Digital Commons Network^™

Improving Patient Access To Providers By Optimizing Message Center Workflow, Serena Valino

Walden Dissertations and Doctoral Studies

This project was an evaluation of a quality improvement initiative that addressed the practice problem of having large volumes of unanswered messages within the patient portal. To increase patient access to the healthcare provider, a literature search was conducted using the practice-focused question: Can standardization of patient portals improve the message turnaround time? In January 2024, a scoping review of nursing message center pools determined 79 pools lacked standardized names and established workflows for 37 ambulatory clinics. Pool names were identified for each clinic and listed using an Excel spreadsheet. Clinic pool members were isolated, and it was determined by …

Metabolic Screening In Veterans On Antipsychotics Mood Stabilizer, Joy Nneka Eke

Walden Dissertations and Doctoral Studies

Summary This Doctor of Nursing Practice project was conducted to examine a quality improvement initiative that sought to address metabolic syndrome screening consistency for veterans on antipsychotic medications at a U.S. Department of Veterans Affairs health system located in the Midwest region of the United States. The project centered on whether the quality improvement program assessing compliance with the current metabolic syndrome screening process reflects increased early detection of metabolic syndrome to prevent cardiovascular complications. Data collection involved comprehensive chart reviews of 50 veterans’ records. The data collected were analyzed using a specially designed quality improvement initiative assessment form developed …

Staff Education To Improve Nursing Knowledge On Fall Prevention, Mary Del Riffe

Walden Dissertations and Doctoral Studies

Summary Falls in health care facilities constitute the most prevalent incidents among all safety-related mishaps. If unaddressed, falls can result in severe consequences and perhaps fatal outcomes for patients. The Doctor of Nursing practice (DNP) project was developed to address the issue of patient falls in a long-term acute care hospital (LTACH). The practice-focused question was: Will implementation of an educational evidence-based staff fall prevention program improve nurses’ knowledge on fall prevention? The 1-hour staff education program was created based on review of recent evidence. Twelve nurses attended the staff education program. A pre- and posttest were used to evaluate …

Pet Ownership And Health-Related Quality Of Life Among Middle-Aged Adults, Kristi Martin

Walden Dissertations and Doctoral Studies

Pet ownership continues to be part of modern society in the United States. Researchers have explored pet ownership’s impact on chronic diseases and aging populations, but research on health-related quality of life is limited. Grounded in the socioecological model, this quantitative study analyzed data from the 2005-2006 National Health and Nutrition Examination Survey (N = 10,348) to investigate the impact of pet ownership on health-related quality of life among low-income adults aged 30-50 years. Chi-square tests were performed to analyze the associations between age, income, gender, and race with three health-related quality of life metrics. Results showed no statistically significant …

Identifying Common Characteristics Among Female Serial Killers And The Role Of Early Childhood Abuse, Jill Marie Raichel

Walden Dissertations and Doctoral Studies

Approximately 17% of known serial killers in the United States are women, and often their crimes go undetected for years accruing a higher number of victims than their male counterparts. The purpose of this study was to identify common characteristics of female serial killers (FSKs). A multidisciplinary, holistic and developmental approach was used to guide the identification of common characteristics based on theories by Erik Erikson and Carol Gilligan as well as feminist theory. Case studies of 15 FSKs were randomly selected for participation from a list of over 100 known FSKs documented in the Radford Serial Killer database. Common …

Elementary School Teachers’ Perspectives On Project-Based Learning Implementation In Commonwealth Of The Northern Mariana Islands, Xiao Tang

Walden Dissertations and Doctoral Studies

Elementary schools play an essential role in equipping students with 21st-century skills. Project-based learning (PBL) is a student-centered instructional approach that is associated with the development of these skills, yet PBL implementation in elementary schools is not well understood in Saipan, the Commonwealth of the Northern Mariana Islands (CNMI). The research problem addressed in this study was a lack of understanding of elementary teachers’ practices in implementing PBL in Saipan. Guided by constructivist theory, the purpose of this qualitative study was to examine elementary school teachers’ perspectives on the benefits of PBL, the ease or difficulty when implementing PBL, the …

