Digital Commons Network^™

Discovering Secondhand Smoke Exposure Impact On Mental Illness: A Systematic Review & Meta-Analysis, Pooja Bhattarai, Bassema Abufarsakh, Chizimuzo T. C. Okoli

International Nursing Research Congress (INRC)

Background: SHSe remains a major global public health concern and contributes to preventable morbidity and mortality across populations (World Health Organization 2021). While SHSe is well recognized as a risk factor for cardiovascular and respiratory illness, emerging evidence suggests an association with MI and Substance use disorders (SUDs) (Carreras et al., 2019; Nadhiroh et al., 2020; U.S. Department of Health and Human Services, 2024; Van der Eijk & Woh 2023, Lee et al., 2025). Addressing SHSe requires acknowledging its impact and transforming new discovery about the complex factors contributing to MI into action that shapes the future of nursing research. …

Reliable Performance Analysis Of Polyurea Coatings Used In Offshore Wind Turbines, Yu-Chang Lin, Yen-Fu Liu, I-Ming Pan, Ming-Yuan Lin, Kang-Yu Liao, Hung-Hua Sheu, Hung-Bin Lee

Journal of Marine Science and Technology–Taiwan

This study explores the weather resistance, mechanical properties and corrosion resistance of polyurea coatings in marine environments. The relevant analysis results can be used as a reliability assessment of offshore wind turbine structural coatings during their service life under the influence of marine environments. The long-term experiment uses seawater and 70°C thermal aging conditions as coating reliability assessment items. The microstructure of the samples that have been immersed in seawater for a long time and thermally aged is observed using a scanning electron microscope (SEM). The results show that the surface of the 100 and 125 series polyurea coatings is …

Identifying The Causality And Criticality Of Factors Influencing The Promotion Of Asian Island-Hopping Cruise Tourism In Taiwan, Hsiao-Chuan Liu, Gin-Shuh Liang, Feng-Ming Tsai, Yu-Ling Lien

Journal of Marine Science and Technology–Taiwan

Following the COVID-19 pandemic, the global tourism industry has steadily recovered since 2022. Island-hopping cruises have gained increasing attention for enhancing regional connectivity and diversifying marine travel experiences; however, their development in Asia remains limited compared with that in Europe and the Caribbean due to fragmented policy coordination, inadequate port infrastructure, and uneven technological readiness. Although Taiwan possesses a geographic advantage and can serve as a strategic hub linking Asian island destinations, systematic planning and stakeholder coordination remain insufficient, resulting in unclear mechanisms that drive or constrain island-hopping cruise tourism. Existing studies mainly focus on market demand or passenger behavior, …

Technical Analysis And Market Liquidity In Sale-And-Purchase Transactions Of Second-Hand Oil Tankers, Chih-Chung Cheng, Po-Yin Wang, Heng-Chih Chou

Journal of Marine Science and Technology–Taiwan

In addition to using second-hand oil tankers to fulfil immediate shipping needs, shipowners can leverage price fluctuations in the tanker market to make vessel sale-and-purchase (S&P) transactions. Given that the profitability of vessel S&P transactions depends primarily on timing decisions, in this study, technical analysis was applied to identify the optimal transaction timing for 5-, 10-, and 15-year-old second-hand Aframax tankers. In a simulation, an S&P strategy based on technical analysis outperformed a benchmark buy-and-hold strategy, particularly for newer tankers, possibly due to the higher price volatility and lower market efficiency in the markets for these vessels. However, the lack …

Corrosion Testing And Simulation Of Taiwan Offshore Wind Foundations, Yao-Hung Fan, Yen-Fu Liu, I-Ming Pan, Chih-Chung Wen, Hsiu-Chen Yeh, Chien-Ming Lo, Tai-Liang Kuo, Hung-Hua Sheu, Hung-Bin Lee

Journal of Marine Science and Technology–Taiwan

Taiwan is located in the subtropical zone, with high relative humidity and high salinity in the air, and there are marine organisms attached to structures in the sea. This study will analyze the durability of the corrosion structure materials of the underwater foundation of offshore wind turbines based on the local chemical environment and paint materials. The offshore wind turbine underwater infrastructure is placed in the small boat dock area of the National Taiwan Ocean University in Taiwan. Nine kinds of coatings certified by NORSOK M501 were used to prepare specimens, and the metal exposure test was carried out by …

Synchronous Deep Reinforcement Learning For Optimized Storage Assignment Of Ship Blocks, Gawon Lee, Jaehyeon Heo, Misung Kim, Hyerim Bae

