Digital Commons Network^™

Cultural Competence In Pre-Medical Education: Examining Preparedness For Cross-Cultural Care, Fiza N. Khan

Honors Undergraduate Theses

As the U.S. population continues to grow more diverse, there is an urgent need for future healthcare providers to develop strong cultural competence. This study investigates undergraduate pre-medical students’ knowledge, attitudes, and comfort levels toward caring for diverse patient populations, including immigrants, refugees, and individuals from varied cultural backgrounds. The goal was to assess how well students are prepared to provide culturally responsive care before entering medical school. Recognizing that the foundation for medical training begins at the undergraduate level, this study aims to identify specific gaps in readiness that may hinder equitable patient care in the future.

A modified …

Camino A La Salud: Culturally Tailored Diabetes Education For Hispanic Older Adults In Stockton, California, Alondra Aldaba, Alexis Irvine, Jazmyn Monares, Marissa Doblados-Wood

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

AIM: Camino a la Salud addresses diabetes in one of the most affected populations in San Joaquin County, older Hispanic adults and their caregivers. This project aims to increase diabetes knowledge, confidence, and self-management among older adults in Stockton through culturally tailored education and hands-on learning. The project also provided glucometers and visual teaching tools to support skill development and improve diabetes awareness and prevention in this community.

METHODS: This project included three weekly bilingual diabetes education sessions held at El Concilio during their senior food distribution program. Each session covered a different topic: diabetes risks and complications, understanding glucose …

African American And African-Born Black Women’S Perspectives And Experiences With A Cervical Health Education And Hpv-Self Sampling Intervention, Shania Jones, Abubakari Wuni, Adaeze Aroh, Adebola Olamide Adegboyega

Markey Cancer Center Faculty Publications

Background/Objectives: A combination of cervical cancer prevention education and the provision of HPV self-collection kits has been found to increase the uptake of HPV testing among women. However, there is limited research evaluating the perspectives and experiences of women who have participated in a cancer prevention education and received a complimentary HPV self-collection kit. We report the experiences of women who took part in Health is Wealth: a cervical health intervention and received a complimentary HPV self-sampling kit for cervical cancer screening.

Methods: This pilot qualitative study enrolled twenty-four women who participated in one-on-one semi-structured interviews to provide feedback and …

Investing In The Development Of The Next Generation Of Mch Leaders, Karen A. Mcdonnell, Jamal Percy, Lisa Anders, Monique J. Brown Ph.D., Mph, Alice R. Richman, Julianna Deardorff, Monica S. Ruiz, Jihong Liu Sc.D., Kelli Russell, Audrey Snyder, Cassondra Marshall

Faculty Publications

The public health landscape is constantly evolving to address the strengths and needs of the community. Training for the public health workforce is leading the way, establishing an ecosystem approach that integrates individuals within social, political, and environmental contexts to promote health equity within a framework of social justice. One area of public health that is innovatively preparing the next generation of leaders is maternal and child health (MCH). In the United States, key indicators of health disparities within MCH remain stagnant, highlighting the need for training programs that develop future MCH professionals from diverse backgrounds. These professionals will deliver …

Environmental Justice Dimensions Of Orphaned Oil And Gas Wells In The United States, Grace Marie Hauser

Public Health Theses

Orphaned oil and gas (O&G) wells can leak methane and other hazardous pollutants,contributing to air and water contamination that threatens public health while also imposing financial burdens on local governments and taxpayers for remediation. However, the environmental and public health impacts remain understudied, in part due to limited understanding of the number and location of orphaned O&G wells. In this thesis we aimed to (1) create a national orphaned wells dataset covering years through 2024, (2) estimate the count and distribution of orphaned wells in the United States through 2024, and (3) evaluate the association between community environmental justice (EJ) …

Examining The Complex Interplay Of Stress, Social Support, And Drinking Motives On Alcohol Use Behaviors: A Moderated Mediation Model Among College Students, Sabrina Perrin

