Digital Commons Network^™

How Are Women Dealing With Polycystic Ovary Syndrome?, Adrianna A. Brown

Electronic Theses, Projects, and Dissertations

Background and Aims: PCOS is one of the leading multisystem conditions among women of reproductive age. Dietary changes may help improve outcomes associated with PCOS and its comorbidities. While a lower carbohydrate, moderate protein diet is often recommended, those with PCOS often use temporary diets or dietary supplements instead of or in addition to prescription medications due to dissatisfaction with their treatment options. Additionally, studies examining the usefulness of supplements and their effects on PCOS symptoms are lacking. This study explored the prevalence of use of temporary diets, prescription medications, and dietary supplements among women with PCOS.

Methods: An anonymous …

The Effects Of Administration Policies On Patient Care Quality And Healthcare Service Costs, Rajveer Kaur

Electronic Theses, Projects, and Dissertations

This study examines how administrative policies in U.S. healthcare systems affect patient care quality and service costs. It addresses a gap by analyzing the combined effects of policy, leadership, and technology on both clinical outcomes and financial performance. Using a qualitative descriptive approach guided by the PRISMA protocol, the study systematically identified and analyzed eighteen peer-reviewed articles. The findings show that value-based purchasing policies relate to improved patient safety indicators. Standardized clinical protocols and workforce competency initiatives strengthen care consistency and reduce hospital readmissions. The use of digital health technologies, such as telehealth and predictive analytics, helps optimize resources and …

Associations Between Water Intake, Dietary Quality, And Beverage Consumption Among University Students, Mohammad A. Qazi

Electronic Theses, Projects, and Dissertations

Title: Associations Between Water Intake, Dietary Quality, and Beverage Consumption Among University Students

Background and Aims: Sugar-sweetened beverage (SSB) and ultra-processed food (UPF) consumption significantly contribute to chronic disease risk and is often more common in underserved and racially/ethnically diverse communities. Drinking water is a low-cost, calorie-free behavior that may support healthier beverage and dietary patterns. Previous studies show that increased daily water consumption positively correlates with better diet quality and is inversely correlated with SSB and UPF consumption. This study aims to examine whether (1) increased daily water intake is associated with self-reported diet quality and (2) self-reported hydration …

Promoting Influenza Vaccination Among College Students, Wajeeha Khan Valley

Electronic Theses, Projects, and Dissertations

Influenza remains a significant public health concern on college campuses, where high population density, shared living environments, and frequent social interaction increase the risk of viral transmission. Despite the availability of safe and effective influenza vaccines, vaccination rates among college-aged students remain consistently low. Many students underestimate their personal risk for influenza and hold persistent misconceptions regarding vaccine safety, effectiveness, and side effects. The widespread use of social media further influences these attitudes, as misinformation can rapidly spread while credible health messaging often struggles to gain visibility. It is important to eliminate vaccine hesitancy among college students through innovative, behavior-focused …

Targeting The Dorsolateral Prefrontal Cortex With Transcranial Direct Current Stimulation To Improve Depression And Anxiety In Parkinson's Disease, Brock Renicks

Honors Theses

The aim of this study is to observe the outcomes of transcranial direct current stimulation (tDCS) as a treatment for Parkinson’s Disease (PD). This study will primarily look at changes in depression and anxiety, as these symptoms are often comorbid with Parkinson’s Disease. Transcranial direct current stimulation is a non-invasive, very low-intensity form of electrical stimulation of the brain. It is being increasingly used as a form of treatment for Parkinson’s Disease and depression and anxiety, however the literature is ambiguous, showing mixed results throughout various studies, with no standardization of tDCS administration. To determine the effect of tDCS on …

A Program Evaluation Of A Family-Based Healthy Weight Program For Overweight And Obese Children And Their Families, Ashley Heimbouch, Margaret Platel, Kelly Betts

