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Decreasing Emergency Department (Ed) Revisits: Providing Resources That Address Overutilization For Patients With Substance Use Disorder, Amber May

Doctor of Nursing Practice Final Project Abstract

Date of Doctor of Nursing Practice Project Completion

Summer 8-5-2025

Faculty Advisor

Rebecca Tsusaki PhD, APRN-CNP, WHNP-BC, IBCLC

ABSTRACT

PURPOSE This quality improvement project was intended to decrease emergency department (ED) revisits by 10%, from high-utilizer patients (those with more than 10 ED visits in the past year), by implementing community health worker–led follow-up phone calls within one week of discharge, over a 30-day period. The project was conducted at a large metropolitan hospital in Houston, Texas.

BACKGROUND Non-urgent revisits and overutilization affect ED wait times, are associated with overcrowding, contribute to unnecessary care delays, impact patient satisfaction scores, and …

Staff Education Program To Improve Nursing Knowledge On Fall Prevention Strategies, Chioma C. Achonye

Walden Dissertations and Doctoral Studies

In nursing practice, falls among adults aged 65 and above are a critical concern due to their potential to cause serious injuries and complications. As a result, fall prevention has become a top priority for healthcare providers striving to ensure patient safety and quality. The Doctor of Nursing Practice (DNP) project was designed to address the issue of falls in long-term care facilities by implementing a staff education program focused on patient fall risk assessment, identifying intrinsic and extrinsic factors influencing falls, and implementing evidence-based interventions. The DNP project practice-focused question was Does an education program on fall prevention strategies …

Enhancing Nursing Knowledge Of Sud Screening Tools In Va Primary Care, Marlene Joan Margerum

Walden Dissertations and Doctoral Studies

Substance use disorders (SUDs) are a persistent public health concern among veterans. A recognized knowledge gap exists among Veterans Affairs (VA) primary care nurses regarding validated SUD screening tools—the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C), Drug Abuse Screening Test (DAST-10), and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)—limiting opportunities for early identification and coordination of care. This Doctor of Nursing Practice (DNP) project evaluated if a structured staff education intervention improved primary care nurses’ knowledge, confidence, and preparedness to support interdisciplinary SUD screening practices. Guided by Patricia Benner’s novice to expert model and the analysis, design, development, implementation, and …

Coming Out And Social Acceptance: Understanding Lgbtq Veterans' Minority Stressors, Conrado Augustine Martin

Walden Dissertations and Doctoral Studies

This quantitative study explored the experiences of LGBTQ veterans residing in Ohio, examining the relationship between the coming out process, social acceptance, and minority stress. Lesbian, gay, bisexual, trans, and queer (LGBTQ) military veterans face higher rates of minority stressors, resulting in higher rates of suicidal ideation and mental health issues, which impact healthcare practices that affirm their identity. Discrimination, microaggressions, coming out, identity disclosure, and social belonging were identified as key contributing factors. Guided by Meyer’s minority stress theory, the study aimed to assess whether levels of outness, and identification with the LGBTQ community correlated with experiences of minority …

Staff Education To Improve Knowledge Of The Patient Health Questionnaire-9 Assessment, Josie Weber

Walden Dissertations and Doctoral Studies

This doctoral project was focused on a staff education initiative to enhance the proper use of the Patient Health Questionnaire-9 (PHQ-9), a validated depression screening tool, in an outpatient behavioral health (OBH) clinic. Despite its clinical utility, the PHQ-9 is often underused or inconsistently applied due to knowledge gaps among nursing staff. Inconsistent screening can delay diagnosis and treatment, negatively affecting patient outcomes. I conducted this project to address these gaps by implementing structured training to promote high-quality, patient-centered care. The practice-focused question was: Does a structured PHQ-9 training session improve staff knowledge in an outpatient behavioral health clinic, as …

Socioeconomic Determinants Of Depression And Anxiety Disorders In Puerto Ricans Living On The Island And The Mainland, Herman Alvarado