The Lived Experiences Of Clinicians Who Treat Black Males Who Have Experienced Intimate Partner Violence, Gifty A. Acheampong

Walden Dissertations and Doctoral Studies

Intimate partner violence (IPV) is a global issue that negatively affects humanity. The harmful effects of IPV often result in lifelong consequences for victims. Researchers have consistently identified women and children as the primary victims of IPV, although men can also be affected. The social stigma around men seeking formal help as victims is that they must endure physical, emotional, financial, sexual, and psychological abuse in intimate relationships. Because psychological abuse is the most common form experienced by male IPV victims, there is a higher prevalence of IPV within the Black community. However, research on help-seeking behaviors among Black men …

The Effect Of Gender, Race, And Age On 30-Day Readmission Rates Among Heart Failure Patients In Mississippi, Patricia Ann Mondy

Walden Dissertations and Doctoral Studies

A sizeable number of U.S. heart failure patients are readmitted within 30 days of hospital discharge. There was a need to explore ways to reduce this number and improve the care of heart failure patients when they are discharged home. The purpose of this quantitative correlational study was to determine if there is a relationship between age, gender, and race of heart failure patients and 30-day readmissions in the U.S. state of Mississippi in 2019. The dependent variable was heart failure 30-day readmissions, and the independent variables were age, gender, and race. Wagner’s chronic care model was the theoretical framework …

The Relationship Between Internal Controls, Unfavorable Financial Statement Audit Opinions, And Nonprofit Financial Performance, Gwen Rachel Bedell Gadbois

Walden Dissertations and Doctoral Studies

Executives of nonprofit organizations face fiscal and operational challenges due to limited resources, threatening long-term viability. Weak internal controls and financial reporting systems can stem unfavorable Single Audit opinions and reduced funding, concerning to auditors and fiscal agencies. Grounded in resource dependency theory, the purpose of this quantitative ex post facto secondary data analysis was to examine whether financial performance differed by audit opinion and internal control indicators among U.S. nonprofits receiving federal aid. Data included 158 U.S. nonprofits that received $750K–$7M in federal aid in 2021 with qualified, adverse, or disclaimer audit opinions. A three-way analysis of variance revealed …

A Cultural Staff Education Project To Improve Hypertension Management In African American Adults, Rosemary Nguatem Folefa Fonya

Walden Dissertations and Doctoral Studies

In this evidence-based educational project, I identified the gap in practice with the lack of nurses' knowledge in culturally tailored hypertension management among nurses caring for African American adults at a family nurse practitioner clinic. In this Doctor of Nursing Practice (DNP) project, I focused on a staff education initiative to improve nurses' knowledge to reduce disproportionately high rates of hypertension, complications, and mortality due to factors such as limited access to care, medication nonadherence, mistrust of providers, and improve on culturally competent interventions. The guiding practice-focused question was: Does educating nurses on hypertension in the African American population improve …

Preventing Psychotropic Medication Duplication: Improving Communication Between Primary Care And Psychiatric Providers, Linda Nwachuku

Walden Dissertations and Doctoral Studies

This project is an education-based initiative designed to address the persistent problem of psychotropic medication duplication in integrated care settings. Duplication occurs when patients receive multiple prescriptions of the same or similar psychotropic drugs. The practice gap exposes patients to adverse drug events, complications of polypharmacy, and reduced adherence, and subjects the providers to liability. The practice-focused question guiding this project is: For primary care and psychiatric providers, will an education program on structured communication and medication reconciliation, compared to current usual practices, increase provider confidence and awareness of the risks of duplication, communication strategies, and increased the use of …

Effective Change Management Strategies For Minimizing Financial Impact And Operational Disruption, Nhung K. Tran

Walden Dissertations and Doctoral Studies

Ineffective organizational change strategies represent a persistent challenge for organizations undergoing transitions. Business leaders who must maintain operational stability and safeguard financial performance during periods of change need effective strategies to support successful implementation. Grounded in an 8-step change model, organizational information processing, and stakeholder theories, the purpose of this qualitative pragmatic inquiry research project was to identify effective change management strategies used by business leaders to minimize financial loss and operational disruptions during transitions. The participants were eleven leaders from nonprofit, higher education, corporate, faith-based, agriculture, and military sectors who had effective change management strategies. Data were collected through …

