Digital Commons Network^™

A Quality Improvement Initiative To Improve Central Line Insertion Care Using An Evidence- Based Practice Checklist, Jonathan Andre Barbour

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Central line infections in a 33-bed Cardiovascular Intensive Care Unit (CVICU) at a large academic medical center located in the northeastern United States were increasing for patients after cardiovascular surgery. These infections could, potentially, lead to longer hospital stays and lost revenues for the health system. A project explored the implementation of an evidence-based practice (EBP) sterile procedure standardized checklist during central line insertions

Purpose: A quality improvement (QI) initiative project sought to improve central line insertion compliance while monitoring the bedside implementation of an EBP checklist.

Intervention: The Agency for Healthcare Research and Quality’s (AHRQ) Central line-associated bloodstream …

Development Of A Protocol To Improve The Use Of Diabetes-Specific Formula, Lauren Nicole Sanetrik

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Enteral nutrition (EN) is often necessary for hospitalized patients who are unable to meet their nutritional needs orally. Patients with diabetes mellitus (DM) receiving EN are at risk of hyperglycemia, which contributes to poor wound healing, infection, and prolonged hospitalization. Diabetes-specific formulas (DSFs) are designed to optimize glycemic control compared with standard formulas (SFs); however, their use is inconsistent due to the absence of standardized protocols.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement and evaluate a protocol to increase DSF utilization among patients with DM receiving EN, with the goal …

An Evidence-Based Practice Initiative To Promote Debriefing Within The Obstetrics Surgical Team, Rachel Lynn Runatz

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Operating room debriefing is an evidence-based strategy shown to improve communication, efficiency, patient safety, and safety culture; however, debriefing is inconsistently performed in obstetric operating rooms due to workflow, cultural, and time-related barriers.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to increase the frequency of debriefings in the Birthing Center operating rooms at WVU Medicine Children’s Hospital through implementation of a nurse-driven, evidence-based debriefing initiative.

Intervention: A nurse-driven debriefing protocol was implemented using the Iowa Implementation for Sustainability Framework. Interventions included staff education, accessible laminated debriefing documents, identification of nurse champions, leadership support, and …

The Effects Of Music Therapy On Anxiety And Sedation Requirements For Total Knee Arthroplasty Patients Undergoing Regional Anesthesia: An Evidence-Based Practice Pilot Initiative, Kyra Marie Savrese

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Excessive noise in the operating room negatively impacts patient comfort and outcomes, particularly in patients undergoing spinal anesthesia who have the potential for awareness.

Background: Research demonstrates that music therapy is a low-cost, low-risk intervention that reduces perioperative anxiety and sedative requirements. Literature supports the use of music as an adjunct to anesthesia care, especially in orthopedic populations.

Purpose: At J.W. Ruby Memorial Hospital, orthopedic procedures with regional anesthesia expose patients to high noise levels, often leading to increased anxiety, sedation use, and longer recovery times. Addressing this problem aligns with institution goals for safe, patient-centered care.

Methods: Using …

Do Transdiagnostic Factors Predict Emotion Recognition?, Grace L. Wheeler

Graduate Theses, Dissertations, and Problem Reports (ETD)

While emotion recognition deficits have been found in several anxiety and related disorders (e.g., social anxiety, obsessive-compulsive), consistent results have not been established. To clarify the relationship between emotion recognition abilities and anxiety, the current study tested if transdiagnostic factors related to anxiety are predictors of emotion recognition abilities. Data was analyzed from participants (N = 188) recruited via CloudResearch; they completed measures of three transdiagnostic factors related to anxiety (e.g., anxiety sensitivity, intolerance of uncertainty, and rumination), followed by an emotion recognition task. Multiple regression analyses revealed higher levels of anxiety sensitivity predicted worse recognition for anger, disgust, …

Improving Sedative Administration In Patients Receiving Paralytics During Intubation: A Quality Improvement Initiative Within A Large Academic Medical Center In West Virginia, David Bryon Underwood

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Awake paralysis (AWP) occurs when long-acting neuromuscular blockers outlast short-acting sedatives during intubation, leaving patients chemically paralyzed but conscious. This highlights the critical need for timely post-intubation sedation.