Walden Dissertations and Doctoral Studies

Research shows that, among Hispanics, depression and anxiety disorders are the two most prevalent mental disorders, particularly for Puerto Ricans. The socioecological model approaches mental health conditions from a perspective where multiple levels in society influence health-related behaviors. Based on this approach, this quantitative study looked at how socioeconomic factors - marital status, education, employment, and residential status were related to a diagnosis of depression or anxiety in Puerto Ricans. This study also explored whether there were differences between two groups of Puerto Ricans: those living on the island compared to those living in the 50 states. Analysis was conducted …

Perceptions Of Nonclinical Healthcare Executives On Advancing Physical Therapists Into Executive Healthcare Leadership Positions, Lindsey Johnston

Walden Dissertations and Doctoral Studies

Healthcare professionals often aspire to transition beyond clinical roles into organizational leadership. In particular, physical therapists may seek executive leadership opportunities beyond rehabilitation departments. However, there is limited understanding of how nonclinical healthcare executives perceive physical therapists advancing into these roles. This qualitative study aimed to understand nonclinical healthcare executives' perceptions regarding physical therapists’ advancement to executive healthcare leadership positions. The study was guided by new institutional theory and Level 5 leadership theory and addressed four research questions to explore these perceptions in depth. A general qualitative methodology was employed, with data collected through semistructured, virtual interviews with eight nonclinical …

Real-Time Temperature Estimation Of The Machine Drive Sic Modules Consisting Of Parallel Chips Per Switch For Reliability Modelling And Lifetime Prediction, Tamer Kamel, Olamide Olagunju, Temitope Johnson

School of Engineering, Computing and Mathematics

This paper presents a new methodical procedure to monitor in real time the junction temperature of SiC Power MOSFET modules of parallel-connected chips utilized in machine drive systems to develop their reliability modelling and predict their lifetime. The paper implements the on-line measurements of temperature-sensitive electrical parameters (TSEP) approach, particularly the quasi-threshold voltage and the on-state drain to source voltage, to estimate the junction temperature in real time. The proposed procedure firstly applied computational fluid dynamics analysis on the module under study to determine the chip which undergoes the maximum junction temperature during typical operation of the module. Then, a …

Helping Families Learn About Social Emotional Learning, Madalyn Ross

Masters Projects

Having developmentally appropriate social-emotional skills is an essential component of a growing child, yet many children lack the social-emotional skills necessary to be successful in the classroom. Families play an important role in the development of a child, but research shows that there are significant gaps in the knowledge and use of social-emotional learning (SEL) that families have. This project explores the importance of family involvement and knowledge surrounding SEL by looking at certain aspects that hinder SEL growth, such as trauma and excessive screen time, and aspects that help children excel in SEL development, such as teacher education and …

Information Theory Optimization Of Signals From Small-Angle Scattering Measurements, Robert P Rambo, John A Tainer

Faculty, Staff and Student Publications

Small-angle X-ray scattering (SAXS) of particles in solution informs on the conformational states and assemblies of biological macromolecules (bioSAXS) outside of cryo- and solid-state conditions. In bioSAXS, the SAXS measurement under dilute conditions is resolution limited, and through an inverse Fourier transform, the measured SAXS intensities directly relate to the physical space occupied by the particles via the P(r)-distribution. Yet, this inverse transform of SAXS data has been historically cast as an ill-posed, ill-conditioned problem requiring an indirect approach. Here, we show that through the applications of matrix and information theories, the inverse transform of SAXS intensity data is a …

Association Between Allostatic Load And Accelerated White Matter Brain Aging: Findings From The Uk Biobank, Li Feng, Zhenyao Ye, Zewen Du, Yezhi Pan, Travis Canida, Hongjie Ke, Song Liu, Shuo Chen, L Elliot Hong, Peter Kochunov, Jie Chen, David K Y Lei, Edmond Shenassa, Tianzhou Ma

Faculty, Staff and Student Publications

White matter (WM) brain age, a neuroimaging-derived biomarker indicating WM microstructural changes, helps predict dementia and neurodegenerative disorder risks. The cumulative effect of chronic stress on WM brain aging remains unknown. In this study, we assessed cumulative stress using a multi-system composite allostatic load (AL) index based on inflammatory, anthropometric, respiratory, lipidemia, and glucose metabolism measures, and investigated its association with WM brain age gap (BAG), computed from diffusion tensor imaging data using a machine learning model, among 22 951 European ancestries aged 40 to 69 (51.40% women) from UK Biobank. Linear regression, Mendelian randomization, along with inverse probability weighting, …

