Digital Commons Network^™

Invisible Shipwrecks And Neurological Endangerment: The Trade-Off In Seeking Asylum - Reframing The Neurobiological Cost Of Forced Migration, Eisha Giran

CISLA Senior Integrative Projects

Forced migration along the Spain–Morocco route represents one of the most visible humanitarian crises of the twenty-first century, yet its neurological dimensions remain insufficiently examined. This paper investigates how prolonged displacement and trauma reshape neural systems involved in stress regulation, memory, and emotional processing. It introduces the concept of neurological endangerment, defined as a condition of prolonged and inescapable threat exposure during forced migration in which stress-response systems remain chronically activated, opportunities for recovery are structurally constrained, and cumulative neurobiological risk persists beyond the period of immediate danger.

To address the gap between biological measurement and lived experience, this paper …

Case Report: Acute Encephalopathy Revealing Severe Babesiosis With Lyme Co-Infection, Czarina Gebrelle K. Soriano, James Espinosa, Alan Lucer

Rowan-Virtua Research Day

Acute confusion in older adults is a common emergency department presentation with a broad differential diagnosis. Tick-borne illnesses can cause significant systemic disease and may present with nonspecific neurologic or constitutional symptoms, making early recognition challenging. Babesiosis is a tick-borne parasitic infection transmitted by Ixodes ticks and may occur concurrently with other infections such as Lyme disease, further complicating diagnosis. We present a case of a 67-year-old male who presented with acute confusion and was found to have concurrent babesiosis and Lyme disease. This case highlights the importance of maintaining a high index of suspicion for tick-borne co-infections in patients …

The Klatskin Tumor: A Tumor At The Liver’S Crossroads, Asma Zahid, Sergey Medlenov, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We present a 68-year-old female with no significant oncologic history who presented to

the emergency department with a  two –week history of progressive jaundice and diarrhea.

Systematic ED evaluation revealed marked hyperbilirubinemia (total bilirubin 22.3 mg/dL), a

cholestatic laboratory pattern, and multimodal imaging demonstrating multifocal hepatic

masses, a porta hepatis soft tissue mass,  and biliary ductal dilatation consistent with hilar cholangiocarcinoma (Klatskin tumor) with metastatic disease.

A CA 19-9 marker was markedly elevated at 379 U/mL. The patient was admitted and she underwent successful biliary decompression via ERCP with stent placement.  Outpatient oncologic therapy was initiated. This case highlights the …

Bacteriophage Therapy Vs. Standard Antibiotics: A Review Of Treatment Efficacy For Recurrent Pediatric S. Pyogenes (Gas) Infections, Kartik Kannan Oms-I, Karina Malhotra Oms-I, Gabrielle Coccio Oms-I, Janhavi Belwalkar Oms-I, Jason Rienzo Oms-I, Samay Shukla Oms-I, Valerie J. Carabetta Phd

Rowan-Virtua Research Day

Background: Antibiotic resistance poses a growing threat to pediatric infectious disease management, particularly in the treatment of Streptococcus pyogenes (GAS) infections.¹ While β-lactam antibiotics remain the first-line standard of care, their utility is limited by allergy prevalence and rising resistance among alternative antibiotic agents, such as macrolides, lincosamides, and tetracycline.^2,3 Given these trends, bacteriophage therapy has emerged as a promising adjunctive treatment modality, offering targeted bacterial lysis while sparing commensal microbiota.⁴

Methods: A systematic literature search was conducted across PubMed and Embase (2000–2025) using terms related to antibiotic resistance, Streptococcus pyogenes, bacteriophage therapy, and pediatric populations. …

Cd8+ T Cell Differentiation Into Nk-Like Effector Cells Drives Transplant Rejection, Dawei Zou, Stephanie G Yi, Yulin Dai, Luan Truong, Lillian W Gaber, Richard J Knight, Xiang Xiao, Rafik M Ghobrial, Xian C Li, Zhongming Zhao, Wenhao Chen, A Osama Gaber

