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.

It is estimated that in the European Union 2 million deaths each year (42% of total) are as a result of cardiovascular disease, of which atherosclerosis is a major underlying factor. In 2006 this was estimated to cost the European Union an astonishing €192 billion. Once considered a lipid storage disorder it is becoming apparent that atherosclerosis is in fact due to an inflammatory dysfunction, with a number of endogenous and exogenous activators coming to light. The process of atheroma formation is poorly understood. This study seeks to discover the underlying mechanisms of plaque development with the view to develop novel therapeutics for this disease. Our results demonstrate a modulatory role of endogenous low density lipoprotein (LDL), “bad cholesterol”, on bacterial infections. Using primary human umbilical vein endothelial cells (HUVECs) I have shown that “non-self” oxidised LDL can reduce cell surface expression of pattern recognition receptors (PRRs) of the innate immune system, causing modulation of the cellular response directed towards atherosclerosis-associated bacterial pathogen-associated molecular patterns (PAMPs). Triple label fluorescent confocal microscopy of HUVECs revealed altered trafficking and targeting of PRRs of the innate immune system when endogenous LDL were combined with a bacterial infection in comparison to infection alone, indicating a source of the inflammatory dysfunction observed in this disease. This study illustrates that oxidatively modified LDL has a profound effect on bacterial infection, dramatically altering cellular response which may begin to explain the root cause of atherosclerosis. Through experimentation with human embryonic kidney (HEK) transfectants and HUVEC PRR silencing this study uncovered lipid raft dependant Toll-like receptors (TLRs) as fundamental culprits of this multi-factorial disease, with emphasis on TLR2 and TLR4. Future therapy designed for atherosclerosis will unquestionably involve the manipulation of TLR signalling.

O polimorfismo é um fenômeno relativamente comum entre os compostos farmacêuticos, e um dos principais problemas na produção e desenvolvimento de medicamentos. Sua presença pode acarretar prejuízos para a saúde da população e forte impacto econômico para as indústrias farmacêuticas ao influenciar diretamente nas propriedades mecânicas e biofarmacêuticas de insumos e produtos acabados. A investigação de polimorfismo associado aos oxicans, grupo pertencente à classe dos fármacos anti-inflamatórios não esteróides (AINEs), sofreu um incremento nos últimos anos, e para o fármaco tenoxicam relata-se a existência de quatro formas polimórficas na literatura. O objetivo deste trabalho foi caracterizar a presença de diferentes formas polimórficas de tenoxicam em insumos farmacêuticos ativos e formulações farmacêuticas orais e avaliar a influência sobre a dissolução in vitro. Com base na literatura, a análise inicial com a substância química de trabalho (SQT) demonstrou padrão difratométrico forma III. Diferentes condições para formação de formas polimórficas de tenoxicam foram aplicadas conforme Cantera et al. (2002), contudo, os diferentes processos de preparação de polimorfos do tenoxicam não conduziram a modificações na estrutura cristalina original da SQT. Dados complementares foram obtidos através da espectrofotometria no IV e DSC, que indicaram a inexistência de modificações no espectro original e ausência de eventos térmicos atípicos. A caracterização dos insumos farmacêuticos do tenoxicam, provenientes de diferentes fornecedores, por IV, DRX e perfil de dissolução indicou presença da estrutura cristalina (forma III), sem apresentar diferenças significativas entre os perfis de dissolução in vitro. As especialidades farmacêuticas do tenoxicam disponíveis no mercado nacional, ao serem submetidas à análise por DRX, também apresentaram estruturas cristalinas forma III. Apesar de ocorrer perfis de dissolução diferentes entre as formulações, estas não apresentaram comprometimento em sua qualidade. Contudo, muitas vezes as transformações pós-processamento podem induzir a alterações na estrutura cristalina e por consequência, problemas biofarmacêuticos. Tal fato demonstra a importância do estudo do polimorfismo, ao avaliar e correlacionar a presença de estruturas cristalinas com alterações na qualidade e desempenho de insumos e produtos farmacêuticos. / Polymorphism is a relatively common phenomenon among pharmaceutical compounds, and one of the main problems in producing and developing drugs. Its presence may harm people’s health and have a strong economic impact on the pharmaceutical industries by directly influencing the mechanical and biopharmaceutical properties of inputs and finished products. The investigation of polymorphism associated with oxycans, a group belonging to the class of non-steroidal anti-inflammatory drugs (NSAIDs), has grown in recent years, and it is reported that there are four polymorphic forms for tenoxycam the literature. The purpose of this study was to characterize the presence of different polymorphic forms in active pharmaceutical inputs and oral pharmaceutical formulations and evaluate their influence on in vitro dissolution. Based on the literature, the initial analysis with the reference standard showed a form III diphractometric pattern. Polymorphic forms of tenoxycam were prepared according to Cantera et al. (2002), but the different preparation processes of tenoxycam polymorphs did not lead to modifications of the original crystalline structure of the reference standard. Complementary data were obtained by spectrophotometry in IV and DSC, indicating that there were no modifications in the original spectrum and no atypical thermal events. The characterization of the pharmaceutical inputs of tenoxycam, from different suppliers, as IV, DRX and dissolution profile indicated the presence of a crystalline structure (Form III), without presenting significant differences between the in vitro dissolution profiles. The pharmaceutical specialties of tenoxycam available on the national market, on being analyzed by DRX also presented crystalline structures Form III. Although there was different dissolution profiles between the formulations, they showed no impairment in their quality. However, often the post-processing transformations can induce alterations in the crystalline structure and, consequently, biopharmaceutical problems. This shows the importance of the study of polymorphism with the evaluation and correlation of the presence of crystalline structures with alterations in the quality and performance of pharmaceutical inputs and products.

