Digital Commons Network^™

A Systematic Review Of Cultural And Structural Barriers To Mammogram Access Among Immigrant Women, Abeer Wael Abukamil, Samar Ghassan Chehab, Sabrina Khan, Rima Charara

Medical Student Research Symposium

Introduction:

Mammograms are crucial for early breast cancer detection and reducing mortality (5). However, U.S. minorities, particularly immigrants, are less likely to receive screenings (9). Identifying barriers can help tailor interventions to meet immigrant women’s needs.

Methods:

Studies were found on PubMed using a systematic review protocol following PRISMA guidelines (8). Search terms included “minority,” “mammograms,” and “barriers.” Articles were then selected for a full-text review by three authors. 220 articles were narrowed down to 7 by relevance and date of publishing (2005 and beyond).

Results:

Cultural barriers often limit immigrant women’s access to breast cancer screenings. In certain non-Western …

"I Know Who I Am": Draw-And-Tell Conversations With Gender-Creative Children, Eline Leemans Lenne

Dissertations and Theses

A growing number of children identify in various gender-creative ways, likely due to broader social awareness and affirmation of transgenderism. Gender-creative children face higher risks for adverse social, academic, mental health, and healthcare outcomes compared to non-transgender peers. Support from loved ones along with guidance from pediatric providers can mitigate poor outcomes and ensure that gender-creative children live healthy and happy lives. Young gender-creative children's perspectives about the aforementioned topics are markedly absent from the literature, which instead highlights adolescent and adult proxy perspectives.

In this participatory arts-based study anchored by a constructivist epistemology and informed by post-structuralist, queer, and …

Capitalizing On Natural Language Processing (Nlp) To Automate The Evaluation Of Coach Implementation Fidelity In Guided Digital Cognitive-Behavioral Therapy (Gdcbt), Nur Hani Zainal, Regina Eckhardt, Gavin N Rackoff, Ellen E Fitzsimmons-Craft, Elsa Rojas-Ashe, Craig Barr Taylor, Burkhardt Funk, Daniel Eisenberg, Denise E Wilfley, Michelle G Newman

2020-Current year OA Pubs

BACKGROUND: As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches' implementation fidelity.

AIMS: We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches' implementation fidelity to GdCBT delivered as part of a randomized controlled trial.

METHOD: Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and …

The Impact Of Long Covid On Language Proficiency Across Different School Levels In Hong Kong, Shebe S. Xu, Yixun Li, Wanyi Li, Catherine M. Capio, Winnie W.Y. Tso, Derwin K.C. Chan

Health Sciences Faculty Publications

Long COVID, where symptoms persist after recovering from COVID-19, can affect cognitive functions like language. However, little is known about its impact on children’s language skills, especially across different school levels. This study investigated the impact of long COVID on language proficiency among 1244 children (Asian; 53.5% boys) from kindergartens (N = 408, Mage = 4.42 ± 1.26 years), primary schools (N = 547, Mage = 9.69 ± 1.96 years), and secondary schools (N = 289, Mage = 14.97 ± 1.85 years) in Hong Kong. Language proficiency was assessed using the Language Experience and Proficiency Questionnaire (LEAP-Q), which measured speaking, …

2025- The Twenty-Ninth Annual Symposium Of Student Scholars

Symposium of Student Scholars Program Books

The full program book from the 29th Annual Symposium of Student Scholars, held on April 16-18, 2025. Includes abstracts from the presentations and posters.

The Structural Inequality Of Status Quo Clinical Communication, Joelle Robertson-Preidler

Faculty and Staff Publications

No abstract provided.

Cultural Linguistic Bias In Language Assessments For Children, Madison Wester

Spring Showcase for Research and Creative Inquiry

Cultural linguistic bias is present in almost all language assessments for children, such as the Preschool Language Scales (PLS-5) and the Clinical Evaluation of Language Fundamentals (CELF-5). Cultural linguistic bias is bias against those who speak a different dialect, such as African American Vernacular English or Appalachian English. Bias in these assessments leads to over-diagnosing children with language disorders, which is harmful in a number of ways. To decrease this bias, SLPs should take a language sample to assess a child’s natural language. However, this process can be time-consuming, which is why the use of online tools, such as SUGAR, …

The Brca1/Brca2 Test: A Swiss And American Analysis Of The Effective Facilitation Of Genetic Healthcare Equity For Breast Cancer Prevention, Elizabeth Cahill

