Digital Commons Network^™

Comparing Stress Levels And Experiences Between Mothers And Fathers Of Children With Angelman Syndrome, Katherine Helen Fix

Theses and Dissertations

Angelman syndrome (AS) is a neurogenetic disorder characterized by significant developmental and cognitive impairments, disruptive behaviors, and a hallmark happy demeanor. Past studies have shown that certain features of AS contribute to increased parental stress. Other studies report that in general the stress of parents of children with disabilities is influenced by stereotypical gender roles surrounding factors including daily care taking tasks, financial responsibility, and medical care involvement. This study aimed to compare perspectives among mothers and fathers of individuals with AS to identify discrepancies and themes relating to stress, specific hardships, and caregiving roles. Parents of children with AS …

A Connected Life: Functional Communication, Social Participation, And Real-World Outcomes In Chronic Post-Stroke Aphasia, Lauren Marie Hammond

Theses and Dissertations

This dissertation examines functional communication in persons with chronic post-stroke aphasia (PWA), with a focus on how communication ability is conceptualized, measured, and related to real-world participation. While traditional aphasia assessments primarily measure impairment-level language abilities, they often fail to capture the contextual, multimodal, and interactive nature of communication as it occurs in everyday life. Addressing this gap, the present work investigates functional communication from multiple perspectives, including measurement approaches, assessment development, and real-world communication outcomes.

Aim 1 presents a scoping review of functional communication assessments used in aphasia research and clinical practice. Studies were reviewed to identify formal and …

Probability Of Fentanyl Adulteration In Cocaine Selectively Decreases Cocaine Demand, Cecilia Nunez, Jin H Yoon, James Mackillop, Margaret C Wardle

Faculty, Staff and Student Publications

Fentanyl-related, cocaine-overdose deaths have drastically increased, yet research on how people who use cocaine perceive fentanyl adulteration is limited. This study developed the novel Adulterated Cocaine Purchasing Task (ACocPT), a modification of the original Cocaine Purchasing Task, to quantify how people respond to fentanyl adulteration in cocaine. In the ACocPT, participants indicated how much cocaine they would purchase when cocaine had no (0%) vs. some (10%) probability of fentanyl adulteration. Study aims were: 1) determine how possible fentanyl adulteration affects cocaine demand, and 2) determine which individual characteristics predict continued demand for cocaine despite fentanyl adulteration. This Amazon Mechanical Turk …

Dyadic Associations Between Stress And Sleep Quality And Moderating Effects Of Emotional Intimacy And In Survivors Of Young Adult Cancer And Their Spouses: An Observational Study, Haejeong An, Seokhun Kim, Michael Roth, Kathrin Milbury, Dalnim Cho

Faculty, Staff and Student Publications

Background: Survivors of young adult (YA) cancer often experience substantial stress during the transition to survivorship, which may impair sleep. Although the stress-sleep link is well established, its role within survivor-spouse dyads remains unclear. Emotional intimacy may influence how couples regulate stress and affect sleep. This study examined dyadic associations between stress and sleep among survivors of YA cancer and their spouses and significant others (hereafter spouses) and tested emotional intimacy as a moderator.

Methods: A total of 103 survivor of YA cancer-spouse dyads completed self-reported measures of stress, emotional intimacy, and sleep quality. An actor-partner interdependence moderation model was …

Examining The Relationship Of Work Stressors And Resilience Among Inpatient Oncology Nurses: A Cross-Sectional Study:, Blanca Melida Vasquez-Clarfield

Theses & Dissertations

Burnout among inpatient oncology nurses remains a concern in a specialty marked by high patient acuity, complex care regimens, emotional intensity, and repeated exposure to suffering and death. Resilience is often discussed as a protective resource in nursing, yet less is known about how personal resilience and work resilience relate to work stress and burnout within inpatient oncology practice. This study examined the relationships among perceived work stress, personal resilience, work resilience, and burnout among registered nurses working in inpatient oncology units. It also explored whether selected nurse characteristics were associated with these variables and how nurses described workplace stressors, …

Exploring The Relationship Between Workplace Social Capital, Organizational Commitment, And Intent To Stay Among Clinical Nurses In The Acute Care Setting, Leigh Erin Griffis-Cogan

Theses & Dissertations

Background

The persistent nursing shortage, exacerbated by the COVID-19 pandemic and the subsequent “Great Resignation,” continues to challenge healthcare systems nationwide. High turnover rates among acute care nurses negatively affect patient outcomes, organizational stability, and healthcare costs. Prior research highlights the importance of workplace factors, such as social capital and organizational commitment, in shaping nurses’ intentions to stay in their roles. However, limited studies have examined these relationships collectively within the acute care setting.

