Medicine and Health Sciences Commons^™

Self-Stigma Of Seeking Help, Psychological Safety, And Employee Assistance Program Use In Nurses, Latisha Lenee Marshall

Walden Dissertations and Doctoral Studies

Employee assistance programs (EAPs) remain underutilized across various U.S. work sectors, including nursing. There are several barriers that impede nurses from using EAP services, including self-stigma of seeking help (SSOSH) and psychological safety (PS). The purposes of this study, which used the health promotion model as its theoretical framework, were to determine (a) if there was a difference in the level of SSOSH in nurses who have used EAPs and those who have not used EAPs, (b) if there was a difference in the level of PS in nurses who have used EAPs and nurses who have not used EAPs, …

Exploring The Relationship Among Nurse-Specific Factors And Triage Accuracy In The Emergency Setting, Krisada Suamchaiyaphum

ETDs from 2020-2029

Triage is a critical function of emergency nursing practice, directly influencing patient safety, flow, and outcomes in the emergency department (ED). Despite widespread use of standardized triage training and resources, triage accuracy among ED nurses remains suboptimal. The purpose of this three-manuscript dissertation was to examine factors associated with triage accuracy in the ED setting. Manuscript One was an integrative literature review of 14 studies published between 2011 and 2021, with reported triage accuracy rates ranging from 59.3% to 82%. Primary factors associated with triage accuracy were: nurse-specific, patient, and work environment factors. Manuscript Two reported a retrospective study of …

The Influence Of The Mental Health Parity And Addiction Equity Act On Residential Behavioral Healthcare Facility Availability In The United States: A State-Level Analysis, Amanda Mellowspring

ETDs from 2020-2029

The need for accessible, quality behavioral healthcare (BH) has increased dramatically over recent decades. The availability of BH services for patients has long been complicated by high cost, lack of insurance coverage, and location accessibility. BH organizations face ongoing challenges to meet the demand for services including costs of operation, worker shortages, and navigating the payer landscape. The history of BH in the U.S. provides the foundation to conceptualize federal regulations and attempts at parity. Literature regarding federal legislation, such as the Mental Health Parity Addiction and Equity Act (MHPAEA), the Affordable Care Act, and Medicaid expansion; BH facilities and …

Development And Validation Of A Theoretically Informed Instrument To Measure The Antecedents Of Microbreaking Intentions (I-Mami) Of Procedural Healthcare Workers, Robin Riddle

ETDs from 2020-2029

ABSTRACT Work-related musculoskeletal disorders (WMSD) affect 77% of nurses and 60% of surgeons, exceeding rates in other occupational sectors and threatening healthcare workforce sustainability. Microbreaking is brief, strategic pause of 20 seconds to five minutes performed every 20 to 40 minutes during medical procedures. It has demonstrated effectiveness in reducing fatigue, improving accuracy, and lowering physiological stress markers without extending medical procedure duration. Despite this evidence, adoption remains limited, and no theoretically informed instruments exist to measure the behavioral determinants of microbreaking intentions among procedural healthcare workers. Investigators of this three-manuscript dissertation developed and established content and construct validity as …

Psychosocial Outcomes In Adults With Cleft Lip And Palate: Exploring The Relationship Between Cleft Severity, Mental Health, And Treatment Satisfaction, Haley Hannabass

ETDs from 2020-2029

Introduction:This study aimed to examine psychosocial outcomes in adults with cleft lip and palate (CL/P), focusing on how cleft severity (unilateral versus bilateral) influences depression, anxiety, social functioning, oral health–related quality of life, and satisfaction with treatment outcomes. Individuals born with clefts often continue to face psychosocial challenges even after surgical repair, and limited research has compared how these outcomes differ by cleft type in adulthood. Materials and Methods:A cross-sectional design was used, including 24 adults aged 18 years and older who had undergone cleft repair and were finished or in active orthodontic treatment at UAB. Participants completed an online …

