Digital Commons Network^™

An Analytical Evaluation Of Economic Geography Within Maine And Its Resource Industries: 1600 To Present, Maureen Mantooth

Graduate Theses and Dissertations

Resource peripheries represent a fringe area within economic geography, originating from the core-periphery theory developed by Friedmann and Miller. This concept has evolved to address global and regional contexts, referring to marginalized regions that rely heavily on the extraction and export of natural resources. By studying these regions, we gain a deeper understanding of critical components in global economic systems. This dissertation focuses on Maine as a case study of a resource periphery, using the framework proposed by Hayter et al. (2003) within the broader regional contexts of New England and the United States. Key factors explored include resource exploitation, …

Clinical Validation Of A Vaginal Cervical Cancer Screening Self-Collection Method For At-Home Use: A Nonrandomized Clinical Trial, Megan B Fitzpatrick, Colleen Mcnicholas, Lindsay Kuroki, Et Al.

2020-Current year OA Pubs

IMPORTANCE: One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening.

OBJECTIVE: To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport.

DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites …

Effect Of A Digital Health Exercise Program On The Intention For Spinal Surgery In Adult Spinal Deformity: Exploratory Cross-Sectional Survey, Marsalis Christian Brown, Christopher Quincy Lin, Christopher Jin, Matthew Rohde, Brett Rocos, Jonathan Belding, Barrett I. Woods, Stacey J. Ackerman

Rothman Institute Papers

BACKGROUND: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic's (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD.

OBJECTIVE: This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users' intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery.

METHODS: Individuals …

“Everybody Else Seems To Be Able To Get Help”: Rural Regulation, Access Loss, And Antigovernment Sentiment, Jennifer Sherman

West Virginia Law Review

This Essay draws upon two decades of the author’s research on rural United States communities to explicate ways in which the regulatory state has intervened in rural areas and economies, often with the claim of protecting land, natural resources, and/or wildlife. The outcomes are frequently disastrous for the human populations of those communities and generally are not planned for or mitigated by policy. The Essay argues that rural distrust of and aversion to government oversight is not caused primarily by ideological or cultural stances, but rather is an outcome of experiences of abandonment by the agencies that are meant to …

Epigenome-Wide Association Study Of Incident Type 2 Diabetes In Black And White Participants From The Atherosclerosis Risk In Communities Study, Sowmya Venkataraghavan, James S Pankow, Eric Boerwinkle, Myriam Fornage, Elizabeth Selvin, Debashree Ray

The Brown Foundation: Institute of Molecular Medicine

Aims/hypothesis: DNA methylation studies of incident type 2 diabetes in US populations are limited and to our knowledge none include individuals of African descent. We aimed to fill this gap by identifying methylation sites (CpG sites) and regions likely influencing the development of type 2 diabetes using data from Black and White individuals from the USA.

Methods: We prospectively followed 2091 Black and 1029 White individuals without type 2 diabetes from the Atherosclerosis Risk in Communities study over a median follow-up period of 17 years, and performed an epigenome-wide association analysis of blood-based methylation levels with incident type 2 diabetes …

Alert Design In The Real World: A Cross-Sectional Analysis Of Interruptive Alerting At 9 Academic Pediatric Health Systems, Swaminathan Kandaswamy, Julia K W Yarahuan, Elizabeth A Dobler, Matthew J Molloy, Lindsey A Knake, Sean M Hernandez, Anne A Fallon, Lauren M Hess, Allison B Mccoy, Regine M Fortunov, Eric S Kirkendall, Naveen Muthu, Evan W Orenstein, Adam C Dziorny, Juan D Chaparro

Faculty, Staff and Students Publications

Objective: To assess the prevalence of recommended design elements in implemented electronic health record (EHR) interruptive alerts across pediatric care settings.

Materials and methods: We conducted a 3-phase mixed-methods cross-sectional study. Phase 1 involved developing a codebook for alert content classification. Phase 2 identified the most frequently interruptive alerts at participating sites. Phase 3 applied the codebook to classify alerts. Inter-rater reliability (IRR) for the codebook and descriptive statistics for alert design contents were reported.

Results: We classified alert content on design elements such as the rationale for the alert's appearance, the hazard of ignoring it, directive versus informational content, …

The Association Between County-Level Social Determinants Of Health And Cardio-Kidney-Metabolic Disease Attributed All-Cause Mortality In The Us: A Cross Sectional Analysis, Antoinette Cotton, Pedro Rvo Salerno, Salil V Deo, Salim S Virani, Khurram Nasir, Ian Neeland, Sanjay Rajagopalan, Naveed Sattar, Sadeer Al-Kindi, Yakov E Elgudin

Faculty, Staff and Students Publications

Background: The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions.

