From Mandate To Meaning: Designing Implementation Supports For Organizational Readiness In Behavioral Health Service Planning, Lauren K. Mergen

Theses and Dissertations--Education Sciences

Behavioral health agencies often struggle to translate the Transformational Collaborative Outcomes Management (TCOM) framework into practice when implementation is externally mandated. This study examined how educational leaders can support meaningful use of TCOM tools under a Midwestern state’s October 2024 requirement that behavioral health providers use the state Child and Adolescent Needs and Strengths assessment in service planning.

Using a Mixed Methods Action Research design, the study progressed through six phases: Diagnosis, Reconnaissance, Planning, Acting, Evaluation, and Monitoring. The Diagnosis Phase identified a knowledge-to-practice gap and weaknesses in implementation support infrastructure. Practitioner surveys administered immediately after training and six months …

Clinical Test Cases For Commissioning, Qa, And Benchmarking Of Model-Based Dose Calculation Algorithms In 1⁹2ir Hdr Gynecologic Tandem And Ring Brachytherapy, Vasiliki Peppa, Maude Robitaille, Fatemeh Akbari, Shirin Enger, Rowan Thomson, Firas Mourtada, Gabriel Fonseca

Department of Radiation Oncology Faculty Papers

PURPOSE: To develop clinically relevant test cases for commissioning Model-Based Dose Calculation Algorithms (MBDCAs) for ¹⁹²Ir High Dose Rate (HDR) gynecologic brachytherapy following the workflow proposed by the TG-186 report and the WGDCAB report 372.

ACQUISITION AND VALIDATION METHODS: Two cervical cancer intracavitary HDR brachytherapy models were developed based on a real patient, using either uniformly structured regions or realistic segmentation. The patient's computed tomography (CT) images were processed, converted to a series of digital imaging and communications in medicine (DICOM) CT images, and imported into two treatment planning systems (TPSs), the Oncentra Brachy and BrachyVision. The original segmentation …

Metabolism As A Regulator Of Sleep And Cortical Activity In Health And Alzheimer’S Disease, Nicholas J. Constantino

Theses and Dissertations--Neuroscience

Metabolic flexibility is essential for maintaining normal physiological function, enabling an organism to sense, flux, utilize, and switch fuel sources in response to changing energetic availability, demand, and cellular needs. Energetic demands are state-dependent, with wake and sleep exhibiting distinct metabolic profiles. Sleep is highly sensitive to changes in metabolism and requires metabolic flexibility to both transition into and maintain sleep stability. Alzheimer’s disease (AD) is increasingly recognized as a disease of altered metabolism yet is often framed as a disease of energetic failure. We instead define AD as a disease of metabolic inflexibility, characterized not by insufficient energy availability, …

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

The Immune Hangover: Understanding The Influence Of Alcohol Use, Abstinence, And Post-Abstinence Drinking On Monocyte Plasticity, Madison B. Blanton

Theses and Dissertations--Pharmacy

Alcohol consumption is widespread in the United States, with 80% of individuals aged 12 and older reporting alcohol use and 1-in-4 engaging in risky drinking behaviors. Alcohol misuse heightens susceptibility to infections and delays wound healing, indicating a disrupted immune system. Previous studies show alcohol rewires immune cells, especially monocytes and macrophages, which play critical roles in tissue homeostasis and host defense.

Using a rhesus macaque model of ethanol self-administration, we demonstrate that after 6-months of drinking, monocytes exhibit decreased cytokine production and significant transcriptomic changes, indicating a hypo-inflammatory state. In contrast, 12-months of chronic alcohol use induces hyperinflammatory responses, …

Investigating The Potential Role Of Toxoplasma Gondii In The Development Of Equine Protozoal Myeloencephalitis, Brooklyn Nicole Shirah

Theses and Dissertations--Veterinary Science

Equine protozoal myeloencephalitis (EPM) is a neurologic disease of horses prevalent in the Americas, caused by the coccidian parasites Sarcocystis neurona and Neospora hughesi. Toxoplasma gondii is a related parasite that infects nearly all warm-blooded animals, including horses. Prior studies show conflicting results on whether T. gondii contributes to EPM, in part because no validated T. gondii serologic assay exists in horses. This study developed a recombinant TgSAG1 ELISA and confirmatory Western blot. These assays evaluated T. gondii seropositivity in 789 serum samples from healthy and neurologic horses across multiple geographic regions and examined 31 paired serum:CSF samples for …

Molecular Mechanisms And Metabolic Consequences Of Glucocorticoid Resistance, Genesee J. Martinez