Journal of Marine Science and Technology–Taiwan

This paper presents a deep reinforcement learning (RL) framework for optimizing block storage allocation in shipbuilding yards. During the shipbuilding process, vessels are constructed in block units to maximize the operational efficiency. Following assembly, these blocks must be stored in limited yard spaces, creating a complex variant of the binary packing problem. This storage allocation problem is further complicated by operational constraints, including the barge capacity and transportation time restrictions. Moreover, poor storage decisions can lead to redundant block movements, which can adversely affect downstream processes and increase operational costs. To resolve this problem, a policy-gradient-based synchronous RL model was …

A Resilience Early Warning Assessment Of The Maritime Supply Chain: A Case Study Of China’S New Energy Vehicle Exports, Xiuqian Chen, Liangyong Chu, Mengyao Wang, Jiayin Du, Yiming Zhang, Xiyao Xu

Journal of Marine Science and Technology–Taiwan

Enhancing resilience through early warning is a critical strategy for mitigating disruption risks in the maritime supply chain (MSC). This study proposes a novel early warning assessment framework to determine the resilience of the MSC. It is referred to as a resilience early warning system. An evaluation index system for shipping enterprises is developed based on four dimensions: withstand capacity, adaptive capacity, learning capability, and the external environment. A resilience assessment model that uses the Bayesian best-worst method (BBWM) and the extension cloud model (ECM) is established to quantify MSC resilience. An early warning evaluation model based on a Bayesian …

Public-Port Throughput As An Activity Proxy For Near-Port Air Quality And Health: A Transferable Two-Scale Framework (Kaohsiung, 2017–2024), Ping-Jen Wang, Ying-Lin Hsu, Shih-Hao Chang, Bao-Tzung Wu

Journal of Marine Science and Technology–Taiwan

We developed a two-scale time series framework using monthly container throughput (20-foot equivalent units, TEU) as a port activity indicator. Applied to Kaohsiung, Taiwan (2017–2024), we related TEU to near-port NO₂ and PM₂.₅ (monthly) and air quality to outpatient respiratory diagnoses (weekly) across the 2019–2020 sulfur rules and the COVID-19 pandemic. Transfer-function models indicate TEU tends to lead near-port NO₂ by 6–9 months. Structural break tests at policy dates indicate nonsignificant changes in levels and slopes, suggesting gradual rather than abrupt shifts in the activity–pollution linkage. Weekly two-pollutant distributed-lag Poisson models estimated relative risks (lags 0–8) per interquartile range (IQR) …

Fostering And Maintaining Relational Trust Between Massachusetts Public School Superintendents And Their School Committees, John J. Robidoux

Educational Studies Dissertations

ABSTRACT

The effectiveness of public school governance in Massachusetts relies on the collaborative partnership between superintendents and elected school committees. However, school committee members often lack professional backgrounds in education, leading to role confusion, political friction, communication breakdowns, and a reduced ability to develop and maintain effective relationships with the superintendent. While the structural roles of these entities are well-defined by policy, there is limited research on the internal, lived experiences of district leaders navigating the multifaceted dynamics of relational trust as they relate to effective school district operations. This study addresses the gap in understanding how relational trust is …

Creating Collaborative Strategies: The Influence Of Principal Leadership In Teacher Retention In Rural Secondary Schools In Dhalai District, Tripura, Northeast India., Valerian Castelino

Educational Studies Dissertations

Teacher retention has become a growing concern across India and the world. In rural, tribal, and multilingual contexts, the challenge is even greater. This research, Creating Collaborative Strategies: The Influence of Principal Leadership in Teacher Retention in Rural Secondary Schools in Dhalai District, Tripura, Northeast India, explores how school leadership influences teachers’ decisions to remain in rural schools. The research focuses on Tripura, a small state in Northeast India known for its tribal diversity, geographic isolation, multilingual classrooms, and limited educational resources. The research is informed by a multi-theoretical framework: Herzberg’s Two-Factor Theory, Non-Economic Capital Theory, and Transformational Leadership …

Waste Heat Driven Direct Contact Membrane Desalination Coupled With Reverse Brayton Cycle: Techno-Economic Analysis And Multi-Objective Optimization, Erfan Ghamati, Mehdi Khiadani, Barun K. Das

Research outputs 2022 to 2026

This research examines the integration of a reverse Brayton cycle (RBC) used in a hydrogen liquefaction plant with a direct contact membrane distillation (DCMD) system for waste heat recovery and freshwater production. Waste heat from RBC compressors is used to run the DCMD plant, with parametric analysis evaluating the effect of feed Reynolds number, permeate mass flow rate, module length and pinch temperature of heat exchangers on thermal and economic performance of the hybrid system. Both parallel and series multi-stage DCMD configurations are compared with higher feed and permeate flow rates enhancing the temperature polarisation coefficient and permeate flux. A …