Methods: We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 - 25, II: 26 - 50, III: 51 …

Difference-Makers For Collecting Sexual Orientation And Gender Identity Data In Oncology Settings, Mandi L Pratt-Chapman, Edward J Miech, Megan A Mullins, Shine Chang, Gwendolyn P Quinn, Shail Maingi, Matthew B Schabath, Charles Kamen

Faculty, Staff and Student Publications

Purpose: The purpose of this analysis was to identify key difference-making conditions that distinguish oncology institutions that collect sexual orientation and gender identity (SOGI) data across a sample of American Society of Clinical Oncology (ASCO) members.

Methods: From October to November 2020, an anonymous 54-item web-based survey was distributed to ASCO members. Coincidence analysis was used to identify difference-making conditions for the collection of SOGI data.

Results: ASCO members' responses to just three items consistently distinguished practices that reported collecting both SO and GI data (n = 25) from those who did not (n = 20): (1)."Do you ask your …

Arctic Militarization: How The United States Developed The Arctic At The Cold War’S Beginning, 1945-1965, Daniel J. Morris

Doctoral Dissertations and Projects

At the Cold War’s start, the United States conducted a robust Arctic militarization policy for North American defense against the Soviet Union. U.S. officials feared an Arctic invasion or an over-the-North-Pole attack. The Arctic policies created Alaskan statehood, the distant early warning (DEW) line radar stations, Greenland military installations, failed Arctic diplomacy, the International Geophysical Year of 1957-1958 (IGY), and Arctic military activities. In 1945, the United States started its Arctic militarization programs as its international relationship with the Soviet Union deteriorated. First, Alaska transitioned from a U.S. territory to a state, which federal money entered Alaska for national defense. …

Developing Evaluation Metrics To Measure The Us National Institute Of Health Plans To Enhance Diverse Perspectives: A Protocol For A Consensus-Based Study, Yulia A Levites Strekalova, Sanjay Jain, Pinaki Sarder

2020-Current year OA Pubs

INTRODUCTION: The diversity of participating investigators representing diverse disciplines, career stages, stakeholder groups, regions and types of institutions is essential for the success of large-scale research programmes. In 2021, the National Institutes of Health introduced a requirement for some of its large grants to include a separate section that describes the project's plan for enhancing diverse perspectives (PEDPs). Our project aims to develop consensus-based PEDP evaluation metrics and instruments that can be systematically and sustainably collected across the projects.

METHODS AND ANALYSIS: Evaluation work is organised into three objectives. First, shared knowledge about PEDP infrastructures, activities and outcomes will be …

Support For The United States In The United Nations On Cold War Issues And The Distribution Of Foreign Aid To Central American And Caribbean Countries, Gerald R. Webster

The Geographical Bulletin

The agenda of the General Assembly of the United Nations has been dominated by Cold War battles between the United States and the Soviet Union during much of the organization's 45-year history. Do countries who support the United States on votes associated with the Cold War receive larger quantities of U.S. foreign assistance? This paper examines two hypotheses pertaining to this question with regard to the voting behavior of 12 Central American and Caribbean countries between 1970 and 1987. The cross-sectional analysis finds significant evidence for a link between U.N. voting behavior and the quantities of per capita U.S. foreign …

How Electricity Utility Practitioners In The United States Approach Power System Resilience, Shardul Tiwari, Aritra Chakrabarty, Chelsea Schelly, Mostafa Sahraei-Ardakani, Gaby Ou, Jianli Chen

Michigan Tech Publications

This study explores the understanding and practice of resilience among electrical utilities in the United States, focusing on how practitioners in the utility sector conceptualize and apply resilience in their work. As electricity becomes increasingly central to modern life, powering critical infrastructure and essential services, the resilience of power systems has gained prominence in energy policy and planning. However, there is a lack of standardized definitions and approaches to resilience in both academia and practice, particularly from an energy service perspective. The research employs a qualitative approach, utilizing semi-structured interviews with experts (practitioners) from transmission and distribution utilities in the …

Extended Travel As An Introduction To Geography, Michael E. Lewis, Jeffery C. Patton

