Medicine and Health Sciences Commons^™

Evidentiary Standards For Newly Approved Antibiotics For Uncomplicated Urinary Tract Infections, Rosa Rodriguez-Monguio, Enrique Seoane-Vazquez, John H. Powers Iii

Pharmacy Faculty Articles and Research

Importance: Uncomplicated urinary tract infections (uUTIs) are among the most common bacterial infections and are typically treated with existing oral antibiotics. In 2024–2025, the FDA approved two new oral agents, sulopenem etzadroxil/probenecid and gepotidacin, via expedited review pathways, for the treatment of uUTIs. Objective: To assess the clinical significance and regulatory evidence supporting FDA approval of sulopenem/probenecid and gepotidacin for uUTI, and to analyze the adherence of pivotal phase III trials to regulatory standards for approval and FDA guidelines. Design, Setting, and Participants: Comparative descriptive analysis of publicly available data from phase 3 randomized, double-blind, active-controlled clinical …

Safety And Feasibility During Early Implementation Of Robotic-Assisted Percutaneous Coronary Intervention, Dung Thuong Ho, Manh Cuong Nguyen, Tran Tran Nguyen, Long Tran, Huy Nguyen, Dil Mai, Tuong Mien Ngo, Duc Chinh Nguyen, Chi Cuong Tran, Khiem D. Ngo

School of Medicine Publications

Background: Robotic-assisted Percutaneous Coronary Intervention (R-PCI) is an advanced technique offering potential advantages for both patients and interventional cardiology practices. In 2023, Can Tho S.I.S General Hospital implemented its first robotic system for PCI procedures. This study aimed to evaluate the safety and clinical outcomes during the early learning curve of R-PCI.

Methods: This prospective study included all patients undergoing R-PCI with the CorPath GRX Vascular Robotic System at Can Tho S.I.S General Hospital from April to September 2023. Baseline patient characteristics, procedural details, and six-month follow-up data were collected. Primary outcomes included Clinical Success, defined as < 30% residual diameter stenosis in the target vessel without major adverse cardiovascular events (MACE) during hospitalization (e.g., death, myocardial infarction, target-vessel revascularization, stroke), and robotic success, defined as achieving clinical success with partial manual support or no manual support.

Results: Thirty-one patients …

The Impact Of Simulation-Based Education On Novice Nurses’ Knowledge Of Pressure Injury Prevention, Michelle "Mikki" Cantu

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries remain a significant patient safety concern in acute care settings despite the availability of evidence-based prevention guidelines. Novice nurses, who often have limited clinical experience and exposure to wound care education, may be less prepared to consistently identify risk factors, accurately stage pressure injuries, and implement appropriate preventive strategies. Simulation-based education offers an experiential learning approach that supports the translation of evidence-based knowledge into clinical practice. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the effectiveness of simulation-based education in improving novice nurses’ knowledge of pressure injury identification and prevention. The …

Quality Improvement Project: Enhancing Self-Efficacy Through Inacsl Standards Training, Amy Bortner

Doctor of Nursing Practice Projects

Simulation-based education (SBE) is a widely used instructional strategy in nursing curricula; however, formal training for faculty and staff who implement it may be inconsistent or limited. Current literature supports the need for structured, evidence-based training to ensure effective use of simulation-based education and promote best practices in teaching and learning. The Doctor of Nursing Practice (DNP) project aims to improve perceptions and self-efficacy regarding the use of the International Nursing Association of Clinical Simulation and Learning (INACSL) standards, which guide simulation education. Driven by Kurt Lewin’s change theory and Jeffries Simulation Theory, twelve volunteers completed the Faculty Attitude and …

Zinc Imbalance And Its Effect On Nutritional Status, Behavior, Gut Microbiota, And Inflammatory Biomarkers In Btbr T+Itpr3tf/J And C57bl/6j Mice: Insights Into Autism Spectrum Disorder, Asma Nasrullah Ahmadani

Thesis/ Dissertation Defenses

Background: Autism spectrum disorder (ASD) has been associated with altered zinc homeostasis and disruptions in the gut microbiota. Zinc is a vital trace mineral involved in multiple biological processes such as inflammatory regulation, intestinal integrity, and neurobehavioral function, and has an important role in influencing microbial activity along the gut–brain axis. Both deficiency and excess of zinc can alter microbial balance. However, their collective effects on behavior, overall physiology, and mineral status in ASD-relevant models are not yet fully understood.

