Digital Commons Network^™

Reducing Emergency Department Overuse Through Patient Education, Maddie Pieper, Joshua Heuertz

Doctor of Nursing Practice Projects: College of Nursing

Background/Introduction

Emergency departments (EDs) are designed to provide rapid evaluation and management of acute, life-threatening, and time-sensitive conditions. However, EDs are frequently used for nonemergent or low-acuity concerns that could be managed in primary care or urgent care settings. This overuse contributes to rising healthcare costs, resource strain, longer wait times, and overcrowding. Underserved populations may rely more heavily on ED services because of barriers such as limited primary care access, language differences, low health literacy, restrictive work schedules, transportation challenges, and difficulty navigating the healthcare system. These factors can make the ED seem the most accessible source of care. …

The Ethical Imperative Of Public Health Institutions To Protect The Reproductive Autonomy Of Vulnerable Populations, Kennethea Wilson

Electronic Theses and Dissertations

This dissertation establishes the ethical responsibility of public health institutions to safeguard reproductive autonomy, especially among vulnerable populations. While reproductive decision-making is traditionally framed within individual clinical encounters, this work contends that reproductive autonomy is fundamentally a matter of public health ethics. Socioecological determinants, including social, legal, environmental, and structural factors, often constrain individuals’ ability to make meaningful reproductive choices, leading to preventable harm.

Reproductive autonomy is defined as the capacity to make informed decisions about whether and when to conceive, as well as how to parent. The dissertation critiques the sufficiency of clinical ethics frameworks, such as informed consent …

Agenda (Pdf), Department Of Surgery

Surgery Research Symposium

Agenda for the 4th Annual Surgery Research Symposium held May 7, 2026.

To Reveal Hpws Factors Shaping Turnover Intention Within The Uzbekistan Automotive Industry, Jinwoong Yoo, Isroiljon Alimov, Hyunmi Jang, Saeyeon Roh

Plymouth Business School

Drawing on the JD-R theory, this research examines a paradox: HPWS elements, typically deemed as job resources, can function as job demands under certain conditions, increasing turnover intention in Uzbekistan’s automotive sector. Using fsQCA on 230 responses, four configurations were discovered, including a robust pattern indicating that when most resources exist, including compensation, the absence of communication can shape turnover intention. Findings extend the JD-R theory by revealing how HPWS can act as demands depending on resource combinations, and provide suggestions for leaders and HR managers to adjust HPWS practices in high-growth and resource-constrained environments in Uzbekistan.

May 7, 2026

The Breeze, 2020-

No abstract provided.

Genetic Analysis Of The X-Linked Adrenoleukodystrophy Gene Abcd1 In Drosophila Uncovers A Conserved Phenotype, Joshua Manor, Sharayu V Jangam, Hyung-Lok Chung, Pranjali Bhagwat, Jonathan C Andrews, Hillary Chester, Shu Kondo, Saurabh Srivastav, Juan Botas, Ann B Moser, Suzette M Huguenin, Michael F Wangler

Duncan NRI Faculty and Staff Publications

X-linked adrenoleukodystrophy (X-ALD) is a progressive neurodegenerative disorder caused by a loss-of-function (LOF) mutation in the ATP-binding cassette subfamily D member 1 (ABCD1) gene, leading to the accumulation of very long-chain fatty acids (VLCFAs). This disorder exhibits striking heterogeneity; some male patients develop an early childhood neuroinflammatory demyelination disorder, while other patients, including adult males and most affected female carriers, experience a chronic progressive myelopathy. Adrenocortical failure is observed in almost all male patients, with the age of onset varying, sometimes being the first diagnostic finding. The gene underlying this spectrum of disease encodes an ATP-binding cassette (ABC) transporter that …

Pharmacogenomic-Guided Prescribing And Polypharmacy Across Age Groups In Obsessive-Compulsive Disorder: A Retrospective Study, Sheldon R Garrison, Matthew W Boyer, Anthony W Zoghbi, Rachel A Schwartz, Nicolette Weisensel, Martin E Franklin, Madeline M Hartig, Maharaj Singh, Sreya Vadapalli

Faculty, Staff and Students Publications

Background: This study evaluated medication utilization in children, adolescents, and adults with obsessive-compulsive disorder (OCD), a chronic psychiatric condition characterized by intrusive thoughts and repetitive behaviors. Although first-line treatments include selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT), the heterogeneous biological underpinnings contribute to suboptimal outcomes, with 40-60% of individuals not responding to SSRIs. This complex phenotype often leads to psychotropic polypharmacy, which may be mitigated by incorporating combinatorial pharmacogenomic (PGx) testing into protocol-based care to identify potential gene-drug interactions.

