Digital Commons Network^™

Supporting Recovery: Intersections Of Health, Belonging, And Help Seeking After A Campus Mass Casualty Event, Sharon Jalene, Jason A. Ciccotelli, Lauren Gatto, Christian Ison, James Carbajal, Andrew Hooyman

Physical Therapy Faculty Articles and Research

Mass casualty events (MCE), such as campus shootings, can severely impact the mental health of students, faculty, and staff. This study examined the psychological effects of an MCE at a minority-serving institution and explored how sense of belonging, cardiorespiratory fitness, and treatment preferences influenced recovery. To measure the impact of the MCE on mental health an anonymous survey was administered four to five months post-MCE to university students, faculty and staff. Within the survey, participants were asked to retrospectively report their depression (PHQ-9) and anxiety (GAD-7) symptoms as they recalled them two weeks prior to the MCE, and as they …

Examining Variations In Non-Conventional Health Care Utilization Among Students At A Hispanic-Serving Institution, Monideepa B. Becerra, Karina E. Corral

Journal of Social, Behavioral, and Health Sciences

The use of non-conventional health care, such as complementary and alternative medicine (CAM) and traditional healing practices, is increasing in the United States. Little is known, however, about its prevalence and influencing factors among college students—especially of varied racial/ethnic background. This study examined these patterns among college students using a cross-sectional survey conducted at a Hispanic-serving institution. Participants reported their use of non-conventional care, and demographic and motivational factors were analyzed using descriptive and bivariate analyses. Of the 641 participants, a majority reported CAM use (96%) and visits to a traditional healer (83%), with higher prevalence among Hispanic and female …

Comment On: Managing Sickle Cell Disease And Related Complications In Pregnancy: Results Of An International Delphi Panel, Deva Sharma, Ilknur Pamuk, Kenneth I. Ataga, Alexandra Benachi, Selim Büyükkurt, Sophie Lanzkron, Hakan Ozdogu, Shivan Pancham, Lydia H. Pecker, Susan E. Robinson, Safak Yilmaz Baran

Cardeza Foundation for Hematologic Research

Consensus-based recommendations on managing sickle cell disease in pregnancy were recently published in a hematology journal. As this topic is also of great interest to obstetricians and gynecologists, we summarize some of these recommendations, while highlighting the challenges of providing evidence-based medical care to pregnant individuals with sickle cell disease.

From Fields To Flu: Mapping H5n1 Zoonotic Risk In California Rice Fields, Mariati Messinger

Walden Dissertations and Doctoral Studies

Highly Pathogenic Avian Influenza (HPAI) H5N1 threatens agriculture, wildlife, and public health in California, where flooded rice fields in the Central Valley provide surrogate wetland habitat for migratory waterfowl and may create ecological interfaces for viral spillover into poultry systems. This quantitative ecological study examined whether county-level rice acreage, Lesser Snow Goose activity, and their interaction were associated with poultry HPAI H5N1 outbreak incidence during complete winter seasons available for analysis. Guided by One Health and disease ecology frameworks, secondary data from USDA, eBird, PRISM, and public surveillance sources were analyzed for 36 county-winter observations using negative binomial regression, logistic …

Staff Education To Improve Nurse Competency In Phq-9 And Gad-7 Screening Using A Standardized Behavioral Assessment In An Outpatient Mental Health Setting, Ernest Ogbeide

Walden Dissertations and Doctoral Studies

Evidence-based practice was the basis for this quality improvement project, which involved developing and implementing a staff education program to enhance nurses' competency in administering, scoring, and interpreting behavioral health screening tools (PHQ-9 and GAD-7) for outpatient mental health services. Variability in competency amongst clinical staff to use these standardized screening tools for evaluating anxiety and depression was identified as a problem, as there was no structured, evidence-based education and competency validation process for clinical staff to use, which has the potential to decrease early identification of anxiety and depression among patients and impact clinical assessment and decision-making. The practice …

"It's Probably Like A Web": Complex Relationships Between Pain And Mental Health Among Bisexual+ Women With Chronic Pain, Aster Harrison, Mansha Mirza

Department of Occupational Therapy Faculty Papers

INTRODUCTION: Bisexual+ women experience higher rates of both mental illness and chronic pain when compared to either straight or lesbian women. Their experiences of the relationship between their mental health and chronic pain remain underexplored. This article presents an intersectional Interpretive Phenomenological Analysis of the experiences of six bisexual+ women with chronic pain.

