Medicine and Health Sciences Commons^™

Depression In Individuals With Chronic Liver Disease: Improving Screening In The Outpatient Setting, Kayla Corine Wright

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Individuals with chronic conditions such as chronic liver disease experience higher rates of depression, often underdiagnosed and placing high risk demographics in jeopardy of adverse outcomes, including worsening prognosis, decreased quality of life, and increased symptomatology.

Purpose: Evidence advocates for routine depression screening within high-risk patient populations. This paper outlines the implementation of a quality improvement initiative aimed at enhancing depression screening at a selected outpatient liver clinic within an extensive hospital system by implementing the PHQ-9 questionnaire during patient clinic visits, where no standardized screening protocol was previously in place.

Methods: The Plan-Do-Study-Act cycle guided the implementation …

Predicting Access Barriers And Facilitators To Pediatric Specialty Care Among Children With Complex Chronic Conditions, Elisabeth Vestal

MUSC Theses and Dissertations

Children with complex chronic conditions (CCC) face healthcare inequities when accessing pediatric specialty care. Social or economic barriers may exacerbate the challenges faced by families with a child/children with CCC and include increased geographical distance to specialty services, familial poverty, inadequate neighborhood resources, and food insecurity. Understanding how social and economic factors may impact equitable access to care are essential in improving health outcomes for children with CCC. The first manuscript in this compendium is an integrative review focused on the barriers and facilitators of accessing pediatric specialty care for rural dwelling children with CCC. The second manuscript presents a …

Aging Skeletal Muscle: Influence Of Obesity And Role Of The Exercise Responsive Nuclear Receptor Nor-1, Hector G. Paez

Alternative Theses and Dissertations (AETDs)

Skeletal muscle mass and function are critical components of overall health and quality of life. Advanced age is associated with skeletal muscle disease characterized by a loss of muscle mass, function, and quality. Indeed, low muscle mass and function is associated with poor disease outcomes and greater mortality, greater incidence of falls, and a high fiscal and societal cost. Aging contributes to a decline in skeletal muscle health through several intrinsic and extrinsic mechanisms including impaired nutrient sensing, mitochondrial dysfunction, inflammation, physical inactivity, and proteostatic imbalance. Obesity, an increasingly prominent public health concern, is becoming more common in the elderly …

The Effects Of Cannabinoids On Migration-Related Protein Expression In Ewing’S Sarcoma, Allison Lashall

Theses

Ewing’s sarcoma is an aggressive pediatric bone cancer that has low five-year survival rates, primarily due to metastatic disease and resistance of recurring tumors to traditional treatment options; therefore, novel treatment options are needed. The compound cannabidiol (CBD) has been shown to reduce cell viability, migration, and invasion in several tumor types, though the cellular mechanism of action is not well understood. Our lab has demonstrated the ability of CBD to reduce viability, migration, and invasion of Ewing’s sarcoma cells in vitro and is investigating differential protein and cytokine expression of known mediators of migration, such as intercellular adhesion molecule …

Sex Differences In The Association Between Glial Fibrillary Acidic Protein And Cognitive Performance In Autosomal Dominant Alzheimer’S Disease, Taryn Gordon

Doctor of Psychology (PsyD)

The rising incidence of Alzheimer’s Disease and its disproportionate prevalence in the female sex has led to a growth in research focused on preclinical Alzheimer’s Disease and the histopathological brain changes. However, limited research has focused on preclinical changes in Autosomal Dominant Alzheimer’s Disease populations and sex differences within these unique populations. This study aimed to address gaps in the literature by examining biological markers of neuroinflammation, glial fibrillary acidic protein (GFAP), in preclinical Autosomal Dominant Alzheimer’s Disease mutation carriers and non-carriers, and its relationship with cognitive function and sex. Archival data was utilized from the Colombia-Boston biomarker study of …

Assessing The Impact Of Femur Morphological Variations On Pediatric Hip Joint Biomechanics Using Statistical Shape Modeling, Tamara Chambers

Doctoral Dissertations and Master's Theses

This dissertation aimed to (1) quantify morphological variations in the pediatric hip joint and (2) evaluate the sensitivity of an infant musculoskeletal model (MSM) to these variations, considering hip joint center estimation errors. A shape statistical model (SSM) of decedent infant femurs from the Ortolani collection was created using ShapeWorks, capturing key morphological features, such as variations in the femoral neck-shaft and anteversion angles. Seven synthetic femurs were generated from the SSM to create SSM-informed MSMs, which were systematically evaluated through kinematics and kinetics analyses in OpenSim. Incorporating the SSM led to slight changes in the pediatric MSMs’ kinematics but …

