Digital Commons Network^™

Improving Medication Adherence Of Long-Acting Injectable Antipsychotics In Schizophrenia Through Staff Education, Rosemary Eboka

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was developed as a staff education, evidence-based quality improvement project to enhance psychiatric nursing staff’s knowledge of long-acting injectable (LAI) antipsychotics. The project addressed variability in medication adherence among individuals with schizophrenia, despite evidence that use of LAIs reduces relapses and hospitalization. Nurses play a critical role in medication administration, patient education, and adherence monitoring, underscoring the importance of addressing knowledge gaps. The project question was: Does staff education on LAIs for outpatient psychiatric nursing staff improve nursing knowledge compared to pre- to post-education? The purpose of the project was to assess the …

Neurophysiological Connectomic Signatures Of Consciousness During Propofol-Induced General Anesthesia, Yuqin Li, Xiaoxiao Chen, Hui Zheng, Senqi Li, Qingyu Teng, Chengyu Wang, Fali Li, Zhongcong Xie, Daniel Sessler, Zhe Zhang, Peng Xu, Ti-Fei Yuan, Tao Xu

Faculty, Staff and Student Publications

General anesthesia induces reversible changes in consciousness through cortical activity and connectivity alterations, yet the functional connectome dynamics underlying propofol-induced unconsciousness remains unclear. We analyze high-density 128-channel electroencephalogram (EEG) from 31 surgical patients using source localization to identify neurobiological connectome signatures of propofol anesthesia. Propofol anesthesia increases delta and theta functional connectivity and decreases alpha, beta, and gamma connectivity. A classification model and dynamic analysis of consciousness loss reveals that alpha-band connectivity between parietal, occipital, and subcortical regions is critical for sustaining consciousness, with its disruption marking a key transition to unconsciousness. EEG from 46 additional patients under mild sedation …

Evaluating The Implementation Of Oregon's Dsm-5-Informed Autism Eligibility Revisions: Interest-Holder Perspectives And Policy Implications, Bradley Josef Hendershott

Dissertations and Theses

Under the Individuals with Disabilities Education Act (IDEA), states establish their own autism spectrum disorder (ASD) eligibility criteria, resulting in substantial interstate variation and frequent misalignment with medical diagnostic standards. In 2019, Oregon revised its ASD eligibility criteria by directly incorporating DSM-5 diagnostic criteria, reflecting proponents' theory of action that this alignment would improve conceptual clarity, identification accuracy, and coherence across educational and medical systems. While an early implementation study documented generally positive early effects reported by evaluators, no research has systematically examined whether the DSM-5 alignment achieved its anticipated effects, how the revised criteria function after multiple years of …

Accurate Interpretation Of Within-Host Dissemination Using Barcoded Bacteria, Rachel T Giorgio, My T Le, Ting Zhang, Caitlyn L Holmes, Karthik Hullahalli

2020-Current year OA Pubs

Bacterial dissemination across tissues is a critically important process influencing infection outcomes. Monitoring within-host dissemination is challenging because conventional measures of bulk bacterial burden cannot distinguish between lineages that are shared between tissues and those that replicate locally. This limitation can be overcome using barcoded bacteria, where deep sequencing of the barcode locus and comparisons of barcodes between tissues define which lineages spread within the host. Numerous studies have used barcoded bacteria to generate high-resolution maps of dissemination. However, since multiple cells in the infectious inoculum can contain identical barcodes, inferences about dissemination can be confounded when distinct lineages from …

General Anesthesia Versus Conscious Sedation For Mechanical Thrombectomy In Patients With Acute Ischemic Stroke In The Most Trial, Umeshkumar Athiraman, Akash Roy, Andrew Barreto, Joseph Broderick, Colin Derdeyn, Jordan Elm, James C Grotta, James Ingles, Achala Vagal, Max Wintermark, Opeolu Adeoye

2020-Current year OA Pubs

BACKGROUND: Several observational studies have supported the use of conscious sedation (CS) for endovascular thrombectomy in patients with acute ischemic stroke and associated general anesthesia (GA) with poor functional outcomes. Recently, few randomized controlled trials have shown no difference in the functional outcomes between GA and CS. The aim of this paper is to compare the outcomes of GA versus CS in patients with acute ischemic stroke undergoing mechanical thrombectomy in the MOST (Multi-arm Optimization of Stroke Thrombolysis) trial.

