Digital Commons Network^™

A Retrospective Chart Review: Screening Patients With Type 2 Diabetes For Depression, Jennifer Sheldon, Glynnis Haley, Monica Ketchie

The Corinthian

Type 2 Diabetes Mellitus is defined as an impaired production of insulin resulting in elevated blood glucose levels (Brutsaert E., 2020). Globally, approximately 8% to 9% of adults have diabetes mellitus, the majority of which (95%) have Type 2 Diabetes Mellitus, equating to between 624 million to 702 million people (WHO, 2020). Type 2 Diabetes Mellitus represents the seventh leading cause of death, with approximately 1.5 million new cases diagnosed annually in the United States (CDC, 2020).

Depression is clinically defined as a mental health disorder that presents with a continually depressed mood or a loss of interest in daily …

Staff Education To Improve End-Of- Life Pain Management Confidence Among Long-Term Care Nurses, Andrea Osuji

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education On The Administration Of Long-Acting Antipsychotic Injections And Its Effect On Outcomes, Matilda Che

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education Program On Medication Reconciliation In Primary Care With Integrated Pain Clinic, Jemimah Nimako-Mensah

Walden Dissertations and Doctoral Studies

No abstract provided.

Seasonal Variation And Size Distribution Of Particulate Matter In The Mississippi Delta: Implications For Source Attribution, Abigail E. Barnett

Honors Theses

This study examines seasonal patterns of particulate matter in the Mississippi Delta using data from PurpleAir sensors, with a focus on particle size distributions across PM₁.₀, PM₂.₅, and PM₁₀. The purpose of this research is to evaluate whether particulate trends in the region reflect signatures consistent with wildfire smoke or are better explained by local environmental and agricultural factors.

Daily average concentrations were analyzed and grouped by season to compare spring and summer conditions. Results show that all particle size fractions increased from spring to summer. However, PM₁₀ concentrations remained consistently higher than PM₂.₅ in both seasons. The PM₂.₅/PM₁₀ ratio …

Improving Medication Adherence In Outpatient Mental Health Care Through Staff Education And Training, Nonye Frances Nwokoro

Walden Dissertations and Doctoral Studies

No abstract provided.

Examining A Positive Variation Of The Good Behavior Game With Head Start Children At Risk For Child Adversity And Externalizing Behavior Problems., Alexandra Gibson, Courtney P D Goldenberg, Malinda J. Colwell, Amelia E. Talley, Joaquín Borrego, Adam T. Schmidt

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children participating in the Head Start program in the United States are predominantly from underserved groups, have increased rates of child adversity, and are at risk for externalizing behavior problems in the classroom. The Good Behavior Game (GBG) is an effective classroom management strategy for reducing disruptive and off-task classroom behaviors. However, previous research has not examined the GBG within the Head Start context.

METHODS: The current case-controlled study evaluated the effectiveness of the GBG in six Head Start children aged 3-5. Researchers conducted daily classroom behavioral observations of disruptive behaviors, and teachers completed pre- and post-treatment assessments of …

Predicting And Decoding Allosteric Binding Sites Using Protein Language Models And Structure-Based Machine Learning: An Energy Landscape-Guided Explainable Ai Framework, Kamila Riedlová, Vít Skrhák, William G. Gatlin, Max Ludwick, Lucas Turano, Marian Novotný, David Hoksza, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

Computational prediction of allosteric binding sites in protein structures remains a persistent challenge, as these regulatory pockets evade detection by both sequence-based and structure-based algorithms. Both computational and physical origins of this predictive asymmetry remain insufficiently understood. In this study, we systematically examine the determinants of binding site predictability using a dual framework that integrates a fine-tuned protein language model and the structure-based method P2Rank as complementary tools probing a diverse data set of 453 human kinases, together with a physics-based interpretability layer derived from energy landscape frustration analysis. Both predictors exhibit a sharp and reproducible dichotomy on protein kinases, …

The Picture Exchange Communication System (Pecs) As A Functional Form Of Low-Technology Aided Augmentative And Alternative Communication (Aac): A Systematic Review, Faith K. Curran

Pacific Journal of Health

This systematic literature review was completed with the aim of investigating the functionality of the low-technology aided Augmentative and Alternative Communication (AAC), Picture Exchange Communication System (PECS). In this review, functionality was defined by how successful AAC users used PECS. Fifteen peer reviewed primary sources which were published between 2020 and 2025 were selected to provide a current and relevant analysis. There was not enough current research to support the use of PECS across various functions of language. However, PECS is mainly used for one to two language functions, object requesting and commenting. Further research studying the success rates of …