Perspectives On Career Advising At A Large Private Religious Institution, Lane Toshio Muranaka

Theses and Dissertations

This study examines the role of career advising at Brigham Young University (BYU), a faith-based institution where professional guidance focuses on spiritual development and purpose-driven learning. Through qualitative interviews with career advisors across various disciplines, the research explores how advisors define student success, integrate faith into their advising practices, and support students in aligning their career aspirations with personal meaning and the university's religious mission. Grounded in the belief that holistic education fosters lifelong success, BYU emphasizes the development of the "total person," including moral and spiritual dimensions. Findings reveal that student success is not solely measured by employment outcomes …

Metabolic Dysfunction-Associated Steatotic Liver Disease In People With Type 1 Diabetes., Brynlee Vermillion, Yuanjie Mao

Ambulatory and Primary Care Articles

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a significant comorbidity in individuals with type 1 diabetes (T1D), despite its historical association with type 2 diabetes. This review focuses on summarizing current findings regarding the role of insulin resistance in the development of MASLD in T1D, as well as examining the relationship between MASLD and diabetes-related complications. We will also briefly discuss the prevalence, diagnostic challenges, associated complications, and potential mechanisms underlying MASLD in T1D. Although insulin resistance is well established in MASLD among those with type 2 diabetes, its role in T1D requires further clarification. Emerging markers, …

Method For Target Detection In A High Noise Environment Through Frequency Analysis Using An Event-Based Vision Sensor, Will Johnston, Shannon Young, David Howe, Rachel Oliver, Zachary Theis, Brian Mcreynolds, Michael L. Dexter

Faculty Publications

Event-based vision sensors (EVSs), often referred to as neuromorphic cameras, operate by responding to changes in brightness on a pixel-by-pixel basis. In contrast, traditional framing cameras employ some fixed sampling interval where integrated intensity is read off the entire focal plane at once. Similar to traditional cameras, EVSs can suffer loss of sensitivity through scenes with high intensity and dynamic clutter, reducing the ability to see points of interest through traditional event processing means. This paper describes a method to reduce the negative impacts of these types of EVS clutter and enable more robust target detection through the use of …

Interactive 3d Segmentation For Primary Gross Tumor Volume In Oropharyngeal Cancer, Mikko Saukkoriipi, Jaakko Sahlsten, Joel Jaskari, Lotta Orsmaa, Jari Kangas, Nastaran Rasouli, Roope Raisamo, Jussi Hirvonen, Helena Mehtonen, Jorma Järnstedt, Antti Mäkitie, Mohamed Naser, Clifton Fuller, Benjamin Kann, Kimmo Kaski

Faculty, Staff and Student Publications

Radiotherapy is the main treatment modality of oropharyngeal cancer (OPC), in which an accurate segmentation of primary gross tumor volume (GTVt) is essential but also challenging due to significant interobserver variability and the time consumed in manual tumor delineation. For such a challenge an interactive deep learning (DL) based approach offers the advantage of automatic high-performance segmentation with the flexibility for user correction when necessary. In this study, we investigate an interactive DL for GTVt segmentation in OPC by introducing a novel two-stage Interactive Click Refinement (2S-ICR) framework and implementing state-of-the-art algorithms. Using the 2021 HEad and neCK TumOR dataset …

Examining The Factor Structure And Correlates Of The Flourishing-At-Work Scale In United States School Psychologists, Nikita Pike

Electronic Theses and Dissertations Archive

Despite moderate levels of stress and burnout in their work, school psychologists in the United States tend to be satisfied with their jobs. Although researchers have addressed why school psychologists view their work as important, there is yet another important feature of the workplace that has not been examined in this population: flourishing at work. This study aimed to enhance the understanding of flourishing at work in school psychologists by examining an existing scale, the Flourishing-at-Work Scale, completed online by a national sample of United States school psychologists. Data from a sample of 369 practicing school psychologists were used in …

