Digital Commons Network^™

Understanding The Underutilization Of The Campus Recreation Facility: A Mixed-Methods Examination Of Basic Psychological Need Satisfaction, Social Physique Anxiety, Sense Of Community, And Physical Environment Barriers, Caden M. Pfingsten

Master's Theses or Doctor of Nursing Practice

Campus recreation facilities have been identified as important contributors to student well-being, academic persistence, and institutional belonging. Despite these documented benefits, a persistent gap exists between available services and actual student utilization at many institutions. This study examined the psychological, social, and environmental factors associated with students' underutilization of the Campus Recreation Facility (CRF) at a mid-sized Midwestern public university in favor of paid off-campus commercial gym memberships.

Using a cross-sectional survey design, 169 students completed a battery of validated and researcher-adapted instruments assessing basic psychological need satisfaction (autonomy, competence, and relatedness), Sense of Community, and social physique anxiety across …

The Influence, Dependency, And Targeting Of Fatty Acid Uptake In Er+ Breast Cancer, Abigail E. Goen

Dartmouth College Ph.D Dissertations

Estrogen Receptor-positive/ Human Epidermal Growth Factor 2-negative, breast cancer (ER+/HER2- BC) is the most prevalent subtype of BC, impacting millions of individuals. Although early screening and treatment with endocrine therapy has greatly enhanced survival, this subtype sustains a steady increase of risk for recurrent disease for decades after diagnosis, indicating the persistence of residual cancer cells that are capable of maintaining dormancy for >20 years prior to metastatic outgrowth. Dormant cells reprogram metabolic pathways which can be profoundly influenced by the tumor microenvironment in promoting quiescence or proliferation. Fatty acid oxidation dependency has been noted as a hallmark of drug …

Visual Aids And Numeracy In Healthcare: Leveraging The Drawing Effect, Zephyr J. Markley

Capstone Showcase

Healthcare decisions often require patients to interpret numerical risk information under stress, yet many struggle with low numeracy, which can distort comprehension and undermine informed consent. Well-designed visual aids can improve diagnostic inference, calibrate confidence, and support better choices, especially for patients with limited numeracy, but their impact depends on whether users can actually interpret the format accurately. Drawing may further enhance these tools by adding a tactile, generative layer that engages visual, semantic, and motoric processing while helping patients organize information into concrete models.

Passive visual aids appear useful but limited because they often position patients as observers rather …

The Prevalence Of Diabetic Retinopathy In American Indians Or Alaska Natives And Non-Indigenous Americans: A Systematic Review And Meta-Analysis., Caberry W. Yu, Keean Nanji, Anubhav Garg, Michele Zaman, Jane Jomy, Abdullah El-Sayes, Catherine Sun, Shreyas Bhat, Mark Phillips, Dena Zeraatkar, Jinhui Ma, Enrico Borrelli, Sunir J Garg, David H. Steel, Tien Yin Wong, Sobha Sivaprasad, Charles C. Wykoff, Varun Chaudhary

Wills Eye Hospital Papers

TOPIC: To estimate the prevalence of diabetic retinopathy (DR) in adult American Indian or Alaska Native (AIAN) and non-AIAN patients with diabetes.

CLINICAL RELEVANCE: Although diabetes mellitus is more prevalent among AIAN patients compared with non-AIAN patients, the evidence is inconsistent regarding whether AIAN patients have a higher prevalence or severity of DR.

METHODS: We searched Ovid MEDLINE, EMBASE, and Web of Science databases from inception through February 23, 2025. We included primary studies evaluating the prevalence of DR in Americans with diabetes. The prevalence of (1) DR, (2) diabetic macular edema (DME), (3) proliferative diabetic retinopathy (PDR), (4) vision-threatening …

A Zinc Chelate Of Lysine/Glutamic Acid Reduces Alcohol-Induced Ciliary Dysfunction, Emily Do, Daren L. Knoell, Christopher Bauer, Deanna Mosley, Deandra R. Smith, Derrick R. Samuelson, Todd A. Wyatt

Journal Articles: Environmental, Agricultural & Occupational Health

Alcohol misuse is a known risk factor for pneumonia, and up to 50% of individuals who misuse alcohol are zinc deficient. Chronic alcohol misuse can lead to alcohol-induced ciliary dysfunction (AICD), preventing effective mucociliary clearance and protection against lung infection. Because zinc salts fail to alter AICD, we hypothesized a form of zinc (Zinpro Zinc LG) with enhanced cell uptake would protect against AICD. Human and mouse airway epithelial cells were treated with 50 mM ethanol for 1-24 h followed by the ciliostimulatory agents. Cilia beat frequency (CBF) and cAMP-dependent protein kinase (PKA) activity were assayed. Cyclic AMP or beta …

