Digital Commons Network^™

Using Natural Products In Patients With Cancer: More Than Chemotherapy, Gailen D. Marshall

Oxford ICSB

The fundamental goal of cancer therapy is to cure the cancer. However, the approach to that goal is complicated and varies depending upon the type and stage of the tumor as well as the clinical characteristics of the patient. Cancer treatment focused on killing the tumor has considerable comorbidities associated with each therapy. Common side effects such as systemic immunosuppression, bleeding, anemia and specific organ-based pathologies each have their own significant morbidity/mortality risk. The use of natural products, both as direct antitumor agents and as moderators/mitigators of side effects of antitumor agents has a long history. Recent studies seek to …

Transforming Patient Safety And Care Practices Through Interprofessional Education, Kaleena Ramirez, Claudia C. Tamara, Jennifer Sells, Karen Clatt, Banan Abuharb, Mary Coolbaugh-Murphy, Iris Culwell, Anca Fumurescu, Mary Gust, Lori Simmons, Delores Whiteing, Annie Koenig, Sara Martinez, Wilton Muriithi, Shaun T. Caldwell, Susan Lee, Mary Sizemore, Kimberly Ann H. Krumwiede

Advances in Cancer Education and Quality Improvement

As healthcare increasingly relies on interdisciplinary teams to deliver safe and effective care, the development of interprofessional collaboration competencies among students in health care professions has become an educational priority. In response, The University of Texas MD Anderson Cancer Center School of Health Professions integrated a longitudinal interprofessional education curriculum to foster collaborative practice readiness and prepare students for team-based interdisciplinary environments that ensure safe and patient-centered care. The curriculum was guided by the Interprofessional Education Collaborative 2016 and 2023 core competencies for interprofessional collaborative practice, reinforced with the Real Colors® Personality Instrument and Team Strategies and Tools to Enhance …

Interprofessional Education Development In An Oncology-Focused Healthcare Institution, Mary Sizemore, Michael Morris, Mohamed Ait Aiss, Gregory Botz, Jolyn Taylor, Joshua Kuban, Diane C. Bodurka

Advances in Cancer Education and Quality Improvement

Background: Despite growing recognition of the value of interprofessional education (IPE), most IPE work has focused on undergraduate learners, leaving a critical gap in postgraduate and clinical environments. This report describes a phase 1, formative, pre-implementation quality improvement (QI) initiative to establish an institution-wide IPE program at an oncology center without a traditional medical school.

Methods: We used a developmental, multiphase mixed methods design integrating 3 inputs: (1) Virtual Interprofessional Teaching and Learning (VITAL) faculty-development feedback, (2) IPE Steering Committee feedback, and (3) simulation evaluation used as an applied context (not the sole focus). Surveys were administered to VITAL participants, …

Memory Processes In Older Adults With Hearling, Camryn L. Kirkham

AuD Capstone Projects - Communication Sciences and Disorders

Emerging research has shown links between hearing loss in older adults and memory declines; however, findings remain mixed. The present study examined differences in memory performance between older adults with hearing loss and normal-hearing peers, as well as associations between hearing ability and memory. An exploratory analysis of associations between high-frequency hearing ability and memory performance was also conducted. Participants included 38 older adults with hearing loss (n=20) and normal hearing (n=18) who completed audiologic testing and memory tasks assessing working, semantic, and episodic memory. Contrary to expectations, no significant group differences in memory performance were observed between the hearing …

Long Work Hours, Suboptimal Diabetes Management, And Differences By Sex And Race/Ethnicity, Nhanes (2011-2018), Tailisha Gonzalez, Margrethe Horlyck-Romanovsky, Terry T.-K. Huang, Sandra E. Echeverria

Publications and Research

In the United States (US), occupational segregation by sex and race/ethnicity can contribute to health disparities. Although work schedule characteristics have been previously linked to elevated cardiovascular risk, little is known about the effects on chronic disease management in women and minoritized workers. We examined the association between work hours and diabetes management among US workers, testing for differences by sex and race/ethnicity. We utilized 2011–2018 National Health and Nutrition Examination Survey (NHANES) data on working adults (age ≥20 years) with diagnosed diabetes (n = 1041). Suboptimal diabetes management was defined as HbA1c ≥7%. Work hours were categorized per WHO …

