Medicine and Health Sciences Commons^™

Quantitative Fluorescence Imaging Using A Paired Agent Approach For Improving Surgical Decision Making, Sanjana Pannem

Dartmouth College Ph.D Dissertations

Surgical resection remains to be the cornerstone of treatment for most solid tumors, where the primary objective is to remove all visible and microscopic disease. However, the extent of tumor resection is inherently limited by the surgeon’s ability to distinguish tumor from normal tissue, intraoperatively. As a result, positive surgical margins (PSM), where residual tumor remains after surgery, are a common occurrence and are associated with increased recurrence, need for adjuvant therapies, dismal patient outcomes, and high healthcare costs.

Fluorescence guided surgery (FGS) has emerged as a promising technique to enhance intraoperative visualization of tumors and may help reduce the …

Improving New Graduate Nurse Clinical Readiness Through Interprofessional Collaboration And High-Fidelity Simulation, Alyssa M. Starkey

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement (QI) project was to enhance new graduate nurse (NGN) clinical readiness through an interprofessional high-fidelity simulation focused on recognizing and responding to patient deterioration during nurse residency onboarding.

Background

New graduate nurses often feel uncertain about recognizing clinical deterioration and communicating. Research shows that simulation-based and interprofessional training improve judgment, teamwork, and communication. This project aims to achieve at least a 10% increase in NGN clinical readiness following the implementation of a high-fidelity simulation program.

Methodology

A pre–post QI study based on Kolb’s Theory and PDSA principles was conducted in a nurse residency …

The Role Of The Ventral Tegmental Area In Reward And Addiction: A Comprehensive Review, Emad Ali Albadawi

Neurosciences

The ventral tegmental area (VTA) is a central hub in reward and motivation, integrating heterogeneous neuronal populations and projection-defined circuits to regulate learning, decision-making, and addiction. This review synthesizes anatomical organization and cellular diversity (dopaminergic, GABAergic, and glutamatergic neurons, including multitransmitter co-release), and maps major efferent pathways constituting the mesolimbic and mesocortical systems. We highlight computational roles of VTA activity, including reward prediction errors, incentive salience, and context memory integration, and summarize drug class-specific mechanisms that perturb VTA output. We then outline time-dependent neuroadaptations across mesocorticolimbic networks and discuss therapeutic implications spanning pharmacological, behavioral, and emerging circuit-targeted interventions. Together, these …

Associations Of Regional White Matter Hyperintensities Severity With Different Visual Rating Scales And Domain-Specific Cognitive Impairment, Xiaolu Zheng, Sipei Pan, Yi Man, Zhenghao Shi

Neurosciences

Objective: To explore the association between regional white matter hyperintensities (WMHs) severity and domain-specific cognitive impairment.
Methods: We analyzed 95 WMHs patients retrospectively and evaluated cognitive function. We quantified regional WMHs severity using the Scheltens Rating Scale (SRS) and Cholinergic Pathways Hyper intensities Scale (CHIPS). According to the regional WMHs scores, we divided the patients for intergroup comparisons of WMHs severity with domain-specific cognitive scores via the nonparametric Wilcoxon rank-sum test.
Results: Neither the SRS nor the CHIPS total scores showed statistically correlation with cognitive scores (p > 0.05). However, in the bands lateral ventricles of periventricular hyperintensities …

To Calculate The Nationwide Incidence/Prevalence Figures For Charcot-Marie-Tooth Disease, The Entire Population Must Be Screened, Sinda Zarrouk, Josef Finsterer

Neurosciences

No abstract provided.

Alterations In Gut Microbiota And Their Association With Intestinal Mucosal Injury In Children With Febrile Seizures, Lin Yang, Shuan Yin, Wenchao Zou

Neurosciences

Objective: To explore the correlation between diversity of the gut microbiota and key markers of inflammation and intestinal mucosal injury in pediatric febrile seizures (FS).

