Medicine and Health Sciences Commons^™

Development Of Ultrafast Protein Digestion And Standards Free Quantitation Methods For Mass Spectrometric Analysis, Praneeth Ivan Joel Fnu

Dissertations

A wide variety of biologically important molecules, such as enzymes, antibodies, hormones, transporters and receptors are proteins by composition and they play key roles in biological functions such as cellular regulation, communication, metabolism and physiological function. Protein dysfunctions and abnormalities are associated with numerous diseases, making proteins critical targets for understanding disease mechanisms and developing therapeutic interventions. Protein-based therapeutics such as monoclonal antibodies, hormones and vaccines gained popularity due to their high specificity, efficacy, and ability to treat complex diseases that are often difficult to address with small-molecule drugs.

Given the important role of proteins in a variety of biological …

Seeing The Unspoken: A Pilot Eye-Tracking Study Of Moral Injury Among Veterans, Eva M. Valdez

Dissertations

This pilot study examined associations between self-reported moral distress, state distress, combat exposure, deployment history, and maximum pupil reactivity among veterans diagnosed with PTSD. Participants viewed neutral and morally relevant images while pupil responses were recorded using eye-tracking technology. Self-report measures included moral distress severity, exposure to potentially morally injurious events, Subjective Units of Distress Scale (SUDS) ratings, total deployments, number of combat deployments, and Combat Exposure Scale scores. Maximum pupil reactivity was calculated by subtracting the mean z-scored maximum pupil response during neutral image presentations from the mean z-scored maximum pupil response during morally relevant image presentations. This variable …

The Relationship Between Depression And Cognitive Proficiency Index Across Biological Sex, Angela N. Ferdinardo

Dissertations

Depression is a widely studied mood disorder, and understanding its effect on cognitive functioning has become an important area of research. While research has examined relationships among depression, working memory, and cognitive deficits, limited research has explored depressive symptoms and cognitive proficiency across biological sex. Depression manifests similarly in men and women, though men are more likely to experience irritability, impulsivity, and anger, while women tend to experience sadness, stress, and sleep disturbances (Johns Hopkins Medicine, 2023). Women are also more likely to seek treatment and cope differently than men. This study examined the relationship between depression and cognitive proficiency …

Association Between Stress Mindset, Psychological Symptoms, And Psychosocial Risk In Liver Transplant Patients, Sarah Kay Brill

Dissertations

Psychosocial functioning is a central component of liver transplant evaluation, yet less is known about how cognitive factors, such as stress mindset, relate to transplant readiness. The present study examined the association between stress mindset and psychosocial risk, as well as its relationship with depressive symptoms, anxiety, and perceived stress among patients undergoing liver transplant evaluation. Patients included 62 adults completing standard pre-transplant assessment measures, including the Stress Mindset Measure–Specific (SMM-S), Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale (PSS). Hierarchical logistic regression analyses indicated that stress mindset was …

Exploring Perceptions Of Self-Efficacy Among Newly Graduated Nurses In The Labor And Delivery Unit After The Use Of Rapid Cycle Deliberate Practice For Obstetric Emergencies, Amber L. Hulsey

Dissertations

Background: The average turnover rate among newly graduated nurses (NGNs) in the United States is 25-30% within their first year, with increased rates in high-stress units like obstetrics and critical care. Many risk factors contribute to the high turnover rate of NGNs, but one modifiable factor is feelings of self-efficacy. Studies have shown that simulation training can increase self-efficacy in obstetric emergencies. This study was conducted to explore feelings of self-efficacy among NGNs working in the labor and delivery unit after a rapid cycle deliberate practice (RCDP) simulation of an OB emergency.

Methods: The study used a descriptive …

The Use Of A Sepsis Escape Room Simulation To Enhance Undergraduate Nursing Student's Clinical Judgment, Alaina Peterson

Dissertations

Background: Less than 10% of new graduate registered nurses meet practice-ready expectations for clinical judgment competencies, and 52% of critical care nurses are unable to adequately define sepsis. Traditional clinical rotations offer inconsistent exposure to high-acuity, low-frequency events such as sepsis, leaving new graduates unprepared for independent practice. Escape room simulations use the proven effectiveness of high-fidelity simulations with gamification to develop clinical judgment through active learning, teamwork and problem-solving.

