Digital Commons Network^™

A Quality Improvement Approach To Reducing Chronic Obstructive Pulmonary Disease Readmissions, Florwisse Rubio

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

The problem identified at the project site is that care transitions for patients with COPD lack standardized discharge processes, leading to inconsistent education, limited follow-up, and poor coordination of care.

Aim of the Project:

The primary aim was to improve patient outcomes by reducing the 19.6% 30-day readmissions among older adults diagnosed with COPD at the selected project site by implementing a standardized discharge intervention over 12 weeks, measuring progress, and ensuring appropriate workflow. The initiative of this project sought to foster a sense of proper continuity of care through timely follow-up, interprofessional communication among patients and providers, and …

Vehicle Autonomy To Ecosystem Intelligence: A Systematic Review Of Dynamic Vision Architectures In Surface Mining Operations, Nana Yaa Damtewaa Anti, Samuel Frimpong, Muhammad Azeem Raza

Mining Engineering Faculty Research & Creative Works

Autonomous Haulage Systems (AHS) have significantly transformed surface mining operations by improving safety, productivity, and operational consistency. Currently, AHS predominantly rely on vehicle-centric perception architectures. Onboard LiDAR, radar, cameras, and Global Navigation Satellite Systems (GNSS) perform sensing, interpretation, and decision-making within individual systems. These processes enable collision avoidance and path tracking. However, they are limited in their ability to consider the broader, dynamic mining environment characterized by dust, terrain degradation, geotechnical instability, heterogeneous traffic, and rapidly evolving operational conditions. This paper presents a systematic review of dynamic vision systems of AHS in surface mining. It critically analyzes the transition from …

Loss Of Palmitoylation Impacts The Interaction Between The Organic Anion Transporting Polypeptide (Oatp) 1b1 And Oatp1b3., Cecilia E. Villanueva, Whitney M. Nolte, Priscilla Flores-Ascencio, Bruno Hagenbuch

Manuscripts, Articles, Book Chapters and Other Papers

The organic anion transporting polypeptide (OATP) 1B1 and OATP1B3 are hepatic transporters that mediate the uptake of numerous therapeutics like antibiotics and statins. Various post-translational modifications, eg, phosphorylation and glycosylation, have been shown to impact OATP1B1 and OATP1B3 function and localization. S-palmitoylation (also known as S-acylation or palmitoylation) is a reversible post-translational modification that adds palmitic acid (C16:0) to cysteine residues and can influence a protein's function, localization, and protein-protein interactions. In this study, we investigated and characterized palmitoylation in OATP1B1 and OATP1B3. Using site-directed mutagenesis and acyl-resin-assisted capture assays, residue Cys24 was identified as the palmitoylation site for both …

Development And Implementation Of Educational Modules On Management Of Neonates With Critical Congenital Heart Disease In The Delivery Room (Learn-Chd)., Noorjahan Ali, Brenda Law, Alyssa R. Thomas, Philip T. Levy, Ruby Gupta, Summer Elshenawy, Danielle Reed, Leeann R. Pavlek, Jennifer Shepherd, Sharada H. Gowda, Molly K. Ball, Beth Ann Johnson, Chloe Joynt

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Neonates with congenital heart disease may require delivery room interventions beyond standard care. Because existing guidelines and educational programs rarely address these needs, we developed and evaluated targeted educational modules.

METHODS: Teams were randomized to online eLearning modules or directed readings. Individual pre-/post-knowledge scores were compared. Team performance was tested in simulated delivery scenarios including abruption, hypoplastic left heart syndrome, d-transposition of great arteries and congenital complete heart block.

RESULTS: 32 teams from 9 centers participated. The module group had improved knowledge scores (mean change 6% vs -0.3% e-Learning group, p = 0.01). Simulation performance was similar between groups …

Not Just A Pediatric Condition: Down Syndrome Across The Lifespan., Emily Haury, Jacqueline Kitchen, Brenda Rogers

Manuscripts, Articles, Book Chapters and Other Papers

With increasing life expectancy for individuals with Down Syndrome (DS), there are growing numbers of adult DS patients needing care from primary care physicians who are knowledgeable regarding their health needs and risks. The Global Down Syndrome Foundation (GDSF) Medical Care Guidelines for Adults with Down Syndrome identify important areas of focus: mental health, dementia, diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, hypothyroidism and celiac disease. Additionally, there are unique considerations regarding cancer risk and screenings, as well as vaccination. Young adults with DS should have a structured transition from pediatric to adult care like any patient with chronic illness …

Can Laws Be Flexible? Rethinking Legislation For Innovation, Nicholson W. Price Ii, Nick K. Schneider, Ariel Dora Stem, Jochen K. Lennerz

Articles

Agile legislation adapts principles from agile software development to lawmaking, emphasizing iteration, multi-stakeholder feedback, and embedded revision. We outline this learning-oriented governance model using three case studies: Germany’s stepwise digital health legislation, the EU AI Act, and U.S. FDA user-fee reauthorization. These examples highlight legislative designs that enable structured generation of real-world data and evidence during implementation, informing regulatory interpretation and iterative refinement in rapidly evolving technological domains.

