Digital Commons Network^™

Implementing A Structured Lifestyle Counseling Program To Improve Weight Management In Obese Adults Ages 18–65 Within The Private Primary Care Setting, Ntoge Sone Penda

Walden Dissertations and Doctoral Studies

Obesity is a major public health concern that affects millions of adults. As a chronic, progressive disease, obesity increases the risk of developing several medical conditions. Although evidence-based clinical practice guidelines recommend comprehensive lifestyle modification as a first-line treatment, implementation of structured lifestyle counseling in primary care remains inconsistent. The practice-focused question guiding this Doctor of Nursing Practice (DNP) quality improvement project was: Among obese adults aged 18–65 years in a private primary care setting, does implementing a structured lifestyle counseling program improve body weight and body mass index (BMI) outcomes over an 11-week period? An organizational change process guided …

Implementation Readiness For National Cancer Survivorship Care Standards, Christiane J. El Khoury, Meera Gupta, Maryem Shirzadi, Heidi Dowst, Martha Mims, Maysa Abu-Khalaf, Hoda Badr

Kimmel Cancer Center Faculty Papers

IMPORTANCE: Cancer survivorship care is a growing public health priority, yet delivery remains variable across health systems. The National Standards for Cancer Survivorship Care provide a framework for high-quality care, but little empirical evidence exists regarding health system readiness to implement these standards in routine practice.

OBJECTIVE: To assess implementation readiness for the National Standards for Cancer Survivorship Care and identify perceived barriers to implementation.

DESIGN, SETTING, AND PARTICIPANTS: This real-time Delphi survey study was conducted from January to March 2025 at a National Cancer Institute-designated comprehensive cancer center. Participants were multidisciplinary experts involved in cancer survivorship care delivery, care …

2026 Focused Update Of The Saudi Heart Association Guidelines On Best Practices In The Management Of Chronic Coronary Syndromes, Owayed Alshammeri, Halia Alshehri, Shukri Alsaif, Mirvat Alasnag, Fatema Qaddoura, Fahad Alqahtani, Yosra Abdulahad A Turkistani, Walid Alharbi, Adel Tash, Mohammad Alshehri, Khalid Al Faraidy, Waleed Alhabeeb

Journal of the Saudi Heart Association

Background: Chronic coronary syndromes (CCS) continue to impose a substantial clinical and economic burden in Saudi Arabia. Since publication of the 2022 Saudi Heart Association (SHA) CCS guidelines, important advances have emerged in diagnosis, pharmacotherapy, cardiometabolic risk reduction, antiplatelet management, and revascularization. This 2026 focused update selectively revises and clarifies key recommendations to reflect these advances within the Saudi context.

Methods: A multidisciplinary SHA expert panel conducted a structured review of randomized trials, meta-analyses, and relevant international guidance published since 2022. Updates were restricted to areas with substantive new evidence or evolving clinical practice. Recommendations were formulated through expert consensus …

Software Tools And Simulation Exercises For Radiation Oncology Cyber-Attack Resiliency, Yevgeniy Vinogradskiy, James Lamb

Department of Radiation Oncology Faculty Papers

This review summarizes the rationale for radiation oncology cyberattack simulation exercises, recent results from multi-institutional resiliency drills, and the landscape of software tools developed to help clinics resume radiotherapy treatments rapidly and safely during a cyberattack or other major clinical software outage. Simulation exercises using record-and-verify (R&V) downtime and File Mode treatment delivery have identified failure modes not apparent in theoretical planning alone, including risks related to treatment documentation, repeated fractions, patient setup, and missed safety checks. Available software tools emphasize insulated backup of DICOM-format planning data and clinical notes, treatment-state dashboards, File Mode treatments, redundant R&V installations, and human-readable …

Improved Foraminal Expansion And Pain Scores Following Placement Of Novel Expandable Interlaminar Stabilization Device For Lumbar Spinal Stenosis, Robert P. Norton, Ian Koch, Kendra Primavera, Roy Y. Miloh, Alex R. Vaccaro, Mitchell K. Ng

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To evaluate radiographic durability and clinical outcomes following placement of a novel expandable interlaminar stabilization device for single-level lumbar spinal stenosis. Specifically, we aimed to: 1) quantify immediate postoperative posterior column distraction; 2) determine whether foraminal expansion is improved postoperatively without radiographic subsidence; and (3) assess potential improvements in patient-reported pain/clinical outcomes.

