Digital Commons Network^™

Dibh Liver Sbrt: Comparative Analysis Of Vmat 6fff And 10fff For Safety And Efficiency, Justen Hudson

Masters Projects

Purpose:

To evaluate the dosimetric performance and delivery efficiency of 6MV flattening filter free (6FFF) and 10MV flattening filter free (10FFF) VMAT beam energies for deep inspiration breath- hold (DIBH) liver stereotactic body radiation therapy (SBRT), with emphasis on treatment time, breath-hold demands, and organ at risk (OAR) sparing.

Methods:

Ten previously treated DIBH liver SBRT patients were retrospectively replanned using standardized VMAT geometry, identical optimization objectives, and consistent contouring. Each patient received paired 6FFF and 10FFF plans generated in Eclipse using AcurosXB. Dosimetric endpoints included target coverage, conformity index (CI), gradient index (GI), and OAR dose metrics based on …

Staff Education To Integrate The Cdc Prediabetes Risk Test Into Primary Care Intake, Helen Ndangam

Walden Dissertations and Doctoral Studies

This staff education project involves addressing the gap in using a standardized prediabetes screening protocol at an outpatient primary care clinic in Maryland, which leads to missed early interventions. Standardizing this process is vital for nursing practice to promote preventive care and optimize workflows. The practice-focused question was for medical support assistants (MSAs) at an outpatient primary care clinic: How does implementing a competency-based education program on the Centers for Disease Control and Prevention (CDC) Prediabetes Risk Test (Centers for Disease Control and Prevention [CDC], n.d.) affect staff knowledge, workflow confidence, and screening compliance over a 7-week period? The purpose …

Staff Education To Reduce Burnout Among Psychiatric Nurses Caring For Patients With Schizophrenia, Gloria Laizer

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice staff education project addressed occupational burnout among psychiatric registered nurses caring for patients with schizophrenia. Workplace violence, compassion fatigue, emotional exhaustion, and staffing shortages place psychiatric nurses at high risk for burnout, threatening nurse well-being, workforce retention, and patient safety. The practice site lacked a standardized resilience education program. The practice-focused question was, In psychiatric nurses caring for patients with schizophrenia, does implementation of an evidence-based resilience education program, compared with current practice, reduce occupational burnout? The purpose was to implement and evaluate such a program, informed by the Johns Hopkins evidence-based practice (JHEBP) Model …

Improving Nurses’ Knowledge Of Barcode Medication Administration Using Structured Education In Group Homes, Bernadette Beleho Woueko

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) educational project evaluated the effectiveness of a structured Barcode Medication Administration (BCMA) education program in enhancing nurses’ knowledge of BCMA and promoting medication safety. Because local BCMA compliance rates were 15 percentage points below the organizational benchmark, an educational intervention was implemented using the Johns Hopkins Evidence-Based Practice Model and the Plan-Do-Study-Act framework. Fifteen staff members, including Registered Nurses, Leaders, and Managers, participated in two educational sessions focused on BCMA use, medication safety, case studies, and role-play activities. Findings demonstrated a significant increase in BCMA knowledge, with scores improving from 68.4% to 86.7% (p < .001). These results support the continuation of BCMA education, competency validation, and training programs to reduce medication errors and enhance patient safety. Keywords: Barcode Medication Administration, BCMA, medication administration errors, nursing education, patient safety, evidence-based practice, educational project.

Staff Education To Improve Hypertension Management Knowledge, Angelor Eliscard

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing Practice (DNP) staff education project, I addressed inconsistent staff knowledge of evidence-based strategies for preventing and controlling hypertension among African American women in an outpatient primary care setting. The practice-focused question was: In an outpatient clinical setting, what was the impact of an evidence-based staff education program on healthcare providers' knowledge of hypertension prevention and control strategies for African American women, as measured by pretest and posttest scores? The purpose of this project was to implement and evaluate a structured staff education program to improve providers' knowledge of evidence-based strategies for preventing and controlling hypertension …

Stewardship In Action: Reducing Unnecessary Antimicrobial Use In Long-Term Care, Mariatu Sulaiman

