Digital Commons Network^™

Evaluating The Diagnostic Accuracy Of Ophthalmology Residents: Balancing Resident Autonomy With Patient Safety, Charles Zhang, Sinan Ersan, Timothy-Paul H. Kung, Yousef Yousef, Margaret M. Deangelis, Andrew L. Reynolds

Journal of Academic Ophthalmology

Background: Ophthalmology residency programs aim to cultivate competent, independent-thinking ophthalmologists. However, achieving a balance between resident autonomy and patient safety presents a difficult challenge.

Purpose: To evaluate the diagnostic accuracy and safety of a resident-driven on-call model, wherein consulting with a senior resident or attending physician is at the discretion of a postgraduate year 2 or 3 resident.

Methods: This was a retrospective study evaluating emergency department ophthalmology consultations at Erie County Medical Center, a level one trauma center in Western New York, between 1 January 2019 and 31 December 2021. Resident diagnoses and critical examination findings …

Teaching Slit Lamp Funduscopy With A Self-Guided E-Learning Module With Model Eye And Validation Of A Self-Assessment Tool, Irene Pak, Isabell Kassaye, Adam Alyafaie, Albert Xu, Neeti Parikh, Madeline Yung

Journal of Academic Ophthalmology

Background: Slit lamp funduscopy is an essential diagnostic tool used by ophthalmologists to visualize the posterior structures of the eye. However, the fast-paced nature of outpatient care in ophthalmology often limits preceptor teaching opportunities for medical students during clerkships. This challenge is exacerbated by the minimal preclinical exposure to ophthalmology and the technical complexity of the slit lamp examination. Therefore, curricular reform is needed to improve medical student competency in ophthalmic examination skills.

Purpose: To develop a self-guided e-learning module to teach medical students slit lamp funduscopy and evaluate a self-assessment tool for slit lamp funduscopy skills.

Methods …

Evaluating Ergonomics Education In United States Ophthalmology Residency Programs, Simran Ohri, Changseok Lee, R. Rishi Gupta, Alice Y. Zhang

Journal of Academic Ophthalmology

Background: Musculoskeletal disorders are prevalent among ophthalmologists because of occupational risks that include repetitive movements and uncomfortable postures. Teaching proper ergonomic practices early in an ophthalmologist’s career may help avoid outcomes such as chronic pain and early retirement.

Purpose: To investigate the level of formal ergonomics education in U.S. ophthalmology residencies.

Methods: An Association of University Professors of Ophthalmology (AUPO) approved survey was distributed to program directors and coordinators of 113 residency programs via the AUPO email listserv.

Results: The survey had a response rate of 33.6%. Of the 38 programs that responded, only 13 (34.2%) …

Ophthalmology At The Veterans Health Administration: How Sex And Other Factors Affect Salary, Tyler J. Carman, David H. Parkinson, Nabiha B. Habib, Charles W. Ryan, Danielle T. Dupuis, Julie M. Rosenthal, Denise S. Kim, Denise A. John, Alejandra M. Maiz, Rajesh C. Rao

Journal of Academic Ophthalmology

Purpose: To determine factors that contribute to current salary differences among ophthalmologists employed by the Veterans Health Administration (VHA).

Methods: We performed a cross-sectional analysis of full-time equivalent salaries of Veterans Health Administration ophthalmologists who received a federal salary in 2021. Differences in average salary with respect to various demographic variables were analyzed.

Results: Data for 632 salaried VHA ophthalmologists (262 females [41.5%]) were included. Although biological sex alone did not have a crude, statistically significant effect on average VHA ophthalmologist salary (p = 0.116), a substantial discrepancy was noted in adjusting for other significant demographic …

Telemedicine Versus Conventional Care For Nonspecific Neck Pain: A Randomized Controlled Study, Selki̇n Yilmaz Muluk, Sevtap Badil Güloğlu, Begüm Ünlütaşkiran

Turkish Journal of Medical Sciences

Background/aim: Telemedicine (TM) can overcome travel barriers in nonspecific neck pain (NNP), yet a comprehensive, physiatrist-supervised TM model has not been directly compared to standard in-clinic care. The aim of this study was to determine whether a video-based exercise and remote follow-up program is as effective as conventional follow-up in reducing pain and disability in NNP.