The Geographical Bulletin

This paper describes an alternative to capstone field courses in undergraduate curricula. Early opportunities for faculty guided exploration and discovery provide students with firsthand field experience and is an effective means of recruiting and retaining qualified geography majors. A wide ranging, rapid movement model is more effective for introducing students to the spatial character of geography than single destination capstone courses

Youth Soccer In The United States, Alessandrea C. Handley, Cathy C. Handley, Hope E. Handley, Lawrence M. Handley, Lawrence R. Handley, Nathanial S. Handley

The Geographical Bulletin

There are four million youth playing soccer in the United States and its growth rate of 1300 percent between 1975 and 1988 make it the fast growing sport in America. In every state, soccer reaches the youth from ages 4 to 19. Texas and California lead the nation in the number of youth playing the sport. Not only a sport for boys, soccer is one of the most popular sports for girls in the country. This paper examines and discusses the distribution of youth soccer across the U.S. during the years 1975-1988. Distributions based on race, per capita income, sex …

Punch Cd3-Ols: A Phase 3 Prospective Observational Cohort Study To Evaluate The Safety And Efficacy Of Fecal Microbiota, Live-Jslm (Rebyota) In Adults With Recurrent Clostridioides Difficile Infection, Paul Feuerstadt, Teena Chopra, Whitfield Knapple, Nicholas W Van Hise, Erik R Dubberke, Brian Baggott, Beth Guthmueller, Lindy Bancke, Michael Gamborg, Theodore S Steiner, Daniel Van Handel, Sahil Khanna

2020-Current year OA Pubs

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of fecal microbiota, live-jslm (RBL; REBYOTA)-the first single-dose, broad consortia microbiota-based live biotherapeutic approved by the US Food and Drug Administration for preventing recurrent Clostridioides difficile infection (rCDI) in adults following standard-of-care (SOC) antibiotic treatment.

METHODS: PUNCH CD3-OLS was a prospective, phase 3, open-label study, conducted across the US and Canada. Participants were aged ≥18 years with documented rCDI and confirmed use of SOC antibiotics. Participants with comorbidities including inflammatory bowel disease and mild-to-moderate immunocompromising conditions could be enrolled. A single dose of RBL was rectally administered …

Decades Of Division: Analyzing Hate Crimes In The Usa (1991–2022), Sangeeth Sajan Baby

Dissertations, Theses, and Capstone Projects

This project comprehensively analyses hate crime data in the United States, leveraging advanced data analysis and visualization techniques to unmask patterns and insights. By utilizing datasets of criminal offenses reported by law enforcement agencies such as the FBI, this study explores the dynamics of hate crimes across racial, religious, gender, and sexual orientation groups. The analysis reveals key findings, including the disproportionate targeting of African Americans and LGBTQ+ individuals, the prevalence of hate crimes in specific locations like residences and educational institutions, and the consistent patterns of attack types and locations across different racial groups. Analysis of crime data over …

Healthcare Costs In The United States By Demographic Characteristics And Comorbidity Status, Naomi N Adjei, Allen Haas, Charlotte C Sun, Hui Zhao, Paul G Yeh, Sharon H Giordano, Iakovos Toumazis, Larissa A Meyer

Faculty, Staff and Student Publications

Objectives: Current, real-world healthcare cost information is needed to project future expenditures and inform policy. We estimated the healthcare costs for adults in 2019 in the United States by age, sex, race/ethnicity, geographic region, and comorbidity.

Methods: We aggregated and summarized the healthcare costs in 2021 US dollars using claims data derived from Optum's deidentified Clinformatics® Data Mart Database, which includes inpatient, outpatient, and prescription claims for commercial and Medicare Advantage beneficiaries nationwide.

Results: A total of 9 227 901 adults were included in the analysis. The largest group represented was 71 to 75 years old (13%), female (53%), White …

Peacebuilding At The San Diego-Tijuana Border: A Ground Level View, Rebeca Cazares-Adame Md, Mph, Andrew Blum Phd

Kroc IPJ Research and Resources

This brief complements the work of researchers like Kleinfeld and Blattman by seeking to understand in a more inductive way the work of peacebuilders on the ground in Tijuana, a city experiencing systemic, chronic violence. Based on survey research and interviews conducted with those peacebuilders, the brief identifies insights that can help inform a peacebuilding field that includes and integrates work in conflict zones and non-conflict zones experiencing widespread violence. Developing this more integrated approach is particularly important at the moment as we move into President Trump’s second term and begin to see the impacts of his administration in the …

Incidence And Survival Of Children And Adolescents With Wilms Tumor, United States, 2001-2020, Andres F Espinoza, Ekene Onwuka, David A Siegel, Shifan Dai, Sanjeev A Vasudevan, Michael E Scheurer, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Background: Wilms tumor (WT) is the most common pediatric malignancy of the kidney. Past studies describing WT incidence and survival used surveillance data with < 30% of the US population. We evaluated differences in WT incidence and survival comparing demographic groups and tumor characteristics.