METHODS: Each woman completed two semi-structured interviews. Interviews were analyzed with Interpretive Phenomenological Analysis, beginning with in-depth case study analysis of each person's interviews before moving to comparison across cases.

RESULTS: Results indicated a complex web of multidirectional relationships between mental health and chronic pain. These relationships …

Clinical Phenotypes Associated With Nrxn1 Deletions In Five Children With Autism Spectrum Disorder In Oman, Samira Said Alhousni, Ahmed Idris, Watfa Al-Mamari, Abeer Al-Sayegh

Sultan Qaboos University Medical Journal

NRXN1 (2p16.3) is essential for synaptic function and has been implicated in autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, the phenotypic features associated with NRXN1 copy number variants remains incompletely characterised, which complicates risk assessment in genetic counselling. This case series describes five children, who were evaluated at the Genetics and Developmental Pediatrics Clinic of a tertiary care hospital in Muscat, Oman, from 2011 to 2023, with rare NRXN1 deletions (57–150 kb). All met DSM-5 criteria for ASD and had speech and language delays with cognitive impairment. Consanguinity was reported in three of the families and two had …

Acute Opioid Responses Are Modulated By Dynamic Interactions Of Oprm1 And Fgf12, Paige M Lemen, Alexander S Hatoum, Arpana Agrawal, Et Al.

2020-Current year OA Pubs

We generated time-series data for 105 morphine- and naloxone-related traits across ~700 BXD mice (64 diverse strains for both sexes) for 3 hr after a single morphine injection. Variations in responses were mapped using genome sequencing-based genotypes. The locomotor responses to morphine mapped to the µ opioid receptor gene (

When You Are Done Before You Have Begun: A Focus-Group Research Study On The Perception Of Burnout In Physician Assistant Students, Iris M. Villanueva

Pacific Journal of Health

Objective: This study explored Physician Assistant (PA) students’ perceptions of burnout and underlying factors to guide program-level mitigation strategies. Participants: 28 students from the University of the Pacific’s PA program participated in this study. Methods: 5 focus group interviews were conducted. Themes were identified using inductive thematic analysis.  Results: Students described burnout as emotional exhaustion, cynicism, and loss of interest in academics, driven by internal pressures, time demands, and inconsistent assessments, and linked to strained relationships, guilt, and isolation. Coping strategies included breaks, enjoyable activities, peer connection, and exercise. Students recommended program-level strategies, such as scheduled class bonding, flexible scheduling, …

Interpretable Case-Control Inference Through Log-Linear General Location Models, Zacharia Stuart

Mathematics & Statistics ETDs

This dissertation analyzes one of the few publicly available NFL injury datasets to study field type and non-contact lower-limb injuries. Field type is studied jointly with other risk factors to understand how these factors interact to affect injury risk. The data were gathered through a case-control sampling scheme, which limits direct inference on absolute injury probabilities. While not the most common approach for case-control data, this dissertation models the retrospective distribution directly through Log-Linear General Location Models (Log-Linear GLOMs). Through a log-linear structure placed on a log-odds-ratio reparameterization, the model provides directly interpretable marginal and interaction contributions to injury log-odds …

Mitigating Cancer Therapy-Related Cognitive Impairment By Targeted Activation Of Undruggable Phosphatase., Zhimeng Yao, Yuhua Meng, Huanyi Li, Yinhui Jiang, Xiaona Lin, Mengyuan Hu, Qing Liu, Xiaofu Qiu, Hongzheng Ren, Yunlong Pan, Bin Pan, Zexiong Guo, Shuyao Zhang, Dianzheng Zhang, Li Yang, Shegan Gao, Weijing Deng, Jianfan Chen, Hao Zhang