METHODS: A retrospective review was performed of adult patients undergoing single-level decompression supplemented by an interlaminar device for symptomatic lumbar spinal stenosis by a single surgeon from 2024 to 2025. Radiographic parameters included anterior, middle, and posterior disc height, foraminal height, and …

Equity In Evaluation: Examining Grading Practices And Student Experiences In Speech-Language Pathology Education, Jennifer Essig

Teaching and Learning in Communication Sciences & Disorders

Traditional grading practices remain the norm in communication sciences and disorders (CSD) education, despite evidence these systems may exacerbate inequities and affect motivation and perceptions of learning. This study examined how traditional and alternative grading practices are experienced by undergraduate and graduate students enrolled in CSD programs. Using a convergent mixed-methods design, survey data were collected from 73 students regarding perceptions of grading, motivation to learn, and emotional responses to assessment. Quantitative analyses indicated that students in alternatively graded classrooms reported significantly higher perceptions of fairness, clarity, and learning than those in traditionally graded settings. Qualitative analysis revealed contrasting emotional …

Targeted Interprofessional Education (Ipe) Curriculum For First-Year Speech-Language Pathology (Slp) Graduate Students, Cody Marie Busch

Teaching and Learning in Communication Sciences & Disorders

ASHA requires that SLP graduate programs facilitate opportunities for interprofessional collaborative practice (IPCP). Research suggests that IPCP initiatives should be integrated throughout the curriculum, rather than isolated interprofessional education (IPE) experiences. 15 first-year SLP graduate students participated in a year-long IPE curriculum focused on the IPEC Core Competencies. Quantitative and qualitative data revealed improved perception of IPCP and appreciation of opportunities to interact with other disciplines. Students noted that SLP graduate programs should integrate IPCP opportunities because they set them up for success with collaboration and help remove the SLP “silo.” Finally, students reported that they plan to use the …

Supporting Neurodivergent Students In Communication Sciences And Disorders: Best Practices Integrating Udl And Tilt In Academic Courses, Jacqueline A. Towson, Nancy Mcintyre, Alexis Cunha

Teaching and Learning in Communication Sciences & Disorders

In this tutorial, we explore effective andragogical strategies to support neurodivergent students in higher education programs, specifically within academic course in the field of communication sciences and disorders (CSD). By integrating the evidence-based education practices of Universal Design for Learning (UDL) and the Transparency in Learning and Teaching (TILT) framework, faculty can create inclusive and supportive learning environments in academic courses to better support neurodivergent students in CSD programs. We discuss practical applications of these frameworks through two sample assignments, supported by recent research, and provide actionable recommendations for faculty in higher education. The goal of this tutorial is to …

Csdeep Learning Seminar: Connecting Students, Faculty, And Alumni To Promote A Creative Path To Success, Chao-Yang Lee, Emily Jones

Teaching and Learning in Communication Sciences & Disorders

What do the best college students do to cultivate their intellectual and personal development? How does learning type lead to professional success and personal fulfillment? We report the design and implementation of a seminar in which undergraduate students in Communication Sciences and Disorders collaborated with peers, faculty, and alumni to explore the meaning and application of deep learning. Participants examined how learning type shapes college experience through book discussions and conversations with alumni. Feedback from participants suggests that the book discussions and alumni conversations broadened the students’ perspective on learning type, purpose of college education, and success and failure. The …

Simulated Participant Engagement In Communication Sciences & Disorders Programs: A Scoping Review, Jason Konzelmann, Richard I. Zraick

Teaching and Learning in Communication Sciences & Disorders

Introduction. Simulated participants (SPs) are widely used in medical and nursing education, but their application in allied health, including Communication Sciences and Disorders (CSD), remains limited. Despite accreditation standards supporting simulation in CSD training, student engagement with SPs is still uncommon.

