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Timing, Orbital Pacing, And Provenance Of Late Paleogene Loess In The Western United States, Xiangwei Guo Jan 2026

Timing, Orbital Pacing, And Provenance Of Late Paleogene Loess In The Western United States, Xiangwei Guo

Earth & Environmental Sciences Dissertations - Archive

This project examines the timing of loess emergence, the nature of the fluvial–eolian transition, orbital forcing on dust accumulation, and sediment recycling in the late Paleogene White River Formation (Group) of Wyoming and Nebraska, western United States. By integrating traditional sedimentology with machine learning–enhanced grain-size analysis, this research shows that loess accumulation at Flagstaff Rim in central Wyoming began during active fluvial deposition at approximately 35.8 Ma, indicating a gradual transition from fluvial to eolian conditions. Machine learning complements field sedimentology and granulometric interpretation while enabling the development of new, testable hypotheses. Extending this framework eastward to Toadstool Geologic Park …


Occurrence Of Microplastics In The Urban Air And Water Systems And Associated Exposure Risks, Jenny K. Nguyen Jan 2026

Occurrence Of Microplastics In The Urban Air And Water Systems And Associated Exposure Risks, Jenny K. Nguyen

Earth & Environmental Sciences Theses - Archive

Microplastics (MP) pollution is an emerging health concern that affects humans and the environment. Urban areas are high exposure zones due to consistent anthropogenic and industrial activity. With air and water as important MP transport and exposure pathways, monitoring and estimating their human exposures are necessary. Air samples were collected from Dallas-Fort Worth (DFW) and Houston in Texas and Cusco, Peru and water samples were from Tarrant County (DFW), Texas. The samples were analyzed using the pyrolysis-gas chromatography/mass spectrometry (Pyr-GC/MS) and the EDI (estimated daily intake) of inhalation and ingestion (normal and high exposures) were calculated. PS, PP, PE, PVC, …


Mitochondria In Local Control Of Programmed Cell Killing & Resilience, Rashna Sharmin Jan 2026

Mitochondria In Local Control Of Programmed Cell Killing & Resilience, Rashna Sharmin

Biology Dissertations - Archive

Specialized cells are commonplace and defined by different compartments. Organelle transport across cell compartments is critical for cell function, as in morphologically complex neurons. Specialized cells can undergo programmed elimination, an essential facet of normal development. My central thesis question asks how intracellular transport of mitochondria, the cell’s energy producers, regulate fated elimination of complex cells. I explored this using the specialized tail-spike cell (TSC) of the roundworm C. elegans. The TSC dies embryonically through the novel ‘tripartite’ developmental killing program, Compartmentalized Cell Elimination (CCE).  In my study, I defined and characterized events at the CCE initiation compartment of the …


Quantification Of Illicit And Prescription Drug Residues In Pasteurized Donor Human Milk: A Comprehensive Analytical Approach, Michelle Brenner, Kaytlin Krutsch, Ashlynn Baker, Dhavalkumar Patel, Palika Datta Jan 2026

Quantification Of Illicit And Prescription Drug Residues In Pasteurized Donor Human Milk: A Comprehensive Analytical Approach, Michelle Brenner, Kaytlin Krutsch, Ashlynn Baker, Dhavalkumar Patel, Palika Datta

Department of Pediatrics Faculty Publications

Objective

To assess the risk of infant exposure to illicit and prescription drug residues, from infant-ready, pooled, pasteurized donor human milk (PDHM) provided by healthy, screened, voluntary non-remunerated donors to a not-for-profit milk bank.

Study Design

A total of 150 pooled samples, representing 742 donor contributions, were analyzed for 15 illicit and prescription drug analytes using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Detected concentrations were evaluated for clinical significance.

Result

All 150 PDHM samples tested negative for residues of marijuana, amphetamines, benzodiazepines, fentanyl, hydrocodone, and morphine. Three samples (2%) contained trace amounts of oxycodone (< 0.6 parts per billion), yielding exposures over 455 times lower than established standards for infant safety (Relative Infant Dose: < 0.022%; standard safety threshold 10%).