Aim: This comprehensive study explored the effect of dietary zinc variation on body weight, food intake, behavior, gut microbiota composition, …

Algorithmic Opacity In Opioid Risk Scoring And The Need For Transparent Ai Regulation, Sherry Yun Wang, Ryan Stofer, Zhouzhou Chu, Xiao Huang, Ang Li

Pharmacy Faculty Articles and Research

NarxCare®, a proprietary opioid risk scoring system embedded in Prescription Drug Monitoring Programs (PDMPs), has generated significant patient complaints. We adhered to the technical specifications and applied them to PDMP and IQVIA PharMetrics® Plus Closed Health Plan claims database. Despite adding socioeconomic covariates, precision (0.01–0.32) was far below the reported benchmark of 0.75, and F1 scores (0.02–0.39) were also substantially lower than the benchmark value of 0.65, across all our reconstructed models.

Quality Improvement Project: Provider Knowledge Improvement For Care Of The Severely Hypertensive Obstetric Patient, Victoria Abramowitz

Doctor of Nursing Practice Projects

Gaps in confidence among emergency department (ED) and maternal child health services (MCHS) staff negatively impacts effectiveness and timeliness of response to high acuity obstetric emergencies, such as severe obstetric hypertension. The purpose of this quality improvement project was to evaluate the impact on provider self-efficacy with the implementation of evidence-based education and standardized procedures for severe obstetric hypertension management, aimed at evaluating the degree of success of increasing provider confidence. The project was guided by Lewin’s change theory and Donabedian’s structure-process-outcome theoretical framework. With a quasi-experimental design and the PDSA implementation framework, 20 staff from both the ED and …

Quality Improvement Project: Impact Of National Culturally And Linguistically Appropriate Services (Clas) Standards Education On Behavioral Health Providers’ Self-Efficacy, Zita Anigbou

Doctor of Nursing Practice Projects

Health disparities among culturally and linguistically diverse populations continue to negatively affect access to and quality of behavioral health care. Limited provider education on the National Culturally and Linguistically Appropriate Services (CLAS) Standards contributes to communication barriers, reduced therapeutic engagement, and lower provider confidence. The purpose of this quality improvement project was to evaluate the impact of evidence-based CLAS Standards education on behavioral health providers’ self-efficacy in delivering culturally and linguistically appropriate care. Guided by Lewin’s Change Theory and the Health Equity Implementation Framework, a quantitative pre-test–post-test quasi-experimental design was used. A convenience sample of three behavioral health nurse practitioners …

Implementation Of A Standardized Suicide Risk Screening Protocol Using The Columbia-Suicide Severity Rating Scale (C-Ssrs) In An Outpatient Mental Health Clinic, Kemisola Ebietomiye

Doctor of Nursing Practice Projects

The outpatient mental health clinics across the United States lack consistent suicide risk assessment methods. This project developed standardized procedures which used Columbia-Suicide Severity Rating Scale (C-SSRS) assessment together with provider education and electronic health record systems to evaluate how these elements impacted provider self-efficacy and their ability to record screening results. The project used a pre-post design to examine (n=24) psychiatric providers at an urban outpatient clinic through the combined methods of Lewin's Change Theory and the Plan-Do-Study-Act framework. The General Self-Efficacy Scale measured provider self-efficacy, and structured EHR audits tracked documentation rates pre- and post-implementation over six weeks. …

Quality Improvement Project: Empowering Nurses And Medical Assistants To Improve Medication Adherence: A Screening-Based Quality Improvement Initiative, Maria Garcia

Doctor of Nursing Practice Projects

Medication nonadherence is a persistent challenge in clinical settings that negatively influences patient outcomes and is often driven by cost, access, and patient-related barriers, as widely documented in the literature. Nurses and medical assistants play a critical role in identifying these barriers; however, inconsistent screening and limited staff confidence may hinder intervention. The purpose of this quality improvement project was to evaluate the impact of implementing the Brief Medication Questionnaire (BMQ) on staff confidence in addressing medication adherence and to assess clinic-wide utilization of the tool. The project was guided by the Iowa Model of Evidence-Based Practice and Lewin’s Change …

