Digital Commons Network^™

Expanding Expanded Access: A Case Of Onc201 And The Ethical Limitations Of Compassionate Use, Ava C. Hutchings

Honors Theses

This study examines the ethical and structural limitations of the Expanded Access program in the United States, with particular focus on its application to terminal pediatric illness. Although the program is intended to provide patients with life-threatening conditions access to investigational therapies outside of clinical trials, its effectiveness in serving critically ill children remains uncertain. This program is analyzed through careful consideration of regulatory review and ethical theory. Key policies governing Expanded Access are examined alongside scholarly discussions of pediatric autonomy and parental authority.

A case study of ONC201, a now-approved investigational drug, is used to illustrate how Expanded Access …

Mental Health Screening For The Military Spouse: Prevention In Practice, Lura Allison Mcgrath

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Abstract

In recent years, a focus on mental health has moved to the forefront of healthcare. This is especially true when caring for United States military service members. The military spouses of these service members also struggle and suffer from mental health disorders. However, the mental health needs of military spouses often receive insufficient attention. Research shows military spouses are at an increased risk of developing mental health disorders and/or suffering from mental illness. A large contributor is the impact of the military lifestyle and its challenges for these spouses. However, research also reveals there has been minimal effort put …

Bacteriophage Therapy For Klebsiella Pneumoniae: Phage Screening And Efficacy Assessment In Macrophages/Neutrophils And Mouse Model, Mounika Duggineni

Biotechnology Theses

Klebsiella pneumoniae causes infections such as pneumonia and urinary tract infections, necessitating alternative therapies. As an emerging MDR pathogen, evaluating newer therapeutic strategies is essential. This study utilized bacteriophages and Klebsiella pneumoniae strains kindly provided by Dr. John, who previously isolated and characterized broad-host-range bacteriophages from hospital wastewater targeting diverse clinical K. pneumoniae isolates. Among fifteen lytic bacteriophages identified across multiple genera, bacteriophage #418 was selected and purified using ultrafiltration, yielding higher functional titers than PEG-based methods. In vitro assays showed Bacteriophage #418 nearly killed bacteria after 2 hours of co-incubation. Ex vivo studies using healthy donors human macrophages …

Implementation Of A Planned Extubation Nurse-Led Safety Bundle In A Pediatric Cardiac Intensive Care Unit, Broderick Sutton

Doctor of Nursing Practice Final Project Abstract

Purpose: To implement and evaluate a nurse-led planned extubation safety bundle designed to improve nurse preparedness, interdisciplinary communication, workflow consistency, and confidence during planned extubation events in a pediatric Cardiac Intensive Care Unit (CICU).

Background: Planned extubation in critically ill pediatric cardiac patients requires effective interdisciplinary coordination. Variability in nurse preparation, communication, and knowledge of sedation pharmacokinetics contributed to workflow inefficiencies and patient safety concerns. Evidence supports standardized nurse-led protocols to improve extubation readiness and reduce practice variability.

Methodology: A prospective pre-post quality improvement project was conducted over eight weeks in a pediatric CICU. The intervention included a nurse-led planned …

Staff Education To Improve Interpretation And Documentation Of Category Ii Fetal Heart Rate Patterns In Labor And Delivery Nurses, Lizette Girado

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education To Improve Clinical Task Prioritization Among Outpatient Clinical Staff, Adebayo Arowolo

Walden Dissertations and Doctoral Studies

No abstract provided.

Improving Diagnostic Accuracy Through Implementation Of An Artificial Intelligence-Enabled Ambient Scribe In Skilled Nursing Psychiatric Practice, Ernest Glenn Gorleski

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education On The Use Of Music To Alleviate Anxiety In Patients With Dementia Within Long-Term Care Facilities, Anyinkeng Lydia Tazi

Walden Dissertations and Doctoral Studies

No abstract provided.

The Implementation Of A Home Blood Pressure Monitoring Program, Michelle Oxendine

Walden Dissertations and Doctoral Studies

No abstract provided.