Methods: We analyzed new cases of WT among patients aged < 20 years at diagnosis by using incidence data from US Cancer Statistics (USCS) for 2003-2020 and 5-year relative survival (RS) data from the National Program of Cancer Registries (NPCR) for 2001-2019. To assess incidence trends, average annual percent change (AAPC) was calculated by using joinpoint regression. Relative survival (RS) and all-cause survival were calculated overall and by demographic and clinical variables.

Results: During 2003-2020, 8218 cases of WT were reported in USCS, which represented an age-adjusted incidence rate of 5.7 cases per million. Rates were the highest among females (6.3), children aged 0-4 years (17.2), and non-Hispanic Black patients (7.1). Overall, trends remained stable (AAPC = -0.4, 95% CI: -1.4 to 0.4). Among 7567 cases of WT in NPCR, 5-year RS was 92.6%. Patients with the lowest …

Covid-19 Vaccine Hesitancy Among Black Women In The Us, Brittany C Slatton, Farrah G Cambrice, Serwaa S Omowale

Faculty, Staff and Student Publications

IMPORTANCE: COVID-19 vaccine hesitancy among Black women is a critical public health concern, potentially exacerbating existing health disparities and impacting community-wide vaccination efforts.

OBJECTIVE: To explore the factors associated with COVID-19 vaccine hesitancy among Black women in the US and identify the specific concerns and experiences shaping hesitant attitudes toward vaccination.

DESIGN, SETTING, AND PARTICIPANTS: Qualitative study using in-depth, semistructured interviews conducted virtually between June and November 2021. Thematic analysis was used to identify key themes from the interview data. Participants were recruited through social media platforms and word-of-mouth referrals from various regions of the US. Interviews were conducted remotely …

Landslide At River's Edge: Alum Bluff, Apalachicola River, Florida, Joann Mossa, Yin-Hsuen Chen

Center for Geospatial Science, Education & Analytics Faculty Publications

When rivers impinge on the steep bluffs of valley walls, dynamic changes stem from a combination of fluvial and mass wasting processes. This study identifies the geomorphic changes, drivers, and timing of a landslide adjacent to the Apalachicola River at Alum Bluff, the tallest natural geological exposure in Florida at similar to 40 m, comprising horizontal sediments of mixed lithology. We used hydrographic surveys from 1960 and 2010, two sets of LiDAR from 2007 and 2018, historical aerial, drone, and ground photography, and satellite imagery to interpret changes at this bluff and river bottom. Evidence of slope failure includes a …

Abundance And Other Food Fixations, Margot J. Pollans

Elisabeth Haub School of Law Faculty Publications

Although most people in the United States no longer devote the majority of their time to food production, processing, and distribution, food remains a daily fixation. This Article explores three driving food fixations--abundance, thinness, and health--and situates each against an inverse fear--scarcity, fatness, and illness, respectively. Mapping these threats onto U.S. food policy, this Article examines, among other policy arenas, food waste policy, nutrition and health claim labeling law, and food additive regulations. Across food policy, these fixations feed what this Article calls the “politics of abundance.” This politics helps to insulate the food industry from deeper systemic reform aimed …

No Remedy For Colonization, Sigrid Vendrell-Polanco

Faculty Articles

The United States purports to maintain a democratic relationship with its inhabited territories, yet the Supreme Court continues to uphold twentieth century laws that affirm rather than abrogate colonial policies. The gap between how the United States idealizes democracy and its real world application, especially in its five colonized territories (Puerto Rico, American Samoa, Guam, the Northern Mariana Islands, the United States Virgin Islands, and American Samoa), is not just growing—it is becoming a chasm. These colonies are currently referred to as United States territories. In 2023, the U.S. territory of Puerto Rico experienced a controversial sovereignty challenge surrounding the …

Regional Variation And Correlation Of Big Five Personality Traits With Rates Of Insufficient Sleep And Diabetes In The United States, Isabella Chirakos, Brennan Schroeder