Handling Missing Data In Copd Research, Chia-Ying Chiu

ETDs from 2020-2029

Chronic Obstructive Pulmonary Disease (COPD) remains a major global health concern and one of the leading causes of death in the United States, affecting approximately 4.6% of adults and reaching a prevalence of 9.4% in Alabama according to 2024 National Health Interview Survey. The disease imposes a substantial burden on quality of life and healthcare costs and contributes to increased disability-adjusted life years and years of life lost, as highlighted by the 2022 Lancet Commission report. Despite its im-pact, COPD is frequently diagnosed only after irreversible lung damage has occurred, largely due to under-recognized symptoms and limited diagnostic tools. Early …

Anorectal Complications In Acute Leukaemia: A Retrospective Analysis Of Clinical Characteristics, Management And Outcomes In A Tertiary Care Setting In Oman, Najwa Al Himali, Murtadha Al Khabori, Mohamed Al Huneini

Sultan Qaboos University Medical Journal

Objectives: Anorectal complications are common and serious issues among patients with haematological malignancies, leading to significant morbidity and mortality. Limited data are available on their incidence, microbiology screening and management. This study aimed to improve the understanding of these complications in patients diagnosed with acute leukaemia in Oman. Methods: This retrospective study was conducted at Sultan Qaboos University Hospital, Muscat, Oman and included patients diagnosed with acute leukaemia who developed anorectal complications over the past decade (2015–2024). Results: A total of 100 patients were included in this study; 50% had acute myeloid leukaemia (AML), 35% had acute lymphoblastic leukaemia (ALL) …

Biomarkers Of Response To Neoadjuvant Palbociclib Plus Anastrozole In Endocrine-Resistant Estrogen Receptor-Positive/Her2-Negative Breast Cancer: A Phase 2 Trial, Tim Kong, Alex Mabry, Maureen Highkin, Jeremy Hoog, Zhanfang Guo, Adrian Gonzales-Gonzales, Shana Thomas, Yingduo Song, Feng Gao, Mateusz Opyrchal, Lindsay Peterson, Foluso Ademuyiwa, Julie Margenthaler, Rebecca Aft, Katherine Glover-Collins, Leslie Nehring, Yu Tao, Souzan Sanati, Ian S Hagemann, Fouad Boulos, Li Ding, Stephen T Oh, Ron Bose, Jason D Weber, Jingqin Luo, Cynthia X Ma, Et Al.

2020-Current year OA Pubs

CDK4/6 inhibitors (CDK4/6i) improve outcomes for estrogen receptor (ER) positive/HER2-negative breast cancers (BCs), yet intrinsic and acquired resistance exist. Here, we evaluated anastrozole in combination with palbociclib (ANA/PAL) in the NeoPalAna Endocrine-Resistant cohort (NCT01723774). Thirty-four patients with clinical stage II/III ER + /HER2- BCs resistant to standard neoadjuvant endocrine therapy (on-treatment Ki67 > 10%) received neoadjuvant ANA/PAL, with serial biopsies analyzed. The primary endpoint, complete cell cycle arrest (CCCA; Ki67

Redefining The Role Of Chaperones For Dot/Icm T4bss-Mediated Substrate Translocation By Legionella Pneumophila, Sukhithasri Vijayrajratnam, Ahmet Hasanovic, Joseph P Vogel

2020-Current year OA Pubs

Legionella pneumophila, the etiological agent of legionnaires' disease, establishes its intracellular niche through the Dot/Icm type IVB secretion system, which translocates ∼300 effector proteins into host cells. Efficient secretion of many effectors requires the IcmS and IcmW chaperones, which interact with both substrates and the type IV coupling protein DotL. A prior model proposed that IcmSW are released from substrates during translocation by transfer to the C terminus of DotL and then recycled to the cytoplasm. This model predicts an excess cytoplasmic pool of IcmSW and their dissociation from DotL. We tested these predictions using quantitative stoichiometric analysis of Dot/Icm …

Dual Roles Of Trpv2 In The Innate Immune Response To Cytosolic Dna: Arresting Dormant And Boosting Activated Sting, Chen Cheng, Hsiang-Ting Lu, Shan Li, Zhongsheng You

