Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

Chapter 16 - Representing Clients Who Are Mentally Ill Or Intellectually Disabled, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

There are, however, some clients who are not competent to make decisions affecting their own welfare; and counsel may need to take special measures in these cases. If counsel reasonably believes that mental illness or an intellectual disability has so severely “diminish[ed]” the client’s “capacity to make adequately considered decisions in connection with the representation . . . [that] a normal client-lawyer relationship with the client” cannot be maintained, and if counsel furthermore “reasonably believes” that the client “is at risk of substantial physical, financial or other harm unless action is taken and [that the client] cannot adequately act in …

Pride And Portrayal: The Effects Of Gender Identity And Generational Cohort On Lgbtq+ Perceptions Of Media Coverage, Dang H. Le

Communication Theses - Archive

Public debates over LGBTQ+ issues have intensified in the United States in recent years, placing news media at the center of conflicts over representation, fairness, and credibility. While a substantial body of research has analyzed how LGBTQ+ people are portrayed in news coverage, far less attention has been paid to how LGBTQ+ audiences themselves evaluate that coverage. Understanding these perceptions is increasingly important as declining trust in journalism intersects with political polarization and ongoing policy debates surrounding LGBTQ+ rights. This study examines how generational cohorts and gender identity shape LGBTQ+ audiences’ perceptions of news coverage quality, perceived media hostility, and …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Implementing A Standardized Resilience Bundle For Neonatal Intensive Care Nurses, Jennifer Bouzid

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Nurse resilience is associated with improved psychological well-being, professional satisfaction, and retention. Neonatal intensive care unit nurses are frequently exposed to emotionally traumatic clinical events that may contribute to burnout, compassion fatigue, and turnover. A women’s hospital in central Texas identified increased nurse turnover and lower employee engagement scores related to well-being and intent to stay within the neonatal intensive care unit.

Purpose: The purpose of this quality improvement project was to implement and evaluate a standardized resilience support bundle for nurses following traumatic clinical events.

Methods: Guided by the Plan-Do-Study-Act framework, the project implemented a resilience bundle that …

The Role Of Parenting In Mitigating Epigenetic Cardiometabolic Risk In Predominantly Latino Preschoolers, Adamari López

Open Access Master's Theses

Background: Childhood obesity is a highly prevalent public health concern with significant consequences for health and development across the lifespan. Risk is disproportionately elevated among children from marginalized racial and ethnic groups and socioeconomically disadvantaged backgrounds, highlighting persistent disparities in long-term health outcomes. Epigenomic mechanisms, including DNA methylation (DNAm), have emerged as a promising approach for understanding the biological embedding of metabolic risk; however, prior research has largely emphasized deficit-based models, with limited attention to protective family-level factors. The present study examined whether participation in a positive parenting intervention was associated with epigenetic cardiometabolic risk among preschool-aged children. Methods …

Exploratory Investigation Of Greenhouse Gas Emissions In A Natural And Restored Salt Marsh, Sophia Motta

Open Access Master's Theses

Coastal wetlands are typically considered greenhouse sinks, specifically playing an important role in the global carbon cycle (Chmura et al., 2003), but new studies have pointed to anthropogenic interference leading to the understanding that altered tidal salt marshes may also be producers of methane to the atmosphere, contributing to the greenhouse effect. Hydrologic alteration including due to sea level rise (SLR), peat subsidence, impounded water, and decreased accretion rate disruption can have negative effects on marsh biochemistry leading to potential changes in electron acceptor availability, redox gradient shifts, and microbial community structure within the environment. This research is intended to …

Herbivore Cues And Plant Damage-Associated-Compounds Jointly Alter Seed Germination And Seedling Herbivory, Katherine Overstrum

Open Access Master's Theses

While plant defense against herbivory is primarily thought to occur following attack, there is also evidence that plants can detect and respond to pre-attack cues. These cues include chemicals released from damaged conspecifics and kairomones, non-attack-related substances emitted by an herbivore that plants can detect and use to their benefit. It is unknown, however, whether or how plants react to the interaction of these pre-attack cues. We measured germination, growth, and herbivore susceptibility of B. nigra seedlings in an experiment that crossed the presence/absence of crushed B. nigra leaves with the presence/absence of mucus of a generalist herbivore, A. subfuscus …