Scholarship in Medicine - All Papers

Background: Diabetes and insufficient sleep are prevalent health concerns, and determining potential contributing factors could help decrease the incidence of these issues. This study aims to explore potential associations between insufficient sleep and diabetes mellitus, examining whether these negative health outcomes can be linked geographically and by personality traits. Results could help create more effective programs to combat diabetes and insufficient sleep.
Materials and Methods: The study utilized longitudinal health data and roadmaps from 2016 and 2023 for each state, categorizing the data into four regions: Northeast, Midwest, South, and West. We incorporated personality data from the Synthetic Aperture Personality …

The Animated Frontier: Fluctuations Of Power Across Time And Space In Flows Of U.S. And Japanese Animated Media, Kendall Belopavlovich

Dissertations, Master's Theses and Master's Reports

This project critiques the historical and contemporary relationships between the U.S., Japan, and marginalized groups through the lens of animation. The U.S. and Japan share a complex history, from the opening of Japan during the Edo period to events like Pearl Harbor and the atomic bombings, which shaped their present-day alliance. Furthermore, the U.S. and Japan are the central nodes in flows of animation, where both nation states have dominated the global market at various points in animation’s history. Today, Japan's soft power in media is significant, and the flow of power between these nations has influenced media forms and …

Empowering U.S. Allies In The Indo-Pacific: An "America First" Approach To Great Power Competition, Nathaniel Benjamin

Graduate Theses/Dissertations

The Indo-Pacific is the primary area for Great Power Competition between the United States and China. China’s rapid but cautious rise has allowed it to achieve a position that threatens to upset the norms and rules of the U.S.-led system in the region. The second Trump Administration has pursued an “America First” policy since taking office in January 2025, but pushing U.S. allies to take on more responsibility for their own defense will not be enough. U.S. allies are major regional players and should be trusted to uphold the principles of the current international system; therefore the U.S. must limit …

From Curiosity To Controversy: American Perception Of Japanese Immigrants, 1853-1924, Chloe Elizabeth Curbelo

Theses and Dissertations

In the mid-nineteenth century, as the United States reached the Pacific through westward expansion, Asia emerged as a new stage for commerce and power. Japan, long isolated under the Tokugawa shogunate, became an object of American fascination when forced into relations. While early depictions cast Japan as an exotic yet uncivilized nation in need of Western guidance, Japan’s rapid modernization and the growing number of Japanese immigrants on the West Coast transformed curiosity into anxiety. My paper traces this evolution of perception from 1850 to 1924, arguing that shifting views of Japan and its people reflected America’s ethnocentric notions of …

The War On Knowledge And How Everyone Is A Part Of The Problem: Through The Lens Of Science Communication And The Trump Administration, Aidan D. Valcich

CEG 450 Cultural, Environmental, and Global Studies Capstone

Science communication as an emerging field of study has become increasingly important in the age of the internet and rapid information dissemination. The work of science communication focuses on the complexities of communicating sciences between experts and non-experts such as politicians and laymen. The importance is not only communicating the science but also why everyone, not just the experts, should care. In what has been called the War on Knowledge, there has been an increase in attacks against science and academia. A major example of this is in the United States during both of the presidential terms of Donald Trump. …

Aestheticizing And Engendering Disease: The Case Of Tuberculosis, Abigail Dollries

Dartmouth College Master’s Theses

This thesis examines how tuberculosis, known in the nineteenth century as “consumption,” was aestheticized in American cultural and medical discourse, particularly in industrial cities of the North between 1830 and 1850. It addresses the paradox at the heart of the disease’s representation: while tuberculosis was medically pathologized, it was simultaneously romanticized, especially when afflicting elite white women. The central problem explored is how this aestheticization of illness functioned to reinforce gender, class, and racial hierarchies by transforming suffering into a symbol of virtue, refinement, and social status. Using a cultural-historical methodology, this project analyzes a range of sources, including medical …

Improved Survival And Decreased Cancer Deaths In Young Adults With Cancer After Passage Of The Affordable Care Act Dependent Coverage Expansion, Michael Roth, Clark R Andersen, Amy Berkman, Stuart Siegel, Branko Cuglievan, J Andrew Livingston, Michelle Hildebrandt, Jaime Estrada, Archie Bleyer

Faculty, Staff and Student Publications

Background: The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19-25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited?

Methods: The ACE DCE 7-year age range of 19-25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7-year age spans: ages 12-18 and 26-32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative …