Digital Commons Network^™

Point-Of-Care Ultrasound Foundations In Physics And Image Acquisition: An Innovative Hands-On Active Learning Workshop, Cherie Tator, Saul Flores, Alan Riley, Kiyetta Alade

Faculty, Staff and Students Publications

Introduction: We developed an innovative, active learning workshop to introduce foundations of point-of-care ultrasound (POCUS) physics and instrumentation. The workshop design aimed to reduce cognitive load and encourage learner-centered engagement through hands-on exploration that reinforces key principles and connects theory to practice.

Methods: First-year medical students participated in small-group, student-driven exercises to explore POCUS machine controls, transducers, and image acquisition skills. Each group was supported by a faculty member to guide activities and ensure accuracy. Students scanned pickles, hard-boiled eggs, and olives with pits; these items were selected for their low cost, sonographic characteristics, and recognizability. Later in the semester, …

Pd-L1-Centric Whole Blood-Based Immune Signature Profiles Of Tuberculosis Patients During Therapy, Johanna Eggeling, Martina Sester, Christoph Lange, Jan Heyckendorf, Barbara Kalsdorf, Anna M Mandalakas, Andrew R Dinardo, David Lewinsohn, Dagmar Schaub, Tina Schmidt, Eva Tolosa, Maja Reimann, Patricia M Sánchez Carballo

Faculty, Staff and Students Publications

This prospective study investigated whole blood-based immune cell biomarkers for pulmonary tuberculosis (TB) immunoprofiling. Blood samples from 34 healthy controls and 51 tuberculosis patients were analyzed at three timepoints: Prior to therapy (T0), after 14 days of therapy (T1), and at the end of treatment (Te). Using multiparameter flow cytometry, 386 immune cell populations were analyzed. Predictive models were developed using two machine learning algorithms. A TB5LF change score, which was based on five cell populations, effectively distinguished tuberculosis patients from controls (AUC = 0.89) and tuberculosis patients before and at the end of treatment (AUC = 0.92). Similarly, the …

Host- And Pathogen-Related Determinants Of Pulmonary Versus Extrapulmonary Tuberculosis, Begna Tulu, Thomas Theo Brehm, Reinout Van Crevel, Tobias Dallenga, Andrew R Dinardo, Keertan Dheda, Johanna Eggeling, Wendemagegn Enbiale, Matthias I Gröschel, Jialun Hao, Vinod Kumar, Arjan Van Laarhoven, Rolanda Londt, Gareth Prosser, Philippa Randall, Norbert Reiling, Jan Rybniker, Ulrich E Schaible, Erwin Schurr, Isabelle Suarez, Sebastian J Theobald, Robert J Wilkinson, Christoph Lange

Faculty, Staff and Students Publications

Tuberculosis (TB) primarily manifests as pulmonary TB (PTB), but extrapulmonary TB (EPTB) remains a major clinical challenge. Distinct diagnostic and therapeutic difficulties arise from differences in immune responses, pathogen behaviour and host susceptibility. However, the factors driving disease localisation are still incompletely understood. We conducted a comprehensive narrative review of studies examining differences between PTB and EPTB in terms of epidemiology, mycobacterial factors, genetic and epigenetic determinants, host immune responses, transcriptomic profiles, cytokine and chemokine patterns, and immunophenotypes. EPTB is more common among females, children, older adults and immunocompromised individuals with deficient granuloma formation. This review is intended to provide …

A Year In Review On Tuberculosis And Non-Tuberculous Mycobacteria Disease: A 2026 Update For Clinicians And Scientists, Simone Tunesi, Graham Bothamley, Gunar Günther, Yousra Kherabi, Liga Kuksa, Berit Lange, Christoph Lange, Natalie Lorent, Francesca Saluzzo, Martina Sester, Xenia Emilie Sinding Iversen, Marc Tebruegge, Conor Tweed, Anca Vasiliu, Lorenzo Guglielmetti, Tuberculosis Network European Trials Group (Tbnet)

Faculty, Staff and Students Publications

Background: Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide, while infections from non-tuberculous mycobacteria (NTM) represent a growing public health threat. In its 20th year of activity, the Tuberculosis Network European Trials group (TBnet; www.tbnet.eu) is one of the leading research networks in Europe. In this review, we summarize the main advances in TB and NTM that occurred in 2025.

