Digital Commons Network^™

Act And Posttraumatic Growth In Military Veterans: Growth Through Flexibility After Adversity, Andrew J. Moller

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Military veterans are disproportionately exposed to potentially traumatic events across service eras. While much of the clinical and research literature has focused on posttraumatic stress disorder (PTSD) and symptom reduction, a growing body of work highlights the possibility of posttraumatic growth (PTG) following adversity. PTG refers to positive psychological changes that may emerge through engagement with traumatic experiences, including enhanced appreciation for life, renewed purpose, personal strength, deepened relationships, and reintegration into community roles. Importantly, PTG does not imply the absence of distress but may coexist alongside ongoing trauma-related symptoms. Understanding processes that facilitate growth alongside suffering may support more …

Clinical Considerations For Black Student Athlete Development, Jahnia Margarita Green

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Black student athletes exemplify the complexity of navigating intersecting identities at pivotal points in their development. They are also more likely to make premature commitments to their athletic identity and in turn suffer from psychological distress during times of transition (Beamon, 2012). The focus on Black collegiate athletes is informed by persistent mental health challenges associated with higher levels of competition or transitions (e.g., injury or retirement) within collegiate athletics (Brewer & Petitpas, 2017; Menke & Germany, 2019). This paper aims to develop culturally informed clinical considerations through the analysis of the Black student athlete experience and structural aspects of …

Trauma Processing And Sleep Inconsistencies In Firefighters: A Proposed Program To Bridge Gaps And Set Heroes Up For Success, Megan Griffin

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

This doctoral paper presents a comprehensive review of the literature supporting the need for an integrated training program addressing sleep disruption, trauma exposure and processing, and substance use as a self-medication strategy among firefighter populations. Drawing on empirical research, the paper examines the prevalence and interaction of posttraumatic stress disorder (PTSD), moral injury, sleep disturbances, and substance use within this occupational group. The introduction provides operational definitions of PTSD and moral injury and synthesizes existing research on trauma exposure, sleep impairment, and substance use functions among firefighters. The literature review also highlights evidence-based, exposure informed interventions to facilitate adaptive trauma …

A Brief Self-Help Intervention For Anxiety And Depressive Symptoms Utilizing Cognitive Behavioral Therapy And Dialectical Behavior Therapy Within Correctional Settings, Genevieve L. Ray

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Individuals within incarcerated settings are far more likely to experience symptoms that meet criteria for a mental health disorder compared to the general population. This population is often underserved due to various financial and resource constraints. Self-help interventions have grown in popularity due to their proven effectiveness and accessibility for consumers, particularly for anxiety and depression symptoms. A self-help intervention for those in a correctional setting would not require extensive additional personnel amid financial constraints and would increase access to care. Many self-help interventions that are currently published apply to the community population, but readily accessible resources that reside in …

Diagnosis And Treatment Of Trauma In Adolescents: A Doctoral-Level Clinical Psychology Course, Jasmine M. Cervantes

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Adolescent trauma is a significant mental health concern that can profoundly disrupt emotional, cognitive, social, and developmental functioning. Although evidence-based interventions for adolescent trauma are well established, doctoral-level psychology training programs may provide limited instruction focused specifically on the unique developmental, cultural, and clinical considerations required when treating traumatized adolescents. This paper presents the development of a ten-week doctoral-level elective course designed to address this gap in clinical training. The curriculum provides foundational knowledge regarding the prevalence, developmental impact, diagnosis, and treatment of adolescent trauma, with an emphasis on posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). Students …

Exploring Red Palm Oil As A Sustainable Plasticizer For Carbon Black-Filled Ssbr/Br Tire Tread Compounds: A Comparative Evaluation Of Commercial Alternatives, Norma Arisanti Kinasih, Mohamad Irfan Fathurrohman, Santi Puspitasari, Dewi Kusuma Arti, Abdulhakim Masa

