Digital Commons Network^™

Urine Good Care: Catheter-Associated Urinary Tract Infection Prevention At The Bedside, Ruby Yost

Master's Projects and Capstones

Catheter-Associated Urinary Tract Infections (CAUTIs) have been associated with increased morbidity, mortality, healthcare costs, and length of stay and is one of the most common healthcare-acquired illnesses accounting for up to 40% of hospital-acquired infections (Rubi et al., 2022). Because 65-70% of CAUTIs are preventable, reducing the incidence has become a focus area for infection control and nursing quality management among hospital organizations (Tang et al. 2025). CAUTIs are urinary tract infections that occur in patients with indwelling urinary catheters and are typically associated with bacterial colonization of the urinary tract. The aim of this QI Project is to increase …

Implementation Of A Standardized Antibiotic Order Set To Improve Evidence-Based Antibiotic Prescribing In Oral Surgery, Lashundra Miles

Walden Dissertations and Doctoral Studies

Inconsistent antibiotic prescribing practices in an oral surgery clinic contributed to variation in antibiotic selection, timing, dosing, redosing when indicated, and duration. This variation limited adherence to evidence-based prescribing recommendations and highlighted the need for a workflow-based strategy to support antibiotic stewardship. The purpose of this quality improvement project was to increase use of a standardized antibiotic order set through reminder-based reinforcement and to improve evidence-based prescribing practices. The practice-focused question examined whether implementing the standardized antibiotic order set, supported by workflow-integrated reminders and ongoing performance feedback, would improve order-set utilization during a 6-week implementation period. The project was guided …

Draining The Risk, Holding The Line: A Nurse-Driven Approach To Catheter-Associated Urinary Tract Infection Prevention, Thy Nguyen

Master's Projects and Capstones

Catheter-associated urinary tract infections (CAUTIs) remain among the most common preventable healthcare-associated infections, with CMS eliminating reimbursement for hospital-acquired cases since 2008. Within a five-unit, high-acuity microsystem at an urban acute care hospital, four CAUTIs were documented between January and July 2026 despite established prevention protocols. Adherence gaps were identified in catheter necessity assessment, maintenance practices, and nurse-driven removal protocol use. This quality improvement project was guided by the Johns Hopkins Evidence-Based Practice framework and Lewin's Change Theory. A targeted nursing education intervention addressing bladder scanning, dependent loop identification, and catheter care bundle adherence was implemented across the microsystem over …

Improving Rsv Vaccination Uptake Through Nurse-Led Educational Intervention, Lawrence Onuorah

Walden Dissertations and Doctoral Studies

In this quality improvement project, the DNP scholar explored the impact of a nurse-led staff education approach on improving respiratory syncytial virus (RSV) vaccine uptake. RSV disease results in negative health outcomes and even death among vulnerable individuals. Despite the availability of U.S. Food and Drug Administration (FDA)-approved vaccines, uptake remains low due to limited provider knowledge and inconsistent vaccine recommendations. Therefore, the project question addressed whether a staff education program would increase providers’ perceived knowledge of RSV vaccine recommendation and confidence to engage in patient education. The purpose of this quality improvement project was to implement a nurse-led staff …

Confidence Versus Competence: Addressing Nursing Knowledge Gaps In Catheter Care To Reduce Catheter-Associated Urinary Tract Infections, Leslie Anne Villanueva Bautista

Master's Projects and Capstones

Catheter-associated urinary tract infections (CAUTIs) remain among the most prevalent and preventable healthcare-associated infections (HAIs), contributing substantially to patient morbidity, mortality, prolonged hospitalization, and healthcare expenditures. Most hospital-acquired UTIs are related to urinary catheters, and this burden costs the United States alone an estimated $340 to $450 million annually (Yang et al., 2022). CAUTIs are UTIs that occur in patients with indwelling urinary catheters. This quality improvement project aimed to increase adherence to existing bladder scanning protocols and strengthen urinary catheter care to prevent CAUTI. Baseline staff nurse knowledge was obtained, and reinterpretation of the facility’s existing protocols and bundles …

Bcg Overexpressing Ag85b Reprograms Host Immune Response Through Coordinated Transcriptional Networks, Vivek Chauhan, Rakesh Kumar, Raja Veerapandian, Enrique I. Ramos, Chinnaswamy Jagannath, Shrikanth Gadad, Subramanian Dhandayuthapani