Switzerland: Global Health and Development Policy

This paper investigates the accessibility and equity of BRCA1/BRCA2 genetic testing in Switzerland and the United States—two high-income nations with vastly different healthcare models. While genetic testing for breast cancer prevention has the potential to save lives through early detection and targeted interventions, access to such services remains uneven. This study uses a comparative approach to analyze how healthcare systems, insurance structures, psychological barriers, genetic literacy, and the vocational mobility of genetic counseling shape the extent to which individuals can access BRCA testing. Primary data were collected through expert interviews with a Swiss health economist and a French genetic counselor …

Leveraging And Advancing The Foundation Models For Clinical Trajectory Analysis Based On Electronic Health Record Data, Jianping He

Dissertations and Theses (Open Access)

Enhancements in foundation models have provided significant potentials for clinical applications. This dissertation leverages and advances foundation models for a range of clinical tasks using electronic health record (EHR) data, demonstrating their applicability in Clinical Temporal Relation Extraction (CTRE), disease prediction, and patients trajectory analysis.

Aim 1 is to efficiently adapt large language models (LLMs) for CTRE in both full data and few-shot settings. This study leveraged four LLMs: GatorTron-Base, GatorTron-Large, LLaMA3.1, and MeLLaMA. The proposed fine-tuning strategies include: (a) standard fine-tuning; (b) hard-prompting; (c) soft-prompting; (d) Low-Rank Adaptation (LoRA). We found that nearly all proposed fine-tuning strategies outperformed existing …

Traumatic Brain Injury Prevention Through Helmet Safety Education For Parents And Free Helmets For Elementary-Aged School Children, Kelli E. Camp

Doctor of Nursing Practice Projects

Problem Description: Head injuries from bicycle accidents are a leading cause of emergency visits among elementary-aged children, particularly in rural areas (Safe Kids Worldwide, 2017). Helmets significantly reduce traumatic brain injuries (TBIs) up to 88% (Field Neurosciences Institute, n.d.). However, low-income families, especially in rural areas, often lack access to helmets and safety education, resulting in lower helmet use and higher injury rates. These challenges are amplified in communities facing high traffic injury rates, limited access to safety resources, and economic constraints (Gilna et al., 2022; World Health Organization, 2023).

Setting: This project took place in Othello, WA (pop. 8,915), …

Understanding The Relationship Between Executive Function And Language During The Preschool Period, Haya Q. Kidwai

Senior Theses

Executive functions (EFs) are abilities that help us to control our actions, pay attention, and go against automatic responses. EF skills include working memory, inhibition, and cognitive flexibility, all of which develop rapidly during early childhood alongside other developmental abilities like language. In fact, previous research has found a relationship between EFs and language abilities. Therefore, the current study investigated the correlation between EFs and language in the preschool period, a pivotal moment in their development. Specifically, the current study examined the relationship between working memory and inhibition and expressive vocabulary and morphosyntax measures in 7 children 4-6 years old. …

Investigating Child-Informed Considerations For Animated Picture Symbols Representing Emotion For Aac Use In Children With Asd, Hannah Kitsmiller

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Development of emotional competence is an important area of consideration when supporting individuals who use augmentative and alternative communication (AAC). Emotional competence includes skills related to identifying and communicating about one’s emotions. Individuals who use AAC may struggle to develop strong skills in emotional competence. One potential barrier to developing emotional competence may be access to symbols that facilitate understanding of the represented emotion. Emotions are abstract and challenging to represent in visual symbols. Additionally, evidence suggests individuals with autism spectrum disorder (ASD) may have visual perceptual differences when viewing faces. Current emotion symbols are often depicted using isolated facial …

Harnessing Knowledge And Data For Clinical Information Extraction In The Era Of Large Language Models, Yan Hu

Dissertations and Theses (Open Access)

The rapid digitization of healthcare records has led to the widespread adoption of Electronic Health Records (EHRs), which contain rich, unstructured clinical notes. These notes hold valuable information for patient care and clinical research, but their complexity and unstructured nature pose significant challenges for effective utilization. Clinical Information Extraction (IE) aims to bridge this gap by transforming unstructured text into structured data, enabling automated analysis. Traditional Natural Language Processing (NLP) techniques, such as Named Entity Recognition (NER), have been widely used for clinical IE, but recent advancements in Large Language Models (LLMs) like GPT-3.5, GPT-4, and LLaMA have opened new …

Llm-Ie: A Python Package For Biomedical Generative Information Extraction With Large Language Models, Enshuo Hsu, Kirk Roberts

Faculty, Staff and Student Publications

Objectives: Despite the recent adoption of large language models (LLMs) for biomedical information extraction (IE), challenges in prompt engineering and algorithms persist, with no dedicated software available. To address this, we developed LLM-IE: a Python package for building complete IE pipelines.

