Digital Commons Network^™

Dose Adjustment Of The Anti-Seizure Medications Levetiracetam And Lamotrigine During The Postpartum Period. Schedule Plan, Safety And Efficacy, Nadejda Khmelev, Firas Fahoum, Lilach Goldstein

Department of Neurology Faculty Papers

INTRODUCTION: Lamotrigine (LTG) and Levetiracetam (LEV) are anti-seizure medications (ASMs) widely used for treatment of women with epilepsy (WWE) of childbearing age due to low teratogenic potential. Physiological changes during gestation results in enhanced clearance. Drug level monitoring and frequent dose adjustments are required to avoid decline in serum levels and compromised seizure control. Postpartum, physiological changes reverse and ASM clearance trends back to pre-pregnancy rate. Rapid metabolic changes make drug level monitoring and dose adjustments challenging. A delay in dose decrement could result in toxicity. The optimal postpartum dose reduction rate hasn't been established.

METHODS: We retrospectively examined medical …

Pharmacy Deserts And Health Inequities In St. Louis City: A Geospatial Analysis Of Access Disparities And Determinants, Antoine Brantley, Dominic Mosha, Bobie Williams, Quinn J Hill, Shontae Fluelen, Marcus Howard, Elvin Geng, Matifadza Hlatshwayo-Davis

2020-Current year OA Pubs

BACKGROUND: Pharmacy deserts, or areas lacking convenient access to pharmacies, can limit access to medications and reduce adherence. In U.S. cities, pharmacy deserts are disproportionately concentrated in racial/ethnic minority and low-income neighborhoods. This study examined the demographics and spatial distribution of pharmacy deserts in St. Louis City, Missouri, and their associations with sociodemographic and healthcare access determinants.

METHODS: Pharmacy deserts were defined as census tract block groups whose centroids were more than 1 mile from a pharmacy, or more than a half mile and located within a tract where at least 20% of households lacked vehicle access. Demographic and socioeconomic …

Safety And Feasibility Of Talimogene Laherparepvec In Peritoneal Surface Malignancies: Results From The Tempo Trial, John H. Stewart, Donna Niedzwiecki, Melissa Lowe, Ashley Moyer, Emily Bolch, Shannon Diane Maclaughlan, Edward A. Levine, Omeed Moaven, Niharika Mettu, John H. Strickler, Dan G. Blazer

School of Medicine Faculty Publications

Peritoneal surface malignancies (PSMs) remain a therapeutic challenge, particularly in patients with unresectable disease who cannot benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The Talimogene Laherparepvec for the Treatment of Peritoneal Surface Malignancies (TEMPO) trial (NCT03663712) is the first phase 1, multicenter, open-label study to evaluate intraperitoneal (i.p.) administration of talimogene laherparepvec (T-VEC), an FDA-approved oncolytic virus, in this setting. Nineteen patients with unresectable PSMs from appendiceal, ovarian, small bowel, and peritoneal carcinomas were enrolled; 18 received treatment across three escalating dose cohorts (4 × 10-4×10 PFU). The primary endpoint was safety and tolerability, with secondary endpoints assessing viral …

There’S Cardio And There’S Cardio: How Fitness And Sexual Attitudes Relate To Needs For Approval And Loneliness, Isaac Robertson

Honors College Theses

This study looked to collectively investigate the relationships of both fitness/sexual activity attitudes with a need for social approval, while also determining if biological sex could play a role in either of these relationships. Additionally, loneliness and mental well-being were examined with the aforementioned variables. Predominantly white (82.5%) females (75%) data were analyzed after completing an online survey (N = 40). Significant relationships were found between fitness attitudes and a need for social approval in women only (r (28) = -.50, p = .005) and between sexual activity attitudes and a need for social approval in men only (r (8) …

Application Of Augmented Reality Technology As A Dietary Monitoring And Control Measure Among Adults: A Systematic Review, Gabrielle Victoria Gonzalez, Bingjing Mao, Ruxin Wang, Wen Liu, Chen Wang, Tung Sung Tseng