Background: A 2024 review in the Neurological Critical Care Unit (NCCU) revealed that 72% of patients who received rocuronium were not given a post-intubation sedative. The difference in duration of action of paralyzing agents versus sedatives can result in patients being conscious while paralyzed, potentially resulting in hemodynamic instability and psychological harm.

Purpose: The quality improvement initiative aimed to reduce the number of patients receiving neuromuscular blocking agents without post-intubation sedation. …

Genetics Of Mycangial Development And Host Colonization Within The Ambrosia Symbiosis, Mckeon James Laws

Graduate Theses, Dissertations, and Problem Reports (ETD)

Ambrosia beetles, a polyphyletic group of weevils, utilize pouch-like structures at various locations on the body to transport for their sole food source, their fungal partner. Ambrosia fungi are known to originate from multiple unrelated fungal lineages with no consensus of traits required to become a fungal cultivar. While the biology and ecology of both partners is in many cases well understood, the genetic underpinnings of this fascinating mutualism remain a mystery. The aim of this dissertation is to add to the understanding of the ambrosia symbiosis by providing insights into its molecular and genetic underpinnings through RNA sequencing data, …

Walking In The Footsteps Of My Ancestors: A Deep Map Of Cherokee Forced Removal, Deborah Lyn Kirk

Graduate Theses, Dissertations, and Problem Reports (ETD)

In this study of the place of Cherokee forced removal, I use a Third Space approach to blend Indigenous Methodologies, Deep Mapping, Geospatial mapping and analysis, and 3D Geography. Using a hybrid platform that provides a mélange of media types, storytelling forms, and interactive tools, I reimagine and retell the story of the Cherokee “Trail of Tears.”

In accordance with Cherokee philosophies of duyuktv, harmony, and “a good mind” I first sought out Cherokee sponsorship from community respected and culturally knowledgeable Cherokee citizens; partnered with the National Trail of Tears Association (NTOTA); submitted my research proposal to the Cherokee …

Empowered Choices: A Quality Improvement Women’S Health Initiative In Faith-Based Nursing For Women Recovering From Substance Use Disorder, Jennifer Mewshaw

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Women with substance use disorder (SUD) face higher rates of unplanned pregnancy, reproductive infections, and delayed prenatal care. Faith community nurses (FCNs) often already serve within this community and have a long history of promoting public health interventions. However, they lack the knowledge and confidence in sexual and reproductive health (SRH) education.

Evidence Review: A literature review identified barriers to SRH care for women with SUD and the role of FCNs in community and public health interventions. Evidence supports providing FCNs with the knowledge and skills to deliver SRH education and support for women with SUD using trauma-informed and …

Implementation Of A Ventilator-Associated Pneumonia Bundle To Reduce The Incidence Of Ventilator-Associated-Pneumonia And Improve Patient Care, Taylor Ryan Rice

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Ventilator-associated pneumonia (VAP) is a concerning complication that can

develop from complications when a patient is placed on a mechanical ventilator. Endotracheal

intubation puts patients at risk for micro aspiration, which can lead to VAP.

Evidence Review: Nine articles were selected for review; after critical appraisal, seven were

kept for further review. Evidence in these articles shows that using evidence-based methods in a

VAP bundle can decrease the length of stay, mechanical ventilator days, and the incidence of

VAP.

