Digital Commons Network^™

Olfaction And Clinical Cognition In Medicine: An Under-Theorized Sensory Modality In Healthcare, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Olfaction is the most evolutionarily ancient sensory modality and retains privileged neuroanatomical connections to limbic and threat-detection systems. Despite its biological significance, olfactory perception is under-discussed in contemporary medical education and academic literature, particularly in healthcare environments.

Objective: To examine olfaction as a low-bandwidth, high-salience diagnostic signal in medicine; to explore its neurobiological foundations; and to analyze its ethical, social, and professional implications within Emergency Medicine and other clinical settings.

Methods: Narrative synthesis of neuroscience, evolutionary biology, volatile organic compound (VOC) research, and clinical observational practice.

Discussion: Olfactory pathways bypass primary thalamic relay and project directly to limbic structures …

The Physics And Biology Of High-Risk Falls: Biomechanical Analysis And Physics Assists In Understanding Why The Threshold For High-Risk Was Lowered To 10 Feet, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Recent revisions to the National Guideline for the Field Triage of Injured Patients lowered the high-risk fall threshold from >20 feet  to >10 feet for all ages. Guideline changes are multifactorial and typically reflect epidemiologic registry data, injury severity trends, and systems-level performance feedback. However, biomechanical analysis assists in understanding the importance of the change.

Objective: To demonstrate that a 10-foot fall generates sufficient kinetic energy and deceleration forces to exceed structural tolerance thresholds in multiple human tissues, and to show that fundamental physics independently supports the recent trauma protocol change.

Methods: Application of gravitational motion equations (v = …

The Ones That Got Away:Shared Misses, Shared Mastery — A Proposal For Leveraging Spaced Retrieval, Variable Reinforcement, And Collective Learning In Emergency Medicine Residency, James Espinosa D, Robin Lahr, James Lee, Swet M. Patel, Alan Lucerna

Rowan-Virtua Research Day

Background

Residents frequently engage in individual question-bank study for board preparation; however, missed questions are typically processed in isolation. Educational psychology demonstrates that spaced retrieval and variable reinforcement enhance durable learning. Psychological safety further supports collective sense-making in professional education . The addition of a periodic, structured, collective shared-review process model may leverage these principles within residency training.

Objective

To propose a resident-driven educational initiative that transforms individually missed board-style questions into a shared, psychologically safe learning stream that promotes durable knowledge retention and community-based mastery.  The movement of this stream could be a chief resident responsibility, or could be …

Detecting Early Operational Turbulence In The Emergency Department Using Fourier And Wavelet Analysis: A Conceptual Framework For Signal-Informed Anticipation And Prediction In The Ed Complex Adaptive System, James Espinosa, David Ho, Alan Lucerna

Rowan-Virtua Research Day

Background:

We theorize that Emergency Departments (EDs) function as complex adaptive systems characterized by nonlinear interactions, oscillatory demand patterns, and abrupt phase transitions from stable flow to turbulent states. Traditional dashboards rely on threshold metrics that detect instability after degradation becomes visible. Many ED data streams are significantly retrospective as well as compression-averaged into temporal systems such as days, months, quarters or even years. Signal processing methods—particularly Fourier and wavelet analysis—offer the  framework for detecting latent oscillatory shifts preceding overt operational change from laminar to transitional to turbulent flow states. This could lead to better methods of adaptation.

Conceptual Framework: …

Beyond Traditional Emergency Medicine Residency Match Interviews: Behavioral Questions As Stress Tests For Resident Selection A Theory-Driven Micro-Assessment Framework For Detecting High-Value Traits, Alan Lucerna, James Lee, Robin Lahr, James Espinosa

Rowan-Virtua Research Day

Background: Traditional residency selection metrics incompletely capture behavioral traits essential for emergency medicine (EM) performance.

Objective: To propose a theory-driven framework using structured behavioral questions as stress tests to detect high-value traits.

Methods: Conceptual analysis of three standardized behavioral prompts assessing execution, systems thinking, and team orientation.

Results: Distinct response patterns align with observable domains associated with reliability, performance, and leadership.

Conclusion: Behavioral stress test questions offer a scalable, low-cost method to enhance residency selection processes.

When Individual Implicit Bias Meets Ed System Turbulence: Expanding The Implicit Bias And Cultural Bias Conceptual Frame To Support Reflective Decision Making Through Both Individual Bias Reduction Strategies As Well As System-Level Design Approaches, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Cultural and implicit bias have been widely studied as contributors to disparities in healthcare delivery. Prior literature has largely conceptualized bias as an individual-level cognitive phenomenon occurring within clinician–patient interactions. However, emergency departments (EDs) function as complex adaptive systems (CAS), characterized by time pressure, uncertainty, cognitive load, and environmental noise. These conditions may contribute to the expression of implicit bias in clinical care.

