Enhancing Military Health System Organizational Efficiency And Quality Of Care Through A Social-Ecological Framework, Eric L. Peipelman

College of Graduate Studies: Theses & Dissertations

Timely and fair adjudication of incivility-related actions within the Department of Defense (DoD) and Military Health System (MHS) is increasingly crucial for maintaining accountability, mission readiness, and quality of care. Ongoing delays in resolving workplace complaints and inefficiencies in resource-heavy adjudications highlight the need to shift from reactive complaint handling toward proactive civility promotion and transparent decision-making. This Integrated Learning Experience (ILE) introduces the Peipelman Civility Discussion and Assessment Toolkit (PCDAT)—a comprehensive, evidence-based framework designed to improve civility, optimize resources, and enhance communication, even in the MHS. Based on the Social-Ecological Model (SEM) and adapted from the Workplace Power and …

Trends Among Suspected Opioid Overdose Emergency Medical Service (Ems) Incidents In Georgia From 2019-2023, Ashton Harris

College of Graduate Studies: Theses & Dissertations

Opioid overdoses remain a problem in the United States, underscoring the need for additional surveillance tools to monitor trends in opioid overdoses. Emergency Medical Services (EMS) data is a timely surveillance method that captures more potential overdoses than hospitals by representing the pre-hospital setting. Research questions in the study assess EMS responses to suspect opioid overdose incidents from 2019-2023 in Georgia to encompass the following characteristics: timeframe (pre, during, post-pandemic), urban versus rural counties, race/ethnicity, categorical type of first responder, mean dosage of naloxone in milligrams administered, and death. 84,359 records meeting the inclusion criteria were initially retrieved from the …

Metabolic Syndrome Beyond Diagnostic Criteria: Population-Scale Integrative Metabolomics Characterization, Marwa Talal

Theses and Dissertations

Background: Metabolic syndrome (MetS) is a complex cluster of interrelated metabolic abnormalities associated with elevated cardiometabolic risk. While diagnosis is based on well-established five clinical criteria, these may overlook early or atypical metabolic alterations. Large-scale metabolomic profiling offers an opportunity to identify biochemical signatures of MetS beyond diagnostic bias and to evaluate their relative importance across different presentations of the syndrome.

Methods: Data from 117,147 UK Biobank participants were analyzed in a cross-sectional design. High-throughput NMR quantified 75 circulating metabolites, for. Univariate analyses, MetS subtype stratification, and elastic net models with SHAP interpretation were applied to assess feature …

The Effects Of Speak Out! On Hypokinetic Dysarthria In Individuals With Idiopathic Parkinson’S Disease, Linden King

Murray State Theses and Dissertations

The purpose of this single subject research study was to prove the efficacy of SPEAK OUT! therapy in improving loudness, rate of speech, and quality of life for individuals who have hypokinetic dysarthria due to Parkinson’s Disease. In this A-B-A design, five weeks of SPEAK OUT! therapy was provided twice a week to four individuals with a diagnosis of Parkinson’s disease. Results showed an increase in loudness in conversation and improved quality of life measured by statistical and visual analysis. These findings contribute to the research behind the use of SPEAK OUT! therapy for individuals with HKD due to PD.

Association Between Internet Use For Health Information And Alzheimer’S Disease Diagnosis Among Older Adults With Diabetes In The United States: Examining Racial And Gender Disparities, Henry M. Zeidan

College of Graduate Studies: Theses & Dissertations

This study uses data from the National Health and Aging Trends Study (NHATS) Round 13, collected in 2024, to examine whether internet use for health information is associated with Alzheimer’s disease diagnosis among older adults with diabetes in the United States. Given the rising adoption of digital health, understanding who benefits from online health resources is increasingly important. The research also examines whether these associations differ across racial and gender groups, offering insight into potential disparities in digital health engagement and cognitive outcomes. Findings from this study will inform clinical practice, public health programming, and strategies to ensure equitable access …

The Effects Of Expectancies And Attention To Placebo Relevant Sensations On The Open-Label Placebo Response, Miranda Connelly