Dissertations and Theses

College student alcohol use remains a public health concern, yet the psychological and social mechanisms that contribute to high-risk drinking patterns are not fully understood. Guided by the motivational model of alcohol use and stress-buffering theory, this study tested a moderated mediation model to examine how perceived stress, coping motives for drinking, and perceived social support interact to influence alcohol use behaviors. A sample of over 1,100 diverse urban college students completed measures of stress, social support, drinking motives, and four alcohol-related outcomes: binge drinking, frequency of alcoholic drinks consumed, negative drinking consequences, and use of protective behavioral strategies (PBS) …

Examining Healthcare Access Disparities: Social Determinants And Patient Experiences At Valley Healthcare, Mikaila Larmond

Theses and Dissertations

Persistent disparities in healthcare access continued to affect low-income, rural, and underserved populations across the United States. This capstone project explored these disparities within Valley HealthCare, a regional provider in Columbus, Georgia, by examining how social determinants such as income, education, geography, and transportation shaped healthcare engagement among adult patients. A mixed-methods case study design was used to analyze survey data, patient satisfaction feedback, and organizational reports from a sample of 80 adult patients between January and March 2025.

The results showed that patients residing in lower-income or geographically isolated areas reported significantly higher rates of missed appointments. Individuals with …

Continuous Monitoring Of Sterility: Bacterial Contamination And Disinfectant Performance In Dental Clinics, Nathaly Alsalloum, Tarek Aboajwa, Shuaib Alahmad, Nermin Almouhammad

International Arab Journal of Dentistry

Objectives: This study aimed to (1) evaluate contamination levels across three clinics (endodontic, extraction and surgery, and fixed prosthodontics), (2) identify the types and prevalence of bacteria, (3) estimate the effectiveness of a commercial disinfectant, and (4) determine the bacterial species most responsive to the disinfectant.

Methods: Equal surfaces (17.98 cm²) were swabbed, cultured on nutrient agar for the total aerobic microbial count before and after disinfection, and analyzed using settle plates. Bacterial identification was conducted through colony characteristics, Gram staining, and biochemical tests. Data were processed using SPSS version 26.

Results: The endodontic clinic exhibited …

Informal Caregivers Connecting On The Web: Content Analysis Of Posts On Discussion Forums, Michelle L. Foster, Chinenye Egwuonwu, Erin Vernon, Mohammad Alarifi, M. Courtney Hughes

Faculty Articles, Papers, and Other Scholarship

Background: About 53 million adults in the United States offer informal care to family and friends with disease or disability. Such care has an estimated economic value of US $600 million. Most informal caregivers are not paid nor trained in caregiving, with many experiencing higher-than-average levels of stress and depression and lower levels of physical health. Some informal caregivers participate in web-based forums related to their caregiving role.

Objective: This study aimed to explore how informal caregivers use easy-to-access caregiving web-based forums, including the types of information they share and seek from others. It also aimed to gain insights into …

Impact Of Tobacco Control Policies On Socioeconomic Inequalities In Smoking Prevalence And Quit Ratios: An Ecological Study In The European Union (2009–2020), Ariadna Feliu, Esteve Fernandez, Irene Tamí-Maury, Cristina Martinez

Faculty, Staff and Student Publications

Background: Tobacco control efforts have succeeded in reducing smoking prevalence and increasing smoking cessation rates in the European Union Member States (EU27). However, the impact of these policies has been unequal across different income groups.

