The Prevalence Of Diabetic Retinopathy In American Indians Or Alaska Natives And Non-Indigenous Americans: A Systematic Review And Meta-Analysis., Caberry W. Yu, Keean Nanji, Anubhav Garg, Michele Zaman, Jane Jomy, Abdullah El-Sayes, Catherine Sun, Shreyas Bhat, Mark Phillips, Dena Zeraatkar, Jinhui Ma, Enrico Borrelli, Sunir J Garg, David H. Steel, Tien Yin Wong, Sobha Sivaprasad, Charles C. Wykoff, Varun Chaudhary

Wills Eye Hospital Papers

TOPIC: To estimate the prevalence of diabetic retinopathy (DR) in adult American Indian or Alaska Native (AIAN) and non-AIAN patients with diabetes.

CLINICAL RELEVANCE: Although diabetes mellitus is more prevalent among AIAN patients compared with non-AIAN patients, the evidence is inconsistent regarding whether AIAN patients have a higher prevalence or severity of DR.

METHODS: We searched Ovid MEDLINE, EMBASE, and Web of Science databases from inception through February 23, 2025. We included primary studies evaluating the prevalence of DR in Americans with diabetes. The prevalence of (1) DR, (2) diabetic macular edema (DME), (3) proliferative diabetic retinopathy (PDR), (4) vision-threatening …

Strengthening Workforce Stability And Operational Efficiency In The Transition To Practice: A Quality Improvement Project, Alana L. Lemoine

Master's Theses and Capstones

Abstract 

Background: The transition to professional practice is a challenging period for new graduate nurses, and inadequate support can contribute to high turnover and reduced job satisfaction. Structured mentorship programs have been proposed as an effective strategy to improve retention, support professional development, and enhanced perceived impact during the first year of practice for new graduate nurses.

Local problem: Within a single microsystem, new graduate nurses faced challenges related to access to formal mentorship and support throughout the transition to practice. Baseline data indicated that only 50% of nurses had access to active mentorship, and retention rates in 2024 were …

Improving Timely Pain Reassessments And Documentation Using Nurse Education And Visual Reminders: A Quality Improvement Project, Madison Grace

Master's Theses and Capstones

Background: Effective pain management requires nurses to complete and document an entire pain assessment cycle, including the initial assessment, intervention, and reassessment (Wolters Kluwer, paragraph 5, 2020). Timely reassessments are essential for determining whether interventions were effective or if additional actions need to be taken to improve patient pain and comfort. Despite established hospital policies and guidelines, inconsistencies in timeliness of pain reassessments and associated documentation are a common challenge faced.

Local Problem: Baseline chart audits on a 22-bed combined pediatric and adult medical-surgical unit identified opportunities to improve adherence to timely pain assessments and documentation. With only 65% percent …

Improving Staff Knowledge And Consistency In Sat And Sbt Practices In The Critical Care Unit: A Quality Improvement Initiative, Morgan Crapo

Master's Theses and Capstones

Abstract

Background: Spontaneous Awakening Trails (SATs) and Spontaneous Breathing Trials (SBTs) are key components of the ICU Liberation Bundle and have been associated with shorter durations of mechanical ventilation, reduced intensive care unit (ICU) length of stay (LOS), and improvement in patient outcomes. Despite having strong evidence supporting their use, implementation remains inconsistent due to knowledge gaps, workflow barriers and interdisciplinary communication challenges.

Local Problem: This quality improvement (QI) project aimed to improve critical care nurses’ knowledge and confidence regarding the implementation of SATs and SBTs through an evidence-based educational intervention.

Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, this QI …

A Quality Improvement Project: Enhancing Nursing Knowledge And Patient Safety In The Prevention Of Hospital-Acquired Pressure Injuries (Hapis) In A Medical-Surgical Unit, Kristen Vartabedian

Master's Theses and Capstones

Background: Hospital-acquired pressure injuries (HAPIs) are a significant quality indicator within the hospital system. HAPIs increase hospitalization, morbidity, and associated healthcare costs. The current evidence suggests that ongoing nursing education can improve pressure injury prevention and help in the early identification.

Local Problem: Nurses within a medical-surgical unit demonstrated a gap in knowledge in the identification of hospital acquired pressure injuries and lack of accuracy when charting skin findings. Thus, contributing to a delay in recognition and treatment of HAPIs.