Cervical Cancer Screening Among Women Across The United States, Srivathsan Vijaya Raghavan

Walden Dissertations and Doctoral Studies

While cervical cancer is not among the most frequently diagnosed cancers in the United States, it remains a significant concern due to its preventability through regular Pap smears and Human Papillomavirus (HPV) vaccination. However, incidence rates are rising as screening participation among U.S. women declines. This quantitative study (N = 15714) explored cervical cancer screening behaviors by analyzing levels of community involvement and social functioning, guided by the socioecological model (SEM). The dependent variable was cervical cancer screening, while the independent variables were community involvement and social functioning. The study controlled for health insurance status, age, race, ethnicity, employment, education, …

Quality Improvement Project: Faculty Preparedness For Recognition, De Escalation, And Reporting Of Violence In Clinical Education Settings, Dawn "Deedee" D. Moline

Doctor of Nursing Practice Projects

Violence and aggression in healthcare settings present ongoing safety concerns for nursing faculty supervising students during clinical education, particularly when teaching occurs in hospital environments where faculty are not employed. Faculty often rotate across multiple clinical sites and may lack consistent preparation or access to standardized safety education and reporting systems. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the effect of a targeted educational intervention on nursing faculty perceived preparedness to recognize, de escalate, and report aggression encountered during clinical instruction. Guided by Bandura’s Social Cognitive Theory and Lewin’s Three Stage Change Model, …

Promoting Participation In Leisure Activities At The Center For Living And Learning, Katie Eison

OTD Capstone Projects

The Center for Living and Learning is a private nonprofit residential treatment facility on a 30-acre farm in Franklin, TN, housing adults who experience severe and persistent mental illnesses such as schizophrenia and schizoaffective disorder. The Center provides opportunities for leisure activities during the day; however, due to symptomology such as avolition, anhedonia, and social withdrawal, residents often struggle with participation in valued leisure activities. This doctoral capstone project aimed to promote participation in leisure activities, social participation, and community engagement. The Interest Checklist and Leisure Satisfaction Measure were administered to determine residents’ individual interests and satisfaction levels with leisure …

Quality Improvement Project: Improving The Clinical Teaching Experience Through Clinical Adjunct Orientation, Elissa Saunders

Doctor of Nursing Practice Projects

Clinical adjunct nursing faculty often transition into academic roles without formal preparation, leading to role insecurity and high turnover rates that negatively impact student clinical experiences. The purpose of this quality improvement (QI) project was to implement a structured orientation checklist to improve perceived clinical teaching competency among novice clinical adjunct faculty. The project aimed to standardize onboarding and support the transition from clinical practice to academia. A quantitative pre-post intervention design was used with a convenience sample of clinical adjunct faculty employed for less than one year at a rural university nursing program. The project was guided by Kotter’s …

Enhancing Provider Self-Efficacy And Documentation In Hypertension Management, Stephanie Nsiah

Doctor of Nursing Practice Projects

Primary care providers often experience inconsistent confidence and incomplete documentation when managing hypertension, contributing to suboptimal blood pressure control. This quality improvement project addressed the need for structured provider education at an outpatient family clinic. The purpose was to evaluate the impact of a structured educational intervention on provider self-efficacy and documentation completeness. Using a quasi-experimental pre-post design guided by the Plan-Do-Study-Act model and Lewin's Change Theory, a 60-minute educational session was delivered to 12 licensed providers. Participants completed pre- and post-intervention self-efficacy surveys using the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) and Feasibility of Intervention …

Equine-Assisted Interventions For Pediatric Clients With Cerebral Palsy: A Handbook For Occupational Therapists, Draydin Ferguson, Lesley Khan-Farooqi, Phd, Otd, Otr

Spring 2026 OTD Capstone Symposium

This poster outlines the development of an evidence-informed instructional handbook intended to guide Occupational Therapists in implementing equine-assisted interventions with pediatric clients diagnosed with Cerebral Palsy.

Groove ‘N’ Grow: Promoting Social Participation Through Dance And Movement, Juliana N. Ward, Karen Park

Spring 2026 OTD Capstone Symposium

Groove ‘n’ Grow is a structured pediatric occupational therapy group program designed to improve social participation, engagement, and sensory regulation in children with developmental and sensory processing differences through dance and movement-based activities. The program was developed as part of an occupational therapy doctoral capstone project and implemented within a pediatric outpatient therapy clinic. The purpose of the program is to provide children with developmental and sensory processing differences opportunities to practice peer engagement, cooperative participation, emotional regulation, and emotional awareness in a supportive small-group environment.

