Digital Commons Network^™

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 …

Law School Veterans Clinics: Helping Veterans, Training Students, Improving The System, Alexander W. Scherr

Scholarly Works

This essay makes the case for law schools to create clinics and externship courses that address the needs of veterans. Veterans legal work offers excellent opportunities to represent individual veterans to obtain the benefits they earned through service to our country. At the same time, veterans clinic work can enlist students in systemic advocacy that changes how institutions address veterans' needs through appellate, administrative, and class action advocacy. Law students who work in veterans clinics develop skills they can readily transfer to other practice areas while working closely with clients and developing their professional identities. Finally, veterans clinics help law …

Business Risk, Capital Markets, And Sustainable Companies, Christopher Bruner

Scholarly Works

Corporate sustainability is inherently bound up with corporate risk, and particularly with risk-taking incentives of various corporate actors – including directors and officers who manage the business, and shareholders who can exert pressure upon corporate governance in various ways. This article sets out a framework for thinking about corporate risk-taking incentives and how they might be reformed to curb excessive risk and externalization of costs, thereby improving corporate sustainability.

Resisting Federal Preemption, Desiree Leclercq

Scholarly Works

One of the most pressing issues in constitutional law is how states may—and should—resist federal preempting laws and policies with which they disagree. It’s a problem faced by red and blue states alike in an age of extreme political polarization. Despite having legitimate reasons to resist the federal government on matters that affect local citizens and interests, states seem to have few options. Conventional wisdom is that they engage in either direct resistance through litigation that challenges the constitutionality of preempting laws, or evasion by quietly enacting arguably non-compliant laws hoping to avoid enforcement. Both strategies adopt a belligerent stance …

Perfecting Our Submission? Mann And Trump, Ruffin And Roberts, Joseph S. Miller

Scholarly Works

Presidential power is vast, both under law and in practice. Who holds presidents accountable, and by what means? Courts wrestle with these intertwined questions of power and accountability. The majority opinion in the 2024 presidential immunity case, Trump v. United States, is eerily resonant, rhetorically, with a notorious judgment enhancing one person’s power over others by shielding that power utterly from criminal-law accountability. That judgment, from 1829, is Judge Thomas Ruffin’s infamous slavery-law opinion for the North Carolina Supreme Court in State v. Mann. I juxtapose the two opinions, which share jarringly similar claims about the nature of power, rule, …

Green Dividends: A Case Study In Green Dividends And The Conditions For Private Ordering Solutions, Anne M. Tucker

Scholarly Works

This Essay introduces a novel private ordering solution to facilitate corporate investments in pro-social and environmental initiatives: Green dividends. Green dividends are an optional increase in shareholder dividends that are returned to the company to be reinvested in environmental initiatives or kept by a shareholder. Green dividends pose an alternative to the current gridlocked debate that corporations can’t, won’t, shouldn’t, and shouldn’t even try to act in pro-social or environmental ways. Turning the common refrains on their head converts each narrative into an element for a successful private ordering solution: authority, accountability, shareholder buy-in, and government-backed enforcement. With Green dividends, …

Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis In The Management Of Intermediate-Risk Pulmonary Embolism: Primary Results Of The Peerless Randomized Controlled Trial, Wissam A. Jaber, Carin F. Gonsalves Md, Stefan Stortecky, Samuel Horr, Ripal T. Gandhi, Keith Pereira, Jay Giri, Sameer J. Khandhar, Khawaja Afzal Ammar, David M. Lasorda, Brian Stegman, Lucas Busch, David J. Dexter, Ezana M. Azene, Nikhil Daga, Fakhir Elmasri, Chandra R. Kunavarapu, Mark E. Rea, Joseph S. Rossi, Joseph Campbell, Jonathan Lindquist, Adam Raskin, Jason C. Smith, Thomas M. Tamlyn, Gabriel A. Hernandez, Parth Rali, Torrey R. Schmidt, Jeffrey T. Bruckel, Juan C. Camacho, Jun Li, Samy Selim, Catalin Toma, Sukhdeep Singh Basra, Brian A. Bergmark, Bhavraj Khalsa, David M. Zlotnick, Jordan Castle, David J. O'Connor, C. Michael Gibson, For The Peerless Committees And Investigators

Department Surgery Faculty Publications

BACKGROUND: There are a lack of randomized controlled trial data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism.