Purpose

The purpose of the quantitative cross-sectional study was to examine the relationships between workplace social capital, organizational commitment, and intent to stay among clinical nurses …

Using Confirmatory Factor Analysis To Identify Symptom Clusters In Individuals With Acquired Disabilities, David S Tulsky, Aaron J Boulton, Pamela A Kisala, Callie E Tyner, Ryan Pohlig, Nancy D Chiaravalloti, Jerry Slotkin, Heather B Taylor, Mark Sherer

Faculty, Staff and Student Publications

Purpose: Acquired disabilities, such as spinal cord injury, traumatic brain injury, limb loss (or other major limb injury/illness), or stroke, are typically accompanied by an array of physical and emotional symptoms and social challenges that interfere with recovery and affect quality of life (QOL). Despite advances in personalized medicine, interrelationships between symptoms remain unclear, and clinicians often treat individual symptoms in isolation. The objective of this study was to identify clusters of symptoms that occur across sudden-onset disability populations, with a long-term goal of identifying targets for clinical intervention.

Methods: Participants were 755 adults who sustained a spinal cord injury, …

"On The Same Rope": An Exploratory Study Of Staff Experiences At The Mountain Seed Foundation's Healing Base Camp Program, Jill C. Kivikoski

Counseling & Human Services Theses & Dissertations

Since the escalation of Russia’s invasion of Ukraine in 2022, Ukrainians have faced significant social and public health challenges, particularly among Service Members, Veterans, and their Families (SMVF), including disability, traumatic stress, and barriers to mental health care (Kostenko et al., 2024; Krasnodemska et al., 2023; O’Grady & Galouchka, 2023). Retreat based programs grounded in shared military identity may offer an accessible form of support (Barrett & Currin, 2024). Mountain Seed Foundation’s (MSF) Healing Base Camp (HBC) was developed to promote healing and resilience among Ukrainian SMVF (Mountain Seed Foundation, n.d.).

This qualitative dissertation used a single-case study design (Yin, …

Length And Framing Of Anti-Junk Food Ads Impact Inclinations To Consume Junk Food Among Normal Weight, Overweight, And Adults With Obesity, Ross C. Hollett, Brennen Mills, Stephanie L. Godrich, Julia Butt, Gina S.A. Trapp

Research outputs 2022 to 2026

Background: Unrestricted junk food advertising increases the risk of short-term junk food consumption among viewers. We aimed to estimate the impact of junk food and anti-junk food advertisements differing in length and framing on junk food consumption inclinations. Methods: Adult participants (N = 505) were exposed to a randomly selected junk food advertisement or anti-junk food advertisement and reported their immediate craving and consumption intentions. These responses were separately analysed for two groups based on Body Mass Index (BMI): participants classified as within the normal range (18.5–25), and a combined group with BMI values indicating either overweight (25+) or obesity …

Mental Health Literacy Among Perinatal Healthcare Professionals In The United Arab Emirates: A Multiphase Convergent Mixedmethods Study, Rouwida Khalil Elkhalil

Dissertations

Perinatal mental disorders (PNMDs) pose a significant public health concern due to their impact on maternal well-being, infant development, and family functioning. Effective identification and management of PNMDs depend largely on the mental health literacy (MHL) of healthcare professionals, particularly those working in perinatal settings. However, MHL among perinatal healthcare professionals in the United Arab Emirates (UAE) remains underexplored. This dissertation aimed to examine and conceptualize MHL among perinatal healthcare professionals in the UAE, explore factors influencing its application in clinical practice, and inform evidence-based improvements in perinatal mental health care. A multiphase convergent mixed-methods design was employed across four …

Standardized Home Blood Pressure Log Implementation For Patients With Hypertension To Increase Patient Awareness And Clinical Action, Ashley Alcala

Doctoral Dissertations & Projects

Background: Home blood pressure monitoring (HBPM) is recommended for hypertension management, yet primary care clinics often lack standardized workflows for distributing, collecting, and using home blood pressure (BP) data. Inconsistent reporting and limited patient understanding of their own BP trends, such as whether readings are stable, elevated, or unchanged, reduce providers ability to make timely clinical decisions.