Regulation And Function Of The Rna-Binding Protein Khsrp During Neuronal Development, Regeneration And Axonal Injury Response, Courtney Nicole Buchanan

Theses and Dissertations

Axons, which extend long distances from neuronal cell bodies, rely on localized mRNA translation to swiftly respond to extracellular stimuli and physiological states. This work investigates the mechanism underlying the RNA-binding protein KHSRP’s, axonal mRNA translation and regulatory pathways involved in neuronal growth and regeneration. Our results indicate that KHSRP deletion in mice leads to upregulation of growth-associated mRNAs linked to neuronal morphology and function, resulting in increased axon growth and altered memory consolidation. Indicating a critical role for KHSRP in neuronal development and function through post-transcriptional regulation (Chapter 2). Additionally, we show there is a rapid increase in axonal …

Student Voice: Perceptions Of Sense Of Belonging And Involvement Among Underrepresented Prelicensure Nursing Students, Maria Peña

Dissertations (1934 -)

ABSTRACT STUDENT VOICE: PERCEPTIONS OF SENSE OF BELONGING AND INVOLVEMENT AMONG MINORITIZED PRELICENSURE NURSING STUDENTS Maria Y. Peña, MSN, RN, CNE Marquette University Efforts like holistic review admissions by nursing programs to create a more ethnically diverse student body have led to increased enrollment of students with underrepresented ethnic and cultural social identities. However, these students continue to experience higher attrition rates compared to their White, middle-class peers. Although both sense of belonging and student involvement are positively correlated with academic success, limited research explores these constructs together from the perceptions of students with underrepresented ethnic and cultural social identities …

Parental Knowledge And Perception Of Obesity And Effect On Feeding Behavior And Child's Weight Status, Fidelia Senayah

Walden Dissertations and Doctoral Studies

Childhood obesity is a significant public health problem that leads to poor health outcomes in affected children, including the potential for developing chronic diseases in adulthood if not addressed at an early stage. While there are several studies on childhood obesity, data on parental obesity knowledge and risk perception as it relates to feeding behavior and child weight outcome is inadequate. No data were found on the topic in Ohio, which has a high rate of childhood obesity and overweight. This study examined how parental obesity risk knowledge and risk perception influenced parental feeding behavior and children’s weight status in …

The Role Of The Basolateral Nuclear Complex & Central Nucleus Of The Amygdala In Fear-Conditioned Responses To External Stimuli And Anxiety Responses, Oluwaseyi A. Adelakun

Senior Theses

This thesis reviews the role of the amygdala, particularly the basolateral nuclear complex (BLA) and central nucleus (CeA), in fear-conditioned responses and generalized anxiety disorder (GAD). By investigating the neurological and physiological mechanisms that influence the amygdala’s fear and anxiety responses, further connections can be made between this region and other notable brain regions, like the prefrontal cortex (PFC). We review both human and rodent models to explore the overlap between the two and explore various therapeutic interventions that regulate amygdalar activity and therefore mitigate anxiety symptoms. Key research into the patient SM, who lacks fear responses due to bilateral …

Perceptions Of Virtual Reality In Cardiac Pharmacy Education, Morgan E. Mendes

Senior Theses

Background: The reformation of how educational content is portrayed is not a new phenomenon. However, the world of pharmacy has been slow to adapt, particularly considering higher education’s declining attendance rates and less engaging lectures. XR can be a great addition to learners’ curriculum, particularly VR, with various applications including adjunctive pharmacotherapy, patient counseling, pharmacist training, and pharmacological modeling. Despite the various barriers VR integration faces, the benefits of VR necessitate its future implementation into our COP curriculum as an augmentative form of learning.

Methods: An independent study of 11 students at the UofSC COP was conducted in the Spring …

Application Of A Mepilex Border Dressing To Prevent Heel Pressure Injury, Melissa Sterlin

All Doctor of Nursing Practice (DNP) Scholarly Projects

• Problem:

Heel pressure injuries (HPIs) are preventable, yet they can easily occur when policies specifically targeting heel protection are lacking. A quality improvement methodology was implemented on two intensive care units (ICUs) within an organization which involved revising existing policies to standardize practices and mitigate occurrences.