Methods: This study compared 15 FS children (FS group) and 15 healthy individuals (normal control group). The participants underwent 16S rDNA sequencing to analyze gut microbiota profiles. ELISA was employed to measure peripheral blood concentrations of the pro-inflammatory cytokines TNF-α and IL-6, as well as intestinal mucosal injury indicators such as endotoxin (BT), D-lactate (D-Lac), and diamine oxidase (DAO). Analysis assessed the correlation between gut microbiota composition, inflammatory factors, and indicators of intestinal mucosal damage …

Timing Matters: Optimizing Oncology Involvement In Pediatric Neuro-Oncology Pathways In Saudi Arabia, Ali H. Algiraigri, Mohammed Basamh, Ghadeer Alobaid, Lama M. Alsulami, Razan A. Almutairi, Zahraa S. Alsultan, Rawan M. Hammad

Neurosciences

Objective: To explore current practices and barriers in pediatric neuro-oncology care coordination, and to identify opportunities to optimize care pathways. Timely coordination between pediatric neurosurgery and oncology is critical for optimal outcomes in children with central nervous system (CNS) tumors. However, in many centers, pediatric oncologists are not involved until after surgery, which contributes to treatment delays and repeated procedures. Methods: A cross-sectional survey was conducted among neurosurgeons and pediatric oncologists in Saudi Arabia. The questionnaire addressed the timing of oncological involvement, neuroimaging practices, cerebrospinal fluid (CSF) cytology collection, and opinions on care coordination solutions. Results: A total of 62 …

Comparison Of Free-Hand Technique And Neuronavigation In Intraventricular Shunt Catheter Placement, Ümit Kocaman, Durmuş O Karakoyun, Emre Çavuşoğlu

Neurosciences

Objective: To compare the accuracy and clinical outcomes of proximal catheter placement using neuronavigation guidance versus the traditional free-hand technique in patients undergoing ventriculoperitoneal shunt (VPS) surgery. Methods: We performed a single-surgeon, before–after cohort study: free-hand cases (2013–2019) and neuronavigation cases (2020–2024). Ethics approval was obtained (İzmir Bakırçay University; Approval No. 2407; 20 Aug 2025). The primary endpoint was a composite of first-attempt ventricular entry and absence of postoperative day-1 (POD1) Grade-3 malposition. Secondary endpoints included grades, 12-month proximal tip dysfunction, and operative duration. Results: Fifty-two patients were included (neuronavigation N = 24; free-hand N = 28). Composite success was …

Science First, Formatting Second: Is It Feasible To Adopt A Free-Format Submission Policy?, Anas Alyazidi

Neurosciences

No abstract provided.

Neuroinflammation At The Crossroads Of Neurodegeneration: The Roles Of Microglia And Astrocytes In Parkinson's Disease, Alzheimer's Disease, And Multiple Sclerosis, Mohannad A. Almikhlafi

Neurosciences

Neuroinflammation plays a critical role in the pathogenesis of neurodegenerative disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis. This review explores the underlying mechanisms of neuroinflammation, with a focus on the roles of microglia, astrocytes, peripheral immune cell infiltration, and cytokine release. The complex interplay between oxidative stress and chronic inflammation accelerates neurodegeneration, contributing to disease progression. Microglial activation, initially protective, becomes harmful when sustained over time, driving chronic inflammation. Similarly, astrocytes once considered passive are now recognized for their active involvement in both inflammatory and neuroprotective responses, depending on their activation state. Prolonged activation of microglia and …

Protein Intake In Children With Cerebral Palsy: A Narrative Review Highlighting The Implications Of Protein Intake On Muscle Mass, Growth, And Overall Nutritional Status, Manar Waleed Simbawa, Sheikha Nasser Alqahtnai

