Digital Commons Network^™

Lifestyle Modifications Versus Antihypertensive Therapy: Efficacy In Blood Pressure Control Among Adults With Hypertension, Alexander J. Butler

The PA Department Journal of Medical Science

Hypertension is one of the leading causes of cardiovascular disease and preventable deaths in the United States. Pharmacological treatment remains the standard of care despite challenges such as cost, adherence, and side effects. The purpose of this article is to discover the effectiveness of non-pharmacological treatment in comparison to pharmacological treatment for reducing blood pressure in patients with hypertension. PubMed was searched using key terms such as “HTN,” “antihypertensive,” “antihypertensive agents,” “exercise,” “physical activity,” and “running.” Operators and filters were used to narrow results down to 31 where 4 quality articles were selected for review. Non-pharmacological treatment/lifestyle changes produced reductions …

Treating Adult Adhd: Comparing The Effectiveness And Tolerability Of Stimulant And Non-Stimulant Medications, Sara Dahbour

The PA Department Journal of Medical Science

Introduction: Adult ADHD can impair work, relationships, and quality of life. Stimulants are commonly first-line treatment, but adverse effects, misuse concerns, contraindications, and medication availability can limit use. This review compared stimulant and non-stimulant medications in adults with ADHD for effectiveness and tolerability.

Methods: PubMed was searched using the terms “ADHD,” “stimulant medications,” and “non-stimulant medications.” Filters were applied for English-language, free full-text articles published from 2021 through 2026, including randomized controlled trials, systematic reviews, and meta-analyses. Of 38 filtered results, four articles were selected for relevance to effectiveness, tolerability, adverse effects, and quality of life in adults …

Targeting Downstream Nmda Receptor Pathways In Ischemic Stroke: A Literature Review Of Emerging Adjunctive Therapies, Lauryn P. Pergal

The PA Department Journal of Medical Science

In the United States, an estimated 795,000 people experience a first or recurrent stroke each year.¹ Despite advances in early recognition protocol, reperfusion therapies, and rehabilitation, stroke is still the fourth leading cause of death, after heart disease, cancer, and accidental injury. Ischemic strokes account for around 87% of all strokes.¹ Long-term sequelae of ischemic stroke survivors include disability, dementia, depression, and ongoing fatigue.² As a result, stroke causes decreased quality of life, economic burden, and caregiver stress.

Management strategies for ischemic stroke have evolved considerably over the past several decades. The current acute treatment strategy focuses …

Evaluating Finerenone For Kidney Disease Progression In Patients With Type Two Diabetes And Chronic Kidney Disease, Erin C. Elgas

The PA Department Journal of Medical Science

Introduction: Type two diabetes contributes to chronic kidney disease progression in a multitude of ways within metabolic and hemodynamic factors. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, offers new solutions in slowing or stopping kidney disease progression in type two diabetics. The purpose of this review is to understand if adding finerenone can help slow kidney disease progression in adults with type two diabetes already receiving RAS inhibition.

Methods: A specific PubMed search with keywords including “type two diabetes”, “kidney disease” and “finerenone”, with filters and operators applied, supplied four articles for review.

Results: Finerenone was associated with decreased primary kidney …

A Policy Analysis Of Accountability And Governance In Journalism By Artificial Intelligence (Ai) In Egypt, Amira Ahmed Salama

Theses and Dissertations

The growing use of Generative Artificial Intelligence (GenAI) and AI-assisted tools in journalism raises governance questions concerning accountability, human oversight, transparency, verification, editorial responsibility, and implementation. In Egypt, these issues arise within an emerging but fragmented governance environment that includes national AI guidance, media regulation, professional self-regulation, and developing newsroom practices. This study examines how these arrangements can be integrated into a coherent national sector-specific policy framework for GenAI and AI-assisted journalism.