Methods: This quality improvement project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation of educational flipbooks. Materials contained standardized wound …

Implementing A Nurse Re-Education Program To Promote Timely Use Of The Jada® System In The Postpartum Hemorrhage Cascade: A Quality Improvement Project, Maegan E. Doody

Master's Theses and Capstones

Background: Postpartum hemorrhage (PPH), defined as blood loss greater than 1,000 mL after delivery, is a leading cause of maternal morbidity in the United States. Identification of risk factors and timely intervention are critical to improving maternal outcomes after delivery. First-line interventions include manual uterine massage, uterotonic medications, and antifibrinolytic medications; however, when bleeding is not well controlled, the Jada® System (Jada) is a newer vacuum-induced hemorrhage control device with a high efficacy and safety profile, particularly when implemented earlier in the hemorrhage cascade.

Local Problem: In 2025, the annual rate of PPH within the microsystem was 7.29%, …

Reducing Readmissions For Copd Through Improved Education: A Gap Analysis, Raphael Gaughan

Master's Theses and Capstones

No abstract provided.

Promoting Equitable Access To Postpartum Hemorrhage Education: A Quality Improvement Project Using Educational Interventions For Night Shift Nurses, Michelle Stella

Master's Theses and Capstones

Abstract

Background: Postpartum hemorrhage (PPH) is a serious condition that can lead to maternal morbidity or mortality following the birth of their child. It is important for nurses to be properly educated to manage this condition quickly and efficiently. Night shift nurses often face barriers to accessing educational opportunities during their shift because most education is tailored to daytime hours.

Local Problem: At the project site facility, night shift nurses perceived inconsistent access to education compared to day shift nurses. This gap highlighted the need for more flexible educational modalities to meet the needs of night shift nurses.

Methods: This …

Enhancing Patient Safety And Team Communication Via Standardized Unit Handoff Tools In Inpatient Rehabilitation, Julia Rae Before

Master's Theses and Capstones

Abstract

Background: Interdisciplinary safety huddles in healthcare are used to facilitate staff communication, voice patient safety concerns and identify high acuity patients, as well as identify current unit issues that need resolution. Using characteristics of safety huddles, revising patient report sheets to include pertinent safety information often shared during huddles may lead to an increase in staff perception of communication as well as awareness to patient safety concerns. Within an in-patient rehabilitation hospital, anonymous staff reports indicated dissatisfaction with interprofessional communication and microsystem data revealed increased events of adverse patient outcomes and safety concerns. Baseline data indicated inconsistent patient handoff …

A Patient-Centered Approach To Improving Patient And Family Education On Perioperative Processes To Reduce Anxiety: A Quality Improvement Initiative, Ashley Lauren Doherty

Master's Theses and Capstones

Background: Perioperative anxiety is common among surgical patients and their family members. Anxiety may be increased by uncertainty and limited understanding of the surgical experience. Improving perioperative education may enhance understanding, reduce anxiety, and support a more patient and family centered surgical experience.

Local Problem: A Post-Anesthesia Care Unit (PACU) identified knowledge gaps in patient and family education about the perioperative process. The existing waiting room bulletin board was outdated and provided limited information. PACU nurses observed anxiety-related behaviors and confusion among patients and family members about the perioperative process. Patient satisfaction surveys routinely collected by the hospital also demonstrated …

Enhancing Safety And Efficiency In Cardiac Admission Handoffs Through Implementation Of An I-Pass Checklist: A Quality Improvement Project, Soraia D. Barros

Master's Theses and Capstones

Abstract

Background: Effective care handoff is a necessary step for maintaining patient safety during hospitalizations. The goal of this quality improvement project was to improve the completeness of information, particularly cardiac-related, provided by the ED staff to the CSSU nurses. The implementation involved the creation of a cardiac checklist and applying it to the pre-existing I-PASS forms used during asynchronous handoff.

Local Problem: The macrosystem implemented an updated system for handoffs between the ED and CSSU by substituting an over-the-phone report with a faxed I-PASS sheet. The result, as identified by the CSSU staff, is that reports contain undetailed patient …

Improving Effective Completion Of Catheter Care Using A Reminder System To Minimize Incidence Of Catheter-Associated Urinary Tract Infections: A Quality Improvement Project, Morgan K. Leonard

Master's Theses and Capstones

BACKGROUND: CAUTI rates can be decreased by implementing a care cluster for RNs for CAUTI care into morning assessments and medication administration to ensure it is being done regularly with reminders through cards at the computers in patient rooms. LOCAL PROBLEM: The local problem in the microsystem were the catheter-associated urinary tract infection (CAUTI) rates at 1.199, while the national benchmark is 1.000 (Medicare, n.d.).