Objective: The purpose of this project was to determine the effectiveness of a sepsis escape room simulation to improve perceived clinical judgment skills of undergraduate nursing students. The intervention was …

Exercise Self-Efficacy And Physical Wellness In A Worksite Wellness Program: Exploring Factor Structure And Perceptions, Micah B. Mcglathery

Dissertations

Exploring Perceptions of Exercise Self-Efficacy and Physical Wellness in a Worksite Wellness Program

Abstract

Worksite wellness programs are increasingly adopted to address insufficient exercise participation and other health-related behaviors that put employees at risk of chronic disease. Although quantitative outcomes are well-documented, there is limited research exploring how employees perceive these programs' impact on personal behavior change, particularly in relation to exercise self-efficacy. Guided by the Social Cognitive Theory and the Exercise is Medicine initiative, this study qualitatively investigates employee perceptions of a worksite wellness program’s influence on physical wellness and confidence to exercise. A phenomenological approach using semi-structured interviews …

The Primary Care Brief Intervention Competency Assessment Tool (Bi-Cat): Examining Reliability And Validity, Arielle Guillod

Dissertations

Within primary care, the Primary Care Behavioral Health (PCBH) model integrates behavioral health services into medical settings through brief, population‑based interventions delivered by behavioral health consultants (BHCs). Although effective performance in this role requires competencies distinct from traditional mental health practice, few psychometrically sound tools exist to assess clinical skills in primary care. The Brief Intervention Competency Assessment Tool (BICAT) is commonly used for this purpose but lacks published evidence supporting its reliability and validity. This dissertation examined the psychometric properties of the BICAT across two studies. Study 1 evaluated factor structure, internal consistency, and construct validity in a heterogeneous …

Effect Of Virtual Reality Intervention Of Postoperative Pain In Pediatric Surgical Patients, Tara L. Kempker

Dissertations

Problem: Pediatric surgical procedures are associated with preoperative anxiety. Preoperative anxiety is associated with higher postoperative pain. Multiple studies have found that decreasing preoperative anxiety using Virtual Reality (VR) Intervention also decreases postoperative pain scores and use of rescue analgesics in postoperative care units (PACU). However, there is no standardized protocol for use of VR interventions and in our institution, VR was not utilized at all.

Methods: This quality improvement (QI) initiative utilized a quasi-experimental design and convenience sampling. Quantitative data was collected during visits for scheduled operative visits for pediatric surgical patients ages seven to 18 years …

Sleep Disturbances Affect Sleep Quality Of Hospitalized Adults, Tonjia Hardesty

Dissertations

Abstract

Background: Sleep disturbances affect the quality of sleep hospitalized adults experience, possibly extending patient recovery time. Treatment of insomnia frequently includes pharmacological interventions exposing patients to potential side effects, leading to negative patient outcomes.  The purpose of this project was to determine if a sleep hygiene toolkit including eye masks, earplugs, advocacy cards, and removal of nicotine patches at bedtime would improve patient sleep quality without use of pharmacological interventions.

Methods: A descriptive observational design was used in this quality improvement (QI) project. A convenience sample of 37 (N =37) participants over the age of 18 years and …

Psychotropic Medication Use In Older Adults In A Long-Term Care Facility: Implications For Screening Tool, Callie M. Johnson

Dissertations

Psychotropic medication use in older adults aged 65 years and older residing in the long-term care facility has a complex issue in the high use of psychotropic medications. Older adults residing  in long-term care (LTC) facilities are affected and prescribed at least one psychotropic or antidepressant medication.

Enhancing Well-Being: Implementing Weekly Social Interventions For Older Adults In Independent Living, Rosa Huang

Dissertations

Loneliness and social isolation significantly impact the physical and mental well-being of older adults. This quality improvement project implemented an eight-week social intervention designed to reduce loneliness and enhance well-being through weekly sessions incorporating mindfulness exercises, gratitude journaling, and structured socialization activities. The intervention was delivered by nursing students to a sample of residents in a Midwestern independent living community. While most standardized measures of loneliness and mood did not show statistically significant changes, the project resulted in a statistically significant increase in social network engagement as measured by the Lubben Social Network Scale-6 (LSNS-6). The findings suggest that group-based …

Exploring Primary Care Providers’ Compassionate Care And Their Evidence-Based Practice With Death, Grief, And Loss: Patient Experience And Perspective, Kathryn Krzykala

