Digital Commons Network^™

Dementia Detection In Low-Resource Languages: Evaluating Translation-Assisted Transfer Learning For Multilingual Clinical Assessment, Kylar A. Deloach

Honors Theses

Alzheimer's disease (AD) is a growing global health concern, with millions of people affected worldwide and cases expected to rise significantly in the coming decades. Early detection is critical for patient treatment and care, and recent advances in natural language processing (NLP) have shown promise in identifying linguistic markers associated with AD. However, most existing work has focused on English, leaving speakers of other languages with limited access to such tools. This study investigates how effective AD detection models trained on English data are at transferring to Greek, a low-resource language with limited dementia-related speech data available. We propose a …

Predicting Epileptic Seizures From Eeg Signals Using Machine Learning, Hamzah Luqman, Galal M Binmakhashen, Hanan Alali, Marwa Alsleebi, Hamdi A. Al-Jamimi, Motaz Alfarraj, Shahid Bashir, Brent Hedgcock, Ali Mir, Raidah Albaradie

Neurosciences

Objective: To develop a machine learning-based model for predicting epileptic seizures by analyzing electroencephalogram (EEG) signals and classifying the interictal and preictal phases.

Methods: The EEG signals were analyzed in both the time and frequency domains using advanced feature extraction techniques. Three different machine learning approaches were employed, with special focus on long short-term memory (LSTM) networks. Features were extracted and classified to differentiate between seizure and non-seizure phases. The proposed models were evaluated using the publicly available CHB-MIT EEG dataset. The study was conducted between September 2022 and September 2024.

Results: Among the tested models, the LSTM-based approach using …

Food Fortification Strategies To Address Micronutrient Deficiencies In Cambodia: A Scoping Review Of Policy Implementation, Industry Capacity, And Public Health Outcomes, Sokha Yem, Sreypeov Tun, Sokunthea Kem

Indonesian Journal of Public Health Nutrition (IJPHN)

Background: Micronutrient deficiencies remain a major public health challenge in Cambodia, with iron deficiency anaemia, iodine deficiency disorders, zinc deficiency, and vitamin A deficiency disproportionately affecting women of reproductive age and children under five. Food fortification—the deliberate addition of essential micronutrients to commonly consumed foods—has been widely recognised as a cost-effective population-level intervention to address nutritional gaps. Objective: To systematically map and synthesise existing evidence on food fortification strategies in Cambodia, focusing on policy implementation, industry production capacity and compliance, regulatory enforcement, and public health outcomes. Methods: A scoping review was conducted following the Arksey and O’Malley methodological framework and …

The Pressure Is On For Pediatric Primary Lymphedema (Ple): Guiding Future Occupational Therapy Clinicians To Address The Unmet Needs And Enhance Care At An Academic Health Center, Ginger A. Kohler

Post-Professional Occupational Therapy Doctorate - Innovations in OT Symposium: Transforming Possibilities into Practice

Objective: Pediatric primary lymphedema (PLE) in adolescents is a rare, chronic condition frequently associated with delayed diagnosis and limited healthcare provider awareness. The purpose of this capstone project was to enhance Entry‑Level Doctor of Occupational Therapy (OTD) Students’ knowledge of the characteristics, management strategies, and available resources for PLE in adolescents, while increasing awareness of the critical role of occupational therapists certified in lymphedema therapy.

Methods: A hybrid educational module consisting of two one‑hour sessions, one asynchronous and one in‑person, was developed and delivered to Residential Entry-Level OTD Students at the Medical University of South Carolina (MUSC). Module content included …

Applying Lean Six Sigma To Optimize Pediatric Liver Transplant Workflows: An Investigational Quality Improvement Initiative And Process Improvement Framework, Sarah E. Auletta

Online/Hybrid MPH Integrative Learning Experience (capstone projects)

For children with end-stage liver disease, liver transplantation is the only cure. While organ scarcity is a national challenge, internal pre-listing processes remain within an institution's control. This quality improvement initiative applied Lean Six Sigma and mixed-methods process mapping to the pediatric deceased donor liver transplant pathway at Boston Children's Hospital. By integrating five years of electronic health record data with multidisciplinary interviews, the project developed a comprehensive process map and performance dashboard.