Doctor of Nursing Practice Projects: College of Nursing

This project’s purpose was to complete a program evaluation of the Building Healthy Families (BHF) program to determine its effect on children and their families’ health outcomes. The specific aims of success were 1) an improved perception of health-related quality of life for children and parents and 2) decreased body mass index (BMI) percentiles for age and sex in children from baseline measurements and scores compared to measurements and scores at 3 months and 6 months of program completion. The project was completed in a community setting on the University of Nebraska Medical Center’s Western Nebraska campus, and the population …

Platelet Gαz Regulates Ovarian Tumor Growth And Mediates The Effects Of Chronic Stress, María G. Torres Carrizalez

Dissertations and Theses (Open Access)

Ovarian cancer is the most aggressive gynecologic cancer, with 12,450 estimated deaths in 2026. Elevated platelet counts are commonly observed in patients with ovarian cancer and are associated with enhanced tumor growth and poor prognosis. Patients with ovarian cancer are frequently exposed to elevated levels of stress, which has been correlated with accelerated disease progression and increased mortality. Interestingly, the platelet Gαz protein is activated by epinephrine through the α2A-adrenergic receptor, suggesting a potential mechanistic link between stress signaling and platelet-driven tumor progression. To investigate this, I evaluated the role of platelet Gαz in ovarian cancer using control (Gz^{fl/fl …}

Learning About The Direct Experiences Of Very Young Children With Hearing Loss: A Feasibility Study, Jenni M. Funk

Undergraduate Honors Capstone Projects

We aimed to explore the feasibility of employing a developmentally appropriate, modified puppet interview method to elicit thoughts and perspectives directly from very young children (ages 3 to 6 years old) who are deaf or hard-of-hearing. Little is known about the direct experiences of children with hearing loss, making it difficult to improve care. In our field of speech and hearing sciences, there is no current method of gathering direct experiences of young children and placing them at the center of care. We proposed that researchers may be able to learn about the direct experiences of very young children who …

From Synapse To Circuit: Mechanisms Of Behavioral Flexibility And Its Restoration After Prenatal Alcohol Exposure, Jayapriya Chandrasekaran

Biomedical Sciences ETDs

Behavioral flexibility—the ability to adapt behavior when contingencies change—is a fundamental executive function supported by orbitofrontal–striatal circuitry. This dissertation examined molecular, motivational, and circuit mechanisms underlying flexibility and its restoration after prenatal alcohol exposure (PAE). In healthy mice, GluN2B-containing NMDA receptors in the orbitofrontal cortex increased during outcome updating, while AMPA receptor subunits in the dorsal striatum rose during new learning, defining temporally distinct plasticity processes. PAE impaired reversal learning under low-reward conditions, but not when motivation was high, indicating altered thresholds for circuit engagement rather than permanent loss. Finally, optogenetic stimulation of OFC→dorsal striatum projections rescued flexibility in PAE …

Exploring Clinical Reasoning In Occupational Therapy Students Using Think Aloud During Computerized Patient Simulation, Candra Selene Talylor

Graduate Theses and Dissertations (2019 - present)

The objective of this research was to explore the effects of the think aloud (TA) method on the development of clinical reasoning in occupational therapy students completing an online simulation assignment. The study aimed to determine if thinking aloud develops clinical reasoning in occupational therapy students as evidenced by a change in clinical reasoning skill scores and investigates the relationship between students' overall clinical simulation competency scores.

This study used a mixed methods design, combining quantitative and qualitative data to explore and measure the use of the TA strategy on the development of clinical reasoning skills. The sample from this …

Big Feelings, Fast Decisions: Emotion Regulation As A Moderator Of Impulsivity In Binge And Emotional Eating, Emma G. Folk

Graduate Theses and Dissertations (2019 - present)

Emotion-driven impulsivity and difficulties with emotion regulation are both associated with maladaptive eating behaviors, including binge eating and emotional eating. However, it remains unclear whether broader emotion regulation difficulties intensify the influence of impulsive responses to emotional states on these behaviors. This study examined whether emotion dysregulation moderates the relationship between emotion-driven impulsivity and maladaptive eating behaviors. Participants were 266 adults (ages 18–65) who completed measures of impulsivity, emotion regulation difficulties, binge eating, and emotional eating. Moderation analyses were conducted using PROCESS in SPSS, controlling for body mass index (BMI) and gender. Negative and positive urgency were significantly associated with …