METHODS: Patients who underwent mechanical thrombectomy for acute ischemic stroke under GA or CS in the MOST trial were included. The …

Validating Uas-Based Ndvi Data With Satellite Landsat Imagery For Bald Eagle Habitat Prediction In The Del Rio Springs Ecosystem, Noah Morales, Ronny Schroeder, Elise Anderson

Student Works

Vegetation health is commonly assessed using the Normalized Difference Vegetation Index (NDVI), which can be derived from multispectral sensors operating at different spatial resolutions. Validating NDVI products across sensor platforms is essential to determine their reliability for environmental monitoring and habitat assessment. This research compares NDVI derived from moderate-resolution satellite imagery and high-resolution unmanned aircraft system (UAS) imagery collected over the same study area. Landsat imagery, provided through the joint USGS–NASA mission, was used to represent satellite-based vegetation patterns, while high-resolution multispectral data were acquired using a MicaSense sensor mounted on a UAS to capture fine-scale vegetation detail.

NDVI values …

Associations Between The Microbiome And Immune Responses To An Adenovirus-Based Hiv-1 Candidate Vaccine Are Distinct Between African And Us Cohorts, Yuhao Li, Daniel J Stieh, Lindsay Droit, Andrew Hyoungjin Kim, Rachel Rodgers, Kathie A Mihindukulasuriya, Leran Wang, Maria G Pau, Olive Yuan, Herbert W Virgin, Dan H Barouch, Megan T Baldridge, Scott A Handley

2020-Current year OA Pubs

Optimization of prophylactic vaccine regimens to elicit strong, long-lasting immunity is an urgent need highlighted by the COVID-19 pandemic. Stronger vaccine immunogenicity is frequently reported in individuals living in high-income countries compared to individuals living in low- and middle-income countries. While numerous host genetic and immune factors may influence vaccine responses, geographic restrictions to vaccine effectiveness may also be influenced by the intestinal microbiota, which modulates host immune systems. However, the potential role of the gut microbiota on responses to HIV-1 vaccines has not yet been explored. We analyzed the bacteriome by targeted 16S sequencing and the virome by virus-like …

Community-Associated Quinolone-Resistant And Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli Isolates Are Similar To Clinical Infection Isolates By Sequence Type And Resistome, Emily E Benedict, Wesley Agee, Tiffany Hink, Katelyn L Parrish, Kimberly A Reske, Kate Peacock, Rachel E Bosserman, Alyssa Valencia, Akshay Saluja, Elianora Ovchiyan, Olivia Arter, Kevin Jolani, Erik R Dubberke, Gautam Dantas, Jennie H Kwon

2020-Current year OA Pubs

No abstract provided.

Variable And Conserved Features Of Copy-Back Viral Genome Populations Generated De Novo During Sendai Virus Infection, Yanling Yang, Yuchen Wang, Carolina B López

2020-Current year OA Pubs

Copy-back viral genomes (cbVGs) are generated during the replication of negative-sense RNA viruses when the polymerase drops off from the genome and reattaches to the nascent strand. cbVGs have strong immunostimulatory properties and impact infection outcomes. Despite their importance, the composition and mechanisms of

Engineering Chimeric Antigen Receptor Cd4 T Cells For Alzheimer's Disease, Pavle Boskovic, Rotem Shalita, Wenqing Gao, Hailey Vernon, Yu Lin Deng, Marco Colonna, Robbie G Majzner, Ido Amit, Jonathan Kipnis

2020-Current year OA Pubs

Alzheimer's disease (AD) is the prevailing cause of age-associated dementia worldwide. Current standard of care relies on antibody-based immunotherapy. However, antibody-based approaches carry risks for patients, and their effects on cognition are marginal. Increasing evidence suggests that T cells contribute to AD onset and progression. Unlike the cytotoxic effects of CD8

Larval Zebrafish Minimize Energy Consumption During Hunting Via Adaptive Movement Selection, Thomas Darveniza, Robert Wong, Shuyu I Zhu, Zac Pujic, Biao Sun, Matthew Levendosky, Ramesh Agarwal, Michael H Mccullough, Geoffrey J Goodhill

