Medicine and Health Sciences Commons^™

Magnesium-Based Metal Matrix Nanocomposite Implants And Nanobubble-Based Delivery Systems: Integrated Strategies For Bone Loss Treatment With Cytocompatibility Evaluation, Lucas José Martinho Bizuti

Honors Undergraduate Theses

This thesis intends to investigate the development of different multimodal therapeutic strategies for combating bone loss. Most specifically, this paper will emphasize the utilization of Magnesium-Based Metal Matrix Nanocomposite Implants (MMNC) and Nanobubble-Based Delivery Systems as options for future treatment focus. The effects of biodegradable magnesium implants were evaluated for cytotoxicity and cytocompatibility via Hematoxylin and Eosin, and Masson’s Trichrome staining, as well as radiological images. The Nanobubble-Based Delivery System is being developed and optimized as a delivery system to target osteoclast activity. This paper focused on optimizing experimental parameters, which include Rotational speeds for nanobubble stimulation under microgravity conditions …

Effect Of Plant-Based Vs. Standard American Diet On Cardiovascular Parameters In College Students, Timothy J. Horanic

Honors Undergraduate Theses

This study examines how adherence to different dietary patterns—specifically a plant-based diet compared to the standard American diet—can influence physiological indicators tied to cardiovascular health, including heart rate variability (HRV), blood pressure (BP), and heart rate (HR). Among these markers, HRV is considered especially sensitive to autonomic nervous system (ANS) regulation and may offer earlier insight into physiological stress or dysfunction than HR or BP alone. Although nutritional habits are widely believed to impact heart health, few investigations have focused on how specific long-term diets affect autonomic and cardiovascular metrics in healthy, college-aged adults. This study aims to investigate if …

Exploring The Link Between Hospice Setting And Caregiver-Reported Quality Scores, Aidan J. John

Honors Undergraduate Theses

Access to high quality hospice care largely varies across different care environments and regions within the United States. This can shape the experiences of family caregivers who support patients at the end of life. As hospice enrollment expands nationwide, understanding how care delivery changes between home-based services and more skilled inpatient and outpatient services has become integral for examining overall performance.  There are many noticeable differences in provider availability and resources between different programs that can influence the level of support families receive, including timeliness of symptom management and effectiveness of communication with hospice staff. This study evaluated whether hospice …

Bridging The Gap: Investigating The Impact Of Adequate Prenatal Care On Adverse Maternal Outcomes Among Black And African American Women, Ciaera Ambroise

Honors Undergraduate Theses

The United States continues to face a maternal health crisis marked by persistent racial disparities, with Black women experiencing pregnancy-related mortality rates three times higher than those of White women. Despite national efforts to expand access to prenatal services, inequities in maternal outcomes remain, indicating that the quality of prenatal care may be as critical as its timing and frequency. The purpose of this thesis is to examine whether adequate prenatal care, compared to inadequate prenatal care, is associated with reduced adverse maternal outcomes among Black and African American women in the United States. Guided by a PICO question, this …

Relationships Between Quadriceps Neuromuscular Function And Time From Surgery Following Acl Reconstruction Are Sex-Specific, Tatiana Restrepo

Honors Undergraduate Theses

Anterior cruciate ligament reconstruction (ACLR) is associated with persistent quadriceps dysfunction, including muscular weakness and altered spinal and cortical excitability. While recovery has been widely studied, most investigations focus on isolated domains and fixed postoperative time points. Emerging evidence suggests females often experience slower or less complete quadriceps recovery compared to males, yet the time-dependent nature of these sex-specific outcomes remains unclear. The purpose of this study is to examine whether relationships between time since ACLR and quadriceps neuromuscular outcomes differ by sex across muscular, spinal, and cortical domains. Adults aged 18–35 with a history of primary, unilateral ACLR were …

Exploring Anticholinergic Neurotoxicity: Diphenhydramine's Impact On Neuro-2a Cell Morphology, Expression, And Viability, Jordan B. Mcintyre

Honors Undergraduate Theses

Anticholinergic medications, such as diphenhydramine (commonly known as Benadryl), are increasingly recognized for their association with cognitive impairment and neurodegenerative disease. These medications, which inhibit the action of acetylcholine, a neurotransmitter essential for the formation and utilization of the central and peripheral nervous system, have been implicated in conditions such as dementia and may impact fundamental cellular processes like neurogenesis and cell proliferation. This study investigates the effects of diphenhydramine on neurogenesis when introduced to Neuro-2a cells during differentiation. For all studies cells were plated on coverslips or in 6-well plates with differentiation media containing 0 ng/mL, 50 ng/mL, …

