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Perceived Value Incongruence in the Built Environment and Nurse Outcomes in Inpatient Behavioral and Psychiatric Care Settings: A Sequential Exploratory Mixed-Methods Study
No full textMany people who become nurses feel called to help others with high-quality, compassionate, empathetic care in alignment with the nursing profession’s core values. However, the reality of modern healthcare often conflicts with these values, leading many nurses to feel disheartened and drained, contributing to severe burnout, turnover, and dropout that plague health systems and harm patient care.
Person-environment (PE) fit is critical to well-being and satisfaction in nursing. Poor PE fit can involve conflicts between an employee’s abilities and job demands, inadequate resources to complete tasks, and more. It can also arise from incongruence between an employee’s values and aspects of their job. Studies show that nurses experience negative feelings and poor job outcomes – like burnout, role stress, dissatisfaction, intention to leave, and drop out – when they cannot provide care in alignment with their values. Although not always considered in PE fit or value alignment, built environments can provide affordances and resources that support fit, create fit-hindering demands and stressors, and communicate messages that can conflict with an organization’s or employees’ values. Such conflicts could be especially salient in behavioral care, where nurses must balance competing demands and ethical quandaries with few resources.
This sequential exploratory mixed-methods study investigated whether inpatient behavioral care nurses experience value incongruence or support in their built environments and how these experiences impact job outcomes. In-depth interviews with nurses at two hospitals in the Southeastern United States informed the creation of a nationwide survey that quantitatively assessed the impacts of perceived built environmental value support on burnout, turnover intention, and job satisfaction. The research findings and focus groups with nurses and design professionals inspired a new design toolkit to help healthcare organizations and designers plan, design, and evaluate inpatient behavioral care environments that align with nurses’ values, support their well-being and job outcomes, and ultimately benefit patient care and organizational objectives. Although many factors affect nursing, this study’s findings suggest that perceptions of value alignment in built environments tangibly impact nurses. The built environment is one tool that healthcare organizations can use to help improve nurses’ job outcomes, increase retention, and enhance patient care
Bifunctional Fusion Protein PDL1sFv/MICAe for Cancer Immunothearpy
Get PDFCancer immunotherapy has highlighted the importance of immune checkpoint blockade and innate immune cell engagement in battling tumor-mediated immune suppression in the past few decades. However, with cancer development, advanced tumors are often found to develop resistance towards single-target immunotherapy due to the complexity of the immunosuppressive mechanisms within the tumor microenvironment (TME). To address this, we developed a novel bifunctional fusion protein, PDL1sFv/MICAe, which combines the tumor-targeting capability of an anti-PDL1 single-chain variable fragment (sFv) with the NK cells immunostimulatory properties of the MICA extracellular domain.
In vitro functional assays revealed that PDL1sFv/MICAe significantly enhanced cytotoxicity towards natural killer (NK) cells against PD-L1 positive cancer cells despite minimal changes in IFN-γ or granzyme B secretion, suggesting that the PDL1sFv/MICAe promotes NK cell activation via non-canonical mechanisms. Similarly, cytotoxic T cells, which often exhibit suppressed function in PDL1–rich environments, showed rescued cytotoxicity upon treatment, independent of IL-10 regulation.
Post-treatment transcriptomic analysis of NK cells revealed significant upregulation of genes involved in signal transmission pathways rather than genes classically linked to cell-mediated killing or stress responses. These findings suggest a possible alteration in NK cell signaling dynamics in the observed functional enhancement in cytotoxicity.
Although no synergistic effect was observed in co-culture assays involving NK cells and cytotoxic T cells, the fusion protein effectively activated each cell type independently towards PDL1-positive cancer cells. These results highlight the therapeutic potential of PDL1sFv/MICAe as a dual-function protein capable of reactivating suppressed immune responses of T cells while inducing NK cell cytotoxicity within the TME.
