Digital Commons Network^™

Preoperative Patient Sentiment Is Associated With Postoperative Outcomes In Adult Spinal Deformity Surgery, Ross J. Gore, David Mazur-Hart, Mohan K. Sunkara, Aaqib Ali, Qizar Ali, Christopher J. Lynch

Center for Secure and Intelligent Critical Systems (CSICS) Publications

Study Design:

Prospective observational pilot study of adult spinal deformity surgery patients.

Objective:

To determine whether preoperative patient sentiment, quantified using a 21-class valence scale extending the CARP paradigm implemented through an offline Large Language Model, predicts postoperative outcomes.

Summary of Background Data:

Predicting adult spinal deformity surgery outcomes remains challenging with traditional clinical and radiographic parameters alone. Although patient psychological factors and expectations significantly influence postoperative satisfaction and quality of life, systematic approaches to capture these factors are underdeveloped. Offline Large Language Models offer scalable, privacy-preserving psychological risk stratification.

Materials and Methods:

We prospectively enrolled 18 patients undergoing adult …

Memoryart: Enhancing Llms Via Multi-Memory Models With Adaptive Resonance Theory For Healthcare Agents, Renke Dai, Hebin Hu, Jiahui Zhang, Yilin Kang, Ah-Hwee Tan

Research Collection School Of Computing and Information Systems

Though promising in healthcare consultation applications, large language models (LLMs) face critical limitations in retaining and utilizing long-term memory across multiturn interactions. In particular, existing memory enhancing paradigms are constrained by limited context windows and embedding-based retrieval, often failing to maintain task relevance and still suffering from memory prototype collapse in multi-turn healthcare consultation. To address these challenges, we propose a cognitively-inspired memory framework named MemoryART, which is grounded in Adaptive Resonance Theory (ART)—a cognitive and learning theory of how humans and animals adapt to dynamic environments. MemoryART employs three memory modules—working memory, episodic memory, and semantic memory to support …

'Guide The Tide' - Supervision Of International Medical Graduates In The Emergency Department: A Mixed Methods Study, Purnasankar Bhowmik

Theses

Australia’s emergency departments (EDs) have experienced significant stress since the COVID-19 pandemic. An increase in the number of patient presentations, a lack of in-patient beds for the disposition of admitted patients and long waiting times are contributing factors jeopardising patient safety. In addition, the shortage of skilled staff to look after patients in the ED is the paramount concern currently and moving forward. Similarly to many other specialty areas of medicine, EDs rely on international medical graduates (IMGs) to fill the gaps in the medical workforce. However, concerns have been raised regarding IMG diversity in training requirements, clinical skills and …

Nativity And English Language Use In Relation To Undiagnosed And Diagnosed Diabetes In U.S. Adults, Aliya Kuerban Phd, Fnp-Bc, Ms, Ma, Rn

Nursing: Faculty Presentations

Introduction and Objective: Diabetes detection varies across demographic and immigration-related groups. Foreign-born adults and individuals with limited English proficiency may be less likely to have diabetes identified, even when the disease is present. This study examined demographic, socioeconomic, and immigration-related correlates of undiagnosed and diagnosed diabetes among U.S. adults.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES, 2011-2023) were analyzed using survey-weighted multinomial logistic regression. Diabetes status was categorized as no diabetes, undiagnosed diabetes, or diagnosed diabetes based on self-report and laboratory criteria. Models sequentially adjusted for age, sex, race/ethnicity, nativity, English language use, income, and education. …

Behavioral And Psychological Financial Hardship Among Caregivers Of Pediatric Cancer Patients, Josiane Kabayundo, Cheng Zheng, Edward S. Peters, Don W. Coulter, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

BACKGROUND: Financial hardship encompasses material, behavioral, and psychological domains; however, most research among caregivers of pediatric cancer patients has focused on material hardship. This study examined factors associated with behavioral and psychological financial hardship among caregivers of pediatric cancer patients in Nebraska.