Methods: Ecological study with the country as unit of analysis. We used the Tobacco Control Scale (TCS) in EU27 in 2010 and the prevalence of smoking and quit ratios from the Eurobarometer surveys (2009, n=27 788; and 2020, n=28 288). We analysed the relationship between the TCS scores (2010) and smoking indicators and their relative changes (between 2009 and 2020) using scatter plots and multiple …

Diversity In United States Dementia Prevention Trials: An Updated Systematic Review Of Eligibility Criteria And Recruitment Strategies, Najoua Lazaar, Sabine E Van Beek, Awaale F Rirash, Janne M Papma, Jaime Perales-Puchalt, Ashley R Shaw, Eric D Vidoni, Sanne Franzen

Faculty, Staff and Student Publications

Introduction: Given the elevated dementia risk in underrepresented demographic groups in the USA - particularly in Latino and Non-Latino Black individuals compared to Non-Latino White individuals - it is vital that these groups are well-represented in dementia prevention research. Eligibility criteria and recruitment strategies may play a key role in promoting participant diversity. The aim of this review was to examine eligibility criteria and recruitment strategies in US dementia prevention trials in light of participant diversity.

Methods: A systematic review was conducted using Medline (including PubMed), Embase, Cochrane Library, and CINAHL. We explored the percent White participants for trials using …

Use Of Digital Health Interventions For Cancer Prevention Among People Living With Disabilities In The United States: A Scoping Review, Chinenye Lynette Ejezie, Lea Sacca, Sylvia Ayieko, Sara Burgoa, Yasmine Zerrouki, Diana Lobaina, Goodness Okwaraji, Christine Markham

Faculty, Staff and Student Publications

BACKGROUND: The use of digital health strategies for cancer care increased dramatically in the United States over the past 4 years. However, a dearth of knowledge remains about the use of digital health for cancer prevention for some populations with heath disparities. Therefore, the purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for people with disabilities.

METHODS: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and the Arksey and O'Malley methodological framework. The Embase, PubMed, Ovid MEDLINE, and CINAHL/EBSCO databases were …

Challenges And Opportunities Of Universal Health Coverage In Africa: A Scoping Review, Evaline Chepchirchir Langat, Paul Ward, Hailay Gesesew, Lillian Mwanri

Centre of Excellence in Women and Child Health

Background: Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions.

Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature …

40 Years Passing By In (A) “Heartbeat”, Christopher Janney

Monsoon: South Asian Studies Association Journal

This article outlines the forty-year history go Christopher Janney’s iconic performance work “HeartBeat.” Trained as an architect and jazz musician, Janney combines these two disciplines to create large interactive light/sound installations and performances. On the one hand, he attempts to make architecture more like music, more “alive” using real-time sensing devices as on his “Harmonic Convergence” installation on the Miami International Airport. On the other hand, he attempts to make music more like architecture, more physical more visual. In his “HeartBeat” performance, a dancer wears a heartbeat device that amplifies his/her heartbeat in “real time.” Over this pulse, live musicians …

Yoga Sūtra Book Four And The Yogabindu, Christopher Key Chapple

Monsoon: South Asian Studies Association Journal

Four themes from the fourth pāda of Patañjali’s Yoga Sūtra are examined here: karma (IV:2-13), individuality (IV:16), humility (IV:20-22), and freedom (IV:29-34). Affirmations and variant interpretations of these four are provided from Haribhadra Virahāṅka’s Yogabindu, most likely composed a century or two later.

Collective Karma: From The Yogasūtra To Taylor Swift, Zoë Slatoff

Monsoon: South Asian Studies Association Journal

The Indian knowledge traditions speak at length about karma, which is divided into three categories—accumulated (saṃcita), ripe (prārabdha), and future (kriyamāṇa). While much is said about our individual karma and how it affects our repeated reincarnation in cyclic existence, how does this affect others and how do others affect us? In other words, as this paper explores, what is our reciprocal and collective karma?

Painting Liberation: A Visual Ontology Of The Interplay Of Mind And Consciousness In Book Four Of The Yoga Sūtras, Melissa Townsend

Monsoon: South Asian Studies Association Journal

This presentation explores how artistic practice can illuminate philosophical questions about the nature of mind, consciousness, and liberation as articulated in Book Four of the Yoga Sūtras of Patañjali. Through a series of paintings that visually translate these sūtras, I propose that art offers a unique, experiential means of engaging with the complex relationship between citta (mind) and puruṣa (consciousness).