Faculty, Staff and Student Publications

T cells are central drivers of transplant rejection, yet the differentiation fates underlying this process remain unclear. Using single-cell transcriptomic profiling of human kidney allograft biopsies, we identified a predominant infiltrating CD8+ T cell subset exhibiting killer cell lectin-like receptor (KLR)+ NK-like features. Mechanistic studies in mice showed that the KLR+ subset emerged de novo post-transplantation and dominated the CD8+ T cell infiltrate in rejecting allografts. These NK-like CD8+ T cells expressed high levels of interferon regulatory factor 4 (IRF4), and Irf4 deletion disrupted their differentiation and induced transplant acceptance. Therapeutically, either costimulation blockade or mTOR inhibition substantially reduced the …

Predicting And Decoding Allosteric Binding Sites Using Protein Language Models And Structure-Based Machine Learning: An Energy Landscape-Guided Explainable Ai Framework, Kamila Riedlová, Vít Skrhák, William G. Gatlin, Max Ludwick, Lucas Turano, Marian Novotný, David Hoksza, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

Computational prediction of allosteric binding sites in protein structures remains a persistent challenge, as these regulatory pockets evade detection by both sequence-based and structure-based algorithms. Both computational and physical origins of this predictive asymmetry remain insufficiently understood. In this study, we systematically examine the determinants of binding site predictability using a dual framework that integrates a fine-tuned protein language model and the structure-based method P2Rank as complementary tools probing a diverse data set of 453 human kinases, together with a physics-based interpretability layer derived from energy landscape frustration analysis. Both predictors exhibit a sharp and reproducible dichotomy on protein kinases, …

The Meaning Of Physical Activity In The Context Of Health Sciences: A Concept Analysis, Martín G. Farinola

International Journal of Physical Activity and Health

Physical activity has been defined in numerous ways. Thus, this study aimed to conduct a concept analysis of the existing physical activity definitions in the health sciences literature to evaluate its conceptual precision and assess the need for a revised or novel concept better suited for this domain. The concept analysis was accomplished using tools derived from philosophical semantics. The analysis identified six definitions that explicitly state what physical activity is with sufficient clarity to allow for conceptual examination. The findings indicated that these definitions frequently merge the concept of physical activity with its contextual attributes. To address these semantic …

Selection Of Graphic Symbol Collections By Speech And Language Pathologists For Students With Autism Spectrum Disorder, Vasiliki Hadjicharalambous, Donald R. Fuller, Eliada Pampoulou

Communication Sciences & Disorders Faculty Publications

Graphic symbol collections are often implemented in assessment and interventions with clients with autism spectrum disorder (ASD). The selection of the optimal collection is considered by speech-language pathologists (SLPs) a challenging task. Since limited literature exists on the factors that guide this selection specifically for clients with ASD, this study aimed to explore those in detail, for which a qualitative design was followed. Semi-structured interviews were conducted with SLPs who shared their views on the factors that affect this selection. A thematic analysis of the interview transcripts took place. The outcomes showed that SLPs focus on multiple factors, grouped as …

Purine Metabolic Adaptation Protects The Endothelium From Disturbed Flow-Induced Dna Damage And Atherosclerosis, Qian Ma, Yongfeng Cai, Zhidan Zhang, Dingwei Zhao, Yuan Zhao, Peishan Xu, Tammy Lu, Wendy Zhang, Qiuhua Yang, Yaqi Zhou, Varadarajan Sudhahar, Tohru Fukai, Hanjoong Jo, Yiming Xu, Yuqing Huo

Faculty, Staff and Students Publications

Despite effective lipid-lowering therapies, atherosclerosis continues to be a leading cause of death, with considerable residual cardiovascular risk. Atherosclerotic lesions develop preferentially at arterial regions exposed to disturbed flow (d-flow), which induces genomic stress, endothelial injury, and barrier dysfunction. Hemodynamic forces are known to reprogram endothelial metabolism, but the role of de novo purine synthesis (DNPS), which supplies nucleotides for genome maintenance and whose terminal steps are catalyzed by the bifunctional enzyme ATIC, remains undefined in atherosclerosis. By integrating bulk and single-cell multiomics with in vitro flow systems and in vivo models, we show that d-flow upregulates DNPS and ATIC …

Predator Or Prey: The Analysis Of Gender And Race On The Perception Of Black Men As Sexual Assault Victims, Jordyn Livingston, Dr. Florencia Cornet