Neurosciences

Children with cerebral palsy experience nutritional challenges that affect protein intake and may contribute to poor muscle mass and growth faltering. Since protein plays a major role in preserving muscle mass and supporting growth, ensuring adequate intake is critical. A comprehensive literature search was conducted for observational studies published between 2006 and 2025. The reviewed studies results were grouped into: [1] Protein intake, with values ranging from 0.66 to 4.1 g/kg/day, with higher intake observed among ambulatory or orally fed children, [2] Nutritional Status and Body Composition, as reduced muscle was reported in children with severe motor impairment, and [3] …

Role Of Bevacizumab In Multiple Glioblastomas: A Retrospective Single-Center Analysis, Yongrui Zhao, Yidong Chen, Leiming Wang, Ye Cheng, Feng Yan, Jiankun Xu

Neurosciences

Objective: To explore the prognostic factors of multiple glioblastomas (M-GBMs) and the role of bevacizumab (BEV) in M-GBMs. Methods: 162 patients treated for primary glioblastoma (GBM) from 2020 to 2024 were retrospectively reviewed. Kaplan–Meier analysis was performed to compare progression-free survival (PFS) and overall survival (OS) between the single glioblastoma (S-GBM) group and the M-GBMs group. Independent predictors of OS among M-GBMs patients were evaluated via multivariable Cox regression analysis. Results: 116 patients had S-GBM, and 46 had M-GBMs. Compared with S-GBM patients, M-GBMs patients had poorer PFS (6.5 vs. 11 months, p<0.001) and OS (15.5 vs. 21 months, p=0.005). In the M-GBMs group, based on the RANO resection criteria, both univariable analysis and multivariable Cox models confirmed that the extent of resection, use of radiotherapy and chemotherapy, p53 overexpression, and use of BEV were all factors that significantly influenced OS. Specifically, the use of BEV prolonged OS from 12 months to 19.5 months (p = 0.017). From the initiation of BEV therapy, the median PFS was 5.5 months (95% CI 4.45–6.56 months), and the median survival was significantly longer than in those who did not received BEV (10 vs. 3 months, p = 0.021). Conclusion: The extent of resection, radiotherapy/chemotherapy, p53 …

Extrapulmonary Small Cell Carcinoma Presenting As Bilateral Papilledema, Hyponatremia, Encephalitis, Seizures, Crmp5-Igg Reactivity, And Prominent Anterior Tubular Perivascular Spaces, Ramsis Benjamin, Drew Thomas, Nina Mourao, J. Judd Fite, Brianna Woodliff, Shubhank Goyal

School of Medicine Publications

Background: Paraneoplastic syndromes that affect both the optic disc and the brain parenchyma typically harbor antibodies directed toward CV2/collapsin response-mediator protein 5 (anti-CRMP5), amphiphysin, Ma antigen 2 (Ma2/Ta), and Yo. The most common cancers linked to anti-CRMP5 antibodies include small-cell lung carcinoma (SCLC), followed by thymoma, renal cell carcinoma, and thyroid papillary carcinoma. A long-held belief explains papilledema as related to increased pressure within the subarachnoid space or the microvascular capillaries, but intracranial pressures within the normal standard range may exist in a person with a paraneoplastic syndrome and papilledema. The glymphatic system, a central waste-clearance conduit, may play a …

Evaluation Of A Wearable Wireless Respiratory Monitoring System (Rms) For Detecting And Predicting Clinical Deterioration, Shreya Kolipaka, Jeffrey I. Joseph, Do

Student Papers, Posters & Projects

Introduction & Objectives

- Mortality within 30 days after major surgery is the third leading cause of death worldwide.¹

- Post-operative adverse events leading to mortality include pneumonia, respiratory failure, sepsis, kidney failure, pulmonary embolism, and major cardiac events.^2,3

- Early warning signs of clinical deterioration are commonly missed due to infrequent clinical assessments, delaying timely diagnosis and intervention.^2,4

- On the general hospital floors, vital signs are monitored every 4 to 8 hours, suggesting patients could be unmonitored 96% of their hospital stay.¹