Journal of Materials Exploration and Findings

This study investigates the application of red palm oil (RPO) as an alternative vegetable oil resource to substitute petroleum-based plasticizers, which have environmental and health concerns, in carbon black (CB)-filled SSBR/BR tire tread compounds. The plasticizing effects of RPO were thoroughly evaluated by comparing them with a commercial bio-based plasticizer, Epoxidized Soybean Oil (ESBO), and two safer petroleum-based oils, Naphthenic Oil (NYNAS) and Treated Distillate Aromatic Extract (TDAE). The initial investigation shows that fatty acid composition is imposing regarding the plasticizing effect. The higher unsaturated fatty acid content in RPO than in ESBO improved tensile strength and degraded rolling resistance …

Metallurgical Investigation Of A Modified Eye Bolt Failure Caused By Improper Weld Extension, Specification Deviation, And Crevice Corrosion, Dimas Muhammad Fawwaz, Reza Miftahul Ulum, Johny Wahyuadi Soedarsono, Yudha Pratesa

Journal of Materials Exploration and Findings

A modified eye bolt from the David Arm Manhole Storage Tank underwent thorough metallurgical study due to the consequences of the bolt's malfunction during operation. Safety issues arose when the manhole door detached during operation. The mechanical testing and chemical composition analysis of the bolts indicated they were manufactured from an ASTM A193 Grade B7 material used for high-temperature bolting. This material did not conform to the engineering drawing, which mentioned SA 563A, which is about nuts, not bolts. This contradiction clearly shows that the eye bolt which was installed does not conform to the intended design. Welded connections of …

Improving K-Card Observation Fidelity To Sustain A Culture Of Continuous Learning, John L. Ricks Iii

Master's Projects and Capstones

Problem

            Despite improvements in central line-associated bloodstream infection (CLABSI) attribution, variability in Kamishibai card (K-card) observation practices and documentation limited the unit's ability to identify, learn from, and correct persistent deviations from expected practice. Baseline data showed frequent incomplete documentation and a pattern of completing K-card observations outside bedside shift report.

Context

This project took place in a 20-bed medical-surgical ICU, using the existing K-card process to support high-reliability prevention of hospital-acquired conditions (HAC). Baseline assessment revealed inconsistent observation workflows, incomplete documentation, and unclear roles and expectations.

Interventions

A standardized K-card observation workflow was developed through rapid-cycle testing. Observations were …

Don’T Fall For It: Just-In-Time Staff Education To Reduce Patient Falls On An Adult Telemetry Unit, Forrest Wilcox, Kyle Knight, Jennifer Paiz, Zaira Garcia-Vega

Master's Projects and Capstones

Objective: Patient falls remain a leading cause of preventable harm among hospitalized adults and carry significant clinical and financial consequences. On an adult medical-surgical telemetry unit at this study site, a one-year review of 45 fall events found that most falls occurred among patients classified as high risk on the Morse Fall Scale, frequently without continuous observation or consistent purposeful rounding. Aim: The aim of this project is to reduce falls on the telemetry unit to the national benchmark of 3.2 falls per 1,000 patient days within a 6-month period. Methods: A just-in-time (JIT) education intervention was delivered to registered …

Healthcare Students’ Experiences Using Artificial Intelligence Simulation Tools In Clinical Simulated Laboratory Practice, Delicia S. Cousin

Student Dissertations

Artificial intelligence-driven simulation has become an important component of healthcare education by providing students with opportunities to strengthen clinical reasoning, decision-making, and technical skills in a safe learning environment. Despite its growing adoption, limited research has explored how healthcare students experience artificial intelligence-driven simulation during clinical laboratory practice. The purpose of this qualitative case study was to explore healthcare students’ experiences using artificial intelligence-driven simulation tools during clinical laboratory practice. Guided by Experiential Learning Theory and Transformative Learning Theory, the study examined how students interpreted, reflected upon, and learned from these experiences. Data were collected through a researcher-developed Qualtrics questionnaire …

Rejection Of Fe (Iron) And Kmno4 (Organic Substance) Parameters In Peat Water Using Organic Membranes, Muhamad Rafli Sakti Mulia Gonera, Siti Umi Kalsum, Sarah Fiebrina Heraningsih