School of Medicine Publications

Antigen 85B (Ag85B), an immunodominant protein secreted by Mycobacterium tuberculosis (Mtb), induces robust T-cell-mediated immunity in host cells. Previous studies have demonstrated that recombinant BCG strains overexpressing Ag85B (BCG85B) confer significant protection against tuberculosis in mouse models. This study hypothesized that enhanced protection by recombinant BCG85B results from modulation of host immune gene expression by the Ag85B antigen. To test this, RNA-seq analysis was performed on splenocytes from mice immunized with the wild-type BCG (BCG-WT) and BCG85B strains. Differentially expressed genes (DEGs) in the splenocytes of BCG85B-immunized mice indicated upregulation of immune-related KEGG pathways, including Th1/Th2 and Th17 differentiation, NF-kappa …

Metabolic Regulation And Immunity In The Spaceflight Environment, Graeme Grainger, Riley Dienna, Astrid Senko, Angela Cebula, Arden Rodriguez Arden Rodriguez

Discovery Day - Daytona Beach

Long-duration spaceflight exposes astronauts to chronic ionizing radiation and microgravity that disrupts homeostasis in the immune system and cellular metabolism. While simulated spaceflight models demonstrate altered T-cell polarization and sex-dependent shifts toward regulatory phenotypes, the metabolic mechanisms driving these immune changes remain unclear. Immune cell function is tightly linked to metabolic programming, with effector T cells relying on glycolysis and regulatory T cells favoring oxidative metabolism, making them highly sensitive to shifts in nutrient availability and redox balance. Emerging research further suggests that neutrophils act as metabolic regulators capable of reshaping the immune microenvironment through oxidative stress, cytokine production, and …

An Interprofessional Organization Change Process To Reduce Catheter-Associated Urinary Tract Infections, Bolatito Owolabi

Walden Dissertations and Doctoral Studies

This organization change process initiative addressed a critical safety practice gap regarding catheter-associated urinary tract infection (CAUTI) prevention in a 450-bed acute care facility. This gap was recognized based on evidence that the facility’s CAUTI Standardized Infection Ratio (SIR) was above the national benchmark—and daily necessity assessment compliance of only approximately 50%. This gap was attributed to an organizational interprofessional culture, which hindered timely device removal. Prolonged catheter dwell times increase patient morbidity, extend hospital stays, and expose the organization to severe financial penalties. The project aimed to safely reduce device dwell times by structurally empowering bedside nurses. I used …

Gene Therapy Strategies To Enhance Antifungal Immunity In Microgravity, Riley Dienna

Discovery Day - Daytona Beach

During spaceflight, the immune system of astronauts becomes impaired due to microgravity, resulting in increased susceptibility to infections caused by pathogens such as Candida albicans. One of the most common clinical treatments for aggressive candidiasis is amphotericin B, a polyene antimycotic that targeted ergosterol in the fungal cell membrane and compromised the stability of the membrane. However, due to the chemical similarities between ergosterol and cholesterol, this treatment also affects the somatic cells of patients it is administered to. A novel treatment is therefore required to combat the aggressive fungal infection while minimizing damage to the host’s cells. This project …

Numerical Analysis Of The Sir Model For Predicting Disease Spread, Victoria Gaibor, Isabel Tejada, Kate Moore

Discovery Day - Daytona Beach

This project, Numerical Solutions of the SIR Model for Predicting Disease Spread, investigates the application of numerical methods to analyze the dynamics of infectious diseases using the classical Susceptible–Infected–Recovered (SIR) model. The SIR model, a system of nonlinear ordinary differential equations, is widely used to describe how diseases such as COVID-19 propagate through a population. The primary objective of this study is to solve the SIR initial value problem using multiple numerical techniques, including Euler’s method, Runge–Kutta methods, and multistep methods, and to compare their accuracy and efficiency. The model is implemented using given initial conditions and parameters, and additional …

A Distinct Form Of Fat Fibrosis Is Linked To Insulin Resistance In People With Hiv, Diana L Alba, Alaa Abdellatif, Moon Kyung Choi, Stephen M Brown Mayfield, Thuy An T Pham, David I Berrios, Antonio E Rodriguez, Marin Ewing, Tony R Figueroa, Judy Gonzalez-Vargas, Ningyan Zhang, Zhiqiang An, Dawei Bu, Steven G Deeks, Philipp E Scherer, Peter W Hunt, Suneil K Koliwad

The Brown Foundation: Institute of Molecular Medicine

BACKGROUND

Despite antiretroviral therapy (ART), people with HIV (PWH) are at heightened risk for insulin resistance (IR) and type 2 diabetes (T2D). Subcutaneous adipose tissue (SAT) fibrosis contributes to metabolic disease, but its role in IR among PWH is unknown. We investigated the relationship between SAT fibrosis and IR in PWH, along with transcriptional signatures to distinguish it from SAT fibrosis due to obesity.