The study adopts a qualitative methodology combining a descriptive qualitative document analysis with stakeholder semi-structured interviews. Four governance instruments were analyzed: the Council of Europe’s Guidelines on the …

Grievability Of The Abject As Narrated By Exiles, Sylvia Azmy

Theses and Dissertations

This thesis analyzes two novels: Inaam Kachachi’s Sawaqi al-Qulub (2005) and Shady Lewis’s ʿAla Khatt Grinitsh (2019), to understand the relationships between figures of migration, as the exile narrates his encounters with refugees. It uses Julia Kristeva’s Powers of Horror: An Essay on Abjection (1980) and Judith Butler’s Frames of War: When Is Life Grievable? (2009) as theoretical frameworks to examine the deaths of refugees and their corpses (utmost of abjection) in the two novels. Scholars have argued that the literature of forced migration is becoming more inclusive than migration narratives, a term that has focused on student travelers, exilic …

Pathways Of Influence: Indigenous Peoples’ Agency And Leadership In Arctic Governance, Justin Barnes

Theses and Dissertations (Comprehensive)

For the peoples and communities who have lived in the Arctic since time immemorial, Arctic governance is not only about international cooperation, environmental management, or geopolitical competition. It is also about sustaining and advocating for Indigenous livelihoods, relationships with land and water, rights and responsibilities, and opportunities for future generations – all themes directly affected by political decisions made across local, regional, national, and international levels. This dissertation begins from a central question about how Indigenous Peoples exercise their agency and influence in Arctic governance despite operating within an international system largely organized around states. It examines this phenomenon by …

The Bidirectional Effects Of Traumatic Brain Injury And Caudal Fin Amputation On Regeneration In Zebrafish (Danio Rerio), Makenna Wiebe

Theses and Dissertations (Comprehensive)

Traumatic brain injury (TBI) and caudal fin amputation initiate robust regenerative responses in adult zebrafish (Danio rerio), yet whether regenerative activity in one tissue influences repair at a distant site remains unclear. This study investigated the bidirectional effects of concurrent brain and peripheral injury on regeneration and functional recovery. Specifically, we assessed the effects of TBI on caudal fin regeneration, caudal fin amputation on neural stem cell-associated cellular responses, and combined injury on behaviour. Adult zebrafish received no injury, TBI, caudal fin amputation, abdominal puncture, or combined TBI and caudal fin amputation. I assessed caudal fin regeneration morphometrically and evaluated …

The Power Of The Mind: Exploring The Perceived Benefits Of Spiritual Meditation For Children's Loss And Grief, Shefali Bhalla

Theses and Dissertations (Comprehensive)

Grief and loss can significantly affect children’s emotional, cognitive, and social development, yet many existing interventions remain difficult to access due to stigma, cost, and limited cultural fit. Meditation has shown promise as a low-cost and adaptable strategy for supporting emotional regulation, but little is known about how children themselves perceive its usefulness in grief-related contexts. The present study explored children’s beliefs about the usefulness of spiritual meditation as a coping strategy across grief, interpersonal conflict, and positive emotional vignettes. Fourteen children between the ages of 8 and 13 participated in individual Zoom sessions in which they listened to three …

Endogenous Light In The Brain: Investigating Sources, Propagation, And State-Dependent Emission, Emre Cicek

Theses and Dissertations (Comprehensive)

Ultraweak photon emission (UPE), and by extension light, has long been thought to be a modality of communication in nature. Prior studies have already identified that UPE can depend on cell type and can be used to discern between malignant and benign cells. However, besides theoretical models, not much effort has been made to identify possible biological structures that would allow for light to be used as a method of communication in the human body. According to the framework set by Shannon’s Information Theory, for communication to be possible at minimum a transmitter, a transmission channel, and a receiver are …

Time Series Mediation Analysis With Non-Linear And Machine Learning Methods, Timothy Marsh

Theses and Dissertations (Comprehensive)

Non-linearity in mediation analysis has been primarily studied in the context of binary variables which encode a treatment and control, estimating a `direct` and `indirect` effect of a covariate (a.k.a. treatment) X on a response Y, with a third variable M (the `mediator`) that is affected by X and in turn affects Y. The focus of mediation analysis in general is to quantify the overall effect of X on Y, including the effect through M. This presentation will focus on one or more continuous treatments and apply non-linear methods, including splines and machine learning models, to mediation analysis in a …