Examining The Active Ingredients In An Anti-Stigma Intervention For Individuals With A Criminal History, Kaylee Cook

Electronic Theses and Dissertations Archive

Obtaining employment is key to successful reintegration for people who have been incarcerated. However, employers are often hesitant to hire formerly incarcerated persons due to general negative attitudes toward them and concern that they will not exhibit positive work behaviors. Interventions to reduce general types of stigma exist, with primary strategies involving education and/or contact. Most research examining the effectiveness of stigma-reducing strategies largely focus on reducing identity-based stigma (e.g., race, mental illness), with limited research on reducing choice-based stigma, such as those with criminal histories. However, regardless of targeted stigma, there is no consensus regarding which intervention format (i.e., …

A Critical Seat At The Table: A Qualitative Examination Of Resiliency And Retention Among Black School Psychologists, Jasric Bland

Electronic Theses and Dissertations Archive

As discussions on systemic racism, diversity, equity, and inclusion in education increase, advocacy for Black students is essential, as their voices are often undervalued (Anderson & Graham, 2015). School psychologists play a crucial role in decisions that affect students’ academic, social, and emotional well-being, yet the challenge of increasing Black representation in the field persists (Goforth et al., 2021; Grapin et al., 2016; Proctor et al., 2017), making advocacy and representation a challenge. This raises an important question about retaining Black practitioners within school psychology, however, research on the resiliency and retention of Black school psychologists remains limited. Further studies …

A Legacy Of Writing, Teaching, And Leading: Amplifying The Voices Of Four Women Who Shaped The National Writing Project, Ellen Ann Shelton

Electronic Theses and Dissertations Archive

The origin story of the National Writing Project (NWP) is attributed to James Gray, who, in 1974, developed the foundations of a program that would eventually become a national network of teacher-leaders. Networks, however, require multiple theories of action to move forward into the future. They cannot survive on one person’s vision alone. To meet the needs of K16 educators in an ever-changing education landscape, the initial vision needed broadening, models of work, multiple points of entry, and a constant focus of keeping teachers at the center of the work. Because of the work of many, the network continues 50 …

Gender And Sexuality In Homeschooling: An Analysis Of Gender Constructs And Sexual Behaviors Within Homeschooling Communities, Hannah Grace Badley

Electronic Theses and Dissertations Archive

Homeschooling has grown increasingly popular as a form of alternative education both in the United States and globally. However, research examining the public health implications of this homeschooling is minimal, especially research focusing on sexual behaviors and gender identity development. Similarly, research on homeschooling tends to focus on the caregivers' or parents' perceptions or motivations to homeschool, as opposed to centering the experiences and voices of those who are or were homeschooled. Because of this, very little is known about the ways homeschooled youth experience sexual health education, how gender identity development occurs, and how homeschoolers access reproductive healthcare. To …

Three Essays In Forward-Looking Statements, Social Media Collaboration, And Climate Talents, Jing-Chi Chen

Electronic Theses and Dissertations Archive

This dissertation consists of three essays on Forward-Looking Statements (FLS), Social Media Collaboration, and Climate Talents. The first essay examines how FLS impact investor trading behavior and market liquidity. We find that FLS are associated with reductions in investor trading costs, largely driven by lower market-maker inventory costs. FLS also associate with increased market depth on both sides of the bid-ask spread and greater retail and institutional trading activity, with retail investors being more responsive. Cross-sectional tests show these associations are stronger during market downturns and when earnings guidance is absent. Results are robust to instrumental variable regressions using managerial …

Matters Of The Heart And Mind: Cardiovascular And Psychosocial Risk Factors For Cognitive Impairment And Dementia Among Older Adults In The Us, Markquest Jarius Ajoku

Electronic Theses and Dissertations Archive

Cognitive function decline has been associated with cardiovascular and psychosocial factors. The resulting cognitive impairment and dementia (CID), including Alzheimer’s disease and other related dementia, impose a significant burden among older adults (aged 65 or older), which is expected to increase by 55% or more. CID affected 20% of older adults in the US, and the risk of CID doubles every five years after age 65. This study examined the impact of heart diseases or stroke, depressive symptoms in middle-age, and loneliness on the risk of CID among older adults in the US. We conducted a longitudinal study using the …