Coaching Hero: An Investigation Of Psychological Capital In Black Women Entrepreneurs, Deana Diana Kennedy

Walden Dissertations and Doctoral Studies

The disparity of psychological capital (PsyCap) among diverse cultures and genders in the entrepreneurial area weakens access to the economic and social resources required to develop and sustain entrepreneurial ventures. Black women entrepreneurs continue to lag behind their counterparts in other ethnicities in generating revenue from entrepreneurial efforts, hindering U.S. business maturity. The purpose of this qualitative, constructivist grounded theory study was to explore how coaching facilitates the development of PsyCap among Black women entrepreneurs and the perceived socioeconomic barriers that influence this development. The social cognitive theory and a positive psychology conceptual framework grounded this study. The participants comprised …

The Hunga Volcanic Eruption Atmospheric Impacts Report, Simon Carn

Michigan Tech Publications

No abstract provided.

Editorial – Dec 2025, Edwin Van Teijlingen, Rafat Jan

Journal of Asian Midwives (JAM)

No abstract provided.

Factors Associated With Preterm Premature Rupture Of Membranes: A Case-Control Study In A Tertiary Hospital In Kabul, Afghanistan, Atia Sharif Nadi, Freshta Sharif Tawakkuli, Zainab Sharif Ezadi, Sayed Murtaza Sadat Hofiani, Shoaib Murtaza Sadat Naeemi, Ahmad Komail Frogh

Journal of Asian Midwives (JAM)

Background: It is essential to identify preterm premature rupture of membranes (PPROM) and its associated risk factors to reduce its impact. This study aims to find the demographic, reproductive, and obstetric factors associated with PPROM among women in Kabul, Afghanistan.
Methods: This case-control study was conducted over six months in 2023 at a tertiary hospital in Kabul, Afghanistan. We included 40 cases of PPROM and 80 controls without PPROM in this study. We used structured questionnaires to collect demographic, reproductive, and obstetric characteristics of the participants. To find the factors associated with PPROM, Logistic regression was performed using IBM SPSS …

Too Young, Too Risky: Maternal And Neonatal Outcomes Of Teenage Pregnancy In Pakistan, A Scoping Review, Sumia Andleeb Abbasi, Noor E Marfa Shivji, Warisha Qamar, Tayyaba Riaz Abbasi, Abdullah Riaz Abbasi, Raja Adan Asif

Journal of Asian Midwives (JAM)

Introduction: Teenage pregnancy is a global concern that affects both the developed and developing regions. Adolescent pregnancy is associated with serious maternal and child health outcomes. This paper aims to identify the prevalence and patterns of maternal child health outcome of adolescent’s pregnancies.
Methods: This review utilized the PRISMA-ScR guidelines. To identify the outcomes of the adolescent pregnancies, a wide-ranging search strategy was implemented. Data were extracted from 15 eligible studies with a total population of 5692participants from Pakistan. The studies included maternal characteristics, mode of delivery, and neonatal outcomes. Only quantitative methods were included.
Results: The review of 15 …

Transcriptional Coregulator Zmiz1 Modulates Estrogen Responses That Are Essential For Healthy Endometrial Function, Myeongjin Yi, Cynthia J Willson, Mark Y Chiang, Yong Song, Goutham Venkata Naga Davuluri, Christopher Day, Ramakrishna Kommagani, Joseph Rodriguez, Asgerally T Fazleabas, John P Lydon, Francesco J Demayo

Faculty, Staff and Students Publications

Estrogen is a critical regulator of endometrial health. Aberrant estrogen stimulation can result in infertility, endometrial cancer, and endometriosis. Here, we identified Zinc Finger MIZ-Type Containing 1 (Zmiz1) as a coregulator of uterine estrogen signaling. ZMIZ1 is colocalized with an estrogen receptor α–binding (ESR1-binding) super enhancer. ZMIZ1 mutations are found in endometrial cancer and its RNA levels trend toward reduction in endometrium of patients with endometriosis. ZMIZ1 is dynamically expressed in human endometrial tissues during the menstrual cycle. Disrupting ZMIZ1 in cultured human endometrial stromal cells resulted in impaired cell proliferation and decidual differentiation. Ablation of Zmiz1 using …

