Medicine and Health Sciences Commons^™

Implementation Of The Phq-9 For Early Detection Of Depression In Older Adults, Elsie Kumba Kamara

Walden Dissertations and Doctoral Studies

No abstract provided.

El Papel Del Bilingüismo En La Atención Médica A Pacientes Hispanohablantes, Ariela Deleon

Student Scholar Symposium Abstracts and Posters

Spanish-speaking patients in the United States frequently face significant barriers to quality healthcare due to language differences between themselves and their providers. This project examines how English-Spanish bilingualism among healthcare professionals meaningfully improves the quality of care delivered to Spanish-speaking patients. To analyze this, the project draws on a review of academic literature on bilingualism, language concordance, medical interpretation, and health outcomes, as well as interviews with healthcare professionals across various fields who possess different levels of Spanish fluency and regularly work with Spanish-speaking patients. This project argues that bilingualism among healthcare providers is not merely a supplementary skill but …

Building Nurse Managers’ Knowledge And Confidence To Lead Clinical Ladder Success: A Theoretically Informed Educational Framework, Michelle Joann Chlebinski

Doctoral Projects

Background: Clinical Ladder Programs (CLPs) offer a structured pathway for nursing professional growth, fostering clinical excellence while improving nurse satisfaction and longterm retention. Although nurse managers play a pivotal role in facilitating the CLP, there is currently no comprehensive educational framework to enhance their knowledge and confidence in supporting clinical ladder advancement. Purpose: The aim of this DNP project is to develop implement, and evaluate an educational framework grounded in Benner’s Novice-to-Expert framework and Watson Caring Science® to enhance nurse managers' knowledge and confidence in leading nurses towards clinical ladder success. Methods: In a quasi-experimental study using a single-group, pre-post …

Examining A Positive Variation Of The Good Behavior Game With Head Start Children At Risk For Child Adversity And Externalizing Behavior Problems., Alexandra Gibson, Courtney P D Goldenberg, Malinda J. Colwell, Amelia E. Talley, Joaquín Borrego, Adam T. Schmidt

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children participating in the Head Start program in the United States are predominantly from underserved groups, have increased rates of child adversity, and are at risk for externalizing behavior problems in the classroom. The Good Behavior Game (GBG) is an effective classroom management strategy for reducing disruptive and off-task classroom behaviors. However, previous research has not examined the GBG within the Head Start context.

METHODS: The current case-controlled study evaluated the effectiveness of the GBG in six Head Start children aged 3-5. Researchers conducted daily classroom behavioral observations of disruptive behaviors, and teachers completed pre- and post-treatment assessments of …

Applying User-Centered Design To Develop A Culturally Sensitive, Low-Calorie Meal Plan For Enhancing Dietary Behavioral Control In Masld, Maya Balakrishnan, Paola Martinez, Brett Deng, Ivonne Arguelles, Crystal Arguelles, Terri L Fletcher, Natalia I Heredia, Myriam Ibarra, Anna Christine Rome

Faculty, Staff and Students Publications

Background: Dietary changes are essential for managing metabolic dysfunction-associated steatotic liver disease (MASLD), yet patients often face barriers related to knowledge, skills, cost, time, and cultural fit.

Aims: The purpose of this paper is to report a process for culturally tailoring a dietary intervention and its application to create a calorie-restricted meal plan for Mexican and Central American patients with MASLD. Guided by the Theory of Planned Behavior and user-centered design, we produced a culturally tailored seven-day structured meal plan aligned with dietary guidelines for MASLD and weight loss.

Methods: We conducted a three-phase, mixed-methods process among Mexican/Central American patients …

Cd8+ T Cell Differentiation Into Nk-Like Effector Cells Drives Transplant Rejection, Dawei Zou, Stephanie G Yi, Yulin Dai, Luan Truong, Lillian W Gaber, Richard J Knight, Xiang Xiao, Rafik M Ghobrial, Xian C Li, Zhongming Zhao, Wenhao Chen, A Osama Gaber

Faculty, Staff and Student Publications

T cells are central drivers of transplant rejection, yet the differentiation fates underlying this process remain unclear. Using single-cell transcriptomic profiling of human kidney allograft biopsies, we identified a predominant infiltrating CD8+ T cell subset exhibiting killer cell lectin-like receptor (KLR)+ NK-like features. Mechanistic studies in mice showed that the KLR+ subset emerged de novo post-transplantation and dominated the CD8+ T cell infiltrate in rejecting allografts. These NK-like CD8+ T cells expressed high levels of interferon regulatory factor 4 (IRF4), and Irf4 deletion disrupted their differentiation and induced transplant acceptance. Therapeutically, either costimulation blockade or mTOR inhibition substantially reduced the …