Modeling Individual Self-Protective Behavior During Epidemics, Geonsik Yu, Michael J. Garee, Mario Ventresca, Yuehwern Yih

Faculty Publications

Protecting public health from infectious diseases requires collective action, as individual behaviors—such as vaccination and mask-wearing—directly influence disease dynamics. During the COVID-19 pandemic, unexpected public responses often undermined the effectiveness of interventions, highlighting the need to understand collective behavioral patterns and motivations to design more effective mitigation strategies. This study presents an agent-based simulation model that captures how individuals adjust self-protective behaviors based on evolving opinions about disease risk and examines how these decisions interact with external factors, such as public health interventions, to shape collective outcomes. To improve the representativeness of the simulated population, multiple datasets were integrated to …

Tunable Tripcides Suppress Virulence Factor Secretion During Staphylococcus Aureus Infection And Kill Dormant Cells, Hasan Tükenmez, Taylor M Nye, Suzanne Hickerson, Chloe L P Obernuefemann, Jerome S Pinkner, Karen W Dodson, Michael G Caparon, Scott J Hultgren, Et Al.

2020-Current year OA Pubs

Antimicrobial resistance (AMR) in common bacterial pathogens, including methicillin-resistant

Inflammatory Markers In The Emergency Department And Ptsd Symptoms In The Aurora Study: A Longitudinal Cohort Study, Kristen Nishimi, Stacey L House, Et Al.

2020-Current year OA Pubs

BACKGROUND: Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months.

METHODS: Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, …

Nivolumab Plus Ipilimumab For Chemotherapy-Refractory Metastatic Castration-Resistant Prostate Cancer: Results From The Randomized Portion Of The Phase 2 Checkmate 650 Trial, Padmanee Sharma, Russell K Pachynski, Et Al.

2020-Current year OA Pubs

We report on the randomized portion of the phase 2, open-label CheckMate 650 trial (NCT02985957), in which docetaxel-experienced, biologically male patients with chemotherapy-refractory metastatic castration-resistant prostate cancer were randomized 2:2:1:2 to nivolumab 3 mg /kg plus ipilimumab 1 mg /kg (n = 73), nivolumab 1 mg /kg plus ipilimumab 3 mg /kg (n = 74), ipilimumab 3 mg /kg (n = 38), or cabazitaxel (n = 74). Primary endpoints were objective response rate and radiographic progression-free survival; key secondary endpoints included overall survival, prostate-specific antigen response rate, and safety. This portion of CheckMate 650 was not designed to statistically compare …

Comparative Effectiveness Of Low Versus High Dose Upadacitinib As Maintenance Treatment In Patients With Ulcerative Colitis: A Real-World Cohort Study From The United States, Priya Sehgal, Gursimran S. Kochhar, Harpreet Kaur, Himsikhar Khataniar, Raina Shivashankar, James D. Lewis, Aakash Desai

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: There is limited real-word data comparing efficacy of low dose upadacitinib (UPA) to high dose UPA as maintenance therapy for ulcerative colitis (UC).

METHODS: This was a retrospective cohort study utilizing the U.S. Collaborative Network in adults ≥18 years old with UC who initiated UPA 15 mg compared to 30 mg for maintenance therapy between April 2022 and December 2023. The primary outcome was a composite of intravenous steroid use, oral steroid use, or colectomy from 12 to 60 weeks from the index UPA prescription. Propensity score matching (PSM) was performed for demographics, co-morbid conditions, laboratory, and IBD medication …

Development Of Novel Plasma Proteomic Biomarkers For Cancer-Associated Thrombosis In An Advanced Cancer Cohort, Preeti, Mrinal Ranjan, Dang Pham, Juan L Bueno, Micheline M Resende, Michael E Scheurer, Christopher I Amos, Chao Cheng, Ang Li

Faculty, Staff and Students Publications

Background: Existing risk models for cancer-associated thrombosis (CAT) show suboptimal performance in selective high-risk populations with cancer. Affinity-based plasma proteomics offers a novel approach for detecting CAT risk.

