Beyond Genes: Non-Canonical Mechanisms Driving Antimicrobial Resistance In Bacteria, Leonard Koolman, Chijioke Emenike, Debasis Mitra, Sourav Chattaraj

Research Outputs: 2025-Present

Antimicrobial resistance (AMR) is traditionally discussed in the context of horizontally acquired resistance genes and point mutations at target loci. However, this gene-centred model fails to account for a large number of clinically important modalities of resistance. There is now substantial evidence implicating bacteria in the ability to escape the effects of antibiotics in a variety of non-canonical ways, which are not considered in traditional diagnostic and surveillance pipelines. Among these factors, we can list those arising from global regulatory networks, phase variability, epigenetic tuning, small RNAs, genome structural variability, and phenotypic states like tolerance and persistence. This review will …

Modelling The Hydrologic Impact Of Land Cover On Stormwater Detention Basins In Harris County, Tx, Kabita Sapkota

Electronic Theses and Dissertations

Harris County on the upper Gulf Coast in Southeast Texas is susceptible to both riverine and coastal flooding due to intense, short-duration thunderstorms, slow-moving frontal systems, and tropical hurricanes. Low-lying terrain, clay soils with poor drainage, high annual rainfall, and a widespread network of bayous and streams all contribute to frequent flooding. To reduce the impacts of urbanization and the loss of surface storage, the Harris County Flood Control District (HCFCD) built detention basins throughout the county to temporarily store stormwater runoff and release it slowly, lowering peak flows and preventing downstream flooding and erosion. These basins vary in land …

A Quality Improvement Project: Increasing Nurse Satisfaction With Patient Educational Material Related To Pain Management Options During Labor, Madison Grant

Master's Theses and Capstones

BACKGROUND:

Pain management is a large portion of what nurses manage during the patient’s time on the labor and delivery unit. The primary forms of pain management that is available to women during this time includes epidurals, nitrous oxide, stadol/diphenhydramine, and nonpharmacological options such as breathing techniques. It is essential that patients are aware of all pain management options prior to entering the unit for delivery, however sometimes nurses have to help to close the educational gap.

LOCAL PROBLEM:

Within the microsystem, it was acknowledged that many patients lacked the education of their pain management options prior to delivery which …

Implementing Nurse-Driven Education On Patient’S Inpatient Boarding Status: An Emergency Department Quality Improvement Project, Jack Wallace

Master's Theses and Capstones

BACKGROUND:

Nurse-led education to inpatient boarding patients in the emergency department is essential to improve patient’s understanding with their care and nurse’s satisfaction surrounding communicating with their patients. Inpatient boarding in the emergency department is associated with poor patient outcomes, adverse events, and reduced communication between patient and nurse.

LOCAL PROBLEM:

Within this microsystem there is a gap in patient understanding of their admission status. This includes who the patient’s provider is, which provider to direct questions to, and why the patient is still in the emergency department.

METHODS:

The plan-do-study-act quality improvement framework was utilized to improve nurse-led patient …

Timing And Temperature Of Newborn Baths: A Qualitative Improvement Initiative Through Nursing Staff Development, Eileen Harwood

Master's Theses and Capstones

Abstract

BACKGROUND: Newborn bathing is a common task performed in a labor and delivery unit of a hospital, a newborn’s bath temperature, timing and how long it is performed, are important metrics to consider. Due to a newborn’s immature thermoregulation, there are multiple implications that come with receiving a bath that is not an optimal temperature or that is too soon after birth. As newborn bathing is often overlooked task due to its quotidian nature, a literature review of current evidence-based practice revealed the urgency to keep the optimal conditions at the forefront of considerations for both nurses and caregivers. …

A Quality Improvement Initiative To Enhance The Effectiveness Of Pre-Anesthesia Documentation And Nurse Satisfaction In The Pacu, Stephanie Colon

Master's Theses and Capstones

Background: Documentation is an essential component of healthcare delivery, especially in perianesthesia nursing. Electronic health records (EHR) have helped create high-quality documentation according to the standards of the American Nurses Association. However, EHRs have been found to be burdensome on nurses when they interfere with their workflow.

Local Problem: The documentation process for pre-operative anesthesia assessments within a nine bed PACU in Southern New Hampshire was found to be inefficient, increased chances of error or mistakes, and delayed patient data being accessible to the team.