Objective

To reframe cultural and implicit bias in the ED as both an individual cognitive property as well as a system-dependent and modulated  phenomenon and to propose that the operational state of the ED influences the …

Helping Waldo (The Poster) Be Found: Teaching Search Literacy, Discoverability And Search Engine Optimization As Core Scholarly Skills In Graduate Medical Education, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: In modern academic medicine, trainees are taught how to search the biomedical literature but rarely taught how to structure their own scholarly work so that it can be discovered. This creates a diffusion gap in which high‑quality educational innovations, case reports, and operational insights remain difficult to locate despite being presented or archived.

Objective: To propose a concise educational module that teaches residents the principles of search literacy and scholarly discoverability.

Methods: A conceptual curriculum framework was developed drawing on literature from information science, medical education, and diffusion theory. The module introduces the paired competencies of 'Finding Waldo' (literature …

Sharing Research Posters With The World: Clinical Education Posters Can Demonstrate Global Diffusion And Conceptual Portability--Evidence From Readership Maps, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Traditional academic metrics emphasize citation counts and journal impact factors as measures of scholarly influence. These metrics often overlook the early and informal diffusion of ideas across global clinical communities. Educational posters and case-based teaching materials frequently circulate through digital repositories, yet little attention has been paid to how readership analytics may illuminate patterns of knowledge diffusion across healthcare systems.

Objective

To explore the concept of conceptual portability and to introduce readership mapping as a framework for understanding how clinical ideas travel across diverse global contexts.

Methods

We examined readership analytics from an institutional digital repository hosting clinical posters …

Constructive Affirmation: Proposing An Empowering Term For What Good Teaching Attendings Already Do-- Integrating Affirmation And Constructive Criticism Through Learning Science, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Feedback is central to residency training, and quite naturally many educational cultures emphasize corrective feedback and error identification. Learning science suggests that reinforcement of correct cognitive patterns is equally essential for expertise development. This paper introduces the concept of constructive affirmation as an integrated feedback model combining affirmation and constructive criticism.

Objective

To propose a learning science framework for clinical feedback in residency training centered on the concept of constructive affirmation.

Methods

This conceptual analysis synthesizes literature from medical education, cognitive psychology, neurobiology of learning, and complexity science to examine how different feedback types influence pattern recognition, cognitive load, …

Congruence (Healthy Adaptation And Resilience) Under Stress: A Human Systems Model For Healthcare Microsystems Integrating Virginia Satir’S Communication Theory With Clinical Microsystems And Complex Adaptive Systems Using The Emergency Department As A Model Of Adaptive Team Function, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Emergency departments operate as complex human systems under continuous cognitive, emotional, and operational stress. Healthcare delivery occurs within clinical microsystems—small frontline units where patients, clinicians, and staff interact directly. While microsystem theory has provided an operational framework for improving quality and safety, less attention has been given to the relational communication dynamics within these systems.

Objective:

To integrate Virginia Satir’s human systems theory with clinical microsystem theory and complex adaptive systems thinking in order to better understand communication patterns, team dynamics, and adaptive functioning within emergency medicine residency programs and ED clinical teams.

Conceptual Framework:

Satir described several communication …

The Epidemiology Of Sledding Injuries: Clinical Patterns And Public Health Prevention Strategies, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Sledding is a widely enjoyed winter recreational activity among children and adolescents. Although commonly perceived as low risk, sledding can result in extremity fractures, head injuries, and collision-related trauma. Emergency Departments frequently encounter sledding injuries during winter months, providing both clinical insight and opportunities for injury prevention counseling. An estimated 20,000–30,000 sledding-related injuries occur annually in the United States, most involving children and adolescents.

Objectives: To describe patterns of sledding injuries presenting to the Emergency Department and highlight practical safety recommendations physicians can communicate to families.

Methods: Conceptual review integrating Emergency Department observational experience with published literature on pediatric …

Reframing The Step Study: The Health Significance Of Emergency Physician Step Count Results In Light Of Contemporary Benchmark Evidence, James A. Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

Background:

The STEP study (2023), a prospective observational study of emergency medicine residents and attending physicians, demonstrated that clinicians rarely achieve the commonly cited 10,000-step benchmark during clinical shifts. Since that time, large-scale dose–response analyses suggest that substantial health benefits occur at lower step counts (~7,000 steps/day), with diminishing returns beyond this range.

