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Indirect Requests: Sociopragmatic Aspects Of Non-Conventionalised Indirect Directives, Hammed Mohammadpanah

Linguistics & TESOL Dissertations - Archive

Directives are divided into three types, corresponding to different levels of explicitness. To get a hearer who has left the front door open on a cold winter night while taking off their shoes, one can use a direct directive (e.g., Close the door!), a conventionalised indirect directive (e.g., Can you close the door?), or a non-conventionalised indirect directive (e.g., It’s –15 outside.). Inherently implicit in nature, non-conventionalised indirect directives (NCIDs) have been understudied due to being the most context-dependent and form-independent type of directives, which underscores the central role of context-based inferencing and contextual salience in processing and studying them. …

Advance Care Planning Utilization Among Non-White Individuals With Heart Disease And Cancer Using Health Retirement Study (Hrs) Data, Trizah M. Njoroge

Nursing Dissertations - Archive

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …

Improving Glucose Levels In Adults With Type 2 Diabetes, Kaitlin Castillo

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Type 2 diabetes is a growing health crisis, posing significant challenges not only to individual well-being but also to healthcare systems' financial sustainability. The prevalence of type 2 diabetes continues to rise annually, contributing to increased medical costs, hospitalizations, and long-term complications. Houston, Texas, has a diabetes prevalence of 13.5%, exceeding the national average of 10%. A clinical gap exists in providers’ ability to prevent and manage type 2 diabetes. Prioritizing prevention, early intervention, and improved patient monitoring can reduce incidence rates, lower healthcare costs, and enhance overall population health. A Plan Do Study Act model was utilized for the …

Reducing Stress Related To Injection Therapy: A Zen Bundle Approach, Valoree Bowen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Needle fear and stress are common barriers preventing adults from seeking necessary medical treatments, including intramuscular (IM) injection therapy. Research highlights the need for evidence-based interventions to mitigate this fear and improve patient experience.

Objective: This evidence-based pilot project included a Zen Bundle—an intervention incorporating shared decision-making, aromatherapy, and distraction—to evaluate the impact on stress reduction and patient satisfaction in a retail vitamin shop in North Texas.

Methods: The project utilized a pre-and post-intervention design over eight weeks. Participants completed pre-surveys assessing stress levels using a Visual Analog Scale before choosing an intervention (aromatherapy, distraction, or both) during IM …

Management Of Obesity In Adults 18 And Older, Donna Callicoat

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Obesity is a significant public health concern in the United States, with increasing prevalence and substantial healthcare costs. Despite evidence-based guidelines for obesity management, primary care clinics often fail to implement them effectively, leading to missed opportunities in preventing obesity-related comorbidities such as cardiovascular disease, type 2 diabetes, and certain cancers.

Purpose: This evidence-based project aimed to implement the American Heart Association/American College of Cardiology/Obesity Society (AHA/ACC/TOS) obesity guidelines in a rural Texas primary care clinic. The goal was to assess the effectiveness of these guidelines in reducing weight, body mass index (BMI), and waist circumference among adults with …

Multidisciplinary Approach To Reduce The Heart Failure Readmission Rate, Nisha Thekkedam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States, 6.7 million adults have been diagnosed with heart failure (HF), a number projected to rise to 8.5 million by 2030. National data indicate a 30-day readmission rate of 18.2% among HF patients from 2010 to 2017. In Texas, around 12% of the Medicare population in Texas, and specifically 11% of the Medicare population in North Texas County, have been treated for HF. A North Texas hospital reports an 18-20% HF readmission rate over the past several years. Purpose: This EBP project included the implementation of a care bundle using the Dutch Heart Failure …

Reducing Caregiver Burden For The Caregivers Of Heart Failure Patients, Joyce W. Kimani

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Family members and friends of heart failure patients serve as informal caregivers for many heart failure patients, helping with the management of day-to-day heart failure care. Many caregivers of heart failure patients experience stressors associated with caregiving, including social, psychological, financial, emotional, and physical stress. Reducing caregiver burden is important in improving both patient and caregiver well-being. Healthcare systems can improve caregiver outcomes and encourage the long-term sustainability of informal caregivers by addressing caregiver needs through focused support strategies. The Agency for Healthcare Research and Quality framework was used to develop an evidence-based guideline that healthcare professionals can follow in …

Efficient Treatment Of Postoperative Nausea And Vomiting In Adults Recovering From General Anesthesia, Peter A. Palko

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

This manuscript explores strategies to address postoperative nausea and vomiting (PONV), a significant complication affecting up to 30% of surgical patients and 80% of those at high risk. Despite its prevalence, appropriate prophylactic administration of antiemetic medications remains suboptimal, with national rates at 67% and certain academic facilities reporting only 32%, far below the 90% recommended threshold. These deficiencies underscore the urgent need for evidence-based interventions to enhance clinical adherence and improve patient care outcomes.

