Digital Commons Network^™

Relationships Between Adolescents With Substance Use Disorders, Their Guardians, And Expressive Arts Therapy: A Literature Review, Sarah K. Unkefer

Expressive Therapies Theses

This literature review collects the comprehensive, current research around effective treatment of adolescents with substance use disorder (SUD) and explores ways to provide psychoeducation for the adolescent and their guardians to foster healthy relationships and open communication. This author explores the ways that expressive arts therapy influences treatment and long-term recovery of adolescents with substance use disorders (SUDs) by addressing familial communication and internalized stigma. Previous studies have shown that the current primary reaction from guardians is forcing abstinence, which often damages the adolescent-guardian relationship. Since this is one of the most important relationships in an adolescent’s projected recovery journey, …

Biomechanical Effects Of Bilateral Torsion And Skeletal Fusion: A Case Study, Linnéa Forbes

Honors Projects

As part of both a personal endeavor and an academic project, I have investigated the aetiology and treatment of seemingly idiopathic and debilitating leg pain in a patient over the past 10 years. Via collaboration with medical professionals at Cincinnati Children’s Hospital, Cincinnati Premier Physical Therapy, and Cincinnati Women’s TriHealth, I have identified sources of pain at the anatomical level. The combination of internal femoral torsion, external tibial torsion, pes planus, and bony fusions appear to be major perpetuators of the pain. An effective treatment continues to be evasive. To date, I have attempted to find answers through genetic approaches, …

Quantifying Sleep Wake Rhythms In The Hospital Environment With Digital Technologies, Carsten Skarke, Nadim El Jamal, Michael V. Genuardi, Thomas G. Brooks, Antonijo Mrčela, Nicholas F. Lahens, Makayla Cordoza, Sean Sarles, Amarachi Mbadugha, Dineth R. Karunamuni, Shikhar Gupta, Charles J. Bae, Amita Sehgal, Thomas P. Cappola, Jacob T. Gutsche, Pavan Atluri, Nimesh D. Desai, Michael A. Acker, Gregory R. Grant, Richard J. Schwab, Ilene M. Rosen, Garret A. Fitzgerald

Division of Cardiology Faculty Papers

Postoperative clinical care is prone to circadian desynchronization that may influence health outcomes. In an exploratory, feasibility-oriented and signal-exploration effort, we collected 1.8 million data points using 11 remote sensors during preoperative, in-hospital and post-discharge settings in 13 elective cardiac surgery patients (5.2% enrolled from 252 screened). We found that room traffic continued during nighttime with ≥1 visit/h. Sound levels exceeded the recommended 45 dBA threshold (51.9 ± 3.3 vs. 48.3 ± 4.2 dBA during nighttime). Brightness dropped at night (89.9 ± 87.7 to 3.7 ± 9.8 lux), but bright light exposures occurred. Ambient room temperature lacked sleep-inducing diurnal variability. …

Mapping The Evidence On The Maternal–Fetal Triage Index (Mfti): A Scoping Review, Taylor Harris, Kelsey Downie, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Maternal morbidity and mortality remain persistent challenges in the United States, with obstetric triage serving as a critical point of entry for timely recognition and management of high-acuity maternal-fetal conditions. Despite recommendations for acuity-based triage models, many obstetric units continue to rely on non-specific emergency triage tools, such as the Emergency Severity Index (ESI), which inadequately account for pregnancy-specific physiological changes and fetal status. To address these limitations, the Association of Women’s Health, Obstetric and Neonatal Nurses developed the Maternal-Fetal Triage Index (MFTI), a five-level obstetric-specific triage tool. Although the MFTI has been increasingly adopted in clinical practice, the …

Genetic Predispositions To Cancer: What Pediatricians Need To Know, Sarah Gubara, Nicole Wood

Pediatrics in Practice: A CME Podcast

Pediatric hematology/oncology physician Nikki Wood, DO, explains how pediatricians can recognize genetic cancer risk, refer to genetics appropriately, and support families through long‑term surveillance.

Click here to stream the podcast episode.

