The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

“Now Serving… Not Quite Yet”: Improving Waiting Room Experience Through Consistent Communication In The Emergency Department, Juan Carlos Serrato

Master's Projects and Capstones

Context: The quality improvement project was implemented in the front-end microsystem of a 36-bed emergency department (ED) in a non-profit, Magnet-designated California hospital. Problem: Communication with non-roomed patients at Hospital X was inconsistent, contributing to dissatisfaction. In June 2026, Press Ganey reported that 61.4% of patients felt they were informed about delays. Baseline observation identified gaps in staff explanations of estimated wait times, next steps in care, and opportunities to ask questions. Intervention: A 30-day pilot provided staff education on the AIDET communication framework through formal in-service education and daily huddles. Patient-facing materials explained the ED process …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

Gender Disparities In Sheltered Status And Systemic Drivers Of Homelessness In Johnson City, Tennessee, Preet Patel, Dr. Opal Frye-Clark

Journal of Appalachian Health

The article examines the homelessness crisis in Johnson City, Tennessee, a mid-sized Appalachian city. First, analysis of Point-in-Time (PIT) counts from 2023 to 2025, conducted in 2025, showed persistently high unsheltered rates (35.88% – 47.17%), with men comprising 60 – 65% of the unhoused population. Men experiencing homelessness also had approximately half the odds of being counted as sheltered compared with women, indicating a gender disparity in sheltered status. Second, an interview with an experienced public health practitioner from the Appalachian Region contextualized these findings by identifying systemic drivers, including the regional housing crisis and policy restrictions, and supporting equitable …

Improving Diabetes Self-Management Through A Partnership Between Clinical Providers And Community Educators In Appalachian Communities, Soghra Jarvandi, Lydia Hoskins, Karen Carver, Andrew May

Journal of Appalachian Health

Introduction: The burden of diabetes is an increasing public health challenge, especially in the Appalachian Region.

Purpose: This study assessed the impact of a community-based diabetes education program on glycemic control.

Methods: Health Extension for Diabetes (HED) is a 4-month diabetes education program offered by Extension educators in collaboration with clinical providers. Participants’ data were collected via phone interviews at baseline and after completing the program. Assessments included self-reported HbA1c, socio-demographics, diabetes knowledge, self-efficacy, and self-management behaviors. Data were analyzed by SAS software using paired analyses.

Results: Of the 105 participants in the program, 87 (83%) completed the post-assessment. Among …

School-Centered Tobacco Retailer Exposure And Neighborhood Opportunity Across Urban And Rural Tennessee, Sima Namin Dr, Jacob Black, Jennifer Ferris, Robert E. Heidel Dr

Journal of Appalachian Health

Introduction: Tobacco retailer availability contributes to youth tobacco use, and retailers are concentrated in socioeconomically disadvantaged communities. However, few studies have examined how school-centered retailer exposure intersects with neighborhood opportunity in a predominantly rural Appalachian state.

Purpose: The purpose of this study is to assess the association between neighborhood opportunity and school-centered tobacco retailer exposure across Tennessee (TN), including differences by rurality and Appalachian status.

Methods: We constructed a tract-level, school-centered youth tobacco exposure index for TN using tobacco retailer locations and public and private K-12 school data. The index incorporated retailer proximity, density, and distance-decay accessibility measures. Child Opportunity …

Deaths Of Despair Among Cancer Survivors In Rural/Urban Appalachia (2000-2022), Jason Semprini, Anders Erickson, Nosa Osazuwa-Peters

Journal of Appalachian Health

Introduction: Rising deaths of despair (premature deaths from suicide, overdose, alcohol, and violence) in adults under age 65 persist across the United States, especially in Appalachia. People diagnosed with cancer may face elevated risks of such deaths due to pain, psychosocial distress, and financial hardship.

Purpose: Deaths of despair trends were compared among adults with cancer across Appalachian and non-Appalachian regions, stratified by sex and rurality.

Methods: Analyzing SEER-21 Incidence-Based Mortality data (2000–2022), deaths caused by suicide, cirrhosis of the liver, or accidents (includes overdose) were identified among adults aged 20–64 years. Annual mortality rates per 100,000 total population were …

Disparities In Access To Medicare-Approved Medical Specialists In Rural Kentucky, Logan Hurm, Jacob A. Welch, James Adkins

Journal of Appalachian Health

Introduction: Approximately 20% of the United States population resides in a rural community; however, only 10% of all healthcare resources and physicians are dedicated to these areas. Appalachia, and Kentucky (KY) in particular, have higher populations living in rural areas which leads to a greater number of individuals affected by medical access disparities. As of 2026, 21% of KY’s population is eligible for Medicare, making access to Medicare-accepting specialty physicians crucial for the state’s population.

