Digital Commons Network^™

Cone Vs. Vmat Srs Planning For Dual Targets: Effects Of Target Size, Separation, And Isocenter Displacement, Hannah Angeli

Masters Projects

Objective: This study compares cone-based and volumetric modulated arc therapy (VMAT) stereotactic radiosurgery (SRS) planning for dual intracranial targets, examining the effects of target size, inter-target separation, and isocenter displacement on dosimetric outcomes. Methods: Plans were generated for spherical targets of 8.0 mm, 10.0 mm, and 12.0 mm diameters using both VMAT and cone-based techniques with single-isocenter configurations. Key metrics including maximum dose, volumes of normal brain receiving 12 Gy and 50% of the prescription dose (V12Gy, V50%), high-dose volume (V100%), gradient index, and target coverage were evaluated. Results: Cone-based plans demonstrated superior dose conformity and reduced normal tissue exposure …

Ancient Maya Crisis And Resilience, James Aimers

Climate Change and the Individual, 2025-26

During the Maya Terminal Classic period (from about 750-1050 AD), many Maya sites in Mexico, Belize, Guatemala, and Honduras were abandoned. This radical change has been investigated for over 100 years, with drought and climate change recently given a central role. My research on the Maya collapse demonstrates great variability in the Terminal Classic, and not all sites were abandoned. In this lesson I focus on variability and resilience in the human response to climate change.

Real-Time Experiences Of Racism And Stress In Association With Postpartum Weight Retention: A Longitudinal Ecological Momentary Assessment Study, Dara M Méndez, Amanda L Tapia, Sarah A Sanders, Andrea D Casas, Marquita Smalls, Esa M Davis, Stephen L Rathbun, Tiffany L Gary-Webb, Lora E Burke, Serwaa S Omowale, Linda A Adodoadji, John J Gianakas, Y Lai, Maisa Feghali, Meredith L Wallace

Faculty, Staff and Student Publications

Racial inequities in postpartum weight have been documented with limited studies on the influences of racism and other forms of discrimination. In a prospective longitudinal study applying ecological momentary assessment (EMA) and ambulatory assessment of weight, we measured the association between discrimination, stress, and postpartum weight change. The Postpartum Mothers Mobile Study is a cohort of 313 pregnant and birthing individuals who were followed during their second and third trimesters through 1 year postpartum. They were recruited in clinical settings between 2017 and 2020 in a major city center in Pennsylvania. Measures of racism and gender-based discrimination were collected via …

Decreasing Emergency Department (Ed) Revisits: Providing Resources That Address Overutilization For Patients With Substance Use Disorder, Amber May

Doctor of Nursing Practice Final Project Abstract

Date of Doctor of Nursing Practice Project Completion

Summer 8-5-2025

Faculty Advisor

Rebecca Tsusaki PhD, APRN-CNP, WHNP-BC, IBCLC

ABSTRACT

PURPOSE This quality improvement project was intended to decrease emergency department (ED) revisits by 10%, from high-utilizer patients (those with more than 10 ED visits in the past year), by implementing community health worker–led follow-up phone calls within one week of discharge, over a 30-day period. The project was conducted at a large metropolitan hospital in Houston, Texas.

BACKGROUND Non-urgent revisits and overutilization affect ED wait times, are associated with overcrowding, contribute to unnecessary care delays, impact patient satisfaction scores, and …

Improving Medication Adherence Among Patients With Anxiety, Abong Miyeh

Walden Dissertations and Doctoral Studies

Addres+D14sing medication non-adherence among patients with anxiety disorders is crucial in nursing practice due to its significant impact on patient outcomes and healthcare costs. This doctoral project explores the effectiveness of staff education in enhancing nurses' skills in promoting medication adherence within this population. The practice-focused question for this project is "What evidence supports the effectiveness of a staff education program in increasing nursing staff knowledge about evidence-based strategies for improving medication adherence among patients with anxiety disorders?" The purpose of this doctoral project is to investigate the effectiveness of staff education interventions in improving medication adherence among individuals with …

The Impact Of Socio-Emotional And Provider Support On Hiv Testing In Southern United States, Ijeoma Onyinyechi Nwazuruokeh

