Digital Commons Network^™

Speech-Language Pathologists’ Preparation To Become Clinical Educators, Alivia English

Master's Theses and Doctoral Dissertations

Clinical education is significant in a student clinician’s educational journey to prepare them for their career after graduation. It provides the hands-on component that can only be learned and fully understood through performing. The literature regarding students’ experiences in clinical education is vast, but there is a shortage of literature that explores the perceptions of clinical educators (CEs). This thesis consists of three articles. The first article explores the perceptions speech-language pathologists’ have regarding the preparation they received to become CEs, and then the second article takes a look at how the requirements to becoming CEs differ across similar clinical …

The Relationships Between Parent/Guardian And Teacher Inclusion In School Decision-Making Processes, Perceptions Of School Quality, And Retention In Schools, Julie Bergmann

Master's Theses and Doctoral Dissertations

This study offers an explanation of the relationship between the inclusion of parents/guardians and teachers in Michigan K-12 public school decision-making processes, perceptions of school quality, and subsequent parent/guardian and teacher retention by the school. Decision-making structures and participation in those structures, participants’ own childhood experiences, trust, agency, relatedness (belonging), and usefulness were considered in constructing a model of best fit to explain the relationships between decision-making inclusion, perceptions of quality, and retention. What emerged from this 225-participant (121 parents/guardians and 104 teacher) survey was a model that affirms that professional learning communities (PLCs) are a structure that supports greater …

Language Barriers In Clinical Trials: Exploring Impacts On Continuity And Participants’ Engagement And Effective Mitigation Strategies, Harsha Ani Das

Master's Theses and Doctoral Dissertations

Clinical trials are crucial for advancing medical knowledge and developing new treatments. However, language barriers can pose significant challenges for participants, particularly in understanding trial procedures, risks, and benefits. Existing policies, guidelines, and studies from 2020 to 2024 identify key challenges in recruiting and retaining non-English-speaking participants. The lack of data on dropout rates highlights the need for improved language services and culturally sensitive communication methods. Findings demonstrate the importance of addressing linguistic disparities to enhance trial inclusivity and success. Innovative strategies to overcome language-related hurdles include the use of professional interpreters, translated materials, and community engagement initiatives. By addressing …

How Math Games Engage Parents With Children, Greg M. Williamson

Master's Theses and Doctoral Dissertations

This research study begins to explore how the use of math games focused on foundation skills can potentially support parents and families in mathematics interactions. The primary goal was to examine parents' perceptions of the impact of math games on their engagement with their children. In addition, embedded guides were provided for parents to engage in mathematical discourse, and support specific math strategies. The qualitative study involved the families of six students who were entering fourth grade and attending a summer-school program. The students and their families engaged in a six-week intervention where they received two math board games and …

Detection Of Data Leakage And Disruption Of Covert Timing Channel In Secure Drone Communication Using Machine And Deep Learning, Jonathan Walatkiewicz

Master's Theses and Doctoral Dissertations

The utilization of recreational drones has experienced a substantial increase in both the United States and globally. However, it is noteworthy that most drones, classified as Internet of Things devices, are produced with a limited security lifecycle. This study's findings are of paramount importance, as traditional computing exploits can be applied to drones, designating them as high- value targets. This study examines the detectability and disruptability of covert timing channel traffic in secure drones. The investigation aims to ascertain the effects of multiple interarrival times, distances ranging from 1 to 330 feet, various detection algorithms, and stream sizes between 32-bit …

Developing A Guideline And Feasibility Tool For Highway Infrastructure Readiness For Autonomous Vehicles, Soujanya Pillala

Master's Theses and Doctoral Dissertations

Autonomous Vehicles (AVs) are one of the advanced technologies that is being developed, and infrastructure modifications supporting AVs will be the next major research that is needed. A systematic literature review methodology is used to explore key parameters needed for implementation of AVs. The key parameters are analyzed against economic implications, costs and projected benefits of the integration of Level 4 and Level 5 AVs into the highway system, offering a nuanced understanding of deployment of AV technologies. The research aims at developing a guideline and framework for highway infrastructure readiness for AVs, a toolbox for policy makers and government …

The Interplay Between Friendship Quality And Emotion Regulation In The Prediction Of Weight-Related Concerns Among Adolescent Girls, Vasavi Ganesan Shanthi