Materials and methods: The LLM-IE supports named entity recognition, entity attribute extraction, and relation extraction tasks. We benchmarked it on the i2b2 clinical datasets.

Results: The sentence-based prompting algorithm resulted in the best 8-shot performance of over 70% strict F1 for entity extraction and about 60% F1 for entity attribute extraction.

Discussion: We developed a Python package, LLM-IE, …

Codesigning Training For Health Providers To Improve Detection And Response To Elder Abuse, Bianca Brijnath, Marina G. Cavuoto, Peter Feldman, Briony Dow, Josefine Antoniades, Joan Ostaszkiewicz, Sigrid Nakrem, Catriona Stevens, Patricia Reyes, Gianna Renshaw, Micah D.J. Peters, Andrew Gilbert, Elizabeth Manias, Duncan Mortimer, Joanne Enticott, Claudia Cooper, Cheryl Durston, Brenda Appleton, Meghan O'Brien, Marion Eckert, Simona Markusevska

Research outputs 2022 to 2026

Background and Objectives: Screening for elder abuse can improve detection, but many health providers lack the necessary skills and confidence. To address this, training for health providers on elder abuse screening was codesigned as part of a trial aimed at improving elder abuse detection and response. Research Design and Methods: Between March and April 2023, 7 health providers and 10 older people and family carers participated in 2 national Australian online codesign workshops. Using the World Café method, discussions focused on what knowledge and skills health providers needed for screening; clinical and social issues affecting screening and referral; and support …

It-Enabled Services In Online Healthcare Platforms, Anqi Zhao

Dissertations and Theses Collection (Open Access)

Despite the growing prevalence of IT-enabled applications and interventions, online healthcare platforms (OHPs) face notable challenges in addressing technological and informational barriers, maintaining patient and physician engagement, and ensuring quality of care. To address these challenges, this dissertation examines the impact of IT-enabled services in OHPs across key stages of the healthcare service process—preconsultation, consultation, and postconsultation.

In the preconsultation stage, we scrutinize the effects of online preconsultation from both physician and patient perspectives. The findings reveal that preconsultation, significantly increases the consultation physician’s response speed,support abundance, and informational support. However, because emotional support is the …

"When The Bills Keep On Coming:" The Experiences Of Seafood Processors During The Covid-19 Pandemic, Shannon Guillot-Wright, Laura Porterfield, Brenda Wilson, Lacy Davis

Faculty, Staff and Student Publications

Essential workers were at increased risk during the COVID-19 pandemic, including seafood processors who are often rendered invisible within the public sphere. To examine the health and safety concerns of seafood processors, many who are low income or im/migrant workers on H-2B visas, our team conducted qualitative research with 44 participants. We found that in addition to high occupational health hazards that existed before the pandemic, COVID-19 increased workers' financial risks, which put them in more dangerous health and safety positions, since they needed to work through physical and mental health illness. These financial risks can be seen through the …

Environmental Health Disparities In Pediatric Cancer: A Report From The Fourth Symposium On Childhood Cancer Health Disparities, Thanh T Hoang, Zdenko Herceg, Don W Coulter, Adam De Smith, Manish Arora, William E Funk, David Haynes, Stephen H Linder, Leticia M Nogueira, Amy E Hughes, Lindsay A Williams, Jeremy M Schraw, Michael E Scheurer, Philip J Lupo

Faculty, Staff and Student Publications

The 4th Symposium on Childhood Cancer Health Disparities was held at Texas Children's Hospital in Houston, Texas, on September 26, 2023. The symposium registered 94 attendees from different backgrounds (e.g. clinicians, epidemiologists, exposure assessment scientists, geospatial experts) with an interest in environmental health disparities of pediatric cancer susceptibility and treatment outcomes. The focus of the symposium was to provide an overview of the role of environmental risk factors in studies of pediatric cancer, introduce novel exposure assessment tools that can be applied to the field, and highlight opportunities to study the impact of environmental health disparities in pediatric cancer susceptibility …

Associations Between Cardiovascular Disease And Utilization Of Dental Preventive And Periodontic Services, Amirhossein Fakhre Yaseri