By engaging both adaptive and innate immunity, PDL1sFv/MICAe represents a promising strategy for improving immunotherapy outcomes in solid tumors resistant to conventional treatments
From Pencil to Pixel: How Leadership Shapes Organizational Responses To Competence-Destroying Technological Change
Get PDFThis dissertation examines how managerial leadership enables organizations to overcome inertia during competence-destroying technological change through a historical comparative case analysis of the animation industry\u27s transition from hand-drawn to computer-generated imagery (CGI) between 1980-2000. Drawing on archival data from Disney, Pixar, and Don Bluth Studios, I identify three distinct leadership approaches—pioneering, bridging, and preserving—that differently influenced how workforces adjusted their views of identity, process, and change. These adjustments led to three different outcomes: transformative integration, constrained adoption, and entrenched resistance. This research makes three theoretical contributions and develops a novel framework that explains how leadership can constrain or enable transformation, particularly in mature, legacy-rich industries confronting disruptive innovation. First, it extends embedded agency theory by demonstrating how central actors can successfully drive competence-destroying change. Second, it advances organizational inertia literature by identifying specific leadership mechanisms that enable successful technological transitions despite deeply embedded capabilities. Third, it contributes to technological change research by revealing how organizations can navigate process-focused transformations that maintain existing products while revolutionizing production methods. The findings have implications for organizations currently grappling with transformative technologies like artificial intelligence, suggesting how leaders can facilitate technological adoption while preserving core capabilities
Mathematics Achievement: The Impact of Cooperative Learning Strategies on Math Anxiety and Self-Efficacy Among Adult Basic Education Students
Get PDFMany adult basic education (ABE) students struggle to pass the mathematics portion of the GED, limiting their access to educational and employment opportunities. This Dissertation in Practice addressed the problem of low math achievement at the New Beginnings Adult Learning Center by implementing cooperative learning strategies aimed at reducing math anxiety, increasing self-efficacy, and promoting student engagement.
Grounded in the principles of improvement science, the eight-week intervention introduced daily Think-Pair-Share routines during math instruction. The goal was to create a more supportive classroom environment where students felt encouraged to participate and build confidence in their math skills. Data were collected through pre- and post-intervention surveys measuring math anxiety and self-efficacy, GED Ready test scores, daily student engagement exit tickets, and instructor anecdotal notes.
The findings showed increased student engagement, a greater willingness to participate in collaborative learning, and improvements in both self-efficacy and math anxiety scores. Heat maps were used to track individual engagement patterns over time, while bar charts illustrated shifts in GED math readiness and survey results. Instructors also observed positive behavioral changes, including students initiating math-related peer discussions.
Although cooperative learning structures have been widely studied in K–12 settings, this study adapts and applies these strategies to an adult basic education context. It offers new insights into how cooperative learning routines, such as Think-Pair-Share, can support adult learners who often face unique challenges.
This study contributes to the limited body of research on adult basic education math instruction by demonstrating the potential of cooperative learning to address barriers. These findings suggest practical strategies ABE instructors and program leaders can use to foster supportive classrooms that strengthen student engagement and build the self-efficacy needed for success in math
From Collaboration to Achievement: Exploring Co-teaching as a Strategy to Close the Gap in Mathematics for Students With Disabilities
Get PDFThis study addressed the persistent achievement gap in Algebra 1 for students with disabilities (SWD) at Popular High School (PHS), a rural high school within Sweet County School District (SCSD). In response to historical underperformance on the South Carolina Algebra 1 End-of-Course (EOC) assessment and the school’s designation for Additional Targeted Support and Improvement (ATSI), the district piloted a co-teaching intervention to provide more inclusive and supportive instruction for SWD. In this context, co-teaching refers to a collaborative instructional model in which a general education and a special education teacher share responsibility for planning, delivering, and assessing instruction in the same classroom.
Grounded in the principles of improvement science, the intervention was implemented using a Plan Do Study Act (PDSA) cycle. During the planning phase, the research team selected two Algebra 1 sections for co-teaching based on IEP data, student needs, and staffing capacity. Teachers were paired according to collaboration skills and participated in targeted professional development provided by Solution Tree. Students and parents were informed of the model, and participation included student self-efficacy surveys and classroom observations.
The intervention officially began in January 2025 during the district’s second semester block schedule. Data were collected from multiple sources to evaluate the implementation and outcomes of the co-teaching model. These sources included baseline and follow-up student self-efficacy surveys, structured classroom observations, and teacher interviews and surveys. Observations were used to document the co-teaching models in use, student engagement, differentiation practices, and the overall classroom environment. The special education teacher also completed reflective activities to assess professional growth and instructional collaboration.
Findings revealed several key outcomes. First, classroom observations showed a transition from the “one teach, one assist” model to more balanced strategies such as parallel teaching and station teaching by the middle of the semester. These shifts coincided with increased student engagement, more individualized instruction, and stronger collaboration between teachers. Second, the special education teacher reported increased confidence in instructional delivery and growth in co-teaching practices. Third, students remained enrolled in the co-taught sections during the drop/add period, suggesting early acceptance of the model.
