Medicine and Health Sciences Commons^™

Development And Implementation Of An Ob/L&D Sbar Framework To Enhance Communication Between Obstetric Nurses And Anesthesia Providers: A Quality Improvement Initiative, Jenna E. Bigam, Laina J. Uzarski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication between obstetric (OB) nurses and anesthesia providers is critical to ensure patient safety during epidural placements in labor and delivery (L&D) settings. At a large teaching hospital, communication gaps were identified when OB nurses requested anesthesia for epidural placements without consistently providing vital patient information. The lack of structured communication can result in important details being overlooked, which may lead to delays in care and potential patient harm. To address this, the SBAR (Situation, Background, Assessment, Recommendation) communication framework was implemented to standardize and improve information exchange. This Doctorate of Nurse Anesthesia Practice (DNAP) project aimed to enhance …

Social Participation And Health-Related Quality Of Life For Adults With Neurodevelopmental Disabilities: Capabilities Mediation And Employment Status And Social Security Disability Insurance Moderation, Kayi Ntinda

Theses and Dissertations

Social participation is a key determinant of health-related quality of life (HRQoL) of adults with neurodevelopmental disabilities (NDDs), yet how individuals with NDDs engage socially to support their HRQoL remains poorly understood. Furthermore, the influences of personal capabilities, employment status, and Social Security Disability Insurance (SSDI) as social factors for well-being are underexplored with this population.

This cross-sectional study investigated the direct and indirect effects of social participation on HRQoL, examining capabilities as a mediator and employment status and SSDI receipt as moderators. The study sample comprised 304 adults with NDDs (females = 83.3%; age range 18 to 60 years …

Occupational Therapy Educators’ Perceptions Of Preparedness To Teach Students Culturally Responsive Care For Diverse Patient Populations, Jack Ruelas

Theses and Dissertations

This phenomenological investigation examined occupational therapy faculty preparedness for teaching culturally responsive care to entry-level doctorate students in Texas. Despite Accreditation Council for Occupational Therapy Education (ACOTE) mandates requiring cultural competence education, significant gaps persist between regulatory requirements and faculty readiness to deliver such instruction effectively. The study explored three interrelated dimensions: (1) faculty perceptions of their preparedness to teach cultural competence, (2) institutional training and support mechanisms, and (3) pedagogical integration strategies for culturally responsive content.

Employing interpretive phenomenology grounded in Freire's critical pedagogy and Iwama's Kawa Model, this investigation utilized a two-phase data collection methodology with eleven faculty …

Chronic Lower Extremity Anomalies: Impact Of Diabetic Induced Foot Amputations On Human Locomotion, Anthony Arnoldo Melgar

Theses and Dissertations

This research aims to understand the physiological changes that the human body undergoes post partial foot amputation (PFA). A total of three studies were conducted to fully comprehend biomechanical changes and adjustments that occur during locomotion for affected individuals. The first study of this thesis focuses on obtaining kinematic data for both the ankle joint angle and ankle joint torque for the healthy population, as well as for the affected PFA population. Results were compared, and notable differences were present between the two. The second study of this thesis dealt with individual muscle forces. To obtain the muscle force data, …

What Is Clinical Excellence, And How Do Healthcare Companies Achieve It?, Lorena R. Muller

Electronic Theses, Projects, and Dissertations

Clinical excellence is the benchmark for quality in modern healthcare organizations, encompassing safe, effective, patient-centered, timely, efficient, and equitable care. For organizations to develop excellent care facilities, they must clearly define the roles and responsibilities of their healthcare teams. These necessities include strong leadership, a structured staff, a functioning clinical support system, and finally, a focus and strategy to help their community's population health needs. By examining existing programs and developing them in response to the needs of healthcare organizations and communities, this article explores various ways to achieve excellence.

Medical Surveillance In Custodial Jsas: Preventing Bloodborne Pathogen Exposure, Kiara Gadea

Electronic Theses, Projects, and Dissertations

Custodians play an important role in maintaining our surroundings safe and sanitary. However, in doing so, they are their exposure to health hazards that put them at risk, yet these exposures are often overlooked. One major risk they face is contact with bloodborne pathogens, which put custodial staff at risk for infections such as hepatitis B. While Job Safety Analyses (JSA’s) outline various protective measures, many fail to incorporate medical surveillance as part of their risk management program. Overlooking this important detail leaves custodians vulnerable to health risks that can be prevented.