METHODS: PEERLESS is a prospective, multicenter, randomized controlled trial that enrolled 550 patients with intermediate-risk pulmonary embolism with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary end point was a hierarchal win ratio composite of the following (assessed at the sooner of hospital discharge or 7 days after the procedure): (1) all-cause mortality, (2) intracranial hemorrhage, (3) major bleeding, (4) clinical deterioration and/or escalation …

Long-Term Safety And Effectiveness Of The Treo Stent Graft For The Endovascular Treatment Of Infrarenal Abdominal Aortic Aneurysms, Matthew J. Eagleton, Michael C. Stoner, John Henretta, Maciej Dryjski, Jean M. Panneton, Apostolos Tassiopoulos, Manish Mehta, Benjamin Pearce, Mel J. Sharafuddin, Treo Investigators

Department Surgery Faculty Publications

Objective

Report on the long-term safety and effectiveness of the TREO stent graft in endovascular repair of AAA from a US investigational device clinical study.

Methods

Data from a multicenter, nonrandomized, prospective, US investigational device exemption pivotal study (NCT02009644) were used. From November 2013 to February 2016, 150 patients were enrolled at 29 US centers. Safety endpoints were defined as major adverse events (i.e., all-cause mortality, myocardial infarction, stroke, renal failure requiring renal replacement therapy, respiratory failure, paraplegia, bowel ischemia, and procedural blood loss of 1,000cc or greater). Effectiveness endpoints were defined as no aneurysm rupture, absence of sac increase …

Upper Airway Soot And Facial Burns Do Not Necessitate Intubation, Jessica Burgess, John Dubensky

Department Surgery Faculty Publications

Introduction

Identifying which patients are at risk for respiratory decompensation, whether from airway compromise or inhalation injury, is an important component of initial burn resuscitation. Findings that traditionally suggest the need for intubation include cutaneous burns to the face and neck, soot seen in the upper airway, and carbonaceous sputum. However, evidence suggests that a significant number of pre-burn center intubations are ultimately unnecessary. The purpose of this investigation was to determine if head and neck burns or sputum seen in the upper airways were correlated with the need for intubation.

Methods

This was a retrospective review of adults admitted …

A Rare Case Of Metastatic Myxofibrosarcoma To The Right Colon, Timothy K. Farrell, Matthew A. Carnell, Vincent J. Obias

Department Surgery Faculty Publications

Myxofibrosarcoma (MFS) is a common soft tissue sarcoma typically arising in the extremities of older adults. Metastatic spread usually involves the lungs, lymph nodes, or bone. We describe a rare case of metastatic MFS to the colon in a 76-year-old man, three years after surgical excision and radiation treatment for a left flank primary tumor. The patient presented with symptoms of obstipation and was found to have a 4 cm cecal mass confirmed by imaging and colonoscopy. Biopsy and surgical pathology confirmed metastatic MFS. A right colectomy was performed without complication. This case highlights an uncommon site of MFS metastasis …

Is It Getting Better? An Evaluation Of Two Successive Generations Of Chatgpt In Answering Specialized Vascular Surgery Questions, Dongjin Suh, Quang Le, Leana Dogbe, Kedar Lavingia, Michael Amendola

Department Surgery Faculty Publications

Purpose: Large language models (LLMs) can generate clinically relevant text; however, their performance in highly specialized medical domains remains uncertain. This study evaluated ChatGPT-3.5 and ChatGPT-4 (OpenAI) using vascular surgery board–style questions from the Vascular Education and Self-Assessment Program, version 4 (VESAP4) and compared the two public model versions (June and November 2023).