Aim of the Project:

To evaluate the effectiveness of an evidence-based protocol that utilizes Mepilex border dressings to prevent hospital-acquired HPIs in ICUs.

• Review of the Evidence:

Across various studies, common themes emerged, notably the utilization of prophylactic Mepilex foam dressings as effective interventions specifically targeted in the ICU.

• Project Design:

A protocol …

Reducing Patient Falls In A Behavioral Health Unit: Improvement Through Audit Implementation, Kristin Gardner

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Fall-related events are a significant source of harm, with more than 700,000 patients falling every year in U.S. hospitals. The project was implemented in a 41-bed acute inpatient adult behavioral health unit (BHU). Over the last eight quarters, the BHU experienced an average of 3.16 falls per 1,000 days, exceeding the benchmark's median of 2.53 total falls.

Aim of the Project: The primary aim of this project was to decrease overall falls in an acute inpatient behavioral health unit.

Review of the Evidence: A comprehensive literature review identified intervention prevention bundles, compliance auditing, and staff education as effective ways …

Reducing Falls Through Enhanced Staff Compliance With The Fall Bundle, Lester Lubuguin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

Patient falls represent a critical issue that incurs significant health and economic burdens for both individuals and healthcare organizations. Annually, falls and fall-related injuries are responsible for nearly 3 million emergency room visits and 1 million hospitalizations, costing an estimated $50 billion. Evidence suggests that a multi-factorial approach—often referred to as a "fall bundle"—is effective in reducing the incidence of falls. However, staff non-compliance with this bundle can undermine its effectiveness.

Aim of the Project:

The project aimed to reduce the incidence of falls by enhancing staff compliance with fall prevention measures through audits and feedback conducted by designated …

Sex Differences In Active Avoidance And Neural Circuit Mechanisms In Contextual Fear Generalization, Carly Vincent

Theses and Dissertations

The current studies were aimed to investigate two behavioral hallmarks of anxiety and stress-related disorders, avoidance responses and the over-generalization of fear. In the first set of studies, active avoidance and extinction learning, that parallels exposure therapy in preclinical rodent models, were used. It is known that stress can influence aversive learning and extinction training, which can result in poor extinction retention. However, it is not well understood how the stress response is facilitating extinction resistance in active avoidance learning across sexes. Therefore, the first set of studies aimed to investigate the role of biological sex and glucocorticoid receptor (GR) …

Discovering Therapeutic Strategies In Colorectal Cancer Via Synthetic Lethal Genetic Screens On Patient-Derived Organoid Models, Sana Khalili

Theses and Dissertations

Precision medicine is a revolutionary approach of targeting genetic alterations that are present only in tumor cells to find vulnerabilities that can be targeted with therapy. Identifying genetic dependencies in human colon cancer could help identify effective treatment strategies. Genome-wide CRISPR-Cas9 dropout screens can reveal all genetic dependencies, some of which could be exploited as therapeutic targets using existing drugs.

In this dissertation, I comprehensively characterized genetic dependencies present in a colon cancer organoid avatar, and validated tumor-specific selectivity of select pharmacologic agents. I identified all somatic mutations, all expressed genes, and conducted a genome-wide CRISPR dropout screen to elucidate …

Mitochondrial Function In The Maternal Brain: A New Perspective On Gestational Stress And Pathology Of Postpartum Depression, Erin Rene Gorman-Sandler

Theses and Dissertations

Postpartum depression (PPD) is a major psychiatric complication of childbirth, affecting up to 20% of mothers, yet remains understudied. Mitochondria, dynamic organelles crucial for cell homeostasis and energy production, share links with many of the proposed mechanisms underlying PPD pathology. Brain mitochondrial function is affected by stress, a major risk factor for development of PPD, and is linked to avoidance and social behaviors. Considering the importance of mitochondria in regulating brain function and behavior, we hypothesized that mitochondrial dysfunction is associated with behavioral alterations in a chronic stress-induced rat model of PPD. Chronic mild unpredictable (CMUS) stress during late gestation …

Pelvic Floor Physical Therapy In Pregnant And Postpartum Women, Madison G. Kaup

Senior Theses

This project had three main goals: 1) Explore how pregnancy and childbirth affect the female pelvic floor anatomy and physiology, 2) Examine current practices through a literature review and interviews conducted with pelvic floor physical therapists currently practicing in various clinical settings across the United States, and 3) Develop suggestions to mitigate the challenges currently faced in the field by patients and therapists.

