DNP, Kent State University, 2021, College of Nursing

Background: Healthcare providers in highly stressful environments experience the effects of workplace stress, burnout, compassion fatigue, and secondary traumatic stress due to several work-related factors. Among them, ethical issues, high emotional burden, institutional and patient/family demands are commonly experienced stressors. These experiences can be characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment related to poor professional quality of life and lack of self-care. Prolonged, these characteristics may result in unsatisfactory quality outcomes and patient safety events. The COVID-19 pandemic has introduced new challenges in providing healthcare to the critically ill and additional pressures on the professional quality of life of advanced practice providers (APPs). Resources are needed to support APPs in navigating the many stressors experienced and maintain a satisfactory professional quality of life. Mindfulness based interventions have been used to promote self-care abilities to improve professional well-being and work life-balance in many professions including healthcare. Mobile mindfulness applications are available and can allow mindfulness practices to be easily accessed and integrated into daily practice. Methods: A quality improvement approach was utilized to implement and evaluate a mobile mindfulness-based application. Thirty-seven APPs were recruited from a large urban medical center, within 8 different ICU specialties, during the second wave of the COVID -19 outbreak in October 2020 through -January 2021. All participants were asked to practice a 10 minute daily mindfulness-based intervention via a mobile application (Headspace) for 30 days. A quasi-experimental pre-and post-test design was used to measure professional quality of life and mindfulness before and after the intervention. Objectives: To determine the portability and efficacy of a mobile mindfulness application to improve provider comp (open full item for complete abstract)

Committee: Amy Petrinec PhD (Committee Chair); Marilyn Nibling DNP (Committee Member); Pam Stephenson PhD (Committee Member); Cindy Byrd DNP (Advisor) Subjects: Health Care; Health Care Management; Nursing

Psy. D., Antioch University, 2020, Antioch Seattle: Clinical Psychology

Stigma toward individuals with eating disorders is common and well-documented. Individuals with eating disorders regularly report experiencing stigma associated with perceptions that they are to blame for their illness, that their illness is trivial compared to other conditions, or that they are engaging in disordered behavior to gain attention. These stigmatizing attitudes toward eating disorders are also reported by the general public and healthcare professionals, including those who treat eating disorders. Treatment of these illnesses at all levels of care often include paternalistic approaches such as coercion and compulsion that can have both adverse and advantageous consequences. While there are ethical, clinical, and legal justifications for these treatment approaches, this study provides a novel exploration of the relationships between stigma toward individuals with eating disorders and coercive and compulsive treatment. This was accomplished using a survey methodology to assess the attitudes and treatment practices of treatment providers across the United States. The results of this study suggest that there is no significant relationship between treatment providers' attitudes toward individuals with eating disorders and coercive or compulsive treatment methods. Implications for clinical practice and future research are discussed and center on the need for additional inquiry to better understand the complexities of these two variables in light of the ongoing debate concerning the risks and v benefits of coercive and compulsive treatment. This dissertation is available open access at AURA, http://aura.antioch.edu and Ohio Link ETD Center, https://etd.ohiolink.edu

Committee: Chris Heffner Psy.D., Ph.D. (Committee Chair); Shannon Albert Psy.D. (Committee Member); Cara Dalbey Psy.D. (Committee Member) Subjects: Behavioral Sciences; Clinical Psychology; Ethics; Health Care; Mental Health; Psychology; Quantitative Psychology; Social Psychology

Doctor of Nursing Practice , Case Western Reserve University, 2025, School of Nursing

