Medicine and Health Sciences Commons^™

Contribution Of G4 Structure To Alzheimer’S Disease And Tau Pathology, Lena Michaela Kallweit

Electronic Theses and Dissertations

The occurrence of Alzheimer’s Disease (AD) is rapidly increasing as our global population ages. With the majority of therapeutic drugs in the last couple of decades failing clinical trials, new molecular targets are needed to combat the expected influx of new AD cases. AD pathogenesis is associated with abnormal protein aggregation, characterized in part by intracellular accumulation of hyperphosphorylated tau (p-tau) in neurofibrillary tangles (NFTs). RNA has been identified as a major non-proteinaceous component of NFTs and has been implicated as an active cofactor in tau aggregation and spread. Recent work has shown that aggregates from AD brains contain almost …

Leader Rounding For Outcomes To Improve Employee Retention, Laura R. Escobar

Electronic Theses and Dissertations

Intention to leave a nursing staff position, if not addressed, may lead to an increased rate of nursing turnover. High turnover rates can negatively affect staffing patterns, increase organizational costs, and disrupt the continuity of patient care. A quantitative quasi-experimental pre-/posttest design was used to evaluate the impact of the High Reliability Organization Leader Rounding for Outcomes tool to reduce the intent-to-leave scores, as measured by the Turnover Intention Scale (TIS-6), compared to current practice over 12 weeks. Implementation of the tool provided a structured leader rounding process designed to strengthen communication, recognize staff contributions, and proactively identify workplace concerns. …

Patient Wait Time And Throughput Interventions In The Cardiology Outpatient Setting, Chioma Ohiri Tawose

Electronic Theses and Dissertations

Healthcare collaboration and patient care require effective communication. Poor communication impacts wait time. Inadequate communication in the outpatient cardiology clinic can lead to disruptive patient throughput, or workflow, and extend patient length of visit. The purpose of this project was to implement a means of communication for clinicians and healthcare assistants to improve patient flow and cut down idleness, ultimately reducing patient wait time. The project established the incorporation of a built-in electronic health record communication notification system, the Event Button, for asynchronous communication between staff. A quantitative quality improvement design was used to conduct this project. Inferential and descriptive …

Production, Characterization, And Diagnostic Application Of Monoclonal Antibodies Against The N-Protein Of Avian Metapneumovirus Subgroup B, Ravi Gupta

Electronic Theses and Dissertations

Avian metapneumovirus (aMPV) is a respiratory pathogen that causes Turkey Rhinotracheitis (TRT) in turkeys and Swollen Head Syndrome (SHS) in chickens. The infection leads to facial swelling, nasal discharge, reduced egg production, and poor growth. This virus is classified into four subgroups: aMPV-A, B, C, and D, with two other novel subgroups, in which aMPV-A, B, and C are most prevalent in the commercial flocks. In early 2024, aMPV-A and B outbreaks have been reported in the US, resulting in severe economic losses. An economic assessment estimates around $112 million in losses in Minnesota and up to $434 million in …

Accessing Campus Mental Health Services In A Nigerian Southwestern University: Barriers To Academic Success, Caroline Dada

Electronic Theses and Dissertations

Mental health disorders are a significant health concern among higher education institutions in sub-Saharan Africa, including Nigeria. A substantial treatment gap exists in the Nigerian healthcare system, and this gap is further worsened by cultural and religious barriers, which reinforce stigma that discourages students from seeking professional help. This qualitative narrative inquiry explored the barriers students encountered when accessing mental health services at a university in Southwestern Nigeria, to increase service access. Qualitative semistructured interviews were conducted with seven professional mental health providers at a university counseling center between March and April 2025. Inductive thematic analysis was used to identify …

Building Relationships: Does Perceived Counselor Cultural Humility Improve Client Satisfaction Of Mental Health Services Within Therapeutic Dyads Of Dissimilar Identities?, Noah Schoch

Electronic Theses and Dissertations

A wealth of clinical research has uncovered the presence of mental health treatment disparities and a lack of treatment consistency when working with clients of dissimilar identities. The purpose of this dissertation study was to investigate potential causes for the observed disparities minoritized individuals have experienced and understand if cultural humility was a variable that affected mental health treatment satisfaction when counselor-client had dissimilar cultural identities. This was achieved through the following research questions: (1) What is the relationship between the extent of client perceived racial/ethnic similarity within the therapeutic dyad and client-rated mental health treatment satisfaction? (2) What is …