Cal Poly Humboldt theses and projects

Placebo analgesia has shown promise in treating pain, but practitioners are reluctant to prescribe deceptive placebos. Open-label, or honestly prescribed placebos, offer an ethical alternative. Open-label placebos seem to work largely through experimenter-manipulated expectancy, as well as social/environmental factors. Additionally, verbally guided attention to relevant placebo sensations might bolster pain relief. In the present study, expectancy and attention were experimentally manipulated within a 2 (expectancy: high/low) x 2 (attention: high/low) between-subjects design with a no-treatment comparison group. Pain was experimentally induced in all five experimental groups using the well-established cold pressor task. The primary dependent variables were pain tolerance and …

Examining The Physiological Stress-Reducing Effects Of Virtual Nature Exposure And Slow Breathing, Jesse Benefiel

Cal Poly Humboldt theses and projects

In a time of excess stress, it is essential to examine accessible stress-reduction methods. Research has demonstrated that virtual nature exposure and slow breathing can independently reduce stress, but the literature is lacking with regard to their combined effects. The present study aimed to replicate independent effects of breathing and nature on stress and to test for potential effects, including whether their combination would produce an interaction effect. Using a 2 Environment (Natural v. Control) by 2 Breathing (Slow v. Normal) between-subjects design, 63 participants completed a modified color-word Stroop task to induce stress and were then exposed to either …

Early Icu Physiological Subtyping From Time-Series Data: A Comparative Study Of Feature Complexity, Predictive Performance, And Model Interpretability, Rojeena Khadka

College of Graduate Studies: Theses & Dissertations

Intensive Care Unit (ICU) patients do not follow a single uniform physiological pattern. Patients admitted with the same diagnosis show different clinical trajectories over time making standardized classification and treatment approaches insufficient. The increasing availability of large-scale electronic health records in MIMIC-IV makes it possible to investigate such heterogeneity through data-driven approach that captures how physiology evolves during the early phase of ICU admission. This thesis compares two analytical pipelines designed to identify physiological subtypes from the first 48 hours of ICU time series data. This study then assesses how well these subtypes predict in-hospital mortality. The first approach, referred …

Effects Of The Menstrual Cycle Phase On Rpe, And Symptom Characteristics In Pre-Professional Female Soccer Players, Emily Potts

College of Graduate Studies: Theses & Dissertations

Hormonal fluctuations across the distinct phases of the menstrual cycle have been shown to influence physiological and psychological responses to exercise, with some evidence suggesting phase-dependent changes in symptom presentation and ratings of perceived exertion (RPE); however, findings remain inconsistent, and few studies have examined these relationships across an entire competitive season in female soccer players. The purpose of this study was to examine changes in RPE and menstrual symptoms across cycle phases, as well as the relationships between RPE and symptom reporting in pre-professional female soccer players. A total of 22 female soccer players (age 22± 1.85) were recruited …

Body Image Perception In African American Women, Ages 20-55 Years, Trina Suttles

College of Graduate Studies: Theses & Dissertations

This qualitative study explored the factors that influence body image perception among African American women in the metropolitan Atlanta, Georgia area and examined how these perceptions shape physical activity and dietary behaviors. Body image perception is a critical psychocultural factor influencing obesity-related behaviors, particularly among African American women who navigate culturally specific beauty standards and health beliefs. Guided by the Socioecological Model, this study addressed three research questions: (1) how African American women perceive their body image, (2) how these perceptions influence health behaviors, and (3) what multilevel factors shape body image perceptions. This study employed consensual qualitative research (CQR) …

Nutrient-Driven Transcription Factor-Dna Interactions And Their Signaling Mechanisms In Metabolic Disease, Evelyn A. Bates

Theses and Dissertations--Nutritional Sciences

Metabolic homeostasis is maintained through tightly coordinated signaling networks that integrate diverse physiological inputs. Central to this regulation are transcription factors, which sense nutrient, hormonal, and vitamin-derived signals and translate them into coordinated gene expression programs. Transcription factor activity is governed by DNA binding, recruitment of coregulatory proteins, and interactions with specific response elements in gene promoters, which allows them to selectively modulate diverse metabolic pathways. Owing to their multifactorial and tunable nature, transcription factors have emerged as promising targets for the treatment and diagnosis of metabolic diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD). This dissertation explores the molecular …

