University of Tennessee Institute of Agriculture
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(De)Touring Hawai\u27i Through Popular Media
No full textUnder the United States’ colonization of Oceania, literature and media have been among the primary methods in both establishing and perpetuating American occupation of the Hawaiian Islands. This dissertation argues for the decolonization and deoccupation of Hawaiʻi in (American) popular culture, establishing a DeTour/tour continuum through which to read representations of the Hawaiian Islands in popular media. Through readings of film, television, famous persons such as Jason Momoa, contemporary poetry and novels, and the writer’s own creative work, this dissertation seeks to establish new avenues of existing in and reading representations of Hawaiʻi for both Hawaiians, locals to Hawaiʻi, and outsiders
Necessary Components of a Social Emotional Learning Program for Rural Elementary School Counseling: A Delphi Study
No full textRural students and school counselors remain underexplored within school counseling and social-emotional learning literature. Rurality includes geographical and cultural nuance that may impact how professional school counselors engage in aspects of their comprehensive school counseling programming to meet the needs of all students served. The first manuscript consists of a PRISMA scoping review (Tricco et al., 2018) of 56 empirical studies and dissertations that explored the service delivery of rural school counselors in alignment with the American School Counselor Association (ASCA) focus areas of college and career, social emotional, and academic domains. The review suggested that studies less frequently showcased how the rural cultural context was intentionally addressed in service provision, services that aligned with social emotional learning were more prevalent, and classroom guidance and collaboration were among the most frequently highlighted services within the literature. The manuscript outlines implications, including the need for continued exploration to examine how rural cultural context intersects with rural PSC program development. Based upon these findings, manuscript two includes a Delphi study with a panel (n = 12) of experienced rural elementary school counselors nationwide. The purpose of the study was to examine the necessary components of a social emotional learning program for rural elementary school counseling. This process resulted in the development of 131 unique items broken down into three overarching domains: creating and delivering, creating, and delivering. These items constitute the necessary elements of creating and delivering a rural elementary school counseling social emotional learning program. The author discusses implications for school counselor preparation and training, such as how working within a rural setting may impact the selection and implementation of evidence-based practices within counselor training courses. Furthermore, implications for future research are shared
Enhancing Follow-Up Care: Implementing Routine Depression Screenings in Primary Care Visits
Get PDFBACKGROUND: Depression is a prevalent mental health condition, often underdiagnosed in rural areas such as Appalachia, where access to behavioral health services is limited. National guidelines from the United States Preventative Services Task Force recommend routine depression screenings for adults; however, inconsistent implementation in primary care may delay diagnosis and treatment. The PHQ-9 tool has been proven effective for early detection of depression and improving patient outcomes when routinely applied in clinical settings.
LOCAL PROBLEM: A rural primary care clinic in East Tennessee lacked a standardized process for administering the PHQ-9 during follow-up visits, resulting in missed opportunities to detect worsening or newly developed depression. Although new patients were routinely screened, follow-up assessments were inconsistently performed. The purpose of this project was to implement a routine PHQ-9 screening process during follow-up appointments to improve early depression identification, increase access to community resources, and improve timely, appropriate referrals.
METHODS: The Johns Hopkins Evidence-Based Practice Model guided project implementation. Retrospective baseline data on PHQ-9 usage and referrals were collected. Interventions were developed using evidence-based literature, staff input, and tested through PDSA cycles. Data was analyzed using Microsoft Excel to evaluate changes in screening rates and referrals.
INTERVENTIONS: The intervention included PHQ-9 form distribution throughout the clinic, an educational session, and later integration of the PHQ-9 into the EMR following low initial compliance. Ongoing staff training and workflow adjustments supported sustained practice change.
RESULTS: Screening compliance increased from 49% to 93.5%. A statistically significant improvement in screening was observed (p \u3c 0.001). There were 29 total referrals during implementation compared to 3 total referrals in retrospective data collection.
