Medicine and Health Sciences Commons^™

Connectivity, Classroom, And Contagion: An Ecological Analysis Of Testing Availability, Sex Education, And Sti Rates In The Upper Midwest, Macey M. Boerhave

Honors Thesis

Rural and frontier communities in the Upper Midwest face unique challenges that shape how young people access sexual health information and testing. While sexually transmitted infection (STI) rates continue to rise nationally, less is known about how sexual health education, digital access, and geographic distance influence these trends at a county level. This study examines the relationship between broadband internet access rates, poverty rates, proximity to free or low-cost STI testing sites, and county-level STI rates among individuals aged 15-24 in selected counties across South Dakota, North Dakota, Minnesota, Iowa, and Nebraska. Using an ecological, cross-sectional design, county-level STI surveillance …

Effects Of A Major Disruption On Mental Health Of Pregnant Women In South Carolina, Lizmarie Maldonado

MUSC Theses and Dissertations

Mental health conditions are a leading cause of death among pregnant and postpartum women, and untreated mental health conditions are associated with adverse maternal and birth outcomes. Major disruptions, such as pandemics, hurricanes, or wildfires, create unprecedented challenges and may impose additional stressors during an already vulnerable time. Community or medical care disruptions during such events may lead to adverse health outcomes. This dissertation seeks to characterize the impact of a recent major disruption on mental health outcomes among pregnant women using administrative claims data for all births in South Carolina in 2019 and 2020. By leveraging unique data sources, …

Suena Como Nosotros: A Spanish-English Storybook For Growing Voices, Stephanie Czajka

Undergraduate Theses

The purpose of this project is to address the lack of speech therapy resources available to bilingual Spanish-English-speaking children between the ages of four to six. It will target common speech and language difficulties observed in children during the critical language development period, between the ages of four and six. This book will provide an accessible, culturally relevant speech therapy resource that can be used in the comfort of the home. Through the creation of this book, equity in healthcare access will be promoted, and bilingual pride and identity will be supported. The objectives of this project include designing and …

Occupational Therapy And Periodontics Collaboration To Improve Hand Health And Fine Motor Skills In Dental Student, Zainab Alsuwaiyan

Master's Theses (2009 -)

Background: A study conducted in 2023 by the Occupational Therapy (OT) Department and Marquette University school of dentistry (MUsoD) demonstrated that many student participants scored below average on hand function testing, indicating a need for occupational therapy intervention. Objective: The purpose of this study was to evaluate the effectiveness of occupational therapy–led training for periodontics and registered dental hygienist faculty on the performance of dental students in the Introduction to Clinical Practice course (DEIN 7114). Methods: Faculty teaching in DEIN 7114 were recruited for this study. They participated in educational sessions led by occupational therapy faculty focusing on musculoskeletal disorders …

Identifying Major Sources Of Leptospira Interrogans In San Juan Bay And Río Grande De Loíza Estuaries Of Puerto Rico, Logan Mccullers, Dave Bachoon

Biology Theses

This study evaluated the presence of pathogenic Leptospira interrogans, potential carriers, and environmental factors influencing their occurrence in the San Juan Bay Estuary (SJBE) and Río Grande de Loíza (RGDL) watersheds of Puerto Rico from 2024–2025. Detection of this pathogen from water samples was performed using the lipL32 PCR assay. The likely hosts of L. interrogans were determined using fecal source tracking (FST) assays for human (HF-183), canine (BacCan-UCD), equine (HoF597), and rat mitochondrial DNA NADH dehydrogenase subunit 2 gene (RatMt) markers. In 2024, 91 samples were collected (March: 50; June: 41), and in 2025, 124 samples were collected …

Development And Application Of A Multiplex Bead-Based Platform For Quantifying Host-Pathogen Protein-Protein Interactions, Larah Gorayeb

Electronic Theses and Dissertations

Host-pathogen protein-protein interactions are the key drivers of infectious diseases, where events such as pathogen adhesion and signaling are directly associated with disease severity. One example of this is Malaria, in which the Plasmodium falciparum infected erythrocytes adhere to endothelial receptors to avoid splenic clearance. This study investigated interactions between PfEMP1 CIDR1 field domains and host receptor CD36 using a multiplex platform to quantitatively determine binding affinities. Variants RP18 and RP27 exhibited strong affinity, suggesting a role in cytoadherence and disease severity. To evaluate broader applicability, the platform was expanded to the interaction between host protein SIVA1 and Helicobacter pylori …

The Role Of Intravascular Ultrasound Imaging In 30-Day Readmissions Among Acute St-Elevation Myocardial Infarction Patients, Britta Watson

MUSC Theses and Dissertations

Cardiovascular disease (CVD) remains one of the leading causes of death in the United States. Coronary artery disease (CAD) is the largest contributor to deaths that result from cardiovascular disease. When CAD is left untreated, it can result in an acute ST elevation myocardial infarction (STEMI). To treat coronary blockages caused by CAD, a percutaneous coronary intervention (PCI) is performed. A PCI is a non-invasive procedure that uses coronary balloons and stents to open a narrowed or blocked coronary artery and restore blood flow.

An acute ST elevation myocardial infarction (STEMI) is a major cause of early hospital readmissions. Technological …

Staff Education To Improve Nursing Knowledge Of Catheter-Associated Urinary Tract Infection Prevention Practices, Maylin Fernandez

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing Practice quality improvement project, I used a staff education intervention to address nursing knowledge gaps related to catheter-associated urinary tract infection (CAUTI) prevention in a large outpatient urology clinic in the southeastern United States. Registered nurses (N = 28) participated in a single, 45-minute, in-person education session comprising PowerPoint slides, facilitated discussion, and printed job aids based on national guidelines. I used a single-group pre-/posttest design to evaluate the effect of the intervention. The primary outcome was staff knowledge measured using a paper-based, 17-item knowledge test administered immediately before and after the session. The secondary …

Cognitive And Mental Health Challenges: Addressing The Impact Of Traumatic Brain Injuries In Adults, Hannah E. Smith, Lesley Khan-Farooqi, Phd, Otd, Otr, Anne Mcdonnell, Mpa, Otr/L, Cbist

Student Capstone Papers

This capstone examined the challenges adults face following traumatic brain injuries (TBIs) and explored interventions aimed at enhancing cognitive functioning and mental health. This capstone also aimed to reduce caregiver stress and burnout by expanding knowledge and resources focused on cognitive and mental health within the population. TBIs can result from a variety of causes, affecting cognitive abilities, mental health, and functional outcomes. This capstone shows evidence-based interventions designed to improve cognitive functioning, facilitate engagement in meaningful activities to improve mental health, and enhance overall quality of life for adults recovering from TBI. This also will demonstrate potential for occupational …

Nursing Migration And The Global Workforce: How The U.S. Nurse Shortage Impacts Developing Countries, Mololuwa Faithful Lasekan

Honors Thesis

As United States (U.S.) healthcare organizations face persistent staffing gaps driven by an aging population, burnout, and limited educational capacity, many institutions increasingly rely on internationally educated nurses (IENs) to stabilize their workforce. This reliance intersects with longstanding structural challenges in low- and middle-income countries (LMICs), where inadequate compensation and limited professional opportunities contribute to high migration intentions among nurses. Using a systematic literature review guided by PRISMA principles, this study synthesized evidence and five major themes emerged: (1) push factors driving nurse emigration from LMICs, (2) pull factors attracting nurses to the U.S., (3) digital globalization and post-COVID recruitment …

Relationship Between Hepatitis B Virus Screening, Vaccination, And Spread In Sierra Leone, Muhammed Sarmodu Mansaray

