Medicine and Health Sciences Commons^™

The Association Between Personal Particulate Matter Exposures And Cognitive Function Among Stroke Patients, Kentucky, Usa, Nana Afua Ankomah Dei

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Stroke, a major cause of long-term disability and cognitive problems in the U.S., significantly affects people’s quality of life. Exposure to particulate matter (PM_2.5) may result in systemic inflammation and oxidative stress, which can worsen the cognitive function of post-thrombectomy stroke patients. This project thus assessed the relationship between PM_2.5 exposure and its effect on the cognitive function of post-thrombectomy stroke patients. Fifteen stroke patients (9 non-Appalachian and 6 Appalachian) undergone thrombectomy were recruited. Personal PM_2.5 exposure was measured using wearable sensors for a week during the study period. Montreal Cognitive Assessment (MoCA) scores and covariates …

Optimizing Efficiency In Joint Injections In An Outpatient Orthopedic Oncology Clinic Using Lean Six Sigma, William Alexander Byrd

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Prolonged in-room wait time in an outpatient orthopedic oncology clinic was identified as an important driver of dissatisfaction and operational inefficiency. Baseline in-room times in this setting were reported as M=96.2 minutes for patients receiving injections and M=92.9 minutes for those not receiving injections. This quality improvement project used Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, Control) framework to streamline clinic workflow for the joint injection process. Over an eight-week period, four key interventions were introduced: a standardized order set for medications, pre-bundled supplies and portable supply toolbox, telephone pre-consenting of patients, and optimized scheduling of …

Advancing Menstrual Health And Hygiene In Rural Kenya: A Guideline Based Approach, Tessia R. Winnfield

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Objective: To develop an evidence-based clinical practice guideline for menstrual health management addressing menstrual education, teacher training, menstrual school absenteeism, male student engagement, pain management, and provision of menstrual kits with product options.

Design: This evidence-based practice guideline development project used the Agency of Healthcare Research and Quality (AHRQ) Framework and the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). I conducted a systematic literature review and a critical appraisal to identify best practices for menstrual hygiene interventions in rural communities.

Setting: The guideline development occurred within an academic Doctor of Nursing Practice program focused on rural communities.

Participants: Seven stakeholders …

Organizational Support And Burnout In Occupational And Physical Therapists: A Quantitative Correlational Study In The Acute Care Setting, Brenda Ballou-Boyd Mrs.

Occupational Therapy Doctorate Capstone Projects

Background: The United States is positioned for an upcoming healthcare crisis with an estimated deficit of 100,000 healthcare professionals by 2028 (Mercer, 2024). Burnout is well documented among the healthcare community and is a major contributing factor to an ongoing shortage of healthcare professionals, including occupational and physical therapists. Most prior research has focused on burnout from a personal level, but addressing burnout from an organizational level may be more effective in reducing this phenomenon among occupational and physical therapy providers.

Purpose: Despite the high levels of burnout reported, a substantial gap exists in research dedicated towards the …

Differences In Comorbidities, Presenting Symptoms, Demographics, And Patient Reported Outcomes In Long Covid By Initial Test Status, Stephanie Georgoudiou

Nursing Dissertations - Archive

Importance Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), remains a major global health concern. Recovery may result in persistent symptoms known as post-acute sequelae of SARS-CoV-2 (PASC), or long COVID. Most studies focus on individuals with laboratory-confirmed infection; however, some patients with COVID-like illness and negative tests also develop persistent symptoms. Testing status should not delay appropriate interventions or specialist referrals. Early, symptom-based care is essential to improve outcomes.

Objective To compare patient-reported outcomes and demographics between long COVID patients who tested positive versus negative during their initial illness.

