Medicine and Health Sciences Commons^™

Quality Improvement Initiative To Improve Adherence To Ob Hemorrhage Policy And Standardize Pitocin Administration During Cesarean Sections To Reduce Postpartum Hemorrhage Risk, Lauren R. Litz, Monica Blauser

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, and Pitocin administration is an important component of hemorrhage prevention and management during cesarean delivery. Variation in Pitocin timing, dosing, method of administration, and adherence to evidence-based recommendations may compromise patient safety and create barriers to standardized obstetric anesthesia care. The purpose of this Doctorate of Nurse Anesthesia Practice quality improvement project was to evaluate current anesthesia provider practices for Pitocin administration during cesarean delivery, compare observed practices with the California Maternal Quality Care Collaborative hemorrhage toolkit and Society for Obstetric Anesthesia and Perinatology Enhanced Recovery After Cesarean recommendations, …

Enhancing Patient Outcomes In Obstetric Neuraxial Anesthesia: Evaluation Of A Structured Documentation Tool For Post-Dural Puncture Headache Tracking (Pdph), Jacqueline Saldana Tovar, Ahmad Hasaan

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

The purpose of this Doctor of Nursing Practice (DNP) project is to evaluate the incidence, management, and practice variation of post-dural puncture headache (PDPH) in an obstetric population using retrospective data from standardized follow-up tools. The project aims to identify inconsistencies in procedural techniques, documentation practices, and adherence to evidence-based guidelines across anesthesia provider levels. By analyzing key clinical variables and patient outcomes, this project seeks to identify gaps in current practice, improve data reliability, and support the development of standardized protocols for PDPH assessment and management. Ultimately, the goal is to enhance quality of care, promote evidence-based decision-making, and …

Enhancing Sbar Documentation And Telecommunication Between Nursing And Anesthesia Teams In The Obstetric And Labor And Delivery Unit, Apollonia C. Anderson, Celeste Meda

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication during obstetric handoffs is essential for promoting maternal and neonatal safety, yet communication failures remain a significant contributor to adverse events due to inconsistent and unstructured handoff practices. This Doctor of Nursing Anesthesia Practice (DNAP) quality improvement project was developed following the recommendations of the 2025 DNAP project, which implemented the OB/L&D-specific SBAR tool. This project evaluated the use of this communication tool in areas of OB interdisciplinary team communication accuracy, efficiency, and collaboration, particularly during obstetric epidural requests within a community-based labor and delivery unit. Guided by the Plan-Do-Study-Act (PDSA) framework (Institute for Healthcare Improvement, 2020). Utilized …

Id-More Vision: Real-Data Machine-Learning Assessment For A Digital-Twin-Inspired, Xr-Ready Rehabilitation Prototype, Rickey L. Clark

Master's Theses

Rehabilitation assessment often relies on periodic observation, while many XR prototypes show scripted rather than recorded-motion evidence. iD-MORE Vision is an offline pipeline trained on KIMORE and IRDS and linked through JSON packets to a two-mode Unity desktop prototype. Both datasets include controls and rehabilitation participants with neurologic, musculoskeletal, or mobility impairments. This improves relevance but does not clinically validate the system.

Under fixed subject-wise splits, the primary five-seed Random Forest predicted KIMORE clinician scores with MAE 6.087 ± 0.044 cTS and R² 0.568 ± 0.006; the subject-level R² interval crossed zero. The primary IRDS five-run CUDA GRU averaged 0.877 …

Characterization Of Catechol-Type Siderophore(S) From P. Mosselii Cfml 90-83, Kemper R. Rasnake

Electronic Theses and Dissertations

Iron is essential for many biological processes, where it is used as a cofactor. Even though it is abundant in the Earth’s crust, it is in an insoluble form unavailable to microorganisms in the soil. To overcome this, bacteria produce siderophores, which are secondary metabolites that have a high affinity for iron. This allows bacterial cells to obtain insoluble iron that is essential for survival. Pseudomonas mosselii, a Gram negative bacterium, was isolated from soil. It was selected for further analysis as it was found to produce siderophore(s) under iron-limited conditions, which have not been characterized previously. Therefore, we aimed …

A Geometric Morphometric Analysis Of Acetabular Shape Variation Across Bat Families, Jordan L. Huff

Electronic Theses and Dissertations

Bats are the only mammals capable of powered flight, and research is concentrated on this adaptation. Their non-flight locomotion has received comparatively little attention. Previous studies show that non-flight locomotor behaviors vary across families. Members of Pteropodidae are efficient climbers but cannot effectively walk, whereas Phyllostomidae and Vespertilionidae are better at terrestrial locomotion but show reduced arboreal capabilities. The non-flight locomotion of Hipposideridae and Rhinolophidae is less understood, although rhinolophids exhibit limited terrestrial locomotion. This study examined whether differences in locomotor behavior are associated with variation in acetabular morphology. A geometric morphometric analysis of acetabular shape was conducted across multiple …

