Digital Commons Network^™

Fostering Adolescents’ Social-Emotional Skills In A Community Setting, Elizabeth Benitez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Adolescents face growing emotional, behavioral, and social challenges, especially in community recreation settings with high energy, peer interaction, and sensory demands. These environments often expose difficulties in emotional regulation, communication, and conflict management, highlighting the need for structured social-emotional learning (SEL). This capstone project aimed to develop and implement an occupation-centered SEL program integrating the Zones of Regulation (ZOR), CASEL competencies, and Developmental, Individual Differences, Relationship-Based (DIR) Floortime principles within the Clark County Hollywood Parks and Recreation after-school program. Guided by the Person–Environment–Occupation (PEO) model, the project sought to help adolescents practice emotional awareness, self-management, and interpersonal skills in their …

Got Sleep?: The Introduction Of Sleep Hygiene To Justice Involved Individuals, Charisma Lynn Cato

UNLV Theses, Dissertations, Professional Papers, and Capstones

Individuals transitioning out of incarceration often experience challenges with sleep due to the residual effects of confinement. Although this is common among justice-involved individuals, there is limited research on how to address their sleep hygiene self-efficacy after release. Furthermore, despite the wide use of social-emotional learning (SEL) across multiple disciplines, little is known about its influence on sleep-related behavior change in re-entry populations. To address this, the Got Sleep program, designed and implemented at Hope for Prisoners (HOPE), a community site geared toward re-entry assistance, integrated occupational therapy (OT) principles and an SEL approach with practical sleep hygiene strategies to …

Enhancing Accessibility And Inclusivity In The Performing Arts With Occupational Therapy Frameworks, Carmela Clarice Tabora Clave

UNLV Theses, Dissertations, Professional Papers, and Capstones

In live theater performances, there are numerous sensory demands, including unpredictable noises, lighting, crowd movement, vocalization, and transitions in and out of the theater. Teachers, support staff, and chaperones who attend these performances may face barriers in supporting their children in unfamiliar environments, and community volunteers who have never assisted during these shows may not know how to support children who need it if they have not had prior exposure to children with diverse needs. This capstone project provides families, teachers, and volunteers with pre-visit resource guides with occupational therapy perspectives on sensory processing for student matinees and sensory-inclusive performances …

An Occupation-Based Protocol For Mobile-Gaming Ergonomics, Lan Doan

UNLV Theses, Dissertations, Professional Papers, and Capstones

The increasing prevalence of mobile gaming has introduced unique ergonomic challenges that may contribute to musculoskeletal disorders (MSDs) and repetitive strain injuries (RSIs). The purpose of this feasibility study was to evaluate the practicality and preliminary effectiveness of an ergonomic protocol designed to improve posture, reduce pain, and maintain gaming performance among mobile gamers. A pre-post design was implemented with two participants aged 18–34 years. The six-week intervention included ergonomic education, postural training, scheduled breaks, and targeted stretching and strengthening exercises. Quantitative data on gaming performance using Call of Duty Mobile Scores, pain assessed through the Short-form McGill Pain Questionnaire …

Multiple Intracranial Aneurysms: An International Consensus Statement, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

Introduction: Multiple intracranial aneurysms (MIAs) pose diagnostic and therapeutic challenges, and widely used rupture-risk scores have not been validated for this subgroup. Research question: To develop expert-based recommendations for the diagnosis, rupture-risk assessment, treatment selection, and follow-up of patients with MIAs. Material and methods: A modified Delphi process was conducted. After topic generation from the literature, iterative questionnaires were administered anonymously online to invited experts. Consensus was prespecified as ≥70% agreement. Twenty-six of 35 invitees (74.3%) completed the survey. Results: Consensus identified the ruptured lesion in aneurysmal subarachnoid hemorrhage (aSAH) using computed tomographic angiography (CTA) and 3D rotational digital subtraction …

Exploring Bidirectionality In Global Health Partnerships: Perspectives From U.S. Pediatric Residency Programs., Anik Patel, Pauline Kamau, Justus Simba, Ashley Combs, Adelaide Barnes, Kathy Ferrer, Heather Haq, Duncan K. Hau, Lee Morris, Brittany Murray, Amy Rule, Reena P. Tam, Lisa Umphrey, Megan S. Mchenry

