Medicine and Health Sciences Commons^™

A Dosimetric Comparison Of 6-Mv Flattening Filter And Flattening Filter-Free Photon Beams For Stereotactic Body Radiation Therapy Of Adrenal Tumors, Sarah Mcintosh

Masters Projects

Purpose: This study aimed to compare dosimetric characteristics and treatment delivery efficiency between 6-MV Flattening Filter (FF) and Flattening Filter-Free (FFF) photon beams for adrenal Stereotactic Body Radiation Therapy (SBRT). While FFF beams have demonstrated dosimetric and efficiency advantages at other SBRT sites, there is limited data about their use in adrenal SBRT.

Methods and Materials: A retrospective dosimetric comparison was performed using 10 patients previously treated with adrenal SBRT. For each patient, two Volumetric Modulated Arc Therapy (VMAT) plans were generated in Eclipse: one using 6-MV FF beams and one using 6-MV FFF beams, resulting in 20 total treatment …

Examining The Association Between Socioeconomic Factors And Cervical Cancer Among Minority Women In The United States, Darla Fils

Walden Dissertations and Doctoral Studies

Cervical cancer remains a significant public health concern, with African American and Hispanic women experiencing disproportionately higher incidence and mortality rates in the United States. Socioeconomic factors, including income, education, employment status, and place of residence, may contribute to these disparities by affecting access to preventive services, timely diagnosis, and follow-up care. This quantitative cross-sectional study examined associations between these factors and cervical cancer incidence among African American and Hispanic women while controlling for age and health insurance status. Guided by the socio-ecological model, the study used 2022 Behavioral Risk Factor Surveillance System data from N = 33,886 African American …

Staff Education To Improve Diabetic Care In A Primary Care Setting, Sally Uyen Nguyen

Walden Dissertations and Doctoral Studies

Inadequate patient education, inconsistent screening, missed referrals, and follow up with diabetes patients are challenges primary care managers and staff must overcome. Patients may experience negative effects that lead to poor health outcomes, delayed diagnosis, and undertreatment when provider and staff members are not educated about diabetes. The practice-focused question guiding the Doctor of Nursing Practice (DNP) staff education project involved exploring whether a staff education intervention on standardized diabetes care and screening protocols could improve physicians, managers, and medical assistants’ (MAs) knowledge of diabetes care in primary care clinics. The purpose of this project was to enhance staff knowledge …

Staff Education To Improve Early Identification Of Behavioral Escalation And Timely Clinical Intervention In An Adult Group Home Setting, Gayduo Barr

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing Practice (DNP) staff education project addressed a gap in staff knowledge regarding the early identification of behavioral escalation and timely intervention in an adult group home setting. The practice-focused question was: Does staff education about early identification of behavioral escalation and timely clinical intervention improve the knowledge of staff working in an adult group home setting? The purpose was to improve staff knowledge of behavioral escalation, triggers, trauma-informed care, and intervention strategies. I delivered a structured educational intervention to 14 house managers. Educational content included behavioral escalation stages, triggers, de-escalation techniques, trauma-informed care, documentation, and …

Staff Education On Fall Reduction For Residents Of Long-Term Care Facility, Lauretta Ifeoma Iwuala-Mcwilliams

Walden Dissertations and Doctoral Studies

Falls pose a major safety risk for elderly individuals living in long-term care facilities, leading to injuries, hospitalizations, loss of autonomy, increased healthcare expenses, and higher morbidity and mortality rates. In the facility involved in this project, the incidence of falls was above anticipated benchmarks. Factors such as high staff turnover and reliance on agency staff resulted in inconsistent knowledge among personnel regarding fall prevention measures. Purpose: This Doctor of Nursing Practice quality improvement initiative aimed to implement and assess an evidence-based educational program designed to enhance staff understanding and skills related to fall-risk assessment, the identification of both intrinsic …

Staff Education To Improve Staff Knowledge On Fall Prevention, Nginjoh Presilia Njofang

Walden Dissertations and Doctoral Studies

Patient safety risks associated with falls are a major issue in adult inpatient medical-surgical environments because nursing inconsistencies with regard to fall risk assessments, individualized fall prevention interventions, and documentation could impede adherence to best practices. To overcome this knowledge gap among RNs in the selected environment, a DNP education project aimed at standardized fall-prevention staff education was initiated. The question for the practice was whether standardized staff education would increase knowledge among nurses regarding fall-risk assessments, preventive measures, and documentation requirements, based on pretest and posttest results. In the course of a one-hour educational session conducted face-to-face, twenty RNs …

