Medicine and Health Sciences Commons^™

Exploring The Impact Of Age On Traumatic Brain Injury Cause And Recovery In Arkansas: A Retrospective Review, Abby Jones, Steven Wheeler, Jessica Danley

2026 Honors Symposium

Traumatic brain injuries (TBIs) remain a major public health concern, and increasing evidence goes to show the significance of the effect of age in quality of care, diagnosis, and recovery outcomes. In rural states, such as Arkansas, where research has shown a lack of resources and higher fatality rates among TBI patients, healthcare professionals can become better informed and equipped as a result of research efforts to uncover the effects of age on cause and recovery for inpatient TBI individuals in the early stages (Daugherty et al., 2022). Current research and prior evidence suggests that older individuals are more likely …

Integrative Machine Learning Of Genetic And Lifestyle Factors For Personalized Skin Health, Yassine Benachour, Lina Maloukh, Barbara Geusens

All Works

Objective: To develop an AI framework that combines genetic, phenotypic, and lifestyle data for profiling skin-health patterns and generating hypothesis-supporting summaries for potential decision support. Methods and procedures: A dataset of 5,254 individuals integrates six genes (FLG, AQP3, MMP-1, MMP-3, SOD2, GPX), six phenotype severities, and 20+ lifestyle factors. Mutation burden and interactions are tested by ANOVA. K-modes clustering identifies four interpretable dermatological profiles within the cohort and is embedded in leakage-free nested cross-validation (train-only selection; test labels from training centroids). Subtypes are predicted from genetics plus lifestyle using an XGBoost (XGB) classifier; explainability uses gain, permutation importance, and SHAP …

Improving Feeding Outcomes: Occupation-Based Feeding Interventions From Nicu To Outpatient Pediatrics, Bailey Ciardelli

OTD Capstones

A researcher from an entry-level doctorate program examined gaps in feeding and sensory-based care for premature infants in the Neonatal Intensive Care Unit (NICU) and outpatient pediatric feeding setting. The Improving Feeding Outcomes project aimed to improve feeding readiness, sensory regulation, and caregiver confidence through the development of occupation-based, family-centered interventions. This report evaluates the implementation of evidence-based resources, including caregiver education handouts, a NICU staff training presentation, a caregiver tummy time group, and a standardized infant feeding assessment tool integrated into outpatient pediatric therapy practice. These interventions were designed to address gaps in OT-led infant feeding and sensory care, …

“Treatment Not Tents:" The Medicalization Of Homelessness In California’S 2022-2025 Legislative Agenda, Elana R. Straus

Yale Medicine Thesis Digital Library

Modern homelessness emerged in the 1980s due to political choices that cut the social safety net and decreased the availability of affordable housing. Medicalized views of homelessness that frame homelessness as driven by individual pathology, particularly mental illness and addiction, emerged in research, media, and politics at this time. Homelessness has persisted since and remains particularly high in regions, including California, where the housing markets are most constrained. In this context, California advanced multiple legislative changes between 2022 and 2025 that increased pathways to involuntary treatment and criminal-legal control over people experiencing homelessness. In this thesis, I demonstrate how legislators …

Measles Vaccine Hesitancy Improvement Bundle To Improve Vaccination Rates In A Rural Outpatient Clinic, Ramie Malone

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction

Despite the Centers for Disease Control and Prevention's recommendations to vaccinate children against measles, a decline in measles vaccination rates has been observed at a rural family medicine clinic. While numerous factors contribute to the decline in vaccination rates—including parental doubts about the necessity of vaccination, concerns about vaccine side effects, and insufficient education—the latter remains a fundamental underlying cause of suboptimal vaccination coverage.

Objectives

This project focused on surveying, educating, and boosting parents' confidence in measles vaccines for children under five to raise the measles vaccination rate.

Methods

This project used a pre- and post-intervention bundle over an …

Reducing 30-Day Readmission Rates In Patients With Heart Failure, Charles Mccoy

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Globally, heart failure affects approximately 54 million individuals and has reached pandemic levels, contributing to elevated 30-day readmission rates (Sa et al., 2024). Background: In the United States, 30-day readmission rates range from 18% to 20%, with similar rates across all states. The current rate was documented as 29% at the study setting hospital. Objective: Implement a Quality Improvement project based on education, evidence-based order sets, and referral to palliative care to reduce 30-day readmission rates among adults with heart failure. Methods: Nursing staff completed education specific to heart failure, and patients received the American Heart Association Self-Check assessment. …

Ask, Advise, And Act: A Smoking Cessation Bundle For Cancer Patients, Crystal Tencate

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Smoking is the number one cause of preventable illness and death in the United States. For patients undergoing cancer treatment, continued tobacco use poses serious risks. In surgical oncology, smoking is associated with poorer treatment outcomes, increased postoperative complications, delayed wound healing, and higher mortality. For patients requiring reconstructive surgery, smoking-related complications can be devastating, sometimes resulting in significant wound complications or loss of the reconstruction. Despite these well-established risks, smoking cessation interventions are not consistently integrated into clinical practice.