Ensemble Dependence Of Mechanical Relaxation In Molecular Dynamics Simulation, Mason E. Hyde

Open Access Master's Theses

This thesis investigates whether the selection of thermodynamic ensemble introduces quantifiable differences in the stress relaxation modulus G(t), storage modulus G”(w), loss modulus G”(w), and phase angle d(w) computed from equilibrium molecular dynamics simulations of the AAA-1 asphalt model. A 72-molecule, 12-component representation of AAA-1 bitumen was simulated under three ensembles (NPT, NVT, and NVE) at three temperatures (400.15 K, 443.15 K, and 533.15 K) with three independent replications at each condition, yielding 27 total simulations. Stress autocorrelation functions were computed from each production trajectory and Fourier-transformed to obtain frequency-dependent rheological properties.

The computed properties …

Kinematic And Muscle Activity Differences During Dual Task Cutting In Ncaa Soccer Players, Abigail Mccarthy

Open Access Master's Theses

Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries in collegiate soccer, but also in the world. Professional soccer observes a prevalence of around 10-18 percent (Walden et al., 2013). The United States alone reports up to 2 million acute ankle sprains annually (Herzog et al, 2019). LAS ranked top 3 in types of injuries within collegiate soccer with hamstring tears and concussions (Chandran et al., 2021). Around 40 percent of people who experience a lateral ankle sprain will experience chronic ankle instability, and since spraining ankle once at a greater risk now for spraining ankle again. …

Noninvasive Optical Assessment Of Tissue Hemodynamics In Preterm Infants And Mastectomy Skin Flaps, Samaneh Rabienia Haratbar

Theses and Dissertations--Biomedical Engineering

Adequate tissue blood flow and oxygenation are essential for maintaining cellular viability and normal organ function. Disruptions in microvascular perfusion and oxygen delivery contribute to ischemia- and hypoxia-related diseases, including stroke, cancer, retinopathy of prematurity (ROP), and mastectomy skin flap necrosis. Reliable, noninvasive approaches for assessing tissue hemodynamics are therefore critical for improving diagnosis and therapeutic decision-making, particularly in settings where conventional methods are limited. This dissertation investigates the clinical and physiological importance of measuring tissue blood flow and oxygenation across neonatal and surgical applications using both clinical monitoring and advanced optical imaging techniques. In the first study, high-speed pulse …

Evaluating Training Effectiveness And Learning Transfer In The Kentucky Transportation Cabinet Safety Academy, Amanda L. Casolare

Theses and Dissertations--Civil Engineering

Effective evaluation of safety training is crucial to ensure that learning translates into safe work practices, particularly in high-risk public sector environments. The Kentucky Transportation Cabinet (KYTC) is developing a Safety Academy to enhance hazard recognition, risk management, and safety leadership within the organization. However, the Safety Academy has not yet been implemented, and formal evaluation methods for training have not been established. This study aimed to examine evidence-based training evaluation techniques and develop recommendations for evaluating the KYTC Safety Academy prior to program implementation.

This study employed an applied pre-implementation research design grounded in a comprehensive review of safety …

Other Eyes: The Dilemma Of Authorship And Autobiography In Sylvia Plath, John Ashbery, And Cristina García, Kevin J.B. O'Connor

Theses and Dissertations--English

This dissertation analyzes authorship in contemporary American literature, harnessing the writings—prose and poetry—of Sylvia Plath, John Ashbery, and Cristina García to challenge traditional classification and periodization schema. Hewing to the notion of authorship as a dilemma—a simultaneity of forces pressing upon the author, demanding a response—each chapter unravels critical moments of authorial expression that continually inscribe the importance of praxis and futurity. Comprehending authorship as a relational dilemma to be brooked, and indeed, overcome in a panoply of gestures, frees it theoretically from the perils of prior models by drawing attention to authorship’s agential and multi-modal aspects. Melding archival research …

Clinical Test Cases For Commissioning, Qa, And Benchmarking Of Model-Based Dose Calculation Algorithms In 1⁹2ir Hdr Gynecologic Tandem And Ring Brachytherapy, Vasiliki Peppa, Maude Robitaille, Fatemeh Akbari, Shirin Enger, Rowan Thomson, Firas Mourtada, Gabriel Fonseca

Department of Radiation Oncology Faculty Papers

PURPOSE: To develop clinically relevant test cases for commissioning Model-Based Dose Calculation Algorithms (MBDCAs) for ¹⁹²Ir High Dose Rate (HDR) gynecologic brachytherapy following the workflow proposed by the TG-186 report and the WGDCAB report 372.

