Medicine and Health Sciences Commons^™

Multidisciplinary Approach To Reduce The Heart Failure Readmission Rate, Nisha Thekkedam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States, 6.7 million adults have been diagnosed with heart failure (HF), a number projected to rise to 8.5 million by 2030. National data indicate a 30-day readmission rate of 18.2% among HF patients from 2010 to 2017. In Texas, around 12% of the Medicare population in Texas, and specifically 11% of the Medicare population in North Texas County, have been treated for HF. A North Texas hospital reports an 18-20% HF readmission rate over the past several years. Purpose: This EBP project included the implementation of a care bundle using the Dutch Heart Failure …

Reducing Caregiver Burden For The Caregivers Of Heart Failure Patients, Joyce W. Kimani

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Family members and friends of heart failure patients serve as informal caregivers for many heart failure patients, helping with the management of day-to-day heart failure care. Many caregivers of heart failure patients experience stressors associated with caregiving, including social, psychological, financial, emotional, and physical stress. Reducing caregiver burden is important in improving both patient and caregiver well-being. Healthcare systems can improve caregiver outcomes and encourage the long-term sustainability of informal caregivers by addressing caregiver needs through focused support strategies. The Agency for Healthcare Research and Quality framework was used to develop an evidence-based guideline that healthcare professionals can follow in …

Efficient Treatment Of Postoperative Nausea And Vomiting In Adults Recovering From General Anesthesia, Peter A. Palko

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

This manuscript explores strategies to address postoperative nausea and vomiting (PONV), a significant complication affecting up to 30% of surgical patients and 80% of those at high risk. Despite its prevalence, appropriate prophylactic administration of antiemetic medications remains suboptimal, with national rates at 67% and certain academic facilities reporting only 32%, far below the 90% recommended threshold. These deficiencies underscore the urgent need for evidence-based interventions to enhance clinical adherence and improve patient care outcomes.

A quality improvement (QI) initiative was implemented to enhance prophylactic treatment and reduce inefficiencies in PONV management. Following a comprehensive literature review, the project employed …

Guideline For The Management Of Immunotherapy-Related Adrenal Insufficiency At A Cancer Center, Rachna R. Patel

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.

Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Tips Toolkit To Prevent Falls In Hospitalized Older Adults: A Rural Hospital Approach, Viridiana G. Gonzalez Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Falls remain the leading cause of injury-related deaths among hospitalized older adults, contributing to significant morbidity, extended hospital stays, and increased healthcare costs. Implementing effective fall prevention strategies is especially challenging in rural hospitals due to staffing shortages, limited funding, and variability in clinical practice.

Local Problem: A 30-bed Medical-Surgical Unit in a rural Southwest Texas hospital experienced a rise in patient falls among older adults aged 65 and older, including several incidents requiring advanced medical treatment and one resulting in serious injury. A gap analysis revealed inconsistent implementation of tailored fall prevention strategies.

Methods: A quality improvement (QI) …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

An Application Of The Transtheoretical Model To Vaping Cessation: Measure Development For The Processes Of Change, Autumn Tamlyn

Open Access Master's Theses

Statement of the Problem: An estimated 18.6% of individuals aged 18-24 and 15.9% of individuals aged 25-29 are vaping, with approximately half of the individuals in each of these groups reporting daily use. With vaping behavior on the rise, the current study aims to provide valuable information to understand patterns of vaping behavior to support intervention development and implementation.

Method: The aim of the current study was to develop a Processes of Change (POC) measure for vaping cessation in a young adult population in the United States. Previous POC measures, extensive qualitative literature review, and review of existing …

Association Between Vitamin D Status And Cortisol Concentration Among Pregnant Women, Kenneth Addae

Open Access Master's Theses

Objective: Vitamin D deficiency (VDD) and high circulating cortisol during pregnancy have each been linked to adverse maternal and child outcomes such as preterm birth. However, limited research has explored the association between vitamin D status and cortisol concentration during pregnancy. Our objective for this study was to determine the association between vitamin D status and cortisol concentration among pregnant women.