Walden Dissertations and Doctoral Studies

HIV was first diagnosed over 40 years ago in the United States; however, HIV remains an epidemic. An understanding of how socio-emotional support, social isolation, and support from an individual's provider influence HIV testing in the Southern United States can be a key to increasing testing rates and ultimately reducing the incidence and prevalence of HIV in the Southern United States. The purpose of this non-experimental quantitative study was to examine the relationship between HIV testing, socio-emotional support, and social isolation, and how these variables are further moderated by an individual having provider support in the Southern United States. The …

Staff Education To Improve Knowledge Of The Patient Health Questionnaire-9 Assessment, Josie Weber

Walden Dissertations and Doctoral Studies

This doctoral project was focused on a staff education initiative to enhance the proper use of the Patient Health Questionnaire-9 (PHQ-9), a validated depression screening tool, in an outpatient behavioral health (OBH) clinic. Despite its clinical utility, the PHQ-9 is often underused or inconsistently applied due to knowledge gaps among nursing staff. Inconsistent screening can delay diagnosis and treatment, negatively affecting patient outcomes. I conducted this project to address these gaps by implementing structured training to promote high-quality, patient-centered care. The practice-focused question was: Does a structured PHQ-9 training session improve staff knowledge in an outpatient behavioral health clinic, as …

Faculty And Administrators' Perspectives Of Generative Artificial Intelligence At An Online Higher Education Institution, Devon Edmund

Walden Dissertations and Doctoral Studies

The problem addressed in this study was that faculty and administrators in higher education are not prepared to address the use of generative artificial intelligence (GAI) innovations in institutional policies and practices. The pace of advancement of GAI in higher education (HE) left institutions to determine policies and practices without industry best practices or guidelines established by accreditors or regulatory bodies. The purpose of this qualitative study was to explore the perspectives of faculty and administrators at an online HE institution on how to respond to the emergence of GAI through institutional policies and practices. The theory supporting the study …

Helping Families Learn About Social Emotional Learning, Madalyn Ross

Masters Projects

Having developmentally appropriate social-emotional skills is an essential component of a growing child, yet many children lack the social-emotional skills necessary to be successful in the classroom. Families play an important role in the development of a child, but research shows that there are significant gaps in the knowledge and use of social-emotional learning (SEL) that families have. This project explores the importance of family involvement and knowledge surrounding SEL by looking at certain aspects that hinder SEL growth, such as trauma and excessive screen time, and aspects that help children excel in SEL development, such as teacher education and …

Association Between Allostatic Load And Accelerated White Matter Brain Aging: Findings From The Uk Biobank, Li Feng, Zhenyao Ye, Zewen Du, Yezhi Pan, Travis Canida, Hongjie Ke, Song Liu, Shuo Chen, L Elliot Hong, Peter Kochunov, Jie Chen, David K Y Lei, Edmond Shenassa, Tianzhou Ma

Faculty, Staff and Student Publications

White matter (WM) brain age, a neuroimaging-derived biomarker indicating WM microstructural changes, helps predict dementia and neurodegenerative disorder risks. The cumulative effect of chronic stress on WM brain aging remains unknown. In this study, we assessed cumulative stress using a multi-system composite allostatic load (AL) index based on inflammatory, anthropometric, respiratory, lipidemia, and glucose metabolism measures, and investigated its association with WM brain age gap (BAG), computed from diffusion tensor imaging data using a machine learning model, among 22 951 European ancestries aged 40 to 69 (51.40% women) from UK Biobank. Linear regression, Mendelian randomization, along with inverse probability weighting, …

Perspectives On Career Advising At A Large Private Religious Institution, Lane Toshio Muranaka

Theses and Dissertations

This study examines the role of career advising at Brigham Young University (BYU), a faith-based institution where professional guidance focuses on spiritual development and purpose-driven learning. Through qualitative interviews with career advisors across various disciplines, the research explores how advisors define student success, integrate faith into their advising practices, and support students in aligning their career aspirations with personal meaning and the university's religious mission. Grounded in the belief that holistic education fosters lifelong success, BYU emphasizes the development of the "total person," including moral and spiritual dimensions. Findings reveal that student success is not solely measured by employment outcomes …

The Emergence Of An Object Of Regulatory Concern: The European Union’S Artificial Intelligence Act, Galán, Alexis, Schmidt, Rebecca

Santa Clara Journal of International Law

No abstract provided.