Purpose: The purpose of this project was to improve oral care for intubated patients and keep

the incidence of VAP …

New Fossil Mygalomorph Spiders (?Idiopidae, Pycnothelidae) From The Lower Cretaceous Crato Formation Of Brazil, Elis Maria Gomes Santana

Graduate Theses, Dissertations, and Problem Reports (ETD)

The infraorder Mygalomorphae represents one of the earliest-diverging lineages of spiders, but its fossil record remains sparse relative to the modern diversity of the group. This is a reflection of both ecological and preservational biases, such as the predominantly fossorial habits of many mygalomorphs and the strong bias of the spider fossil record toward amber deposits. Compression fossils from rock deposits are therefore especially important for documenting the evolutionary history of the group. Here, two new mygalomorph fossils from the Lower Cretaceous Crato Formation, Araripe Basin (Brazil) are described. The first specimen is tentatively referred to ?Idiopidae based on male …

Population Dynamics And Future Viability Of The Eastern Massasauga Rattlesnake (Sistrurus Catenatus) In Southwest Michigan, Matthew John Klein

Graduate Theses, Dissertations, and Problem Reports (ETD)

Managing at-risk species or populations requires understanding the demographic and genetic drivers of long-term population trends. The eastern massasauga rattlesnake (Sistrurus catenatus) is a federally threatened species facing multiple interacting threats across its range. Habitat loss from wetland drainage and agricultural land conversion has caused range contractions and geographic isolation of populations. Because remaining populations are often small and widely separated, most are now genetically isolated, threatening their long-term viability. Reversing these declines requires understanding population dynamics, quantifying extinction risk, identifying drivers of long-term viability, and assessing the effects of inbreeding and the potential for genetic rescue to …

Application Of Heron's Formula, Hidefumi Katsuura

Faculty Research, Scholarly, and Creative Activity

We apply Heron's formula to obtain a generalized Ptolemy's theorem, to prove Euler's formula for the volume of a tetrahedron, and to prove Klain's theorem on reversible tetrahedra. After that, we prove triangle inequalities derived from a tetrahedron, find an inequality on the circumradius of a tetrahedron, find a volume expression of an isosceles tetrahedron, and give a condition for four points in the space to be co-planar.

Faculty Perceptions Of Engaging Generation Z Students Through Positive Education In The Classroom, Ashley D. Ragsdale

Electronic Theses and Dissertations

This qualitative study examined the engagement gap between Generation Z students and faculty in higher education, emphasizing how positive education approaches can help faculty become more confident and effective instructors. Generation Z students prefer instant internet access and digital learning, have shorter attention spans, and tend to be disengaged when instructors rely on traditional teaching methods. After the COVID-19 pandemic, this engagement gap became more evident. This basic qualitative study used semistructured interviews, reflexive journaling, and nonparticipatory observations. Participants included full-time health science faculty at a private university in central Texas. Each had at least 2 years of teaching experience …

A Guide To The Style Of Domenico Scarlatti With An Analysis Of Six Sonatas, Joseph Mcdermott

Graduate Theses, Dissertations, and Problem Reports (ETD)

This document aims to inform pianists preparing to perform keyboard sonatas by Domenico Scarlatti (1685-1757). Readers will learn about Scarlatti's professional life and his compositional characteristics. Analyses of six sonatas, the influence of Spanish traditional music, and details on performance practices are used to illustrate his style. The six sonatas included in this study are Sonata in G Major, K. 63; Sonata in C minor, K. 22; Sonata in F minor, K. 238; Sonata in F minor, K. 239; Sonata in D Major, K. 490; and Sonata in D Major, K. 491. The influence of Spanish traditional music is discussed …

Appendices A, B, C, D, & E For "In Their Own Words: Qualitative And Quantitative Analyses Of What Students, Staff, And Faculty Say About Vertical Transfer", Alexandra W. Logue, Vita Rabinowitz, Kerstin Gentsch, David Wutchiett, Barbara Condliffe, Sophia Sutcliffe, Yoshiko Oka, Stephanie Abbeyquaye, Rhina Torres, Nayeon Yoo, Kyle Du

Publications and Research

Deposited here are the Appendices (A, B, C, D, & E) for an article to be published in 2026 in Journal of Postsecondary and Student Success. The abstract of this article is:

This research analyzed higher education constituencies’ statements about vertical transfer (student transfer from community to bachelor’s colleges). Data consisted of both focus group excerpts involving dozens of students, staff, and faculty, and of answers to open-ended survey questions completed by thousands of students and faculty. Results were generally consistent using both qualitative (topic identification) and quantitative (bigram frequency and sentiment analysis) analyses. The results were also compared …

