Digital Commons Network^™

A Lifecycle Governance And Learning Health System Framework For Trustworthy, Generalizable, And Sustainable Human-Ai Partnership In Clinical Practice: Lessons From The Asthma-Guidance And Prediction System (A-Gps), Chung-Il Wi, Shauna Overgaard, Momin Malik, Dave Watson, Deepak Sharma, Jennifer Le-Rademacher, Dan Kelleher, Lu Zheng, Joshua Ohde, Brian Lynch, Ashwani Khurana, Sunghwan Sohn, Mahmoud M Aljuhani, Chris Carpenter, Manuel Arteta, Jason Greenwood, Martha Hartz, Randy Foss, Elif Polat, Imad Absah, Carla Davis, Meera Gupta, Lynnea Myers, Björn Nordlund, Cui Tao, Mark L Wieland, Christi Patten, Amie Jones, Prathibha Varkey, Brenna T Loufek, David E Vidal, Nari Gopala, Eric Klee, Vijay H Shah, John D Halamka, Matthew R Callstrom, Nicholas L Rider, Hongfang Liu, Constantin Aliferis, Vesna D Garovic, Young J Juhn

Faculty, Staff and Students Publications

The integration of artificial intelligence (AI) into clinical decision support (CDS) holds promise for proactive, personalized, and precision care. However, current understanding of how to establish trustworthy human-AI partnerships is in its infancy, despite its critical importance for implementing AI in healthcare. We present the Asthma-Guidance and Prediction System (A-GPS) as a case study of a practice-integrated AI platform that demonstrates how trustworthy, generalizable and sustainable AI can be developed, evaluated, and implemented in real-world asthma care. We describe major challenges and solutions based on our real-world experience during the process and offer the practical framework, approaches, tools and workflow …

Anatomy Of The Orbit: Radiologic And Surgical Anatomy Of Anterior And Medial Approaches, Emily Garvey, Benjamin Bitner, Mindy R. Rabinowitz

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Purpose of Review: To review relevant medial orbital anatomy as well as the most commonly used approaches to this space. Recent Findings: The use of the endoscopic endonasal approach for access to the medial orbit, including the intraconal space, has expanded allowing for removal of previously “inoperable” pathology. Summary: Each approach has their strength when considering access to the medial orbit, the transcaruncular incision allows for fast access with limited dissection while the transpalebral approach allows for visualization of the medial orbit but also extended access to the superior and lateral orbit. Conversely, the conjunctival approach allows for wider access …

Early Detection Of Alzheimer's Disease And Related Dementias From Spontaneous Speech Using Foundation Speech And Language Models: Comparative Evaluation, Jingyu Li, Lingchao Mao, Xi Mao, Hairong Wang, Zhendong Wang, Xuelei Sherry Ni

School of Economics and Finance Faculty Publications

Background: Alzheimer's disease and related dementias (ADRD) are progressive neurodegenerative conditions where early detection is critical for timely intervention and care planning. However, current diagnostic methods are often inaccessible, costly, and delayed, especially for underserved populations. There is a growing need for scalable, noninvasive tools that can support timely diagnosis. Spontaneous speech contains rich acoustic and linguistic markers that can serve as noninvasive behavioral markers for cognitive decline. Foundation models, pretrained on large-scale audio or text data, generate high-dimensional embeddings that encode rich contextual and acoustic information.

Objective: This study benchmarks open-source foundation language and speech models to evaluate their …

Implementation And Effectiveness Of An Enhanced Recovery Protocol For Children Undergoing Surgery: The Enrich-Us Stepped-Wedge Cluster-Randomized Trial, Mehul V Raval, Yao Tian, Willemijn Schäfer, Salva N Balbale, Mallory N Perez, Martha-Conley E Ingram, Alison Lehane, Charesa J Smith, Gwyneth A Sullivan, Audra J Reiter, Andrew Hu, Johanna M Borst, Sarah C Blake, Sharron Close, Teaniese L Davis, Bonnie S Essner, Kurt F Heiss, Lynn W Huang, Erin Wymore, Deysi Paniagua-Perez, Kirsty M Engelhardt, Peter M Graffy, Julie K Johnson, Craig W Lillehei, Brian W Gray, Seth D Goldstein, Scott S Short, Samir R Pandya, Janice A Taylor, Christopher Gayer, Adam B Goldin, Matthew M Boelig, Kristy L Rialon, Tim Jancelewicz, Aaron M Lipskar, Mubeen Jafri, Elisabeth T Tracy, Matthew T Harting, Jason P Sulkowski, P Benson Ham, Kaveh Vali, Robert A Cina, David T Schindel, Saleem Islam, Erin A Teeple, Sohail R Shah, Ankush Gosain, David H Rothstein, Megan A Brockel, Jillian Chown, Jane L Holl

