Background: It is estimated that 27 million people are exploited for labor, services, and commercial sex globally each year (Oliviera et al., 2024). Forced labor generates an estimated $236 billion US dollars each year (ILO, 2024). In Alaska, 30% of our homeless young adults identify as having been, or are, victims of trafficking (Stremple, 2024). Education for providers and health care staff is lacking when it comes to identifying trafficking victims. Data shows that 63% of surveyed health care providers have not had training in human trafficking (Oliviera et al., 2024). Purpose: The purpose of this DNP Project was to increase the ability for a trafficking victim to be recognized in an urgent care setting. An opportunity exists to improve outcomes by providing fast and easy education to providers and health care staff. Methods: The participants for this project consisted of male and female medical assistants, registered nurses, nurse practitioners and other providers, laboratory technicians and administrative staff of an urgent care office. Recruitment was done via word-of-mouth where a flier was presented, and participation was optional. Results: The total number of participants was 13 (n = 13). All participants (100%) completed the pretest and posttest. Where a p value of 0.05 is considered significant, the combined data showed an overall p value of 0.034, which is considered statistically significant. Conclusion: The pre and posttest gave undoubtable insight that education did improve knowledge and confidence in the health care workers by simply watching a four-minute educational video.

This dissertation presents a comprehensive experimental investigation into the dynamicsof wingtip vortices and the application of spanwise blowing jets as a method for active flow control on both fixed-wing and rotor blade systems. Wingtip vortices are a natural three-dimensional phenomenon of finite wings that reduces aerodynamic performance and create hazardous wakes. In the case of rotorcraft, the blade wake can be particular detrimental in the form of Blade Vortex Interactions (BVI). This work investigates the impact of wingtip jets on the aerodynamic performance and flow around both a small aspect ratio wing and a rotor. Wind tunnel experiments are conducted on a NACA 0012 fixed-wing model with jet slots at the wingtip, downstream of a built-in settling chamber. Force balance measurements determine the impact of active flow control on aerodynamic loads, while Particle Image Velocimetry (PIV) data are acquired at three chordwise locations to characterize the flow around the wingtip. The results demonstrate that the addition of wingtip jets increases both overall lift and drag, with the effects being more pronounced at lower freestream velocities for a given jet supply pressure ratio. PIV analysis reveals that the jets fundamentally alter the flow field, displacing the primary wingtip vortex and inducing a more complex flow field with secondary counter-rotating vortices. This outward movement of the primary vortex, combined with a reversal of the spanwise flow, directly correlates with the increased lift observed in the force balance experiments. Wingtip jet effects on the wingtip vortex are also investigated on a rotor with two blades. The rotor is set with a 12-degree blade angle of attack and a 6-degree disk tilt relative to a Reyonlds number of 2.45 × 10^4 based on chord length. PIV data acquired at four azimuthal blade positions confirm that, similar to the fixed-wing model, the jets displace the blade tip vortex and reverse the spanwise flow. The comparative analysis reveals that the jets are most effective at low Re, which are experienced by the retreating blade due to a reduced relative freestream velocity, where flow separation is a major concern. The application was less effective on the advancing blade, where the presence of BVI remains an issue.