Methods: We conducted a non-systematic review of articles published in 2025, with a strong emphasis on research with current or potential impact on clinical practice. We also selected the most impactful papers regarding the management of adult …

Updates In The Management Of Peanut Allergy, S Shahzad Mustafa, Aikaterini Anagnostou, Matthew Greenhawt

Faculty, Staff and Students Publications

Peanut allergy is a significant rising public health problem affecting both children and adults. Early peanut introduction has been adopted in multiple westernized nations as a preventative strategic measure to reduce the risk of developing peanut allergy, although implementation faces barriers. Multiple therapies to treat peanut allergy have been developed, including oral immunotherapy and omalizumab as approved treatments to provide protection against reactions from accidental exposure and reduce the risk of anaphylaxis, offering options beyond strict avoidance. Strategies in the developmental pipeline include epicutaneous immunotherapy and sublingual immunotherapy. The future is bright for individuals with peanut allergy, as these breakthroughs …

Improving Compliance With Safe Sleep Guidelines For Vulnerable Patients In A Community Safety Net Hospital Neonatal Intensive Care Unit, Andrew Beverstock, Samantha Carlton, Hillary Lee, Thomas Lu, Kelsi Morgan, Ashlee Smith-Patel, Kelli Phillips, Joseph Hagan, Pablo Lohmann, Caraciolo Fernandes, Lisa Owens, Daniela Dinu

Faculty, Staff and Students Publications

Introduction: Modeling safe sleep in the neonatal intensive care unit (NICU) increases the likelihood that parents will follow these practices after discharge. Many NICU infants are put to sleep unsafely, and unsafe sleep practices are the leading cause of nonnatural death among children locally. We created safe sleep standards for infants older than 32 weeks based on national guidelines: infants should be placed supine in a flat, empty crib and should never be swaddled loosely. We aimed to increase the weekly percentage compliance with safe sleep recommendations from a baseline of 58% (0.58 compliant) to 85% (0.85 compliant) by March …

Predictors Of Inpatient Rn Turnover In Rural And Urban Vha Hospitals, Katherine G Bay, Chase S Eck, Melissa K Knox, Paras Mehta, Laura A Petersen

Faculty, Staff and Students Publications

Background: The rising demand for health care delivery and an aging workforce is of particular concern in rural areas, where health care access depends upon an adequate nursing workforce. To address this shortage and optimize care, it is essential to measure when registered nurses (RN) leave inpatient direct care positions (ie, inpatient RN turnover) and identify modifiable factors correlated with RN turnover.

Objectives: Apply a novel method for characterizing inpatient RN turnover to understand factors associated with variation in RNs leaving inpatient positions at rural and urban Veterans Health Administration (VHA) hospitals.

Project design: Retrospective cohort study.

Subjects: Direct care …

Findings And Recommendations From The State Of The Art (Sota) Conference On Nursing Research To Improve Veteran Outcomes, Amelia E Schlak, Sarah Krein, Laura A Petersen, David Atkins, Catherine Battaglia, Elizabeth Burkhart, Renee Colsch, Marguerite Daus, Heather Gilmartin, Nipa Kamdar, Melissa Knox, Ann Kutney-Lee, Christine M Olney, Kathryn Rugen, Tracy Weistreich, Sheila Cox Sullivan, On Behalf The Nursing Sota Planning Committee

Faculty, Staff and Students Publications

The Veterans Health Administration (VHA), the largest employer of nurses in the United States, has more than 120,000 nursing personnel providing care to over 9 million Veterans across diverse settings. Despite nursing's central role in delivering and sustaining care, research on strengthening the nursing workforce and optimizing nursing practice has remained underdeveloped in VHA. To address this gap, VHA's Office of Research and Development, in partnership with the Office of Nursing Services, convened a State of the Art (SOTA) conference in November 2023 focused on nursing. The Nursing SOTA brought together nurses, researchers, operational leaders, and other stakeholders to review …

Relationship Between Number Of Assigned Patients And Rn Time To Administer Medications During The Peak-Time Medication Pass, Chase S Eck, Melissa K Knox, Paras D Mehta, Christine Yang, Laura A Petersen

Faculty, Staff and Students Publications

Background: Inpatient nurse staffing affects patient outcomes. Less is known about the mechanism of this relationship and how lower overall staffing in a unit affects individual RN activities at the bedside.

