Digital Commons Network^™

Melodies & Memories: An Occupational Therapy-Based Music Program For Individuals With Dementia, Adrianna Mcentire

Occupational Therapy Doctoral Capstones

The purpose of the doctoral capstone experience was to develop and implement Melodies & Memories to use music interventions to improve quality of life, social participation, cognitive functioning, emotional and behavioral regulation, and physical functioning while providing personalized, client centered care through the use of music.

Fostering Development Through Participation In A Gymnastics-Based Occupational Therapy Program, Alex Theisen

Occupational Therapy Doctoral Capstones

The purpose of implementing a gymnastics-based OT program is to incorporate gymnastics-based movement into interventions that support and enhance each client’s progress toward their unique OT goals, address deficits affecting occupational performance, and increase participation through play-based interventions. The purpose of the doctoral capstone project is to expand knowledge of population needs to develop and facilitate the implementation of a gymnastics-based pediatric occupational therapy program that will promote participation and safety while meeting the individual needs of clients.

The Role Of Reassurance Messages In Pediatric Oncology, Isabelle Faller

Doctoral Dissertations

Despite decreasing mortality rates, the high prevalence and incidence of pediatric cancer necessitate the need for advancements in the treatment of psychological concerns, specifically the reduction of patient distress and anxiety. A more comprehensive understanding of current reassurance messages in clinical practice can aid in developing a standardized framework for providing reassurance in pediatric oncology. Qualitative Content Analysis was employed to examine the types of messages nurses use to reassure patients (to reduce their anxiety about a future health-related event) and how effective nurses perceive these messages to be in relieving patients' anxiety. The adult participants, located at hospitals throughout …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.

Le Défi Mondial : Panorama Comparatif Des Soins Néonatals Au Maroc Et Aux États‑Unis, Manasi Joshi

NEXUS: The Liberty Journal of Interdisciplinary Studies

Cette étude comparative examine les soins néonatals au Maroc et aux États-Unis après un stage dans une clinique privée à Rabat. Bien que les pratiques médicales principales soient universelles, leur application varie dans différents pays selon les circonstances socio-économiques et culturelles. Basée sur des observations directes, des entretiens avec des professionnels de soins néonatals marocains et une analyse de la littérature sur ce sujet dans ces deux pays, cette recherche discute de quatre différences principales : la disponibilité des ressources, l’accès aux soins de qualité, l’influence culturelle et les obstacles financiers. Malgré la pénurie évidente de personnel dans les hôpitaux, …

Cultivating Civility: A Multicomponent Approach To Reducing Workplace Incivility In An Assisted Living Facility, Sanam Bral, Kaylyn Chang, Catherine Dinh, Sanjil Kumar, Truc Mai Moon

Master's Projects and Capstones

Workplace incivility remains a common challenge in healthcare, negatively affecting communication, staff well-being, and the quality and safety of resident care. Baseline survey findings from a faith-based assisted living facility in Southern California identified concerns related to workplace incivility, psychological safety, and gaps in staff knowledge of available reporting resources. This project aimed to reduce workplace incivility by improving staff knowledge and recognition of uncivil behaviors, with a target of at least 90% staff training attendance among nursing, assistive nursing, and medical technicians, and 80% attendee-reported high confidence level (agree or strongly agree) in recognizing incivility and understanding reporting options. …

Fireready Oc: Developing A Public Health Protocol For Wildland-Urban Interface (Wui) Fire Events In Orange County, Christian Andre O. Gequillo, Allyson Hayakawa, Selin Erdogan, Natalie Albarran

Master's Projects and Capstones

Objective/Problem: Wildland-Urban Interface (WUI) fires expose communities to a greater number of hazardous pollutants than traditional wildfires and can pose significant health risks; however, Orange County does not have a standardized public health protocol to address WUI fires. A review of the literature identified the need for standardized WUI fire guidance that is focused on improved preparedness and response. Aim: The FireReady OC quality improvement project aimed to develop an evidence-based public health protocol to improve Orange County’s public health preparedness and response for WUI fire events from 0% to 10% during the 12-week period from May 27, 2026, to …

