Digital Commons Network^™

Enhancing A Trauma-Informed Reintegration Framework Through Occupation-Based Program Development For Adolescent Survivors Of Human Trafficking In Northeast Arkansas, Faith Welch

Occupational Therapy Doctoral Capstones

The purpose of the doctoral capstone was to enhance Hope Found's existing trauma informed reintegration framework through the development of an occupation-based framework. The enhanced framework focused on integrating developmentally responsive intervention planning, educational programming, implementation guidance, resource organization, documentation recommendations, and outcome measurement strategies to strengthen trauma-informed service delivery and support community reintegration for adolescent survivors of human trafficking and exploitation.

Variability In Eligibility And Outcomes: A Cross-Comparison Of New York City Mental Health Courts, Caitlin Sanders

Student Theses

Mental health courts (MHCs) represent a critical diversion mechanism for justice-involved individuals with serious mental illness (SMI), yet substantial variability in eligibility criteria, assessment practices, and program structure limits our understanding of how court-level policies shape participant access and outcomes. This exploratory study provides the first systematic cross-borough comparison of all five New York City MHCs, achieving a 100% response rate across courts. Using an adapted version of a statewide MHC survey instrument, data were collected from court representatives via structured survey administration and supplemental interviews. Findings indicate significant variation across courts in legal and clinical eligibility criteria, assessment personnel …

Cortical Plasticity Following Peripheral Nerve Injury In The Upper Extremity, Samah Gassass

WUSM Theses and Dissertations – All Programs

Peripheral nerve injury (PNI) in the upper extremity results in significant sensorimotor impairment. Nearly 40-50% of patients affected by PNI fail to restore normal hand and arm function and recovery remains variable. Recovery related cortical plasticity is recognized as an important factor, though its relationship to meaningful outcomes remains unclear. This dissertation examined how cortical activity patterns relate to functional recovery after PNI through a systematic review and three subsequent cross-sectional studies.

The systematic review of multimodal neuroimaging studies on cortical plasticity after upper extremity nerve transfer found that good recovery is generally linked to restoration of contralateral or typical …

The Role Of Reassurance Messages In Pediatric Oncology, Isabelle Faller

Doctoral Dissertations

Despite decreasing mortality rates, the high prevalence and incidence of pediatric cancer necessitate the need for advancements in the treatment of psychological concerns, specifically the reduction of patient distress and anxiety. A more comprehensive understanding of current reassurance messages in clinical practice can aid in developing a standardized framework for providing reassurance in pediatric oncology. Qualitative Content Analysis was employed to examine the types of messages nurses use to reassure patients (to reduce their anxiety about a future health-related event) and how effective nurses perceive these messages to be in relieving patients' anxiety. The adult participants, located at hospitals throughout …

Prospective Effects Of Positive Resilience Resources During Young Adulthood: Predicting Daily Stress Responses Three Years Later Amidst A Changing World, Melissa Elwin, Bep Uink, Rachel Delahaye, Alana Battel, Jasmine Powell, Stefano Occhipinti, Jacqueline Allen, Kathryn L. Modecki

Research outputs 2022 to 2026

Background: With young adults' rates of mental health problems alarmingly high, understanding resilience characteristics that help young people adapt, adjust, and even thrive in the face of stress is a pressing need. This study takes a daily diary approach, examining four resilience factors, measured a priori, covering multiple domains. Young adults' daily stress responses (reactivity, recovery, inertia) during the globally stressful lockdown period three years later were then explored as key outcomes. Methods: Leveraging two waves of data, young adults (ages 17–25, N = 108) completed demographic and psychometric measures at Wave 1. Resilience factors were operationalized using residualized scores …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.

Le Défi Mondial : Panorama Comparatif Des Soins Néonatals Au Maroc Et Aux États‑Unis, Manasi Joshi

NEXUS: The Liberty Journal of Interdisciplinary Studies

Cette étude comparative examine les soins néonatals au Maroc et aux États-Unis après un stage dans une clinique privée à Rabat. Bien que les pratiques médicales principales soient universelles, leur application varie dans différents pays selon les circonstances socio-économiques et culturelles. Basée sur des observations directes, des entretiens avec des professionnels de soins néonatals marocains et une analyse de la littérature sur ce sujet dans ces deux pays, cette recherche discute de quatre différences principales : la disponibilité des ressources, l’accès aux soins de qualité, l’influence culturelle et les obstacles financiers. Malgré la pénurie évidente de personnel dans les hôpitaux, …