Conclusion

Comprehensive analysis detected no clinically …


Causal Effect Estimates Of Online E-Cigarette Marketing Exposure On Future E-Cigarette Harm Perception And Use, Paul T. Harrell, Nicholas T. Williams, Kara E. Rudolph, Rachel Ayala Guzman, Ateeqa Ijaz, Nicole Rychagov, Aaron Null, Silvia S. Martins Jan 2026

Causal Effect Estimates Of Online E-Cigarette Marketing Exposure On Future E-Cigarette Harm Perception And Use, Paul T. Harrell, Nicholas T. Williams, Kara E. Rudolph, Rachel Ayala Guzman, Ateeqa Ijaz, Nicole Rychagov, Aaron Null, Silvia S. Martins

Department of Pediatrics Faculty Publications

Background

Globally, over 10 million youth use e-cigarettes; United States use, in particular, dramatically rose in the late 2010's, exceeding year-over-year increases from any other substance in over four decades. This rise has been partially attributed to youth online e-cigarette marketing exposure, but has not been appropriately studied.

Methods

We examined youth data from the Population Assessment of Tobacco and Health (PATH) spanning the dramatic increase period (Waves 4, 4.5, and 5; 2016-2019). We estimated average risk differences (RD) for Wave 5 e-cigarette harmfulness perception and use comparing all youth versus no youth reporting past-month online e-cigarette marketing exposure in …


Protecting Wetlands In The State Of Texas: Assessing Gaps In Regulations, Knowledge, And Professional Roles And Responsibilities, Grace A. Moy Jan 2026

Protecting Wetlands In The State Of Texas: Assessing Gaps In Regulations, Knowledge, And Professional Roles And Responsibilities, Grace A. Moy

Landscape Architecture Masters & Design Theses

Wetlands rank among earth's most productive ecosystems, providing crucial ecological services such as hydrological regulation, water purification, and habitat support (US EPA, 2015). In Texas, however, rapid urbanization, inconsistent policy enforcement, and the absence of statewide protection frameworks of hastened wetland degradation (Brody & Kang, 2011). Without a robust state regulatory framework (Environmental Law Institute [ELI], 2020), these ecosystems face increasing threats from development and hydrological disturbances.

This thesis aims to identify regulatory and knowledge deficiencies that influence Texas’ current wetland protection status and to offer targeted professional recommendations for landscape architecture professionals to address these shortcomings in future public …


Emotional Intelligence In Blended Vs. Non-Blended Families With Childhood Trauma, Rose Johnson Rodriguez M.S. Jan 2026

Emotional Intelligence In Blended Vs. Non-Blended Families With Childhood Trauma, Rose Johnson Rodriguez M.S.

Selected Full Text Dissertations, 2011-

This study examined whether family structure (blended vs. non-blended) influenced changes in emotional intelligence (EI) among adults, while controlling for baseline EI and childhood trauma. Participants were 420 adults (292 from non-blended families and 128 from blended families) who completed pre- and post-treatment assessments of emotional intelligence using the Assessing Emotions Scale and completed the Childhood Trauma Questionnaire (CTQ) at baseline. Multicollinearity diagnostics revealed some overlap between emotional and physical abuse on the CTQ, but no severe violations. The overall model was significant, F (7, 412) = 16.95, p < .001, R2 = .224, explaining 22% of the variance in EI change. Baseline EI significantly predicted change (p < .001), while CTQ subscales were non-significant. Family structure had a small but statistically significant effect on EI change, F (1, 412) = 4.79, p = .029, partial η2 = .011, with adults from blended families showing slightly greater increases in EI than those from non-blended families. Findings suggest that while family context may shape emotional growth, baseline emotional functioning remains the strongest predictor of change. Future studies should recruit larger samples to enhance power and explore the mechanisms underlying these associations.


Exploring The Romantic Relationship Experiences Of Adults With Adhd (A Qualitative Study), Daniella Bababekov M.S. Jan 2026

Exploring The Romantic Relationship Experiences Of Adults With Adhd (A Qualitative Study), Daniella Bababekov M.S.