Master's Theses and Doctoral Dissertations

Adolescent girls are especially vulnerable to weight-related concerns such as body dissatisfaction, disordered eating, and body surveillance. These issues are often linked to difficulties in emotion regulation (ER) and the quality of friendships. This study explored how ER and friendship quality, both independently and interactively, predict these weight-related issues. A sample of 106 girls aged 11–21 completed questionnaires on ER, friendship quality, body dissatisfaction, objectified body consciousness, and disordered eating behaviors. Results from hierarchical regression analyses showed that greater ER difficulties were significantly associated with increased body dissatisfaction, emotional eating, and restrained eating. Additionally, negative friendship quality predicted emotional eating. …

Self-As-Context Moderation Of Relationship Fusion: A Comparison Of Intimate And Familial Relationship Impact On Weight Concern, Carly Carrasco-Wyant

Master's Theses and Doctoral Dissertations

This study explored how fusion in important relationships relates to weight concern and whether these effects are moderated by self-as-context perspectives and racial and ethnic background. Grounded in acceptance and commitment therapy (ACT) and relational frame theory (RFT), eight models were constructed to evaluate influence of important others when absent or present and when moderated by self-as-context, racial and ethnic background and in multiple moderation models analyses using data from 1,323 participants. Results indicated that fusion with family was significantly associated with greater weight concern, when family was absent (ß = 0.10, p = .03) and present (ß = 0.12, …

Integrated Behavioral Health In Pediatric Primary Care: Identifying Latent Patient Subgroups And Differential Outcomes, Karen Glownia

Master's Theses and Doctoral Dissertations

Fifty percent of children do not receive care for their mental health concerns, while 95% are seen annually within primary care by age 6. Individual, cultural, and systemic barriers limit access to mental health care. Integrating mental health services into primary care has the potential to increase awareness, reduce costs, and decrease stigma. However, integrated primary care often relies on a brief and targeted intervention approach that may not be suitable for all families. Therefore, it is important to examine differential outcomes within this setting. Methods: This study analyzed retrospective data from 3,494 new patient medical records at a large …

Examination Of Barriers To Accessing Integrated Behavioral Health Care, Alyssa Buthman

Master's Theses and Doctoral Dissertations

Research has found that pediatric integrated behavioral health (IBH) significantly increases utilization of behavioral health services, but there are still families who are missing out. The purpose of the current study is to examine characteristics that may influence or impede utilization of an IBH referral. Phase 1 utilized survey methodology paired with electronic medical record review in a sample of 24 caregivers to pediatric patients to investigate whether parent-reported perceived stigma of accessing mental health care, barriers to accessing health care in general, and child symptom severity uniquely predicted referral utilization. Phase 2 used electronic medical record data in a …

Caregiver Training To Enhance Care Interactions With Persons With Neurocognitive Disorders: An Additive Treatement Study, Samantha J. Killian

Master's Theses and Doctoral Dissertations

Persons with neurocognitive disorders (NCD) rely on family and friends to help them with everyday tasks, yet informal caregivers might not be aware of the need to scaffold tasks or know how to maximize the care recipients’ engagement. The current study recruited three men who were full-time family caregivers for women (spouses, their mother). The study assessed the care recipients’ need for scaffolding of instrumental tasks and the caregivers’ perception thereof and then trained the caregivers in task analysis and prompting. An additive treatment design examined the differential effects of a two-part training intervention on caregivers’ perceptions of the need …

Latent Classes Of Comorbid Clinical Presentations For Patients With Psychogenic Non-Epileptic Seizures, Joseph W. Tu

Master's Theses and Doctoral Dissertations

Psychogenic non-epileptic seizures (PNES) are episodes of motor, sensory, and/or cognitive seizures without detectable epileptic activity. The integrative cognitive model conceptualizes PNES as an activation of learned mental representations of a seizure often combined with concurrent physiological arousal. PNES are not treatable by antiepileptic medications and are often accompanied by psychiatric and medical comorbidities, complicating treatment following diagnosis. Further, individuals with PNES often incur greater medical costs through hospital admissions and emergency department visits. Multidisciplinary care including behavioral health interventions like cognitive behavior therapy have demonstrated initial success at reducing seizure frequency but impacts on healthcare utilization are unknown. Patients …

Investigation Of Sleep Disorders And Related Influencing Factors Among The Elderly In Southeast Coastal Regions Of China: A Cross-Sectional Survey Analysis, Yaopian Chen, Fu Su, Haixia Xiang, Jinhong Xia

Student Publications [Scholarly]

Objective: To assess the sleep status and prevalence rate of the elderly in southeast coastal areas of China, and analyze related factors. Methods: A questionnaire survey was conducted among elderly individuals in Wenzhou City, Zhejiang Province, situated in the southeast coastal areas of China, using a multi-stage random sampling method. A total of 903 elderly people aged ≥ 60 years were selected for the survey. The questionnaire aimed to assess their sleep status using PSQI and to evaluate related factors using Self-designed General Information and Health Behavior Questionnaires, SAS, GDS-15, ESS, AD8, SHAP, WHOQOL-BREF, among other tools. Logistic regression was …

Agentic Ai Systems In Professional Domains: A Probabilistic Framework For Role Suitability And Legal Accountability, Matthew Veach

Master's Theses and Doctoral Dissertations

This thesis presents a cross-sector analysis of agentic AI systems deployed in STEM, education, healthcare, and enterprise domains, with a focus on role suitability, orchestration maturity, and legal accountability. It introduces the Bounded Agentic Suitability Envelope, a dual-bound scoring framework that evaluates deployment viability using weighted assessments of agent capability and decomposed role complexity. Through case studies from Fujitsu, Cleveland Clinic, Carnegie Learning, and Duolingo, the thesis demonstrates measurable gains in efficiency, personalization, and compliance. It argues for an augmentation-first strategy, preserving human roles in high-context domains while enabling targeted replacement in low-complexity workflows. To mitigate risk, the thesis formalizes …

Neuropsychological Assessment Accuracy In Diagnosing Early-Onset Alzheimer’S Disease, Elise Thomas

Master's Theses and Doctoral Dissertations

Early-onset Alzheimer’s disease (EOAD), a progressive neurological condition, is often difficult to diagnose before substantial neuronal damage. Neuropsychological assessments offer a more cost-effective and accessible method for detecting early cognitive decline, yet limited research exists on optimal combinations for EOAD identification. This study analyzed data from 24 clinical studies to determine the diagnostic accuracy of FDA-approved EOAD assessments used in combination. No single combination was found to be superior across all diagnostic metrics. MMSE + MoCA + ADAS-Cog showed the highest sensitivity, MMSE + MoCA + RBANS the highest specificity, MMSE + RBANS the highest AUC value, and MMSE + …

Evaluating Educational Bias In Executive Function Assessments: A Comparison Of Reacstick And The Nih Toolbox In Individuals With Multiple Sclerosis, Maura Lane

Master's Theses and Doctoral Dissertations

This study investigated the influence of educational attainment on executive function performance across two cognitive assessment tools—ReacStick (RS) and the National Institute of Health Cognition Toolbox Cognition Battery (NIH Toolbox-CB)— in individuals with multiple sclerosis (MS). Participants with confirmed MS diagnoses completed both cognitive assessment tools, and the correlation between years of education and task performance was analyzed to evaluate the presence of educational bias. Results showed that NIH Toolbox-CB scores were significantly associated with education level, whereas RS parameters did not demonstrate this relationship. These findings suggest that RS performance may be less influenced by educational background and could …

Predicting 18-Month M-Chat-R/F With Pediatractmv3.0 Motor And Social/Communication/Cognition Domains, Ryan Krebs

Master's Theses and Doctoral Dissertations

Background. The developmental cascade framework suggests early delays in one system can impact others. Infants born preterm or with autism spectrum disorder (ASD) often show such delays. Methods. The study included 498 infants enrolled in PediaTracTM a novel caregiver-report measure. The convergent validity of PediaTrac with the Ages and Stages Questionnaire (ASQ-3) was examined, along with its ability to predict ASD risk at 18 months using cross-sectional (9- and 12-month) and longitudinal (0–12-month) latent traits of motor (MOT) and social/communication/cognitive (SCG) abilities. Results. Strong convergent validity was found between PediaTrac and ASQ-3 domains at both time points. MOT at 9-months …

Global Consensus On Optimal Exercise Recommendations For Enhancing Healthy Longevity In Older Adults (Icsfr), Mikel Izquierdo, Philipe De Souto Barreto, Hidenori Arai, Heike A Bischoff-Ferrari, Eduardo L Cadore, Matteo Cesari, Liang-Kung Chen, Paul M Coen, Kerry S Courneya, Gustavo Duque, Luigi Ferrucci, Roger A Fielding, Antonio García-Hermoso, Luis Miguel Gutiérrez-Robledo, Stephen D R Harridge, Ben Kirk, Stephen Kritchevsky, Francesco Landi, Norman Lazarus, Teresa Liu-Ambrose, Emanuele Marzetti, Reshma A Merchant, John E Morley, Kaisu H Pitkälä, Robinson Ramírez-Vélez, Leocadio Rodriguez-Mañas, Yves Rolland, Jorge G Ruiz, Mikel L Sáez De Asteasu, Dennis T Villareal, Debra L Waters, Chang Won Won, Bruno Vellas, Maria A Fiatarone Singh

Faculty, Staff and Students Publications

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational …

Tailor Swiftly: Lessons Learned From A Nationwide Implementation Of An Antimicrobial Stewardship Program For Asymptomatic Bacteriuria, Trenton M Haltom, Sophia Braund, Rogelio Hernandez, Larissa Grigoryan, Barbara W Trautner, Eva Amenta

Faculty, Staff and Students Publications

Objective: Overtreatment of asymptomatic bacteriuria (ASB) is a major cause of antibiotic overuse. We facilitated a nationwide implementation of an ASB antimicrobial stewardship intervention in 41 Veterans Affairs facilities. Twenty-one sites participated in a Virtual Learning Collaborative (VLC) with monthly webinars. We assess what VLC teams learned from one another in these webinars.

Methods: The bi-monthly VLC webinars featured expert presentations and spotlighted 1-2 site teams, asking them to discuss their barriers and facilitators for the intervention. Data come from analyses of descriptive field notes from the webinars and chat transcripts. Field notes were analyzed using the "sort and sift, …

How Gps Communicate The Urgent Suspected Cancer Referral Pathway To Patients: A Qualitative Study Of Gp-Patient Consultations, Jessica Russell, Laura Boswell, Athena Ip, Jenny Harris, Hardeep Singh, Ashley Nd Meyer, Traber D Giardina, Afsana Bhuiya, Katriina L Whitaker, Georgia B Black

Faculty, Staff and Students Publications

Background: The UK National Institute for Health and Care (NICE) recommends that GPs inform patients referred onto the urgent suspected cancer (USC) pathway about what to expect from the service. However, there is a lack of evidence on patient experience and information needs at the point of referral. It is a challenge for GPs to communicate the reasons for referral and provide reassurance.

Aim: To examine how GPs communicate a potential cancer diagnosis and USC referral in practice.

Design & setting: This is a secondary analysis of a dataset of 23 audio-recorded GP-patient consultations, selected from a larger dataset of …

Application Of A Digital Quality Measure For Cancer Diagnosis In Epic Cosmos, Andrew J Zimolzak, Sundas P Khan, Hardeep Singh, Jessica A Davila

Faculty, Staff and Students Publications

Objectives: Missed and delayed cancer diagnoses are common, harmful, and often preventable. We previously validated a digital quality measure (dQM) of emergency presentation (EP) of lung cancer in 2 US health systems. This study aimed to apply the dQM to a new national electronic health record (EHR) database and examine demographic associations.

Materials and methods: We applied the dQM (emergency encounter followed by new lung cancer diagnosis within 30 days) to Epic Cosmos, a deidentified database covering 184 million US patients. We examined dQM associations with sociodemographic factors.

Results: The overall EP rate was 19.6%. EP rate was higher in …

Cervical Cancer Prevention Behaviors In Young Black Women, Angela J Johnson, Monica J Johnson, Juinell B Williams, Emma Muscari, Laura Palmo, Michelle Ruiz, Brianna Bush, Lisa C Campbell

Faculty, Staff and Students Publications

Background: In the United States, Black women have the second highest incidence of cervical cancer (CC) due to high incidence of human papillomavirus (HPV), slow HPV clearance rates, and low receipt of preventive pap smears and vaccines.

Objective: A Black Feminist Thought framework was used to examine how the media portrayal of Black women, racial identity, and familial factors impact CC prevention behaviors among young Black women.

Design: Black women enrolled at a large southeastern university consented and participated in an online mixed-methods survey examining facilitators and barriers to CC prevention behaviors. Quantitative items were analyzed via descriptive statistics, and …

‘Antibiotics Are Like Gold’: A Qualitative Study Of Patient Perspectives On The Use Of Antibiotics Without A Prescription, Lindsey A Laytner, Patricia Chen, Barbara Wells Trautner, Susan Nash, Ashley Collazo, Fabrizia Faustinella, Kiara Olmeda, Azalia Mancera, Roger Zoorob, Michael K Paasche-Orlow, Larissa Grigoryan

Faculty, Staff and Students Publications

Background: Using antibiotics without a prescription (non-prescription use) is common in the USA and contributes to antibiotic misuse, potentially harming individuals and threatening public health. At the individual level, safety issues related to non-prescription use include adverse drug reactions and disruption of healthy microbiomes. At the public health level, non-prescription use increases the risk of antimicrobial resistance.

Objectives: This qualitative study explored the reasons and motivations underlying non-prescription use among adult outpatients with varying healthcare coverage and education.

Methods: We used purposive sampling to recruit participants who endorsed using non-prescription antibiotics in a larger quantitative survey. Participants were patients recruited …

Advancing Narcolepsy Advocacy: Bridging Patient Narratives And Systemic Change, Ahmed Salem Bahammam, Lindsay Jesteadt, Hamza Dhafar, Amir Sharafkhaneh

Faculty, Staff and Students Publications

We introduce the Stigma-to-Structure Advocacy Framework, a novel, evidence-based model designed to transform narcolepsy advocacy by systematically bridging patient narratives with structural change. Narcolepsy remains a profoundly underdiagnosed and misunderstood neurological disorder, with persistent diagnostic delays and pervasive cultural stigma undermining patient well-being and access to care. Despite recent progress in awareness and support, advocacy efforts remain fragmented and insufficiently integrated with health policy, particularly in low- and middle-income countries. This perspective advances a strategic evolution of narcolepsy advocacy through the Stigma-to-Structure Advocacy Framework, which is anchored in three pillars: narrative-driven awareness, clinical system integration, and policy activation. Drawing on …

Age-Related Variations In Hba1c Improvemecnts: Insights From A Telehealth-Supported Community-Based Intervention, Laura Porterfield, Xiaoying Yu, Amber B Amspoker, Craig A Johnston, Aanand D Naik, Salim S Virani, Christie M Ballantyne, Ashok Balasubramanyam, Elizabeth M Vaughan

Faculty, Staff and Students Publications

Background and objectives: We previously demonstrated that a telehealth-supported community health worker (CHW) intervention significantly improved clinical outcomes in diabetes care. However, the extent to which these benefits vary across different age groups remains unclear. This study evaluated the effectiveness of a CHW-led multidimensional diabetes intervention in reducing HbA1c across age groups.

Research design and methods: We conducted a retrospective analysis of 10 studies (n = 301) that focused on low-income Hispanic adults with or at risk for type 2 diabetes. The intervention included CHW-participant coaching via mobile Health (mHealth), monthly CHW-led group education, and bidirectional mHealth feedback among …

Utility Of Microbial Cell-Free Dna Sequencing In The Diagnosis Of Mycobacterial Infections In A Quaternary Care Center, Fernando H Centeno, Todd Lasco, Ahmed M Hamdi, Mayar Al Mohajer

Faculty, Staff and Students Publications

We examine the performance of microbial cell-free DNA (mcfDNA) next-generation sequencing (NGS) testing on patients admitted to a quaternary care hospital in Houston, Texas. The test was 75.0% sensitive and 97.8% specific for all mycobacterial infections. mcfDNA NGS results led to adjustments in antimicrobial therapy for seven of nine patients with positive results.

Impact Of A Cerebrospinal Fluid Diagnostic Stewardship Intervention On Quantity Of Tests, Length Of Stay, Antibiotic Prescriptions, And Cost, Aaron Pathak, Sabra Shay, Todd Lasco, Mayar Al Mohajer

Faculty, Staff and Students Publications

Redundant and low-value cerebrospinal fluid analysis for suspected meningitis can increase costs and antimicrobial use. Our diagnostic stewardship intervention limited available infectious disease cerebrospinal fluid assays to seven common tests, including a multiplex polymerase chain reaction panel. There was no significant difference in the cost of testing or clinical outcomes.

Inclusion Of Patient-Centered, Non-Microbiological Endpoints And Biomarkers In Tuberculosis Drug Trials, Andrew R Dinardo, Wilbert Sabiiti, Stephen H Gillespie, Sophia B Georghiou, Norbert Heinrich, Norbert Hittel, Sami Taghlabi, Danna Carrero Longlax, Mikashmi Kohli, Ursula Panzner, Collins Musia, Christoph Lange, Anca Vasiliu, Rob J W Arts, Anna M Mandalakas, Morten Ruhwald, Lieven J Stuyver, Reinout Van Crevel

Faculty, Staff and Students Publications

Tuberculosis drug trials are primarily designed to identify antibiotic regimens with the strongest potency to kill Mycobacterium tuberculosis. However, microbiologic cure is not synonymous with improved health and recovery. Beyond antimicrobial efficacy, parameters such as morbidity and mortality related to lung function, cardiovascular health, and cancer should be prioritized. This narrative review emphasizes the critical need to emphasize clinical outcomes as much, if not more, than microbiological endpoints. We examine the underlying pathophysiological mechanisms and determinants of non-microbiological outcomes in tuberculosis, providing a synthesis of current knowledge. While there is growing evidence for some biomarkers to risk stratify TB …