Quality Improvement Project Standardizing Simulation In Nursing Education: A Faculty Training Initiative, Andrea Reyes

Doctor of Nursing Practice Projects

Simulation-based education is essential in nursing programs as clinical placement opportunities decline. However, inconsistent faculty preparation can compromise the quality of simulation delivery. The purpose of this quality improvement project was to implement and evaluate a standardized simulation faculty training initiative to determine its impact on nursing faculty's confidence in simulation facilitation. Guided by the Jeffries Simulation Framework and Lewin’s Change Theory, a quasi-experimental pre-post design was used to examine changes in faculty confidence following participation in a training program aligned with national standards and guidelines. Faculty confidence was measured using the Simulation Educator Needs Assessment Tool (SENAT) administered pre- …

Improving Diabetes Care: Staff Training On Updated Ada Guidelines, Jeffrey Wilson

Doctor of Nursing Practice Projects

The incidence of diabetes is rising, requiring clinical staff to stay current with the American Diabetes Association (ADA) Standards of Care. A lack of knowledge and outdated practices were revealed during the needs assessment at the project site. This quality improvement (QI) project sought to determine whether ADA‑centered educational training could impact staff members' knowledge of diabetes. Orem’s Self‑Care Deficit Nursing Theory and Lewin’s Change Theory served as the theoretical frameworks to promote provider competence and adherence to evidence‑based diabetes treatment. Quasi‑experimental pre–post design was used with a convenience sample of four clinical staff at a rural outpatient clinic. Study …

Quality Improvement Project: Protecting Young Kidneys: Optimizing Albuminuria Management In Youth With Diabetes, Mili Vakharia

Doctor of Nursing Practice Projects

Diabetic nephropathy is a major microvascular complication and the leading cause of chronic kidney disease (CKD) among individuals with diabetes. Children and adolescents with type 1 and type 2 diabetes face a higher risk of developing CKD earlier in life due to longer disease duration, poor glycemic control, and delayed CKD diagnosis. Guidelines emphasize timely detection and intervention to slow disease progression. Albuminuria is an early marker of glomerular injury and signals the need to initiate CKD treatment. Despite evidence supporting early detection and treatment, standardized management of albuminuria in pediatric diabetes care remains inconsistent. This Doctor of Nursing Practice …

Quality Improvement Project: Use Of The Behavioral Risk Assessment Tool To Enhance The Utilization Of The Behavioral Emergency Response Team, Joseph Sindhu

Doctor of Nursing Practice Projects

Workplace violence is a global challenge, and nurses often encounter patient aggression. The purpose of this quality improvement project was to enhance the use of a behavioral assessment tool derived from the Brøset Violence Checklist and the Behavioral Emergency Response Team (BERT) to de-escalate workplace violence. This project aimed to improve behavioral assessment documentation and BERT use in a critical care unit by 30% within 5 weeks. Guided by the Donabedian Model theoretical framework and Lewin's Change Theory, the project employed a quasi-experimental, pretest-posttest design in an advanced heart failure unit with full-time nurses as participants. The Plan-Do-Study-Act (PDSA) framework …

Standardizing Patient-Centered And Trauma-Informed Communication Practices Among Staff In A Behavioral Health Setting, Jayla Brown

Doctor of Nursing Practice Projects

The purpose of this quality improvement project was to evaluate the effect of an evidence-based educational intervention on staff attitudes toward trauma-informed and patient-centered communication in an outpatient behavioral health clinic. Guided by Lewin’s Change Theory and Jean Watson’s Theory of Human Caring, the project aimed to improve staff knowledge, attitudes, and confidence in applying trauma-informed communication strategies across all clinic roles. An eight-week educational intervention based on the SAMHSA Trauma-Informed Care Toolkit was implemented for clinical and administrative staff. A quantitative pretest–posttest quasi-experimental design was used, with outcomes measured using an adapted Attitudes Related to Trauma-Informed Care scale. All …

Outcomes Of Radiation Integrated With T-Cell-Engaging Bispecific Antibodies In Relapsed/Refractory Multiple Myeloma, Heta Patel, Harper Hubbeling, Kyle Yu, Maribel Carpenter, Michael Lariviere, John Plastaras, Adam Cohen, Shivani Kapur, Dan Vogl, Adam Waxman, Edward Stadtmauer, Alfred Garfall, Sandra Susanibar-Adaniya

Student Papers, Posters & Projects

No abstract provided.