Materials and methods: This parallel-group randomized controlled trial (registered in ClinicalTrials.gov) included 68 adults (mean age = 40.52 years) with NNP who were randomly allocated 1:1 to the TM group (TG, n = 34) or control group (CG, n = 34). Both received identical …

The Impact Of Hypophosphatemia On Biochemical Profile And Renal Outcomes In Primary Hyperparathyroidism: A Nationwide Retrospective Study, Nai̇m Ata, Beki̇r Uçan, Hali̇l Durantaş, Oğulcan Boz, Mustafa Şahi̇n, Mustafa Mahi̇r Ülgü, Şuayi̇p Bi̇ri̇nci̇, Muhammed Kizilgül

Turkish Journal of Medical Sciences

Background/aim: Although low phosphorus (P) concentrations are a recognized feature of primary hyperparathyroidism (PHPT), they are not among the diagnostic or surgical criteria. The present study evaluates the association between serum phosphorus levels and clinical outcomes in PHPT patients.

Materials and methods: A search of the Turkish Ministry of Health’s National Electronic Database was conducted using ICD-10 diagnostic codes and laboratory data to identify PHPT cases within the Turkish population from 2017 to 2022.

Results: The records of a total of 113,330 PHPT patients (77.5% female; mean age 58.9 ± 15.6 years) were analyzed, revealing a mean serum phosphorus level …

Preoperative Awareness Of Nasal And Facial Aesthetic Deformities Among Rhinoplasty Candidates, Ağah Yeni̇çeri̇, Nagi̇han Gülhan Yaşar, Burak Hazir, Meli̇h Çayönü

Turkish Journal of Medical Sciences

Background/aim: This study primarily aimed to evaluate the preoperative awareness of nasal and facial anatomical deformities among patients scheduled for primary rhinoplasty. The secondary objective was to assess changes in patients’ self-perception and aesthetic expectations regarding surgical outcomes following preoperative consultation with the surgeon.

Materials and methods: In this prospective cross-sectional study, 56 adult patients seeking primary aesthetic rhinoplasty at a tertiary care center were included. Each participant completed a 10-item anatomical evaluation form. An experienced rhinoplasty surgeon independently evaluated the same parameters. Additionally, participants completed a two-item visual analogue scale (VAS) questionnaire both before and after the preoperative consultation. …

Serial D-Dimer Measurements Dynamically Predict Severity In Acute Biliary Pancreatitis: A Prospective Observational Study, Kemal Tekeşi̇n, Tolga Canbak, Ayli̇n Acar, Fati̇h Başak, Hasan Kumru, Olgun Erdem

Turkish Journal of Medical Sciences

Background/aim: Early risk stratification is required in cases of acute biliary pancreatitis (ABP). Traditional scoring systems such as Ranson’s criteria are complex and often delay treatment. D-dimer, a basic marker of systemic inflammation and coagulation, has shown promise as a prognostic tool. The present study investigates whether the predictive accuracy of serial serum D-dimer measurements is superior to that of the Ranson and BISAP scoring systems for moderate-to-severe ABP.

Materials and methods: Included in this single-center prospective observational study were 264 patients diagnosed with ABP between July 2022 and July 2025 whose collected data were analyzed. The participants were categorized …

Impact Of Patient Education Meetings On Disease Knowledge In Chronic Urticaria Patients, Nazan Beyhan, Hati̇ce Eylül Bozkurt Yilmaz, Asli Çi̇ftci̇, Ömür Aydin, Di̇lşad Mungan, Betül Ayşe Si̇n, Gülfem Eli̇f Çeli̇k, Murat Türk, İnsu Yilmaz, Sevi̇m Bavbek

Turkish Journal of Medical Sciences

Background/aim: Chronic urticaria (CU) is a manageable disease with symptoms of itching and visible lesions that can disrupt daily life and reduce quality of life. The severity of symptoms can vary, and the cause is often unknown. Concerns among patients as regards to treatment and prognosis highlight the need for disease education to enhance self-management and reduce anxiety. The present study examines the effect of disease education on the knowledge level of CU patients.

Materials and methods: Patients with CU who presented to the allergy clinics of two tertiary university hospitals were invited to inperson education sessions including slide presentations …

Validity And Reliability Of The Turkish Version Of The Topical Corticosteroid Phobia (Topicop) Scale, Esra Ağaoğlu, Hi̇lal Kaya Erdoğan, Hi̇lal Çavuş, Selma Meti̇ntaş

Turkish Journal of Medical Sciences

Background/aim: Concerns about the use of topical corticosteroids (TCSs), commonly referred to as corticophobia, are widespread among dermatology patients and often lead to nonadherence to TCS treatment. This study aimed to evaluate the validity and reliability of the Turkish version of the topical corticosteroid phobia (TOPICOP) scale.