The study revealed a median of 65 days elapsed between referral and waitlist activation—a timeline entirely within internal operational control. This delay was concentrated in two specific …

Knowledge Gaps In High-Energy Sacral Fracture Treatment And Management, Ashraf N. El Naga, Marko H. Neva, Ahmed Abdelazim Hassan, Gregory D. Schroeder, Mohammad El-Sharkawi, Sebastian F. Bigdon, Andrei F. Joaquim, Klaus Schnake, Richard Bransford, Emre Yilmaz

Rothman Institute Papers

High-energy sacral fractures (HESF) are often challenging injuries due to the location of the sacrum at the junction of the spine and pelvis, the complex biomechanics of the pelvic ring and the wide spectrum of injury patterns, which make treatment standardization challenging. Despite advances in classification systems - particularly the AOSpine Sacral Injury Classification - significant gaps remain in understanding optimal management. To review and discuss the management and identify knowledge gaps related to HESF. A narrative review of the literature was conducted, focusing on five domains: 1. Relative instability and biomechanics affected in different injury patterns; 2. The significance …

Empowering Nurses To Save Lives: Suicide Prevention Education And Training For Outpatient Nurses In Prince George’S County, Maryland, Oludoyin O. Ajala

Walden Dissertations and Doctoral Studies

Suicide remains a significant public health concern, with increasing prevalence across diverse populations. Outpatient nurses frequently encounter individuals at risk for suicide; however, many report limited confidence and inconsistent use of evidence-based assessment tools, contributing to missed opportunities for early intervention. The purpose of this Doctor of Nursing Practice staff education project was to implement a structured suicide prevention education program to improve nurses’ knowledge, confidence, and ability to identify and manage suicide risk. The practice-focused question examined whether implementing a structured suicide prevention education program for outpatient nurses would increase knowledge and confidence in identifying and intervening with patients …

Staff Education On Structured Phq-9 Administration To Enhance Depression Screening In Outpatient Mental Health Care, Zekarias F. Abessa

Walden Dissertations and Doctoral Studies

In outpatient mental health settings, inconsistent use of the Patient Health Questionnaire-9 (PHQ-9) due to gaps in knowledge and lack of standardized training can lead to missed opportunities for early identification of depression and delayed treatment. Mental health nurses play a key role in screening and early intervention, underscoring the criticality of this role in practice. The Doctor of Nursing Practice (DNP) project explored whether a structured PHQ-9 staff education program could improve staff knowledge compared to baseline practice. The project involved using an intervention-based quality improvement design to enhance staff knowledge of administering and interpreting the PHQ-9 screening tool. …

Cyanosis-Associated Coagulopathy In Neonates Undergoing Cardiopulmonary Bypass: A Scoping Review, Lily Crickmar

Student Works

2. Structured summary:

A. Background: Patients with cyanotic congenital heart disease exhibit coagulation abnormalities related to chronic hypoxemia, which may increase the risk of bleeding and thrombosis, particularly during cardiopulmonary bypass.

B. Objective: This scoping review mapped the existing literature on coagulation disturbances and perioperative hemostatic outcomes in pediatric patients with cyanotic congenital heart disease.

C. Methods: 14 studies meeting the inclusion criteria were identified through structured database searching. The data were collected and synthesized descriptively due to heterogeneity in study design, patient populations, and coagulation assessment methods.

D. Results: Across studies, cyanotic patient physiology was associated with platelet dysfunction, …

Inconsistent Post-Fall Follow-Up And Documentation In A Skilled Nursing Facility, Brooke Beier

Celebrating Scholarship and Creativity Day (2018-)

Falls remain a significant safety concern in skilled nursing facilities and are associated with increased morbidity, hospitalization, and loss of independence among older adults. While fall prevention strategies are widely implemented, inconsistent post-fall follow up and incomplete documentation can negatively impact residents and the facility. At a moderate-sized skilled nursing facility in central Minnesota, a review of recent fall reports identified inconsistencies in post-fall follow-up documentation, as well as gaps in staff education and the absence of a clearly defined post-fall documentation policy. The facility experienced 44 resident falls in the month of January alone, highlighting the urgency of addressing …

Cleft Palate And The Coordination Of Wnt Signaling And Pax9 In Murine Palatogenesis, Landon Wyatt