Walden Dissertations and Doctoral Studies

Antimicrobial overuse in long-term care facilities (LTCFs) contributes to antimicrobial resistance, avoidable healthcare costs, and adverse drug events, particularly when antibiotics are prescribed for asymptomatic bacteriuria rather than symptomatic urinary tract infections (UTIs). Evidence-based clinical practice guidelines, including the McGeer Criteria, provide standardized approaches for differentiating true UTIs from asymptomatic bacteriuria and supporting appropriate antimicrobial prescribing. The purpose of this evidence-based practice project was to evaluate the development and implementation of a clinical practice guideline incorporating the McGeer Criteria into an antibiotic stewardship program in an LTCF. The practice-focused question examined what evidence supports strategies for reducing unnecessary antimicrobial use …

Staff Education To Improve Obesity Risk Assessment And Referral Practices, Omolara Aminat Oshokoya

Walden Dissertations and Doctoral Studies

Summary This staff education project addressed inconsistent obesity risk assessment practices in an adult primary care setting. Obesity is associated with increased rates of cardiovascular disease, diabetes, hypertension, and other chronic conditions. At the project site, obesity assessment practices relied largely on body mass index (BMI), resulting in inconsistent identification of obesity-related risks and referral needs. The purpose of this project was to educate providers on the Edmonton Obesity Staging System (EOSS) to improve obesity risk identification and referral practices. The project evaluated whether the staff education intervention improved providers' knowledge and use of the Edmonton Obesity Staging System (EOSS) …

Reducing Live Discharges Using A Tiered Protocol In A Rural Hospice: A Quality Improvement Project, Jemma Lowak

Doctor of Nursing Practice Final Project Abstract

Purpose: To reduce 30-day caregiver-driven hospice revocations by implementing a tiered post-admission nursing visit protocol based on caregiver preparedness. Background: Caregiver distress and inadequate support contribute to hospice revocations and interruptions in care. Increased nursing contact during the first week of enrollment may improve caregiver preparedness and reduce crisis-driven hospitalizations. Methodology: An eight-week quality improvement project using the Plan-Do-Study-Act framework was implemented at a rural hospice agency. Caregivers completed a Caregiver Preparedness Survey to assign preparedness tiers and guide additional nursing visits during the first week. Process measures included survey completion and protocol adherence. Outcome measures included caregiver preparedness and …

Improving Adherence To Remote Patient Monitoring (Rpm) For Patients With Hypertension, Chioma Udegbune

Student Scholarly Projects

Practice Problem: Hypertension is a leading contributor to cardiovascular disease, and suboptimal adherence to remote patient monitoring (RPM) limits opportunities for timely intervention and effective blood pressure management in outpatient primary care.

PICOT: The PICOT question that guided this project was: Among outpatient clinic nursing staff responsible for remote patient monitoring (RPM) in adults with hypertension (P), how does implementation of a structured nurse-led education and reminder protocol (I), compared to standard RPM practices consisting of routine onboarding and passive reminder processes (C), influence patient adherence to RPM protocols (O) over a 10-week period (T)?

Evidence: Evidence supports nurse-led education, …

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 …

Development Of A Clinical Practice Guideline For Hpv Vaccination In Low-Income Adolescents Using The Agree Ii Framework, Jariatu Fatu Bundu

Walden Dissertations and Doctoral Studies

Human papillomavirus (HPV) vaccination is an effective strategy for preventing HPV-related cancers; however, vaccination initiation and series completion remain suboptimal among adolescents, particularly those from low-income and underserved populations. This Doctor of Nursing Practice project addressed an evidence-to-practice gap involving the absence of a standardized clinical practice guideline (CPG) for HPV vaccination in a family practice setting serving predominantly low-income adolescents. The purpose of the project was to develop and validate an evidence-based CPG to standardize provider recommendations and support improvement in HPV vaccination initiation and series completion. Evidence was appraised and synthesized using the Johns Hopkins Evidence-Based Practice Model, …

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 …

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 …

Nursing Staff’S Perception Of The Implementation Of The Obstetric Emergency Code Pink, Mareena Johnson