Methods: Using the Plan-Do-Study-Act (PDSA) model, a quality improvement project was performed to update and …

A Quality Initiative To Reinforce Nursing Staff Education On Fall Prevention Interventions To Enhance Patient Safety And Outcomes On A Medical-Surgical Unit, Jolena Senesombath

Master's Theses and Capstones

Background:

Patients are at an increased risk for falls on a medical-surgical unit due to a variety of factors such as increased age, medications, altered mobility, and more. Several fall prevention interventions are used to prevent falls, including use of call bells, bed and chair alarms, maintain a clutter free environment, using a fall risk assessment upon admission, and providing patient and staff education. Reinforcing education for nursing staff has been shown to be one of the most effective interventions in preventing and reducing the number of falls as it increases awareness of falls.

Local Problem:

Within the microsystem, patient …

Improving Intensive Care Unit Nurses' Knowledge And Confidence In Performing Effective Spontaneous Awakening Trials: A Quality Improvement Project, Sophia T. Merry-Carreiro

Master's Theses and Capstones

Abstract

BACKGROUND

Mechanically ventilated ICU patents often require sedation for comfort and ventilator compliance. However, oversedation is linked to negative outcomes such as delirium, prolonged ventilation, and increased duration of ICU stay. Current best practices now support the use of daily sedation interruptions such as Spontaneous Awakening Trials (SATs). Despite these recommendations, implementation of SATs remain inconsistent and suboptimal.

LOCAL PROBLEM:

Within the ICU in a northern new England hospital, there was a need to improve nurse confidence and knowledge in SATs practices through staff education.

METHODS:

Using the Plan-Do-Study-Act (PDSA) model, a quality improvement project was developed to improve …

Prioritizing Safety Through Evidence-Based Fall Prevention Signage: A Medical-Surgical Quality Improvement Project, Sonila Murati

Master's Theses and Capstones

Background: Falls in the inpatient setting can result in prolonged hospitalization, injury, and increased healthcare costs. Older adult patients are particularly vulnerable due to age-related physiological decline and comorbidities, underscoring the need for effective fall prevention strategies.

Local Problem: In a medical-surgical telemetry unit at a New Hampshire hospital, monthly patient falls continued to be a persistent concern. Leadership identified inconsistent adherence to fall precautions as a key contributing factor, particularly concerning a predominantly older adult population with high fall risk. This project aimed to reduce preventable falls by reinforcing staff awareness through visual reminders.

Methods: Guided by the Plan-Do-Study-Act …

Enhancing Patient Safety By Increasing Daily Weight Measurement For Intensive Care Through Nursing Education: A Quality Improvement Project, Liz Prior

Master's Theses and Capstones

Background: For critically ill patients in the Intensive Care Unit (ICU), accurate daily weight measurements are crucial for monitoring fluid status and ensuring correct medication dosages. However, variations in measurement techniques, accuracy, and documentation can render this data unreliable. This often leads to a reliance on less accurate measures, which may contribute to longer treatment courses and suboptimal patient outcomes.

Local Problem: At a 3-bed ICU in a critical access hospital, staff interviews revealed inconsistencies among nurses in the daily measurement of patient weights. The lack of a standardized protocol created barriers to the usefulness of serial daily weight data. …

Enhancing Triage Accuracy And Nursing Confidence Of The Emergency Severity Index To Improve The Effectiveness Of Triage Through Targeted Education: An Evidence-Based Quality Improvement Project, Mia K. Saucedo

Master's Theses and Capstones

Background: The Emergency Severity Index system is a standardized triage scoring guide used by emergency department nurses to efficiently assess patients based on severity and projected recourse needs. Studies have found that knowledge and confidence gaps among nurses may lead to improper triage score, leading to the misallocated spread of resources and longer wait times, increasing rates of morbidity and mortality. Early recognition of patient severity is vital for providing proficient patient care and improving patient outcomes and increased education is needed to improve this gap in nursing knowledge and confidence.

Local Problem: At a small, critical care access center …

Reinforcing Nursing Staff Knowledge For Accurate Cam-Icu Assessment And Documentation In A Medical Icu: A Quality Improvement Project, Tiffany Rzepka

Master's Theses and Capstones

Background: Delirium is an acute state of confusion that can lead to increased morbidity and longer hospital stays. Patients in the ICU are at high risk for developing delirium due to additional risk factors such as mechanical ventilation and sedation. The Confused Assessment Method for the Intensive Care Unit (CAM-ICU) is a tool used by nursing staff to document and assess for delirium.