Selected Full Text Dissertations, 2011-

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that affects approximately 2.5% of the adult population globally (APA, 2022) and can influence functioning across multiple domains of functioning, including romantic relationships. Fourteen adults currently in romantic relationships participated in semi-structured interviews. Data were analyzed using Auerbach and Silverstein’s (2003) grounded theory method. The purpose of this study was to explore the lived experiences of adults with ADHD in romantic relationships, in order to inform interventions and strategies targeting the unique difficulties faced by this population and their partners. Findings suggest that ADHD influences romantic relationships through interconnected relational processes, including …


Know Your Worth: A Qualitative Study Examining Factors That Psychologists Consider When Setting Their Fees, Emily Rispoli M.S. Jan 2026

Know Your Worth: A Qualitative Study Examining Factors That Psychologists Consider When Setting Their Fees, Emily Rispoli M.S.

Selected Full Text Dissertations, 2011-

Fee-setting in psychotherapy is a routine yet complex aspect of clinical practice that shapes access to care, the sustainability of private practice, and the therapeutic relationship. Despite its importance, limited research has examined how psychologists determine their fees in modern practice. Existing literature has largely focused on ethical guidelines, economic considerations, and the meaning of money in therapy, with less attention to how clinicians navigate fee-setting in real-world contexts. The purpose of this qualitative study was to explore the factors licensed psychologists consider when setting and adjusting their fees in self-employed, out-of-network private practice. Fourteen psychologists (Ph.D. and Psy.D.) participated …


Mental Health Stigma And Its Associations With Depression, Suicidality, And Help-Seeking Among Muslims Living In The United States, Tarnem Amer M.S. Jan 2026

Mental Health Stigma And Its Associations With Depression, Suicidality, And Help-Seeking Among Muslims Living In The United States, Tarnem Amer M.S.

Selected Full Text Dissertations, 2011-

Muslims living in the United States (MLUS) have higher rates of depression (Sloan & Haner, 2023) and are more likely to report a history of suicide compared to other faith groups (Awaad et al., 2021). Nonetheless, help-seeking rates among Muslims remain lower than those among non-Muslims (Ahmad et al., 2023). Mental health stigma has been identified as a key barrier to seeking care, but its mechanisms and outcomes have been understudied among MLUS. The present study examined three types of stigma (mental health public stigma, mental health self-stigma, and mental health help-seeking stigma) and their associations with psychiatric symptoms and …


Self-Efficacy Of The Minority Student Therapist: Exploring The Intersections Of Impostorship And Internalized Racism, Marilenny Herrera M.S. Jan 2026

Self-Efficacy Of The Minority Student Therapist: Exploring The Intersections Of Impostorship And Internalized Racism, Marilenny Herrera M.S.

Selected Full Text Dissertations, 2011-

The self-efficacy of ethnic and racial minority student therapists is significantly influenced by the complex interplay of the impostor phenomenon (IP) and internalized racism, which are often compounded by broader societal and systemic factors. IP, which is common among minority individuals (Bravata et al., 2020), has been shown to be shaped by racialized experiences that impact perceptions of competence and belonging (Cokely et al., 2017). It is important to understand how these factors may affect minority student therapists, particularly as the number of psychology doctorate recipients from underrepresented minority groups continues to rise (American Psychological Association, 2019). The present qualitative …


Sink Or Swim: Standard Swim Lessons As A Novel Intervention For Reducing Generalized Anxiety In Children, Joseph S. Brier Jan 2026

Sink Or Swim: Standard Swim Lessons As A Novel Intervention For Reducing Generalized Anxiety In Children, Joseph S. Brier

Selected Full Text Dissertations, 2011-

Anxiety disorders are the most common mental health conditions in children ages 6–18, with an estimated worldwide prevalence of 6.5% (Rapee et al., 2023; Polanczyk et al., 2015). Although psychological interventions are highly effective, only about 60% of children with anxiety receive professional help within 12 months of symptom onset (Ghandour et al., 2019). Swimming lessons may represent a widely available, low-cost, and naturally motivating alternative intervention for anxiety. Learning to swim targets mechanisms responsible for the development and maintenance of anxiety, including avoidance and maladaptive cognitions (Mowrer, 1951; Dymond & Roche, 2009), and emerging evidence suggests that treating one …


Somatosensory Realignment Following Single And Dual Force-Field Adaptation, Dylan Zangakis, Aaron Wong, Amanda S. Therrien Jan 2026

Somatosensory Realignment Following Single And Dual Force-Field Adaptation, Dylan Zangakis, Aaron Wong, Amanda S. Therrien