Weathering More Than Storms: Understanding The Mental Health Disparities Of Black Farmers In The Appalachian Region, Aliyah Smith

Electronic Theses and Dissertations

Black farmers in Appalachia represent a vital and historically marginalized population within one of America’s most economically distressed regions. Black farmers have endured generations of systemic racism, resulting in land loss, economic hardship, and mental stressors. This study examines the intersection of race, agriculture, and behavioral health to illustrate how structural barriers and cultural stigmas shape the mental well-being of Black farmers across Appalachia.

Findings from the analysis will guide the development of a conceptual model based on constructs from the Social-Ecological Model (SEM), Intersectionality Theory, and Critical Race Theory (CRT). This study will use Key Informant Interviews (KIIs) conducted …

Staff Education On The Implementation Of An Evidence-Based, Suicide-Risk-Assessment Education Program For Psychiatric Staff, Yemurai Emily Dzikiti

Walden Dissertations and Doctoral Studies

Suicide is a major public health concern, and consistent suicide risk assessment is essential for patient safety in psychiatric settings. This Doctor of Nursing Practice staff education project addressed a knowledge gap in evidence-based suicide risk assessment among psychiatric clinicians in an outpatient mental health setting. The practice-focused question examined whether an evidence-based suicide risk assessment education program would improve clinicians' knowledge from pre- to post-education. The educational intervention consisted of a 60-minute in-person training session on evidence-based suicide risk assessment using the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) framework. Ten psychiatric …

A Mindfulness-Based Stop Technique Training To Improve Nurses’ Knowledge And Self-Efficacy In Stress And Burnout Prevention, Rukiat Abolanle Afinni

Walden Dissertations and Doctoral Studies

Nurse burnout and stress are well-documented occupational concerns in outpatient clinical settings, where high patient acuity and chronic staffing shortages leave nurses with little structured support for proactive self-care. To address this gap, a mindfulness-based STOP (stop, take a breath, observe, proceed) training program was developed and evaluated for outpatient nurses. The evidence-based practice question was: Among nurses in an outpatient clinical setting, what is the impact of a mindfulness-based STOP technique training on nurses' knowledge of stress and burnout prevention and self-efficacy in applying the technique? A one-group pretest-posttest design was used with eight participants. A project-developed questionnaire measured …

The Relationship Between Depression And Cognitive Proficiency Index Across Biological Sex, Angela N. Ferdinardo

Dissertations

Depression is a widely studied mood disorder, and understanding its effect on cognitive functioning has become an important area of research. While research has examined relationships among depression, working memory, and cognitive deficits, limited research has explored depressive symptoms and cognitive proficiency across biological sex. Depression manifests similarly in men and women, though men are more likely to experience irritability, impulsivity, and anger, while women tend to experience sadness, stress, and sleep disturbances (Johns Hopkins Medicine, 2023). Women are also more likely to seek treatment and cope differently than men. This study examined the relationship between depression and cognitive proficiency …

Measuring Health System Readiness In Saint Lucia Using International Health Regulations Capacity Indicators, Melissa Steele

Walden Dissertations and Doctoral Studies

Emerging infectious diseases continue to challenge national health systems, particularly in small island developing states with limited preparedness resources. Limited evidence comparing the International Health Regulations (2005) State Party Self-Assessment Annual Reporting (IHR SPAR) capacities of small island developing states with those of high-income countries limits efforts to identify preparedness gaps and strengthen health systems. The purpose of this quantitative comparative study was to evaluate Saint Lucia's preparedness using IHR SPAR indicators, compare its preparedness with the United States, and assess changes between 2023 and 2024. Guided by the World Health Organization Health System Framework, a quantitative cross-sectional design using …

A Mixed-Methods Study Of The Lived Experiences Of Patients And Caregivers Receiving Home Health Occupational Therapy Services, Peyton A. Mendias

Student Capstone Papers

Home health occupational therapy (OT) supports individuals’ safety, independence, and participation in their natural environments; however, patients and caregivers may face barriers that affect the implementation of therapy recommendations. This capstone project explored patient and caregiver experiences with home health OT and identified factors influencing implementation of OT recommendations. We used a sequential explanatory mixed-methods design guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model. Eight participants, including three patients and five caregivers, completed an electronic survey, and one caregiver participated in a follow-up semi-structured interview. We analyzed quantitative data using descriptive statistics and qualitative data using reflexive thematic analysis. Findings …