Pain Into Purpose Through Reboot Recovery, Kristin R. Barnes

OTD Capstone Projects

This doctoral capstone project was completed in partnership with REBOOT Recovery, a non-profit organization dedicated to providing trauma healing through faith-based, peer-led courses. The purpose of this project was to develop a qualitative survey methodology to evaluate and analyze issues/successes that arise for participants and leaders of the 12-week courses. Additionally, educational content was developed for the justice impacted/justice involved communities on how to rebuild relationships post incarceration and how to stay connected during incarceration. To obtain more information and data on the experience of previous leaders of REBOOT courses and potentially how to improve their experience, a survey was …

Expanding Maternal Support Beyond The Studio: Implementation Of A Postpartum Email Series And Community Open House Initiative, Madison Campbell

OTD Capstone Projects

The transition to motherhood presents significant physical, emotional, and occupational challenges, with many postpartum individuals experiencing unmet needs related to mental health, role adjustment, and access to supportive resources. This capstone project, completed at Nurture Nashville Yoga, aimed to expand maternal support through the development of a four-week postpartum email education series and the implementation of a community maternal wellness open house. A needs assessment identified priorities including normalization of postpartum experiences, emotional regulation, confidence in daily routines and infant care, and access to community resources. In response, an evidence-informed email series was created to provide education on postpartum recovery, …

Promoting Occupational Skills For Safe And Independent Aging, Alandry Vise

OTD Capstone Projects

This capstone project was completed in collaboration with BrightStone, a nonprofit organization in Franklin, Tennessee, that provides vocational, social, and residential programming for adults with intellectual and developmental disabilities. The purpose of this project was to address the increasing needs of the organization’s aging student population by promoting safety, independence, and occupational engagement across day and residential settings. A needs assessment guided the development and implementation of an 8-week educational curriculum addressing aging-related topics, including physical changes, nutrition, mental health, cognitive changes, fall prevention, home safety, and healthy routines. Additional deliverables included staff training to support long-term sustainability of aging-related …

Program Development To Support Executive Functioning Skills For Adults With Down Syndrome At Gigi's Playhouse, Madison M. Wasylewski

OTD Capstone Projects

This capstone project focused on the development and implementation of adult education integrating occupational therapy principles to support executive functioning skills in adults with Down syndrome at GiGi’s Playhouse Nashville. Executive functioning skills learned include planning, organization, attention, and problem-solving which are essential for independent living but are often areas of challenge for this population.

The project involved designing and delivering a 12-week curriculum for the GiGi U program along with encouraged participation in career readiness, life skills, and individualized tutoring sessions. Interventions emphasized self-advocacy, communication, time management, and daily living skills through interactive, real-world activities.

Outcomes included increased participant …

Program Development In Special Needs Ministry For Individuals With Disabilities, Kasey Sobek

OTD Capstone Projects

The Embrace Ministry is a special-needs ministry at Brentwood Baptist that serves individuals of all ages, creating a safe and supportive environment to meet the unique needs of individuals and families impacted by disability. This doctoral capstone project was completed in partnership with Embrace, with the shared objective of developing targeted curriculum and training to enhance participation and engagement in the day program and ministry service settings. This project addressed the identified need for enhanced volunteer and staff training curriculum, as well as day program curriculum development and evidence-informed strategies to address diverse sensory, behavioral, and functional needs. Key outcomes …

Supporting Self-Regulation In Early Childhood Through Parent–Child Movement And Sensory Play, Meris Gilliam

OTD Capstone Projects

The focus of this capstone was to develop a parent–child movement and sensory play program for Nurture Nashville, a local yoga and wellness studio focused on promoting holistic well-being and community connection. The program consisted of a four-week movement and music-based class for preschool-aged children and their caregivers, designed to support self-regulation, motor development, and social interaction through play-based activities. The program also emphasized caregiver education to promote co-regulation strategies and strengthen parent–child connection beyond the class setting.

Empowering Dancers At Move Inclusive Dance, Matthew Gunn

OTD Capstone Projects

This doctoral capstone project was completed through a partnership with MOVE Inclusive Dance in Franklin and Bellevue, Tennessee. MOVE Inclusive Dance is a nonprofit organization that empowers individuals of all ability levels to learn life skills through dance. The aim of this project was to create video content for both internal and external audiences, as well as spread the mission and vision of the agency to surrounding areas of Nasvhille. Goals promoted occupational therapy-based skills such as play, work, education, and social participation. Projects were created with sustainable content to promote the longevity of use within the agency. De-escalation strategies …

Preliminary Evaluation Of A Dialectical Behavior Therapy-Based Skills Training Class For High School Students, Jared T. Izumi, Bethany Walczak, Jamie K. Elizalde, Matthew Hayes

Education Faculty Articles and Research

School mental health issues have become an increasingly important issue for our youth. Schools are a vital resource for providing prevention-based services to students. This study evaluated a pilot implementation of a dialectical behavior therapy (DBT) based skills intervention in a single high school in the Midwest. The sample included a convenience sample of 39 students from three different teachers across three trimesters. Social-emotional learning (SEL) skills, DBT skill use, dysfunctional coping, fidelity, and intervention attendance information were collected. We used a hybrid fixed effects/multi-level model to evaluate the effects of the intervention (McNeish, 2023). Students increased their use …