2020-Current year OA Pubs

Animals must balance behavioral goals with the energetic costs of movement. How such trade-offs are implemented algorithmically during natural behavior, and how they adapt to changing energetic constraints, remains poorly understood. Here we show that larval zebrafish adjust their motor strategies during prey hunting to minimize energy expenditure. Using high-speed video tracking and 3D computational fluid dynamics simulations, we quantified the energy costs (in Joules) of different movement types across three developmental stages. While the structure of discrete movement types ("bouts") remained stable with age, their selection probabilities changed depending on their energetic cost, such that more expensive bouts were …

Cannabis And Psychedelics Among U.S. Young Adults: Use, Messaging Exposure, Perceptions, And Legalization Support, Carla J Berg, Cassidy R Loparco, Darcey M Mccready, Laura C Schubel, Patricia A Cavazos-Rehg, Erin Kasson, Shriya Thakkar, Diane M Ndisebuye, Y Tony Yang

2020-Current year OA Pubs

This study assessed the correlates of cannabis and psychedelic use and legalization support among young adults in the United States (US). Using 2025 data among adults ages 18-34 (

Autoimmune Encephalitis: The Psychological Impact Of Brain Inflammation, Ophelia Hyde

Creating Healthy Work Environments (CHWE)

Autoimmune Encephalitis (AE) is a disease in which the cells of the immune system attack the brain, causing inflammation also known as encephalitis. Brain Inflammation diminishes its proper functioning and can severely impact basic processing skills. The presentation of AE is difficult to identify, because it varies depending on the antibodies involved and the location of inflammation. Autoimmune encephalitis can gradually worsen over time, and can even be fatal. The disease is rare, but as diagnosis methods improve, more and more cases are being discovered. Autoimmune Encephalitis has been found to be more common in women than men. There …

Managing Acute Myocardial Infarction In Remote Oman: Real-World Data From Al Wusta Governorate, Thuraiya Malik Abdullah Al Harthi, Ibrahim Al Mahrouqi, Amin Elbanna, Karema Hamed, Mohammed Abushilla, Venkatesh Kumar, Maryam Al Nabhani, Hasina Al Harthi, Abdulmunim Al Farsi, Adil Al Mahrouqi

Sultan Qaboos University Medical Journal

Objectives: Acute ST-segment elevation myocardial infarction (STEMI) is a time-sensitive cardiac emergency requiring prompt reperfusion therapy. Management and outcomes in remote areas are underexplored. This study explored the STEMI reperfusion network in Al Wusta governorate in Oman and evaluated the effectiveness of pharmacological thrombolysis in general practitioner (GP)-led, resource-limited hospitals. Methods: This retrospective study reviewed administrative health registries and medical records of patients presenting with STEMI to hospitals in the Al Wusta governorate between June 2017 and December 2024. Response to thrombolysis was defined as 50% resolution of ST-segment on electrocardiogram. Outcomes post-thrombolysis were prespecified. Multivariate logistic regression was used …

Satellites, Urban Heat, And Environmental Justice: Community As The Bridge Between Analysis And Action, Joshua B. Fisher, Ambar Rivera, Ava Cison, Ashley Agatep, Kainani Tacazon, Sophia Spiegleman, Alison Mckenery, Rio E. Fisher, Reginald Archer, Jason A. Douglas

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Heat waves are increasing in frequency, intensity, magnitude, and duration, causing a disproportionate impact on marginalized communities exposed to urban heat islands. Newly emerging spaceborne thermal sensing instruments, such as ECOSTRESS and Hydrosat, now have the capabilities to measure urban surface temperatures accurately at the block level (< 100 m) and with enough frequency to capture transient heat waves (daily to subweekly). Such data are critical for monitoring and informing policy and mitigation efforts, such as resurfacing, green space, cooling stations, and medical mobilization. These serve to advance environmental justice and reduce health risks—and deaths—among the most vulnerable: minority, low-income, elderly, those with physical- and mental-health preconditions, unhoused, children, and outdoor workers. While scientists have increasingly used satellite data to quantify urban heat islands and risks to communities, there remains a significant gap in action resulting from such analyses—a figurative and literal “valley of death.” Reviewing over 500 scientific publications, we identify a critical lack of engagement with the communities being analyzed (10.9%; n = 58); yet, community engagement is key to bridging such analysis with subsequent action. Here, we demonstrate how participatory community engagement directly with data and analysis leads to increased policy changes and mitigation efforts. Our framework has immediate implications for how scientists may augment their work and thought processes to achieve …