Manuscripts, Articles, Book Chapters and Other Papers

Introduction Despite growing interest, little guidance exists to re-evaluate global health partnerships (GHPs) through promoting bidirectionality. This study aims to understand the perspectives of United States (U.S.) pediatric global health (GH) faculty on institutional bidirectional practices to inform future discussions with international collaborators. Methods An internally, iteratively developed REDCap-based online survey (REDCap, Vanderbilt University, Nashville, TN), by our diverse author group, collected qualitative data from January 18 to February 20, 2023. Free-text responses were reviewed and coded inductively, with findings framed to generate themes for subsequent engagement with international partners. Results Of the 88 U.S. programs that identify as having …

Postpartum Care, Maternal Knowledge, And Perceptions Of Recommendations For Change, Michelle Embrey

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to understand how current postpartum care practices affect women and investigate women’s understanding of current postpartum care practices. This project also sought to investigate recommendations for change in postpartum care practice, women’s knowledge of these recommendations, and how they perceive these changes in relation to their own care. The project was conducted via an anonymous online questionnaire and was distributed through social media. Results showed that most women were favorable to changes recommended by the American College of Obstetricians and Gynecologists and the World Health Organization.

Gut Dysbiosis And Microbial Metabolites In Atopic Dermatitis: Implications For Immune Regulation Along Gut-Skin Axis, Khushbakhat Alia, Hira Khan, Hamna Muzaffar, Nighat Perveen, Sara Alrashedi, Yusra Al Dhaheri, Yasir Waheed, Mohammed Tauqeer Alam, Muhammad Naseem, Khalid Muhammad

All Works

Atopic dermatitis (AD) is a multifactorial skin disorder characterized by immune dysregulation, impaired epidermal barrier, and strong microbial imbalance. Although genetic susceptibility and environmental triggers are established AD drivers, growing evidence highlights the gut skin axis as an important but underexplored AD pathogenesis factor. Gut microbiota dysbiosis, loss of short-chain fatty acid (SCFA)-producing bacteria, and altered metabolite profiles, such as tryptophan derivatives and secondary bile acids, have been linked to systemic immune imbalance and skin inflammation. However, the precise mechanism by which gut microbial alterations influence cutaneous immunity remains unclear. This review synthesizes recent advances from clinical and experimental studies …

Neurodiversity Among Nurses: Consequences For Wellbeing And Burnout, Megan Pohlmann

WUSM Theses and Dissertations – All Programs

Background/Introduction – Current research highlights three critical aspects of nurse wellbeing: the subjective personal perspective, multifaceted complexity, and variation across individuals. A particular gap in past research is a lack of understanding of how neurodivergence may impact nurses’ workplace wellbeing. Neurodiversity is the variation in human minds and neurocognitive functioning, and neurodivergence is the divergence from what society would consider the norm. Like wellbeing, it is difficult to capture, recognize, and define, which causes confusion among neurodivergent individuals and employers alike. With up to 20% of individuals displaying neurodivergent traits in the workplace, it is important to recognize that those …

Examining The Association Of Nurse Staffing Levels With Delayed Antibiotic And Insulin Administration: A Mixed Methods Study, Mikie Desyana Rachman

WUSM Theses and Dissertations – All Programs

Background: Recent reports indicated that medication errors contributed to 10% of preventable harm among hospitalized patients with over half occurring during the administration stage. Despite emerging research using EHR data to examine care processes and clinical outcomes, limited studies have integrated objective and subjective nursing staffing measures to evaluate how nursing staffing levels could be associated with delays in care delivery.

Method: A parallel convergent mixed-methods study was conducted in four adult medical-surgical units at a Midwestern Academic Medical Center from January 1 – March 31, 2025. Quantitative data of insulin and IV antibiotic administration records, laboratory results, and nurse …

Psychosocial Predictors Of Depression And Anxiety In Thai Stroke Caregivers, Chanatip Tongyonk, Sorawit Wainipitapong, Chavit Tunvirachaisakul, Aurauma Chutinet, Michael Maes, Thitiporn Supasitthumrong

Chulalongkorn Medical Journal

Background: Caregivers of stroke survivors often face significant psychological challenges, yet limited research in Thailand has explored how patient and caregiver characteristics jointly influence caregiver mental health outcomes.

Objective: To identify characteristics of ischemic stroke patients and their caregivers that may predict distress, sadness, and anxiety symptoms in the caregivers.