Purpose: This research aims to quantify healthcare disparities among rural communities in KY through quantification of the potential distance required to travel to access specialty …

Reducing Potentially Preventable Emergency Department Visits (Ppvs) Through A Telehealth Intervention In Children With Asthma Within A Managed Care Organization (Mco), Renee A. Roker

Doctor of Nursing Practice Final Project Abstract

Abstract

Purpose:  The purpose of this quality improvement project was to reduce unnecessary ED utilizations among children with asthma enrolled in a Medicaid managed care health plan. The project aimed to improve access to care and enhance asthma self-management.

Background:  Asthma is one of the leading causes of Emergency Department (ED) utilization, among vulnerable populations. Members experience barriers to timely primary and specialist care, contributing to Potentially Preventable ED Visits (PPV) rates. This places managed care organizations (MCOs) at risk for financial penalties if not meeting the Texas PPV benchmark.

Methodology:  Guided by the Chronic Care Model, Lean Six Sigma …

Hubungan Paparan Informasi Anemia Dan Tablet Tambah Darah (Ttd) Melalui Media Digital Dengan Kebiasaan Konsumsi Makanan Ibu Hamil Berdasarkan Food Frequency Questionnaire (Ffq), Muthiah Salsabilah, Bernadette Oktavia Jelita, Thariq Zafar Surapati, Alya Khairunnissa, Primasti Nuryandari Putri, Ratu Ayu Dewi Sartika

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background: Proper nutrition is important for the mother and baby. The media is an important source of information for every pregnant woman, but the information might be inaccurate.

Aim: This study aims to examine the association between exposure to digital media information on anemia and iron-folic acid (IFA) supplementation and the food consumption habits of pregnant women as measured by the Food Frequency Questionnaire (FFQ) at Puskesmas Kecamatan Beji, Depok City in 2024.

Method: This study utilized a cross-sectional design involving secondary data analysis of the 2024 antenatal care (ANC) survey conducted at Beji Primary Health Center, Depok City. Purposive …

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

Non-Metropolitan Vs. Metropolitan Variations In Alcohol, Illicit Drug, And Prescription Therapeutic Drug Misuse, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Key Findings

Alcohol Use. The prevalence of past year and past 30-day drinking was lower among non-metropolitan (non-metro) than metropolitan (metro) residents. However, non-metro drinkers engaged in more frequent binge drinking than metro drinkers. Drinking 3-5, 6-19, and 20-30 days over the past 30 days were higher among non-metro than metro residents.

Illicit Drug Use. Hallucinogens were the mostly commonly used illicit drugs among non-metro as well as metro residents. Methamphetamine use was significantly higher among non-metro than metro residents.

Prescription Pain Reliever Use. The misuse of prescription pain killers, primarily prescription opioids, was higher among non-metro than …

Baseline Nutrition Knowledge And Feasibility Of A Whatsapp-Delivered Nutrition Education Intervention Among California Wildland-Urban Interface Firefighters, Lauren E. Anderson

Master's Theses

Wildland firefighters perform physically demanding work under challenging environmental conditions that place substantial demands on nutritional health and occupational performance. Despite the importance of nutrition in supporting physical performance, recovery, and long-term health, limited research has examined nutrition knowledge and dietary behaviors among California wildland firefighters or evaluated the feasibility of remotely delivered nutrition education interventions within this occupational population. Therefore, the purpose of this pilot study was to assess baseline nutrition knowledge, nutrition self-efficacy, and dietary behaviors while evaluating the feasibility of a 12-week WhatsApp-delivered nutrition education intervention among California wildland firefighters.

