Digital Commons Network^™

Usa V. Lamar Mccullough

2026 Decisions

USDC for the District of New Jersey

Paul Lisenby V. Olympus Corporation Of The Americas

2026 Decisions

USDC for the Eastern District of Pennsylvania

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

Early Childhood Teachers’ Perceptions Of Early Childhood Teacher Leadership, Their Leadership Experiences, And Teacher Leadership Skill Development, Danyle Watkins

Walden Dissertations and Doctoral Studies

The problem that was addressed in this study is that research into early childhood leadership has focused on early childhood directors and programs for leadership, but little research has been conducted on early childhood teachers’ (ECTs’) perceptions of the ECT leadership. Guided by the McCormick Center Whole Leadership Framework, the purpose of this basic qualitative study was to explore ECTs’ perceptions on characteristics of teachers as leaders, their leadership experiences, and their leadership skill development in a Midwestern U.S. state. Data were collected through semistructured interviews with 10 ECTs employed in licensed early childhood centers serving children from birth through …

Conceptual Framework And Key Considerations For Field-Based Infrastructure In Food Is Medicine Research, Shreela V Sharma, Colleen Tewksbury, Christopher R Long, Colleen Spees, Ronit A Ridberg, Reshma Gupta, Erin P Ferranti, Naomi Tice, Eric Peterson, Brian Levine

Faculty, Staff and Student Publications

In 2023, the American Heart Association launched the Healthcare by Food (HCXF) initiative to establish a rigorous evidence base for Food Is Medicine (FIM) programs, so that patients with acute or chronic disease could access FIM programs as a covered benefit under their health insurance. The HCXF initiative is engaging in research, advocacy, and education to support the development and testing of interventions that improve health outcomes. The HCXF initiative launched 9 task forces aligned with research progress, including the Field-Based Infrastructure task force designed to examine broader questions to help support either earlier or later stages of the HCXF …

Emergency Nurses' Perceptions Of Interpersonal Empathy When Caring For Department Superusers, Makeba K. Cavette

Walden Dissertations and Doctoral Studies

Compassion fatigue syndrome (CFS) is a significant challenge for healthcare professionals, particularly nurses in the emergency department (ED), due to the demanding, high-pressure nature of their work environment and their increased exposure to human suffering. The purpose of this qualitative phenomenological descriptive study, guided by Nursing Theory of Personal Empathy, was to describe the meaning of ED nurses' interactions with superuser patients and how these interactions affect ED nurses' empathy and susceptibility to developing CFS. A purposive sample of 8 ED nurses with at least 3 years of experience as ED staff nurses working with superuser patients participated in semistructured …

The Relationship Between Employees’ Involvement, Process Improvement, And Customer Satisfaction In Manufacturing Industries, Nawres Fouad

Walden Dissertations and Doctoral Studies

Customer satisfaction remains a challenge for some manufacturing organizations despite the widespread implementation of TQM practices. Manufacturing leaders must improve customer satisfaction because it enhances customer retention, organizational competitiveness, and long-term business performance. The purpose of this quantitative correlational study was to examine the relationships between employees' involvement, process improvement, and customer satisfaction. The expectancy-disconfirmation theory grounded the research project. Participants were 68 middle managers employed in manufacturing organizations in Ontario, Canada. Data were collected through an anonymous online survey using the Utrecht Work Engagement Scale (UWES-9) and the TQM Practices Scale. The data were analyzed using descriptive statistics, Cronbach’s …

Staff Education To Improve Depression Screening And Management Using Phq-9, Elizabeth Aja

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education initiative. It was motivated by the realization that depression is often under-recognized when standardized screening practices are not consistently implemented. The identified practice gap was inconsistent administration, interpretation, and documentation of the PHQ-9 by the nursing staff. The practice-focused question examined whether a staff education intervention would improve nurses’ knowledge and confidence in using the PHQ-9 for depression screening. The purpose of the project was to implement and evaluate an evidence-based educational program on PHQ-9 administration, scoring, interpretation, and documentation. Data analysis included descriptive statistics on pretest and posttest scores from 14 participating …

Predictive Analytics For Nurse Staffing Optimization And Patient Outcomes, Rhonda Lynn Fisher