The results indicate that co-teaching has the potential to improve instructional access and support for SWD in high school mathematics. While challenges such as pacing and balancing content coverage with individualized support were noted, no major negative effects or unintended consequences were reported. The study highlighted the importance of pre-implementation planning, role clarity, and sustained collaboration as essential factors for success.
The intervention aligned with the district’s broader goals of expanding access to rigorous instruction and inclusive service delivery. It has also informed planning for future improvement cycles. Based on initial results and strong teacher and student engagement, the district is considering expanding co-teaching models to additional schools and subject areas. This study contributes to the growing body of research on inclusive practices in secondary education and offers a practical model for rural districts seeking to close achievement gaps for students with disabilities
Evaluating the Impact of Medicaid Expansion on Non-Small Cell Lung Cancer Care and Health Disparities
Get PDFPersistent disparities in non-small cell lung cancer (NSCLC) outcomes reflect broader structural inequities shaped by race, place, and socioeconomic conditions. This dissertation examined trends in NSCLC outcomes over the past two decades and evaluated the impact of Medicaid Expansion (ME) under the Affordable Care Act on improving outcomes and reducing disparities, especially in marginalized communities.
Using nationally representative datasets, three interrelated studies were conducted. The first assessed trends in NSCLC incidence, early-stage diagnosis, and 3-year survival from 2002-2021, stratified by metropolitan status, deprivation (Social Deprivation Index), and segregation (Index of Concentration at the Extremes). While incidence declined and early-stage diagnosis and survival improved overall, disparities persisted, particularly in rural, deprived, and segregated areas.
The second study used difference-in-differences models to evaluate ME’s effects on insurance coverage, early diagnosis, and survival among NSCLC patients aged 18-64 from 2009 to 2019. ME was associated with significant gains in coverage (+2.21 ppt), early diagnosis (+1.76 ppt), and 3-year survival (+1.81 ppt), with notable improvements in segregated communities and among non-Hispanic Whites.
The third study analyzed county-level mortality data from 2008 to 2019 to assess ME’s impact on all-cause and cause-specific mortality. ME was linked to reduced all-cause mortality (-2.97 per 100,000) and significant declines in mortality from heart disease, chronic respiratory disease, and homicide, especially in highly segregated counties.
Overall, findings show that while NSCLC outcomes have improved nationally, disparities remain. Medicaid expansion contributed meaningfully to improving NSCLC outcomes and reducing mortality, particularly in segregated communities, highlighting its value in advancing health equity
Alternative Therapeutics for Human Breast Cancer: Nutraceutical Underpinnings, in Vitro Metabolomic Profiling, Treatment Efficacy, and Contextual Ethical Implications
No full textBreast cancer remains one of the most prevalent diseases worldwide, yet therapeutic equity is still lacking. Standard treatments including surgery, radiotherapy, chemotherapy, and long-term hormone therapy. These approaches are often accompanied by significant side effects. While newer methods such as immunotherapy and targeted therapies have emerged, chemotherapy protocols and incorporation have remained largely unchanged in the past decades. In this context, nutraceuticals represent an alternative or adjuvant to therapy worthy of exploration. The reviewed literature highlights the anti-carcinogenic activity in selected nutraceuticals, marjoram, thyme and persimmon, considering their phytochemical constituents and secondary metabolites. Metabolomic profiling using the Biolog Phenotype Mammalian Microarray (PM-M) system reveals unique metabolic fingerprints of breast cancer cells, both at baseline and in response to chemotherapy (doxorubicin). The analysis includes breast cancer subtypes derived from primary tumor origins, metastatic sites, and those defined by molecular features including strong estrogen and progesterone-positive, and triple-negative status. Plates PM-M1 to PM-M4 reveal distinct patterns energy utilization from sole sources present in the well. Plates PM-M5 to PM-M-8 evaluate the cellular responses to effectors such as hormones, growth factors and ions in a dynamic response measuring capacity. In these last plates, the breast cells have the same uniform energy source, glucose. These findings reveal subtype-specific metabolic shifts, suggest preliminary biomarkers, and set the stage to test other therapeutics and their effects on healthy cells, such as the selected nutraceuticals. Nutraceuticals may play a pivotal role in expanding access to more affordable, safer, and standardized treatment options. From an ethical standpoint, promoting research in this area aligns with efforts to advance therapeutic equity by expanding access to therapeutics and comprehensive care for breast cancer patients. A health policy framework is proposed, encompassing a breast cancer task force, an online access tool, and integration of research into care. This offers a path in the backdrop of an urbanizing United States towards unifying the delivery of rural and urban breast cancer care. Nutraceuticals are revealed through this body of work to have a multitude of positive biological effects and promising anticancer properties; the metabolomic findings presented include distinct subtype-specific therapeutic signatures and biomarkers, and the ethical analysis supports a pathway toward equitable, globally applicable breast cancer treatment