Advancing Occupational Therapy In Sports: Bridging The Gap In Mental Performance, Gianna N. Scarantino

Occupational Therapy Student Scholarship

Occupational Therapy’s (OT’s) role in sports mental performance remains an underrecognized and emerging area of practice, with limited awareness among OTs, a lack of available educational resources, and currently no established pathway into the field. The purpose of this doctoral capstone project was to increase awareness of OT’s role in sports mental performance through the development and evaluation of a comprehensive educational resource. The educational resource included a digital portfolio, recorded PowerPoint lecture, educational Instagram content, and a Linktree that organized all project materials into one accessible location. Four licensed OTs completed a Qualtrics pre-resource knowledge checklist, reviewed the educational …

Connecting Through Art: A Collaborative Art Program For The Deaf Community, Andrey Meg Bacal, Cristina Dumitrescu, Gary Dennis, Regina Brejda, Maija Vizvary, Jacie Schneider

Occupational Therapy Student Scholarship

This doctoral capstone project developed, implemented, and evaluated a Deaf-centered, ASL-accessible community art program at the Jessye Norman School of the Arts in Augusta, Georgia. The project addressed communication and environmental barriers that may limit participation in meaningful leisure and community-based occupations. Two ASL-interpreted art sessions and a community art show were completed, with evaluation using adapted PROMIS-based survey items, implementation observations, and quality improvement feedback. Because only two usable anonymous survey responses were available at each time point, findings were summarized descriptively and interpreted as feasibility and implementation information rather than evidence of effectiveness. The project supported the feasibility …

Empowering Women Through Surf Therapy: A Trauma-Informed Facilitation Toolkit, Ashlie Steppe

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

Women who have experienced trauma often face challenges with emotional regulation, sense of safety and daily functioning. Additionally, one in three women experience trauma throughout their lifetime and this can lead to difficulty with connection, body awareness, and engagement in meaningful activities. A local non-profit surf therapy organization was established to provide women with a supportive community and meaningful, nature-based activity to promote healing and connection. The purpose of this quality improvement capstone experience was to address and develop a sustainable trauma-informed wellness toolkit to support facilitators in delivering structured wellness activities within the program. The toolkit specifically addressed key …

An Environmentally Relevant Phthalate Mixture Impairs Ovulatory Prostaglandin And Progesterone Receptor Pathways In Human Granulosa Cells In Vitro, Katie L. Land, Hong Xu, James W. Akin, Patrick R. Hannon

Obstetrics and Gynecology Faculty Publications

Ovulatory defects are the leading cause of female infertility. Widespread exposure to endocrine-disrupting chemicals, such as phthalates, may contribute to the high prevalence of failed ovulation among infertile women. Using primary ovarian granulosa cells obtained from women, we tested the hypothesis that exposure to an environmentally relevant mixture of phthalate metabolites (MPTmix) impairs essential mediators of the ovulatory process, including progesterone (P4), progesterone receptor (PGR), and prostaglandins (PGs). The composition of the MPTmix was derived from urinary phthalate levels in women. Ovarian granulosa cells, obtained from in vitro fertilization patients, were acclimated in culture to regain responsiveness to hCG (human …

Chatbot Therapy - Help Or Hindrance, Kadi Rae Smith

Anthós

Introduction

Generative artificial intelligence (Gen-AI) chatbots are complex computer programs designed to mimic human conversations using programming that incorporates large language models (LLM) and natural language models (NLM) to simulate human interactions that are being rapidly integrated into everyday life across an increasing amount of online platforms. This article explores the applications and efficacy of chatbots for mental healthcare, from self-directed chatbot interactions to clinician-supervised implementation of chatbot-based therapeutic tools, weighing the benefits and limitations of this ever-expanding technology.