Likes For Love: Examining The Relationship Of Sociocultural Factors On Social Media Influences Of Instagram Use For Young Black Women, Cheria S. Jackson

Electronic Theses and Dissertations

In recent years there has been a push toward studying ethnic minority women related to the psychological implications of image and beauty, as historically the focus has been on the experiences of European women (Awad et al., 2015). Black women must process sexual development, attitudes, and behaviors through the lens of the sexual scripts and stereotypes of their ethnic group and must negotiate between mainstream and culture specific norms of sexuality (Daniels and Zurbriggen, 2016; Jerald et al., 2017). The presence of these scripts signifies a difference between Black women and other races about how they may internalize and react …

(Un)Intended Consequences Of Race In Medicine: The Ethics Of Race-Based Medical Practice And The Perpetuation Of Structural Racism, Allegra Merriweather

Electronic Theses and Dissertations

This dissertation proposes that race-based medicine acts as a form of structural racism that is ethically indefensible. While it may be claimed to be a neutral diagnostic tool, the medical use of race as a biological proxy only further enforces the very hierarchies it purports to remediate, reinscribing inequity from conception to death. Building off Jacques Ellul’s work on Technique, we interpret race-based medicine as a self-perpetuating system that values procedural expediency over moral accountability. In nine chapters, the analysis follows the ways this technique is manifested in genetics and assisted reproduction, where commodified racial selection preserves social hierarchies; in …

Integrating The Five As Framework To Enhance Person-Centered Care For Adults Living With Obesity, Alexandra Charles

Electronic Theses and Dissertations

Obesity has adverse effects on physical health, emotional well-being, and mental functioning. To effectively address this highly prevalent and multifaceted condition, the use of a structured, evidence-informed framework is essential to support providers in delivering consistent, person-centered care for individuals living with obesity. The Five As is a powerful yet not commonly implemented framework in many primary care practices. The Five As framework (Ask, Assess, Advise, Agree, Assist) offers a structured model to guide clinicians in delivering consistent, supportive, and transformative care for individuals with obesity.

The goal of the project was to implement a timely and cost-effective protocol/tool that …

From Awareness To Action: Improving Advanced Directives With The Five Wishes In College Aged Young Adults, Dina M. Giovanetti

Electronic Theses and Dissertations

This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of …

Avaren-Fc's Effects On Lymphoma Cells., Jacob Hahn

Electronic Theses and Dissertations

This thesis investigates the therapeutic potential of Avaren-Fc (AvFc), a novel lectin fusion protein that integrates the Fc region of human IgG1 with the engineered lectin Avaren, specifically targeting lymphoma. The study delineates the in vitro binding capabilities of Avaren-Fc with a human B-cell lymphoma cell line, a canine B-cell lymphoma cell line, healthy canine peripheral blood mononuclear cells (PBMCs), and healthy human PBMCs. AvFc was shown to exhibit significant binding to human lymphoma cells. Furthermore, the direct cytotoxicity of Avaren-Fc against canine lymphoma cells, canine lymphoma cells and healthy canine PBMCs was assessed. It was found that there is …

Safety Evaluation Of Epicertin, An Oral Biotherapeutic Candidate For Treating Ulcerative Colitis: A 28-Day Repeated Dose Toxicity Study., Jimmy Fernando Cifuentes Jimenez

Electronic Theses and Dissertations

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic, relapsing inflammation of the colon and rectum with limited treatment options. Among them, immunosuppressive agents have a high rate of adverse side effects and do not cure the disease. EPICERTIN (EPT), a recombinant variant of the cholera toxin B subunit (CTB) with a C-terminal hexapeptide extension consisting of a KDEL endoplasmic reticulum (ER) retention motif, is a promising oral biotherapeutic candidate for the treatment of UC. EPT has demonstrated mucosal healing activity in mouse models of colitis and human colonic explants. EPT's mechanism of action involves binding to GM1 …

Congolese Mothers' Beliefs That Influence Health-Seeking Behaviors For Their Infants., Shawn Meiman