From Browsing To Building: Navigating Your Google Resource Space (Drive & Site), Libby Cunningham

Capstone Projects

This capstone project aimed to develop a trauma-informed, evidence-based support hub for Court Appointed Special Advocates (CASA) working with children involved in the foster care system. CASA advocates are frequently exposed to secondary trauma, burnout, and compassion fatigue, which can impact their effectiveness and overall well-being. Additionally, trauma exposure significantly affects children’s emotional regulation, behavior, and participation in daily occupations. The primary objective of this project was to design, develop, and organize a comprehensive digital resource platform tailored to the needs of Kalamazoo CASA and their active cases. Utilizing evidence-based literature on trauma-informed care and secondary trauma, relevant resources were …

The Missing Link Between Occupational Therapy And Hemodialysis: Program Development And Implementing Intradialytic Ot In A Rural Hospital Setting, Madison Maki

Capstone Projects

Occupational therapy (OT) has demonstrated effectiveness in supporting individuals undergoing hemodialysis, a life‑altering yet lifesaving treatment for end‑stage renal disease (ESRD) and chronic kidney disease (CKD). Despite this, hospitalized patients who require dialysis often receive reduced rehabilitation services due to the time‑intensive nature of dialysis and the productivity demands placed on therapists. Additionally, gaps in therapist knowledge regarding the unique functional deficits and educational needs of this population further limit service delivery.

This doctoral capstone project (DCE), conducted at Upper Peninsula Health System (UPHS), a hospital in rural Northern Michigan, addressed these barriers through the development of a comprehensive resource …

Development Of 6-Week Tier 2 Intervention Tracks Within An Elementary Mtss Framework, Maxwell Lyle

Capstone Projects

The Multi-Tiered System of Supports (MTSS) is designed to provide levels of support with differing intensity that align with student needs. Tier 1 is universal instruction provided to all students in the classroom. Students who do not demonstrate adequate progress may receive Tier 2 interventions, which are primarily small-group and, when appropriate, individual interventions that are skill-specific, time-bound (6–8 weeks), and include progress monitoring. Students who do not respond to Tier 2 may require Tier 3 supports, which are intensive, individualized interventions. Many school systems lack consistent, structured Tier 2 supports, particularly in Occupational Therapy-related skills, such as fine motor …

Eating Vs. Competing: Comparing Pressures Of Disordered Eating In Lean And Non-Lean Sports, Brielle G. Newland, Meredith Meyer

Undergraduate Honors Thesis Projects

In the current study, I compared the risk factors of disordered eating between athletes in weight dependent and non-weight dependent sports, specifically the motivating pressures to pursue this behavior. Weight dependent or “lean athletes” participate in sports with emphasis on weight, size, or bodily appearance. Non-weight dependent or “non-lean athletes” participate in sports without emphasis on weight or aesthetics, which tend to be team sports. While there are many different disordered eating risk factors in athletics, the current study focused on sport based pressures and societal based pressures. Participants included undergraduate student athletes on female athletic teams or dance minors …

From Tradition To Transition: Evaluating Culinary Medicine As A Tool For Metabolic Health Among Nigerian Immigrants In The United States And The United Kingdom, Simi Oduwole M.S.

Department of Nutrition Student Projects

This scoping review examines existing publications to evaluate whether Culinary Medicine can be used as a tool for metabolic health among Nigerian immigrants in the United States and the United Kingdom. Nigeria is one of the fastest-growing populations globally, with increasing migration to high-income countries such as the United States and the United Kingdom. Evidence suggests that Nigerian immigrants experience a rise in diet-related chronic diseases, including obesity, diabetes, and cardiovascular disease, as duration of residence increases. This phenomenon is often attributed to dietary acculturation and shifts toward Westernized eating patterns. This scoping review evaluates whether culinary medicine can mitigate …

Development Of Resources To Support Independence In And Access To Nature-Based Activities, Riley Carpender

