Digital Commons Network^™

Improvements Upon Reprocessing Of Orthopedic Single-Use Instruments, Alyssa P. Nguyen

Master's Projects and Capstones

Internal Medline data for Hospital A, a level I academic trauma center, identified a quality gap due to improper segregation and underutilization of orthopedic single-use device reprocessing bins. The baseline reprocessing rate of 4% for orthopedic products results in missed sustainability opportunities, financial strain, and increased regulated waste. A proposed quality improvement intervention implemented updated communication strategies, visual management tools, and education modules to reinforce current reprocessing workflows and close knowledge gaps. Outcome measures include the percentage of SUDs collected for reprocessing, survey results on reprocessing awareness, and potential financial savings in Appendix I. Early data showed a 10% year-to-year …

Knowledge, Attitudes, And Practices (Kap) Of Parents Regarding The Prevention And Control Of Childhood Iron Deficiency Anemia In Egypt: A Cross-Sectional Study, Omnia Soliman

Theses and Dissertations

Childhood Iron Deficiency Anemia (IDA) remains a major public health challenge in Egypt, where its persistently high and rising prevalence carries substantial consequences for child growth, cognitive development, immunity, and long-term health outcomes. Globally, approximately 40% of children aged 6–59 months are affected by anemia (World Health Organization, 2025), and Egypt mirrors this burden, with national data showing a worsening trend in recent years. In Egypt, national strategies have traditionally focused on biomedical interventions such as iron supplementation and food fortification, while less attention has been directed toward behavioral and household-level determinants, particularly parental knowledge, attitudes, and practices (KAP) related …

Investigating Patient Reported Outcomes (Pros) Of Long Covid, Luke A. Sims

Summer Research Program Abstracts

No abstract provided.

Nature-Based Therapy In The Uae: Leveraging Ecosystems To Alleviate Depression And Anxiety, Aya Abdul Karim Al-Taani, Mahmoud Mohammad Al-Gharaibeh, Ahmed A. Al-Taani

All Works

This review synthesizes current evidence on the relationship between natural ecosystems and mental health outcomes with a particular focus on arid and rapidly urbanizing contexts such as the United Arab Emirates (UAE). It introduces the Multi-Ecosystem Therapeutic Framework for Arid Urban Environments, which moves beyond generalized "nature exposure" models by systematically linking distinct environmental systems to mental health outcomes through identifiable psychological, physiological and social mechanisms. The framework is structured around three interconnected components: ecosystem types (urban green spaces, desert landscapes, mountain environments and blue spaces), mediating mechanisms (including psychological restoration, stress reduction, physical activity and social interaction) and mental …

Beyond Symptoms: Examining Perinatal Mental Health Care Among Black, Indigenous And People Of Color With Polyendocrine Metabolic Ovarian Syndrome, Vinaya Thomas

Electronic Theses and Dissertations

Perinatal mood and anxiety disorders (PMADs) are as a public health concern in the United States. Individuals from minoritized racial/ethnic groups face a significantly elevated risk of maternal morbidity, mortality, mental health disorders, and associated adverse outcomes. Emerging studies also reveal a higher likelihood of experiencing perinatal mental health concerns in individuals with polycystic ovarian syndrome (PCOS), currently known as polyendocrine metabolic ovarian syndrome (PMOS). People who identify as Black, Indigenous, or a person of color (BIPOC) face unique healthcare challenges given the added structural and social burdens. This online survey study aimed to 1) understand the relationship between PMOS …

Analysis Of U.S. Army Body Composition Policies: Implementation Effectiveness And Recommendations For Policy Enhancement At Brooke Army Medical Center, Michael L. Rizzo

Doctor of Nursing Practice (DNP) Manuscripts

US Army body composition policies (AR 600-9 and recent directives) are essential for military readiness, injury prevention, and force health protection, yet implementation gaps persist, particularly with the 2026 Department of Defense (DoD)-mandated waist-to-height ratio (WHtR < 0.55) transition. This DNP project evaluated policy implementation effectiveness at Brooke Army Medical Center using the W.K. Kellogg Foundation Logic Model and CFIR 2.0 framework. Analysis of 2022–2025 de-identified administrative data and 16 stakeholder questionnaires identified ≥10 implementation gaps, including low awareness of new standards and workload impacts. The project developed 8 evidence-based recommendations and an implementation roadmap to improve compliance, optimize resources, reduce administrative burden, and strengthen military readiness.