Objective:

To reinterpret the findings of the STEP study in light of contemporary evidence regarding step count and health outcomes.

Methods:

We revisited observational data from the STEP study, which measured step counts during emergency department shifts across three campuses using pedometers. These findings were compared with …

The Safety Paradox Of Emergency Department Shift Length: Why The Relationship Between Hours Worked And Patient Safety Is More Complex Than It Appears, James A. Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

Background: Emergency department shift duration has long been debated as a determinant of patient safety. While longer shifts may increase cognitive fatigue, shorter shifts may increase the frequency of patient handoffs, which themselves introduce communication risk. Objective: To conceptualize emergency department shift length as a safety paradox arising from the balance between fatigue and handoff-related communication risks. Conceptual Framework: We propose the Emergency Department Shift Length Safety Paradox model illustrating the nonlinear relationship between shift duration and patient safety. Implications: Optimal shift design may depend on balancing fatigue risk and communication risk within a complex adaptive healthcare system. Conclusion: Emergency …

Emergency Medicine As A Complex Adaptive System Apprenticeship: A Conceptual Framework For Understanding The Development And Emergence Of Systems Leaders From The Field Of Emergency Medicine, James Espinosa, Alan A. Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background

Emergency physicians are frequently observed to assume leadership roles in hospitals and health systems. Prior literature, including policy and leadership analyses from the American College of Emergency Physicians, has described this phenomenon and highlighted the emergency department’s central position within hospital operations. However, most explanations focus on enumerating leadership competencies rather than identifying the developmental mechanism through which those competencies emerge.

Objective

To propose a conceptual framework explaining how emergency medicine training functions as an apprenticeship in managing complex adaptive systems.

Conceptual Model

The emergency department (ED) operates as a highly dynamic environment characterized by nonlinear patient inflow, interdependent …

A Systems-Based Approach To Supporting Resident Scholarly Productivity: Building A High-Throughput Academic Pipeline In Emergency Medicine Residency Training Through Poster Development Apprenticeship, James Espinosa, Alan Lucerna, Robin Lahr, James Lee, Swet Patel, Henry Schuitema

Rowan-Virtua Research Day

Background: Many residency programs require scholarly output; however, consistent and high volume production of posters and publications can be challenging. Anecdotal evidence from a variety of programs suggests variability in outcomes across programs, often influenced by differences in mentorship, structure, and available scholarly infrastructure. Objective: To describe a reproducible, systems-based model for generating high-volume resident scholarly output through alignment of expectations, culture, infrastructure, and faculty engagement. Methods and Conceptual Model: We outline a multi-domain framework derived from sustained programmatic experience, incorporating structural requirements, leadership alignment, cultural reinforcement, workflow standardization, and active faculty participation. The model is supported by practical tools …

Reframing Outpatient-To-Ed Transitions As A Patient Safety Interface: Recognizing, Structuring, And Preserving Signal Across Clinical Boundaries Conceptualizing The Call-In To Ed Referral Model As A Handoff Of Care Model, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background

Transitions of care are recognized sources of patient safety risk. Structured handoff processes have improved communication reliability in inpatient and emergency department (ED) settings. However, outpatient-to-ED referrals—despite representing a transfer of care—are not consistently conceptualized or operationalized as formal handoffs.

Objective

To reframe outpatient-to-ED referrals as clinical handoffs occurring across a system boundary, and to propose a conceptual and operational framework to improve safety through recognition, structure, and signal preservation.

Methods

Conceptual analysis informed by clinical experience, systems thinking, and existing literature on handoffs and patient safety. Comparative evaluation of structured (ED→ED, ED→inpatient) versus less-structured (outpatient→ED) transitions.

Results

Outpatient-to-ED …

Designing Patient Update Intervals In The Emergency Department: A Queueing-Theory And Operational Science Model Of Patient Updates And Progress Signaling To Improve Patient Experience, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background Patients in the Emergency Department (ED) frequently experience uncertainty while awaiting diagnostic results, reassessment, and disposition. Even when clinical processes are progressing, prolonged informational silence may create the perception of that those processes are not advancing.

Objective To develop a conceptual and operational mathematical, queuing-theory based  model linking bedside communication, conversational time, and informational silence to patient experience.

