Digital Commons Network^™

Outcomes With Cerclage For Short Cervix ≤20.9 Mm Before 24 Weeks In Singletons Without Prior Preterm Birth: A Focused Meta-Analysis Of Randomized Controlled Trials, Rupsa Boelig, Kypros Nicolaides, Orion Rust, Katsufumi Otzuki, Sietske Althuisius, Gabriele Saccone, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

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

Department of Pediatrics Faculty Papers

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

Timing Matters: Safe And Timely Insulin Administration, Katlyn Lenox

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

Review of the Evidence: Evidence-based literature …

Increasing Referrals To The Lung Cancer Screening Program, Megan Randall

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

Mindfulness To Reduce Psychotropic Prescriptions In Home-Based Elderly Patients, Mojisola Akinola Olusegun

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Home-based adults aged 65 years and older receiving care at a community behavioral health center exhibited high psychotropic polypharmacy, with over 80% prescribed two or more psychotropic medications, exceeding The Center for Medicare and Medicaid services (CMS) guidance for safe use. This pattern heightened risks for adverse drug events, functional decline, and avoidable healthcare utilization, while exposing a practice gap characterized by underuse of non-pharmacologic interventions.

Aim of the Project: The Doctor of Nursing Practice (DNP) project aimed to determine whether integrating a structured Mindful Breathing and Meditation (MBM) program into routine services could reduce psychotropic medication burden …

Optimizing Daily Central Line Review: A High-Reliability Qi Project, Heather Khan

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Prolonged central line use increases the risk of infection. At baseline, central line utilization in a 21-bed medical intensive care unit exceeded organizational goals and the national median. Gaps in the central line review process and variation in staff knowledge contributed to overutilization.

 Aim of the Project: The project team aimed to improve patient outcomes by reducing the central line standardized utilization ratio (SUR) from 0.93 to the national median of 0.79 over 12 weeks.

Review of the Evidence: Evidence supports standardization, use of decision-support tools, measurement, and auditing to reduce central line utilization. Leadership engagement, safety culture, and …

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

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

Aim of the Project:

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

Improving Timely Hospice Pain Reassessments Through A Quality Improvement Initiative, Brianna Strong-Mosley

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In a hospice care organization, a practice gap was observed in prompt pain reassessment with an onset or increase of pain, as mandated within a 48-hour timeframe by the Centers for Medicare and Medicaid Services (CMS). Baseline data showed that only 40% of eligible patients with a pain score of ≥ 6 received a documented pain reassessment within 48 hours. Overall patient satisfaction with hospice services was 45%.

Aim of the Project: The quality improvement project aimed to enhance pain management by increasing the percentage of eligible hospice patients with a documented pain score of ≥ 6 from a …

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

Utilizing A Multidisciplinary Team Approach To Opioid Stewardship In A Long-Term Acute Care Hospital, Lesley Moore

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

The opioid crisis continues to negatively affect patient safety and healthcare outcomes across the United States. Long-term acute care hospitals (LTACHs) care for medically complex patients who often require prolonged pain management and are at increased risk for opioid-related adverse events. At the project site, a 32-bed LTACH, 72% of reviewed patient charts included an opioid prescription upon admission, exceeding recommended prescribing benchmarks and identifying a gap in opioid stewardship practices. The absence of a standardized opioid stewardship program (OSP) and opioid risk screening process increased the risk of opioid misuse, dependency, and adverse patient outcomes.

Aim of the …

Implementing The Walking Impairment Questionnaire For Peripheral Artery Disease Screening And Referral, Lisa Doyle

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity, mortality, and lower extremity amputation. At a Level 1 veterans medical center, the absence of a standardized screening and referral process contributed to delayed identification of symptomatic PAD and underutilization of supervised exercise therapy (SET). Between August 2024 and July 2025, only four veterans completed SET despite a large high-risk population, demonstrating a significant gap in evidence-based recommendations and clinical practice.