Formative Work To Guide Implementation Of An Evidence-Based Breast And Cervical Cancer Prevention And Early Detection Behavioral Health Program In Clinics: Qualitative Study Guided By The Consolidated Framework For Implementation Research, Marlyn A Allicock, Crystal Costa, Ashley Hedrick Mckenzie, Preena Loomba, Roshanda S Chenier, Ross Shegog, Angelita Alaniz, Maria E Fernandez, Lara S Savas

Faculty, Staff and Student Publications

Background: Salud en Mis Manos (SEMM) is a community health worker-delivered evidence-based intervention shown to increase breast and cervical cancer screening in medically underserved Latinas. Despite SEMM's success in community-based settings, clinic-based implementation is limited.

Objective: This study aimed to identify factors influencing the implementation of SEMM in clinic settings using the Consolidated Framework for Implementation Research (CFIR) to inform and refine implementation strategy development.

Methods: We developed theory-informed (eg, CFIR, Social Cognitive Theory, and Readiness) interview guides to elicit barriers and facilitators of SEMM clinic implementation. We conducted 12 semistructured interviews with clinic leaders, outreach coordinators, and community health …

Urine Good Care: Catheter-Associated Urinary Tract Infection Prevention At The Bedside, Ruby Yost

Master's Projects and Capstones

Catheter-Associated Urinary Tract Infections (CAUTIs) have been associated with increased morbidity, mortality, healthcare costs, and length of stay and is one of the most common healthcare-acquired illnesses accounting for up to 40% of hospital-acquired infections (Rubi et al., 2022). Because 65-70% of CAUTIs are preventable, reducing the incidence has become a focus area for infection control and nursing quality management among hospital organizations (Tang et al. 2025). CAUTIs are urinary tract infections that occur in patients with indwelling urinary catheters and are typically associated with bacterial colonization of the urinary tract. The aim of this QI Project is to increase …

Molecular Characterization Of Pasteurella Multocida Capsular Type A Strains Isolated From Different Regions Of Anatolia, Türkiye​, Adam Bashir Tawor, Osman Ergani̇ş, Asli Balevi̇, Suliman Mohamed Yousof Sadam

Turkish Journal of Veterinary & Animal Sciences

Pasteurella multocida serotype A is an important pathogen that causes respiratory illness in both farm animals and poultry, leading to severe economic losses worldwide. This study aimed to isolate P. multocida capsular type A (capA) as well as investigate the virulence-associated genes (VAGs) within the isolates. Samples (n = 250) were collected in the Anatolia region from cattle (n = 130), sheep (n = 70), goats (n = 45), and pet birds (n = 5) with clinical respiratory signs. Polymerase chain reaction (PCR) assays were conducted using kmt1 and capA primers for P. multocida species identification and capsular serogroup A …

Creating Consistency: Standardizing Gestational Diabetes Group Visit Framework In High-Risk Obstetric Care, Danielle Pack

Master's Projects and Capstones

Objective: Gestational diabetes mellitus (GDM) requires timely and consistent education to promote effective self-management and improve maternal and fetal outcomes. Baseline observations at a Santa Clara County high-risk obstetric clinic identified variation in educational materials, educator delivery, referral processes, and workflows between English- and Spanish-language GDM group visits. A review of the literature supported standardized diabetes education and group prenatal care as strategies to improve consistency, efficiency, and patient access. Aim: This quality improvement project aimed to develop and implement a standardized GDM group visit framework for nurse practitioners, registered dietitians, and scheduling staff, with the goal of increasing compliance …

You Haven’T Been Forgotten: Driving Improvements In Trust, Transparency, And Accountability Through A Patient-Centered Communication Initiative In The Emergency Department, Ellie Mead