A Bilingual Ai-Based Chatbot For Nutrition Education In A Food Is Medicine Intervention For High-Risk Pregnant Women: Design And Development Study, Lorena Macias-Navarro, Nalini Ranjit, Gregory W Bounds, Brendon A Providence, Yesmeena Shmaitelly, Naomi M Tice, Shreela V Sharma

Faculty, Staff and Student Publications

Background: Conversational agents (artificial intelligence [AI]-based chatbots) offer a novel approach to health interventions by providing personalized, adaptive interactions that improve over time based on user engagement. In nutrition education, given the wide variation in knowledge, skills, and abilities across participants, AI-based chatbots have the potential to enhance accessibility, engagement, and behavior change. Food is Medicine (FIM) interventions, which aim to improve food security and diet quality among multicultural, at-risk populations, often face challenges related to sustained engagement and use.

Objective: This paper describes the design, development, and iterative refinement of a bilingual AI-driven nutrition chatbot integrated into an FIM …

Enhancing Gender Congruence And Life Satisfaction In The Borderland Through Gender-Affirming Communication Services, Kimberley Ramirez

Open Access Theses & Dissertations

Transgender individuals frequently encounter barriers to accessing gender-affirming healthcare, particularly within marginalized borderland communities. Communication-based gender affirmation, including voice therapy and nonverbal communication training, remains an underexplored yet essential component of transgender health and psychosocial well-being. The purpose of this study was to examine the impact of gender-affirming communication services on voice-gender congruence and life satisfaction among transgender individuals living in the U.S.-Mexico borderland region. A single-subject experimental design (ABAB) was implemented with six participants initially enrolled in the study. Four participants completed all intervention phases and were included in final analysis. Intervention consisted of individualized gender-affirming communication services targeting …

Detecting Early Physiological Signs Of Work-Related Muscle Strain And Fatigue Using Quantitative Sensory Testing, Omar Alberto Cano

Open Access Theses & Dissertations

Background: Work-related musculoskeletal disorders (WRMSDs) are a major source of occupational disability and economic burden worldwide. Early detection of physiological strain remains challenging since traditional methods often rely on self-reported pain or diagnosis after symptom development. Quantitative Sensory Testing (QST) may provide an objective, non-invasive method for identifying early sensory changes associated with repetitive upper-extremity loading. Purpose: This pilot study examined the responsiveness of Pressure Pain Threshold (PPT) and Thermal Threshold Testing (TTT) for detecting Acute muscular strain and fatigue following repetitive manual task performance. Methods: A within-subject counterbalanced design was conducted with sixteen healthy participants. Each participant completed both …

Identifying The Role Of Occupational Therapy In Suicide Prevention, Grey Buchheit

Capstone Projects

Occupational therapists are uniquely positioned to identify and support individuals experiencing suicidal ideation; however, suicide prevention education remains limited within occupational therapy curricula despite its relevance across diverse practice settings. This doctoral capstone experience sought to address this educational gap by developing evidence-based suicide prevention resources for Western Michigan University's Doctor of Occupational Therapy Program while promoting student wellness and burnout prevention as complementary components of suicide prevention. Guided by a literature review, SWOT analysis, faculty interviews, and a needs assessment that included a survey of Level I fieldwork educators, this project identified opportunities to strengthen occupational therapy education related …

Supporting Neurodiversity-Affirming Practice For Young Adults: Resource Development For A Level I Occupational Therapy Fieldwork Clinic, Grace Campbell

Capstone Projects

Neurodiversity-affirming and strengths-based practices are a growing area of focus within occupational therapy, viewing neurological differences as natural variations of human diversity rather than deficits to be corrected. This Doctoral Capstone Experience (DCE) focused on applying these perspectives within the Work-to-Work Clinic, a Level I occupational therapy fieldwork clinic that serves young adults with neurodevelopmental conditions such as Autism, ADHD, and intellectual disability. Commonly-used assessments and treatment materials at the clinic were outdated, deficit-focused, and poorly suited to this population’s developmental stage, leaving many clients with unmet needs. Additionally, Level I fieldwork students are still developing clinical reasoning skills and …