METHODS

We analyzed body composition and SAT fibrosis (hydroxyproline) in 46 PWH and 74 people without HIV (PWoH), excluding individuals with T2D. We examined fibrosis-related gene transcription in the SAT using a targeted panel and measured …

Bibliometric Analysis Of The Top 100 Most Cited Publications From Saudi Arabia Reveals The Predominance Of Medical Fields, Mahmoud Kandeel, Abdulla Al-Taher

Saudi Medical Journal

Objectives: To explore the citation impact, journals, international collaborations, trends of research topics and gain more visibility for the Saudi contribution to the global scientific landscape. Methods: This bibliometric study analyzes the top 100 cited publications affiliated with Saudi Arabia in Scopus, from inception to January 2026. The extracted bibliometric indicators include total citation metrics, sources, collaboration maps, and co-occurrence networks of keywords and collaborations. Results: The results indicate a strong predominance for medicine and health sciences as the subjects of the most prolific and significant number of citations. A substantial proportion of the most cited papers originates from major …

The Al-Bahah Paradox: Divergent Patterns Of Increased And Decreased Infectious Disease Incidence Relative To National Saudi Rates Over 12 Years Of Surveillance, Mohammed A. A. Alqumber

Saudi Medical Journal

Objective: To identify statistically significant deviations in notifiable infectious disease incidence between Al-Bahah region and national Saudi averages, and to generate hypotheses that may inform future epidemiological, microbiological, and public health investigations. Methods: In April 2026, a 12-year retrospective ecological study (2013–2024) was conducted using surveillance data from the Saudi Ministry of Health for 37 notifiable infectious diseases across 20 health regions. Cumulative incidence rates, standardized morbidity ratios (SMRs), and Z-tests compared observed cases in Al-Bahah against national estimates. Results: Overall incidence was 15.8% lower in Al-Bahah than nationally (86.42 versus 102.68; incidence rate ratios = 0.842; p …

The Role Of Chimeric Antigen Receptor Regulatory T Cells In Promoting Immune Tolerance In Solid Organ Transplantation: Mechanisms And Therapeutic Potential, Maher S. Alwethaynani

Saudi Medical Journal

Solid organ transplantation (SOT) is a life-saving procedure for patients with end-stage organ failure; however, lifelong immunosuppressant use is needed to prevent allograft rejection. These drugs increase the risk of non-Hodgkin lymphoma, liver, kidney, and lung cancers, and heighten susceptibility to oncogenic viruses, including hepatitis B and Epstein-Barr virus. The usage of chimeric antigen receptor (CAR) regulatory T (Treg) cells is a promising approach to induce transplant tolerance while minimizing dependence on immunosuppressants. The CAR Tregs offer the potential to enhance graft survival and quality of life by reducing immunosuppressant-related morbidity and mortality. Despite remarkable progress in transplantation tolerance, challenges …

Meta-Analysis On The Effect Of Tai Chi Chuan On Human Biomechanics And Health From (2021–2025), Bijad S. Alqahtani, Husam A. Almalki

Saudi Medical Journal

Objective: Prior reviews emphasize overall health outcomes of Tai Chi Chuan (TCC) but rarely resolve the biomechanical intermediates (such as Center of Mass (CoM)–Center of Pressure (CoP) control, joint loading) that link practice to clinical function—knowledge that matters for balance, fall risk, and osteoarthritic knee load management. This systematic review and meta-analysis aim to test the null hypothesis that TCC produces no improvement versus comparators in (i) biomechanical stability indices (mediolateral/anterior–posterior CoM–CoP separation; COP Root Mean Square RMS) and (ii) related clinical functions (such as Time up and go (TUG), Berg balance scale (BBS), Western Ontario and McMaster Universities Osteoarthritis …

Improving Chlamydia Testing For Females Through Universal Screening In Outpatient Pediatric Primary Care: An Adolescent Quality Improvement Initiative, Christina Howard

Doctor of Nursing Practice (DNP) Manuscripts

Chlamydia is the most common sexually transmitted infection in the United States in adolescents and young adults (Dutra & Lazenby, 2023). Per Smith, Reirden, and Nyquist (2022), adolescents and young adults between the ages of 15 and 24 account for more than 60% of new chlamydia infections each year. Testing for chlamydia is not standardized, and it is estimated that only 50% of those who qualify receive a yearly screening American Sexual Health Association. (2021). If outpatient testing and treatment is not improved these asymptomatic cases will be missed, infections in general will increase, and reinfections may occur leading to …

Comparative Analysis Of Artificial Intelligence (Ai) Implications For Active Learning And Assessment At Various Curricular Levels Of Stem And Health Sciences In Developed Versus Underprivileged Countries, Vinay Munlapudi, Santanu De

FDLA Journal

Today’s all-pervasive emergence of artificial intelligence (AI) necessitates a comprehensive evaluation of its role in education, especially for occupational disciplines in health sciences and STEM. AI has reshaped student learning and instructors’ navigation of the evolving, post coronavirus infectious disease (COVID-19) global academic landscape. This study aimed at encapsulating evidence-based AI implications for student-centered, active learning and assessment at various curricular levels of science, technology, engineering, mathematics (STEM) and health sciences education in developed versus underprivileged or less developed countries. An extensive, scoping review of 65 recent, scholarly publications was conducted over six months through diverse search engines (PubMed, Google …

The Effectiveness Of "Little Doctor" Training On Health Knowledge And Behavior Of Karawang Primary Students (2025), Aurelia A. Erawan, Shahnaz F. Azzahra, Rubee P. Risdiyanto, Patricia Andini, Muhammad K. Ramadhan, Ailsa T. Kirana, Istingadah Desiana Md, Raden M. Rifada Md

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

Background. Acute respiratory infection (ARI) remains a major public health problem in Indonesia, with West Java reporting the highest incidence. Poor Health-Related Behavior (HRB) practices are associated with increased ARI risk. The "Little Doctor" program is a government initiative that focuses on school health and aims to promote HRB among students. Along with this goal, this study aimed to determine the effectiveness of the program in improving knowledge of HRB and ARI among elementary school students in Pancawati Village, Karawang Regency.

Methods. This study employs a quasi-experimental one-group pretest-posttest design. Participants were selected based on inclusion criteria referring to the …

Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii

Patient Experience Journal

Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

The 2025 Measles Outbreak In Texas, Tamer Oraby, Martial L. Ndeffo-Mbah

School of Mathematical & Statistical Sciences Faculty Publications

Background: In 2025, Texas experienced its largest measles outbreak in decades, reporting 762 cases by mid-August. Measles is a highly contagious but vaccine-preventable infection transmitted mainly among unvaccinated individuals and capable of causing severe outcomes.

Methods: We investigate counterfactual measles control scenarios based on daycare and school closures and reactive vaccination of infants and children, including mixed interventions. We analyze the 2025 Texas outbreak using an age-structured multi-stage SEIR model formulated as a system of ordinary differential equations. The model is fit to case data using Bayesian inference to estimate the effective reproduction number and generate posterior predictive trajectories under …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

Measuring Health System Readiness In Saint Lucia Using International Health Regulations Capacity Indicators, Melissa Steele

Walden Dissertations and Doctoral Studies

Emerging infectious diseases continue to challenge national health systems, particularly in small island developing states with limited preparedness resources. Limited evidence comparing the International Health Regulations (2005) State Party Self-Assessment Annual Reporting (IHR SPAR) capacities of small island developing states with those of high-income countries limits efforts to identify preparedness gaps and strengthen health systems. The purpose of this quantitative comparative study was to evaluate Saint Lucia's preparedness using IHR SPAR indicators, compare its preparedness with the United States, and assess changes between 2023 and 2024. Guided by the World Health Organization Health System Framework, a quantitative cross-sectional design using …

Know Your Birth, Jasmine Mckelvey, Reagan L. Hunt, Michaela M. David

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Maternal mortality remains a significant public health concern in rural Kenya because of limited healthcare resources, inadequate emergency obstetric training, and barriers to accessing timely, high-quality maternal care. This quality improvement project evaluated the implementation of the Know Your Birth educational intervention, a culturally responsive, simulation-based training program designed to improve healthcare providers' knowledge, confidence, and competency in evidence-based maternal and newborn care. The project was conducted at Sega Dispensary in Sega, Siaya County, Kenya, and included 26 healthcare staff members. Guided by the Plan-Do-Study-Act framework, participants completed a brief educational presentation followed by three interactive skills stations focused on …

An Update On The Role Of Multimodal Analgesia In Perioperative Pain Management, Whitney N. Kuwamoto, Grace C. Eddy, Edward R. Mariano, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Multimodal analgesia has become a foundational principle of acute perioperative pain management and enhanced recovery and involves the application of nonpharmacologic, pharmacologic, and/or interventional techniques. The overall goal of this approach is to apply a combination of different modalities that target discrete points along the pain pathway and thereby avoid the overreliance on opioids and associated side effects. Since our review in 2018, there have been significant developments that have prompted an updated review of multimodal analgesia. In this article, we identify and summarize important trends that influence the current approach to acute perioperative pain management as well as provide …

Leveraging Administrative Health Data To Capture Rare Adverse Drug Reactions: Identifying Pediatric Patients With Trimethoprim-Sulfamethoxazole Acute Respiratory Distress Syndrome., Keith Feldman, Jenna Miller, Katherine Doane, Laura Loftis, James W. Antoon, Kevin J. Downes, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Rare adverse drug reactions (ADRs) are underrecognized and underreported in the electronic medical record (EMR). These events often require clinical review, making systematic identification challenging. The study aim was to develop an approach to prioritize identification and validation of a rare ADR to trimethoprim-sulfamethoxazole causing acute respiratory distress syndrome (TMP-SMX ARDS) across medical institutions. We developed a clinical phenotype based on 2 local TMP-SMX ARDS cases mapped to standardized elements of a national comparative healthcare database (PHIS). We validated identification of TMP-SMX ARDS at scale across medical institutions. A set of scoring criteria was created to prioritize cases and generate …

Current Practices Of Index Hospitalization Anticoagulant Use In Pediatric Patients With Acute Myeloid Leukemia., Abbey Elsbernd, Natalie Grills, James W. Antoon, Kathyrn Kyler, Lucas E. Orth, Timothy J. Savage, Matt Hall, Jennifer Goldman, Shannon L. Carpenter

Manuscripts, Articles, Book Chapters and Other Papers

Management and prevention of thromboembolism (TE) in pediatric acute myeloid leukemia (AML) are challenging because of prolonged periods of thrombocytopenia and associated bleeding. There are no guidelines for prophylactic or therapeutic anticoagulation for children with AML. This study aimed to understand the use of anticoagulation and its association with bleeding events (BEs) during index hospitalization in children with AML, both with and without thromboses. A retrospective cohort study was performed using the Pediatric Health Information System administrative database of index hospitalizations for patients aged 1 to 21 years from 2016 to 2024 with the diagnosis of AML across 49 children's …

Expression Levels Of Heat Shock Protein 72 And Their Correlation With Biomarkers Of Renal Function Among Hispanic Construction Workers Exposed To Ambient Heat In El Paso, Texas, Maria Fuentes

Open Access Theses & Dissertations

Heat shock proteins (HSP) are intracellular molecular proteins that are upregulated in response to cellular stress, including heat exposure. Through their protective functions, HSP help maintain protein structure, prevent protein denaturation, and preserve cellular homeostasis during states of physiological stress. Because of their cytoprotective properties, HSP have emerged as potential biomarkers for detecting early signs of tissue injury and predicting clinical outcomes associated with heat related illnesses (HRI), including acute kidney injuries (AKI). AKI is a leading cause of hospitalizations due to heat stress exposure and heat stroke. In the absence of early detection and effective therapeutic interventions, AKI may …

Improving Clostridioides Difficile Prevention Practices Through Standardized Stool Collection And Hand Hygiene, Dunya Khateeb, Laura Martin, Jessica Zhang

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Healthcare-associated Clostridioides difficile (C. diff) infections increase patient morbidity, length of stay, and healthcare costs (Simor, 2010). Our quality improvement project seeks to reduce C. diff infection rates and enhance prevention practices on the Med-Acute Unit at Sutter Medical Center Sacramento (SMCS) by utilizing the Plan-Do-Study-Act (PDSA) framework. Interventions will be implemented between March 2026 and July 2026. The project examined whether introducing a standardized stool collection tote and improving hand hygiene compliance would reduce C. diff infection rates. Participants included all nursing staff on the unit. Data is being collected through observational hand hygiene audits, collaboration with the SMCS …

Essays On Opioid Prescription Limit Policy Diffusion, Evaluation, And Opioid Use Disorder Treatment Utilization, Md Ashiqur Rab

All Dissertations

The drivers of the opioid epidemic in the United States include the oversupply of prescription opioids, the availability of illicit drugs, under-resourced healthcare settings, and several socio-economic factors. Federal and state-level initiatives, including policy interventions to curb the oversupply of prescription opioids, providing access to healthcare, prevention and recovery support services, and community-level engagement, have been adopted to combat the opioid epidemic. Motivated by the need to better understand the policy and recovery efforts to address the epidemic, this dissertation examines opioid prescription limit policy diffusion, evaluation, and treatment utilization patterns. This dissertation comprises three manuscripts that offer a comprehensive …