Theses and Dissertations

Cardiovascular disease (CVD), including coronary artery disease, heart failure, myocardial infarction, and stroke, remains a leading cause of global mortality, with approximately 20.5 million deaths in 2021. Despite advancements in medical science, CVD prevalence continues to rise, underscoring the need for preventive approaches and increased awareness. CVD is closely associated with oral diseases, and poor oral health is linked to worse cardiovascular outcomes. This study investigates the association between CVD and the utilization of dental preventive and periodontal services using data from the Dental Experience and Research Exchange (DERE) database, which aggregates clinical data from dental practices across the U.S. …

Addressing Gaps In Access: Examining Language Barrier Accommodations In Medicaid Member Handbooks, 2015-2019, Sanskruti Patel

Senior Theses

Objective: This study examines the linguistic accessibility of Medicaid Managed Care Organization (MCO) handbooks from 2015 to 2019 by analyzing the instructions provided to access interpreter and written translation services. Trends were compared over time, considering state and plan-level factors that impact equitable healthcare access for Limited English Proficiency (LEP) enrollees.

Methods: A systematic search using manual efforts and FOIA requests located all publicly available Medicaid handbooks from 2015-2019 (N=657) across 39 states with comprehensive MCO plans. These handbooks were coded by independent reviewers to assess the study outcome variables. Random mixed-effects logistic and linear regression models were conducted to …

The Role Of Chatgpt In Personal Statements For Plastic Surgery Residency Applications: Program Directors' Perspective., Krishna A Patel, Carly J Suriano, Jeffrey E Janis

Medical Education Articles

BACKGROUND: Personal statements are a required component of plastic surgery residency applications but can be extremely time- and labor-intensive. Artificial intelligence (AI) programs like ChatGPT can streamline personal statement writing, but their use, especially if undisclosed, can have ethical implications. This study elucidates the perspective of plastic surgery residency program directors (PDs) regarding the importance of personal statements in reviewing applicants and whether ChatGPT should be utilized.

METHODS: An anonymous, 6-question multiple-choice survey was designed and administered in 3 rounds via REDCap to 120 current plastic surgery residency PDs. An additional email reminder was administered by the principal investigator. Data …

Impact Of A Transplant Nurse Navigator In The Dialysis Setting, Judith D. Pozzerle

Electronic Theses and Dissertations

Patients with kidney disease have better patient outcomes and quality of life with a kidney transplant. However, the transplant process is complicated with inherent inequalities and biases and patients frequently fail to initiate a referral for transplant evaluation. The Centers for Medicare and Medicaid have now placed financial incentives to improve the number of patients transplanted. The only way to increase the number of patients transplanted is to start with a referral for evaluation. Studies have been done highlighting the barriers, but there is a lack of studies implementing strategies to improve these numbers. Utilizing Kotter’s change theory and describing …

Acculturation Experiences Of International Students In The U.S. Cacrep-Accredited Counselor Education Programs: Challenges, Support Systems, And Systemic Barriers, Nargiza Amirova

Counseling & Human Services Theses & Dissertations

International students significantly enrich U.S. counselor education and supervision programs by contributing diverse cultural perspectives that inspire teaching, research, and professional growth. Yet, these students often face complex challenges including cultural adjustment, language barriers, social isolation, and the academic demands of counseling academic programs that impact their educational outcome s and psychological well-being. Systemic barriers, such as visa restrictions and institutional unawareness, further complicate their experiences. This study explored acculturation experiences of international students enrolled in CACREP-accredited counselor education programs in the United States.

Using Interpretative Phenomenological Analysis (IPA), in-depth interviews were conducted with seven international students on J1/F1 visas, …

Exploring University Student Mental Health And Wellbeing Through A Low-Barrier Peer-Led Service: Emerging Insights From The Living Room, Amanda L. Cole, Fiona Navin, Dawn Reid

Research outputs 2022 to 2026

Universities are increasingly recognising the importance of addressing the social and emotional wellbeing of their students. Mental health challenges experienced while at university can hinder academic achievement and exacerbate existing mental ill-health. In response to this identified need, many institutions have implemented mental health services, such as psychological and counselling support. However, barriers such as stigma, accessibility, and effectiveness often limit their reach and impact. Many students do not avail themselves to services, or access the supports available, due to these barriers. This study gathered initial data from 110 participants who visited Edith Cowan University’s “The Living Room” (TLR) within …

Automated Data Analysis For Concussion Patient Records: A Flutter-Based Desktop Application, Fhaheem Tadamarry

USF Tampa Graduate Theses and Dissertations

Concussions are a prevalent and complex medical condition requiring careful clinical assessment and data-driven insights for effective management. This thesis presents the development of an automated data analysis system for concussion patient records, integrating Flutter-based desktop application development with SQL-driven data processing. The system provides a streamlined, interactive interface for clincians and researchers to upload, visualize, and analyze patient data efficiently.