From Sentiment And Risk To Trade: A Country-Level Study On Geopolitical Trade Effects, Seung Heo

Publications and Research

Can geopolitical risk reshape international trade? I construct directed, monthly measures of bilateral geopolitical risk and its associated sentiment from approximately 5.1 million news articles in the GDELT Event Database, and estimate their effect on trade among eight Asia-Pacific economies at the HS2 product level over 2015--2025, using Poisson pseudo-maximum-likelihood gravity local projections with high-dimensional fixed effects. Pooled across countries, rising risk produces an immediate expansion of trade led by verbal threats and by news tone orthogonal to event content, rather than by material acts, indicating that how a conflict is reported can move trade before the conflict materializes. A …

“Because We Take Our Values To War” Analyzing The Views Of Un Member States On Aidriven Lethal Autonomous Weapon Systems, Rangita De Silva De Alwis

Chicago Journal of International Law

In paragraph two of its resolution 2 on lethal autonomous weapon systems, pursuant to U.N. General Assembly resolution 78/241, the General Assembly requested the Secretary-General to solicit the views of Member States and Observer States regarding lethal autonomous weapons systems (LAWS). Specifically, the request encompassed perspectives on addressing the multifaceted challenges and concerns raised by LAWS, including humanitarian, legal, security,

The Seeds Of Peace And Justice, Shai Dothan

Chicago Journal of International Law

Some positive developments in international law had humble beginnings. They started from a small group of idealists who wanted to change the world for the better. Once their ideas gathered momentum, they got the support of people with power and transformed the world. State after state followed each other in a cascade toward improving international law. The purpose of this paper is to investigate the conditions that are beneficial for the initial germination of ideas with the potential to positively revolutionize international law. By using a series of case studies focused on the initiation of major transformations that improved international …

The Classical Limit In Geometric Quantization By Group Extension, Paul Bracken

School of Mathematical & Statistical Sciences Faculty Publications

Physical systems as a rule are associated with a symmetry group. The group approach to geometric quantization makes use of this to introduce a quantization by means of group extension. This procedure is discussed and applied to a physical system whose group law has its origin with the Galilean group. The main intention is to investigate the classical limit and its relationship under this approach to geometric quantization. The classical quantization conditions are obtained based on a deeper foundation.

Utilizing A Culture System For Horizontal Cells To Study Neural Circuit Assembly In The Developing Mouse Retina, Ross M Perez, Yong H Park, Ajeet Singh, Collin Todora, Marlon F Mattos, Daniela Becerril, Rajashree Venkatraman, Arlene A Hirano, Nicholas C Brecha, Rinki Ratnapriya, Benjamin J Frankfort, Elizabeth Zuniga-Sanchez

Faculty, Staff and Students Publications

The precise wiring of the nervous system relies on neurons extending their processes at the right time and place to find their appropriate synaptic partner. The mechanisms that determine when and where neurons extend their neurites during synaptogenesis remains a central question in the field. In the present study, we used a cell culture system coupled with live imaging to investigate the wiring mechanisms in the developing mouse retina. We focused on horizontal cells which are a class of interneurons in the outer mouse retina known to synapse selectively to the distinct types of photoreceptors. Previous research has shown horizontal …

Using Lotilaner Ophthalmic Solution, 0.25% To Treat Demodex Blepharitis In Patients Who Were Initially Misdiagnosed: A Case Series, Laura M Periman, Richard Lindstrom, Paul Karpecki, Brandon Ayres, Eric Donnenfeld, Marjan Farid, Ian Benjamin Gaddie, Preeya K Gupta, Selina Mcgee, Kelly K Nichols, Stephen Pflugfelder, Christopher E Starr, Nandini Venkateswaran, Elizabeth Yeu, Cecelia Koetting