Faculty, Staff and Student Publications

Importance: Despite evidence that enhanced recovery protocols (ERPs) improve outcomes in adults undergoing surgery, adoption for pediatric populations has lagged.

Objective: To assess the implementation and clinical effectiveness of a consensus-based ERP for pediatric patients undergoing elective gastrointestinal (GI) surgery.

Design, setting, and participants: A prospective type 2 hybrid implementation-effectiveness, stepped-wedge, cluster-randomized by entry date into implementation phase, trial of pediatrics patients, 10 to 18 years of age, undergoing elective GI surgery at 18 US sites from September 2019 to June 2024.

Interventions: Sites were randomized into 3 groups, each spending at least 9 months in a control phase, with …

Evaluating Clinical Practice Guidelines For Managing Missed Appointments And Patient Re-Engagement In An Outpatient Mental Health Clinic, Agnes Limunga Jackai

Walden Dissertations and Doctoral Studies

No abstract provided.

Improving Medication Literacy In Older Adults With Chronic Kidney Disease Through Nurse-Led Education, Markesia R. Forward

Walden Dissertations and Doctoral Studies

No abstract provided.

1st National University International Conference On Health Professions Education, Sultan Qaboos University

Sultan Qaboos University Medical Journal

No abstract provided.

A Tactile Trans-Flexor Carpi Radialis Surface Landmark Technique For Median Nerve Local Injection: A Cadaveric Study, Clark Chen, Keenan Sobol, Connor Hickey, Duncan Vannest, John Ibrahim, James Raphael

Einstein Health Papers

PURPOSE: Median nerve (MN) block under local anesthesia at the wrist is commonly performed but can be limited by anatomic variation, particularly absence of the palmaris longus tendon. This study investigates a novel trans-flexor carpi radialis (trans-FCR) technique for MN anesthesia that uses the flexor carpi radialis (FCR) tendon as a consistent surface landmark.

METHODS: Fourteen fresh frozen upper extremity cadaver specimens were used. A 25-gauge needle was inserted through the FCR sheath approximately 4 cm proximal to the wrist crease in a transverse fashion, angled approximately 0° to the vertical and parallel to the wrist crease. The trans-FCR technique …

Selective And Differential Roles Of Pvhcrh Neurotransmitters In Diet-Induced Obesity In Mice, Zhiying Jiang, Yuhan Cao, Michelle He, Cunjin Su, Runzhou Yang, Maojie Yang, Jing Cai, Hongli Li, Yuanzhong Xu, Shi-Bin Li, Hiroshi Yamaguchi, Luis De Lecea, Benjamin R Arenkiel, Qingchun Tong

The Brown Foundation: Institute of Molecular Medicine

Stress and diet are known to synergistically promote risks of obesity but the underlying neural basis remains elusive. Corticotropin-releasing hormone neurons in the paraventricular hypothalamus (PVHCRH) are stress responsive and release both CRH and glutamate. Here we generated a mouse model with gain or loss of release in CRH or glutamate from PVHCRH neurons. While these models showed no changes in body weight when fed chow, they exhibited contrasting effects when fed high-fat high-caloric diets (HFD). Whereas disrupting glutamate release from PVHCRH neurons led to diet-induced obesity (DIO), that of CRH caused no impact. Conversely, augmented CRH release led to …

Phosphate-Mediated Regulation Of Intracellular Calcium Dynamics, Huma Shahzad, Mohammed S. Razzaque