Biomarkers In Alzheimer's Disease Clinical Trials: 2025, Amanda M. Leisgang Osse, Yadi Zhou, Jefferson W. Kinney, Andrew Hooyman, Ayan Sengupta, Jorge Fonseca, Aaron H. Burstein, Laura Nisenbaum, Howard M. Fillit, Feixiong Cheng, Jeffrey L. Cummings

Physical Therapy Faculty Articles and Research

Biomarkers play an important role in Alzheimer's disease (AD) clinical trials in several contexts of use, including defining trial eligibility and serving as outcome measures. Utilizing clinicaltrials.gov, a registry of clinical trials, we assessed biomarker usage across all active AD disease-targeted therapeutic (DTT) trials. Biomarkers are widely used in AD DTT trials, with 84% including a fluid, imaging, and/or digital biomarker, either as an inclusion criterion or as an outcome measure. In DTT trials, biomarkers were included in 83% of Phase 3 trials, 91% of Phase 2 trials, and 72% of Phase 1 trials. Biomarkers were used for trial inclusion …

State Siting Of Renewable Energy – Preemptive Power Grab Or Power Play?, Sarah Everhart

Duke Environmental Law & Policy Forum

The United States needs more—and cleaner—energy. Experts project that in the near future, the United States will need to significantly increase its electricity generation. Currently, the burning of fossil fuels remains a significant source of power generation in the United States. However, these fossil fuels produce greenhouse gases that are one of the main drivers of the impending and likely disastrous, climate change. Therefore, it has never been more vital to decarbonize the energy sector. However, there are two significant impediments to the deployment of renewable energy: restrictive local siting laws and community opposition.

According to the Sabin Center for …

Offshore Wind In Vertically-Integrated Versus Deregulated Models: Considerations For State Policymakers, Caroline Daniel

Duke Environmental Law & Policy Forum

Energy law scholars and economists have long studied the theoretical differences between vertically-integrated and deregulated models of electricity regulation. Now, diverse regulatory approaches and advances in renewable electricity technology present the opportunity to go beyond the abstract. This case study applies tenets of energy law and economic theory to offshore wind initiatives to concretize lessons of a clean energy transition for state policymakers going forward.

By comparing Virginia’s and New York’s offshore wind ventures, this analysis lends nuance and practicality to otherwise abstract energy regulation principles. These states are leaders in the volatile offshore wind industry, a target for the …

Environmental Law’S Missing Piece: The Right To Nature, Ori Sharon

Duke Environmental Law & Policy Forum

For decades, environmental law has been trapped in a binary value system: it either treats nature instrumentally, as property to be used for human benefit, or views it as intrinsically valuable, deserving protection for its own sake. Both approaches, though ethically powerful, have struggled to deliver consistent and enforceable protections. As ecological crises deepen, this conceptual stalemate is no longer just inadequate—it is dangerous.

This article argues that environmental law remains structurally incomplete. It has overlooked a third category of value—relational value—long recognized in ethics and conservation science but largely absent from legal doctrine. Relational values arise from the lived, …

Search Techniques In Pubmed, Kristin Kroger

Library Learn - Complete Video Collection

This recording provides an overview of essential PubMed search techniques to develop a structured search strategy, integrate MeSH terms with keywords, refine and manage results, access full‑text articles, and make use of key My NCBI features to streamline ongoing research.