In Adults Older Than 18 Years With Obesity Living In Massachusetts, Can Engaging In A Weight Loss Program Help Them Lose Weight After Insurance Stops Covering Their Weight Loss Medications?, Angel Nagawa

Capstones

Executive summary

The Problem

Obesity rates continue to rise sharply across the United States. Weight loss medications have high compliance but face major insurance restrictions. Strict clinical criteria leave many patients without accessible treatment options.

The Proposed Solution

Launch structured, lifestyle-focused clinical weight loss programs. Provide an effective, accessible alternative to restricted pharmaceutical therapies.

Supporting Evidence

Evaluated data from three distinct randomized controlled trials. Findings confirm successful long-term weight management for program participants. Results prove effective control over serious obesity-related comorbidities.

Policy recommendation

Implement structured lifestyle programs as a primary, frontline intervention modality. Improve broad-scale patient health outcomes across clinical …

Artificial Intelligence (Ai) For Social Innovation In Health Education: Promoting Health Literacy Through Personalized Ai-Driven Learning Tools – A Systematic Review, Dina Mansour Tbaishat, Maha Waleed Elfadel

All Works

Background: Artificial Intelligence (AI) is transforming health education by enabling personalized, adaptive, and scalable approaches that may enhance aspects of health literacy. Despite rapid adoption, comprehensive synthesis of AI tools’ impact on health literacy as social innovation is limited. Understanding these effects guides educators, developers, and policymakers in designing potentially effective, inclusive, and ethical AI interventions. This review examines generative AI models, chatbots, and adaptive learning systems in supporting health literacy globally. Methods: A systematic review was conducted following PRISMA guidelines. Literature was identified primarily through PubMed/Medline, Scopus, and ScienceDirect. Connectedpapers.com was used exclusively as a citation chasing tool, performing …

An Advanced Healthcare System With An Automated Vit Model For Dermoscopic Skin Cancer Identification, Ahed Abugabah, Prashant Kumar Shukla, Suchi Mishra, Abhishek Dwivedi

All Works

Early and reliable diagnosis of skin cancer from dermoscopic images remains challenging due to class imbalance, subtle inter-class variations, lesion boundary ambiguity, and illumination inconsistency, which can degrade the robustness of conventional convolutional neural networks (CNNs). To address these limitations, this study proposes an automated smart healthcare framework for dermoscopic skin cancer diagnosis using an Enhanced Vision Transformer (E-ViT) that improves global-context modeling through self-attention while strengthening fine-grained lesion representation learning. Unlike standard ViT configurations, the proposed architecture integrates multi-scale patch embedding and attention refinement to better capture border irregularities and color–texture heterogeneity that are critical for melanoma discrimination. Furthermore, …

Weathering The Divide: Social Determinants, Neighborhood Context, And Systemic Lupus Erythematosus Among African American Women, Vanessa Cl Morman

Electronic Theses and Dissertations

Background: Systemic lupus erythematosus (SLE) disproportionately affects African American women and contributes to racial health disparities in the United States. Although genetic susceptibility influences disease risk, growing evidence suggests that social determinants of health (SDOH), including neighborhood conditions, structural racism, and socioeconomic disadvantage, contribute to disease development and progression. Epigenetic mechanisms may provide a biological pathway linking adverse social conditions to chronic disease disparities. This dissertation examined the influence of SDOH on SLE disparities through evidence synthesis and empirical investigation to inform public health practice and policy.

