BSN student Valeria Soria Guzman has been translating for her parents for as long as she can remember. She knows three languages so far – and is learning two more – and she aspires to use her polylingual abilities to increase access and equity for health care patients through the nursing field.
“It’s so hard when you’re sick and when you’re at your lowest point and to not have somebody who understands you,” says Guzman. “To not have somebody who can share that compassion with you in your own language is difficult.”
Guzman moved to the U.S. from Mexico with her family when she was two years old. She is a first-year nursing student at the Bill and Sue Gross School of Nursing at the University of California Irvine (UCI), and she is also the first in her entire family to attend college.
After learning English in the third grade, Guzman found that her background in Spanish made it easy for her to pick up other languages as well. Aside from English and Spanish, Guzman also knows French, is working on American Sign Language and has just begun to dip her toes into Portuguese. As a child, Guzman became her family’s translator at more than just the grocery store – she found herself translating at medical offices, filling out complicated documents with her limited children’s vocabulary of English, and trying to get both her parents and the physicians to understand each other.
“I feel like that’s why I want to go into nursing specifically so that I can walk a patient through the treatment and help them along the way, even if they don’t speak the language,” she says.
Guzman is constantly seeking opportunities at UCI to help those facing a language barrier, especially in the medical field. Currently, she works on the translating team for a research study that is looking for ways to help dementia patients through technology.
“A lot of their patients are lower income and Spanish-speaking only,” Guzman says. “So what I do is translate documents, like ones from the research, into Spanish so the researchers can have focus groups with these Spanish-speaking participants.”
Guzman sees the accessibility of documents in languages other than English as a major point in achieving accessible care. In the future, she plans to use her abilities to serve non-English speaking communities wherever she is most needed. She especially wants to serve areas lacking in non-Spanish speakers, even if it means leaving the large Spanish-speaking community that she values so much behind.
“The thing I’ve missed most since coming to UCI is speaking Spanish in a community setting, and I feel like that’s why I like to seek out a bunch of different Spanish speaking opportunities because I want to have that again,” says Guzman.
In a diverse area in Alabama where 40% of the population is below the poverty line, nursing is a life-changing career path that provides financial stability and promising opportunities. However, in 2018, the University of West Alabama’s Division of Nursing had a 77% NCLEX pass rate, which is below the national average and the minimum for continued program accreditation.
With the students’ nursing careers and the program’s accreditation on the line, the department leaders created a plan to increase UWA’s NCLEX pass rate to continue to provide nursing education and opportunities for their students. In 2021, the UWA Division of Nursing’s first-time NCLEX pass rate rose to 100%.
Incorporating Online Test Prep Played Major Role
To increase UWA’s NCLEX pass rate, department leaders provided students with additional support in the form of mentorship, grants, and adopted online NCLEX online test prep tools from UWorld. A year later, the UWA nursing program’s pass rate rose to 84%, which was a promising start.
Following the initial improvement, the UWA faculty decided to make test prep a program policy rather than just a recommendation. By making the practice questions required, we could help students build essential test-taking habits throughout the semester, while also seeing what the NCLEX questions are like and learning the material. Online test prep became 5% of a student’s overall grade in Advanced Adult Health and Critical Care, a course students take in the final semester of the nursing program. To meet assignment requirements, students had to complete a minimum of 2,000 questions and achieve an overall score of 65% correct. Most students had to take between 3000 and 6000 test items to achieve the benchmark for the percentage of correctly answered questions. Students had five to six weeks to complete this assignment.
Ultimately, every student in the spring 2021 semester passed their NCLEX on the first attempt, making UWA the only program in the state of Alabama to achieve a 100% pass rate.
When students are given the right tools and are incentivized to use them, success stories like this can happen.
Also Essential: Providing Support for Minority and Disadvantaged Students
Universities can take other helpful measures to provide their students with enough support, resources, and opportunities to experience success. At UWA, many steps are taken to give the diverse student body equal and exciting opportunities including scholarships and mentorships to empower students of color.
In summer 2020, the UWA Division of Nursing was awarded a $2.4 million grant from Health Resources and Services Administration (HRSA) for nursing scholarships over five years. With this grant, UWA created Project EARN (Educating Alabama Rural Nurses), which provides invaluable financial aid scholarships for students from disadvantaged backgrounds.