ACQUISITION AND VALIDATION METHODS: Two cervical cancer intracavitary HDR brachytherapy models were developed based on a real patient, using either uniformly structured regions or realistic segmentation. The patient's computed tomography (CT) images were processed, converted to a series of digital imaging and communications in medicine (DICOM) CT images, and imported into two treatment planning systems (TPSs), the Oncentra Brachy and BrachyVision. The original segmentation …

Inside The Box: Containerization And The Limits Of Trade Unionism In The International Longshoremen's Association, 1945-1977, Calvin Horning

Theses and Dissertations--Geography

The International Longshoremen’s Association (ILA), the union of dock workers on the East Coast of the United States, saw a dramatic change in form and fortune in the middle of the 20^th century as the shipping industry and global labor underwent an immense reorganization. In the context of this reorganization, I argue that due to internal conservatism and racism alongside external state pressure, the ILA moved from an unruly, mafia-ruled union to a highly organized, professionalized, well-paid core of workers that served to support the United States’ capitalist-imperialist project.

Through archival material spanning over three decades, I analyze the …

Economic Inequality And Family Formation In The United States, Elizabeth S. Krause

Theses and Dissertations--Economics

This dissertation evaluates economic inequality and family formation in the United States in three essays. In Essay 1, I estimate the effect of providing subsidized access to immediate postpartum contraceptives on birth spacing and infant health among low-income teen mothers. The intent-to-treat estimates indicate a 20% reduction in the monthly short-interval birth rate among teens 12-14 months after policy enactment. I also find evidence that the policy increased the average interval between births and reduced preterm and low-birth weight births and NICU admission rates. In Essay 2, I provide evidence that single mothers and single women without children are important …

Metabolism As A Regulator Of Sleep And Cortical Activity In Health And Alzheimer’S Disease, Nicholas J. Constantino

Theses and Dissertations--Neuroscience

Metabolic flexibility is essential for maintaining normal physiological function, enabling an organism to sense, flux, utilize, and switch fuel sources in response to changing energetic availability, demand, and cellular needs. Energetic demands are state-dependent, with wake and sleep exhibiting distinct metabolic profiles. Sleep is highly sensitive to changes in metabolism and requires metabolic flexibility to both transition into and maintain sleep stability. Alzheimer’s disease (AD) is increasingly recognized as a disease of altered metabolism yet is often framed as a disease of energetic failure. We instead define AD as a disease of metabolic inflexibility, characterized not by insufficient energy availability, …

Beyond The Veil: Critical Black Kantianism And The Ethics Of Structural (In)Visibility, Paradise A. Stanford

Theses and Dissertations--Philosophy

This dissertation develops what I call Critical Black Kantianism, a reconstructive approach to Kantian moral philosophy that centers race, recognition, and the structural conditions under which moral agency is formed. While Kantian ethics typically presumes idealized agents operating within just social contexts, this project argues that such abstraction obscures how racial domination actively shapes autonomy, dignity, and self-consciousness. Drawing on W.E.B. Du Bois’ account of double consciousness, Black feminist thought, and contemporary theories of recognition, I show that moral agency is not merely exercised within social environments but is constituted through them—often under conditions of misrecognition that fracture autonomy.

Against …

Linking S‑Pillar Empirical Criteria With Boundary And Finite Element Models For Underground Stone Pillar Analysis, Benjamin Diddle

Theses and Dissertations--Mining Engineering

The objective of this thesis is to strengthen the relationship between empirically based stone pillar design methods and two numerical modeling techniques by calibrating boundary element and finite element models to the S‑Pillar empirical criteria and observed pillar behavior in underground stone mines. The first component of the research investigates the displacement‑discontinuity boundary element method implemented in LaModel, quantifying the influence of the lamination thickness and element size on stone pillar safety factor predictions. Results showed that optimal thickness depends on overburden modulus, while larger element sizes introduce significant SF differences from S-Pillar values once the grid size exceeds 5 …

Reciprocity-Based Transfer Function Techniques For Acoustic Source Reconstruction, Spring Isolator Characterization And Structural Damping Assessment, David Pum Thian Lal Paite Neihguk

Theses and Dissertations--Mechanical and Aerospace Engineering

Reciprocity implies that a system responds identically when the source and receiver positions are interchanged. This dissertation applies this principle to address three practical challenges in noise and vibration characterization, where conventional approaches are limited by inaccessible interfaces, constrained excitation conditions, or metrics that do not fully capture vibroacoustic behavior.