Improving Obesity Management In Primary Care Through Provider Education, Natalie Anderson

Doctor of Nursing Practice Projects

Background: Childhood obesity is a significant public health concern associated with metabolic, cardiovascular, and psychosocial complications. Despite the availability of evidence-based pediatric obesity management guidelines, adherence to these guidelines remains inconsistent in primary care settings. Purpose: This evidence-based quality improvement project aimed to determine whether provider education on the 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity, combined with implementation of an electronic health record (EHR) clinical decision support prompt, improved provider knowledge and adherence to guideline-recommended obesity management practices. Method: A pre-post quasi-experimental study was …

Agent-Based Modeling Of Cellular Dynamics In Adoptive Cell Therapies, Yujia Wang

Dissertations and Theses (Open Access)

Adoptive cell therapies (ACT) have shown promising progress in combating cancer, but clinical responses remain heterogeneous. Key determinants, including the functional states of infused cells, tumor–immune interactions, and dosing strategies, are difficult to resolve experimentally in the dynamic and heterogeneous tumor microenvironment, limiting optimization of ACT products and treatment regimens. To address the gap, we developed ABMACT (Agent-Based Model for Adoptive Cell Therapies), a computational framework that reconstruct key cellular functions, interactions, and molecular signatures to recapitulate cell population dynamics associated with differential treatment responses. ABMACT encodes autonomous “virtual cells” using literature-informed rules calibrated with experimental data, enabling simulation of …

Ai-Driven Segmentation And Volumetric Response Modeling Of Liver Regions To Radiotherapy, Aashish Chandra Gupta

Dissertations and Theses (Open Access)

In liver-directed radiotherapy (RT), liver regions receiving higher doses typically undergo atrophy while contralateral/adjacent lower-dose regions may exhibit compensatory hypertrophy through regeneration of healthy tissue. Optimizing the RT plan to promote regional hypertrophy while minimizing the risk of developing atrophy has the potential to enhance post-RT liver function and long-term survivorship. However, current clinical practice largely relies on global liver dose-volume metrics during RT-planning, which may obscure favorable dose-response correlation and limit actionable guidance for clinicians. Therefore, we hypothesized that post-RT regional liver response is governed by a combination of region-specific dose-volume and patient clinical features, and that these responses …

Regulation Of Müllerian Duct Mesenchyme Transcription During Mammalian Sex Differentiation, Haowen Li, Richard R Behringer, Rachel D Mullen

Dissertations and Theses (Open Access)

Sp7/Osterix (Osx) encodes a zinc-finger transcription factor of the Specificity-protein family discovered by Nakashima et al. at the MD Anderson Cancer Center. While primarily recognized for its role in osteogenesis, Osx has also been implicated in mammalian reproductive development, particularly in male sex differentiation, where Müllerian Duct (MD) regression occurs, mediated by anti-Müllerian hormone (AMH) signaling. AMH-induced regression signals are transduced by the mesenchymal tissue surrounding the ductal structure, known as the Müllerian Duct mesenchyme (MDM). It was discovered that AMH signaling is necessary and sufficient for driving Osx expression in MDM. A previous transgenic mouse reporter …

Emergency Medical Services Mental Health: Causes Of Providers Leaving The Industry, Brian C. Selke

Graduate Theses and Dissertations (2019 - present)

Employee resilience and mental health have become critical concerns in Emergency Medical Services (EMS) as workforce shortages increasingly threaten staffing stability and patient care. National Registry of Emergency Medical Technicians (NREMT) data indicates that more than 30% of eligible EMS providers did not recertify between 2020 and 2023, raising concerns about workforce sustainability. This study examines EMS providers’ intentions to leave the profession and identifies workplace factors associated with turnover. A statewide survey of more than 1,200 licensed EMS providers in Alabama was analyzed using regression techniques to evaluate the relationship between workplace conditions and turnover intentions. Results demonstrate that …

Pavlovian Conditioning And Self-Control: From Laboratory To Classroom Application, Saba Mahmoudi

All Graduate Theses and Dissertations, Fall 2023 to Present

Impulsive choice, the preference for a smaller-sooner reward (SSR) over a larger-later reward (LLR), is associated with various challenging behaviors (e.g., gambling and substance-used disorders). Many interventions can reduce impulsive choice but those that produce long-lasting effects typically require long training durations or are difficult to implement in applied settings. This dissertation evaluated a novel Pavlovian training approach designed to promote self-control. In Experiment 1, procedures from Mahmoudi and Madden (2024) were replicated in the laboratory with the addition of a truly random control group. The study also assessed whether presenting the conditioned stimulus (CS) before a choice would increase …