School of Medicine Publications

Phosphate (Pi) and calcium (Ca2+) are essential mineral ions that play coordinated roles in maintaining normal cellular functions. While various steps of calcium signaling are well characterized, emerging evidence suggests the critical role of both intracellular and extra cellular phosphate in regulating intracellular Ca2+. In the cytoplasm, phosphate influences ATP production and organelle calcium buffering and influences the activity of calcium pumps, such as sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA) and the plasma membrane Ca2+-ATPase (PMCA). Extracellular phosphate, taken up via sodium-dependent phosphate transporters, triggers signaling cascades that affect the processes of calcium influx, storage, and release. Additionally, high extracellular phosphate levels …

Adherence To The Eat-Lancet Diet And The Risk Of Heart Failure In Individuals With Cardiovascular-Kidney-Metabolic Syndrome Stages 0–3: A Prospective Cohort Study, Peng Fu, Hong Zheng, Kuangyi Wu, Yulong Lan, Dan Wu, Weiqiang Wu, Huancong Zheng, Zefeng Cai, Yuxian Wang, Qiuyue Lin, Bo Zhang, Youren Chen

Research outputs 2022 to 2026

Background and objective – In 2019, the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems proposed the EAT-Lancet planetary health diet as a universal reference dietary pattern aimed at promoting human health while minimizing environmental degradation. However, epidemiological evidence regarding the association between adherence to the EAT-Lancet diet and the risk of heart failure (HF), particularly among individuals with cardiovascular-kidney-metabolic syndrome (CKMs) stages 0–3, remains limited. Therefore, this study aimed to examine the associations between adherence to the EAT-Lancet dietary pattern, its individual dietary components, and the risk of HF among individuals at CKMs stages 0–3. Materials and methods …

A Study Of Descriptive Values Of Echocardiography In Unanesthetized Syrian Hamsters, Kasidit Ladkhoksung, Nattapart Lerdkarnvijai, Thanakorn Ngamsawat, Napassorn Napassorn, Suphisara Chantharadech, Pattharat Asvaesoontorn, Thawat Lekdumrongsak, Sirilak Surachetpong

The Thai Journal of Veterinary Medicine

The Syrian hamster (Mesocricetus auratus) is the most commonly presented hamster species in veterinary practice, yet descriptive echocardiographic values remain limited, particularly under conscious conditions. This study aimed to establish normal two-dimensional, M-mode, and Doppler echocardiographic values in healthy conscious Syrian hamsters and to evaluate the influence of age, body weight, and sex on cardiac parameters. Forty Syrian hamsters (27 males and 12 females; one excluded) underwent physical examination, thoracic radiography, and echocardiography. Age and body weight were recorded. Echocardiographic parameters were analyzed for their distribution and correlation with age and body weight. All echocardiographic parameters demonstrated a …

Assessment Of Platelet Activation In Dogs With Naturally Occurring Acute Pancreatitis, Guhyun Kwon, Seulgi Bae

The Thai Journal of Veterinary Medicine

Recent studies have demonstrated that platelets are crucial in inflammation and immune responses. Alteration in platelet activity impact morbidity and survival due to the formation of intravascular clots or bleeding resulting from impaired platelet function. Aiming to evaluate changes in platelet activity in dogs with naturally occurring acute pancreatitis (AP), we identified differences in quantitative and morphological platelet indices, as well as the ratio of platelets expressing P-selectin on their surface (activated platelet ratio; APR) between dogs with naturally occurring AP and healthy dogs. The study included 9 client-owned dogs with AP (the AP group) and 28 client-owned healthy dogs …

Dissociation Between Physical Reasoning And Tool Use In Individuals With Left Hemisphere Brain Damage, Shuchen Liu, Seda Karakose-Akbiyik, Alfonso Caramazza, Filipa Dourado Sotero, Laurel J. Buxbaum, Aaron L. Wong