Theses and Dissertations--Pharmacology and Nutritional Sciences

Glucocorticoids are vital steroid hormones that govern metabolism, stress responses, and immune functions through intricate, tissue-specific mechanisms, both genomic and non-genomic. These hormones bind to the glucocorticoid receptor (GR), which then acts as a transcription factor to modulate gene expression. Chronic elevation of glucocorticoid levels may lead to glucocorticoid resistance, resulting in adiposity, inflammation, and insulin resistance, thereby adversely affecting multiple metabolic tissues. Whether produced endogenously or administered exogenously, excessive, chronic glucocorticoid concentrations impair glucocorticoid signaling. Although there are two primary isoforms of the receptor, GR⍺ and GRβ, only GR⍺ interacts with glucocorticoids.Through the research conducted in this dissertation, we …

Expanding The Role Of Muscle Stem Cell Fusion In Muscle Under Hypertrophic Stimulus, Jensen Goh Zhong Sheng

Theses and Dissertations--Physiology

Muscle stem cells (MuSCs) are a unique stem cell population that can activate in response to both injury and growth stimuli. Studies on muscle regeneration have shown MuSC activation follows a uniform progression through proliferation, differentiation, and fusion. Therefore, to determine whether MuSC replication is a prerequisite for differentiation under hypertrophic stimulus, I used a lineage-tracking mouse model (Pax7^rtTA; TRE-H2B-GFP) to label MuSC nuclei and simultaneously tracked DNA synthesis via EdU incorporation. This dual-labeling approach allowed us to not only distinguish MuSC-derived nuclei but also demarcate which MuSC had proliferated prior to fusion. I then employed a mechanical …

A Tale Of Two Serpins: Pathologic And Protective Roles Of Agt And Pai-1 In Metabolic And Cardiovascular Disease, Alex C. Pettey

Theses and Dissertations--Physiology

Metabolic and cardiovascular diseases are leading causes of morbidity and mortality worldwide. Conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD), aortic aneurysm, and cardiac fibrosis have limited pharmacological therapies, underscoring the need for deeper mechanistic investigations. Serine protease inhibitors (serpins) have been implicated in these pathologies and represent potential therapeutic targets. Despite structural homology, serpins regulate diverse physiological processes through both protease inhibition and non-inhibitory mechanisms. This dissertation examines the roles of two serpins, angiotensinogen (AGT) and plasminogen activator inhibitor-1 (PAI-1), in preclinical models of metabolic and cardiovascular disease to identify novel mechanisms that may inform future therapeutic strategies. …

Investigation Into The A/Ss Of Cervical Cancer And Its Effects On Tumor Control Probability In Radiation Therapy, Cameron Thayer-Freeman

Theses and Dissertations--Radiation Medicine

The standard of care for locally advanced cervical cancer is chemoradiation, consisting of conventional external beam therapy (EBT) followed by a boost of high dose rate (HDR) brachytherapy. These two radiation treatments will illicit different degrees of biological response depending on the tissue in question, and quantifying the overall effect the combined treatments will have require some form of biological modeling. The linear quadratic (LQ) model of cell survival is the most widely used radiobiological model in clinics across the nation.

It is quantified by the parameters a and ß, which model how radiation generates lethal damage in a population …

Environmental Detection And Quantification Of Equid Alphaherpesviruses In Equine Facilities Using Air Sampling, Emma E. Hyde

Theses and Dissertations--Veterinary Science

Equid alphaherpesvirus 1 and 4 (EHV-1/-4) circulate at equestrian facilities, contributing to outbreaks. Due to the complexities of the pathogen, including the limited predictability of reactivation from latency and the effects associated with secondary sites of viral replication, abortion, and neurologic disease, EHV infections are of utmost concern to the equine industry. Recent studies have highlighted the prevalence of the viruses in stabling areas at competitions, though little is known about this phenomenon in other high-traffic equine environments. This thesis presents two studies using air sampling surveillance methods to further explore the viral detection in other equine environments (veterinary facility …

A Quality Improvement Project: Nurse-Led Nutritional Support To Reduce Missed Chemotherapy Appointments, Eva Balboa

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction/Background

Malnutrition affects approximately 43% of cancer patients nationally and is associated with missed chemotherapy appointments, treatment interruption, and poor clinical outcomes. At a 30-chair outpatient cancer center in South Texas, a retrospective chart review revealed that 45% of patients experienced malnutrition-related symptoms contributing to appointment disruptions. Despite evidence-based recommendations for routine nutritional screening and support, no standardized protocol existed at this site.