Materials and methods: The TOPICOP scale comprises 12 items grouped into 2 dimensions: beliefs (6 items) and worries (6 items). For cultural adaptation, the scale was forward and backward translated. The final Turkish version was administered to 123 patients with chronic dermatoses who rated their perceptions of TCSs using a 4-point Likert scale. …

Exploring Gender Differences In The Impact Of Sleep And Fatigue On Disease Severity In Rheumatoid Arthritis: A Moderated Mediation Model, Musa Salmanoğlu, Habi̇p Yilmaz

Turkish Journal of Medical Sciences

Background/aim: Rheumatoid arthritis (RA) is often accompanied by fatigue and sleep disturbances, which aggravate disease severity. Gender differences in these interrelationships remain insufficiently understood. This study aimed to examine whether fatigue mediates the association between sleep quality and disease severity in RA, and whether these pathways differ by gender.

Materials and methods: A single-center study was conducted with 68 RA patients (55.9% female). Disease severity was assessed using the Routine Assessment of Patient Index Data-3, fatigue using the Bristol Rheumatology Fatigue Multidimensional Questionnaire, and sleep quality using the Pittsburgh Sleep Quality Index (PSQI).

Results: Fatigue significantly mediated the relationship between …

Effects Of Communication Boards On Improving Communication In Assisted Living Care Facilities, Koleen Beatrice Arribas

Master's Projects and Capstones

Problem: A Residential Care facility utilizes paper charting causing limited access to vital information such as code status, allergies, and/or diet for those caring for the resident.

Context: Exceptional charting only when a resident’s condition changes may not provide enough vital information for the caregiver to administer medication or provide proper support during an emergency, such as the resident’s DNR status.

Interventions: A communication board was placed in a secure space near the nurses’ station with key resident information. Nurses would huddle at the board at before the change of shift and make updates as necessary.

Measures: Staff input in …

Improving Pressure Injury Prevention With Educational Programs For Caregivers And Nurses, Michella B. Kahanding

Master's Projects and Capstones

Problem: Pressure injuries are preventable with adequate interventions and knowledge by healthcare staff; however, skilled nursing facilities struggle with pressure ulcer prevention (PUP). Patient suffering and associated costs with treating these injuries are considerable.

Context: Staff education in knowledge regarding PUP is lacking, and annual PUP education is ineffective in reducing the number of pressure injuries in these facilities.

Interventions: Staff education on prevention strategies includes education, pre- and post-knowledge assessments, return demonstration and product use will be implemented

Measures: Results from the baseline knowledge of appropriate PUP in caregivers, pre- and post-test for knowledge retention, teach back techniques to …

Language Attrition As A Social Process, Or Barzilay

Master's Projects and Capstones

Language attrition is a process in which the gradual decline in proficiency of a language occurs when another language becomes more prominent among individuals, families, and broader societies. This shift often occurs not by choice but by necessity, as speakers are expected to adapt to the other language in educational settings, for employment, and to conform to societal pressures in their new environments. Although language attrition is often described as an individual loss of proficiency, contemporary research reveals a far more complex picture—one shaped by factors that determine which languages are valued and which fade into obscurity. These forces collectively …

Optimizing Electronic Health Record Workflow To Improve Flu Vaccinations In A Primary Health Clinic, Xzalyn Arianah Hernandez

Master's Projects and Capstones

Among the Latinx population influenza vaccination rates remain disproportionately low due to vaccine hesitancy, misinformation, limited access to healthcare, and socioeconomic barriers. Influenza related hospitalizations and deaths have risen in recent years as rates continue to drop across all age groups, as a result of this issue. This quality improvement project aims to increase staff satisfaction and flu vaccination rates among Latinx patients by the implementation of a more efficient workflow process. Different interventions were designed to address workflow inefficiencies and medical assistant dissatisfaction. These interventions included 1) integrating the Immunization Clinic function in EPIC to streamline flu vaccine documentation …

Reducing Hospital-Acquired Pressure Injuries Through Targeted Nurse Education On The Braden Scale And Skins Bundle, Sarah Nicole Farkas

Master's Projects and Capstones

Objective: Hospital-acquired pressure injuries (HAPIs) continue to rise nationally despite overall reductions in other hospital-acquired conditions. This project sought to address gaps in nurse knowledge, inconsistent prevention practices, and workflow barriers contributing to HAPI development on a Trauma Medical-Surgical Unit (Unit A). Aim: This project aims to decrease the number of HAPIs on the Trauma Medical Surgical Unit by 11%, from nine HAPIs to eight HAPIs, following implementation of nurse education on the proper use of the Braden Scale and the SKINS Bundle from October 6, 2025, to November 14, 2025. Methods: A pre-intervention survey was administered to identify baseline …

