Digital Commons Network^™

The Risk Protection Value Of “Moral Hazard”, Angie Acquatella, Victoria Marone

Cowles Foundation Discussion Papers

Health insurance lowers the out-of-pocket price of healthcare, and it is well-established that this leads to higher utilization of care. This manifestation of “moral hazard” is typ ically viewed as a social cost of insurance. Within a standard model, this paper shows that a consumer’s ability to change her behavior in response to insurance can also play a central role in the ability of insurance to protect her from risk. We provide a theoretical characterization of this channel and quantify its importance empirically. Under stan dard parameterizations and estimates in the literature, we find that insurance-induced healthcare utilization can account …

Shsp Dean's Newsletter, Summer 2026, Brian J. Nickerson

SHSP Dean’s Newsletter

No abstract provided.

Breaking Point: Exploring Side Bets, Support, And Pension Investment As Predictors Of Turnover Intention In Urban Policing, Kenneth M. Quick, Kevin T. Wolff

Publications and Research

Guided by Becker’s side-bet theory, this study examines turnover intentions among officers in the New York City Police Department by assessing pension investment and affective commitment as accumulated organizational “side bets,” alongside job satisfaction, perceived organizational support, and workplace conditions. Data was drawn from an online survey of 1,454 officers. Population weights based on gender, race/ethnicity, and rank were applied to improve representativeness. Weighted multinomial logistic regression models examined predictors of turnover intention, while second-difference tests of average marginal effects (AMEs) assessed whether workplace factors operated differently across tenure groups. Results indicate that perceived organizational attitudes and workplace conditions significantly …

Uti, Delirium, And Dementia: A Conceptual Bioinformatics Framework For Clinical Attribution, Rob E. Carpenter, Andrew Krouse

Human Resource Development Faculty Publications and Presentations

Urinary tract infection (UTI) is frequently invoked to explain delirium, confusion, and functional decline in persons with dementia. Yet urine positivity in this population often reflects asymptomatic bacteriuria, colonization, chronic pyuria, contamination, or sampling noise rather than clinically attributable infection. For biomedical informatics and computational diagnostics readers, this narrative review contributes an integrative conceptual bioinformatics framework for probabilistic clinical attribution of suspected UTI in dementia under uncertainty. We formalizes the attribution problem by distinguishing organism detection from a clinically plausible infection-related contribution to neurocognitive decline. The framework integrates clinical, laboratory, biological, and longitudinal data to clarify whether urinary findings are …

Department Of Justice Office On Violence Against Women Campus Program Grant: Cwru Impact Evaluation, Hannah Regan, Emma Getz, Megan Gergen

Mather Center Research Briefs

This brief reviews the goals of the Mather Center's DOJ Campus Program grant and evaluates their impact on our campus. It also outlines how we intend to sustain this work following the conclusion of the grant's funding period.

Ultrasound-Guided Iv Placement In Difficult Access Patients, Hilary P. Babb Bsn, Rn

Nurse Residency

In hospitalized adult patients with difficult intravenous access, how does ultrasound-guided peripheral IV catheter insertion compared with traditional landmark/palpation techniques affect first-attempt success and catheter failure rates during hospitalization?

Enhancing Colonoscopy Effectiveness: The Impact Of Split Dose Bowel Preparation, Samantha Balestrieri Bsn, Rn

Nurse Residency

In patients undergoing screening colonoscopies, does a split-dose bowel preparation regimen, compared with a standard single-dose regimen, result in improved colonic visualization and adenoma detection?

Optimizing Nursing Management Of Alcohol Withdrawal In The Emergency Department: A Comparison Of Benzodiazepines And Phenobarbital, Brook Kulis Bsn, Rn

Nurse Residency

In adult patients presenting to the emergency department with alcohol withdrawal syndrome, how does phenobarbital treatment compared with benzodiazepine-based treatment protocols affect emergency department and hospital length of stay, medication requirements, rates of hospital readmission, and overall patient outcomes?

Improving Patient Outcomes Through Nurse-Led Care Coordination, Anna Berry Rn

Nurse Residency

In patients admitted to the hospital, how does nurse-led care coordination compared to none, or patient reliance alone, impact better patient outcomes, better medication management and reduce hospital readmissions?

Reducing Caregiver Burden In Hospice Care, Aubrey Martin Bsn, Rn

Nurse Residency

In family caregivers of adult hospice patient’s, does a nurse-led support program, compared with usual hospice education, reduce caregiver burden?

Comparing Intraosseous (Io) Access To Intravenous (Iv) Access, Isabella Ouellette Rn, Charlyn Achola Rn, Catherine Marcoullier Rn

Nurse Residency

In adult patients experiencing cardiac arrest, how does intraosseous access compared to intravenous access affect time to medication administration and return of spontaneous circulation (ROSC) during resuscitation?