Co-Active Therapeutic Filmmaking: A Methodology Pilot Project, Blair Webber

Expressive Therapies Theses

This pilot project examined the intersection of drama therapy and filmmaking. Drawing on the Co-Active Therapeutic Theater model from drama therapy and digital storytelling and participatory video methods from social work research, this methodology designed and delivered a co-created filmmaking intervention at a residential treatment center for adult men with co-occurring mental health and substance use disorder. Four participants made a seven-minute-long short fictional film based on their definition of active recovery and a theme of recovery they wished to share with an audience. It was screened at the treatment center for staff and their fellow residents. Data collection was …

Staff Education To Improve Phq-9 Knowledge, Confidence, And Competency In An Outpatient Mental Health Clinic, Zainab Lawal

Walden Dissertations and Doctoral Studies

No abstract provided.

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Complications Following Orthognathic Surgery In Patients With Cleft Lip And/Or Palate: A Single-Centre Retrospective Analysis Of 57 Consecutive Patients, Ahmed Shawqi Alqattan, Ahmed Al Hashmi, Said Al Rashdi, Mohammed Al Nabhani

Sultan Qaboos University Medical Journal

Objectives: The most prevalent craniofacial abnormality in infants is cleft lip and/or palate (CL/P). Orthognathic surgery is necessary for 25–60% of patients in order to enhance face aesthetics and masticatory function. Nevertheless, there is a lack of defined complication profiles in this particular population. Thus, this study aimed to describe the spectrum and frequency of complications following orthognathic surgery in CL/P patients at a tertiary care referral centre. Methods: This retrospective cohort study included consecutive CL/P patients who underwent orthognathic surgery at Al Nahda Hospital, Muscat, Oman, between 2008–2022. Variables analysed included demographics, procedure type, length of stay and predefined …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Cpt1a Loss Promotes Lung Metastasis In Immune-Competent Mice Via A Mechanism Of Mtdna Release And Chronic Activation Of Sting Pathway, Xiaoyong Wang, Shu-Ting Chou, Yoonha Hwang, Jin Chen, Deanna N Edwards

Faculty, Staff and Students Publications

The metastatic progression of breast cancer involves complex interactions between tumor cells and immune cells, including T cells that exert cytotoxic pressure to limit metastasis. Tumor cells reprogram their metabolism to evade immune surveillance, a critical step to achieving metastatic outgrowth. Using an unbiased CRISPR screen targeting metabolism-related genes and a clinically relevant spontaneous metastasis mouse model, we identified CPT1A, the rate-limiting enzyme in fatty acid β-oxidation, as a suppressor of immune-dependent metastasis. Loss of CPT1A enhances lung metastasis in immunocompetent mice, but not Rag1 KO mice that lack mature lymphocytes. Loss of CPT1A triggers cytosolic mitochondrial DNA (mtDNA) release …

Increasing Medication Adherence In Those With Hypertension, Holly Kimiecik

Evidence-Based Practice Project Reports

Hypertension is a chronic condition characterized by persistently elevated blood pressure and remains a significant contributor to morbidity and mortality in the United States. According to the Centers for Disease Control and Prevention (2024), approximately 47.7% of U.S. adults have hypertension, yet only about one in five achieve blood pressure control below 130/80 mm Hg. Medication adherence plays a critical role in managing hypertension and preventing complications. Adults aged 18 years and older prescribed antihypertensive medications from a primary care clinic in Valparaiso, Indiana, participated in this six-week quality improvement intervention. Evidence from a comprehensive literature review supports combining patient …

Nurse-Driven Infusion Protocols In Diabetic Ketoacidosis: A Scoping Review, Nicholas Morrell Pierce Msn, Rn, Cen, Ccrn, Mary Cassandra Scott Bsn, Rn, Ccrn, Cen, Alvertis Demetreis Warren Bsn, Rn, Ccrn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Diabetic ketoacidosis (DKA) is a high-risk acute emergency requiring timely insulin titration, intensive monitoring, and coordinated interdisciplinary care. Traditionally, management relies on provider-driven insulin infusion adjustments, which may introduce delays and workflow inefficiencies. Emerging nurse-driven insulin infusion protocols aim to standardize care, improve safety, and enhance clinical efficiency. The purpose of this scoping review was to evaluate existing evidence comparing nurse-driven versus provider-driven insulin infusion protocols in the management of adult patients with DKA.