Hemophagocytic Lymphohistiocytosis In A Pediatric Lung Transplant Recipient, David Moreno Mcneill, Maria C Gazzaneo, Ernestina Melicoff-Portillo, Nahir Cortes-Santiago

Faculty, Staff and Students Publications

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare complication of solid organ transplantation and is a syndrome of systemic hyperinflammation secondary to dysregulation of the inflammatory response, primarily involving lymphocytes and macrophages. It is often fatal and therefore early recognition and treatment are crucial. Among 11 adult cases of HLH in post-lung transplant cases found in the literature, only one patient survived.

Case: We report the first known pediatric case of HLH following lung transplantation. The patient, a previously healthy adolescent, developed end-stage bullous lung disease secondary to acute respiratory distress syndrome (ARDS) and underwent bilateral lung transplantation. Two months posttransplant, …

Education Research: Eeg Instruction: Findings From A Scoping Review, Alexis Peedin, Jeffrey B Ratliff, Urvashi Vaid, Swati A Karmarkar, Moushumi Sur, Vivianne Van Kranen-Mastenbroek, Dimitrios Papanagnou, Marian H J M Majoie, Dorene F Balmer, Satid Thammasitboon

Faculty, Staff and Students Publications

Background and objectives: Although EEG interpretation is a key skill in neurology, EEG instruction is variable and its landscape remains underexplored. Thus, we conducted a scoping review to expand the literature by providing a structured mapping of the EEG instruction literature and a foundation for future research in EEG instruction.

Methods: We followed a structured methodological framework for scoping reviews and report the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Research questions explored theoretical frameworks, methodologies, learner populations, instructional methods, and assessment approaches. Eligibility criteria were iteratively modified to focus …

Fibroblasts Are The Primary Contributors To A Disrupted Micro-Environment In End-Stage Pediatric Hypertrophic Cardiomyopathy, Chang-Ru Tsai, Iki A Adachi, Xiao Li, James F Martin

Faculty, Staff and Students Publications

Background: Hypertrophic cardiomyopathy (HCM) is a relatively rare but debilitating diagnosis in the pediatric population, and patients with end-stage HCM require heart transplantation. Here, we have examined the transcriptome in ventricular tissue from this patient group to identify cell states and underlying cellular processes unique to pediatric HCM.

Methods: We performed single-nucleus RNA sequencing (snRNA-seq) on explanted hearts at transplant in 3 pediatric patients with end-stage HCM and compared findings to pediatric control and adult HCM.

Results: We identified distinct underlying cellular processes in cardiomyocytes, fibroblasts, endothelial cells, and myeloid cells compared with controls. Pediatric HCM was enriched in cardiomyocytes …

Insights From A Survey Of School Nurses: Assessing The Challenges Of Constipation In Schools

Faculty, Staff and Students Publications

Objectives: School nurses are key responders to students with constipation, yet their experiences are underreported. This study surveyed their observations regarding constipation, identified barriers to student restroom access, and assessed educational needs.

Methods: In this descriptive, cross-sectional survey study, an anonymous online survey was distributed to school nurses participating in a virtual education series. The survey assessed nurse demographics, frequency of encounters with constipation and encopresis, school restroom policies, barriers to restroom use, accommodation requests, and training in constipation management.

Findings: Of 125 respondents, 95% encountered students with constipation at least monthly and 55% reported ≥ 6 encounters monthly. Commonly …

Hes V20 Surpasses Galad For Hcc Detection: A Review Of Multi-Dimensional Biomarker Scores And Studies

Faculty, Staff and Students Publications

This was a narrative review of select studies published through September of 2024. We review the shift toward multi-dimensional scores such as HCC early detection screening (HES), GALAD, ASAP, and mt-HBT represents a significant advancement in biomarker research for hepatocellular carcinoma (HCC) detection. Unlike single biomarker approaches, these scores integrate various clinical and biochemical factors to enhance predictive accuracy by reflecting different complementary aspects of disease progression and HCC oncogenesis. Proper testing and validation of biomarker scores in phase 3 biomarker studies is essential before wide use can be recommended. We also review the comparative performance of biomarker scores in …