Aim of the Project: The aim of this project was to improve patient outcomes by standardizing screening for symptomatic PAD using the Walking Impairment Questionnaire (WIQ) to …

Identifying Palliative Care Needs In The Emergency Department, James Sullivan

All Doctor of Nursing Practice (DNP) Scholarly Projects

This quality improvement project evaluated the implementation of the Palliative Care and Rapid Emergency Screening (P‑CaRES) tool to improve early identification of unmet palliative care (PC) needs among adults with advanced, life‑limiting illnesses presenting to a community emergency department (ED). The problem addressed was the absence of a standardized PC screening process, resulting in delayed recognition, missed referral opportunities, fragmented care, and repeated ED utilization. Guided by Plan‑Do‑Study‑Act cycles and the OhioHealth Change Management Model, the project integrated P‑CaRES into ED workflows, provided staff education, and established structured referral pathways. Over 12 weeks, clinicians completed 65 screenings; 57 patients met …

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

Review of the Evidence: Evidence supports structured handoff frameworks …

Tailoring Interventions For Patient Safety Protocol: A Strategy To Prevent Inpatient Falls, Yashu Adhikari

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Inpatient falls were a significant safety issue at the project site, substantially affecting patient outcomes and organizational resources. The identified gap was the lack of individualized, patient-centered fall-prevention strategies despite the presence of standard fall-prevention bundles. The baseline fall rate of 6.04 was 20% higher than the national benchmark of three to five falls per 1,000 patient days, indicating a clear need for improvement.

Aim of the Project: The quality improvement (QI) project aimed to improve patient safety by reducing inpatient falls through implementation of the AHRQ Fall Tailoring Interventions for Patient Safety (TIPS) protocol on a …

Standardized Infection Prevention Protocol To Reduce Surgical Site Infections In Pediatric Neurosurgery, Pisey Kareth

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Surgical site infections (SSIs) are a significant concern in the pediatric neurosurgical patient population and are associated with increased morbidity, longer hospital stays, and increased medical expenses. The absence of a standardized preoperative infection prevention process led to variability in perioperative care practices and infections at the practicum site.

Aim of the Project: The aim of the project was to reduce the incidence of SSIs among pediatric patients undergoing neurosurgical procedures who were initially evaluated in an ambulatory setting.

Review of the Evidence: Evidence supports the implementation of bundled infection prevention strategies as a more effective approach to reducing …

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

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

All Doctor of Nursing Practice (DNP) Scholarly Projects

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

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

Review of the Evidence: Recent …

The Mental Health Of Athletes: Channeling Frustration, Aggression, Internal/External Behaviors In The Real World To Improve Performance, Jabari Johnson

Dissertations

This qualitative study examined how college athletes, 18 years and older, experience and interpret internalizing behaviors and externalizing behaviors within contact and non-contact sports, and how those experiences are shaped by gender, racial/ethnic background, and socioeconomic status. The study addressed a gap in the literature by centering athletes’ own perspectives on how emotions, coping, identity, and performance intersect within collegiate sport contexts. A purposive sample of 12 athletes completed a demographic questionnaire and participated in semi-structured interviews conducted in person between December 2025 and February 2026. Interview transcripts were deidentified and analyzed using reflexive thematic analysis following Braun and Clarke’s …

Strengthening The Shield: Exploring Post-Traumatic Growth In Law Enforcement, Aaleiyah C. Spaulding

Dissertations

Law enforcement officers are routinely exposed to traumatic incidents that can lead to psychological distress, including posttraumatic stress disorder (PTSD). However, emerging literature highlights the potential for posttraumatic growth (PTG), a positive psychological change following adversity. This study examined the prevalence and predictors of PTG in a sample of 33 police officers from a Midwestern department. Using validated self-report measures, the study assessed the role of trauma exposure, cognitive restructuring of core beliefs, and perceived organizational culture, particularly supervisor support. Results indicated that both internal (core belief reflection) and external (supervisory support) factors significantly predicted PTG. Additionally, involvement in a …

Board Exam Preparation Resource Trends In Academic Health Sciences Libraries Serving Colleges Of Osteopathic Medicine Programs., Joanne Muellenbach, Kyle Robinson, Hsin-Liang (Oliver) Chen, Harold S Bright, Lori Fitterling

PCOM Scholarly Works

BACKGROUND: The study seeks to identify the board exam preparation (prep) resources made available to medical students by academic health sciences libraries and other departments within U.S. colleges of osteopathic medicine (COM) programs, and the extent to which these resources are utilized by medical students and educators.