Objectives: Estimate the relationship between the number of patients assigned to an RN and time spent on medication administration at the peak-time medication pass (PTM), a common nursing task.

Research design: Estimate the association using multivariable linear regression to adjust for patient severity and staff and unit fixed effects.

Subjects: All 9272 RNs administering medications during the PTM on 243 inpatient units in 113 VHA hospitals in 2019.

Measures: …

Using Medication Pass Analysis To Examine Longitudinal Changes In Va Inpatient Nurse Staffing And Workload Before And Through The Covid-19 Pandemic: 2019-2022, Melissa K Knox, Chase S Eck, Lynette Dorsey, Paras D Mehta, Christine Yang, Laura A Petersen

Faculty, Staff and Students Publications

Background: The COVID-19 pandemic resulted in extended disruption to the health care system. National-level data-driven comparisons of inpatient nurse staffing and workload before and during the pandemic have been limited.

Objectives: Assess the extent to which registered nurse (RN) staffing and workload changed from prepandemic levels in a national integrated health care system.

Research design: Longitudinal descriptive analysis. Medication pass analysis using bar code medication administration data for the peak-time medication pass (PTM) assessing year-over-year changes from 2019 to 2022. To assess significance of year-over-year changes in means we used the Welch 2-sample t test.

Subjects: Staff (N=42,999) administering PTM …

A Review Of Current Research And Barriers To Access: Exploring Disparities In Pediatric Epilepsy Surgery, Nikita Das, Ali A Mohamed, Akshat Katyayan, Meena Vessell

Faculty, Staff and Students Publications

Background: Drug-resistant epilepsy (DRE) impacts at least 30% of pediatric epilepsy patients, adversely affecting neurodevelopment and quality of life, as well as risk of sudden unexplained death in epilepsy (SUDEP). While surgical intervention has proven to be an effective treatment for DRE, disparities in access to surgical care persist. Compared to adults, pediatric patients face unique challenges, including delayed recognition of surgical candidacy, limited access to specialized epilepsy centers, complex care coordination, and socioeconomic barriers.

Summary: This review explores the current state of pediatric epilepsy surgery, highlighting its effectiveness in achieving seizure freedom, improving neurocognitive outcomes, and reducing long-term healthcare …

‘The Way We Do Our Translation’: A Case Study Of Translation Policy For Spanish Speakers In The Public Parks Of Sonoma County, California, Gabriel González Núñez, Ángel María Casas Grageab, Christina Guerrero Harmon

Writing and Language Studies Faculty Publications

Signs in public spaces can provide essential information. Especially at times of crises, and in places where there are large populations who speak a minoritized language, translation is often employed to create multilingual signage for the benefit of the community. After all, translated signs appear because some authority considers that a certain message is important enough to be visibly communicated to the public, including those who do not speak the State’s preferred language. The decision as to whether to translate or not certain signs may seem arbitrary, but one would hope that it is the result of a guided policy …

Drone Dichotomy: Investigating The Application Of Unmanned Aerial Systems For Offensive And Defensive Chemical, Biological, Radiological, And Nuclear-Related Tasks, Evan Jacob Martinovitch

Graduate Theses/Dissertations

This thesis investigates the application of unmanned aerial systems (UAS) for both offensive and defensive chemical, biological, radiological, and nuclear (CBRN) tasks to determine if they serve as a force multiplier on the modern battlefield. As CBRN weapons reemerge as realistic threats alongside the rapid proliferation of UAS, the intersection of these fields presents unique challenges and opportunities. Through a methodology that examines the history of the UAS-CBRN intersection, military doctrine, and the status of UAS technology, this research evaluates the capability of current and emerging UAS against specific CBRN delivery, reconnaissance and surveillance, and decontamination tasks. The analysis conducted …