Objectives

 The purpose of this quality improvement project was to implement a nurse-led nutritional support protocol and evaluate its effectiveness in (1) reducing the missed chemotherapy appointment rate from 10% to 5%, (2) achieving 100% compliance with …

A Guideline For Underserved Adult Residents In Need Of Affordable Transportation Access To Healthcare, Tammie E. Walker

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

During the development of the 2022 Tarrant County Public Health Community Health Assessment, two gaps were identified that contribute to disparities: transportation and access to healthcare in areas of high need (Y. M. Wingate, Ed.D., Community Health Assessment Division Manager, Tarrant County Public Health, personal communication, June 20, 2025). As of 2017, 5.8 million individuals reported delaying medical care due to a lack of accessible transportation in the U.S. (Wolfe et al., 2020). The National Health Interview Survey (NHIS) of 2022 reported that 5.9% of residents living in the West South-Central region, which includes Texas, found that, within the …

The Caregiving Experience: Comparing Stress And Quality Of Life Among Caregivers Of Children With And Without Autism Spectrum Disorder, Mona Khayal

Antioch University Dissertations & Theses

This comparative cross-sectional study investigated caregiving burden, quality of life, and anxiety among primary caregivers of children with autism spectrum disorder compared to caregivers of typically developing children. Using Bronfenbrenner’s Ecological Systems Theory, 66 caregivers (31 autism, 35 comparison) of children aged 6-18 completed the Zarit Burden Interview-12, WHO Quality of Life-BREF, and GAD-7. According to the results, autism caregivers reported substantially higher burden (M = 31.26 vs. 13.23, d = 2.42) and anxiety (M = 9.13 vs. 4.63, d = 1.04), with 90% exceeding clinical burden thresholds compared to 26% of comparison caregivers. Quality of life was lower across …

Managing Complexity: Manager-Stakeholder Communication, Relational Dynamics, And The Dual Nature Of Rtw Communication, H. Bertolini, Marc Corbière, Alessia Negrini, Nadine Larivière, Patrizia Villotti, Dominic Prévost, Meryl Caiada, Jason Amorim, Fergal O'Hagan

Études primaires

Purpose

The return to work (RTW) process of worker absent due to common mental disorders (CMD) or musculoskeletal disorders (MSD) represents a complex challenge that involves multiple stakeholders. The aim of this study was to examine how managers perceive the factors that facilitate or hinder communication with other stakeholders during the RTW process.

This qualitative study was based on four focus groups conducted in Canada (Quebec and Ontario) with 18 managers.

Thematic analysis identified five themes related to facilitators and seven themes related to communication obstacles. Among the main facilitators, trust, clarity, and collaboration emerged as key elements …

Lumbosacral Orthosis Can Improve Postural Control In Older Adults With Chronic Low Back Pain, Régis M.-L. D'Assomption, Christian Lariviere, Hakim Mecheri, Suzy Ngomo, Rubens A. Da Silva

Études primaires

Background

Older adults with chronic low back pain may report poor postural control and increased fall risks. Possible key mechanisms are altered lumbar spine proprioception, stiffness and mobility, which could be enhanced through lumbar stabilization approaches. The purpose of this study was thus to evaluate the immediate effects of two lumbar stabilization approaches on postural control measures, namely a lumbosacral orthosis and the abdominal drawing-in maneuver.

Methods

57 older adults (> 65 yrs): 22 with chronic low back pain and 35 healthy controls performed two trials (30 s) of a semi-tandem balance task on a force platform, while three experimental …

If Only Pickups And Vans Could Fly: Vehicle Maintenance And The Challenge Of Safely Lifting Large Vehicles On A Two-Post Lift, Damien Burlet-Vienney, Sylvie Beaugrand, Maud Gonella, Bertrand Galy, Élise Ledoux

Études primaires

The use of automotive lifts requires mechanics to work under or near a multi-ton load. Based on consultation with stakeholders, pickups and vans appear to pose problems when raised using two-post above-ground lifts (2PAG lifts), the most common type of automotive lift in garages. The aim of this study is therefore to highlight the work activity performed by mechanics when raising pickups and vans on 2PAG lifts and to describe the factors they take into account to ensure vehicle stability. Data collection took place under actual conditions in five garages. A total of 108 lifting situations were filmed and analyzed, …

Non-Invasive Detection Of Intracranial Pressure, Andrei V. Nesterenko

Honors Undergraduate Theses

Intracranial pressure is a critical metric used when managing tumors, strokes, TBIs, hydrocephalus, and other operative conditions. Traditional methods for continuous ICP monitoring, intraparenchymal catheters, epidural transducers etc., are invasive and carry a high risk of infection. Previous attempts to create accurate, easy to use, and non-invasive ICP monitoring techniques have been unsuccessful. In this study, we investigated the utility of supraorbital and posterior auricular photoplethysmography to monitor changes in ICP during orthostatic tilt and hyperventilation, which increase and decrease ICP respectively.

