Digital Commons Network^™

Town Of Sugar Hill, New Hampshire 63rd Annual Report Year Ending December 31, 2024, Sugar Hill Town Representatives

Sugar Hill, NH Annual Reports

This is an annual report containing vital statistics for a town/city in the state of New Hampshire.

Annual Reports Of The Selectboard And Other Town Officers, Charlestown, N.H., For The Year Ending December 31, 2024, Charlestown Town Representatives

Charlestown, NH Annual Reports

This is an annual report containing vital statistics for a town/city in the state of New Hampshire.

2024 Milton Annual Town Report, Milton Town Representatives

Milton, NH Annual Reports

This is an annual report containing vital statistics for a town/city in the state of New Hampshire.

Implementing Gallup 12+ Employee Engagement Survey In A Critical Access Hospital, Catherine R. Hardwick

Honors Theses and Capstones

Objective: To utilize the Gallup Q12+ survey to assess baseline staff engagement among nurses and nursing assistants at a critical access hospital, implement direct education intervention, and evaluate its impact on staff engagement rates, with the goal of identifying micro and macro-problems.

Methods: This quality improved project was conducted at Littleton Regional Hospital, a level Ⅲ trauma center and critical access hospital. The PDSA cycle started on March 1 and ended May 10. The Gallup Q12+ survey was sent to Registered Nurses, Licensed Nursing Assistants, and Nursing Technicians to establish baseline staff engagement levels and areas that need improvement. Directed …

Using Rna Sequencing To Examine Encephalic Gene Expression In Cactus Mice, Sarah A. Nicholls

Honors Theses and Capstones

Many of the exact mechanisms by which desert-adapted animals avoid dehydration-induced complications are unknown, though there are likely ties to the general mammalian dehydration response, a multisystem process spearheaded by the brain. Peromyscus eremicus, the cactus mouse, can survive its whole life without intaking water and is commonly used as a model to study desert adaptations. In this study, we have used bulk transcriptomics to characterize the differential gene expression across hydrated and dehydrated P. eremicus in five major regions of the brain: the cerebral cortex (referred to throughout much of this paper as the cortex), hippocampus, thalamus, midbrain, …

Noise In The Acute Care Patient Setting, Taylor A. Cota, Brynn Roberts

Honors Theses and Capstones

Noise levels in hospital environments can negatively impact patient satisfaction and recovery, particularly in high-acuity units such as Progressive Care Units (PCUs) (Choiniere, D. B., 2010). Patient satisfaction surveys at the PCU at Exeter Hospital have consistently identified noise as a concern, highlighting the need for rigorous quality improvement (QI) planning phase to determine whether a structured intervention, such as white noise implementation, is indicated.

This project focuses on the initial planning phase of the Plan-Do-Study-Act (PDSA) cycle (Institute for Healthcare Improvement, n.d.) to assess the feasibility and necessity of introducing white noise machines to enhance patient experience on the …

Poetry Is Change: Close Reading In The Context Of Trauma Research, Maeve Cecilia Tobin Flusser

Honors Theses and Capstones

No abstract provided.

Frozen Commons: Food Security And Food Sovereignty In Rural Alaskan Communities And Tribes, Catey Selby, Weiwei Mo

Honors Theses and Capstones

This project explored the challenges, needs, and potential solutions related to food security and food sovereignty in rural Alaskan communities. These communities have long relied on traditional subsistence practices like fishing, hunting, and foraging, but those practices have been increasingly affected by climate change, regulatory restrictions, and commercial overfishing. Key issues identified included shorter hunting seasons, changes in animal migration, unsafe ice conditions, habitat loss, complex land ownership, and permitting barriers. Large-scale commercial fisheries also put additional pressure on subsistence resources, reducing access to traditional food sources.