Methodology/Taxonomy

A literature review was conducted primarily using Web of Science, accessed through Portland State University, and Google Scholar, with specifications …

The Weight Of Stigma, Rebekah A. King, Michael S. Sinha

All Faculty Scholarship

Many health care providers, both implicitly and explicitly, perpetuate stigma in their treatment of patients classified as obese. While medical professionals understand that a one-size-fits-all approach to treatment is ineffective, patients classified as obese are frequently offered limited treatment options that fail to account for their unique needs. Access to a range of effective treatment options has historically been limited, but new GLP-1 receptor agonist medicines like Wegovy (semaglutide) and Zepbound (tirzepatide), have shown incredible promise in addressing the obesity crisis. Unfortunately, these transformative drugs are costly, in high demand, and not widely covered by insurance, rendering them inaccessible for …

An Exploratory One Health Investigation Of Mycobacterium Tuberculosis Complex At The Camel–Human Interface In Abu Dhabi Emirate, United Arab Emirates, Gobena Ameni, Aboma Zewude, Asha Antony, Tsegaye Shamebo, Temesgen Mohammed, Nabeeha Hassan Abdelgaleel, Mohamud Sheek-Hussein, Balázs Ádám, Robert Barigye, Markos Tibbo

All Works

This exploratory cross-sectional One Health study characterized LIODetect TB-ST antibody reactivity in dromedary camels and abattoir workers in Abu Dhabi Emirate and investigated tuberculosis-compatible lesions in slaughtered camels. Sera from 356 camels sampled from farms and livestock holdings (izbas), 393 camels presented for slaughter at Al Bawadi Abattoir, and 86 abattoir workers were screened with LIODetect TB-ST. All 25 LIODetect-reactive slaughtered camels underwent detailed postmortem examination; nonreactive slaughtered camels were not examined postmortem. Lesions identified in two reactive camels were evaluated by histopathology, Ziehl–Neelsen staining, and IS6110 polymerase chain reaction (PCR). LIODetect reactivity was detected in 33/356 field camels (9.3%, …

Increasing Colorectal Cancer Screening Rates At A Federally Qualified Health Center: A Quality Improvement Project, Kaeli H. Mcphee

DNP Scholarly Projects

Abstract 

Background: Colorectal cancer (CRC) is on the rise and is currently the second leading cause of cancer-related death in the United States (Wender, 2022). CRC screening rates are below national goals, particularly among underserved populations. At Lowell Community Health Center (LCHC), only 41.9% of eligible adults were up to date with CRC screening as of 2024.

Purpose: This quality improvement project aimed to increase CRC screening rates among average-risk adults aged 45 to 75 by implementing a multifaceted, low-burden intervention targeting both provider and patient behaviors.

Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, the intervention included: (1) provider and …

Reducing Healthcare Provider Stigma Toward Opioid Use Disorder: Evaluating An Asynchronous Multimedia Training In Primary Care, Ashley M. Holmes

DNP Scholarly Projects

Background: Stigmatizing attitudes among healthcare providers toward individuals with opioid use disorder (OUD) represent a critical barrier to care, treatment retention, and equitable healthcare utilization.

Local Problem: A primary care practice in Lewiston, Maine, serving a medically underserved region heavily impacted by the opioid crisis. Community Health Needs Assessment identified healthcare provider stigma and treatment access gaps as primary obstacles to OUD in this county.

Methods: Utilizing a Plan-Do-Study-Act (PDSA) quality improvement framework, an asynchronous, multimedia-driven educational curriculum was implemented among primary care clinicians (N = 7 invited; n = 4 completed). A mid-stream pivot from an in-person to asynchronous …

Monocyte Activation In People With Hiv And Tuberculosis Coinfection And Effect Of Tuberculosis Preventive Therapy: An Analysis Of The Actg A5279/Brief Tb Trial, Moises A. Huaman, Manuel G. Feria, Michelle A. Kendall, Ashley Mckhann, Khuanchai Supparatpinyo, Claire A. Chougnet, Xinyu Du, Frederick K. Sawe, Kristine M. Erlandson, Netanya S. Utay, Michael M. Lederman, Susan Swindells, Amita Gupta, Richard E. Chaisson, Carl J. Fichtenbaum

Journal Articles: Infectious Diseases

BACKGROUND: Monocyte activation contributes to the pathogenesis of inflammation-driven comorbidities in people with HIV (PWH). We investigated the impact of tuberculin skin test (TST)/interferon-γ release assay (IGRA) status and tuberculosis preventive therapy (TPT) on monocyte activation in PWH.