Background: Autism Spectrum Disorder (ASD) affects approximately 1 in 36 children in the United States. Core features include deficits in social communication, repetitive behaviors, and associated comorbidities such as irritability, aggression, and sleep disturbances. Neuroinflammation and immune dysregulation are increasingly recognized as contributing factors in ASD pathophysiology. Transcranial photobiomodulation (tPBM), a non-invasive neuromodulation technique utilizing red and near-infrared light, has demonstrated neuroprotective, anti-inflammatory, and cognitive benefits in several neurological conditions. Preliminary evidence suggests potential therapeutic effects of tPBM in ASD.Objective: This study analyzed collected survey data from parents of adolescents and young adults with ASD who participated in at-home, self-guided sessions using twice-daily ProNeuroLIGHT transcranial and abdominal photobiomodulation therapy. The goal was to examine trends, patterns, and potential impacts of the intervention on non-compliant behaviors and parental stress, with secondary consideration of sleep quality. Methods: Twenty-one participants aged 5–34 years (mean age 11.7; 15 males, 6 females) from Latin America origin who used infrared/red LED head caps and abdominal wraps twice daily for 20 minutes. Parents completed validated Spanish versions of the Home Situation Questionnaire–ASD (HSQ-ASD) and Autism Parenting Stress Index (APSI) at baseline and follow-ups. Paired t-tests, Wilcoxon tests, and mixed-model analyses were performed to assess changes over time, with significance set at p < 0.05. Results: Statistically significant improvements were observed from baseline to both follow-up points. By the final follow-up (mean 129 days), HSQ total scores decreased by 32.7 points (p < 0.0001), HSQ mean severity scores by 1.4 (p < 0.0001), SI and DS subscale scores by 15.8 and 16.9 (p = 0.0009 and < 0.0001, respectively), and APSI scores by 13.5 (p < 0.0001). Mixed-model regression confirmed consistent daily reductions across all measures. Neither age nor sex showed significant effects. Discussion: Results indicate that combined transcranial and abdominal PBM was associated with significant reductions in non-compliant behavior and parental stress. Potential mechanisms may include modulation of neuroinflammation, improvement of gut microbiome balance, and enhancement of glymphatic clearance systems often disrupted in ASD. Conclusion: Transcranial and abdominal photobiomodulation appears to be a safe, well-tolerated, and promising non-invasive intervention for reducing behavioral challenges and caregiver stress in the ASD population that participated. Further large-scale, controlled trials are warranted to confirm efficacy, establish standardized treatment parameters, and explore underlying physiological mechanisms.

Energy production in wind turbines can be increased in three main ways: lengthening the blades, accessing high wind speeds, and optimizing turbine efficiency. Increasing the blade length has been a common way to substantially increase wind turbine energy production. However, this trend of longer blades has led to many challenges, in particular, structural challenges from larger deflections, logistical challenges from transportation difficulty, and manufacturing challenges from the lack of specialized manufacturing warehouses.Additive manufacturing (AM) has shown promise in addressing some of these challenges by enabling complex, optimal geometries, simplifying manufacturing, and increasing accessibility by printing the blades on site. In order to leverage AM, this thesis investigates the use of computational optimization, in particular multi-objective optimization, to balance competing objectives as a means to determine the optimal design of wind turbine blades. The optimal design will be a compromise between annual energy production (AEP) and various structural performance metrics. This goal is achieved by first investigating two AM feasible internal structures, lattice-based and topology optimized designs. These two designs are compared across key performance metrics, including compliance and natural frequency. The topology optimized design demonstrates superior performance and is selected for a full multi-objective blade optimization. This multi-objective optimization is performed to maximize both the annual energy production and first natural frequency. The performances of the resulting optimal designs are then quantified through comparison to an existing optimal composite wind turbine blade. Overall, the findings highlight the potential of optimization-driven additively manufactured blade design.