A quality improvement (QI) initiative was implemented to enhance prophylactic treatment and reduce inefficiencies in PONV management. Following a comprehensive literature review, the project employed …

Guideline For The Management Of Immunotherapy-Related Adrenal Insufficiency At A Cancer Center, Rachna R. Patel

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.

Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Tips Toolkit To Prevent Falls In Hospitalized Older Adults: A Rural Hospital Approach, Viridiana G. Gonzalez Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Falls remain the leading cause of injury-related deaths among hospitalized older adults, contributing to significant morbidity, extended hospital stays, and increased healthcare costs. Implementing effective fall prevention strategies is especially challenging in rural hospitals due to staffing shortages, limited funding, and variability in clinical practice.

Local Problem: A 30-bed Medical-Surgical Unit in a rural Southwest Texas hospital experienced a rise in patient falls among older adults aged 65 and older, including several incidents requiring advanced medical treatment and one resulting in serious injury. A gap analysis revealed inconsistent implementation of tailored fall prevention strategies.

Methods: A quality improvement (QI) …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

Portable Magnetic Resonance Imaging Safety, Comfort, And Compatibility With Mobile Vehicular Platforms, Jacob Howard

Yale Medicine Thesis Digital Library

Magnetic Resonance Imaging (MRI) has evolved rapidly since its early days of imaging vials of water and mice when it was known as “zeugmatography”. As advancements in semiconductors increase computational power and algorithmic techniques stretch what we can do with this power, MRI capability is advancing beyond the conventional restraints of room-bound scanners. Low-field magnetic resonance imaging (LF-MRI) that utilizes magnets typically 1/10th the size of traditional magnets has opened the door to mobilizing this imaging modality and increased flexibility in scanner design. With these developments, a new generation of portable MRI (pMRI) is beginning its use in the hospital …

Sharing Unexpected News After Traumatic Death: A Modified Delphi Study, Kirsten Lalli

Yale Medicine Thesis Digital Library

BackgroundGlobally, violence against healthcare workers in Emergency Departments (EDs) is alarmingly common and increasing in prevalence. While workplace violence is possible in any patient encounter, disclosure of traumatic deaths to family and friends may be uniquely high-risk.

Research AimsThe objective of this study is to establish consensus guidelines with multidisciplinary staff to improve safety in the emergency department of a large, urban, Level I trauma center when disclosing traumatic deaths.

HypothesisInterdisciplinary professionals in an emergency department can create consensus around best practices to improve safety in the ED when disclosing traumatic deaths.

MethodsWe conducted this study using a modified Delphi …

The Influence Of Gender On Perceptions Of Warmth And Competence In Leaders, Atticus Carroll

Open Access Master's Theses

Humans rely on stereotyping to simplify and process a complex world. The Stereotype Content Model (SCM) identifies two main dimensions of stereotyping known as warmth and competence. Previous literature has focused on perceptions of cisgender men and cisgender women, referring to those whose gender identity aligns with their sex assigned at birth, along these dimensions. However, nonbinary individuals reject the traditional gender binary, and it is not known how warmth and competence perceptions will be applied to this demographic. This study investigated whether a nonbinary leader would be rated lower on warmth, competence, and desire to have as a boss …

A Systematic Review Of The Role Of Emotion Regulation In Predicting Behavioral Inhibition Symptoms Among School-Aged Youth, Anne C. Nields

Open Access Master's Theses

Mental health challenges represent a key construct to focus on in support of childhood and adolescent well-being. Mental health challenges represent the leading cause of disability among children and adolescents. Recent research on critical periods in brain development shows that early childhood and adolescence mark times in which behavioral, neurodevelopmental, and mental health features arise. Anxiety disorders, which involve the excessive presence of fear and anxiety, are among the most common psychiatric disorders affecting youth and adults today. Emotion regulation (ER) and behavioral inhibition are important constructs correlated to anxiety which may be leveraged to predict and intervene on the …