The exposure to inhaled anesthetics can happen during anesthetic induction or emergence. The process of GA induction is the most likely time OR staff, especially anesthesia providers, may be exposed to residual inhaled anesthetic vapors. Exposure may also occur when the mask is removed from the patient's face to instrument the airway as the anesthetic gas is still being conducted through the circuit of the anesthesia machine which is connected to the mask that was on the patient's face. The purpose of this DNP quality improvement descriptive-cross-sectional project was to educate anesthesia providers regarding the potential harmful effects of exposure to residual inhaled anesthetic agents during the processes of GA induction and emergence. This took place at a tertiary care facility in Northeast Ohio. The education also ensured provider understanding of the WAG scavenging system. Anesthesia providers were surveyed prior to and after the delivery of education on the harmful effects of inhaled anesthetics, safe handling practices of volatile anesthetics, and the WAG scavenging system. The survey created was based off a five-point Likert scale with some questions having written responses. Descriptive and inferential statics were analyzed utilizing SPSS for the statistical analysis. To address the change in provider knowledge and willingness to adopt new practices, a paired samples t-test was conducted to analyze results from matched items on the pre and post survey, with statistical significance set at p<.05. When analyzing the completed data, the inferential statistics demonstrated there was no statistically significant difference (t=0, p = 1.00) in provider knowledge before and after education. There was statistical significance (t = 2.753, p=.022) between improved knowledge after education and the likelihood an anesthesia provider will change their practice. More research is needed on the hazardous effects of chronic exposure to the newer halogenated anesthetics suc (open full item for complete abstract)

Committee: Christopher Bibro (Committee Chair); Sonya Moore (Committee Co-Chair); Amanda Richmond (Committee Member) Subjects: Adult Education; Biology; Health Care; Health Sciences; Medicine; Microbiology; Morphology; Nursing; Public Health Education; Statistics

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2025, Health Programs

This dissertation investigates the impact of the Affordable Care Act (ACA) on the utilization of preventive colorectal cancer (CRC) screening among Americans under 65, focusing on healthcare providers' perspectives. The ACA, a significant healthcare reform, aimed to expand access to preventive services, including CRC screenings, vital for early detection and improved outcomes. This study employed quantitative analysis with a component of qualitative analysis utilizing a modified version of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) to gather quantitative and qualitative data from healthcare providers in Maryland, Virginia, and the District of Columbia. The quantitative analysis assessed changes in CRC screening rates, patient compliance, and the effects of ACA-related policy changes, while the qualitative analysis explored providers' insights on barriers to screening, the role of patient education, and the overall effectiveness of the ACA in improving preventive care. Findings indicate a substantial increase in CRC screening utilization and frequency since the ACA's passage, with healthcare providers perceiving significant improvements in patient access and compliance. However, the study also highlights ongoing challenges, including financial barriers and enhanced patient education. These insights are critical for informing future healthcare policies and practices to reduce disparities in CRC screening and improve overall preventive care outcomes. This research contributes to the growing body of literature on healthcare reform and preventive care, offering valuable perspectives from those directly involved in delivering care. The findings underscore the importance of continued efforts to address disparities and optimize the benefits of healthcare policies like the ACA.

Committee: Rachel Tate (Committee Chair); Jesse Florang (Committee Member); Jennifer Harris (Committee Member) Subjects: Health; Health Care Management; Health Education; Health Sciences

Doctor of Philosophy, The Ohio State University, 2024, Educational Studies

Each year in the United States, an estimated 57.8 million adults and 7.7 million children experience mental health issues with far-reaching implications (National Alliance on Mental Illness [NAMI], 2023). Despite our increased awareness in the aftermath of the COVID-19 pandemic, which both exposed and exacerbated the problem, access to services remains severely limited for 163 million Americans living in Mental Health Professional Shortage Areas (NAMI, 2023). There is an insufficient supply of mental health providers in America, and an additional 8,251 practitioners are needed immediately to adequately meet the needs of the people (Health Resource & Services Administration [HRSA], 2023b). However, this deficit will not be resolved soon, as nearly half of mental health practitioners currently report intentions to leave their employment (Centers for Disease Control [CDC], 2023). Furthermore, resolving the shortage will require more than hiring additional mental health professionals (HRSA, 2023b). Compared to the larger workforce, mental health providers have a higher risk of experiencing detrimental occupational outcomes (Cocker & Joss, 2016; Ledoux, 2015; Ondrejkova & Halamova, 2022; Sinclair et al., 2017; Sorenson et al., 2016). Burnout, one of the occupational harms associated with the unique demands of care work, is a driving force in the provider retention problem (CDC, 2023; Hoge et al., 2007; Morse et al., 2012). Although there is a direct link between burnout and a lack of organizational support (Schaufeli & Greenglass, 2001), there is a lack of research examining systemic causal factors. Most existing studies neglect to explore links between work characteristics and employee well-being and are restricted to investigating individual traits as contributors (CDC, 2023). The present study confronts the gap in the literature through a systemic exploratory analysis. This quantitative study examined the link between workplace environments and mental health (open full item for complete abstract)