Cultivating Civility: A Multicomponent Approach To Reducing Workplace Incivility In An Assisted Living Facility, Sanam Bral, Kaylyn Chang, Catherine Dinh, Sanjil Kumar, Truc Mai Moon

Master's Projects and Capstones

Workplace incivility remains a common challenge in healthcare, negatively affecting communication, staff well-being, and the quality and safety of resident care. Baseline survey findings from a faith-based assisted living facility in Southern California identified concerns related to workplace incivility, psychological safety, and gaps in staff knowledge of available reporting resources. This project aimed to reduce workplace incivility by improving staff knowledge and recognition of uncivil behaviors, with a target of at least 90% staff training attendance among nursing, assistive nursing, and medical technicians, and 80% attendee-reported high confidence level (agree or strongly agree) in recognizing incivility and understanding reporting options. …

Fireready Oc: Developing A Public Health Protocol For Wildland-Urban Interface (Wui) Fire Events In Orange County, Christian Andre O. Gequillo, Allyson Hayakawa, Selin Erdogan, Natalie Albarran

Master's Projects and Capstones

Objective/Problem: Wildland-Urban Interface (WUI) fires expose communities to a greater number of hazardous pollutants than traditional wildfires and can pose significant health risks; however, Orange County does not have a standardized public health protocol to address WUI fires. A review of the literature identified the need for standardized WUI fire guidance that is focused on improved preparedness and response. Aim: The FireReady OC quality improvement project aimed to develop an evidence-based public health protocol to improve Orange County’s public health preparedness and response for WUI fire events from 0% to 10% during the 12-week period from May 27, 2026, to …

Improving Nursing Adherence To Chg Bathing And Pivc Maintenance Practices To Reduce Hospital-Onset Bacteremia In An Adult Medical-Surgical Unit, Mohabat Barikzai, Dinazar Altamirano, Edward Rivas, Sarah Trilles

Master's Projects and Capstones

Preventing hospital-onset bacteremia (HOB) is a healthcare priority given its association with increased morbidity, mortality, prolonged hospitalization, and healthcare costs. Literature identifies inconsistent adherence to evidence-based practices for chlorhexidine gluconate (CHG) bathing and peripheral intravenous catheter (PIVC) maintenance as a modifiable risk factor for HOB. This quality improvement (QI) project evaluated whether implementing standardized nurse education, routine compliance audits, and performance feedback would improve adherence to evidence-based CHG bathing and PIVC maintenance practices. The project aimed to achieve at least 90% nursing compliance with HOB prevention practices over an intended 8-week implementation period. A pre-post quality improvement design was implemented …

Food For Thought: Building Confidence In Healthy Food Choices Among Seniors In A Residential Facility Through Nutrition Education, Amy Rodríguez

Master's Projects and Capstones

This quality improvement project evaluated the effectiveness of a 10-week nutrition education program designed to improve nutrition knowledge and confidence among independently living older adults residing in a low-income senior housing community. Aim By August 10, 2026, this project aimed to increase average nutrition knowledge and confidence scores related to selecting nutritious foods and preparing healthy meals by 20% among senior housing facility residents. Methods A microsystem assessment, literature review, SWOT analysis, fishbone diagram, and GANTT chart were completed to guide project development and implementation. Weekly nutrition education workshops were conducted over a 10-week period and included presentations, group discussions, …

Breaking The Silence: Standardizing Routine Intimate Partner Violence Screening At A Community Clinic Serving The Latinx Community, Victoria M. Hall

Master's Projects and Capstones

Intimate partner violence (IPV) affects the Latinx population disproportionately due to socioeconomic status, cultural stigma, and language barriers. However, routine screening remains inconsistent and unstandardized at a local community clinic in San Francisco’s Mission District, despite evidence-based practices recommending it. The gap in IPV screenings across the Adult, Teens, and Women’s clinics resulted in only 1.6% of patients being screened in July 2025 and 4.1% in June 2026. This quality improvement project aimed to address low screening rates by standardizing IPV screening through a printed bilingual screener, a 60-minute staff in-service on IPV and the new screening protocol, and by …

“Now Serving… Not Quite Yet”: Improving Waiting Room Experience Through Consistent Communication In The Emergency Department, Juan Carlos Serrato