Evaluating The Readability Of Online Patient Education Materials For Avascular Necrosis, Gabriella B. Smith, Grady H. Hofmann, Anna V. Gussner, Nicole S. Pham, Nneoma O. Duru, Kevin G. Shea

Journal of Patient-Centered Research and Reviews

Purpose: Avascular necrosis (AVN) is a progressive pathology affecting pediatric and adult patients. Given the risks of joint collapse and surgery, patients frequently research their condition online. The average reading level in the United States is approximately the eighth-grade level. The National Institutes of Health (NIH) recommend that patient materials be written at or below a sixth-grade level. This study aimed to assess the readability and quality of online AVN resources.

Methods: A Google search using the terms “avascular necrosis” and “osteonecrosis” was conducted, and firstpage results were aggregated. Flesch-Kincaid Grade Level, Gunning Fog Index, and Flesch Reading Ease tests …

A Mixed Methods Study Of Inpatients’ Experiences, Priorities, And Health-Related Quality Of Life During High- Flow Nasal Cannula Therapy, Cintamani H. Ellsworth, Rebecca S. Bartlett

Journal of Patient-Centered Research and Reviews

Purpose: High-flow nasal cannula (HFNC) is an oxygen delivery method with numerous benefits for severely ill patients. There is a paucity of research focused on the perspectives of patients receiving HFNC oxygen therapy. This study aimed to engage with patients to gain a clearer understanding of their experiences, priorities, and health-related quality of life.

Methods: A cross-sectional, mixed methods study was completed with 10 adult inpatients who had received HFNC oxygen therapy during their hospital admission. Semi-structured interviews and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to identify participant perceptions of their physical and …

Under Pressure And Underrecognized: The Role Of Social Workers And Case Managers In Screening For Social Determinants Of Health In The United States, Melissa L. Habrat, Lindsay D. Nelson, David A. Nelson

Journal of Patient-Centered Research and Reviews

Social determinants of health (SDOH) screening is increasingly embedded in clinical care, yet the work of asking, documenting, and responding to social needs often falls to social workers and nurses or professional case managers who operate under significant time, staffing, and system constraints. We conducted a narrative review to examine how SDOH influence outcomes, identify systemic and emotional barriers to effective screening, and synthesize evidence-informed strategies that support implementation. Across included sources, findings clustered into three domains: challenges in integrating screening (policy and accreditation pressure, staffing and resource constraints, EHR documentation and interoperability limits, closed-loop referral and cross-sector partnership gaps, …

Joy To The Rehabilitation World: A Call To Incorporate Enjoyment Into Clinical Practice, Cristina Colón-Semenza, Raymond Jones, Winston Kennedy

Journal of Patient-Centered Research and Reviews

Although multiple academic disciplines recognize the motivational power of joy, rehabilitation professionals have, historically, underemphasized this construct in clinical practice. In addition, many clinicians report persistent challenges in motivating patients to adhere to prescribed exercise regimens. In response, there is growing advocacy for integrating affective-based interventions into practice. This overview aims to 1) raise awareness among rehabilitation professionals about the role of joy in physical rehabilitation, 2) illustrate how joy influences physical activity engagement and recovery outcomes, 3) outline evidence-based strategies for enhancing joy in clinical settings, and 4) introduce validated measures of joy suitable for use in practice. By …

A Reflection On Growing Up With Hyperacusis, Jemma-Tiffany Rosewater, Katherine Melton

Journal of Patient-Centered Research and Reviews

I, the first author, explore here my personal experiences growing up with severe hyperacusis pain, a rare condition that significantly affected my childhood but also gave me a deeper understanding of how medical professionals interact with children. I discuss the many ways my condition was dismissed or misunderstood by doctors, and I examine the broader negative implications that this dismissal had on both my physical health and day-to-day life. This article also emphasizes the power and sway that the words of medical professionals hold compared to the voices of children. I reflect on how outdated yet common misconceptions about hyperacusis, …

Scaling Learning Health Systems: Highlights From The 2026 Health Care Systems Research Network Annual Conference, Deborah Hamlin

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network convened for its 2026 Annual Conference on April 21– 23 in Dallas, Texas, at the Sheraton Dallas Hotel. The conference centered on the theme, “Scaling Learning Health Systems: Data-Driven Pathways to Better Outcomes,” featuring 99 peer-reviewed abstract and panel presentations, along with 21 poster presentations, and emphasized the growing role of collaborative, data-enabled research in transforming care delivery and improving patient outcomes.