PCOM Scholarly Works

Cancer therapy-related cognitive impairment (CTRCI) is a debilitating neurotoxic condition adversely impacting cancer patients during and post-cancer treatments. The cancer treatments linked to CTRCI include chemotherapy, hormone therapy, targeted therapy, and immunotherapy. Despite CTRCI severely affecting the psychological and social, cognitive functions, and the overall quality of life of cancer survivors, no effective medications are available currently. Our prior studies have indicated hippocampal tyrosine phosphatase protein tyrosine phosphatase receptor type O (PTPRO) as a putative target for CTRCI. However, phosphatase is historically considered undruggable, and delivering drugs across the blood-brain barrier (BBB) is challenging. Here, we developed a novel delivery …

The Fourth Trimester: Enhancing Postpartum Depression Detection In Primary Care Through Early Screening And Patient Education, Riley Goldschmidt

DNP Projects

Background:
Postpartum depression (PPD) is a common and often underrecognized complication, with many cases going undetected due to inconsistent screening practices in primary care. Delayed identification can negatively impact maternal well-being, infant bonding, and overall family health outcomes. This quality improvement project aimed to improve early detection of PPD by implementing routine screening and patient education during newborn visits in a primary care clinic.

Methods:
The intervention integrated the Edinburgh Postnatal Depression Scale (EPDS) into the existing newborn visit workflow and introduced an evidence-based educational toolkit containing information on PPD symptoms, guidance for seeking care, and a QR code for …

Improving Outpatient Provider Preparedness Through Simulation-Based Training: A Quality Improvement Project, Kristina Weyer

DNP Projects

Introduction:
Simulation-based training is an effective educational strategy, particularly for high-acuity, low-frequency events such as patient decompensation in outpatient settings. However, there is a gap in both literature and practice regarding provider participation in simulation, as competing clinical demands often limit engagement. Local organizational leaders identified limited opportunities for outpatient providers to practice management of acute decompensating patients. The purpose of this project was to evaluate provider competence and confidence in managing a decompensating patient in the outpatient setting and to assess perceptions of the value of time spent in simulation.

Methods:
This quality improvement project evaluated providers who participated …

Targeted Nursing Bootcamps For Critical Access Hospital Nurses: A Program Evaluation., Nicholas Popp

DNP Projects

Background: Registered Nurses employed in critical access hospital settings are required to care for patients across the lifespan with varying levels of acuity. The registered nurse (RN) must be competent in providing medical, surgical, pediatric, obstetric, and intensive care-level services. However, the additional training they receive to care for their patients may be minimal or nonexistent, leading them to seek employment at other facilities due to safety concerns. Leadership within the organization believed that implementing targeted monthly nursing skills boot camps could increase nurses’ competence, confidence, and retention in critical access hospital settings.

Aims: This program evaluation project aimed to …

Bridging The Gap: Development And Implementation Of A Caregiver Educational Guide For Post-Lung Transplant Caregivers, Megan Aller

DNP Projects

Background: Caregivers of post-lung transplant recipients play a critical role in postoperative recovery, as patients require continuous support during the first three months after transplant. Despite this responsibility, caregivers frequently experience burden, stress, and challenges adapting to the complex demands of the caregiving role.

Aim: To evaluate the feasibility and preliminary outcomes of a tailored caregiver education and support guide for caregivers of lung transplant recipients.

Local Problem: Within the local transplant program, caregiver education primarily relied on verbal instruction with limited caregiver-specific take-home resources.

Methods: This quality improvement project used a two-group pretest–posttest design to evaluate the …

Nurse-Led Quality Improvement Asthma Self-Management In Primary Care, Jolene Steinert-Abderhalden

DNP Projects

Background:
Poorly controlled asthma contributes to preventable morbidity, yet many adults lack consistent self-management support. Local Problem: Baseline assessment at a rural Midwestern clinic revealed limited asthma knowledge, inconsistent action-plan use, and low confidence among adults with Asthma Control Test (ACT) scores below 20.