Journal of Materials Exploration and Findings

Peat water is a surface water source widely used by people in swampy and lowland areas, but it has poor quality characteristics such as high organic matter content, low pH, and dissolved metal levels such as iron that exceed the threshold. These conditions can cause health problems and reduce the quality of clean water so that effective treatment technology is needed. This study aims to analyze the effectiveness of ultrafiltration membranes made from chitosan from shrimp shell waste in rejecting iron (Fe) and organic substances in peat water, and to determine the effect of pressure on separation performance. This study …

Feasibility And Patient-Reported Outcomes Of Full-Body Red And Near-Infrared Photobiomodulation For Musculoskeletal Pain In A Predominantly Hispanic/Latino Population: A Single-Arm Pilot Study, Robson Dias Scoz, Frida Garza, Ivana Burberg, Isabella Moreno, Melissa Espinosa Cantu, Mia Dominguez, Juan Gonzalez

Physical Therapy Faculty Publications

Objective: To characterize feasibility, tolerability, and patient-reported outcomes after a 10-session full-body red and near-infrared photobiomodulation (PBM) protocol for musculoskeletal pain in a predominantly Hispanic/ Latino community sample.

Background: PBM is a non-pharmacological intervention with potential analgesic and anti-inflammatory effects. Evidence from community-based and Hispanic/Latino populations remains limited, and full-body LED protocols are incompletely standardized.

Methods: This single-arm observational pilot study included 40 adults with self-reported acute or chronic musculoskeletal pain. Participants completed baseline and post-protocol Qualtrics surveys. The intervention used a full-body LED panel emitting 630, 660, 830, and 850 nm light in continuous-wave mode for 20 min per …

Early Immune Dysregulation In Mtb/Siv Co-Infection Resists Cart Treatment At The Single-Cell Level, Todd Bradley, Shabaana A Khader, Deepak Kaushal

Faculty, Staff and Student Publications

Using single-cell transcriptomics of bronchoalveolar lavage cells from Mtb/SIV co-infected rhesus macaques on cART, we reveal profound immune dysregulation during early SIV co-infection of latent tuberculosis. SIV induces a sharp decline in CD4+ T cells, NK, and NKT cells, with incomplete recovery of Mtb-specific TH1 effector responses despite viral suppression. Instead, a persistent TH17-skewed environment emerges, alongside sustained myeloid inflammation driven by Type I interferon signaling and pro-inflammatory regulators such as KLF6 and NFKB1. Ligand-receptor network analyses demonstrate expanded CD4+ T cell-macrophage crosstalk and loss of immune homeostasis that cART fails to fully restore. These findings expose …

Leadership Style And Employee Outcomes In Private Practice Outpatient Physical Therapy Clinics, Catherine Beuerle Martin, Debra Ann Beazley

Lynchburg Journal of Medical Science

Background: Workforce retention, employee engagement, and job satisfaction are ongoing challenges in outpatient physical therapy practice. Leadership style has been identified as a potentially modifiable organizational factor that may influence clinician experience and workplace outcomes. Despite extensive leadership research in other health professions, evidence specific to outpatient physical therapy settings remains limited. 

Purpose: To examine the relationships between private practice outpatient physical therapy clinic directors’ perceived leadership styles and staff physical therapists' work engagement, job satisfaction, turnover intention, leadership effectiveness, satisfaction with leadership, and willingness to exert extra effort.

Methods: This cross-sectional correlational study surveyed licensed staff physical …

From “Fixer” To “Facilitator”: A Clinical Review Of Shared Medical Appointments As A Strategy For Workforce Sustainability, Barbara A. Slusher

Lynchburg Journal of Medical Science

Clinician burnout remains a significant threat to workforce sustainability, particularly in resource-constrained settings managing complex chronic diseases. While shared medical appointments (SMAs) have demonstrated clear benefits in patient satisfaction and access, their impact on clinician well-being and professional fulfillment is less clearly defined. This review evaluates whether participation in SMAs improves clinician satisfaction and mitigates burnout by facilitating a conceptual transition from isolated “Fixer” to collaborative “Facilitator.”