The Mysteries Of Postpartum Ocd: A Systematic Review, Taryn Shaffer

Honors Program: Senior Projects (Public)

Background: The research on postpartum mental health is growing, with most focusing on physical and sexual wellness, or well-known mental health symptoms such as psychosis, depression, and stress. However, as the research grows, so does the interest in lesser-known or under-considered postpartum mental health symptoms, including Obsessive-Compulsive Disorder (OCD). The focus of this research can be the exacerbation of already-present OCD symptoms, or the onset of them during pregnancy and the postpartum period. The purpose of this systematic review was to analyze research on OCD in pregnant and postpartum women. Specifically, the review included an analysis of measures used to …

Hepatopulmonary Syndrome As Presentation Of Pediatric Metabolic Dysfunction-Associated Steatohepatitis, Shruti Sakhuja, Stacey S Beer, Kalyani R Patel, Alexiss M Williams, Nhu Thao Galvan, John A Goss, Krupa R Mysore

Faculty, Staff and Students Publications

Childhood obesity is rising and leading to serious co-morbidities, among which is metabolic dysfunction-associated steatotic liver disease (MASLD) predisposing individuals to cirrhosis. We describe a young 11-year-old Hispanic male who presented with hepatopulmonary syndrome secondary to cirrhotic portal hypertension from metabolic dysfunction-associated steatohepatitis (MASH), necessitating liver transplantation. Despite lifestyle modifications post-transplantation, the patient experienced persistent weight gain and recurrence of steatosis, emphasizing challenges of managing pediatric MASLD. The burden of childhood obesity is increasing and impacting children significantly earlier than previously believed. Our case is one of the few to report the severe complications of MASH in a young, pre-teen …

2-Aminobutyrate Mediates The Impact Of Air Pollution On Blood Biomarkers Of Alzheimer’S Disease, Anum Saeed, Chris Mckennan, Jane E Clougherty, Peidi Zhou, Sheila Tripathy, Ellen J Kinnee, Jiaxuan Duan, Kevin Kip, Xuemei Zeng, Victor Villemagne, Tharick Pascoal, Mark Mapstone, Eric A Whitsel, Oscar I Lopez, Christie Ballantyne, Thomas K Karikari, Bing Yu, Steven Reis, Annie Cohen

Faculty, Staff and Students Publications

Introduction: We examined the impact of mid-life metabolites on late-life Alzheimer's disease (AD) plasma biomarkers and whether these metabolites mediate air pollution effects.

Methods: In the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) cohort, we applied high-dimensional regression and meditation models, adjusting for observed and latent confounders, with replication in the Atherosclerosis Risk in Communities (ARIC) study. Exposures included mid-life fine particulate matter (PM2.5), black carbon, metals, and metabolites. Outcomes were: late-life plasma p-tau(181, 217, and 231) and amyloid beta 42/40 (Simoa assays).

Results: In the Heart SCORE study, seven lipid- and amnio acid-pathway metabolites measured in mid-life were …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …

Towards Dementia-Inclusive Digital Text-Based Health Information: A Multi-Method Investigation Of Cognitive And Affective Accessibility, Margi Engineer

All Dissertations

This dissertation examines the accessibility, readability, emotional tone, and trustworthiness of digital, text‑based dementia information and investigates how older adults with and without dementia cognitively and affectively engage with such content. It further explores the potential of generative AI to improve dementia information delivery through the development of a domain‑specific retrieval‑augmented generation (RAG) large language model (LLM) chatbot designed to deliver accessible, stigma‑free information. The dissertation comprises four studies using complementary quantitative and qualitative methods. Study I conducts a large‑scale content analysis of 300 medical articles, 35 websites, and 50 blogs, applying readability metrics, LIWC‑based linguistic and sentiment analysis, and …

Antidepressant-Like Effects Of Extinction Learning As An Animal Model Of Behavioral Therapy, Jing Liu, Sarah E Bulin, David A Morilak