When students have financial support through aid and scholarships, they can spend more time focusing on their education and getting ready to take the licensing exam and less time worried about working to pay bills and support themselves or their families
New Programs
Dr. Mary Hanks, RN, MSN, EdD, the Division of Nursing Chair; and Dr. Chineda Hill, EdD, MSN, CNL, an Associate Professor of nursing at UWA, have also recently developed a new program, Sustah2Sister, that focuses on empowering women of color to build professional relationships and nurture seeds for life-long success. This program is a series of seminars that includes guest speakers to inspire and support women of color at UWA, including nursing students.
The Widespread Impact of Students Passing Their NCLEX
One of UWA’s university-wide missions is to serve the surrounding community. This region in Alabama has a diverse population, with over 40% living in poverty. Just like many places all over the country, surrounding rural hospitals are also in desperate need of more nurses.
When a nursing student passes their NCLEX exam, many opportunities open up for them. The field of nursing is a life-changing career path that brings financial stability to many disadvantaged and minority students.
For UWA nursing students, passing the NCLEX opens up the opportunity for immediate job placement in an industry that has a constant need for more qualified workers. After passing their NCLEX, many UWA graduates decide to stay and work in Alabama, with some going to work in the rural areas that are experiencing a nursing shortage crisis. Since studies show that patients respond better to those that look like them, it’s valuable to the community as a whole that UWA’s diverse nursing students are now entering the workforce.
Increasing the NCLEX pass rate to 100% was an impressive feat, but it also has real-life outcomes that are widespread and optimistic. Ultimately, the UWA Division of Nursing’s success story can be attributed to many factors. With supportive department leaders, hardworking students, university-wide efforts, and the right test prep tools, nursing programs across the country can thrive.
Three Duke University School of Nursing researchers and their collaborators were recently awarded new funding for pilot projects — all centered around reducing health inequities and improving patient care.
This year’s pilot program required that faculty members submit proposals that incorporate at least one of the following racial justice themes:
Dismantling structures that perpetuate racism;
Advancing solutions that ensure health equity in marginalized populations;
Multilevel approaches to addressing social contributors to health;
Methods that improve the participant experience and address racial equity in data collection, analysis, and reporting.
The School’s Center for Nursing Research (CNR) is pleased to announce this year’s grants address the clinical context of sickle cell disease (SCD) management and associated health disparities for adults in Sierra Leone; improve our understanding of the pediatric urobiome, particularly in underserved populations; and acquire large datasets that will allow Duke researchers access to variables needed to improve understanding of health disparities.
Since 2017, the pilot program has encouraged researchers to investigate relevant and innovative ideas that promote health equity and address the School’s Research Areas of Excellence: data science, health innovation, population health and precision health. The goal of the program is to encourage team science and endorse scientific inquiry that positions investigators to be competitive for extramural research funding. The program is administered by the CNR and funded through a generous award from A. Eugene Washington, M.D., M.P.H., M.Sc., chancellor for health affairs, Duke University, and president and CEO, Duke University Health System.
“It was important for the CNR to invest in pilot research that addresses health equity and racial justice so that we are well-positioned to contribute to the future of nursing science,” said Christin Daniels, assistant dean for research development. “This year’s topics tackle a wide variety of pressing challenges – locally and globally, and we’re thrilled to support our researchers’ endeavors toward solving big problems. This pilot program is made possible by our volunteer reviewers, and we’d like to thank them for their collegiality and service. We’d also like to thank Chancellor Washington for the generous award that allows us to offer this program.”
Extending SCD Management: Adapting Management Recommendations to Sierra Leonean Context
Ibemere serves as the principal investigator for her study entitled “Extending Sickle Cell Disease (SCD) Management: Adapting Management Recommendations to Sierra Leonean Context.” She is collaborating with Paula Tanabe, PhD, MSN, MPH, RN, FAEN, FAAN, vice dean, research, and Laurel Chadwick Professor of Nursing, Nirmish Shah, MD, associate professor of medicine, and Cheedy Jaja, PhD, assistant dean for global engagement, University of South Florida.
Evidence-based guidelines exist for sickle cell management, but they do not currently account for the unique perspectives of sub-Saharan populations, who have the greatest prevalence of SCD. Approximately 75 percent of those born with SCD are born in sub-Saharan Africa, and 50 to 90 percent will die before the age of 5. The estimated life expectancy for adults with SCD in Sierra Leone is 20 to 30 years shorter than in high-resourced settings. To reduce the inequitable access to a clinical model for SCD management, the project team will assess clinician and community member knowledge of the National Heart, Lung, and Blood Institute SCD recommendations and evaluate existing SCD management algorithms (e.g. SCD toolbox) for the clinical context in Sierra Leone.