Methods: The Prenatal Health and Nutrition (PHAN) study was a pilot cross-sectional study of 30 healthy pregnant women conducted in targeted areas in Rhode Island. Data was collected on sociodemographic characteristics, substance use, perceived stress scale, household food security, …

Financial Factors And Relationship Satisfaction: A Systematic Review Using The Tccm Framework, David Gardner

Open Access Master's Theses

Relationship satisfaction is critically important for the overall health of the relationship and is therefore inherently desirable for anyone who wants to maintain a long-term romantic relationship. Financial factors have been associated with relationship satisfaction in past research, demonstrating a need for systematic exploration. The purpose of the study is to systematically explore how financial behaviors, values, and macroeconomic systems are connected to relationship satisfaction. The current systematic review follows the PRISMA framework for exclusion and identifies 30 articles studying financial factors and relationship satisfaction from Scopus, PsychInfo, and Web of Science. The analysis followed the Theory, Context, Characteristic, and …

Innovative Biomechanical And Engineering-Based Assessments Of Hip Mechanics In Individuals With Hip-Related Pain, Holly M. Stanze

Theses and Dissertations--Kinesiology and Health Promotion

Individuals with hip-related pain exhibit altered movement patterns, and worse fear of movement (kinesiophobia), compared to asymptomatic controls. Exacerbation of hip pain during movement and the role of hip symptom duration may help further our understanding of specific movement patterns that are associated with hip-related pain. A better understanding of the potential connections between hip-related symptom duration, kinesiophobia, hip pain during movement, and lower limb mechanics in those with hip-related pain may allow for more efficient referrals to clinicians and lead to more effective rehabilitation. In addition, the impact of hip-related pain on intra-articular hip loading patterns is not well …

Psychological Impacts In Exercise Riders And Professional Jockeys Following Injury, Kelley M. Renner

Theses and Dissertations--Kinesiology and Health Promotion

One of the most well-known equestrian sports, horse racing, is not only a cornerstone of Kentucky’s economy, but also a vital part of its culture, with professional jockeys playing an essential role in the local communities and traditions that define the state. Despite its popularity and financial impact, mental health challenges within the sport have continually been shrouded in silence and ignored in research (Ball et al., 2007). Equally concerning is the high injury prevalence, and psychological impact of these injuries (e.g., psychological distress, depression, anxiety, loss of identity, and self-esteem (King et al., 2022; Losty et al., 2019; McConn-Palfreyman …

The Effects Habitual Training Shoe Use Has On Running Economy When Transitioning To High Performance Running Shoes, Dalton C. Harris

Theses and Dissertations--Kinesiology and Health Promotion

Background: The recent increase in popularity of minimal shoes in endurance running is linked to potential improvements in running economy and reduced injury risk. However, high performance running shoes, specifically designed to improve running economy remain the fastest shoe to wear when racing. Purpose: Knowing this, the aim of this paper is to examine whether or not the habitual use of minimal shoes increases the benefits of the high performance shoes. This will guide practitioners and athletes when establishing shoe rotations and training plans during race preparation. Methods: The study consisted of 4 sessions: Sessions 1 and 2 were maximal …

Proximity And Density Of Tobacco Retail Locations To Kentucky Schools And The Relationship To Youth Perceptions Of Harm And Susceptibility To E-Cigarette Use, Hannah Cardona

Theses and Dissertations--Kinesiology and Health Promotion

Purpose: To explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students’ perceptions, perceived norms, susceptibility to, and use of e-cigarettes. Design: A mixed-methods analysis of youth’s self-reported survey results and geographical data. Setting: 106 Kentucky elementary, middle, and high schools which participated in #iCANendthetrend’s tobacco education program between September 2023 and May 2024. Subjects: Convenience sample of students from Ky schools (N = 7,823) Measures: Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms. Analysis: ANOVA tests used to compare responses of elementary, middle, and high school students. Chi-squared tests were used …