Objectives: To identify plasma biomarkers for CAT using proximity extension assays in an advanced cancer cohort.

Methods: We performed a nested case-control study using the Olink Explore HT panel. The final cohort included 57 patients with CAT and 113 matched control patients from 5 selected cancer types who had samples collected between cancer diagnosis and chemotherapy initiation. Random survival forest model was used to assess nonlinear associations with CAT in 5416 normalized …

Inflammatory Markers In The Emergency Department And Ptsd Symptoms In The Aurora Study: A Longitudinal Cohort Study, Kristen Nishimi, Sarah Linnstaedt, Thomas Neylan, Lauren Mckibben, Liz Marie Albertorio-Sáez, Ying Zhao, Stacey House, Francesca Beaudoin, Xinming An, Jennifer Stevens, Gari Clifford, Tanja Jovanovic, Laura Germine, Scott Rauch, John Haran, Alan Storrow, Paul Musey, Phyllis Hendry, Sophia Sheikh, Brittany Punches, Robert Swor, Jose Pascual, Mark Seamon, Elizabeth M Datner, Claire Pearson, David Peak, Roland Merchant, Robert Domeier, Niels Rathlev, Brian O'Neil, Paulina Sergot, Leon Sanchez, Steven Bruce, Steven Harte, Ronald Kessler, Karestan Koenen, Kerry Ressler, Samuel Mclean, Aoife O'Donovan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months.

METHODS: Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, …

True North: Full Issue Download

Quill & Scope

Silence is embedded into the life of medical students. Silence pierces the air when you are standing in the back of a patient room observing the conversation, feet aching, wondering if your presence is unnecessary and overwhelming for the patient. We are transient members of the healthcare team. We contribute to patient medical records with out notes and bedside conversations, yet we lack power in the system---the authority to sign orders, be responsible to true coordination of care, the autonomy that residents wield to make healthcare decisions.

It is easy to lose your sense of self in this silence. We …

Staff Education On Lipoprotein (A) Screening And Clinical Follow-Up In Primary Care, Deshawntae Griffin

Walden Dissertations and Doctoral Studies

No abstract provided.

Improving Postoperative Handoff For Placenta Accreta: Implementing A Structured Handoff Communication Tool, Isabelle L. Gerrard

Doctor of Nursing Practice Final Project Abstract

Purpose Implement a standardized postoperative handoff tool to improve interdisciplinary communication during transfer of placenta accreta spectrum (PAS) patients from the operating room to an obstetric intensive care unit at an academic women's hospital.

Background Placenta accreta spectrum (PAS) is a high-risk obstetric condition requiring coordinated multidisciplinary care. At the project site, operating room (OR)-to-obstetric intensive care unit (OB ICU) handoffs lacked a standardized process. This resulted in inconsistent communication and omission of critical information. Nurses reported reduced confidence. Standardized handoff tools can improve communication and promote safer transitions of care.

Methodology This 10-week quality improvement project used Plan-Do-Study-Act methodology …

Values-Based Clinical Ethics: A New Model Of Health And Ethics Consultation For Patients Suffering In Extremis, Adam Trainer

Electronic Theses and Dissertations

This dissertation argues that contemporary clinical ethics is inadequately equipped to support patients suffering in extremis because it relies on an insufficiently discriminating account of health and a constrained model of moral reasoning. Drawing on Bernard Lonergan, it reconceives health as an emergent, multi-layered, heuristic notion shaped by biological, psychological, social, and existential goods. On that basis, it critiques principlism’s global applicability thesis and the undergirding claim that its principles form part of the common morality, arguing that this justificatory structure is philosophically insufficient and practically limited for clinical ethics in cases marked by profound suffering, moral plurality, and normative …

Modalities Of Vision Restoration In Optic Neuropathies And Retinal Disease, Batsheva Rubin, Fabio Lavinsky, Rachel Cain, Ajay E. Kuriyan, Gadi Wollstein, Ronald Zambrano, Joel Schuman