To address this gap, a quality improvement project was implemented to strengthen smoking cessation efforts among advanced practice providers (APPs) …

Nursing Bundle To Improve Quality Metrics For Postoperative Patients, Kristine G. Coronado

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Postoperative pulmonary complications and inconsistent implementation of preventive nursing interventions remain significant challenges on acute care surgical units. The purpose of this quality improvement project was to reduce postoperative respiratory failure, hospital readmissions, and length of stay while improving nursing compliance with evidence-based interventions. A nursing care bundle, RISE—Respiratory therapy (structured, nurse-guided incentive spirometry), Incentivize movement (early ambulation), Sit up (head-of-bed elevation ≥30 degrees), and Eliminate germs (twice-daily oral care)—was implemented on an acute care surgical ward in South Texas. Nursing compliance with the preventative measures and patient outcomes were compared between pre- and post-implementation cohorts. Following implementation, nursing compliance …

Improving Asthma Management In Schools: A Comprehensive Approach To Education, Environmental Enhancements And Asthma Action Plans, Yesenia Trevino

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Asthma contributes to school absenteeism, especially in underserved communities. This project aimed to enhance asthma management at a South Texas elementary school through staff and student education, monthly air filter changes, and personalized Asthma Action Plans (AAPs).

Methods

A quality improvement project at a South Texas elementary school involved 40 asthmatic students over eight weeks, using the Plan-Do-Study-Act (PDSA) framework. It included staff and student education, air filter maintenance, and facilitation of Asthma Action Plans (AAPs). Pre/post surveys, custodial logs, AAP audits, and attendance were analyzed, with paired t-tests used to assess changes (N=32).

Results

There was 71.9% …

Starting Strong: Improving Mmr Vaccination Rates In Kindergartners, Regina Bryan

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

During the 2023–2024 academic year, measles, mumps, and rubella (MMR) vaccination coverage among kindergarten students in this school district did not meet the Healthy People 2030 target, thereby elevating the risk of disease outbreaks. This quality improvement project aimed to improve MMR vaccination initiation and completion through coordinated, school-based interventions.

Methods

Guided by the Plan-Do-Study-Act framework, an eight-week immunization bundle was implemented across 14 elementary schools in South Texas. Interventions included reminder calls, multilingual education, districtwide communication, and a partnership with a nonprofit clinic that provides free or reduced-cost vaccines through on-site and community clinics. Pre- and post-intervention …

Ambient Listening: Using Artificial Intelligence To Transcribe Provider Office Visits, Odia Russette

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Electronic health record (EHR) documentation burdens contribute to increased “pajama time” or after–hours charting, reduced job satisfaction, and provider burnout. Provider burnout leads to provider and critical access point losses. Ambient–listening artificial intelligence (AI) technologies have emerged as a possible tool to reduce charting burdens; however, evidence from outpatient wellness settings remains limited.

Local Problem: At an urban adult wellness clinic in Texas with limited resources for completing tasks, in-clinic and after-hours “pajama time” charting burdens contributed to provider fatigue, job dissatisfaction, and burnout.

Methods: A quality improvement (QI) project using the Plan-Do-Study-Act (PDSA) framework implemented an AI ambient …

A Quality Improvement Project To Decrease Medication Prior Authorization Approval Times, Amena Guinn Babers

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Medication prior authorization requirements add to administrative burden, increase labor costs, and delay patient access to treatment in outpatient specialty settings. This bottleneck directly influences nursing workload and economic performance.

Purpose: To evaluate the fiscal and performance significance of implementing an electronic prior authorization (ePA) process, standardized tracking tools, and staff education in a small orthopedic clinic.

Methods: A pre–post quality improvement design was used. Descriptive statistics and inferential analyses (independent‑samples t tests and Mann–Whitney U tests) were conducted to compare time to approval, staff hours worked, satisfaction scores, and medication pickup timeframes.

Results: Significant reductions were observed in …

Inpatient Stroke Quality Improvement, Briyawna N. Wyatt

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient nursing documentation for stroke care is essential for meeting quality metrics, maintaining continuity, and supporting timely decisions. Gaps can lead to inconsistent care, metric failures, and reduced staff confidence. This quality improvement initiative aimed to improve metric compliance, documentation consistency, and nursing knowledge and satisfaction. A three-part intervention included targeted education, a standardized documentation verification form, and ongoing feedback from stroke champions. Outcomes measured were metric compliance, knowledge (pre/posttests), documentation completeness (Venous Thromboembolism (VTE), education, Modified Rankin Scale), and staff satisfaction. Results showed significant improvement in nursing knowledge (p < .005), reduced metric fallouts, and better documentation across all indicators. Staff satisfaction increased by about 20%. Overall, combining education, standardized tools, and continuous feedback improved documentation practices, enhanced compliance with stroke metrics, and increased nursing knowledge and satisfaction, supporting better care processes and patient outcomes.