Problem: Despite evidence supporting HBPM, patients rarely brought usable BP logs to follow‑up visits, limiting providers ability to assess BP control, identify trends, and make timely medication or care plan adjustments.

Approach: This project used a Plan‑Do‑Study‑Act (PDSA) model to implement a standardized …

Learning In Motion: How Small Groups Can Promote Self-Regulated Learning In Physical Therapy Students, Sara Mclaren

STEMPS Theses & Dissertations

Self-regulated learning (SRL) is a critical skill for success in rigorous graduate health professions programs, where students must independently manage complex academic demands. Despite its importance, limited research has examined SRL processes among Doctor of Physical Therapy (DPT) students in the didactic phase of training. Guided by Zimmerman’s cyclical model of self-regulated learning, this study examined SRL behaviors among second-year DPT students and explored how small group learning contexts may influence engagement in SRL processes and academic performance.

This mixed-methods study included 39 DPT students enrolled in a physical therapy program at a public university in the southeastern United States. …

Beyond Parallel Programmes: A Roadmap For Operational Integration Of Family Planning And Nutrition In Low- And Middle-Income Countries, Marleen Temmerman, Samuel Ojong

Centre of Excellence in Women and Child Health

No abstract provided.

Beyond Parallel Programmes: A Roadmap For Operational Integration Of Family Planning And Nutrition In Low- And Middle-Income Countries, Marleen Temmerman, Samuel Ojong

Centre of Excellence in Women and Child Health

No abstract provided.

Empathy, Compassion Fatigue, And Resilience In Central Florida Firefighters And Ems Personnel, Lisa M. Correll

PhD in Education

The purpose of this nonexperimental quantitative study was to determine the relationship between empathy, compassion fatigue (CF), and resilience in firefighters and EMS personnel. Career firefighters and EMS personnel (N = 76) in Central Florida participated in an online survey that included demographic information, the Empathy Assessment Index, Professional Quality of Life Scale, and the Connor-Davidson Resilience Scale-10. Participants reported high perceptions of empathy (M = 4.11), resilience (M = 3.98), and quality of life (M = 3.28), but CF was perceived at low levels (M = 2.97). Empathy was not predictive of CF, indicating that overall empathy alone does …

The Effects Of Covid 19 Job Demands On Public Sector Employees’ Organizational Commitment: The Mediating Roles Of Work Engagement And Job Burnout, And The Moderating Role Of Supervisor Support, Benjamin R. Kaufman

Psychology Theses & Dissertations

United States citizens rely on state government employees to provide essential public services. During the COVID-19 pandemic, these employees responded by administering both routine and novel procedures to protect public health, often placing them on the frontlines and at increased risk of contagion. Concurrently, the pandemic-driven economic downturn created budget shortfalls that threatened the job and financial security of the state workforce. Together, these conditions substantially increased job demands for state government employees.

Guided by the Job Demands–Resources (JDR) Model, this study examined how COVID‑19-related job demands influenced state employees’ work engagement, job burnout, and organizational commitment, and whether supervisor …

Narratives Of Dis-Ease: A Genre Study Of Pathography, Sylvelyn Jo A. Almanzor

Akda: The Asian Journal of Literature, Culture, Performance

This essay establishes pathography as a distinct genre of creative nonfiction, tracing the development, form, and cultural significance of this body of literature. I have broadly defined it as narratives on personal experiences of Gabriel Marcel's "dis-ease"—covering and critiquing the human understanding and experience of sickness, pain, and grief—which has evolved from autobiographical narratives and life-writing of patients and medical professionals to a recognized form of creative nonfiction. This study will analyze the genre's structure, themes, and rhetorical strategies with consideration to cultural significance and how it negotiates the human understanding of suffering, healing, and societal attitudes toward existence and …