Methods: A retrospective review was conducted of individuals with OCD aged 8 to 65 years who received either …

Effects Of Natural And Urban Soundscapes On Affective States And Concentration In Educational Settings, Ahmad Rusdi, Fani Eka Nurtjahjo, Mutiara Sari, Elmira Syamsa Musliha, Hasya Nadhira, Rahmanisa Maharani, Gladys Marisca, Aisyah Raihana Azzah

Journal of Environmental Science and Sustainable Development

Although environmental noise has been extensively studied, limited research has compared the differential effects of natural and urban soundscapes on psychological outcomes. This pilot study examined the impact of urban and natural soundscapes on students’ concentration and affective responses. A pre–post experimental design with two groups was implemented, involving 12 undergraduate participants (aged 18–24 years) with equal gender representation. Concentration was measured using the polyshape board, which was preliminary validated in this study, while affective states (pleasantness and arousal) were assessed using the Affect Grid Scale (AGS) before and after exposure. Given the limited sample size and the ordinal data, …

Posttraumatic Symptoms As Predictors Of Engagement With A Mobile App For Coping After Military Sexual Trauma: Public Usage Data Analysis Study, Shilpa Hampole, Shannon Mccaslin-Rodrigo, Valerie Carr, David Schuster, Sofia Reyes, Sarah Senti, Kelly M. Ramsey, Jason E. Owen, W. Christopher Skidmore, Amy E. Street, Katherine Taylor, Margaret Anne Mackintosh

Faculty Research, Scholarly, and Creative Activity

Background: Military sexual trauma (MST) can have significant adverse effects on mental health and well-being, often leading to posttraumatic stress disorder (PTSD) symptoms and maladaptive beliefs. Although effective psychotherapies exist, stigma, confidentiality concerns, and systemic barriers often hinder help-seeking among service members and veterans. Mobile mental health apps offer an accessible and anonymous support alternative, potentially addressing such barriers. However, app effectiveness depends on user engagement and emerging evidence suggests that engagement may be shaped by symptom severity. Objective: This retrospective observational study aimed to explore the relationship between posttraumatic symptom severity and user engagement with Beyond MST (US Department …

Gut Microbiota Modulation Of Regulatory Dna Elements Revealed By Massively Parallel Functional Characterization, Chadmirah Zaratiana, Adheet Ganesh, Yang E Li, Et Al.

2020-Current year OA Pubs

Cis-regulatory elements (CREs) are central to dynamic gene regulation in hepatocytes, yet most functional annotations derive from in vitro models that poorly capture physiological regulation. We systematically profiled 109,386 human liver-derived CREs using massively parallel reporter assays in hepatocytes under matched in vitro and in vivo conditions. In vivo-active functional CREs (fCREs) were enriched for H3K27ac and chromatin accessibility and were regulated by diverse transcription factors in the human liver. We further demonstrate that gut microbiota-derived signals modulate fCRE activity and target gene expression in vivo, in part via the KEAP1/NFE2L2 antioxidant pathway. Specific microbial metabolites directly altered the activity …

Current Options And Future Trends In Green Fuels Storage, Muhammad Anas Maqbool, Md Jahir Rizvi, Yeaw Chu Lee, Pablo Borja Rosales

School of Engineering, Computing and Mathematics

The global transition to renewable energy underscores the urgent need for safe, efficient, and cost-effective storage solutions for green hydrogen and green ammonia. This review critically examines their fundamental characteristics and unique behaviours, emphasising storage, handling, and integration engineering challenges. To identify the influential studies, knowledge gaps and future trends in the research area, a systematic Scopus-based bibliometric and data analysis is conducted. A novel approach is adopted to identify the better green energy storage option between green hydrogen storage and green ammonia storage, combining a risk-mitigation assessment framework, strengths, weaknesses, opportunities, threats (SWOT) analysis, and a multicriteria taxonomy based …