A Qualitative Analysis Of Youtube-Based Dietary Messaging On Type 2 Diabetes For South Asians, Sukhmani K. Dhaliwal

Honors Undergraduate Theses

While South Asians experience a disproportionately high risk of Type 2 Diabetes Mellitus (T2DM), culturally tailored dietary guidance remains limited within healthcare settings. As digital platforms increasingly serve as sources of health information, YouTube has grown as a prominent space for the publishing and consumption of dietary advice. This study examines how diet-related messaging about T2DM is communicated in YouTube videos directed at South Asian populations.

Using qualitative thematic analysis, 21 videos published between 2016 and 2025 by influencers with a wide reach were analyzed. Videos were selected based on relevance to South Asian audiences, focus on dietary management of …

Spanish-Speaking Parents' Health Literacy And Comprehension Of Idea Terminology, Daria Hernandez

Honors Undergraduate Theses

This study aims to examine how personal health literacy can affect Spanish-speaking parents’ comprehension of special education documentation, specifically within the scope of Communication Sciences and Disorders (CSD) and Individuals with Disabilities Education Act (IDEA) terminology; in order to gain insight into the readability of commonly used terms within special education documents. Across the United States, limited health literacy across organizations and individuals is an extremely pressing issue as it can limit the ability for individuals to make the proper decisions involving their healthcare and education. This issue is exacerbated when considering Hispanic populations, with their personal health literacy levels …

A Systematic Literature Review Of The Menstrual Cycle And Its Impact On Aerobic Performance In Female Athletes, Jaymie G. Loidolt

Honors Undergraduate Theses

The purpose of this systematic review is to examine existing literature regarding the menstrual cycle and its impact on aerobic performance in female athletes. This comprehensive review was conducted using the PRISMA 2020 method of analysis. All studies included involved normally menstruating females conditioned in endurance sport. Studies analyzing anaerobic sports, abnormally menstruating females, or physically inactive females were excluded. The databases used included: PubMed, Sport Discus, and Web of Science. The results of these were imported into JBIsumari for deduplication, title and abstract, and full text screening. The results conclude objective performance variables are unchanged regarding the phase of …

Healthcare Access And Community Nursing Outreach Effectiveness In Underserved Zip Codes In Central Florida, Miah Sanchez

Honors Undergraduate Theses

Access to healthcare depends on more than whether healthcare services are available. A person’s ZIP code, income, education, transportation options, health literacy, and neighborhood resources can all affect whether care is reached at the right time and in an appropriate setting. This literature review examines healthcare access and the role of community nursing outreach in underserved ZIP codes across Central Florida. The review synthesizes current literature on social determinants of health, geographic disparities, medically underserved populations, and community-based nursing interventions to better understand how these factors shape access to care. Across the literature, poverty, limited transportation, lower educational attainment, neighborhood …

Cardiovascular Disease Risk Profiles Among Metropolitan And Nonmetropolitan Young Adults - A Cross-Sectional Analysis Of The 2024 National Health Interview Survey (Nhis), Steven Dimitrakakis

Honors Undergraduate Theses

Cardiovascular disease (CVD), a group of disorders affecting the heart and blood vessels, is one of the leading causes of death worldwide, driven by genetic, lifestyle, and environmental factors. Young adults, although not a common group at risk for CVD, can face reduced health quality due to physical limitations and other environmental factors that can increase their risk for development of CVD. Depending on where young adults live, their risk of developing CVD varies. Young adults fall within the category of individuals ranging in age from 18-24 years old, the average between all ages for young adults between the research …

Analysis Of Alternative Gene Splicing Of Natural Killer Cell Exhaustion Markers During Siv Infection, Soledad B. Zayas

Honors Undergraduate Theses

Natural killer cells play a critical role in the innate immune response against Human Immunodeficiency Virus and Simian Immunodeficiency Virus infections. During HIV/SIV infection, NK cells undergo functional impairment characterized by an imbalance between activating and inhibitory surface receptors. The upregulation of inhibitory receptors, TIGIT and TIM-3, has proven to contribute to NK cell exhaustion during different retroviral infections. Although alternative splicing regulates immunity related genes, its role in TIGIT and TIM-3 expression during SIV infection remains poorly understood. This study aimed to characterize alternative splicing patterns of TIGIT and TIM-3 and evaluate transcript variant expression during SIV infection in …

