Digital Commons Network^™

Swimming In Uncertainty: Filling Data Gaps And Providing An Educational Platform For Beach Water Quality At Tybee Island, Georgia, Lukas Roberson

College of Graduate Studies: Theses & Dissertations

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Swimming in beaches water contaminated with high levels of bacteria can make you sick. Current monitoring at the public beaches on Tybee Island consists of weekly monitoring and enumeration of fecal indicator bacteria that takes 24 hours for results. If the number of bacteria exceed regulatory limits, a public health advisory is issued, and affected waters are retested until …

Enhancing Military Health System Organizational Efficiency And Quality Of Care Through A Social-Ecological Framework, Eric L. Peipelman

College of Graduate Studies: Theses & Dissertations

Timely and fair adjudication of incivility-related actions within the Department of Defense (DoD) and Military Health System (MHS) is increasingly crucial for maintaining accountability, mission readiness, and quality of care. Ongoing delays in resolving workplace complaints and inefficiencies in resource-heavy adjudications highlight the need to shift from reactive complaint handling toward proactive civility promotion and transparent decision-making. This Integrated Learning Experience (ILE) introduces the Peipelman Civility Discussion and Assessment Toolkit (PCDAT)—a comprehensive, evidence-based framework designed to improve civility, optimize resources, and enhance communication, even in the MHS. Based on the Social-Ecological Model (SEM) and adapted from the Workplace Power and …

Maternal Healthcare In The United States: An Exploration Of The Organizational And Political Determinants Of Maternal Healthcare Quality And Outcomes, Tamaya S. Browder

College of Graduate Studies: Theses & Dissertations

Despite having an advanced U.S. healthcare system, childbirth remains risky in the US, especially for socially vulnerable populations. Medicaid covers a large portion of births and is equipped to implement large-scale interventions to improve maternity care and patient outcomes. Two studies were conducted to (a) examine the relationship between organizational factors in U.S. hospitals and adverse clinical outcomes among Medicaid-insured maternity patients, and (b) analyze state-level Medicaid bundled payment models for maternity care. Guided by the Donabedian Quality of Care Model, Study One used logistic regression on data from the 2018-2020 National Inpatient Sample to explore how hospital organizational factors …

Identification Of A Rural Black Community-Based Mental Health Intervention Via Cbpr, Kirsten Mengell

College of Graduate Studies: Theses & Dissertations

Poor mental health in the US has increased since 2011 (Mental Health America, 2022). Rural communities face disparities in mental health shortages (Andrilla et al., 2018). African Americans face additional barriers, including a historical underutilization of mental health and high mental health stigma. This is significant given the higher rates of mental distress and discrimination among rural African Americans compared to Whites (James et al., 2017), and a recent increase in suicide among Black Americans (Stone et al., 2023). Illustrating a need for options within rural Black communities that can overcome professional shortages and cultural barriers to improve mental health …

Organ Chips And Translational Research: Identifying And Examining New Ethical Issues, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

Organ chips, also known as organ-on-a-chip devices, tissue chips, or microphysiological systems, have emerged over the last decade as a promising translational technology amidst growing concern about the translational crisis between laboratory research and patient bedside. Pointing to high rates of failure between nonhuman animal models and safety and efficacy in humans, organ chips and similar new approach methods have attracted substantial public and private investment. As human-cell-based alternatives to animal models, organ chips promise more predictive, efficient, and ethical platforms for pharmaceutical and toxicity testing. Engineered cultivation systems that enable cells to assemble into tissue-like structures (e.g. kidney, brain, …

Anything But Endo: Diagnostic Buck-Passing In Endometriosis Diagnosis, Rita Dexter, Megan Kitts, Heather Welty, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

People living with endometriosis, a disease in which tissue similar to the lining of the uterus grows elsewhere in the body, often experience prolonged diagnostic journeys because of symptom variability, normalisation of period pain and other symptoms, and lack of awareness of the condition. In this article, we analyse the endometriosis diagnostic journey through the lens of epistemic injustice. Drawing on in-depth interviews with 52 people living with endometriosis in the United States, we introduce the concept of diagnostic buck-passing to characterise the phenomenon wherein individuals who seek treatment for their symptoms end up stuck in a cycle of seeing …