Objectives. This scoping review examined recent literature on SP use in CSD programs involving speech-language pathology or audiology students or providers. We explored how SPs were integrated and identified gaps for future research.

Methods. Guided by PRISMA-ScR, we searched six databases and an internet search yielded one additional article. Studies published between 2019 and 2025 were included if they …

Ulcerative Cutaneous Sarcoidosis Without Systemic Involvement: An Isolated Presentation, Kayla Brockmeyer, Simona A. Alomary, Ananya Udyaver, Lauren Banner, Alessio Gianni, Sweta Subhadarshani

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Frailty And Activities Of Daily Living In Older Adults In Primary Care: A Cross-Sectional Study, Öznur Adadıoğlu, Ahmet Seven, Esin Danç

Makara Journal of Health Research

Background: This study aimed to examine frailty status and activities of daily living among older adults.

Methods: This descriptive and cross-sectional study was conducted with 306 voluntary participants aged 65 years and older who were registered at a primary healthcare center in a city in Türkiye. Data were collected using the Participant Information Form, the FRAIL Scale, and the Katz Index of Activities of Daily Living.

Results: Among the participants, 36.9% were non-frail, 42.2% were pre-frail, and 20.9% were frail. The mean Katz Index score was 5.42 ± 1.35. The mean scores of activities of daily living …

Osteoporosis Knowledge, Health Beliefs, And Calcium Intake Among Malaysian Chinese Adults In Perak: A Cross-Sectional Study, Thean Hui Ru, Nurul Aimi Ab Kadir, Fatin Izzaty Mohd Shahrin

Makara Journal of Health Research

Background: The Malaysian Chinese population records the highest national prevalence of osteoporotic hip fractures. This study investigated the relationships between osteoporosis knowledge, health beliefs, and calcium intake among Malaysian Chinese adults.

Methods: A cross-sectional study was conducted among 205 Malaysian Chinese adults in Kampar, Perak, using the adapted Osteoporosis Prevention and Awareness Tool (OPAAT), Osteoporosis Health Belief Scale (OHBS), and a 30-item Food Frequency Questionnaire (FFQ).

Results: Participants demonstrated low osteoporosis knowledge (6.84 ± 2.92), with low perceived susceptibility (14.87 ± 5.00), moderate perceived seriousness (17.81 ± 5.20), and barriers to calcium intake (15.61 ± 4.15), and …

E-Cigarette Awareness, Usage Patterns, And Sociodemographic Determinants Among Malaysians Adolescents: A Cross-Sectional Study, Izdihar Kamal, Nabilah Mohd Abd Wahab, Nurul Mawaddah Mohammad, Rashidi Ahmad, Muhammad Khalis Abdul Karim, Hatikahaty Mohd Diah, Munirah Ahmad Dahari, Nur Biha Mohamed Nafis, Mohd Faris Abdullah Sani, Sulayman Muhammad Kabeer, Nur Biha Mohamed Nafis, Juliana Mohd Radzi

Makara Journal of Health Research

Background: Electronic cigarette (e-cigarette) use among Malaysian adolescents is rising rapidly, raising significant public health concerns. This study assessed awareness, understanding of risk, and e-cigarette use among secondary school students in Negeri Sembilan, Malaysia, and identified sociodemographic predictors of use.

Methods: A cross-sectional survey was conducted among 323 students from three government secondary schools using a validated questionnaire. Data were then analyzed using descriptive statistics and logistic regression.