The paintings function as a form of “visual ontology,” inviting viewers to engage with abstract philosophical concepts in a sensory, tangible way. By depicting the interplay between the mutable processes of the mind and the unchanging awareness of consciousness, these …

Identifying, Organizing, And Prioritizing Ideas On How To Support The Entangled Relation Between Theory And Practice In Occupational Therapy Education: A Group Concept Mapping Study, Rina Juel Kaptain, Jacob Østergaard Madsen, Anna Marie Lassen, Kristina Tomra Nielsen

Journal of Occupational Therapy Education

Transfer of learning from an academic setting to clinical practice and vice versa represents a challenge. The aim of this study was therefore to identify, organize, and prioritize ideas on how to support the entangled relation between theory and practice in occupational therapy (OT) education. To gain broad perspectives on the topic, Group Concept Mapping (GCM) was applied among OT students, lecturers, and fieldwork educators. GCM included six phases: Preparing (formulating a focus prompt), Generating ideas (brainstorming based on focus prompt: “To support the relation between theoretical and practical elements in the OT program there is a need for.. …

Factors Influencing Reflection And Self-Assessment Of Simulation Performance: Comparing Student And Preceptor Ratings, Kaitlin R. Sibbald, Diane E. Mackenzie

Journal of Occupational Therapy Education

Simulation with simulated patients is increasingly used in occupational therapy. Ensuring the debrief component meets student needs to develop their self-assessment skills for participating in a self-regulating profession is essential. This explanatory mixed-methods research sought to explore factors contributing to accurate and inaccurate self-assessment of simulation performance for novice occupational therapy learners in a part-time introductory fieldwork course. Self-ratings and preceptor-ratings of performance on eleven simulation objectives were compared for sixty-five novice occupational therapy students. Factor analysis was used to explore contributors to differences in ratings between students and preceptors. Students’ written plus-delta debrief reflections were analyzed to explore what …

The Impact Of Socioeconomic Status On Substance Use Amongst The Hispanic Maternal Population, Emily C. Olivo

Honors Undergraduate Theses

Aim: To explore and synthesize existing research that focuses on the relationship between socioeconomic status and the use of substances amongst the maternal Hispanic population. By examining research and these factors, interventions can be identified to lower reported substance use rates amongst Hispanic mothers of childbearing ages.

Background: Minorities such as Hispanic women deal with a myriad of struggles, especially during motherhood. Socioeconomic status and substance use can contribute to a large part of the struggles faced by this population. Hispanic and Latina will be used interchangeably throughout this review of literature.

Method: A comprehensive electronic review of 3 databases …

Navigating The Path: Understanding And Overcoming Challenges For College Students With Disabilities, Nahal Salimi, Bryan Gere, Elaine Mora, Roy K. Chen

School of Rehabilitation Services & Counseling Faculty Publications

Higher education can be challenging for many students, but for those with disabilities, it presents additional hurdles. Oftentimes, students with disabilities must navigate both their academic responsibilities and the unique challenges posed by their disabilities. This chapter provides a comprehensive overview of the most frequently reported challenges and barriers to academic success for students with disabilities in higher education. The chapter focuses on several key issues, including but not limited to societal attitudes surrounding disability and provision of academic accommodation, students' willingness to disclose their disabilities in their institutes, and difficulties with social integration. Each of these challenges is explored …

The Use Of Music Therapy And Various Mechanisms Of Diversion To Aid Caregivers Of Those With Alzheimer’S Disease And Dementia, Sarah Elizabeth Kane

Doctor of Nursing Practice Projects

Background: Alzheimer’s Disease and Dementia inhabit an increasingly alarming number of individuals within the United States with the majority of their caregivers being loved ones with limited to no healthcare education. This DNP project was designed to specifically educate caregivers of those with Alzheimer’s Disease and Dementia. The goal of this project was to increase the knowledge of the disease while also increasing the ability and confidence to better care for their loved ones. In using the resources outlined in this project, such as music therapy and diversional tools, the caregiver would see a decrease in emotional outbursts and …