2020-Current year OA Pubs

The cGAS/STING-dependent innate immune pathway is central in the cellular response to cytosolic DNA derived from viral infections, genotoxic stress, or mitochondrial defects. While efficient activation of the pathway is crucial for defending against pathogens and cancer, maintaining its dormancy without stimuli is equally important to avoid autoimmunity. However, the precise control of the cGAS/STING pathway remains poorly understood. Here, we report that the ion channel TRPV2 regulates both the dormancy and activation of STING. TRPV2 associates with STING and suppresses spontaneous STING activation in the absence of cytoDNA but dissociates from STING and promotes its activation by releasing Ca

Distinct Contributions Of Etv2+ And Flk1+ Progenitors To Endothelial, Hematopoietic, And Cardiac Lineages, Dereck Alleyne, Minseo Kim, Jun Wu, Yoojung Kwon, Ye-Ram Kim, Ashraf Ul Kabir, Matthew Ishahak, Jeffrey R Millman, Changxu Fan, Hyung Joo Lee, Karen Krchma, Xiaoyun Xing, Kory Lavine, Ting Wang, Kyunghee Choi

2020-Current year OA Pubs

The ETS family transcription factor ETV2, VEGFA, and its receptor FLK1 are essential for hematopoietic, vascular, and cardiac development. Here, we combine dual Etv2 and Flk1 lineage tracing with molecular profiling to define how mesoderm progenitors are allocated to hematopoietic, endothelial, cardiomyocyte, and smooth muscle lineages. We demonstrate that hematopoietic, endothelial, and cardiac valves arise from dual Etv2

Apolipoprotein E4 And Its Later-Life Health Effects On The Multiple Sclerosis Population, Dean Zeldich, Chia Hsin Cheng, Yi Guan, Sriman Narain, Bang-Bon Koo

Department of Neurology Faculty Papers

BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS) is a chronic autoimmune disease causing neuroinflammation and neurodegeneration. The apolipoprotein E4 (APOE4) allele, a major genetic risk factor for late-onset Alzheimer's Disease, accelerates cognitive decline and neuroinflammatory processes, including blood-brain-barrier disruption. This study explores the impact of APOE4 on later-life health in MS patients using biomarkers from the UK Biobank.

METHODS: MS patients were grouped by APOE4 carrier status: MS-E4 and MS-nonE4. Age- and sex-matched non-MS controls (control-E4, control-nonE4) were included for comparison. Analyses assessed retinal nerve fiber layer thickness (RNFL) from optical coherence tomography (OCT), blood biomarkers, cognitive performance, and brain magnetic …

Bridging The Gap Transition From Pediatric Care To Adult Care, Jordan Garcia, Haley Henry, Amina Jamma, Guiliana Jimenez Carrion, Alexis Lowary, Jenna Potts, Josie Ramirez, Iman Siraj

2025

No abstract provided.

Amino Acid Pet Tracers For Cancer Imaging And Response Assessment, Ugur Akca

ETDs from 2020-2029

Triple-negative breast cancer (TNBC) and high-grade glioma (HGG) pose significant diagnostic and therapeutic challenges due to their aggressive biology and the limitations of [¹⁸F]FDG PET, which suffers from nonspecific uptake in inflammatory tissues, complicating differentiation of viable tumor from treatment-related effects. Computed Tomography, while strong for structural changes, has limited soft tissue contrast for distinguishing tumor from inflammation, and Magnetic Resonance Imaging, despite superior soft tissue resolution, struggles with differentiating active tumor from post-treatment changes like edema or necrosis due to nonspecific enhancement. These challenges highlight the necessity for complementary and advanced imaging strategies for improved diagnosis and monitoring. This …