School of Public Health Faculty Publications

Background/Objectives: Traditional dietary monitoring methods such as 24 h recalls rely on self-report, leading to recall bias and underreporting. Similarly, dietary control approaches, including portion control and calorie restriction, depend on user accuracy and consistency. Augmented reality (AR) offers a promising alternative for improving dietary monitoring and control by enhancing engagement, feedback accuracy, and user learning. This systematic review aimed to examine how AR technologies are implemented to support dietary monitoring and control and to evaluate their usability and effectiveness among adults. Methods: A systematic search of PubMed, CINAHL, and Embase identified studies published between 2000 and 2025 that evaluated …

Effects Of Communication Boards On Improving Communication In Assisted Living Care Facilities, Koleen Beatrice Arribas

Master's Projects and Capstones

Problem: A Residential Care facility utilizes paper charting causing limited access to vital information such as code status, allergies, and/or diet for those caring for the resident.

Context: Exceptional charting only when a resident’s condition changes may not provide enough vital information for the caregiver to administer medication or provide proper support during an emergency, such as the resident’s DNR status.

Interventions: A communication board was placed in a secure space near the nurses’ station with key resident information. Nurses would huddle at the board at before the change of shift and make updates as necessary.

Measures: Staff input in …

Improving Pressure Injury Prevention With Educational Programs For Caregivers And Nurses, Michella B. Kahanding

Master's Projects and Capstones

Problem: Pressure injuries are preventable with adequate interventions and knowledge by healthcare staff; however, skilled nursing facilities struggle with pressure ulcer prevention (PUP). Patient suffering and associated costs with treating these injuries are considerable.

Context: Staff education in knowledge regarding PUP is lacking, and annual PUP education is ineffective in reducing the number of pressure injuries in these facilities.

Interventions: Staff education on prevention strategies includes education, pre- and post-knowledge assessments, return demonstration and product use will be implemented

Measures: Results from the baseline knowledge of appropriate PUP in caregivers, pre- and post-test for knowledge retention, teach back techniques to …

Language Attrition As A Social Process, Or Barzilay

Master's Projects and Capstones

Language attrition is a process in which the gradual decline in proficiency of a language occurs when another language becomes more prominent among individuals, families, and broader societies. This shift often occurs not by choice but by necessity, as speakers are expected to adapt to the other language in educational settings, for employment, and to conform to societal pressures in their new environments. Although language attrition is often described as an individual loss of proficiency, contemporary research reveals a far more complex picture—one shaped by factors that determine which languages are valued and which fade into obscurity. These forces collectively …

Improving Efficiency In Volunteer Onboarding, Madeline Ly Bredehoft, Samantha Nicole Contreras

Master's Projects and Capstones

Project Access, a nonprofit organization serving residents of affordable housing communities, depends significantly on volunteers and student interns to deliver health, education, and employment programming. The current onboarding process lacks standardization, resulting in inconsistent training quality, delayed volunteer readiness, increased staff workload, and reduced engagement and retention. This quality improvement (QI) project aims to address these deficiencies by developing and implementing a standardized onboarding toolkit. The toolkit will include orientation modules, a learning agreement, defined deliverables, and digital resources to facilitate communication and clarify expectations. The project is guided by a PICOT question focused on efficiency and engagement, a structured …

Improving Interdisciplinary Communication And Collaboration With The Standardization Of Doula Care Through An Informatics Tool, Shela Le

Master's Projects and Capstones

Objective: The 22-bed Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post-implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for a month, a post-survey assessed these …

Optimizing Electronic Health Record Workflow To Improve Flu Vaccinations In A Primary Health Clinic, Xzalyn Arianah Hernandez

Master's Projects and Capstones

Among the Latinx population influenza vaccination rates remain disproportionately low due to vaccine hesitancy, misinformation, limited access to healthcare, and socioeconomic barriers. Influenza related hospitalizations and deaths have risen in recent years as rates continue to drop across all age groups, as a result of this issue. This quality improvement project aims to increase staff satisfaction and flu vaccination rates among Latinx patients by the implementation of a more efficient workflow process. Different interventions were designed to address workflow inefficiencies and medical assistant dissatisfaction. These interventions included 1) integrating the Immunization Clinic function in EPIC to streamline flu vaccine documentation …

Reducing Hospital-Acquired Pressure Injuries Through Targeted Nurse Education On The Braden Scale And Skins Bundle, Sarah Nicole Farkas