Aht Diagnoses: The Influences Of Clinical Presentation And Evidence Of Impact, Ruairi Smith-Dewey, Angela Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Christopher Greeley, Danielle Horton, Nicole Johnson, Jan Leonard, Megan M Letson, Caitlin Mcnamara, Ashley Sherman, Shalon Nienow, Stuart Sommers, Joanne N Wood, James Anderst

Faculty, Staff and Students Publications

Background: The frequency of abusive head trauma (AHT) diagnoses by child abuse pediatricians (CAPs), especially regarding external evidence of head impact, has been questioned.

Objectives: To compare CAP diagnoses in subjects with subdural hemorrhage (SDH) across clinical presentations, including subgroups with and without external evidence of head impact. Additionally, we aimed to describe subjects with SDH and concomitant suspicious injuries (CSI) without evidence of head impact.

Participants and setting: Multicenter retrospective study including subjects < 24 months old with SDH.

Methods: Subjects were divided into groups based on clinical presentations: Ill SDH only, Non-ill SDH only, and SDH + CSI. Groups were subcategorized based on presence/absence …

Yield Of Injury Testing For Contacts Of Children Evaluated For Physical Abuse, Lígia Batista, Joanne N Wood, Tagrid M Ruiz-Maldonado, M Katherine Henry, Jan Leonard, Angela Bachim, James D Anderst, Farah W Brink, Hannah B Sahud, Lori D Frasier, Nancy S Harper, Natalie Laub, Colleen J Bressler, Daniel M Lindberg

Faculty, Staff and Students Publications

Background: Siblings and household contacts of physically abused children are at increased risk for physical abuse and may have injuries that are not clinically apparent. However, injury testing recommendations for contact children remain debated.

Objective: Our objective was to describe testing practices and yield for contacts of physically abused children.

Participants and settings: This is a cross-sectional study of children < 10 years old evaluated for physical abuse at 10 US pediatric referral centers in the CAPNET research network.

Methods: We report the proportion of contact children who had a skeletal survey (SS) or neuroimaging and describe the proportion of tests that identified injuries.

Results: Among 6256 index evaluations, 4863 contacts were identified. Among 794 contacts with physical examinations, …

Fronto-Cerebellar Features Associate With Cognitive Dysfunction In Childhood-Onset Systemic Lupus Erythematosus, Hanne Van Der Heijden, Gabrielle Alonzi, Amanda Cao, Raquel Van Gool, Merve Koç Yekedüz, Lise Vrolix, Itamar Ronen, Vanessa Rameh, Kyle Mcbrearty, Aditi Deokar, Robert P Sundel, Eyal Muscal, Joseph Gonzalez-Heydrich, Andrea Knight, Joyce C Chang, Jaymin Upadhyay

Faculty, Staff and Students Publications

Objective: Cognitive dysfunction (CD) is a prevalent symptom in childhood-onset systemic lupus erythematosus (cSLE). This study aimed to investigate the neurobehavioral basis of CD in cSLE.

Methods: Patients with cSLE (N=20) and age- and sex-matched healthy controls (HCs, N=20) completed questionnaires and multiple neurocognitive tests. The Systemic Lupus Erythematosus Disease Activity Index 2000 and laboratory markers were used to monitor patients' clinical status. Neuroimaging assessments included functional near-infrared spectroscopy (fNIRS), functional magnetic resonance imaging (fMRI), and structural MRI.