Immediate Nerve And Tendon Transfers After Wide Resection Of A Radial Nerve Malignant Peripheral Nerve Sheath Tumor: A Case Report And Surgical Technique, Joanne Zhou, Sai Shreya Kambham, Andrew Fang, Christopher Frey, Michael Macavoy

Faculty, Staff and Student Publications

The authors have reported on immediate nerve and tendon transfers postresection of a radial nerve-based malignant peripheral nerve sheath tumor in a 15-year-old female with neurofibromatosis. The median nerve branch to flexor carpi radialis was transferred to the posterior interosseous nerve, the median nerve branch to flexor digitorum superficialis was transferred to the nerve to extensor carpi radialis brevis, and the pronator teres tendon was transferred to the extensor carpi radialis brevis tendon, with 3-year outcomes reported. Tumor excision, tendon, and nerve transfer yielded negative margins and remission. Functional wrist/finger extension appeared at 6 months and increased until 3 years …

Genealogy-Based Trait Association With Locater Boosts Power At Loci With Allelic Heterogeneity, Xinxin Wang, Ryan Christ, Erica Young, Chul Joo Kang, Indraniel Das, Edward A Belter, Markku Laakso, Louis J M Aslett, David Steinsaltz, Nathan O Stitziel, Ira M Hall

2020-Current year OA Pubs

A key methodological challenge for genome-wide association studies is how to leverage haplotype diversity and allelic heterogeneity to improve trait association power, especially in noncoding regions where it is difficult to predict variant impacts and define functional units for variant aggregation. Genealogy-based association methods have the potential to bridge this gap by testing combinations of common and rare haplotypes based purely on their ancestral relationships. In parallel work, we have developed an efficient local ancestry inference engine and a novel statistical method (LOCATER) for combining signals present on different branches of a locus-specific haplotype tree. Here, we develop a genome-wide …

+Cd49a+Cd103+ Cytotoxic Tissue-Resident Natural Killer Cells Infiltrate And Control Solid Epithelial Tumor Growth In Mice, Nina B Horowitz, Jennifer A Foltz, Et Al.

2020-Current year OA Pubs

Human tissue-resident natural killer (NK) cells (trNK cells), broadly defined by markers of tissue residency, such as CD49a [

Early-Life Wnt4 Expressing Colon Stromal Cells Orchestrate Lifelong Mucosal Homeostasis Via Bmp-Driven Inkt Cell Imprinting, Xi Lin, Chloe Hyun-Jung Lee, Ting Zhang, Agne Antanaviciute, Thomas Hanley, Jonathan N Glickman, Nikhila S Bharadwaj, Vicki Rosen, Jenny E Gumperz, Matthew K Waldor, Alison Simmons, Thomas Gensollen, Richard S Blumberg

2020-Current year OA Pubs

The early-life intestinal microenvironment plays a pivotal role in shaping immune cell development. Here, we identify a colonic Wnt4-expressing stromal cell, enriched during early-life, that promotes iNKT cell proliferation via BMP-MAPK signaling. These stromal cells are spatially associated with iNKT cells and macrophages and exhibit high Bmp2 expression during the neonatal period. Depletion of BMP2 in Wnt4

The Picture Exchange Communication System (Pecs) As A Functional Form Of Low-Technology Aided Augmentative And Alternative Communication (Aac): A Systematic Review, Faith K. Curran

Pacific Journal of Health

This systematic literature review was completed with the aim of investigating the functionality of the low-technology aided Augmentative and Alternative Communication (AAC), Picture Exchange Communication System (PECS). In this review, functionality was defined by how successful AAC users used PECS. Fifteen peer reviewed primary sources which were published between 2020 and 2025 were selected to provide a current and relevant analysis. There was not enough current research to support the use of PECS across various functions of language. However, PECS is mainly used for one to two language functions, object requesting and commenting. Further research studying the success rates of …

The Use Of Video Laryngoscopy In Pregnant Women Undergoing Non-Obstetric Surgery, Samantha Gastaldo