Caravel Undergraduate Research Journal

Men sexual assault victims have gained more attention in recent years. Despite the growing sociological literature on violence against men, previous research provides little acknowledgment of Black men sexual assault victims. In this manuscript, I analyze emerging literature in the socio-medical sciences to explore how gender and race affects the perceptions of Black men as sexual assault victims. Specifically, I utilize intersectionality as a theoretical framework to synthesize literature on blackness and masculinity in sexual assault victims to conclude that there is an intersectional point that disadvantages Black males, portraying them as sexual predators. In so doing, I provide research …

The Victimization Of Heterosexual Males: A Literature Review On Domestic Violence, Chris Friendly, Christine Palmer Mph, Edd, Ches

Caravel Undergraduate Research Journal

Domestic violence, defined as both emotional and physical abuse in intimate relationships, is a pressing issue in today’s society. Because of its serious nature, domestic violence has become a topic of great interest and concern for many public health researchers. However, an overwhelming degree of the studies conducted by these investigators only examine the effects of domestic violence on the female population. In this literature review, 27 sources, both peer-reviewed articles and literature reviews, were previewed. Of the 27 sources, only four were specific to male victimization. This literature review highlights the research disparity between female and male domestic violence …

Knowledge Of Advance Care Planning And Advance Directives Among Us Adults: Implications For Health Policy And Practice, Anisah Bagasra, Gretchen Agans

Faculty Articles

Background:

Objectives:

A Retrospective Look At Self-Reported Mental Health Prevalence In Division Iii Student-Athletes, Jacob F. Neri

Masters Theses/Capstone Projects

Mental health concerns among collegiate athletes have gained increased attention, but there has been limited research focus on Division III student-athletes. This study aimed to examine the self-reported prevalence of anxiety, depression, anger, stalking/harassment, abuse/assault, alcohol/substance abuse, self-harm, suicide ideation, and suicide attempt to identify contributing factors amongst this population. A retrospective, cross-sectional study was conducted looking at data collected from the student-athlete mental health history & well-being questionnaire that was administered as part of their pre-participation exam (PPE) prior to the beginning of each academic year. A total of 554 Division III student-athletes were included in the study. Results …

Nuclear Export As A Therapeutic Vulnerability In Zfta-Rela Ependymoma, Siri M Ippagunta, Amir Arabzade, Srinidhi Varadharajan, Erik Emanus, Amanda Bland, Alisha Kardian, Nicholas Laboe, Hua Sun, Tuyu Zheng, Amelia Hancock, Mark Zhai, Emma Caesar, Maxwell Park, Wilda Orisme, Melissa Johnson, Brittany Rodgers, Gregory H Turner, Jeffrey Steinberg, Burgess Freeman, Martine F Roussel, Anang Shelat, Richard Kriwacki, Thomas E Merchant, Benjamin Deneen, Michael D Taylor, Sameer Agnihotri, Shondra Pruett-Miller, Jacob A Steele, Anoop Murthy Kavirayani, David W Ellison, Arzu Onar-Thomas, Giles Robinson, Stephen C Mack, Kelsey C Bertrand

Faculty, Staff and Students Publications

Background: Ependymoma (EPN) is the third most common pediatric brain tumor with no targeted therapies available to patients. In supratentorial ependymoma, the most frequent driver alteration is a gene fusion between ZFTA and RELA (denoted ZR), leads to constitutive localization of ZR in the nucleus. Because ZR is not currently druggable, we tested whether ZR expression leads to aberrant protein interactions that could represent therapeutic vulnerabilities.

Methods: Using CRISPR-Cas9 pooled screening, we identified many novel druggable ZR interacting proteins including XPO1, CARM1, SMARCA4, and CDK1. We focused on the nuclear export protein (XPO1), given the ability of most XPO1 inhibitors …

From Confidence To Competence: Embedding Critical Genai Literacy In Physician Associate Education, Chanceeth Chandrakanthan, Amy H. Donaldson-Perrott Mrs, Jane Secker, Julie Voce, Tamara S. Ritsema

Journal Of Indian Physician Associates

Background: Generative artificial intelligence is now embedded in how many healthcare students learn. Tools provide rapid explanations, summaries and practice questions, but use does not equal AI literacy, particularly where accuracy, medicines safety and guideline alignment matter.

Objective: To describe current use of generative AI by Physician Associate students and outline a practical approach to teaching critical AI literacy.