Genetic Overlap Between Functional Impairment And Depression And Anxiety Symptom Severity: Evidence From The Glad Study, Megan Skelton, Jessica Mundy, Abigail Ter Kuile, Brett Adey, Cherie Armour, Joshua Buckman, Jonathan Coleman, Molly Davies, Colette R. Hirsch, Matthew Hotopf, Ian Jones, Gursharan Kalsi, Georgina Krebs, Sang Hyuck Lee, Yuhao Lin, Andrew M. Mcintosh, Alicia J. Peel, Christopher Rayner, Katharine Rimes, Daniel J. Smith, Katherine N. Thompson, David Veale, James T.R. Walters, Christopher Hübel, Gerome Breen, Thalia C. Eley

School of Psychology

BACKGROUND: Functional impairment in daily activities, such as work and socializing, is part of the diagnostic criteria for major depressive disorder and most anxiety disorders. Despite evidence that symptom severity and functional impairment are partially distinct, functional impairment is often overlooked. To assess whether functional impairment captures diagnostically relevant genetic liability beyond that of symptoms, we aimed to estimate the heritability of, and genetic correlations between, key measures of current depression symptoms, anxiety symptoms, and functional impairment.

METHODS: In 17,130 individuals with lifetime depression or anxiety from the Genetic Links to Anxiety and Depression (GLAD) Study, we analyzed total scores …

Conservative Oxygen Therapy In Mechanically Ventilated Critically Ill Adult Patients: The Uk-Rox Randomized Clinical Trial, Uk-Rox Investigators, Daniel S Martin, Doug W Gould, Tasnin Shahid, James C Doidge, Alex Cowden, Zia Sadique, Julie Camsooksai, Walton N Charles, Miriam Davey, Amelia Francis-Johnson, Roger M Garrett, Michael P W Grocott, Joanne Jones, Lamprini Lampro, Diane M Mackle, B Ronan O'Driscoll, Alvin Richards-Belle, Anthony J Rostron, Tamás Szakmány, Alex Warren, Paul J Young, Kathryn M Rowan, David A Harrison, Paul R Mouncey

Peninsula Medical School

IMPORTANCE: Supplemental oxygen is frequently given to patients in intensive care units (ICUs); however, there is insufficient evidence to guide its therapeutic use and to minimize the potential harm caused by administering too little or too much.

OBJECTIVE: To determine whether reducing exposure to supplemental oxygen through a strategy of conservative oxygen therapy by using a peripheral oxygen saturation (Spo2) target of 90% (range, 88%-92%) reduces mortality at 90 days in mechanically ventilated adult patients receiving supplemental oxygen in the ICU.

DESIGN, SETTING, AND PARTICIPANTS: Multicenter, pragmatic, randomized clinical trial conducted in 97 ICUs in the UK including 16 500 …

Examining The Factor Structure And Correlates Of The Flourishing-At-Work Scale In United States School Psychologists, Nikita Pike

Electronic Theses and Dissertations Archive

Despite moderate levels of stress and burnout in their work, school psychologists in the United States tend to be satisfied with their jobs. Although researchers have addressed why school psychologists view their work as important, there is yet another important feature of the workplace that has not been examined in this population: flourishing at work. This study aimed to enhance the understanding of flourishing at work in school psychologists by examining an existing scale, the Flourishing-at-Work Scale, completed online by a national sample of United States school psychologists. Data from a sample of 369 practicing school psychologists were used in …

Examining The Active Ingredients In An Anti-Stigma Intervention For Individuals With A Criminal History, Kaylee Cook

Electronic Theses and Dissertations Archive

Obtaining employment is key to successful reintegration for people who have been incarcerated. However, employers are often hesitant to hire formerly incarcerated persons due to general negative attitudes toward them and concern that they will not exhibit positive work behaviors. Interventions to reduce general types of stigma exist, with primary strategies involving education and/or contact. Most research examining the effectiveness of stigma-reducing strategies largely focus on reducing identity-based stigma (e.g., race, mental illness), with limited research on reducing choice-based stigma, such as those with criminal histories. However, regardless of targeted stigma, there is no consensus regarding which intervention format (i.e., …