Capstone Projects

This capstone paper discusses the need for resources that support independence in and access to nature-based activities that support health and wellbeing. Occupational therapists (OTs) have expertise in recommending and implementing adaptations to increase individuals’ engagement in nature-based activities. There is currently a gap in the literature regarding access to nature-based activities, and a lack of understanding of how these activities may be implemented, either by caregivers, educators or healthcare professionals. During my capstone I created a guide with modifications for gardening activities for children, wrote an article on how to adapt nature journaling to be more accessible, coded and …

Maternal Inflammation Alters Nuclear And Mitochondrial Dna Methylation Patterns In Neonatal Brain Monocytes, Andrew Ebenezer, Jonathan Hicks, Brooke Hollander, Alexander Hone, Mona Batish, Robert Akins, Adam Marsh, Elizabeth Wright-Jin

Department of Medicine Faculty Papers

Neonatal hypoxic ischemic encephalopathy (HIE) is a common birth complication that can cause death or lifelong disabling conditions like cerebral palsy, epilepsy, and autism. It is well established that maternal infection and inflammation are significant risk factors for HIE but reasons for this increase in neurological risk to the offspring remain unknown. Inflammation or infection are associated with epigenetic changes and may contribute to the increased risk of neurodevelopmental disability in exposed offspring. Here, we analyzed and compared DNA methylation patterns in brain monocytes isolated from control, maternal immune activation (MIA), and an inflammation sensitized HIE (IS-HIE) CF-1 mouse model …

Exploring Occupational Therapy’S Role In Addressing Mental Health Disparities And Emergency Service Utilization Among Homeless Populations: A Comprehensive Review, Megan Darnell

Capstone Projects

Occupational Therapy (OT) is a healthcare profession focused on enabling individuals to engage in meaningful activities and roles through a client-centered approach. This doctoral capstone experience (DCE) was completed in the Emergency Department (ED) at Bronson Methodist Hospital, where individuals experiencing homelessness frequently present with unmet mental health needs. A gap was identified in the accessibility and utilization of community-based mental health and social resources, contributing to repeated ED utilization. The purpose of this DCE was to examine how resource provisions impact the frequency of ED visits and engagement with community mental health services among this population. Objectives include developing …

Role Of Occupational Therapy In Hippotherapy And Therapeutic Riding: A Mental Health Perspective, Ava Morrison

Capstone Projects

The purpose of my doctoral capstone experience (DCE) was to gain knowledge about the unique role that occupational therapy (OT) plays in equine-assisted therapy at the Cheff Therapeutic Riding Center, with an emphasis on Therapeutic Riding. Equine-assisted therapy, including hippotherapy and therapeutic riding, is an emerging area of occupational therapy practice that promotes physical, cognitive, emotional, and social well-being through structured interactions with horses. Despite growing evidence supporting the therapeutic benefits of equine-assisted interventions, confusion remains regarding the distinctions between hippotherapy and therapeutic riding, highlighting the need for increased education and advocacy within the field. In addition, there is a …

Dnp Final Report: Can Implementing A Mindfulness-Based Program Help Reduce Stress In Nursing Students?, Shelby Devreeze Msn, Rn, Cpn, Cne-Cl

DNP Final Reports

Stress among nursing students is a well-documented problem that contributes to physical, mental, and emotional issues, substance abuse, and program dropout. A mindfulness-based stress reduction program was implemented with nursing students to evaluate its impact on perceived stress levels over a five-week period. A review of evidence-based articles provides strong evidence that this intervention correlates with reduced reported stress. An MBSRP was implemented with nursing students who completed a Perceived Stress Scale 10 (PSS-10) before the intervention and again after five weeks.

Results from this project showed a statistically significant reduction (t=2.725, p=0.025) in stress among the nursing student population …

Evaluating The Feasibility And Preliminary Effectiveness Of A Tailored Diabetes Education Program For Rural Residents, Brittany L. Smalls, Oluwatosin Leshi, Suraksha Khanal, Grejika E. Abram-Erby

Journal of Appalachian Health

Introduction: Diabetes is a top ten Rural Healthy People 2030 priority for health improvement among rural Americans. Socioeconomic, environmental, geographic and political barriers contribute to the type 2 diabetes (T2D) prevalence and its disparate impact in rural communities. However, promoting proper self-care behaviors via self-management education can help people with diabetes better manage their condition.