Sample Preparation Effects On Liquid Scintillation Counting Quench, Jason Rusch

ETDs from 2020-2029

Liquid Scintillation Counting (LSC) is a critical technique in operational health physics, particularly for contamination surveys. However, common, expedient sample preparation choices often introduce unpredictable levels of quench, compromising the accuracy of results. This thesis investigates the impact of common preparation variables including vial material, cap lining, solid sample matrix presence, cocktail volume, and radioactivity. The impact of these sample preparation variables were evaluated using the quench methods on two fundamentally distinct commercial LSC systems, the Perkin Elmer Tri-Carb 4910TR (employing tSIE correction) and the Hidex 600 SL (employing TDCR correction). A total of 320 samples were evaluated on each …

Physiological And Neuroimmune Effects Of Manual Therapy, Murdi S. Alanazi

ETDs from 2020-2029

Manual therapy (MT) is widely used across healthcare disciplines for the management of musculoskeletal conditions. Emerging evidence indicates that MT may also influence broader physiological systems such as the nervous and the immune systems. However, the mechanisms underlying these effects are still not well understood, and limited evidence exists regarding the neuroimmune effect of MT in neurologically impaired populations such as multiple sclerosis (MS). The overall aim of this dissertation was to investigate the physiological effects of MT, synthesizing current evidence across mechanistic domains, and generating pilot data to inform future research. This dissertation was structured around four manuscripts. The …

Clinical Decision Support Using Medical Imaging Artificial Intelligence, Yun-Chi Lin

ETDs from 2020-2029

Medical imaging plays a central role in modern clinical decision-making, yet its effective integration with artificial intelligence (AI) remains challenged by real-world clinical constraints. This dissertation investigates how medical imaging-based AI frameworks can be strategically designed to support clinical decision-making for two distinct but clinically critical scenarios: acute pandemic care and chronic neurodegenerative disease management. In acute pandemic settings, such as the COVID-19 crisis, healthcare systems face an urgent need for rapid risk stratification under conditions of data scarcity and operational stress including surges in patient volume and limited medical resources. This work explores strategies for developing deep learning models …

Does Market Penetration Of Medicare Advantage Plans Impact The Financial Performance Of Texas Critical Access Hospitals?, Charles Anthony Brocato

ETDs from 2020-2029

ABSTRACT This study investigated the impact of increasing market penetration of Medicare Advantage plans on the financial performance of Critical Access Hospitals (CAHs) in Texas, specifically focusing on days cash on hand (DCOH) and operating margin (OM). With over 20% of Americans relying on CAHs for healthcare, the financial viability of these hospitals is crucial for rural community health. The study analyzed longitudinal data from 72 CAHs in Texas between 2018 to 2023, a period marked by significant changes in the healthcare landscape due to the COVID-19 pandemic. Despite increased enrollment in Medicare Advantage plans rising from 26% to 40%, …

The Efficacy Of Computerized Visual Scanning Training Tools In Vision Rehabilitation Following Acquired Brain Injury, Lulwah Almulhim

ETDs from 2020-2029

Various neurological conditions, including acquired brain injuries, can cause visual scanning deficits, which disrupt the ability to gather and interpret visual information. Computerized training tools, such as light boards, are utilized to enhance functional vision and occupational performance. The Dynavision (D2) is a well-established visuomotor training tool primarily utilized to address visual field and visual scanning deficits. The Bioness Integrated Therapy System (BITS) is a touchscreen-based rehabilitation tool designed to assess and enhance vision, motor skills, cognition, and balance. To our knowledge, normative data for BITS visual scanning programs have not been established. We conducted a scoping review to identify …

Investigating Stromal Cell-Mediated Biomechanics For Angiogenesis And Reperfusion In A 3d Microfluidic Model For Ischemic Vascular Disease, Vaishali Bala

ETDs from 2020-2029

Peripheral artery disease (PAD) affects millions worldwide, causing tissue ischemia and impaired healing due to insufficient blood flow. Current therapeutic strategies to promote revascularization remain limited, largely because the mechanical regulation of angiogenesis is poorly understood. While biochemical growth factors like VEGF have been extensively studied, the role of mechanical forces generated by stromal cells in the perivascular matrix remains underexplored. This dissertation investigated how stromal cell contractility drives vascular growth through mechanotransduction pathways and modulation of endothelial cell-cell junctions. Using 3D fibrin or fibrin-collagen-I-based microtissues and compartmentalized microfluidic devices, we characterized the mechanical phenotypes of multiple fibroblast populations and …

Editorial: Advancing Musculoskeletal Health: Bridging Basic And Clinical Research On Biomechanical Properties Of Joints, Ligaments, Tendons, And Associated Structures, Xin Jin, Snehal S. Shetye, Mengcun Chen

Center for Translational Medicine Faculty Papers

No abstract provided.