Small Mammal Communities Within And Land Coverage Around Southwestern Missouri Prairies, Kaitlyn J. Bebensee

Graduate Theses/Dissertations

Land alterations can reduce the amount of suitable habitat necessary for persistence of an associated species. Within such constrained habitats, limited resources may elicit competition, which could cause shifts in abundance and occurrence of species. Missouri prairies have been declining in size, making it imperative to collect reference data on mammal populations within and land use types around remnants. For this study, I trapped small mammals in Southwestern Missouri prairies because they can be indicators of environmental health and can vary in abundance between prairies. I focus on the diet of two dominant small mammals, Peromyscus maniculatus and Microtus ochrogaster …

United States Mainstream Meat Market Entry: An Analysis On Speciality Goat Meat Products, Madison Raye Schmitz

Graduate Theses/Dissertations

Understanding consumers' perspectives and motivations is key when looking into making goat meat more accepted in the mainstream meat market. Previous research has shown there is a demand for goat meat from different populations in the US. Consumers also care more about the quality of the food they purchase. Understanding that goat meat has lower cholesterol and is leaner than other red meat is important to incorporating goat meat in niche consumer markets. Providing consumers with a product that is familiar to them is more acceptable than giving consumers a cut of meat they are unfamiliar with. Standard products like …

Gene Editing And The Accessibility Of Bioterrorism: Rethinking Global Biosecurity In The Post-Covid-19 Era, Nicholas Morales

Graduate Theses/Dissertations

COVID‑19 demonstrated how a single biological event can strain health systems, disrupt supply chains, undermine national security, and erode public trust. This shock occurred as biotechnology became dramatically more accessible: gene editing and synthetic biology tools once limited to specialized laboratories are now widely available through inexpensive equipment, open‑source data, and decentralized expertise.

This expanded access accelerates innovation but also broadens the threat landscape. The ability to reconstruct pathogens using publicly available sequences and mail‑order DNA shows that complex biological synthesis is no longer confined to state programs. These risks are amplified by opaque biotechnology activities in China, Russia, and …

Using 1:1 Behavior-Analytic Instruction To Enhance Outcomes Of A Social-Emotional Learning Curriculum: A Retrospective Single-Case Clinical Evaluation, Cierra Vandermeer

Graduate Theses/Dissertations

Social-Emotional Learning (SEL) is the process through which people acquire and apply skills to manage emotions, form relationships, make responsible decisions, and pursue personal and shared goals, and these competencies shape identity development and daily functioning (Collaborative for Academic, Social, and Emotional Learning [CASEL], 2020). While there are many SEL programs and curricula that exist for school-aged children, there are few curricula that a) have a focus on 1:1 instruction for preschool to primary-aged children, and b) integrate and incorporate Applied Behavior Analysis (ABA) principles. This thesis reviewed a retrospective case study of a six-year-old female-identifying student who participated in …

When Speech Speaks Louder Than Truth: Language Variation And Credibility In The Courtroom, Melanie E. Spinnie

Graduate Theses/Dissertations

This study aims to investigate how linguistic variation affects perceptions of credibility in courtroom settings. It focuses on how jurors, judges, and other individuals in the legal system may exhibit bias (consciously or unconsciously) based on how a defendant or witness speaks-- this could include speech disorders as well as differences in dialect, accent, and speech style. Through review of relevant literature, review of a relevant historical case, conducting a survey, and conducting a semi-structured interview, this study explores whether certain speech patterns or characteristics are disproportionately associated with negative judgments during legal proceedings, such as reduced credibility and trustworthiness. …

A Geospatial Assessment Of Groundwater Salinization In A Multi-Aquifer System: Durango, Mexico, Juan Lopez-Sierra