Dissertations

Research on primary care providers’ (PCPs) education regarding Death, Grief, and Loss (DGL) remains limited. Specifically, data is lacking regarding patients' perceptions and opinions on what they need and expect from their PCPs regarding grief and loss. This exploratory mixed-method study comprised 146 participants who had experienced death and non-death loss. It examined participants' perceptions of 1) PCP compassion, 2) PCP utilization of evidence-based grief and loss practices, 3) their own level of comfort discussing DGL with their PCPs during medical visits, and 4) their personal grief and loss experiences. The findings revealed that PCPs' grief-informed evidence-based treatment, as reflected …

An Attachment Perspective For Help-Seeking Intentions Among Emerging Adult Women Child Sexual Abuse Survivors, Dominique Giroux

Dissertations

Child sexual abuse (CSA) is an adverse childhood experience and a global health issue. Approximately one in four girls encounter CSA per year. Research evidence suggests approximately 50% of CSA survivors encounter sexual revictimization during adulthood (Walker & Wamser-Nanney, 2023), but formal help and intervention can mitigate further psychosocial harm experienced by CSA survivors (Widom et al., 2008). Attachment theory has provided a theoretical framework for identifying individuals at risk for revictimization and help-seeking patterns, such that individuals who have insecure attachment styles report more revictimization frequency, but the literature is mixed about attachment styles and help-seeking (Brenner et al., …

Exploring How Therapist Trainees’ Mentalization, Attachment Styles, And The Working Alliance Impact Treatment Outcomes In Psychotherapy, Hanali Gilbert

Dissertations

A burgeoning area of research within the past 30 years has sought to identify which specific therapist factors contribute to differential treatment outcomes (Barkham et al., 2017). The purpose of the current naturalistic study was to explore how two personal characteristics of therapist trainees, mentalization capacity and attachment styles, impact early treatment outcomes at two Midwestern psychology training clinics. This study also examined whether therapist mentalization and the working alliance interacted to influence client outcomes. Therapists completed the Mentalization Scale (MentS; Dimitrijević et al., 2018) and the Experiences in Close Relationships scale (ECR; Brennan et al., 1998), while the Working …

Predicting Clinical Outcomes Of Non-Specific Low Back Pain By Studying The Interaction Of Clinical And Demographic Factors Of A Retrospective Data Set, Erica Michelle Fernandes

Dissertations

The purpose of this research is to investigate demographic factors, including age, gender, body mass index (BMI), race, marital status, insurance type, severity of disease (initial pain level), and clinical factors such as number of visits (no. of visits) at physical therapy (PT), length of time at PT and the type of clinician either physical therapist versus physical therapy assistant (PTA), that most predict PT clinical outcomes in patients with nonspecific low back pain (NSLBP) and see if there is an interaction between demographic and clinical variables.

Methods

The current study is a retrospective, cross-sectional, observational study using secondary electronic …

Addressing Mental Health Issues And The Effectiveness Of Cognitive Behavioral Therapy And Mindfulness-Based Interventions Among Athletes, Shelby Jones-Stachnik

Dissertations

This literature review identifies mental health concerns among competitive athletes and evaluates psychological interventions to address these challenges. Specifically, the review explores the mental health concerns experienced by athletes engaged in high-level sport. It examines whether cognitive behavioral therapy and mindfulness-based interventions are effective approaches for improving psychological outcomes in this population. A systematic review of peer-reviewed research was conducted, and findings were synthesized to evaluate the effectiveness of cognitive behavioral therapy and mindfulness-based interventions. The review included randomized controlled trials, quasi-experimental studies, and meta-analyses examining psychological interventions in athletic populations. Findings across the literature indicate that both cognitive behavioral …

Personal And High-Intensity Gait Factors Associated With Balance And Walking Improvement With Outpatient Stroke Rehabilitation: A Retrospective Study, Heather Staal

Dissertations

Objective: The purpose of this study is to examine the relationships between personal factors and High-Intensity Gait variables and balance and walking improvement in an outpatient stroke population.

Background: Stroke is a leading cause of long-term disability, with persistent gait and balance impairments commonly limiting independence and participation. High-intensity gait training (HIGT) is an evidence-based rehabilitation approach that improves walking outcomes following stroke; however, guidance on how specific training variables are applied in outpatient physical therapy settings remains broad.