Purpose: To account for the social environmental factors that affect rural residents, a tailored diabetes education program was developed, and the program’s effectiveness in improving diabetes knowledge and T2D-related health outcomes was assessed.

Methods: Using data collected from Appalachian Kentucky residents enrolled in a six-week, …

Rural Community Perspectives On Hurricane Helene In Western North Carolina, Jennifer A. Horney, Lilly Moreau, Search Wnc

Journal of Appalachian Health

Introduction: After making landfall on the Florida Gulf Coast in September 2024, Hurricane Helene impacted Western North Carolina (WNC) with historic flooding, landslides, and hurricane-force winds. More than 100 deaths in the region were attributed to the storm’s direct impacts.

Purpose: The purpose of this study was to assess community perspectives of long-term recovery in Mitchell and Yancey Counties, two rural WNC counties severely impacted by Hurricane Helene.

Methods: A 14-question interview guide was developed based on prior disaster research and the community engagement work of Sustaining Essential and Rural Community Healthcare (SEARCH). Questions covered post-Helene experiences related to access …

Exploring Systemic Challenges In The Western North Carolina Dental Safety Net: A Qualitative Analysis, Blaire Mirmow, Bill Milner, Nadia Laniado

Journal of Appalachian Health

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings. …

The Effects Of Hurricane Helene On Mental Health And Physical Activity, Hunter Smathers, Robyn York, Jarrett Walbolt

Journal of Appalachian Health

Introduction: Hurricane Helene brought widespread damage to Southern Appalachia, disrupting utilities, health care, and recreation. While natural disasters are linked to declines in mental and physical health, few studies have examined their effects on distinct types of physical activity (PA).

Purpose: This study evaluated the effects of Hurricane Helene on perceived stress, depressive symptoms, post-traumatic stress disorder (PTSD) symptomology, and intentional (exercise for health benefits) and incidental (physical labor or transportation) PA. Evacuation status influence was also explored.

Methods: Twenty participants completed assessments four weeks before (BASE), immediately after (0POST), and four weeks after landfall (4POST). Measures included the Perceived …

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

Postpartum Depression, Anxiety, And Psychological Flexibility In Nicu Mothers: Implications For Acceptance And Commitment Therapy, Riya Desai, Alexa Bonacquisti

Research Day

Pregnancy and the postpartum period may be physiologically and psychologically demanding for women as they navigate a multitude of factors. This experience may be further complicated by stressful reproductive events, such as newborn admission into the Neonatal Intensive Care Unit (NICU). Having a baby admitted to the NICU is often particularly challenging for mothers from a psychological perspective, serving as an added layer that may contribute to postpartum depression and anxiety. Psychological flexibility is the concept of openness, adaptability, and readiness in the face of adversity. For NICU mothers, psychological flexibility serves as a possible therapeutic target to address postpartum …

Factors Associated With Concussion Knowledge And Misconceptions In Students Depending On Athlete Status, Joseph Fontanals, Ruta Clair

Research Day

Introduction: Concussions represent a significant public health concern, with widespread implications across various populations from athletes and military personnel to the general public. Despite increased attention in both research and public discourse, substantial gaps in knowledge and persistent misconceptions continue to influence concussion recognition, reporting, and management behaviors. Research consistently demonstrates variable levels of concussion knowledge across different populations. Misconceptions about concussions persist even among populations with higher general awareness. Despite education and public awareness campaigns many adults have surface knowledge of symptoms and misunderstand injury and recovery. These identified knowledge gaps and misconceptions have significant implications for public health, …

Evaluating Motivation In Stem Education: A Positive Self-Talk Intervention, Tiffany Copeland, Richard Allen, Sophia Pham, Kristin Gagnier

Research Day

INTRODUCTION: This study evaluated a social-emotional learning intervention that taught positive self-talk to high school students from underrepresented minority groups in science, technology, engineering, and math (STEM). The setting of this study was a place-based program that immersed students in hands-on STEM activities while located in Philadelphia’s life science hub. Before taking a science assessment, students set effort-based goals and learned to say self-talk statements such as “I will give my best effort” and “Even when it's hard, I will give 100%.”

METHODS: This mixed-methods program evaluation compared pre- and post-intervention data using a paired-samples t-test, linear regression, and correlation …