Improving Nursing Adherence To Chg Bathing And Pivc Maintenance Practices To Reduce Hospital-Onset Bacteremia In An Adult Medical-Surgical Unit, Mohabat Barikzai, Dinazar Altamirano, Edward Rivas, Sarah Trilles

Master's Projects and Capstones

Preventing hospital-onset bacteremia (HOB) is a healthcare priority given its association with increased morbidity, mortality, prolonged hospitalization, and healthcare costs. Literature identifies inconsistent adherence to evidence-based practices for chlorhexidine gluconate (CHG) bathing and peripheral intravenous catheter (PIVC) maintenance as a modifiable risk factor for HOB. This quality improvement (QI) project evaluated whether implementing standardized nurse education, routine compliance audits, and performance feedback would improve adherence to evidence-based CHG bathing and PIVC maintenance practices. The project aimed to achieve at least 90% nursing compliance with HOB prevention practices over an intended 8-week implementation period. A pre-post quality improvement design was implemented …

Food For Thought: Building Confidence In Healthy Food Choices Among Seniors In A Residential Facility Through Nutrition Education, Amy Rodríguez

Master's Projects and Capstones

This quality improvement project evaluated the effectiveness of a 10-week nutrition education program designed to improve nutrition knowledge and confidence among independently living older adults residing in a low-income senior housing community. Aim By August 10, 2026, this project aimed to increase average nutrition knowledge and confidence scores related to selecting nutritious foods and preparing healthy meals by 20% among senior housing facility residents. Methods A microsystem assessment, literature review, SWOT analysis, fishbone diagram, and GANTT chart were completed to guide project development and implementation. Weekly nutrition education workshops were conducted over a 10-week period and included presentations, group discussions, …

Breaking The Silence: Standardizing Routine Intimate Partner Violence Screening At A Community Clinic Serving The Latinx Community, Victoria M. Hall

Master's Projects and Capstones

Intimate partner violence (IPV) affects the Latinx population disproportionately due to socioeconomic status, cultural stigma, and language barriers. However, routine screening remains inconsistent and unstandardized at a local community clinic in San Francisco’s Mission District, despite evidence-based practices recommending it. The gap in IPV screenings across the Adult, Teens, and Women’s clinics resulted in only 1.6% of patients being screened in July 2025 and 4.1% in June 2026. This quality improvement project aimed to address low screening rates by standardizing IPV screening through a printed bilingual screener, a 60-minute staff in-service on IPV and the new screening protocol, and by …

Standardizing Gestational Diabetes Group Education In An Outpatient Maternal-Fetal Medicine Clinic: A Quality Improvement Project, Nina Prieto

Master's Projects and Capstones

Gestational diabetes mellitus (GDM) requires timely and consistent education to support effective self-management and reduce maternal and fetal complications. Baseline assessment of an outpatient maternal-fetal medicine clinic identified variation in educational materials, teaching approaches, referral processes, scheduling, and workflows across English- and Spanish-language GDM group visits. This quality improvement project aimed to standardize the group visit process and increase staff compliance with standardized materials and workflows from 0% to 50% over a 12-week period. Data were collected through direct observation of group and individual education sessions, stakeholder feedback, review of existing materials, referral and attendance patterns, and workflow analysis. These …

“Now Serving… Not Quite Yet”: Improving Waiting Room Experience Through Consistent Communication In The Emergency Department, Juan Carlos Serrato

Master's Projects and Capstones

Context: The quality improvement project was implemented in the front-end microsystem of a 36-bed emergency department (ED) in a non-profit, Magnet-designated California hospital. Problem: Communication with non-roomed patients at Hospital X was inconsistent, contributing to dissatisfaction. In June 2026, Press Ganey reported that 61.4% of patients felt they were informed about delays. Baseline observation identified gaps in staff explanations of estimated wait times, next steps in care, and opportunities to ask questions. Intervention: A 30-day pilot provided staff education on the AIDET communication framework through formal in-service education and daily huddles. Patient-facing materials explained the ED process …