Results: Nearly one-third (31.9%, N = 103) reported prior e-cigarette use. Although 63.2% (N = 204) demonstrated good awareness, only 14.6% (N = 47) understood associated health risks. Peers …

Assessing Healthcare Access Among Overweight And Obese Individuals In Türkiye Using Latent Variable Modeling, Banu Beyaz Sipahi

Makara Journal of Health Research

Background: Overweight and obesity are critical determinants of healthcare access, yet evidence on how the COVID-19 pandemic reshaped these dynamics in Türkiye remains limited. This study investigates whether the early post-pandemic recovery period altered healthcare access patterns for individuals with excess weight.

Methods: Using nationally representative microdata from the 2014, 2016, 2019, and 2022 Turkish Health Surveys, we constructed a latent Healthcare Access Index based on six indicators of unmet care needs. Probit models were estimated to assess associations between BMI categories and healthcare access, controlling for socioeconomic and demographic factors. The 2022 wave serves as the early …

Physical Activity Intensity And Memory In Middle-Aged And Older Adults In China, Simi Tang, Yucheng Gao

Makara Journal of Health Research

Background: Memory decline represents a major challenge in aging populations, and physical activity may help preserve cognitive function. However, evidence on whether different activity intensities are associated with memory remains inconclusive.

Methods: Using five waves of the China Health and Retirement Longitudinal Study (2011–2020), this study investigated the association between physical activity intensity and memory among middle-aged and older adults in China. Individual fixed-effects models were applied to control for unobserved time-invariant heterogeneity. The outcome was memory score, and the main predictors encompassed high-, moderate-, and low-intensity physical activities.

Results: Based on 52,135 person–wave observations from 21,423 …

Staff Education On Frailty And Senior Surgical Safety, Kimberly Buhay Gibu

Walden Dissertations and Doctoral Studies

This staff education doctoral project addressed a practice gap involving limited education on frailty assessment and senior surgical safety within the general surgery department of a large, integrated healthcare system. Frailty is associated with increased postoperative complications, hospitalizations, readmissions, and mortality among older adults, making early recognition essential to improving surgical outcomes. The practice-focused question project was: Does education on frailty screening and senior surgical safety improve the knowledge, confidence, and intent of general surgery staff in a large, integrated health system? The purpose was to develop, implement, and evaluate an evidence-based educational intervention. The project was guided by the …

Two-Thirds Return But Performance Suffers: Acl Reconstruction Outcomes Across Elite European Women's Soccer Leagues, Haneef Khan, Forest Rodriguez, Amina Khan, Ashley Rosenberg, Stephen Marcaccio

Student Papers, Posters & Projects

PURPOSE: To analyse return-to-play (RTP) rates, timing and performance outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR) in elite European women's soccer players across the top five leagues.

METHODS: We reviewed ACL injuries sustained by female professional soccer players across the Bundesliga, Women's Super League, Primera División Femenina, Serie A Women and Première Ligue between 2007 and 2025. Players were included if they had a confirmed ACL injury requiring ACLR and one season of performance data pre- and post-injury. Players were excluded if the injury occurred during their rookie season or after the 2023 season. Data were collected from Soccerdonna.de …

Relationship Between Sociodemographic Factors And Opioid Overdose Mortality In Milwaukee County, 2020-2021, Elizabeth David

Walden Dissertations and Doctoral Studies

Opioid overdose deaths increased significantly from 2020 to 2021, with Milwaukee County experiencing higher rates than the national and state averages. African American and Hispanic residents faced disproportionately high fatal overdose rates. The purpose of this quantitative retrospective cross-sectional study was to examine the associations among socioeconomic status, race, age, access to treatment (measured by emergency medical services [EMS] naloxone administration), and opioid overdose mortality among underserved minority populations in Milwaukee County. Guided by the social-ecological model, the study analyzed data from the Milwaukee Health Department and the Milwaukee County Medical Examiner's Office across 34 ZIP codes. Inclusion criteria for …