The female pelvic floor undergoes extensive changes throughout pregnancy as its structures are targeted by laxity-inducing hormones and mechanical stress from the growing fetus. During childbirth, the system is stretched beyond its physiological limit, causing damage to …

Let’S Make It A Game: Utilizing An Escape Room To Study Variables And Interventions That Impact The Development Of Psychological Safety, Kimberly N. Williams

Doctoral Dissertations and Master's Theses

To thrive in today’s competitive markets, organizations must harness the insights of all members. This requires employees to feel comfortable collaborating and sharing diverse knowledge—a process enabled by psychological safety. Although extensively studied over the past two decades, how and when psychological safety develops remains unclear. This research addresses these gaps by exploring temporal changes in psychological safety and examining the role of team inputs, processes, and interventions in shaping psychological safety perceptions at individual and team levels. This study utilized a quasi-experimental design with repeated and independent measures in a sample of 74 medical and physician assistant students. Within-subject …

Severe Hypertension In Postpartum: How A Nurse Driven Protocol Can Be Used To Decrease A Delay In Treatment, Kayleigh Momme

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The problem at the practicum site is a delay in the treatment of severe range hypertension in postpartum patients due to IV push antihypertensives being administered by resident physicians who are clinically stationed in another building as opposed to the primary nurse.

Aim of the Project: The overall aim is to institute a protocol that will prevent a time delay for the treatment of severe range blood pressures in postpartum patients.

Review of Evidence: Hypertensive disorders during pregnancy and the immediate postpartum period are the leading cause of maternal morbidity and mortality. Obstetric related governing bodies have come to …

Implementation Of Barcode Medication Administration To Reduce Vaccine Errors, Elizabeth R. Schwarz

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In the project organization, a large ambulatory medical group, there have been high rates of vaccine administration errors, particularly within family practice locations, which have the most variety of vaccines given.

Aim of the Project: This project aimed to improve the safety of vaccine administration by implementing barcode medication administration (BCMA) in two family practice locations.

Review of the Evidence: BCMA is increasingly recommended for outpatient settings by patient safety groups like the Institute for Safe Medication Practices (2022). Studies show BCMA can save time, improve vaccine data capture and can decrease medication errors by up to 74% (Evanson …

Reducing 30-Day Post-Stroke Readmissions With A Discharge Checklist Tool, Monika Robinson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The practice site, a nationally certified stroke care hospital, faced challenges with 30-day post-stroke readmission rates of 8.7%, below the national average of 12.44%. This quality improvement initiative aimed to reduce avoidable readmissions to below 4.7% by implementing a structured education process using a post-stroke checklist for all stroke admissions.

Aim of the Project: The primary goal was to ensure that all stroke patients received consistent discharge education. This was achieved by introducing the American Heart/Stroke Association Post-Stroke Discharge Checklist, aligning with best practices to standardize patient education.

Review of Evidence: Evidence shows inconsistencies in the discharge process, particularly …

Towards Understanding The Relationship Between Hearing Loss And Cognition In Healthy Aging, Samaneh Nemati

Theses and Dissertations

Age-related hearing loss (ARHL) has been increasingly linked to cognitive decline, both directly and through structural brain changes. This study utilized data from the Aging Brain Cohort project at the University of South Carolina (ABC@UofSC) to investigate the relationships between hearing impairments, cognitive performance, and gray matter volume across key brain regions. Specifically, the study aimed to: (i) examine the mediating role of gray matter volume in the relationship between ARHL and cognitive impairments; (ii) investigate the role of regional brain age gap in mediating the relationship between ARHL and cognitive decline; and (iii) delineate the distinctive impact of ARHL …

Factors Affecting The Transition From Pediatric To Adult Care Among Culturally Deaf Young Adults And Young Adults Who Are Deaf Or Hard Of Hearing, Anna Strickland Kell

Theses and Dissertations

Introduction: Adolescence to adulthood is marked by many transitions, including the transition from a pediatric to an adult medical home, also referred to as a health home. For young adults who are culturally Deaf, deaf, or hard of hearing, this transition may be complicated by population-specific needs related to language, literacy, and accessibility. Prior research with transition-age adolescents and young adults who are culturally Deaf, deaf, or hard of hearing has primarily focused on education or hearing health exclusively. The purpose of this research was to investigate the transition of health care from pediatric to adult services among culturally Deaf …