METHODS: We conducted a cross-sectional survey of caregivers of children diagnosed within the past 5 years and treated at two pediatric oncology specialty clinics. Behavioral hardship was defined as delaying medical or mental healthcare due to cost, while psychological hardship was measured by worry about ability to pay medical bills. Descriptive statistics and poisson regression with robust variance …

Art As Medicine: Exploring The Intersection Of African Cultural Practices And Art Therapy To Examine Its Efficacy In Pain Management And Healing Among Black Women With Lupus, Kandace I. Simmons

Art Therapy | Master's Theses

This thesis examined the intersection of chronic illness and systemic inequities faced by Black women living with lupus. These women often encountered unique challenges in managing their health and well-being, exacerbated by both the physical and sociocultural implications of the disease. Through a Black Feminist/Womanist theoretical lens, this research investigated the potential of art therapy to serve as a transformative instrument for pain management and healing when infused with culturally relevant practices. Employing a narrative approach and qualitative methodology, this study explored the lived experiences of African American women with lupus, incorporating their art and personal stories to inform the …

Pelvic Health Physical Therapy Education For Spanish Speakers Assessing Empowerment Through Education: Preliminary Findings, Tess Swake, Kira Negrete, Marisela Trenado-Alba, Erika Benitez, Alessandra Peraza-Aguillón

Student-Faculty Research - College of Physical Therapy

The Problem: Pelvic Floor Dysfunction (PFD) disproportionately impacts the US Latinx population, who experience up to a 1.8x higher rate of urinary incontinence, yet they face significant language and cultural barriers in healthcare.

The Gap: Current Spanish educational materials often exceed recommended reading levels, and published research on pelvic health physical therapy tailored for primary Spanish speakers is non-existent.

The Purpose: To evaluate the effectiveness of accessible Spanish-language materials (text, graphics, and video) in empowering patients by improving their knowledge of pelvic anatomy, common conditions, and baseline health.

When Speech Speaks Louder Than Truth: Language Variation And Credibility In The Courtroom, Melanie E. Spinnie

Graduate Theses/Dissertations

This study aims to investigate how linguistic variation affects perceptions of credibility in courtroom settings. It focuses on how jurors, judges, and other individuals in the legal system may exhibit bias (consciously or unconsciously) based on how a defendant or witness speaks-- this could include speech disorders as well as differences in dialect, accent, and speech style. Through review of relevant literature, review of a relevant historical case, conducting a survey, and conducting a semi-structured interview, this study explores whether certain speech patterns or characteristics are disproportionately associated with negative judgments during legal proceedings, such as reduced credibility and trustworthiness. …

Large Language Models Improve Readability Of Patient Education Materials On Vascular Conditions, Melissa Chen Xu, Nicola Habash, Justin Do, Jiaying Bi, Dawn Salvatore, Paul J Dimuzio, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

Objective: Patient education materials frequently exceed the recommended sixth-grade reading level. Although large language models (LLMs) have shown inconsistent accuracy in medical query responses, they have demonstrated promise in simplifying complex text. This capability has not yet been studied in vascular patient education materials. This study evaluates whether ChatGPT-4o and Gemini 1.5 Pro can improve the readability of Society for Vascular Surgery (SVS) patient education flyers. Methods: SVS health flyers were selected based on five common vascular conditions: abdominal aortic aneurysm, carotid artery disease, deep vein thrombosis, peripheral artery disease, and varicose veins. Each flyer was submitted to ChatGPT-4o and …

Healthy Starts: Cooking, Culture & Confidence, Lindsey Plumb

Student Research Design & Innovation Symposium

Healthy Starts: Cooking, Culture, and Confidence for Healthier Families is a culturally tailored nutrition intervention designed for pediatric patients and caregivers served by the Nutrition Teaching Center at Hasbro Children's Hospital in Providence, Rhode Island. The program addresses high rates of childhood overweight and obesity, food insecurity, and low caregiver confidence in meal preparation among racially, ethnically, and socioeconomically diverse families. Grounded in Social Cognitive Theory, Healthy Starts focuses on building practical cooking skills, nutrition knowledge, and self-efficacy through bilingual, hands-on cooking classes, family nutrition workshops, and peer support circles. Sessions emphasize preparing affordable, culturally familiar meals while accommodating religious …