Methods: This integrated learning experience consisted of three complementary manuscripts. Aim 1 was …

Bone, Muscle, And Physical Function Measures In Older Adults According To Levels Of Social Disadvantage: A Cross-Sectional Study, Jason Talevski, Sharon Brennan-Olsen, Stefanie Bird, Sara Vogrin, Alison Beauchamp, Mizhgan Fatima, Cassandra Smith, Gustavo Duque

Research outputs 2022 to 2026

Summary: This cross-sectional study of 300 older adults (aged ≥ 50 years) found that less education, lower income, and health care card ownership are associated with reduced bone, muscle, and physical function measures. This underscores the need for targeted preventive strategies for osteoporosis and sarcopenia that address socioeconomic-related disparities. Purpose: The prevalence of chronic diseases follows a social gradient, although this is unclear in musculoskeletal conditions. This study aims to examine the association between social disadvantage and diagnostic measures of osteoporosis and sarcopenia in community-dwelling older adults. Methods: A single-centre, cross-sectional study was conducted in adults (≥ 50 years) residing …

Co-Creating An Intervention To Prevent Injuries In Police Force Recruits: A Concept Mapping Study Of Police Force Recruits, Police Force Staff, Health Professionals, And Research Experts, Myles Murphy, Andrea B. Mosler, Garth Allen, Alex Donaldson, Clare L. Ardern, Carolyn A. Emery, Martin Hägglund, Jonathan M. Hodgson, Joanne L. Kemp, Debra Langridge, Tiffany Mcalinden, Thomas Mirco, Sophia Nimphius, Simone Radavelli-Bagatini, Kiera Staley, Vanessa Sutton, Evert Verhagen, Andrea M. Bruder

Research outputs 2022 to 2026

Objective: Police force recruits have a high musculoskeletal injury burden, which results in a substantial economic burden and can lead to attrition. The objective of this study was to identify and prioritise the strategies perceived as important and feasible to reduce the prevalence, incidence, and burden of injury in police force recruits. Design: Mixed-methods concept mapping study. Methods: Forty-eight participants were recruited from four broad groups: police force recruits/officers; police force staff; health professionals; and research experts. Participants brainstormed statements in response to a prompt (“To prevent injury and/or reduce the impact of injury on law enforcement recruit training, I …

Ambulatory Blood Pressure Variability In Prediction Of Target Organ Injury: The Ship Ahoy Study, Coral D Hanevold, Jang Dong Seo, Stephen R Daniels, Bonita E Falkner, Michael A Ferguson, Joseph T Flynn, Julie R Ingelfinger, Philip R Khoury, Marc B Lande, Kevin E Meyers, Mark Mitsnefes, Joshua Samuels, Elaine M Urbina

Faculty, Staff and Student Publications

Background: Ambulatory hypertension is associated with elevated left ventricular mass index (LVMI), cardiac dysfunction, and increased arterial stiffness in adolescents. Whether the addition of measures of BP variability improves the prediction of subclinical cardiovascular target organ damage (TOD) over mean BP measures is not known.

Methods: We assessed clinic and ambulatory BP (ABP), anthropometrics, and TOD in 397 adolescents. ABP means standard deviation (SD), BP, and heart rate (HR) dipping were calculated; coefficients of variability (CV) were calculated (SD/mean) to assess ABP variabilities. Measures of TOD included LVMI, left ventricular hypertrophy (LVH), LV systolic shortening, LV diastolic function (e'/a'), and …

Eccentric Exercise: Muscle Damage To The New Normal, Kazunori Nosaka

Research outputs 2022 to 2026

No abstract provided.