Committee: Darcy Haag Granello (Committee Chair); Paul Granello (Committee Member); Noelle Arnold (Committee Member) Subjects: Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Counseling Education; Counseling Psychology; Health Care; Health Care Management; Medical Ethics; Mental Health; Occupational Health; Occupational Psychology; Organization Theory; Organizational Behavior; Psychology; Psychotherapy; Public Health; Public Health Education; Systems Design; Therapy

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

As of the end of the twentieth century, biological drug therapies were at the forefront of health research for treating life-threatening diseases. Despite their therapeutical benefits stemming from providing great treatment hope against lethal diseases, biological drugs end up placing a financial burden on the American healthcare system. In the last decade, biological drug skyrocketing prices have significantly impacted net drug expenditures. The biological drug market needs more competitors. This impacted the passage of the Biological Price Competition and Innovation Act in 2010, introducing biosimilars, the highly safe and effective but less expensive biological copycat alternative drugs. However, a decade after biosimilars introduction, healthcare administration barriers limit American pharmacists and physicians from adopting biosimilars. Hence, the current low American health care provider biosimilar adoption rate must be improved to realize significant healthcare savings. Although many literature studies have examined biosimilar clinical adoption hurdles among American pharmacists and physicians in their siloed medical care settings, they have yet to focus on creating a comprehensive un-siloed biosimilar adoption plan based on their inputs. Therefore, to determine the essential elements to boost biosimilar adoption, this qualitative exploratory study thoroughly examined the literature. It then gathered the viewpoints of pharmacists and physicians who were acquainted with biosimilars by conducting semi-structured question interviews with 13 pharmacists and 8 physicians for a total of 21 participants. The findings of this study suggest that to create a dynamic and competitive biosimilar comprehensive clinical adoption plan, increasing HCPP education, having sufficient healthcare reimbursement, improving the roles of essential stakeholders, and increasing communication among key stakeholders are all necessary to increase biosimilars' trust and adoption, facilitati (open full item for complete abstract)

Committee: David Meckstroth (Committee Chair); Karen Lankisch (Committee Member); Bora Pajo (Committee Member) Subjects: Health; Health Care; Health Care Management; Health Education; Health Sciences; Higher Education; Higher Education Administration

Psy. D., Antioch University, 2023, Antioch Seattle: Clinical Psychology

This study utilized Primary Care Provider (PCP) perspectives to unveil major barriers to prescribing buprenorphine to youth (ages 16-25) with opioid use disorder (OUD). Semi-structured interviews were conducted with seven PCPs recruited through convenience and snowball sampling. Interviews were conducted and recorded via Zoom video conferencing. Transcripts were generated and analyzed for themes using a Constructivist Grounded Theory (CGT) approach. The CGT of the present study describes four major barriers that limit PCP prescription of buprenorphine to youth: 1) PCPs Feel Overwhelmed, 2) PCPs Feel Ill Equipped to Treat Youth Patients with OUD, 3) PCPs Hold and Observe Stigma toward Patients with OUD—Especially Youth, and 4) Structural and Systemic Barriers. Each major barrier consists of related subcategories and sub-subcategories. Findings offer stakeholders suggestions for targeting individual, relational, clinical, and systemic level changes to increase primary care access to buprenorphine for youth ages 16-25.

Committee: Michael J. Toohey PhD, ABPP (Committee Chair); Michelle Peavy PhD, MAC, SUDP (Committee Member); Melissa Kennedy PhD (Committee Member) Subjects: Behavioral Sciences; Health; Health Care; Medicine; Mental Health; Psychology; Public Health

Master of Arts (MA), Bowling Green State University, 2023, Mental Health and School Counseling

Human trafficking is a significant crime and human rights violation that impacts more than 27.6 million individuals globally and is incredibly complex in nature (U.S. Department of State, 2023). Survivors are subjected to extreme conditions of abuse, neglect, and coercion leading to the need for competent and compassionate service providers and community support efforts (Kenny et. al, 2022). Service providers working with survivors of human trafficking are exposed to traumatic stories and events daily putting them at high risk for developing symptoms of vicarious trauma (Cohen & Collens, 2013). Due to the nature of their work, it is important to identify protective factors and methods of self-care for service providers that can prevent or reduce the impact of vicarious trauma. The goal of this study was to determine the effectiveness of trauma-informed yoga on the symptoms of vicarious trauma felt by service providers working with survivors of human trafficking.