Evolution Of A Client‐Level Dataset: 20 Years Of National Child Traumatic Stress Network Data Collection, C. A. Purbeck, A. N. Cooke, L. J. Liang, C. Smith, J. Staten, J. Epstein, H. B. Hodgdon, Jessica Eslinger, A. Wells, J. Goodrich, T. H. Bethel, K. Willett, Y. C. Fu, J. A. Fairbank, E. C. Briggs

Center on Trauma and Children Faculty Publications

Objectives: For 20 years, the National Child Traumatic Stress Network's (NCTSN) data collection efforts have been a central mechanism for Clinical Quality Improvement (ClQI). The NCTSN is a federally funded initiative in the United States composed of programs dedicated to raising the standard of care and increasing access to services for children and families who have experienced traumatic events.

Methods: These efforts span three initiatives: the Core Data Set (CDS), the Clinical Improvement through Measurement Initiative (CIMI) Measurement Based Care (MBC), and CIMI Data Sharing (CIMI-DS) that collected and analyzed client-level data to improve care for children and families served …

Visual Aids And Numeracy In Healthcare: Leveraging The Drawing Effect, Zephyr J. Markley

Capstone Showcase

Healthcare decisions often require patients to interpret numerical risk information under stress, yet many struggle with low numeracy, which can distort comprehension and undermine informed consent. Well-designed visual aids can improve diagnostic inference, calibrate confidence, and support better choices, especially for patients with limited numeracy, but their impact depends on whether users can actually interpret the format accurately. Drawing may further enhance these tools by adding a tactile, generative layer that engages visual, semantic, and motoric processing while helping patients organize information into concrete models.

Passive visual aids appear useful but limited because they often position patients as observers rather …

Connecting Through Art: A Collaborative Art Program For The Deaf Community, Andrey Meg Bacal, Cristina Dumitrescu, Gary Dennis, Regina Brejda, Maija Vizvary, Jacie Schneider

Occupational Therapy Student Scholarship

This doctoral capstone project developed, implemented, and evaluated a Deaf-centered, ASL-accessible community art program at the Jessye Norman School of the Arts in Augusta, Georgia. The project addressed communication and environmental barriers that may limit participation in meaningful leisure and community-based occupations. Two ASL-interpreted art sessions and a community art show were completed, with evaluation using adapted PROMIS-based survey items, implementation observations, and quality improvement feedback. Because only two usable anonymous survey responses were available at each time point, findings were summarized descriptively and interpreted as feasibility and implementation information rather than evidence of effectiveness. The project supported the feasibility …

Auditory Memory In Children Who Stutter, Sanaa Mahran Mohamed Qandel, Nihal Hisham Abdelhamid Mostafa, Nihal Hisham Abdelhamid

Journal of Medicine in Scientific Research

Background Stuttering has been described as a disorder in motor speech in which disruption in the timing between laryngeal, respiratory, and vocal tract rhythm of speech. It is characterized by prolongations and involuntary repetitions of sounds. Children who stutter (CWS) characterized by inability to produce sounds, with intra-phonemic disruption and involuntary silent pauses. Many studies have examined central auditory processing skills and reported impairments, yet auditory memory skills have not been adequately evaluated, leaving a gap in the available information. Aim of the study Assessing auditory memory performance and auditory memory abilities in CWS. Methods: Measuring recognition memory, memory for …

Health Care Governance And Structural Exclusion In Florida: A Human Rights Analysis Of Access For Latinx Communities, Natalie Medrano