Honors Theses

Cleft palate is a common craniofacial birth defect that arises when the molecular and morphogenetic events guiding secondary palate formation lose coordination during a narrow developmental window. In mice, successful palatogenesis requires the paired palatal shelves to grow vertically, elevate above the tongue, and fuse at the midline; disruption of any of these steps can result in clefting. Two important regulators of this process are canonical Wnt signaling and the transcription factor Pax9, both of which contribute to normal palatal mesenchymal growth and patterning during early development. This paper first examines whether altered Dkk1/Wnt signaling contributes to the Pax9-null palate …

Prevalence Of Low Energy (Lea) Risk In Division Iii Female Distance Athletes, Ciara Murphy

Masters Theses/Capstone Projects

Context 

Low energy availability (LEA) occurs when energy intake is insufficient to support normal physiological functions after exercise (Loucks, 2011). Prolonged LEA can negatively affect metabolic functions, reproductive health, and bone density, and contribute to the development of the female athlete triad and relative energy deficiency in sport (RED-S) (Papageorgiou, 2017).

Objective

The objective of this study was to explore the prevalence of LEA among Division III female distance athletes.

Design

Cross-sectional study

Setting

Online questionnaire administered through Qualtrics

Participants 

A total of 12 Division III female distance athletes (ages 18-23).

Intervention

Anonymous, electronic questionnaire assessing symptoms associated with low …

Occupational Stressors And Health Impacts Among First Responders, Mason N. Roach

Honors College Theses

The United States 911 emergency response system is an interconnected web of public services that seeks to provide its community with care, resources, and safety in times of need. However, the impact of this support on the employees providing the service often goes unnoticed. This review identifies and analyzes the unique strains on first responders' physical and mental health using the Job Demand-Control Model and the Allostatic Load Model. A review of available research literature supports the conclusion that occupational-related stress, including trauma exposure, shift work, poor leadership, and inadequate communication, can have long-lasting negative impacts on provider health.

Comparison Of Free-Hand Technique And Neuronavigation In Intraventricular Shunt Catheter Placement, Ümit Kocaman, Durmuş O Karakoyun, Emre Çavuşoğlu

Neurosciences

Objective: To compare the accuracy and clinical outcomes of proximal catheter placement using neuronavigation guidance versus the traditional free-hand technique in patients undergoing ventriculoperitoneal shunt (VPS) surgery. Methods: We performed a single-surgeon, before–after cohort study: free-hand cases (2013–2019) and neuronavigation cases (2020–2024). Ethics approval was obtained (İzmir Bakırçay University; Approval No. 2407; 20 Aug 2025). The primary endpoint was a composite of first-attempt ventricular entry and absence of postoperative day-1 (POD1) Grade-3 malposition. Secondary endpoints included grades, 12-month proximal tip dysfunction, and operative duration. Results: Fifty-two patients were included (neuronavigation N = 24; free-hand N = 28). Composite success was …

Effect Of Music Therapy And Music Focused Interventions On Fall Rates In A Memory Care Unit, Emily Spanier, Cassie Howe, Hannah Reiter, Paige Mauer

Celebrating Scholarship and Creativity Day (2018-)

This quality improvement project examined the effect of music therapy and activity-focused interventions on fall rates in a memory care unit at a long-term care facility. The project was developed after staff identified falls as a major safety concern, with the memory care unit accounting for a disproportionate number of facility-wide falls. Through audits and observations, the team found that boredom, wandering, restlessness, and lack of meaningful engagement were common contributing factors to falls among residents with dementia. To address this issue, the team implemented low-cost, person-centered interventions including playing familiar music through Alexa, encouraging participation in simple arts and …

The Effect Of Education Using The Lecture Method And Puzzle Games On The Level Of Knowledge And Attitude Toward Balanced Nutrition Among Students Of Sdn Pakintelan 01 In Gunung Pati District, Semarang City, Erlin Nurlina, Syifa Qolbiyah Nasir

Indonesian Journal of Public Health Nutrition (IJPHN)

Fulfilled nutritional needs play an important role at school age. The beginning of nutritional problems occurs due to knowledge factors, so it is necessary to implement efforts to provide information about balanced nutrition. Nutrition education research using lecture and puzzle game methods was conducted at SDN Pakintelan 01 aimed at determining changes in the level of knowledge and attitudes of students regarding balanced nutrition. The type of research is Quasy Experiment and uses a pretest-post test design with control group design. The sampling technique uses stratified random sampling. The number of samples of the control group given education (lecture method) …