The project focused on identifying key stakeholders—such as government agencies, tribal organizations, and …

Mental Health Outcomes And Client Perception Of Religious/Spiritual Integration In Psychotherapy, Cole R. Bouchard-Liporto

Honors Theses and Capstones

Religion and spirituality have been shown to have positive effects on physical and mental health in recent years. Despite this, research suggests religion and spirituality as characteristics of clients to be overlooked in modern secular psychotherapy treatments. This study investigated mental health outcomes from psychotherapy related to the perceived integration of religious and spiritual beliefs. A survey was administered to and taken by 178 University of New Hampshire students on the web-platform Qualtrics to investigate client psychotherapy experiences and their perception of how their religious and spiritual beliefs and values were integrated. The research conducted for this study points to …

Realignment In The South China Sea: Filipino-Australian Relations In The Face Of Chinese Expansionism And American Isolationism, Abigail L. Smart

Honors Theses and Capstones

To explore middle-power strategies, this policy paper examines the emerging bilateral defense partnership between Australia and the Philippines, scheduled for signing in 2026. Both Australia and the Philippines, as mutual defense partners to the United States, are faced with insecurity given the second Trump administration's comments towards a strict “America first” policy. Faced with constant threat from Chinese expansionism in the South China Sea, the Philippines, in particular, is vulnerable if America withdraws its military support. Conversations about the importance of middle-power-to-middle-power relationships often disregard the Philippines' role in the South China Sea conflict. China continues to claim rock formations, …

18s Metabarcode Analyses Of Eukaryotic Species In The Respiratory Microbiomes Of Wild Canids From New Hampshire, Collin Sinclair Blake

Honors Theses and Capstones

This study is of an exploratory nature and focuses on characterizing the eukaryotic microbiota present in the respiratory tissues of six wild canids and one domestic canine. The contents of this document largely pertain to dry lab analyses of 18S barcodes in bioinformatics programs – primarily QIIME2 running in the GitBash command line, service for which was hosted by the UNH Ron Bioinformatics training server. All procedures listed within the section below were performed by second parties at the UNH Hubbard Center for Genomics Studies (HCGS), the New Hampshire Veterinary Diagnostics Lab (NHVDL), and the UNH Microbial Ecology and Emerging …

A Comparison Of Pacing Strategies Between Males And Females Running In Carbon-Fiber Plated Shoes, Amanda P. Ares, Allison A. Petry, Morgan M. Koskela, Owen R. Daigle, Summer B. Cook

Honors Theses and Capstones

Carbon-fiber plated (CFP) shoes have been shown to enhance performance in elite runners, with less research on recreational runners. It is also unknown how CFP shoes affect pacing strategy during races. Additionally, it is known that male and female recreational runners pace differently throughout running races. Purpose: This study aimed to compare pacing strategies between male and female recreational runners running in non-CFP and CFP shoes during a 5km time trial. Methods: Twenty-one male and female recreational runners (22±4 years, 1.7±0.07m, 65.2±7.0kgs) completed two 5km time trials in non-CFP and CFP shoes in a randomized order. Participants were blinded to …

Improving Perinatal Outcomes With The Mood Disorder Questionnaire: A Quality Improvement Project To Increase Identification And Referral, Elizabeth R. Bargardo

Master's Theses and Capstones

Abstract

Background: Perinatal mental health is a growing concern, with under identification and lack of access to mental health as contributing factors. Screening tools such as the Mood Disorder Questionnaire are one way to increase identification of patients at risk for bipolar-spectrum disorders and subsequent postpartum psychosis and initiate referrals to appropriate mental health services.

Local Problem: One outpatient women’s health center has a 94% screening rate for the Edinburgh Postnatal Depression Score (EPDS) for anxiety and depression but has not implemented a screening for bipolar disorder. In addition, while approximately one in five perinatal patients struggles with a mental …

The Effects Of Heat Stress On The Rumination In Lactating Dairy Cows, Kailey Anne Deighan