Faculty, Staff and Student Publications

Exposure-based behavioral therapy, the most effective treatment for posttraumatic stress disorder (PTSD), also reduces depressive symptoms. However, neurobiological mechanisms underlying the beneficial effects of exposure-based behavioral therapy on depression remain unknown. Our lab has established fear extinction as a rat model of exposure therapy to investigate the mechanisms underlying its therapeutic behavioral effects in chronically stressed rats. In this study, we demonstrated that extinction learning reduced immobility in the forced-swim test and reversed chronic stress-induced reduction in sucrose preference. Chemogenetic inactivation of pyramidal neurons in the ventral medial prefrontal cortex (vmPFC) prevented these antidepressant-like effects of extinction. Extinction learning enhanced …

Community Vitality: Establishing Blue Zone Based Education For Elementary Students, Eliza G. Heinrich

Honors College Theses

Blue Zones are areas of the world where people live longer and healthier lives. These areas share several key characteristics called the Power 9 (Buettner & Skemp, 2016). The goal of this study was to increase general knowledge of Blue Zones as well as the implementation of healthy habits to increase the longevity of the population of Calloway County, Kentucky through educational sessions of elementary students. Researchers involved in this study asked participants to fill out a pre-test to gauge knowledge of Blue Zones. Participants then underwent several educational sessions and activities surrounding the Power 9. Participants were then asked …

Personality Characteristics Of Emergency Nurses And Their Subjective Fit In The Emergency Department, Jose Michael Maria

Theses & Dissertations

Nursing workforce challenges in the United States persist despite widespread recruitment and retention efforts, and the COVID-19 pandemic has further exacerbated shortages, turnover, and workforce instability. Despite interventions such as residency programs, financial incentives, and organizational initiatives, long-term retention remains inconsistent, particularly in high-demand settings like emergency departments. Ongoing issues such as overcrowding, rising patient acuity, and workforce attrition contribute to burnout, compassion fatigue, and compromised patient outcomes, perpetuating a cycle of staffing strain. Grounded in Person–Environment Fit theory, this research proposes that aligning emergency nurses’ personality traits with the specialty practice environment, the emergency department, may offer a more …

Caring For Transgender People In Healthcare: A Qualitative Descriptive Study With Nurses Working In An Acute Healthcare Setting, Gabriela Roxana Matson

Theses & Dissertations

Transgender individuals frequently encounter numerous obstacles when accessing healthcare services, including stigma, discrimination, and inadequate understanding from healthcare providers. Structural, interpersonal, and anticipation barriers significantly hinder transgender patients' access to care. Structural barriers include a lack of healthcare providers knowledgeable in transgender health and financial constraints. Interpersonal barriers involve discrimination, such as refusal to use correct pronouns or provide gender-affirming care. Anticipation barriers stem from fear of mistreatment, causing many to avoid seeking medical care altogether. Nurses play a vital role in upholding inclusive and affirming healthcare This qualitative descriptive study explored the subjective experiences of registered nurses who provided …

A Systematic Review And Meta-Analysis On The Levels Of Supportive Care Needs In Adults With Cancer, Caroline B. Silveira, Rech, Maria Petropoulou, Pietro S. Rössler, Francine F. De Souza, Helena B. Böhmer, Amanda L. Giacomet, Richard Alejandro B. De Barros, Lucélia De C. De Barros, Vagner R.Z.B. Pereira, Nanci Da S.T. Junqueira, Pedro Lopez

Research outputs 2022 to 2026

Objective: To estimate the levels of supportive care needs among adults with cancer using the Supportive Care Needs Survey–Short Form 34 (SCNS-SF34) and to examine demographic, clinical, and treatment-related determinants. Methods: A systematic review and meta-analysis was conducted (CRD42024604977). Studies reporting SCNS-SF34 scores in adults with cancer were included. Searches were performed across six different databases (November 2024; updated August 2025). Random-effects meta-analyses were undertaken to estimate the pooled mean scores across the five SCNS-SF34 domains and total score. Subgroup and meta-regression analyses explored potential determinants. Results: Ninety-five studies (n = 32,493) were analysed. The unmet needs observed tended to …