"It Made Me Want To Get Into Healthcare Even More": A Simulation-Based Healthcare Mentoring Program, Jack Mccarthy

Yale Medicine Thesis Digital Library

The healthcare industry in the United States continues to experience rapid growth, yet workforce shortages persist across a wide range of medical professions. In order to increase the pool of qualified individuals pursuing healthcare, innovative strategies are needed to increase interest in healthcare fields among youth. Prior research has identified that healthcare career interest is driven in part by motivational characteristics including interest in math and science, self-efficacy, and social factors like the expectations of parents and caregivers. Mentoring, career exploration, and informal learning have been identified as strategies that increase student interest in and commitment towards healthcare careers. This …

Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Implementing A Standardized Resilience Bundle For Neonatal Intensive Care Nurses, Jennifer Bouzid

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Nurse resilience is associated with improved psychological well-being, professional satisfaction, and retention. Neonatal intensive care unit nurses are frequently exposed to emotionally traumatic clinical events that may contribute to burnout, compassion fatigue, and turnover. A women’s hospital in central Texas identified increased nurse turnover and lower employee engagement scores related to well-being and intent to stay within the neonatal intensive care unit.

Purpose: The purpose of this quality improvement project was to implement and evaluate a standardized resilience support bundle for nurses following traumatic clinical events.

Methods: Guided by the Plan-Do-Study-Act framework, the project implemented a resilience bundle that …

Kinematic And Muscle Activity Differences During Dual Task Cutting In Ncaa Soccer Players, Abigail Mccarthy

Open Access Master's Theses

Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries in collegiate soccer, but also in the world. Professional soccer observes a prevalence of around 10-18 percent (Walden et al., 2013). The United States alone reports up to 2 million acute ankle sprains annually (Herzog et al, 2019). LAS ranked top 3 in types of injuries within collegiate soccer with hamstring tears and concussions (Chandran et al., 2021). Around 40 percent of people who experience a lateral ankle sprain will experience chronic ankle instability, and since spraining ankle once at a greater risk now for spraining ankle again. …

Test-Retest Reliability And Validity Of The Gas Exchange Threshold, Erik Ryan Snell Mr.

Theses and Dissertations--Kinesiology and Health Promotion

Theoretically, the gas exchange threshold (GET) demarcates the moderate and heavy intensity domains, whereby exercise performed at and below the GET results in a change in oxygen consumption ([ΔVO₂] ≤ 200 mL), and exercise above the GET results in a slow component (ΔVO₂ > 200 mL). This study examined the reliability and validity of the GET. 14 subjects performed two maximal graded exercise tests (GXTs) to determine the GET and its reliability. The minimal difference (MD = 21W) was applied to determine the GET above (GET_+MD) and below (GET_-MD) power outputs for 30 min …

Biomechanical Effects Of Exercise-Based Interventions In Chronic Nonspecific Low Back Pain: A Systematic Review And Meta-Analysis, Lara De Vecchi Machado

Theses and Dissertations--Kinesiology and Health Promotion

Chronic nonspecific low back pain (CNLBP) is the leading cause of years lived with disability worldwide and represents a complex, multifactorial, and heterogeneous condition. It is characterized by substantial interindividual variability in muscle activation patterns, lumbo-pelvic coordination, and movement strategies. Although exercise is widely recommended as a first-line intervention and its clinical benefits are well established, the biomechanical mechanisms underlying functional improvement remain fragmented in the literature and are rarely synthesized quantitatively.

This dissertation conducted a systematic review with meta-analysis to investigate the biomechanical effects of exercise-based interventions in individuals with CNLBP. A total of 39 studies were included and …

A Specification-Driven Framework For Self-Supervised Learning In Specialized Vision Domains, Mahmut S. Gokmen

Theses and Dissertations--Computer Science

Self-supervised learning (SSL) has emerged as a principled approach to visual representation learning that derives supervisory signal directly from unlabeled data, enabling foundation models to be trained at scale without manual annotation. Deployments in medical imaging and biometric recognition have demonstrated the potential of this paradigm, yet the assumptions that make SSL effective on natural image benchmarks fail systematically in specialized domains. Generic SSL pipelines encode a tacit assumption that the most informative correspondence is spatial proximity within a single acquisition. In specialized domains this assumption breaks at the level of the data-generating process: the signal that carries domain-specific information …

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 …

Simulation Training In Radiation Oncology, Michael C. Schell, Andrew W. Beavis, Derek W. Brown, Michael Milano, Michael O'Neill, Yan Yu, Daniel C. Pavord, Peter Dunscombe

Department of Radiation Oncology Faculty Papers

Simulation training can be used in the design of new processes or, more commonly, to train and re-train healthcare personnel in standard processes. Simulation training is one avenue to making radiation oncology a high reliability health care intervention. In this paper, we explore the relevance of simulation training to the provision of high-quality and safe radiation oncology practice against the background of simulation training conducted in high reliability industries. The use of simulation training in healthcare, as well as specific examples in radiation oncology, is reviewed. An outline of the steps for developing a simulation training program is provided. Simulation …

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 …