Local Problem: The microsystem in this project is a 16-bed medical ICU in central New Hampshire. In the microsystem, CAM-ICU documentation compliance is tracked monthly, but the accuracy of the documentation is not routinely assessed. Stakeholders have …

Enhancing Patient Outcomes And Safety By Reinforcing Nursing Staff Education About Fall Risks And Prevention In The Orthopedic Unit: A Quality Improvement Project, Sarah S. Walsh

Master's Theses and Capstones

Abstract

Background: Inpatient falls remain a significant concern for orthopedic units, especially among elderly post-surgical patients. Despite existing protocols, fall incidents persist due to various modifiable and non-modifiable risk factors. Nursing staff play a critical role in fall prevention, and targeted education is essential to reinforce best practices.

Local Problem: The orthopedic microsystem reported 13 falls during the 2023–2024 fiscal year, with contributing factors including post-operative weakness, patient confusion, and inconsistent communication. Staff surveys revealed gaps in education, awareness, and communication related to fall incidents.

Methods: A quality improvement initiative using the Define, Measure, Analyze, Improve, Control (DMAIC) model was …

Directing Patient Hand Hygiene Before Meals In The Icu: A Quality Improvement Project To Enhance Patient Safety, Nicholas Davini

Master's Theses and Capstones

BACKGROUND:

Hospital-acquired infections (HAIs) are a major problem in healthcare, increasing patient morbidity, mortality, and costs. While staff hand hygiene is a well-established infection control measure, less attention is paid to patient hand hygiene (PHH) despite CDC recommendations.

LOCAL PROBLEM:

An intensive care unit (ICU) in northeastern Massachusetts had no formal policy for patient hand hygiene, and hospital leadership expressed support for enhancing infection control practices.

METHODS:

Using the Plan-Do-Study-Act model, a quality improvement project was implemented to encourage PHH before meals. Baseline PHH rates were collected through observation. The intervention involved registered nurses (RNs) directing patients to use hand …

Educating Staff On Effective Ways To Improve Medication Discharge Instructions In Emergency Departments (Ed): A Quality Improvement Project, Isabelle L. Kuhn

Master's Theses and Capstones

Background: Emergency Departments (EDs) serve a vital role in treating acute conditions, yet they face challenges in ensuring patients understand discharge instructions, particularly those related to medications. Approximately 70% of ED patients demonstrate deficits in at least one discharge domain, including medication understanding. Limited health literacy, time constraints, and rushed environments contribute to these gaps. Improving discharge communication is critical to reduce medication errors and prevent avoidable readmissions.

Local Problem: In a Northern New England ED, an assessment of the microsystem highlighted that patients often struggled to understand medication discharge information, increasing the risk of non-adherence and readmission. …

Optimizing Surgical Count Accuracy And Efficiency Through Enhanced Operating Room Communication To Promote Patient Safety: A Quality Improvement Project, Jessica L. Limbocker

Master's Theses and Capstones

Abstract

Background: Retained surgical items (RSIs) are classified as “never events” because they are preventable and pose significant risks to patient safety. This quality improvement (QI) project aimed to reduce the risk of RSIs, particularly during Cesarean sections by identifying gaps in surgical count practices and implementing targeted interventions.

Local Problem: At the project site, baseline assessments revealed gaps in surgical count practices. These included inconsistent documentation, absence of formal education on count procedures, and communication barriers among the intraoperative team—all contributing to increased risk of RSIs.

Methods: This QI project implemented a multi-faceted intervention to enhance …

Enhancing Patient-Centered Suicide Prevention: A Quality Improvement Project Addressing Educational Gaps In Staff Caring For Veterans, Shayla Craigue

Master's Theses and Capstones

Veterans are at significantly higher risk for suicidal ideation (SI) than the general population and often encounter barriers to care such as stigma, trauma, and distrust in healthcare systems. This quality improvement project, conducted at a Veterans Affairs (VA) Urgent Care Clinic, aimed to enhance trauma-informed care by addressing educational gaps among clinical staff. Using the Plan-Do-Study-Act (PDSA) model, the intervention included a pre-intervention survey to assess baseline knowledge, a targeted educational poster informed by survey findings, and a post-intervention survey to measure changes in staff confidence, resource awareness, and understanding of the role of the mental health response team, …

Improving Nurse Knowledge And Attitudes Through Education On Integrative Pain Management In A Medical-Surgical Unit: A Quality Improvement Project, Samantha Hamilton

Master's Theses and Capstones

Abstract

Background: Pain management in medical-surgical microsystems is complex, with many patients experiencing acute and chronic pain that can be difficult to control. Nurses often receive limited continuing education on integrative and comprehensive pain management strategies, highlighting a need to improve their knowledge and attitudes toward evidence-based, multimodal approaches.