Abstracts From The 2026 Health Care Systems Research Network (Hcsrn) Annual Conference, Dallas, Texas, Health Care Systems Research Network

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network (HCSRN) comprises 18 learning health systems with integrated care delivery and embedded research units. The network’s annual conference serves as a forum for research teams from member institutions to disseminate project findings, explore scientific collaborations, and share insights about population-based research practices that can measurably improve health and health care for all. The theme of this year’s conference was “Scaling Learning Health Systems: Data-Driven Pathways to Better Outcomes.” Abstracts presented at HCSRN 2026 are published in this issue supplement of the Journal of Patient-Centered Research and Reviews, the journal of record for HCSRN’s annual …

A Micro-Computed Tomographic Evaluation Of Root Canal Isthmuses In Maxillary And Mandibular First Molars Of A Black South African Population, Casper Jonker, Anna Catherina Oettlé

Peninsula Dental School

Objective:To evaluate root canal isthmuses in maxillary and mandibular first molars of Black South Africans usingmicro-computed tomography.Methods:The prevalence, location (root third) and type of isthmuses were recorded on 93 maxillary and 84mandibular first molars from 116 skeletonized individuals. Associations with arch side, sex and age were examined bychi-squared test, with strength of association given as the bias-adjusted Cramér’s V and 95% confidence interval (CI).Reliability used percentage agreement and Cohen’s kappa (κ) coefficient.Results:Intra- and inter-observer agreement were excellent: 96.73% (κ= 0.90) and 97.78% (κ= 0.95) for themaxillary teeth and 94.12% (κ= 0.75) and 96.08% (κ= 0.94) for the mandibular teeth. Apical …

Book Review: Arming East Asia: Deterring China In The Early Cold War, Richard H. Immerman

Parameters Bookshelf – Online Book Reviews

Author: Eric Setzekorn

Reviewed by Richard H. Immerman, emeritus professor of history, Temple University

Covering American policy toward Asia in the Harry S. Truman and Dwight D. Eisenhower administrations, Arming East Asia: Deterring China in the Early Cold War looks to “enhance the historical sensibilities of contemporary policymakers, thereby enabling them to make informed—and by implication, better—decisions as the United States again confronts an aggressive China in the twenty-first century,” according to the reviewer. It focuses on the years 1952–60, though offers no “surprises for informed readers.”

Copyright: ©2026 Richard H. Immerman

Book Review: Warfare In Peacetime: Proxies And State Powers, Scott Heal

Parameters Bookshelf – Online Book Reviews

Author: Christopher C. Harmon

Reviewed by Scott Heal (US Army)

Warfare in Peacetime: Proxies and State Powers defines proxy, lists the advantages and disadvantages of using proxies, and offers seven case studies, including the USSR and East Germany, the United States and the Nicaraguan Contras, and Iran and Hezbollah. The reviewer notes, “those studying limited warfare or the challenges in understanding and addressing gray-zone activities will find Harmon’s framework and analysis practical and informative.”

Book Review: Nexus: A Brief History Of Information Networks From The Stone Age To Ai, David R. Leard

Parameters Bookshelf – Online Book Reviews

Author: Yuval Noah Harari

Reviewed by Colonel Daniel R. Leard, US Army War College Fellow at Princeton University

Built on the ideas that stories are important and bind civilizations, which results in human societies working as information networks, Nexus: A Brief History of Information Networks from the Stone Age to AI, by Yuval Noah Harari, is the third book exploring the evolution of humanity. Harari unpacks the idea that the networks people create have flaws and people tend to exploit these flaws to misuse power. Though the topic is heavy, the reviewer notes, Harari “presents deeply complex issues in …

Book Review: Death, Dominance, And State-Building: The Us In Iraq And The Future Of American Military Intervention, Connor Halliday

Parameters Bookshelf – Online Book Reviews

Author: Roger D. Petersen

Reviewed by Major Connor Halliday (US Army), instructor of international affairs at the United States Military Academy

Death, Dominance, and State-Building: The US in Iraq and the Future of American Military Intervention, by Roger D. Petersen, analyzes America’s strategy in Iraq over the last 20 years and offers lessons learned for future US military interactions and state-building ventures. Reviewer Connor Halliday notes, “Military practitioners, strategists, and scholars of civil wars and state-building will all find Petersen’s work insightful and thought-provoking. The book’s value lies not just in its analysis of Iraq, but in its broader lessons …