Adding a medical surveillance section to custodial JSA’s, …

Bilingual Budget-Friendly Hispanic Cookbook And Resource Guide For Food Pantries In San Bernardino County, Anasofia Garay Guzman

Electronic Theses, Projects, and Dissertations

San Bernardino County is faced with a significant issue of food insecurity with its residents relying on food pantries to meet their food and nutritional needs. However, the food items offered at food pantries are often limited in quantities and the variety is inconsistent, which makes it a challenge for families wanting to prepare healthier budget friendly meals while maintaining its cultural relevance. This project consists of two main key components: a bilingual, culturally relevant budget-friendly Hispanic cookbook and a comprehensive resource guide about ways and ingredient substitutions adaptable to the recipe based on what is available.

The cookbook included …

Impact Of Cysteine And Tyrosine Dipeptides On Cho Cell Performance In A Perfusion Mimic, Corrin L. Pruitt

All Theses

Perfusion cell cultures typically achieve higher cell densities and generate higher volumetric productivities than fed-batch cultures due to continuous nutrient supply and spent media removal. Despite these advantages, perfusion cell cultures remain underutilized for licensed product manufacturing, primarily due to the lack of small-scale perfusion models for high-throughput process development and the complexities involved in media formulation capable of supporting high cell densities during long-term continuous operation. To avoid nutrient limitation at high cell densities, current perfusion processes rely on using higher perfusion rates, which results in significant media wastage and downstream product dilution. Therefore, there has been an effort …

Exploring Factors Influencing Care And Outcome Among Stroke Patients In Tennessee, Omodele Agbejimi

Electronic Theses and Dissertations

Introduction: Stroke is the fifth leading cause of death in Tennessee. Socioeconomic variables influence the delivery of stroke treatment and its outcomes. Despite advances in acute stroke care, the burden of stroke keeps increasing. This study aimed to explore literature on factors contributing to stroke care and outcomes in the U.S., assess the determinants of stroke patients’ outcomes, and examine the geographical disparities in stroke hospitalization and stroke death rate and their association with stroke care accessibility in Tennessee.

Methods: A scoping review was conducted using socio-ecological models to explore literature on factors contributing to stroke care and outcomes. A …

Did California's Mental Health Services Act Improve Mental Health? Evidence From Self-Reported Data, Bennett Rider

All Theses

This analysis evaluates the impact of California’s Mental Health Services Act (MHSA), which was implemented in 2006 to increase access and improve quality of mental health care for Californians. Difference-in-differences analyses were applied to evaluate the impact of the MHSA on the number of poor mental health days in the past month (PMHDs) that survey respondents had self-reported, relative to a control group with similar pre-policy trends. Using survey data from the Behavioral Risk Factor Surveillance System (BRFSS), this study found that the MHSA’s full implementation is associated with California respondents reporting 0.118 fewer poor mental health days in the …

Impact Of S-Phase Kinase Protien 2 Blockades On Hematopoetic Stem Cell Metabolism, Nicole Elmaraghy

Electronic Theses, Projects, and Dissertations

Hematopoietic stem and progenitor cells (HSPCs) quiescence is vital for the success of bone marrow transplantation, as it preserves long term self- renewal and prevents premature exhaustion (Takubo et al., 2013; Wilson et al., 2008). However, bone marrow transplant (BMT) failure remains a clinical challenge, often due to lack of long-term engraftment and insufficient stress reliance. Both of these characteristics are tightly linked to disrupted stem cell quiescence and metabolic imbalance (Anso et al., 2017; Vannini et al., 2016). One key player is S-phase kinase protein (SKP2), an E3 ubiquitin ligase that targets cell cycle inhibitors, like p27, for proteosome …

Do Finances Determine Our Fate?: Understanding The Relationships Between Socioeconomic Status, Inflammation, And Cancer Recurrence Risk, Faith Wilbourne

Master's Theses

Individuals of a low socioeconomic status (SES) are more likely to experience a cancer recurrence relative to individuals with a higher SES. This may be partially explained by the stressors of living with a low SES. These stressors can increase inflammatory markers known to elevate the risk of cancer development. Health-promoting behaviors such as exercise, adequate sleep, and a healthy diet can reduce systemic inflammation. Health behaviors may therefore moderate any potential relationship between SES and cancer recurrence risk. This study explored associations between SES (income, educational attainment) and inflammatory markers related to cancer recurrence while seeking to determine if …

Effects Of Sex And Aging In The Response To Global Cerebral Hypoperfusion, Alexis Mcalister

Dissertations and Theses (Open Access)