Integrating The Simplified Silhouette Score Into The Vector In Partition (Vip) Algorithm For Cluster Validation, Luke Xavier Pirrotta

Electronic Theses and Dissertations Archive

Clustering analysis is a fundamental technique in machine learning, with K-means and its variants being widely used for their interpretability and efficiency. The Vector in Partition (VIP) algorithm extends K-means by incorporating a multi-dimensional distance measure for nested genetic data structures. Still, it inherits the challenge of selecting the optimal number of clusters (k). This thesis proposes integrating the simplified silhouette score (SSI) into VIP’s optimization options to improve k selection. Through simulation studies comparing SSI with currently implemented methods (Elbow, Slope, and Minimum AIC and BIC), we demonstrate that SSI consistently performs on par or better than existing methods, …

Doping-Driven Modulation Of Structural, Magnetic, And Magnetocaloric Properties In Orthochromites For Advanced Low-Temperature Cooling Technologies, Jolaikha Sultana

Electronic Theses and Dissertations Archive

Magnetocaloric oxides materials have garnered increasing attention as environmentally friendly materials that may be used in systems that are alternatives to conventional gas-based refrigeration, a notable example being low-temperature magnetic cooling applications. In this study, the structural, magnetic, and magnetocaloric properties of Al3+-doped rare-earth orthochromites (RECrO3, where RE = Ho, Er, Gd, Tm, Tb, and La) were systematically investigated. A gradual decrease in lattice parameters and unit cell volume was observed from LaCrO3 to TmCrO3, consistent with the expected lanthanide contraction across the rare-earth series. The substitution of Al3+ at the Cr3+ site induced lattice contraction, reduced octahedral distortion, and …

The Role Of Lithium-Ion Batteries Vent Gas Production On Thermal Runaway Propagation In Containerized Energy Storage Systems, Ala' Qatramez

Electronic Theses and Dissertations Archive

This study assesses the safety hazards associated with lithium-ion battery vent gas in containerized energy storage systems, focusing on convective heat transfer caused by direct impingement during thermal runaway. Computational fluid dynamics using k-ω SST turbulence model and LIM1TR, a thermal runaway model, simulations were used to study the dynamics of vent gas jet and estimate the heat fluxes and convection heat transfer coefficients at the module's top surface. Twelve cases were investigated, varying three gap heights between cells and their module walls chosen based on estimates from a deployed system, along with four vent gas jet velocities based on …

Extreme Value Theory View Of High Emitter Diesel Vehicles In The Us From 1991 To 2021, M. Matti Maricq, Gary A. Bishop

Fuel Efficiency Automobile Test Publications

Extreme value theory (EVT) is a statistical method to characterize the tails of distributions, such as high emitter vehicle emissions. The present work addresses the United States (US) diesel fleet. EVT confirms that high emitters contribute disproportionately to adverse air quality. It further reveals that high emitter emissions have responded differently to progressively tighter emissions standards compared to fleet averages. Carbon monoxide (CO) and hydrocarbons (HC) high emitter emissions fell in concert with the fleet average after widespread implementation of the diesel oxidation catalyst to meet US Environmental Protection Agency (EPA) Tier 1 emissions standards, but remained unchanged after introduction …

Conservative Oxygen Therapy In Mechanically Ventilated Critically Ill Adult Patients: The Uk-Rox Randomized Clinical Trial, Uk-Rox Investigators, Daniel S Martin, Doug W Gould, Tasnin Shahid, James C Doidge, Alex Cowden, Zia Sadique, Julie Camsooksai, Walton N Charles, Miriam Davey, Amelia Francis-Johnson, Roger M Garrett, Michael P W Grocott, Joanne Jones, Lamprini Lampro, Diane M Mackle, B Ronan O'Driscoll, Alvin Richards-Belle, Anthony J Rostron, Tamás Szakmány, Alex Warren, Paul J Young, Kathryn M Rowan, David A Harrison, Paul R Mouncey

Peninsula Medical School

IMPORTANCE: Supplemental oxygen is frequently given to patients in intensive care units (ICUs); however, there is insufficient evidence to guide its therapeutic use and to minimize the potential harm caused by administering too little or too much.