Doctor of Nursing Practice Scholarly Projects

This quality improvement project looks at the proposed implementation of endotracheal intubation guidelines regarding pregnant patients undergoing non-obstetric surgery and how the use of video laryngoscopy versus the traditional practice will affect the first pass rate of the endotracheal tube intraoperatively. Statistics show that 2% of women undergo non-obstetric related surgery during pregnancy. Physiological changes during pregnancy, including increased laryngeal mucosa swelling and higher metabolic oxygen consumption, result in a heightened risk of apnea and hypoxemia during intubation. Pregnant women experience an eightfold higher incidence of failed intubation compared to non-pregnant populations. The number of patients classified as Mallampati 4 …

Athletic Trainers And Access To Healthcare For Transgender Collegiate Athletes Of Color: The Role Of Intersectionality, Tarah Althea Holness

Walden Dissertations and Doctoral Studies

No abstract provided.

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Nurse-Driven Infusion Protocols In Diabetic Ketoacidosis: A Scoping Review, Nicholas Morrell Pierce Msn, Rn, Cen, Ccrn, Mary Cassandra Scott Bsn, Rn, Ccrn, Cen, Alvertis Demetreis Warren Bsn, Rn, Ccrn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Diabetic ketoacidosis (DKA) is a high-risk acute emergency requiring timely insulin titration, intensive monitoring, and coordinated interdisciplinary care. Traditionally, management relies on provider-driven insulin infusion adjustments, which may introduce delays and workflow inefficiencies. Emerging nurse-driven insulin infusion protocols aim to standardize care, improve safety, and enhance clinical efficiency. The purpose of this scoping review was to evaluate existing evidence comparing nurse-driven versus provider-driven insulin infusion protocols in the management of adult patients with DKA.

Methods

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From August 2023 through November 2025, …

Increasing Safe Driving Among Adults With Neurological Impairments In A Rural Setting, Melissa V. Burt

Occupational Therapy Capstone Presentations

This capstone project examined challenges related to safe driving for adults living in rural communities with neurological impairments. Guided by the Person-Environment-Occupation Model and Toglia's Dynamic Interactional Approach, the project focused on increasing awareness, accessibility, and utilization of occupational therapy (OT) led assessments, community-based services, and educational outreach on driving safety. Clinical skill development was demonstrated through standardized and informal assessments and evidence-based interventions with adults with neurological conditions. Program implementation included driving risk assessments, one-on-one CarFit sessions, the creation of educational pamphlets, and educational presentations to increase community and provider awareness of OT's role in driving rehabilitation. CarFit surveys …

Co-Active Therapeutic Filmmaking: A Methodology Pilot Project, Blair Webber

Expressive Therapies Theses

This pilot project examined the intersection of drama therapy and filmmaking. Drawing on the Co-Active Therapeutic Theater model from drama therapy and digital storytelling and participatory video methods from social work research, this methodology designed and delivered a co-created filmmaking intervention at a residential treatment center for adult men with co-occurring mental health and substance use disorder. Four participants made a seven-minute-long short fictional film based on their definition of active recovery and a theme of recovery they wished to share with an audience. It was screened at the treatment center for staff and their fellow residents. Data collection was …

Improving Restraint Care Plan Documentation Among Nursing Staff, Samson E. Okotie

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to improve nursing compliance with restraint care plan documentation standards using bundled interventions, including targeted education, electronic health record (EHR) prompts, and unit-based audit and feedback processes. The goal was to achieve at least a 70% improvement in documentation compliance within 12 weeks.

Background: Accurate restraint documentation is essential for patient safety, ethical practice, interdisciplinary communication, and regulatory compliance. Despite existing policies and education, institutional audits revealed compliance rates of 50% or less, demonstrating a persistent gap in practice and the need for structured interventions.