The Environmental Impact On The Development Of Equine Degenerative Myeloencephalopathy, Victoria C. Reynolds

Honors Undergraduate Theses

The objective of this study was to examine potential associations between environmental factors and the progression of Equine Degenerative Myeloencephalopathy (EDM). While environmental contributions to neurodegenerative diseases are increasingly recognized in human patients, little is known about their role in EDM. A comprehensive literature review highlighted the lack of research in this area. Data for this study were collected by Dr. Amy Johnson at the University of Pennsylvania's New Bolton Center. The two main areas studied were a horse’s lifestyle (specifically turnout conditions) and their geographical proximity to chemicals (pesticides, airborne neurotoxins, and water contaminants). Statistical analysis revealed there was …

Improving Healthcare Professionals’ Comfort Level Screening For Intimate Partner Violence, Madison M. Mitzel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Pregnancy increases a woman’s risk of experiencing intimate partner violence (IPV). Although healthcare visits typically increase during pregnancy, IPV screening is often overlooked, and many women remain unaware of available domestic violence resources. 
Local problem: Globally, women are impacted by IPV, with those living in rural areas facing a higher risk. 
Methods: The Abuse Assessment Screen (AAS) was implemented in a rural women’s health facility to screen patients for IPV. Prior to implementation, healthcare professionals within the facility received education regarding the screening protocol and available resources for patients. 
Interventions: The comfort level of the healthcare professionals discussing IPV …

Improving Blood Pressure Control Through Lifestyle Modification In African Americans Adults With Uncontrolled Hypertension, Tasha Leonard

Doctor of Nursing Practice (DNP) Scholarly Projects

African American adults have the highest incidence of uncontrolled hypertension (HTN), leading to premature cardiovascular death in Texas and worldwide. In a South Texas cardiac clinic, over 90% of African American adults with HTN also have obesity, compared with 55% of their Caucasian counterparts. The most prevalent factor affecting this group is poor understanding of blood pressure management, which leads to nonadherence to dietary and exercise recommendations, medication regimens, and blood pressure monitoring. The objective was to determine whether lifestyle modification using a hypertensive bundle would improve blood pressure management among African American adults in the clinical setting. The initiative …

A Guideline To Address Barriers To Mental Health Treatment Experienced By Law Enforcement Officers, Jacqueline Estrella

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Law enforcement officers are exposed to repeated trauma on the job that may negatively affect their mental health. Officers may avoid seeking mental health treatment due to police culture, stigma, and other barriers which may increase risks for suicide, absenteeism, and maladaptive coping.

Objectives: Develop an evidenced-based guideline to address barriers law enforcement officers face in seeking mental health treatment.

Methods: The National Quality Measures Clearinghouse (NQMC) Domain Framework was used to guide a literature review to identify best practices suitable for a guideline. Articles were graded for strength based on the John Hopkins Nursing Evidence Based Practice (JHNEBP) …

Optimisation Of Sampling For A New Skin Microbiome Assay Pilot Study, Anita Smith

Theses

Recent interest in the diverse ecosystem of bacteria, fungi and viruses that make up the skin microbiome has led to numerous studies investigating the microbiome in healthy skin and in dermatological diseases. An imbalance of the normal skin microbial flora can cause some skin diseases, and current culture techniques are often unable to detect a microorganism to further our understanding of the clinical–microbiological correlates of disease and dysbiosis. Atopic dermatitis and rosacea are presentations that General practitioners (GPs) often manage that may have an infective or microbiological component and can be challenging to treat. Further research using culture-independent techniques is …

Breast Milk Versus Formula Feeding In The Development Of Necrotizing Enterocolitis Among Nicu Infants: An Integrative Review, Mackenzie Jameson, Faye Li, Liudmila Ryzhova, Mia Smith

Master's Projects

Introduction/Question: NEC is a serious condition characterized by the death of intestinal tissue, primarily affecting premature infants or those with low birth weight. The incidence of NEC poses a significant concern in neonatal healthcare due to its substantial mortality risk, particularly among vulnerable populations. This condition can lead to various complications, including sepsis, nutritional deficiencies, delays in growth and development, and, in severe cases, death. NEC not only impacts the health of the infant but also affects the emotional well-being and bonding experiences of parents. Despite advancements in neonatal care, the rate of NEC has increased, highlighting the need …