Honors Theses and Capstones

This study aimed to (1) investigate the association between Temperature-Humidity Index (THI) and rumination activity patterns in lactating dairy cows, and (2) explore the breed-specific impacts of THI on rumination time in Holstein and Jersey cows. The first hypothesis was that higher THI values would be associated with decreased rumination time (RT). The second hypothesis proposed that Holsteins, due to their lower heat tolerance, would experience greater reductions in RT than Jerseys under heat stress. From June 1 to October 1, 2024, daily climatic data were collected in New Hampshire using VisualCrossing to calculate THI. Each day was categorized into …

Effective Measurement-Based Care For Depression Within Va Health Systems: A Quality Improvement Initiative, Amie L. Doyle

DNP Scholarly Projects

Background: Depression is highly common among U.S. veterans, surpassing civilian rates. Measurement-Based Care (MBC), including the Patient Health Questionnaire-9 (PHQ-9), facilitates systematic symptom monitoring and treatment enhancement. At Manchester VA Medical Center (VAMC), PHQ-9 completion in primary care was low (18.93% in May 2025) due to workflow inefficiencies, provider workload, and dependence on Mental Health Service Line (MHSL) referrals.

Local Problem: Underutilization of the PHQ-9 in primary care hampers early detection and effective treatment of depression among veterans.

Methods: Four primary care teams received training on using the Behavioral Health Laboratory (BHL) software, which facilitates pre-visit electronic completion of the …

Improving Transitions In Care: The Post-Discharge Follow-Up Process For Va Hospitalizations, Kristina Huntoon

DNP Scholarly Projects

BACKGROUND: Transitions in care from hospitalization to home are a high-risk period for patients. Without care coordination during these transitions in care, patients are left trying to manage their care without any support. The VA has a mandated two-day post-discharge contact process that requires a member of the patient’s primary care team to contact the patient within two business days of a VA discharge.

METHODS: The Plan-Do-Study-Act method of quality improvement was used for this project. Baseline assessment included review of patient medical records for 15 months before the intervention, which included 27 discharges from unit 78C. The patient medical …

An Integrated Approach To Patient Safety In The Medical Device Industry: A Quality Improvement Project, Kaylee Boisvert

DNP Scholarly Projects

Background: The currently established product surveillance process at Boston Scientific is a reactive one which presents compliance risks, patient safety risks, and quality risks. Evolution to a proactive process is necessary to protect public health, allow for commercialization of devices that have a robust safety, reliability, and efficacy profile, and to identify and react to risk before or at the early stages of a problem.

Methods: A pre-implementation survey of baseline opinions associated with decision-making, efficiency, effectivity, and safety of the current product surveillance system was performed. A baseline time study was performed associated with the process, which was separated …

The Impacts Of Social Media On Teacher Environment Perceptions, Victoria Puglia

Doctoral Dissertations

Social media significantly influences teachers’ perceptions of their professional environment, shaping job satisfaction, respect, autonomy, and professional support. This dissertation, split into three articles, investigates how exposure to positive, negative, or mixed social media posts impact these perceptions, addressing concerns surrounding teacher well-being and attrition in K-12 education. The study began with a literature review in Article 1 to establish a theoretical framework, followed by a series of validation steps to refine a survey instrument aligned with teaching perception constructs in Article 2. The final survey was administered to 406 K-12 teachers across the United States in Article 3, using …

Developing An Evidence-Based Culture Through Journal Club: A Pilot Study, Allison Davidson

DNP Scholarly Projects

Evidence-based practice is essential for improving patient outcomes and reducing healthcare costs, yet its implementation in nursing remains limited due to persistent barriers such as lack of knowledge, leadership support, time, and resources. Despite these challenges, nurses generally hold positive attitudes toward EBP, indicating a strong foundation for future initiatives aimed at enhancing education, training, and organizational commitment. To fully integrate evidence-based practice into nursing care, healthcare systems must address these barriers and invest in sustained support, ensuring that clinical decisions are consistently guided by the best available evidence. A pilot nursing journal club, led by an evidence-based practice mentor …

Optimizing Compression In Venous Leg Ulcers To Improve Wound Healing Rates Through Wound Care Nurse Support: A Quality Improvement Project, Temilola Obisesan