Tarsal Tunnel Syndrome Due To Post-Traumatic Osseous Tunnel Formation: A Rare Case And Surgical Management, Dev Y. Patel, Eshan Doshi, Fiona Zimmerman, Jamal Revolus, Michael Kimball, Michael Franco

Cooper Rowan Medical Journal

Tarsal tunnel syndrome (TTS) is classically a compressive neuropathy of the posterior tibial nerve beneath the flexor retinaculum, presenting with plantar foot pain and paresthesias. Standard surgical management of TTS involves release of the flexor retinaculum to decompress the nerve. We report a rare and unusual case of TTS in which the posterior tibial nerve was encased within a post-traumatic osseous tunnel accompanied by dense fibrotic tissue, representing an atypical and previously undescribed etiology of nerve entrapment. In this case, surgical decompression required a modified approach involving meticulous dissection of the tibial nerve from its encasement by heterotopic ossification and …

Evaluating Medical Student Geriatric Competency Using A 5ms-Based Assessment Tool, Lauren R. Hersh Md, Amy Cunningham Phd, Mph, Xiya Wu Md

Cooper Rowan Medical Journal

INTRODUCTION

Driven by an aging Baby Boomer generation, the United States is navigating a demographic transformation with far-reaching implications that include increased demand for chronic disease management and long-term care as well as increased stress on both healthcare costs and infrastructure. Generating a workforce competent in the delivery of care to older patients with complex, multimorbid conditions is fundamental to addressing this shift. Recognizing that the development of primary and specialty care physicians skilled in geriatric care begins in medical school, the American Geriatric Society developed minimum competencies grounded in the Geriatric 5Ms (Mind, Mobility, Medication, Multicomplexity, and …

Understanding Continuity Of Care Through The Voices Of. Providers And Families In Massachusetts, Ami Patel

Educational Studies Dissertations

Continuity of care is an important component of early childhood education that emphasizes stable, consistent, and responsive relationships among children, caregivers, and families. Although research has demonstrated the importance of stable caregiver-child relationships, much of the existing literature has focused on center-based childcare settings. This qualitative study explored how providers and families perceived long-term caregiving relationships, communication practices, and family-provider partnerships as shaping continuity of care. The purpose of this study was to examine licensed family childcare providers’ and families’ perspectives regarding the perceived developmental benefits, relational experiences, and challenges associated with continuity of care. Guided by attachment theory, sociocultural …

The Perceptions Of K-5 Teachers Regarding Their Preparedness To Implement Trauma-Informed Practices, Matthew P. Londo

Educational Studies Dissertations

Childhood trauma significantly impairs students' cognitive, emotional, and behavioral functioning, yet teachers frequently lack the preparation necessary to address its effects in classroom settings. This mixed-methods study examined the perceptions of K-5 teachers regarding their preparedness to implement trauma-informed practices (TIPs) at a public elementary school in a mid-sized urban district in central Massachusetts. A convergent mixed-methods design was employed to gather data from 20 selected K-5 educators via a structured Likert-scale questionnaire and semi-structured Zoom interviews. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed through inductive thematic analysis. Findings revealed that participants employed four primary …

Guardians In Orbit: Legal Justifications And Limits Of Defensive Satellite Operations, Yurika Ishii

International Law Studies

The deployment of “bodyguard satellites”—spacecraft designed to autonomously detect and counter hostile space objects—has moved from classified capability development to explicit national security policy across a growing number of States. This article examines the circumstances under which interference with another State’s satellite may be legally justified under international law, analyzing several possible grounds: self-defense under Article 51 of the UN Charter, forcible countermeasures, non-forcible countermeasures, and necessity. Drawing on a survey of national space defense policies, jurisprudence of the International Court of Justice, and the law of State responsibility, the article reaches two principal conclusions. First, across all justificatory frameworks, …

On The Origins Of Western Religion And Thought: How Do We Get Home?, The Philosophical Discussion Group

The Philosopher's Stone

• On the Origins of Western Religion and Thought: How do we get Home?

Medical Debt Among Low-Wage Workers In The United States: Reason To Worry And Reason To Hope, Mathieu Despard, Stephen Roll, Eva Stahl, Camila Salvagno

Center for Social Development Research

With one in five low-wage workers reporting medical or dental debt they cannot afford to pay, financial assistance programs (also known as charity care) are an important resource. Federal law requires nonprofit hospitals to offer such programs, but evidence suggests that workers experience administrative burdens in learning about and applying for the assistance. Drawing upon data from the Workforce Economic Inclusion and Mobility (WEIM) survey, this brief presents findings on associations between the characteristics of low-wage workers and their experiences with financial assistance programs. The brief also shares examples of how hospital policies and patients’ needs may not align, presenting …