prevention of mental disorders of mothers during and after delivery. Purpose: The purpose of this performance improvement project was to establish a perinatal depression risk screening protocol and improve nursing knowledge on PD at a community-based hospital in Miami. Theoretical Framework: Beck’s postpartum depression theory Method: The project gained support and buy-in from the administration and management team of the healthcare institution. It included a comprehensive literature review used as a guide to establishing a perinatal depression screening protocol. Finally, staff nurses received education on PD, followed by an assessment for improved knowledge and retention of information. Result: A paired-samples t-test was conducted to compare pretest and posttest results for Registered nurses after receiving education on perinatal depression, N = 70. The results suggested improved knowledge and retention of new information. Conclusion: The perinatal depression screening protocol provided a framework for the assessment and first-line management for perinatal depression. There was evidence of improved nursing knowledge and retention of information on maternal mood disorders, especially perinatal depression.

Background: Cancer-related fatigue is one of the most common symptom experienced by cancer patients throughout their cancer trajectory. However, very little effort has been made within many oncology practices to assess this clinical problem and to provide timely nursing interventions to reduce its impact. While there have been tremendous advancements in the treatments of the disease aspects of cancer in term of medicine and advanced technology, basic assessment of related physiological concerns, such as fatigue, have not seen the same progress. Purpose: The purpose of this quality improvement project was to develop an evidence-based cancer-related fatigue assessment guideline and a screening protocol adopted from the National Comprehensive Cancer Network algorithm to assess cancer-related fatigue for oncology patients at their initial visit to the oncology unit toward timely intervention. Theoretical Framework: The ADAPTE collaboration model was used. This is an international framework that provides guidance on guidelines development and modification for healthcare providers. Method: This initiative began with a series of formal and informal conversations with major key stakeholders who were primarily the front-line oncology nurses at the practice unit. Based on the need of the unit, a consensus was reached to modify an existing clinical tool currently used to screen patients for emotional distress and to develop a clinical tool and guideline to screen cancer patient to reduce cancer-related fatigue as well. Outcome and Result: A clinical assessment tool was developed based on the patient population needs and the nursing staff concerns to yield an outcome that met the needs of this patient population. An evidence-based assessment guideline was introduced to key stakeholders and recommendations were made to integrate the new revised guideline into practice. The research department, professional practice, and the performance leadership continue to revise the current protocol to include continuous assessment of cancer-related fatigue into policy and procedure. Conclusion: This quality improvement project once implemented will benefit cancer patients as well as oncology practitioners by use of available resources and evidence-based guidelines to improve nursing practice and patient quality of life.

Research has shown a strong correlation between oral and systemic disease; therefore, there is an increased need for collaboration between dental and medical professionals. The purpose of this study was to examine the current opportunities that exist for interprofessional education (IPE) at Nova Southeastern University (NSU), the perceived need for IPE for dental and health science/nursing students, the perceived advantages of an IPE program, the features that should be included in an IPE program, and the perceived administrative and financial barriers to increased interprofessional activities. This study surveyed graduate faculty and staff from NSU’s College of Health Care Sciences, College of Dental Medicine, and College of Nursing regarding their views on IPE. The study used the Health Professions IPE Survey. Responses were factor analyzed, which revealed two dimensions: Positive IPE Perception and NSU IPE. There was an overwhelmingly positive response to IPE for dental, health science, and nursing students as evidenced by component one (Positive IPE Perception); however, there was a more negative perception about IPE at NSU as evidenced by component two (NSU IPE), possibly due to financial and administrative considerations. Factor analysis of this data legitimizes the need for future survey development. Future research should examine enablers for IPE by eliciting faculty feedback. Faculty reluctance to engage in IPE activities can be addressed by designing faculty development programs based on Adult Learning Theory (ALT) concepts. Future IPE program development will need to include adequate institutional support, funding, faculty development, and faculty involvement in planning.

The purpose of this qualitative dissertation study was to examine the lived experience and meaning making of challenges, benefits, satisfaction, and professional sustainability for the advanced practice provider in the burn surgery specialty service. The problem addressed was the knowledge gap resulting from a lack of literature describing aspects of the advanced practice provider role in the burn specialty. An interpretive phenomenological analysis, informed by the philosophy of Dr. Martin Heidegger, was undertaken. Participants were solicited from the American Burn Association Advanced Practice Provider (APP) special interest group site. The results provided a thick description of the lived experience of the Burn APP offering, illuminating commonalities and distinctions to promote role gratification and fulfillment leading to professional success and prolonged engagement. Keywords: advanced practice provider, nurse practitioner, physician assistant, interpretive phenomenology, hermeneutics.

Objective: The purpose of this study was to investigate pneumonia readmissions of older adults with dementia. Readmission rates and predictive factors of older adults with and without dementia were compared in this study. Subjects: A nationally representative sample of 389,198 discharge records, representing 370,003 patients, was extracted from the 2013 Nationwide Readmission Database. Methods: Descriptive statistics were utilized to describe the demographics of the sample population. Differences between groups were analyzed using chi-square or t test statistics as appropriate. A generalized linear model was used to examine predictive factors for pneumonia readmissions. Results: Older adults with dementia had a readmission rate of 23.52% and were 2.9 times more likely to experience a pneumonia readmission than older adults without dementia. Significant differences in characteristics were found when comparing (a) older adults with and without dementia, (b) older adults with and without dementia who were readmitted, and (c) older adults with dementia who were and were not readmitted. Factors that significantly interacted with dementia included (a) discharge disposition, (b) number of chronic conditions, (c) risk of mortality, and (d) median household income. Conclusions: Classifying older adults with dementia as a high-risk group for pneumonia readmissions is supported by the findings of this study. More over, dementia diagnoses significantly affect discharge disposition, there are characteristic differences among older adults with dementia, and comorbidities and risk of mortality significantly affect pneumonia readmissions. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.

Abstract Purpose: It is not clear as to whether sensory dominance is affected by test distance. Jiang et al previously reported that that the sensory dominant eyes may be affected by refractive error; however this study was done at a near distance only (60 cm). In this study, we investigated the effect of two different test distances (near, 60 cm vs distance, 6 meters) on the laterality of ocular dominance. Methods: Ocular sensory dominance was quantified in 60 subjects with a technique that involves the dichoptic presentation of a Mondrian noise and a Gabor patch. The threshold to detect the Gabor patch was measured in the presence of decreasing contrast in the Mondrian stimulus. Each eye was tested 50 times and thresholds from two eyes were compared with t-test. If the difference between the two eyes was significant, a subject was classified as having clear ocular sensory dominance and the eye that had lower thresholds was defined as the dominant one. If difference between the two eyes was not significant, a subject was classified as having unclear ocular sensory dominance. Ocular sensory dominance was measured at two different viewing distances, one for near at 60cm away and the other one for far at 6m away. Results: In 31 subjects (51.7 %), dominant eyes remained the same for near and distance viewing. In 15 (25.0 %) subjects, who showed clear ocular sensory dominance at distance, ocular sensory dominance became unclear at near. In 11 (18.3 %) subjects, that had unclear ocular sensory dominance at distance, showed clear ocular sensory dominance at near. In 3 (5.0 %) subjects, the laterality of the dominant eye switched between far and near distance. Conclusions: The effect of viewing distance on ocular sensory dominance is a continuous spectrum. In majority of the population, ocular sensory dominance is not affected. In 43.3 % of the population, ocular sensory dominance varies between unclear and clear status. Only in very rare cases, laterality of dominant eyes switches between near and distance.