Predicting Evapotranspiration, Quick Flow, And Recharge In The Contiguous United States Through 2100, Paige Aldenberg

Open Access Master's Theses

Groundwater pumping has more than doubled since 1950 across the United States and now accounts for more than 50% of water use in much of the country. These high pumping rates have exceeded recharge in many aquifers, especially in the dry Western United States. As a result, water levels are declining, increasing water scarcity for humans, and causing various adverse ecosystem impacts. So, predictions of future groundwater recharge rates, especially in the face of changing climates, are necessary for informing future water management practices. While historical groundwater recharge rates have been estimated across broad geographic regions, high-resolution predictions of future …

Analyzing Manual Careful And Destructive Disassembly Using Decision Trees For Consumer Electronics Battery Cells, Ivy Ozuna

Open Access Master's Theses

In a world increasingly powered by portable electronics, the amount of battery waste produced and how to process the waste is paramount. An important component of these devices is the lithium-ion (Li-ion) cylindrical batteries, which store the power essential to their function. Cylindrical Li-ion cells - particularly the 18650, 21700, and 26650 formats - are among the most widely used battery types due to their standardized design, durability, and high energy density. Their cylindrical shape provides structural integrity, making them resistant to mechanical stress and thermal fluctuations. Additionally, their widespread adoption in industries like consumer electronics (CEs), electric vehicles (EVs), …

Impact Of Adverse Childhood Experiences And Hostile Attribution On Adult Romantic Relationship Dynamics, Richeila Lora

Open Access Master's Theses

The purpose of this study was to examine whether experiencing ACEs and hostile attributions led to engaging in conflict behaviors in adult romantic relationships. Additionally, it was examined whether hostile attributions served as a moderator in the relationship between experiencing ACEs and engaging in conflict behaviors. Participants were adults (N = 3.684) from the German Family Panel dataset. Structural equation modeling was used to examine the associations between experiencing ACEs, hostile attributions, and conflict behaviors. It was found that both experiencing ACEs and hostile attributions were related to engaging in conflict behaviors. However, hostile attributions did not serve as …

Diet Quality And Quality Of Life Among People With Parkinson’S Disease, Elizabeth Tierney

Open Access Master's Theses

Poor diet quality (DQ) and reduced quality of life (QoL) are concerns for people with Parkinson’s disease (PwPD). Non-motor (NMS) and motor symptoms (MS) significantly impact the DQ and QoL of PwPD which can be alleviated through diet intervention. This study examined the relationship between DQ and QoL in PwPD and investigated participant perspectives to identify themes related to nutrition care. This was a secondary data analysis of EMPOWER PD. Diet intake was assessed via the Dietary Screening Tool (DST). Quality of life was assessed by the Parkinson’s Disease Questionnaire-39-item (PDQ-39). Participant perspectives were collected through 1:1 interviews. Nineteen participants …

Herbivore Kairomones Affect Germination Speed, Seedling Growth, And Herbivory, Brooke Pellegrini

Open Access Master's Theses

Seeds and seedlings are particularly vulnerable to herbivory. Unlike mature plants, which can wait until herbivory is experienced to induce defense, seeds and seedlings face mortality if they wait. Slug mucus functions as a kairomone, a non-attack-related substance emitted by consumers that is detected by a prey species (in this case, plants). While snail mucus has been shown to induce defense in seedlings, it is not widely confirmed whether slugs have the same effect and whether seeds can also detect and react to such herbivore cues. We investigated how exposure to Arion subfuscus mucus affected growth and defense in Brassica …

Financial Factors And Relationship Satisfaction: A Systematic Review Using The Tccm Framework, David Gardner

Open Access Master's Theses

Relationship satisfaction is critically important for the overall health of the relationship and is therefore inherently desirable for anyone who wants to maintain a long-term romantic relationship. Financial factors have been associated with relationship satisfaction in past research, demonstrating a need for systematic exploration. The purpose of the study is to systematically explore how financial behaviors, values, and macroeconomic systems are connected to relationship satisfaction. The current systematic review follows the PRISMA framework for exclusion and identifies 30 articles studying financial factors and relationship satisfaction from Scopus, PsychInfo, and Web of Science. The analysis followed the Theory, Context, Characteristic, and …