Putting The L In Elsi: Legal Methods For Bioethics Research, Anya E R Prince, Benjamin Berkman, Donald Ford, Dov Fox, Christi Guerrini, Amy Koopmann, Natalie Ram, Jessica L Roberts, Kayte Spector-Bagdady, Sonia Suter

Center for Medical Ethics and Health Policy Staff Publications

Lawyers and law professors are increasingly involved in interdisciplinary scientific teams and grant research to answer ethical, legal and policy questions related to biomedical topics. Yet, the methods that lawyers use to conduct legal research and analysis are not always familiar to scientists and social scientists conducting peer review of a proposed project with legal aims or a publication reporting a legal study. To better facilitate interdisciplinary ethical, legal, and social implications collaboration, there is a need to better explain how legal research methodologies can provide robust tools to address a range of nuanced biomedical questions. This paper explores …

Differences Between Government, Consortium, And Private Database Stewards Impacting The Genomic Data Market: A Survey Of U.S. Academic Genetic Researchers., Amanda K Greene, J Denard Thomas, Kaitlyn Jaffe, Luyun Chen, Kerry A Ryan, Brian J Zikmund-Fisher, J Scott Roberts, Amy L Mcguire, Katherine Hendy, Kayte Spector-Bagdady

Center for Medical Ethics and Health Policy Staff Publications

Background: Despite major shifts in U.S. federal government data sharing requirements, their impact, and relation to researcher choice of database, are underexplored. This study surveyed genetic researchers regarding trends, priorities, perceptions of quality, impact on research outcomes, and genomic data sharing and use across government, consortium, and private databases.

Methods: As part of an exploratory sequential mixed methods project, we surveyed 294 U.S.-based genomic academic researchers.

Results: Genetic researchers generally have a choice between databases, which allows them to prioritize data quality. This might explain recent trends toward the use of government and consortium databases away from private ones. Respondents …

Can I Get A Witness? The Ethical Dimensions Of Family Presence In Patient Suffering, Jennifer Blumenthal-Barby, Trevor M Bibler, Holland Kaplan, Adam Omelianchuk, Joanna Smolenski

Center for Medical Ethics and Health Policy Staff Publications

For patients who are suffering, the bedside presence of a family member can provide comfort, and many people hold that there is moral value in being present with a conscious, suffering patient. Yet what is the moral significance of the absence of family members when a patient is minimally conscious or unconscious and not aware of their absence? Clinicians are often troubled when family members and surrogate decision-makers who are able to spend a significant amount of time at an unconscious, seriously ill patient's bedside do not do so. Clinicians feel frustrated that they must bear the burden of witnessing …

Toward Ethical Provenance Tracking: The Ga4gh Model Data Access Agreement (Daa), Alexander Bernier, Bartha Maria Knoppers, Jonathan Lawson, Robyn Mcdougall, Maili Raven-Adams, Vasiliki Rahimzadeh

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Standardizing contractual clauses that govern data access enables research institutions to responsibly steward genomic and related health data while enabling its efficient downstream reuse.

Methods: We describe a document analysis study using both qualitative and comparative law analytical approaches to identify the most common categories of clauses from 29 different data access agreements used by human biomedical research consortia globally. We furthermore characterized the legal positions and standard practices for each common element of the agreement and synthesized across them to develop model clauses. A total of 3 discussion sessions were organized virtually to refine the clauses among members …

Access To Digital Health Technologies: Personalized Framework And Global Perspectives, Sanjiv M Narayan, Mina K Chung, Demilade Adedinsewo, Luisa C C Brant, Leslie L Davis, David Duncker, Jennifer L Hall, Janet K Han, Carolyn S P Lam, Eldrin Lewis, Joseph Loscalzo, Manlio F Márquez, Vasiliki Rahimzadeh, Fatima Rodriguez, Prashanthan Sanders, Emma Svennberg, Kenneth Stein, Mintu Turakhia, Clyde Yancy, Antonis A Armoundas

