Digital Commons Network^™

Vaccine Hesitancy And Uptake During Pregnancy: Investigating The Role Of Emotional Mental Imagery, Julie L. Ji, Zoe Bradfield, Lies Notebaert, Joshua Lake, Catherine Hughes, Jane Warland, Julian Basanovic, Colin Macleod, Margie Danchin, Christopher C. Blyth, Katie Attwell

School of Psychology

Background Vaccine hesitancy and suboptimal vaccine uptake pose significant threats to public health, but modifiable psychological factors underpinning them are under-investigated. We examined the prevalence of spontaneous emotional mental imagery relating to infectious diseases and perinatal vaccines and its unique associations with vaccine hesitancy and uptake behaviour. Methods In a two-part longitudinal study, a sample of 411 English-speaking pregnant women attending a large public maternity hospital in Western Australia completed a baseline survey assessing levels of vaccine hesitancy and vaccine uptake (status and timing) during pregnancy for influenza, pertussis, and COVID-19. Vaccine uptake data were collected through official immunisation records. …

Cefepime Pharmacokinetics In Critically Ill Children With Multiple Organ Dysfunction Syndrome Using Volumetric Absorptive Microsampling, Victor Amajor, Amanda Bwint, Steven Shein, Janet Hume, Courtney Rowan, Leeanne Flygt, Matthew Malone, Erin Stenson, Scott Weiss, Matt Zinter, Sujatha Kannan, Mary Dahmer, Ryan Nofziger, Manjunath Pai, Athena Zuppa, Nathaniel Rhodes, Mark Hall, Marc Scheetz, Kevin Downes

Department of Pediatrics Faculty Papers

Up to half of critically ill children experience multiple organ dysfunction syndrome (MODS), which worsens outcomes and increases mortality risk. Cefepime is a broad-spectrum antibiotic commonly used in pediatric sepsis, but its pharmacokinetics during MODS has not been evaluated. We performed a prospective, observational study of critically ill children with MODS who were administered cefepime and collected up to 15 whole blood samples over 3 days using volumetric absorptive microsampling (VAMS). We performed nonlinear mixed-effects modeling to develop a population PK model for cefepime in children with MODS. We then reran our final population PK model using estimated plasma concentrations …

Timing Matters: Safe And Timely Insulin Administration, Katlyn Lenox

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely insulin administration is essential for safe inpatient diabetes management and is strongly associated with improved glycemic control and fewer adverse events. Despite ADA recommendations to administer insulin within 30 minutes of point‑of‑care (POC) glucose testing, internal data showed only 44% compliance, with an average delay of 44 minutes. These delays increased the risk of hypo‑ and hyperglycemia and highlighted the need for workflow redesign and strengthened nursing processes.

Aim of the Project: To increase the percentage of insulin doses administered within 30 minutes of POC glucose testing, reduce adverse glycemic events, enhance patient safety, and align practice with …

Purposeful Rounds: A Structured Fall Prevention Plan: Final Report, Cincerlyn Lewis

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are the most frequently reported preventable events in hospitalized patients.  Falls in the project unit were increasing, and a gap analysis revealed variation in how nurses assessed fall risk and implemented interventions. Evidence indicated that inconsistent rounding undermined situational awareness and delayed identification of patient needs. This gap highlighted the need for a structured, evidence‑based rounding process to improve consistency and reliability.

Aim of the project: The Purposeful Rounds (PR) project aimed to implement a structured process to improve rounding consistency and staff responsiveness, while reducing fall rates over a 12‑week period.

Review of the Evidence: Evidence-based literature …

Increasing Referrals To The Lung Cancer Screening Program, Megan Randall

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Lung cancer is the leading cause of cancer-related deaths worldwide and is frequently diagnosed at advanced stages when treatment options are limited. A Veterans Administration (VA) primary care clinic demonstrated lower referral rates to the lung cancer screening (LCS) program than a comparable VA clinic despite having a higher prevalence of tobacco users. Existing electronic health record reminders focused on smoking cessation and did not systematically assess eligibility for LCS, contributing to underutilization of the screening program.