Not Fully Synthetic: Llm-Based Hybrid Approaches Towards Privacy-Preserving Clinical Note Sharing, Atiquer Rahman Sarkar, Yao-Shun Chuang, Xiaoqian Jiang, Noman Mohammed

Faculty, Staff and Student Publications

The publication and sharing of clinical notes are crucial for healthcare research and innovation. However, privacy regulations such as HIPAA and GDPR pose significant challenges. While de-identification techniques aim to remove protected health information, they often fall short of achieving complete privacy protection. Similarly, the current state of synthetic clinical note generation can lack nuance and content coverage. To address these limitations, we propose an approach that combines de-identification, filtration, and synthetic clinical note generation. Variations of this approach currently retain 36%-61% of the original note's content and fill the remaining gaps using an LLM, ensuring high information coverage. We …

Enhancing Cross-Domain Generalizability In Social Determinants Of Health Extraction With Prompt-Tuning Large Language Models, Cheng Peng, Zehao Yu, Kaleb E Smith, Wei-Hsuan Lo-Ciganic, Jiang Bian, Yonghui Wu

Faculty, Staff and Student Publications

The progress in natural language processing (NLP) using large language models (LLMs) has greatly improved patient information extraction from clinical narratives. However, most methods based on the fine-tuning strategy have limited transfer learning ability for cross-domain applications. This study proposed a novel approach that employs a soft prompt-based learning architecture, which introduces trainable prompts to guide LLMs toward desired outputs. We examined two types of LLM architectures, including encoder-only GatorTron and decoder-only GatorTronGPT, and evaluated their performance for the extraction of social determinants of health (SDoH) using a cross-institution dataset from the 2022 n2c2 challenge and a cross-disease dataset from …

Enhancing Medical Coding Efficiency Through Domain-Specific Fine-Tuned Large Language Models, Zhen Hou, Hao Liu, Jiang Bian, Xing He, Yan Zhuang

Faculty, Staff and Student Publications

Medical coding is essential for healthcare operations yet remains predominantly manual, error-prone (up to 20%), and costly (up to $18.2 billion annually). Although large language models (LLMs) have shown promise in natural language processing, their application to medical coding has produced limited accuracy. In this study, we evaluated whether fine-tuning LLMs with specialized ICD-10 knowledge can automate code generation across clinical documentation. We adopted a two-phase approach: initial fine-tuning using 74,260 ICD-10 code-description pairs, followed by enhanced training to address linguistic and lexical variations. Evaluations using a proprietary model (GPT-4o mini) on a cloud platform and an open-source model (Llama) …

Explainable Diagnosis Prediction Through Neuro-Symbolic Integration, Qiuhao Lu, Rui Li, Elham Sagheb, Andrew Wen, Jinlian Wang, Liwei Wang, Jungwei W Fan, Hongfang Liu

Faculty, Staff and Student Publications

Diagnosis prediction is a critical task in healthcare, where timely and accurate identification of medical conditions can significantly impact patient outcomes. Traditional machine learning and deep learning models have achieved notable success in this domain but often lack interpretability which is a crucial requirement in clinical settings. In this study, we explore the use of neuro-symbolic methods, specifically Logical Neural Networks (LNNs), to develop explainable models for diagnosis prediction. Essentially, we design and implement LNN-based models that integrate domain-specific knowledge through logical rules with learnable weights and thresholds. Our models, particularly Mmulti-pathway and Mcomprehensive, demonstrate superior performance over traditional models …

Recovery Of Verbal Working Memory Depends On Left Hemisphere White Matter Tracts, Randi C Martin, Junhua Ding, Ali I Alwani, Steve H Fung, Tatiana T Schnur