Nurses’ adherence to infection prevention guidelines is crucial for reducing healthcare-associated infections and ensuring patient safety. However, non-compliance remains prevalent within healthcare settings. Nudge interventions, based on behavioral economics, have emerged as a promising approach to subtly influence decision-making without coercion. This dissertation explored the perceived acceptability and utility of nudge interventions among nurses, focusing on their potential to enhance adherence to the use of personal protective equipment (PPE). This study used a qualitative descriptive approach, guided by the Health Belief Model, to investigate nurses' perception of infection risk, the efficacy of infection prevention and control guidelines, and various nudge strategies as part of their professional roles. By understanding theseinterventions' acceptability and practical utility, this research aimed to provide insights into the design and implementation of effective nudge strategies that respect professional autonomy while improving adherence to infection prevention practices. Fourteen registered nurses working in acute care settings with at least 1 year of direct care experience were recruited purposively. Semi-structured interviews were conducted via Zoom, transcribed, and analyzed using thematic content analysis. This study found that nurses generally accepted nudges, especially when they were integrated into the workflow and supported clinical priorities. Visual and environmental cues were viewed as helpful when salient and proximal to the clinical workflow, but their effectiveness diminished when they became overly familiar, or when organizational support for PPE use was uncertain. Nurses used a variety of heuristics and situational judgments to rationalize PPE omissions, especially during perceived low-risk or time-pressured situations. Repeated exceptions and other modifying factors contributed to gradual erosion of adherence. These findings indicate that nudges may improve PPE adherence when they are salient, contextually appropriate, and supported by organizational norms. Nudges could interrupt automatic behaviors briefly but were limited in their ability to counter rationalizations when competing priorities were present. The study highlights the importance of designing behaviorally informed interventions that fit into the clinical workflow, remain salient, and are congruent with clinical judgment. The findings will inform future interventions intended to promote adherence to infection control measures in healthcare environments.

Background: Sleep plays a foundational role in maintaining physical and mental health, yet over one-third of U.S. adults report getting less than the recommended seven hours of sleep per night. Insufficient sleep is linked to an increased risk of cardiovascular disease, diabetes, obesity, depression, impaired cognition, and poor quality of life. Despite the clinical relevance, structured sleep hygiene education is underutilized in primary care. The Centers for Disease Control and Prevention (CDC) classifies inadequate sleep as a public health epidemic, underscoring the need for evidence-based, scalable interventions. In alignment with the Healthy People 2030 objective to increase the proportion of adults who get sufficient sleep, this project aims to integrate brief, accessible sleep education into routine clinical care to promote healthier sleep behaviors and reduce chronic disease risk (Office of Disease Prevention and Health Promotion [ODPHP], n.d.).Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate whether a brief, structured sleep hygiene education session improves adult patients’ sleep knowledge and self-reported sleep behaviors in a suburban-urban primary care clinic. Methods: The project was implemented at Family Healthcare Clinic, which serves a racially, ethnically, and socioeconomically diverse population. Eligible patients (≥18 years old) presenting for routine primary care visits will be invited to participate voluntarily. Participants completed a 10-item pre-quiz on sleep knowledge, attended a 10-minute education session, and completed a post-quiz and brief self-assessment on sleep habits and fatigue. Data was collected using paper-administered surveys and analyzed in Excel. No identifiable information was collected. Results: A total of 23 adults participated, ranging in age from 22 to 70 years, with diverse demographic representation. Participants’ mean sleep knowledge scores improved from 6.1 (SD = 1.0) to 8.9 (SD = 0.8) following the 10-minute nurse-led education session (t(22) = 12.47, p < .001). Most participants (91%) indicated plans to change their sleep habits, most commonly by reducing screen time before bed (71%), maintaining a consistent bedtime (64%), and limiting caffeine intake (55%). Participants with high fatigue ratings expressed great intent to adopt healthier practices, reflecting increased awareness of how inadequate sleep affects daytime function. Qualitative feedback indicated high satisfaction, with participants describing the session as short, simple, and applicable to daily life. Conclusion: This project demonstrated that a brief, evidence-based, provider-led sleep hygiene education session can significantly improve adult patients’ knowledge and motivation to change behaviors associated with sleep quality. The alignment between increased fatigue awareness and behavior change intentions supports prior research emphasizing the role of self-recognition in promoting healthier habits. Integrating concise sleep education into routine primary care is a feasible, scalable strategy to advance the Healthy People 2030 goal of improving sleep health and reducing chronic disease risk