Predictors Of Sanction Length Following Correctional Disciplinary Hearings: The Role Of Individual Characteristics, Misconduct Type, And Placement In Segregation, Jade Renee Horton

Electronic Theses and Dissertations Archive

Misconduct by incarcerated individuals is a significant threat to institutional safety. While research has highlighted discrepancies in who engages or who is reported as engaging in misconduct and suggests staff biases may impact disciplinary decisions, available research tends to narrowly focus on the use of disciplinary segregation as an outcome and often neglects other potential disciplinary outcomes that are less serious and the predictors of those outcomes. The current study examined predictors of the seriousness of outcomes, measured in length (weeks) of imposed sanction, of disciplinary hearings. It was hypothesized that those who are identified as Black, with a serious …

Three Essays In Forward-Looking Statements, Social Media Collaboration, And Climate Talents, Jing-Chi Chen

Electronic Theses and Dissertations Archive

This dissertation consists of three essays on Forward-Looking Statements (FLS), Social Media Collaboration, and Climate Talents. The first essay examines how FLS impact investor trading behavior and market liquidity. We find that FLS are associated with reductions in investor trading costs, largely driven by lower market-maker inventory costs. FLS also associate with increased market depth on both sides of the bid-ask spread and greater retail and institutional trading activity, with retail investors being more responsive. Cross-sectional tests show these associations are stronger during market downturns and when earnings guidance is absent. Results are robust to instrumental variable regressions using managerial …

Extreme Value Theory View Of High Emitter Diesel Vehicles In The Us From 1991 To 2021, M. Matti Maricq, Gary A. Bishop

Fuel Efficiency Automobile Test Publications

Extreme value theory (EVT) is a statistical method to characterize the tails of distributions, such as high emitter vehicle emissions. The present work addresses the United States (US) diesel fleet. EVT confirms that high emitters contribute disproportionately to adverse air quality. It further reveals that high emitter emissions have responded differently to progressively tighter emissions standards compared to fleet averages. Carbon monoxide (CO) and hydrocarbons (HC) high emitter emissions fell in concert with the fleet average after widespread implementation of the diesel oxidation catalyst to meet US Environmental Protection Agency (EPA) Tier 1 emissions standards, but remained unchanged after introduction …

Solvent- And Binder-Free Additive Manufacturing Of Polymer-Derived Ceramics: Rheological Tuning And Structural Performance, Laxmi Sai Viswanadha, Jeremy Watts, Mohammad Naraghi

Materials Science and Engineering Faculty Research & Creative Works

Silicon carbide (SiC) ceramic matrix composites are widely used in aerospace applications due to their high strength, heat resistance, and corrosion resistance. However, traditional machining methods make it challenging to fabricate complex shapes. This study presents a solvent-free and binder-free direct ink writing (DIW) method for producing SiC/SiOC composites using polycarbosilane SMP-10, a preceramic polymer that acts as both the ceramic precursor and the liquid phase, thereby eliminating the need for volatile solvents and sacrificial binders. By adjusting the SiC content, printable ink formulations were developed, and their flow properties were analyzed. The influence of geometric factors, such as inter-wall …

Supporting Young Learners With Disabilities In Inclusive Classrooms: A Toolkit For General Education Teachers, Emily M. Raleigh

Masters Projects

Many young elementary students with disabilities often experience difficulty maintaining engagement in their learning and managing their emotions in general education classrooms. These challenges can have a negative influence on their ability to interact with their peers, develop foundational academic skills, and feel a sense of belonging. At the same time, many general educators report a lack of effective training, strategies, and confidence in implementing supports to students with disabilities, particularly in the areas of self-regulation and engagement. This project responds to this issue through the creation of a visual support toolkit developed for use in inclusive early elementary classrooms. …

Announcing The 2025 Induction Of Members Into The Accounting Hall Of Fame, American Accounting Association

Accounting Hall of Fame Brochures

No abstract provided.