Sediment Redox-Driven Iron Flux And Phytoplankton Community Responses: Implications For Cyanobacterial Suppression And Functional Stability Across Boreal Lakes, Julia K. Kozak

Theses and Dissertations (Comprehensive)

Freshwater eutrophication contributes towards the development of cyanobacterial harmful algal blooms (cHABs), but nutrient availability alone does not fully explain variation in phytoplankton community composition or physiological performance. While phosphorus (P) availability has been known to regulate phytoplanktonic biomass, iron (Fe) is an important micronutrient supporting Fe-heavy processes within cyanobacteria (i.e., nitrogen fixation and photosynthetic electron transport). Sediment Fe availability in freshwater ecosystems is regulated by reduction oxidation (redox) conditions at the sediment-water interface (SWI), where nitrate (NO₃^-) has been found to maintain oxidizing conditions and prevent the reduction of Fe(III) to more readily bioavailable soluble Fe(II), …

Diagnostic Delays In Endometriosis Among Reproductive-Aged Women: An Evidence-Based Primary Care Policy Proposal, Francis P. Ronayne

Capstones

No abstract provided.

Sustainable – Low-Cost - Upgrade Of Activated Sludge Process For Nitrogen And Phosphorus (N&P) Removal From Wastewater, Abanoub N. Basta

Theses and Dissertations

Many municipal wastewater treatment plants (WWTPs) in developing countries were designed primarily for organic matter and suspended solids removal and therefore face increasing difficulty in meeting modern nitrogen (N) and phosphorus (P) discharge requirements. Conventional biological nutrient removal upgrades commonly require additional reactor volume, recirculation systems, aeration energy, and capital investment. Accordingly, sustainable retrofit strategies that improve nutrient removal within existing treatment footprints are increasingly needed, particularly in water-scarce and land-constrained regions.

This study investigated the integration of water hyacinth (Eichhornia crassipes) into the aeration stage of an activated sludge process as a hybrid nature-based enhancement for nitrogen and phosphorus …

A Comparative Study: Force Majeure And The Theory Of Unforeseen Circumstances Across Different Jurisdictions In The Middle East, Omar Hamed Sawan

Theses and Dissertations

The motivation behind this study stems from recent global disruption events that impact construction projects worldwide. These events vary across a wide spectrum, whether they are political events such as the Russo-Ukraine war or the war in the Middle East, economic events such as inflation or currency devaluations; or environmental events such as climate change and the emergence of public health crises like the Covid-19 pandemic. These series of events underscore the growing importance of understanding how the different legal frameworks address unforeseeable events in the construction industry. In this context, force majeure and the theory of unforeseen circumstances (also …

Improving Adherence To The Ticket-To-Test C. Difficile Protocol In A Medical-Surgical Microsystem, Georgette Marie D. Lim

Master's Projects and Capstones

Problem: Poor adherence to the ticket-to-test protocol on the 3 South unit led to unnecessary C. difficile testing, inappropriate isolation, and workflow variation. These issues mirror national concerns about over-testing and misdiagnosis, which can inflate hospital‑onset C. difficile rates and increase costs.

Context: This project was implemented on a medical‑surgical unit, a team with a strong culture of collaboration, education, and engagement in quality improvement. The unit benefits from structured oversight through the C. difficile committee, which reports to the performance improvement team.

Interventions: The Institute for Healthcare Improvement Model for Improvement guided four PDSA cycles, with …

From State To Nation: A Federal Framework For Breast Cancer Primary Prevention Informed By California's Paths To Prevention, Serena Padda

Master's Projects and Capstones

The United States’ federal government should adopt a primary prevention framework for breast cancer modeled after Breast Cancer Prevention Partners’ (BCPP) Paths to Prevention: the California Breast Cancer Primary Prevention Plan. The plan focuses on systemic actions to reduce breast cancer risk through a social and racial justice lens. Breast cancer is the leading diagnosed cancer among women in the United States, with incidence rates increasing annually by 1% since 2012. Disparities persist in communities disproportionately burdened by chemical and environmental exposures, contributing to unequal and preventable risk. Current federal policy focuses primarily on secondary prevention through screenings, which does …