The chasms between SCD outcomes in low-income settings contrasted with those in high-resource settings are linked to systematic decisions and structural barriers which impede workforce development and patient access to care. If left unaddressed, researchers expect continued poor health outcomes for individuals living with SCD in sub-Saharan Africa. Guided by the culture-centered approach, this study will engage Sierra Leonean colleagues, elevating the voices of historically marginalized and minoritized populations while investing in the clinical improvement of SCD disease management within this specific cultural context.
These findings will inform the development of a SCD care management model rooted in evidence-based practice for providers, and the preliminary data will help inform the development of a future NIH R21 submission.
Stability of the Pediatric Urinary Microbiome
Principal investigator Kelly will lead the study entitled “Stability of the Pediatric Urinary Microbiome” along with her collaborators Lisa Karstens, PhD, assistant professor, Oregon Health and Science University, and Tatyana Sysoeva, PhD, assistant professor of microbiology, The University of Alabama in Huntsville.
Urinary tract infections (UTIs) are the most common outpatient infections in the U.S. and are among the most serious bacterial infections encountered by pediatricians. In children, UTIs can result in life-long health consequences including renal scarring, hypertension, renal insufficiency, and pregnancy complications, such as preeclampsia and preterm birth. Antimicrobial resistance of urinary pathogens that cause UTIs is increasing, yet antibiotics remain the standard treatment for UTIs in children. Antibiotic use increases resistance and may change the child’s microbiome. There is a pressing need to develop non-antibiotic therapeutics for UTI treatment, especially in children.
UTIs are more common in Latinx and white children. Inability to make frequent trips to a clinic for urine collection presents a barrier to care that is exacerbated in marginalized populations. At-home urine collection and storage would improve adherence and enhance the quality of the urobiome data.
This pilot study will utilize urine samples in children taken over the course of two months to determine the stability of the urinary microbiome in children and determine if at-home collection is viable, particularly in the Latinx population. The team will translate their study materials into Spanish and work with a community advisory board to ensure the Latinx community helps guide the research. The long-term goal of this study is to develop a predictive test that can identify children at increased risk of UTIs as well as a non-antibiotic intervention strategy. Kelly and team anticipate using the study data towards a future R01 grant submission.
National Representative Databases for Clinical Research
Myers will serve as the principal investigator of the study entitled “National Representative Databases for Clinical Research.” The research team includes Michael Cary, PhD, RN, Elizabeth C. Clipp Term Chair in Nursing and associate professor and Nancy Crego, PhD, RN, CCRN, CHSE, assistant professor, and Michael J. Smith, MD, professor of pediatrics, Bradley Hammill, DrPH, associate professor, and Gina-Maria Pomann, PhD, assistant professor, with the School of Medicine.
National administrative databases are rich sources of clinical information that may serve as the basis for a multitude of research projects. The School of Nursing and overall Duke community have limited access to such databases. In addition, the databases are not in formats that allow untrained analysts to perform appropriate analyses. This pilot project seeks to purchase the following data sources and convert data into user-friendly formats for Duke research utilization:
Kid’s Inpatient Database from Healthcare Cost and Utilization Project (HCUP)
National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Surveys
National Immunization Survey
National Inpatient Survey
National Emergency Department Sample Census Data and Area Health Resources Files
Myers and team will use this data to build the School of Nursing’s first data warehouse, Health e-Data. The data contained within the warehouse will significantly enhance our ability to access and study large-scale, national clinical data.
The warehouse will also advance our ability to address racial equity in data collection, analysis, and reporting. Incomplete race data is a serious and persistent problem that hampers progress. Fortunately, the HCUP databases have created multiple procedures to address this issue. They have identified standardized categories for race and ethnicity, developed novel imputation methods to reduce the impact of existing missing data on disparities research, and linked zip code-level information (e.g., racial distribution, income, education, and poverty level) from the U.S. Census to address socioeconomic status data. They now also include data examining social determinants of health . As such, the creation of the Health e-Data warehouse will allow researchers to examine racial disparities more robustly and rigorously.