Through a continuous 5-minute recording on a tilt-table we characterized SOA and PAA waveforms in 12 participants (ages …

Evaluating The Burnout Mitigating Effects Of A Structured Mentorship Program In Newly Hired Advanced Practice Providers, Melissa Soper

DNP Projects

Importance: Burnout is a leading driver of clinician intent to leave, lower productivity, increased medical errors, and increased resource use.

Objective: The purpose of this project was to evaluate the effects of an evidence-based mentorship program on newly hired advanced practice providers’ (APPs’) level of stress, burnout, and professional fulfillment.

Results: At baseline, APPs demonstrated higher stress levels, moderate professional fulfillment, and low burnout. Outcomes showed improvement at the end of a mentorship program.

Conclusion: Longitudinal studies with larger sample sizes are needed to determine the true effect of a 6-month mentorship intervention on APP burnout, stress, and professional fulfillment.

Establishing An Advanced Practice Provider-Led Transient Ischemic Attack Clinic: A Quality Improvement Initiative, Brittany A. Young

DNP Projects

Background: Due to lack of subspecialized neurological care in many rural community settings, care in tertiary hospitals is in demand. Insufficient care pathways can lead to lack of bed and provider availability. Advanced Practice Provider Transient Ischemic Attack clinics have been shown to be safe alternatives to hospital admission, for patients who meet criteria. This study targeted practice change at a 1000 bed tertiary academic hospital.

Methods: The quasi-experimental study sample inclusion criteria included Transient Ischemic Attack patients presenting to the emergency department with an ABCD2 < 4, complete symptom resolution, and no new cardiac changes on monitoring. A pre and post survey with educational PowerPoint intervention was provided to all emergency department and Neurology providers and nurses. A Transient Ischemic Attack clinic was established with a corresponding order set to be utilized for streamlined outpatient work up.

Results: During the pilot period, 29 admissions were deferred with 69% …

Sepsis In Sight: Immersive Vr Simulation For Pediatric Training, Kelsey Wagler

DNP Projects

Abstract

Objectives: This project aimed to decrease the time required to administer antibiotics and fluid boluses to pediatric patients with sepsis by implementing a virtual reality (VR) simulation program. The initiative sought to enhance bedside nurses’ and pediatric residents’ knowledge, clinical reasoning, and confidence in sepsis assessment, early recognition, and evidence-based management. A secondary objective was to evaluate the effectiveness of VR simulation as an educational strategy for nurses in a high-acuity pediatric setting.

Design: This quality improvement project used a quasi-experimental design that incorporated a VR simulation intervention followed by a structured debriefing and targeted education session. Participants completed …

Stronger Together: Exploring The Impact Of Peer Support Meetings On Stress And Burnout In Ambulatory Nurse Managers, Sara Wellman

DNP Projects

Background

Nurse manager (NM) burnout is common and leads to decreased staff productivity, departmental effectiveness, and leadership capacity. This results in decreased staff morale, poor conflict management, and ineffective communication. Stress reduction and resilience programs have been shown to reduce burnout and enhance resilience in NMs, but more focus needs to be directed toward NMs who work in ambulatory settings.

Purpose

The aim of this project was to evaluate the effectiveness of a peer-to-peer resilience intervention in reducing stress and burnout among ambulatory nurse managers.

Methods

This project used a pre-test/post-test survey design and a convenience sample of ambulatory NMs. …

Treatment Of Clear Cell Renal Cell Carcinoma (Ccrcc) In Interventional Radiology, Silvia M. Mendoza

Student Research Poster Presentations 2026

This project focuses on clear cell renal cell carcinoma (ccRCC) and the role that interventional radiology plays in treating this form of cancer. Clear cell renal cell carcinoma is the most common form of kidney cancer and is often diagnosed using diagnostic imaging such as CT scans, MRIs, and biopsies. This research includes information explaining what ccRCC is, its common symptoms, prognosis, methods of treatment, and what interventional radiology is. Some forms of treatment include surgery and immunotherapy. The main treatment of this project is minimally invasive ablation therapy. Techniques such as radiofrequency ablation, microwave ablation, and cryoablation use imaging …