Asthma Integrative Review: Effects Of Aerobic Exercise On Asthma Exacerbation, Abigail Williams, Dazya Crayton, Nicole Stasiak, Sabrina Stich

Master's Projects

Asthma is a chronic respiratory illness defined by airway inflammation and episodes of exacerbation. Pharmacological intervention remains the treatment of choice; however, there is growing evidence to support moderate intensity aerobic exercise as adjunct therapy to promote asthma control. The integrative review evaluates current evidence supporting the PICO question: In adults with mild to moderate asthma, what is the effect of prescribed aerobic exercise on reducing exacerbations? A systematic search of CINAHL, Health Source: Nursing, MEDLINE, and PubMed identified eligible studies. The inclusion criteria required peer-reviewed quantitative articles written in English and published within the past five years. In addition, …

Dual Language Learner Status In Relation To Cortisol For Children In Head Start Preschool, Keala Bratsch

West Chester University Graduate Theses, Dissertations, and Final Projects

Early childhood education (ECE) has well documented school readiness benefits, especially for children facing economic hardship. Yet preschool context poses challenges that are associated with elevated stress levels and potential long-term tax on physiological systems that respond to stress. The present study examined dual language learner (DLL) status in relation to levels of the stress hormone cortisol among low-income children attending Head Start Preschool programs. Participants included 207 children ages 3- 5 years who attended preschool in 2021-22 (60.9% attending a dual-language learning school, 39.1% attending an English-instruction-only preschool; all participants meeting the criteria for low-income), and their parents or …

Modeling Inherited Retinal Disease In Zebrafish, Meet Patel

Theses and Dissertations--Biology

Inherited retinal diseases (IRDs) affect millions of people worldwide. Majority of IRDs are caused by degeneration of rod and cone photoreceptor cells (PRCs) due to gene mutations. The overarching goal of my dissertation is to model and evaluate the molecular role of various gene candidates involved in IRDs such as cone rod dystrophy (CRD) and retinitis pigmentosa (RP).

Mutations in CDHR1, a photoreceptor specific cadherin have been associated with CRD and recapitulated in mouse CDHR1 knockouts. However, the molecular function of CDHR1 remains unknown. CDHR1 has been shown to localize at the leading edge of murine rod nascent outer segment …

Implementing A Competency-Based Cross-Training Program To Enhance Patient Flow, Jill E. Shanklin

DNP Projects

Objective: To evaluate the effect of a competency-based cross-training program on perinatal nurses’ preparedness to care for medical-surgical (med-surg) overflow patients and to support patient flow.

Design: Quality improvement project using a quasi-experimental pre–post design.

Setting: A 44-bed perinatal unit within a university-affiliated medical center in the United States.

Participants: Registered nurses employed in the perinatal unit for ≥6 months; 24 completed the preintervention survey and 28 completed the postintervention survey.

Interventions: A competency-based cross-training program consisting of e-learning modules, simulation-based competency validation, and structured policy and procedure review.

Main Outcome Measures: Self-reported comfort, …

Enhancing Tray Integrity: A Quality Improvement Project To Reduce Central Sterile Processing Defects, Ashley Conn

DNP Projects

Background: Instrument tray defects contribute to surgical delays, workflow disruptions, rework in sterile processing, inefficient instrument utilization, and patient safety risks.

Purpose: The purpose of this quality improvement project was to reduce orthopedic instrument tray defects through targeted education and standardized tray audits with double-check verification in a large academic medical center.

Methods: A quasi-experimental pre-post design was utilized to evaluate the impact of the intervention. Tray errors were captured using a standardized binary indicator. Staff satisfaction and confidence surveys were measured using Likert-scale surveys.

Results: Orthopedic trays were analyzed before (n=1,017) and after (n=941) implementation. Post-implementation, tray errors decreased …

Riddle Me Resilient: Investigating The Impact Of Riddle Based Class Openings On Student Resilience And Well-Being, Carolyn T. Brown

DNP Projects

Abstract

Background: Burnout among nurses and nursing students is a widespread and well‑documented problem that adversely affects professional performance and psychological well‑being. Resilience serves as a key protective factor, helping buffer the effects of academic stress and reducing burnout over time. Incorporating brief, low‑stakes cognitive challenges—such as a riddle—can help foster resilience.

Purpose: This project evaluated the impact of incorporating riddles into a wellness-focused course, Introduction to Mindfulness and Wellness, on resilience and well-being among undergraduate nursing students.