Aim of the Project: The aim of this quality improvement project was to increase referrals to the LCS program by improving identification …

Poor Adherence To Established Clinical Guidelines In Outpatient Bladder Cancer Management, Melanie Boren

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The outpatient urology practice encountered challenges with adherence to Clinical Practice Guidelines (CPGs), primarily due to unfamiliarity and lack of operational accountability. This led to a low adherence rate of only 40% among patients with bladder cancer. Key issues included inadequate training and knowledge gaps regarding CPGs.

Aim of the Project: The project aimed to improve patient care and outcomes in bladder cancer treatment by enhancing patient retention and adherence to treatment protocols. Evidence-based interventions were implemented to optimize care delivery and support adherence to prescribed treatments.

Review of Evidence: A literature review highlights the effectiveness of nurse navigator …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

A Quality Improvement Approach To Reducing Chronic Obstructive Pulmonary Disease Readmissions, Florwisse Rubio

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

The problem identified at the project site is that care transitions for patients with COPD lack standardized discharge processes, leading to inconsistent education, limited follow-up, and poor coordination of care.

Aim of the Project:

The primary aim was to improve patient outcomes by reducing the 19.6% 30-day readmissions among older adults diagnosed with COPD at the selected project site by implementing a standardized discharge intervention over 12 weeks, measuring progress, and ensuring appropriate workflow. The initiative of this project sought to foster a sense of proper continuity of care through timely follow-up, interprofessional communication among patients and providers, and …

Reducing Emergency Department Boarding Using Pull-Based Throughput Intervention: Quality Improvement Project, Eunice Dundu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Emergency department (ED) boarding increases overcrowding and delays care. A 200-bed acute care hospital in the southeastern United States has a median time from inpatient bed readiness to ED departure that exceeds its hospital benchmarks, resulting in prolonged boarding and delays. Hospital data showed a median bed-ready-to-departure time of 76 minutes, exceeding the target of less than 45 minutes. Workflow analysis identified delays in transport activation, communication, and accountability as major contributors to inefficiency.

Aim of the Project: ED throughput quality improvement project aimed to reduce the median time from when an inpatient bed is marked ready to …

Improving Medication Reconciliation Compliance In Home Health Admissions, Paula A. Petrie-Rivas

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Clinician compliance with medication reconciliation at a home health agency was below regulatory expectations, with agency performance significantly lower than state and national averages. Workflow inefficiencies, inconsistent clinician practices, and limited training contributed to noncompliance, increasing the risk of medication discrepancies, preventable rehospitalizations, and Medicare reimbursement penalties.

Aim: This quality improvement project implemented a standardized medication reconciliation workflow using the Agency for Healthcare Research and Quality’s MATCH toolkit to improve clinician compliance during admission to home health.

Evidence: Literature supports structured medication reconciliation as an effective strategy to improve safety during transitions of care. The MATCH toolkit provides a …

Enhancing Medication Timeliness Through Structured Handoff In A Mental Health Facility, Belinda Zinhu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Delayed medication administration in an adult inpatient mental health facility exceeded organizational benchmarks and posed risks to patient safety, treatment effectiveness, and continuity of care. Baseline electronic health record (EHR) audits showed that about 30% of scheduled medications were administered outside the organization's acceptable timeframe, and inconsistent nurse shift handoffs contributed to the delays.

Aim of the Project: The aim of the quality improvement project was to improve patient outcomes by implementing the I-PASS standardized handoff communication tool to reduce late medication administration from 30% to 15% within 12 weeks.

Review of the Evidence: Evidence supports structured handoff frameworks …

Pressure Injury Prevention Bundle Implementation In An Acute Care Unit, Hannah K. Pobi

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Pressure Injuries are quality indicators that reflect the quality of care delivered to patients. With a hospital-acquired pressure injury rate above 12%, the project site exceeded the national benchmark average of 5-8% for acute inpatient settings. The cost of managing hospital acquired pressure injury ranges from $20,900 to $151,700 per patient, compounded by complications in a patient’s treatment plan.

Aim of the Project: To reduce the prevalence of HAPIs in a step-down unit to below 8% by implementing the Pressure Injury Prevention bundle. The PIP bundle, an evidence-based intervention, primarily aimed to educate the nursing team on its …

Fall Tailoring Interventions For Patient Safety: A Program Evaluation, Shirley Morrison

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls with injury rates had increased for over two years at the project hospital until nurse leaders implemented a new fall-prevention intervention. Patient falls are the most common preventable adverse event in acute care hospitals, with approximately 700,000 to 1 million occurring annually in the United States. Before implementing the Fall Tailoring Interventions for Patient Safety (TIPS) toolkit, the hospital’s program lacked an evidence-based approach and a fall communication board to alert staff, patients, and families about the individual fall risk status, leaving a significant gap in patient-centered care.