Electronic Theses and Dissertations

In 2024, approximately 100,000 refugees were admitted to the United States, with 20% coming from the DRC, while Kentucky continues to rank fourth in the country for refugee resettlement. The increasing number of Congolese refugee children in the United States and Kentucky necessitates a greater understanding of these beliefs and practices to ensure equitable, quality, and culturally informed health services. The purpose of this study was to explore Congolese refugee mothers’ culturally and socially situated beliefs, perceptions, practices, and resources related to health care that may influence their views and practices of preventive well-child health care for their infants in …

The Role Of Psychological Capital And Case Management Intensity In Patient Activation In Permanent Supportive Housing Residents., Sarah J. Carter

Electronic Theses and Dissertations

This dissertation explores patient engagement with health, or patient activation, in the formerly homeless population housed in Permanent Supportive Housing (PSH) and receiving case management support. Research is limited on patient activation in PSH residents; consequently, there is minimal understanding of factors contributing to one’s attitudes and behavior towards health care in this group. Psychological Capital refers to the components of hope, self-efficacy, resilience, and optimism. Research in other marginalized groups indicates increasing psychological capital may improve health behaviors. Case management provides support to PSH residents and forms of social support have been associated with improved health outcomes. Applying the …

Assessing Post-Pandemic Engagement In The Supplemental Nutrition Program For Women, Infants, And Children (Wic) In Northeast Tennessee, Christen Minnick

Electronic Theses and Dissertations

Since 1974, the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) has provided healthy food resources, nutrition education, and provider referrals for families at risk for poor nutrition. Public health professionals have consistently presented evidence that WIC engagement reduces premature births and infant mortality, improves child health and development, and increases specialized care access for participants. While average monthly participation in WIC has increased since the program’s inception, trends indicate that only around half of eligible families have consistently engaged with the program since 2011. Research has linked declining WIC participation to administrative burden, citing learning, psychological, compliance, …

The Role Of Fast-Food Consumption, Residential Fast-Food Exposures, And Urinary Essential Trace Heavy Metals In Colorectal Cancer (Crc) Outcomes., Jeevan Adhikari

Electronic Theses and Dissertations

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the …

Residential Segregation And Breast Cancer In Louisville: Impact Of Race And Contextual Factors On Advanced-Stage Diagnosis, Delayed Treatment, And Disease-Specific Mortality., Toheeb Ajani Mustapha

Electronic Theses and Dissertations

Female breast cancer (BC) remains the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among U.S. women. Despite advances in detection and treatment, substantial inequities in BC outcomes persist, driven in part by structural forces such as residential segregation. This dissertation examined the relationship between residential segregation, BC outcomes, and key contextual factors in Louisville, Kentucky. Using data from the Kentucky Cancer Registry, American Community Survey, CDC’s Population-Level Analyses and Community Estimates, and the National Neighborhood Data Archive, the study tested two hypotheses: (1) higher Black/low-income segregation is associated with elevated risks of adverse BC …

Increasing Histidyl Dipeptides In Skeletal Muscle Preserves Muscle Mass And Function In Heart Failure., Mamata Hiraman Chaudhari

Electronic Theses and Dissertations

Introduction: Heart failure is a systemic disease associated with multiple comorbidities, such as skeletal muscle wasting and cardiopulmonary disease. Muscle wasting in heart failure patients is a severe comorbidity associated with decreased exercise capacity and poor quality of life. Previous reports show that oxidative stress is increased in the skeletal muscle of heart failure patients, which can directly lead to muscle wasting. However, antioxidant intervention in these patients was unable to improve cardiac function and consequently had no effect on muscle wasting. Although oxidative stress is the primary driver of skeletal muscle atrophy, no attempt has been made to examine …

A Multilevel Analysis To Evaluate Variability In Sdoh Clusters Within Rurality And Its Effects On Cancer-Specific And All-Cause Mortality In The Us., Stephie Ann Abraham

Electronic Theses and Dissertations

Social determinants of health (SDOH) factors have consistently been shown to impact all-cause and cancer-specific mortality. Area-level SDOH factors that coexist to form “high-risk” clusters are more prevalent in rural than urban areas. However, heterogeneity within rural and urban areas may contribute to variations in SDOH factors that could influence higher mortality rates and is not considered in other studies. The primary objective of this study was to utilize ecological and individual-level data to determine if the composition of SDOH clusters within counties in the rural-urban continuum contributes to differences in all-cause (AC) and cancer-specific mortality rates of lung and …