Correctional Officer Suicide: A Theory-Driven Investigation Of Acquired Capability And Suicide Behavior, Abigail R. Andersen

All-Inclusive List of Electronic Theses and Dissertations

A growing body of research suggests that correctional officers (COs) die by suicide at a significantly higher rate compared to the general population and some other public safety personnel. Despite what is known about this phenomenon, an understanding of the risk factors driving the high rate of suicide among this population remains unclear. Specifically, little attention has been paid to specific risk factors for suicide among this population and there is an overall absence of theory-driven research investigating CO suicide. The present study sought to address the gap in this area of research by investigating potential risk factors for suicide …

Characterization Of Regulation Of Ace2 And Morphogenesis (Ram) Pathway Components In Aspergillus Fumigatus, Devi Naga Jyothi Bale

Theses and Dissertations (ETD)

Aspergillus fumigatus CotA is a conserved protein kinase and predicted orthologue of Cbk1, a terminal kinase of the Regulation of Ace2 and Morphogenesis (RAM) network. In our previous study, disruption of CotA resulted in carbon source dependent invasive growth with the mutant exhibiting preferential growth on glucose but severely impaired growth on alternate carbon sources. This pathway in other fungi has been implicated in the regulation of morphogenesis, stress responses, and virulence, but this study is the first one to characterize it in the pathogenic filamentous fungus.  In yeast, the RAM network includes the CotA ortholog, Cbk1, and associated proteins, …

Comparative Performance Of Physiological Vital-Sign Forecasting Under Random And Patient-Wise Splitting Using Deep Learning, Lavanya Vasavi Chittem Reddy

Theses and Dissertations

Physiological vital-sign forecasting estimates future measurements based on recent temporal patterns and can support analysis of continuously recorded monitoring data. This study comparatively evaluated deep feedforward, recurrent, bidirectional recurrent, long short-term memory, and bidirectional long short-term memory architectures for one-step-ahead forecasting of peripheral oxygen saturation, heart rate, and pulse rate. Each model received consecutive observations of peripheral oxygen saturation, heart rate, pulse rate, respiratory rate, and age, while separate single-output models predicted the next value of the selected target.

Random and patient-wise data splitting were compared using identical input definitions, preprocessing procedures, model architectures, and training hyperparameters. The strongest architecture …

Smart Medical System Integrating Clinical Workflows For Robust Skin Cancer Detection Across Heterogeneous Pathologies, Ahed Abugabah, Prashant Kumar Shukla, Suchi Mishra, Abhishek Dwivedi

All Works

Skin cancer is among the most prevalent and life-threatening dermatological diseases worldwide, with melanoma responsible for a substantial proportion of skin cancer–related deaths due to delayed and unreliable diagnosis. Conventional clinical screening based on visual inspection and expert interpretation is inherently subjective and often affected by inter-observer variability, lesion heterogeneity, and imaging artifacts, highlighting the need for accurate and generalizable automated diagnostic systems. This study proposes a novel hybrid deep learning architecture for skin cancer classification that integrates an attention-guided autoencoder with a transformer-inspired global context modeling module, forming a unified and robust representation learning framework. The encoder–decoder structure is …

An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda

Electronic Theses and Dissertations

Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.

Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive …

Body Composition And Muscle Health Changes After Providing Vascular Imaging Results In Older Adults: Secondary Analysis Of A Randomised Controlled Trial, Jack Dalla Via, Simone Radavelli-Bagatini, Marc Sim, Abadi K. Gebre, Catherine P. Bondonno, Kun Zhu, Shelby Mullin, John T. Schousboe, Richard J. Woodman, Markus P. Schlaich, Moira Sim, Pawel Szulc, Douglas P. Kiel, Wai H. Lim, Robin M. Daly, Jonathan M. Hodgson, Joshua R. Lewis

Research outputs 2022 to 2026

Background: Provision of vascular imaging results has been investigated to prompt changes towards healthy lifestyle behaviours, but effects on body composition and muscle health are unknown. Aim: This secondary analysis of a 12-week parallel-group randomised controlled trial (RCT) aims to explore body composition and muscle health effects of providing healthy lifestyle education (Ed) with and without abdominal aortic calcification (AAC) results. Methods: A total of 240 Australian community-dwelling older men and women (mean ± SD age 68 ± 5 years; 58% female; 57.1% with evidence of AAC) were randomised to AAC + Ed (n = 121) or Control + Ed …