Moss-Magee Rehabilitation Papers

Evidence that adaptive motor learning coincides with a realignment of somatosensory perception has led to hypotheses that a shared mechanism underlies both processes. This implies that these two phenomena should exhibit similar properties. However, studies of somatosensory realignment with visuomotor adaptation have shown mixed support, possibly due to a confounding coactivation of sensory prediction errors and multisensory integration. Although the former is thought to drive adaptation, both processes may contribute to somatosensory realignment. Here, we examined somatosensory realignment following force-field adaptation, which is not confounded by multisensory integration. Across two experiments, we tested whether somatosensory realignment mimics three canonical properties …


Comparing The Evolution Of The Advanced Practice Nurse Role: Insights From Switzerland And Kenya, Carole Mackavey, Sara Kohler, Eunice Ndirangu, Rachel Kimani, Constance Shumba, Bernard Mutwiri, Colette Henderson, Anna Jones Jan 2026

Comparing The Evolution Of The Advanced Practice Nurse Role: Insights From Switzerland And Kenya, Carole Mackavey, Sara Kohler, Eunice Ndirangu, Rachel Kimani, Constance Shumba, Bernard Mutwiri, Colette Henderson, Anna Jones

School of Nursing & Midwifery, East Africa

The article explores the evolution of Advanced Practice Nurse (APN) roles in Switzerland and Kenya, highlighting their development, challenges, and influence on healthcare delivery. Despite notable differences in income levels and healthcare infrastructure, both countries are committed to strengthening primary care through the deployment of APNs. Switzerland uses APNs to address provider shortages and improve chronic disease management, whereas Kenya uses them to increase access in underserved areas. A comparative analysis explores how regulatory frameworks, educational models, scope of practice, and health system priorities influence the adoption of advanced practice nursing (APN). Switzerland’s established healthcare system supports the integration of …


2026 Klatsky Endowed Lecture In Human Rights, Beth Van Schaack Jan 2026

2026 Klatsky Endowed Lecture In Human Rights, Beth Van Schaack

Case Western Reserve Journal of International Law

No abstract provided.


Oregon, Katelyn Banks, Allison Medulan Jan 2026

Oregon, Katelyn Banks, Allison Medulan

Water Law Review

H.B. 3372, 83d Legis. Assemb., Reg. Sess. (Or. 2025)H.B. 3342, 83d Leg. Assemb., Reg. Sess. (Or. 2025)


Robert Macfarlane, Is A River Alive? Jan 2026

Robert Macfarlane, Is A River Alive?

Water Law Review

No abstract provided.


Women In Leadership Seminar Series, An Integrated Approach, Diane B. Tuttle Jan 2026

Women In Leadership Seminar Series, An Integrated Approach, Diane B. Tuttle

Doctor of Leadership

Need Problem Opportunity (NPO) Statement

Women of faith aspiring to leadership positions in the nonprofit sector need to be strategically equipped with specialized knowledge, experience, and interpersonal awareness.

Key Insights That Emerged From Research

When this journey began, I envisioned my project focusing on executive leadership transitions in nonprofit organizations. However, through interactive discovery in this doctoral program, I realized that the scope was too narrow. Women at different career levels wanted to learn, grow, and have opportunities to connect with other women. This led me to develop a seminar series intended for women interested in personal and professional growth. …


Sabbath For Everyone: A Guidebook For Practicing Rest, Ryan Thorson Jan 2026

Sabbath For Everyone: A Guidebook For Practicing Rest, Ryan Thorson

Doctor of Leadership

While Sabbath practices are central to God’s design for human flourishing, Compassion Church currently lacks a shared, accessible formation pathway that supports individuals and households in practicing Sabbath in sustainable, life-stage–appropriate ways within the demands of contemporary life and ministry.

This doctoral project responds to that need by developing and testing a Sabbath formation guidebook designed to help individuals and communities engage Sabbath as a gift through the practices of stopping, resting, praying, and playing. A key insight emerging from the research is that Sabbath is not merely a discipline to be mastered but a relational space in which God …


Wellspring For Renewal And Transformation In Ministry, Deborah Cundey Owen Jan 2026

Wellspring For Renewal And Transformation In Ministry, Deborah Cundey Owen

Doctor of Leadership

Ministry leaders increasingly experience burnout and isolation within performance-driven leadership cultures in the United States that fail to cultivate self-awareness, resilience, and spiritual formation. This Need/Problem/Opportunity (NPO) emerged through stakeholder engagement, expert interviews, and academic research, revealing that leaders are not primarily lacking ministry skills but the emotional, spiritual, and relational capacity to sustain those skills in healthy ways.