For Daniela Vargas, MSN, MPH, MA-Bioethics, RN, PHN, a nursing school textbook presented an early rude awakening to racism in nursing. Vargas, who identifies as an indigenous brown woman and whose family came from Mexico, was shocked by the generalized depictions of people of color in the NCLEX prep book. “It was in a way a precursor to what I started to not only experience myself, but also with colleagues who are people of color, what their experiences were in the profession as I moved through nursing school and then post nursing school as well,” she says.
Vargas, a nurse since 2016, now serves as co-lead for the National Commission to Address Racism in Nursing. In January, the commission released an eye-opening survey on racism within nursing. The national study found that nearly half of the respondents reported widespread racism in the profession.
According to more than 5,600 respondents, racist acts are principally perpetrated by colleagues and those in positions of power, says a press release. Over half (63%) of nurses surveyed say that they have personally experienced an act of racism in the workplace with the transgressors being either a peer (66%) or a manager or supervisor (60%).
A subtler racism
Vargas says that the survey’s findings did not surprise her. Today’s racism, she says, may not be as obvious as the discrimination practiced in previous times. “I would say it’s less blatant and less in your face than it was perhaps in decades past.”
Healthcare institutions, notes Vargas, may come out with public statements against racism. “Yet the cultures that remain in many of the units where nurses work, that has not changed. It’s just they’ve evolved into being less in your face, and in a way people have gotten more sophisticated in how racism gets expressed.”
For instance, management or peers might make it harder for a nurse of color to obtain a promotion, she notes. Or staff nurses would refuse to work with student nurses of color during clinical instruction.
On top of nurse burnout and nurses leaving the profession because of the pandemic, “you have this compounded racism that faces many nurses already,” Vargas says. “And it’s built up over time. Especially for newer nurses, they go into nursing without the tools or the knowledge that this is occurring in the profession, and then once they’re in it, and they’re practicing, then they’re like, Whoa, what just happened? And I have not been taught how to address this, because it’s not something we learned in nursing school.”
“As I continued to go into the profession, I then finally was able to say, this is racism. I’m not just experiencing nurse bullying or incivility. It’s now become much more toxic and insidious than what I thought I was going into when I was in nursing school,” Vargas says.
Seeking solutions
In addressing racism in nursing, “the first thing that needs to be done is acknowledge that it exists,” Vargas says. Also, when onboarding a new nurse to an institution or unit, “there needs to be some built-in curriculum that has an antiracist standpoint to it, that comes with an expectation that this is not tolerated at this institution from the get-go.”
Serious accountability needs to be put into place, Vargas says. “There’s a piece of accountability that needs to be had in regard to what type of accountability measures an institution is doing, because saying that you want to be it is very different than the action.” For example, just as there are whistleblower hotlines for abuse or unethical behavior, hotlines could be established for racist behavior, she suggests.
Similarly, she says, licensing bodies can put in place mechanisms to report racism. “There has to be a real conversation in the nursing profession in regard to accountability of the individual nurse too” because racism affects not only patient care, the patient experience, and the community experiences but also affects colleagues as well. “I don’t think that we have enough measures currently in place that seek accountability on the side of nurses experiencing racism.”
“What this survey did was really allow nurses of color to be able to share their lived experiences,” says Vargas. “And that is important because the voices of nurses of color are now being heard.”
“What this survey is a launchpad for, is to say this is no longer tolerated in the profession. It does not coincide with our code of ethics and we will be the generation that moves the profession forward in not tolerating it and allowing future generations to go without accountability.”
A new study published in the Journal of the American Medical Association Internal Medicine (JAMA IM) found several factors – including staff assumptions about minoritized groups – may play a role in the variability in the quality of care provided to U.S. nursing home residents with advanced dementia
The study, “Nursing Home Organizational Culture and Staff Perspectives Influencing Variability in Advanced Dementia Care: The ADVANCE Study,” identified organizational factors and staff perceptions at nursing homes that may drive known variability in the type of care provided nursing home residents with advanced dementia, especially in the use of more aggressive interventions like tube-feeding or hospitalizations. These aggressive interventions are considered by many to be markers of poor quality of care, as they often do not promote clinical benefits or comfort among persons with advanced dementia.
Prior research has shown Black residents (versus white residents and those in facilities in the southeastern part of the United States) get more aggressive care, including greater use of feeding tubes and hospital transfers.