Prevalence And Predictors Of Inappropriate Antibiotic Prescriptions Among Dentists In Muscat Governorate, Oman, Wajiha Abdul Majeed Al-Lawati, Manar Alsanaa Ali Alzeedi, Elham Mohammadi, Noora Alhosni

Sultan Qaboos University Medical Journal

Objectives: Inappropriate antibiotic prescriptions represent a major healthcare concern, contributing to increasing antimicrobial resistance. Dentists account for up to 10% of antibiotic prescriptions, highlighting the need for rational prescribing practices. This study aimed to assess the prevalence and predictors of inappropriate antibiotic prescriptions by dentists in primary health clinics in Muscat Governorate, Oman. Methods: This retrospective cross-sectional study was conducted on dental antibiotic prescriptions issued between July and December 2024 in government and private dental care facilities across Muscat Governorate. Clinics were randomly selected and data were extracted from electronic patient records using a structured form. Descriptive statistics, Chi-square tests …

A Nurse-Led Clinical Practice Guideline To Improve Medication Adherence Among Psychiatric Home-Health Patients, Amber Murillo - Alonzo

Walden Dissertations and Doctoral Studies

Medication nonadherence among psychiatric patients receiving home-health services contributes to symptom relapse, preventable hospitalizations, and decreased quality of life. Inconsistent medication education and adherence monitoring within home-health settings may further exacerbate this problem. The purpose of this Doctor of Nursing Practice project was to develop and evaluate a nurse-led clinical practice guideline (CPG) designed to improve medication adherence among psychiatric home-health patients. The practice-focused question asked: What evidence, based on content expert review using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, supports the quality and usability of a CPG to improve medication adherence in a …

Quality Improvement Project: Impact Of Mindfulness-Based Stress Reduction On Nurse Burnout In Skilled Nursing Facilities, Chinenye Okafor

Doctor of Nursing Practice Projects

Burnout is a persistent and critical problem in skilled nursing facilities, contributing to reduced job satisfaction, increased turnover, and compromised quality of care. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the impact of a Mindfulness-Based Stress Reduction program on burnout among registered nurses in a skilled nursing facility. Guided by the Job Demands–Resources framework and Lewin’s Change Theory, a quantitative pretest–posttest design was implemented using the Plan–Do–Study–Act. Ten nurses consented to participate in an eight-week intervention, and four completed both pre- and post-intervention measures. Burnout was measured using the Maslach Burnout Inventory–Human Services …

Quality Improvement Project: Improving Pneumococcal Vaccination Rates Through Provider Education In Primary Care, Leikasha Allen

Doctor of Nursing Practice Projects

Pneumococcal disease remains a major cause of illness and mortality among adults aged 65 years and older, leading to severe pneumonia, bacteremia, and meningitis, particularly in vulnerable populations. Although effective vaccines and clear Centers for Disease Control (CDC) and Advisory Committee Immunization Practice (ACIP) guidelines, vaccination in this age group remains inadequate. This Doctor of Nursing Practice (DNP) quality improvement project aimed to determine the impact of pneumococcal vaccination compliance through evaluating provider knowledge, confidence, and adherence to evidence-based guidelines through targeted education. Guided by Rogers’ Diffusion of Innovation Theory and the Health Belief Model, a 20-minute evidence‑based educational session …

Implementation Of A Mentoring Toolkit: A Quality Improvement Project, Joshlyn Neu

Doctor of Nursing Practice Projects

Nursing faculty mentorship is an essential component of professional development, job satisfaction and faculty retention. However, many schools lack a structured approach to preparing their faculty members to act as mentors. This quality improvement project set out to determine whether the implementation of a formal mentoring toolkit would improve nursing faculty members perceived competency to act as mentors. Guided by Bandura’s Social Cognitive Theory (SCT), Lewin’s Change Theory, and the latest evidence-based research, this project sought to answer the following question: In full-time nursing faculty members teaching in a BSN program at a small, private college (P), how does the …