Nourishing Births: A Program Evaluation Proposal For Community-Based Nutrition Education, Food Access, And Garden Engagement Among Black Birthing People, Naa Deedei-Vera Hammond

Master's Projects and Capstones

Black birthing people in the United States continue to experience unequal maternal health outcomes, shaped in part by racism and barriers to nutritious food, culturally relevant health education, and supportive community spaces. While prenatal nutrition education and food assistance programs can provide important resources, information alone cannot address the challenges many people face when trying to access healthy and affordable food during pregnancy. The Nourishing Births Initiative is a proposed community-based maternal health program designed to respond to these needs by bringing together prenatal nutrition education, help connecting to food resources, community gardening, and peer support for Black birthing people …

Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

Impact Of Implementing Standard Wound Care Guidelines For Patients In The Home Care Setting On Patient Outcomes, Raymond Anthony Flores Jr

Doctor of Nursing Practice (DNP) Projects

Wound care is among the most significant public health concerns, affecting millions of people worldwide. Most individuals with wounds end up self-managing their condition from their homes due to being discharged early from the hospital, owing to various reasons, and the costs associated with health care. Although home wound management offers convenience and lower costs for patients, it is also associated with substantial challenges, including limited access to and use of appropriate care protocols, wound management tools, and sufficient education on the topic, as well as limited professional advice. These limitations contribute to poor outcomes, including slow healing rates, infections, …

Deep Brain Stimulation In Early-Stage Alzheimer's Disease: A Systematic Review Of Neuropsychological Outcomes, Nora Huey

Doctoral Dissertations

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory impairment, and disruption of neural networks involved in cognitive functioning. Although existing treatments may provide symptomatic benefit, there remains a need for interventions capable of slowing or stabilizing disease progression. Deep brain stimulation (DBS) has emerged as a potential neuromodulatory intervention for early-stage AD through stimulation of memory- and cognition-related neural circuitry. This dissertation employed a systematic review research methodology to examine teh neuropsychological and neurobiological outcomes associated with DBS targeting the fornix (DBS-f) and nucleus basalis of Meynert (DBS-NBM) in individuals with early-stage AD over 12–24 …

Adolescent And Young Adult Cancer Survivorship: Supportive Care Needs, Resources, And Barriers, Allison Bryn Koplos

Master's Projects and Capstones

Background: Adolescent and young adult (AYA) cancer survivors experience unique physical, psychosocial, developmental, and healthcare-related challenges that often persist beyond treatment completion. Although survivorship resources have expanded, gaps in supportive care needs persist. This scoping review examined the supportive care needs, survivorship resources, and barriers to accessing supportive care among AYA cancer survivors.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. Peer-reviewed literature published between 2000 and 2026 was identified through searches in PubMed and Google Scholar. Studies examining supportive care needs, survivorship resources, or supportive care services …

The Making Of A Counselor: How My Life Shaped My Purpose, Grace M. Christopherson

Dissertations, Theses, and Projects

This Plan B Project Analysis of Self explores the life experiences of an aspiring school counselor. The goal of a self-analysis project is to further explore the contents of oneself before entering the mental health field. Personal stories and experiences will be debriefed with the purpose of showing what has led to a pursuit in a career as a mental health counselor. Assessment results will also be shown and drawn from further enhancing the analysis of self. Additionally, theoretical orientation will be elaborated on and illustrated. All the different aspects of the analysis of self will reveal development both professionally …

Robust Statistical Methods For Microbiome Abundance Data, Yiming Shi

WUSM Theses and Dissertations – All Programs

Differential abundance analysis in microbiome studies aims to identify taxa whose abundance differs across biological or clinical conditions. The observed data are typically taxon-specific sequencing read counts, representing reads assigned to different taxa within each sample. These counts are indirect measurements of the underlying microbial abundance profile and are constrained by sample-specific library sizes. Microbiome count data are also typically sparse, overdispersed, and heteroscedastic. Together, these characteristics create substantial challenges for differential abundance analysis and make the results highly sensitive to normalization procedures, model specification, and the statistical methods used for inference.