Prinsip Military Necessity Dalam Hukum Internasional Humaniter, Hersapta Mulyono

Jurnal Hukum & Pembangunan

Abstract

A Novel Geospatial Tool For Assessing Risks And Opportunities For Conversion Of Ccr Closures Into Productive Solar Energy Generation Sites, Marc Theisen

World of Coal Ash Proceedings

Closure of Coal Combustion Residuals (CCR) surface impoundments and landfills offers unique opportunities for conversion to solar power sites with the potential to offset costs of post-closure care via generation of clean electricity. In 2023 the US Environmental Protection Agency (EPA) collaborated with the National Renewable Energy Laboratory (NREL) to create a report entitled “Coal Ash Disposal Sites and Opportunities for Solar Photovoltaic Development” (EPA Publication #540-S-23-004). The purpose of this document was to identify closed CCR units and provide key factors for their potential for solar photovoltaic (PV) development. In 2022, the EPA’s RE-Powering Initiative identified 772 current CCR …

Establishing Sustainable Vegetation On A Challenging Legacy Ccr Site, Derek Oosterhouse, Blake Arthur

World of Coal Ash Proceedings

American Electric Power (AEP) is closing and restoring a legacy Coal Combustion Residuals (CCR) site in Ohio that once held a power plant that pioneered innovative steam generation technology. The plant was closed in 1975. Today, the legacy CCR site is being transformed back to natural, sustainable vegetation. To comply with and close the Stormwater Pollution Prevention Plan (SWPPP) permit, permanent stabilization is required on the site. AEP, one of the largest electric companies in the country, holds a core principle to respect the environment through creative sustainable solutions. AEP connected with Profile Products, the world’s largest manufacturer and supplier …

Future Strategies For Beneficial Use Harvesting, Gabe Lang, Patrick Kiser

World of Coal Ash Proceedings

TVA is the largest public power company in the U.S. and has historically operated a fleet of 12 coal-fired plants as part of their diverse generating portfolio. To date, eight of the coal plants have been retired and the remaining four plants are projected to shut down in the next couple of decades. The decommissioning of these plants is driving a transition to harvesting of ponded and landfilled CCR’s to continue to support ready-mix concrete and other industries that enable infrastructure development. However, the regional market demand limits the ability to initiate widespread harvesting activities during near-term CCR Unit closure …

Methods To Enhance Groundwater Remediation During Cbr And Mass Transfer Controls On Post-Closure Groundwater Cleanup At Ccr Impoundments, Sean Larkin, Jacob Chu, John Blue

World of Coal Ash Proceedings

Utilities are implementing closure‑by‑removal (CBR) of coal combustion residual (CCR) impoundments as part of corrective action programs to meet groundwater protection standards (GWPSs) and are evaluating closure strategies for Legacy Units. Although CBR and associated decanting and dewatering systems can substantially reduce source mass and improve groundwater quality, lingering “tail” concentrations in the aquifer are often observed after closure because groundwater remediation typically requires extended timeframes. These persistent concentrations may be compounded by secondary source zones beneath the former impoundment, where constituent mass stored in low‑permeability materials or immobile pore spaces is slowly released into the transmissive aquifer after CBR. …

Engineered Turf And Solar Renewable Performance On Ccr In Extreme Weather, Tate Niekamp, Bryan Scholl, Ming Zhu, Thomas Orzech

World of Coal Ash Proceedings

The engineered turf final closure system, ClosureTurf®, is installed on a 309-acre coal combustion residual (CCR) unit at the TVA Shawnee Fossil Plant in West Paducah, KY. Approximately 100 megawatts of the PowerCap® solar photovoltaic (PV) system is currently being deployed directly atop the engineered turf cover. An overview of the ClosureTurf® and PowerCap® systems are presented along with a comparison to traditional soil covers and conventional utility-scale solar arrays. From August 2023 through July 2025, onsite and local weather data stations reported over 20 storm events including severe thunderstorms, tornado outbreaks, winter storm systems, atmospheric rivers, and post-tropical cyclones. …

A Cost-Effective, Low-Impact Remedial Approach For Metals: Utilizing Phyto-Enhancement To Accelerate Ph Adjustment Of Shallow Groundwater, Jerry Wylie, Thomas Colton