METHODS: We analyzed peripheral blood mononuclear cells from participants from the A5279/BRIEF-TB trial, which compared 1 month of rifapentine/isoniazid (1HP) versus 9 months of isoniazid (9H) as TPT in PWH. All included participants were on suppressive antiretroviral therapy and had available TST or IGRA results at study entry. Samples collected at week 0 (pre-TPT) and week 48 (post-TPT) were analyzed. Monocyte subset …

2026 Cancelled Titles With Alternate Access, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

The Use Of Visual Autobiographies In First, Second, And Third-Generation Children Of Immigrants In Navigating Belonging And Identity, Sorprisela Martinez

Art Therapy | Master's Theses

This study explored how autobiographical artmaking supports adolescents of immigrant-origin in understanding identity and sense of belonging through visual and narrative reflection on personal stories. The qualitative research approach was guided by three research questions examining: (1) the ways autobiographical work expresses complexities of immigrant heritage and multiple identities; (2) how narrative lens supports a deeper interpretation of autobiographical expressions; and (3) how adolescents’ understanding of their parents’ migration stories contributes to their own identity formation and self-presentation. Seven adolescents participated in a two-session, arts-based process that included creating autobiographical books, discussion of their images, and reflection on their cultural …

Wise Beyond Our Years: Menopause, Negative Body-Image, And Art As A Catalyst To Self-Acceptance, Nicole Lea

Art Therapy | Master's Theses

This mixed methods study examined the impact of menopause on women’s body image and self-acceptance through an arts-based group intervention. Quantitative data was collected using the Body Image Self-Compassion Scale, and qualitative data was gathered through art-making, group discussion, and individual interviews. Participants were (n=5) menopausal women aged 46-52 from the Bay Area who reported negative body image related to menopause. The intervention consisted of four one-hour open studio workshops with a fifth meeting added in which participants created altered books while engaging in peer support and discussion. Descriptive statistics indicated an increase in mean body image self-compassion scores from …

Unpacking And Re-Imagining Dental Ethics With Anti-Oppressive And Interdisciplinary Praxis, Eleanor Fleming Phd, Dds, Mph, Ficd, Facd

Journal of the American College of Dentists

Dental ethics are assumed to be neutral in their intent. With a social contract grounded in liberalism and assumptions centering whiteness, the resulting ethics reinforce hierarchy, otherness, and inequities. Because concepts and practices are rarely neutral, dental ethics is embedded with biases, which results in it falling short of the demands of the 21st century and exacerbating health inequities rather than supporting efforts for health justice. This manuscript invites the reader to reflect critically and re-imagine dental ethics using anti-oppressive and interdisciplinary praxis. For the improvement of public health, the narrowing of inequities, and a functioning oral health system, the …

A World Of Connection: Asd, Morgan M. Gayton

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2026

Autism Spectrum Disorder is a diagnosis that affects many school-aged children (CDC, 2025). Autistic children can have more difficulties engaging with both their peers and their families, which can lead to a lack of social participation. A World of Connection: ASD was a doctoral capstone project centering on social participation for autistic youth. The project blended the capstone student’s expanded knowledge in performing arts with their education in Occupational Therapy to create a 4-part capstone experience. A scoping review targeting the question “what are the most effective performing arts methods to enhance the social participation of autistic children” yielded 9 …

Moving Forward With Purpose: Aadej Adopts New Mission, Vision, And Values Statements, Jasmine Shafagh Dmd

AADEJ - The Communicator

Regular feature from the president of AADEJ, Dr. Jasmine R. Shafagh with the latest updates from AADEJ.

Achieving Successful Occupational Performance During Transitions In Eating Disorder Treatment, Elise Kay Ramberg

Occupational Therapy Capstones

Introduction: Individuals with eating disorders experience challenges in occupational engagement that stem from contributing meaning, value, and purpose to occupations that support eating disorder behaviors rather than promote quality of life (Mack et al., 2023). Recovery is highly dependent on the transition between both levels of care and back into the patient’s natural environment. Occupational therapists play an essential role in supporting patients as they transition and learn to re-engage in their lives outside of their eating disorder (Mack et al., 2023). The purpose of this project was to create materials for the occupational therapist to employ with eating disorder …

Mitigating The Effects Of Technology Use In The Classroom: An Occupational Therapy Approach, Hannah E. Ibach

Occupational Therapy Capstones

Background: The average child spends three times the recommended time on technology, which is leading to a wide range of consequences affecting education, such as fine motor, cognitive, and social deficits (Christensen, 2021; McGough, 2021; Qi et al., 2023). Parents and teachers play a crucial role in helping children be prepared for their education, yet many are not aware of the impacts of too much technology use (Srivastava, 2022). Developing strong foundational skills early in childhood is critical for setting the stage for long-term educational success. When skills are nurtured from a young age, children are better prepared to adapt …

Holistic Occupational Therapy Approach In Addressing Women’S Health Needs & Access To Care, Lilja Jurva