Center for Medical Ethics and Health Policy Staff Publications

The emergence and rapid adoption of digital health technologies (DHT) present unprecedented opportunities to democratize and reduce disparities in health care by monitoring health and disease at the point of care in all patients. However, limited access to DHT is becoming a major obstacle to realizing these goals. Access to DHT is influenced not only by well-recognized social determinants of health, but also by digital determinants of health, such as digital literacy and the need for broad access to digital infrastructure, as well as commercial and economic factors. Addressing these challenges and designing unbiased systems of care are essential to …

Clinicians’ Views On A Patient Decision Aid For Deep Brain Stimulation In Parkinson’S Disease, Hillary S King, Jennifer Blumenthal-Barby, Benjamin H Levi, Sol De Jesus, Harini Sarva, Laura Y Cabrera

Center for Medical Ethics and Health Policy Staff Publications

Introduction: For people with Parkinson's disease (PD), deciding whether to pursue deep brain stimulation (DBS) has become increasingly complex. Evidence suggests current approaches to collaborative decision-making may fall short of accepted standards. Thus, a decision support intervention, such as a patient decision aid (PtDA) may be warranted. PtDAs have been shown to improve patients' knowledge, expectations, and participation in decision-making for other, similar healthcare decisions. We therefore sought to assess neurologists' awareness of, and experience using, PtDAs, and to solicit their opinions on the ideal features of a PtDA for PD patients considering DBS.

Methods: Sixteen United States-based neurology clinicians …

Imagining Genomics And Population Health In 2050: Anticipating Future Research, Policy, And Governance Needs, Bartha Maria Knoppers, Yann Joly, Ma Apos N H Zawati, Habiba Alsafar, Jeffrey C Barrett, Laura Blackburn, Brian Hon-Yin Chung, Martina C Cornel, Edward S Dove, David Glazer, Calvin Wai-Loon Ho, Muin J Khoury, Anna C F Lewis, Anneke Lucassen, Peter F R Mills, Colin Mitchell, Nicola Mulder, Ainsley J Newson, Anthony Ng, Paul D P Pharoah, Vasiliki Rahimzadeh, Megan C Roberts, Saskia C Sanderson, Jeffrey M Skopek, Ron Zimmern, Eric M Meslin

Center for Medical Ethics and Health Policy Staff Publications

No abstract provided.

Evidence-Based Policymaking And Global Governance: An Examination Of The Role Of The Policy Studies Organization And Ecosoc, Chick Edmond

Political Science & Geography Faculty Publications

Transnational challenges, such as climate change, global inequality, pandemics, digital governance, and institutional legitimacy crises, are becoming increasingly complex, therefore, the demand for evidence-based decision-making has become an important developing normative and practical issue in the area of global governance. The Economic and Social Council (ECOSOC) is the principal organ of the UN responsible for coordinating policy processes across all areas of economic, social and development issues. However, despite ECOSOC’s ability to make decisions concerning how the world addresses these problems, it has been widely criticized for being unable to translate expert knowledge into tangible policy outcomes. Therefore, this paper …

Diagnosing The Discourse: How The Academy Of Breastfeeding Medicine Constructs And Constrains Treatment Of Tethered Oral Tissues, Mary E. Miller

Antioch University Dissertations & Theses

While breastfeeding is recognized as fundamental to global public health, oral restrictions that can affect infant latch, milk transfer, and feeding efficiency warrant further examination within policy frameworks. This dissertation proposes an expanded conceptualization of tethered oral tissues (TOTs) that encompasses not only anatomical frenal restrictions but also fascial tensions, neuromuscular limitations, and other conditions restricting orofacial function that may be congenital or acquired. The purpose of this study was to critically examine how this clinical guidance document shapes understandings and responses to TOTs. Using Carol Bacchi’s “What’s the Problem Represented to Be?” approach, a critical discourse analysis of the …

Navigating Financial Futures: A Case Study Of A Targeted Financial Literacy Program For African American College Students, Michael L. James