Advancing Maternal Health Equity In Nebraska: Examining Prenatal Care Access Disparities, Policy Context, And Doula Integration As A Complementary Solution, Marlette Grace Dulcinee Mabiala-Maye

Theses & Dissertations

Maternal health inequities persist across the United States, with Black, Native American, and immigrant-origin women facing disproportionate barriers to timely prenatal care. This dissertation examined access to prenatal care in Nebraska, a mixed rural and urban state with extensive maternity care deserts, through three interrelated aims. Aim 1 analyzed PRAMS data using survey-weighted regression with race-by-socioeconomic-status interactions to characterize disparities in the timing and barriers to care. Aim 2 evaluated the state’s October 2020 Medicaid expansion across pre-pandemic, acute pandemic, and post-expansion periods. Aim 3 applied qualitative description and the Consolidated Framework for Implementation Research to interviews withtwenty-three maternity care …

Improving Pressure Injury Prevention Through Braden Scale Compliance And Education In The Emergency Department, Joycelyn Lee, Kira Simone Faerstain, Alyssa Kristine Ortiz, Ashley Briseida Cruz

Master's Projects and Capstones

Pressure injuries are a major burden in healthcare, particularly in the Emergency Department (ED). Patients can be sedentary for prolonged periods of time and don't always get their skin checked promptly. Patients visiting the ED often have comorbidities and patient-specific medical needs, such as seniors with fragile skin, malnourishment, immobility, etc. At a Southern Los Angeles Hospital, leadership found that there was a need for improvement in this area. Implementing standardized risk assessment methods can help to improve the consistent use of the Braden Scale as a predictive and preventive tool for identifying patients' risk for pressure injuries and promoting …

Fall Risk In Community-Dwelling Adults: A Comparison Of English And Spanish-Speaking Individuals, Jesus D. Gomez

Dissertations, 2020-current

Falls are a leading cause of injury-related mortality among middle-aged and older adults. Although vestibular dysfunction, hearing loss, behavioral factors, and social determinants of health have been associated with increased fall risk, few studies have examined these relationships. Furthermore, limited research in audiology and vestibular science has investigated fall-risk vulnerability among Spanish-speaking individuals.

This study aimed to: (1) estimate the prevalence of fall risk among community-dwelling adults and compare prevalence between English-speaking and Spanish-speaking participants; (2) assess the prevalence of previously undiagnosed benign paroxysmal positional vertigo (BPPV) and compare prevalence between language groups; and (3) develop predictive models of fall …

Brain Perivascular Macrophages Regulate Endothelial Cell Function Via A Cmaf-Dependent Transcriptional Program In Mouse And Human, Simone Brioschi, Julia A Belk, Steffen E Storck, Yue Wu, Zhuoying Wang, Ziang Feng, Lynn Van Olst, Josie L Emery, Raki Sudan, Junjie Wu, Siling Du, Marco Genua, Federica La Terza, Alex J Edwards, Khai M Nguyen, Jessie Sanford, Daniel D Lee, Mattia Bugatti, Arnold J Federico, Yun Chen, Zuoxu Wang, Silvia Penati, Patrick Fernandes Rodrigues, Alina Ulezko Antonova, Hui Qi Loo, Igor Smirnov, Susan Gilfillan, Carmen M Halabi, Jennifer Ponce, Jun Yan, Howard Y Chang, Gwendalyn J Randolph, William Vermi, Marina Cella, Michael Meers, Renato Ostuni, David Gate, Aivi T Nguyen, Carlos Cruchaga, Song Hu, Jonathan Kipnis, Marco Colonna

The Brown Foundation: Institute of Molecular Medicine

Brain perivascular macrophages maintain brain physiology, yet their transcriptional regulators and functions in health and disease remain unclear. Using single-cell multi-omics and functional experiments, we identify cellular musculoaponeurotic fibrosarcoma oncogene (cMAF) as a key transcription factor for brain perivascular macrophages, and conditional deletion of cMAF disrupts their phenotype in vivo. Functionally, cMAF drives insulin-like growth factor-1 (IGF1) expression in perivascular macrophages, enabling communication with endothelial cells. Consistently, cMAF deletion in perivascular macrophages causes transcriptional alterations in cerebral arteries, affecting vascular functions. Notably, cMAF emerges as the main transcription factor for human perivascular macrophages, suggesting conservation of this transcriptional module. During …