World of Coal Ash Proceedings

SynTerra will present a unique, low-cost, low-impact approach to metals remediation in shallow groundwater at a former industrial site located in the Atlantic Coastal Plain. The approach employs pH adjustment of groundwater using agricultural lime coupled with the use of daikon radish to augment lime contact time and to increase depth of soil augmentation. This method is designed to be a more sustainable, less resource-intensive, and less technically challenging remedial alternative with lower estimated overall costs. The primary corrective action—source removal—has been completed. However, the oxidation of residual sulfide-bearing minerals has resulted in persistent low-pH groundwater, which increases the solubility …

Improving Economic And Environmental Outcomes Of Legacy Coal Ash Ponds, Grace Wilken

World of Coal Ash Proceedings

This project demonstrates a novel approach to utilize legacy coal ash waste ponds by processing the solids for use in cement/concrete and bioremediating the water fraction through algae cultivation. The algal biomass can then be used for animal feed, biofuels, or other valuable bio-products. There is an increasing demand for more environmentally friendly and cost-effective materials for concrete production, such as coal fly ash, yet a decreasing supply of ash as coal power plants are decommissioned in the transition to other energy sources. However, there are billions of tons of coal ash accumulated in legacy ash ponds across the US. …

Perceived Principal Influence Tactics And Early-Tenure Teacher Status, Vanessa Perez-Peterson, Christopher Benedetti

School Leadership Review

Teacher staffing stability remains a persistent challenge for schools, particularly during the early years of teachers’ placement. This study examined whether teachers’ perceptions of principal influence tactics were associated with early-tenure status, defined as 0–3 years at their current campus. Guided by influence tactics theory, a quantitative, cross-sectional design was employed using survey data from 167 certified teachers in Southeastern Texas. Participants completed the Influence Behavior Questionnaire–General (IBQ-G), and composite indices of noncoercive, soft-coercive, and hard-coercive tactics were included in a logistic regression model, along with teacher and principal demographic variables. None of the three influence-tactic categories was significantly associated …

Mind Over Measure: The Role Of Self-Care Practices In Mitigating Mental Health Strain Among K-12 Educators, Jerry Burkett, Ryan Hulla

School Leadership Review

Teacher mental health is a critical concern in K-12 education, with high rates of burnout demanding effective protective strategies. This study investigated the relationship between five dimensions of teacher self-care (Physical, Psychological, Emotional, Spiritual, and Professional) and overall mental health outcomes, while specifically exploring differences between elementary (K-5) and high school (9-12) educators. A sample of K-12 teachers completed the Mental Health Inventory (MHI-5) and the Self-Care Inventory. Correlational analysis found that all five self-care dimensions were significantly and positively associated with mental health, with Professional Self-Care demonstrating the strongest link (r=.48, p

Dictionary Of A Vietnamese-American* Borderland, Ngọc Hải Nguyễn '26

Senior Scholarly and Creative Symposium

This project, composed of a contextualising research paper and an autoethnographical writing creative component, explores the conceptualisation of Anzaldúa's (2021) borderlands by applying to the author's own experience as a Vietnamese-native student growing up along multiple cultural points of inquiry (primarily the American culture). The core research question of this paper is What does it mean to be at the crossroads of many cultures? In the research paper, the author first contextualises the current discourse on borderlands, along with a justification for their usage of storytelling as a mode of inquiry. The author implements a framework theorised through Loveless (2019) …

Corrective Action Alternative Evaluation For Surface Impoundment Remedy – Two Case Study Examples, Qian Zhang, Andrew Bittner

World of Coal Ash Proceedings

Illinois Administrative Code Part 845 requires owners and operators of coal combustion residual (CCR)-containing impoundments with groundwater protection standard (GWPS) exceedances to perform a Corrective Action Alternatives Analysis (CAAA) to evaluate viable remedies prior to selecting and implementing corrective action. The goal of a CAAA is to holistically evaluate a range of factors for the various corrective actions being considered at an impoundment. This presentation summarizes two CAAAs conducted for surface impoundments (SIs) at two power plants. Each CAAA applied a consistent decision framework that evaluates corrective action options using multiple performance criteria, such as: • Magnitude of Reduction of …