The first study develops and validates an inverse method to characterize ducted acoustic sources using acoustic free velocity. Acoustic reciprocity is applied to simplify transfer function measurements. The method is extended to large cross-section ducts, where the source is reconstructed as a collection of point sources along a plane. Validation …

Human Resource Policy And Practice In The American Regional Theatre: The Intersection Of The Actors’ Equity Association And The League Of Resident Theatres, Kathleen Holland

Theses and Dissertations--Arts Administration

Human resource management plays a critical yet understudied role in the American regional theatre, an industry characterized by project-based labor, mixed union and nonunion workforces, and deeply ingrained cultural norms that prioritize artistic production over worker well-being. This dissertation examines how institutional human resource policies intersect with the Actors’ Equity Association (AEA) collective bargaining agreement and the League of Resident Theatres (LORT), and the implications of these intersections for human resource practice in regional theatre organizations. While entertainment-industry unions predate the formalization of contemporary human resource management, little scholarship has examined how union agreements may shape or substitute for organizational …

A Tale Of Two Serpins: Pathologic And Protective Roles Of Agt And Pai-1 In Metabolic And Cardiovascular Disease, Alex C. Pettey

Theses and Dissertations--Physiology

Metabolic and cardiovascular diseases are leading causes of morbidity and mortality worldwide. Conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD), aortic aneurysm, and cardiac fibrosis have limited pharmacological therapies, underscoring the need for deeper mechanistic investigations. Serine protease inhibitors (serpins) have been implicated in these pathologies and represent potential therapeutic targets. Despite structural homology, serpins regulate diverse physiological processes through both protease inhibition and non-inhibitory mechanisms. This dissertation examines the roles of two serpins, angiotensinogen (AGT) and plasminogen activator inhibitor-1 (PAI-1), in preclinical models of metabolic and cardiovascular disease to identify novel mechanisms that may inform future therapeutic strategies. …

Investigation Into The A/Ss Of Cervical Cancer And Its Effects On Tumor Control Probability In Radiation Therapy, Cameron Thayer-Freeman

Theses and Dissertations--Radiation Medicine

The standard of care for locally advanced cervical cancer is chemoradiation, consisting of conventional external beam therapy (EBT) followed by a boost of high dose rate (HDR) brachytherapy. These two radiation treatments will illicit different degrees of biological response depending on the tissue in question, and quantifying the overall effect the combined treatments will have require some form of biological modeling. The linear quadratic (LQ) model of cell survival is the most widely used radiobiological model in clinics across the nation.

It is quantified by the parameters a and ß, which model how radiation generates lethal damage in a population …

Seasonal Population Dynamics And Interspecific Interactions Of Drosophila Suzukii, Eleanor Mccabe

Theses and Dissertations--Entomology

Invasive species are a growing problem, and it is important to investigate how invasives interact with novel ecosystems, which are characterized by distinct abiotic and biotic factors. In this dissertation, I investigate abiotic and biotic factors affecting two invasive pests in central Kentucky, Drosophila suzukii and Zaprionus indianus. In Kentucky, seasonality, and landscape features on population dynamics and fitness are unknown. I found that D. suzukii overwinters in Kentucky and that wild berry species improve winter survival. I used local weather data to identify meteorological variables that best predict D. suzukii populations. I tested the extent to which D. suzukii …

Managing Dietary Nonstructural Carbohydrates In Insulin Dysregulated Horses: Pasture, Long-Stem Forage, And Restrictive Grazing Strategies, Morgan J. Askins