Methods: This project employed an Institutional Review Board approved pre-post survey design to measure the effect of an intervention focused on …

Evaluating The Implementation And Use Of A Standardized Screening Process To Increase Flu Vaccine Uptake In A Rural Health Primary Care Clinic, Mackenzie L. Pierce

DNP Projects

Background: Research has shown that an annual influenza vaccine is the most effective way to both prevent and reduce the risk of hospitalization and severe health complications of the flu. A yearly influenza vaccination is recommended for everyone age 6 moths and older.

Local Problem: Rural communities have lower rates of influenza vaccination which can be due in part to a lack of screening and education on vaccines and their importance. No process for influenza vaccine status screening existed at the project site prior to this project.

Methods: A quality-improvement project was conducted to evaluate the implementation of a standardized …

Evaluation Of A Nicotine Prevention Program In A Third Grade Classroom, Jennifer A. Pile

DNP Projects

Purpose: The purpose of this project was to increase knowledge of nicotine products and promote negative perceptions of nicotine use among third-grade students through early prevention education.

Background: Prevention is key and to prevent nicotine use, there must be an educational program with that aim in a much younger population. Third grade encompasses 8-, 9-, and 10-year-olds. This group is in the middle childhood stage and begin more complex thinking and problem-solving skills. There is physical and emotional development among this group.

Methods: This is a quasi-experimental study among third grade students in Breckinridge County Kentucky with pretest and …

Unintentional Medication Discrepancies In Outpatient Cardiac Procedures: Identifying Modifiable Barriers, Julie M. Turner

DNP Projects

Background: Medication reconciliation (MR) reduces medication errors during care transitions; however, unintentional medication discrepancies (UMDs) remain common due to variable practices and lack of standardization. Patients undergoing elective cardiac procedures are particularly vulnerable given complex medication regimens.

Purpose: This quality improvement project evaluated implementation of a Medication Reconciliation Barrier Identification Checklist (MRBIC) in the cardiac catheterization laboratory to identify patient, staff, and system-level contributors to UMDs.

Methods: A quasi-experimental pre–post design was conducted at a large academic medical center. During a six-week intervention, nurses and providers completed the MRBIC during pre-procedure MR. Barrier scores were compared with …

Advancing Rural Health Equity Through Systematic Sdoh Screening- A Quality Improvement Initiative, Laura C. Combs

DNP Projects

Background: Social determinants of health (SDoH) significantly affect health outcomes and healthcare utilization, particularly in rural communities. In 2024, the Centers for Medicare & Medicaid Services mandated SDoH screenings in the inpatient setting, with recommendation to implement in rural clinics without specifying a standardized tool, resulting in inconsistent identification of needs, e.g., food insecurity, housing instability, mental health concerns, financial strain, and transportation barriers.

Purpose: This quality improvement initiative implemented a standardized SDoH screening tool in a rural outpatient clinic to evaluate changes in referral rates to community-based resources pre- and post-implementation and to improve patient reporting of social needs. …

Building Confidence And Team Communication: Implementation Of A Rapid Response In Situ Simulation Program In The Neonatal Intensive Care Unit, Janell F. Hacker

DNP Projects

Background: Neonatal code events are high-risk, low-frequency occurrences in the neonatal intensive care unit (NICU). Simulation-based training is used to support skill development, maintain competencies, and enhance team performance.

Purpose: The purpose was to determine if a multidisciplinary, high-fidelity, rapid response in situ simulation program would impact confidence and communication among frontline healthcare providers during neonatal code events.

Methods: A quasi-experimental, pretest-posttest study was conducted in a 90-bed Level IV NICU. A multidisciplinary, high-fidelity in situ rapid response simulation program was implemented over a 3-month period for frontline NICU healthcare providers. Pre- and post-surveys assessed perceptions of role clarity, …

Implementation Of A Cardiomems Screening Tool To Increase Provider Awareness And Referrals In Eligible Patients, Monica Rios

DNP Projects

Background: Heart failure affects over 6 million Americans and causes more than one million hospitalizations annually. CardioMEMS, a remote pulmonary artery pressure monitoring device, effectively reduces hospitalizations, yet its use remains limited due to provider and system barriers. The purpose was to increase CardioMEMS referrals for eligible heart failure patients through targeted provider education and a standardized screening tool.

Local Problem: Kentucky experiences higher heart failure hospitalization rates than the national average, contributing to prolonged hospital stays and rising healthcare costs.

Methods: A pre—post quasi-experimental study was conducted at an academic medical center. Baseline chart review of 47 patients evaluated …