Mtorc2-Nav1.2 Signaling Drives Early Hyperexcitability In Alzheimer’S Disease Mouse Model, Nolan M Dvorak, Jeffrey L Noebels

Faculty, Staff and Students Publications

Hyperexcitability is a biomarker of early-stage Alzheimer’s Disease (AD) and hastens cognitive decline later in its course. Mechanistic target of rapamycin (mTOR) signaling contributes to the slope of this trajectory, as evidenced by early increased brain expression and the rescue of hyperexcitability by genetic deletion of mTOR complex 2 (mTORC2); however, a molecular mechanism directly linking mTOR signaling to membrane hyperexcitability in early-stage AD remains elusive. Here, we show that hyperactive mTOR signaling stimulates the voltage-gated Na+ channel 1.2 (Nav1.2), a previously identified downstream phosphorylation target of mTORC2 and a key regulator of membrane electrogenesis. Augmented Nav1.2 channel function induced …

Evaluating The Pulse Of Exercise Programs: Developing And Validating The Intervention Usability Scale For Exercise (Iuse) To Enhance Implementation And Adherence, Anne Inger Mørtvedt, Eva Ageberg, Steven Elmer, Kevin Trewartha, Erich Petushek

Michigan Tech Publications

Background: Adherence to exercise interventions is often suboptimal, despite numerous studies documenting barriers and facilitators. Usability may be a critical yet underexplored determinant of adherence. This study aimed to develop and assess the psychometric properties of the Intervention Usability Scale for Exercise (IUSE). Methods: Item generation and content validation involved cognitive interviews and feedback from eight exercise intervention stakeholders and ten target users from the general public. Subsequently, 526 target users from University, Qualtrics and Prolific participant panels assessed exercise programs through an online survey. Dimensionality was assessed using Principal Component Analysis (PCA), Exploratory Factor Analysis (EFA), and bifactor models. …

Implementation And Effectiveness Of A Food Education Intervention To Promote Plant-Based Foods: A Partially Cluster-Randomized Controlled Trial, Henna Vepsäläinen, Satu Kinnunen, Sari Niinistö, Leena Forma, Suvi T. Itkonen, Tuuli E. Korhonen, Liisa Korkalo, Heli Kuusipalo, Jelena Meinilä, Kaija Nissinen, Susanna Raulio, Ros Sambell, Mari Åkerlund, Suvi M. Virtanen, Maijaliisa Erkkola

Research outputs 2022 to 2026

Background: Legumes can substitute for meat and are thus a particularly important food group for environmental sustainability. As the use of legumes among Finnish children is marginal, there is potential for a substantial increase in their consumption. However, food education delivered through early childhood education and care (ECEC) settings has rarely focused specifically on environmentally sustainable foods, such as legumes. This study describes the implementation and effectiveness of an ECEC-delivered food education intervention within the FoodStep study. Methods: The partially cluster-randomized FoodStep intervention aimed to increase the supply of vegetables, legumes, fruits, berries, and sustainable fish while reducing the provision …

Preventive Behaviors Associated With Fall Incidence Among Older Adults Living In Rural Communities Of Thailand: A Cross-Sectional Study, Rujira Nonsa-Ard, Sirapat Khodseewong, Kasama Wongprachum, Chaiwut Bourneow, Ploypailin Aneknan, Sumattana Glangkarn, Davina Porock

Research outputs 2022 to 2026

Background: The escalating population of older adults poses a significant challenge, particularly in lower-middle-income countries like Thailand. Falls represent a critical public health concern in this demographic. This study aimed to identify risk factors influencing fall occurrence in older adults within a specific rural community context, where the majority of participants remain engaged in farm work.