An Examination Of Lifetime Traumatic Brain Injury And Anti-Inflammatory Medication Use In The Risk For Alzheimer's Disease, Mikaela A. Drewel

All Graduate Theses and Dissertations, Fall 2023 to Present

Alzheimer’s disease (AD) is the leading cause of dementia in individuals aged 65 years and older. There are a number of lifestyle and genetic factors that affect one’s risk for AD including traumatic brain injury (TBI), and genes such as those for Apolipoprotein E (APOE) and brain-derived neurotrophic factor (BDNF). This study examined sex differences in how TBI history influences risk for AD, exploring genetic variants suspected to play a role in TBI recovery. Additionally, in following an inflammatory mechanism in TBI, the study also determined if nonsteroidal anti-inflammatory drug (NSAID) use reduced subsequent risk for AD. The study analyzed …

The Effects Of Psychological Stress On Gut Health In Mice Fed Either A Healthy Diet Or The Total Western Diet, David Keenan Thomas Prescott

All Graduate Theses and Dissertations, Fall 2023 to Present

The Total Western Diet (TWD), a rodent diet designed to model the typical American dietary pattern, has been shown to worsen inflammation and colitis severity in mice. Psychological stress has also been associated with increased intestinal inflammation, barrier dysfunction, and alterations to the gut microbiome. The goal of this study was to determine whether combining the TWD with psychological stress would further worsen colitis severity and alter the gut microbiome. To investigate this, mice were fed either a healthy control diet or the TWD and exposed to psychological stress using a social disruption stress model. Colitis was induced using established …

Formulation And Analysis Of Physiochemical And Sensory Properties Of Ready-To-Mix Whey Protein Phospholipid Concentrate Beverage, Chris Jaquin

All Graduate Theses and Dissertations, Fall 2023 to Present

Whey protein phospholipid concentrate (WPPC) is commonly recovered as a coproduct in filtration process whose aim is to obtain whey protein isolate (WPI) from whey protein concentrate (WPC). Whey protein phospholipid concentrate is high in milk fat globule membrane (MFGM), which has been shown in rodent and human studies to have a variety of physiological benefits, including an increase in exercise capacity. Whey protein phospholipid concentrate is currently considered as an underused dairy coproduct, with most of it either being disposed of or used as animal feed. This research consisted of incorporating WPPC in a protein shake–like beverage at a …

Youth Agricultural Engagement And Its Association With Dietary Diversity, Household Food Insecurity, And Nutritional Status In Southwest Nigeria, Sherif Olasoji

All Graduate Theses and Dissertations, Fall 2023 to Present

Youth remain underserved in nutrition research, policy, and programming despite being an integral part of the food systems. While the nutrition-sensitive agriculture framework has been established, there is limited evidence demonstrating how youth engagement in agriculture can serve as a pathway to improve nutritional outcomes. The study assessed youth agricultural engagement and its association with household dietary diversity, household food insecurity, and nutritional status in southwest Nigeria.

Using a cross-sectional design, data on socio-demographic characteristics, agricultural engagement, dietary diversity, household food insecurity, body mass index, and skin carotenoids were collected from 143 youth aged 15 to 35 from Ekiti, Osun, …

A Replication Study - Mental Health And Suicide Risk Among High School Students And Protective Factors — Youth Risk Behavior Survey, United States, 2023, Hannah Baiyor

Capstone Experience: Master of Public Health

The original study (Verlenden et al., 2024) aims to analyze how various protective factors may buffer poor mental health and suicide risk outcomes among US students in grades 9-12, an important public health topic as suicide is one of the leading causes of death among US teens (Centers for Disease Control and Prevention, 2024a). Through studying these associations, this study aims to uncover pathways to positive mental health outcomes and reduced suicide risk. The study utilizes the 2023 YRBS dataset, a nationally representative sample of US public and private school students in grades 9-12, to estimate prevalence of four mental …

Hope Kit Program, Monica Reuber

Capstone Experience: Master of Public Health

Suicide is a leading cause of death in adolescents and young adults, with a disproportionate burden of those deaths in rural areas such as Kansas. High rates of depressive symptoms, suicidal thoughts, and suicidal attempts, combined with a shortage of mental health providers, emphasize the need for community-based intervention.

This capstone is designed to develop a plan for Hope Kits, a proposed suicide prevention program, among youth in grades 7-12 in Sheridan County, Kansas to improve coping skills, promote help-seeking behavior, and reduce suicide risks.