The proposed solution automates data cleaning, preprocessing, and statistical analysis, ensuring robust and reliable insights into demographic, clinical, and recovery-related factors. Key analyses include sex-based differences injury mechanisms, prior head injury impact, mood disorder correlations, and time-to-treatment variations. The …

Bridging Gaps In Cancer Care: Utilizing Large Language Models For Accessible Dietary Recommendations, Julia A. Logan, Sriya Sadhu, Cameo Hazlewood, Melissa Denton, Sara Burke, Christina A. Simone-Soule, Caroline Black, Corey Ciaverelli, Jacqueline Stulb, Hamidreza Nourzadeh, Yevgeniy Vinogradskiy, Amy Leader, Adam Dicker, Wookjin Choi, Nicole L Simone

Department of Radiation Oncology Faculty Papers

Background/Objectives: Weight management is directly linked to cancer recurrence and survival, but unfortunately, nutritional oncology counseling is not typically covered by insurance, creating a disparity for patients without nutritional education and food access. Novel ways of imparting personalized nutrition advice are needed to address this issue. Large language models (LLMs) offer a promising path toward tailoring dietary advice to individual patients. This study aimed to assess the capacity of LLMs to offer personalized dietary advice to patients with breast cancer. Methods: Thirty-one prompt templates were designed to evaluate dietary recommendations generated by ChatGPT and Gemini with variations within …

Roadmap To Better Mental Health Care, James R. Kilgore, James C. Somers, Jenna Rolfs, Everett Allen, Tom Colletti, Blake Rogers, Maggie Banger, Nikoleta Delis, Debra S. Munsell Dhsc, Pa-C

Lynchburg Journal of Medical Science

This article will describe the current providers involved in delivering mental health services, the projected needs for mental health providers in the next decade, and interventional strategies that may enhance their delivery of care. By adopting comprehensive, patient-centered interdisciplinary strategies, and utilizing new and innovative tools and pharmaceutical agents healthcare providers can mitigate the adverse effects of lack of access and the delivery of mental health care.

Obesity Awareness Among Pregnant Hispanic Women In Urban New Jersey, Cloris Bustamante

Walden Dissertations and Doctoral Studies

The rising prevalence of obesity among pregnant women presents significant health risks for mothers and children, beginning as early as intrauterine life throughout adulthood. The purpose of this quantitative cross-sectional study was to investigate whether demographic factors influenced obesity awareness as a personal issue in pregnant Hispanic women. The precaution adoption process model guided the study, a theoretical framework focusing on stages of health behavior change, including awareness, decision making, and action. A purposive sample of 134 pregnant Hispanic women aged 18 years or older receiving prenatal care in urban New Jersey was surveyed using the English (15) and Spanish …

A Workflow Enabling The Automated Synthesis, Chain-End Degradation, And Rapid Mass Spectrometry Analysis For Molecular Information Storage In Sequence-Defined Oligourethanes, Julia R Shuluk, Christopher D Wight, James R Howard, Mary E King, Sarah R Moor, Rachel J Dehoog, Samuel D Dahlhauser, Livia S Eberlin, Eric V Anslyn

Faculty, Staff and Students Publications

The field of molecular information storage has recently expanded to include abiotic sequence-defined polymers. While robust methods have been developed, there is a current bottleneck in the throughput of this work as information density is increased. Herein, we introduce an automated workflow in which a commercial peptide synthesizer composed of a single XYZ liquid-handling robot was adapted to both synthesize and sequence sequence-defined oligourethanes. Our sequencing method was improved to cut down the number of samples required for each oligomer from 13 to one. Additionally, we introduce the use of desorption electrospray ionization mass spectrometry as our analysis method for …

Enhancing Interprofessional Staff Competence In Culturally Sensitive Patient Education: A Web-Based Health Literacy Toolkit For Brazilian Immigrants In Florida, Faila Reis Pereira Dos Santos

Student Scholarly Projects

Practice Problem: Brazilian immigrants in Florida face cultural and language barriers that hinder their ability to understand and engage with healthcare services. Additionally, healthcare providers often lack the cultural competency needed to deliver effective patient education, contributing to poor health literacy within this population.

PICOT: The PICOT question that guided this project was: For healthcare interprofessional staff supporting Brazilian immigrants in Florida (P), how does the development of a web-based health literacy toolkit (I), compared to standard educational methods (C), influence their competency in delivering culturally sensitive patient education (O)?

Evidence: Research demonstrates that culturally tailored health literacy interventions improve …