Occupational Therapy Capstones

Background: As women across the lifespan experience complex physical, emotional, and occupational challenges related to maternal transitions, mental health needs, chronic conditions, and rural healthcare disparities, occupational therapy is uniquely equipped to address the complex challenges. Services have been proven to be directly correlated to lower incidence of preterm birth, cesarean delivery, low birth weight, excessive gestational weight gain, diabetes mellitus, and hypersensitive disorders, and higher incidence of vaginal delivery. A clear gap for maternal support services was identified in the Grand Forks community through literature review, interviews, and community engagement, leading to the development of NoDak Therapy and Wellness. …

The Role Of Occupational Therapy In The Prevention Of Sudden Unexpected Infant Death (Suid), Natalie Ryan Mcfarren

Occupational Therapy Capstones

Background: Each year, 3,700 infants die from SUID; this equates to about ten infants per day. SUID is an umbrella term that covers three separate subcategories: suffocation and strangulation in bed, sudden infant death syndrome (SIDS), and unknown (Cribs for Kids, 2026). Suffocation and strangulation in bed is the only subcategory that is 100% preventable with safe sleep practices, while the risk of SIDS can be decreased by adhering to safe sleep guidelines. While the prevalence of SUID has decreased since the 1992 Back to Sleep campaign, current data indicate a plateau, if not a slight increase, in SUID cases …

Occupation-Based Transition Planning Guide For High School Students With Disabilites., Kelsey Milleson

Occupational Therapy Capstones

Background: The transition from high school to adulthood is a critical period influencing independence, employment, and community participation for students with disabilities (Carroll et al., 2025; Rosner et al., 2020). Despite mandates under the Individuals with Disabilities Education Act (IDEA), many students experience poor postsecondary outcomes, including limited employment and increased reliance on caregivers (Benson et al., 2021; U.S. Department of Education, 2020). Effective transition planning should begin early, be individualized, and emphasize real-world skill development such as daily living, vocational skills, and self-advocacy (Cleary & Persch, 2020). However, school-based programs often lack consistency, structure, and performance-based outcome measures, reducing …

The Effects Of Stress-Related Hormones On Excitatory Synapse Formation, Autumn C. Garvey

Honors Undergraduate Theses

Stress profoundly influences brain function through neuromodulatory hormones that regulate synaptic plasticity, yet how temporal patterns of hormone exposure shape excitatory synapse formation remains poorly understood. This study investigates how exposure to stress hormones, norepinephrine and cortisol, affects excitatory synapse development. While existing research primarily compares concentration models, real-world stress occurs in variable patterns that may produce distinct neural outcomes. To address this gap, differentiated Neuro2A neuronal cells are exposed to norepinephrine or cortisol under a continuous treatment paradigm designed to model chronic stress conditions. Following treatment, immunofluorescence imaging is utilized to quantify excitatory synapse formation through analysis of presynaptic …

Comparative Analysis Of Serum-Free Culture Conditions On Cell Proliferation And Extracellular Vesicle Production By Adipose-Derived Stem Cells, Ayna Ghulldu

Honors Undergraduate Theses

Adipose-derived stem cells (ADSCs) are promising candidates in regenerative medicine due to their proliferative capacity, self-renewal, and secretion of extracellular vesicles (EVs) that mediate intercellular communication. Serum-free media has been increasingly explored for MSC culture as it eliminates xenogeneic components, improving human therapeutic suitability. However, comparative evaluation of distinct serum-free formulations on ADSC proliferation and EV output simultaneously remains limited. This study compares a serum-containing medium to three proprietary serum-free media prototypes differing in composition, including the presence or absence of extracellular matrix proteins, to inform the optimization of culture conditions for clinical use. Proliferation, EV characteristics, and gene expression …

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …

Barriers To Immunity: Understanding Covid-19 Vaccine Uptake In Africa, Emilia Blechschmidt

Honors Theses

This thesis examines the factors influencing COVID-19 vaccine uptake across African countries, with a focus on structural, informational, and behavioral barriers to immunization. Drawing on cross-country data, the study analyzes how access to transportation, reliable information, and healthcare resources shape vaccination rates, alongside the effect of demographics and institutional factors in shaping individual perceptions of risk and vaccine safety.

The findings emphasize that the broader strength and preparedness of national health systems strongly influence vaccine uptake. Countries that demonstrated higher coverage of routine childhood immunizations, such as polio and hepatitis B, also tended to perform better in COVID-19 uptake efficiency …