A logic model guides the program development, which aligns with available literature and Social Cognitive …

Navigating The Dark Side: Emotional Labor's Impact On Hr Professionals' Wellness, Esmeralda Amelia Rendón

Electronic Theses and Dissertations

This qualitative descriptive study was designed to document and describe how female-identifying human resource (HR) generalist practitioners serving as sole or primary employee relations practitioners in small- to medium-sized organizations across the United States experience and manage emotional labor in their roles, cope with its demands, and how these experiences impact their wellness and perceptions of organizational support. Despite the centrality of emotional labor (EL) in human resource professionals’ (HRPs) roles, little was known about how HRPs in these underresourced environments cope with these demands. Data were collected through semistructured virtual interviews with eight participants and analyzed using Braun and …

The Rpm-1/Phr Signaling Hub Modulates Tau-Induced Neurodegeneration Through Regulation Of Microtubule Stability And Mapk Pathways In C. Elegans, Xinxing Ding

Theses and Dissertations

Neurodegenerative diseases, including Alzheimer's disease and frontotemporal dementia, are characterized by the accumulation of pathological tau proteins and progressive neuronal loss. Although research regarding tau-mediated toxicity is extensive, the specific pathology that determine whether neurons maintain homeostasis or succumb to collapse under tau-induced stress remain incompletely elucidated. A central, yet still insufficiently understood, feature of these diseases is the disruption of the microtubule (MT) cytoskeleton . The PHR protein family is evolutionarily highly conserved; within this family, RPM-1 in C. elegans functions as an intracellular signaling hub that regulates axon development, synapse formation, axon termination, and various microtubule-associated processes. This …

Dissecting Ms4a4a Function In Microglia And Its Role In Alzheimer’S Disease Pathogenesis, Emma Pascal Danhash

Arts & Sciences Graduate Student Theses and Dissertations

Genome-wide association studies have begun to uncover the complex genetic architecture of Alzheimer's disease (AD). Expression of many AD risk loci is enriched in microglia, the resident immune cells of the brain. Common variants near the MS4A gene family have been associated with AD risk and altered soluble triggering receptor expressed on myeloid cells 2 (sTREM2) levels in the cerebrospinal fluid (CSF). MS4A4A is a microglial gene that encodes a tetraspan membrane protein that regulates anti-inflammatory responses in macrophages. However, the mechanism by which MS4A4A contributes to microglial function and AD pathogenesis remains unknown. In this dissertation, I leveraged a …

The Effects Of Education And Training On Clinical Staff’S Knowledge, Perception, And Clinical Practice Of The Medication Reconciliation Process, Stephanie A. Williams

Doctor of Nursing Practice Projects

Medication-related harm affects approximately one in 30 patients in healthcare settings. Accurate medication reconciliation (MedRec) is essential for identifying medication discrepancies, preventing medication errors, and reducing adverse drug events. Clinical staff play a critical role in ensuring the accuracy of medication lists in primary care settings.

This evidence-based quality improvement project evaluated the effect of a structured MedRec training intervention on MedRec knowledge, perceptions, and practices among clinical staff in a primary care clinic in Southeast Texas. The project used a single-group, quantitative, quasi-experimental design. A convenience sample of 32 clinical staff members completed knowledge and perception assessments before and …

How Recent Medicaid Defunding Has Impacted San Bernardino County Residents Access To Health Care Services, Samantha I. Rios

Electronic Theses, Projects, and Dissertations

Background: Medicaid is a critical source of health insurance for low-income populations in the United States, providing access to essential preventative, primary, and reproductive health care services (Donohue et al., 2022). The Medicaid defunding of 2025 and policy changes that follow have raised concerns regarding increased barriers to care, particularly among low-income and vulnerable populations who rely on safety-net providers such as Planned Parenthood (Planned Parenthood, 2025). The purpose of this study was to examine how the 2025 Medicaid defunding has impacted access to general and reproductive health care services among residents of San Bernardino County, California.

Conclusion: The research …

A Culturally Responsive Sexual Health Education Framework For Community Clinics In The Inland Empire, Lilianna Mora Ledezma

Electronic Theses, Projects, and Dissertations

Sexually transmitted infections (STIs) continue to disproportionately affect underserved communities, where barriers such as limited healthcare access, stigma, healthcare anxiety, medical mistrust, and language differences may discourage individuals from seeking routine screening and timely treatment. This project examined current public health literature, surveillance data, and federal guidance to identify evidence-based strategies that community clinics can implement to improve patient engagement in sexual health services. The findings demonstrated that effective STI prevention extends beyond testing alone and is strengthened through culturally responsive care, stigma reduction, patient-centered communication, standardized clinic workflows, and effective patient navigation. As a result, this project developed a …