Aim of the Project: The aim of the project was …

Reducing Catheter-Associated Urinary Tract Infections In Progressive Care, Kelli S. Bylsma

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Catheter-associated urinary tract infections (CAUTI) harm patients and increase healthcare costs. In fiscal year 2025, the progressive care unit reported a CAUTI rate 2.5 times the National Healthcare Safety Network benchmark of 1.0 infection per 1,000 catheter days. A gap analysis revealed that the project site lacked a policy mandating chlorhexidine baths for catheterized patients, resulting in suboptimal catheter hygiene and ineffective bactericidal intervention.

Aim of the Project: The aim of the quality improvement project was to reduce CAUTI rates by 50% through daily chlorhexidine baths for catheterized patients in the progressive care unit.

Review of the Evidence: Recent …

The Effects Of Functional Coaching On Increasing Functional Play Behaviors In Adults, Abby L. Pattengale

Theses and Dissertations

Play is a critical developmental context for children with autism spectrum disorder (ASD), supporting cognitive, social, communication, and adaptive skill development. However, many adults, specifically registered behavior technicians (RBTs), demonstrate limited engagement in developmentally appropriate play behaviors, which can restrict the quality of play-based interventions, which are essential for effective treatment. However, little research has examined interventions designed to improve adult play behaviors. The purpose of this study was to evaluate the effects of functional coaching on increasing adult functional play behaviors during therapy sessions with children diagnosed with ASD. Two RBTs participated in the study, and two children receiving …

On The True Interstellar Anisotropy Of Tev Cosmic Rays And Its Implications For The Local Interstellar Medium, Noufel D. Maalal

Theses and Dissertations

Several ground-based cosmic ray (CR) air shower experiments have produced sky maps of intensity anisotropy in the energy range from 1 TeV to a few hundred TeVs with very high statistics and angular resolution. These measurements provide opportunities to study CR sources and propagation in the interstellar medium (ISM). Such studies present two major difficulties. Firstly, CRs are deflected by the heliospheric magnetic field on the last stretch of their journey to Earth. Secondly, measurements at different latitudes are difficult to compare, leading to uncertainties in latitudinal variations on the order of the observed anisotropy. Experiments usually assume latitudinal variations …

Usa V. Naajeh Torres

2026 Decisions

USDC for the Middle District of Pennsylvania

Hope College Magazine, Volume 58, Number 1: Summer 2026, Hope College

Hope College Magazine

No abstract provided.

Fy 2024-2025 Annual Report (Lwlc), Lwlc Faculty And Staff

LWLC Publications

No abstract provided.

Relationships Between Shared Group Properties: Theory, Measurement, Estimation, And Adjustment, Mark A. Maltarich, Paul D. Biese, Nichelle C. Carpenter

Faculty Publications

Teams researchers, meta-analysts, and others often study relationships between group-level constructs measured by aggregating individual-level variables, but it is well-known that group-mean correlations are influenced by individual-level relationships. We review multilevel issues and current practices in estimating and adjusting group-mean associations. We give special attention to comparisons across levels of analysis, and to adjustments for estimating population parameters. A Monte Carlo simulation study indicates that the two most commonly used adjustments in meta-analysis are ineffective in estimating population-based effect sizes. They frequently overestimate true relationships, sometimes severely. Indeed, simulations show that common adjustments move estimates away from population values in …

Dnp Final Report: Implementing The 5-2-1-0 Lifestyle Framework To Address Elevated Bmi In Pediatric Primary Care, Mary K. Williams

DNP Final Reports

Pediatric obesity remains a significant public health concern, particularly in rural areas where access to specialty care is limited. Primary care settings provide an important opportunity for early identification and intervention through family-based lifestyle modification. The purpose of this quality improvement project was to evaluate the feasibility and preliminary impact of implementing the 5-2-1-0 healthy habits framework, developed by researchers at Penn State, in a rural pediatric primary care clinic to promote improved lifestyle behaviors among children with elevated body mass index (BMI).