Background: Depression prevalence in hospice and palliative care ranges from 24% to 70%, with rates increasing in the final months of life. When unaddressed, depression is associated with increased pain, fatigue, and dyspnea, decreased adherence to care plans, and impaired ability to experience meaning and closure at end of life. Consistent identification is limited by lack of standardized screening methods, diagnostic complexity due to symptom overlap with terminal illness, and time constraints. The Patient Health Questionnaire-2 (PHQ-2) offers a brief, validated screening tool with 91% sensitivity and 86% specificity in palliative care settings. Purpose: This quality improvement project aimed to provide an educational intervention for registered nurses (RNs) and social workers (SWs) at MultiCare Hospice to improve knowledge and confidence related to depression assessment and measure intent to utilize a depression screening tool that consists of the PHQ-2 with supplemental questions. Methods: Participants watched a 15-minute educational intervention addressing depression in hospice care, distinguishing grief from depression, and PHQ-2 administration, scoring, interpretation, and follow-up protocols. Pre- and post-intervention surveys assessed knowledge through multiple-choice questions and confidence through Likert-scale questionnaires. Paired t- tests, independent t-tests, and descriptive statistics were used for analysis. Results: Three participants completed pre- and post-intervention surveys (two RNs and one SW). Knowledge scores remained at 96.30% pre- and post-intervention. Confidence increased from 3.42 to 4.08 on a 5-point scale, with a large effect size (Cohen's d = 1.155). Intent to utilize the PHQ-2 was high (M = 4.83/5.0), with no discipline differences. Conclusion: This project demonstrated clinically meaningful confidence improvements and high implementation intent despite small sample size limiting statistical power. The intervention effectively bridged the gap between theoretical knowledge and clinical application. However, low participation rate highlights significant recruitment barriers. Results suggest brief educational interventions can enhance clinician readiness for depression screening, though further evaluation is needed before implementing broader practice change strategies.

Introduction: Menopause is associated with increased susceptibility to cardiovascular disease (CVD), the leading cause of death in women worldwide, but the mechanism is currently unknown. Estrogen has been shown to play a role in CVD and studies have suggested that loss of estrogen signaling in the intestine during menopause may lead to worse myocardial infarction (MI) outcomes in female mice. Meanwhile, suppressing inflammation in the gut using pre- and pro-biotics has been shown to protect the heart from ischemic heart disease caused by MI through unknown means. Though data support a functional relationship between menopause, gut, and heart health, further studies are needed to reveal the functional role of estrogen in the gut and improve our understanding of how this system is affected when estrogen signaling is lost during menopause. To address this, large-scale proteomics analysis was utilized to identify relevant pathways across three experimental models and two species that investigate changes in hormonal status, sex, and inflammation with respect to estrogen. Methods: Utilizing the 4-vinylcyclohexene diepoxide (VCD) mouse model of menopause, the effects of estrogen were investigated in vivo by comparing mice at different stages of hormonal status (premenopausal, menopausal, male, and aged), then ex vivo by treating premenopausal and menopausal mouse ileal organoids with an inflammatory stressor. Human colon carcinoma brush border expressing (Caco-2 BBe) cells were treated in vitro with 17β-estradiol (E2) and evaluated to determine changes in the expression of key proteins involved in inflammation. Proteomic analysis was performed on mouse ileal tissue, organoids treated with or without lipopolysaccharides (LPS), and Caco-2 BBe cells treated with LPS or flagellin (FLAG) either alone or in the presence of E2. These data were then evaluated to determine key estrogen-mediated pathways and promising prospects for validation. Results: Initially, we found that the expression of estrogen receptor beta (ERβ) in Caco-2 BBe cells was significantly decreased in cells that were fully differentiated or confluent in culture compared to proliferating cells. It was also shown that E2 treatment in Caco-2 BBe cells altered the expression of toll-like receptors 5 (TLR5) and 7 (TLR7), tumor necrosis factor alpha (TNFα), interleukin-1 alpha (IL-1α), and the antimicrobial peptides (AMPs) REG3γ and RELMβ. Further, analysis of post-translational modifications (PTMs) in mouse tissue and human cells revealed decreased phosphorylation of cytoskeletal keratins and reduced histone acetylation under estrogen deficient conditions. Estrogen was also shown to serve a protective role in gut barrier function and evaluating orthologs across mouse- and human cell models highlighted key areas of cross-species conservation. Discussion: Collectively, the findings presented in this dissertation suggests that loss of estrogen disrupts cytoskeletal organization and epigenetic regulation within the gut epithelium, leading to barrier dysfunction and inflammation that may increase cardiovascular disease risk in menopausal women through gut-mediated inflammation. Though there is more to explore, these data will eventually lead us in the right direction to improve therapies available to aging and menopausal women.