Design, Setting, and Participants This secondary …

Long Acting Beta2-Adrenergic Receptor Agonists Reverse Diabetic Nephropathy And Liver Steatosis In Murine Models Of Diabetes And Are Associated With Protection In Retrospective Human Studies, Brennan Winkler

MUSC Theses and Dissertations

Diabetes Mellitus (DM) affects 13.9% of men and 14.3% of women worldwide, a total of approximately 828 million people. Patients with diabetes are at risk of several complications including diabetic nephropathy (DN) and metabolic-associated steatohepatitis (MASH). These diseases eventually lead to end stage kidney disease (ESKD) and liver failure requiring dialysis and organ transplantation. In addition, diabetes exacerbates disease severity of autosomal dominant polycystic kidney disease (ADPKD), the most common potentially lethal genetic disease to affect humans with a prevalence of 1 in 500-1000. Therefore, a therapeutic approach that can attenuate organ damage and restore function in patients with DM, …

A Scenario Analysis Of The Impact Of H.R.1 2025 Medicaid Coverage Loss And Payment Reductions On U.S. Hospital Operating Margins, Tangee Pruitt

MUSC Theses and Dissertations

The “Big Beautiful Bill” is expected to affect the financial health of U.S. hospitals. We performed a scenario analysis using five case studies combined with national data on payer mix information to illustrate potential impact in 2027. The scenarios explored the following question: What is the expected healthcare access and economic impact of H.R.1 under three sets of assumptions: 1) loss of Medicaid coverage for 10% or more of an institution’s current patients who will then become uninsured; 2) decrease in Medicaid payments by 10% or more; 3) loss of Medicaid coverage and decrease in Medicaid payments simultaneously. We defined …

The Impact Of Heavy Resistance Training On Type Ii Muscle Fibers Throughout Female Reproductive Stages, Lily G. Colberg

Scripps Senior Theses

Type II muscle fibers, also known as fast-twitch muscle fibers, are reliant on aerobic glycolysis and are crucial for high-force contractions, mobility, and rapid movements, such as fast reflexes. Heavy resistance training has been found to increase type II muscle fiber concentration in young, middle-aged, and elderly individuals. However, there have been few studies conducted on female-only sample populations. In women, the impact of heavy resistance training on type II muscle fibers is affected by the progressive decline of estrogen that defines the transition throughout the four female reproductive stages: premenopause, perimenopause, late-transition menopause, and postmenopause. Menopausal estrogen depletion causes …

Evaluating Acupuncture As An Adjunct To Standard Ulcerative Colitis Therapy, Mia A. Ciotti

Scripps Senior Theses

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by recurring cycles of flare and remission that significantly affect patients’ quality of life. Standard allopathic treatment for UC centers on mesalamine, a 5-aminosalicylic acid drug that acts locally on the colon to reduce inflammation, but does not cure the disease entirely. Acupuncture, rooted in Traditional Chinese Medicine, has been proposed as an adjunct therapy for inflammatory conditions, yet its biomedical efficacy remains uncertain due to methodological limitations and insufficient controls of prior studies.

This study proposes a randomized, participant and assessor blinded clinical trial evaluating mesalamine, true acupuncture, sham …

Broadening The Fetal Alcohol Paradigm: Bdnf Methylation As A Link Between Paternal Alcohol Use And Offspring Neurodevelopmental Deficits, Caitlin E. Muñoz

Scripps Senior Theses

Developmental effects of fetal alcohol exposure are extensively documented as a consequence of maternal gestational alcohol consumption. However, similar consequences of paternal alcohol consumption remain understudied. This proposed pilot study will examine preconception paternal alcohol consumption within its capacity to induce heritable epigenetic modifications in sperm, such that offspring are susceptible to adverse in utero neurodevelopment and neonatal neurobehavioral outcomes. Specifically, it will examine DNA methylation patterns along the brain-derived neurotrophic factor (BDNF) exon IV promoter in paternal spermatozoa. BDNF exon IV is considered a key locus in neurogenesis regulation, synaptic plasticity, and cortical development. It is hypothesized that BDNF …

Anterior Cruciate Ligament Injury Resilience In Women's Lacrosse: An Ecological Dynamics Approach, Annika J. Wozney