Walden Dissertations and Doctoral Studies

This evidence-based quality improvement project assessed the use of a Predictive Analytics Staffing Decision-Support Tool (PASDST) to enhance nurse staffing alignment, workforce planning, and patient outcomes in an acute care setting. Traditional staffing relied mainly on historical census data and fixed nurse-to-patient ratios, with limited real-time information on admissions, discharges, census, and patient acuity. Guided by the Johns Hopkins Evidence-Based Practice Model, a 12-week pilot of PASDST was conducted on one acute care unit. Baseline data from 30 stakeholders—five nurse managers and 25 bedside nurses—were collected. Quantitative responses were analyzed via frequencies and percentages, while open-ended responses underwent thematic analysis. …

Improving Suicide Risk Identification Through Standardized Implementation Of The Columbia–Suicide Severity Rating Scale (C-Ssrs) In An Adult Outpatient Behavioral Health Setting, Mirabel Ngwe Boma

Walden Dissertations and Doctoral Studies

Suicide risk may fluctuate throughout treatment, making ongoing assessment essential for timely identification and intervention. At the project site, an adult outpatient behavioral health practice, the Columbia–Suicide Severity Rating Scale (C-SSRS) was administered consistently at intake but inconsistently at follow-up visits, creating gaps in suicide risk reassessment and documentation. The purpose of this quality improvement project was to evaluate the effect of standardized implementation of the C-SSRS during intake and follow-up visits on suicide risk screening compliance over a 9-week period. The practice-focused question asked how standardized implementation of the C-SSRS, compared with current practice, affected suicide risk screening compliance …

An Exploration Of Successful Cloud Database Migration Strategies Used By Small And Medium-Sized Enterprises Leaders In The United States, Ashli Jarrett

Walden Dissertations and Doctoral Studies

Cloud database migration can improve organizational performance in small and medium-sized enterprises (SMEs), but SME leaders are concerned about ineffective migration strategies, which can increase risks to data security, regulatory compliance, and operational continuity. Grounded in diffusion of innovation theory, the purpose of this qualitative pragmatic inquiry project was to explore the effective strategies SME leaders use to manage secure cloud database migrations, mitigate risks, enhance data security, ensure regulatory compliance, and improve organizational effectiveness. The participants were 10 SME leaders in the United States who had successfully adopted cloud-based database systems. Data were collected through semistructured interviews and publicly …

Implementation Of Standardized Suicide Risk Screening With Staff Education In An Outpatient Psychiatric Clinic, Gwendoline Nfotiog

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was a quality improvement staff education initiative focused on improving suicide risk screening and documentation in an outpatient psychiatric clinic. Inconsistent use of validated screening tools and documentation practices created risks for missed identification of patients at risk for suicide. Addressing this gap was essential to improve patient safety and support evidence-based behavioral healthcare. In the project, I examined whether implementing standardized suicide risk screening with staff education would improve screening and documentation consistency over 12 weeks. The purpose was to increase staff knowledge, screening compliance, and documentation accuracy. Pre- and postimplementation chart audits, …

Drying Kinetics And Shrinkage In Dual-Layer Earthen Buildings: In-Situ Assessment Of Cobbauge, Matthew Fox, Jim Carfrae, Jack Morewood, Mohamed Boutouil, François Streiff, Steve Goodhew

School of Art, Design and Architecture

This case study investigates the long-term drying kinetics and shrinkage of CobBauge, a wet dual-layer earthen construction system undertaken upon the first UK CobBauge building. The methodology involved the use of Time Domain Reflectometry (TDR) moisture sensors which were laid in a novel dual layer earthen material and enable moisture monitoring within the wall following construction. Average vertical shrinkage during the five-month monitoring period was 43 mm (2.05%), while average Volumetric Moisture Content (VMC) fell from 11%vol to 5.7%vol. There was little lateral movement and shrinkage was non-uniform. The study assessed the long-term drying kinetics of CobBauge in a wet, …

Stop Holding New York Workers Back: An Evaluation Of Non-Compete Agreements, Maxwell J. Nares

Seton Hall Journal of Legislation and Public Policy

No abstract provided.

Implementation Of Visual Bed Indicator Lights To Improve Fall Prevention Processes, Andrea Leffew

Master's Projects and Capstones

Problem: Inpatient falls remain a significant patient safety concern associated with preventable patient harm, prolonged hospitalization, and increased healthcare costs. Routine fall bundle validations identified inconsistent adherence to safe bed configuration practices, such as beds left raised and bed alarms turned off.