“The study identified several factors that nursing homes could target to improve delivery of goal-directed care to all residents. One is to improve provider knowledge and communication skills that less aggressive interventions may be more in line with the residents’ wishes and best evidence,” said Dr. Lopez. “For example, many nurses may believe that feeding tubes prolong the life of advanced dementia patients, but this is not borne out by existing studies. Nursing homes need to make sure their staff is aware that hand feeding is better for residents. Based on prior research, aggressive interventions can be less effective compared to less-intensive interventions, like feeding residents manually, while requiring more time of the nursing staff provides better care to their patients.”
The most concerning finding was that staff in nursing homes had preconceptions that families of Black residents did not want to engage in advance care planning and preferred more aggressive care.
“Staff preconceptions that Blacks are less willing to engage in advance care planning and want more aggressive care speaks to the need to address systemic racial biases in nursing homes,” said Dr. Mitchell, noting that nursing homes in the United States tend to be racially segregated and low-resource homes tend to have more Black residents. “Achieving health equity for all nursing home residents with advanced dementia must be the driving force behind all efforts aimed at reducing disparities in their care.”
Researchers conducted 169 staff interviews at 14 nursing homes in four states. They identified factors that were typical of nursing homes that provided less intensity of care including: the quality of the physical environment (e.g., good repair, non-malodorous), the availability of standardized advance care planning, greater staff engagement in shared decision-making, and staff understanding that feeding tubes do not prolong life. Aggressive intervention was considered suboptimal.
More equitable advanced dementia care, the study concluded, may be achieved by addressing several factors, including staff biases towards Black residents. Other solutions include increasing support and funding for low-resourced facilities, standardizing advance-care planning, and educating staff, patients, and their families about evidenced-based care and goal-directed decision-making in advanced dementia.
Other researchers collaborating in this study work at Beth Israel Deaconess Medical Center, Harvard Medical School, Meyers Primary Care Institute, University of Massachusetts Medical School, Oregon Health & Science University School of Nursing, the University of Tennessee at Martin, Emory Center for Health in Aging and the Nell Hodgson Woodruff School of Nursing at Emory University, the Center for the Study of Aging and Human Development at Duke University School of Medicine, and the Geriatrics Research Education and Clinical Center at Veteran Affairs Medicine Center.
According to the findings of a new national survey of nurses by the National Commission to Address Racism in Nursing (the Commission), nearly half reported that there is widespread racism in nursing, demonstrating a substantial problem within the profession. Comprised of leading nursing organizations, the Commission examines the issue of racism within nursing nationwide and describes the impact on nurses, patients, communities, and health care systems to motivate all nurses to confront systemic racism. Integrity calls on the profession and nurses to reflect on two realities, one as the most trusted profession while also being a product of our environment and culture. It is necessary to work toward connecting these two realities.
“My colleagues and I braced ourselves for these findings. Still, we are disturbed, triggered, and unsettled by the glaring data and heartbroken by the personal accounts of nurses,” said Commission Co-Lead and American Nurses Association (ANA) President Ernest J. Grant, PhD, RN, FAAN. “We are even more motivated and committed to doing this important work justice. Racism and those individuals who do not commit to changing their ways but continue to commit racist acts have absolutely no place in the nursing profession.”
According to more than 5,600 survey respondents, racist acts are principally perpetrated by colleagues and those in positions of power. Over half (63%) of nurses surveyed say that they have personally experienced an act of racism in the workplace with the transgressors being either a peer (66%) or a manager or supervisor (60%).
Superiority continues to surface as a primary driver from nurses representing predominantly white groups along with nurses who are advantaged and privileged by unfair structural and systemic practices. These survey findings move beyond the rhetoric to the reality and should serve as a call-to-action for all nurses to confront racism in the profession.
“Structural and systemic practices that allow the racist behaviors of leaders to continue to go unaddressed must be dismantled,” said Commission Co-lead and National Black Nurses Association (NBNA) President and CEO Martha A. Dawson, DNP, RN, FACHE. “As cliché as it sounds, it starts at the top. Leaders must be accountable for their own actions, set an example for their teams and create safe work environments where there is zero-tolerance for racists attitudes, actions, behaviors, and processes. Leaders must also create a climate that gives permission and support to dismantle institutional policies and procedures that underpin practice inequities and inequalities.”