Results: cSLE patients demonstrated moderate disease activity with high inflammation and immune dysregulation, alongside low medication adherence. Relative to HCs, cSLE patients …

Black Equality In Ocd Neurogenomics (Belong): Study Protocol, Iasha J Williams, Dalia Y Marquez, Kara E Lopez-Lengowski, Malini Bommiasamy, Ogechi Cynthia Onyeka, Slayton J Underwood, Juliana E Avery, Jacob Gluckman, Thariana Pichardo, Rhea Chandler, Yulu Brown, Katie Mangen, Emma Grace Choplin, Black Equality In Ocd Neurogenomics (Belong) Study Team, Sonyia C Richardson, Joseph D Buxbaum, Eric A Storch, James J Crowley, Sidney H Hankerson, Dorothy E Grice

Faculty, Staff and Students Publications

Obsessive-compulsive disorder (OCD) is a chronic, serious psychiatric disorder that affects 2%-3% of the population and is associated with high personal and societal costs. Genetic factors are estimated to explain roughly half the risk of developing OCD, and genomic studies are just beginning to identify common and rare genetic variants mediating this risk. A major goal of genomic studies is to yield insights into the etiology of OCD and identify molecular targets for the development of novel therapeutics. However, the overwhelming majority of subjects in existing genetic studies are of European ancestry, limiting the generalizability of these findings. To address …

Knowledge, Attitudes, And Practices Among Sexually Active Individuals Toward Trichomoniasis In The Ashaiman Municipality, Ghana: A Cross-Sectional Study, Christopher Yaw Dumevi, Percival Delali Agordoh, Yaw Osei Owusu, Josephine Afi Nukpedu Banini, Roberta Araba Amoquandoh, George Boateng Kyei, Patience B Tetteh-Quarcoo, Irene Ayi, Patrick F Ayeh-Kumi

2020-Current year OA Pubs

BACKGROUND AND AIMS: Trichomoniasis is a significant public health concern due to its implications for reproductive health and HIV transmission. Despite its prevalence, there is limited understanding of community knowledge, attitudes, and practices (KAP) regarding trichomoniasis in Ghana. This study aimed to assess KAP toward trichomoniasis among sexually active individuals in the Ashaiman Municipality of the Greater Accra Region.

METHODS: A hospital-based cross-sectional study was conducted from February to April 2024 among 397 sexually active individuals aged 15-65 years. Participants were selected via simple random sampling. Data were analyzed using SPSS version 26 and Stata version 17. Descriptive statistics summarized …

Neurofibromatosis Type 1-Plexiform Neurofibromas: Integrating Treatment Across Pediatric And Adult Populations, Amy E Armstrong, Andrea M Gross, Laura J Klesse, Steven D Rhodes, Shivani Ahlawat, Verena Staedtke, Camilo A Molina, Angela C Hirbe

2020-Current year OA Pubs

Plexiform neurofibromas (PNs) are a hallmark of neurofibromatosis type 1 (NF1), affecting ∼50% of individuals with the condition. Originating from Schwann cells and other peripheral nerve sheath components, these tumors can cause significant morbidity, including functional impairment, diminished health-related quality of life, chronic pain, and malignant transformation. Managing NF1-PNs is challenging because of disease variability, differing growth rates, and age-related differences in clinical presentation and treatment tolerability. This review examines current therapeutic strategies, including surgery, medical therapies, and emerging treatments, emphasizing individualized care. Highlighted here is the need for age-specific treatment planning, particularly as disease progression, comorbidities, and side-effect profiles …

Deep Learning In Fetal, Infant, And Toddler Neuroimaging Research, Jenna H Chin, Madeleine K Wyburd, Vladislav Ayzenberg, Laurie Bayet, Berkin Bilgic, Emily M Chen, Yuting Chen, Áine Dineen, Shohei Fujita, Janelle Liu, Yohan Jun, M Catalina Camacho, Lilla Zöllei

2020-Current year OA Pubs

Artificial intelligence (AI) is increasingly being integrated into everyday tasks and work environments. However, its adoption in medical image analysis has progressed more slowly due to high clinical stakes, limited availability of labeled data, and substantial variability in imaging protocols and population. These challenges are further pronounced in the field of fetal, infant, and toddler (FIT) neuroimaging, where datasets are especially scarce and subject to large amounts of anatomical variability. However, deep learning (DL), a specific method within machine learning, which is itself a subfield of AI, has emerged as a powerful framework to adapt to the challenges of medical …

Examination Of Heart Rate Response To Performance Errors In Competitive Division Iii Field Hockey, Olivia Muir