Master's Projects and Capstones

Context: The quality improvement project was implemented in the front-end microsystem of a 36-bed emergency department (ED) in a non-profit, Magnet-designated California hospital. Problem: Communication with non-roomed patients at Hospital X was inconsistent, contributing to dissatisfaction. In June 2026, Press Ganey reported that 61.4% of patients felt they were informed about delays. Baseline observation identified gaps in staff explanations of estimated wait times, next steps in care, and opportunities to ask questions. Intervention: A 30-day pilot provided staff education on the AIDET communication framework through formal in-service education and daily huddles. Patient-facing materials explained the ED process …

Improving Pressure Injury Prevention Through Braden Scale Compliance And Education In The Emergency Department, Joycelyn Lee, Kira Simone Faerstain, Alyssa Kristine Ortiz, Ashley Briseida Cruz

Master's Projects and Capstones

Pressure injuries are a major burden in healthcare, particularly in the Emergency Department (ED). Patients can be sedentary for prolonged periods of time and don't always get their skin checked promptly. Patients visiting the ED often have comorbidities and patient-specific medical needs, such as seniors with fragile skin, malnourishment, immobility, etc. At a Southern Los Angeles Hospital, leadership found that there was a need for improvement in this area. Implementing standardized risk assessment methods can help to improve the consistent use of the Braden Scale as a predictive and preventive tool for identifying patients' risk for pressure injuries and promoting …

Advancing Maternal Health Equity In Nebraska: Examining Prenatal Care Access Disparities, Policy Context, And Doula Integration As A Complementary Solution, Marlette Grace Dulcinee Mabiala-Maye

Theses & Dissertations

Maternal health inequities persist across the United States, with Black, Native American, and immigrant-origin women facing disproportionate barriers to timely prenatal care. This dissertation examined access to prenatal care in Nebraska, a mixed rural and urban state with extensive maternity care deserts, through three interrelated aims. Aim 1 analyzed PRAMS data using survey-weighted regression with race-by-socioeconomic-status interactions to characterize disparities in the timing and barriers to care. Aim 2 evaluated the state’s October 2020 Medicaid expansion across pre-pandemic, acute pandemic, and post-expansion periods. Aim 3 applied qualitative description and the Consolidated Framework for Implementation Research to interviews withtwenty-three maternity care …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Rickettsia Africae Discovered In A Short-Term Urban Traveller To South Africa: A Case Report, Zunairah Sikder

Binghamton University Undergraduate Journal

Rickettsia Africae is a pathogen that causes African tick-bite fever (ATBF). Transmission typically occurs from ticks within the Central and South African regions. Previous studies suggested that ATBF is not uncommon amongst travelers to rural sub-Saharan Africa, especially during the rainy months of November through April. However, this case report highlights a woman who contracted ATBF in novel conditions. The 70-year-old woman reported travelling strictly to and from the local church and hotel for her four-day stay in July. After returning to America, the patient experienced extreme irritation on her arm, as well as complaints of headaches. She presented to …

A Message From The Managing Editor, Carissa Bayack

Binghamton University Undergraduate Journal

A message from the 2025-2026 Managing Editor of the Binghamton University Undergraduate Journal, Carissa Bayack.

For Weight Loss: Why Do Glp-1 Agonists Work, And How Can We Make Them Work Better?, Charlise Giang, Jieyi Meng, Mahmoud Ali Mohammad, Zhenqi Liu, Xinle Wu, Yi Zhu

Children’s Nutrition Research Center Staff Publications

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have revolutionized the management of not only type 2 diabetes but also obesity. However, even with rapid therapeutic advances in GLP-1RAs, questions regarding the fundamental principles of GLP-1-mediated weight loss and the enhanced efficacy of next-generation therapies remain. In this comprehensive review article, we first examine the milestones of GLP-1, from its initial discovery and biological characterization to its successful translation into clinical therapy. Furthermore, this review highlights the latest clinical trial data, specifically HbA1c reduction, weight-loss efficacy, and safety profiles, while exploring current pipelines of major pharmaceutical companies. Additionally, we delineate the mechanistic …

A Dosimetric Comparison Of Halcyon 6x-Fff And Truebeam 6x In Prone Left Whole Breast Radiation Therapy, Maritza Soto, Kelly Labant, M.S., Cmd, Rt(T), Kristen Vu, M.S., Cmd, Rt(T)

Masters Projects

Purpose:

This retrospective study compared dosimetric differences between prone left whole breast radiation (WBRT) treatment plans originally generated for Halcyon using 6X flattening- filter-free (FFF) beams and replanned for a conventional TrueBeam using 6X beams.