Of those nurses who report that they have witnessed an act of racism in the workplace, 81% say it was directed towards a peer. Nurses say that they have challenged racist treatment in the workplace (57%), but over half (64%) said that their efforts resulted in no change.
“Nurses are ethically and professionally obligated to be allies and to speak up against racism, discrimination, and injustice for our patients and fellow nurses,” said Commission Co-Lead and National Coalition of Ethnic Minority Nurse Associations (NCEMNA) President Debra A. Toney, PhD, RN, FAAN. “Civil rights and social movements throughout history offer the blueprint, which demonstrates that diligent allyship is key to progress. To the nurses that challenge racism in the workplace, do not get dismayed by inaction, but continue to raise your voice and be a change agent for good.”
Many respondents across the Hispanic (69%) and Asian (73%) populations as well as other communities of color (74%) reported that they have personally experienced racism in the workplace. Overwhelmingly, the survey findings indicate that Black nurses are more likely to both personally experience and confront acts of racism. Most Black nurses who responded (72%) say that there is a lot of racism in nursing compared to 29% of white nurse respondents. The majority (92%) of Black respondents have personally experienced racism in the workplace from their leaders (70%), peers (66%) and the patients in their care (68%). Over three-fourths of Black nurses surveyed expressed that racism in the workplace has negatively impacted their professional well-being.
“The acts of exclusion, incivility, disrespect and denial of professional opportunities that our nurses have reported through this survey, especially our Black, Hispanic and Asian nurses, is unacceptable,” said Commission Co-lead and National Association of Hispanic Nurses (NAHN) President Adrianna Nava, PhD, MPA, MSN, RN. “Racism is a trauma that leaves a lasting impact on a person’s mental, spiritual, and physical health as well as their overall quality of life. As the largest health care workforce in the country, we must come together to address racism in nursing as the health of our nation depends on the health and well-being of our nurses.”
Since its inception in January of 2021, the Commission has been intentional and bold in leading a national discussion to address racism in nursing. The Commission has convened listening sessions with Black, Indigenous, and People of Color (BIPOC) nurses and hosted a virtual summit focused on activism with foremost subject matter experts. Collaborating with top scholars on the issue, the Commission developed a new definition of racism to establish a baseline for holding conversations, reflecting on individual or collective behaviors, and setting a foundation for the work ahead.
“The collective voices and experiences of BIPOC nurses nationally have provided a call for overdue accountability within the nursing profession to acknowledge and address the structural racism rooted within nursing, especially policies that have anti-Black and anti-Indigenous histories,” said Commission Co-lead and Member-at-Large Daniela Vargas, MSN, MPH, MA-Bioethics, RN, PHN. “The next generation of BIPOC nurses deserve more than performative activism and empty words that continue to yield no progress toward structural changes within the nursing profession or racial equity. The breadth of the nursing profession through the Code of Ethics for Nurses holds all nurses accountable for calling out racism and replacing racist policies rooted in white supremacy with ethical and just policies that promote and implement accountability, equity, and justice for nurses and the communities that we serve.”
Nursing’s challenges with the issue of racism are reflective of the larger society. As a profession, we need to confront these same challenges with racial inequities within the profession. As such, the Commission’s work is urgent to create safe and liberating environments for all nurses so that the profession exemplifies inclusivity, diversity, and equity. The Commission urges all nurses across every health care setting and environment to join us in boldly confronting systemic racism. We must address upstream sources of racism in order to build sustained safe and effective environments of optimal care delivery ideal for every nurse and every patient regardless of race, origin or background. Nurses can learn more and share a story of experiencing racism or being an ally for change today.
*Data was collected through a survey administered by the National Commission to Address Racism in Nursing Between October 7-31, 2021, 5,623 nurses completed this survey. *
To increase UWA’s NCLEX pass rate, department leaders provided students with additional support in the form of mentorship, grants, and adopted online NCLEX online test prep tools from 
Ibemere serves as the principal investigator for her study entitled “Extending Sickle Cell Disease (SCD) Management: Adapting Management Recommendations to Sierra Leonean Context.” She is collaborating with 
Principal investigator Kelly will lead the study entitled “Stability of the Pediatric Urinary Microbiome” along with her collaborators Lisa Karstens, PhD, assistant professor, Oregon Health and Science University, and Tatyana Sysoeva, PhD, assistant professor of microbiology, The University of 
Myers will serve as the principal investigator of the study entitled “National Representative Databases for Clinical Research.” The research team includes 