Master's Projects and Capstones

Objective: Hospital-acquired pressure injuries (HAPIs) continue to rise nationally despite overall reductions in other hospital-acquired conditions. This project sought to address gaps in nurse knowledge, inconsistent prevention practices, and workflow barriers contributing to HAPI development on a Trauma Medical-Surgical Unit (Unit A). Aim: This project aims to decrease the number of HAPIs on the Trauma Medical Surgical Unit by 11%, from nine HAPIs to eight HAPIs, following implementation of nurse education on the proper use of the Braden Scale and the SKINS Bundle from October 6, 2025, to November 14, 2025. Methods: A pre-intervention survey was administered to identify baseline …

A Quality Improvement Initiative To Streamline Flu Vaccine Documentation And Increase Staff Engagement, Carla E. Giron

Master's Projects and Capstones

Objective: This quality improvement project was implemented in an urban community health clinic primarily serving low-income and Latinx patients. Factors such as demographics, socioeconomic status, health, and transportation contribute to low U.S. influenza vaccination rates (Chen et al., 2020), while EHR training can improve provider satisfaction and efficiency (DiAngi et al., 2019). This microsystem faced inconsistent workflow processes, limited EHR training, and documentation errors that contributed to low staff satisfaction rates and influenza vaccination rates. An average of 11.4% of patients received a flu vaccine in October 2023 and 2024. Medical assistants (MAs) completed a pre-intervention survey indicating that 35% …

Bridging Gaps In Safety: A Team-Based Approach To Reducing Falls Among Older Adults, Enzali Min

Master's Projects and Capstones

A skilled nursing facility in the San Francisco Bay Area is experiencing fall rates surpassing the national average throughout the year. Falls among elderly residents lead to multi-level complications, from minor bruising to major injuries such as fractures, head injuries and hospital transfer, and in the most severe cases, higher mortality rates. To address the issue of high fall rates at the nursing facility, the post-fall huddle protocol was developed on the unit. The team intends to reduce the facility's fall rate by 25% over the next five weeks, from October 1 through November 5, 2025, along with improving the …

The Pressure Is On: A Quality Improvement Project To Educate Nurses On Hospital Acquired Pressure Injuries, Lance Ward

Master's Projects and Capstones

Objective Hospital acquired pressure injuries (HAPIs) are injuries developed by admitted patients, from treatment interventions that they encounter during their hospital stay. If a patient acquires a HAPI during their stay, the hospital is required to cover all expenses related to the injury. An in-patient trauma unit at a large medical center wishes to improve patient care by educating nursing staff on preventive measures of HAPIs. A review of relevant literature on HAPIs from the past five years was conducted to identify HAPI preventions tools, such as the Braden Scale and SKINS bundle, as well as the best methods to …

From Fear To Familiar: Reducing Technology-Induced Anxiety In Seniors, Justin Kyle V. Manalang

Master's Projects and Capstones

Abstract

This quality improvement project focuses on reducing the average technology-induced anxiety score among senior community members through 1:1 mentorship sessions. Aim During an eight-week period from September 10, 2025, to November 5, 2025, this project will reduce the severity of technology-induced anxiety by 25% from the established baseline. Methods: A 5P Microsystem assessment was conducted alongside an initial questionnaire to gauge the residents’ interests and concerns regarding technology use. From the results, focused mentorship sessions were conducted once a week and pertained to the chief complaint the resident had for eight weeks. The mentorship sessions were one-to-one and individualised …

Enhancing Psychotropic Medication Documentation Through Staff Education To Promote Increased Compliance Rates And Patient Safety, Matalyn F. Kirkes

Master's Projects and Capstones

Objective: Inappropriate psychotropic medication use and documentation poses a risk to patient safety and health as well as premature death while also leading to regulatory noncompliance (Bednarczyk et al., 2022). Improving nurse documentation can help patients maintain safe and adequate prescriptions and doses. Context: Baseline data collected within our microsystem revealed gaps in nurse comfort and knowledge around documentation requirements. The nursing staff (LVNs/RNs), who we received the baseline data from, are responsible for assessments, documentation, and patient monitoring, for which there is significant variability in understanding the required expectations. Interventions: The education for the skilled nursing staff as well …

Stop, Look, And Save A Spot! Implementing The Hapi Prevention Tool, A Visual Cuing System That Aims To Reduce Hospital-Acquired Pressure Injuries In Acute Care Units, Jada Baldoza