The Pressure Is On: A Quality Improvement Project To Educate Nurses On Hospital Acquired Pressure Injuries, Lance Ward

Master's Projects and Capstones

Objective Hospital acquired pressure injuries (HAPIs) are injuries developed by admitted patients, from treatment interventions that they encounter during their hospital stay. If a patient acquires a HAPI during their stay, the hospital is required to cover all expenses related to the injury. An in-patient trauma unit at a large medical center wishes to improve patient care by educating nursing staff on preventive measures of HAPIs. A review of relevant literature on HAPIs from the past five years was conducted to identify HAPI preventions tools, such as the Braden Scale and SKINS bundle, as well as the best methods to …

Enhancing Psychotropic Medication Documentation Through Staff Education To Promote Increased Compliance Rates And Patient Safety, Matalyn F. Kirkes

Master's Projects and Capstones

Objective: Inappropriate psychotropic medication use and documentation poses a risk to patient safety and health as well as premature death while also leading to regulatory noncompliance (Bednarczyk et al., 2022). Improving nurse documentation can help patients maintain safe and adequate prescriptions and doses. Context: Baseline data collected within our microsystem revealed gaps in nurse comfort and knowledge around documentation requirements. The nursing staff (LVNs/RNs), who we received the baseline data from, are responsible for assessments, documentation, and patient monitoring, for which there is significant variability in understanding the required expectations. Interventions: The education for the skilled nursing staff as well …

Stop, Look, And Save A Spot! Implementing The Hapi Prevention Tool, A Visual Cuing System That Aims To Reduce Hospital-Acquired Pressure Injuries In Acute Care Units, Jada Baldoza

Master's Projects and Capstones

Objective: Hospital-acquired pressure injuries continue to be a major challenge in many healthcare settings as it poses increased risk in patient safety. Additionally, it creates a significant financial burden on hospitals as it increases operational costs that can increase strain on healthcare resource demands. Nurses play a major role in mitigating these injuries through practicing quality patient care and utilizing prevention strategies that have been proven effective. Aim: A quality improvement project was conducted by introducing a visual cueing system, the HAPI Prevention Tool to investigate its potential sustainability on reducing HAPI rates in the medical-surgical unit. Methods: The QI …

Implementing A Standardized Doula Awareness Tool To Improve Team Collaboration And Patient Understanding, Stephanie Wong

Master's Projects and Capstones

Setting: 22-bed, Labor and Delivery (L&D) unit in the Bay Area serving diverse birthing patients. Problem & Context: The unit lacks a standardized model to introduce doulas, clarify their roles, or communicate their value. Evidence shows that doulas feel unseen by other hospital staff (Kett et al., 2022) and report that their role can be misunderstood, undervalued, or unrecognized, creating barriers to effective partnership (Louis-Jacques et al., 2024). Pre-survey: Only 19.2% of the participating volunteer doulas felt patients understood their role as a doula, and 11.5% felt patients were only slightly knowledgeable. In terms of collaboration, just 15.4% felt consistently …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Evaluation Of Remote Sensing Technologies For Bull Kelp Detection In The Greater Farallones National Marine Sanctuary, Melina Shak

Master's Projects and Capstones

The Greater Farallones National Marine Sanctuary (GFNMS), located off the coast of Northern California contains approximately 90% of the region’s bull kelp. Bull kelp is a foundational species that provides food and shelter supporting diverse marine ecosystems, but due to recent anthropogenic stressors, 90% of kelp forests along the California coast have been lost. The Greater Farallones Association (GFA) is actively working on restoration efforts, where monitoring is essential for assessing recovery success. My research addresses GFA’s need to reduce reliance on intensive, time-consuming Unmanned Aerial Systems (UAS) surveys by identifying accurate, cost-effective, and scalable remote sensing technologies for kelp …

Improving Knowledge To Improve Care: Strengthening Nurse Expertise In The Emergency Management Of Diabetic Ketoacidosis, Minda Murphy

Master's Projects and Capstones

Abstract

Setting: A high acuity emergency department within a large hospital system. Problem: Nurses in the emergency department reported inconsistent understanding and utilization of the existing Diabetic Ketoacidosis (DKA) protocol. Pre-intervention survey results showed that 84% of nurses identified the DKA order set as confusing, and only 15% reported feeling “very comfortable” with the protocol. These knowledge gaps contributed to delays in glucose monitoring, inconsistent insulin administration, uncertainty about order-set responsibilities, and variable adherence to evidence-based management. Context: DKA is a time-sensitive, high-risk emergency that requires precise, protocol-driven actions to prevent complications such as electrolyte imbalance, cerebral edema, prolonged hospitalization, …