Normalization defines the scale on which samples are …

Interplay Of Autophagy And Mtor Signaling On Amyloid-Beta, Samuel Wycoff

WUSM Theses and Dissertations – All Programs

Alzheimer's disease (AD) is characterized by the accumulation of amyloid-β (Aβ), a process thought to result from an imbalance between Aβ production and clearance. Autophagy, a major intracellular degradation pathway regulated by the mechanistic target of rapamycin (mTOR), has emerged as a potential therapeutic target for restoring Aβ homeostasis, although its precise role in Aβ metabolism remains unclear. This study investigated how pharmacological modulation of autophagy and mTOR signaling influences Aβ levels in both in vitro and in vivo models.

Wild-type SH-SY5Y neuroblastoma cells were treated with a panel of autophagy-modulating compounds, and extracellular Aβ secretion was quantified alongside the …

Surveillance And Comparative Genomics Of Bacteria From Hospital And Human Reservoirs, Emily E. Benedict

WUSM Theses and Dissertations – All Programs

Bacteria are diverse and adaptable and, consequently, present in a wide variety of environments. They are capable of growing under intense pressures, including those brought on by the human immune system and disinfection strategies. To survive these pressures, bacteria develop resistances. Antimicrobial resistance, which occurs when a microbe is no longer responsive to the antibiotic intended to control it, is one such adaptation that presents an especially serious threat, as it limits treatment options for infections caused by antimicrobial resistant microbes. Similarly, the ability of bacteria to survive in environments subjected to heavy disinfection efforts, such as intensive care units …

Investigating The Ability Of Presequences To Influence Mitochondrial Protein Import, Youmian Yan

WUSM Theses and Dissertations – All Programs

Mitochondria are essential organelles housing over 1000 proteins, 99% of which are nuclear-encoded and synthesized in the cytosol. Most mitochondrial proteins are targeted by a positively charged sequence called the presequence, which lacks a common sequence motif and is poorly conserved across evolution. Accumulating evidence suggests that presequences encode meaningful information that influences mitochondrial protein uptake. For instance, multiple stress response models propose that stress sensing proteins contain “weak” presequences which allows them to monitor mitochondrial health. However, there is a lack of systematic examination about how presequences influence import kinetics and what constitutes presequence strength. These gaps in knowledge …

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 …

Multiomic And Single-Cell Analysis Of Tumors And Their Immune Microenvironment For Personalized Cancer Therapy, Kartik Singhal

WUSM Theses and Dissertations – All Programs

Precision oncology aims to match cancer treatment to the biology of an individual patient’s tumor. However, tumors that share a diagnosis can differ in their molecular features, cellular composition, clinical course, and response to therapy, making it difficult to determine which treatment will benefit an individual patient. This dissertation integrates genomic, transcriptomic, and single-cell multiomic computational analysis to characterize tumors across their somatic alterations, transcriptional cell states, microenvironment, and the immune response they elicit.

The first study describes a rare case of donor-derived follicular lymphoma following kidney transplantation. Genomic profiling showed that the donor and recipient tumors shared 31 somatic …

The Impact Of A Play-Based Nature Camp On Self-Regulation In School-Age Children, Margaret Berkemeyer

Doctoral Dissertations

This study is a program evaluation with a mixed-methods design that evaluated the effectiveness of Y Rangers, a summer camp offered by the YMCA of San Francisco, in increasing the self-regulation abilities of school-age children. A total of 18 caregivers completed the quantitative portion of this study that included pre/post-test analyses of self-regulation measures. There were no statistically significant changes between pre and post assessments of self-regulation. A subset of seven caregivers and three Y Rangers counselors participated in interviews, the transcripts of which were analyzed using interpretive phenomenological analysis. Caregivers experienced Y Rangers as a unique opportunity for their …