Methods:

Ten prone whole left breast treatment plans were paired and retrospectively analyzed. Clinically treated Halcyon 6X flattening filter free plans were replanned on TrueBeam using flattened 6X beams in Eclipse v16.1. Contours for all plans were generated using artificial intelligence-based autosegmentation, reviewed by a medical dosimetrist and radiation oncologist, and forward planned with a tangent technique in EZFluence to achieve identical planning objectives. Dose …

Fall Risk In Community-Dwelling Adults: A Comparison Of English And Spanish-Speaking Individuals, Jesus D. Gomez

Dissertations, 2020-current

Falls are a leading cause of injury-related mortality among middle-aged and older adults. Although vestibular dysfunction, hearing loss, behavioral factors, and social determinants of health have been associated with increased fall risk, few studies have examined these relationships. Furthermore, limited research in audiology and vestibular science has investigated fall-risk vulnerability among Spanish-speaking individuals.

This study aimed to: (1) estimate the prevalence of fall risk among community-dwelling adults and compare prevalence between English-speaking and Spanish-speaking participants; (2) assess the prevalence of previously undiagnosed benign paroxysmal positional vertigo (BPPV) and compare prevalence between language groups; and (3) develop predictive models of fall …

Cultural Tailoring Of Digital Nutrition Interventions: A Scoping Review Of Adaptation Strategies, Evaluation Methods, And Evidence Gaps, Wendy Liang

Master's Projects and Capstones

Background: Nutrition-related chronic diseases disproportionately affect culturally diverse populations, highlighting the need for effective and equitable interventions. Digital nutrition interventions have expanded rapidly due to their accessibility; however, the extent to which they incorporate and evaluate cultural tailoring remains unclear.

Research aim: This scoping review maps the existing evidence on culturally tailored digital nutrition interventions, describes cultural adaptation strategies used, examines methods used to evaluate cultural appropriateness, and identifies gaps for future research and public health practice.

Methods: A scoping review was conducted following the PRISMA-ScR guidelines.

Findings: Culturally tailored digital nutrition interventions generally improved participant engagement, acceptability, and dietary …

Frailty As A Framework To Understand Tuberculosis Severity, Recovery, And Sequelae, Yoscelina Estrella Martinez-Lopez, Benjamin W. Black, Jessica Lee, Brian J. Buta, Lisa Y. Armitige, William A. Fountain, Rafael Samper, Aanand D. Naik, Joanne Turner, Blanca I. Restrepo

School of Medicine Publications

Tuberculosis (TB) causes profound systemic illness, and many survivors experience long-term sequelae associated with disability and premature mortality. Current TB severity indicators capture isolated aspects of disease and may not reflect the integrated physiological impact of infection on the host. Frailty, a multidimensional syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, predicts adverse outcomes and guides clinical management in geriatrics. We propose frailty as an integrative framework for understanding the systemic effects of TB across the life course, encompassing disease severity, recovery, and long-term sequelae. We discuss biological mechanisms through which Mycobacterium tuberculosis infection may erode physiological …

Advancing Occupational Therapy Practice: Evaluating A Continuing Education Module To Support The Integration Of 3d Printing Into Clinical Care, Sophia Wilkes, Rebecca Ozelie

Student Journal of Occupational Therapy

This study aimed to evaluate whether a continuing education module could improve occupational therapy practitioners’ perceived knowledge, awareness, confidence, and clinical utilization of 3D printing in occupational therapy practice, while also examining how access to resources may influence implementation A 14-week cross-sectional pre–post design was used with occupational therapy practitioners participating in a one-hour educational session followed by a three-week trial of 3D printer access. Participants completed pre- and post-surveys assessing perceived knowledge, awareness, and confidence, and maintained a utilization log to track clinical use.

Results indicated a statistically significant increase in perceived knowledge and awareness of 3D printing following …

Saudi Heart Association Scientific Statement On Cardiovascular–Kidney–Liver-Metabolic (Cklm) Syndrome, Waleed Alhabeeb, Abdulhalim J. Kinsara, Ahmed Mitwalli, Ali A. Alshehri, Faisal Aba-Alkhail, Ismail Raslan, Khalid Aljohani, Mohammed Arafah, Muthana Sahlawi, Saud Alsifri, Suleiman M. Kharabsheh

Journal of the Saudi Heart Association

Background: Cardiovascular, kidney, metabolic, and liver diseases are closely interconnected and frequently coexist. While the cardiovascular–kidney–metabolic (CKM) framework provides a unified model, increasing evidence supports a central role for hepatic disease, particularly metabolic dysfunction–associated steatotic liver disease (MASLD), in this continuum. The Saudi Heart Association (SHA) therefore aimed to introduce the cardiovascular–kidney–liver–metabolic (CKLM) syndrome as an expanded framework and provide expert guidance on its pathophysiology, staging, screening, and management, with relevance to the Saudi population.