- Changes in respiratory rate (RR) are the earliest and most sensitive …

The Big Picture Of The Small Intestine, Reagan Kangas

Celebrating Scholarship and Creativity Day (2018-)

Histology is the study of microscopic tissue structures and is used to understand the function of tissues and visualize the cellular organization within them. It is an important tool in biology and medicine, used for diagnosing disease (i.e., cancers, infections, inflammatory diseases, etc.) and studying organ structure and function. The goal of this poster is to compare preparation and staining techniques, specifically paraffin versus frozen sectioning methods, along with Masson’s trichrome versus hematoxylin and eosin (H&E) staining. These methods differ in processing time, tissue preservation, and the level of detail they reveal under a microscope. This project uses small intestines …

Effect Of Music Therapy And Music Focused Interventions On Fall Rates In A Memory Care Unit, Emily Spanier, Cassie Howe, Hannah Reiter, Paige Mauer

Celebrating Scholarship and Creativity Day (2018-)

This quality improvement project examined the effect of music therapy and activity-focused interventions on fall rates in a memory care unit at a long-term care facility. The project was developed after staff identified falls as a major safety concern, with the memory care unit accounting for a disproportionate number of facility-wide falls. Through audits and observations, the team found that boredom, wandering, restlessness, and lack of meaningful engagement were common contributing factors to falls among residents with dementia. To address this issue, the team implemented low-cost, person-centered interventions including playing familiar music through Alexa, encouraging participation in simple arts and …

Investigating The Synthesis And Antibacterial Activity Of A Main-Chain Cationic Polymer, Emily Smith

Honors Theses

Antibiotic resistance is a growing threat to public health. Due to the overuse of antibiotics in agriculture, the overprescription of antibiotics, and the misuse of antibiotics by patients, antibiotic resistance is spreading at an alarming rate. As antibiotic resistance spreads, the antibiotics we depend on to treat common infections become ineffective. Therefore, it is imperative to develop novel treatments for infections that do not increase the prevalence of antibiotic resistance. One treatment being explored is the use of synthetic polymers with antibacterial properties. Synthetic polymers are advantageous because they can be synthesized from widely available precursors and their structure is …

Cleft Palate And The Coordination Of Wnt Signaling And Pax9 In Murine Palatogenesis, Landon Wyatt

Honors Theses

Cleft palate is a common craniofacial birth defect that arises when the molecular and morphogenetic events guiding secondary palate formation lose coordination during a narrow developmental window. In mice, successful palatogenesis requires the paired palatal shelves to grow vertically, elevate above the tongue, and fuse at the midline; disruption of any of these steps can result in clefting. Two important regulators of this process are canonical Wnt signaling and the transcription factor Pax9, both of which contribute to normal palatal mesenchymal growth and patterning during early development. This paper first examines whether altered Dkk1/Wnt signaling contributes to the Pax9-null palate …

Network Analysis: An Application Of Graph Theory In Biology, Kiana Dunbar

Honors Theses

Graphs are simple, visual representations of entities as nodes connected by edges. They are used to convey relationships within a system. Networks are comprised of interrelated entities that are not easily separable, producing complex, structured data. These can be seen in social groups, highway systems, and even in biological systems. This paper surveys concepts in graph theory for application to the analysis of network data to understand disease. The features of graphs provide a useful framework for thinking about relationships between different genes or proteins. The structure of graphs is also compatible with a variety of machine learning tools. Especially …

Staff Education On The Implementation Of Walking Interventions, Cynthia Ononobi

Walden Dissertations and Doctoral Studies

The doctoral project was a staff education project aimed at improving the knowledge of psychiatric nurses on the use of structured walking interventions to manage depression. The practice problem was related to the lack of consistency in the application of walking as a treatment for depression. This gap was significant to address because psychiatric nurses are in the center of behavioral activation, and insufficient knowledge may deny patients the right to potentially valuable, affordable, and nonpharmacological treatment. The practice-based question was: Among psychiatric nursing staff does education on structured walking intervention, compared to standard care, improve staff knowledge and skills …