Walden Dissertations and Doctoral Studies

Hepatitis B virus (HBV) presents a significant public health burden in Sierra Leone. Although the estimated prevalence was 8.7% in 2021, comprehensive statistical data has been limited in general. Programmatic interventions for HBV control such as systematic screening and vaccination have remained limited as well. The purpose of this quantitative cross-sectional study was to examine the relationship between screening and vaccination practices and HBV prevalence in Sierra Leone while controlling for age, sex, education and health care access. The theoretical framework incorporated the Integrated Screening Action model, which highlights screening as a critical disease prevention strategy, and the Social Ecological …

Perioperative Pressure Injury Prevention Education Program, Stephanie M. Reed

Walden Dissertations and Doctoral Studies

Pressure injuries (PIs) are localized injury to the skin and/or underlying tissue, usually over a bony prominence, resulting from sustained pressure including pressure associated from shear. Surgical patients are estimated to represent 42% of hospital acquired PIs. PIs result in poor patient outcomes, increase length of stay, add billions to heath care costs are no longer reimbursed by Centers for Medicare/Medicaid Services. Prevention of PI is different in the perioperative setting due to the complexities of surgery. This project focused on developing, delivering, and evaluating a robust education program for perioperative staff on PI prevention in the perioperative setting. The …

Association Between Childhood Exposure To Family Substance Abuse, Mental Health Issues, And Cervical Screening Among Women Ages 18-65 In South Carolina, Ashley Laine Hamm

Walden Dissertations and Doctoral Studies

Adverse childhood experiences (ACEs) have been associated with adverse health outcomes in adulthood; however, less is known about their relationship with preventive health behaviors such as cervical cancer screening. The purpose of this quantitative, correlational study was to examine associations between selected ACEs and cervical cancer screening among women aged 18–65 in South Carolina. Data were drawn from the 2020 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) and included 1,323 women. Binary logistic regression analyses were used to examine unadjusted and adjusted associations between ACE exposures and being up to date with Pap testing, controlling for age, race/ethnicity, income, …

Sociodemographic Factors And Dating Violence Among Adolescents Living In Rural Southern U.S. Communities, Kiara Patricia Sims-Thrasher

Walden Dissertations and Doctoral Studies

Adolescent dating violence (ADV) is a significant public health issue that disproportionately affects youths in southern rural communities, yet these populations remain underrepresented in research. The purpose of this quantitative cross-sectional study was to examine the association between ADV and sociodemographic factors (gender, race, age, and education level), alcohol consumption, and bullying among adolescents in Alabama, Arkansas, and Mississippi using data from the 2021 Youth Risk Behavior Surveillance System. Guided by the social-ecological model, binary logistic regression analyses were conducted to assess relationships between ADV victimization and the selected predictors. Results indicated that females had significantly higher odds of reporting …

The Association Between Advanced Technology Use And Quality Of Life Among Those With A Disability, Sarah Antus

Walden Dissertations and Doctoral Studies

Advanced medical technology use among individuals with physical disabilities remains understudied, creating a significant gap in understanding its impact on quality-of-life (QoL) outcomes across demographic and age groups. Guided by the social ecological model, the purpose of this quantitative study was to examine associations between advanced medical technology use, disability status, demographic factors (age, gender, and race/ethnicity), and QoL outcomes using 2017–2018 National Health and Nutrition Examination Survey data. The sample included 9,254 individuals age 6 years and older with physical functional limitations and complete technology-use and QoL data. Advanced medical technology use was significantly associated with improved QoL (p < .001). Disability status demonstrated a statistically significant but modest association with technology use, OR = 0.84, 95% CI [0.83, 0.85], p < .001. Age-stratified analyses indicated that advanced technology use significantly predicted improved QoL among adults aged 20 years and older, OR = 6.90, 95% CI [6.89, 6.91], p < .001, but not among youths aged 6–19 years (p = .929). Gender was a significant predictor of technology use, with females having higher odds than males, OR = 1.07, 95% CI [1.06, 1.08], p < .001. Race/ethnicity was also significantly associated with technology use; compared with non-Hispanic White adults, Mexican American (OR = 0.43, 95% CI [0.42, 0.44], p < .001), other Hispanic (OR = 0.58, 95% CI [0.57, 0.59], p < .001), and non-Hispanic Black adults (OR = 0.79, 95% CI [0.78, 0.80], p < .001) had lower odds of advanced medical technology use. The study may inform health care stakeholders about strategies to promote equitable access to advanced medical assistive technologies for social change