Examining The Relationship Between Sleep And Physical Activity Among University Students, Maddie Stock

Senior Honors Theses and Projects

Sleep and physical activity (PA) are important factors for maintaining overall health and are positively associated. The relationship between sleep and PA is well-documented for the general adult population, but there is less research on college students who are in a formative stage of developing lifelong health behaviors. The purpose of this study was to examine the relationship between aerobic PA and sleep in college students. College students at a Midwest University were invited to participate by completing the American College Health Association’s National College Health Assessment evaluating students’ health behaviors over the previous 1-2 weeks. These values were used …

An Analysis Of Eating Disorders As A Comorbidity Of Autoimmune Diseases, Madeleine Shore

Scripps Senior Theses

For many autoimmune disease patients, psychiatric conditions are a common comorbidity. Although there are many shared mechanisms between autoimmune disease and psychiatric conditions, current research surrounding mental health among autoimmune disease patients often focuses on mood disorders rather than eating disorders. Despite the high risk for developing psychiatric conditions, most autoimmune disease patients are not screened for eating disorders. This lack of screening is significant, because if an eating disorder is missed by a healthcare provider, the autoimmune or eating disorder condition could be exacerbated, resulting in severe illness or even fatality. Given an existing link between comorbid psychiatric disorders, …

"It's A Dance": Examining Midwives As Choreographers Of Reproduction In Maine, Annie Goldstein

Honors Theses

This thesis examines the contemporary work of community-based Maine midwives through the theoretical framework of choreography. In the context of this work, choreography can be understood as the well-thought-out, purposeful undertaking of a process during which negotiation, coordination, and improvisation are required to adapt to constantly changing circumstances. Using choreography, this thesis attempts to understand how Maine midwives navigate global market processes and practice under authoritative forms of biomedicine, ultimately linking them to other midwives across various global sites. Situated within Maine’s maternal health landscape that is characterized by the ongoing closure of labor and delivery units and rural hospitals, …

The Role Of Mscs In The Il23/17 Pathway And Their Response To Mechanical Stress, Norma Aileen Dominguez Jimenez

Honors Theses

Mechanical stress plays a central role in shaping cellular behavior within skeletal tissues. At the enthesis, where tendons and ligaments attach to bone, repeated mechanical loading is strongly associated with inflammation and the development of ankylosing spondylitis (AS). Although mesenchymal stem cells (MSCs) are known to contribute to tissue structure and repair at these sites, their potential role in inflammatory signaling, particularly within the I 23/IL 17 pathway, remains unclear. In this thesis I investigated whether MSCs are capable of expressing cytokines involved in this pathway and how mechanical stress and differentiation influence this expression. Using the mouse derived C3H/10T1/2 …

A Regime Of Fear: Barriers To Healthcare Access In Times Of Intensifying Anti-Immigrant Rhetoric And Immigration Enforcement, Kathryn F. Masetti

Honors Theses

The U.S. immigration regime produces the conditions that deny immigrants equitable access to healthcare. The Trump administration’s second term, characterized by aggressive immigration enforcement and anti-immigrant rhetoric, continued to intensify these conditions, contributing to a widespread decline in healthcare utilization by immigrant patients throughout the United States. This thesis investigates how policies and rhetoric from the Trump Administration, including immigration enforcement, shape the barriers that immigrants with and without status encounter when accessing healthcare services in Maine, and how the fear of surveillance, detention, or deportation influences how immigrant communities perceive and utilize healthcare services. Two in-depth semi-structured qualitative interviews …

The Untold Art History Of Grillz: An Introduction Exhibition At The Ica, Helena Opuama

MA in Fine and Decorative Art and Design Dissertations

The Untold Art History of Grillz: An Introduction Exhibition at the ICA is a prompt multisensory exhibition scheduled to open 15th April 2028 in celebration of World Art Day, at the Institute of Contemporary Arts, in London, UK. The exhibition critically utilises postcolonial frameworks to explore the dismissed decorative history of dental adornment and its influence on contemporary grill design today.