Learning-Based Multi-Objective Operation Of Microgrid With Renewable Uncertainty And Demand-Side Management, Zeina Bahij

Theses

A microgrid is a small-scale power grid that can operate in either the grid-connected mode or the islanded mode. It consists of energy generation and storage devices for both power and thermal demands, where the thermal energy from the exhaust heat that cannot be transmitted over long distances can be utilized locally. The supply side may include dispatchable generation units with adjustable outputs and energy storage, alongside non-dispatchable renewables that depend entirely on resource availability. On the demand side, thermal loads are satisfied through waste heat recovery from exhaust gas (to maximize overall system efficiency) and direct fuel combustion. Electrical …

Rooted Worlds, Eli Groborchik

Theses

Plant Awareness Disparity (PAD) describes a widespread cognitive bias where plant life is systematically overlooked in favor of its animal counterparts. This disconnect is acutely visible in natural history museums where plant life is notoriously difficult to display. Rooted Worlds is an interactive, physical-digital installation designed to combat this bias by bridging the emotional and educational gap between audiences and Earth’s diverse ecosystems. Rejecting traditional flat screens and passive dioramas, the exhibit utilizes a fourteen-foot, 270-degree cylindrical projection screen to immerse visitors in six distinct, digitally rendered global biomes, creating a restorative and engaging space that leverages Attention Restoration Theory …

What’S Kept, Caitlin Smith

Theses

This thesis examines the collective psychological aftermath of de-industrialization in a rust belt city, processed through perspectives of nostalgia and betrayal. By reframing childhood memories of instability and inherited narratives, a framework is established for investigating the modalities through which love and attachment may obscure entangled harm, and how grief operates across both collective and personal registers. Found objects are situated as sites of projection where memories are abstracted and reconstituted. The processes of decay and weathering serve as analogues for psychological trauma, reframing deterioration as an inevitable and generative condition. Natural elements act as metaphors for neutrality, challenging imposed …

Understanding The Lubrication Mechanisms Of Environmentally Compatible Protic Ionic Liquids, Davis Kipkania Kiboi

Theses

The development of environmentally sustainable lubricants is increasingly important as industries seek to reduce friction, wear, energy losses, and environmental impact. Choline amino acid protic ionic liquids (PILs) have emerged as promising candidates due to their bio-based constituents, tunable molecular structures, and favorable lubrication properties. However, the influence of amino acid structure on their lubrication mechanisms and tribological performance remains poorly understood. This dissertation investigates the physicochemical properties, tribological behavior, and tribofilm formation mechanisms of choline amino acid PILs to establish structure–property–performance relationships for sustainable lubricant design. Ten choline amino acid PILs containing glycine, alanine, lysine, leucine, isoleucine, aspartic acid, …

Improving Neutron Scattering And Fission Modeling With Modern Machine Learning, Karl Daningburg

Theses

We describe the development of a novel emulator for the fission fragment decay code, $\texttt{CGMF}$, which calculates the emission of prompt neutrons and $\gamma$ rays from fission fragments.  The emulator described in this work uses a combination of a noisy emission model and mixture density network to model the neutron and $\gamma$-ray multiplicities and energies.  In this manuscript, we display the power of this type of emulator for not only modeling average prompt fission observables but also correlations between fission fragment initial conditions and these observables, using both neutron-induced and spontaneous fission reactions. We find that neutron ($\gamma$-ray) multiplicities can …

Beyond Lactate: Real-Time Resuscitation Targets For Septic Shock During Critical Care Transport, James L Li, Aaron J Lacy, Michael J Defilippo

2020-Current year OA Pubs

No abstract provided.