Moss-Magee Rehabilitation Papers

Tool use and physical reasoning are often assumed to rely on shared cognitive and neural mechanisms. At some level, this correspondence is expected: using an object typically requires understanding its physical properties. However, both capacities are complex and multicomponential, so the relationship between them may vary across levels of representation and task demands. Here, we asked whether third-person physical reasoning about object dynamics can dissociate from tool use (i.e., performing a tool's typical action) in individuals with left-hemisphere stroke. We tested 11 patients, five of whom showed impairments in tool use. Physical reasoning was assessed using a novel collection of …

Frailty Is A Predictor Of Inpatient Mortality And Unplanned Icu Admission Following Early Fixation Of Intertrochanteric Fractures., Victor Koltenyuk, Jared Sasaki, Nithin Gupta, Zachary Chanmin, Ruby G Patel, Taylor Manes, Jack W Weick

Surgery Articles

Purpose: This study sought to examine the role of frailty in predicting inpatient mortality following early surgical fixation of intertrochanteric (IT) fractures.

Methods: The ACS-TQIP (2017-21) database was queried for patients with intertrochanteric fractures undergoing surgical fixation within 48 h. Frailty status was determined using the 5-item modified frailty index (mFI-5) (0 = nonfrail, 1 = prefrail, and, 2 = frail, and > 2 = severely frail). The primary end point was inpatient mortality. Secondary end points were unplanned ICU admission and thromboembolic events (DVT or PE). Significance was considered a p-value < 0.05.

Results: Frailty, as determined by the mFI-5, was …

The Higher Education Health Insurance Trap: How Underinsurance Fuels Health Inequity And Educational Inaccessibility, Hallie E. Vanney, David J. Satin

Journal of Patient-Centered Research and Reviews

Higher education institutions are increasingly committed to recruiting more diverse students. As these efforts succeed, institutions face the parallel challenge of meeting an evolving student body's broader and more complex healthcare needs. This article highlights how student health insurance is a critical need that may be unmet by institutions traditionally designed for young, healthy, able-bodied students. Graduate and professional students are particularly vulnerable to a “health insurance trap”; they may discover, only after enrollment, that their plan does not cover essential care, they can no longer work full-time to gain commercial insurance, they have aged out or do not have …

Redefining Skincare For Sensitive Lives, Ashlyn G. Sierra Ms

Honors College Theses

This study outlines how a skincare company that is both ethically and effectively developed for people suffering from eczema could create accessible, affordable products as well as maintain its commitment to being inclusive. The study uses scientific data regarding eczema in order to examine why certain aspects of skin care are helpful or dangerous when it comes to individuals who suffer from eczema, in addition, it provides an assessment of current skin care product offerings that are designed for people with eczema. Using the Wise Leadership Framework, the study presents a hypothetical business plan for a new, eczema-based skin care …

Experiences Of Gay, Bisexual, And Transgender Nurses Working In A Hospital Setting, Layla C. Bradley

Walden Dissertations and Doctoral Studies

No abstract provided.

Simultaneous Multielectrode Recordings Along The Human Scala Tympani: Evidence For Level-Dependent Place Coding, Amit Walia, Matthew A Shew, Shannon M Lefler, Amanda J Ortmann, Patrick Ioerger, Jordan Varghese, Jacques A Herzog, Craig A Buchman

2020-Current year OA Pubs

The cochlea systematically encodes sound frequency and intensity via a precisely organized tonotopic map, in which traveling waves peak at specific cochlear locations. A fundamental but incompletely understood aspect of auditory coding involves how stimulus intensity shapes this tonotopic organization. In animal models, increasing intensity shifts the cochlear traveling wave peak basally; however, physiological evidence for such intensity-dependent shifts in human cochlear processing is limited. Here, we performed simultaneous multielectrode electrocochleography recordings along the human scala tympani to characterize how cochlear place coding varies as a function of stimulus intensity. In subjects with preserved cochlear mechanics, including individuals with auditory …

Mosunetuzumab Monotherapy Is Active And Tolerable In Patients With Relapsed/Refractory Richter Transformation, Katharine L Lewis, Nancy L Bartlett, Et Al.