Information Exchange Through Social Networks Links To Adoption Of Child Feeding Practices In Nepal, Mohammad Masudur Rahman

Theses and Dissertations

While there have been notable decreases in child undernutrition (i.e., stunting) over the past few decades, it remains a major concern in Nepal, with 25% of children under the age of five experiencing chronic undernourishment. There is considerable scope for improving nutrition-related behaviors to address this ongoing issue. In Nepal, knowledge regarding appropriate child feeding practices is often inadequate, and thus additional sources of accurate information are required. Information through multiple sources (i.e., interpersonal communication, mass media, and mobile SMS) provides opportunity to reach households who inadequately practice childcare. Information improves knowledge and information exchange (i.e., receiving or sharing) usually …

The Role Of The Physical Therapist In Managing Type 2 Diabetes: Systematic And Qualitative Perspectives, Garrett Matthew Hainline

Theses and Dissertations

Introduction: Physical activity (PA) is an effective tool in the management of Type 2 Diabetes (T2D). PA recommendations for people with T2D are to achieve at least 150 minutes per week of moderate intensity PA. This assists to maintain blood glucose control and reduce cardiovascular disease risk factors. Unfortunately, people with T2D are less likely than their normoglycemic peers to meet PA recommendations.

Veterans of the armed forces experience T2D at even greater levels than the general population, with prevalence at about 20%. In addition, T2D and pre-diabetes are elevated among younger veterans, including those of recent conflicts. Reducing rates …

Demographic Characteristics As Moderators For The Association Between Cigarette Smoking And Type 2 Diabetes Mellitus, Aregash Tewoldeberhan Kidane

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a major public health problem and is associated with increased morbidity, mortality, and healthcare expenditure in the United States. Several studies have been conducted that showed cigarette smoking is associated with an increased incidence and prevalence of diabetes mellitus (DM); however, there is no published information in the literature on the moderating effects of gender/sex and race/ethnicity on this association. The purpose of this quantitative, cross-sectional study was to address this gap in the literature and examine the association between cigarette smoking and DM and the moderating effect of sex and race/ethnicity on the association between cigarette …

The Danger Online Pharmacies Pose On Clients With Eating Disorders In The Prescription Of Glp-1 Agonists For Weight Loss, Madyson R. Frisbie

Selected Honors Theses

This literature review explores the prevalence of utilizing online pharmacies to obtain glucagon-like peptide 1 agonist, Semaglutide, for cosmetic weight loss and the danger that route of obtaining medication places on clients with eating disorders such as anorexia nervosa and bulimia nervosa. In addition, research was conducted to establish practice recommendations to eliminate the possibility of a client with an eating disorder from obtaining a GLP-1 agonist when it is inappropriate for their health status. Various articles were used to gain information about the drug in general, its mechanism of action, indications, positive outcomes, and adverse effects. Additional articles were …

An Integrated Theoretical Socio-Technical Framework For Implementing Service Robots’ Integration In Healthcare, Sujatha Alla

Engineering Management & Systems Engineering Theses & Dissertations

Healthcare workers, either clinical or non-clinical, are obligated to serve patients. However, lack of a sufficient number of professionals leads to burnout, severe stress, and, consequently, decreased quality of services. In this context, very few countries have been successful in employing service robots to perform dull, dirty, and/or dangerous tasks related to patient wellbeing/healthcare, while most countries are still skeptical about it. As robotics advances, there is an opportunity for healthcare to take advantage of this technology to reduce personnel workload and to reduce the possibility of exposure to contagious pathogens. However, healthcare is a vulnerable environment and requires critical …

The Role Of Policy Entrepreneurs In Understanding Oral Health Care Policy: A Case Study Approach Analyzing Multiple Streams Framework In Nc Oral Health Policy, Lori Gordon Hendrick

School of Public Service Theses & Dissertations

The United States Surgeon General has defined oral diseases as a “silent epidemic” that affects the most vulnerable citizens. More often, this includes those from low socio-economic backgrounds, children, elderly, and many members of ethnic minority groups. Although preventative and treatment modalities have improved over the past fifty years, some Americans continue to have little to no access to educational and preventative programs. The lack of access to dental care for all ages and oral health care literacy remains one of the largest health concerns for American citizens making it a “wicked problem”. Historically, raising Medicaid enrollment has failed to …