Phase 2 Study Of Zilovertamab Vedotin In Participants With Metastatic Solid Tumors, Funda Meric-Bernstam, Martin Gutierrez, Enrique Sanz-Garcia, Diego Villa, Jun Zhang, Jennifer Friedmann, Fengting Yan, Mark A Socinski, John Sarantopoulos, Luis E Raez, Quincy S Chu, Maxime Chénard-Poirier, Manash Chatterjee, Hong Ren, Qi Liu, Douglas A Levine, Komal L Jhaveri

Faculty, Staff and Student Publications

Purpose: Zilovertamab vedotin, an antibody‒drug conjugate targeting receptor tyrosine kinase‒like orphan receptor 1 (ROR1), had manageable safety and promising antitumor activity in participants with relapsed or refractory non-Hodgkin lymphomas. We evaluated zilovertamab vedotin in participants with previously-treated metastatic solid tumors.

Methods: This phase 2, open-label, nonrandomized study (NCT04504916) enrolled participants with metastatic triple-negative breast cancer, hormone receptor‒positive (HR+) breast cancer, nonsquamous non‒small-cell lung cancer, platinum-resistant ovarian cancer, or pancreatic cancer. Participants received zilovertamab vedotin ≤2.5 mg/kg once every 3 weeks (Q1/3W) or < 1.75 mg/kg twice every 3 weeks (Q2/3W). Primary endpoint was objective response rate (ORR) per RECIST v1.1 by blinded independent central review. ROR1 protein expression was correlated with clinical outcomes.

Results: 102 participants were enrolled (Q1/3W, n=70; Q2/3W, n=32). ORR was 1% (95% CI, 0%‒8%) with …

Optimizing Coral Sexual Propagation Ex Situ: Synergistic Effects Of Multiple Cues On The Larval Settlement Of Caribbean Corals, Chloe Daniel

All HCAS Student Capstones, Theses, and Dissertations

For coral restoration to be effective at an ecosystem scale, ex situ coral propagation needs to be optimized and cost-effective. One of the major bottlenecks to sexual propagation of Caribbean corals ex situ is low larval settlement, typically induced by the presence of crustose coralline algae (CCA) and microbial films. Previous studies found that coral larval settlement can be enhanced by colored substrates, healthy reef sounds, and the presence of food. This study assessed the potential synergistic effects of colored substrate, reef sounds, and food, along with the commonly used settlement cues (CCA and microbial films) on the larval settlement …

“Asking For Help Feels Like A Weakness”: Factors Shaping First-Year Students’ Expectations Of Stem Course Office Hours, Jeremy L. Hsu, Grace Holick, Rebecca M. Green, Elaine Benaksas Schwartz, Melissa Rowland-Goldsmith

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Background

Office hours are one of the most ubiquitous resources for students in STEM courses. However, there has been only limited work examining what students think of STEM course office hours, and we are not aware of any past work that has examined (1) how students perceive STEM course office hours upon entering college, and (2) how these perceptions change over time and the factors that shape these perceptions and expectations of what will occur in office hours. Here, we utilize a longitudinal series of surveys to capture first-year students’ perceptions and expectancies for office hours at the beginning of …

Metabolic Dysfunction-Associated Steatotic Liver Disease In People With Type 1 Diabetes., Brynlee Vermillion, Yuanjie Mao

Ambulatory and Primary Care Articles

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a significant comorbidity in individuals with type 1 diabetes (T1D), despite its historical association with type 2 diabetes. This review focuses on summarizing current findings regarding the role of insulin resistance in the development of MASLD in T1D, as well as examining the relationship between MASLD and diabetes-related complications. We will also briefly discuss the prevalence, diagnostic challenges, associated complications, and potential mechanisms underlying MASLD in T1D. Although insulin resistance is well established in MASLD among those with type 2 diabetes, its role in T1D requires further clarification. Emerging markers, …

Information Theory Optimization Of Signals From Small-Angle Scattering Measurements, Robert P Rambo, John A Tainer