Senior Honors Theses and Projects

Anterior cruciate ligament (ACL) injuries remain a significant concern in the sport of women’s lacrosse due to the amount of cutting and rapid deceleration movements in the sport. Non-contact ACL injuries in women’s lacrosse arise from complex interactions involving biomechanical, anatomical, and neuromuscular factors. Traditional ACL injury prevention programs (IPPs) often focus on strengthening and neuromuscular training in controlled environments with pre-planned movements, which may not adequately simulate the cognitive demands and unpredictability during a competition. An ecological dynamics approach is proposed that considers the athlete, the game environment, and the immediate task to emphasize the athlete-environment relationship. By incorporating …

The Role Of Resistance Training In Modifying Cardiovascular Diseases And Diabetes, Mikayla P. Rucinski

Senior Honors Theses and Projects

This review of literature examines the role of resistance training as an effective intervention for modifying risk factors associated with cardiovascular diseases and diabetes. Evidence from clinical and exercise interventions indicates that resistance training improves glycemic control by increasing lean muscle mass, enhancing insulin sensitivity, and facilitating greater glucose uptake in individuals with diabetes. In addition, resistance training has been shown to reduce resting blood pressure, improve lipid profiles, enhance vascular function, and decrease fat mass. Collectively, these physiological adaptations contribute to lowering the development and progression of cardiovascular disease across various populations. The findings support resistance training as an …

Atypical Antipsychotic-Induced Weight Gain Preventive Bundle: A Quality Improvement Project, Jocelyn Urbano

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Antipsychotic-induced weight gain (AIWG) is a common, clinically significant adverse effect associated with second-generation antipsychotic medications and contributes to increased cardiometabolic risk among individuals with serious mental illness (SMI; Carolan et al., 2025; Hegde et al., 2024). Individuals experiencing homelessness or social instability often encounter additional barriers to maintaining healthy lifestyle behaviors and consistent engagement in healthcare, further increasing metabolic risks and treatment issues (Hamel et al., 2024; Kelly et al., 2025). This preventive care bundle, designed to reduce the risk of AIWG, was implemented in an outpatient behavioral health clinic serving an underserved urban Texas population.

As metformin may …

The Tilt Continuum: Investigating The Relationship Between Emotions And Peformance In Esports., Rowan D. Steyn

Williams Honors College, Honors Research Projects

Despite widespread agreement in esports communities that tilt leads to poorer performance, this belief remains largely anecdotal. Most existing research relies on self-reported experiences of tilt and perceived decreases in performance, with very little to no empirical evidence supporting this consensus. This project seeks to provide the first systematic, within-person investigation of how varying levels of tilt relate to performance across competitive matches over time. By using post-match surveys and tracking objective performance indicators ( Match win/loss), the study will assess whether tilt consistently predicts poorer outcomes or if the relationship is more complex and nuanced, for example, a possible …

Evaluation Of The Physical Properties And In Vitro Safety Of Chitosan-Quercus Infectoria Topical Gel, Rani Naga Rakshitha Tillapudi

Theses, Dissertations and Capstones

Due to ongoing inflammation, inadequate blood flow, oxidative stress, and reduced tissue regeneration, chronic diabetic wounds heal slowly, which is a serious health concern. It is important to examine novel strategies that tackle these issues because conventional treatments frequently fail. Therefore, this study examined the physical properties and biocompatibility of a novel topical gel formulated with chitosan and Quercus infectoria gall extract.

Over 28 days, pH, spreadability, texture, homogeneity, color, and drug concentration were assessed. UV-visible spectrophotometry and FTIR analysis were used to establish chemical stability. The MTT assay was used to test its safety in human dermal fibroblast adult …

Meta-Analysis: Diabetes Mellitus And The Risk Of Endometrial Cancer, Tricia Ho, Marika Ongpauco, Han Ha Ngoc Nguyen

Physician Assistant Studies | Graduate Research Papers

Background: Many studies have looked at the relationship between diabetes mellitus and development of endometrial cancer. This study provides an updated systematic review and meta-analysis of the estimated effect of diabetes and the risk of endometrial cancer.