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.

O polimorfismo é um fenômeno relativamente comum entre os compostos farmacêuticos, e um dos principais problemas na produção e desenvolvimento de medicamentos. Sua presença pode acarretar prejuízos para a saúde da população e forte impacto econômico para as indústrias farmacêuticas ao influenciar diretamente nas propriedades mecânicas e biofarmacêuticas de insumos e produtos acabados. A investigação de polimorfismo associado aos oxicans, grupo pertencente à classe dos fármacos anti-inflamatórios não esteróides (AINEs), sofreu um incremento nos últimos anos, e para o fármaco tenoxicam relata-se a existência de quatro formas polimórficas na literatura. O objetivo deste trabalho foi caracterizar a presença de diferentes formas polimórficas de tenoxicam em insumos farmacêuticos ativos e formulações farmacêuticas orais e avaliar a influência sobre a dissolução in vitro. Com base na literatura, a análise inicial com a substância química de trabalho (SQT) demonstrou padrão difratométrico forma III. Diferentes condições para formação de formas polimórficas de tenoxicam foram aplicadas conforme Cantera et al. (2002), contudo, os diferentes processos de preparação de polimorfos do tenoxicam não conduziram a modificações na estrutura cristalina original da SQT. Dados complementares foram obtidos através da espectrofotometria no IV e DSC, que indicaram a inexistência de modificações no espectro original e ausência de eventos térmicos atípicos. A caracterização dos insumos farmacêuticos do tenoxicam, provenientes de diferentes fornecedores, por IV, DRX e perfil de dissolução indicou presença da estrutura cristalina (forma III), sem apresentar diferenças significativas entre os perfis de dissolução in vitro. As especialidades farmacêuticas do tenoxicam disponíveis no mercado nacional, ao serem submetidas à análise por DRX, também apresentaram estruturas cristalinas forma III. Apesar de ocorrer perfis de dissolução diferentes entre as formulações, estas não apresentaram comprometimento em sua qualidade. Contudo, muitas vezes as transformações pós-processamento podem induzir a alterações na estrutura cristalina e por consequência, problemas biofarmacêuticos. Tal fato demonstra a importância do estudo do polimorfismo, ao avaliar e correlacionar a presença de estruturas cristalinas com alterações na qualidade e desempenho de insumos e produtos farmacêuticos. / Polymorphism is a relatively common phenomenon among pharmaceutical compounds, and one of the main problems in producing and developing drugs. Its presence may harm people’s health and have a strong economic impact on the pharmaceutical industries by directly influencing the mechanical and biopharmaceutical properties of inputs and finished products. The investigation of polymorphism associated with oxycans, a group belonging to the class of non-steroidal anti-inflammatory drugs (NSAIDs), has grown in recent years, and it is reported that there are four polymorphic forms for tenoxycam the literature. The purpose of this study was to characterize the presence of different polymorphic forms in active pharmaceutical inputs and oral pharmaceutical formulations and evaluate their influence on in vitro dissolution. Based on the literature, the initial analysis with the reference standard showed a form III diphractometric pattern. Polymorphic forms of tenoxycam were prepared according to Cantera et al. (2002), but the different preparation processes of tenoxycam polymorphs did not lead to modifications of the original crystalline structure of the reference standard. Complementary data were obtained by spectrophotometry in IV and DSC, indicating that there were no modifications in the original spectrum and no atypical thermal events. The characterization of the pharmaceutical inputs of tenoxycam, from different suppliers, as IV, DRX and dissolution profile indicated the presence of a crystalline structure (Form III), without presenting significant differences between the in vitro dissolution profiles. The pharmaceutical specialties of tenoxycam available on the national market, on being analyzed by DRX also presented crystalline structures Form III. Although there was different dissolution profiles between the formulations, they showed no impairment in their quality. However, often the post-processing transformations can induce alterations in the crystalline structure and, consequently, biopharmaceutical problems. This shows the importance of the study of polymorphism with the evaluation and correlation of the presence of crystalline structures with alterations in the quality and performance of pharmaceutical inputs and products.