Staff Education On Metabolic Syndrome Screening In Patients Receiving Long-Acting Injectable Psychotropics, Efetze Metangpa Akana

Walden Dissertations and Doctoral Studies

Summary This Doctor of Nursing Practice project was a staff education initiative designed to improve metabolic syndrome screening practices for patients receiving long-acting injectable psychotropic medications in an outpatient psychiatric setting. People living with serious mental illness face a heightened risk of cardiometabolic conditions, and inconsistent screening leads to delayed detection, avoidable illness, and ongoing health disparities, underscoring the importance of this practice gap within nursing practice due to nurses’ central role in medication oversight and preventive care. A key limitation of the project was the small sample size and short-term evaluation period, which limited generalizability and did not allow …

Stat-Independent Functions Of Janus Kinases 1 And 2 Are Obligatory For The Postnatal Development Of Mammary Epithelial Ducts, Rayane Dennaoui, Madison N. Wicker, Carson Moen, Michaela Schlederer, Kerry Vistisen, Aleata A. Triplett, Thomas Rülicke, Hallgeir Rui, Lukas Kenner, Emilio Casanova, Kay-Uwe Wagner

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Janus kinases 1 and 2 and STAT transcription factors are critical signaling nodes for numerous growth factors. In the mammary gland, JAK2 and STAT5a/b are essential for alveolar cell differentiation and lactation, but little is known about the cooperative roles of JAKs and STATs before pregnancy. We examined female mice conditionally deficient in JAK1/2 and discovered that both kinases jointly regulate epithelial cell proliferation and ductal morphogenesis. To assess the role of downstream STATs, we generated genetic models co-deficient in STAT3/5a/5b with or without STAT1 or JAK1. Although loss of STAT3/5a/5b leads to a JAK1-dependent upregulation of STAT1, the formation …

Myd88 Signaling In Myeloid Cells Induces Gastrointestinal Tract Injury And Systemic Inflammation After West Nile Virus Infection, Shih-Ching Lin, Fang R Zhao, Matthias Mack, Gabriel Mbalaviele, Michael S Diamond

2020-Current year OA Pubs

Humans with autoantibodies to type I interferons (IFNs) are at higher risk for neurological disease after West Nile virus (WNV) infection. IFN signaling deficient WNV-infected mice develop greater inflammation in the brain, which correlates with loss of gut barrier integrity. Here, we investigate the immune pathways that mediate this virus-gut-brain axis of inflammation. Myd88

Inducible Deletion Of Dgat1 And 2 From Microglia Exacerbates Neurodegeneration And Endolysosomal Lipid Accumulation In Male Ps19 Mice, G Travis Tabor, Alexandra Litvinchuk, Yun Chen, Austin Allison, Carisa Zeng, Hao Hu, Peter B Lin, Prabal Sharma, Samira Parhizkar, Sihui Song, Xin Bao, Abhirami K Iyer, Shih Feng You, Javier Remolina Serrano, Melissa Manis, Emily Franke, Anil G Cashikar, Carla M Yuede, Celeste M Karch, Eric J Huang, Maxim Artyomov, Jason D Ulrich, David M Holtzman, Et Al.