METHODS: Reminder cards were placed in patient rooms on the computers which are highly utilized by staY while providing patient care to serve as a reminder to complete catheter care in a high task burden …

Improving Efficiency In The Intensive Care Unit Through Reduction Of Nurse Burnout: A Quality Improvement Initiative, Johanna Grace Koroma

Master's Theses and Capstones

Abstract

Background: Intensive care unit (ICU) nursing is prone to high levels of burnout, which poses concern for staff wellbeing, patient safety, and microsystem strain (Kerlin et al., 2020). Educational interventions may serve as a means of increasing awareness on the issue and reducing the effects of burnout, through promotion of evidence-based management strategies.

Local Problem: One ICU microsystem identified several key contributing factors to nurse burnout, including staffing shortages, limited resources, competing responsibilities within the macrosystem, and insufficient organizational support (Zhang et al., 2025). Baseline survey data of the population observed a prevalence of 50% “high” burnout profiles among …

Increasing Patient Feedback Survey Completions Through Patient-Centered Nursing Communication: A Quality Improvement Project, Lindsey E. Pawlowski

Master's Theses and Capstones

Background: Patient feedback is essential to providing the best possible nursing care. Positive patient experiences can impact overall patient satisfaction, loyalty, and trust.

Local Problem: On a pediatric unit at a New England hospital, an assessment of the microsystem revealed that there was a low number of monthly patient feedback survey completions, which limited insight into patient experiences.

Aim Statement: The primary aim of this project was to increase the number of monthly National Research Corporation (NRC) surveys to ten by June 30, 2026.

Methods: This quality improvement project was guided by the Plan-Do-Study-Act (PDSA) model. The first stage of …

Increasing Nursing Perceptions On Advanced Directives Through Education To Promote Patient Centered Care, Michelle Strong

Master's Theses and Capstones

No abstract provided.

Improved Daily Communication To Reduce On-Time First Case Start (Fcots) Delays In The Operating Room: A Quality Improvement Project, Autumn Tourangeau

Master's Theses and Capstones

BACKGROUND: First Case On-Time Starts (FCOTS) are a key indicator of perioperative efficiency and influence operating room (OR) utilization, staff productivity, patient satisfaction, and healthcare costs. Baseline data from an ambulatory perioperative unit demonstrated persistent variability in FCOTS performance and inconsistent interdisciplinary communication regarding surgical delays.

Local Problem: Inconsistent communication and documentation of first-case delays limited interdisciplinary awareness of workflow barriers and contributed to ongoing variability in FCOTS performance.

Intervention: A standardized, HIPAA-compliant daily communication process was implemented, consisting of an end-of-day email summarizing FCOTS delays and the documented reasons for delays. Educational materials and standardized documentation tools were introduced …

Improving Equipment Safety And Operational Efficiency In The Labor And Delivery Setting Using A Standardized Bedside Equipment Checklist: A Quality Improvement Project, Clara E. Lane

Master's Theses and Capstones

Background: Timely and effective neonatal resuscitation depends on the immediate availability and functionality of emergency equipment. Within labor and delivery settings, equipment failures or delays in obtaining necessary supplies and equipment can be detrimental to neonatal health outcomes. Standardized equipment verification processes have been recommended to improve equipment readiness and reduce preventable delays in care provision during neonatal emergencies.

Local Problem: Baseline observational data within the labor and delivery microsystem identified inconsistencies in equipment verification processes, resulting in variable equipment readiness across the microsystem. Staff reported variations in room preparation, safety checks, and concerns related to missing or malfunctioning equipment …

Incorporating Structured Safety Huddles To Improve Nursing Communication And Reduce Medical-Surgical Inpatient Fall Rates: A Quality Improvement Project, Alexia K. Leonard

Master's Theses and Capstones

BACKGROUND: Patient falls are a significant concern for patient safety in the acute care setting and are typically connected to inadequate communication during shift transitions. Bedside shift report is considered the standard of care, however, barriers are still present when shifting patient care responsibilities among nursing staff. A literature review identified standardized safety huddles as an evidence-based practice to improve areas of communication, teamwork, situational awareness, and patient safety. This quality improvement (QI) project concentrated on the implementation of a standardized evening safety huddle in order to improve nursing communication and reduce patient falls on an inpatient medical-surgical/telemetry unit. METHODS: …

Improving Telemetry Alarm Fatigue By Reducing Perception Of Noise Through Education: A Quality Improvement Project, Emma Bergeron

Master's Theses and Capstones

Background: The perception of excess telemetry noise has a negative impact on nursing staff workflow, emotional stress, physical stress, and alarm fatigue. This can create a distressing workplace, interrupt the ability to answer telemetry alarms in an appropriate amount of time, and further worsen alarm fatigue in nursing staff.