Faculty, Staff and Student Publications

Small-angle X-ray scattering (SAXS) of particles in solution informs on the conformational states and assemblies of biological macromolecules (bioSAXS) outside of cryo- and solid-state conditions. In bioSAXS, the SAXS measurement under dilute conditions is resolution limited, and through an inverse Fourier transform, the measured SAXS intensities directly relate to the physical space occupied by the particles via the P(r)-distribution. Yet, this inverse transform of SAXS data has been historically cast as an ill-posed, ill-conditioned problem requiring an indirect approach. Here, we show that through the applications of matrix and information theories, the inverse transform of SAXS intensity data is a …

Grade Concept Paper 9: Rationale And Process For Creating A Grade Ontology, Paul Whaley, Brian Alper, Joanne Dehnbostel, Carlos Alva-Diaz, Stavros Antoniou, Antonio Bognanni, Javier Bracchiglione, Therese Kristine Dalsbø, Sean Grant, Jennifer Hunter, Alfonso Iorio, Malgorzata Lagisz, Harold Lehmann, Sheyu Li, Joerg Meerpohl, Saphia Mokrane, Cauê Monaco, Ignacio Neumann, Kevin Pottie, Shahab Sayfi, Nigar Sekercioglu, Jasvinder Singh, Bernardo Sousa-Pinto, Janice Tufte, Lenny Thinagaran Vasanthan, Li Wang, Jun Xia, Xiaomei Yao, Holger Schünemann

Faculty, Staff and Students Publications

Context: As the rate of research production accelerates, the ability to efficiently and unambiguously communicate judgments relating to the synthesis, evaluation, and use of scientific information becomes paramount.

Perspective: Scientific information can be viewed as a "layered infrastructure" of data, evidence, knowledge, and use. The GRADE approach serves as a de facto data standard for this infrastructure, supporting movement between layers by reducing ambiguity in claims to knowledge (in the form of judgements of certainty in the evidence when answering research questions) and level of commitment to possible solutions to problems (in the form of strength of recommendations for interventions). …

Survival To Hospital Discharge In The Fetus With Moderate To Severe Mitral Regurgitation Either In Isolation Or In Combination With Aortic Valve Stenosis Or Atresia, A Fetal Heart Society Collaborative Study, Betul Yilmaz Furtun, Kavitha Pundi, Anita Moon-Grady, Nicole Cresalia, Asela Nieuwsma, Sarah K Gelehrter, Bhawna Arya, Mary T Donofrio, Christopher Statile, Ann Kavanaugh-Mchugh, Lindsay Freud, Elijah Bolin, Megan Warner, Sowmya Balasubramanian, James Strainic, Carol Wittlieb-Weber, Nelangi M Pinto, Lisa Hornberger, Shaine A Morris

Faculty, Staff and Students Publications

Background: Case series report high mortality after fetal diagnosis of moderate to severe mitral regurgitation in combination with left atrial dilation, hydrops, or restrictive atrial septum. However, overall outcomes and specific high-risk features remain unclear.

Methods: We performed a multicenter retrospective cohort study of fetuses with ≥moderate mitral regurgitation and normal cardiac connections evaluated January 1, 2005 to January 31, 2016. Fetuses undergoing fetal cardiac intervention (FCI) were described separately. We assessed associations between fetal echocardiographic features and discharge mortality using mixed logistic regression and classification and regression tree modeling, stratified by studies performed < 28 and ≥28 weeks gestational age (GA).

Results: Of 67 fetuses, 96% had …

Asset And Deficit Thinking: Ed.D. Students’ Perceptions And Preferences Around Their Instructors’ Feedback, Rebecca R. Simataa, Jordan O'Connell, Kateri Johnson, Christopher Dufault

Essays in Education

This study investigated cohort-based Ed.D. students’ perceptions and preferences related to deficit and asset-based instructor feedback. The researchers collected data from 28 current Ed.D. students through a survey based on Henderson et al.'s (2016) Feedback for Learning questions. While students generally perceived feedback as asset-focused, they expressed a need for more growth-oriented, individualized responses. Additionally, male participants significantly perceived more asset-based feedback than females, suggesting that demographic alignment between instructors and students may influence perceptions around feedback. Implications suggest that Ed. D. faculty can enhance feedback practices by choosing transactional or transformative approaches based on students' needs and preferences, offering …