Methods

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From August 2023 through November 2025, …

Purine Metabolic Adaptation Protects The Endothelium From Disturbed Flow-Induced Dna Damage And Atherosclerosis, Qian Ma, Yongfeng Cai, Zhidan Zhang, Dingwei Zhao, Yuan Zhao, Peishan Xu, Tammy Lu, Wendy Zhang, Qiuhua Yang, Yaqi Zhou, Varadarajan Sudhahar, Tohru Fukai, Hanjoong Jo, Yiming Xu, Yuqing Huo

Faculty, Staff and Students Publications

Despite effective lipid-lowering therapies, atherosclerosis continues to be a leading cause of death, with considerable residual cardiovascular risk. Atherosclerotic lesions develop preferentially at arterial regions exposed to disturbed flow (d-flow), which induces genomic stress, endothelial injury, and barrier dysfunction. Hemodynamic forces are known to reprogram endothelial metabolism, but the role of de novo purine synthesis (DNPS), which supplies nucleotides for genome maintenance and whose terminal steps are catalyzed by the bifunctional enzyme ATIC, remains undefined in atherosclerosis. By integrating bulk and single-cell multiomics with in vitro flow systems and in vivo models, we show that d-flow upregulates DNPS and ATIC …

Anthropometric Measurements Inform Complete Concentric Collapse Status In Patients With Obstructive Sleep Apnea, Jordan Weiner, Eugene Chio, Raj Dedhia, Colin Huntley, Michael Hutz, Phillip Huyett, Daniel Lee, Philip Losavio, Ilya Perepelitsyn, Ryan Soose, David Kent

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: Hypoglossal nerve stimulation in the US requires drug-induced sleep endoscopy to exclude patients with complete concentric collapse. This is an expensive and time-consuming requirement. We hypothesized that supine pharyngeal width, and other demographic and polysomnographic variables would associate with complete concentric collapse.

STUDY DESIGN: Prospective, multicenter cohort study.

SETTING: 10 centers in the United States with experience selecting patients for and performing airway surgeries for sleep apnea including hypoglossal nerve stimulation implantation.

METHODS: 600 patients meeting criteria for hypoglossal nerve stimulation underwent measurement of supine pharyngeal width and collection of demographic and polysomnographic data followed by drug-induced sleep endoscopy. …

Searching For A Connection Between Intellectual Humility And Decision-Making Ability, Mansi Verma, Kristin Kirchner

Caravel Undergraduate Research Journal

The present study investigated whether there was a relationship between intellectual humility and decision-making. The participants were 32 undergraduate students recruited from the University of South Carolina. Data was collected through self-reported measures of intellectual humility from the participants and their answers to questions testing for decision-making ability in a single survey. Results indicate that there is a correlation between the scores on the Intellectual Humility Scale and CRT scores. Overall, there does appear to be a relationship between intellectual humility and decision-making.

Examining Biobehavioral Indicators Of Adhd In Children With Fxs, Hannah Pressler, Kayla Smith, Ramsey Coyle, Elizabeth Will, Jane E. Roberts

Caravel Undergraduate Research Journal

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity behaviors that are inconsistent with developmental age. Children with fragile X syndrome (FXS), a genetic neurodevelopmental disorder, are often diagnosed with comorbid ADHD (53–59% of males with FXS). Despite the prevalence of ADHD in FXS, little is known about the early manifestation of ADHD. The current project aims to explore group differences in play behaviors between children with FXS and typically developing (TD) children as well as the relationship between infant play behavior and heart activity to future ADHD attention outcomes. Participants included male children with FXS and …

The Effects Of Eating Disorder Knowledge On Dieting Beliefs, Kaitlyn Finn, Melanie Palomares, Kristin Kirchner

Caravel Undergraduate Research Journal

The study at hand was designed to look into the issues of eating disorder awareness and dieting attitudes. Specifically, it was hypothesized that individuals with more knowledge of eating disorders would be less likely to believe in dieting. It was additionally hypothesized that there would be a difference in amount of eating disorder knowledge seen between pre-determined age groupings. This was hypothesized due to the nature of the inception of eating disorders as a clinical diagnosis. Eating disorders did not begin to be added as a category into the Diagnostic and Statistical Manual until the 80’s, suggesting that participants of …

Dominance Linearity And Steepness In Captive Western Lowland Gorillas, Nate Wichmann

Caravel Undergraduate Research Journal

Many animals live in social groups for a variety of reasons, whether it is for hunting strategies, predator avoidance, or enhanced resource acquisition. These groups often develop a social network and/or dominance hierarchy within the population, with certain individuals gaining advantages or disadvantages based upon one’s rank within a group. Dominance hierarchies can be assessed on the grounds of structure, and, more recently, steepness.  Structure can be assessed by determining and comparing the rank of each individual (quantified by David’s scores). These scores can then be plotted and analyzed to determine the steepness of the dominance hierarchy. A dominance hierarchy …

Teaching Exercise: A Survey On Educational Aids And Self-Efficacy, Joshua I. Eaton, Lucas Morgan, Matthew Hermes