Methods A back-of-the-envelope operational model was constructed to estimate the time required for bedside update communication during a typical physician shift. A queueing-theory framework was applied to examine how intervals between informational updates influence perceived waiting burden. Concepts from queueing theory …

Preliminary Results From Assessing Medical Students’ Familiarity With Adverse Childhood Experiences (Aces) And Trauma-Informed Care (Tic), Kaylea Shoulders, Portia Tasnim Shaheed, Kartik Kannan, Rachel Silliman Cohen, Beth Cooper, Christine Schroeder, Yahaira Márquez

Rowan-Virtua Research Day

Adverse childhood experiences (ACEs) are highly prevalent and associated with significant long-term health outcomes1; however, physicians often report feeling underprepared to address trauma in clinical care. While medical education increasingly includes exposure to ACEs and trauma-informed care (TIC), limited research has examined how these topics are integrated and experienced within osteopathic medical education (OME). This project aims to assess medical students’ familiarity with ACEs and TIC at Rowan-Virtua School of Osteopathic Medicine and to potentially help inform curricular improvement efforts. This study adapts and extends prior research2 using an anonymous survey administered via Qualtrics. Recruitment targeted medical students across years …

In School Age Children With Autism Spectrum Disorder, Does Academic Achievement And Social Development Improve In Inclusive Classroom Environments?, Ashley A. Macquaid

Rowan-Virtua Research Day

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by difficulties in social skills, communication, and sensory processing 1. ASD affects approximately 1 in 100 children internationally 2. With the growing prevalence, classroom inclusivity of individuals with autism has emerged as a priority in education. However, current literature presents a range of positive and negative factors without clear indication of effective classroom placement for students' specific needs. This research aims to determine if inclusive classroom environments improve academic achievement and social development for school-age children with ASD. A systematic search on PubMed, Embase, and Cochrane databases yielded studies published between …

Comparing Community-Based And Social Media Interventions To Improve Vaccine Uptake In Low-Income U.S. Populations, Tanisha Shah, Nico Santorelli, Maureen Kennedy, Aastha Lele, Syed Ahmad Bilal, Megan Chien, Judith Anne Lightfoot

Rowan-Virtua Research Day

Background:

In recent years, vaccination has become a highly politicized topic, contributing to decreased trust in medical professionals. Exposure to medical misinformation, distrust in government and research, and concerns about vaccine safety have all led to increased vaccine hesitancy and decreased vaccine uptake. These trends are more widely seen in low socioeconomic status (SES) and certain racial populations, posing a significant public health concern despite the effectiveness of vaccines.

Objective: This literature review aims to compare the effectiveness of community-based interventions led by clinicians and community health leaders with social media campaigns in increasing vaccine uptake among low-income populations in …

Feasibility Of 90-Day Follow Up For Patients With Intracerebral Hemorrhage: Early Data From A Neuro Icu Sleep Quality And Delirium Study, Sierra Triolo, Bethany C. Young, Mikel Shea Ehntholt, Anuoluwapo Fadare, Jamie R. Feinour, Jennifer A. Jond, Jonathan Perumpail, Kevin Eaise, Lily Roessler, Shay Lynn Greco, Vanessa Salasky

Rowan-Virtua Research Day

Background. Neuro intensive care unit (ICU) patients often experience sleep deprivation due to serial neurologic assessments, among other factors. Subjective sleep disturbance has been associated with increased delirium risk in patients with intracerebral hemorrhage (ICH).¹ However, relationships between specific sleep features, delirium and subsequent outcomes in neurocritically ill patients have not been studied.¹ Additionally, ICH-related clinical research has not historically been conducted at Virtua Our Lady of Lourdes (VOLOL) Hospital. This study aimed to assess feasibility of obtaining quantitative sleep data, delirium assessments, and 90-day functional outcomes in neurocritical care patients with ICH.

Hypothesis. We hypothesized that 90-day …

Do International Alumni Give Differently? A Study On The Alumni Philanthropic Perspective Of Trust And Key Relational Factors Affecting Attitude Towards Giving, John Held

Dissertations

Philanthropy plays a key role in the funding of institutions of higher education. Previous research has focused on domestic populations, exploring the antecedents and elements of philanthropy in higher education. The literature has yet to examine differences in these elements between domestic and international, or distance extremes, amongst alumni populations. This study investigates the perceptions and motivating factors influencing alumni who experience significant geographic separation from their Higher Education Institution (HEI) and their philanthropic support for their alma mater. The conceptual model includes factors at the organization-to-organization, person-to-organization, and person-to-person levels and their moderating effects on the relationship between trust …