A targeted literature search of PubMed, the Cochrane Library, and Google Scholar identified peer-reviewed publications examining shared medical appointments and clinician-centered outcomes, including burnout, clinician satisfaction, and workforce sustainability. …

Hidden Infarctions: Understanding And Managing Myocardial Infarction With Non-Obstructive Coronary Arteries Through A Multimodal Lens, Catalina Esquivel

Lynchburg Journal of Medical Science

Myocardial infarction with non-obstructive coronary arteries (MINOCA) accounts for 5–15% of myocardial infarctions and disproportionately affects women and minority populations. It is defined by clinical evidence of myocardial ischemia with

Professional Values And Workplace Alignment In Dpt Alumni: A Quantitative Cohort Analysis, Debra Ann Beazley, Stephen Elam, Penny S. Elam, Lawrence S. Ramiscal, Pt, Dpt, Ph.D.

Lynchburg Journal of Medical Science

Background: Professional values are foundational to physical therapy practice and are emphasized throughout Doctor of Physical Therapy (DPT) education. Although identity formation literature suggests that core values may persist after graduation, less is known about how workplace context, career stage, and clinical performance relate to the long-term enactment of values among practicing clinicians.

Purpose: To examine whether professional values among DPT alumni differ across demographic groups, career stages, and outpatient settings, and to explore associations among organizational support, workplace value alignment, and historical educational performance.

Methods: A cross-sectional survey study was conducted among University of Lynchburg DPT alumni …

Navigating The Maternal Health Crisis: Enhancing Maternal Health Outcomes In New Jersey, Nyrobi Barnes

Doctoral Dissertations and Projects

The purpose of the study was to better understand the implications of race and ethnicity on perinatal health experiences and maternal health outcomes in non-Hispanic Black women (nHBw) in New Jersey and mitigate the maternal health crisis. A secondary outcome was to propose an evidence-based initiative to elicit equitable care in New Jersey via grant-funded programs at the New Jersey Department of Health. Although New Jersey has made progress in improving maternal and infant health outcomes, racial disparities continue to persist. The research aims to further understand implications of race and ethnicity on adverse perinatal health experiences and maternal health …

Defining Quality Of Life: The Lived Experience Of Adults With Pulmonary Hypertension And The Impact Of Activity-Induced Respiratory Distress, Bethany Jean Adams

Walden Dissertations and Doctoral Studies

Pulmonary hypertension (PH) is a progressive, life-limiting disease that significantly affects quality-of-life (QoL). Limited research has explored lived experiences of individuals with PH. Guided by Parse’s human becoming theory, this qualitative descriptive phenomenological study explored the lived experiences of individuals affected by PH and examined how activity-induced respiratory distress affected QoL. The research Question was: How do individuals with PH describe the impact of activity-induced respiratory distress on their QoL. I conducted interviews with nine participants, including eight adults diagnosed with PH and one caregiver of an individual with PH. Data were analyzed using Saldaña's comparative coding framework to identify …

Predictors Of Academic Performance In First-Year Bsn Students: The Role Of Emotional Exhaustion, Alcohol Use, And Resilience, Jennifer Nerius

Doctoral Dissertations and Projects

The first year of nursing school can be academically demanding and emotionally challenging as students adjust to rigorous coursework, clinical expectations, and professional responsibilities. Understanding factors that influence student well-being and academic success is important for supporting students during this transition. The purpose of this quantitative longitudinal correlational study was to examine the relationships among emotional exhaustion, alcohol use, resilience, and academic performance in first-year Bachelor of Science in Nursing (BSN) students. Guided by Resilience Theory, the study explored whether resilience was associated with emotional exhaustion and alcohol use and whether emotional exhaustion, resilience, and alcohol use predicted academic performance. …

The Posture Of Recovery; A Quantitative Analysis Of Post-Exercise Heart Rate Restorateion In College Athletes, Matthew Scott Ferriter