Reinforcement Learning Improves Llm Accuracy And Reasoning In Disease Classification From Radiology Reports, Yishu Wei, Yi Lin, Adam Flanders, George Shih, Yifan Peng

Department of Radiology Faculty Papers

Accurate disease classification from radiology reports is essential for many applications. While supervised fine-tuning (SFT) of lightweight LLMs improves accuracy, it can degrade reasoning. We propose a two-stage approach: SFT on disease labels followed by Group Relative Policy Optimization (GRPO) to refine predictions by optimizing accuracy and format without reasoning supervision. Across three radiologist-annotated datasets, SFT outperformed baselines and GRPO further improved classification and enhanced reasoning recall and comprehensiveness.

Micro-Ct Evaluation Of Root Canal Transportation And Centering Ability In Mesial Canals Of Mandibular First Molars, Selen Ince Yusufoglu, Esma Saricam, Mert Ocak, Ferhat Geneci, Burak Bilecenoğlu

Journal of Dentistry Indonesia

Background: This study aimed to evaluate canal transportation, centering ability, structure model index (SMI), surface area, and root canal volume changes in the mesial canals of mandibular first molars using micro-CT.

Methods: Twenty-four mandibular first molars with two separate mesial canals and moderate curvature were included. Teeth were scanned using micro-CT before instrumentation and randomly divided into three groups (N = 8). Root canals were prepared using OneShape, OneCurve, and Rotate file systems, followed by post-instrumentation micro-CT scanning (10µm/pixel resolution). Changes in canal volume, surface area, transportation, centering ability, and SMI were analyzed at the apical, middle, and …

Evaluation Of An Audiovisual Educational Tool With Reinforcement Messages For Orthodontic Patients: A 6-Month Randomized Controlled Trial, Laura Restrepo Quijano, Maria Paula Vasco Gomez, Natalia Hurtado Velasquez, Luis Fabian Benitez Moreno

Journal of Dentistry Indonesia

Background: Orthodontic treatment increases the risk of bacterial plaque accumulation; therefore, oral hygiene education is essential to prevent complications, but its impact is usually limited when it is not reinforced with effective tools. This study aims to evaluate an audiovisual educational tool with reinforcement messages, compared with a verbal explanation about the proper use of the orthodontic oral hygiene kit.

Methods: This was a randomized controlled trial that included 62 patients randomly assigned to an intervention group: 31 patients who received an educational video plus three reinforcement messages via WhatsApp, and a control group: 31 patients who received …

Sinus Formation As A Manifestation Of Chronic Periodontitis In Mandibular Anterior Region: A Report On 2 Cases, Anisha Kumari, Shikha Tewari

Journal of Dentistry Indonesia

Background: Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone. Clinical manifestations of Persistent chronic periodontitis may mimic varied clinical manifestations, including those of apical abscess and systemic involvement.

Case report: This report presents the management of an intraoral sinus mimicking a chronic apical abscess in the mandibular anterior region associated with deep periodontal pockets in two male patients in their early thirties. With careful clinical and radiological examination and ruling out of endodontic and systemic involvement, the …

Correlation Between Maxillary Morphology And Sinus Dimensions In Skeletal Class I, Ii, And Iii Subjects: A Comparative Study, Nida Shaikh, Dipti Shastri, Pradeep Tandon, Gyan Prakash Singh

Journal of Dentistry Indonesia

Background: This study aimed to evaluate variations in maxillary and sinus morphology and their correlations with skeletal malocclusion patterns using CBCT.