Methods:
This quality improvement project used a pre- and post-intervention design guided by Lean methodology and the Plan-Do-Study-Act (PDSA) framework. Interventions: Registered nurses delivered standardized asthma education, inhaler-technique review, and action plan reinforcement with monthly structured follow-up for 16 weeks.

Results:
Among four enrolled participants, three completed follow-up. Mean ACT scores improved from 17.5 at baseline …

Evaluating Preoperative Education Modalities For Orthopedic Surgery Patients, Hannah Johnson

DNP Projects

Effective preoperative education is essential as total joint arthroplasty (TJA) procedures shift to outpatient care, yet traditional education methods may not be meeting patients’ diverse learning styles. This Doctor of Nursing Practice (DNP) project aimed to evaluate the impact of multimodal preoperative education (in-person, virtual, hybrid video modules, or a combination) on patient-reported anxiety and discharge readiness, as well as length of stay (LOS), surgical site infections (SSIs), and 30-day readmissions. The in-person portion could not be implemented due to staffing constraints. The pre-post evaluation was conducted with a sample of 273 patients undergoing elective hip and knee arthroplasty (pre …

Evaluating An Educational Intervention On Penicillin Allergy De-Labeling Among Graduate Nursing Students, Allison Desmond

DNP Projects

Background
Approximately 10% of patients report a penicillin allergy; however, up to 90% of these individuals are not truly allergic. Inaccurate penicillin allergy labels contribute to inappropriate antibiotic use, increased healthcare costs, and antimicrobial resistance. Education on penicillin allergy testing remains limited among future Family Nurse Practitioners (FNPs).

Methods
A quantitative quality improvement project using a pretest-posttest design was conducted among second- and third-year Doctor of Nursing Practice–Family Nurse Practitioner (DNP-FNP) students enrolled in Pharmacology II or Advanced Practice Nursing III at a Midwestern liberal arts college. Participants completed a 15-minute voiceover PowerPoint educational intervention on penicillin allergy testing and …

Improving Provider Knowledge And Confidence In Hormone Replacement Therapy Through A Quality Improvement Educational Intervention, Caitlin Schmidt

DNP Projects

Background
Menopause is associated with symptoms that can significantly diminish quality of life. Hormone replacement therapy (HRT) remains the most effective intervention for moderate to severe menopausal symptoms. Despite evidence-based guidelines endorsing its use in appropriately selected patients, HRT utilization remains limited.

Local Problem
A gap in provider knowledge and confidence regarding HRT prescribing was identified in a rural primary care clinic in the Midwestern United States. The clinical needs assessment revealed an absence of standardized menopause-specific education and highlighted an opportunity to improve evidence-based menopause management.

Methods
This quality improvement project employed a pre-post educational design guided by the …

Registered Nurse Procedural Sedation In Operating Room: An Analysis Of Patient Safety And Nurse Confidence Efficacy Of 2 Years Post Implementation, Cassandra Fredrickson

DNP Projects

Background
A Midwest hospital implemented a registered nurse (RN) procedural sedation program to provide safe, cost-effective sedation for selected operating room procedures under physician supervision, improving patient access while optimizing anesthesia resources.

Methods
A retrospective descriptive program evaluation examined 1,117 patients who received RN-administered procedural sedation for vascular and neurovascular procedures during 2022 and 2024. Outcomes included anesthesia consultation, anesthesia takeover, reversal agent use, and adverse events. Patient demographics and procedure duration were analyzed. Six procedural sedation nurses completed a self-efficacy survey assessing confidence in sedation-related competencies. Descriptive statistics and qualitative review of adverse event narratives were performed.