Screening Novel Secreted Proteins For Their Effects On Pancreatic Islet Function Using Qpcr-Based Gene Expression Analysis, Deepti Agarwal, Neha Mishra, Marcus Seldin

Cumberland Medica

Type 2 diabetes (T2D) involves progressive dysfunction of pancreatic β-cells and systemic insulin resistance. Although a handful of secreted factors acting on pancreatic islet have emerged as important therapeutic targets, many additional signaling processes remain unknown. The identification of such mediators can make a new contribution to the regulation of islet biology and serve as another approach for disease treatment. This study aimed to investigate whether three novel peptides could modulate islet-specific gene expression in vivo. Methods: Male C57BL/6J mice were injected with proteins then pancreatic tissues were collected six hours post-treatment. Total RNA was isolated, converted to cDNA, and …

Fifteen Years, 450 Acres: Inside The Tva Gallatin Ash Pond Closure, Brian Egan, Shane Harris

World of Coal Ash Proceedings

This presentation is focused on the TVA Gallatin Ash Pond Complex Closure. The project team embarked on a major coal ash pond remediation effort in 2023, targeting a 450-acre site with operations expected to continue over a 15-year period. The long-term and massive scope of this dig and haul project required the design and construction of extensive supporting infrastructure, including haul roads suitable for large earthmoving equipment, major pipelines for process water rerouting, and a robust water treatment facility. Key components of the work include maintaining slope stability, conducting comprehensive air quality monitoring, and ensuring high standards for coal ash …

Evaluation Of Bottom Ash For Beneficial Use, Danielle Sylvia Cofelice, Thomas Haskins

World of Coal Ash Proceedings

Historically, bottom ash has been beneficially used as a drainage layer within the final cover system for a coal combustion residual (CCR) landfill, positioned above the linear low-density polyethylene liner and below the protective soil cover and topsoil layers. This sustainable approach not only diverts bottom ash from waste management streams but also conserves natural resources by replacing the need for virgin materials, resulting in significant cost savings for ratepayers. To support the continued use of bottom ash in this application, an environmental assessment was completed. The assessment included sampling of bottom ash, an alternative drainage layer composed of virgin …

Research Week 2026 Awards, Scholarly Communications

Liberty University Research Week

The Research Week 2026 Awards includes a list of winners and the ceremony program.

Soundtrack Of Struggle: Racial Injustice, Resistance, And Redemption In To Pimp A Butterfly, Carson Yee

Culture, Society, and Praxis

This paper explores and analyzes the extent to which Kendrick Lamar’s 2015 album, To Pimp a Butterfly, is a profound examination of the contemporary socio-political scene within the United States of America. In the introduction, the topic of protest art is discussed, highlighting the album’s role in addressing America’s ongoing struggle with racial justice. A context surrounding Kendrick Lamar and the formation of the To Pimp a Butterfly album follows, which then sets the stage for a thorough analysis of the various lyrical, musical, and contextual elements that suggest this album is a deeper evaluation of socio-political issues in America. …

Framing And Diffusion Of The 4b Movement: Why We Are Seeing A Resurgence, Kendall M. Goodwin

Culture, Society, and Praxis

In this study I examine how framing and diffusion has played a role in the resurgence of the 4B Movement over social media. First, I reviewed literature on sociological concepts and theories such as social movement framing and diffusion as well as Almeida’s social movement model. From there, I made a coding chart where I utilized the literature review to know what to code for. Then, I began collecting data. From November 2024 to January 2025, I collected and coded 656 TikTok videos. I then analyzed each of these videos, finding that social movement framing coupled with specific environmental factors …

Paternalism Under The Guise Of Partnership: How Modern Treaties In Canada Fall Short In Building Nation-To-Nation Relationships Between Indigenous Governments And The Crown, Maci Clements

Culture, Society, and Praxis

Indigenous nations in Canada have an inherent right to self-determination of their governments and traditional territory; however, how best to implement and ensure this right remains up for debate within Indigenous scholarship. In contrast to such debates, the Canadian State boasts the modern treaty process as the apex tool of Indigenous self-governance, permitting legitimate nation-to-nation relationship building. In this paper, I use an Indigenous feminist analytical framework to investigate if the negotiation and arrangement of existing modern treaties successfully accomplish the goal of creating a nation-to-nation partnership between Indigenous nations and the Crown. Following a critical reading of the modern …