Honors Undergraduate Theses

Access to health care in the United States is a complex system shaped by statutory programs and the discretionary powers of state governance. This thesis examines how Florida’s healthcare system structures access through administrative design, with particular attention to its impact on Latinx communities. Although formally race-neutral, Florida’s reliance on Medicaid non-expansion, managed care delivery, and complex eligibility processes produces systemic barriers that limit access for low-income populations. Drawing on the international right-to-health framework articulated in General Comment No. 14 of the International Covenant on Economic, Social and Cultural Rights, alongside Latinx Critical Race Theory (LatCrit), this study analyzes how …

Proactive Safety Reasoning In Human-Robot Collaboration In Disassembly Through Llm-Augmented Stpa And Fmea, Morteza Jalali Alenjareghi, Fardin Ghorbani, Samira Keivanpour, Yuvin Adnarain Chinniah, Sabrina Jocelyn

Études primaires

Disassembly tasks in human–robot collaboration (HRC) environments present safety challenges due to hazardous materials, control system variability, and physically demanding operator tasks. To address these challenges, we propose an AI-augmented risk assessment framework integrating System-Theoretic Process Analysis (STPA) and Failure Mode and Effects Analysis (FMEA). This framework is implemented in four configurations: Term Frequency– Inverse Document Frequency (TF-IDF), Fine-tuned Large Language Models (LLMs), Retrieval-Augmented Generation (RAG), and RAG with a structured Knowledge Graph (KG) built from safety standards. The system supports real-time, standards-compliant safety reasoning by generating interpretable, context-specific recommendations. We evaluate these configurations across GPT-3.5 TURBO, GPT-4o, GPT-4.1, and …

Acceptability, Usability, And Clinical Integration Of A Clinic-Based Digital Game For Hpv Education: Qualitative Perspectives From Adolescents, Parents, And Healthcare Providers, Elizabeth Reifsnider, Satya Subedi, Nouran Ghonaim, Megan Whaley, Angela Chia-Chen Chen

Ellmer School of Nursing Faculty Publications

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and …

Preoperative Patient Sentiment Is Associated With Postoperative Outcomes In Adult Spinal Deformity Surgery, Ross J. Gore, David Mazur-Hart, Mohan K. Sunkara, Aaqib Ali, Qizar Ali, Christopher J. Lynch, Christopher Ames

Center for Secure and Intelligent Critical Systems (CSICS) Publications

Study Design: Prospective observational pilot study of adult spinal deformity surgery patients.

Objective: To determine whether preoperative patient sentiment, quantified using a 21-class valence scale extending the CARP paradigm implemented through an offline Large Language Model, predicts postoperative outcomes.

Summary of Background Data: Predicting adult spinal deformity surgery outcomes remains challenging with traditional clinical and radiographic parameters alone. Although patient psychological factors and expectations significantly influence postoperative satisfaction and quality of life, systematic approaches to capture these factors are underdeveloped. Offline Large Language Models offer scalable, privacy-preserving psychological risk stratification.

Materials and Methods: We prospectively enrolled 18 patients undergoing adult …

Therapeutic Landscape Of Early Symptomatic Alzheimer's Disease Translated Into Everyday Practice For Geriatric Providers., Melissa J Bailey-Taylor, Paula Morrow, James Hendrix, Katherine E. Galluzzi, Golnosh Sharafsaleh

PCOM Scholarly Works

Alzheimer's disease (AD) accounts for 60-80% of all dementia cases. Recent advances in diagnostic biomarkers of early symptomatic AD (ie, mild cognitive impairment and mild dementia due to AD) and amyloid-targeting therapies (ATTs) have the potential to improve outcomes for patients with AD. Two ATTs (donanemab and lecanemab) are currently approved and available for use in the US. Both ATTs can slow disease progression as well as cognitive and functional decline in patients with early symptomatic AD. Treatment with ATTs is associated with specific safety concerns such as amyloid-related imaging abnormalities. Therefore, the benefit versus risk profile needs to be …