You’Re Too Slow! Self-Selected Volitional Efforts Reveal Unexploited Neuromuscular Reserve Capacity Compared To Maximal Efforts During Fatiguing, Load Equated Resistance Exercise, Brian Benitez

Theses and Dissertations--Kinesiology and Health Promotion

This investigation examined how movement intent influences neuromuscular excitation strategies during fatiguing resistance exercise, comparing maximal intended concentric efforts versus self-selected volitional efforts during load-equated Smith machine back squat exercise to quantify reserve capacity and characterize underlying neuromuscular mechanisms. Twenty-three resistance-trained participants (12 males, 11 females) completed a repeated-measures design, with replication, across six visits, performing smith machine back squat repetitions-to-failure at 70% 1RM under maximal intent (accelerate rapidly) and volitional intent (self-selected effort) conditions. Maximal voluntary isometric contractions used rapid (instantaneous 10-second effort) and ramp (5-second build-up, 5-second maximal) protocols. Surface electromyography (sEMG) was recorded from vastus lateralis and …

Magnetic Heating Efficiency Of Magnetite Nanoparticles: Dependence On Size And Alternating Magnetic Field, Sarah E. Kubican

Theses and Dissertations--Biomedical Engineering

Magnetic heating mediated by magnetic iron oxide nanoparticles (MION) has several clinical applications including cancer thermal therapy, tissue thawing for organ preservation, and magnetogenetics. However, current models of magnetic heating, including the widely used linear response theory, inadequately predict MION heating efficiency. An experimental study covering alternating magnetic field (AMF) strengths and frequencies ranging from 3.98 – 27.85 kA/m and 103.6 – 984.1 kHz, respectively, with a range of MION core diameters 9.5- 30.3 nm was conducted to elucidate the relationships between these AMF parameters and MION sizes and the resulting heating efficiencies. Heating efficiency was found to increase approximately …

Pathogen Surveillance Of Viruses And Antimicrobial Resistance Through Wastewater Based Epidemiology, William Strike

Theses and Dissertations--Biomedical Engineering

Pandemic surveillance is a cornerstone in public health safety, as it enables identification of pathogens circulating within a community before they become widespread outbreaks. Wastewater based epidemiology has blossomed in recent years due to its success in the SARS-CoV-2 pandemic, but this form of public health surveillance has a global equity problem. A large majority of the wastewater-based surveillance work has been done in large metropolitan cities with access to advanced testing infrastructure, which poses a challenge as we consider where pandemics have historically emerged. Therefore, there is a need to identify, adapt, and develop workflows to meet the needs …

Targeting Prmt5 In Inflammation And Cancer: A Nexus Of Endotoxin Signaling, Antigen Presentation And Immune Evasion., Jimmy James Msemo

Theses and Dissertations--Medical Sciences

Protein Arginine Methyltransferase 5 (PRMT5) is a member of PRMT family that controls both intrinsic and extrinsic oncogenic processes [1]. Protein arginine methyltransferase 5 (PRMT5) is a type II methyltransferase that exerts widespread influence over gene expression, splicing, DNA repair, and immune regulation through symmetric dimethylation of arginine residues on histone and non-histone proteins [2]. The addition of methyl groups induces gene silencing through producing dictatorial histone marks like H2AR3ne2s, H3R8me2s and H4R3mes [3], which act as epigenetic repressive marks on gene promoters. In non-histone proteins, PRMT5 can methylate and regulate transcription factor proteins such as p53, E2F1, and p65, …

Investigating Regulation And The Regulome Of The Nucleic Acid Binding Protein Spovg Within Borrelia Burgdorferi, Timothy C. Saylor