Out-Of-Pocket Costs And Antihypertensive Medication Use Among Veterans: A Natural Experiment, Alexander R. Zheutlin, Alexander Chaitoff, Daniel Addo, Joshua A. Jacobs, Catherine G. Derington, Eric L. Stulberg, Peter A. Glynn, Bernardo Modenesi, Jordana B. Cohen, Adam P. Bress

Department of Neurology Faculty Papers

BACKGROUND: Blood pressure (BP) control remains suboptimal in the United States despite available low-cost antihypertensive medications. Even small out-of-pocket medication costs may contribute to adherence. We determined whether $0 versus >$0 out-of-pocket costs for antihypertensive medications is associated with differences in adherence, discontinuation, BP control, and cardiovascular outcomes.

METHODS: We included veterans with newly diagnosed hypertension who initiated antihypertensive medication in the Veterans Health Administration from 2004 to 2022. A fuzzy regression discontinuity design with 2-stage residual inclusion leveraged differences in medication copay policy at a 50% service-connected disability threshold (≥50% service-connected disability: $0 out-of-pocket cost versus < 50%: $8 monthly cost). Outcomes included 1-year medication nonadherence (proportion of days covered < 80%), 1-year medication discontinuation (no medication in the final 90 days of the study year), 1-year BP control (systolic BP/diastolic BP < 140/90 mm Hg and < 130/80 mm Hg) and cardiovascular disease events (myocardial infarction, coronary revascularization, peripheral artery disease, or stroke).

RESULTS: Among 417 …

Navigating Screens For Neurodivergent Individuals, Avery Wilson

Honors Theses

As technology becomes more prevalent in everyday life, it is important to consider the implications that this may have for one's mind and well-being. These implications are particularly important for vulnerable populations, such as neurodivergent individuals, who may have unique sensitivities to technology consumption. This paper reviews current literature to provide an overview of the implications of using media on the neurodivergent population, such as individuals with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD), who often possess unique brain sensitivities that influence technology consumption.

To begin, the paper examines the changes in brain structure and functioning in children …

Development Of A Multiplex Assay For Early Detection Of Pancreatic Cancer In High-Risk Groups, Sheng Pan, Ramesh Karki, Lisa A Lai, Chad J Creighton, Teresa A Brentnall, Randall E Brand, Ru Chen

Faculty, Staff and Student Publications

No abstract provided.

Deep Learning And Experimental Validation Of Brca1-Associated Protein-1 Missense Variant Pathogenicity In Uveal Melanoma, Nikhil Davé, David J. Taylor Gonzalez, Mak B. Djulbegovic, Linda A. Cernichiaro-Espinosa, Benjamin A. King, Carol L. Shields, Matthew W. Wilson

Wills Eye Hospital Papers

OBJECTIVE: To benchmark the pathogenicity predictions of AlphaMissense, a deep learning model, against high-throughput functional scores from saturation genome editing (SGE) for all experimentally tested BRCA1-associated protein-1 (BAP1) missense variants in uveal melanoma (UM).

DESIGN: Cross-sectional analytical study comparing computational predictions with experimentally derived functional classifications and clinical annotations.

SUBJECTS PARTICIPANTS AND/OR CONTROLS:  ClusteredAll 4619 BAP1 single amino acid substitutions profiled in a published Regularly Interspaced Short Palindromic Repeats-Cas9 SGE viability assay. No separate control cohort was required. Clinical Variant Database (ClinVar)-annotated variants within this set served as an independent reference.

METHODS: Saturation genome editing log₂-fitness …

Staff Education To Integrate Evidence-Based Practice Of Music Therapy As An Adjunct To Cognitive Behavioral Therapy For Anxiety And The Use Of Anxiety Screening Tool In An Outpatient Clinic, Virginia Bahena

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is essential for improving quality, safety, and outcomes in healthcare; however, gaps in staff knowledge and readiness continue to limit consistent implementation in outpatient settings. This Doctor of Nursing Practice project was a practice-focused quality improvement initiative designed to evaluate the impact of a targeted staff education intervention on EBP knowledge and readiness. The practice-focused question guiding the project was: Does a targeted staff education intervention improve knowledge and readiness to integrate brief music therapy as an adjunct to cognitive behavioral therapy (CBT) and appropriately utilize the Generalized Anxiety Disorder-7 (GAD-7) screening tool in an outpatient setting? …