Doctoral Dissertations and Projects

Heart rate recovery (HRR) has been frequently used as a noninvasive indicator of autonomic reactivity following high-intensity exercise. However, limited research has explored the effects of post-exercise body posture (PEBP) on HRR following acute bouts of high-intensity exercise in collegiate athletes. The purpose of this quantitative repeated-measures experimental study was to investigate if recovery posture (supine [SUP]; tripod [TRI]; standing upright [SU]) affected HRR during the first five minutes following a standardized high-intensity interval training (HIIT) session. Thirty-seven collegiate athletes completed three total testing sessions. Participants completed all three recovery posture conditions in a randomized order. Heart rate (HR) was …

Cells And Networks In Flux: Rethinking Ontogenesis And Pathogenesis, Mark L. Tykocinski

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Organ and tissue functions emerge from the coordinated activity of cell networks. Therapeutics that act on pathogenic cell networks, modulating their cellular interplay, follow naturally. Over several decades, our laboratory has developed a series of approaches for rewiring cell networks, culminating in a class of cell surface-directed signal converter proteins (SCPs) that do so by modulating juxtacrine and autocrine signaling in and among their nodal cells. A first such SCP has now produced encouraging clinical data for cancer immunotherapy. Yet, these early network-directed fusion proteins rest on a deliberately simplified picture: discrete end-cell types plugged into graphically tractable networks. That …

Staff Education To Enhance Nurse Knowledge Of Standardized Sud Screening Using The Dast-10 In An Outpatient Psychiatric Setting, Peters Olugbemiga Adu

Walden Dissertations and Doctoral Studies

The utilization of substance use disorder (SUD) screening tools at the practice site was inconsistent, contributing to limited identification and diagnosis of SUDs. The project was conducted at a psychiatric outpatient clinic in an urban region of Maryland that serves many patients with co-occurring mental health and substance use disorders. The purpose of the project was to develop, implement, and evaluate a staff education program focused on the Drug Abuse Screening Test (DAST-10). The primary goal was to improve staff knowledge and understanding of the DAST-10 screening tool. A 14-item multiple-choice questionnaire was administered before and after the educational intervention …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Exercise Modulates Microbial Metabolites And Induces Stromal Remodeling In Pancreatic Cancer, Cayla Xue, Thais F Bartelli, Vidhi Chandra, Le Li, Justina Ortiz, Truong Lam, Hetal Patel, Jonghae Lee, Pradeep Shrestha, Hannah Savage, Olivereen Le Roux, Haoyue Liu, Tamara Vallejo-Schmidt, Ryan De Maleki, Vasanta Putluri, Nagireddy Putluri, Joseph F Petrosino, Jared K Burks, Javier A Gomez, Jlenia Guarnerio, Matthew H G Katz, An Ngo-Huang, Laura R Prakash, Nathan H Parker, Maria Q B Petzel, Lin Tan, Seyda Baydogan, Florencia Mcallister, Keri L Schadler

Faculty, Staff and Students Publications

Exercise induces a variety of changes in the tumor microenvironment, with beneficial effects in several tumor types. However, a better understanding of the clinical effects of exercise and mediating mechanisms is needed to maximize the utility of exercise for patients. In this study, we analyzed tumors from patients with pancreatic ductal adenocarcinoma (PDAC) in the PancFit trial and identified an exercise-induced reduction in cells expressing α-smooth muscle actin (αSMA). Interrogation of changes in tumor stromal composition with exercise in a murine PDAC model revealed a microbially influenced reduction in αSMA+ cells and Il6-expressing inflammatory cancer-associated fibroblasts (iCAF). Cholic acid, a …

Exercise Modulates Microbial Metabolites And Induces Stromal Remodeling In Pancreatic Cancer, Cayla Xue, Thais F Bartelli, Vidhi Chandra, Le Li, Justina Ortiz, Truong Lam, Hetal Patel, Jonghae Lee, Pradeep Shrestha, Hannah Savage, Olivereen Le Roux, Haoyue Liu, Tamara Vallejo-Schmidt, Ryan De Maleki, Vasanta Putluri, Nagireddy Putluri, Joseph F Petrosino, Jared K Burks, Javier A Gomez, Jlenia Guarnerio, Matthew H G Katz, An Ngo-Huang, Laura R Prakash, Nathan H Parker, Maria Q B Petzel, Lin Tan, Seyda Baydogan, Florencia Mcallister, Keri L Schadler