Antioch University Dissertations & Theses

This dissertation presents a qualitative analysis of a targeted financial literacy program designed for African American college students. The dissertation examined how African American college students describe and make meaning of their participation in a targeted financial literacy program, particularly in relation to the program’s structure, content, and delivery. Despite growing interest in financial literacy education, interventions that acknowledge the persistent wealth gap and systemic financial inequities faced by African Americans remain underexplored. Employing a case study research method within a program understanding framework, this study investigated a program at Historically Black Colleges and Universities (HBCUs). Findings reveal that the …

Digital Griots Playing Lottery Tickets: A Study Of Hip Hop And Social Transformation In Ghana's #Fixthecountry Movement, Jaime M. Kowlessar

Antioch University Dissertations & Theses

On June 28, 2021, activist Ibrahim Mohammed (Macho Kaaka) was murdered in Ejura, Ghana, after using social media to criticize government failures. When protesters demanding justice were shot by security forces, politically engaged Ghanaian hip hop artists refused silence, contributing to Ghana’s #FixTheCountry movement—the nation’s largest youth mobilization in a generation. Yet scholarly debates about how hip hop contributes to social change remain unresolved, divided between those celebrating its activist potential and those critiquing its limitations. This dissertation introduces the lottery ticket theory as an alternative framework for understanding cultural activism’s relationship to political transformation. Rather than asking whether hip …

Green Space: Investigation Into The Role Pocket Parks Play In Biodiversity And Human Well-Being, Jacalyn Speicher

Antioch University Dissertations & Theses

Natural communities and the birds that inhabit them are essential to the physical and emotional well-being of human residents in urban settings. The action research undertaken in this study addresses the social and environmental justice issues of equity, accessibility, and diversity afforded avian and human communities in the design of pocket parks within the urban landscape. As urbanization consumes the natural landscape, people and birds must adapt to the novel challenges of a changing environment. I studied 10 pocket parks identified in Center City, Philadelphia, Pennsylvania between January and June 2026. This time frame spanned the seasons from winter to …

Enhancing Graduate Surgical Education: Recommendations For Development Of Common Surgery Education And Training Accreditation Standards, Edwin Christopher Ellison, David B. Hoyt, L. D. Britt, Gerald B. Healy, John R. Potts Iii, Michael M. Awad, Eric A. Gantwerker, Apostolos Gaitanidis, Carol R. Bradford, Robert Phillip Burns, Mary T. Hawn, John G. Hunter, Cheryl T. Lee, Keith D. Lillemoe, Najjia N. Mahmoud, Jeffrey B. Matthews, Michael W. Neumeister, Kathleen C. Y. Sie, The Independent Committee For Graduate Surgical Education

Department Surgery Faculty Publications

Background:

Concerns persist within the surgical community that completion of an accredited surgical residency no longer consistently ensures that trainees are ready for independent practice. In response, the Independent Committee for Graduate Surgical Education (ICGSE) was established in January 2025 to address the unique requirements of surgical training. The committee’s mandate was to recommend program standards that would potentially optimize education and training for surgical residents, with the goal of improving patient care.

Methods:

The ICGSE, consisting of 71 surgeons across 16 specialties, reviewed the history of surgical accreditation and relevant literature. Workgroup-led discussions identified strategies for improving trainee readiness …

Catching The Forgotten: Repairing The Safety Net For Cofa Migrants In The United States, Brian Aguilar

Lewis & Clark Law Review

Citizens of the Freely Associated States—the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Belau—are permitted to live and work in the United States without a visa under the Compacts of Free Association (COFA). Yet, for nearly three decades, COFA migrants were excluded from the federal public benefits safety net. This exclusion, a product of legislative oversight in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, devastated communities like the Marshallese in Springdale, Arkansas, who endured dangerous working conditions, poverty, and severe health vulnerabilities without access to critical federal benefits programs. While …

Investigating Policy Enactment In Community Sport Coaching: Directions For Future Research, Ben Ives, Dawn Penney, Jimmy O’Gorman, Adam J. Nichol, Paul Potrac, Lee Nelson