Methods: Some studies were found on databases such as PubMed and Iceberg. The remaining studies were extracted from the initial studies found. Binary data was collected and the raw data was imputed into a Fixed Effects Model.

Results: A total of 25 studies were included in this meta-analysis, generating statistically significant results (p < 0.001, OR 2.05, 95% Cl 1.92-2.19).

Discussion: Diabetes is found to be …

The Effects Of Antidepressant Medications On Sleep Quality In Dominican University Of California Students, Natalie L. Davis, Kenna Wohlford, Stephanie Lee

Physician Assistant Studies | Graduate Research Papers

We spend approximately one third of our life time sleeping or attempting to sleep. The quality of our sleep is equally, if not more important than the amount of sleep we get. This study assesses the effects that medications, specifically antidepressants, can have on sleep quality in Dominican University of California students. 118 participants completed a Qualtrics survey including questions regarding stress, sleep quality, medication lists, and demographics. This study utilized the Pittsburgh Sleep Quality Index (PSQI) to quantify participants’ sleep quality as the outcome. Participant stress levels were assessed with a Likert scale question asking for stress levels on …

Burnout And Workforce Outcomes Among Registered Nurses, Madeline Willcoxen

Theses, Dissertations and Capstones

Purpose: The purpose of this study was to examine the relationship between staffing and organizational support interventions and workforce outcomes among registered nurses providing direct patient care in hospital settings. The study focused on three measurable outcomes: emotional exhaustion, absenteeism, and annual nurse turnover. The population included hospital-based registered nurses, and the comparison involved standard staffing and support conditions.

Methods: A systematic literature review was conducted following PRISMA 2020 guidelines. Studies published between 2015 and 2026 were identified using PubMed, CINAHL, Scopus, and PsycINFO databases. Inclusion criteria required quantitative studies examining staffing or organizational support interventions among registered nurses in …

Exploring Dominican University Nursing Students’ Perceptions Of Economic Barriers To Accessing Essential Women’S Health Products, Annabelle E. Burke

Nursing | Senior Theses

Period poverty is defined as inconsistent or inadequate access to feminine hygiene products, and it has been shown to negatively impact physical and mental health, academic performance, and dignity across diverse populations. Existing research highlights financial strain, social stigma, and insufficient support as key barriers to menstrual equity among individuals experiencing homelessness, adolescents living in low-resource environments, low-income women, and general undergraduate students (Brinkley & Niebuhr, 2023; Dave et al., 2022; Gruer et al., 2021; Lahme et al., 2018; Parkinson et al., 2024; Gilchrist et al., 2024). However, no studies have examined these issues amongst Dominican University nursing students who …

Paternal Involvement And Bonding In Neonatal Intensive Care Unit: Evaluating Daily Caregiving, Emotional Well-Being, And Father-Infant Connection, Ava G. Kinyon

Nursing | Senior Theses

Background: Premature birth and serious neonatal conditions frequently require infants to obtain care in the NICU, producing psychological and emotional obstacles for families. Despite the fact that skin-to-skin contact has been extensively researched for its strengths in encouraging stability and bonding, there persists restricted importance and understanding on paternal participation in routine caregiving tasks such as feeding, diapering, temperature checks, and swaddling. Purpose: This study aims to evaluate paternal participation in daily NICU caregiving tasks to address gaps in comprehending how these experiences impact bonding and emotional well-being among fathers of hospitalized infants. Methods: This study will employ a quasi-experimental …

The Impact Of Home Birth Integration On Maternal-Neonatal Outcomes And Patient Satisfaction: An Integrative Review, Mary E. Hillaker, Jennifer K. Jacobitz

All Electronic Theses and Dissertations

Introduction: Home birth is a safe option for low-risk populations. As awareness of home birth increases, so do the families choosing home birth. Governing bodies recommend well integrated maternal health systems, yet the impact of level of integration on perinatal outcomes and patient satisfaction has not been specifically examined. The purpose of this integrative review is to identify the impact home birth integration has on maternal and neonatal outcomes, patient satisfaction, and how communities can improve their integration level.
Methods: A keyword search of current literature was conducted using CINAHL, PubMed, and Scopus databases. An additional hand search of 2 …