Through a limited chronological selection of physical objects, holographic projections, archival photographs, oral histories, and social media contributions; the exhibition co-narrates the history of dental adornment across four historical periods. These periods include Precolonial Traditions (14th-15th century); Colonial Evolutions …

Meconium Metal Concentrations And Infant Temperament And Development, Fiona Fogarty

Dissertations and Theses

BACKGROUND: Prenatal exposure to metals poses significant health consequences for early childhood development. Understanding the factors influencing metal concentrations that infants are exposed to in-utero is crucial for developing targeted interventions, particularly when maternal characteristics and environmental factors, may contribute to varying levels. Meconium offers insight into in-utero exposures for the developing infant, and the effect of each individual metal may be mediated or exacerbated by another and therefore should be studied in the context of a mixture. The effect of metal mixture exposure, as measured in meconium, on milestone and temperament outcomes has yet to be determined.

DESIGN: …

Addressing Obesity And Diabetes In Appalachian Kentucky, Hannah E. Orens

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

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

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

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Anchoring Roots And Spreading Branches: The Growth And Regulation Of Art Therapy In Singapore, Christine Phang

Art Therapy | Doctoral Dissertations

The development of art therapy in Singapore has advanced rapidly over the last two decades. Yet, to date, there has not been a comprehensive overview of art therapy in Singapore. Additionally, more research is needed to understand how the complex component of regulation can benefit the profession of art therapy. This study therefore set out to paint a picture of art therapy in Singapore, capture the art therapy community’s thoughts and opinions concerning regulation, and identify actionable ways to advance the profession. A mixed method design was employed which utilized a survey and interviews to gather quantitative, qualitative, and arts-informed …

Creativity In A Flash: Exploring The Perceived Therapeutic Effects Of Combining Creative Arts Therapies And Flash Technique, Celia J. Gagnon

Art Therapy | Doctoral Dissertations

Since the onset of the COVID-19 pandemic, research has revealed a significant strain on mental healthcare systems and healthcare professionals. Concurrently, there has been a rapid escalation in the prevalence of anxiety, depression, loneliness, and adolescent suicide rates, all of which have reached critical levels (World Health Organization, 2025; World Health Organization, 2022; Institute for Health Metrics and Evaluation, 2025; American Psychiatric Association, 2024). Post-pandemic, these statistics continue to rise across all nations and socioeconomic groups (WHO, 2025). Consequently, there is an urgent need to intensify research that supports the enhancement of mental health services globally (Institute for Health Metrics …

Enhancing Self-Acceptance And Reducing Anxiety Through Tree Ring Self-Portraits In Art Therapy: A Mixed-Methods Study, Stacey Kamp

Art Therapy | Doctoral Dissertations

This mixed-methods dissertation examined the therapeutic potential of the Tree Ring Self-Portrait, a novel art therapy intervention designed to enhance self-acceptance and reduce anxiety through symbol-based, life-phase self-portraiture grounded in narrative meaning-making and image-based processing (White & Epston, 1990; Moon, 2010; Hinz, 2020). Adults who self-identified with anxiety-related concerns were recruited through community and clinical referral sources and completed a standardized three-session intervention involving reflective mapping of life phases, a watercolor-based concentric-ring self-portrait process, and a guided review of the completed artwork with semi-structured interviews. The final sample (n = 20; ages 22–74) included participants with varied engagement in psychotherapy …

Improving Hypertension Management With An Educational Patient Intervention Bundle, Gertie Silva

Doctor of Nursing Practice (DNP) Scholarly Projects

Aim

Uncontrolled hypertension remains a significant risk factor for cardiovascular disease. This quality improvement project aimed to improve hypertension knowledge and blood pressure control among adults with uncontrolled hypertension by implementing lifestyle counseling, home blood pressure monitoring, and regular follow-up.

Design

This quality improvement project used a pre- and post-intervention design.