Background: Suicide remains a critical concern to public health that is experienced at disproportionately higher rates within rural communities. These populations face heightened barriers, including limited access to care, stigma, and social isolation. Since primary or integrated healthcare settings often represent the first or only point of contact for those at risk for suicide, provider preparedness is crucial to preventing suicide.Purpose: The purpose of this project was to enhance provider knowledge and confidence in identifying and managing suicidal or high-risk patients within MHC Healthcare, an integrated rural healthcare center in Tucson, AZ. It aimed to increase awareness of evidence-based and relevant local suicide prevention resources and to improve interdisciplinary competence through education. Methods: The Suicide Prevention Toolbox was electronically disseminated to 111 MHC providers across disciplines via email. This implementation was guided by the Knowledge to Action Framework and followed the Plan-Do-Study-Act model. This educational toolbox included evidence-based strategies, screening tools, and local resources for providers. A post-presentation survey was used to evaluate the perceived knowledge, confidence, and intent or likelihood of applying the presented material. Results: Five providers completed the evaluation survey. Despite limited responses, results demonstrated positive trends. Most participants reported increased knowledge, confidence, and a likelihood to integrate suicide prevention strategies into their practice. Qualitative comments highlighted the value of interdisciplinary communication and identified barriers such as maintaining patient safety and contact. Conclusions: Findings from this project support brief, targeted educational interventions to strengthen provider competence in suicide prevention within rural integrated healthcare. Although the scope of this project was small, it underscores the importance of integrating suicide prevention into ongoing professional training and improvement initiatives. Continued refinement of this intervention for broader implementation could enhance provider confidence and competency, as well as interprofessional collaboration, ultimately improving patient outcomes and safety.

Background: Major Depressive Disorder (MDD) is common across all demographics and occurs more frequently in individuals with chronic medical conditions. Among these, patients with type 2 diabetes(T2D) are two to three times more likely to develop depression due to disease related stress, anxiety, and lifestyle changes. Given this high comorbidity, routine screening using validated tools such as the Patient Health Questionnaire-9 (PHQ-9) during primary care visits is essential. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project aimed to improve staff knowledge, confidence, and intent to use the PHQ-9 for depression screening among patients with T2D in Integrity Healthcare clinic. The goal was to promote early identification and management of depressive symptoms to enhance patient outcomes and quality of care. Methods: A pretest and posttest design guided by the Plan-Do-Study-Act (PDSA) framework was used. The educational intervention covered the bidirectional relationship between depression and T2D, recognition of overlapping symptoms, and PHQ-9 administration, scoring, and interpretation. Staff completed pre and posttests measuring knowledge, confidence, intent to use the PHQ-9 with T2D patients. Results: Five out of five clinic staff participated, completing pretests, attending the intervention, and completing posttests. Knowledge scores slightly improved, with posttest averages reaching 100%. Confidence increased, as all participants strongly agreed they could score and integrate the PHQ-9 into workflow. Intent scores were high, indicating readiness for routine screening. Qualitative feedback revealed themes of workflow and patient-related barriers, improved understanding of PHQ-9 relevance, and opportunities for digital integration to enhance efficiency. Conclusions: The project demonstrated that an educational intervention can effectively improve staff knowledge, confidence, and intent to use the PHQ-9 for patients with T2D, supporting early detection and better health outcomes.