Characteristics Associated With Eurolupus Versus Modified National Institutes Of Health Cyclophosphamide Regimen Use In Children And Young Adults With Lupus Nephritis, Kristen R Miller, Stacy P Ardoin, Christine Bearer, Emily Hause, Joyce Hui-Yuen, Nicole Ling, Maria Pereira, Meredith Riebschleger, Kelly Rouster-Stevens, Aliese Sarkissian, Julia Shalen, William Daniel Soulsby, Marinka Twilt, Eveline Y Wu, Laura B Lewandowski, Scott E Wenderfer, Jennifer C Cooper

Faculty, Staff and Students Publications

Objective: To determine the demographic and clinical characteristics associated with use of the EuroLupus or modified National Institutes of Health (NIH) cyclophosphamide (CYC) regimen for treatment of lupus nephritis (LN) at North American pediatric centers.

Methods: A retrospective cohort study was conducted at 11 North American centers. Patients < 22 years of age with active LN treated with CYC using the EuroLupus or NIH regimen between July 2014 and June 2021 were included. Data were extracted via electronic medical record review. Demographic and clinical characteristics were compared at CYC initiation. A multivariable generalized estimating equation with logit link was fit to model EuroLupus use. An exchangeable correlation structure was used to account for correlation within centers. Independent variables were chosen using elastic net regression.

Results: The cohort consisted of 191 patients (85 EuroLupus, 106 NIH) with a median age of 15.3 years at CYC initiation. In multivariable analysis, characteristics significantly associated with EuroLupus regimen use (vs NIH regimen use) included more recent year of CYC initiation, longer disease duration, Hispanic ethnicity and Asian race (as compared …

Factors Associated With Child Protective Services Referrals In Young Children With Isolated Skull Fractures, Tagrid M Ruiz-Maldonado, Daniel M Lindberg, Angela Bachim, Lori Frasier, Terra N Frazier, Nancy S Harper, Sara E Kruczek, Farah Brink, Jennifer E Wolford, Jan Leonard, M Katherine Henry

Faculty, Staff and Students Publications

Objective: Many young children with isolated skull fractures are referred to child protective services (CPS) despite being assessed to have a low likelihood of abuse. We sought to identify factors associated with CPS referrals in this population and to quantify hospital-level variation.

Methods: We performed a multicenter retrospective cross-sectional study of children < 2 years with skull fractures with or without a small underlying intracranial hemorrhage (ICH) and no additional injuries undergoing a child abuse pediatrics (CAP) subspecialty evaluation. We explored associations between demographic factors, clinical characteristics, psychosocial risk factors, and hospital site with CPS referral status. We performed multivariable logistic regression, adjusting for transfer status and all significant covariates from unadjusted analyses. We utilized marginal standardization to calculate the estimated probability of CPS referrals at each site, adjusting for all factors in the final model.

Results: Of 528 children, 303 (57.4%) were referred to CPS, with 86.5% referred prior to CAP consultation. In multivariable logistic regression, presence of psychosocial risk factors (OR 4.00; 95% CI 2.25, 7.11), in-person CAP consult (OR 3.93; 1.61, 9.62), inflicted or no trauma history provided (OR 6.15; 3.30, …

Phenotypic Variability And Paternal Inheritance Of A Chd8 Variant Causing Intellectual Developmental Disorder With Autism And Macrocephaly Confirmed By Epigenetic And Structural Analyses, Yutaka Furuta, Jonathan H Sheehan, Et Al.

2020-Current year OA Pubs

BACKGROUND: Intellectual developmental disorder with autism and macrocephaly (IDDAM, OMIM #615032) is an autosomal dominant neurodevelopmental disorder characterized primarily by intellectual disability, autism spectrum disorder, macrocephaly, tall stature, gastrointestinal symptoms, and variable neurological manifestations. Most cases result from de novo pathogenic variants in CHD8.