Predicting And Managing Hepatocellular Carcinoma Recurrence After Liver Transplant: A Single-Center Experience 2012-2024, Jesse Civan, Madison Force, Ali Raza Shaikh, Adam Bodzin, Daniel Lin

Division of Gastroenterology and Hepatology Faculty Papers

Background: Hepatocellular carcinoma (HCC) is a major cause of mortality in the United States, but it can be cured with orthotopic liver transplant (OLT) in selected patients. Despite curative intent, post-OLT recurrence can occur in up to 15% of patients. The need for a program of post-OLT surveillance is widely accepted but the specifics of an optimal program have not been established. There is interest in identifying lower-risk cohorts of patients in whom an abbreviated strategy of surveillance may prove adequate, utilizing tools such as the RETREAT score. Unique challenges are posed in the post-transplant population regarding safety and …

Multiplanar First-Ray Deformity And Its Impact On Tibial Sesamoid Assessment: A Radiographic Analysis​, Yasim Zafar, Madelaine Adkins, Jessica Sima

School of Podiatric Medicine - Student Research

This study evaluated whether discrepancies in tibial sesamoid position (TSP) between anteroposterior (AP) and sesamoid axial radiographs are associated with first-ray deformity parameters: first metatarsal rotation angle (MRA), sesamoid rotation angle (SRA), intermetatarsal angle (IMA), and hallux valgus angle (HVA). We hypothesized that increased frontal-plane external rotation of the first metatarsal would be the primary contributor to AP–axial TSP mismatch.

This secondary analysis used deidentified radiographs from Shibuya et al. (J Foot Ankle Surg. 2019). Adults aged 18–80 with measurable TSP on both AP and axial views were included; patients with prior foot trauma or osseous surgery were excluded. Only …

Challenges, Stressors, And Resilience Resources Experienced By Older Black Women In Rural South Carolina Throughout The Covid-19 Pandemic, Arielle N'Diaye, Camryn Garrett, Sarah Wilcox Phd, Bankole Olatosi Ph.D., Xiaoming Li Ph.D., Shan Qiao Ph.D.

Faculty Publications

Background

Resilience has been established as a protective factor against mental health challenges (e.g., anxiety, depression). From an intersectional perspective, the stressors experienced by Black women living in rural communities are likely to have been exacerbated during the COVID-19 pandemic. This study aims to identify the challenges and stressors experienced and the resilience resources available to and relied upon by rural, Black women, during the pandemic.

Methods

Individual, in-depth, structured interviews (n = 24) were conducted among Black women living in rural South Carolina, recruited by local community health workers, from January to April of 2024. All interviews were recorded, …

Liposclerosing Myxofibrous Tumor Of The Foot: A Case Report, Mohammad Junayed Khan, Sufiyan Mannan Ahmed, Asad Mustafa, Sairah Asghar, Mohammad Tanjim Hossain

School of Podiatric Medicine - Student Research

Statement of Purpose: This case presents a rare sclerosing-type atypical lipomatous tumor with myxomatous features—the first and only known reported case of an ALT in the foot—along with its pathology, treatment, and management.

Case Study: Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) represents the most common liposarcoma subtype, with recurrence and dedifferentiation risk influenced by tumor location. Retroperitoneal tumors recur frequently, while those in the lower extremity rarely do. Liposarcoma of the foot is exceedingly rare.

A 61-year-old male presented with a slowly enlarging, mildly tender lump on the right plantar heel. Radiographs demonstrated a 3 cm oval soft-tissue thickening without calcification. …

Regional Brain Age Is Decreased In Children With Sickle Cell Anemia, Amy E Mirro, Landon C Power, Jinli Wang, Paula Germino-Watnick, Heather Roberts, Yonca Cam, Kristin P Guilliams, Slim Fellah, Yasheng Chen, Hongyu An, Jin-Moo Lee, Andria L Ford, Melanie E Fields

2020-Current year OA Pubs

DeepBrainNet, a machine learning tool, uses magnetic resonance imaging (MRI) to predict an individual's brain age, allowing calculation of the brain age gap (predicted chronological age) for use as a biomarker of brain health. We tested the DeepBrainNet tool in sickle cell anemia (SCA) on 210 brain MRIs from 130 children (90 with SCA; 40 healthy controls) to investigate the hypothesis that children with SCA would have a younger predicted brain age than healthy controls as an index of aberrant brain development. DeepBrainNet estimates brain age from 80 axial slices of each brain, with the median used as global brain …

Benefit Of Rituximab Maintenance After First-Line Bendamustine-Rituximab In Patients With Mantle Cell Lymphoma, Yucai Wang, Imran A Nizamuddin, Brad S Kahl, Et Al.