Local Problem: The local problem identified was the perception of telemetry noise and alarm fatigue. The purpose of this study was to assess the extent of alarm fatigue and perception of telemetry noise on the unit.

Methods: The study consisted of an assessment of the microsystem itself and the observed impact …

Improving Nurse Well-Being And Patient Safety Through A Structured Break Buddy System: A Quality Improvement Project, Elizabeth Harrington

Master's Theses and Capstones

Abstract

Background: Nursing burnout has become an increasing concern due to heavy workloads, staffing shortages, and the inability of nurses to consistently take uninterrupted rest breaks during their shifts. Missed breaks contribute to fatigue, emotional exhaustion, decreased job satisfaction, and an increased risk of patient safety events. Evidence suggests that structured break interventions may improve opportunities for recovery during the workday.

Methods: A quality improvement (QI) project was conducted on a respiratory care unit at a midsized hospital in central New Hampshire using the Plan-Do-Study-Act (PDSA) framework. A microsystem assessment identified inconsistent break-taking as a significant gap. A five-question anonymous …

Introducing Education For Sensory Approaches In Mental Health-Related Emergency Department Visits: A Quality Improvement Project To Enhance Patient-Centered Care, Jesse O'Neill

Master's Theses and Capstones

Background: Barriers to specialty care access have resulted in emergency departments (ED) operating as temporary psychiatric hold facilities for their communities. Patients boarding in the ED are demonstrated to use a disproportionate percentage of facility resources with minimal benefit to the patient. The Institute for Healthcare Improvement identifies the impact of the healthcare environment on patient outcomes and suggests staff training to foster trauma-informed practice culture (Schall et al., 2020).

Local Problem: High-stress healthcare environments can escalate maladaptive patient behaviors and the use of restrictive interventions. Traditional use of restrictive interventions lacks supportive evidence and contradicts person-centered care goals (Molloy …

Implementing A Standardized Patient Report Sheet To Improve Timeliness And Efficiency Of Patient Handoff Reports: A Quality Improvement Project, Brian F. Mclaughlin

Master's Theses and Capstones

Abstract

Background: A successful patient handoff report is a foundational element of nursing care, it encompasses the patient's medical history, current treatment plan, patient-centered goals, and notes of consideration. Blazin et. al. (2020) identified unsuccessful patient handoff reports as the root cause of many medical errors. Improving the patient handoff report process provides opportunities for increased registered nurse job satisfaction, reduced medical errors, and increased time efficiency.

Local Problem: Anecdotal discussions with nursing staff on an adult medical-surgical unit  revealed frustration with the patient handoff reporting process. Nursing staff cited interruptions, lengthy patient handoff report times, and the need to …

Cheshire Advisory Council Agenda & Minutes 2026, Carl Majewski

Advisory Council

No abstract provided.

Bmal1 Mediates Sex-Specific Circadian Regulation Of Cardiac Ion Channels And Temporal Arrhythmia Vulnerability, Brian P. Delisle, Ezekiel Rozmus, Abhilash Prabhat, Spencer B. Procopio, Xiping Zhang, Emilia Entcheva, Karyn A. Esser, Elizabeth Schroder

Physiology Faculty Publications

No abstract provided.

C/Ebpα Is Essential For Gonadal But Not Inguinal White Adipose Tissue Formation In Mice, Krista Y. Hu, Yu-Lin Ma, Esme A. Dodge, Olivia A. B. Maguire, Caio V. Matias, Ryan K. Barney, Hector S. Himede, Juliana Gomez Pardo, Miriam Cepeda, Scott M. Gordon, Robert C. Bauer

Physiology Faculty Publications

Objective: The distribution of excess white adipose tissue (WAT) in obesity correlates with risk for comorbidities. Thus, understanding depot-specific WAT developmental mechanisms is translationally relevant. SNPs near the gene CEBPA associate with waist to hip ratio, and while C/EBPα is a recognized regulator of adipogenesis, there is no previously known role for C/EBPα in regulating adipose distribution.

Methods: We crossed Cebpa floxed mice to the AdipoQ-Cre transgenic mouse strain, generating mice with adipocyte-specific knockout of Cebpa (Cebpa_ASKO). Mice were phenotyped on a chow diet and after prolonged high-fat diet (HFD) feeding.