Understanding Social And Cognitive Influences In Medical Students' Learning Processes For Step 1: An Interpretivist Case Study., Ashley Elaine Triplett

Electronic Theses and Dissertations

This qualitative interpretivist case study explores, at a singular institution, medical students’ perspectives on the social and cognitive factors influencing the learning process as students prepare for the Step 1 examination. While prior research regarding medical students Step 1 preparation have focused primarily on wellness, stress, and career outcomes, limited studies have examined medical students' lived experiences to navigate what occurs during the learning process while they prepare for this critical exam. Utilizing a qualitative case study approach, this dissertation draws on fourteen student interviews, seven that passed Step 1 on their first attempt, and seven that failed. Findings reveal …

Breaking The Silence With Routine Genitourinary Syndrome Of Menopause Screening: A Quality Improvement Project, Ashley R. Noel

Electronic Theses and Dissertations

Affecting upwards of 87% of women in post menopause, genitourinary syndrome of menopause is greatly under-diagnosed, and consequently, under-treated. Genitourinary syndrome of menopause refers to health conditions impacted by hypoestrogenic state experienced in menopause. Common symptoms of GSM include vaginal dryness, irritation, clitoral or labial atrophy, dyspareunia, decreased libido, anorgasmia, dysuria, recurrent UTI, urinary incontinence (Kaufman et al., 2025). Despite the burdensome consequences of GSM, women are unlikely to vocalize their symptoms and seek treatment. Additionally, societal beliefs of shame surrounding sexual health impede patients and clinicians from addressing GSM specifically (Mili et al., 2021). As a result, the North …

Safety In Stability: A Cdc-Guided Evaluation Of Hospital Fall Prevention Practices, Matthew C. Dougherty

Electronic Theses and Dissertations

Hospital falls remain a persistent and preventable cause of patient harm, emphasizing the need for continuous evaluation of fall prevention practices. This project assessed the effectiveness of AdventHealth Orlando’s fall prevention policy using the Centers for Disease Control and Prevention (CDC) Program Evaluation Framework. A mixed-methods design incorporated quantitative analysis of 12 months of fall data and qualitative feedback from frontline staff surveys and discussions. Results demonstrated a decrease in total falls from 549 in the previous year to 528 in the current year, indicating early progress despite the incomplete reporting period. Unit-level analysis showed a mean improvement of 16.9% …

Enhancing Provider Knowledge And Implementation Of Medication For Opioid Use Disorder (Moud) To Improve Treatment Outcomes: A Quality Improvement Project., Motunrayo Abigael Ibraheem

Electronic Theses and Dissertations

This quality improvement project sought to enhance healthcare providers' knowledge and attitudes toward Medication for Opioid Use Disorder (MOUD) at Galt Ocean Rehab Center to improve treatment outcomes for patients with opioid use disorder. Despite evidence supporting the efficacy of MOUD, significant knowledge gaps and stigmatizing attitudes among providers create barriers to optimal care. Sixteen healthcare providers participated in a comprehensive educational intervention grounded in Jean Watson's Theory of Transpersonal Caring and the Institute for Healthcare Improvement's Model for Improvement. The intervention consisted of a 4-hour workshop, six weekly reinforcement sessions, and the implementation of standardized buprenorphine management protocols. Pre- …

Mechanisms Of Correlated Neuronal Activity In The Globus Pallidus, Hamza Albawaliz

Electronic Theses and Dissertations

This thesis investigates the mechanisms of correlated neuronal activity in the globus pallidus externus (GPe), a key structure in the basal ganglia. Neuronal activity in the GPe is reportedly decorrelated in healthy subjects but can become highly correlated in Parkinson’s disease. However, high-density neuronal recordings in the GPe of healthy rats reveal a surprising degree of correlated activity. This raises the question of whether intrinsic properties or network connectivity alone can account for such patterns. To explore this, a computational model was developed in which GPe neurons are represented as coupled phase oscillators influenced by experimentally derived phase-response curves and …

Development Of A Non-Faradaic Impedimetric Biosensor Based On Reduced Graphene Oxide For The Detection Of Brain-Derived Neurotrophic Factor (Bdnf), Mariana N. Martins