Introduction

The prevalence of dementia worldwide is projected to double by the year 2030 and triple by 2050. Vascular cognitive impairment and dementia (VCID) encompasses diseases that lead to cognitive decline and dementia due to cerebrovascular disease. VCID is the second most common form of dementia after Alzheimer’s disease, accounting for approximately 15- 40% of all dementia cases. Reductions in cerebral blood flow from intracranial and extracranial atherosclerosis increase VCID risk, even in the absence of overt clinical or imaging evidence of stroke/embolization. The pathology seen in patients with chronic cerebral hypoperfusion, such as inflammation, neuronal loss, white matter abnormalities, …

Microbial Metabolite Regulation Of Microglial Ahr Signaling In Alzheimer’S Disease, Ghalya E. Alrousan

Dissertations and Theses (Open Access)

Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by amyloid-β plaque accumulation, neuroinflammation, and cognitive decline. Recent evidence suggests that systemic factors, particularly the gut microbiota and its metabolites, play a significant role in shaping brain immune responses, including microglial activation. However, the mechanisms linking gut dysbiosis to microglial dysfunction in AD are poorly understood. The aryl hydrocarbon receptor (AHR), a ligand-activated transcription factor responsive to tryptophan metabolites, has recently gained attention as a key regulator of neuroinflammation and microglial function. I hypothesize that the loss of beneficial microbial AHR ligands, specifically indole derivatives, during aging and AD …

Evaluating The Impact Of Medicaid Expansion On Non-Small Cell Lung Cancer Care And Health Disparities, Marvin Idoteyin Okon

All Dissertations

Persistent disparities in non-small cell lung cancer (NSCLC) outcomes reflect broader structural inequities shaped by race, place, and socioeconomic conditions. This dissertation examined trends in NSCLC outcomes over the past two decades and evaluated the impact of Medicaid Expansion (ME) under the Affordable Care Act on improving outcomes and reducing disparities, especially in marginalized communities.

Using nationally representative datasets, three interrelated studies were conducted. The first assessed trends in NSCLC incidence, early-stage diagnosis, and 3-year survival from 2002-2021, stratified by metropolitan status, deprivation (Social Deprivation Index), and segregation (Index of Concentration at the Extremes). While incidence declined and early-stage diagnosis …

Evaluating Covid-19, Influenza, And Rsv Vaccine Effectiveness, Iromi N. Jayawardena

All Dissertations

Respiratory infectious diseases, including COVID-19, influenza, and RSV, pose significant public health challenges, especially during the respiratory virus season. Vaccination remains the primary intervention to mitigate morbidity and mortality associated with these diseases. Vaccine effectiveness (VE) can vary between seasons and populations, necessitating continuous evaluation. This study aims to evaluate the effectiveness of the 2024-2025 COVID-19 mRNA vaccine, 2024-2025 seasonal influenza vaccine, and single-dose RSV vaccine over two seasons.

Utilizing electronic health records (EHRs) from the Prisma Health healthcare system, this dissertation emulated target trials to assess the vaccine effectiveness of each vaccine. Risk set propensity matching was used to …

Emotional Safety In Pediatrics: The Impact Of Child Life Services On Healthcare Professionals’ Perceptions Of Their Own, Patients’, And Families’ Outpatient Experiences, Jenni Davis

All Dissertations

Medical visits, regardless of setting, are stressful for children and their families. Care that focuses on the emotional safety of children and families can help reduce this stress. However, not all staff feel prepared to provide emotionally safe care. Child life specialists (CLSs) are specifically trained to support emotional needs during healthcare encounters. Their presence may help staff stress as well, not just stress for children and families.

This study used three surveys to understand stress among healthcare staff working in pediatric outpatient clinics and surgery settings, and how support from a CLS affects staff, children, and families. All staff …

From Classroom To Workplace: Evaluating Communication Curriculum In Physician Assistant Education, Camryn G. Evett

Honors Thesis

Effective communication is a critical competency for physician assistants (PAs), impacting patient outcomes, interprofessional collaboration, and clinical decision-making. This paper explores the many communication challenges faced by PAs, including navigating supervisory relationships, clarifying scope of practice, building patient trust, and managing clinical interactions. It also examines how the national accrediting and certifying bodies such as the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), the National Commission on Certification of Physician Assistants (NCCPA), and professional organizations such as the American Academy of Physician Associates (AAPA) shape communication training through formal standards. These frameworks influence curricular design, assessment methods, …

In A Safe-Space Of Her Own: Alice's Journey Through A Traumatized Wonderland To Find Attunement And Recovery, Cheston A. Axton

Electronic Theses and Dissertations

Throughout Alice’s Adventures in Wonderland/Through the Looking-Glass’s 160-year existence, Lewis Carroll’s seven-year-old protagonist has experienced many changes and alterations. With an ever-growing pop culture interest, Alice’s original narrative has undergone numerous adaptations, with each new variation diving deeper into the impact of trauma on Wonderland.

This thesis continues this existing discourse by examining Wonderland’s capacity to facilitate recovery in the aftermath of severe trauma. Through this research, the traumatic experiences of Alice, from Christina Henry’s The Chronicles of Alice: Alice and American McGee’s Alice: Madness Returns, are examined concerning their effect(s) on her construction of Wonderland, as …

Orchestrated Architecture Dismantling: Borrelia Burgdorferi’S Coordinated Destruction Of Adaptive Immune Responses, Craig A. Land

Electronic Theses and Dissertations

Borrelia burgdorferi represents the most prevalent vector-borne bacteria in North America, affecting ~476,000 Americans annually yet persisting despite robust immune responses. This project reveals spirochetes target adaptive immunity through coordinated lymphatic colonization and precision immune dysregulation.

Using comparative host models (C57BL/6 vs. reservoir Peromyscus leucopus), we demonstrate lymph node colonization within 48-hours, with spirochetes exploiting LYVE-1-positive lymphatic structures as dissemination highways while avoiding the interior of follicular regions. Critically, we identify targeted CD4+ T-cell elimination in germinal center border zones at 21-DPI, precisely when these cells should be coordinating protective immunity. Concurrent upregulation of inhibitory receptor CD32b creates molecular …

Resistance Training Load-Volume Effects On Maximal Strength, Isometric Force-Time Characteristics, And Force-Velocity Relationships, Chieh-Hsin Yu

Electronic Theses and Dissertations

The investigations concerned the effects of resistance training programs with different load–volume configurations on multiple strength characteristics, including maximal strength, isometric force–time properties, and force–velocity (F–v) relationships. Following a review of training interventions across these variables, two ecologically valid resistance training prescriptions were compared: high-load, low-volume (HLLV) and moderate-load, moderate-volume (MLMV). Fourteen recreationally trained participants were grouped into either HLLV (three sets of two repetitions at ≥ 80% 1RM) or MLMV (three sets of ten repetitions at 60–80% 1RM), incorporated into the main lifts of a 4-week program. Strength was assessed using back squat one-repetition maximum …

The Impact Of Estrogen Loss On Caveolin Expression And Cardiac Myocyte Remodeling In Ovariectomized Mice Following Chronic Sympathetic Stimulation, Juliana Barnie

Electronic Theses and Dissertations

Cardiovascular disease (CVDs) remains the top cause of death globally, with postmenopausal women at higher risk due to estrogen decline. Beta-Adrenergic (β-AR) signaling is a major regulator of heart function. Caveolins, structural proteins of caveolae, coordinate cell signaling activities in the heart by co-localizing with estrogen receptors and β-AR and contribute to maintaining healthy cardiac function. The caveolin scaffolding domain (CSD), a binding component of caveolin, has shown therapeutic potential in animal models of heart disease. However, most studies on CSD have been completed in male mice. This thesis evaluates the therapeutic potential of CSD in female mouse models and …

Organizational Health Literacy In Pediatric Cardiovascular Programs, Eva Gomez

Graduate Doctoral Dissertations

Health literacy refers to a person’s ability to access, understand and use health-related information in order to effectively manage one's health and navigate healthcare experiences. This responsibility does not rest solely upon the individual; healthcare organizations also have a vital role in assisting individuals in accessing, understanding and using health information through their interactions with the healthcare system. Organizational health literacy (OHL) can serve as a strategy to ensure that all individuals have equitable access to health information and services. The Ten Attributes of a Health Literate Healthcare Organization established the foundational principles of organizational health literacy. The present study …

Exploring Transgender And Gender Expansive Youth's Experiences With Vicarious Minority Stress, Erin T. Pereida

Graduate Doctoral Dissertations

In the United States (U.S.), transgender and gender expansive (TGE) youth experience elevated rates of depressive symptoms, self-harm behaviors, and suicidality compared to cisgender peers. Mental health professionals and researchers often use the gender minority stress model to explain these elevated rates, positing that stressors related to minority identity experienced above and beyond normative daily stress contribute to adverse mental health outcomes. One emerging component of the model requiring further investigation is vicarious minority stress; stress experienced indirectly through witnessing or learning of gender minority stressors affecting other TGD individuals or the community more broadly. The present study explored this …