Several key insights shaped the project. Burnout is less a function of workload than of identity; leaders operating from performance rather than belovedness are spiritually and neurologically vulnerable. Emotional regulation functions as spiritual formation. Concepts such as differentiation, non-anxious presence, undefended …


Beyond Rugged Individualism: A Narrative Intervention For Men Languishing In Isolation, Chad Edward Warren Jan 2026

Beyond Rugged Individualism: A Narrative Intervention For Men Languishing In Isolation, Chad Edward Warren

Doctor of Leadership

My NPO (Need, Problem, or Opportunity) addresses the problem that an exceptional number of men in Northwest Montana languish due to prolonged social and emotional isolation.

Across my research, the key insight was that isolation is sustained not only by personal circumstances but also by the cultural narratives that form men’s identities and expectations. Stories function as “maps of meaning,” shaping what men perceive as strength, weakness, and the good life. In this context, rugged individualism, understood as a self-reliance and isolation narrative that prizes toughness and minimal dependence, can foster admirable grit while also reinforcing shame around vulnerability, help-seeking, …


Evangelistic Preaching Essentials: Inviting The Next "Yes", Julie Ann O'Hara Jan 2026

Evangelistic Preaching Essentials: Inviting The Next "Yes", Julie Ann O'Hara

Doctor of Leadership

Churches within the seventy-eight districts of the USA/Canada Region of the Church of the Nazarene do not have consistently effective evangelistic preaching. Evangelistic preaching is central to the denomination's historical identity, rooted in the holiness tradition of gospel proclamation that invites response. Educational pathways for ordination provide limited exposure to evangelistic preaching, relying instead on local-level practice, and opportunities are frequently limited. Consequently, many developing preachers enter ministry with passion but little experience in evangelistic proclamation.

Research conducted in response to the NPO highlighted several insights. First, growth in preaching requires repeated practice, not simply exposure to content. Second, practice …


Addressing Pornography Use Among Christian University Students: A Small Group Study Curriculum, Jeffery P. Styer Jan 2026

Addressing Pornography Use Among Christian University Students: A Small Group Study Curriculum, Jeffery P. Styer

Doctor of Leadership

In the world of 24/7 access to the internet, it has been determined that Christian universities have students who struggle with a habit of viewing pornography impacting current and future relationships, with God, self, and others. These students graduate and are sent out into the world where they continue to struggle with pornography use and its accompanying guilt and shame. It is an injustice for the university and the church (worldwide) not to address this problem.

Research for this project confirms that pornography use is an issue both inside and outside the church. Christians are quick to identify pornography as …


Exploring Young Adult Absence Within Inner-City Churches In Syracuse, New York, Daren Christopher Jaime Jan 2026

Exploring Young Adult Absence Within Inner-City Churches In Syracuse, New York, Daren Christopher Jaime

Doctor of Leadership

Young adults (ages 25–39) in inner-city churches of Syracuse, New York are experiencing increasing disenfranchisement, resulting in diminished participation, increased distrust, and a significant absence from congregational life. Research conducted for this project revealed that young adult disengagement is shaped by generational disconnects, institutional rigidity, cultural irrelevance, and broader social disruptions intensified by the COVID-19 pandemic and the ongoing political and socio-economic instability. The findings also highlighted a major desire among young adults for authenticity, credible leadership, and spaces where their lived experiences are acknowledged rather than dismissed.

This project is situated within my ministry and vocational context which integrates …


Guidelines For Community Engaged Health Research, Carrie Leach, Hayley Thompson, Alex Sass, Patricia Wren, Rodlescia Sneed, Rhonda Dailey, Elizabeth Towner, Maha Albdour, Carla Caringi, Alyssa W. Beavers, Theresa A. Hastert, Vanessa Rorai, Peter A. Lichtenberg, Angulique Outlaw, Ijeoma Nnodim Opara Jan 2026

Guidelines For Community Engaged Health Research, Carrie Leach, Hayley Thompson, Alex Sass, Patricia Wren, Rodlescia Sneed, Rhonda Dailey, Elizabeth Towner, Maha Albdour, Carla Caringi, Alyssa W. Beavers, Theresa A. Hastert, Vanessa Rorai, Peter A. Lichtenberg, Angulique Outlaw, Ijeoma Nnodim Opara

Institute of Gerontology

Executive Summary:

Wayne State University’s Guidelines for Community Engaged Health Research provide a practical framework for designing, conducting, and evaluating ethical, equitable, and impactful health research that engages community experts in projects that advance health equity in Detroit.