Evaluation Of The Impact Of A Pathology Trainee-Driven Manual Review Process For Reference Testing At A Large Academic Center, Carly Maucione, Christopher W Farnsworth, Mark A Zaydman

2020-Current year OA Pubs

BACKGROUND: Increasing reliance on and complexity of laboratory testing necessitates laboratory stewardship initiatives to ensure appropriate test ordering, especially as reference testing costs continue to rise. Prospective manual review processes, although demanding of resources, have been shown to be cost-effective, but literature addressing the value of such a process is lacking.

METHODS: The pathology trainee-driven manual review process of 444 chemistry and microbiology tests on approval at a large academic center was reviewed. Data were extracted from an internal-use call-log and analyzed for test volumes, cancellation rates, and cost savings. A hypergeometric distribution was used to model random variation in …

Enhancing Validation Of Case-Control Omics Signatures Through "Minimalist" Single-Subject Analysis (N-Of-1 Trials): Proof Of Concept In Sepsis, Liam S Wilson, Nima Pouladi, Rachel F Nelson, Elizabeth A Middleton, Neal D Tolley, Mahdieh Shabanian, Colleen Kenost, Robert A Campbell, Matthew T Rondina, Yves A Lussier

2020-Current year OA Pubs

OBJECTIVE: To evaluate if a single-subject study (S3) design, utilizing paired transcriptome samples from the same patient (eg, "sepsis" vs "recovered"), can replicate transcriptomic signatures from small case-control studies, addressing challenges in patient accrual for rare or sub-stratified diseases.

METHODS: We generated a sepsis gene signature (SGS) comprising 300 differentially expressed genes (DEGs; FDR <  5%) from a human sepsis case-control cohort using general linear models (GLMs). Reproducibility of SGS was assessed through three approaches applied to sub-sampled independent datasets: single-subject analyses (N-of-1-MixEnrich), anticipated to perform better; conventional paired-sample GLM analyses; and a traditional case-control GLM analysis.

RESULTS: SGS reproducibility in GLM analyses was inconsistent at smaller cohort sizes (∼80% reproducibility; n = 5) but stabilized at cohort sizes >6. Remarkably, the single-subject-study approach consistently reproduced SGS in each of the 18 subjects individually (100% reproducibility; n = 1).

DISCUSSION: Conventional GLMs are …

Delayed Diagnosis Of A Rare Metabolic Disorder In Adulthood, Isaiah K Mensah, Angie Carreno Martinez, Taylor Wilson, Miguel Valdez, Maria Laura Duque Lasio

2020-Current year OA Pubs

No abstract provided.

Extending The Fundamental Theorem Of Biomedical Informatics For The Ai Era, Philip R O Payne, Jonathan H Chen, Christopher A Longhurst

2020-Current year OA Pubs

BACKGROUND: Charles Friedman's Fundamental Theorem of Biomedical Informatics holds that a person working in partnership with an information resource outperforms that same person unassisted. Since its publication, advances in artificial intelligence (AI), adaptive learning systems, and large-scale data infrastructures have transformed the biomedical ecosystem, extending informatics beyond clinical care into domains such as public health, consumer health, translational science, and the broader life sciences. Such expansion has further underscored the importance of the Fundamental Theorem while also elucidating ways it can be expanded to meet current needs.

OBJECTIVE: To reassess and extend the Fundamental Theorem for the AI era in …

Integration Of A Task Strengthening Strategy For Hypertension Management Into Hiv Care In Nigeria: Baseline Characteristics Of Participants In A Cluster Randomized Controlled Trial, Weixi Chen, Juliet Iwelunmor, Et Al.

2020-Current year OA Pubs

BACKGROUND: Improved access to antiretroviral therapy (ART) has increased survival among people living with HIV (PLWH) but also the burden of cardiovascular risk factors like hypertension. While the task-strengthening strategy for hypertension control (TASSH) is a viable integrated care model, evidence of its clinical impact in Africa is limited. This report presents baseline findings from a trial evaluating 2 implementation strategies for integrating TASSH into HIV care across primary health centers (PHCs) in Lagos, Nigeria.

METHODS: A total of 3,504 PLWH on antiretroviral therapy in 30 PHCs were screened, and 830 were enrolled. Baseline data on patient sociodemographic, clinical, laboratory …

Association Between Thumb Hypoplasia, Radial Longitudinal Deficiency, And Radial Polydactyly, Emma Payne, Charles A Goldfarb, M Claire Manske, Apurva Shah, Andrea Bauer, Lindley B Wall, Could Study Group

2020-Current year OA Pubs

PURPOSE: The expression of the sonic hedgehog protein has been associated with induction of both radial longitudinal deficiency (RLD) and radial polydactyly in animal studies. We sought to investigate the co-occurrence of thumb hypoplasia/RLD and radial polydactyly in a large registry patient cohort and to investigate the clinical presentations of such patients.