2020-Current year OA Pubs

The benefit of rituximab maintenance after first-line (1L) bendamustine-rituximab (BR) in patients with mantle cell lymphoma (MCL) remains uncertain, with inconsistent results from the phase 2 MAINTAIN trial and several retrospective studies. We conducted a large retrospective study at 27 US and Canadian academic centers to examine the benefit of rituximab maintenance after BR. A total of 911 patients received 1L BR between 2010 and 2020, and 703 had an objective response and no evidence of disease progression at the 3-month post-BR landmark. Among those, 394 (56%) received rituximab maintenance and 309 (44%) did not, with largely similar baseline patient …

Ketogenic Diet Dampens Excitatory Neurotransmission By Shrinking Synaptic Vesicle Pools, Marion I Stunault, Pan-Yue Deng, Anjali Yadav, Erica M Periandri, Francisca N De Luna Vitorino, Michael B Thomsen, Jasmin Sponagel, Amelia J Barfield, Renzelle J Ponce, Layla Foroughi, Benjamin A Garcia, Gabor Egervari, Vitaly A Klyachko, Ghazaleh Ashrafi

2020-Current year OA Pubs

Ketogenic diet (KD) is used for the treatment of drug-resistant childhood epilepsy and has been proposed to improve outcomes in neurodegenerative diseases. However, the mechanisms by which KD alters brain circuitry remain unclear. Here, we investigated the impact of KD on hippocampal function through integrative analysis of gene expression and neurotransmission. We found that KD induces extensive transcriptional reprogramming, including altered expression of numerous synaptic genes. Proteomic and genomic profiling revealed significant changes in histone modifications, particularly at promoters of KD-regulated genes. Electrophysiological recordings showed that KD reduces excitatory synaptic gain and short-term plasticity at CA3-CA1 synapses, dampening the summation …

Estimating The Baseline Age When Longitudinal Changes In Biomarkers Accelerate: Application To An Imaging Study Of Preclinical Alzheimer Disease, Chengjie Xiong, Folasade Agboola, Jingqin Luo

2020-Current year OA Pubs

BACKGROUND: Biomarkers are routinely measured from human biospecimens and imaging scans in Alzheimer disease (AD) research. Age is a well-known risk factor for AD. Detecting the baseline age at which the longitudinal change in biomarkers starts to accelerate is important to design preventive interventions. METHODS: We analyzed longitudinal biomarker data by a random intercept and random slope model where the slope (longitudinal rate of change) was modeled as a piecewise linear and continuous function of baseline age. We proposed to estimate the baseline age at the intersection of the two linear functions by multiple methods: maximum (profile) likelihood, minimum squared …

Applying Frame-Is To Characterize Provider-Led Adaptations To A Cervical Cancer Prevention Intervention In Kenya, Harriet Fridah Adhiambo, Katherine Thomas, Megan M Coe, Lynda Oluoch, Valary Ihaji, Mary Bernadette Kerubo, Alex Kinyua, Sarah Njoroge, Kenneth Ngure, Michelle Shin, Thomas A Odeny, Bryan Weiner, Nelly Mugo, Sarah Gimbel

2020-Current year OA Pubs

BACKGROUND: Implementation strategies that are contextually refined are essential for optimizing the delivery of evidence-based interventions (EBI) to prevent cervical cancer in low-resource settings. This paper reports the application of the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture and disseminate strategy adaptations made to a single-visit, screen-and-treat approach with thermal ablation (SV-SAT + TA) strategy aimed at establishing sustainable cervical cancer prevention services in Kenya.

METHODS: A FRAME-IS-based tracking spreadsheet was developed to document bundled site-specific implementation strategy adaptations and across 10 facilities. Data was collected during technical assistants' (TAs) site visits, phone calls, …