Committee: Jared Rose Ph.D. (Committee Chair); Ellise Raghavan Ph.D. (Committee Member) Subjects: Mental Health; Therapy

Doctor of Education (Educational Leadership), Youngstown State University, 2023, Department of Teacher Education and Leadership Studies

The COVID-19 pandemic created massive amounts of stress for frontline healthcare providers. The purpose of this study was to examine perspectives of respiratory therapists, student respiratory therapists, and respiratory therapy managers on trust in leadership during the COVID-19 pandemic. The United States' healthcare and government systems were not prepared for the burden caused by the SARS-CoV-2 virus. High levels of prolonged stress, along with significant amounts of death, can cause burnout and moral injury for frontline healthcare providers. Healthcare leaders must provide effective communication, support, and proper amounts of personal protective equipment to help diminish the effects of burnout and moral injury. This study used Q-methodology, which is a mixed-methods research design, that included 203 staff respiratory therapists, student respiratory therapists, and respiratory therapy managers in the state of Ohio who worked the frontlines, or managed respiratory therapists working the frontlines, during the COVID-19 pandemic. Five distinct groups emerged from perspectives of participants: I'll be There for You, Won't You Please, Please Help Me?, I'll Get You There, What's Going On?, and Show Must Go On. The quality of the leader has profound effect on participants' perspective of how their institution handled the COVID-19 pandemic. The more daily contact and communication with their leaders, the less guilt the participants felt during the COVID-19 pandemic. Harold Kelley's covariation model conceptualizes the entity and circumstance of the COVID-19 pandemic by sharing perceptions of frontline respiratory therapists. Though the United States government considers the COVID-19 pandemic over, frontline respiratory therapists will endure the effects of the COVID-19 virus for years to come.

Committee: Karen Larwin PhD (Committee Chair); Sal Sanders PhD (Committee Member); Kelly Colwell EdD (Committee Member) Subjects: American History; Behavioral Sciences; Communication; Continuing Education; Cultural Resources Management; Demographics; Education; Educational Leadership; Environmental Health; Health Care; Health Care Management; Health Sciences; Higher Education; Higher Education Administration; Management; Medical Ethics; Medicine; Organizational Behavior; Pathology; Personal Relationships; Philosophy of Science; Public Health; Public Health Education; Social Research; World History

Master of Science, The Ohio State University, 2023, Genetic Counseling

With the increasing knowledge of genetics and the expansion of targeted therapy options, genetic testing for conditions like Amyotrophic Lateral Sclerosis (ALS) is increasing in demand. Since relatively few ALS clinics are staffed by a genetic counselor, non-genetics neurology providers will need to play key roles in genetic test result interpretation, communication, and implementation into patient care. However, physicians across various fields of practice have communicated a lack of confidence in interpreting and communicating uncertain genetic results, a common result for patients with ALS who undergo genetic testing. This questionnaire-based randomized controlled study was conducted to assess whether a genetics educational module could increase non-genetics neurology providers' understanding of and comfort with uncertain genetic testing results in ALS-associated genes. This anonymous online study-questionnaire assessed each participant's baseline genetics knowledge and comfort with interpreting and communicating genetic testing results. Following this, participants were randomly assigned to either the intervention or control arm. The intervention arm received a comprehensive genetic testing educational module, while the control arm received a condensed version that only covered inheritance patterns. The study questionnaire then re-evaluated each participant's genetics knowledge. The questionnaire also assessed their clinical interpretation and comfort level when presented with a hypothetical case vignette featuring an uncertain genetic testing result in an ALS-associated gene. While the results did not reach statistical significance due to a low number of respondents, certain trends were observed. As compared to control arm participants, intervention arm participants had a greater increase in knowledge after receiving the educational module and were more likely to include certain key implications of the case vignette uncertain result in their written interpret (open full item for complete abstract)

Committee: Dawn Allain (Advisor); Adam Quick (Committee Chair); Victoria Klee (Committee Member) Subjects: Adult Education; Genetics; Health Education