Context: A 3-month quality improvement project was implemented on a 20-bed medical-surgical telemetry unit within an integrated healthcare delivery system at a 130-bed community hospital in Northern California, which was experiencing an increase in inpatient falls and fall-related sentinel events.

Interventions: Implementation of bed-monitoring technology with visual indicator lights that provided real-time feedback on bed configuration.

Measures: The …

Developing Confidence And Motivation In Writing Through Authentic And Collaborative Writing Approaches, Sara J. Weeks

Masters Projects

Writing is an expressive and complex process that takes time to develop, yet writing in middle school classrooms is primarily used as a way to demonstrate mastery of content rather than develop writers. Writing instruction is limited or used inefficiently in today’s classrooms, which gives students fewer opportunities to engage in authentic writing experiences. As a consequence, middle school students report a lack of confidence and motivation to write. These conditions contribute to stagnant writing achievement for middle school students. Research suggests that improving student writing outcomes requires writing environments that provide authentic, collaborative, and process-oriented writing experiences. However, these …

Evaluating Diagnostic Information Preservation In Weakly Supervised Medical Imaging, Vinceline Bertrand

Electronic Theses and Dissertations 2020 - Present

Weakly supervised medical imaging models trained with coarse image-level labels often report strong performance on metrics such as accuracy and AUC. This thesis argues that these metrics can be misleading: a model may succeed on a coarse diagnostic task while failing to preserve the fine-grained information needed for consequential clinical decisions. It makes this failure measurable through the diagnostic gap, defined as the divergence between coarse and fine-grained diagnostic preservation, across three connected studies. The first shows that near-perfect ovarian ultrasound accuracy reflects visual separability rather than pathological understanding. The second measures the diagnostic gap in a mammographic pipeline, where …

Algebraic And Topological Methods In Computational Neuroscience, Trong-Thuc Trang

Electronic Theses and Dissertations 2020 - Present

Neural data is incredibly rich in combinatorial, topological, and geometrical information, reflecting the intricate shape and connectivity of neural firing patterns. To decipher these structures, neuroscience increasingly relies on advanced mathematical tools to analyze neural activity. Here we study (1) neural codes within the poset P_Code of neural codes and (2) the connectivity of neural population activity within the insular cortex when responding to interoceptive information. In (1), we establish combinatorial constructions for all upward covering relations based on what we call “isolated subsets” with supporting theorems and give a slight modification of the existing downward covering relations. We …

Persepsi Mahasiswa Terhadap Penggunaan Tiktok Sebagai Media Pembelajaran Kosakata Bahasa Mandarin Secara Mandiri, Agnes Meliana, Lukluk Ul Muyassaroh, Sawitri Retnantiti

Journal of Language, Literature, and Arts

This study aims to describe students' perceptions of using TikTok videos as a medium for independent Mandarin vocabulary learning, including the types of accounts used, the benefits obtained, and the challenges encountered. This study employed a descriptive qualitative approach involving 27 students from the 2023 cohort of the Undergraduate Mandarin Language Education Program at Universitas Negeri Malang. Data were collected through semi-structured questionnaires and analysed using the Miles and Huberman interactive model, consisting of data reduction, data display, and conclusion drawing. The findings indicate that students generally hold positive perceptions of TikTok as a medium for Mandarin vocabulary learning. The …

Reducing Primary Cesarean Births Among Nulliparous, Term, Singleton, Vertex (Ntsv) Patients Through Structured Multidisciplinary Communication, Toyin Ajani

Master's Projects and Capstones

Background: Primary cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients remained a persistent quality and safety concern in obstetric care. Unnecessary cesarean birth was associated with increased maternal morbidity, neonatal complications, prolonged recovery, higher healthcare costs, and adverse outcomes in subsequent pregnancies. Problem: A Northern California labor and delivery unit identified an elevated NTSV cesarean birth rate of 26.8%, exceeding the national benchmark of approximately 23%. Variability in provider communication, inconsistent labor management practices, and lack of standardized interdisciplinary collaboration contributed to this quality gap. Context: The project was conducted in a high-volume labor and delivery microsystem serving a …

Decreasing Icu Clabsi Through Improved Central Line Dressing Integrity, Sharmila Reyes Moreno

Master's Projects and Capstones

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant source of preventable patient harm, increased healthcare costs, and prolonged hospital stays. In a 20-bed medical-surgical ICU, CLABSI events increased from one case in 2024 to four cases in 2025, resulting in a standardized infection ratio (SIR) of 1.21, exceeding the organizational target of ≤ 0.87.