METHODS: The Congenital Upper Limb Differences (CoULD) registry was queried for all patients with contralateral diagnoses of thumb hypoplasia/RLD and radial polydactyly, as defined by the Oberg-Manske-Tonkin classification system, between June 2014 and January 2026. The demographic information, medical and musculoskeletal comorbidities, radiographs, and clinical images were collected. …

Brain Volumes In Fetuses With Congenital Heart Disease And Placental Vascular Abnormalities, Erin A O'Brien, Kaylin Taylor, Joshua S Shimony, Cynthia M Ortinau, Et Al.

2020-Current year OA Pubs

OBJECTIVE: Investigate the association between placental vascular abnormalities and regional brain volumes in congenital heart disease (CHD) fetuses with and without genetic abnormalities.

STUDY DESIGN: Secondary analysis of brain magnetic resonance imaging (MRI) and placental pathology data from 121 CHD fetuses enrolled in prospective neuroimaging studies at two centers.

RESULTS: Placental vascular abnormality was present in 46% of fetuses, and genetic abnormality was present in 19%, including 12% with both abnormalities. Fetuses with the combination of placental and genetic abnormalities had smaller brain volumes compared to fetuses without either abnormality for total brain, subcortical gray matter, brainstem, and cerebellum, with …

A Word From The Writing Team (July 2026), Pam Walter, Mfa, Laura Deloretta, Phd

A Word From the Writing Team (Newsletter)

No abstract provided.

Evaluating The Use Of Artificial Intelligence To Enhance Pediatric Simulation Among Associate Degree Nursing Students, Kaitlyn Price

Theses

Abstract

Background: Simulation has long been used to prepare pre-licensure nursing students for clinical practice. Traditional written pre-simulation assignments have been the assignment of choice for many years. However, artificial intelligence (AI) guided preparatory tools may offer students a more interactive, personalized way to enhance their simulation experience.

Purpose: The purpose of this project was to utilize AI technology in pre-simulation preparatory work to enhance learning in second-semester associate degree nursing students. 

Methods: The study consisted of randomized traditional and AI-guided preparatory groups among consenting participants. The sample consisted of 23 participants. Both sets of students completed the same simulation. …

Fostering Inclusion: Supporting Children With Hearing Loss In Social Interactions, Danielle Kaletta, Mary Jan Greer

Summer 2026 OTD Capstone Symposium

This project provided an open-access online program for caregivers of children with hearing loss to facilitate social engagement. Qualitative methods were used to conduct a needs assessment and identify areas of concern, barriers, and limited resources that affect participation in social activities. Based on the needs assessment, a 6-module website was created and published. Occupational therapy-based evidence, research, interventions, and best practices were compiled and adapted to target identified areas. Participants reported overall favorable feedback, stating an increase in knowledge, confidence, and participation.

Llu Dentistry 2026 Summer Edition, Loma Linda University School Of Dentistry

Articulator (Dentistry)

In this issue:

4 | Dean's Message
9 | LLUSD Homecoming 2026: A Celebration of Legacy & Future Growth
19 | Celebrating 48 Years A Tribute to Kathleen Moore Rychman
21 | A Natural Calling: Dr. Yawen Peng, Program Director
22 | A Legacy of Excellence R. David Rynearson, DDS'71, MS'87 honored with the O.B. Vaughan Special Recognition Award
25 | CDA Presents Anaheim
32 | Dental Hygiene Pinning Ceremony
36 | Called to Serve Baccalaureate and the Class of 2026
40 | Commencement
45 | President's Award
46 | Prince Award
54 | Dental Hygiene Student Awards
56 | …

Impacts Of Climate Hazards On Employment And Earnings By Hazard Type, Industry, Race, And Ethnicity, Dania V. Francis, Keren M. Horn

Sustainable Solutions Lab

We examine the relationship between climate-related disasters and subsequent county-level aggregate employment and earnings. We combine earnings and employment data from 2000 to 2023 with data on disasters to estimate local projection impulse response functions relating extreme disaster events to cumulative percent changes in employment and earnings. On average, disasters appear to reduce employment growth three to five years post disaster. There are small positive impacts on earnings. These results are largely driven by responses to hurricanes and tropical storms. Key rebuilding industries such as construction see short-term gains in employment that turn to losses in the longer-term that are …