Faculty, Staff and Students Publications

Introduction: Demodex blepharitis (DB) is a chronic ocular inflammation caused by Demodex mite infestation of the eyelid. DB is often misdiagnosed, as some of its clinical findings and patient-reported outcomes overlap with those of other ocular surface diseases. The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) has reached consensus on the symptomatology, diagnosis, and treatment of DB. Consensus findings from the DEPTH group include that collarettes are pathognomonic for DB and that lotilaner ophthalmic solution, 0.25%, the first and only FDA-approved treatment for DB, should be the first-line treatment for the disease. This case series highlights two instances …

3d Geometric Modelling And Clinical Validation Of Lower Limb And Preliminary 2-Year Post-Operative Clinical Outcomes Of Neutral Boundary Alignment In Total Knee Arthroplasty, Bruno Violante, Lorenzo Deveza, Francesco Pollara, Giovanni Rusconi, Gianroberto Ferreri, Alessandro Annibaldi, Ilwhan Park

Faculty, Staff and Students Publications

Purpose: To introduce a novel three-dimensional (3D) modelling concept for lower limb alignment in total knee arthroplasty (TKA), termed neutral boundary alignment (NBA) and to present preliminary clinical data supporting this physics-based custom alignment strategy.

Methods: NBA is defined as the alignment at which the knee joint line is parallel to the ground during the mid-stance phase of gait, achieving static equilibrium with the NBA axis aligned to gravity. A theoretical geometric model of the lower limb was developed, integrating principles of physics to describe this condition. Preliminary clinical validation was performed using radiographic data from an initial cohort of …

Use Of A Medication Management Algorithm In Depressed Youth Living With Hiv: Secondary Analysis Of A Multisite Randomized Controlled Trial, Graham J Emslie, Beth D Kennard, Kristin Baltrusaitis, Sophia M Jones, Jessica M Jones, Jaime G Deville, Kathleen Pitts, David E Shapiro, Allison Eliscu, Larry K Brown

Faculty, Staff and Students Publications

Objectives: Depression is a prevalent co-occurring condition in youth living with HIV. This report is a secondary analysis of a multisite cluster randomized trial evaluating the efficacy of a health and wellness cognitive behavioral therapy (CBT) combined with a medication management algorithm utilizing measure-based care (COMB-R) compared with enhanced standard of care (ESC). We describe and compare antidepressant prescribing strategies (i.e., antidepressant treatment, type of antidepressant) for youth living with HIV at COMB-R sites to those at ESC sites over the 24-week intervention. We also describe self-reported adherence to antidepressants.

Methods: Participants (12-24 years) were youth living with HIV diagnosed …

Hemispherotomy For Drug-Resistant Epilepsy In A Low-Resource Setting: Surgical Outcomes And Quality Of Life In 23 Children Treated In A Hybrid Program In Panama, Emmajane G Rhodenhiser, David Bonda, Carmen Baez, Hannah K Weiss, Yosef Dastagirzada, Guzman Aranda, Laurent Bruggeman, Ameeta Grover, Shaun D Rodgers, Ruben Kuzniecky, Yvonne Zelenka-Kuzniecky, Howard L Weiner, Eveline Teresa Hidalgo

Faculty, Staff and Students Publications

Introduction: Hemispherotomy is an effective treatment for children with drug-resistant epilepsy (DRE). While hemispherotomy techniques and indications have evolved, access remains predominantly constrained to high-resource settings.

Methods: We performed a retrospective analysis of children who underwent hemispherotomy from 2011 to 2023 by a hybrid team, including local Panamanian and US neurologists, neurosurgeons, and EEG technicians and analyzed surgical, epilepsy, and quality of life (QoL) parameters. Follow-up data were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) guidelines for children with epilepsy.