Faculty, Staff and Student Publications

Researchers propose that the recovery of language function following stroke depends on the recruitment of perilesional regions in the left hemisphere and/or homologous regions in the right hemisphere. Many investigations of recovery focus on changes in gray matter regions, whereas relatively few examine white matter tracts and none address the role of these tracts in the recovery of verbal working memory. The present study addressed these gaps, examining the role of left versus right hemisphere tracts in the longitudinal recovery of phonological and semantic working memory. For 24 individuals with left hemisphere stroke, we assessed working memory performance within 1 …

The Tripod-Llm Reporting Guideline For Studies Using Large Language Models, Jack Gallifant, Majid Afshar, Saleem Ameen, Yindalon Aphinyanaphongs, Shan Chen, Giovanni Cacciamani, Dina Demner-Fushman, Dmitriy Dligach, Roxana Daneshjou, Chrystinne Fernandes, Lasse Hyldig Hansen, Adam Landman, Lisa Lehmann, Liam G Mccoy, Timothy Miller, Amy Moreno, Nikolaj Munch, David Restrepo, Guergana Savova, Renato Umeton, Judy Wawira Gichoya, Gary S Collins, Karel G M Moons, Leo A Celi, Danielle S Bitterman

Faculty, Staff and Student Publications

Large language models (LLMs) are rapidly being adopted in healthcare, necessitating standardized reporting guidelines. We present transparent reporting of a multivariable model for individual prognosis or diagnosis (TRIPOD)-LLM, an extension of the TRIPOD + artificial intelligence statement, addressing the unique challenges of LLMs in biomedical applications. TRIPOD-LLM provides a comprehensive checklist of 19 main items and 50 subitems, covering key aspects from title to discussion. The guidelines introduce a modular format accommodating various LLM research designs and tasks, with 14 main items and 32 subitems applicable across all categories. Developed through an expedited Delphi process and expert consensus, TRIPOD-LLM emphasizes …

Psychometric Properties And Meaningful Change Thresholds For The Qol-E Instrument In Patients With Myelodysplastic Neoplasms, Esther Natalie Oliva, Shien Guo, Jennifer Lord-Bessen, Aylin Yucel, Roberto Latagliata, Massimo Breccia, Giuseppe A Palumbo, Grazia Sanpaolo, Marta Riva, Valeria Santini, Uwe Platzbecker, Guillermo Garcia-Manero, Pierre Fenaux, Christopher G Pelligra

Faculty, Staff and Student Publications

peripheral blood cytopenias, and an increased risk of progression to acute myeloid leukemia. One of the main treatment goals is improving quality of life (QoL), particularly for patients with lower-risk MDS (LR-MDS) who may live longer with compromised QoL. The QOL-E© is a patient-reported outcome (PRO) measure specifically developed to address the lack of a health-related QoL questionnaire for patients with MDS. The objective of this study was to evaluate the psychometric performance of the QOL-E in patients with LR-MDS.

Methods: Data from four clinical trials in MDS (MEDALIST, DARB-MDS, EQoL-MDS, and RevMDS trials) were used to assess construct validity, …

Building Boundary-Crossers In Clinical-Translational Research: An Exploratory Study Of A Novel Communication Intervention, Carrie Cameron, Irene Rull-Garcia, Laura G Meyer, Jose-Armando Fernandez-Guerrero, Erin K Dahlstrom, Christine Bell, Christine Pribbenow

Faculty, Staff and Student Publications

INTRODUCTION: Integrating scientific research across multiple disciplines to advance breakthroughs is at the heart of clinical-translational science (CTS); among competencies that have been identified as essential for progress, skillful communication is critical. Few tools are available to address the social dynamics of the multidimensional diversity characteristics of CTS. We created the "Building a Diverse Biomedical Workforce Through Communication Across Difference (CAD)" workshop intervention. Based on principles of intercultural communication, CAD taught novel situationally-based communication skills to dyads of near-peer mentors and their undergraduate mentees. This study reports on the effectiveness of the operative mechanisms employed in CAD workshops for helping …