Master's Projects and Capstones

Objective: Hospital-acquired pressure injuries continue to be a major challenge in many healthcare settings as it poses increased risk in patient safety. Additionally, it creates a significant financial burden on hospitals as it increases operational costs that can increase strain on healthcare resource demands. Nurses play a major role in mitigating these injuries through practicing quality patient care and utilizing prevention strategies that have been proven effective. Aim: A quality improvement project was conducted by introducing a visual cueing system, the HAPI Prevention Tool to investigate its potential sustainability on reducing HAPI rates in the medical-surgical unit. Methods: The QI …

From Fear To Familiar: Alleviating Technology Anxiety In Older Adults Through A Community-Based Mentorship Program, Inyoung Jang

Master's Projects and Capstones

This quality improvement project was implemented in a senior residential facility in Richmond, California, catering to older low-income adults who frequently experience elevated levels of technology anxiety. Aim This project aims to reduce the mean modified technology-anxiety score among residents aged 65 and older by at least 25% from baseline by November 5, 2025. Methods The Abbreviated Technology Anxiety Scale (MTAS) was modified to consider the cognitive, linguistic, and experiential differences among target population. The original 11-item instrument, which was validated primarily within college-aged populations, used terms and repeated items irrelevant to older people. The adapted tool included five simplified …

Implementing A Standardized Doula Awareness Tool To Improve Team Collaboration And Patient Understanding, Stephanie Wong

Master's Projects and Capstones

Setting: 22-bed, Labor and Delivery (L&D) unit in the Bay Area serving diverse birthing patients. Problem & Context: The unit lacks a standardized model to introduce doulas, clarify their roles, or communicate their value. Evidence shows that doulas feel unseen by other hospital staff (Kett et al., 2022) and report that their role can be misunderstood, undervalued, or unrecognized, creating barriers to effective partnership (Louis-Jacques et al., 2024). Pre-survey: Only 19.2% of the participating volunteer doulas felt patients understood their role as a doula, and 11.5% felt patients were only slightly knowledgeable. In terms of collaboration, just 15.4% felt consistently …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

California Water Reuse: State Of The Industry As Direct Potable Reuse Comes Online, Guy Gutterman

Master's Projects and Capstones

Since the early 1900’s, California has found ways to reuse its wastewater, and in 2023 the state added a new method, Direct Potable Reuse (DPR), to its toolkit. DPR allows for advanced treated wastewater to be sent directly to a drinking water system, without an environmental buffer. Through a synthesis of the literature and related government documents of the state's water reuse history, an analysis of regional water recycling trends, and a survey of water utility professionals, this paper aims to understand DPR's future role in securing California's water supply. Historically, public perception has delayed adoption and development of California's …

Evaluation Of Remote Sensing Technologies For Bull Kelp Detection In The Greater Farallones National Marine Sanctuary, Melina Shak

Master's Projects and Capstones

The Greater Farallones National Marine Sanctuary (GFNMS), located off the coast of Northern California contains approximately 90% of the region’s bull kelp. Bull kelp is a foundational species that provides food and shelter supporting diverse marine ecosystems, but due to recent anthropogenic stressors, 90% of kelp forests along the California coast have been lost. The Greater Farallones Association (GFA) is actively working on restoration efforts, where monitoring is essential for assessing recovery success. My research addresses GFA’s need to reduce reliance on intensive, time-consuming Unmanned Aerial Systems (UAS) surveys by identifying accurate, cost-effective, and scalable remote sensing technologies for kelp …

Raising Awareness Of Oral Cancer At The Royal Cornwall Hospital, Alison Brown, Guy Lambourn, Ness Avery, Safiya Robinson, Tanya Lommerse, Casper Jonker

Peninsula Dental School

No abstract provided.

Stakeholder Criteria For Trust In Artificial Intelligence-Based Computer Perception Tools In Health Care: Qualitative Interview Study, Ansh Rai, Meghan E Hurley, John Herrington, Eric A Storch, Casey J Zampella, Julia Parrish-Morris, Anika Sonig, Gabriel Lázaro-Muñoz, Kristin Kostick-Quenet

Faculty, Staff and Students Publications

Background: Computer perception (CP) technologies hold significant promise for advancing precision mental health care systems, given their ability to leverage algorithmic analysis of continuous, passive sensing data from wearables and smartphones (eg, behavioral activity, geolocation, vocal features, and ambient environmental data) to infer clinically meaningful behavioral and physiological states. However, successful implementation critically depends on cultivating well-founded stakeholder trust.