Graduate Theses/Dissertations

Groundwater salinization poses a critical environmental concern for water resource sustainability in arid and semi-arid regions. This study evaluates spatial and temporal patterns of groundwater salinity across the state of Durango, Mexico, using total dissolved solids (TDS), sodium adsorption ratio (SAR), as salinity indicators and nitrate-nitrogen (NO₃–N) as an anthropogenic indicator. Groundwater quality data were obtained from (CONAGUA), a Mexican water agency. To assess salinity variations with respect to time, while minimizing interannual sampling bias, two multi-year sampling periods were selected: 2012-2013, and 2020-2021. Final datasets consisted of 122 wells for 2012–2013 and 131 wells for 2020–2021. The wells were …

The Ones Who Watched: Technology, Proxy Warfare, And The Testing Ground Hypothesis, Sean J. Oliver

Graduate Theses/Dissertations

Great powers need laboratories for war. This thesis argues that great powers find these laboratories in proxy forces. Proxy warfare is not just a tool for strategic influence. It is a machine for experimentation. This study posits a central testing-ground hypothesis. It contends that great powers deliberately use surrogates to vet emerging technologies, doctrines, and mobilization schemes under the pressure of real combat. The analytical methodology is historical. It traces patterns from the ancient world's proxy forces and the innovations of the Crusades to the Cold War and the digital age. The thesis examines enduring patterns, including the tension between …

Corpus Meum, Mea Electio, Kara L. Coonrod

Graduate Theses/Dissertations

The right to bodily autonomy and reproductive freedom is something I hold very close to my heart. Women who did not wish to embrace motherhood, or who grew beyond the walls of the hearth and home, have been far more often persecuted than praised. Over the past two years, I have created artwork borrowing the visual and material language of the Catholic church (along with personally relevant folklore) to elevate my freedom of choice and bodily autonomy in the face of religiously driven political oppression. Using a less frequently referenced organ from my reproductive system to represent my struggle against …

Herp Count 2025, Camryn Gulledge

Graduate Theses/Dissertations

Herp Count 2025 is a process-based project in which I log and document every herp (reptile or amphibian) I encounter in the wild while investigating the realities of human impact on ecosystems. During 2025, I observed 1,406 individual herps, most of which appeared not in remote wilderness but in the compromised margins of human spaces. When I observe them in a littered area, I collect nearby trash and bring it back to my studio to combine it with a detailed drawing of that specific individual. In my Contact series, I use a clean-touch printmaking process that involves a stretched plastic …

Remediation Impacts Metal Concentrations And Metal Tolerant Bacteria In Soils Of The Missouri Tri-State Mining District, Ophelia R. Pettington

Graduate Theses/Dissertations

After over 100 years of Zn and Pb mining in the Tri-State mining district (TSMD), former mines continue to be sources of metals. Metal contaminated soils can be remediated using plant-microbe interactions. Plants manipulate their microbiome and recruit microbes to increase metal tolerance. Remediating bacteria are site-specific and identifying native microbes can accelerate remediation efforts. Studies relating microbes and metal concentrations in remediated areas in the TSMD are scarce. I collected root and bulk zone soils associated with Andropogon virginicus from remediated and non-remediated sites in Webb City, MO. I used 16S rRNA gene amplicon sequencing to evaluate the bacterial …

The Effect Of Sex On A-To-I Editing In Skeletal Muscle During Inflammation, Skyler Lee

Graduate Theses/Dissertations

Adenosine-to-inosine (A-to-I) RNA editing is a post-transcriptional mechanism mediated by ADAR enzymes that can alter RNA sequence, protein function, and gene regulation. Because ADAR1 is upregulated during inflammation and plays a critical role in innate immunity, previous studies investigated the effects of acute inflammation on RNA editing in male and female mice. Lipopolysaccharide (LPS) was used to induce inflammation, and RNA editing levels were examined in the heart, brain, and skeletal muscle. While editing levels in the heart and brain remained unchanged, skeletal muscle exhibited tissue- and sex-specific differences in editing. In this thesis, LPS treatment affected selective editing, increasing …

American Elderberry's Next Top Pollinator: Evaluating The Role Of Arthropods In Pollination, Jenny K. Burrow