Behavioral Risks, Sophie Coro Rn, Katelyn Piche Rn, Maria Neihauser Rn, Mia Martel Rn

Nurse Residency

In nurses caring for behavioral risk patients, does the use of electronic behavioral alert systems compared to no alert systems reduce nurse-patient workplace violence?

The Impact Of Emergency Nurse Experience On Triage Accuracy During High-Volume Emergency Department Shifts, Grace Littlefield Rn, Mia Cianchette Rn, Benjamin Drummey Rn, Charles Stever Rn

Nurse Residency

PICOT Question: In adult emergency department patients, how does assigning an experienced emergency room nurse to the triage role compared to assigning a less experienced nurse improve triage accuracy rates during high-volume shifts?

Manual Blood Pressure Readings Versus Automatic Blood Pressure Readings, Logan Delano Rn, Rae Hebert Rn, Hannah Rogers Rn

Nurse Residency

In patients under 60, how does manual blood pressure readings compared to automatic blood pressure readings affect the treatments received in a single hospital admission?

Purdue University Extension Program Evaluation Professional Development Pilot Study To Assess Evaluation Competencies Among Educators, Mariah K. Awan, Rama Radhakrishna, Hui-Hui Wang

Journal of Human Sciences and Extension

For the first part of this study, we conducted a descriptive research study with Purdue Extension educators to determine their evaluation competencies and their perceived level of importance for evaluation activities. We also asked about their competence in evaluation methods. For part two, we interviewed Purdue Extension administrators about their perceptions of Program Evaluation as a whole within Indiana Extension. The interview protocol questions were related to perceived roles of administrators, perceived strengths and opportunities for Purdue Extension Program Evaluation efforts, evaluation knowledge needed by educators, and possible future evaluation directions for Purdue Extension. We found that educators indicated mid-level …

Working Out Loud Resilience In Cooperative Extension: Results From An Internal Pilot Program, Lyndi M. Buckingham-Schutt, Debra Sellers, Barbara Dunn Swanson, Jody Catherine Gatewood

Journal of Human Sciences and Extension

This study evaluates Working Out Loud (WOL) Resilience, a program designed to enhance resilience through peer-to-peer learning, targeting social isolation and self-determination. The WOL Resilience pilot program, delivered by Iowa State University Extension and Outreach facilitators, included 29 participants and 5 facilitators over 8 weeks. Participants engaged in weekly sessions focusing on 8 resilience attributes. Evaluation included baseline, midpoint, and post surveys; facilitator feedback forms; and interviews. Results showed improvements in resilience attributes from baseline to post-program and indicated high program acceptability and positive behavioral changes. The peer-to-peer learning model proved beneficial for participants and feasible for delivery through Extension …

Using Needs Assessments To Hear The Voices Of Extension Non-Clients, Odunayo O. Omotilewa, Omolola A. Adedokun

Journal of Human Sciences and Extension

Using data from the University of Kentucky (UK) Extension statewide community needs assessment, this study uncovers the Extension education needs of Kentuckians who are not familiar with the Extension program. Typically, the Extension program development and evaluation model begins with a needs assessment to identify and prioritize community needs, issues, and/or opportunities that can be addressed through targeted educational programming/outreach. As such, needs assessments amplify and empower the voices of community members, especially those who may not be familiar with Extension, and uncover their self-reported need for practical education and assistance. This study investigates differences in Extension education needs between …

Building Community Leadership Capacity Through Extension Partnerships: An Evaluation Case Study, Paul A. Hill, Lendel K. Narine

Journal of Human Sciences and Extension

This evaluation study examines the effectiveness of the Leadership Dixie program in enhancing leadership capacity among participants in Washington County, Utah. As a program partner, Utah State University (USU) Extension conducted the evaluation on the program’s 25th class, comprising 27 participants (N = 27). The program, characterized by 10 monthly “Challenge Day” field tours, was evaluated using two instruments to collect data on participant learning and satisfaction levels, overall program experience, demographics, and impacts on social capital, interpersonal leadership skills, community engagement, and volunteerism. Results indicate strong positive outcomes in social capital, community engagement, and volunteerism while highlighting areas for …

Needs Assessment For Evaluation Competencies Among Extension And Outreach Professionals, Mariah K. Awan, Hui-Hui Wang, Rama Radhakrishna

Journal of Human Sciences and Extension

We conducted an extensive literature review to develop an assessment tool with both quantitative and qualitative items that can be used to conduct a statewide needs assessment of professional development needs in program evaluation for Extension educators and similar non-profit organizations. This tool can be used to identify priority topics for evaluating professional development trainings and materials. It can be easily distributed via Qualtrics. The results of the literature review and the needs assessment survey instrument are shared.