Theses and Dissertations--Medical Sciences

Prior studies indicated Borrelia burgdorferi SpoVG protein was regulated, SpoVG binds specifically to a number of nucleic acids, and SpoVG binds to the non-variable section of the major virulence factor vlsE. Although a direct transcriptional activator or inhibitor was not elucidated, it is shown that SpoVG is regulated based on cell culture density independent of the growth rate of B. burgdorferi, indicating that SpoVG regulation is outside the scope of the alternative sigma factor RpoS. Using a dCas9 CRISPRi construct to target SpoVG resulted in protein expression trending towards upregulation of the BosR-RpoS regulon, and a marked decrease …

Cellular And Behavioral Consequences Of Psychedelic Drug Action In The Claustrum, Tanner L. Anderson

Theses and Dissertations--Neuroscience

Psychedelics are rapidly garnering research attention for their ability to successfully treat a variety of psychiatric diseases after one or a handful of treatments in recent clinical research. Among the conditions treated is substance use disorder (SUD), which afflicted 48.5 million (16.7%) Americans aged 12 and older in 2023 (NSDUH). As clinical trial results continue to show lasting positive effects of psychedelic psychotherapy, there remains an enormous gap in knowledge regarding how these drugs cause lasting changes in the brain to achieve these therapeutic effects. It has been suggested that psychedelics must induce rapid and long-lasting neuronal plasticity in order …

Leveraging Clinical Standards To Improve The Translational Relevance Of Therapies For Experimental Spinal Cord Injury, Aaron L. Silverstein

Theses and Dissertations--Neuroscience

Efforts to improve treatment of spinal cord injury (SCI) often use animals to develop effective therapeutics, intending to improve the survival and the quality of life of persons with SCI. Over half of all SCIs in the United States occur at the cervical level and often cause locomotor deficits and life-threatening breathing dysfunction. Thus, my dissertation is focused on this important patient population.

After beginning with a description of translational research and surveying SCI from a clinical standpoint, I turned to describe experimental models of cervical SCI and more detailed neuroimmunological findings relevant to my work. Then, I conducted a …

Immune Dynamics And B Cell Contributions To Neuroplasticity And Recovery After Stroke, Thomas A. Ujas

Theses and Dissertations--Neuroscience

This dissertation explores the dynamic interplay between the immune system and the brain across stroke and aging using clinical, post-mortem, and pre-clinical models. The immune system plays critical roles in shaping brain function, responding to injury, and mediating recovery. These studies aim to enhance our understanding of neuroimmune dynamics across spatial and temporal dimensions.

In the first part, we conducted longitudinal sampling of aneurysmal subarachnoid hemorrhage (aSAH) patients to track immune cell and cytokine changes at days 3, 5, 7, 10, and 14 post-stroke, with a focus on delayed cerebral ischemia (DCI), a common complication. We observed distinct temporal patterns, …

Understanding The Impact Of The Medicaid Expansion On Hospital Length Of Stay And Emergency Department Use In Kentucky, Cameron Bushling

Theses and Dissertations--Epidemiology and Biostatistics

Three related analyses were performed to try to understand the immediate effects of Medicaid expansion on hospital systems in Kentucky. Medicaid expansion led to a large, sudden increase in the number of individuals eligible for various health care needs. This sudden increase in demand for health services lead to initial hypotheses regarding hospitals’ ability to handle this demand. The first analysis examined hospital average length of stay (LOS) using a linear mixed-effects model. Length of stay was modeled longitudinally between 2013 and 2015 to determine if significant changes in the slope of LOS could be detected after expansion (2014). Separate …

Changes In Cancer Diagnosis And Survival In The United States During The Covid-19 Pandemic, Justin T. Burus

Theses and Dissertations--Epidemiology and Biostatistics

The COVID-19 Pandemic led to global societal disruptions as political leaders and public health authorities attempted to control the spread of the newly discovered SARS- CoV-2 virus. While these measures were designed to lessen morbidity and mortality from a novel pathogen, their impact was also felt in many other, often unintended ways. The purpose of this dissertation is to use cancer surveillance research methods to examine the association between COVID-19 Pandemic-related disruptions and changes in the normal diagnosis and care of cancer in the United States.