Local Problem: Nurses in this 38-bed medical-surgical microsystem identified a gap in education related to integrative pain management strategies. This may lead to a reliance on pharmacological interventions and missed opportunities for holistic, patient-centered care

Methods: A 25-day quality improvement project was conducted using an asynchronous educational PowerPoint on integrative …

Improving The Effectiveness Of Post-Anesthesia Care Unit Transitions: A Quality Improvement Initiative Using A Standardized Nurse Handoff Report Sheet, Myra Mcauley

Master's Theses and Capstones

Background: Effective communication during patient handoff in the post-anesthesia care unit (PACU) is essential to ensuring patient safety and continuity of care. Unstructured or inconsistent handoff processes can lead to information omissions and care delays.

Methods: This quality improvement project implemented a structured nurse-to-nurse handoff report tool in the PACU. A pre- and post-intervention survey design was used to assess nurses’ perceptions of handoff clarity, completeness, and satisfaction. Educational sessions supported implementation.

Results: Pre-intervention survey data revealed dissatisfaction with the current handoff process, citing frequent information gaps. Following implementation of the structured tool, post-survey results showed improved communication clarity, increased …

A Quality Improvement Project: Increasing Pre-Term Infant Safety By Enhancing Skin-To-Skin Time In The Nicu, Maureen A. Cassidy

Master's Theses and Capstones

Background: Skin-to-skin (STS) contact, also known as kangaroo care, is a critical intervention for preterm infants, especially for those in the neonatal intensive care unit (NICU). It promotes neurodevelopmental outcomes, physiological stability, and parental bonding. However, STS often falls below recommended daily levels due to a variety of berries. Exploring aids like belly bands may help address these barriers and promote improved outcomes.

Local Problem: STS time in this NICU microsystem falls significantly below nationally recommended levels, with most preterm infants receiving less than one to two hours daily compared to the World Health Organization’s recommendation of 8-24 hours per …

Enhancing Patient Safety And Nursing Satisfaction In The Operating Room By Implementing Standardized Handoff Communication Sheets: A Quality Improvement Project, Hayleigh Mcneil

Master's Theses and Capstones

Background: Communication is essential to workflow in the operating room. In this microsystem, circulating nurses required relief nurses when necessary breaks were needed. Written communication allows for nurses to quickly access information when they are giving handoff reports.

Local Problem: An operating room in a trauma level two hospital in New England had a verbal handoff that was inconsistent and left relief nurses with incomplete reports. This issue caused a decrease in nursing satisfaction with a potential decrease in patient safety.

Methods: Using the Plan-Do-Study-Act model, a written standardized communication sheet was created and implemented. Data was …

A Quality Improvement Project Reinforcing Nursing Education On Support Resources For Families In The Icu, Emily Siel

Master's Theses and Capstones

BACKGROUND: The Intensive Care Unit (ICU) is often a source of psychological, physical, social, financial, and spiritual distress for families of patients. Multidisciplinary support resources are available but are often underutilized. Nurses are uniquely positioned to assess needs and integrate resources into care. Therefore, enhancing nurses' ability to guide families to appropriate support resources may alleviate distress and promote holistic well-being for patients and their families.

METHODS: The Plan-Do-Study-Act (PDSA) model was used to guide this project. A pre-intervention survey assessed awareness, utilization, and perception of ownership. Following dissemination of the intervention, a post-survey evaluated improvements in knowledge and integration. …

From Myriad To Moderna: The Modern (Bio)Pharmaceutical Company, Ana Santos Rutschman

Faculty Publications

This Article examines the emergence of two modern pharmaceutical companies: Myriad and Moderna. After providing a brief background on each company, this Article contrasts them across the following areas: the technologies they have brought to market; their location; their start-up stages and the role that venture capital played in catalyzing their evolution from start-ups to large corporate structures; their relationships with other entities in the private sector, in academia and in the public sector; and their intellectual property and licensing strategies.