Dosage Considerations For Aspirin Therapy To Prevent Preeclampsia In Pregnancy, Melissa S. Haraway

All Electronic Theses and Dissertations

Introduction: Preeclampsia remains the leading cause of maternal and neonatal mortality worldwide despite extensive and ongoing research on the subject. The use of aspirin therapy to reduce preeclampsia in pregnancy is widely researched and accepted into practice, however, optimal dosing is still debated. The purpose of this review is to identify which dosage of aspirin therapy offers the most effective reduction in preeclampsia without increasing the risk of postpartum hemorrhage.
Methods: The following databases were searched using the framework methodology by Whittemore and Knafl: CINAHL, PubMed, ScienceDirect, Scopus, ProQuest, and Citations. The search criteria limited articles to five years old …

Nanocomposite Mediated Delivery Of 5-Fluorouracil Using Silver Nanoparticles To Promote Wound Healing, Kamal Nath Kasi

Theses, Dissertations and Capstones

Chronic wounds, particularly in diabetic patients, remain a significant clinical challenge due to the complex interaction of persistent infection, chronic inflammation, and impaired cellular regeneration. Conventional drug therapies often fail to achieve effective treatment due to rapid drug degradation, poor targeting, and localized toxicity. This study explores a nanotechnology-based approach by developing and evaluating 5-FU loaded AgNP (AgNP–5FU) as a controlled drug delivery system. AgNP (AgNP) were synthesized and characterized using scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis, particle size, and zeta potential analysis, while Fourier Transform Infrared Spectroscopy (FTIR) analysis suggested possible interaction between 5-FU and the …

Development And In Vitro Characterization Of 5-Fluorouracil–Loaded Plga Nanoparticles For Controlled Drug Delivery, Kavya Yandapalli

Theses, Dissertations and Capstones

Non-Alcoholic Fatty Liver Disease (NAFLD) is a progressive metabolic disorder characterized by excessive lipid accumulation in hepatocytes and chronic inflammation. Nanoparticle-based drug delivery systems offer a promising strategy to enhance therapeutic efficacy while minimizing systemic toxicity. The objective of this study is to formulate and characterize 5-FU–loaded PLGA nanoparticles and evaluate their in vitro performance. 5-FU–loaded PLGA nanoparticles were prepared using the double emulsion solvent evaporation method. The nanoparticles were characterized by particle size, polydispersity index, zeta potential and SEM. Drug encapsulation efficiency, loading capacity and in vitro drug release studies were conducted. The formulated nanoparticles exhibited sizes within the …

Comparative Machine Learning Models For Disease Risk Prediction, Mercy Mawusi Agbley

Theses, Dissertations and Capstones

Accurate prediction of disease outcomes is crucial for improving clinical decision-making and enabling early intervention. This study compares the performance of various statistical and machine learning models for clinical risk prediction using two healthcare datasets: diabetic retinopathy and heart disease. The models assessed include Logistic Regression, LASSO, k-Nearest Neighbors (KNN), Support Vector Machines (SVM), Neural Networks, Random Forests, Gradient Boosting Machines (GBM), and a stacked ensemble model. Prior to modeling, datasets were split into train and test sets. Standardization was applied to numeric features whilst categorical features were one-hot encoded. These transformations were later applied to the test set. Principal …

Hepatocyte Peroxisome Biogenesis And Phytol-Induced Metabolic Stress In Liver Disease, William Galloway