Self-Care Behavior And Diabetes Knowledge In African American Women With Type 2 Diabetes, Rena Renee Barron

Walden Dissertations and Doctoral Studies

African American women experience a disproportionate burden of Type 2 diabetes, and limited evidence exists regarding the relationship between diabetes knowledge and self-care behaviors, particularly among African American female veterans. The purpose of this quantitative, cross-sectional study was to examine the relationship between diabetes knowledge and diabetes self-care among African American women with Type 2 diabetes, including a subsample of African American female veterans, and to evaluate whether the COVID-19 pandemic (2017–2019 vs. 2021–2023) moderated this relationship. Additional variables included age, marital status, physical health, and mental health. Guided by the social-ecological model, de-identified data from the Behavioral Risk Factor …

Improving Advanced Care Planning Conversations And Documentation Through App Education And Standardized Epic Workflow: A Quality Improvement Initiative, Michelle N. Rutter, Emily Goldstein

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Advance care planning (ACP) is essential for ensuring (GOC), particularly in acute care settings, defined in this paper as inpatient hospital environments, including critical and intensive care units (ICU), where a patient’s decision-making capacity could become impaired. ICU patients are often critically ill and may lose the ability to make health care decisions. Family uncertainty regarding patient preferences frequently exacerbates psychological distress regarding GOC. Restricted access to ACP may result in non-concordant medical care, as well as elevated healthcare expenditures driven by the underutilization or inappropriate allocation of critical resources. Despite the recognized importance of ACP and …

Expressive Arts For Women Experiencing Homelessness, Theresa G. Karman, Susan Macdermott, Amy Lyons-Brown

Summer 2026 OTD Capstone Symposium

Background: Women experiencing homelessness due to domestic violence face significant occupational disruptions, including challenges related to emotional regulation, identity, social participation, and engagement in meaningful occupations. Occupational therapy (OT) can support recovery by addressing these occupational needs through trauma-informed and occupation-centered interventions.

Purpose: This doctoral capstone project developed and implemented Express & Empower Studio, a six-week expressive arts program designed to promote emotional expression, self-efficacy, social participation, and engagement in meaningful occupations among women residing in a domestic violence shelter.

Methods: Program development was guided by the Model of Human Occupation (MOHO) and the Expressive Therapies Continuum (ETC) within …

The Cul-De-Sac Paradox: The Relationship Between Walkability, Playability, And Children’S Physical Activity, Lydia Reader

McKelvey School of Engineering Graduate Student Theses & Dissertations

Walkability and playability are two constructs on how the built environment can support physical activity, the former most relevant to adults and the latter designed with children in mind. There are concerns that walkability and playability are intrinsically in competition with one another, with urban forms supportive of physical activity for adults detrimental toward the physical activity of children and vice versa. This thesis explores this conflict using agent-based modeling as a tool for refining the theoretical constructs behind playability and children’s physical activity. We examine the state of the current evidence for the relationship between walkability and children’s physical …

Staff Education To Improve Behavioral Health Integration In Primary Care, Nelly Endah Atu

Walden Dissertations and Doctoral Studies

This staff education project addressed a persistent gap in the delivery of integrated physical and mental healthcare for patients with co-occurring conditions. Fragmented care in primary care contributes to untreated mental health needs, increased patient distress, higher costs, and poor outcomes. The aim of this project was to develop, deliver, and evaluate a staff education program equipping nurses, nurse practitioners, and interdisciplinary team members with the knowledge, skills, and practical strategies needed to improve behavioral health integration in primary care. The practice question was, among interdisciplinary staff in a community health setting, did the implementation of an evidence-based, ADDIE-designed staff …

Racial Trauma And Posttraumatic Growth: Implications For Counselors, Margaret M. Poandl, Nowoola Awopetu, Paul C. Harris Dr.