Research outputs 2022 to 2026

This article calls for a sophisticated investigation of policy enactment in sport-related environments, with community sport coaching used as an example case. Emphasis is placed on the need for in-depth empirical research into and theorisation of: 1) political skills involved in the enactment of policy; 2) emotion management when enacting policy; 3) performative and fabricated aspects of policy enactment; and 4) impacts of policy enactment for the health and wellbeing of workers. In doing so, this article challenges scholars to move beyond the study of policy actor types and to develop more nuanced understandings of the political, economic, organisational, interpersonal, …

Antecedents Of Emergency Services’ Street Level Bureaucrats’ (Slbs) Delivery Of Public Value: An Exploratory Study, Yvonne Brunetto, Ben Farr-Wharton, Aglae Hernandez Grande, Fleur Sharafizad, Matthew Richman

Research outputs 2022 to 2026

Street Level Organisations (SLOs) determine the Psychosocial Safety Climate (PSC) in their workplaces and we examine pathways from SLBs’ PSC and Public Service Motivation (PSM) to discretionary power, work stress, wellbeing and the subsequent delivery of public value. The structural equation modelling results from 195 Australian police, fire, ambulance, and emergency services workers indicate that PSC had a more significant role in explaining SLBs’ delivery of public value compared with PSM. The implication is that SLOs’ management must ensure psychosocially safe and supportive workplaces conducive to building SLBs’ wellbeing, because that is the pathway for delivering public value.

Incorporating New Guidelines Into School-Based Asthma Management, Jessica Michala Jindra, Angela Duff Hogan

Department of Pediatrics Faculty Publications

Purpose of the Review

The aim of this review is to identify barriers and provide solutions to the implementation of inhaled corticosteroid-formoterol as rescue therapy within schools.

Recent findings

GINA guidelines in 2019 and NAEPP in 2020 recommended inhaled corticosteroids combined with formoterol for a rescue inhaler over the traditional short-acting beta-agonist.

Summary

The findings discussed in this article describe the barriers to the implementation of inhaled corticosteroids combined with formoterol for a rescue inhaler in school systems. Traditional asthma action plans, school nursing and parental education, and differences in dosing are some barriers identified. This paper provides solutions for …

Grant-O-Thon: A Designathon-Informed Grant Writing Program To Enhance Research Grant Writing Skills In Low- And Middle-Income Countries, Yusha Tao, Gifty Marley, Lauren Fidelak, Bin Yu, Yusuf Babatunde, Anita N. Walker, Anthony A. Attama, Andrea L. Conroy, Esther K. Afolabi, Dimitrios N. Vatakis, Iheanyi Omezuruike Okonko, Shyngle K. Balogun, Hongyun Fu, Xin Peng, Ijeoma M. Ifeorah, Patience Kukundakwe, Alexandra Cossio, Ifeoma M. Obionu, Ángela Patricia Beltrán López, Matthew Idowu Olatubi, Ucheoma C. Nwaozuru, Yuanyi Chen, Huachun Zou, Eneyi E. Kpokiri, Daniil Wu, Oliver Ezechi, Juliet Iwelunmor, Meredith Labarda, Jason J. Ong, Weiming Tang, Joseph D. Tucker

Department of Pediatrics Faculty Publications

Problem

Early career researchers in low- and middle-income countries (LMICs) face substantial barriers when writing research grants and have limited writing support. A designathon approach was applied to organize a grant writing workshop (grant-o-thon) tailored for early-career LMIC researchers. This study describes the planning, implementation, and participant-reported outcomes of the grant-o-thon as a participatory training approach.

Approach

Grant-o-thons were organized in 2023, 2024, and 2025. Consistent with the designathon model, the grant-o-thon was structured in three stages: preparation using co-creation with end-users, intensive collaborative teamwork supported by mentor feedback and weekly writing deliverables, and structured follow-up. Each grant-o-thon consisted of …

The Intersection Of Abuse, Child Welfare, And The Law For Intimate Partner Violence Survivors: Gender Violence As An Antagonistic Social Force, Julio Montanez

Graduate Studies Theses and Dissertations 2026

Intimate partner violence (IPV)—as gender violence—pits children’s civil rights and women’s civil liberties against each other. To explore this phenomenon, the current work features five (5) studies that aim to understand the systemic consequences of IPV and child maltreatment for victims and survivors of both types of abuse.