Wills Eye Hospital Papers

Visual impairment affects over 250 million people globally and carries a significant psychosocial and economic burden. In recent years, rapid advancements in biomedical engineering and regenerative medicine have driven the development of innovative therapies aimed at restoring visual function. Here, we first provide an overview of the visual pathway, imaging modalities, and the psychosocial and economic burden of vision loss. Then we review four vision restoration approaches: gene and stem cell therapies, optogenetics, retinal prosthetic devices, and visual pathway electrical stimulation. For each therapeutic approach, the mechanism of action, clinical outcomes, adverse events, and current limitations are discussed. Stem cell …

Practicing Professional Intake Consultations With Ai: An Experiential Assignment For An Exercise Prescription Course, Mark E. Hartman

Educational Practices in Kinesiology

The purpose of this article is to describe an assignment that integrates artificial intelligence (AI) with simulation-based learning in an upper-level undergraduate exercise prescription course. A large body of evidence supports the use of simulation-based education, though due to cost and feasibility limitations, it has largely been limited to medical education. This assignment leverages AI as a scalable, low-cost simulation tool, offering exercise science students a highly realistic practice simulation that reinforces both professional reasoning and interpersonal communication skills. In this assignment, titled Simulated Exercise Consultation Using ChatGPT, students practice conducting an intake session as a personal trainer while …

The Impact Of Patient Navigation On The Hepatitis C Care Continuum In Underserved Populations: A Scoping Review, Deauntaye Jones

Honors Theses

Hepatitis C virus (HCV) remains a significant public health concern and is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation when left untreated. Although direct-acting antiviral therapies have made HCV curable for most patients, many underserved populations continue to experience barriers to diagnosis, linkage-to-care, treatment completion, and sustained virologic response (SVR). This study evaluated how patient navigation programs influence progression through the HCV care continuum among underserved populations. Relevant studies published between 2014 and 2025 were identified through searches of PubMed and Embase using terms related to HCV, patient navigation, linkage-to-care, underserved populations, and treatment outcomes. Following title, …

Hyposense: Multimodal Physiologic And Voc Wearable For Early Hypoglycemia Detection, Nidhi R. Patel

Honors Theses

Hypoglycemia remains a significant safety concern for insulin-dependent individuals, especially when blood glucose declines rapidly during exercise, sleep, or periods of impaired hypoglycemia awareness. Current continuous glucose monitors and automated insulin delivery systems have helped to improve diabetes management, but these technologies primarily respond to glucose trends after they have already started and may not actually provide sufficient warning before symptoms occur. This thesis describes the development of HypoSense, a noninvasive wrist worn wearable concept that is designed to support earlier hypoglycemia risk detection through multimodal physiologic and volatile organic compound emission sensing. HypoSense combines volatile organic compounds/gas sensing with …

Serological Evidence Of Onchocerca Volvulus Exposure And Entomological Indicators Of Parasite Transmission, Didier Kapuku Bakajika

Walden Dissertations and Doctoral Studies

No abstract provided.

Development Of An Evidence Based Pressure Ulcer Prevention Bundle For The Medical Surgical Unit, Fanhelea Morency

Walden Dissertations and Doctoral Studies

No abstract provided.

Progressive Cardiac Phenotypes And Reduced Reversibility From Long-Term Cugexp Rna Expression In A Dm1 Mouse Model, Rong-Chi Hu, Mohammadreza Tabary, Xander Ht Wehrens, Thomas A Cooper

Faculty, Staff and Students Publications

Myotonic dystrophy type 1 (DM1) is caused by an expanded CTG repeat in the DMPK gene, resulting in mutant transcripts that form expanded CUG (CUGexp) RNA foci and sequester muscleblind-like (MBNL) RNA-binding proteins. DM1 is multisystemic, with progressive worsening of disease manifestations in affected tissues. Disease progression is attributed to somatic expansion of the CTG repeats with age, resulting in production of CUGexp RNA with enhanced intrinsic toxicity due to increased MBNL sequestration. To determine the degree to which cardiac disease progression can occur independently of repeat expansion, we used a transgenic DM1 mouse model with inducible heart-specific expression of …