Results
Among …

Clinicopathologic Spectrum Of Renal Disease In Sars-Cov-2 Infection And Post-Covid-19 Vaccination, Naya Williams, Mohammed S. Razzaque

School of Medicine Publications

Both SARS-CoV-2 infection and COVID-19 vaccination have been associated with renal complications. In the context of SARS-CoV-2 infection, kidney injury is primarily attributed to a complex interplay of systemic immune dysregulation and vascular damage. Severe infection triggers a cytokine-mediated inflammatory response characterized by elevated levels of pro-inflammatory mediators, resulting in systemic hemodynamic instability, increased capillary permeability, and renal hypoperfusion, ultimately leading to acute tubular injury. In addition, virus-induced endothelial activation promotes a prothrombotic state, microvascular injury, and further impairment of renal perfusion. Collectively, these processes converge to produce acute kidney injury (AKI) and, in severe or prolonged cases, may contribute …

Notch Signaling Regulates The Secretion Of Pro-Metastatic Factors In Extracellular Vesicles In Liposarcoma, Menchus Quan, Yi-Kai Liu, Ying Zhao, Madeline Kay, Kai Sun, Timothy P Gavin, Raphael E Pollock, W Andy Tao, Shihuan Kuang

The Brown Foundation: Institute of Molecular Medicine

Notch signaling is an emerging regulator of liposarcoma (LPS), but its role in mediating communication with the tumor microenvironment (TME) is unclear. Here, we investigate how Notch activation (NICD overexpression) alters the proteomes of LPS-derived extracellular vesicles (EVs). We used quantitative mass spectrometry to profile the EV proteome in multiple contexts: cultured LPS cells, LPS tumor, circulating EVs of LPS-bearing mice, and human LPS samples. We found that Notch signaling increases the secretion of EV proteins that favor tumor progression and metastasis but suppresses immune responses in murine LPS cells. Overlapping murine and human LPS data identifies 18 proteins that …

Elucidation Of Micro/Nanoplastic Signature Of Human And Murine Lung Tissue Utilizing Pyrolysis-Gas Chromatography/Mass Spectrometry, Aerlin D. Decker

Pharmaceutical Sciences ETDs

Micro-and Nanoplastics (MNPs) are ubiquitous biological pollutants that have been identified throughout a variety of biological samples. MNPs have been detected in several human tissues, such as the brain, kidneys, and liver. Lung tissue remains understudied for MNP accumulation despite the large surface area and clear path for exposure. Using Pyrolysis-Gas Chromatography Mass Spectrometry (Py-GC/MS), human lung tissue was evaluated for 12 different polymers, enabling quantification of total plastic per gram of tissue to be identified. Further analysis was performed with Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to investigate heavy metal accumulation in human lung samples and determine whether a …

Ophthoevidence Report: Comparative Effects Of Prophylactic Strategies For Post-Intravitreal Injection Endophthalmitis: Protocol For A Systematic Review And Network Meta-Analysis, Maryam Ghadimi, Dena Zeraatkar, João Pedro Lima, Jinhui Ma, Sunir J. Garg, Peter Kaiser, David Steel, Tien Yin Wong, Sobha Sivaprasad, Charles Wykoff, Varun Chaudhary

Wills Eye Hospital Papers

BACKGROUND: Endophthalmitis is a rare but serious complication of intravitreal injections (IVI). To mitigate the risk of post-injection endophthalmitis (PIE), retinal specialists use different strategies, combining various prophylactic measures. However, existing systematic reviews have evaluated the effects of these measures in isolation, which does not consider their concurrent use in practice. A trustworthy systematic review with network meta-analysis (NMA) by providing a framework for simultaneous comparisons of different prophylactic combinations is essential to guide decision-making.

OBJECTIVES: To present a protocol for addressing the comparative effects of different strategies for the prevention of PIE.