Synthesis And Evaluation Of Novel Mt5-Mmp Inhibitors For Treatment Of Alzheimer’S Disease, Nicholas Borges

Electronic Theses and Dissertations

Alzheimer’s Disease (AD) is a common neurodegenerative disease that is characterized by the accumulation of amyloid beta (Aβ) plaques and presence of neurofibrillary tangles (NFT) in the brain. Aβ oligomers are directly toxic to CNS synapses and can induce tau protein hyperphosphorylation, that causes NFT buildup. For these reasons, Aβ has been investigated as a therapeutic target, yet very few clinical trials have yielded effective drugs for AD treatment until now. Recently, the MT5-MMPmediated η-secretase pathway, which generates synaptotoxic Aη from amyloid precursor protein, has been reported (Wang et al 2024, Wilem et al 2015). Thus, pharmacologic inhibition of MT5-MMP …

Examining Moderators In The Relationship Between Injury/Injury Anxiety And Eating Disturbances In College Women Athletes, Lydia M. Reichley

Undergraduate Theses

Introduction: Injury and injury-related anxiety are common in collegiate athletes and may contribute to maladaptive psychological and behavioral outcomes, including eating disturbances. This study examined the relationship between injury/injury anxiety and eating disturbances, and whether athletic identity, injury self-efficacy, and body shame moderated this relationship. Methods: A cross-sectional design was used with 57 female collegiate and club athletes from Bellarmine University (M age = 19.98 + 1.37). Participants completed an online survey including the Sport Injury Anxiety Scale (SIAS), Athletic Identity Measurement Scale (AIMS), Athletic Injury Self-Efficacy Questionnaire (AISEQ), Eating Attitudes Test (EAT-26), and the Objectified Body Consciousness Scale (OBC; …

Can The Implementation Of The Pause Decrease Death Anxiety And Poor Mental Health In Practicing Nurses?, Lilli Meyer

Undergraduate Theses

Practicing nurses are frequently exposed to patient death, placing them at increased risk for death anxiety and compromised mental health. Despite this, there remains a lack of structured, in-the-moment interventions to support emotional processing within clinical settings. This study evaluates whether the implementation of “The Pause,” a brief moment of silence following a patient’s death, may reduce death anxiety and improve mental health outcomes among practicing nurses. A quantitative survey consisting of eight questions was distributed to nurses in the Louisville, Kentucky area over a three-month period, yielding 26 responses. Findings indicated that 80.8% of participants reported no improvement or …

The Mommy Wine Culture: A Scoping Review Using The Person-Environment-Occupational Model., Sabina Khan

Student Dissertations

Maternal alcohol use as a coping response to parenting-related stress has received growing attention in public health and psychology but remains underexplored within occupational therapy. This gap limits understanding of how daily role demands, environmental pressures, and individual vulnerabilities combine to shape drinking as a functional coping behavior. This dissertation aimed to identify and synthesize factors associated with maternal alcohol use in the context of parenting stress and interpret these determinants using the person–environment–occupation model. A scoping review was conducted following the Arksey and O’Malley framework and reported according to PRISMA-ScR guidelines. Five databases were systematically searched without date or …

Staff Education To Improve Nursing Knowledge Of Follow-Up Adherence Support Strategies In A Large Outpatient Urology Clinic, Ivette Dieguez