Methods: A multidisciplinary expert panel convened under the auspices of the SHA conducted a comprehensive, non-systematic literature review and developed consensus-based recommendations through iterative discussion …

Urine Good Care: Catheter-Associated Urinary Tract Infection Prevention At The Bedside, Ruby Yost

Master's Projects and Capstones

Catheter-Associated Urinary Tract Infections (CAUTIs) have been associated with increased morbidity, mortality, healthcare costs, and length of stay and is one of the most common healthcare-acquired illnesses accounting for up to 40% of hospital-acquired infections (Rubi et al., 2022). Because 65-70% of CAUTIs are preventable, reducing the incidence has become a focus area for infection control and nursing quality management among hospital organizations (Tang et al. 2025). CAUTIs are urinary tract infections that occur in patients with indwelling urinary catheters and are typically associated with bacterial colonization of the urinary tract. The aim of this QI Project is to increase …

Reducing Variation, Improving Outcomes: Standardizing Gestational Diabetes Mellitus Education In A Clinical Microsystem, Thanh Le

Master's Projects and Capstones

Objective: Variations in referral, scheduling, delivery of educational information, patient materials, and documentation hampered the quality of gestational diabetes mellitus (GDM) education in the outpatient maternal-fetal medicine clinic. Purpose: The aim of the quality improvement project was to boost adherence to a standardized GDM group education framework from 0 to 50% in the course of 12 weeks and assess attendance at group visits. Methods: The microsystem analysis was conducted based on observations of group visits conducted in Spanish and English, examination of current processes and resources in use, educator pre-survey, SWOT analysis, and cause and effect analysis. The implementation of …

Standardizing Group Visits For Gestational Diabetes Education: A Quality Improvement Initiative In An Outpatient Maternal-Fetal Medicine Clinic, Nha Nguyen

Master's Projects and Capstones

Objective: At an outpatient maternal-fetal medicine clinic in Northern California, gestational diabetes mellitus (GDM) education is delivered inconsistently across nurse practitioners (NPs) and registered dietitians (RDs), with no standardized curriculum, referral criteria, or educational materials. Aim: By August 12, 2026, this project aimed to develop and implement a standardized GDM group visit framework for NPs, RDs, and scheduling staff in maternal-fetal medicine clinic, increasing compliance with standardized referral, enrollment, and educational processes from a baseline of 0% to 50%. Methods: Using baseline observations, workflow assessment, stakeholder input, and a literature review, the QI team developed standardized bilingual slide …

Closing The Loop: Strengthening Cauti Prevention With Urinary Catheter Management, Erika N. Braun

Master's Projects and Capstones

Objective: Catheter-associated urinary tract infections (CAUTIs) are among the most common preventable healthcare-associated infections and are associated with significant patient harm and increased healthcare costs. Baseline assessment across five adult cardiovascular and critical care units within a community-based acute care hospital identified four CAUTI events during the first half of 2026 and revealed important nursing knowledge deficits related to bladder scanning protocols and urinary catheter management practices. Aim: This Quality Improvement (QI) Project aimed to improve nursing knowledge of evidence-based bladder scanning protocols and urinary catheter management practices through targeted educational interventions implemented over a 10-week period, with …

Demographic And Clinical Characteristics Of Frequent Users Of Emergency Medical Services In Türkiye ​, Burak Bekgöz, İshak Şan

Turkish Journal of Medical Sciences

Background/aim: Overuse of emergency medical services (EMS), particularly unnecessary ambulance requests, places considerable strain on limited healthcare resources and can delay responses to urgent cases. The present study analyzes the demographic characteristics, diagnoses, urgency, and hospital transfer status of frequent users of EMS in Türkiye.

Materials and methods: Included in the study were 41,113 patients who requested EMS four or more times within a year (defined as frequent users for the purpose of the study), excluding interhospital transfers. Data were accessed from the Emergency Medical Services Automation System (ASOS) database, which contains details of patient demographics, diagnoses, triage codes, reasons …