A Project Proposal For Discharge Strategies For Unhoused Patients, Heidi Moore

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project is a practice-focused executive leadership proposal addressing inconsistent discharge planning for unhoused surgical patients in an acute care hospital. Unhoused patients experience disproportionately poor outcomes, including prolonged length of stay, elevated 30-day readmission rates, and fragmented transitions of care. The practice-focused question guiding this project asks whether development of a standardized, housing-informed discharge planning program could improve transitions of care and reduce length of stay and readmissions when compared with current nonstandardized practices. Analytical strategies included synthesis of peer-reviewed literature, review of internal quality and utilization data, assessment of community-level housing instability trends, and …

Lowering Morbidity And Readmissions Of Underserved Preterm Infants To Reduce Acute Care Hospital Spend, Adaugo Amuta

Walden Dissertations and Doctoral Studies

Neonatal readmissions remain a significant challenge in urban acute care hospitals serving indigent preterm infants. These readmissions impose substantial financial burdens, with high-cost conditions such as bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity driving recurring expenditures. This integrative review examined strategies that healthcare administrators can implement to reduce neonatal readmissions, improve care equity, and optimize healthcare spending in hospitals serving vulnerable populations in the Commonwealth of Virginia. A comprehensive literature search of empirical and non-empirical studies yielded 105 results for quality assessment using the Johns Hopkins appraisal tools. A total of 29 were included for thematic analysis. Five main …

Impact Of Suicide Literacy In Hispanic/Latinx Communities, Denisse Centeno Lamas

Walden Dissertations and Doctoral Studies

No abstract provided.

The Relationship Between Social Determinants And Primary Care Utilization Among Medicaid Recipients In A Managed Care Community Health Worker Program, Rachel Elaine Rosensteel

Walden Dissertations and Doctoral Studies

Community health worker (CHW) programs are an increasingly important strategy for addressing social determinants of health (SDOH) within Medicaid systems. However, evidence on how specific SDOH impact healthcare utilization remains limited. In this quantitative, correlational study, the relationship between SDOH factors like housing instability, food insecurity, and transportation barriers, and primary care utilization among adult Medicaid recipients aged 18–65 who participated in a Medicaid managed care organization’s CHW program in Clark County, Nevada, during 2023 were examined. Retrospective administrative data from 441 participants were analyzed using negative binomial regression to assess associations between SDOH factors and postintervention primary care visits …

Financial Stability Success Strategies For Nursing Homes, Jennifer Helene Garrison

Walden Dissertations and Doctoral Studies

Ineffective regulatory strategies can lead to reduced financial stability. Nursing home leaders who wrestle to improve regulatory practices may find their business facing reduced financial sustainability. Grounded in management by objectives theory, the purpose of this qualitative pragmatic inquiry research project was to identify and explore the effective strategies nursing home leaders used to implement regulatory compliance practices that increase financial sustainability. The participants were nine nursing home leaders who had successfully implemented regulatory compliance strategies within their organizations. Data was collected through semistructured interviews, public websites, and current and archival public documents. Through thematic analysis, three themes were identified: …

Assessing The Appropriateness Of Mental Health Patients For Telehealth Care, Jacquelyn Hamed

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project developed an evidence-based clinical practice guideline (CPG) to address the inconsistent selection of patients for telepsychiatry services. Using the Johns Hopkins evidence-based practice model and evaluated through the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, the project translated research findings into a practical tool for improving clinical decision-making. Telepsychiatry has been shown to produce outcomes comparable to in-person care for mild to moderate psychiatric conditions. However, without clear criteria, some patients with complex or high-acuity disorders are inappropriately scheduled for virtual visits, posing safety and quality risks. The CPG …

Telepsychiatry Follow-Up To Reduce Emergency Department Visits In Adults With Bipolar Disorder, Obianuju Tobechukwu Ibe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project involved the development of a clinical practice guideline (CPG) for implementing structured telepsychiatry follow-up visits to reduce relapse rates and emergency department (ED) use among adults with bipolar disorder. The project addressed the growing need for accessible, evidence-based psychiatric follow-up care, particularly for patients facing barriers to consistent in-person visits. The practice-focused question guiding this project was: In adults with bipolar disorder, how do structured telepsychiatry follow-up visits, compared with in-person visits, affect relapse rates and Ed utilization? A systematic review and critical appraisal of current evidence were conducted using the Johns Hopkins …

Community Engagement And Implementation Science: A Hermeneutic Review For Implementation Scientists, Minh X Nguyen, Zhuoheng Yin, Ye Liu, Cory D Bradley, Elvin Geng, Mayuko Itofukunaga, Nyanyiwe M Mbeye, Rayner K J Tan, Sherika Hanley, Radhika Sundararajan, Joseph D Tucker

2020-Current year OA Pubs

BACKGROUND: Community engagement is increasingly part of implementation research. However, some implementation scientists are less familiar with how to use community engagement approaches in implementation research. This hermeneutic review explores the gaps in community engagement within implementation research and examines community engagement approaches for implementation researchers.