Purpose 

Developed for WSU faculty, staff, and research teams, the guidelines support the meaningful involvement of community experts across all phases of research. They respond to common challenges in community-engaged work, including limited experience with engagement approaches, the need for reflexive and equitable practices, and the time and coordination required for authentic collaboration.

The document defines Community-Engaged Research (CEnR) as collaborative work …


Graduate Research & Scholarship Symposium, Office Of Research Jan 2026

Graduate Research & Scholarship Symposium, Office Of Research

Graduate Student Research Symposium

No abstract provided.


Differences In Comorbidities, Presenting Symptoms, Demographics, And Patient Reported Outcomes In Long Covid By Initial Test Status, Stephanie Georgoudiou Jan 2026

Differences In Comorbidities, Presenting Symptoms, Demographics, And Patient Reported Outcomes In Long Covid By Initial Test Status, Stephanie Georgoudiou

Nursing Dissertations - Archive

Importance Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), remains a major global health concern. Recovery may result in persistent symptoms known as post-acute sequelae of SARS-CoV-2 (PASC), or long COVID. Most studies focus on individuals with laboratory-confirmed infection; however, some patients with COVID-like illness and negative tests also develop persistent symptoms. Testing status should not delay appropriate interventions or specialist referrals. Early, symptom-based care is essential to improve outcomes.

Objective To compare patient-reported outcomes and demographics between long COVID patients who tested positive versus negative during their initial illness.

Design, Setting, and Participants This secondary …


2026 Conference On Undergraduate Research And Engagement Program Guide, Oseel Jan 2026

2026 Conference On Undergraduate Research And Engagement Program Guide, Oseel

CURE Proceedings

Full program for the 2026 Conference on Undergraduate Research and Engagement with full listing of sessions presented


Las Dos Teresas: How Women’S Critiques Of Imperialism And Patriarchy Transformed The Spanish Anarchist Movement, Stephanie Mendez Jan 2026

Las Dos Teresas: How Women’S Critiques Of Imperialism And Patriarchy Transformed The Spanish Anarchist Movement, Stephanie Mendez

Women, Gender, and Sexuality Studies Undergraduate Honors Theses

The central question my thesis explores is how women’s participation in the Spanish anarchist movement in the late nineteenth century to early twentieth century transformed the meaning of anarchism and the anarchist movement. The anarchist movement failed to adequately acknowledge structural inequality between men and women. Women anarchists, such as Teresa Claramunt and Teresa Mañé, acknowledged this discrepancy by reimagining the practice of anarchism. They argued for the genuine expression of total liberation. This could only be achievable through the recognition of women’s subordination. They critiqued the role of patriarchy in maintaining women’s subordination. Through their vision for total liberation, …


Cultivating Trust, Communication, And Collaboration: A Relational Leadership Design For Intercultural Collaboration In Nouakchott, Mauritania, Elysse Audrey Burns Jan 2026

Cultivating Trust, Communication, And Collaboration: A Relational Leadership Design For Intercultural Collaboration In Nouakchott, Mauritania, Elysse Audrey Burns

Doctor of Leadership

Foreign-led initiatives operating in Nouakchott, Mauritania, encounter challenges in collaborating effectively with local communities, hindering the growth of sustainable, locally driven leadership and contextually relevant initiatives. This doctoral project investigates how relational dynamics shape intercultural collaboration and responds through the development of a structured relational leadership certificate program grounded in the Mauritanian context.

Using documented discovery workshops and one-on-one interviews with Mauritanian and international practitioners, the research identified recurring concerns regarding decisionmaking authority, communication clarity, and the distribution of responsibility within foreignled initiatives. Participants described patterns in which expectations were inconsistently communicated, local voices were unevenly integrated into decisions, and …