Methods: Educational evaluation using three activities: (1) baseline survey of students about use and attitudes, (2) an embedded compare and critique session in applied pharmacology where small groups assessed AI answers against trusted UK sources, including BNF and NICE guidance, followed …

Measuring Disability Prevalence In Healthcare: A Study Comparing Two Disability Measures, Kristen L. Milefchik, Rhonda K. Dailey, Sharon Milberger

Developmental Disabilities Network Journal

People with disabilities experience significant health disparities and interventions are needed to address them. Measuring disability prevalence is an essential aspect of designing effective, data-driven healthcare strategies. Accurately measuring disability prevalence is challenging given disability is a complex phenomenon, with biological, social, environmental, and cultural components. Previous studies have compared a variety of disability status measurements and found that measurements were incongruent with each other. This study examines the concordance between disability status using two different measures: the nationally recognized American Community Survey (ACS-6) functional difficulty questions and one disability identity question. We used data from 3,621 adult patients participating …

Avoiding Anchoring Bias In Lymphadenopathy: Metastatic Thyroid Cancer Mimicking Tuberculous Lymphadenitis, Giuliano Romano, Mitchell Schwocho, Jacob Morton

Conference Presentation Abstracts

Introduction The differential diagnosis for a new neck mass is broad and includes malignant, infectious, and autoimmune etiologies. A systematic approach incorporating history, physical examination, and diagnostic testing is essential when developing and narrowing down a differential. Case Presentation A 52-year-old man with a history of diabetes, asthma, ankylosing spondylitis on weekly etanercept, and GERD presented with a 2-day history of painless right-sided neck swelling. He denied fever, chills, weight loss, night sweats, dysphagia, dyspnea, cough, recent illness, or constitutional symptoms aside from mild fatigue. He had recently returned from a 1.5- month trip to Bangladesh and had self-discontinued etanercept …

Food-Form Delivery Of Spore-Forming Probiotics As An Alternative To Gavage In Animal Models, Aubreyona Faith Migliori Skalka

All Graduate Theses and Dissertations, Fall 2023 to Present

Western dietary patterns are characterized by nutrient-poor, calorie-rich diets and have been linked to poor health outcomes and gut inflammation phenotypes. Probiotics are often taken to support gut health, but many beneficial bacteria do not survive transport through the digestive system to produce any effect. Spore-forming bacteria, such as Bacillus coagulans, are more resilient due to their hardy outer coat which aids in survival through many obstacles encountered in the gastrointestinal tract, including acidic stomach conditions. In research studies, probiotics are usually given to mice through a procedure called oral gavage, where a tube is used to deliver the …

Targeted Therapy With Braf/Mek Inhibitors And Immune Check Point Inhibitors In Anaplastic Thyroid Cancer - A Case Report, Yagnapriya Ammakola, Muhammad Ibrahim Majeed, Ishmael Jaiyesimi

Conference Presentation Abstracts

Introduction- Anaplastic thyroid carcinoma (ATC) is a highly aggressive malignancy constituting about 1% of all the thyroid neoplasms. It has poor prognosis with median survival of around 3 to 6 months. Recent advancements with targeted therapies have improved the survival outcome in these patients. We report a case of anaplastic transformation of papillary thyroid cancer with BRAF V600E mutation who responded to targeted therapy. Case presentation- A 54 year old male presented with a palpable left sided mass. Labs were unremarkable but imaging with contrast enhanced CT scan showed a 3 cm left thyroid nodule with bilateral cervical lymphadenopathy. Biopsy …

Artificial Intelligence In Dental Education: A Literature Review Of Global Adoption, Pedagogical Outcomes, And Ethical Implications, Betti Shahin, Jeremiah D. Ghodsi, Toleen Mazloum, Denise Hale

Journal of Educational Leadership in Action

Background: Artificial intelligence (AI) is revolutionizing many fields by enabling machines to accomplish tasks that previously required human intelligence, such as learning, decision-making, and problem-solving. In dentistry, AI is increasingly applied to diagnostics, treatment planning, and clinical training. Its integration enhances educational experiences for students while supporting more accurate and efficient patient care.

Objective: This review synthesizes recent research on AI in dental education, highlighting global adoption trends and key pedagogical, ethical, and practical considerations.