Knowledge And Perceptions Of Prebiotics And Probiotics Among University Students, Itzel Martinez

Electronic Theses, Projects, and Dissertations

Background: Gut health gained significant attention in recent years, with prebiotics and probiotics widely promoted for their potential health benefits. However, misinformation about this topic was common, particularly among young adults who were heavily influenced by social media and advertising on health-related topics. Research studies had indicated that knowledge and perceptions of prebiotics and probiotics are based on factors such as age, gender, and academic background. This study aimed to assess the knowledge and perceptions of university students on prebiotic and probiotic foods, identify commonly used resources for information, and analyze the impact of media and demographic variables on their …

The Lived Experiences Of Navajo Nurses During The Covid-19 Pandemic, Stephnie Ann Leeson

Electronic Theses and Dissertations

When COVID-19 was diagnosed on the Navajo Nation, the impact on the people and the healthcare system was not understood. For almost three years, Navajo healthcare workers battled what was known to the Navajo as Dikos Nitsaaígíí Náhást’éíts’áadah, translated as The Big Cough. The Navajo Nation President, Jonathan Nez, referred to it as a Monster, as did many people in the Navajo Nation. Navajo nurses on the frontlines battled the monster daily as they saw friends and relatives succumb to the insidious disease. Much has been written about nurses off the reservations working on the frontline during the pandemic. However, …

Evaluation Of The Zanesville-Muskingum County Ohio’S Mosquito And Tick Disease Vector Control Program, Samantha Wantz

Capstone Experience: Master of Public Health

This project aimed to evaluate the Zanesville – Muskingum County Health Department’s (ZMCHD) Vector Control Program based on performance measures, program indicators, and customer satisfaction. A secondary goal of the project is to evaluate and revise the existing policies and procedures of the program in regards specifically to the safety of the intern. Based on information from the Ohio Department of Health infectious disease dashboard, in the last 10 years (2014-2024) Muskingum County has reported 12 total cases of La Crosse virus, one case of West Nile Virus, and one case of Malaria (Ohio Department of Health, 2024a). ZMCHD has …

Supporting Autistic Students' Mental Wellness: A Community Readiness Model Approach, Cady Walker

Capstone Experience: Master of Public Health

Autism spectrum disorder or difference (ASD) is a lifelong neurodevelopmental disability, usually identified during childhood. However, many adults miss the opportunity for diagnosis during childhood due to previous misunderstandings about autism presentation, camouflaging behaviors, and misdiagnoses. While current diagnostic tools for assessing autism in children are more robust, similar measures are lacking for adults who were not diagnosed in childhood. This gap poses risks for poor mental health outcomes among adults who missed a timely ASD diagnosis, which can be especially challenging for autistic college students. Although some higher education institutions offer support programs for autistic students, most do not, …

Advancing Point-Of-Care Diagnosis Of Joint Infection Using A Diffuse Reflectance Spectroscopy (Drs) System, Erin Elizabeth Drewke

Graduate Theses and Dissertations

Septic arthritis is a severe joint infection that can rapidly destroy cartilage and cause lifelong disability if not diagnosed and treated promptly. Faster, bedside diagnostic tools are needed to reduce delays and support timely treatment decisions while preserving standard laboratory workflows. A syringe-mounted diffuse reflectance spectroscopy (DRS) system was developed for rapid, sterile, point-of-care measurement of synovial fluid optical properties. Broadband light (400–650 nm) was delivered and collected through the syringe barrel without contaminating the sample. An empirical lookup table (LUT) and a boundary-aware Monte Carlo (MC) model were implemented to extract absorption (μₐ) and reduced scattering (μs′) coefficients from …

Multivariate Optical Imaging Of The Oxygen-Metabolism Axis, Jesse D. Ivers

Graduate Theses and Dissertations

Metabolic reprogramming is a characteristic hallmark of multiple pathologies and promotes disease progression, survival, and severity. Current methods to investigate metabolic reprogramming, however, require reductions of dimensionality both because of instrumentation limitations and analysis tools. This work aims to define a blueprint for high dimensional study of the oxygen metabolism axis to enable more sensitive study metabolic reprogramming. We hypothesized (1) multivariate imaging of metabolic and oxygenation metrics in ex vivo tissue sections would elucidate differences in resistant and sensitive head and neck squamous cell carcinoma (HNSCC) xenografts that traditional uni-variate methods miss and (2) an engineered hyperspectral darkfield microscopy …