Walden Dissertations and Doctoral Studies

Site monitoring identified inconsistent adherence to scheduled follow-up care as an operational concern, underscoring the need for standardized nursing strategies to enhance follow-up communication. This staff education project aimed to determine whether a focused educational intervention could improve nursing knowledge of adherence support strategies, with confidence measured as a secondary outcome. Guided by the ADDIE instructional design model and the Johns Hopkins evidence-based practice model, the project was implemented in a large outpatient urology clinic with 18 participating registered nurses. Participants completed anonymous paper-based pretests and posttests surrounding a single 45-minute, live group education session. Educational content covered common barriers …

The Impact Of A Mindfulness Meditation Program On Phq-9 Scores In Eskd Clients At The Dialysis Center, Christi Collins Weaver

Student Scholarly Projects

Practice Problem: Patients undergoing hemodialysis for end-stage kidney disease (ESKD) experience high rates of untreated depressive symptoms, which negatively impact quality of life, treatment adherence, and therefore increased hospitalization and higher mortality rates.

PICOT: In adult patients receiving in-center hemodialysis (P), how does the implementation of a structured mindfulness meditation program (I), compared to usual care (C), affect depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) (O) over an eight-week period (T)?

Evidence: Current literature demonstrates that depression is highly prevalent among individuals with ESKD and is associated with increased morbidity and decreased treatment adherence. Evidence supports mindfulness …

Navigating The Ethical Landscape Of Ai Created Responsibility Gaps In Healthcare, Kelsey Dwyer '26

Honor Scholar Theses

This work is a philosophical analysis of the ethical dilemma of AI-created responsibility gaps, or the idea that it is challenging to find someone to hold responsible for outcomes produced by an autonomous system. In particular, my focus is specifically on addressing responsibility gaps created by AI used in healthcare. This complex issue of responsibility gaps becomes more intense in the setting of critical areas of life like healthcare, where moral responsibility is a foundational component of upholding medical ethics. My paper will take a deep dive into exploring the intricacies of this complex problem by applying a pre-existing conceptual …

Program Evaluation Of A Digital Outreach Initiative For Improving Well-Child Visit Engagement Among Children And Adolescents Aged 3–21 Years, Eseoghene Odhu

Doctoral Dissertations & Projects

Background: Well-child visits are essential to pediatric preventive care because they support immunizations, developmental screening, anticipatory guidance, and early identification of health concerns (Abdus & Selden, 2022; Theunissen et al., 2022). Despite their importance, engagement in recommended visits remains inconsistent across healthcare systems.

Purpose: This program evaluation examined the impact of a digital outreach initiative on well-child visit engagement among children and adolescents within a Midwestern faith-based healthcare organization.

Methods: A pre–post evaluation design was used with de-identified electronic health record data from periods before and after implementation of the initiative. Outcomes included patient enrollment, scheduled visits, completed visits, no-show …

Plastics, Microplastics, And The Gut Microbiome: Restoring Scientific Communication To Fight For Public Health, Benjamin Sanders '26

Honor Scholar Theses

Over the course of eight years from 2016 to 2024, a study by Nature Medicine found that the concentration of plastics in the brain increased by 50%. Even samples from patients with a documented dementia diagnosis showed a greater accumulation of microplastics (Nihart, 2025). In one of the most protected regions of our body, microplastics have made themselves known. In one of the most exposed regions of the human body, the story is no different. With the emergence of gut microbiome science and understanding, researchers are just beginning to discover the unique interplay between the microbiota of our gastrointestinal tract …

Quality Improvement Project: Educating Nursing Faculty On Animal-Assisted Therapy: Enhancing Knowledge And Confidence To Improve Program Outcomes, Sarah J. Whitwell

Doctor of Nursing Practice Projects

The purpose of this quality improvement project was to evaluate whether an educational intervention on animal-assisted therapy (AAT) improved nursing faculty perceived knowledge and confidence in using AAT to improve program outcomes. The problem addressed was the limited knowledge and confidence among nursing faculty regarding the use of non-traditional, evidence-based strategies to support student mental health. This project was guided by the Stetler Model of Evidence-Based Practice and Lewin’s Change Theory and used a quasi-experimental, one-group pre–post design. The project was conducted with nursing faculty teaching in a baccalaureate program at a four-year public university in Oklahoma. A 10-item Likert-scale …