Exploring African Students’ Experiences With Culturally Responsive Mental Health Apps In The U.S., Emelia Essumanba-Josiah

Graduate Research Theses & Dissertations

Digital mental health applications have proven to be effective, yet adoption remains very low among African international students in the United States. This study investigated how 17 university students perceive the usefulness of mental health apps, evaluate existing tools through their cultural lens, and recommend what a culturally responsive app would look like – all through a semi-structured interview with an app exploration exercise at a Midwestern public university. Guided by the Technology Acceptance Model and the African-Centered Wellness Model, there were six (6) key themes that emerged revealing participants carried skewed pre-migration mental health frameworks, dealt with their stressors …

Investigating Speech-Language Pathologists’ Perception On Bilingual/Multilingual Aac Intervention And Quality Of Care., Lillian Griffith

2026 Research Poster Competition

In recent decades, the caseloads worldwide of speech-language pathologists (SLPs) have become increasingly linguistically diverse (Soto & Yu 2014). However, current research in the field of communication sciences and disorders is primarily focused on monolingual populations, with a similar lack of research in the field regarding bilingual/multilingual Augmentative and Alternative Communication (AAC) (Tönsing & Dada 2022). AAC refers to methods of communication other than spoken language and can augment existing speech or serve as an alternative to speech (ASHA n.d.). Although advancements in the field regarding AAC use for monolingual/English-speaking clients have been made, there is a lack of research …

Family- And Cultural-Level Influences For Latine Adolescent Nicotine Use: A Qualitative Study Informing Prevention, Cindy M. Hernandez Castro

Theses and Dissertations

Early tobacco use among Latine adolescents represents a critical public health concern, with 23.8% reporting current use and exceeding rates among other racial/ethnic groups (Birdsey et al., 2023; Gaddy et al., 2022). This early initiation elevates risks for nicotine dependence and related morbidity in adulthood (Tsao et al., 2023). Guided by Structural Ecosystems Theory (Szapocznik & Coatsworth, 1999) and contemporary grounded theory analysis (Braun & Clarke, 2006; Charmaz, 2006; Noble & Mitchell, 2016), this study examined multilevel influences on nicotine-related attitudes among Latine youth, including: (1) familial factors (i.e., parental monitoring, caregiver-youth communication), (2) cultural dynamics (i.e., cultural values and …

Perceptions, Expectations, And Attitudes About Adolescent Telepsychiatry Among Indian American Family Caregivers, Udayvir Jalf

Honors Undergraduate Theses

Adolescent mental health concerns have risen sharply in the United States. The COVID-19 pandemic marked a significant turning point in mental health care access, with telehealth having become a central mode of care delivery. With adolescent telehealth, caregiver involvement has shown to improve treatment adherence and outcomes. Little is known, however, about how Indian American caregivers experience and navigate their adolescent’s virtual mental health care. This qualitative study investigated the perceptions, expectations, and attitudes of Indian American family caregivers regarding adolescent telepsychiatry and caregivers’ involvement. In depth semi-structured interviews were conducted with Indian American caregivers of adolescents who completed at …

How Does The Frequency Of Visits Impact The Quality Of Life For Nursing Home Residents?, Sophie M. Carlton

Honors Undergraduate Theses

This integrative literature review examines the relationship between quantity of visitation and quality of life (QOL) of nursing home residents. The purpose of this review is to examine existing research to determine whether an optimal “dosage” of visitation exists that meaningfully enhances QOL for this vulnerable population. Establishing an evidence based- guideline may help reduce uncertainty for families and promote more consistent improvements in resident well-being. Nursing home residents are the focus of this work because their limited ability to leave the facility makes visitation one of their primary sources of non-occupational social interaction. The COVID19 pandemic further heightened the …