Materials and Methods: All non-image VESAP4 questions (n=384) were presented independently three times to each model version (ChatGPT-3.5 June/November; ChatGPT-4, June/November). Outcomes included accuracy (proportion correct), consistency (same option letter across all three attempts and “consistently correct”), explanation length (word count), and modes of failure classified for …

Reflections On The Importance Of Critical Theory To Teaching Environmental Law, Sean M. Kammer

South Dakota Law Review

The freedom of students to learn about critical approaches to understanding their world is under sustained political attack. In this time of increasing environmental peril and political dysfunction, Professor Sean M. Kammer reflects upon the importance of critical theory (including Critical Race Theory) to understanding - and ultimately redressing - the related problems of resource scarcity and environmental degradation. While these problems can surely be described in terms of "economic inefficiencies" or "ecological disturbances," as they most often are, they must also be understood (and taught) as problems of colonial exploitation and violence. For example, one cannot understand Justice John …

Assessing The Past And Future Of Article Iii, Section 12 Of The South Dakota Constitution, Neil Fulton, Madison Gosch

South Dakota Law Review

The framers of South Dakota's Constitution feared corruption among public officials. This inspired them to implement structural checks on corruption in that organic document. One result of that effort was Article III, Section 12. That provision prohibited legislators from entering contracts authorized during their term. It further prohibited legislators from occupying other public offices during the legislative service or being appointed to offices created or given increased compensation during their term. The expansion of state government's reach over time and a recent reinterpretation of Article III, Section 12 raises the question of how well it aligns with current circumstances. This …

Disputing Death: Medical Futility Laws And Procedures To Facilitate End Of Life Discussions Among Patients, Family, And Practitioners, Emily Greco

South Dakota Law Review

In a world of continuous innovation, medical care in particular has changed the way humans experience life and death—lengthening life and slowing death. But where patients have the opportunity to be kept alive with medical intervention, physicians often struggle ethically with administering care that is ultimately futile or medically inappropriate. Many times patients themselves are unable to communicate, incapacitated by their ailment. As a result, surrogates must step in to make decisions on patients’ behalves. Surrogates, acting as advocates for patients, tend to withhold consent when a provider believes continued intervention is futile and wishes to withdraw or withhold treatment. …

Understanding Rural Legal Deserts To Inform Public Policy: Identifying And Describing Lawyer Gaps In Non-Metropolitan Counties, David J. Peters, Emma Bartling, Emily Meyer

South Dakota Law Review

Rural legal deserts have become a growing topic of interest to legal scholars and social scientists in the U.S. However, current research is limited by measurement issues and by the lack of national-scale analyses. To address these limitations, we identify legal deserts by applying latent profile analysis to lawyer gap rates for N = 2,307 non-metropolitan counties in the U.S. Lawyer gap rates are calculated as local demand for lawyers minus the local supply, using employment in private practice law offices from the Census Bureau. Next, we statistically describe the spatial, demographic, economic, and social characteristics of legal deserts. We …

Reevaluating South Dakota's Child Support Deduction: Balancing Retirement Contributions And Children's Needs, Marilyn Trefz

South Dakota Law Review

This article explores how South Dakota’s child support provisions, particularly the 10% allowable deduction for voluntary retirement contributions from parents’ gross income, affect the fair distribution of financial responsibilities between parents. By exploring the historical context and evolution of this statute, this article highlights the challenges and disparities the 10% deduction creates, particularly for custodial parents living in poverty. Through a comparative analysis with other states and a discussion on balancing retirement savings with child support needs, the article argues for reconsideration of the statutory allowance. The article’s aim is to ensure that the next revision of the child support …

The Office Of The South Dakota Senate President Pro Tempore, Lee Schoenbeck

South Dakota Law Review

The South Dakota Senate’s history, challenges, and processes, as carried out by the office of the President Pro Tempore, have never before been collected in one place. This article does that and is designed to be a guide for future legislators as they lead and strengthen the institution of the South Dakota Senate.

Seaweed (Laminaria Digitata) And Honey Kombucha: A Fermented Antioxidant-Rich Beverage: Fermentation, Anastasia Karpova, Deborah Adesina, Furong Tian, Azza S. Naik

Research Outputs: 2025-Present

Kombucha is a sweetened tea infusion fermented using a symbiotic culture of bacteria and yeast (SCOBY). Recently, kombucha has gained popularity due to its potential health benefits, attributed to its high antioxidant and probiotic properties. The aim of this research was to formulate a novel antioxidant-rich beverage with symbiotic benefits by utilizing ingredients such as Laminaria digitata (brown seaweed), cinnamon, and lavender adjuncts, alongside alternative substrates like acacia honey and conventionally used ingredients such as ginger (Zingiber officinale Roscoe). This study comprehensively evaluated parameters including pH levels, acidity, alcohol content, color, and antioxidant potential of the beverages. All kombucha beverages …