Communicators in Crisis: Lessons Learned From Communications Professionals During the Great Resignation
Get PDFThis study investigated the experiences of communication professionals who participated in the Great Resignation phenomenon between 2020-2022. The research questions focused on the role participants’ working relationship with leadership as it related to their decision to leave their role or pursue a new job. Ten communication professionals participated in a qualitative study comprising of an online interview discussing their experiences during the Great Resignation. Using the interview transcripts, the researcher employed grounded theory to extract recurring codes and draw conclusions based on the participants’ answers. The results of this study inform recommendations for improved working relationships between communication professionals and leadership
Modeling Disaster Resilience through A Human-Centered Lens: Exposure, Vulnerability and Adaptation
No full textThe core of reframing and operationalizing disaster resilience with a human-centered lens is to incorporate concepts from socio-ecological resilience into engineering resilience to better understand the humans’ capability for disaster adaptation. Existing studies have drawn practical implications by identifying actionable thresholds for infrastructure systems under disasters, which can be easily applied by policymakers, emergency managers and municipal agencies. However, how individuals interact with, respond to, or adapt under these infrastructure thresholds remain understudied. This hinders the operationalization of disaster resilience at the human scale.
First, I examined exposure by analyzing how configuration and distribution of urban infrastructure systems, such as tree cover, roads and buildings, contribute to the heat exposure. I developed a physic-informed deep learning model to quantify spillover effects within urban systems, which allows planners and policymakers to identify the most effective heat mitigation strategies across five U.S. cities.
Second, I assessed economic vulnerability of households under consecutive heavy rainfall in the hot-humid southeastern U.S., with a focus on understanding how economic hardships accumulate as the frequency of heavy-to-extreme rainfall events increases. By constructing a precipitation-hardship curve, it allows us to predict future population vulnerabilities over region. The findings of this study can inform disaster managers in developing proactive strategies, such as targeted financial support, before households reach critical tipping points and become trapped in prolonged economic hardships.
The third study investigates how household adapt under two consecutive tropical storms. We developed a novel hybrid framework that integrates random forest-derived insights into binary logit models to uncover how infrastructure disruptions interact with socioeconomic conditions of households to shape their adaptation decisions. This method is robust to “small-n-large-p” settings (such as insufficient survey responses) and can handle multicollinearity. This makes it suitable for behavioral studies using survey data with limited observations and highly correlated variables. It offers a robust and replicable methodology for future studies that aim to improve the understanding of human interactions with infrastructure systems
Three Essays on Mental Health Courts
Get PDFMental illness in the criminal justice system is a major issue, with 2 in 5 incarcerated people in the US having a serious mental illness (Criminalization of People with Mental Illness, n.d.). Prisons have turned into “de facto” mental health facilities when these facilities are not equipped to do so. This means once individuals are released from incarceration, they are often ill-equipped to return to regular life and may get caught up in the cycle of recidivism (Slate, 2017). One method that policymakers have used to solve this problem is mental health courts (MHCs), which are pre-trial diversion programs that provide an alternative to incarceration for people with mental illnesses and connect people with treatment providers and community resources, with the goal of breaking the cycle of recidivism and improving access to mental health services.
To study the effectiveness of these courts and how counties decide to adopt these courts, this research used both qualitative and quantitative methods. Semi-structured interviews and document reviews of four counties in Virginia and South Carolina were used to study what barriers and facilitators counties face when they establish and operate a mental health court. The thematic analysis found that the main facilitator for success was people, both court employees and community employees, working together for the good of the mission, while the main barrier to success was the lack of resources. The interviewed courts showed success in many different facets, such as reduced recidivism, financial savings, and increased access to treatment. To study which policy diffusion mechanism was most important for counties deciding to adopt MHCs, a probit regression was run to measure the likelihood of a county establishing an MHC. The regression shows that the learning mechanism had the largest effect on counties considering MHCs. To study how effective mental health courts are at reducing crime rates nationally, a panel event study was used, comparing crime rates for crimes against property, society, persons, and other crimes before and after mental health court adoption. The results show that there were no significant changes in crime pre- and post-MHC adoption for any type of crime