Methods

Forty-one adults with uncontrolled hypertension took part in an eight-week educational program. Outcomes measured included weight, systolic and diastolic blood pressure, and HK-LS scores. Descriptive statistics and paired-samples t-tests analyzed the results.

Results

Participants showed significant improvements in weight, blood pressure, and hypertension knowledge. Mean weight decreased from …

Reducing Live Discharges In Hospice Care Through A Bundled Intervention, Fiona P. White

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction

 Among Medicare fee-for-service hospice beneficiaries, the national live discharge rate increased from 16.9% in FY2021 to 19.1% in FY2025. At a Medicare-certified hospice agency in a southern state, the pre-intervention live discharge rate of 35.3% substantially exceeded national norms, with 68.7% of events representing patient-initiated revocations.

Methods

 A pre-post quality improvement design guided by the Plan-Do-Study-Act framework was implemented over 8 weeks at a single site with 106 newly admitted hospice patients and 15 clinical staff. The four-component bundled intervention comprised Revocation Risk Assessment administration within 24 hours of admission, structured patient and caregiver education within 72 hours of …

Toolkit To Prevent Venous Thromboembolism Among Surgical Patients, Carine Wawa

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: According to the Centers for Disease Control and Prevention, approximately 900,000 people in the United States are affected annually by venous thromboembolism (VTE) (CDC, 2025). The surgical patient population is vulnerable to VTE due to factors such as immobility, tissue injuries, and inflammatory responses. The lack of standardized protocols for surgical patients causes practice variability among healthcare providers and potentially increases the risk for preventable VTE events.

Methods: A toolkit to prevent VTE was developed utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC). A literature review was conducted, reviewed, and graded using the …

Enhancing Breast Cancer Screening Uptake In Hispanic Women Residing In Rural Texas Through A Quality Improvement Project, Bianca Batchelor-Salazar

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Breast cancer remains a leading cause of cancer-related mortality among women in the United States. Despite the effectiveness of mammography in early detection, Hispanic women in rural communities experience lower screening rates due to socioeconomic, cultural, and access-related barriers. At a rural South Texas clinic, the baseline screening rate among Hispanic women aged 50–74 years was 70.6%, below national benchmarks.

Purpose: To increase breast cancer screening compliance among Hispanic women aged 50–74 years in a rural South Texas family practice clinic.

Methods: Guided by the Lean A3 quality improvement framework, this project implemented a multifaceted intervention bundle that included …

Early Pressure Injury Identification And Intervention In Emergency Department Older Adults Who Are Admitted Into A Community Hospital Intensive Care Unit, Lisa M. Britt

Doctor of Nursing Practice (DNP) Scholarly Projects

A clinical gap was identified when reviewing a hospital acquired pressure injury (HAPI) dashboard from a 369- bed, acute care community hospital located in North Texas. Fifty percent of HAPIs acquired occurred in older adults, aged 60 or higher, who were admitted into the intensive care unit (ICU) from the emergency department (ED). A retrospective review of the electronic health records (EHR) demonstrated that none of the patients had received HAPI prevention interventions while they were in the ED and the inconsistent document of skin assessments resulted in identification of few HAPIs present on admission (POA). The purpose of this …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

Evaluating The Effectiveness Of Scenario-Based Virtual Escape Rooms To Improve Student Confidence In Dosage Calculations, Jennifer A. Cuevas

Theses

Abstract

Background: Accurate dosage calculations (DCs) are critical for patient safety, as medication errors contribute to approximately 7,000-9,000 preventable deaths annually. Nearly 30% of nursing students exhibit weakness in foundational mathematical skills, and a significant confidence gap exists: 70% feel confident in mathematical abilities, yet only 45% feel confident in clinical application, necessitating innovative educational interventions.

Purpose: The purpose of this project was to implement and evaluate a scenario-based virtual escape room intervention to enhance undergraduate nursing students' confidence in DCs.

Methods: Grounded in Kolb’s experiential learning theory, this online asynchronous intervention engaged students through concrete experience, reflective observation, abstract …