A Program To Address Anxiety And/Or Add/Adhd In Children With Cerebral Palsy To Improve Social Participation, Victoria Shaw, Mary Jan Greer

Summer 2026 OTD Capstone Symposium

The purpose of this project was to develop a program for children with cerebral palsy, who experience anxiety and/or ADD/ADHD, that will promote their social participation during play activities. The program lasted for 14 weeks and had two participants, within those 14 weeks, several objectives were accomplished. These objectives include the administration of the needs assessment, implementation of the program modules, pre- and post-interviews with the caregivers and staff, and the finalization of the program. The expected outcome from the program was to determine the effectiveness of the different program modules increasing interactions with peers by decreasing anxiety and improving …

Autonomous Terrain-Mapping Robot For Search And Rescue, Soumil Joshi, Seann Calub

Electrical Engineering

This report documents the design, modular testing, and challenges faced while developing an autonomous terrain-mapping robot intended to navigate to a destination waypoint and deliver a small payload for search-and-rescue applications. The system combines a LiDAR sensor, an IMU sensor, and a Raspberry Pi 3B as the onboard processor, and an ESP32 microcontroller interfacing with motor drivers over a four-wheel chassis. A companion mobile application was developed to enable remote control and monitoring of the robot over a WiFi hotspot connection. A lithium-ion battery pack supplies power to all onboard components, with power budgets verified against component datasheets. Testing progresses …

Assessing Vertebrate Biodiversity In An Agricultural And Urban Impacted River Using Environmental Dna Metabarcoding, Surabhi Nair

AES Theses

Rivers are dynamic freshwater systems that can experience shifts in flood regime that are driven by anthropogenic activity and climate change. These changes may no longer support the native species in the ecosystem and can favor invasive generalist species. The Pajaro River supports a range of urban, agricultural, and natural habitats and is prone to seasonal flooding that can affect habitat conditions and biodiversity. Current vertebrate diversity in the Pajaro River is not well understood, although traditional surveys have documented both rare and invasive species. Environmental DNA, or eDNA, can help address gaps in traditional monitoring by detecting elusive or …

The Allure Of A Slow Life Strategy: How Mating Context And Ecological Harshness Shape Mate Preferences, Lynn K. L. Tan, Nicole Ruiying Chen, Kenneth Tan, Norman P. Li

Research Collection School of Social Sciences

Although mate preferences have been extensively studied across various factors such as physical attractiveness or social status, their connection to life history strategy remains underexplored. Specifically, do individuals prefer mates who display signs of a fast or slow strategy? And what might qualify these preferences? Drawing from life history theory, we suggest that mate preferences are sensitive to cues of prospective mates' life history strategy, and that these preferences are malleable and shaped by ecological conditions. We hypothesize that in general, individuals will favor slow (versus fast) strategists as a mate. This is because modern environments are generally defined by …

Cyberbullying Perpetration: A Systematic Review Of Global Prevalence, Profiles, Antecedents, Consequences, And Interventions, Ysabel A. Guevarra, K. T. A. Sandeeshwara Kasturiratna, Charlotte K. Y. Lee, Andree Hartanto

Research Collection School of Social Sciences

The anonymity afforded by cyberspace enables individuals to engage in harmful online behaviours, most notably cyberbullying perpetration, which has become a pressing social and psychological concern worldwide. Despite extensive research on its antecedents, outcomes and interventions, insights into cyberbullying perpetration remain scattered, highlighting the value of a comprehensive synthesis to capture its multifaceted nature. This systematic review synthesised findings from 54 meta-analyses, comprising 314 effect sizes (Sample size: Range = 3273–1,479,614, Mdn = 46,604) across diverse populations worldwide. Results indicate that approximately one in ten individuals engage in peer cyberbullying, with even higher prevalence in partner-directed forms such as cyber …

Income Tax Over-Withholding And Household Investment Decisions, Xi Novia Chen, Jungbae Kim, Ben Lourie, Chenqi Zhu

Research Collection School Of Accountancy

Over three-quarters of U.S. taxpayers over-withhold taxes, leading to tax refunds. This study explores how over-withholding impacts stock investments by comparing individuals' investment patterns from wages and tax refunds. We find that while some portion of tax refunds are promptly invested, the investment rate is lower than that of wages. This suggests that over-withholding, which alters the label and timing of wages into refunds, influences investment behavior. Our cross-sectional analysis indicates that the differential propensity to invest wages versus tax refunds are more pronounced for individuals with automatic investment setups and lower financial sophistication. These findings underscore the importance of …