Walden Dissertations and Doctoral Studies

The local nursing practice problem addressed by this DNP doctoral project was the inconsistent and uneven response to obstetric emergencies within the health care setting. The purpose of this project was to evaluate the current implementation of the Code Pink protocol, identify any gaps or barriers in its effectiveness, and gather insights from nursing staff to propose refinements that would enhance its reliability and impact., The perception of nursing staff regarding obstetric emergency codes represents a critical dimension in the domain of maternal and neonatal health care, significantly influencing the efficacy of emergency responses and patient outcomes. Obstetric emergencies, such …

Best-Practice Patient Education On Glp-1, Low-Glycemic Diet, Intermittent Fasting, And Exercise For Weight Loss In Obese Nondiabetics, Clara Green

Walden Dissertations and Doctoral Studies

Executive Summary: Clinical Practice Guideline Best-Practice Patient Education on GLP-1, Low-Glycemic Diet, Intermittent Fasting, and Exercise for Weight Loss in Obese Nondiabetics by Clara Green MS, Walden University, 2020 BS, University of Texas at El Paso, 2014 Executive Summary Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2026

Telomere-To-Telomere Genome Assembly And A Pangenome For The Rat, Kai Li, Julia L Ciosek, Sergey Koren, Adam M Phillippy, Yaming Zhu, William A Lauer, Shelise Y Brooks, Gerard G Bouffard, Brandon D Pickett, Beth L Dumont, Melissa L Smith, Theodore S Kalbfleisch, Peter A Doris

The Brown Foundation: Institute of Molecular Medicine

We report a complete rodent telomere-to-telomere genome assembly from the brown rat, Rattus norvegicus. Annotation was enriched with multi-tissue long-read RNA sequencing and uncovered numerous novel genes. Assembly of both sex chromosomes reveals the absence of gene coding in the presumed pseudo-autosomal regions and the presence of centromeric satellite repeats on distal chromosome Y (chrY). We provide evidence of meiotic conjunction between Xp and Yq. The genome assembly reveals several expanded autosomal regions enriched for testis-expressed genes. Finally, we have generated a pangenome from recent high-quality assemblies of 8 distinct inbred rat strain genomes. This allows the strain-specific distribution of …

Race And Ethnicity And Overall Survival In Pediatric Acute Myeloid Leukemia, Daniel J. Zheng, Long Khuong, Catherine Aftandilian, Kira Bona, Emi H. Caywood, Caitlin W. Elgarten, Brian T. Fisher, Cody-Aaron L. Gathers, Taumoha Ghosh, M. Monica Gramatges, Gary Hettinger, Meret R. Henry, Yuan-Shung V Huang, Yimei Li, Kelly Maloney, Amir Mian, Tamara P Miller, Arunkumar Modi, Rajen Mody, Regina M. Myers, Haley Newman, Jose Ortiz, Alix E. Seif, Caroline Smith, Jamie Stokke, Naomi Winick, Jennifer J. Wilkes, Victor Wong, Richard Aplenc, Kelly D. Getz

Department of Pediatrics Faculty Papers

IMPORTANCE: Hispanic and non-Hispanic Black (hereafter, Black) children with acute myeloid leukemia (AML) have historically experienced worse survival outcomes compared with non-Hispanic White (hereafter, White) children. Understanding specific intermediate pathways underlying these outcome disparities is a critical step to directing interventional efforts and resources.

OBJECTIVE: To compare survival outcomes by race and ethnicity in a large contemporary cohort of pediatric patients with AML and to examine presentation acuity, frontline organ toxic effects, and relapse as potential mediators of any observed outcome disparities.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was analyzed from April 2025 to January 2026 and included …

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 …

Pre-Implementation Factors For Active Music Engagement (Ame): Barriers And Facilitators To Integrating An Evidence-Based Dyadic Intervention Into Pediatric Oncology Care., Kristin M. Story, Elizabeth Harman, Kristin Stegenga, Jelena Golubovic, Sheri L. Robb

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pediatric cancer treatment is a difficult and distressing experience that often results in sustained, interrelated distress in young children and parents, and traumatic stress symptoms for some parents. Few evidence-based interventions address this dyadic distress. Active Music Engagement (AME) is a manualized, evidence-based music play intervention that significantly reduces distress in child/parent dyads and mitigates traumatic stress and improves well-being among highly distressed parents and those experiencing sociodemographic risk. Successfully integrating AME into standard care requires a systematic understanding of implementation factors. This study aimed to identify site-specific barriers and facilitators that influenced successful AME delivery during a recently …