CONCLUSIONS: Routine PHQ-9 screening improved depression detection and mental health referrals. Continued staff training, EMR prompts, and expansion to other clinic sites are recommended for sustainability and broader impact
Beyond Dependencies: The Role of Copy-Based Reuse in Open Source Software Development
Get PDFIn Open Source Software, resources of any project are open for reuse by introducing dependencies or copying the resource itself. In contrast to dependency-based reuse, the infrastructure to systematically support copy-based reuse appears to be entirely missing. Our aim is to enable future research and tool development to increase efficiency and reduce the risks of copy-based reuse. We seek a better understanding of such reuse by measuring its prevalence and identifying factors affecting the propensity to reuse. To identify reused artifacts and trace their origins, our method exploits World of Code infrastructure. We begin with a set of theory-derived factors related to the propensity to reuse, sample instances of different reuse types, and survey developers to better understand their intentions. Our results indicate that copy-based reuse is common, with many developers being aware of it when writing code. The propensity for a file to be reused varies greatly among languages and between source code and binary files, consistently decreasing over time. Files introduced by popular projects are more likely to be reused, but at least half of reused resources originate from “small” and “medium” projects. Developers had various reasons for reuse but were generally positive about using a package manager
Targeted Temperature Management to Improve In-Hospital Cardiac Arrest Outcomes in the Pediatric Intensive Care Unit
Get PDFBACKGROUND: Targeted temperature management (TTM) is a critical element of post-cardiac arrest care pathways. Active prevention of hyperthermia and maintenance of normothermia is a TTM strategy associated with improved outcomes.
LOCAL PROBLEM: Our institution failed to initiate TTM within 12 hours after resuscitation. The project’s purpose was to implement TTM for in-hospital cardiac arrest (IHCA) patients in the Pediatric Intensive Care Unit. The project aims were for (1) ≥80% of IHCA patients to receive orders for TTM within one hour of ROSC and (2) ≥80% of IHCA patients to be placed on a homeothermic blanket within two hours of ROSC.
METHODS: The Evidence-Based Process Improvement model was utilized as the framework. A TTM protocol was implemented through Plan, Do, Study, Act cycles. Process measures included adherence to TTM order entry, homeothermic blanket use, and core temperature monitoring. Outcome measures included temperature recordings and PICU length of stay, survival, and morbidity.
INTERVENTIONS: Resources were created to support computerized order entry and homeothermic blanket machine use. They were linked to QR codes that were attached to each homeothermic blanket machine. A recorded PowerPoint presentation was shown to staff weekly.
RESULTS: There was a total of eight IHCA patients during the project timeline. Initial TTM order adherence and core temperature monitoring were 75%, with 0% homeothermic blanket adherence. Homeothermic blanket use increased to 75% during the project’s second month despite no TTM orders. Temperature control improved with homeothermic blanket use (Tmax 37°C, Tmin 35.6°C vs Tmax 38.1°C, Tmin 33.1°C). PICU survival and discharge morbidity improved with homeothermic blanket use (66.7% for both vs 40% for both).
CONCLUSIONS: The scarcity of IHCA events makes initial adoption and sustained adherence to practice change challenging. A concurrent electronic medical record change and a blanket supply shortage complicated implementation. Despite systemic challenges, which must be addressed for sustained success, our results demonstrate that TTM with a homeothermic blanket improves temperature control and survival for pediatric IHCA patients
SUSTAINABLE SUPPLY CHAIN NETWORK DESIGN FOR RENEWABLE ENERGY
Get PDFThis study designs sustainable supply chain networks for renewable energy systems, focusing on carbon dioxide (CO2), hydrogen, and biomass. By integrating economic, environmental, and social factors, the research develops optimized networks to maximize efficiency and minimize costs.
For CO2, the study examines the techno-economic performance of CO2-to-fuel pathways, specifically the CO2-CO-FTS-fuel and CO2-methanol-fuel processes, within the U.S. A life cycle assessment quantifies environmental impacts. Results show that the FTS pathway is preferred at all selected refineries when hydrogen costs 8 billion annually while reducing emissions by 88.8 million tons. Sensitivity analysis highlights electricity and hydrogen prices as cost drivers. The CO2 recycle rate and higher conversion efficiency improve the cost-effectiveness of methanol pathways.
For hydrogen, the study evaluates three delivery pathways—gaseous hydrogen, liquid hydrogen, and ammonia—as carriers, based on costs and greenhouse gas emissions. Hydrogen demand is projected for 1,927 fueling station locations under various fuel cell electric truck (FCET) market penetration scenarios. To enhance computational efficiency, binary variables are replaced with integers. Results reveal the liquid hydrogen pathway as the most cost-effective, with a levelized cost of 2.62/gallon. Multi-feedstock biorefineries yield higher profitability and stable production. Policy recommendations emphasize public awareness and robust biomass supply chains for long-term BECCS viability.
This research provides actionable insights for developing efficient, sustainable renewable energy supply chains