Context: Audits of central line dressings identified frequent edge lifting and dressing disruption despite staff awareness of CLABSI prevention practices. These findings suggested a gap between evidence-based recommendations and consistent clinical practice. The project was conducted in a 20-bed adult medical-surgical ICU serving a diverse …

Improving Peer Feedback Participation Through Psychological Safety Interventions In Labor & Delivery Nurses, Lindsey C. Hora

Master's Projects and Capstones

Abstract 

Background: Labor and Delivery (L&D) units require effective communication, speaking up, and team learning to support safe care. Psychological safety informed this quality improvement project as a contextual strategy to strengthen peer feedback engagement.  

Problem: Peer feedback participation among eligible L&D registered nurses at a large acute care hospital in Santa Clara, California, was 14.29% (N = 112) below the 30% project target and 80% organizational target. Low participation limited routine feedback for professional development, recognition, and team learning.

Interventions: Interventions included psychological safety education, peer feedback reinforcement, workflow integration, platform navigation support, dedicated completion time, and unit champions. …

Optimizing Life Care Planning For Palliative Home Health Care Patients, Lilian Muraya

Master's Projects and Capstones

Problem: In this home health palliative microsystem, many seriously ill patients begin care without timely goals‑of‑care conversations or documented advance directives, leading to fragmented communication and potentially avoidable emergency visits and rehospitalizations.

Context: This quality improvement project took place in a hospital-based home health palliative care program in Northern California, where an interdisciplinary team identified inconsistent Life Care Planning (LCP) practices and variable staff comfort with conducting goals‑of‑care discussions.

Intervention: A structured LCP workflow was developed so that newly admitted palliative home health patients receive a goals‑of‑care discussion and advance directive review within 7 days of start …

Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy

Master's Projects and Capstones

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …

Butte Priority Soils Operable Unit Final 2024 Unreclaimed Sites Sampling: Ur-46 Site Evaluation Summary Report, Pioneer Technical Services, Inc.

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

Consumer Behavior In End-Of-Current-Use Electronics: A Multi-Method Approach To Improving Sustainability Outcomes, Payam Saeedi

Theses

The proliferation of network-connected consumer electronics has created a sustained challenge for sustainability and data security at the End-of-Current-Use (EoCU) stage. In the United States, devices accumulate in storage rather than entering reuse or recycling pathways, and a substantial share of devices change hands without proper data sanitization. This dissertation characterizes and quantifies consumer behavior at EoCU of consumer electronics in the U.S., with the goal of supporting the design of interventions that improve sustainability and data security outcomes. A survey of 4,000 U.S. respondents (3,747 after data cleaning) was developed and deployed across 10 categories of network-connected devices, capturing …

Experimental Material Analysis And Load Monitoring Of Polyurethane–Steel Belts Subjected To Static And Cyclic Dynamic Loading: Implications For Continuous Mooring Line Systems In Wave Energy Converters, Youssef Mohamed

Electronic Theses and Dissertations 2020 - Present

This study experimentally investigates the mechanical and viscoelastic behavior of a steel-cord-reinforced polyurethane synchronous belt capable of withstanding continuous cyclic loading as a potential compliant mooring element for WEC applications. Quasi-static and cyclic tensile tests were conducted to characterize the belt's mechanical response. The quasi-static determined that the belt behaved as a stiff, low-strain tensile member. Under approximately 100 kgf, the belt extended by about 0.107mm over a 250mm gauge length, apparent tensile modulus of 5.41GPa, an axial rigidity of 2.44MN, and an equivalent line stiffness of 9.75MN/m. Cyclic tensile testing showed high dynamic stiffness with stiffness-transfer ratio of 0.924. …

Drivers Of Stopover Distribution Across Two Autumn Migration Routes Of A Long-Distance Afro-Palearctic Migrant, The Common Cuckoo (Cuculus Canorus), Alex Gale, Máire Kirkland, Phil Atkinson, Robert Puschendorf, Chris Hewson