Dosimetric Comparison Between Geometric Centroid And Minimax Isocenter Placement In Single Isocenter Multitarget Stereotactic Radiosurgery Plans In Hyperarc, Matthew Gloudeman

Masters Projects

Single-isocenter multi-target (SIMT) stereotactic radiosurgery (SRS) utilizing Varian HyperArc streamlines clinical workflows but introduces geometric sensitivity for distant outlier lesions when rotational and setup uncertainties are taken into account. The default isocenter location in the HyperArc workspace is the geometric centroid, which is inherently biased toward clusters of lesions. This study evaluates the dosimetric plan quality of an alternative minimax isocenter strategy, which minimizes the maximum lesion-to-isocenter distance, shortening the rotational lever arm to enhance mechanical robustness. Two fractionated SRS (fSRS) plans were generated for ten patients with 3-5 brain metastases using identical beam configurations: one using HyperArc’s default geometric …

The Impact Of Scar Wires On Dose Distribution Of Electron Fields, Ahmad Nour

Masters Projects

Purpose: This phantom study looked at whether changing the Hounsfield unit (HU) value for radiopaque scar wires in Eclipse changed the calculated electron dose distribution. Methods and Materials: Radiopaque wires were placed in the same abdominal area on an anthropomorphic phantom. The wires were set up in a circle. The CT images were brought into Eclipse, the wires were contoured, and the planning target volume was made 1 cm inside the circle of wire. For every wire size and electron energy, two matching plans were made: one plan with no density override and one plan with a density override applied …

Cone Vs. Volumetric Modulated Arc Therapy (Vmat) Stereotactic Radiosurgery (Srs) Planning For Multiple (7) Brain Targets: Dosimetric Tradeoffs And Clinical Decision Guidance, Juan Garcia

Masters Projects

Purpose: This study compared cone-based stereotactic radiosurgery (SRS) and single-isocenter volumetric modulated arc therapy (VMAT) for multiple (7) intracranial targets to evaluate differences in target coverage, conformality, dose falloff, and normal brain exposure.

Methods: A phantom-based study was performed using progressively increasing configurations of 10-mm spherical targets, from one to seven targets. Cone-based SRS and VMAT plans were evaluated using D99, CI100, CI50, gradient index (GI), maximum dose, V12Gy, and V5Gy.

Results: Both planning techniques achieved similar target coverage. Cone based SRS produced a steeper dose gradient, with a mean GI of 2.99 compared with 4.66 for VMAT ( …

Psychological Interventions For Children With Neurodevelopmental Disabilities In The Context Of Neurodiversity: A Systematic Review, Kalliopi Megari, Dimitra V. Katsarou, Evangelos Mantsos, Soultana Papadopoulou, Efthymia Efthymiou, Maria Theodoratou, Maria Sofologi, Eugenia Toki

All Works

Highlights What are the main findings? What is the implication of the main finding?Highlights What are the main findings? What is the implication of the main finding?Abstract Background/Objectives: This systematic review examines psychological interventions for children with neurodevelopmental disabilities within a neurodiversity framework, emphasizing that variations in cognition, behavior, and neurological functioning represent natural forms of human diversity rather than deficits. Methods: A systematic literature search was conducted across the PubMed, PsycINFO, and Google Scholar databases for studies published between 2010 and 2025. Studies were included if they focused on children with autism spectrum disorder (ASD), learning or intellectual disabilities …

Shared Equity Leadership In An Offshore Medical School: Distributing Responsibility For Equity, Vishal B. Surender, Sreekrishna Penna, Oluwabusola Osimosu

Journal of Comparative & International Higher Education

This essay applies the Shared Equity Leadership (SEL) framework to an offshore MD program at a private Caribbean medical school where students complete basic sciences on an island and clinical clerkships across multiple international sites. Using SEL scholarship and de-identified institutional data, we ask how equity work is currently distributed, where gaps emerge in assessment, remediation, and mobility for historically underrepresented students in medicine, and how responsibility for equity might be more deliberately shared. The Woven model of SEL provides a lens to map existing structures like curriculum committees, CQI dashboards, advising systems, and clinical site partnerships. We propose a …

A Rare Sight: Isolated Third Nerve Palsy As The Sole Presentation Of A Non-Functional Pituitary Adenoma, Jorge A. Aboytes, Jose J. Loayza, Ivan Mogollon, Ismael Cantu

Research Colloquium

Introduction: Hypopituitarism results from insufficient pituitary hormone production, often due to adenomas—accounting for ~15% of intracranial tumors. Non-functional adenomas, typically affecting older adults, may present with visual field deficits, headaches, or cranial nerve palsies when extending into the cavernous sinus. Isolated oculomotor (third nerve) palsy is a rare initial manifestation.