DNP Scholarly Projects

BACKGROUND: Venous leg ulcers (VLUs) are the most common lower extremity ulcers, accounting for 75% of chronic leg wounds and affect up to 2% of the population in developing countries. Generally, it has a 1-year recurrence rate of 40-70%. VLUs costs about $11B in the USA and other developed countries annually. Patients with VLUs spend about $7,000 more annually. Compression therapy along with local wound care is the best approach for VLU management, with compression therapy as the gold standard. Currently, compression therapy is underutilized in VLU care. The goal of this QI project is to provide wound nurses who …

Developing A Rural Family Health Curriculum To Promote Retention Of New Graduate Nurse Practitioners, Molly G. Boudreau

DNP Scholarly Projects

Background: There is a critical shortage of primary care providers (PCPs) in rural areas of the United States. Nurse Practitioners (NPs) are essential for addressing the primary care shortage especially in rural communities. However, significant barriers exist to the retention of NPs in rural communities, especially new graduate NPs in the first year of practice. Evidence in the literature suggests bolstering the focus on transition-to-practice for new graduate NPs to improve retention and turnover rates.

Purpose: The aim of this quality improvement project was to develop a structured, postgraduate, on-boarding curriculum at a rural outpatient family medicine clinic with the …

Feeding With Competence: Empowering Parents In Ng Feeding For Nicu Graduates: A Quality Improvement Project, Karen Marsh

DNP Scholarly Projects

Abstract

Background: Infants who are born prematurely stay in a neonatal intensive care unit (NICU) until they are able to take full enteral nutrition by mouth. While in the NICU a nasogastric tube (NG tube) would be used to supplement the volume needed to be ingested for optimal nutrition. Infants typically feed better with a consistent caregiver and at home in an environment with less stimulation. Allowing infants to be discharged with an NG tube allows the parents to be more involved in their infant's care with a shorter hospital stay. An increased number of infants being discharged home with …

A Quality Improvement Initiative To Improve Nurse Reassessment And Documentation Of Administered Prn Pain Medication, Stacy L. Brady

DNP Scholarly Projects

BACKGROUND: Effective pain management remains a critical challenge both globally and with the United States, where more than 51 million adults suffer from pain. Veterans are particularly vulnerable due to the lasting impact of service-related injuries. “Pro re nata” (PRN or “as needed”) pain medications are frequently used to manage pain, but timely reassessment and documentation following a PRN pain medication administered is often missed or delayed. Reassessing and documenting the results after the administration of the PRN pain medication is required by The Joint Commission and the Veterans Affairs Providence Healthcare System’s (VAPHS) standard operating procedure (SOP) states reassessment …

Implementation Of Outpatient Cervical Ripening In The Community Hospital Setting: A Quality Improvement Process, April St Hilaire

DNP Scholarly Projects

Background: Cervical ripening is a critical component of labor induction. Outpatient cervical ripening using mechanical dilators offers a safe patient- centered alternative to inpatient management, with potential benefits in efficiency and patient satisfaction and cost savings.

Local Problem: At a community hospital setting with increasing induction rates, prolonged admission-to-delivery times and prolonged patient stays were observed in patients undergoing inpatient cervical ripening, prompting a need for more efficient, patient centered approaches.

Methods: Using the Plan-Do-Study-Act (PDSA) framework, an outpatient cervical ripening protocol was implemented over a 15-week period to compare inpatient versus outpatient cervical ripening using mechanical …

Improving The Process Of Performing Stroke Assessments Within The Emergency Department: A Quality Improvement Initiative, Michael Ferrone

DNP Scholarly Projects

Background: An acute stroke is a potentially life-threatening medical condition that may lead to significant morbidity and mortality. It is imperative that patients seek emergent medical attention as several of the known interventions are time-limited based upon the time of symptom onset. Once patients present for evaluation, it is of equal importance for medical professionals to recognize that someone may be experiencing an acute stroke and to escalate their care appropriately. Among the various evidence-based stroke assessments, the National Institute of Health Stroke Scale (NIHSS) is often implemented given its ability to detect acute neurological abnormalities and estimate stroke severity. …