Journal of Counselor Preparation and Supervision

Racial trauma is ubiquitous among Black, Indigenous, and People of Color (BIPOC) and people who belong to other marginalized groups. It is likely that counselors will work with individuals who have experienced racial trauma. Aligned with the counseling profession’s values, counselors can take a strengths-based approach that incorporates facilitation of a historical trauma posttraumatic growth (HT-PTG) framework. This paper presents evidence-informed practices that can foster growth on individual and collective levels. A case example is provided that integrates individual- and collective-level interventions bidirectionally, along with implications for counselor training pedagogically, through supervision, and continuing education. Counselors can identify, encourage, and …

The Safe Fishbowl Model: Psychological Safety By Design In Counseling Skills Training, Mike Mariska

Journal of Counselor Preparation and Supervision

Skills training in counselor education can be constrained by performance anxiety, which may reduce participation, limit deliberate practice repetitions, and shift demonstrations to the instructor. This applied-practice manuscript introduces the SAFE (Structured Avatar and Feedback Experience) Fishbowl model, a simulation architecture designed to address performance anxiety while scaling participation. SAFE Fishbowl integrates rotating counselor roles, a real-time coaching loop, structured observation grounded in experiential learning theory, and purposeful debriefing. An implementation example for group counseling leadership skills is provided, along with adaptation guidance across multiple skill domains and delivery modalities. Descriptive course-evaluation feedback illustrates feasibility and perceived usefulness. Implications include …

Integrating Consensual Non-Monogamy In Counselor Education: Practical Guidelines And A Pilot Descriptive Study, Yun-Zhuo (Zoey) Liu, Lena Salpietro

Journal of Counselor Preparation and Supervision

Consensual non-monogamy (CNM) is a prevalent and diverse relationship structure, yet mononormative assumptions persist in counselor training and practice, contributing to stigma and inadequate care. Research indicates that counselors’ CNM-specific knowledge and attitudes are critical to positive therapeutic outcomes (Schechinger et al., 2018), highlighting the need for clear guidance. In response, this paper presents Guidelines for Incorporating CNM in Counseling Curricula. Three domains are grounded in multicultural and social justice principles: foundational knowledge and terminology, challenging bias and promoting self-reflection, and application informed by attachment theory. Additionally, findings from a survey of counselor educators (N = 54) are presented. Results …

U.S. Service Member To Counseling Student, Nicole Marie Arcuri Sanders, Kellie Forziat-Pytel

Journal of Counselor Preparation and Supervision

This qualitative descriptive study examines the absence of military career pathways for licensed mental health counselors (MHCs) and the impact of this structural limitation on service members' career transitions. Findings indicate that both combat and non-combat veterans pursued mental health counseling due to personal service-related mental health experiences and dissatisfaction with available care while in service. Despite these challenges, many participants expressed a strong desire to continue serving their country as professional counselors. Over half of the participants reported separating from the military because no occupational role existed for licensed MHCs. At the same time, most indicated they would have …

Management Of Advanced Periodontal Disease In A Patient With Down Syndrome-A Case Report, Robert T. Verceles

Oral Health

Down Syndrome is a common developmental disability.  Patients with DS may have many co-morbities associated with the condition, which include cardiac abrnormalities and severe periodontal disease.  This case illustrates how a patient with advanced periodontitis was treated in the Special Care Clinic at UOP, Dugoni School of Dentistry.

Relational Reasoning Across Cultures: Consistency And Variation In South Korea, The United States, And China, Alexandra Carstensen, Minju Kim, Youngon Choi, Caren M. Walker

Psychology Faculty Articles and Research

Abstract reasoning in early childhood is often described as following a “relational shift,” over which children become increasingly sensitive to relations. However, recent work has challenged the generality of this account, showing that children in the US and China follow distinct trajectories in a relational match-to-sample task. This difference aligns with multiple cultural and linguistic factors implicated in relational reasoning, where the US and China appear at opposite ends of a continuum, focusing on objects (US) versus relations (CN). This raises the possibility that differences in culture and language may shape variation in the development of abstract reasoning. Here, we …