Case: A 46-year-old man with uncontrolled type 2 diabetes presented with acute right-sided headache, diplopia, ptosis, and right leg weakness. He had right ptosis, a fixed dilated pupil, facial droop, and right leg weakness. Given concern for stroke, he received thrombolytic therapy with partial leg improvement, but persistent diplopia and …

Beyond The Clot: A Rare Case Of Extensive Dvt And Pulmonary Embolism Revealing May-Thurner Syndrome, Jorge A. Aboytes, Jose J. Loayza, Ivan Mogollon, Daniel Pena, Michelle Lopez

Research Colloquium

Introduction: Deep vein thrombosis (DVT) in young adults is uncommon and typically associated with identifiable risk factors. In cases where DVT occurs without apparent provocation, congenital anatomical anomalies should be considered. May-Thurner Syndrome (MTS), a vascular compression disorder involving the left iliac vein, is a frequently overlooked cause of iliofemoral DVT in young individuals, particularly women.

Case Presentation: A 28-year-old woman with no significant medical history presented with acute left leg swelling, pain, and discoloration, along with new-onset dyspnea and chest discomfort. She had recently transitioned to a contraceptive patch and reported reduced mobility due to fatigue. Imaging confirmed left …

Myoelectric Transradial Prosthesis Motor Control With Temporal Convolutional Neural Network Signal Processing, Carolyn Ascha Richardson, Katherine Clark, Francis Genco, Hope Lea, Tobiah Rosser

Discovery Day - Daytona Beach

Transradial (below-the-elbow) amputees account for more than half of all upper limb amputations. Myoelectric prosthetic arms, which use electromyography (EMG) sensors on the surface of the forearm to convert electrical signals from residual limb muscles and mimic hand movement, are popular options for these amputees. However, these prostheses are limited in residual muscle detection and movement accuracy. The objective of this project is to affordably manufacture an externally-powered transradial prosthesis prototype through EMG time-versus-voltage readings collected with six Delsys Trigno Avanti and eight Thalmic MYO EMG sensor channels placed along the extensor digitorum, extensor carpi radialis, extensor carpi ulnaris, flexor …

Fatigue And Circadian Disruption In Long-Haul Ferry Pilots: Human Factors Challenges And Mitigation Strategies, Parneet Makkar

Discovery Day - Daytona Beach

Fatigue and circadian rhythm disruption present significant human factors challenges in long-haul aviation operations, particularly for ferry pilots (pilots responsible for transporting aircraft long distances between locations) who often travel across multiple time zones before beginning flight duties. Circadian rhythms regulate the human sleep-wake cycle and are closely tied to cognitive performance, alertness, and coordination. Rapid travel across time zones can disrupt these rhythms, producing symptoms commonly associated with jet lag such as sleep disturbances, fatigue, and reduced cognitive functioning. For ferry pilots, long travel periods and irregular schedules may increase the likelihood of fatigue before flight operations even begin. …

Mri-Based Estimation Of The Hip Joint Center In Infants Using Two Sphere-Fitting Methods, Victoria Melendez

Discovery Day - Daytona Beach

Accurate estimation of the hip joint center (HJC) is critical for biomechanical modeling and clinical assessment. Common methods include predictive methods (e.g., regression equations) and functional methods such as sphere-fitting. In infants, femoral head-based methods are often limited due to incomplete ossification of the anatomy and poor visualization in computed tomography (CT) images. This study evaluates an alternative approach using MRI-based sphere fitting of the ossified acetabular rim, comparing its accuracy to traditional femoral head-based methods. MRI scans of three male infants (ages 10.7- 12.7 months) were used to manually place landmarks on the ossified acetabulum and the cartilaginous boundary …

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 …