Skills Evaluation Of Adjunct Nursing Faculty: A Quality Improvement Project, Ada Dimino Luong

DNP Scholarly Projects

Abstract

BACKGROUND: With rising student enrollment, colleges and universities are relying more on adjunct clinical nursing faculty as Clinical Nurse Educators (CNEs). Recruiting and retaining qualified CNEs is essential to high-quality clinical education. Although clinically proficient, CNEs may face challenges with teaching methods, instructional strategies, and formative feedback. This quality improvement (QI) project evaluated CNE’s competencies and developed a sustainable multimedia educational tool to enhance feedback skills in clinical education.

METHODS: The Academic Clinical Nurse Educator Skill Acquisition Tool (ACNESAT), a validated 40-item Likert-scale instrument created by Shellenbarger and Sebach, was used to assess CNE competencies. Pre and post intervention …

Optimizing Electronic Health Record Capability To Provide Mindfulness Education To Oncology Patients Experiencing Anxiety, Cynthia Arcieri

DNP Scholarly Projects

Background: The impact of a cancer diagnosis is significant. In 2020, the Centers for Disease Control (CDC) reported over 1.6 million new cases of cancer (National Institutes of Health, 2023). Non-traditional approaches to supporting patients should be considered in providing high-quality cancer care. Mindfulness can help reduce stress reactions and may be beneficial for individuals with anxiety (Vinci et al., 2019). To best support patient care in the landscape of mobile health (mHeatlh) technology, it is essential to adopt best practices that promote patient engagement and empowerment.

Purpose: This quality improvement project aimed to provide oncology patients with a cognitive …

A Quality Improvement Project To Enhance Chronic-Condition And Self-Care Knowledge In Adolescents With Spina Bifida, Ann Paris

DNP Scholarly Projects

Background: Spina Bifida is the most common central nervous system disorder in the United States (CDC, 2024). Even with early surgical repair, patients may have chronic, disabling, multisystem needs (Phillips et al., 2017). Adequate care of Spina Bifida requires a multidisciplinary approach. As such, patients with spina bifida require multiple specialty providers, clinic appointments, care-tasks, and interventions (CDC, 2024, Phillips, et al., 2017). Synthesizing information from multiple care providers can be daunting, especially for adolescents as they grow more autonomous in their care, and especially as they enter the age of pediatric-to-adult transition (Psihogios et al., 2015).

Purpose: …

Development Of An Educational Toolkit For Washington State Nursing Professionals Regarding Climate-Related Impacts On Health, Margaret "Maggie" Pinson

DNP Scholarly Projects

BACKGROUND: Most healthcare professionals (HCPs) know that climate change poses a serious threat to human health, but few physicians and nurses actually discuss climate-related impacts on health with their patients. This knowledge-practice gap poses a risk to patient safety.

PROBLEM: Patients who are unaware of environmental threats to health may develop new illnesses, experience unnecessary exacerbations of underlying health problems and may die.

METHODS: A quality improvement intervention that addressed the educational needs of HCPs as described in the literature was developed and hosted on an online survey platform.

INTERVENTION: Preintervention survey questions captured baseline attitudes, beliefs, and knowledge. The …

Enhancing Resilience In Oncology Nurses Through The Implementation Of A Peer Support Program, Denise M. Robinson-Smith

DNP Scholarly Projects

ABSTRACT

Background: Oncology nurses face high rates of burnout and compassion fatigue, contributing to significant turnover and threatening the stability of the oncology nursing workforce. The projected increase in cancer incidence and the resulting demand for oncology services underscore the urgent need for interventions that enhance nurse resilience. Local Problem: At a major hospital in Jacksonville, Florida, it was found that oncology nurses face a significant gap in emotional support, especially during critical incidents such as patient deaths or traumatic events. Existing resources were insufficient to address the unique stressors faced by this team. Methods: A quality …