Conclusion: AI has significant potential to enhance dental education through innovative teaching, clinical training, and data-driven decision-making. Effective integration depends on institutional …

Qualitative Beta-2-Adrenoceptor Signaling In The Regulation Of Human Airway Epithelia Mucin And Cytokine Production, Fred Graumuller, Diana Cervantes, Tung O. Chan, Niccolette Schaunaman, Dominic R. Villalba, Burton F. Dickey, Julia K. L. Walker, Hong Wei Chu, Raymond B. Penn

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

BACKGROUND: Numerous in vivo studies have demonstrated beta-2-adrenoceptor (β2AR) -agonism as permissive in the development of allergic lung inflammation, and have implicated the arrestin-dependent signaling arm of the β2AR in mediating this effect. However, the specific cell type(s) mediating β2AR regulation of allergic lung inflammation remain unestablished.

METHODS: To explore the potential contribution of airway epithelia in this phenomenon, we compared the ability of ractopamine (RP), recently identified as a Gs-biased beta-agonist, to that of the unbiased/balanced beta-agonist albuterol (ALB), on IL-13-stimulated mucin and cytokine production in human airway epithelia cultures in air-liquid interface (HAE).

RESULTS: ALB, which activates both …

Treatment And Interventions For Sexual Assault In Humanitarian Contexts: Addressing Gaps In Refugee And Idp Camp Care In Myanmar, Erin Nash

Capstone Experience: Master of Public Health

Sexual and gender-based violence (SGBV) remains a pervasive yet under-addressed issue in humanitarian settings. Refugee and internally displaced person (IDP) camps along the Thai– Myanmar border represent a complex nexus of protracted displacement, ethnic conflict, and limited access to medical and psychosocial care. Although the prevalence of sexual assault in these contexts is well-documented, there is a critical gap in the literature regarding effective, context-specific treatment and intervention strategies. This capstone project conducts a comprehensive review of existing research on sexual assault care in humanitarian crises worldwide and assesses its applicability to displaced ethnic minorities from Myanmar. The analysis considers …

Plan To Develop A Theory-Based Diabetes Social Media Campaign For Spanish-Speaking Adults In Finney County, Ks: Integration Of A Promotora, Focused Discussion Groups, And Community Feedback To Ensure Cultural Appropriateness, Julevi P. Bernido

Capstone Experience: Master of Public Health

The 2025 Community Health Needs Assessment (CHNA) shows that over 11% of adults in Finney County, Kansas, have diabetes, which surpasses both state and national averages. Census data from 2016-2020 indicate that 42.6% of residents ages five and older speak a language other than English at home, and 36.1% speak Spanish (United States Census Bureau, n.d.). The CHNA further highlights concerns about language and cultural barriers to care, especially among the Spanish-speaking population. Notably, 21.74% of residents have limited English proficiency—much higher than the state’s 12.1% (CHNA, 2025).

This capstone will develop a theory-based social media campaign plan to support …

Gestational Diabetes And Social Determinants Of Health In Black Women, Darianne Greenwood

Capstone Experience: Master of Public Health

Gestational Diabetes Mellitus (GDM) poses significant health risks, specifically increasing the risk of developing Type 2 Diabetes post-delivery, as well as increasing the risk of adverse neonatal and maternal outcomes. Black women, in particular, experience disproportionately higher rates of GDM incidence, severity, and complications in comparison to White women. Biological factors alone do not account for these disparities, necessitating a deeper examination into how systemic factors, particularly the social environment, influence these inequitable health outcomes. The purpose of this comprehensive literature review is to answer the question: “How do the Social Determinants of Health (SDoH), such as residential segregation, food …

The Influence Of Valence On Action Control: A Comparison Of Simon Effects In The Extrinsic Affective Simon Task (East) And The Spatial Simon Task, Yaara Aleissa

College of Arts & Sciences Senior Theses

People adjust their thoughts and actions in response to a changing environment every day and emotions may influence these actions. Understanding how emotion impacts action control in situations where emotion is central to the action (task-relevant) compared to when it is present in the environment as distracting information (task-irrelevant) is essential. Currently it is unclear when emotion most significantly modulates action control. This study seeks to compare how valence (positive versus negative emotion) impacts action control performance when valence is task-relevant and task-irrelevant by using two modified versions of the Simon conflict task.