Master's Projects and Capstones

Objective: In Spring 2026, the Emergency Department (ED) at Hospital X identified difficulties securing high levels of patient satisfaction. Over one third of patients did not feel adequately “informed about delays,” and observation of nurse-patient interactions in front-end care areas confirmed these communication gaps: in 87% of interactions, nurses did not explain next steps to the patient, and in none of the 51 interactions observed did nurses proactively inform patients about possible delays. Aim: This quality improvement initiative sought to improve the patient experience in the ED and drive a 10% increase in Press Ganey patient satisfaction survey results relating …

Trace Elements In Complete Feeds Used In Intensive Rearing Of Cattle, Poultry, And Pigs: Occurrence And Predicted Transferred Concentrations In Animal-Derived Food, Elizabeta Dimitrieska Stojkovikj, Vangelica Enimiteva, Aleksandra Angjeleska, Risto Uzunov

Turkish Journal of Veterinary & Animal Sciences

This study investigated the concentrations of essential (Zn, Cu, Mn, Co, and Mo) and toxic (Pb, Cd, As, and Hg) trace elements in complete feeds used for the intensive rearing of cattle, poultry, and pigs in North Macedonia and predicted their transfer into animal-derived foods. A total of 107 feed samples were collected from 40 farms between May 2023 and April 2024 and analyzed using inductively coupled plasma mass spectrometry. The results revealed that while most essential elements were within the regulatory limits, Co exceeded the maximum level in two cattle feed samples. Zn, Cu, and Mn levels were generally …

Effect Of Rangeland Quality On Rumen Development Of Angora (Mohair) Goat Kids And Bucks, Betül Zehra Sariçi̇çek

Turkish Journal of Veterinary & Animal Sciences

This study was conducted to determine the effect of rangeland quality on the rumen development of Angora goat kids and bucks. Twenty male singleton Angora goat kids with similar birth dates and birth weights were selected from each farm in an area with three different rangeland quality levels (good, medium, or poor) in Ankara Province. The kids were weaned at 60 days of age and then grazed completely on rangeland until slaughter. Rumen volumetric and papillary development of animals slaughtered at 4 and 7 months of age were determined. Empty rumen length, width, and weight were affected by rangeland quality …

Arterial Architecture Of The Goat Spleen (Capra Hircus) Revealed By Corrosion Casting And Scanning Electron Microscopy, Baran Erdem, Sevi̇nç Ateş, Meryem Karan

Turkish Journal of Veterinary & Animal Sciences

The spleen is an essential organ involved in hematopoietic and immune functions. A comprehensive understanding of its anatomy, including vascular topography and segmentation, is essential for the accurate diagnosis and treatment of splenic diseases, and the minimization of complications during surgical procedures. Detailed knowledge of the vascular architecture also supports the accurate prediction and management of hemorrhage severity in cases of splenic rupture. The spleen’s microvascular system has a unique and complex organization that is distinct from other organs, and its elucidation is critical for understanding splenic function. In the present study, the spleens of 20 hair goats were examined. …

Hard Palate Morphology In The Anatolian Water Buffalo (Bubalus Bubalis), Mehmet Can, Şükrü Hakan Atalgin, Mehmet Faruk Aydin, Soner Bekmezci̇

Turkish Journal of Veterinary & Animal Sciences

This study aimed to examine the morphological and histological features of the hard palate in the Anatolian water buffalo through light and scanning electron microscopy, complemented by gross and morphometric evaluations. Eight hard palates were used in the study. A total of eight Anatolian water buffalo heads from healthy adult female water buffaloes were collected immediately after slaughter from various slaughterhouses in Balıkesir, Türkiye. After analyzing and identifying the obtained hard palate samples, measurements were taken and documented through photography. The papilla incisiva, located in the middle of the caudal concave edge on the ventral surface of the pulvinus dentalis, …

Digital Markers For Passive Remote Monitoring Of Bipolar Disorder: Systematic Review, Thomas P Kutcher, Isha Chakraborty, Kristin Kostick-Quenet, Akane Sano, Nidal Moukaddam, Jeffrey A Herron, Wayne K Goodman, Sameer A Sheth, Ashutosh Sabharwal, Nicole R Provenza

Duncan NRI Faculty and Staff Publications

Background: Bipolar disorder (BD) features episodic shifts among mania, hypomania, depression, mixed states, and euthymia. Timely detection of mood transitions is difficult due to infrequent clinical touchpoints. Digital health technologies, including wearables and smartphones, offer a unique opportunity to passively and continuously monitor behavior and physiology that could reflect underlying mood dynamics in real-world settings.