Honors College Theses

HEPs are an important part of therapeutic treatment because they allow for greater exercise stimulus than can be achieved from supervised exercise alone. 94.7% of physical therapists reported prescribing HEPs to their patients. However, patient adherence to these plans can be as low as 35%. Lack of HEP adherence likely leads to sub-optimal clinical outcomes in physical therapy patients. Self-efficacy is improved in patients by supplementing HEPs with instructional aids, especially in the form of videos instead of pictures or descriptions, because they act as a form of vicarious experience. It is possible that improving self-efficacy through vicarious experience could …

Airborne Fungal Monitoring In Healthcare Environments: A Systematic Review, Dana L. Surwill, Patricia Cruz, Mark P. Buttner, Jennifer R. Pharr, Nancy Lough, Theresa T. Roehr

Environmental & Global Health Faculty Research

Background: Fungal infections pose a significant threat to public health, with over 6.55 million cases and 2.55 million deaths annually. Exposure to fungal spores in indoor environments primarily occurs through inhalation or direct contact with surfaces. Monitoring is critical for early detection and prevention of outbreaks, yet routine airborne fungal testing is not universally mandated across healthcare settings. Methods: A systematic review of peer-reviewed articles from four databases was conducted to identify current airborne fungal monitoring guidelines and best practices for sample collection, culture media, incubation conditions, and results interpretation. Results: Eighteen articles met the inclusion criteria, and four studies …

Diabetic Nephropathy Masquerading As Systemic Disease: The Critical Role Of Renal Biopsy In A Young Uninsured Woman With Nephrotic Syndrome, Yolanda V. Gutierrez, Alexis Vargas Del Toro, Cristina Kochi Yamamoto, Jose Loayza Pintado, Andres Suarez-Parraga

School of Medicine Publications

Nephrotic syndrome can have overlapping features across multiple diseases, making diagnosis difficult without tissue confirmation. We describe a 30-year-old uninsured Hispanic woman with type 1 diabetes, hypertension, and CKD3B who presented with nephrotic syndrome, sepsis, and progressive muscle weakness. Her pleural effusions, periorbital changes, elevated free light chains, and dysphagia raised concern for systemic conditions such as amyloidosis or polymyositis, especially given inconsistent outpatient follow-up. Because her management would differ significantly depending on the underlying cause and due to the high risk of loss to follow-up, a renal biopsy was pursued. Serologic studies were unremarkable, and biopsy ultimately confirmed diabetic …

2025 Nursing Annual Report, Children's Health System Of Texas

2025

No abstract provided.

Ticking Time Bomb: The Economic Ramifications Of Mlb's Pitch Clock, Katie Ciuffreda

Business and Economics Honors Papers

In recent years, Major League Baseball has been challenged with declining engagement and attendance, particularly with younger audiences, with the long duration of games most commonly cited as the reason for disinterest. In response to this, MLB implemented a pitch clock that worked its way through the minor league system until it was introduced to the majors for the 2023 season. The goal for the clock was to reduce game times by increasing pace of play. While early evidence shows that the clock has been successful in that regard, its impact on player performance remains to be explored. This study …

Syrah: A Pipeline To Maximize Spatial Transcriptomics Data Output, Carolyn Brewster, Frederick G Mann, Blair Benham-Pyle, Alejandro Sánchez Alvarado

Faculty, Staff and Students Publications

Spatial analysis of gene expression patterns has been a key technique for revealing the potential functions of genes. Traditionally, these analyses conducted using in-situ hybridizations and other labor-intensive protocols were constrained to examining only a few candidate genes per sample. However, the advent of spatial transcriptomic techniques like Slide-seqV2 has transformed this field, enabling massively parallel exploration of gene expression patterns within their tissue contexts by pairing spatial locations with RNA sequencing. Despite its potential, Slide-seqV2 datasets often produce fewer usable reads than expected. We have identified that a significant source of errors in the technology stems from the chemical …

Automated Analysis Of Radiation Oncology Incident Reports Using Large Language Models, Nathan A. Dobranski

LSU Master's Theses

Patient safety incident reporting in radiation oncology requires expert analysis that is time-intensive and subject to variability. This thesis presents the development and technical validation of a locally deployed large language model (LLM) system for automated incident report analysis across multiple cancer centers. The system was designed for automated summarization and taxonomy assignment of Radiation Oncology Incident Learning System (RO-ILS) reports, operating entirely on local infrastructure to preserve patient privacy. A two-round, multi-rater evaluation methodology was employed, incorporating 600 total expert evaluations from two academic cancer centers. Round 1 established baseline performance using Mistral 7B and Mixtral 8x7B models with …