Staff Education To Improve Knowledge On Discharge Planning And Transitions Of Care For Chronically Ill Patients, Cynthia Adebisi Kadiri

Walden Dissertations and Doctoral Studies

Patients with chronic conditions have the tendency to return to the hospital. Staff education to address high-rate re-hospitalization among patients with chronic conditions is the focus of my Doctor of Nursing Practice project. This is a significant practice problem, since patient outcomes and increased healthcare costs is compromised. Regarding re-hospitalization prevention and ultimate aid in reducing readmissions among people with chronic conditions, the project was used to enhance the knowledge of the nursing staff and competence in transitions of care and discharge planning. The project included 10 nurses who are regularly involved in discharging patients in the medical outpatient clinic. …

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

Cardiovascular Disease And Dyslipidemia In Pediatric Type 1 Diabetes, Grace K Kim, Preneet Cheema Brar, Nidhi Bansal

Faculty, Staff and Students Publications

Purpose of review

Despite advances in type 1 diabetes (T1D) management, mortality is still increased, with cardiovascular disease (CVD) as the leading cause. Dyslipidemia is a highly prevalent modifiable CVD risk factor. We reviewed the existing literature on CVD mortality in T1D to highlight CVD risk in pediatric patients with T1D.

Recent findings

Pathophysiology of T1D and premature CVD risk is still not fully understood. Dyslipidemia remains a highly prevalent and undertreated CV risk factor in T1D. Statins have been shown to be safe and effective to improve CVD risk in adults with T1D, and in children with familial hypercholesterolemia, …

Perceived Inadequate Neighborhood Food Shopping And Cardiovascular Disease Risk: The Multi-Ethnic Study Of Atherosclerosis, Amier Haidar, Ghadi Ghanem, Rishi Rikhi, Karol E Watson, Shreela V Sharma, Michael D Shapiro

Faculty, Staff and Student Publications

Background: Individuals with access to healthy food have healthier diets, improved cardiometabolic risk profiles, and decreased cardiovascular disease (CVD). However, previous studies have focused on the neighborhood food environment as distance to and density of food retailers. Our study examines the association between an individual's perceived adequacy of neighborhood food shopping and incident CVD.

Methods: We analyzed data from 6814 participants in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals aged 45 to 84 who were enrolled in the study between 2000 and 2002 and followed longitudinally. Cox proportional hazards models estimated hazard ratios (HRs) for …

The Impact Of Cannabis Use On Pulmonary Function Among Young Adults: A Literature Review, Ava Petersen

Honors Theses

Cannabis is the most used illicit drug among young adults and many of these users perceive cannabis as harmless and do not believe the drug to be addictive. Cannabis is derived from the flower of the hemp plant and contains cannabinoids THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is the psychoactive component that interacts with the endocannabinoid system to produce a coveted euphoric state among users. Cannabis can be consumed in an edible or combusted and inhaled via joint, pipe, bong, etc. The purpose of this review is to examine the effects of inhaled cannabis on pulmonary function with a specific …

Functional Requirement For Dicer Helicase Arginine Methylation In 26 G Sirna Biogenesis And Oocyte Meiotic Program, Nick Newkirk, Shin-Yu Chen, Tokiko Furuta, Kenneth A Trimmer, Leilei Shi, Sabrina Stratton, Hongyuan Li, Xiaodong Cheng, Mark T Bedford, Swathi Arur

The Brown Foundation: Institute of Molecular Medicine

Spatiotemporal regulation of Dicer is essential for small RNA biogenesis and fertility, yet how its helicase domain is controlled remains unclear. Using Caenorhabditis elegans, we identify a regulatory role for the arginine-rich GRARR motif within helicase domain motif VI of DCR-1. Mutating conserved arginines in this sequence disrupts maternal 26 G endo-siRNA production, impairs oocyte meiosis I and II, and reduces fertility. Biochemically, an asymmetrically dimethylated DCR-1 GRA[R495*]R peptide enhances interaction with ERI-5, a tandem-Tudor protein in the ERIC complex, while loss of DCR-1(R495) diminishes this interaction in vivo. Genetically, eri-5 deletion phenocopies the dcr-1 R495K mutant, supporting a functional …

Changes In Internet Search Term Popularity In Elder Mistreatment (2018-2023): Infodemiology Study Of Google Trends Data, Nicholas Sevey, Melvin Livingston, Kristin Lees-Haggerty, Olanike Ojelabi, Randi Campetti, Jason Burnett, Carolyn E Z Pickering, David Hancock, Rachit Sabharwal, Michael Brad Cannell

Faculty, Staff and Student Publications

Background: Elder mistreatment (EM) is a significant public health problem that is frequently underdetected and underreported. Insufficient public recognition and engagement have been hypothesized as one contributor to this underreporting; however, few data sources exist to quantify public awareness or engagement with EM at the population level.