Objective: This study aimed to systematically review passively collected digital markers for BD mood states, characterize devices/modalities and analytic approaches, appraise risk of bias, and identify design gaps and priorities for clinical translation.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) …

Face Mask Littering: Environmental Impacts, Regulatory Challenges, And Ai-Driven Waste Management Strategies For The Post-Pandemic Era, Pri̇yanka Rathee, Sari̇ta Khatkar, Renu Sehrawat, Pooja Rathee, Anurag Khatkar, Esra Küpeli̇

Turkish Journal of Medical Sciences

The widespread use of polypropylene-based face masks during the COVID-19 pandemic created a significant and persistent source of plastic pollution. This review aims to provide an integrative assessment of the environmental, toxicological, and public health implications of face mask litter and evaluate current waste management challenges and emerging technological solutions in the postpandemic context. A narrative review approach was employed, synthesizing literature published between 2020 and 2025 and indexed in major scientific databases including Web of Science, Scopus, and PubMed. Studies were selected based on their relevance to the issues of environmental contamination, microplastic generation, toxicological effects, regulatory frameworks, and …

Posttraumatic Stress In Newly Diagnosed Epilepsy: Associations With Early Maladaptive Schemas, Anxiety, And Quality Of Life In A 6-Month Prospective Study ​, Mehmet Öztürk, Pinar Öztürk, Fügen Sönmez Çeti̇nkaya, İlker Özdemi̇r

Turkish Journal of Medical Sciences

Background/aim: Epilepsy is a chronic neurological disorder that significantly affects psychosocial functioning, self-perception, and quality of life. Emerging evidence suggests that posttraumatic stress (PTS) symptoms may be more prevalent in individuals with epilepsy than previously recognized, particularly following seizure-related experiences perceived as traumatic. The aim of this study was to evaluate short- and long-term PTS levels in individuals with newly diagnosed epilepsy and examine their associations with anxiety, depression, early maladaptive schemas, and quality of life.

Materials and methods: In this prospective study, 31 individuals with newly diagnosed epilepsy were enrolled. Participants completed a sociodemographic data form, the Post-Traumatic Stress …

Perioperative Effects Of The Quadratus Lumborum Block In Percutaneous Biliary Drainage: A Prospective Randomized Controlled Study ​, Seyyi̇d Furkan Kina, Can Ozan Yazar, Cem Koray Çataroğlu, Erdi̇ Tangobay, Sadik Ahmet Uyanik, Savaş Altinsoy, Reyhan Polat, Jüli̇de Ergi̇l

Turkish Journal of Medical Sciences

Background/aim: The aim of this study was to evaluate the effect of the quadratus lumborum block (QLB) on intraoperative opioid consumption in patients undergoing percutaneous biliary drainage (PBD).

Materials and methods: A total of 57 patients who met the inclusion criteria were randomized into two groups: the sedation group (Group 1, n = 26) and the sedation with QLB group (Group 2, n = 26). The groups were compared in terms of intraoperative anesthetic consumption, vital parameters, postanesthesia care unit (PACU) recovery times, postoperative visual analog scale (VAS) scores, postoperative analgesic consumption, and clinician and patient satisfaction. The study was …

Lactate Dehydrogenase-To-Albumin Ratio As A Novel Prognostic Biomarker For 28-Day Mortality In Thoracic Trauma: A Single-Center Retrospective Cohort Study ​, Özgür Ömer Yildiz, Şükrü Yorulmaz, Eray Çinar, Hüseyi̇n Mutlu, Rami̇z Yazici, Ayşenur Gür, Medi̇ne Akkan Öz, Bensu Bulut, Mustafa Sirri Kotanoğlu, Hakan Güner

Turkish Journal of Medical Sciences

Background/aim: Thoracic trauma accounts for approximately 25% of all trauma-related deaths and remains a significant public health challenge. Early identification of high-risk patients is essential for improving clinical outcomes. The present study evaluates the prognostic value of the lactate dehydrogenase-to-albumin ratio (LDAR) in predicting 28-day mortality in patients with thoracic trauma.