Telehealth Workflow Optimization, Taku Ajongakoh Stella

Walden Dissertations and Doctoral Studies

This evidence-based quality improvement (EBQI) project addresses the 36% telehealth no-show rate at an outpatient behavioral health clinic in Maryland. High attrition rates currently compromise continuity of care and result in a projected annual revenue loss of $124,000. The present project proposed a standardized workflow redesign in the current Integrated Care Approach (ICA) notes Electronic Health Record (EHR) system to address the manual outreach inconsistency. Significant interventions involved the activation of automated multimodal reminders at 72-hour, 24-hour, and 1-hour intervals, and the obligatory 24-hour technical pre-verification connection. Moreover, the project introduced a systematic 48-hour follow-up procedure of missed visits to …

Empowering Nurses To Save Lives: Suicide Prevention Education And Training For Outpatient Nurses In Prince George’S County, Maryland, Oludoyin O. Ajala

Walden Dissertations and Doctoral Studies

Suicide remains a significant public health concern, with increasing prevalence across diverse populations. Outpatient nurses frequently encounter individuals at risk for suicide; however, many report limited confidence and inconsistent use of evidence-based assessment tools, contributing to missed opportunities for early intervention. The purpose of this Doctor of Nursing Practice staff education project was to implement a structured suicide prevention education program to improve nurses’ knowledge, confidence, and ability to identify and manage suicide risk. The practice-focused question examined whether implementing a structured suicide prevention education program for outpatient nurses would increase knowledge and confidence in identifying and intervening with patients …

The Association Between Racial Discrimination And Pregnancy-Related Hypertension Among Department Of Health And Human Services Regions Between 2016 And 2022, Emily Chew

Walden Dissertations and Doctoral Studies

This quantitative study examined the association between racial discrimination and pregnancy-related hypertension among women age 18–40 in the United States, and how this relationship is modified by age and the Department of Health and Human Services (HHS) regions (states). Guided by the social ecological model, this research measured whether race, place, and lived experiences of discrimination contributed to disparities in maternal health outcomes. The study utilized the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System data set (2016–2022) which represented 81% of United States live births (n=249,970). The independent variable was self-reported racial discrimination during pregnancy, delivery, …

Inherited Tbx4 Frameshifting Variants Predicted To Escape Nonsense Mediated Decay In Two Families With Variable Phenotypes, Including Lethal Lung Developmental Disorders, Shruti A Pande, Hiuling Chan Joiner, Przemyslaw Szafranski, Tomasz Gambin, Michelle Wright, Qian Wang, Maiah Walters, Jan M Friedman, Jessica Saunders, Nicholas Avdimiretz, Cornelius F Boerkoel, Nahir Cortes-Santiago, Gail Deutsch, Pawel Stankiewicz

Faculty, Staff and Students Publications

Background: Pathogenic variants involving the transcription factor TBX4 gene have been associated with various skeletal and pulmonary abnormalities, including lethal lung developmental disorders (LLDD).

Methods: Whole-genome sequencing (WGS) with AI-powered platform for variant detection and interpretation followed by Sanger sequencing targeted variant segregation analysis were used. Reverse transcription quantitative PCR (RT-qPCR) and immunohistochemistry (IHC) studies were performed to assess gene and protein expression levels, respectively.