Results: Twenty-three children underwent hemispherotomy. The median age at surgery was 10 years (range 2-20). The …

Dynamic Progression Of Ectopic Lymphoid Structure Formation In Lacrimal Glands Of A Sjögren’S Disease Murine Model, Sara Abdelhamid, Alison V Ramirez, Emre Aksan, Elizaveta A Demianova, Cintia S De Paiva, Maria C Edman, J Andrew Mackay, Sarah F Hamm-Alvarez

Faculty, Staff and Students Publications

Background: Sjögren's Disease (SjD) is a chronic autoimmune condition characterized by lymphocytic infiltration of lacrimal glands (LG) and salivary glands (SG). In SG, these immune structures have properties of ectopic lymphoid structures (ELS) and appear to play a critical role in disease pathology. While the presence of ELS in patients' SG biopsies is linked to disease severity, their presence and composition in LG has not been well characterized.

Methods: The properties and time course of apparent ELS development in LG from the male non-obese diabetes free (NOR) sub-strain of the Non-Obese Diabetic (NOD) mice was investigated at stages encompassing early …

Professionalism In Practice: A Novel Approach To Integrating Small Doses Of Case-Based Professionalism Education Into Monthly Grand Rounds., Allison H Taylor, Andrew Caruso, Kelley Arredondo, Ellen M Friedman, Stacey R Rose

Faculty, Staff and Students Publications

Introduction: Professionalism is a critical construct across the health professions, though learners and faculty report feeling underprepared to navigate difficult situations; education in professionalism is challenged by the absence of a universal definition, time constraints due to overcrowded curricula, and the lack of consistent messaging to learners and faculty.

Methods: Professionalism in Practice (PiP) was developed to provide small doses (∼5 minutes) of case-based professionalism education as part of an existing educational forum (Grand Rounds) to optimize attendance of both learners and faculty. Each vignette highlighted a common professionalism challenge and was aligned with an AAMC professional competency. Sessions were …

Functional Analysis Of Genes Enriched In Male Reproductive Organs: Validation Via Fertility Assessment Of 14 Knockout Mouse Lines, Kazumasa Takemoto, Katarzyna Kent, Kaori Nozawa, Shingo Tonai, Ahn H Pham, Terumi Fujimoto, Thomas X Garcia, Martin M Matzuk, Masahito Ikawa, Keizo Tokuhiro

Faculty, Staff and Students Publications

Tissue-restricted gene expression serves as a key indicator of functional importance within specific organs. Despite advances in high-throughput sequencing and genome editing over the past decade, this principle remains the gold standard for identifying candidate genes for functional studies. In reproductive biology, testis-restricted expression is anticipated to indicate genes crucial for gametogenesis, given the conserved features shared between spermatogenesis and oogenesis. Concurrently, rapid evolution of spermatogenesis-related genes is well documented and thought to arise through duplication and subsequent mutation of ubiquitously expressed genes. In this study, we established 14 knockout (KO) mouse lines for male reproductive organ-enriched genes, all of …

Improving Healthcare Professionals’ Comfort Level Screening For Intimate Partner Violence, Madison M. Mitzel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Pregnancy increases a woman’s risk of experiencing intimate partner violence (IPV). Although healthcare visits typically increase during pregnancy, IPV screening is often overlooked, and many women remain unaware of available domestic violence resources. 
Local problem: Globally, women are impacted by IPV, with those living in rural areas facing a higher risk. 
Methods: The Abuse Assessment Screen (AAS) was implemented in a rural women’s health facility to screen patients for IPV. Prior to implementation, healthcare professionals within the facility received education regarding the screening protocol and available resources for patients. 
Interventions: The comfort level of the healthcare professionals discussing IPV …

Coral Holobiont Lipidome Response To Global Change, Lauren Zane

Open Access Dissertations

Climate change is fundamentally restructuring macro-scale marine ecosystem structure and function by altering microscale metabolic processes and patterns of energy allocation. Scleractinian corals, as major ecosystem engineers, play outsized roles in ecosystem structure and function. They also occupy diverse habitats that differ in temperature regimes, light environments, hydrodynamics, and other environmental conditions, exposing corals to substantial spatial variation in stress and resource availability. Their fragile nutritional symbiosis with algal endosymbionts helps them navigate these environmental variations, but are also highly sensitive to environmental stress, particularly the timing and magnitude of water temperature changes. As pressure from environmental changes increases, the …