The first two studies of this dissertation analyzed reductions in cancer diagnoses in the …

A Comprehensive Exploration Of Stress And Depressive Symptoms In Farm Populations, Julie C. Derringer

Theses and Dissertations--Nursing

High rates of depression and suicide continue to be a concern, despite four decades of growing research into the mental health of farmers. Most farmers have an awareness of a need for improved mental health, but a lack of knowledge persists. As agricultural production demands increase and the number of family farms decreases, the stress placed upon farmers to support the food chain is higher than ever. Understanding the association between farm demands and resources among farmers is key for the development and implementation of programs to decrease occupational stress and depressive symptoms to improve mental health outcomes across farming …

Using Hyperactive Shp-2 Mutants, A Phosphatase, To Identify Interactions With The Rna Helicase Ddx3, Devin Montgomery

Theses and Dissertations--Pharmacy

Protein-protein interactions are critical in cellular signaling pathways. This project investigates binding interactions between SHP-2, a tyrosine phosphatase, and DDX3, an RNA helicase. There is a specific focus on the impact that gain-of-function SHP-2 mutations may impact binding to DDX3 via conformational change. Using immunoprecipitation protocols as well as western blotting we were able to provide insights into SHP-2 molecular mechanisms and subsequent binding to DDX3.

Anxiolytic Intervention: Modulation Of Cell Types Due To Nicotine Withdrawal, Taylor Elder

Theses and Dissertations--Pharmacy

Nicotine use disorder (NUD) remains a leading cause of preventable disease, yet the neurobiological mechanisms underlying nicotine withdrawal are incompletely understood. Emerging evidence implicates neuroimmune signaling and astrocytic regulation of glutamate in shaping the withdrawal-associated affective phenotype. This dissertation investigated these processes using multiple nicotine administration paradigms including osmotic minipump implant, cigarette smoke exposure, and nicotine vapor inhalation to model diverse routes of human nicotine intake.

Chapter 2 examines the effects of these three modes of administration on neuroinflammation and validation of nicotine delivery. Nicotine exposure was confirmed through receptor [³H]Epibatidine nAChR binding assay and serum cotinine measurements. …

Investigating The Role Of Dynamic Signaling Of Nrg3-Erbb4 In The Prefrontal Cortex In Mediating Nicotine Withdrawal Phenotypes, Emily Prantzalos

Theses and Dissertations--Pharmacy

While several pharmacotherapies are currently available for nicotine use disorder (NUD), smoking cessation success rates remain below 10% each year. The molecular mechanisms underlying failed quit attempts continue to represent a critical gap in our knowledge. However, recent advances in understanding the genetic contributions to nicotine dependence offer a promising avenue for developing more effective cessation therapies. Prior research has identified genetic variation in Neuregulin 3 (Nrg3) and its cognate receptor ErbB4 as potential contributors to affective nicotine withdrawal (WD) phenotypes and cessation outcomes. Therefore, this dissertation aims to systematically investigate the region-specific, functional role of the Neuregulin Signaling Pathway …

Leveraging Transcriptomics And Behavior To Investigate Potential Neuronal And Glial Drivers Of Substance Use Disorder Endophenotypes, Jack V. Keady

Theses and Dissertations--Pharmacy

Over 54 million Americans needed substance use treatment in 2023. While there are many facets of substance use disorder, two major issues of interest are the negative reinforcing aspects of substances of abuse, manifesting in part as withdrawal symptomologies, and why a subset of people who use substances of abuse escalate to a use disorder. Nicotine exposure models were used to investigate the mechanisms of withdrawal endophenotypes, as smoking is the leading cause of preventable death in the United States, and a fentanyl self-administration model was used to probe individual differences in escalation phenotypes, as 80% of overdose deaths in …