DNP, Kent State University, 2023, College of Nursing

Unintended pregnancies cost an estimated $12 billion annually in publicly funded benefits, contributes to intergenerational poverty, and results in lower educational attainment for mothers and their children. Several professional organizations recommend all health care providers counsel women regarding contraception at every visit regardless of the reason for the appointment. However, contraceptive services provided in any setting is considered inadequate overall (ACOG, 2022; CDC, 2016). This quality improvement project used the plan, do, check, act methodology to assess patient satisfaction with a provider assisted digital contraception education tool. Assessment was also done to ensure that it does not create any type of burden for the provider. Data collection included patient surveys regarding satisfaction with tool use at the conclusion of the visit. Provider perception of helpfulness of bedsider.org will be assessed using a survey at the end of the data collection period. Support staff perceptions of disruptions in office workflow will also be assessed via a one question survey at the end of the data collection period. The convenience sample included 100 patients scheduled for an appointment for the purposes of contraceptive counseling during the designated data collection periods. The provider sample was limited to the physician provider and the nurse practitioner in the office setting. Ancillary staff (medical assistants, secretaries, schedulers) were also be asked to complete a survey regarding the extent of office workflow disruption. The digital contraception educational tool was found to be satisfactory for patients, providers, and ancillary staff.

Committee: Eldora Lazaroff (Committee Chair); Constance Cottrell (Advisor); Karen Mascolo (Committee Member); Lynn Gaddis (Committee Member) Subjects: Nursing

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2022, Health Programs

Hospice care in the United States focuses on the patient and family unit, aspiring to provide high-quality end-of-life care. Support and palliation of symptoms by the hospice, allows the patient to die comfortably and with dignity with the family by their side. One problem in hospice care is whether quality data reporting shows a correlation between publicly reported quality measures and the families' experience of care. The quality data the public sees is the Hospice Item Set (HIS) data and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data, viewable publicly on the Hospice Compare site. This quantitative study compares the quality data reporting for Avow Hospice in Naples, Florida to determine if increasing visit frequencies, the last three days of life as reported on the HIS, improves the families' experience of care for the CAHPS global measures questions 39 and 40. Forty-five months of data is captured in this study, comparing data from deaths from April 2017 through December 2020. The study results indicate that increasing visits the last three days of life yields no improvement in the families' experience for CAHPS survey question 39, however there is evidence that it improves CAHPS survey question 40. Compounded by the Public Health Emergency (PHE), hospices had to become creative in the types and lengths of visits and services provided to hospice patients. Based on this research conducted, the elimination of the imminent measure pair, and the inception of the new Hospice Outcomes and Patient Evaluation (HOPE) assessment tool, further research is needed to identify the correlation between increased hospice care provider visits and the perceptions of families' experiences.

Committee: Gail Frankle (Committee Chair); Olivia Pollard (Committee Member); Alyncia Bowen (Committee Member) Subjects: Health Care

Doctor of Philosophy, University of Akron, 2021, Counselor Education and Supervision

Previous research indicates that screening for parental Adverse Childhood Experiences (ACEs) is a significant tool for identifying children at risk for maltreatment, in order to intervene and prevent the long-term effects of ACEs. Pediatricians have been tasked with screening for parental ACEs at well child visits, as first line of defense. Studies show that less than half of pediatricians are screening for ACEs (Szilagyi et al., 2016) and there was no literature found on the screening practices of mental health providers. The purpose of the current study was twofold, 1) to increase our understanding of licensed mental health provider's familiarity with the seminal ACE study and their endorsement of the impacts of parental adverse childhood experiences (ACEs), and 2) to understand the influence that these factors and licensed mental health provider's personal exposure to ACEs have on their practice of screening for parental ACEs. A total of 277 mental health providers, licensed in the Midwest, completed a web-based survey consisting of a demographic questionnaire, an adapted version of the American Academy of Pediatrics (AAP) 85th Periodic Survey (PS85) (AAP, 2013), and an ACE questionnaire that included both traditional and expanded ACE items for the present study. Through the employment of three separate simple linear regressions, the results of this study indicated that 1) degree of familiarity with the seminal ACE study was not a significant predictor of frequency of screening for parental ACEs, 2) degree of endorsement of the impacts of parental ACEs is a significant predictor of frequency of screening for parental ACEs, and 3) personal exposure to ACEs was a significant predictor of frequency of screening for parental ACEs. However, previous literature and descriptive statistics of this study indicate that mental health providers are screening for parental ACEs more than pediatricians, which would indicate an increased awareness of the need to screen, (open full item for complete abstract)