Circulating Sphingomyelins Correlate With Plasma T-Tau In Cognitively Unimpaired Older Adults At Risk Of Developing Alzheimer's Disease, Tahmida Sharmin, James D. Doecke, Pratishtha Chatterjee, Steve Pedrini, Hamid R. Sohrabi, Nicholas J. Ashton, Henrik Zetterberg, Manohar L. Garg, Kaj Blennow, Ralph N. Martins

Research outputs 2022 to 2026

Alterations in plasma sphingomyelin (SM) levels have been reported in Alzheimer's disease (AD), pointing to disturbances in lipid metabolism that may contribute to disease pathogenesis. Neuronal damage in early AD triggers tau release into central and peripheral systems. Despite influence from peripheral contributions, alterations in plasma total-tau (T-tau) remain valuable in indicating AD-related neurodegeneration. Investigating relationships between SM metabolism and tau release during preclinical AD may uncover important biochemical processes and support advancing early non-invasive detection and treatment approaches. This cross-sectional study investigated cognitively unimpaired (CU) older adults from the KARVIAH cohort, grouped by cortical amyloid-β (Aβ) status through positron …

Role Of Allied Health Professions In Falls Prevention For Community-Dwelling Older Adults: A Scoping Review, Amy Lawton, Nicholas Tripodi, Rebecca Wospil, Breanna M. Wright, Hylton B. Menz, Suzanne Martin, Daniel R. Bonanno, Corey Linton, Andisheh Bastani, Andrew Ross, Rees Thomas, Daniel Corcoran, Timothy Mcnamara, Danielle Baxter, Brett Vaughan, Rebecca Lane, Jack Feehan

Research outputs 2022 to 2026

Objective: Falls among community-dwelling older adults are prevalent and have serious individual, societal and economic consequences. Allied health professionals provide key falls prevention interventions yet their representation in current clinical practice guidelines is inconsistent. Increased recognition of allied health roles and delivering context-specific guidelines for falls care could help to address workforce gaps and optimise care approaches. This scoping review explored the roles of the allied health professions in falls prevention screening, assessment and intervention for community-dwelling older adults. Design: Scoping review, using the Joanna Briggs Institute methodology for scoping reviews. Data sources: PubMed, CINAHL, Scopus, Cochrane, Web of Science …

The Flourishing Child: Study Protocol For An Acceptability And Feasibility Trial Of A Digital Early Childhood Flourishing Intervention, Zenobia Talati, Jack Kennare, Natasha L. Bear, Lisa Y. Gibson, Robyn Power, Van Zyl Kruger, Desiree Silva, Susan L. Prescott, Jacqueline A. Davis

Research outputs 2022 to 2026

Background: Globally, rates of children with physical and mental health problems are increasing. Health issues in early childhood often persist into adulthood, highlighting the need to ensure children are supported to flourish from the start of life. Objectives: This protocol describes methods used to test the acceptability and feasibility of a novel digital Flourishing Intervention (designed to empower parents and promote child wellbeing), comprising a Flourishing Check (a newly developed online questionnaire) and a Pathway Tool (an online directory of high-quality, evidence-based programmes and resources). Methods: Using a randomised feasibility trial, participants (N = 600 parents of children aged 0–5 …

Factors Influencing Patient Recall For Follow-Up In The Multi-Stage Deployment Of Medical Intelligent Screening Systems, Wenjie Chen

Dissertations and Theses Collection (Open Access)

With the deep integration of artificial intelligence (AI) technology in the healthcare sector, intelligent screening systems have achieved significant breakthroughs in predictive accuracy; however, they commonly face a management challenge in clinical implementation: accurate early warnings but limited patient recall. To address this ineffective technological empowerment issue in practice, this study proposes a theoretical framework featuringbidirectional interactions between "technological empowerment" and"relational empowerment" based on empowerment theory to systematicallyinvestigate the dynamic evolution mechanisms and boundary conditions of patient recall willingness under multi-stage, cross-departmental deployment of medical intelligent screening systems. Using a leading municipal hospital as the primary experimental setting, the study …