Electronic Theses and Dissertations

Neurological disorders affect millions of people worldwide. In the case of Alzheimer’s disease (AD), the rising number of cases significantly increases global healthcare costs. Therefore, early detection of biomarkers at the onset of the disease is essential for early diagnosis. This study presents an electrochemical biosensor designed for the detection of Brain-Derived Neurotrophic Factor (BDNF) in human plasma, incorporating reduced graphene oxide (rGO) to enhance signal sensitivity. Dielectrophoresis (DEP) was employed to deposit rGO flakes on the electrode surface, improving conductivity and sensor performance. Electrochemical impedance spectroscopy (EIS) was used to monitor changes in impedance associated with BDNF binding events, …

Capacity, Allocation And Update Dynamics Of Human Memory Systems, Shaoying Wang

Electronic Theses and Dissertations

Information is encoded and stored in three types of memory: sensory memory (SM), short-term memory (STM), and long-term memory (LTM). SM has a large capacity but retains information for only a brief period. When information transfers to STM, only a limited amount can be stored. Information in STM can then be transferred to LTM, which has a much larger capacity and longer retention time. STM is often conceptualized as working memory (WM) to highlight its role in active information processing. Due to the limited capacity of STM, it is commonly believed that STM serves as the bottleneck for information processing. …

Effects Of Aromatherapy On Promoting Sleep In Patients With Neurological Deficits, Cherylle Reed

Electronic Theses and Dissertations

Reliance on sleep aids in neurological patient population can lead to negative side effects and compromise patient safety. The purpose of this doctoral nursing project was to determine if the implementation of McDonnell and Newcomb’s aromatherapy process will reduce the incidence of sleep-promoting medication administration as compared to the current practice in neurological deficit patients over 4 weeks. A quantitative, quasi-experimental design evaluated effects on sleep quality and pharmacological sleep aids by using McDonnell and Newcomb’s aromatherapy combination of lavender, bergamot, and ylang ylang essential oils placed on a cotton ball at the patient’s bedside each night. The sample included …

A Quality Improvement Project To Standardize Sexual Dysfunction Screening In Primary Care, Ashley M. D’Anna

Electronic Theses and Dissertations

Sexual health is an essential aspect of overall well-being but is often overlooked in primary care due to provider discomfort, time constraints, and lack of standardized screening protocols. This quality improvement (QI) project aimed to implement a consistent approach to screening for sexual dysfunction using the Arizona Sexual Experiences Scale (ASEX), a validated five-item tool assessing sex drive, arousal, orgasm, and satisfaction. Guided by Swanson’s Theory of Caring and Pender’s Health Promotion Model, the project emphasized compassionate, patient-centered care and the promotion of health-enhancing behaviors.

Using the Plan-Do-Study-Act (PDSA) framework, the ASEX tool was incorporated into annual wellness visits following …

Advancing Medical Education With Lifestyle Medicine: A Comprehensive Program Evaluation Using The Kirkpatrick Framework, Shanna L. Mello

Electronic Theses and Dissertations

This dissertation examined how a U.S. national lifestyle medicine residency curriculum influenced resident learning and practice using a program evaluation paradigm with a convergent mixed methods design guided by Kirkpatrick’s four-level evaluation model. The problem addressed was the persistent gap between evidence for lifestyle interventions and the limited preparation residents receive to deliver lifestyle counseling in routine care. The purpose of the study was to evaluate changes in residents’ reactions, learning, and clinical behaviors and to identify early patient-level signals and the implementation conditions that enabled or constrained behavior change. Quantitative methods analyzed archived pre- and posttraining surveys from 148 …

Differences In Peer Social Connections Between Traditional And Online Nurse Residency Programs, Tatum Leonard

Electronic Theses and Dissertations

The anticipated retirement of baby boomer nurses by 2030 will intensify the global nursing shortage, a crisis that demands innovative strategies for onboarding and retaining new graduate nurses. Nurse residency programs (NRPs) are designed to ease the transition from student to practicing nurse, reduce turnover, and foster professional resilience. Amid the COVID-19 pandemic, many NRPs rapidly transitioned from traditional, in-person seminars to synchronous, online formats. This study explored differences in peer social connections between traditional and online NRPs, focusing on three constructs: sense of community, collaborative learning, and peer social support. Using a quasi-experimental, mixed methods approach, this secondary data …