Lost In Translation: Navigating Cultural And Linguistic Barriers For Indian Learners In Tesol Classrooms, Shivam Jaynarayanbhai Gohel

Master's Projects and Capstones

ABSTRACT

This thesis examines the cultural, linguistic and emotional issues of the Indian multilingual students in the U.S. TESOL classroom and explains the value of decolonized and culturally responsive pedagogies to ameliorate foreign language anxiety and create equitable education. Based on the frameworks of Culturally Responsive/Sustaining Pedagogy and Affective Filter Theory, the study integrates existing and existing research to investigate the role of colonial heritage in influencing TESOL practice, the undermining effect of anxiety on academic achievement and the empowering effect of instructions that are inclusive and responsive. Chapter I presents the problem, including how multilingual and multicultural identities of …

Decarbonizing California Wine: Navigating Scope 3 Emissions Challenges And Opportunities, Olivia Regalia

Master's Projects and Capstones

Climate change is already impacting the California wine industry through increases in extreme weather, such as prolonged heatwaves and atmospheric rivers. For the industry to survive, it is important for California wineries to mitigate the effects of climate change and adapt to current and future impacts. Scope 3 greenhouse gas emissions (i.e., emissions generated throughout the supply chain) from glass packaging make up 29% of a typical California winery's carbon footprint, representing both the largest Scope 3 climate impact and greatest opportunity for reductions. This research examined key factors shaping California wineries’ Scope 3 emissions reductions efforts. A mixed-methods approach …

How The Advisor-Advisee Relationship Contributes To Black Student Success At Pwis, Renata Denise Roberts

Theses and Dissertations

This qualitative study explores how the advisor-advisee relationship contributes to Black student success at Predominantly White Institutions (PWIs). Black student enrollment and retention at PWIs continue to decline, especially with national efforts to cut DEI measures. Previous research highlights that engagement and institutional support are critical to persistence and graduation; however, limited literature exists on how academic advising relationships can impede or contribute to Black student outcomes in these environments. Viewing from the lens of Black students’ perceptions, this study examines how the academic advising experience can foster trust and contribute to academic achievement for Black students or impede their …

Maria Vasquez-De Perez V. Attorney General United States Of America

2025 Decisions

Agency

Labram Ii Power Equation And Application To Model A Powder System, Layton Bertrand Bahnmiller

Graduate Theses & Non-Theses

This thesis validates equations that predict power input with machine data for the LabRAM II resonant acoustic mixer (RAM), an industrial tool for mixing powders used in advanced manufacturing and other applications. While RAM offers unique advantages such as gentle mixing and adaptability for sensitive or heterogeneous blends, the manufacturer’s power equation lacked published experimental validation. To address this gap, a custom constantvolume calorimeter was designed to directly measure the energy imparted during RAM operation under controlled conditions. Finite element analysis and analytical heat transfer models ensured calorimeter assumptions were valid. Calorimetric experiments revealed that the vendor’s power input equation …

A Geological And Geochemical Study Of The Philipsburg Mining District, Granite County, Montana, Celine M. Beaucamp

Graduate Theses & Non-Theses

The Philipsburg district, renowned for its rich mining history, has contributed significantly to Montana's mineral production, ranking as the state's second-most productive district. Active from 1865 to the 1980s, it yielded an impressive array of Ag (50-60 million oz), with notable outputs of Au, Zn, Pb, Cu, and battery-grade MnO2. The district features Cordilleran polymetallic veins, some of which are along bedding in Mississippian and Devonian limestone, and others are steeply dipping quartz veins in silicate-rich sedimentary rocks and in the Philipsburg batholith. The veins exhibit a district-wide mineral zonation, marked by Cu- and Ag-rich ores near granite porphyries, with …

Aqueous Geochemistry Drives Microbial Cu, Fe, And Zn Uptake Rates In Yellowstone, A Continental Hydrothermal System, Eva Carolina Andrade-Barahona

Graduate Theses & Non-Theses

Microbial uptake of trace metal cofactors such as copper (Cu), iron (Fe), and zinc (Zn) is governed by biogeochemical processes in hydrothermal systems where metal bioavailability varies widely. In situ microbial metal uptake rates were quantified by applying metal stable isotope probing (MSIP) in the Yellowstone hydrothermal system across diverse geochemical conditions in hydrothermal springs. The findings in these studies revealed that pH exerts a dominant influence on microbial copper uptake rate, also enhanced by increased Cu²⁺ ion availability and dissolved oxygen. Microbial iron uptake, in contrast, displayed a broad tolerance to environmental variability, occurring across a pH range of …