Analyzing Real-Time Behavioral Shifts In Response To Tourism Policy Using Google Trends Data And Advanced Difference-In-Differences (Did) Methods, Aaron Bradley Scott

Doctor of Business Administration Dissertations

Google Trends is a publicly available aggregate search data portal that allows researchers to capture and review search interests. This dissertation analyzes real-time behavioral shifts resulting from tourism policy changes in Venice, Italy using Google Trends data. This work contributes to the current literature in DiD modeling, by using information-seeking behavior that is ahead of observable, lagged, outcomes. Through the integration of recent DiD advancements, this work further extends DiD applications in tourism econometrics, and a case-example of real-world tourism policy assessment. This dissertation highlights changes in search behavior immediately following policy implementation. Additionally, this work highlights Google Trends as …

The End(S) Of Bankruptcy Exceptionalism: Purdue Pharma And The Problem Of Social Debt, Pamela Foohey, Jonathan C. Lipson

Scholarly Works

The Supreme Court’s recent 5-4 decision in the controversial chapter 11 bankruptcy reorganization of opioid-maker Purdue Pharma ends the use of nonconsensual third-party “releases,” which discharge (eliminate) liabilities of non-debtors who may share liability with a corporate debtor. Although the majority opinion is correct that the Bankruptcy Code does not permit this, it failed to recognize the problematic exceptionalism of the lower courts which approved those releases or the “social” qualities of Purdue Pharma’s mass tort liability.

Bankruptcy exceptionalism has been a contested concept since it emerged over fifteen years ago, and reflects a willingness to bend the rule of …

Global Tax Wars In The Digital Era, Assaf Harpaz

Scholarly Works

The digital economy fundamentally disrupts international tax principles that rely on physical presence. When a business earns income abroad, the country of residence (where the taxpayer resides) and the country of source (where income is generated) both have legitimate, competing claims to tax that income. The international tax system tends to favor residence-based taxation. The source country has the right to tax business profits only if the enterprise carries on a permanent establishment within its borders, which typically requires physical presence. The permanent establishment standard becomes flawed in a digital economy where profit shifting practices are abundant and businesses no …

Ai Artists On The Stand: Bias Against Artificial Intelligence-Generated Works In Copyright Law, W. Michael Schuster, Joseph J. Avery

Scholarly Works

Generative artificial intelligence (AI) is revolutionizing the creation of art, literature, and music, challenging the boundaries of intellectual property law. To date, scholars have primarily focused on AI's authorship/entity status and the regulation of its use, overshadowing a critical issue: how AI's involvement in creative processes influences legal judgments in copyright disputes. Our empirical research reveals systemic bias against AI-generated works in such legal matters. In our studies, participants read about a company that had hired either a human designer (condition one) or a generative AI art system (condition two) to produce works of art, and those works of art …

Cliff Running, William Ortman, Dov Fox

Scholarly Works

Professionals must at times make snap judgments that have profound consequences. Does a doctor perform an otherwise forbidden abortion to preserve a patient’s failing health? Does a police officer fire at a suspect pointing an unidentified metal object? The criminal law tells these professionals: Don’t intervene unless the danger is serious and the risk is imminent. But it offers little to guide that determination beyond: Be reasonable. Yet the “right” choice—the one that’s legally safe—often resembles the “wrong” one: a felony punishable by decades in prison. These ambiguous regimes operate as liability cliffs that professionals are forced to traverse at …

Being There: Perils Of Disembodied Mediation, Robert Mcniff

Scholarly Works

The article examines the rise of online mediation, particularly accelerated by the COVID-19 pandemic, and critiques its limitations compared to in-person mediation. Drawing on 20th-century philosophical, psychological, and sociological thought, the analysis argues that online mediation diminishes the embodied, emotional, and intersubjective dimensions of human interaction, which are critical for empathy, moral agency, and meaningful dispute resolution. While online mediation offers convenience, it risks dehumanizing the process by reducing participants to disembodied images, thereby undermining the unique strengths of mediation as a holistic and empathetic alternative to legal adjudication.

Tax Sheltering Death Care, Victoria J. Haneman

Scholarly Works

Death is not free. Funeral, burial, or cremation costs are the third largest category of expense over the lifetime of the average American, while poverty paradoxically remains the fourth leading cause of death. Many are unable to shoulder the often-exorbitant cost of death care without being forced to beg, borrow, or simply abandon human remains. Sufficient resources exist to ensure that everyone is laid to rest with dignity in the United States, but those resources are not evenly distributed. This is a conversation about affordable and humane disposition of remains as a right versus a privilege. It is a discussion …