Analyzing Early Medieval Perspectives Of Fetal Development, Nivedha Srinivasan

Honors Undergraduate Theses

This thesis examines early medieval perspectives of fetal development by analyzing two manuscripts: British Library, Cotton Tiberius A III and Leiden University, Vossianus lat. Q69. This study will investigate how knowledge of pregnancy was shared throughout England before the establishment of universities. Interest in medieval reproductive language has piqued in importance in recent years, especially due to modern legal debates surrounding reproductive rights. By examining descriptions of the nine months of fetal development in these two manuscripts, as well as in widely known earlier medical texts like Pliny’s Natural History and Vindicianus’ Gynaecia, this research explores how monastic writers in …

Oral Health Access Among Ethnic Minority Older Adults In The United States, Jasleen K. Sodhi

Honors Undergraduate Theses

Oral healthcare is a critical yet often overlooked component of overall health among U.S. adults. Ethnic minorities for older adults face heightened risks of poor oral health and related health conditions, while experiencing disparities in access to care. This study aimed to systematically examine and synthesize existing literature to assess the extent to which oral health disparities exist among ethnic minority older adults in the U.S. and explore the roles of socioeconomic factors on these disparities. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we conducted a systematic review of peer-reviewed articles published in English …

Risk And Protective Factors Of South Asian American Youth Mental Health, Jasmine Kaur

Honors Undergraduate Theses

South Asian American youth represent a rapidly growing yet understudied population in United States mental health research. Much of the existing literature aggregates diverse Asian American subgroups, obscuring the unique sociocultural experiences of South Asian adolescents and young adults. This thesis examines the risk and protective factors influencing the mental health of South Asian American youth aged 15–25. A systematic review of peer-reviewed literature was conducted using the databases Web of Science, MEDLINE, PsycINFO, and CINAHL Plus with Full Text. Search terms included culturally specific identifiers, migration-related terminology, youth demographic terms, and mental health outcomes. After removing duplicates and applying …

Exploring The Link Between Hospice Setting And Caregiver-Reported Quality Scores, Aidan J. John

Honors Undergraduate Theses

Access to high quality hospice care largely varies across different care environments and regions within the United States. This can shape the experiences of family caregivers who support patients at the end of life. As hospice enrollment expands nationwide, understanding how care delivery changes between home-based services and more skilled inpatient and outpatient services has become integral for examining overall performance.  There are many noticeable differences in provider availability and resources between different programs that can influence the level of support families receive, including timeliness of symptom management and effectiveness of communication with hospice staff. This study evaluated whether hospice …

Spanish-Speaking Parents' Health Literacy And Comprehension Of Idea Terminology, Daria Hernandez

Honors Undergraduate Theses

This study aims to examine how personal health literacy can affect Spanish-speaking parents’ comprehension of special education documentation, specifically within the scope of Communication Sciences and Disorders (CSD) and Individuals with Disabilities Education Act (IDEA) terminology; in order to gain insight into the readability of commonly used terms within special education documents. Across the United States, limited health literacy across organizations and individuals is an extremely pressing issue as it can limit the ability for individuals to make the proper decisions involving their healthcare and education. This issue is exacerbated when considering Hispanic populations, with their personal health literacy levels …

Improving Adolescent Sexual Health Education Through A Gamified Quality Improvement Initiative In Kenya: Game On For Safe Choices, Alyssa Kashia Lee, Isabel Diazdeleon, Ilyana Karkar

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

Adolescent sexual health remains a significant public health concern in rural Kenya because of the limited access to comprehensive sexuality education; therefore, contributing to high rates of sexually transmitted infections (STIs), HIV, unintended pregnancy, and gender-based violence. This quality improvement project evaluated the implementation of the Game On for Safe Choices, a culturally responsive, game-based sexual health education intervention designed to improve adolescents' sexual health knowledge and confidence. The project was conducted at ByKay Hotel in Sega, Siaya County, Kenya, and included 25 adolescents aged 15–17 years. Guided by the Plan-Do-Study-Act framework, participants completed three interactive educational stations focused on …