Graduate Theses/Dissertations

American elderberry (Sambucus nigra subsp. canadensis) is a woody deciduous shrub native to eastern North America. In addition to its long history of use by indigenous peoples, there is renewed interest in cultivating and consuming American elderberry, primarily driven by expanding health supplement markets. Despite recent advances in horticultural development of American elderberry, its pollination ecology remains poorly understood. In this field study, I evaluated the contribution of arthropod visitors to pollination of American elderberry. To do this, I first characterized the identities and abundances of arthropod visitors via timed arthropod collections and floral observations during peak flowering …

Development And Validation Of The Ipip-Ocean: A Hierarchical Facet-Level Measure Of The Big Five, Caleb Niccum

Graduate Theses/Dissertations

This study focused on developing a mid-range, hierarchical, five-factor, 20-facet personality inventory (the IPIP-OCEAN) composed of 100 items drawn from both the IPIP-NEO-300 and the Abridged Big Five Circumplex. Hierarchical confirmatory factor analysis was used to validate the factor structure. Depression and anxiety, measured with the PHQ-9 and GAD-7, were used to further validate the measure through discriminant and convergent validity by examining whether the domains and facets of the IPIP-OCEAN produced findings consistent with those reported for similar scales in prior depression and anxiety research. Numerous factor analyses were conducted on the IPIP-OCEAN dataset (N = 1,058), and a …

Synthesis And Characterization Of The New G3 Family Of Organoantimony(V) Cyanoximates, Thao Trang Phan

Graduate Theses/Dissertations

Bacterial infections pose a serious threat to humans by developing resistance, rendering antibiotics ineffective. Of the 12 antibiotics recently approved since 2017, 10 belong to an already existing class. Various resistance mechanisms, such as reduced drug uptake, active efflux, drug inactivation, and target modification, can significantly reduce the efficacy of entire classes of antibiotics. Discovering novel strategies to overcome diverse mechanisms of resistance and improve therapeutic efficacy is in high demand. Inorganic compounds with organic ligands (both complexes and organometallics) represent a new class of compounds against which antimicrobial resistance has not yet been established. Recently, we discovered two series …

Bracing The Wobbly “Three-Legged Stool” By Increasing Homeownership Opportunities For Low- And Middle-Income Workers, Regina T. Jefferson

Scholarly Articles

Traditionally, the primary sources of retirement income were personal savings, the private retirement system, and Social Security. These three sources have been described metaphorically as the “three-legged stool” of retirement security. In this framework, each leg was viewed as a separate and distinct source of income that provided support throughout a worker’s retirement. Each source presented different and varying degrees of risks that were pooled collectively among the individual, the employer, and the government. Each source also functioned independently of the other two. Thus, the traditional framework of retirement income was thought to be ideal because it balanced and diversified …

Laudato Si' And The Limits Of Law: Reflections On The Vocation To Protect Integral Ecology, Lucia A. Silecchia

Scholarly Articles

In 2015, Pope Francis’s widely anticipated encyclical, Laudato Si’: On Care for Our Common Home, was released. It was a wide-ranging commentary on the state of the world, with much to say to economists, ecologists, farmers, theologians, educators, architects, artists, and pastors. It may, however, have been of particular interest to lawyers eager to see what Pope Francis had to say about law’s particular role. 

On this question, Laudato Si’ painted an inconsistent portrait of law’s suitability to this task. Pope Francis spoke passionately about the need for law at all levels to tackle the complexities of caring for our …

Strict Scrutiny And The Viewpoint Continuum, A.G. Harmon

Scholarly Articles

Consider the following instances: A cell phone photograph picturing a man's left kneecap. A statement that the speaker thinks, "The name Josiah is really cool." A woman who runs her bicycle over a business owner in order to gain celebrity and increase attention for her new podcast. An intentional lie told to acquire a job. A student who insists on answering his math exam questions in runic symbols.

At one point or another, American courts have considered the merits found in favor of instances similar to these and other like circumstances as amounting to "viewpoints." As such, they …