METHODS: We will search Medline, EMBASE, Cochrane …

Civilian Threat Reduces Distance Perceptions And Officer Punishment In Police Use-Of-Force Encounters, Stephanie A. Cárdenas, Kristyn A. Jones, Yael Granot, Emily Balcetis

Psychology: Faculty Publications

People turn to video evidence to make judgments about the justifiability of an officer’s actions in use-of-force incidents. Despite beliefs that video offers an objective account of events, use-of-force footage elicits different judgments among those watching it. Across four experiments (Ntotal = 2615), we investigated whether discrepant punishment judgments arise in part because of differences in perceptions of the physical space that separates an officer and civilian. We focus on third-party observers’ subjective perceptions, as they shape public discourse and justice outcomes, influence institutional accountability, and fuel public response. Despite watching the same video, civilians appeared physically closer to officers …

Enhancing Nursing Self-Efficacy In Advance Care Planning Conversations Through Role-Play Education: A Quality Improvement Project, Rachel Williams

DNP Projects

Background:
Advance care planning (ACP) conversations are essential for ensuring that patient healthcare preferences are understood and respected; however, nurses often report limited confidence and self-efficacy when initiating these discussions. Educational interventions that emphasize communication skills may improve nurses' preparedness to engage in ACP conversations.

Methods:
A quality improvement project utilizing a pre-post intervention design was conducted on three adult inpatient medical units within a regional Midwestern hospital. Registered nurses participated in an educational intervention consisting of ACP education, role-playing case scenarios, guided discussion, and debriefing. A modified 22-item Advance Care Planning Self-Efficacy Questionnaire was administered before and after the …

Medical Recommendations And Bmi Among Black And Hispanic Adolescent Females, Dorothea Polk

Walden Dissertations and Doctoral Studies

Adolescent obesity persists as a critical public health challenge in the United States, with Black and Hispanic adolescent females experiencing elevated rates. Adolescent obesity contributes to serious long-term health risks, but provider counseling may support body mass index (BMI) management. Guided by the social-ecological model, this study examined whether receiving medical recommendations to control or lose weight was associated with BMI among Black and Hispanic adolescent females aged 16–19 years and whether meal preparation habits and food security status moderated this association, controlling for age, household income, and race/ethnicity. This quantitative, cross-sectional secondary analysis used multiple linear regression analyses to …

Enhancing Surgical Team Readiness: Simulation Training For Power Failure Response In Robotic Procedures, Heather Marie Sorton

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing Practice (DNP) project, I used a quality improvement design to implement and evaluate a simulation-based education aimed at improving perioperative staff knowledge related to robotic power-loss events. A practice gap was identified in staff preparedness for robotic system failures due to limited education on emergency protocols, communication, team roles, and Association of PeriOperative Registered Nurses (AORN)-aligned response processes, impacting patient safety during robotic-assisted procedures. I examined whether implementation of a simulation-based educational intervention improved staff knowledge related to robotic power-loss management. The purpose of the project was to improve staff knowledge and standardize responses to …

Uv Damage Mapping Reveals Different Impacts Of Xpd Mutations On Global Genomic And Transcription-Coupled Dna Repair, Allyson Hoag

Biomedical Sciences ETDs

Nucleotide Excision Repair (NER) is a fundamental cellular process that removes bulky and helical distorting lesions from the genome through the separate responses of its two subpathways – global genomic (GG-NER) and transcription coupled (TC-NER) DNA repair. The pathways converge with the recruitment of the TFIIH complex, a key step that is mediated by the translocase and helicase activities of  its XPD subunit. Germline mutations in XPD result in the clinical disorders, Xeroderma Pigmentosum (XP) and XP combined with Cockayne Syndrome (XP/CS). The goal of this thesis was to understand if XPD XP and XP/CS mutations differentially impact GG-NER and …

Mapping And Modeling Threat-Evoked Brain States After Early Life Adversity, Taylor W. Uselman

Biomedical Sciences ETDs

Early life adversity (ELA) increases lifelong neuropsychiatric vulnerability. Yet how ELA reorganizes brain-wide activity and circuit coordination across later experience remains unclear. This dissertation tests the hypothesis that ELA alters adult brain-wide activity and responses to threat through disrupted coordination among neural systems that regulate emotional experience, including prefrontal-limbic and monoaminergic systems. Longitudinal manganese-enhanced MRI of adult mice exposed to standard or fragmented early care, combined with computational processing and statistical modeling, quantified brain states before, during, and long after innate predator threat. These studies established that acute threat evokes large-scale, distributed brain activity that evolves over time. ELA potentiates …