Objective: This study examined relative internet search interest in EM compared with other forms of abuse (child abuse and domestic violence) in the United States using Google Trends data.

Methods: We analyzed Google Trends data to compare the Relative Search Index (RSI) for the terms "elder abuse," "child abuse," and "domestic violence" in …

Patient Facing Physical Therapy Clinicians’ Experience Of Leader Development Across Their Professional Span: A Phenomenological Inquiry, Judith R. Gelber

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

While healthcare professions call for leadership among its practitioners as a key function of practice, hospital systems typically employ a top town leadership structure. In physical therapy, leadership is centered around managers and educators. This leaves a gap in understanding about leadership at the level of the patient facing clinician. This study explored the experience of leader development across the career span of experienced patient facing physical therapists in the United States. The study used a hermeneutic phenomenological approach undergirded with leader development, experiential learning, and distributed leadership theories. Participant recruitment focused on patient facing physical therapists with ten or …

There Is Strength In Numbers: The Case For Another Model Of Cardiometabolic Hfpef, Sadia Ashraf, Hunter A Hidalgo, Romain Harmancey

Faculty, Staff and Student Publications

No abstract provided.

Designing Next-Generation Cardiometabolic Outcome Trials For Obesity Medicines, Elke Platz, Alexander Peikert, Biykem Bozkurt, Bart Van Der Schueren, Javed Butler, Ildiko Lingvay, Darren K Mcguire, Faiez Zannad, Naveed Sattar

Faculty, Staff and Students Publications

The prevalence of obesity has reached pandemic proportions and is having enormous public health effects. Obesity increases the risk of type 2 diabetes, hypertension, chronic kidney disease, and cardiovascular (CV) disease including coronary artery disease, heart failure, atrial fibrillation, and stroke. Although initial randomized clinical trials of weight-loss strategies through diet and exercise or early medical therapies did not lead to improved CV outcomes, more recent trials using glucagon-like peptide-1 (GLP-1) receptor agonists in individuals with obesity have demonstrated CV benefits. At present, there are multiple cardiovascular outcome trials (CVOTs) of novel GLP-1 receptor agonists and investigational products targeting multiple …

Obstructive Sleep Apnea Treatment Modifies The Effectiveness Of Catheter Ablation For Atrial Fibrillation: Post Hoc Analysis Of The Cabana Trial, Matthew W Segar, Kaleb D Lambeth, Brett Doliner, Joshua R Hirsch, Abdi Rasekh, Mehdi Razavi

Faculty, Staff and Students Publications

No abstract provided.

Rhesus Macaques With An Opa1 Mutation Demonstrate Features Of Autosomal Dominant Optic Atrophy, Tracy N Jaggers, Ana Ripolles-Garcia, Ala Moshiri, Brett D Story, Jun Wang, Rui Chen, Lucy G Moore, Leandro B C Teixeira, Jaeho Shim, Ana C Raposo, Maria Isabel Casanova, Sophie M Le, Sangwan Park, Laura J Young, Soohyun Kim, Karolina P Roszak, Vanessa Ureno, Paige M Karpinen, Nayeli Echeverria, Monica Ardon, Brian C Leonard, Marguerite Knipe, Eliza Bliss-Moreau, Brad Fortune, J Timothy Stout, Jeffrey Rogers, Nicholas Marsh-Armstrong, Sara M Thomasy

Faculty, Staff and Students Publications

Autosomal dominant optic atrophy (ADOA) is an inherited optic neuropathy primarily caused by mutations in OPA1. We identified and defined a spontaneous nonhuman primate (NHP) model of ADOA using rhesus macaques heterozygous for a missense mutation (OPA1A8S). With ocular examinations, ophthalmic imaging, electroretinography, histopathology, immunohistochemistry, and transmission electron microscopy (TEM), we documented retinal nerve fiber layer (RNFL) thinning, retinal ganglion cell (RGC) loss and dysfunction, OPA1 mislocalization, and reduced axonal mitochondrial density in affected macaques. Our investigation revealed substantial phenotypic variability among affected macaques, shedding light on the pathogenesis of ADOA. The retinas were evaluated using techniques …