Committee: Heather Katafiasz (Committee Chair); Rikki Patton (Committee Member); David Tefteller (Committee Member); Wondimu Ahmed (Committee Member); Delila Owens (Committee Member) Subjects: Counseling Education

PhD, University of Cincinnati, 2021, Allied Health Sciences: Communication Sciences and Disorders

Due to COVID-19, communication between healthcare providers and patients is hampered by isolation requirements, use of personal protective equipment (PPE) and lack of access to patients' family. To address this gap, a novel user-friendly, prototype of a mobile communication app, Talking About Living with COVID (TALC©) was developed using human-centered design principles. This dissertation employed a user-centered design approach to develop and test a prototype of a mobile-based communication app that is intended to promote effective communication between the healthcare providers and patients with communication challenges during COVID-19 pandemic and beyond. More specifically, this study aimed to answer two research questions: RQ1: What characteristics of the TALC© prototype do healthcare providers perceive as potentially helpful when interacting effectively with their patients with communication challenges? RQ2: On a well-established reference measure, such as the System Usability Scale (SUS), do healthcare providers rate TALC© as a potentially usable technology in their health setting? Usability was assessed using a think aloud method, where 17 healthcare providers described their interaction with the porotype followed by completion of a System Usability Scale (SUS) and Perceived Satisfaction and User Perceived Value scale. The median score for the SLP group was 77.5 (SUS1); the median score for the Non-SLP group was 92.5 (SUS2). On a 6-point Likert scale, eight participants (SLP= 2; Non SLP =6) indicated that they were “very satisfied” with the TALC© prototype, and nine participants (SLP= 5; Non SLP = 4) indicated that they were “moderately satisfied.” Qualitative data suggest the healthcare providers responded favorably to the prototype, with the majority commenting that the TALC© would be useful to support communication in their setting and has potential to alleviate communication challenges during—and beyond the COVID-19 pandemic.

Committee: Aimee Dietz Ph.D. (Committee Chair); Suzanne Boyce Ph.D. (Committee Member); Nancy Creaghead Ph.D. (Committee Member); Carrie Rountrey Ph.D. (Committee Member); Rhonna Shatz D.O. (Committee Member) Subjects: Speech Therapy

Honors Theses, Ohio Dominican University, 2021, Honors Theses

Advanced practice providers have been integrated into larger roles in EMS systems in the United States, beginning with mobile stroke units (MSUs) in 2014 (34). In addition, Nurse Practitioners have been implemented into Nurse Practitioner Response Units, such as the LAFD NPRU (12,41). Publications were found, vetted and compiled from PubMed, Google Scholar and Stroke Journal (n=34). NPRU utilization in the United States resulted in 52% treat and release percent over the first 6 months of study and 50.2% treat and release percent over the first 18 months of study (12,41). Mobile stroke units in the United States reduced dispatch-to-treatment time by an average of 27.65 minutes (13,16,26,27,29,45,47). Furthermore, MSUs decreased dispatch-to-CT time by an average of 16.5 minutes (23,29,33,47). Both NPRUs and MSUs show promise in benefiting patient outcomes. Further research is necessary to determine widespread application across urban and rural settings in the United States.

Committee: Scott Kravitz M.S. (Advisor); Nicole Powell Ph.D. (Other); Kristall Day Ph.D. (Other) Subjects: Medicine

Master of Arts, Miami University, 2020, Speech Pathology and Audiology

People with mild traumatic brain injury (mTBI) may experience cognitive-communication deficits that go unnoticed by first-line healthcare providers (FHPs). Speech-language pathologists (SLPs) assess and treat these domains, yet are underrepresented on mTBI multidisciplinary teams. This study's aim was to evaluate FHPs' perceived knowledge of and referrals to SLPs for mTBI. Physicians, physician assistants (PAs), nurse practitioners, nurses, and athletic trainers (n = 129) completed an online survey including two Likert scale questions and one free response question relating to SLPs' role in mTBI. FHPs rated their perceived knowledge of the role of the SLP in mTBI management as: very knowledgeable (n = 29, 22%), knowledgeable (n = 33, 26%), somewhat knowledgeable (n = 37, 29%), and not very knowledgeable (n = 30, 23%). One-hundred twenty-eight FHPs ranked their rate of referrals to SLPs for the management of mTBI as: always (n = 10, 8%), most of the time (n = 16, 12%,), about half of the time (n = 11, 9%), sometimes (n = 10, 8%), rarely (n = 25, 19%), and never (n = 56, 44%). Future educational efforts regarding the valuable role of SLPs in mTBI care directed toward FHPs are necessary.