2020-Current year OA Pubs

Brain myeloid cells accumulate neutral lipids in multiple human neurodegenerative disorders and relevant mouse models. These lipids are often assumed to be contained in lipid droplets (LDs). While studies have been performed in cell culture and Drosophila models to characterize glial LDs, the roles of microglial LD biogenesis in mammalian tauopathy are unclear. To address this issue, we induced the deletion of diacylglycerol acyltransferases (DGATs) 1 and 2, enzymes critical for LD formation, from microglia in the PS19 mouse model of tauopathy. Microglial DGAT double knockout (KO) exacerbated neurodegeneration and increased the abundance of brain cholesteryl esters in male PS19 …

Optimizing Practice Facilitation: A Comprehensive Study On Implementation Fidelity And Its Determinants, Demetria Marie Hubbard

ETDs from 2020-2029

Intervention outcomes cannot be fully understood without examining how implementation strategies are delivered. While implementation fidelity to interventions is well recognized as a determinant of effectiveness, the fidelity of implementation strategies—the methods used to support intervention adoption—remains under-documented and under-assessed. Without this information, it is difficult to contextualize why interventions succeed or fail across diverse settings. This three-paper dissertation focuses on practice facilitation (PF), a widely used strategy in primary care quality improvement, as implemented in the Heart Health Improvement Project (HHIP) in Alabama. HHIP, led by the Alabama Cardiovascular Cooperative and funded by the Agency for Healthcare Research and …

Integrated Proteomics To Understand The Role Of Neuritin-1 (Nrn1) As A Molecular Mediator Of Synaptic Resilience In Alzheimer’S Disease, Derian Pugh

ETDs from 2020-2029

Alzheimer’s disease (AD) is the leading cause of dementia in adults over the age of 65, and currently affects approximately 6.9 million people in the United States. By 2060, the number of people age 65 and older with AD is projected to reach 13.8 million, barring the development of disease-altering therapies to prevent, slow or cure AD. Thus, there is a need for progress in the understanding of AD pathophysiology, as well as in the development of diagnostic and therapeutic interventions. Approximately one-third of individuals without dementia at the time of death are found to harbor high levels of amyloid-beta …

Cbct Evaluation Of Planned Vs. Achieved Expansion And Buccal Bone Thickness In Phase I Orthodontic Cases Treated With Clear Aligners, Jared Teeples

ETDs from 2020-2029

Introduction: Within orthodontics, CBCT technology has been used to analyze tooth movement with both fixed appliances and clear aligners. However, little research has evaluated alveolar bone remodeling outcomes in growing patients treated with clear aligner expansion. Methods: This study compared pre-treatment (T0) and post-treatment (T1) CBCTs of Phase I patients treated with clear aligners who had expansion planned in the Invisalign® ClinCheck. CBCTs were collected and analyzed, including 27 maxillary and 22 mandibular arches. The aims were (1) to compare planned vs. actual expansion and (2) to evaluate the arch width (AW) and alveolar bone changes before and after treatment. …

Cysteine Protease Activity In Allergen Recognition And Initiation Of Th2 Allergic Responses, Audrey Rae Meloun

ETDs from 2020-2029

Allergens are non-infectious environmental proteins that can trigger T helper 2 (Th2) cell-mediated inflammation in atopic individuals. Allergens are structurally diverse and typically lack pathogen-associated molecules patterns (PAMPs), which are recognized by pathogen recognition receptors (PRRs). PRRs are the canonical sensors of the innate immune system that typically detect PAMPs in microbes, initiating signaling pathways that drive pathogen clearance. Because allergens generally do not activate PRRs in the same way as infectious agents, alternative detection mechanisms are likely responsible for their recognition and the subsequent initiation of Th2 cell-mediated inflammation. House Dust Mite (HDM), a major indoor allergen, and other …

Exercise Testing And Training For Individuals With Cystic Fibrosis, Najlaa Zayed Alotaibi

ETDs from 2020-2029

Cystic fibrosis (CF) is a progressive genetic disease that impacts multiple systems (e.g., respiratory system). Hence, routine cardiopulmonary exercise testing (CPET) is recommended to track the disease progression in people with CF. Besides the benefits of exercise testing, exercise training is also beneficial for long-term wellness. It is recommended that people with CF engage in at least 30–60 minutes of aerobic exercise 3 days a week. However, despite the significance of exercise testing and training for people with CF, CPET and exercise training are underutilized in international CF centers. According to the literature, the majority of international CF centers use …