Methods: This retrospective observational study analyzes clinical data from outpatient physical therapy episodes in which HIGT is a …

Exercise Therapy For Mood Disorders In Retiring/Former Athletes, Christian Antos

Dissertations

This dissertation examined the potential integration of exercise therapy and psychotherapy as a treatment approach for mood-related difficulties experienced by former elite athletes during the transition out of competitive sport. Retirement from athletics is often associated with significant biopsychosocial challenges, including disruptions in identity, healthy routines, social support, and emotional well-being. Existing literature suggests that exercise may serve as an effective adjunctive intervention for improving mood and overall psychological functioning, though limited research has explored its application among retiring athletes within psychotherapeutic contexts. This literature review synthesized current research related to athletic retirement, neurobiological mechanisms associated with physical activity, and …

Attachment Style, The Working Alliance, And Client Self-Disclosure In Individual Psychotherapy, Jennifer S. Baar

Dissertations

Client self-disclosure is a core component of the psychotherapy process and increased levels of client self-disclosure have been shown to predict more positive therapeutic outcomes (Pattee & Farber, 2008; Sloan & Kahn, 2005). Similarly, the working alliance and attachment are constructs that have been studied in psychotherapy research and are consistently associated with therapeutic outcomes. Specifically, stronger working alliance ratings and higher levels of secure attachment have been found to predict more positive therapy outcomes (e.g., Flückiger et al., 2018; Mallinckrodt et al., 2005; Sauer et al., 2010). As these three constructs have been found to influence psychotherapy outcomes, the …

Understanding And Enhancing Suicide Prevention Strategies In The Military: The Roles Of Culture, Leadership, And Command Climate, Kelly Johanna Pires

Dissertations

Military service members are shaped and molded to fit a military culture that emphasizes mission readiness and continuous preparedness. Countless hours are spent training for various situations that can arise. Many trainings are geared toward worst-case scenarios that can cause an increase in stressors and traumatic events. They are expected to demonstrate resilience and overcome adversity to remain mission-ready. This expectation to be mission-ready creates the space for mental health difficulties as well as stigma and avoidance of help-seeking behaviors. In many cases, the desire to stay mission-ready creates a barrier for conversations around mental health. The military emphasizes qualities …

Evaluation Of Neuroplastic Changes In Psychological Intervention And Contemporary Treatments Of Depression, Taylor Severance

Dissertations

Major depressive disorder is one of the most prevalent mental health disorders worldwide. There is a vast range of treatment options for depression, with varying levels of effectiveness. Recent treatments for depression have expanded, increasing alternative treatments, and it is unknown which treatments have the largest impact on depression. This research was designed to examine the treatments of depression, with a focus on psychotherapy and contemporary treatments such as ketamine, psilocybin, and transcranial magnetic stimulation. A literature review was conducted to assess treatment outcomes and neuroplastic changes in these interventions, as well as combinations of the interventions. Data were evaluated …

Diverse Families Navigating Mental Health At The Pediatrician’S Office: A Mixed Methods Exploration Of The Interplay Of Stress, Culture, And Child Mental Health In The Primary Care Setting, Sara B. Budowsky

Dissertations

Low-income and ethnic minority youth experience high psychiatric need but persistently low participation in traditional mental health care. General pediatricians are often the first and only healthcare providers with whom many families engage around their child’s emotional and behavioral development. Using both quantitative analysis of retrospective secondary data and Interpretative Phenomenological Analysis (IPA) of in-depth interviews with diverse caregivers, this project explored influencers of child mental health and family utilization of pediatric primary-care-based mental health services in the context of a uniquely multicultural clinic serving a predominantly Medicaid population. Three key findings include: 1) Caregiver Stress was a highly significant, …

Vergence Task-Based Neural Pathways With Binocularly Normal Vision And Comorbid Persistent Post-Concussive Symptoms -Convergence Insufficiency, Ayushi Sangoi

Dissertations

Binocular dysfunctions are more prevalent in the persistent post-concussive symptoms (PPCS) population than in the general population. The most prevalent binocular disorder is convergence insufficiency (CI), affecting 3-17% of the general population and up to 10 times as many people with PPCS. CI makes it difficult to fuse or maintain fusion on targets at near, and its symptoms include double or blurry vision and headaches when performing close-range tasks such as reading, which can exacerbate PPCS symptoms. Given controversy over the subjectivity and effectiveness of diagnostic tools and symptom surveys for both PPCS and CI, understanding why CI has high …

Parameter Density Estimation For Cardiac Electrophysiology Models Using Data Consistent Deep Learning, Michael Luo

Dissertations

Mathematical models of biological rhythms and excitable systems can provide insights into mechanisms underlying cardiac electrical dynamics. However, estimating the parameters of these models from experimental observations is often difficult due to noise, heterogeneity, and unobserved variables. For example, in an electrocardiogram (ECG) recording, information about the electrical properties of different regions of the heart is compressed into a single voltage trace. Additionally, variability within these signals may contain important information about population heterogeneity, regional differences in electrophysiology, and time-dependent modulation.