METHODS: We conducted a hermeneutic review to synthesize information in the literature on community engagement in implementation research. We searched PubMed related to community engagement and implementation research. Articles were eligible for inclusion if they were published in English, had full-text available and were likely to add meaning and valuable insights to address our …

Long-Acting Interleukin-7 Improves The Efficacy Of Oncolytic Viral Therapy In Glioblastoma, Yuping Derek Li, David A Giles, Yi Huang, Ashwani Kesarwani, Tong Hu, Logan Page, Amanda De Andrade Costa, Jingqin Luo, Mai T Dang, Albert H Kim, John F Dipersio, David T Curiel, Michael S Diamond, Milan G Chheda, Et Al.

2020-Current year OA Pubs

Despite advances in immunotherapy, the prognosis for patients with glioblastoma (GBM) remains poor. The efficacy of GBM-targeted immunotherapies is limited by the paucity of functional T cells in the tumor microenvironment, a consequence of the local and systemic immunosuppression prevalent in patients with GBM. To overcome these challenges, here we develop a treatment strategy we term "expand and pull," which uses systemic administration of rhIL-7-hyFc, a long-acting recombinant human interleukin-7, to increase peripheral T cell abundance ("expand"), followed by intratumoral oncolytic virus treatment to recruit these cells to the tumor microenvironment ("pull"). We show that rhIL-7-hyFc improves the efficacy of …

Remnant Cholesterol And Atherosclerotic Cardiovascular Disease Risk In Populations With Different Low-Density Lipoprotein Cholesterol Elevations: A Prospective Cohort Study, Hong Zheng, Guanlin Chen, Zhenyu Huo, Yulong Lan, Yuxian Wang, Peng Fu, Weiqiang Wu, Haixiang Zheng, Kuangyi Wu, Zegui Huang, Dan Wu, Shouling Wu, Youren Chen

Research outputs 2022 to 2026

Background: Low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) are risk factors for atherosclerotic cardiovascular disease (ASCVD). However, the extent to which differences in RC levels affect ASCVD risk in populations with varying degrees of LDL-C elevation remains unclear. This study aimed to investigate whether RC can provide additional risk stratification value across different sexes, ages, and elevated LDL-C statuses. Methods: This study included 12 743 elevated LDL-C participants (LDL-C ≥3.4 mmol/L) and 50 073 age- and sex-matched non-elevated LDL-C controls from the Kailuan Study. Elevated LDL-C participants were categorized by RC levels into <0.5, 0.5 to <1.0, and ≥1.0 mmol/L subgroups. Kaplan-Meier curves and Cox proportional hazards models were used to assess the relationship between RC levels and ASCVD risk across different sexes, ages, and high LDL-C statuses. Results: During a median follow-up of 12.8 years, 1686 elevated LDL-C participants (13.2%) and 5252 non-elevated LDL-C participants (10.5%) developed ASCVD. In the borderline-high LDL-C group (3.4 ≤ LDL-C < 4.1 mmol/L), those with the lowest RC levels showed no significant risk difference compared with controls (hazard ratio [HR], 1.03 [95% CI, 0.93-1.13]), and this pattern remained consistent across different sexes and ages. In contrast, in the high LDL-C group (LDL-C ≥4.1 mmol/L), even when RC was at the lowest level, ASCVD risk remained significantly higher than that of controls (HR, 1.20 [95% CI, 1.02-1.41]). CONCLUSIONS: In the borderline-high LDL-C population, those with the lowest RC levels showed no significant risk difference compared with controls, and this pattern remained consistent across different sexes and age subgroups. In the high LDL-C population, even when RC was at the lowest level, ASCVD risk remained significantly higher than that of controls.