Objective: This study aims to investigate, across adolescents, caregivers, clinicians, and developers, the contingencies under which CP technologies are deemed trustworthy in health care.

Methods: We conducted 80 semistructured interviews with a purposive sample of adolescents (n=20) diagnosed with autism, Tourette …

Improving Knowledge To Improve Care: Strengthening Nurse Expertise In The Emergency Management Of Diabetic Ketoacidosis, Minda Murphy

Master's Projects and Capstones

Abstract

Setting: A high acuity emergency department within a large hospital system. Problem: Nurses in the emergency department reported inconsistent understanding and utilization of the existing Diabetic Ketoacidosis (DKA) protocol. Pre-intervention survey results showed that 84% of nurses identified the DKA order set as confusing, and only 15% reported feeling “very comfortable” with the protocol. These knowledge gaps contributed to delays in glucose monitoring, inconsistent insulin administration, uncertainty about order-set responsibilities, and variable adherence to evidence-based management. Context: DKA is a time-sensitive, high-risk emergency that requires precise, protocol-driven actions to prevent complications such as electrolyte imbalance, cerebral edema, prolonged hospitalization, …

Enhancing Fall Prevention Through Post-Fall Huddles In A Skilled Nursing Facility, Eliza R. Galimba

Master's Projects and Capstones

Objective: Falls in skilled nursing facilities increase the risk of injury, readmissions, and higher healthcare costs. This facility’s rates remained high due to inconsistent post-fall protocols, no standardized review process, and insufficient communication. Seventy-five falls were documented in the first eight months of 2025, exceeding the national benchmark of 3–5 per 1,000 patient-days (AHRQ, 2024). Aim: This quality improvement project will occur over a 5-week period from October 1, 2025, to November 5, 2025, and aims to decrease the fall rate by 25%, from 4.3 falls per 1,000 patient-days to 3.3 falls per 1,000 patient-days, through improved team communication and …

Decarbonizing California Wine: Navigating Scope 3 Emissions Challenges And Opportunities, Olivia Regalia

Master's Projects and Capstones

Climate change is already impacting the California wine industry through increases in extreme weather, such as prolonged heatwaves and atmospheric rivers. For the industry to survive, it is important for California wineries to mitigate the effects of climate change and adapt to current and future impacts. Scope 3 greenhouse gas emissions (i.e., emissions generated throughout the supply chain) from glass packaging make up 29% of a typical California winery's carbon footprint, representing both the largest Scope 3 climate impact and greatest opportunity for reductions. This research examined key factors shaping California wineries’ Scope 3 emissions reductions efforts. A mixed-methods approach …

What We Can Learn From Comenius About Why We Educate, David I. Smith

University Faculty Publications and Creative Works

As we wrangle repeatedly over the purposes of schooling and who gets to define them, what might we gain by taking a moment to listen to a thoughtful voice from a place and time not defined by our own mix of prejudices? I invite you to listen to such a voice, one speaking from a different era amid different anxieties and in a different idiom yet addressing questions that remain pressing. It is a voice shaped by a lifetime of educational engagement and reflection in the constant shadow of violence, yet, to the last, invested in the pursuit of delight. …

The Biology Of Green Antelopehorn Milkweed (Asclepias Viridis Walter) And Hemp Dogbane (Apocynum Cannabinum L.) And Response To Triclopyr Formulations And Other Auxin Herbicides, Kayla L. Broster

Theses and Dissertations

Studies were conducted in Oktibbeha and Clay Counties in Mississippi to determine the response of green antelopehorn milkweed and hemp dogbane to triclopyr and other auxin herbicides in non-cropland areas. These studies were conducted at four locations with well established populations for each species throughout 2020 to 2023, with applications repeated at each location the following year if populations persisted. Treatments included a high and low rate of each herbicide studied, with all four triclopyr formulations included for both species. Injury response data were collected two and four weeks after treatment and population density data were evaluated using individual stem …