Theses, Dissertations and Capstones

Hepatocyte peroxisomes are required for metabolism of phytol-derived branched-chain fatty acids through the ACOX2-SCPx beta-oxidation pathway. This study tests whether hepatocyte-specific deletion of PEX16 (Pex16^Alb-Cre), which eliminates peroxisome biogenesis, sensitizes the liver to phytol-induced injury. The Pex16^Alb-Cre mice and their normal control Pex16^fl/fl mice were fed the Lieber-DeCarli liquid with or without 0.1 percent phytol for eight weeks. Serum alanine aminotransferase (ALT) and liver index were measured. Liver sections were stained with hematoxylin and eosin and Masson’s trichrome. Immunoblot analysis of peroxisomal enzyme expression was also performed. Phytol had no effect in Pex16^fl/fl mice as …

Sexually Dimorphic Effects Of Gpnmb Modulation On Vertebral Bone Mass Regulation And Intravertebral Disc Health, Hakem Altawil, Fayez Safadi

Williams Honors College, Honors Research Projects

Osteoporosis and vertebral degeneration are major contributors to musculoskeletal morbidity, yet the molecular mechanisms regulating vertebral bone and intervertebral disc (IVD) homeostasis remain incompletely understood. GPNMB (osteoactivin) has been identified as a regulator of bone remodeling, though its role in spine health is unclear. This study evaluated the effects of GPNMB deficiency on lumbar vertebral bone microarchitecture and IVD integrity in a sex-dependent context.

Six-month-old male and female wild-type (WT) and GPNMB knockout (KO) mice were analyzed using micro–computed tomography (µCT) of lumbar vertebrae (L4–L6) and histological assessment of the L5–L6 IVD. KO males exhibited increased bone volume fraction, bone …

Breaking The Boom-Bust Cycle: Supporting Pediatric Fatigue And Participation After Hsct Using The 5-Pet And Caregiver Education, Annelie Claire Kershaw

OTD Capstones

Pediatric patients recovering after hematopoietic stem cell transplant (HSCT) often experience persistent fatigue, physical deconditioning, cognitive changes, and decreased participation after discharge. Fatigue is complex and multidimensional, making it difficult for children to understand, communicate, and manage as they return to school, play, social activities, and daily life. Occupational therapists are well positioned to support participation, activity pacing, caregiver education, and health management for children recovering after HSCT.

This capstone project addressed the need for developmentally appropriate fatigue management resources through the creation of multiple deliverables. The primary deliverable was the 5-Zone Pediatric Energy and Fatigue Scale (5-PET), which is …

Sociodemographic Differences In Sepsis-Related Medicare Hospitalizations: A State-Level Analysis Of Diagnosis-Related Groups For Severe Sepsis In 2019 And 2022, Alba Kuqi

College of Graduate Studies: Theses & Dissertations

Introduction: This state-level ecological repeated cross-sectional study examined sociodemographic differences in sepsis-related Medicare hospitalizations assigned to Medicare Severity Diagnosis-Related Groups (MS-DRGs) 871 and 872 in 2019 and 2022.

Objective: The study focused on three outcomes: changes in sepsis-related Medicare discharge volume, changes in average Medicare payment per sepsis discharge, and changes in the proportion of MS-DRG 871 discharges relative to MS-DRG 872 discharges.

Methods: Publicly available Medicare inpatient hospital data and state-level demographic data were used to evaluate whether age, race, gender composition, and median household income were associated with these changes across the 50 U.S. states and …

Exploring Acculturation And Its Role In Substance Abuse Behaviors Among Refugee Populations In Bowling Green, Ky: An Interactive Learning Experience Through Provider’S Perspectives., Aishwarya Potluri

College of Graduate Studies: Theses & Dissertations

Substance use among refugee populations is an emerging public health concern shaped/influenced by cultural, social, and structural factors associated with resettlement. This qualitative study explored providers’ perspectives on substance use behaviors among refugees in Bowling Green, Kentucky. Using Health Behavior Theory with acculturation as a contextual construct, semi-structured interviews were conducted with 10 providers working with refugee-serving organizations. Data collected through the interviews was analyzed using thematic analysis in NVivo. The findings indicate that substance use is being influenced by peer exposure, occupational stress, and the increased availability of substances in the United States. Providers identified cultural stigma surrounding mental …