Results: Cebpa_ASKO mice almost entirely lack gonadal …

Dim Light At Night Worsens Cardiac Autonomic Dysregulation In Female Diabetic Mice, Abhilash Prabhat, Shrishti Naidu, Isabel G. Stumpf, Tanya S. Seward, Elizabeth A. Schroder, Brian P. Delisle

Physiology Faculty Publications

Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus. CAN is characterized by impaired cardiovascular autonomic control and is associated with increased mortality, especially among women with type 2 diabetes. Identifying environmental factors that exacerbate the CAN-associated phenotype may reveal modifiable strategies to reduce cardiovascular risk.

Nighttime light exposure is a novel cardiovascular risk factor. Among ∼90,000 individuals, greater nighttime light exposure correlated with increased atrial fibrillation and heart failure risk. Light at night disrupts sympathovagal balance and elevates nocturnal heart rate in humans. Dim light at night similarly disrupts autonomic regulation of heart rate in mice. We …

Pediatric Chop Chemotherapy Acutely Disrupts Satellite-Cell Dynamics And Blunts Muscle Mass In A Sex-Specific Manner, Jainil Daredia, Marc A. Magaña, Carla M.C. Nascimento, Jaden M. Wells, Nicholas T. Thomas, Yuan Wen, Savannah V. Rauschendorfer, Cory M. Dungan, Michael P. Wiggs

Physiology Faculty Publications

Pediatric cancer survival now exceeds 85% owing, in part, to advances and the use of combination chemotherapy treatments such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). Despite its efficacy, CHOP may cause off-target effects during critical pediatric development periods such as impairments of skeletal muscle. We evaluated the acute effects of a CHOP administered to C57Bl/6J mice from postnatal day 28 to 48. CHOP slowed body-weight gain and led to a smaller gastrocnemius fiber cross-sectional area by ~25% in both sexes (n ¼ 11 or 12 males; n ¼ 8 or 9 females). RNA sequencing detected 214 differentially expressed genes …

Skeletal Muscle Methylome-Transcriptome Disruptions During The Onset And Progression Of Colorectal Cancer-Induced Cachexia, Ana Regina Cabrera, Ronald G. Jones, Eleanor R. Shrems, Francielly Morena, Yuan Wen, Tyrone A. Washington, Kevin A. Murach, Nicholas P. Greene

Physiology Faculty Publications

Cancer cachexia is a wasting condition, primarily affecting skeletal muscle, impairing patients’ quality of life, prognosis, and survival. The molecular triggers are incompletely defined, but given prior evidence for epigenetic plasticity in muscle, we speculate that dysregulated DNA methylation plays a role in muscle transcriptional alterations mediating cachexia severity. We aimed to describe and integrate the cachexia methylome and transcriptome. We used a time course approach in a mild cachexia model (colon-26, C26) coupled with a severe cachexia genetic model (Apc^Min/+) in both biological sexes to assess the methylome across degrees of cachexia pathology. The muscle methylome and …

Cytoprotective Role Of Octacosanol In Lipopolysaccharide-Induced Inflammation, Jingrong Tang, Zhi Hong Yang, Wenling Li, Huaitian Liu, Diego Lucero, Denis Sviridov, Olivia White, Julia Kun, Yoh Suke Mukouyama, Alan T. Remaley

Physiology Faculty Publications

Inflammation and endothelial dysfunction are key steps in the pathogenesis of atherosclerosis. Octacosanol (C₂₈H₅₈O, OCT), a very-long-chain saturated aliphatic alcohol (VLCA) with 28 carbons, is the main component of policosanol, a nutraceutical mixture of VLCAs (C20-C34) extracted from plants. Polycosanol in animal models is known to reduce atherosclerosis, but its mechanism of action remains unclear. This study investigates the pathways by which OCT alleviates LPS-induced inflammation in primary human aortic endothelial cells (HAECs). After overnight pretreatment with purified OCT, inflammation in HAECs was induced by lipopolysaccharide (LPS) at 100 ng/ml. The effects of OCT on the …

Agricultural Evidence Synthesis At A Critical Juncture: Quality Gaps And Implications For Evidence-Based Agriculture, Chao Cai, Jane Yatcilla, Justyna Czader, Sylvie Brouder, Jeffrey Volenec

Libraries Faculty and Staff Scholarship and Research

Systematic reviews and meta-analyses have become essential tools for synthesizing evidence to guide agricultural policy and practice, yet whether these syntheses are themselves conducted with sufficient rigor has rarely been systematically assessed. This study provides a field-wide assessment of reporting quality in agricultural evidence synthesis, examining whether existing reviews are conducted with sufficient transparency and rigor to support the policy and practice decisions they are meant to inform. We drew a random sample of 244 systematic reviews and meta-analyses from a bibliometric dataset of 1,709 articles published between 1997 and 2023, evaluating reporting quality using a 12-indicator rubric across four …