2020-Current year OA Pubs

Richter transformation (RT) to diffuse large B-cell lymphoma is an aggressive lymphoma that arises from underlying chronic lymphocytic leukemia or small lymphocytic lymphoma. RT is often chemorefractory, resulting in poor clinical outcomes with standard chemoimmunotherapy. Mosunetuzumab, a bispecific CD20/CD3 T-cell-engaging antibody, was investigated in a cohort of 20 patients with relapsed/refractory RT. Cytokine release syndrome occurred in 65% of patients, almost exclusively grade 1 (20%) or grade 2 (40%), and occurring during the first treatment cycle. Other adverse events included infections, neutropenia, thrombocytopenia, tumor flare, and low-grade neurotoxicity, with no adverse events leading to treatment discontinuation. Mosunetuzumab resulted in an …

Making Process Evaluations More Explanatory - Key Opportunities To Advance Implementation Research, Michel Wensing, Elvin H Geng

2020-Current year OA Pubs

Process evaluation of implementation strategies is increasingly common, but a review by Bracci et al. showed that room for improvement exists. In this contribution, we complement their recommendations by ideas on the design of process evaluations. Process evaluations are meant to provide explanations for why implementation strategies were effective, or not effective. Therefore, they are best guided by theory or frameworks, but the frequent focus on intervention acceptability reflects a lack of imagination on moderators and mediators that influence outcomes. Intervention fidelity is relevant in all process evaluations. Meaningful synthesis of process evaluation studies requires a homogeneous outcome, such as …

Exposure To Agent Orange And Association With Myelodysplastic Syndromes, Mikkael A Sekeres, Matthew J Walter, Et Al.

2020-Current year OA Pubs

No abstract provided.

Feasibility Of Decentralized Real-World Monitoring Of Sars-Cov-2 Booster Vaccines And Covid-19 Outcomes In Myeloma, William A Wood, Mark A Schroeder, Ravi Vij, Et Al.

2020-Current year OA Pubs

Patients with multiple myeloma have an elevated risk of severe complications from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) infection. To demonstrate proof of concept for a pandemic preparedness and response network, the American Society of Hematology Research Collaborative Multiple Myeloma Program developed a prospective, decentralized study within a site-based provider network. In the COVID-19 outcomes in myeloma and the impact of vaccines (COSMIC) study, patients provided consent, permitted electronic health record data collection, completed patient-reported outcomes at baseline, day 30, and day 180 through an electronic study portal, and were compensated for participation. Clinicians at participating sites facilitated …

Divergent Cell-Type Specific Hypoxia Responses In Human Stem Cell-Derived And Primary Islets, Kameron Bradley, Camryn Moore, Matthew Ishahak, Marlie M Maestas, Daniel A Veronese-Paniagua, Jeffrey R Millman

2020-Current year OA Pubs

The success of stem cell-derived islet (SC-islet) therapy for type 1 diabetes is limited by poor graft survival in the hypoxic post-transplantation microenvironment. While the response of SC-islets to chronic hypoxia has been studied, a direct comparison to primary human islets during the acute hypoxic phase has not been performed. Here, we conduct a comparative single-cell transcriptomic and functional analysis of human SC-islets and primary islets exposed to acute hypoxia (1% O

Getting To The Heart Of The Problem: Blood Pressure Management Through Medication Adherence, Mallory G. Livengood

Evidence-Based Practice Project Reports

Clinical hypertension affects one in four adults globally, making it the most common chronic condition. Despite its widespread impact, hypertension can be prevented, as it represents the most modifiable risk factor in preventing cardiovascular disease. The primary purpose of this evidence-based project was to determine whether a one-month follow-up with a healthcare provider improved medication adherence through enhanced hypertension management. Twelve eligible participants were selected from a primary clinic located in Northwest Indiana, based on their newly initiated anti-hypertensive medications or who required a medication adjustment due to poor hypertension management. Each participant’s preferred method of communication was noted, and …

Breastfeeding Promotion For Infants With Neonatal Abstinence Syndrome (Nas), Olivia Czerwonka