Methods: This retrospective study analyzed CBCT records of 70 subjects aged 17–40 years, divided into three groups: Skeletal Class I (N = 25), Class II (N = 25), and Class III (N = 20). Five maxillary skeletal and four sinus parameters were assessed. Intergroup comparisons were performed using one-way analysis of variance (ANOVA) followed by Tukey’s post hoc test. Correlations were evaluated using Pearson’s correlation test. Intra-observer reliability was assessed by re-measuring 8 randomly selected CBCT scans …

Comparison Of Chatgpt, Claude Ai, And Dental Students In The Detection Of Artifacts On Panoramic Radiography, Elif Çeçen Erol, Ceren Aktuna Belgin, Gözde Serindere, Kaan Gunduz

Journal of Dentistry Indonesia

Background: Accurate radiographic diagnosis requires images obtained with proper technique. Artifacts are unwanted irregularities or densities not produced by the primary X-ray beam and may obscure anatomical details in radiographic images. This retrospective study aimed to evaluate the performance of ChatGPT, Claude AI, and intern dental students in detecting artifacts in panoramic radiographs (PRs).

Methods: Between January and December 2024, panoramic radiographs of 40 patients containing 74 artifacts (motion, mispositioning, airway/soft tissue, and foreign body/metal artifacts) were retrospectively evaluated. The artifact detection performance of ChatGPT-4.0, Claude AI 3.5 Sonnet, and intern dental students was subsequently evaluated and compared …

Multicultural, Trauma‑Informed Feeding Protocols For Children With Spd In Student‑Led Ot Clinics, Matt Crummel

Capstone Projects

This capstone project aims to develop and implement feeding protocols for children with sensory processing disorders in a student-led occupational therapy clinic, emphasizing trauma-informed care and multicultural practices. By creating evidence-based interventions and fostering interdisciplinary collaboration, the project seeks to enhance therapeutic outcomes while providing OT students with hands-on learning experiences. OT is a healthcare profession that enhances individuals’ independence in daily activities through personalized interventions targeting physical, sensory, and cognitive skills. Student-led OT clinics offer a valuable learning environment where students work under licensed clinicians to provide therapeutic care.

Sensory processing disorders (SPD) significantly impact feeding behaviors, often leading …

Implementation Of Positive Reinforcement To Promote Staff Adherence To Bowel And Bladder Plans At A Long-Term Care Facility, Alfonso Segura Sanchez

Celebrating Scholarship and Creativity Day (2018-)

Background: Bowel and bladder plans (BBPs), also known as toileting programs, are individualized restorative nursing programs that have strategies to promote continence in residents and reduce the negative consequences of incontinence (Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual Version 1.20.1, 2025). Purpose: Senior nursing students implemented positive reinforcement in a quality improvement (QI) project to reduce rates of incontinence and inconsistent adherence to BBPs at Elim Wellspring, a skilled nursing facility for long-term care in Princeton, MN. According to the Minnesota Department of Human Services and Minnesota Department of Health, the most recent report on quality indicators for …

Admixture-Informed Polygenic Risk Reporting Using The Eprs Framework, Yu-Jyun Huang, Nuzulul Kurniansyah, Matthew O Goodman, Brian W Spitzer, Jiongming Wang, Adrienne Stilp, Cecelia Laurie, Paul S De Vries, Han Chen, Yuan-I Min, Mario Sims, Gina M Peloso, Xiuqing Guo, Joshua C Bis, Jennifer A Brody, Laura M Raffield, Jennifer A Smith, Wei Zhao, Jerome I Rotter, Stephen S Rich, Susan Redline, Myriam Fornage, Robert Kaplan, Nora Franceschini, Daniel Levy, Alanna C Morrison, Eric Boerwinkle, Nicholas L Smith, Charles Kooperberg, Bruce M Psaty, Sebastian Zöllner, Tamar Sofer

Faculty, Staff and Student Publications

Polygenic risk score values vary with genetic ancestry due to differences in population-specific allele frequencies and linkage disequilibrium patterns. We present a framework to calibrate polygenic risk scores based on ancestral makeup. We propose the "expected polygenic risk score" or ePRS, defined as the expected value of a polygenic risk score based on one's global or local admixture patterns. We further define the "residual polygenic risk score" or rPRS as measuring the deviation of the polygenic risk score from the ePRS. The ePRS reflects the baseline ancestry-driven component of genetic risk, whereas the rPRS isolates an ancestry-agnostic measure of genetic …

Hyperdynamic Microtubule-Based Structural Changes In Monocyte-Derived-Neuronal-Like Cells From Patients With Schizophrenia, Alfredo Bellon, Alonso Cortez-Resendiz, Lauren N Forrest, Omar Elmarasi, Janani Iyer, Anjali Iyer, Chachrit Khunsriraksakul, Dajiang Liu, L Elliot Hong, Therese M Jay, Marie-Odile Krebs, Anne Hosmalin