Methods: A cross-sectional study design was utilized, involving 1,256 participants recruited by the multistage random sampling approach. Data were collected via a questionnaire that included: demographic information, the Thai version of the Barthel Activities of Daily Living (ADL), the Thai Fall Risk Assessment Tool …

In-Hospital Mortality Patterns And Readmissions In Patients With Chronic Obstructive Pulmonary Disease: An Analysis Of The Role Of Pulmonary Hypertension, Saad Afzal Khan, Trishna Parikh, Adishwar Rao, Akriti Agrawal, Aarohi Parikh, Farah Kazzaz, Sarah Shin, Harry Karmouty-Quintana, Maulin Patel, Kha Dinh, Bela Patel, Bindu Akkanti

Faculty, Staff and Student Publications

Chronic obstructive pulmonary disease (COPD) may be complicated by pulmonary hypertension (PH). We aimed to understand the impact of PH on in-hospital mortality and quantify the 30-day readmission rate among patients with COPD. For this cross-sectional study, we used the Nationwide Readmissions Database from 2017-2020 to identify adults ≥18 years with COPD. Patients were stratified according to PH diagnosis. Baseline characteristics between groups were compared using the Pearson chi-square test and two-sample t-test. Predictors of in-hospital mortality were determined using multivariate logistic regression analysis adjusted for demographics and confounders. The 30-day readmission rate and prevalence of PH subgroups by baseline …

Exploring Burnout Among Ncaa Collegiate Athletes: The Impact Of Gender, Sport, Seasonal Demands, And Other Contributing Factors, Anneliese Wong

Undergraduate Honors Theses

The purpose of this study was to examine burnout among NCAA Division I student-athletes at one mid-sized University in the Rocky Mountains region of the United States and determine whether differences existed based on gender, sport type, competitive season stage, and burnout dimension. A quantitative, cross-sectional survey design was used and data was collected from 76 student-athletes across 11 varsity sports. Burnout was assessed using items adapted from the Athlete Burnout Questionnaire (ABQ; Raedeke & Smith, 2001), along with additional items assessing fatigue and seasonal experiences.

Descriptive results showed the student-athletes reported the highest mean level of physical burnout, followed …

Development Of A Standardized Evidence-Based Onboarding Process For Primary Care Providers In A Rural Health Setting, Corrie Goodier

Doctoral Scholarly Projects & Capstones

Primary care in the United States continues to face a critical provider shortage. This shortage is especially elevated in the rural regions of the country and is exacerbated by longstanding issues with subpar onboarding and high turnover rates. Failure to retain advanced practice providers in rural primary care settings further diminishes patient access to services, negatively impacts continuity of care, and complicates efforts to maintain patient trust in the nation’s delicate healthcare system.

Improved provider orientation and support processes within rural healthcare systems have the potential to increase satisfaction rates and productivity. The purpose of this DNP scholarly project was …

The Benefits And Barriers To Expanding Crna Programs In Michigan, Grace Van Zweden

Honors Theses

The demand for Certified Registered Nurse Anesthetists (CRNAs) and their delivery of safe, high-quality anesthesia care has increased significantly due to nationwide anesthesia provider shortages and the growing reliance on CRNAs to meet healthcare system needs. This demand underscores the importance of expanding nurse anesthesia programs in Michigan and across the United States to support nurses pursuing advanced education and to improve patient access to essential care within their communities. The CRNA profession has evolved over time to meet the changing needs of the healthcare system, and current CRNA programs require applicants to satisfy rigorous and highly specific admission criteria. …

Consensus Recommendations For Movement Therapies Of Patients With Heritable Vascular Diseases: A Modified Delphi Study, Randy Liu

Summer Research Program Abstracts

No abstract provided.

Strength On Wheels Improves Exercise Motivation In Homebound Older Adults, Supraja Kadagandla

Summer Research Program Abstracts

No abstract provided.