Evaluating The Impact Of A Community-Based Prenatal Education Program On Maternal Knowledge And Intentions In Utah, Aaron T. Hunt, Jenna Dyckman, Kaylee Cox

Journal of Human Sciences and Extension

Maternal and infant health in the U.S. has worsened, with rising rates of maternal mortality, gestational diabetes, postpartum depression, and infant mortality. Prenatal education is a proven strategy to improve outcomes, yet many expecting parents rely on unvetted information or lack access to reliable resources. To address this gap, a pilot prenatal education program was implemented through Utah State University Extension to improve knowledge, attitudes, and intentions related to breastfeeding, nutrition, mental health, and other key topics. The program consisted of 3 1-hour, evidence-based workshops incorporating lectures and interactive activities. A retrospective pre-post survey was completed by 28 pregnant participants …

Affirming Farmer Assets And Visions: Results From A Pilot Appreciative-Inquiry-Based Asset-Mapping Workshop, Andrew R. Smolski, Elisabeth Ramsey, Cathy Royal, Michael Schulman

Journal of Human Sciences and Extension

Cooperative Extension Services and non-profit farm advocacy organizations assist farmers through network development and resource referrals to access information and services needed to operate resilient farms. One method for building networks and assessing existing resources is through participatory asset-mapping tools to document community strengths. In this research brief, we describe the results of a pilot study to test, evaluate, and refine an asset-mapping tool based on Appreciative Inquiry principles. Our goal in the pilot project was to assist the assembled farmers in identifying objectives for a sustainable future and understanding the existing set of resources that would empower them toward …

Geomapping With Python: An Innovative Data Visualization Technique, Tirna Purkait, Dipti Dev

Journal of Human Sciences and Extension

No abstract provided.

Psychological And Neuromechanical Recovery After Concussion: Dual-Task Stability And Kinesiophobia From Return To Play To Six Months., Melissa Anderson, Daniel Le, Mallory Faherty, Carolyn Killelea, Jeffrey Bytomski, Corina Martinez, Michael Bergeron, Timothy Sell

OhioHealth Research Institute Articles

BACKGROUND: Sport-related concussion (SRC) increases the risk of subsequent musculoskeletal injury, yet the mechanisms underlying this vulnerability remain unclear. Fear of movement (kinesiophobia) may contribute to impaired motor control.

PURPOSE: This study examined kinesiophobia and postural stability in adolescent athletes at return-to-play (RTP) after SRC and evaluated changes six months later.

DESIGN: Observational analytical study with cross-sectional (case-control) and prospective cohort components.

METHODS: Thirty-seven concussed athletes (15.7 ± 1.3 years, 45.9% female) and 17 matched controls (16.4 ± 2.1 years, 52.9% female) completed static single-leg stance and dynamic single-leg landing tasks under single- and dual-task (Stroop) conditions. Fear of movement …

Molecular Classification And Association With Survival Outcomes In High-Intermediate And High-Risk Early-Stage Endometrial Cancers: Ancillary Analysis Of Gog-0249., Lindsay M Kuroki, Danielle M Enserro, Heather A Lankes, Kyle C Strickland, Rebecca Previs, Aine Clements, Matthew A Powell, Ann Klopp, Elena Ratner, Paul Disilvestro, Casey Cosgrove, Guilherme Henrique Cantuaria, Nicola M Spirtos, Michael Carney, Mitchell Edelson, Gottfried Konecny, Penny Anderson, Christopher Tarney, Britt K Erickson, Meredith Newton, Krishnansu S Tewari, Premal H Thaker, David Warshal, Amy Armstrong, Xun Clare Zhou, Angeles Alvarez Secord

Women’s Health Articles

OBJECTIVE: Determine whether mismatch repair (MMR) and p53 expression predict recurrence-free survival (RFS) and overall survival (OS) in early-stage endometrial cancer (EC) patients treated with vaginal cuff brachytherapy plus chemotherapy (VCB/C) versus pelvic radiation therapy (RT).

METHODS: In the GOG-0249 trial, 601 patients with high-intermediate risk (HIR) early-stage EC were randomized to VCB/C (carboplatin/paclitaxel for 3 cycles) or pelvic RT. Molecular subgroups, deficient MMR (dMMR), p53 wildtype (p53wt), p53 abnormal (p53abn), were determined by immunohistochemistry. Five-year RFS and OS were analyzed using Kaplan-Meier curves and Cox proportional hazards models, adjusting for lymphadenectomy, planned VCB, and treatment group.