Method: To measure caregivers' burden, stress, depression, and anxiety symptoms, the Hospital Anxiety and Depression Scale (HADS), Zarit Burden Interview (22-item ZBI), and Perceived Stress Scale (PSS-10) were utilized. To define a multi-step mediation model, we used partial least squares structural equation modelling (PLS-SEM).

Result: 97 stroke patients and their …

The Association Between Sarcopenia And Functional Outcomes After Bipolar Hemiarthroplasty In Elderly Patients With Displaced Femoral Neck Fracture. Structural Equation Modeling., Sanzhar Artykbay, Stephen J. Kerr, Saran Tantavisut

Chulalongkorn Medical Journal

Background: Sarcopenia is an underrecognized condition that may impair recovery after hip fracture surgery in older adults.

Objectives: This study aimed to assess the impact of sarcopenia on functional outcomes and hip muscle strength in elderly individuals with femoral neck fractures while accounting for other potential confounding factors through a structural equation model (SEM).

Methods: Between January 2023 and October 2024, a prospective cohort study at a tertiary university hospital enrolled patients aged 60 and older undergoing bipolar hemiarthroplasty for displaced femoral neck fractures. Functional recovery was evaluated at 3-months follow-up using the Barthel Index (BI), Short Physical Performance Battery …

Covid-19–Associated Rhabdomyolysis In Hospitalized Patients: Retrospective Cohort Study, Paula Esquerdo-Serrano, Silvia Otero-Rodriguez, Hector Pinargote-Celorio, Sergio Reus, Esperanza Merino, José-Manuel Ramos-Rincón

Saudi Medical Journal

Objectives: To determine the frequency of rhabdomyolysis in patients hospitalized with COVID-19 and to characterize their clinical features and outcomes. Methods: All adults admitted to the hospital were included in this single-center retrospective cohort study with COVID-19 at a tertiary care institution in Alicante, Spain, between March 2020 and March 2024. A creatine kinase (CK) threshold of 1000 U/L or higher was used to define rhabdomyolysis. Demographic, clinical, laboratory, treatment, and outcome data were collected. Patients with and without rhabdomyolysis were compared, and factors associated with in-hospital mortality (IHM) were analyzed. Results: Among 7,590 hospitalized COVID-19 patients, 20 developed rhabdomyolyses …

Male Pelvic Health In Saudi Arabia: Knowledge–Practice Gap In Pelvic Floor Muscle Exercises And Implications For Preventive Physiotherapy And Health Policy, Wael A. S. Alghamdi

Saudi Medical Journal

No abstract provided.

Post-Stroke Fatigue In Saudi Arabia: A Call To Action, Saad Z. Alqahtani

Saudi Medical Journal

Post-stroke fatigue (PSF) is a major consequence of stroke, with a prevalence of approximately 42–53% among stroke survivors. However, over the last 2 decades, only a few studies have explored PSF in Kingdom of Saudi Arabia (KSA). Findings from these studies show that PSF negatively impacts the quality of life of individuals with stroke. Furthermore, they emphasize the need for education for both health care providers and patients regarding PSF. This call-to-action mini narrative review identifies knowledge gaps and provides recommendations for both researchers and policymakers, including the need for standardized management and the exploration of hospital environment settings. Specifically, …

Contribution Of Interleukin-6 (Il-6) To Body Defense And Healing In Pulmonary Tuberculosis, Hasrah Junaidi, Annis C. Adi, Soedarsono Soedarsono, Soetjipto Soetjipto, Chatarina U. Wahyuni, Fariani Syahrul, Mahmudah Mahmudah, Zakiyuddin Zakiyuddin, Iskandar Arfan, Abdullah A. Mamun, Rubia Sari

Saudi Medical Journal

Objective: To examine the contribution of IL-6 to host defense and healing in pulmonary tuberculosis (TB). Pulmonary tuberculosis continues to pose a significant global health challenge, with disease outcomes determined by complex host–pathogen interactions. Interleukin-6 (IL-6), a multifunctional cytokine, has been implicated in immune regulation and tissue recovery during TB, but its specific role is not fully established. This review aimed to examine the contribution of IL-6 to host defense and healing in pulmonary TB. Methods: A comprehensive literature search was performed across PubMed, Scopus, Web of Science, ScienceDirect, and Medline following PRISMA guidelines, covering publications from 2015 to 2025. …

Building A Road To Mitigate Ambulance Patient Offload Time (Apot), William J. Manguil

Doctoral Projects

Emergency departments (EDs) worldwide are experiencing increased utilization resulting in care delays for patients seeking urgent treatment. Despite critical circumstances that warrant emergency medical services (EMS) response, patients arriving to the ED via ambulance remain vulnerable to delays in care due to prolonged ambulance patient offload times (APOTs). The amount of health care providers and treatment space necessary to initiate care are both limited and often strained resources which dictate the need for innovative interventions to prevent patient harm. The following project outlines the interventions implemented at the project site to improve APOT as a means to enhance patient safety …

Barriers And Bridges: Exploring Factors That Shape Mental Health Service Utilization In Rural America, Margaret Wiwuga

Educational Specialist, 2020-current

Despite disproportionately higher suicide mortality rates and comparable prevalence of mental illness across urban and rural communities in the United States, rural populations across the nation experience significantly lower access to and utilization of mental health services, naturally leading to worse comprehensive outcomes. This literature review examines multifaceted factors shaping mental health service use in rural America, taking note of both barrier and enabling factors that impede or enable these unique populations’ willingness and ability to access and use mental health services. Ten articles published prior to September 9, 2025, were selected from the James Madison University Libraries’ Psychology and …

Black Maternal Mental Health: Counseling Considerations For Prenatal Depression And Anxiety, Morgan Renee Williams

Educational Specialist, 2020-current

The maternal mortality rate of Black women in the United States is four times higher than white women (Centers for Disease Control and Prevention, 2020). The CDC defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy… but not from accidental or incidental causes” (Centers for Disease Control and Prevention, 2024, para. 1). This statistic is a consequence of the inequality within and outside of the American healthcare system (National Academies of Sciences, Engineering, and Medicine, 2020). For the purposes of this research, Black women are defined as any women …

What’S Behind The Mask: The Diagnostic Divide In The Female Autism Phenotype, Shelley Gies Alston

Educational Specialist, 2020-current

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication and restrictive, repetitive behaviors; however, women are diagnosed at significantly lower rates than men. This study examined whether DSM-5-TR diagnostic practices may contribute to the underdiagnosis and delayed identification of ASD in individuals assigned female at birth (AFAB), with attention to masking behaviors, gendered social expectations, and clinician interpretation of symptoms. Grounded in the Female Autism Phenotype (FAP), a retrospective mixed-methods study surveyed 12 AFAB individuals aged 18–24 who self-identified or were formally diagnosed with ASD. Participants completed a 44-item online survey including Likert-scale and open-ended …

Keeping Families Together: Companion Animals As A Public Health Imperative, Lori R. Kogan, Rebecca Niemiec

Journal of One Health Systems

Contemporary US public health frameworks emphasize social, economic, and environmental determinants of health, yet largely overlook the reality that most households include companion animals regarded as family members. This omission has tangible consequences during crises such as housing instability, illness, domestic violence, or disasters, when families are often forced to choose between their own safety and the safety of their animals. We argue that this represents a significant public health failure. Drawing on interdisciplinary evidence, we propose that companion animals function as a social determinant of health, that forced separation constitutes a public health harm, and that Human-Animal Support Services …

Staff Education To Improve Mental Health Prescribers’ Knowledge On Polypharmacy And Deprescribing Strategies For Older Adults, Mercy Oluchi Eke

Walden Dissertations and Doctoral Studies

No abstract provided.

Reducing Catheter-Associated Urinary Tract Infections Through Staff Education In A Nursing Home Setting, Aderonke Abimbola Abatan

Walden Dissertations and Doctoral Studies

No abstract provided.

From Evidence To Practice: Improving Diabetic Patient Outcomes By Increasing Statin Utilization, Elizabeth Mcfalls

Evidence-Based Practice Project Reports

Cardiovascular disease (CVD) prevention in patients with diabetes is essential, as heart disease remains the leading cause of death within this population (American Diabetes Association, n.d.). The purpose of this evidence-based project is to improve patient outcomes by enhancing adherence to statin therapy. A thorough literature review yielded 246 pieces of moderate-to-high-quality evidence; of these, eight articles were appraised in detail and selected for project inclusion. The strongest evidence identified four meaningful interventions. Thus, a multimodal approach was indicated for this project. This included addressing barriers to therapy, creating practice nudges, implementing a shared decision-making (SDM) tool, and utilizing clinical …

Family Quality Of Life And Infant Language Development: A Pilot Study Of Infants Without A History Of Chronic Otitis Media, Aubreigh Cartwright

Dissertations, 2020-current

Chronic otitis media (COM) is a condition associated with hearing fluctuations, recurrent medical interventions, and speech-language concerns. While the audiological impacts for children are well documented, there is less research pertaining to parents’ and caregivers’ experiences. The goal of the overall line of inquiry was to examine the impact of chronic otitis media on parent and caregiver quality of life. Parents and caregivers of ten typically developing infants from six to twelve months of age without COM were administered parent-proxy instruments to determine quality of life, as well as expressive and receptive lexicon. The parents were administered a family intake …

A Measure Of Spatial Orientation In Healthy Adults, Lauren Maloney

Dissertations, 2020-current

Spatial orientation is essential for effective navigation and movement, relying on the integration of sensory inputs from systems such as proprioception, vision, audition, and the vestibular system. The vestibular system, responsible for detecting rotational and linear movements, plays a crucial role in maintaining balance and spatial awareness. However, its specific influence on spatial orientation remains underexplored. This study investigates how vestibular input influences spatial orientation accuracy by examining participants' ability to estimate angular displacement during rotational stimuli. Twenty participants underwent testing using a rotational chair, with stimuli at varying rotational amplitudes (5-400 degrees). Along with their perceived angular displacement (i.e. …

The Effect Of Head Coverings On Directional Microphone Performance, Mariam Mohamed

Dissertations, 2020-current

Background: Directional microphones in hearing aids are a well-established strategy for enhancing speech intelligibility in background noise. While previous studies have examined the effects of hair, spectacles, and earmold venting, no systematic research has addressed whether head coverings, commonly worn for cultural, religious, or personal reasons, affect directional performance.

Objective: This study aimed to determine whether a thin cotton head covering alters the directivity index (DI) of premium receiver-in-canal hearing aids from four leading manufacturers, using laboratory-controlled conditions. 

Methods: A Knowles Electronics Manikin for Acoustic Research (KEMAR) was positioned within a sound-treated room to measure DI for both omnidirectional and …

How Audiologists Are Using Adapted Cognitive Behavioral Therapy For Tinnitus Management: A Preliminary Study, Katherine M. Mueller

Dissertations, 2020-current

Audiologists interact with patients reporting bothersome tinnitus frequently, however there is no standardized protocol to follow when treating/counseling these patients. Cognitive Behavioral Therapy (CBT) is highly researched and has been proven to alleviate bothersome tinnitus symptoms, yet audiologists are not clinically trained in this tinnitus management. Specific forms of CBT that were analyzed in this study include Attention Shifting, Neurophysiological Education, and Progressive Muscle Relaxations. This study surveyed current audiologists to determine how they are using adapted CBT techniques (aCBTt) for tinnitus management. This questionnaire aimed to investigate a) the effect of audiologists’ practice duration on their frequency to recommend …

Stigma Predicts Participation And Autonomy In Chronic Vestibulopathy: An Explanatory Mixed Methods Study, Brandy L. Hollins

Dissertations, 2020-current

Many vestibular disorders are “invisible”, not widely recognized, and challenging for patients to describe. However, its impact is visible and leads to significant challenges. Research has shown that stigma associated with other chronic health conditions can detrimentally affect patient outcomes, suggesting a greater need in this area. The World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) elucidates the role of physical, social, and cultural factors in the manifestation of health conditions within a universal framework. A critical aspect of the ICF’s contextual factors for individuals with vestibular loss is societal perception. Few studies have reported stigmatization …

Enhancing Access Through Integrated Behavioral Healthcare: Expanding Counselor Identity And Social Determinants Of Health Competency, Tiffany N. Snow

Dissertations, 2020-current

Abstract

The counseling profession has historically differentiated its identity by emphasizing a wellness-oriented approach. However, this has often led to the exclusion of counselors from integrated behavioral healthcare (IBH). With the 2024 enactment of the Mental Health Access Improvement Act, counselors now have unprecedented opportunities to serve as behavioral health providers in federal medical settings. This three-manuscript dissertation explores the intersection of counselor professional identity, social determinants of health (SDoH) competency, and interprofessional collaboration within IBH.

Manuscript 1 presents a conceptual framework for reconciling traditional counselor identity with the "medical model" of Primary Care Behavioral Health (PCBH), arguing that this …