Undergraduate Theses and Capstone Projects

This research examines the relationship between heart rate and performance outcomes in competitive DIII field hockey match play. In particular, the research examines the players of the Lynchburg Field Hockey Team, with a focus on player errors. Real-time heart rate data were collected using Beyond PulseTM monitors and synchronized with game footage from the SpiideoTM platform. Player errors were then identified using Spiideo’sTM AI software, and the corresponding heart rate values were recorded, spanning from 3 seconds before and 3 seconds after the player error occurred. The maximum heart rate for each player was also calculated using the equation: HRmax …

Assessing Aesthetic Responsiveness Among Patients In A Free Clinic Setting, Jack E. Pitts

Undergraduate Theses and Capstone Projects

Art therapy has been increasingly recognized as a complementary intervention in healthcare settings, with demonstrated benefits for stress reduction and overall biopsychosocial well-being (Liu 2022; Magsamen, 2014). However, limited research has explored aesthetic engagement within medically underserved and economically disadvantaged populations. This study uses the Aesthetic Responsiveness Assessment to examine the relationship between art and patients receiving care at the Central Virginia Free Clinic in Lynchburg. The survey consists of 14 Likert-scale questions assessing individuals’ cumulative aptitude across three domains: aesthetic appreciation, intense aesthetic experience, and creative behavior. There was an additional 15th qualitative question that assessed the desire for …

Educating Nurses On Caring For Patients With Intellectual And Developmental Disabilities – An Evidence-Based Practice Project, Amyela Adarlo

Loma Linda University Electronic Theses, Dissertations & Projects

Intellectual and developmental disabilities (IDD) refer to a range of conditions that begin before age 18 and impact physical, cognitive, and socioemotional development. Patients with IDD often experience poorer health outcomes due to healthcare providers’ limited training in effective communication strategies. This evidence-based project aims to evaluate whether educating nurses on effective communication with IDD patients improves nurse self-efficacy and confidence in communication and enhances caregiver perceptions of nursing care.

Early Mental Health Screening In The Gi Patient Population: A Quality Improvement Project, Jacqueline Sagala

Loma Linda University Electronic Theses, Dissertations & Projects

Aims

This quality improvement project aimed to increase awareness and better integrate mental health screening in a GI clinic by educating staff and providers. The project evaluated changes in depression literacy, attitudes toward mental illness assessment, perceived training effectiveness, use of the training in clinical practice, and referrals to the Resiliency Clinic.

Background

Patients with chronic GI disorders commonly experience anxiety and depression, yet mental health concerns are often overlooked in specialty care. Although annual depression screening was already a part of the standard care at the Digestive Disease Center at Loma Linda University Faculty Medical Clinics, staff education and …

Implementing A Noise Reduction Protocol To Reduce Perceived Noise In The Icu – An Evidence-Based Practice Project, Soh Jeon

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims:

This project aims to reduce perceived noise in the ICU and promote a healing environment through a multi-interventional noise-reduction protocol and nursing staff education.

Rationale/Background:

The World Health Organization (WHO) recommends that hospital noise levels remain below 35 decibels during the day and 30 decibels at night. However, ICU noise often exceeds 50-70 decibels. Increased noise levels are primarily caused by conversations, monitoring alarms, and routine care activities, such as cleaning and procedures. These high noise levels directly affect patients’ sleep, which is essential to recovery. Insufficient rest can lead to immunosuppression, prolonged mechanical ventilation, and elevated stress …

3rd Place Contest Entry: "Examining Physicians’ Behaviors Regarding Buprenorphine Prescribing For Opioid Use Disorder", Khashayar Eshtiaghi

Eric M. Scandrett Graduate Library Research Prize

This is Khashayar Eshtiaghi's submission for the 2026 Eric M. Scandrett Graduate Research Prize, which won third place. It contains their essay on using library resources, a summary of their research project on physicians' behaviors regarding buprenorphine prescribing for opioid use disorde, and their bibliography.

Khashayar is a student in the Ph.D. in Pharmaceutical Economics and Policy program at Chapman University. Their faculty mentor is Dr. Marc Fleming.