OBJECTIVE: To determine whether reducing exposure to supplemental oxygen through a strategy of conservative oxygen therapy by using a peripheral oxygen saturation (Spo2) target of 90% (range, 88%-92%) reduces mortality at 90 days in mechanically ventilated adult patients receiving supplemental oxygen in the ICU.

DESIGN, SETTING, AND PARTICIPANTS: Multicenter, pragmatic, randomized clinical trial conducted in 97 ICUs in the UK including 16 500 …

Rare Variants In Bmal1 Are Associated With A Neurodevelopmental Syndrome, Vishnu Anand Cuddapah, Dechun Chen, Bumsik Cho, Rebecca Moore, Mohnish Suri, Hana Safraou, Frederic Tran-Mau-Them, Ashley Wilson, Jacqueline Odgis, Atteeq U Rehman, Carol Saunders, Shiva Ganesan, Vaidehi Jobanputra, Stephen W Scherer, Ingo Helbig, Amita Sehgal

Duncan NRI Faculty and Staff Publications

Children with neurodevelopmental disorders exhibit highly penetrant sleep and circadian dysfunction, but the underlying mechanisms are unclear. We asked whether a subset of individuals with neurodevelopmental disorders might have genetic variants in genes known to drive circadian rhythms. Through international collaboration, we identified ten individuals with very rare genetic variants in BMAL1, a core component of the molecular clock. These individuals exhibited overlapping signs and symptoms including developmental delay, autism spectrum disorder, and variably penetrant marfanoid features. We functionally tested the identified BMAL1 variants in cell culture and in vivo and found disrupted BMAL1 function. These findings demonstrate that …

Survival To Hospital Discharge In The Fetus With Moderate To Severe Mitral Regurgitation Either In Isolation Or In Combination With Aortic Valve Stenosis Or Atresia, A Fetal Heart Society Collaborative Study, Betul Yilmaz Furtun, Kavitha Pundi, Anita Moon-Grady, Nicole Cresalia, Asela Nieuwsma, Sarah K Gelehrter, Bhawna Arya, Mary T Donofrio, Christopher Statile, Ann Kavanaugh-Mchugh, Lindsay Freud, Elijah Bolin, Megan Warner, Sowmya Balasubramanian, James Strainic, Carol Wittlieb-Weber, Nelangi M Pinto, Lisa Hornberger, Shaine A Morris

Faculty, Staff and Students Publications

Background: Case series report high mortality after fetal diagnosis of moderate to severe mitral regurgitation in combination with left atrial dilation, hydrops, or restrictive atrial septum. However, overall outcomes and specific high-risk features remain unclear.

Methods: We performed a multicenter retrospective cohort study of fetuses with ≥moderate mitral regurgitation and normal cardiac connections evaluated January 1, 2005 to January 31, 2016. Fetuses undergoing fetal cardiac intervention (FCI) were described separately. We assessed associations between fetal echocardiographic features and discharge mortality using mixed logistic regression and classification and regression tree modeling, stratified by studies performed < 28 and ≥28 weeks gestational age (GA).

Results: Of 67 fetuses, 96% had …

Leishmania In Texas: A Contemporary One Health Scoping Review Of Vectors, Reservoirs, And Human Health, Morgan H Jibowu, Richard Chung, Nina L Tang, Sarah Guo, Leigh-Anne Lawton, Brendan J Sullivan, Dawn M Wetzel, Sarah M Gunter

Faculty, Staff and Students Publications

Leishmaniasis, a vector-borne neglected tropical disease, affects over 6.2 million people globally. Case acquisition is increasingly recognized in the United States, and in Texas, most reported cases are locally acquired and speciated to Leishmania mexicana. We conducted a scoping literature review to systematically assess contemporary research on Leishmania in humans, animals, reservoir hosts, or vectors in Texas after 2000. Out of 22 eligible studies, the most prevalent themes were case reports, followed by studies on domestic animals, reservoirs, and vectors, with several studies bridging multiple disciplines. Climate change, urbanization, and habitat encroachment appear to be driving the northward expansion …