Evaluating Yield And Quality Of Heat-Tolerant Broccoli Varieties For Rhode Island Farmers, Calla Pederson

Open Access Master's Theses

In the United States, broccoli is a popular vegetable, important for its nutrition and economic contributions alike. However, its future production is at risk as broccoli prefers cooler climates, with an optimal temperature range of 15 - 23°C (59 - 73°F) for growth, especially in the weeks leading up to harvest. Temperatures above this threshold lead to failure to develop, damage, and unmarketability. There has also been an emphasis on bringing broccoli production back to the East coast from California, as climate events threatened Californian agriculture and local food has become popular, necessitating outside of season broccoli production during times …

Investigation Of Csld And Pme Genes In Cell Division And Expansion In Physcomitrium Patens, Lia Bozza

Open Access Master's Theses

Cellulose Synthase-Like Ds (CSLDs) are cellulose synthase known to participate in cell plate formation and cell wall remodeling. In the moss model, Physcomitrium patens, double csld2/6 knockout (KO) mutants were previously shown to have gametophore leaf phenotypes that are consistent with defects in cytokinesis, including irregular cell shape, cell separations, and incomplete midrib formation (Wu et al., 2023a). When these mutants were grown on ammonium-free medium to promote gametophore development, the severity of the phenotype was more extreme, including incompletely formed cell plates and multinucleated cells (A. Roberts, personal communication). It was also reported that expression of several enzymes …

Pathogen Surveillance Of Viruses And Antimicrobial Resistance Through Wastewater Based Epidemiology, William Strike

Theses and Dissertations--Biomedical Engineering

Pandemic surveillance is a cornerstone in public health safety, as it enables identification of pathogens circulating within a community before they become widespread outbreaks. Wastewater based epidemiology has blossomed in recent years due to its success in the SARS-CoV-2 pandemic, but this form of public health surveillance has a global equity problem. A large majority of the wastewater-based surveillance work has been done in large metropolitan cities with access to advanced testing infrastructure, which poses a challenge as we consider where pandemics have historically emerged. Therefore, there is a need to identify, adapt, and develop workflows to meet the needs …

Earthquake Wrangler: Leveraging Ios Technology For Earthquake Detection And Early Warning Application To Enhance Public Safety., Luis F. Salome

Theses and Dissertations--Civil Engineering

Earthquakes are devastating natural phenomena and generate secondary hazards such as tsunamis, landslides and fires. Their catastrophic impacts span both developed nations including the United States, Japan, Turkey, and Italy and developing countries such as El Salvador, Haiti, Nepal and the Philippines, where disparities in early warning infrastructure remain important. Seismic events start with stress waves generated by tectonic plate motion, with body waves (P- waves and S-waves) and surface Rayleigh and love waves that carry energy through the earth. While some regions have adopted advanced early warning systems based on seismic hazard models and strong ground motion analysis, others …

Augmenting Machine Learning Technique Through Natural Language, Tasmia Tasrin

Theses and Dissertations--Computer Science

While artificial intelligence (AI) and machine learning (ML) have proven effective at addressing many of the challenges that we face in our everyday lives, there are many situations in which these methods struggle. Examples include environments where AI or ML systems must perform complex behaviors or those where rewards are difficult to calculate. To address this limitation, interactive machine learning (IML) techniques have been introduced, which incorporate machine-understandable human feedback into traditional ML approaches. This feedback is often given as a discrete, positive or negative numeric value. This feedback is typically provided as often as possible to convey a dense …

Preserving Nature: Mapping Patriarchal And Imperial Control In Victorian Fiction, Hannah Schultz

Theses and Dissertations--English

In Thomas Hardy’s Tess of the D’Urbervilles, a group of fallen women see “themselves and surrounding nature forming an organism of which all the parts harmoniously and joyously interpenetrated each other” (65). As relational, boundary-dissolving, ecological subjects, these women are empowered above society’s judgment, made “sublime as the moon and stars” (65). By analyzing such representations of ecological relationality in Victorian fiction, my dissertation reveals new forms of agency for women and racialized others. While many ecofeminists have historically disavowed the nature-gender link as reinforcing the shared oppression of nature and marginalized groups, I depart from this standpoint, as …