Committee: Kelly Knollman-Porter CCC-SLP, Ph.D (Advisor); Renee Gottliebson CCC-SLP, Ph.D (Committee Member); Courtney Robinson CCC-SLP, M.S. (Committee Member) Subjects: Health Care

Doctor of Philosophy (PhD), Wright State University, 2019, Computer Science and Engineering PhD

With massive data collections and needs for building powerful predictive models, data owners may choose to outsource storage and expensive machine learning computations to public cloud providers (Cloud). Data owners may choose cloud outsourcing due to the lack of in-house storage and computation resources or the expertise of building models. Similarly, users, who subscribe to specialized services such as movie streaming and social networking, voluntarily upload their data to the service providers' site for storage, analytics, and better services. The service provider, in turn, may also choose to benefit from ubiquitous cloud computing. However, outsourcing to a public cloud provider may raise privacy concerns when it comes to sensitive personal or corporate data. Cloud and its associates may misuse sensitive data and models internally. Moreover, if Cloud's resources are poorly secured, the confidential data and models become vulnerable to privacy attacks by external adversaries. Such potential threats are out of the control of the data owners or general users. One way to address these privacy concerns is through confidential machine learning (CML). CML frameworks enable data owners to protect their data with encryption or other data protection mechanisms before outsourcing and facilitates Cloud training the predictive models with the protected data. Existing cryptographic and privacy-protection methods cannot be immediately lead to the CML frameworks for outsourcing. Although theoretically sound, a naive adaptation of fully homomorphic encryption (FHE) and garbled circuits (GC) that enable evaluation of any arbitrary function in a privacy-preserving manner is impractically expensive. Differential privacy (DP), on the other hand, cannot specifically address the confidentiality issues and threat model in the outsourced setting as DP generally aims to protect an individual's participation in a dataset from an adversarial model consumer. Moreover, a practical CM (open full item for complete abstract)

Committee: Keke Chen Ph.D. (Advisor); Xiaoyu Lu Ph.D. (Committee Member); Krishnaprasad Thirunarayan Ph.D. (Committee Member); Junjie Zhang Ph.D. (Committee Member) Subjects: Computer Engineering; Computer Science

Psy. D., Antioch University, 2019, Antioch Seattle: Clinical Psychology

To date, disability identity development is a highly understudied construct. There are many models of disability, each interpret disability through a specific lens, but do not address the influence of disability on identity development. The few theories of disability identity that do exist have not been widely adopted. In addition, there is a lack of empirical evidence to support them. Another difficulty is that these theories do not separate different disability groups. Rather, the theories are applied to a broad heterogenous group of disability types. This is a problem because each disability type is quite distinct from the others and therefore each disability requires its own developmental model. On the surface, alternate models of identity development, such as racial identity development, seem similar to what might be expected in the process of disability development, however, as of 2019, no such studies have been conducted or published. It is the purpose of this project to uncover themes of disability identity development as they pertain to people with spina bifida in order to build a framework for understanding the process of identity development in this population. A descriptive phenomenological methodology was used to conduct a thematic analysis of existing literature. A total of 79 articles were reviewed in detail, and common themes and connections were noted. Nine themes of identity development for people with spina bifida emerged. The themes include: (a) employment, (b) family, (c) physical health, (d) psychological and mental health (e) view of disability, (f) sexuality, (g) impact of others, (h) psychosocial, and (i) transition. Each theme was deemed an essential element in understanding the process of identity development for those with spina bifida. This study was limited by the scope of literature reviewed as well as a lack of first-hand accounts of the identity process. This work is intended to be preliminary and to provide direction for further res (open full item for complete abstract)