Identifying Novel Gene Dysregulation Associated With Opioid Overdose Death: A Meta-Analysis Of Differential Gene Expression In Human Prefrontal Cortex, Javan K Carter, Bryan C Quach, Caryn Willis, Melyssa S Minto, Dana B Hancock, Janitza Montalvo-Ortiz, Olivia Corradin, Ryan W Logan, Consuelo Walss-Bass, Brion S Maher, Eric Otto Johnson

Faculty, Staff and Student Publications

Only recently have human postmortem brain studies of differential gene expression (DGE) associated with opioid overdose death (OOD) been published; sample sizes from these studies have been modest (N = 40-153). To increase statistical power to identify OOD-associated genes, we leveraged human prefrontal cortex RNA-seq data from four independent OOD studies and conducted a transcriptome-wide DGE meta-analysis (N = 272). Using a unified gene expression data processing and analysis framework across studies, we meta-analyzed 20, 098 genes and found 335 significant differentially expressed genes (DEGs) by OOD status (false discovery rate <  0.05). Of these, 66 DEGs were among the list of 303 genes reported as OOD-associated in prior prefrontal cortex molecular studies (e.g., genes/gene families OPRK1, NPAS4, DUSP, EGR). The remaining 269 DEGs were not previously reported (e.g., NR4A2, SYT1, HCRTR2, BDNF). There was little evidence of genetic drivers for the observed differences in gene expression between opioid addiction cases and controls. Enrichment analyses for the DEGs across molecular pathway and biological process databases highlight an interconnected set of genes and pathways linked to orexin and tyrosine kinase receptors through MEK/ERK/MAPK signaling to affect neuronal plasticity.

Dna Methylation Signatures Associated With Bipolar Disorder In Peripheral Blood Improve Prediction Models, Markos Tesfaye, Anne-Kristin Stavrum, Kira D Höffler, Kevin S O'Connell, Friederike S David, Melanie E Garrett, Sonia Hesam-Shariati, Bronwyn J Overs, Claudia Pisanu, Luana Spano, Oliver J Watkeys, Antoine Weihs, Rafaella Ardau, Allison E Ashley-Koch, Lavinia Athanasiu, Jean C Beckham, Kyle J Bourassa, Caterina Chillotti, Srdjan Djurovic, Ole K Drange, Josef Frank, Anouar Khayachi, Nathan A Kimbrel, Lourdes Martorell, Susanne Meinert, Ingrid Melle, Gunnar Morken, Pasquale Paribello, Marco Pinna, Gloria Roberts, Guy Rouleau, Peter R Schofield, Esteban Sepúlveda, Giovanni Severino, Vidar M Steen, Frederike Stein, Fabian Streit, Va Mid-Atlantic Mirecc Workgroup, Trine Vik Lagerberg, Martin Alda, Udo Dannlowski, Andreas J Forstner, Janice M Fullerton, Hans J Grabe, Melissa J Green, Tilo Kircher, Javier Labad, Mirko Manchia, Philip B Mitchell, Jair C Soares, Alessio Squassina, Alexander Teumer, Leonardo Tondo, Elisabet Vilella, Ole A Andreassen, Boris Chaumette, Gabriel R Fries, Stephanie Le Hellard

Faculty, Staff and Student Publications

Background: Bipolar disorder (BD) is a major mood disorder influenced by both genetic and environmental factors. While DNA methylation from peripheral tissues can reflect both genetic and environmental influences and reveal insights into disease biology, it remains understudied in BD. DNA methylation signatures may complement polygenic scores (PGS) and hold potential as biomarkers. Here, we conducted the largest epigenome-wide association study (EWAS) of BD to date and evaluated the predictive value of polymethylation scores (PMS) in classifying case-control status.

Methods: DNA methylation from peripheral blood of 1729 cases and 1747 controls, comprising twelve cohorts, was obtained. We performed meta-analyses for …

Improving Esi Triage Accuracy In The Emergency Department, Taibat Mursal Verdi

Walden Dissertations and Doctoral Studies

No abstract provided.