This project included pediatric patients ages 5–16 years presenting for well-child visits with a BMI at or …

Ethos: A Computational Framework For Material Culture Research, Chelsea L. Grafe

Department of Textiles, Merchandising and Fashion Design: Dissertations, Theses, and Student Research

Museum catalog records make large collections searchable, but they do not always preserve the reasoning behind the claims they contain. A record may present a quilt's identity as settled while leaving the reasoning behind that claim invisible, making it difficult for later researchers to check, question, or reuse. This project asks whether museum catalog data can be analyzed in a way that keeps each analytical claim connected to the evidence that supports it. To test this question, the project applies a material-first computational framework named Ethos. Ethos formalizes an object-centered inquiry sequence in which material dependencies establish where analysis begins …

The Effect Of The Continuous Care Model On Self-Practices And Quality Of Life Among Preeclamptic Women, Amira Ahmed Altweel, Salma Abd-Elatty Moawed, Amr Mahmoud Riad, Shaimaa Hassan Mohamady

Nursing

No abstract provided.

The Nature Of Divine Knowledge, Matthew Frise

Faith and Philosophy: Journal of the Society of Christian Philosophers

No abstract provided.

Jason Scott V. Ups Supply Chain Solutions

2026 Decisions

USDC for the District of Delaware

How Much Should A Conversational Recommender System Converse?, Akshit Kumar, Vahideh Manshadi, Akhilesh Tumu

Cowles Foundation Discussion Papers

Conversational recommender systems powered by generative AI can enhance personalization by facilitating information elicitation through follow-up questions. However, engaging in these conversations imposes a communication cost on users. As platforms with different objectives and monetization models deploy these systems, a central question is: how does the platform’s objective and sellers’ strategic response shape the design of these systems in terms of their elicitation strategy? We develop a parsimonious model of conversational elicitation in which interaction generates noisy preference information and imposes a communication cost borne by the user. A user-welfare-maximizing platform elicits more information when accurate niche matching yields large …

The Displacement Effects Of Domestic Outsourcing, Mayara Felix, Michael B. Wong

Cowles Foundation Discussion Papers

Evidence that domestic outsourcing lowers pay comes largely from on-site transfers, in which workers move to a contractor but keep the same jobs. Displacement is rarely observed: whether workers lose their jobs, where they go, how earnings evolve. In Brazil’s 1993–1994 pro-outsourcing reforms, which differentially affected security guards, such transfers were rare; firms instead used occupational layoffs, shedding their guards while keeping other workers. Displaced guards’ employment recovered within five years, but many changed occupations and wages stayed about 12% lower. Lifetime losses average 1.2 to 1.5 years of pre-layoff earnings, concentrated among workers from high-wage firms, reflecting lost premia.

Lawyers' Manual For Appealing Parole Denials: Administrative Appeals And Article 78 Petitions, Parole Preparation Project

All Categories

No abstract provided.

Irrigation Use In A Changing Landscape: A Combined Economic And Hydrologic Approach, Noormah Rizwan, Jamshid Jahali, Molly Sears, Sean Woznicki, Tao Liu, Oskar Marko, Mirjana Radulović

Michigan Tech Publications

Warmer temperatures and erratic rainfall patterns are threatening global water availability. Irrigation is a key risk-mitigation strategy, helping sustain crop yields under climate stress. Limited research has examined farmers' likelihood of irrigating under climate change, or the effects of large-scale irrigation expansion on future water availability, largely due to challenges in acquiring field-level irrigation data. Using an integrated econometric-hydrologic modeling approach, we investigate how short- and long-run climatic conditions shape irrigation incentives and feasibility in Serbia—an increasingly water-stressed region—and how these incentives evolve under future climate scenarios. Our econometric model identifies when and where irrigation becomes a viable option under …

Ms4 Swmpp 2026, John Kay

Municipal Separate Storm Sewer System (MS4) Permit

Stormwater discharges from Sandia National Laboratories/New Mexico (SNL/NM) are eligible for coverage under the National Pollutant Discharge Elimination System (NPDES) Municipal Separate Storm Sewer System (MS4) Permit. This Stormwater Management Plan (SWMP) was prepared by National Technology and Engineering Solutions of Sandia (NTESS) for the Department of Energy (DOE) National Nuclear Security Administration (NNSA) Sandia Field Office (SFO), owner of SNL/NM, located in Albuquerque, NM.