Committee: Dana Waters Ph.D. (Committee Chair); Elizabeth Boland Ph.D. (Committee Member); Brett Kuwada Psy.D. (Committee Member) Subjects: Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Cognitive Psychology; Counseling Education; Counseling Psychology; Developmental Psychology; Health; Health Care; Individual and Family Studies; Mental Health; Personality Psychology; Physical Therapy; Psychology; Psychotherapy; Public Health; Rehabilitation; School Counseling; Social Psychology; Social Work; Sociology; Special Education; Therapy; Vocational Education

MS, University of Cincinnati, 2019, Medicine: Genetic Counseling

Abstract Purpose – The objective of this study was to investigate non-genetics pediatric providers' understanding of a mock genetic test report with a variant of uncertain significance (VUS) result and determine if their understanding of the result is correlated with their experience ordering genetic tests. We also investigated their preferences about contents of the report and additional steps taken to understand the result in order to guide laboratories when formatting genetic test reports. Methods – An anonymous questionnaire was sent to 237 non-genetics pediatric providers at Cincinnati Children's Hospital Medical Center (CCHMC). Participants were asked to give information about their genetic testing ordering practices, answer knowledge questions about a VUS result on a mock genetic test report, rate how much information they prefer on a report, and the resources used to research a VUS result. Results – Of the 51 non-genetics pediatric providers that participated, 78% (n=40) appropriately answered the first of two knowledge questions regarding interpretation of the VUS result and gave at least one appropriate answer for the second question about recommending follow-up based on the VUS result. Thirty-three percent (n=17) of the providers gave the appropriate answer for the first question and selected both appropriate answers for the second question. There was no correlation between participants' ability to answer knowledge questions appropriately and the types of genetic tests they order, if they previously received a VUS result, their comfort with interpreting genetic test results, or the likelihood of referring a patient to a genetics' specialist (P>0.05). Most providers reported that the amount of information in each section of the mock genetic test report was an adequate amount of information. Providers are likely to reference multiple resources to better understand a VUS result, including published literature (82%), gene-specific databases (67%), and col (open full item for complete abstract)

Committee: Melanie Myers Ph.D. (Committee Chair); D. Brian Dawson M.S. (Committee Member); Hua He M.S. (Committee Member); Chinmayee Nagaraj M.S. (Committee Member); Emily Wakefield M.S. (Committee Member) Subjects: Genetics

Doctor of Philosophy (PhD), Ohio University, 2018, Communication Studies (Communication)

This dissertation explores communication about mental illness and other sources of emotional distress inside the Church of Jesus Christ of Latter-day Saints. Though often untrained, religious leaders are the most sought-after source of support for mental illness and emotional distress in the United States. I used interviews, autoethnography, participant observation, and the analysis of cultural documents to gather and analyze discourses which illuminated how several local LDS communities understood mental illness and other forms of emotional distress. I interviewed thirteen Mormon bishops and ten professional mental health care providers who worked with LDS dominant populations about their experiences providing care for members in distress. Three main questions guided my research: What narratives do Latter-day Saints use to make sense of mental illness and other forms of trouble and how does this sensemaking enable or constrain emotional wellness? How does the LDS culture's habitus foster inclusion or stigmatize difference? How does silence around stigmatized issues like mental illness, human sexuality, and gendered violence enable or constrain religious leaders' and communities' ability to appropriately make sense of and respond to trouble? I present my analysis in chapters four, five, six, and seven. In chapter four I outline the spectrum of silence inside LDS communities and situate mental illness along it. I argue that overly programmed life scripts which I term brittle narratives lead some members to stigmatize trouble, have unrealistic life expectations, live by absolutes, and strive for perfection. In chapter five I discuss LDS discourses about human sexuality which I describe as existing in a narrative desert, a discursive landscape that only partially tells a dominant story and uses institutional and social power to police and silence counternarratives. In chapter six I discuss discourses about sexual violence which fall under a category I named narra (open full item for complete abstract)

Committee: Lynn Harter PhD (Committee Chair); William Rawlins PhD (Committee Member); Brittany Peterson PhD (Committee Member); Joseph Bianco PhD (Committee Member) Subjects: Clergy; Communication; Counseling Psychology; Ethics; Gender Studies; Glbt Studies; Health; Mental Health; Organization Theory; Pastoral Counseling; Psychotherapy; Public Health; Religion; Religious Congregations; Rhetoric; Social Research; Spirituality; Womens Studies