This dissertation develops, explores, and evaluates methods that perform feature-based distributional inference for complex nonlinear dynamical systems. The objective …

Transcranial Ac Modulation Of Cerebellar Nuclear Activity In Awake Animals, Nuran Kavakli

Dissertations

Entrainment of cerebellar nuclear (CN) cells via cerebellar transcranial alternating current stimulation (ctACS) has been reported in animals under ketamine/xylazine anesthesia. Our main objective was to demonstrate modulation of CN activity in unanesthetized, freely moving animals using ctACS. Multi-channel carbon-fiber electrodes were implanted into the interpositus nucleus for recording multi-unit (MU) activity, and thin-film electrodes were implanted subcutaneously over the posterior cerebellum for stimulation. A frequency-domain-based metric was developed to quantify modulation from MU signals. The results demonstrated modulation in a wide range of frequencies (4 Hz-300 Hz) as in anesthetized animals. In contrast, the amplitude of the peak in …

Navigating Recovery: A Qualtitive Study Of Harm Reduction And Sobriety Among African American In Redlined Chicago Neighborhoods, Erica N. Tate

Dissertations

This qualitative study examines the lived experiences of African American individuals residing in historically redlined communities in Chicago who are maintaining sobriety using harm reduction strategies. Grounded in the context of structural inequities, the study explores how social determinants of health, including limited healthcare access, transportation barriers, and community disinvestment, shape recovery pathways. Semi-structured interviews were conducted with individuals in sustained recovery and providers, and the data were analyzed using inductive and deductive thematic approaches. Findings indicate that recovery is an ongoing process influenced by environmental exposure, trauma, and access to support systems.

Participants identified harm reduction strategies, such as …

Convergence And Divergence Of Opinion About Treatment Of Binocular Vision Disorders Among Vision Care Professionals, Sonia Young

Dissertations

There are three distinct professions prominent in the field of pediatric vision care. They are ophthalmology, optometry and orthoptics. All professions are integral to the detection and treatment of pediatric binocular vision disorders. However, distinct schools of thought exist to describe the best approach to pediatric binocular vision disorders and their treatments. Literature often highlights two opposing schools of thought represented by the “medical” and “behavioral” approaches. While there is academic debate about the merits and pitfalls of either approach, there is a paucity of nuanced perspectives which more closely resemble the ways in which pediatric ocular clinicians approach diagnosis …

Barriers To Climate Change And Sustainability Action: Nursing Education And Practice, Dawn Marie Smith

Dissertations

Climate change is one of the most pressing public health emergencies of our time and nurses can have a great impact in their current practice and in the education of future nurses (The Alliance of Nurses for Healthy Environments, n.d.; American Nurses Association, 2023; Health Care without Harm, 2025). Deaths due to rising temperatures, vector-borne illness, and food insecurity related to drought and extreme weather are on the rise (WHO, 2024). It has been estimated that globally over 250,000 additional deaths will be attributed to climate related effects between 2030 and 2050 (Watts et al., 2020; WHO, 2023).

A primary …

Silent Struggles: A Qualitative Study On Mental Health Stigma And Help- Seeking Among African Individuals In The U.S, Ololade Ekwere

Dissertations

Approximately one-third of African Americans and Caribbean Blacks who require mental health services seek and utilize them (Evans & Sheu, 2019). Research has shown that stigma surrounding mental health treatment contributes to lower rates of professional help-seeking among Black Americans (Pederson, 2023). Despite the growing diversity within the Black community, limited research exists on how stigma influences professional mental health help-seeking among Africans living in the United States.

The purpose of this qualitative descriptive study was to explore the effect of public stigma on the mental health help-seeking behaviors of Africans living in the United States. Demographic data were collected, …