Materials and methods: This retrospective observational study was conducted at a Level 1 trauma center between September 2022 and February 2025, and included adult patients presenting with thoracic trauma who underwent thoracic computed tomography. Demographic characteristics, clinical parameters, laboratory values, and 28-day mortality were analyzed. Receiver operating characteristic (ROC) …

Histomorphological Changes In Human Septal Cartilage Stored In Different Preservation Solutions ​, Özlem Akkoca, Aki̇f Si̇nan Bi̇lgen, Harun Çoban, Fatma Aslan Yay, Zeynep Kaptan, Funda Balkiliç Akkaya, Rahmi̇ Kiliç, Sami̇ Engi̇n Muz

Turkish Journal of Medical Sciences

Background/aim: To assess the histopathological effects of three preservation solutions (70% ethanol, povidone-iodine, and ciprofloxacin) on human septal cartilage obtained during septoplasty and to compare their preservation characteristics for potential future graft applications. Optimal preservation of septal cartilage is clinically important because well-preserved grafts may reduce the need for secondary cartilage harvesting and the associated donor-site morbidity while facilitating reconstructive procedures during revision surgery.

Materials and methods: A total of 90 septal cartilage specimens obtained from 30 patients undergoing septoplasty were allocated to three preservation groups and stored in the designated preservation solutions at +4 °C. Samples were examined histologically …

Influenza, Covid-19, And Pneumococcal Vaccination Status Among Adults In Türkiye ​, Gamze Şanlidağ İşbi̇len, Serap Gençer, Hüsnü Pullukçu, Meltem Taşbakan, İftahar Köksal

Turkish Journal of Medical Sciences

Background/aim: Vaccines reduce morbidity and mortality caused by infectious diseases that threaten public health. Lifelong immunization programs are essential for the entire population. This study assessed adult vaccination uptake for influenza, pneumococcal, and coronavirus disease 2019 (COVID-19) vaccines in Türkiye and examined the barriers and factors influencing vaccination decisions.

Materials and methods: This cross-sectional survey was designed and conducted by the Immunization Working Group of the Turkish Society of Clinical Microbiology and Infectious Diseases. A 19-item questionnaire was administered to individuals aged 18 years or older to assess influenza, pneumococcal, and COVID-19 vaccination status. The questionnaire collected data on demographic …

Nationwide Characteristics Of Infectious Disease Patients Transported By Helicopter In Türkiye, Ayşe Gülden Bekgöz, Kerem Dost Bi̇lmez, Muhammed Saltuk Deni̇z

Turkish Journal of Medical Sciences

Background/aim: To evaluate the clinical, demographic, and operational characteristics of patients with infectious diseases transported by helicopter ambulance and to examine differences in the transfer patterns, flight durations, and diagnostic categories.

Materials and methods: Registry data of patients with infectious diseases transported by helicopter ambulance were analyzed. Demographic characteristics, diagnoses, referring and receiving hospital types, intraprovincial and interprovincial transfer status, flight durations, and temporal distribution of transfers (hours, days, and months) were evaluated. Flight duration was calculated in minutes and compared between intraprovincial and interprovincial transfers.

Results: A total of 543 patients with infectious diseases were transported by helicopter ambulance. …

Boric Acid Enhances The Antitumor Effects Of Paclitaxel By Modulating Apoptosis, Autophagy-Related Protein Expression, And Proinflammatory Cytokine Expression In Ovcar-3 Ovarian Cancer Cells ​, Nazmi̇ye Bi̇tgen, Gözde Özge Önder, Münevver Baran, Fatma Esen Karakuş, Meli̇ke Akbulut, Arzu Yay

Turkish Journal of Medical Sciences

Background/aim: Ovarian cancer is the eighth most prevalent malignancy among women globally and ranks third among gynecological cancers in terms of incidence. The limited efficacy of standard chemotherapy, primarily due to intrinsic drug resistance and high recurrence rates, highlights the urgent need for novel therapeutic strategies that are both effective and selectively cytotoxic.

Materials and methods: This study aimed to investigate the combined effects of boric acid (BA), a biologically active boron compound with emerging antitumor potential, and paclitaxel (PTX), a conventional chemotherapeutic agent, on cell viability, cell cycle progression, apoptosis, autophagy-related protein expression, and inflammatory signaling in the chemoresistant …

Full Issue, Volume 14, Number 1., Donna J. Peterson Dr., Scott Cummings, Elizabeth Gregory North

Journal of Human Sciences and Extension

No abstract provided.