Faculty, Staff and Students Publications

Exercise induces a variety of changes in the tumor microenvironment with beneficial effects in several tumor types. However, a better understanding of the clinical effects of exercise and mediating mechanisms is needed to maximize the utility of exercise for patients. In this study, we analyzed tumors from pancreatic ductal adenocarcinoma (PDAC) patients in the PancFit trial and identified an exercise-induced reduction in cells expressing alpha smooth muscle actin (αSMA). Interrogation of changes in tumor stromal composition with exercise in a murine PDAC model revealed a microbially-influenced reduction in αSMA+ cells and Il6 expressing inflammatory cancer associated fibroblasts (iCAFs). Cholic acid, …

Osteoarthritis In Saudi Arabia: Current Evidence, Public Perceptions, And Future Research: A Narrative Review, Khalid Yaseen

Journal of Medical Rehabilitation Science

Background and Purpose: Osteoarthritis (OA) is a leading cause of pain and disability worldwide and represents a growing public health concern in Saudi Arabia. This narrative review synthesises current evidence on OA in the Saudi context, with particular emphasis on epidemiology, risk factors, public perceptions, clinical management patterns, and the utilisation of physiotherapy and other conservative interventions. The aim is to inform clinical practice, public health strategies, and health system planning in alignment with Saudi Vision 2030.
Methods: A narrative review was undertaken, drawing on evidence from PubMed/MEDLINE, Scopus, Web of Science, Saudi Digital Library, Ministry of Health (Saudi Arabia) …

Staff Education To Nurses On Trauma-Informed Care, Lorna Sackey

Walden Dissertations and Doctoral Studies

Many nurses receive little formal instruction about trauma-informed principles and their practical application in behavioral health settings. To address this practice gap, the project implemented a staff education program for staff at an intensive outpatient program (IOP) and a partial hospitalization program (PHP) located in a northeastern state. The aim was to increase staff knowledge and confidence in trauma-informed principles within clinical practice. The education program emphasized the relevance of trauma-informed care (TIC) in outpatient behavioral health settings, its principles, and its application in nursing assessments, therapeutic communication, and patient interactions. A pretest and posttest questionnaire consisted of 12 multiple-choice …

Clinical Practice Guideline For Sepsis In Skilled Nursing Facility, Chinyere Okoroh

Walden Dissertations and Doctoral Studies

Sepsis is a life-threatening condition that can rapidly lead to organ dysfunction, septic shock, and death if not recognized and treated early. Older adults in skilled nursing facilities (SNFs) are especially vulnerable because of age-related physiological changes, chronic conditions, weakened immunity, and increased exposure to infections. Consequently, sepsis remains a major cause of hospital readmissions, mortality, and healthcare utilization among SNF residents. The SNF serving as the site for this Doctor of Nursing Practice (DNP) project experienced increased hospital readmissions associated with recurrent sepsis, highlighting the need for a standardized, evidence-based approach to sepsis recognition and management. The practice-focused question …

Relationships Between Lower Body Anthropometrics And Vertical Force-Velocity Profiles In Collegiate American Football Players, Nicholus Adam Despot

Doctoral Dissertations and Projects

The study examined the relationships between lower-body anthropometric characteristics and vertical force-velocity profiles in collegiate American football players. Although the use of force-velocity profiling has increased significantly in recent years, there has been limited research on the association between structural features and key mechanical outputs. A sample of 16 NAIA football players was used to examine how skeletal breadths, girths, and derived ratios relate to key force-velocity metrics. Anthropometric variables were collected using ISAK standards, while force-velocity profiles were obtained through a series of loaded squat jumps on a force platform. Mean propulsive force, velocity and power were used to …