Faculty, Staff and Student Publications

A consistent postmortem finding in schizophrenia (SCZ) is reduction in dendrites' size. However, neurons with larger dendritic trees have also been encountered. In vitro experiments with neurons and neuronal-like cells coming directly from patients with SCZ showed similar results, evidencing at times more extensions and at others less arborizations. The process of extending and retracting neuronal outgrowths depends on microtubules polymerization and depolymerization. The possibility that microtubule polymerization/depolymerization is related to defects in the neuronal structure comes from several microtubular anomalies reported in SCZ such as its abnormal distribution in the cytoplasm, irregular shape of microtubules and even absence of …

Telehealth Workflow Optimization, Taku Ajongakoh Stella

Walden Dissertations and Doctoral Studies

This evidence-based quality improvement (EBQI) project addresses the 36% telehealth no-show rate at an outpatient behavioral health clinic in Maryland. High attrition rates currently compromise continuity of care and result in a projected annual revenue loss of $124,000. The present project proposed a standardized workflow redesign in the current Integrated Care Approach (ICA) notes Electronic Health Record (EHR) system to address the manual outreach inconsistency. Significant interventions involved the activation of automated multimodal reminders at 72-hour, 24-hour, and 1-hour intervals, and the obligatory 24-hour technical pre-verification connection. Moreover, the project introduced a systematic 48-hour follow-up procedure of missed visits to …

Quantitative Fluorescence Imaging Using A Paired Agent Approach For Improving Surgical Decision Making, Sanjana Pannem

Dartmouth College Ph.D Dissertations

Surgical resection remains to be the cornerstone of treatment for most solid tumors, where the primary objective is to remove all visible and microscopic disease. However, the extent of tumor resection is inherently limited by the surgeon’s ability to distinguish tumor from normal tissue, intraoperatively. As a result, positive surgical margins (PSM), where residual tumor remains after surgery, are a common occurrence and are associated with increased recurrence, need for adjuvant therapies, dismal patient outcomes, and high healthcare costs.

Fluorescence guided surgery (FGS) has emerged as a promising technique to enhance intraoperative visualization of tumors and may help reduce the …

Clustering Digestive Tract Tumors Using Transcriptomic And Mutation Data, Dwayne G Tally, Polina Bombina, Jake Reed, Jeffrey Kinne, Lynne V Abruzzo, Kevin R Coombes, Zachary B Abrams

2020-Current year OA Pubs

BACKGROUND: Digestive tract cancers, like most other cancers, are usually categorized based on cell or tissue of origin. Molecular clustering based on the transcriptome often produces the same classification.

METHODS: We developed a new method, Newmanization, to reduce underlying tissue signals from transcriptomic analysis. To test our method, we downloaded data on 1635 samples of digestive tract cancers from The Cancer Genome Atlas. The available data includes transcriptomic data by RNA-Seq, as well as binary mutation allele frequency data by whole exome sequencing. We compared, using silhouette widths and visualization by dimension reduction plots, the effectiveness of Newmanized transcriptome and …

Extrapulmonary Small Cell Carcinoma Presenting As Bilateral Papilledema, Hyponatremia, Encephalitis, Seizures, Crmp5-Igg Reactivity, And Prominent Anterior Tubular Perivascular Spaces, Ramsis Benjamin, Drew Thomas, Nina Mourao, J. Judd Fite, Brianna Woodliff, Shubhank Goyal

School of Medicine Publications

Background: Paraneoplastic syndromes that affect both the optic disc and the brain parenchyma typically harbor antibodies directed toward CV2/collapsin response-mediator protein 5 (anti-CRMP5), amphiphysin, Ma antigen 2 (Ma2/Ta), and Yo. The most common cancers linked to anti-CRMP5 antibodies include small-cell lung carcinoma (SCLC), followed by thymoma, renal cell carcinoma, and thyroid papillary carcinoma. A long-held belief explains papilledema as related to increased pressure within the subarachnoid space or the microvascular capillaries, but intracranial pressures within the normal standard range may exist in a person with a paraneoplastic syndrome and papilledema. The glymphatic system, a central waste-clearance conduit, may play a …