Magnetic Resonance Imaging Of Multiple Sclerosis, Olivia Finlay

Student Research Poster Presentations 2026

Magnetic resonance imaging (MRI) is a key tool in the diagnosis and monitoring of multiple sclerosis (MS). MRI allows doctors to see lesions in the brain and spinal cord and track disease activity over time. MS is an autoimmune neuroinflammatory disorder affecting the central nervous system. MS affects an estimated 900,000 people in the United States. MS most often develops in young adults, typically between the ages of 20 and 30. MS can lead to physical disability, cognitive difficulties, and a reduced quality of life. Globally, studies show that the incidence and burden of MS have increased over the past …

Mobile Stroke Units: Improving Stroke Care, Alysha Gargone

Student Research Poster Presentations 2026

This project examines the role of Mobile Stroke Units (MSUs) in improving stroke diagnosis and treatment time in emergency care. Strokes occur when blood flow to the brain is interrupted, requiring rapid evaluation to reduce brain damage and improve patient outcomes. This study focuses on how MSUs, which are specialized ambulances equipped with computed tomography (CT) scanners and trained medical personnel, allow imaging and clinical decision-making to occur before hospital arrival. The project highlights the importance of CT imaging in quickly identifying stroke type, including ischemic and hemorrhagic strokes, which directly impacts treatment selection. MSU workflow allows for faster diagnosis, …

The Effects Of Virtual Reality Interventions On Gait And Balance In Patients With Chronic Stroke: A Systematic Review, Meghan Darrough, Stephanie Layland, Breena Kravchick

Student Research Poster Presentations 2026

Background: Chronic stroke survivors often experience long-term gait and balance impairments that impact their functional abilities and activities of daily living. Emerging interventions, such as virtual reality (VR), are being evaluated on their potential to enhance rehabilitation outcomes.

Objective: This systematic review aimed to evaluate the effects of virtual reality interventions on gait and balance in individuals with chronic stroke.

Methods: Two literature searches were performed in September 2025 and January 2026 using the CINAHL Complete, MEDLINE, and PubMed databases.

Results: Fourteen studies met the inclusion criteria and were categorized based on balance outcome measures (Berg Balance Scale, Tinetti Performance-Oriented …

Computed Tomography: Contrast Induced Acute Kidney Injury, Keileen E. Trochez Tome

Student Research Poster Presentations 2026

Abstract

Computed tomography is a widely used imaging modality in clinical practice due to its ability to produce detailed cross-sectional images of the body. The administration of iodinated contrast agents enhances the visualization of internal structures and diagnostic accuracy. While pre-contrast scans provide important baseline information, contrast enhanced imaging can further aid in the detection of various pathologies. However, the use of contrast media has raised concerns regarding its potential to contribute to acute kidney injury (AKI), a sudden decline in renal function typically identified in changes in creatinine levels and glomerular filtration rate (GFR). This research reviews current evidence …

Contrast-Enhanced Spectral Mammography, Alyza Vega

Student Research Poster Presentations 2026

Contrast-Enhanced Spectral Mammography (CESM) is an advanced breast imaging technique that enhances the detection and characterization of breast lesions, more specifically in patients with dense breast tissue where conventional mammography is limited. This research explores the principles, clinical applications, advantages, and limitations of CESM. The technique utilizes dual-energy imaging combined with intravenous iodinated contrast to highlight areas of increased vascularity, which are often seen with malignancy. CESM provides both anatomical and functional imaging in one efficient examination. Studies demonstrate that CESM offers higher sensitivity and comparable specificity to traditional mammography, with diagnostic performance approaching that of breast MRI while being …

Alignrt In Radiation Therapy, Collin N. Domozych

Student Research Poster Presentations 2026

This project focuses on the implementation of AlignRT, a surface-guided radiation therapy (SGRT) system, and its impact on improving precision, safety, and efficiency in radiation therapy. AlignRT uses real-time 3D surface imaging to monitor patient positioning and detect motion throughout treatment, allowing for accurate and consistent radiation delivery. This study examines how AlignRT enhances clinical workflows by reducing the need for permanent skin markings and limiting additional imaging, ultimately decreasing unnecessary radiation exposure to patients. Emphasis is placed on its role in high-precision treatments such as stereotactic body radiation therapy (SBRT), where even small positional errors can significantly affect outcomes. …

The Effects Of A Core Strengthening Program On Functional Walking Endurance And The Perception Of Fall Risk In Individuals Over The Age Of 65, Melissa Cencetti, Nicole Evanosky, Amber Hackenberg, Angela Shander, Nick Dworetsky, Ryan Zuch, Andrew Layne

Student Research Poster Presentations 2026

No abstract provided.