Evidence-Based Practice Project Reports

Neonatal abstinence syndrome (NAS) is the exposure in utero to drugs with the incidence in the United States increasing from 4 to 6.3 per 1000 births (Wei et al., 2023). The purpose of this quality improvement project was to implement a breastfeeding support intervention to increase breastfeeding frequency and reduce hospital length of stay of newborns with NAS. A tailored multicomponent guideline based upon the current Ten Steps to Successful Breastfeeding as established by WHO and UNICEF (2017) was implemented. Mothers of infants diagnosed with NAS were recruited using convenience sampling from a Northwest Indiana Hospital. Key stakeholders within the …

Type-1 Ryanodine Receptor Plays An Important Role In Cardiac Hypertrophy And Heart Failure By Increasing Type-2 Ryanodine Receptor-Mediated Calcium Release, Yong-Xiao Wang, Ed Wilson Santos, Sarahann Mistretta, Yuexing Yuan, Harold A. Singer, Shey-Shing Sheu, Yun-Min Zheng

Center for Translational Medicine Faculty Papers

Type-1 ryanodine receptor (RyR1) is essential for skeletal muscle contraction. This Ca²⁺ release channel is expressed in cardiac myocytes; however, its function remains elusive. Cardiac-specific RyR1 overexpression (OE) mice were generated under the cardiac-specific Myh6 promoter. Cardiac hypertrophy (CH), cardiac functions, and mechanistic changes in RyR1 OE and control (wildtype, WT) mice were assessed using hematoxylin and eosin staining, echocardiography, electrocardiogram, quantitative RT-PCR, Western blotting, [³H]-ryanodine binding assay, confocal microscope, ROS dye Amplex Red and 2′,7′-dichlorofluorescein diacetate. RyR1 OE mice had increased whole heart, left ventricular weight, and left ventricular wall thickness, but decreased cardiac output and …

Choosing A Primary Care Provider: A Formative Qualitative Study To Identify Patient Preferences, Chris Gillette, Jan Ostermann, Sarah O'Neal, Aylin A. Aguilar, Kandice Lacci-Reilly, Jessica Valente, Chris Everett, Robin Gibson, Sonia Crandall, Laiton Steele

Journal of Patient-Centered Research and Reviews

Purpose: (1) Identify what characteristics patients evaluate when choosing their primary care provider (PCP), (2) characterize how provider characteristics factor into patients’ choice of PCP, and (3) develop a list of features for a quantitative preference study in the form of a discrete choice experiment (DCE).

Methods: We used a cross-sectional, qualitative study to accomplish the objectives. We recruited participants from an internal medicine clinic and the general public in North Carolina. We used convenience and purposive sampling to recruit participants as a single sample. All participants completed a semistructured interview. We then used a reflexive thematic analysis to analyze …

Incorporating The Use Of Puppets And Puppetry-Based Approaches In Nutrition: A Scoping Review Of Interventions, Basil H. Aboul-Enein, Nada Benajiba, Majd Jan, Sarah Ali Alasmari, Patricia J. Kelly, Stephen F. Gambescia, Elizabeth Dodge

College of Nursing Faculty Papers & Presentations

Puppetry-based activities could serve as a low cost and manageable intervention in improving health-related outcomes. This review aims to identify the research to date and gaps in practice of the role and application of puppetry interventions in nutrition education. A scoping review was conducted using the PICOS framework and PRISMA-ScR guidelines, identifying studies across eight databases between January, 1980 and July, 2025.Twenty-five studies were identified, with the majority (n = 19) aimed at pre-school and school-aged children. Fifteen studies used quasi-experimental, pre-post designs. The use of hand and finger puppets was common, as well as videos and puppet theatre. …

Two-Year Retrospective Evaluation Of Frailty To Optimize Postoperative Spinal Fusion Outcomes In Adults Aged 65 And Older, Sheri Loo

Doctoral Projects

Many older adults over the age of 65 have both spinal stenosis requiring spinal fusion surgery and frailty. As life expectancy has increased, many older individuals will undergo elective spinal fusion surgery to decrease their chronic pain in pursuit of improved quality of life. There is currently an underutilization of frailty screening for risk stratification of postoperative complications. A retrospective chart review over a two-year period from July 2023 to June 2025of adults aged 65 and older who underwent posterior spinal fusion surgery, involving 126 participants, was completed. We assessed the correlation between frailty and postoperative outcomes, discharge disposition, and …