• Study 1 is a qualitative-deductive study featuring a directed content analysis of news media pertaining to a trial court case on lethal child maltreatment and IPV.
• Study 2 is a qualitative-inductive study featuring a feminist critical discourse analysis of trial court data on lethal child maltreatment and IPV.
• Study 3 is a …

Sustainable Development In The Islamic Economy Between Theoretical Foundations And Practical Application, Dr. Ahmed Abbas Abdalhussein

Muthanna Journal of Administrative and Economics Sciences

This research aims to examine the implications of the Islamic vision of sustainable development and to identify the way Islamic law has addressed its environmental, economic, and social dimensions. This is achieved by examining evidence from the Prophet’s biography, which includes foundations that align, in some cases, with the goals of sustainable development, while also encompassing more comprehensive foundations for achieving sustainability. This is particularly true given that these foundations and principles are consistent with Islamic societies, as well as defining the responsibilities of the individual, society, and the state within the framework of the exalted status that God Almighty …

Ai Ethics And Governance For Leaders In Higher Education: A Hermeneutic Phenomenology Of Faculty Early Adopters’ Sensemaking, Pedagogical Innovation, And Transformation, Freddie Seba

Doctoral Dissertations

Artificial Intelligence (AI), especially Generative AI (GenAI), is transforming how we work, learn, acquire, produce, and deliver knowledge, as higher education experiences existential pressures, including demographic changes that reduce enrollment and revenues, as well as shifting public and government perceptions of higher education's value.

This hermeneutic phenomenology dissertation study explores how faculty early adopters critically engage, innovate, and experiment with this nascent transformational technology in their pedagogies amid multilevel pressures: macro—market-driven (neoliberalism) logic, Big Tech, and demographic change; meso—institutional policy, broader faculty community, and pedagogical innovation; micro—widespread student adoption, pedagogical experimentation, and innovation.

This dissertation study centers on shifting AI …

Social Construction Of Female-Headed Households Participating In Hud Public Housing Programs, Emma Forks

Walden Dissertations and Doctoral Studies

The problem this study addressed involved factors associated with long-term program involvement of female-headed households living in public and vouchered housing. The literature indicated a significant gap regarding the reasons women who received federal housing assistance stayed in government housing. The purpose of this generic qualitative study was to examine the experiences of female-headed households living in public housing and Housing Choice Voucher (HCV) housing in a Central Texas region, specifically to identify the factors that limited their ability to leave these programs. Using Schneider and Ingram’s social construction of target populations theory, the data was collected from eight participants …

Career Development And Its Role In Organizational Commitment: An Analytical Survey Of The Opinions Of A Sample Of Employees At Al-Zahrawi Surgical Hospital/Maysan, Salem Haider Resen

Muthanna Journal of Administrative and Economics Sciences

The research aims to reveal the role of career development in its dimensions (training, promotions, career planning) in enhancing organizational commitment, as the research problem was embodied in knowing the role played by career development in the organizational commitment of employees at Al-Zahrawi Surgical Hospital/Maysan? To achieve this, the research relied on a main hypothesis that (there is no statistically significant correlation or effect between career development and organizational commitment). The importance of the research is highlighted by its contribution to the development of human resources strategies to achieve organizational stability at the level of the Iraqi environment. On the …

Barriers To Youth Employment And Economic Mobility In The Bronx, David Cortes

CUNY Mexican Studies Institute

This research aims to uncover systemic factors that limit career stability for young adults in the Bronx. In this paper, I focus on unequal access to educational resources, economic inequality, and the digital divide as connected barriers that shape the quality of education and training youth receive, the resources and networks they have access to, and the opportunities they can realistically maintain over time. Based on a review of public data, media reports and the current literature, I argue that job instability in the Bronx is a structural problem. At the same time, this project pushes back against the assumption …