Impact Of Acute Flight Training Stress On Cardiovascular Health: A Pilot Study, Toni Butler

Discovery Day - Daytona Beach

Impact of acute flight training stress on cardiovascular health: A pilot study  Toni C. Butler, Carolina R. P. Ferreira, Bryan W. Hinton, Noah J. Robbins, Sophia R. Vaden, Andrew H. Schneider, Scott K. Ferguson, Ph.D.   Cardiovascular conditions are among the most common medical issues in certificated pilots and a major source of certification scrutiny. Student pilots experience unique acute stressors during flight training that may influence both physiological and psychological health. Acute stress is known to affect cardiovascular function, including vascular endothelial health; however, the impact of flight training–related stress on cardiovascular function remains poorly characterized. This pilot study tested …

The Effects Of Hypoxia On Balance Systems, Samuel Drescher Drescher, Heather Bond, Allysa Hayden, Victoria Cornaro, Brandon Ibarra, Noah Clark, Frank Cunningham Iv, Carolina Ferreira, Sierra Martinez, Katie Stubits

Discovery Day - Daytona Beach

Hypoxia, a condition characterized by insufficient oxygen availability to body tissues, is known to impair physiological and cognitive function, particularly at high altitudes above 15,000 ft. However, the effects of mild hypoxia (10,000–15,000 ft) remain less well understood. This study, conducted by the department of Human Factors and Behavioral Neurobiology at Embry-Riddle Aeronautical University, investigates the impact of mild hypoxia at 12,000 ft on human balance systems. Specifically, it examines the three primary components of balance: visual, proprioceptive, and vestibular systems. Participants complete nine balance tasks under both normoxic and hypoxic conditions. Tasks are structured to progressively limit sensory input: …

The Effects Of Acute Dietary Nitrate Supplementation On The Inspiratory Muscle Metaboreflex In Young Healthy Adults, Sabrina Ehrenfort, Riley Dienna, Ben Kerns, Hannah Lyons, Rachel Phillips

Discovery Day - Daytona Beach

Increased work of breathing (Wb) triggers the inspiratory muscle metaboreflex, which elevates systemic blood pressure in response to diaphragmatic fatigue. To counteract this, dietary nitrate could act as a source of nitric oxide, which is known to improve muscle power and efficiency (Jones et al., 2018). This study examines the hypothesis that acute nitrate supplementation would attenuate this response. Utilizing the KH2 device from PowerBreathe, 20 healthy participants (mean age: 21.1 ± 2.5 years; range: 18–30 years) underwent a resistive breathing task (RBT) for a total of three minutes at 60% of their maximal inspiratory pressure (MIP). All 20 participants …

Impact Of Stress & Fatigue On Cardiovascular Function In Young Pilots: A Thematic Review, Swarna Manoj

Discovery Day - Daytona Beach

Impact of Stress & Fatigue on Cardiovascular Function in Young Pilots: A Thematic Review   Authors: Swarna Manoj, Scott Ferguson   Keywords: pilot, stress, fatigue, heart rate variability (HRV), cardiovascular disease (CVD) Aviation is expanding globally and young pilots are the major workforce, yet FAA protocols require mandatory ECG only from age 35, with annual cardiac screening after age 40. Over the past five years, a pattern of sudden cardiac arrests in pilots particularly aged 30-40 has urged safety concerns. Despite the existing literature examining fatigue, burnout, stress, sleep hygiene and circadian disruption, only few studies systematically examine how these factors impact …

Analyzing Fungal Growth Dynamics Under Different Environmental Conditions Using A Lotka–Volterra Competition System, Maria Ordonez, Fabrio Araujo

Discovery Day - Daytona Beach

Fungi play a critical role in ecosystems as decomposers that recycle nutrients and maintain environmental balance. Their populations are influenced by multiple environmental factors such as temperature, humidity, nutrient availability, and interactions with other organisms. In this project, the Lotka–Volterra model is used to analyze how competing fungal species interact and how these interactions influence population dynamics over time. By modeling two fungal populations competing for the same limited resources, the equations illustrate how environmental conditions and competition coefficients determine whether one species dominates; both species coexist, or one species becomes extinct. The model provides insight into how changes in …