O polimorfismo é um fenômeno relativamente comum entre os compostos farmacêuticos, e um dos principais problemas na produção e desenvolvimento de medicamentos. Sua presença pode acarretar prejuízos para a saúde da população e forte impacto econômico para as indústrias farmacêuticas ao influenciar diretamente nas propriedades mecânicas e biofarmacêuticas de insumos e produtos acabados. A investigação de polimorfismo associado aos oxicans, grupo pertencente à classe dos fármacos anti-inflamatórios não esteróides (AINEs), sofreu um incremento nos últimos anos, e para o fármaco tenoxicam relata-se a existência de quatro formas polimórficas na literatura. O objetivo deste trabalho foi caracterizar a presença de diferentes formas polimórficas de tenoxicam em insumos farmacêuticos ativos e formulações farmacêuticas orais e avaliar a influência sobre a dissolução in vitro. Com base na literatura, a análise inicial com a substância química de trabalho (SQT) demonstrou padrão difratométrico forma III. Diferentes condições para formação de formas polimórficas de tenoxicam foram aplicadas conforme Cantera et al. (2002), contudo, os diferentes processos de preparação de polimorfos do tenoxicam não conduziram a modificações na estrutura cristalina original da SQT. Dados complementares foram obtidos através da espectrofotometria no IV e DSC, que indicaram a inexistência de modificações no espectro original e ausência de eventos térmicos atípicos. A caracterização dos insumos farmacêuticos do tenoxicam, provenientes de diferentes fornecedores, por IV, DRX e perfil de dissolução indicou presença da estrutura cristalina (forma III), sem apresentar diferenças significativas entre os perfis de dissolução in vitro. As especialidades farmacêuticas do tenoxicam disponíveis no mercado nacional, ao serem submetidas à análise por DRX, também apresentaram estruturas cristalinas forma III. Apesar de ocorrer perfis de dissolução diferentes entre as formulações, estas não apresentaram comprometimento em sua qualidade. Contudo, muitas vezes as transformações pós-processamento podem induzir a alterações na estrutura cristalina e por consequência, problemas biofarmacêuticos. Tal fato demonstra a importância do estudo do polimorfismo, ao avaliar e correlacionar a presença de estruturas cristalinas com alterações na qualidade e desempenho de insumos e produtos farmacêuticos. / Polymorphism is a relatively common phenomenon among pharmaceutical compounds, and one of the main problems in producing and developing drugs. Its presence may harm people’s health and have a strong economic impact on the pharmaceutical industries by directly influencing the mechanical and biopharmaceutical properties of inputs and finished products. The investigation of polymorphism associated with oxycans, a group belonging to the class of non-steroidal anti-inflammatory drugs (NSAIDs), has grown in recent years, and it is reported that there are four polymorphic forms for tenoxycam the literature. The purpose of this study was to characterize the presence of different polymorphic forms in active pharmaceutical inputs and oral pharmaceutical formulations and evaluate their influence on in vitro dissolution. Based on the literature, the initial analysis with the reference standard showed a form III diphractometric pattern. Polymorphic forms of tenoxycam were prepared according to Cantera et al. (2002), but the different preparation processes of tenoxycam polymorphs did not lead to modifications of the original crystalline structure of the reference standard. Complementary data were obtained by spectrophotometry in IV and DSC, indicating that there were no modifications in the original spectrum and no atypical thermal events. The characterization of the pharmaceutical inputs of tenoxycam, from different suppliers, as IV, DRX and dissolution profile indicated the presence of a crystalline structure (Form III), without presenting significant differences between the in vitro dissolution profiles. The pharmaceutical specialties of tenoxycam available on the national market, on being analyzed by DRX also presented crystalline structures Form III. Although there was different dissolution profiles between the formulations, they showed no impairment in their quality. However, often the post-processing transformations can induce alterations in the crystalline structure and, consequently, biopharmaceutical problems. This shows the importance of the study of polymorphism with the evaluation and correlation of the presence of crystalline structures with alterations in the quality and performance of pharmaceutical inputs and products.

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.

The purpose of this study was to establish the perceived caregiving effects among thirty Cuban-born individuals caring for elderly relatives and the relationship of these effects with acculturation. Most common difficulties were lack of private time, or social life, and decreased emotional and physical health. Satisfactions were mostly derived from fostering the elders' welfare. A strong positive relationship was found between caregivers' difficulties and stability of the caregiving dyad (r= - 0.642, p< .001). Caregivers involved in more unstable caregiver-care receiver dyads had more stress associated with caregiving difficulties. The acculturation factors of language, electronic media, and social relations, and the stability of the caregiving dyad accounted for 54 percent of the variation in caregivers' difficulties (p< .001) but only 21 percent of the variation of caregivers' satisfaction (p<.221). These findings provided preliminary data of caregiving characteristics among Cuban-Americans and the importance of including acculturation in studies involving minorities.