The Simon task is a paradigm to …

Parkinson’S Disease And Its Treatments: An Overview, Nathaniel Cook

Senior Honors Theses

Parkinson’s disease (PD) is a neurodegenerative disease closely associated with the accumulation of α-synuclein in neurons, and inhibition in the release of dopamine, a key neurotransmitter of the nervous system. Disruption in dopamine signaling can cause cognitive and motor dysfunctions, with tremor, bradykinesia, and rigidity being the most observable effects. There is no permanent treatment for PD, constituting the need for further research to improve current pharmaceutical approaches and possibly develop a cure. Main areas of research include improving medication via delivery methods, genetic mutation using CRISPR, and adaptive deep-brain stimulation. Recent developments and applications in these areas will be …

Sepsis As An Immune Continuum: Cytokine Storm To Lymphopenia And Pics, Chelsey King

Senior Honors Theses

Sepsis is a leading cause of morbidity and mortality worldwide, driven by a dynamic immune continuum that progresses from early hyperinflammation to profound immunosuppression. This review examines the three overlapping phases of sepsis: the inflammation-mediated cytokine storm driven by dysregulated PRR activation, NF-κB signaling, and NETosis; apoptosis-driven lymphopenia involving caspase-mediated lymphocyte death, dendritic cell dysfunction, and metabolic exhaustion; and prolonged immunoparalysis culminating in persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Key mechanisms linking these phases, including the co-existence of hyper- and hypo-inflammatory states, are synthesized alongside relevant clinical biomarkers such as IL-6, HLA-DR, and single-cell immune profiles. This review highlights …

Preserving Life In An Age Of Autonomy: A Critique Of Physician-Assisted Suicide, Adeline Holcombe

Senior Honors Theses

This thesis critiques physician-assisted suicide (PAS) as a reflection of Western thought’s shift from a biblical sanctity-of-life ethic toward autonomy and relativism. Through analysis of biblical and historical foundations, major cases, and state PAS laws, it argues that legalization weakens the state’s interest in preserving life, normalizes suicide, and exposes vulnerable populations to coercion, inadequate safeguards, and legal expansion. The thesis concludes that PAS laws should be repealed and that palliative care, hospice, and mental health treatment provide more compassionate and ethically sound alternatives.

Volume 17, Christian O’Neill, Kyara Greene, Savva Sidorov, Laura Bisaillon, Luke Clemmer, Hannah Gordon, Kitt Benson, Taylor Blount, Rachel Danzitz, Nicholas Duellman, Chase Gionis, Hima Fernando, Seth Franzyshen, Onyx Gonzalez, Bryan Lin, Samantha Start, Ysabel Wells, Maggie Duncan

Incite: The Journal of Undergraduate Scholarship

Introduction Dr. Amorette Barber, Director, Office of Student Research

From the Editor Dr. Hannah Dudley-Shotwell

Cover Artist’s Statement Maggie Duncan

On Mentoring Dr. Yulia Uryadova

Ukrainian Resistance in the Face of Russification: Nestor Makhno and Anarchism

by Christian O’Neill

Life Vest by Kyara Greene

Isolation and 16S rRNA Identification of Bacteria from Fire Department Connection Pipe by Savva Sidorov

The Effectiveness of Planned Exercise in Reducing ADHD Symptoms in Children by Laura Bisaillon & Luke Clemmer

Linguistic Analysis on Confidence and Communication Strategies with Disparities Between Sign Fluency and Hearing Impairment by Hannah Gordon

Freedmen in Indian Territory by Kitt …

Evaluating Spect Neuroimaging In Psychiatric Diagnosis: A Critical Review And Proposed Randomized Controlled Study, Kiley Carter

Senior Honors Theses

Mental illness affects a substantial proportion of adults in the United States, yet psychiatric diagnosis remains subject to diagnostic variability. Single-photon emission computed tomography (SPECT) is a neuroimaging technique that measures cerebral blood flow and has been proposed as an adjunctive tool for psychiatric evaluation. Existing literature reports group-level perfusion patterns associated with certain psychiatric conditions, suggesting potential utility in diagnosing complex or treatment-resistant cases. However, critics of SPECT emphasize the absence of randomized controlled data demonstrating improved patient outcomes. To address this gap, a prospective randomized controlled trial comparing standard psychiatric care with SPECT-guided evaluation is proposed. The proposed …