Theses and Dissertations--Veterinary Science

Insulin dysregulation (ID) is a complex endocrine disorder, impacting a large percentage of the equine population. ID is the defining characteristic of equine metabolic syndrome (EMS). Within the various classifications of EMS horses, the commonality is ID and their higher risk of laminitis. To mitigate insulin response and laminitis risk in ID horses, current management focuses on restricting pasture exposure and feeding low nonstructural carbohydrate (NSC) rations. Minimal studies have evaluated how ID horses respond to pasture of various NSC, long-stem forages, and restrictive grazing strategies. Providing horse owners and managers with improved nutritional management recommendations for ID horses with …

Between The Rails: Experiential Education And Its Impact On Compliance And Consistency In Racetrack Surface Management, Heather Mackenzie

Theses and Dissertations--Community & Leadership Development

Recent regulatory requirements within the Thoroughbred racing industry have increased expectations for consistent collection and reporting of racetrack surface data. Despite clear standards, implementation in daily operations remains inconsistent, highlighting a gap between regulation, knowledge, and practice. This study examined the impact of an experiential education curriculum on racetrack personnel’s self-efficacy and reporting consistency.

Using a quantitative design, data were collected through pre- and post-surveys measuring self-efficacy and records of the number of days surface data were entered. Descriptive statistics, paired-samples t-tests, and effect size analyses were used. Results showed a statistically significant increase in self-efficacy (p < .001) with large effect sizes, indicating meaningful gains in confidence and comfortability. Reporting consistency did not show a statistically significant change (p = .885).

Overall, experiential education …

Understanding Knowledge And Perceptions Of The Beef Industry On A Land-Grant University Campus, Allison E. Reaves

Theses and Dissertations--Community & Leadership Development

A well-researched phenomenon in the agricultural industry is the effects of constant innovation coupled with an increasing divide between producer and consumer. This issue has been presented as especially prevalent within animal agriculture and the beef industry, a predominant concern considering Kentucky’s agricultural commodities. This study (n = 31) utilized a mixed-methods approach to understand the knowledge, perceptions, and behavior of beef consumers on a land-grant university campus. Methodologies included Python’s DeepFace emotion recognition, semi-structured interviews, and the JMALI agricultural literacy assessment. Findings revealed participants to be below expected agricultural literacy levels of high school graduates (M=11), with no …

A Quality Improvement Project: Nurse-Led Nutritional Support To Reduce Missed Chemotherapy Appointments, Eva Balboa

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction/Background

Malnutrition affects approximately 43% of cancer patients nationally and is associated with missed chemotherapy appointments, treatment interruption, and poor clinical outcomes. At a 30-chair outpatient cancer center in South Texas, a retrospective chart review revealed that 45% of patients experienced malnutrition-related symptoms contributing to appointment disruptions. Despite evidence-based recommendations for routine nutritional screening and support, no standardized protocol existed at this site.

Objectives

 The purpose of this quality improvement project was to implement a nurse-led nutritional support protocol and evaluate its effectiveness in (1) reducing the missed chemotherapy appointment rate from 10% to 5%, (2) achieving 100% compliance with …

A Guideline For Underserved Adult Residents In Need Of Affordable Transportation Access To Healthcare, Tammie E. Walker

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

During the development of the 2022 Tarrant County Public Health Community Health Assessment, two gaps were identified that contribute to disparities: transportation and access to healthcare in areas of high need (Y. M. Wingate, Ed.D., Community Health Assessment Division Manager, Tarrant County Public Health, personal communication, June 20, 2025). As of 2017, 5.8 million individuals reported delaying medical care due to a lack of accessible transportation in the U.S. (Wolfe et al., 2020). The National Health Interview Survey (NHIS) of 2022 reported that 5.9% of residents living in the West South-Central region, which includes Texas, found that, within the …

Toward A World History Of Pre-Modern Coin Imitations, Niv Horesh

Comparative Civilizations Review

Among historians, it has become axiomatic that coinage over three millennia served three purposes: as a medium of exchange, as a store of value, and as a unit of account. The communicative aspects of coinage, i.e. the imagery it carries often by way of issuer propaganda, have been of less interest even if it remains the mainstay of numismatists. But in the world of numismatics, globally framed studies of imagery or iconography are rare. This article is aimed at correcting this imbalance, at least provisionally. It will explore the main archetypes of coinage imitation by way of inferring commonalities or …