RESULTS: Among 315 …

A Comparison Of Regional Food Systems And Food Security In Rural Mississippi And Italy, Reinhard M. Knerr, Athan M. Gregory, Anne Cafer

Journal of Human Sciences and Extension

In the Mississippi (MS) Delta, more than 40% of residents are food-insecure despite predominantly agricultural land use. We hypothesized that limited social networks and non-navigable food market systems constrain MS producers, limit market viability, and hinder regional food sovereignty. This ethnography compared rural Italian and Mississippian food systems through semi-structured interviews of food producers, processors, and marketers. We described differences in social networks between groups that led to differential capacities to share capital and to overcome producer and labor constraints. We also described key differences in governmental and Extension support of local food systems. Finally, we provided suggestions for addressing …

Making Digital Connections: Extension Educators’ Perceptions And Use Of Qr Codes, Kobina D. Fanyinkah, Jefferson D. Miller, Casandra Cox, Will Doss

Journal of Human Sciences and Extension

While Extension educators recognize the potential of digital tools for outreach, there are still barriers to adoption, effective implementation, and acceptance. The goal of this study was to evaluate Extension educators’ perceptions concerning quick-reponse (QR) codes in outreach activities, including their effectiveness, integration, and barriers faced when using them. The study used a qualitative approach in the form of semi-structured interviews of twelve Extension professionals purposely sampled from the Ozark region of the Arkansas Cooperative Extension Service. Participants perceived the effective use of the technology to be related to their target clients’ age and technological proficiency. Additionally, Extension professionals reported …

Financial Wisdom Across Political Identities: Exploring Insights From A Convenience Sample Of Participants During The Global Pandemic, Miguel Quiñones, Virginia Zuiker, Yiting Li, Hanna Yu

Journal of Human Sciences and Extension

The COVID-19 pandemic triggered a global economic crisis that magnified financial hardships and revealed how political affiliation shapes financial behavior. This study examined how U.S. residents with differing political orientations navigated financial uncertainty, drawing on open-ended survey responses collected in fall 2020. Results show both commonalities and nuanced differences across political lines. Across groups, participants emphasized saving for emergencies, living within their means, seeking financial support, and building skills to increase income—underscoring the universality of core financial principles during crises. However, distinctions also emerged: Republican participants more frequently emphasized self-sufficiency, often seeking additional jobs or withdrawing from retirement funds; Independents …

Perspectives Of Scholars, Families, And Advisors On 360-Degree Video Technology In Graduate Education, Oluwatobi A. Mogbojuri, Bridget A. Walsh, Matthew Aguirre

Journal of Human Sciences and Extension

This study explored the experiences of scholars in creating and sharing 360-degree videos, as well as the perspectives of families and advisors who viewed the videos. Focus groups and individual interviews were conducted online using a videoconferencing platform. Perspectives from 20 participants (15 scholars, three advisors, and two family members) were analyzed using thematic analysis. Three primary themes were identified: (1) barriers to 360-degree video use, (2) perspective shifts and limited change, and (3) storytelling and scholar visibility. Findings suggest that 360-degree video technology may be an innovative tool for enhancing recruitment and retention, especially for historically marginalized groups, through …

Reflections On Participation In Collective Impact Initiatives: Through The Lens Of Extension Practitioners, Omolola A. Adedokun, Marian Jaitto-Jeffrey, Jacqueline Corum

Journal of Human Sciences and Extension

Collective Impact (CI) continues to gain recognition as a useful model for guiding the development, implementation, and evaluation of cross-sectoral efforts addressing complex social issues, including substance use recovery and workforce development. However, application of CI in Extension is very scant, and evaluation of its implementation, process, and outcomes remains a persistent challenge. Hence, the need for rigorous process and outcome evaluations of CI initiatives to build the literature base. Using a mix of focus group and survey methods, this process evaluation study examined Extension professionals’ experiences in two CI initiatives, with a specific focus on their perceptions of the …

Evaluating The Lasting Impacts Of A Dialogue-To-Change Program On Racial Understanding Using Ripple Effect Mapping, Mary Emery, Anuradha Choudhary, Mike D. Stout, Grace Langford, Eric Walcott, Marcia Ostrom

Journal of Human Sciences and Extension

This paper explores the impacts of Coming Together for Racial Understanding (Coming Together), using Ripple Effect Mapping (REM). REM is a participatory evaluation tool that captures and analyzes intended and unintended outcomes. This method maps how individual change leads to wider changes in interactions and activities, from personal, interpersonal, institutional, and cultural levels to the widest ripple of the potential for change in policy, structure, and accepted practice. We adapted REM for virtual settings using Google Jamboard to hold two REM sessions with 20 participants and used mapping results to populate a follow-up survey for 2018 and 2019 training participants. …