Twenty-four firefighters completed the baseline assessment and …

Cost-Effectiveness Evaluation Of Artificial Intelligence-Assisted Chest Radiograph Interpretation For Tuberculosis Screening In Rural Health Units In The Philippines, Harold Henrison C. Chiu, Bryan Christopher C. Lao, Gloanne C. Adolor

Graduate School of Business Publications

Background: Tuberculosis remains a major public health burden in the Philippines, where diagnostic delays are amplified by limited radiology capacity in rural health units (RHUs) and geographically isolated and disadvantaged areas (GIDAs). Computer-aided diagnosis (CAD) using artificial intelligence (AI)-assisted chest radiograph interpretation may shorten the screening pathway and reduce reliance on scarce specialist readers. However, its economic value for RHUbased tuberculosis screening has not been fully evaluated.
Methods: We developed a decision-tree cost-effectiveness model in Microsoft Excel 365 to compare AI-assisted chest radiograph interpretation with conventional manual radiologist or teleradiology interpretation among a theoretical annual cohort of 1,000 presumptive tuberculosis …

“It’S Not Just Cost”: Barriers To Mammography Screening Access Among Low-Income Women In The United States—A Scoping Review, Julia Messerman, Callia Nickels, Nigel C. James

Health Studies Faculty Publications

Despite the recognized importance of early detection, disparities in mammography access persist among low-income women in the United States. While financial barriers are often emphasized, less is known about how multiple barriers interact to shape access to screening. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to synthesize evidence on barriers to mammography access among low-income women in the United States. A systematic search of PubMed, CINAHL, and Google Scholar identified peer-reviewed studies published between 2010 and 2025, of which 47 met inclusion criteria. Extracted barriers were categorized into …

Montana Kinship Navigator Program: A Statewide Frontier Initiative Promoting Kinship Family Health And Wellness, Daniel J. Koltz Dr., Peyton Vining, Yu Jiang

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

This practice brief report describes the development, implementation, and new updates of the Montana Kinship Navigator Program (MTKNP), a statewide initiative designed to support kinship caregivers in a large, rural frontier context. Montana’s geographic isolation, limited infrastructure, and sparse population create significant barriers for kinship families, including restricted access to healthcare, transportation, childcare, and social services. These challenges are compounded when caregivers unexpectedly assume responsibility for children, often with limited resources and support. MTKNP addresses these gaps through a comprehensive, evidence-informed model that integrates information and referral services with individualized case management. The program serves both formal and informal kinship …

Association Between Occupational Stress, Sleep Quality, And Premature Ejaculation Among Indonesian Information Technology Workers, Muhammad Faisal Ratman, Suryo Wibowo, Muhammad Ilyas, Retno Asti Werdhani, Dewi Yunia Fitriani

Occupational and Environmental Medicine Journal of Indonesia

Introduction Premature ejaculation (PE) is a common sexual dysfunction that significantly impacts quality of life. Occupational stress and poor sleep quality are hypothesized as risk factors, particularly among Information and Technology (IT) workers who experience unique occupational stressors. This study aimed to evaluate the proportion of PE, examine the influence of occupational stress and sleep quality on PE, and determine whether sleep quality mediates the relationship between occupational stress and PE among Indonesian IT workers.

Methods This cross-sectional study involved 89 married male IT workers who completed online questionnaires, including the Premature Ejaculation Diagnostic Tool (PEDT), Perceived Occupational Stress (POS) …

Depressive Symptoms And Functional Disability Among Older Adults In Nakhon Ratchasima Province, Thailand: A Cross-Sectional Population-Based Study, Jiranya Bureemas, Atthawit Singsalasang

Journal of Health Research

Background: Depressive symptoms have been associated with activities of daily living (ADL) disability; however, evidence among Thai older adults remains limited and inconsistent. This study investigates the association between depressive symptoms and ADL disability in older Thai adults.

Methods: A cross-sectional analytic study was conducted among 312 older adults in Nakhon Ratchasima, Thailand, who were selected using a multistage sampling method. Data were collected between April and July 2023 using structured questionnaires covering demographic and environmental variables. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. ADL disability was measured using the Barthel and Chula ADL Indices. Multiple logistic …

Global Trends In School Disaster Preparedness Research: Bibliometric Analysis Impacts On Public Health And Safety, Muhammad Farid, Muhammad Agita Hutomo, Oktomi Wijaya, Dian Ika Puspitasari

Chulalongkorn Medical Journal

Background: Disasters disrupt daily human activities, arising from natural or artificial triggers, with varying impacts based on community vulnerability and resource capacity. Effective disaster management involves a cycle of mitigation, preparedness, response, and recovery. One of the mitigation measures is to establish school disaster preparedness that integrate education and capacity building.

Objective: The aim of this research is to conduct a bibliometric analysis based on Scopus publications regarding school disaster preparedness.

Methods: A bibliometric analysis was performed on publications indexed in Scopus from 1965 to 2024. Data were processed and visualized using VOSviewer to explore trends in annual outputs, contributing …