Methodology: The project used the Plan-Do-Study-Act (PDSA) framework across …

Improving Emergency Department Throughput: Implementation Of A Nurse-Driven Protocol In Pediatric Fast-Track Patients Presenting With Fever, Kerrigan A. Teeple

Evidence-Based Practice Project Reports

Overcrowding in the emergency department presents significant operational challenges and is associated with adverse patient outcomes (Gottlieb et al., 2020). Despite throughput initiatives, increasing patient acuity and rising census levels continue to strain emergency department efficiency. This quality improvement project evaluated whether implementing a fever-reduction standing order protocol could reduce door-to-provider and door-to-disposition times for pediatric fast-track patients presenting to the emergency department. A review of evidence across 6 databases identified nurse-initiated standing orders as a best-practice strategy to expedite care, improve throughput, and reduce delays in disposition. Guided by this evidence, a standing order protocol for acetaminophen administration was …

Barriers To Palliative Care Access In Rural South Dakota: A Policy And System-Level Analysis, Harshavardhan Kadarkaraisamy

Honors Thesis

Palliative care improves the quality of life for people living with serious illness. It helps by addressing symptoms, improving communication, and providing mental, physical, and spiritual support. However, in South Dakota access to palliative care is limited in rural areas. These challenges include geographic isolation, workforce shortages, healthcare infrastructure, reimbursement, and misunderstandings about palliative care. This thesis examines the key policy barriers that limit access to palliative care in rural South Dakota. This work involves engaging with South Dakota-specific literature, rural health research, policy sources, community education, telehealth expansion, and policy reform. By focusing on the rural context of South …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Variation In Prevalence Of Participation Limitation, Injury Location, And Training Habits Between Young And Master Runners: A Cross-Sectional Study, Rachel Berns, Jo Armour Smith, Natalia Sánchez, Samantha N. Jeffcoat, Susan Sigward, Andrew Hooyman, Shawn Farrokhi

Physical Therapy Faculty Articles and Research

Background/Objectives

Running is a popular form of physical activity, but its growing participation has been accompanied by high rates of injury that may limit ongoing engagement, particularly in older runners. This study explored differences in running participation limitation, injury location, and training characteristics between young (18–34 years) and master (>35 years) runners.

Methods

A total of 207 runners (105 young, 102 master) completed an online survey assessing demographics, training habits, and injury-related participation limitations using the updated Oslo Sports Trauma Research Center Overuse Injury Questionnaire.

Results

Master runners reported higher rates of injury-related participation limitation than young runners (51% …

Anthropometric Measurements Inform Complete Concentric Collapse Status In Patients With Obstructive Sleep Apnea, Jordan Weiner, Eugene Chio, Raj Dedhia, Colin Huntley, Michael Hutz, Phillip Huyett, Daniel Lee, Philip Losavio, Ilya Perepelitsyn, Ryan Soose, David Kent

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: Hypoglossal nerve stimulation in the US requires drug-induced sleep endoscopy to exclude patients with complete concentric collapse. This is an expensive and time-consuming requirement. We hypothesized that supine pharyngeal width, and other demographic and polysomnographic variables would associate with complete concentric collapse.

STUDY DESIGN: Prospective, multicenter cohort study.

SETTING: 10 centers in the United States with experience selecting patients for and performing airway surgeries for sleep apnea including hypoglossal nerve stimulation implantation.

METHODS: 600 patients meeting criteria for hypoglossal nerve stimulation underwent measurement of supine pharyngeal width and collection of demographic and polysomnographic data followed by drug-induced sleep endoscopy. …

Implementation Of Wellness Activities In An Experiential Rotation To Promote Pharmacy Student Well-Being, Neeloufar Fakourfar, Brenda Kilzi, Reza Taheri, Richard Beuttler, Hindu Rao

Pharmacy Faculty Articles and Research

Background

Educational activity

A Quality Improvement Project To Strengthen Hospice Spiritual Care Delivery, Patricia Boudreau

Doctoral Projects

Spiritual care is an essential component of holistic end-of-life nursing, yet it is inconsistently provided in home hospice settings. For this Doctor of Nursing Practice (DNP) quality improvement project, we developed and implemented the Compassionate Spiritual Comfort Integration Program (CSCI), a brief, theory-based educational intervention to strengthen hospice nurses' spiritual care practices. Grounded in Kolcaba's Comfort Theory and Jinpa's Compassion Framework, the CSCI was delivered as a prerecorded webinar. A quasi-experimental single–group pretest–posttest design was used to evaluate changes in spiritual care behaviors, measured with the 17-item Nurse Spiritual Care Therapeutics Scale (NSCTS) and a single-item confidence measure. Twenty-two nurses …

Emerging Near-Infrared Targeted Imaging Pharmaceutics For Ovarian Cancer, Angel J. Phillip, Annu Karithara, Subhash Chauhan, Murali Yallapu

School of Medicine Publications

Background: Accurate intraoperative identification of ovarian cancer is challenging, as standard techniques such as visual inspection, palpation, and histopathology often fail to detect microscopic disease. Residual tumor contributes to poor cytoreductive outcomes, high recurrence rates, and chemoresistance. Near-infrared (NIR) imaging using tumor-specific biomarkers has emerged as a promising approach to enhance intraoperative visualization and improve tumor margin delineation. Methods: A focused literature review was conducted using PubMed to identify preclinical and clinical studies evaluating NIR image-guided strategies in ovarian cancer. Studies involving tumor-targeted probes against folate receptor alpha, α3-integrin, mesothelin, and CA125 were included, with emphasis on probe design, delivery, …

Impact Of Intravenous Thrombolysis On Aspiration Thrombectomy Outcomes: An Imperative Trial Subgroup Analysis, Maxim Mokin, Reade Andrew De Leacy, William Mack, Raul G. Nogueira, Shahram Majidi, Dana Tomalty, Jan Vargas, Brett L. Cucchiara, Kenneth V. Snyder, Victoria Parada

School of Medicine Publications

Background The impact of intravenous (IV) thrombolysis on the outcomes of aspiration thrombectomy as the primary endovascular approach to stroke in patients with large vessel occlusion is unknown.

Methods The Imperative Trial was a prospective, investigational device exemption, multicenter trial of first-line aspiration thrombectomy that assessed the safety and efficacy of the Zoom System, including a novel 0.088 inch aspiration catheter in patients with stroke within 8 hours of onset. We compared procedural, technical, and clinical outcomes of aspiration thrombectomy based on whether patients had received IV thrombolytics prior to the intervention.

Results Among the 260 patients treated with front-line …

Cystic Fibrosis Mental Health And Wellness Questionnaire - Factors And Properties Of A Comprehensive Cf-Specific Self-Report Measure, C. Virginia O'Hayer, Patrick J. Smith, Max J. Genecov, Christopher F. Drescher, Heather Bruschwein, Chelsi N. Nurse, Katherine Lawliss, Darcy C. Esiason, Gunnar H. Esiason

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND: Existing mental health self-report measures have been criticized for over-simplification, lack of CF-specific focus, susceptibility to measurement reactivity bias, and conflation of symptoms of anxiety and/or depression with CF-related symptoms and/or treatment side effects. The CF Mental Health and Wellness Questionnaire (CFMHWQ) is a 25-item measure assessing CF-specific mental health burden symptoms.

METHODS: To examine common underlying factors contributing to scores on the CFMHWQ, principal component analysis (PCA) was conducted of all 25 items. We conducted cross-validation of CFMHWQ principal components, examining unadjusted correlations between each principal component, demographic characteristics (age and biological sex), negative affect (mean rank global …

Complications Following Orthognathic Surgery In Patients With Cleft Lip And/Or Palate: A Single-Centre Retrospective Analysis Of 57 Consecutive Patients, Ahmed Shawqi Alqattan, Ahmed Al Hashmi, Said Al Rashdi, Mohammed Al Nabhani

Sultan Qaboos University Medical Journal

Objectives: The most prevalent craniofacial abnormality in infants is cleft lip and/or palate (CL/P). Orthognathic surgery is necessary for 25–60% of patients in order to enhance face aesthetics and masticatory function. Nevertheless, there is a lack of defined complication profiles in this particular population. Thus, this study aimed to describe the spectrum and frequency of complications following orthognathic surgery in CL/P patients at a tertiary care referral centre. Methods: This retrospective cohort study included consecutive CL/P patients who underwent orthognathic surgery at Al Nahda Hospital, Muscat, Oman, between 2008–2022. Variables analysed included demographics, procedure type, length of stay and predefined …

Increasing Medication Adherence In Those With Hypertension, Holly Kimiecik

Evidence-Based Practice Project Reports

Hypertension is a chronic condition characterized by persistently elevated blood pressure and remains a significant contributor to morbidity and mortality in the United States. According to the Centers for Disease Control and Prevention (2024), approximately 47.7% of U.S. adults have hypertension, yet only about one in five achieve blood pressure control below 130/80 mm Hg. Medication adherence plays a critical role in managing hypertension and preventing complications. Adults aged 18 years and older prescribed antihypertensive medications from a primary care clinic in Valparaiso, Indiana, participated in this six-week quality improvement intervention. Evidence from a comprehensive literature review supports combining patient …