METHODS: The study was conducted in two phases. In phase one, forty-two COM library directors were invited to complete a survey regarding their usage, funding, and access models for available board prep resources. In phase two, semi-structured interviews were conducted via Zoom to explore the library's role in providing access to these resources. …

Neuromuscular Junction Dysfunction In A Subset Of Charcot-Marie Tooth And Related Peripheral Neuropathies Mouse Models, Jonathan R. Funke, Celeste Martinez, Samia L. Pratt, Alaura D. Rice, Abigail L.D. Tadenev, Robert W. Burgess

Health & Biomedical Sciences Faculty Publications

Charcot-Marie Tooth (CMT) disease is a clinically and genetically heterogeneous inherited peripheral neuropathy for which there is no treatment. CMT patients often present with weakness, fatigue, and muscle atrophy in the distal limbs. Improving function at the neuromuscular junction (NMJ) may improve function in some CMT patients. Using mouse models, we investigated eight CMT subtypes for NMJ phenotypes by morphology and functional deficits assessed by electromyography (EMG). We did not find NMJ abnormalities in mice with mutations in Gjb1Y/Δ2 (CMT1X), or Yars1E196K/E196K (diCMTC). Mice with mutations in Ighmbp2Y918S/Y918S (CMT2S) and Pla2g6M1J/M1J (Infantile Neuroaxonal Dystrophy) have neuromuscular …

Univariate And Bivariate Binary Spatial Regression Models With Application To Plant Abundance Data, Amir Hamza Akash

Graduate Theses and Dissertations

Analyzing species distributions is of prime interest in ecological research. Prevalence of a species usually depends on several environmental and topographic features not all of which can be quantified or measured. Spatial random effects play an important role as a surrogate for missing features that can explain similarity in species prevalence patterns between neighboring locations. In this thesis, we focus on a dataset on abundance of plants in the southern part of South Africa. First, we build a hierarchical Bayesian model for binary regression, using the probit link, on presence/ absence of a species based on available covariates. Since the …

Coastal Empire Economic Monitor, 1st Quarter, 2026, Georgia Southern University Center For Business Analytics And Economic Research

Coastal Empire Economic Monitor

No abstract provided.

Enhancing Validation Of Case-Control Omics Signatures Through "Minimalist" Single-Subject Analysis (N-Of-1 Trials): Proof Of Concept In Sepsis, Liam S Wilson, Nima Pouladi, Rachel F Nelson, Elizabeth A Middleton, Neal D Tolley, Mahdieh Shabanian, Colleen Kenost, Robert A Campbell, Matthew T Rondina, Yves A Lussier

2020-Current year OA Pubs

OBJECTIVE: To evaluate if a single-subject study (S3) design, utilizing paired transcriptome samples from the same patient (eg, "sepsis" vs "recovered"), can replicate transcriptomic signatures from small case-control studies, addressing challenges in patient accrual for rare or sub-stratified diseases.

METHODS: We generated a sepsis gene signature (SGS) comprising 300 differentially expressed genes (DEGs; FDR <  5%) from a human sepsis case-control cohort using general linear models (GLMs). Reproducibility of SGS was assessed through three approaches applied to sub-sampled independent datasets: single-subject analyses (N-of-1-MixEnrich), anticipated to perform better; conventional paired-sample GLM analyses; and a traditional case-control GLM analysis.

RESULTS: SGS reproducibility in GLM analyses was inconsistent at smaller cohort sizes (∼80% reproducibility; n = 5) but stabilized at cohort sizes >6. Remarkably, the single-subject-study approach consistently reproduced SGS in each of the 18 subjects individually (100% reproducibility; n = 1).

DISCUSSION: Conventional GLMs are …

Operational Agency: A Permeable Legal Fiction For Tracing Culpability In Ai Systems, Anirban Mukherjee, Hannah H. Chang

Research Collection Lee Kong Chian School Of Business

Modern artificial intelligence (AI) systems act with a high degree of independence yet lack legal personhood—a paradox that fractures doctrines grounded in human-centric notions of mens rea and actus reus. This Article introduces Operational Agency (OA)—a permeable legal fiction structured as an ex post evidentiary framework—and Operational Agency Graph (OAG)—a tool for mapping causal interactions among human actors, organizations, and AI systems. OA evaluates an AI’s observable operational characteristics: its goal-directedness (as a proxy for intent), predictive processing (as a proxy for foresight), and safety architecture (as a proxy for standard of care). OAG operationalizes that analysis by embedding these …