School of Biological and Marine Sciences

Across the globe, many long-distance migratory birds have undergone population declines. Understanding the environmental factors which underly migratory stopover locations can inform conservation strategies for such species. Here, we identify environmental predictors of autumn stopover sites used by UK-breeding male cuckoos (Cuculus canorus) migrating to centralAfrican wintering grounds via two alternative flyways. Between 2011 and 2021, 88 male cuckoos from UK breeding grounds were fitted with <5 g satellite tags connected to the Argos satellite-based tracking system. Filtered stopovers were used to build presence-pseudoabsence distribution models for each flyway, using Boosted Regression Tree and Random Forest algorithms with thirteen climatic, habitat, topographic and anthropogenic variables. Performance was evaluated using 10-fold cross-validation, and weighted ensembles were generated. To assess drought sensitivity, we produced predictions for high- and low-drought years based on Standardised Precipitation–Evapotranspiration Indices (SPEI). Models performed well (AUC=0.79–0.88; TSS=0.50– 0.66) and revealed route-specific environmental predictors. Along the western route, stopover probability was highest in cooler, semi-humid, high-elevation areas with low contemporaneous drought; Iberian mountain ranges emerged as key sites. Along the eastern route, stopover probability was greatest in heterogeneous habitat, with lowlands and uplands favoured over intermediate elevations; the Po watershed appears particularly important. Hunting risk (included to assess anthropogenic threat) was also high at key areas. The spatial extent of stopover regions—and the probability of them being utilised—declined during years ofhigh short-term drought along the western route, and high long-term drought along the eastern route. Whilst Iberian montane stopover regions are sensitive to increasing drought and aridity under climate change, their topographic heterogeneity may provide climatic refuge while limiting intensive land uses. Preference for heterogeneous habitat within the Po watershed highlightsthe need to retain semi-natural habitat within agricultural landscapes. We recommend route-specific conservation measures and higher resolution models using newly available GPS tags to better understand fine-scale site selection within the regions highlighted here.

Acceptability And Impact Of Weight Management Interventions For Adults With Intellectual Disability: Protocol For A Systematic Review And Meta-Analysis, Rohit Shankar, Ananya Ananthakrishnan, Edward Meinert, Rosiered Brownson-Smith

Peninsula Medical School

Introduction Obesity disproportionately impacts people with intellectual disabilities (PwID). Given the challenges that PwID face, such as cognitive deficits, differences in motivation and communication difficulties, the need for tailored interventions for weight management in PwID is recognised. Yet, this population is underserved, with limited weight management interventions for them compared with the general population. Existing reviews suggest that ‘multi-component’ interventions (including physical activity and dietary advice) are impactful at reducing weight in PwID; however, less is known about how these interventions are tailored for PwID, particularly in addressing their cognitive and communication difficulties which may influence how they understand and …

A Prolonged Hydrothermal Past At Santorini Caldera Revealed By Sedimentary Trace Metal And Microbial Signatures, Sofia Della Salla, Vasiliki Papadimitriou, Paraskevi Polymenakou, Steffen Kutterolf, Joost Frieling, David Pyle, Tamsin A. Mather, Stephanos Kilias, Christopher Jones, Tim Druitt, Jonas Preine, Christian Hübscher, Paraskevi Nomikou, Olga Koukousioura, Thomas A. Ronge, Sarah Beethe, Katharina Pank, Carole Berthod, Hehe Chen, Shun Chiyonobu, Acacia Clark, Susan Debari, Ralf Gertisser, Raymond Johnston, Michael Manga, Molly Mccanta, Iona Mcintosh, Ally Peccia, Masako Tominaga, Yuzuru Yamamoto

School of Geography, Earth and Environmental Sciences

Hydrothermal systems in volcanic calderas are critical in signalling volcanic unrest, forming ore deposits, and sustaining chemosynthetic microorganisms. Analysis of a ~3500-year sequence of sediments collected from the Santorini caldera, Greece, during International Ocean Discovery Program (IODP) Expedition 398 reveals the behaviour of a prolonged paleo-hydrothermal system. Sediment geochemical and metagenomic data record vigorous hydrothermal activity and metal fluxes for ~1100 years, within a 2270-year window between two major eruptions. Sediment hydrothermally-derived trace metals are significantly enriched over background (~200-fold for As and Hg, and 10–50-fold for Mn, Sb, Mo, and V), with long-term metal fluxes (9 t yr^{−1 …}