Cultural Tailoring Of Digital Nutrition Interventions: A Scoping Review Of Adaptation Strategies, Evaluation Methods, And Evidence Gaps, Wendy Liang

Master's Projects and Capstones

Background: Nutrition-related chronic diseases disproportionately affect culturally diverse populations, highlighting the need for effective and equitable interventions. Digital nutrition interventions have expanded rapidly due to their accessibility; however, the extent to which they incorporate and evaluate cultural tailoring remains unclear.

Research aim: This scoping review maps the existing evidence on culturally tailored digital nutrition interventions, describes cultural adaptation strategies used, examines methods used to evaluate cultural appropriateness, and identifies gaps for future research and public health practice.

Methods: A scoping review was conducted following the PRISMA-ScR guidelines.

Findings: Culturally tailored digital nutrition interventions generally improved participant engagement, acceptability, and dietary …

The Parkinson's Pathway: Enhancing Knowledge And Care Management In Skilled Nursing, Kaitlyn Chau

Master's Projects and Capstones

Parkinson’s disease (PD) is commonly diagnosed among the older population, contributing to high utilization of skilled nursing facility (SNF) services. Objective: SNF A’s current onboarding and training program for staff discussed general geriatric topics but failed to include structured PD-specific education. This may lead to gaps in competence, confidence, and workflow related to PD care and management, resulting in low quality of patient care, poor health outcomes, and decreased safety and satisfaction. Aim: The project aimed to establish and incorporate a structured PD-specialized education program within a SNF located in Northern California, to increase employees’ self-reported confidence, competence, …

Advancing Occupational Therapy Practice: Evaluating A Continuing Education Module To Support The Integration Of 3d Printing Into Clinical Care, Sophia Wilkes, Rebecca Ozelie

Student Journal of Occupational Therapy

This study aimed to evaluate whether a continuing education module could improve occupational therapy practitioners’ perceived knowledge, awareness, confidence, and clinical utilization of 3D printing in occupational therapy practice, while also examining how access to resources may influence implementation A 14-week cross-sectional pre–post design was used with occupational therapy practitioners participating in a one-hour educational session followed by a three-week trial of 3D printer access. Participants completed pre- and post-surveys assessing perceived knowledge, awareness, and confidence, and maintained a utilization log to track clinical use.

Results indicated a statistically significant increase in perceived knowledge and awareness of 3D printing following …

Reducing Variation, Improving Outcomes: Standardizing Gestational Diabetes Mellitus Education In A Clinical Microsystem, Thanh Le

Master's Projects and Capstones

Objective: Variations in referral, scheduling, delivery of educational information, patient materials, and documentation hampered the quality of gestational diabetes mellitus (GDM) education in the outpatient maternal-fetal medicine clinic. Purpose: The aim of the quality improvement project was to boost adherence to a standardized GDM group education framework from 0 to 50% in the course of 12 weeks and assess attendance at group visits. Methods: The microsystem analysis was conducted based on observations of group visits conducted in Spanish and English, examination of current processes and resources in use, educator pre-survey, SWOT analysis, and cause and effect analysis. The implementation of …

Standardizing Group Visits For Gestational Diabetes Education: A Quality Improvement Initiative In An Outpatient Maternal-Fetal Medicine Clinic, Nha Nguyen

Master's Projects and Capstones

Objective: At an outpatient maternal-fetal medicine clinic in Northern California, gestational diabetes mellitus (GDM) education is delivered inconsistently across nurse practitioners (NPs) and registered dietitians (RDs), with no standardized curriculum, referral criteria, or educational materials. Aim: By August 12, 2026, this project aimed to develop and implement a standardized GDM group visit framework for NPs, RDs, and scheduling staff in maternal-fetal medicine clinic, increasing compliance with standardized referral, enrollment, and educational processes from a baseline of 0% to 50%. Methods: Using baseline observations, workflow assessment, stakeholder input, and a literature review, the QI team developed standardized bilingual slide …

A Comparative Analysis Of Clinical Quality And Readability Of Neuropathic Pain Patient Information Leaflets: Türkiye Versus The United States, Gonul Sari, Argun Pire

Turkish Journal of Medical Sciences

Background/aim: Neuropathic pain management requires high patient adherence and complex dose-titration regimens, making the readability of patient information leaflets (PILs) a critical patient safety factor. This study aimed to compare the clinical content quality and linguistic readability of PILs for neuropathic pain medications between Türkiye (TİTCK) and the United States (DailyMed).

Materials and methods: A total of 11 pairs of innovator medications were analyzed. Clinical content was assessed using the 15-item Keystone Clinical Content Checklist (KCCC). Readability was assessed using the Ateşman index for Turkish texts and the Flesch Reading Ease Score (FRES) for English texts. Information quality and reliability …

Evaluation Of Acne Vulgaris Patient Care In Outpatient Clinics: Guideline Adherence And Patient Education ​, Mefküre Durmuş, Betül Sena Çavdar, İbrahi̇m Etem Arica, Sena Ustaömer, Sena Güzel Karahan, Seçi̇l Çolak, Selcen Şenol

Turkish Journal of Medical Sciences

Background/aim: Acne vulgaris, affecting over 85% of adolescents, is the most prevalent chronic inflammatory skin disorder. Its management is severity-based, with specific drug selections and combinations according to guidelines. However, adherence to these guidelines and the adequacy of patient counseling remain uncertain in real-world practice. The aim in this study was to evaluate prescribing patterns in acne management, assess compliance with guidelines, and promote awareness among healthcare professionals.

Materials and methods: A prospective observational study was conducted in the dermatology outpatient clinic of a tertiary hospital in Türkiye between February and May 2025. Demographic and clinical data were collected, and …

Hounsfield Unit Thresholds In Differentiating Adenoma From Nonadenoma Adrenal Masses: A Retrospective Adrenalectomy-Based Study ​, Burak Özbaş, Muhammet Mustafa Etleç, Hüseyi̇n Dursun, Mustafa Gök, Abdullah Bahadir Öz, Alper Celal Akcan, Ayşa Hacioğlu, Ökkeş İbrahi̇m Karahan, Züleyha Ci̇han Özdamar Karaca, Kürşad Ünlühizarci

Turkish Journal of Medical Sciences

Background/aim: Adrenal incidentalomas are increasingly detected during imaging studies performed for various indications, and their frequency in endocrinology practice has risen in recent years. While adenomas account for approximately 80% of adrenal incidentalomas, the remaining 20% include lesions such as primary malignancies, metastases, and pheochromocytomas that should not be overlooked. Given the risks associated with adrenal biopsy, accurate diagnosis with noninvasive methods is essential. In this retrospective study, we evaluated the Hounsfield unit (HU) values and lesion sizes measured on noncontrast computed tomography (CT) to identify a more accurate threshold than the widely used 10 HU.

Materials and methods: In …

Beyond Individual Willingness: Family Veto, Legal Knowledge, And The Dynamics Of Organ Donation In Türkiye ​, Hasan Gi̇ray Ankara, Hakan Değerli̇, Semi̇h Baş

Turkish Journal of Medical Sciences

Background/aim: The aim was to understand the factors underlying the dynamics of organ donation behavior by focusing on three different aspects. Three models were tested in this regard, namely (i) individual willingness for the donation of one’s own organs, (ii) willingness to approve organ donation for close relatives, and (iii) a family veto gap.

Materials and methods: A national-level adult sample from the Eurobarometer 72.3 survey (collected in 2009) conducted in Türkiye was utilized. Standard and penalized logistic regression models were employed to conduct the analyses.

Results: The results show that discussing organ donation with family members and being aware …

L-Theanine Attenuates Alcl3-Induced Cognitive Dysfunction And Neurotoxicity In Rats: A Behavioral And Biochemical Study, Muhammet Oğuzhan Dönmez, Azi̇ze Şener, Şeyda Karaman Ersoy, Mahdi̇ Marzi̇, Göksel Şener

Turkish Journal of Medical Sciences

Background/aim: The effects of L-theanine (LTN), a natural compound found in tea leaves, on biochemical parameters and cognitive functions were investigated in an aluminum chloride (AlCl3)-induced Alzheimer’s disease-like experimental model.

Materials and methods: A total of 32 male Wistar rats were allocated into four groups: control, AlCl3-induced AD-like group, LTN-treated AD-like group, and donepezil-treated AD-like group. Donepezil was used as a reference drug. For the induction of AlCl3- induced neurotoxicity, AlCl3 was administered by gavage at a dose of 25 mg/kg/day during the 1st week and 150 mg/kg/day for the subsequent 3 weeks. LTN was administered orally at a dose …

Staff Re-Entry Plan — Indian Trail, Flett, Woodridge, Travis Schulhauser

Spokane Wildfire Academic Consortium Repository

Following the downgrade of Level 3 Evacuation orders at Flett Middle School and Indian Trail and Woodridge elementary schools on Aug. 9, district staff worked with Fulcrum Environmental Consulting to conduct visual inspections and air-quality testing at these sites. More than 100 interior and exterior locations were tested, with indoor air quality within the Good-to-Moderate range under the EPA Air Quality Index. Inspectors also found no indication of unusual ash, soot or other settled particulates inside or outside the buildings.

Readability Of Dermatology Patient Education Materials: A Comparative Analysis Of Turkish Dermatology Association Brochures And Texts Generated By Chatgpt And Gemini ​, Ahmet Kağan Özdemi̇r, Bengü Reyhan Botsali Özdemi̇r, Akin Aktaş

Turkish Journal of Medical Sciences

Background/aim: In modern healthcare, patient education materials (PEMs) are essential for bridging the gap between clinical knowledge and patient understanding. However, in Türkiye, where 64.6% of the adult population possesses inadequate or problematic health literacy, traditional medical brochures often exceed recommended reading levels. This study aimed to evaluate and compare the readability of Turkish dermatology PEMs prepared by the Turkish Dermatology Association (TDA) with those generated by artificial intelligence (AI) models.

Materials and methods: A total of 68 TDA PEMs were analyzed. Readability was assessed using the Ateşman Readability Index. Responses were generated by AI models to questions extracted from …

Cervical Conjoined Nerve Root Anomalies: Prevalence And Impact On Posterior Cervical Surgery, Ahmet Eren Seçen, Ayfer Aslan, Musa Onur Özbakir, Uğur Kemal Gündüz, Ali̇ Dalgiç

Turkish Journal of Medical Sciences

Background/aim: Anomalous nerve roots (ANRs) are well described in the lumbosacral spine but are rarely reported in the cervical region. The aim of this study was to evaluate the incidence, clinical characteristics, and surgical outcomes of cervical ANRs, with particular emphasis on conjoined nerve roots, in a single-center clinical series.

Materials and methods: A retrospective analysis was conducted of patients who underwent posterior cervical discectomy for cervical disc herniation at our institution between 2010 and 2025. A total of 113 posterior cervical procedures were performed, and seven patients were found to have surgically confirmed cervical ANRs. For these patients, demographic …

Face Mask Littering: Environmental Impacts, Regulatory Challenges, And Ai-Driven Waste Management Strategies For The Post-Pandemic Era, Pri̇yanka Rathee, Sari̇ta Khatkar, Renu Sehrawat, Pooja Rathee, Anurag Khatkar, Esra Küpeli̇

Turkish Journal of Medical Sciences

The widespread use of polypropylene-based face masks during the COVID-19 pandemic created a significant and persistent source of plastic pollution. This review aims to provide an integrative assessment of the environmental, toxicological, and public health implications of face mask litter and evaluate current waste management challenges and emerging technological solutions in the postpandemic context. A narrative review approach was employed, synthesizing literature published between 2020 and 2025 and indexed in major scientific databases including Web of Science, Scopus, and PubMed. Studies were selected based on their relevance to the issues of environmental contamination, microplastic generation, toxicological effects, regulatory frameworks, and …