Results: We describe two unrelated families with intrafamilial variability in the TBX4 phenotypic expressivity, including LLDDs. WGS analyses revealed two frameshift variants, c.1019del; p.(Arg340GlnfsTer40) in the penultimate exon and c.1167dup; p.(Arg390GlnfsTer30) in the last exon …

Perceptions Of Instructional Accommodations Among Nursing Students With Information Processing Disorder, Imaobong Aliyu

Walden Dissertations and Doctoral Studies

Instructional accommodations in nursing education often emphasize testing adjustments, while classroom-based instructional support for students with information processing challenges remains underexamined. This descriptive qualitative study explored pre-licensure nursing students’ perceptions of instructional accommodations for students with information processing disorders in Southern California. Guided by humanistic learning theory, the study addressed the research question: What are the perceptions of instructional accommodations in the classroom setting among pre-licensure nursing students with information processing disorders? Seven pre-licensure nursing students participated in semistructured Zoom interviews. Data were analyzed using an inductive process consistent with Saldaña’s analytic approach. Analysis revealed one overarching theme- Instructional accommodations …

Optimizing The Charge Nurse Role To Improve Workflow And Communication In A Community Living Center, Ndidi Kalu Ibe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of optimizing the charge nurse role on workflow efficiency and communication within a Community Living Center. Identified practice gaps included role ambiguity, inconsistent delegation, and communication breakdowns, which contributed to delays in care and decreased staff satisfaction. An evidence-based approach was used to standardize charge nurse responsibilities, strengthen leadership practices, and introduce structured communication processes. The project demonstrated that improving role clarity and leadership consistency supports more effective delegation, enhances team communication, and improves care coordination. Outcome included increased staff engagement, improved workflow efficiency, and enhanced patient safety. This initiative …

The Correlation Of Beer, Wine, And Liquor Excise Tax With Alcohol-Impaired Traffic-Related Deaths In All 50 U.S. States, Paul R. Amigh Ii

Walden Dissertations and Doctoral Studies

Alcohol-impaired driving remains a persistent public health and safety problem in the United States, resulting in thousands of preventable deaths each year and substantial societal costs. Policymakers frequently rely on alcohol excise taxes as a deterrence strategy; however, evidence regarding the effectiveness of taxation alone in reducing alcohol-impaired traffic fatalities remains mixed. The purpose of this quantitative, correlational study, grounded in economic deterrence theory, was to assess relationships between state-level beer, wine, and liquor excise tax rates and alcohol-impaired traffic fatality rates per 100,000 population in 2019. A cross-sectional design used secondary data from all 50 U.S. states and the …

Staff Education On Structured Phq-9 Administration To Enhance Depression Screening In Outpatient Mental Health Care, Zekarias F. Abessa

Walden Dissertations and Doctoral Studies

In outpatient mental health settings, inconsistent use of the Patient Health Questionnaire-9 (PHQ-9) due to gaps in knowledge and lack of standardized training can lead to missed opportunities for early identification of depression and delayed treatment. Mental health nurses play a key role in screening and early intervention, underscoring the criticality of this role in practice. The Doctor of Nursing Practice (DNP) project explored whether a structured PHQ-9 staff education program could improve staff knowledge compared to baseline practice. The project involved using an intervention-based quality improvement design to enhance staff knowledge of administering and interpreting the PHQ-9 screening tool. …

Mechanistic Insights Into Enterolactone-Mediated Glut4-Dependent Glucose Uptake, Merritt Smith

Senior Honors Theses

Type 2 diabetes mellitus (T2D) is one of the leading causes of morbidity and mortality in the United States, with approximately 25% of healthcare expenditures directed toward its management and associated metabolic complications. In response to the urgent need for novel therapeutic strategies, recent research has focused on bioactive compounds derived from dietary sources. In light of that, we identified the plant lignan matairesinol (MA) and its gut-derived metabolite, enterolactone (ENL), as agents capable of enhancing glucose uptake in 3T3-L1 differentiated adipocytes. These results suggest that enterolactone may represent a promising dietary supplement for improving glycemic control in patients with …

From Pages To Practice: Course Design For Integrative And Connected Learning, Prutha Deshpande

UNLV Best Teaching Practices Expo

The poster provides resources for the design of courses to incorporate considerable reading, paired with purposeful activities and reflection questions that deepen understanding of key points of learning, support knowledge transfer, and encourage dialogue and connection.