Facilitators And Barriers To Mobile Health Unit Implementation: A Qualitative-Dominant Mixed Methods Study Exploring Staff Perspectives And Service Outreach, Kelsey Hardin

MUSC Theses and Dissertations

Background: Health disparities are linked to rising healthcare costs in the United States, particularly related to healthcare accessibility. Mobile Health Units (MHUs) have proven to be an effective intervention in reducing barriers to healthcare services, for example, providing early access to prenatal care, thus reducing infant mortality rates. This study focused on the facilitators and barriers to implementing an MHU program, based on staff perspectives and service outreach, to improve maternal and infant health outcomes.

Methods: This study employed a qualitative-dominant mixed-methods research design. Data was collected through interviews to assess staff perspectives. Secondary data analysis of quantitative data was …

La Dolce Vita Or The American Way: A Comparative Study Into The Italian And American Healthcare Systems Through An Analysis Of Total Knee Replacements, James (Jim) Mcmurray '26

Honor Scholar Theses

This thesis presents a comparative study of the Italian and the American healthcare systems, using Total Knee Replacements (TKRs) as a standardized metric to evaluate the health policy, financing, and patient outcomes. Despite the United States spending over $10,000 more per capita on healthcare than Italy, American life expectancy is 5 years shorter than Italian life expectancy. Through a mixed-methods analysis of data from the American Joint Replacement Registry (AJRR), the Programma Nazionale Esiti (PNE), the Registri Italiani di ArtoProtesi (RIAP), and the HCUPnet (AHRQ) database, this research identifies multiple disparities throughout the system. Key findings in this thesis include …

Developing Nursing Education On The Assessment Of Asthma Patients With Symptoms Of Shortness Of Breath In Urgent Care, Abigail Akorfa Adase

Walden Dissertations and Doctoral Studies

This quality improvement project aimed to enhance the assessment of dyspnea in patients presenting with shortness of breath, particularly those with asthma, through a staff education program. At the practice site, staff primarily relied on SpO₂ readings to evaluate dyspnea, which often led to misassessment and delays in care. The project addressed this gap by providing urgent care staff with training on comprehensive assessment techniques, including evaluation of respiratory rate, work of breathing, ability to speak, patient history, and use of validated tools such as Borg’s scale and peak flow meters. Twenty triage staff members participated, including licensed practical nurses, …

Fast-Food Consumption And Metabolic Syndrome Risk In African Children And Adolescents, Norkinsha Willis

Walden Dissertations and Doctoral Studies

Childhood obesity and excessive fast-food intake represent a significant public health concern among African American children. Grounded in the social-ecological model, this quantitative, cross-sectional study examined whether frequency of fast-food or pizza meal consumption and reliance on low-cost food was associated with total cholesterol (mg/dL) and waist circumference among African American children and adolescents aged 6–15 years while controlling for key sociodemographic factors (age, gender, parental education status, and annual household income). Secondary data from the 2017–2018 National Health and Nutrition Examination Survey were analyzed (N=184). Descriptive statistics, nonparametric analyses, and a multiple linear regression model were used to analyze …

The Effect Of The Mind Diet On Cognitive Decline In Als Patients With Frontotemporal Dementia, Riya Thomas, Reba Thomas, Eliana Gitelman

Department of Nutrition Student Projects

Amyotrophic lateral sclerosis (ALS) is a progressive disease that affects nerve cells in the brain and the spinal cord, leading to a broad range of neurological issues. Individuals with ALS experience progressive muscle weakness, dysphagia, slurred speech, and impaired movement and cognition. In addition to physical symptoms, around 15-20% of individuals with ALS also develop frontotemporal dementia (FTD). There are limited interventions to slow cognitive decline in this specific population. The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has been associated with slower cognitive decline and reduced risk in neurodegenerative disease among older adults; however, its effects have not been …