METHODS: We conducted genome sequencing through the Undiagnosed Diseases Network (UDN) in a female proband harboring a CHD8 variant of uncertain significance (VUS), whose clinical presentation was consistent with IDDAM but included atypical features such as ptosis and hearing loss. Variant pathogenicity was further evaluated using EpiSign DNA methylation analysis and structural biology modeling.

RESULTS: Genome …

Assessment Of Knowledge And Attitudes Of Undergraduate Students On Trichomoniasis In Ghana, Christopher Yaw Dumevi, Ezekiel Kofi Vicar, Lorie Christla Quansah, Rhoda Oklu, Smith Joshua, Joyce Junior Asiamah, James-Paul Kretchy, George Boateng Kyei, Patience B Tetteh-Quarcoo, Nicholas T K D Dayie, Irene Ayi, Patrick F Ayeh-Kumi

2020-Current year OA Pubs

BACKGROUND: Trichomoniasis is a non-viral neglected sexually transmitted disease of public health importance. Undergraduate students, often experiencing newfound freedom from family oversight, may engage in risky sexual behaviors, predisposing them to trichomoniasis and other sexually transmitted infections (STIs). This study aimed to assess the knowledge, attitudes, and practices towards trichomoniasis and associated factors among the Central University students in the Greater Accra Region of Ghana.

METHODS: An institutional cross-sectional study was conducted between March and July 2024, involving 387 undergraduate students from Central University who were selected using a simple random sampling technique. Data were collected using a structured researcher-led …

A Roadmap To Scale Up Person-Centred Care In The Hiv Response: Recommendations From A Global Consensus-Building Process, Lina Golob, Elvin H Geng, Et Al.

2020-Current year OA Pubs

INTRODUCTION: World Health Organization global normative guidance recommends person-centred care (PCC) approaches to reduce HIV-related mortality and morbidity and to improve health-related quality of life (HrQoL). However, consensus on the priority PCC elements and guidance on how different stakeholders can realize PCC principles at the health systems, service delivery and individual client-healthcare worker (HCW) levels are lacking. We conducted a global consensus-building process to define core PCC elements and develop recommendations for implementation at scale.

METHODS: We used a multi-phase process to build consensus and prioritize recommendations, consisting of a literature review, five stakeholder consultations (34-43 participants each) between July …

Current Practices And Trends In Surgical Decision-Making For Children With Lennox-Gastaut Syndrome: A Cross-Sectional Survey By The Pediatric Epilepsy Research Consortium, Michelle Y Chiu, Renée A Shellhaas, Et Al.

2020-Current year OA Pubs

OBJECTIVE: The objective of this study is to characterize contemporary surgical management practices and factors influencing surgical decision-making in the management of Lennox-Gastaut Syndrome (LGS) across pediatric epilepsy centers in the United States.

METHODS: A 45-item cross-sectional survey was developed and distributed to Pediatric Epilepsy Research Consortium centers. Domains included institutional demographics, surgical evaluation timing and goals, presurgical workup, procedural utilization and outcomes, and barriers to surgery. Descriptive statistics and thematic analysis were performed.

RESULTS: Thirty-two pediatric epilepsy centers participated (38% response), the majority comprising pediatric epileptologists at Level 4 National Association of Epilepsy Centers. Most centers (66%) considered surgery …

Muc15 Ectodomain Architecture Regulates Integrin Clustering To Control Cancer Metastasis, Simei Zhang, Guy M Genin, Et Al.

2020-Current year OA Pubs

Cancer metastasis is governed by physical cues at the cell-matrix interface, with matrix stiffness, ligand density, and topography established as key determinants. Here, a fourth critical factor in cancer metastasis, the architecture of the cell-surface glycocalyx is identified. Using MUC15 as a representative small glycoprotein, mathematical modeling and domain truncation experiments are combined to show that glycoprotein size distribution governs integrin adhesion states and metastatic outcomes. MUC15 localizes to focal adhesions and interact with integrins, while larger glycoproteins such as MUC1 are sterically excluded. These physical effects, rather than intracellular signaling, dictate adhesion state transitions: removing MUC15's ectodomain eliminated its …