Understanding Communication In Green Infrastructure Project Teams In Rochester Ny Region: Coordination, Negotiation, And Constraints, Hayden Berner

Theses

This study explores how communication is perceived and used within multidisciplinary green infrastructure (GI) project teams. As GI continues to grow in the United States, projects increasingly rely on collaboration between professionals from different fields, making communication a critical factor in project success. Using a qualitative research approach, semi-structured interviews were conducted with professionals working on GI projects in the Greater Rochester, New York region. The data were analyzed using an inductive, grounded theory approach to identify key themes related to communication practices, challenges, and outcomes. Results show that communication is not just a tool for sharing information, but a …

2026-05-06 So You Want To Be An Influencer?, Hadia Noor Ahmed

The Spectator Online

No abstract provided.

Somewhere Between Tool And Teammate:A Construct-Level Framework For Ai-Assisted Coding Reliability, Amanda N. Moeller, Abi K. Leyden, Joey Welles, Isaac J. Moelter, Erin E. Johnson, Samuel Hunter, Gina Scott Ligon

Reports, Projects, and Research

Federal Artificial Intelligence (AI) initiatives have increasingly emphasized accelerating AI adoption across government operations while maintaining appropriate governance and oversight mechanisms (Office of Management and Budget [OMB], 2025; The White House, 2025). AI systems are increasingly being integrated into research and operational workflows to support the large-scale analysis of unstructured information. Across high-impact environments, AI-enabled systems are being used to accelerate document review, organize information repositories, extract structured indicators, and support operational and analytic decisionmaking. However, despite rapid adoption, many organizations still lack practical frameworks for determining when AI-generated outputs are sufficiently reliable to support operational use and when human …

Letter From The Editor, Kiley Fry

The Corinthian

No abstract provided.

The Implementation Of A Validated Csec Screening Tool For Youth Age 11 - 17 In A Pediatric Emergency Room, Julie Clark, Josie Doss Phd, Rnc-Ob, Afn-C, Sane-A, Krystal Canady Dnp, Msn, Aprn, Fnp-C, Yameika Head Md, Faap

The Corinthian

Abstract

Youth are a vulnerable population due to their age, developmental level, and dependability on others. Child abuse is a public health issue that addresses a broad range of inflicted harm ranging from neglect to physical and sexual maltreatment. A severe form of child sexual abuse is the Commercial Exploitation of Children (CSEC), also known as Child Sex Trafficking (CST), and Human Minor Sex Trafficking (HMST). For purposes of this paper, CSEC is used for CSEC, CST, and HMST. Commercial sexual exploitation of children includes sexual crimes involving children and adolescents for gain. Due to the child being less than …

Music And Movement For Individuals With Parkinson's Disease, Jordan Butler

The Corinthian

Parkinson’s disease, affecting approximately 10 million people worldwide, causes deficits in fine motor function, speech, and movement, as well as many other secondary symptoms, such as depression (Parkinson’s Foundation, 2020, para. 1). Past researchers have outlined many different studies and interventions regarding Parkinson’s and the effects of various types of music therapy (Andrejeva et al., 2019; Bukowska et al., 2016; Tamplin et al., 2019; Thaut, Rice, Braun Janzen, Hurt-Thaut, & McIntosh, 2019; Zhang, Liu, Ye, Li, & Chen, 2017). This review includes numerous ways that music therapy has benefited, and assisted people diagnosed with Parkinson’s. Vocal practices, auditory stimulation, and …

Growing Up, Going Abroad: A Thematic Analysis Of Cultural Upbringing, Tolerance For Uncertainty, And In-Group/Out-Group Communication, Kristiana Krasteva

Undergraduate Honors Theses

This study examines Study Abroad as a process shaped by students’ responses to uncertainty, rather than as an inherently transformative experience. Drawing on Identity Negotiation Theory, Social Identity Theory, and Uncertainty Reduction Theory, it explores how cultural socialization influences students’ tolerance for uncertainty and, in turn, their patterns of communication and social engagement abroad. Semi-structured interviews were conducted with 12 students who had recently completed a semester abroad, and data were analyzed through a thematic analysis. Findings indicate that students tend to reproduce or extend pre-existing patterns of socialization, rather than fundamentally change them. In-group reliance emerged as a strategic …

Empowering Junior High School Students’ Collaboration Skills Through Science Learning Using The Secret Mission Game, Rahma Fika Kurnia, Imraatul Mufidah, Dyne Rizki Puspitasari

Journal of Innovation and Teacher Professionalism

This study aimed to empower the collaboration skills of Class VII B students at SMP Laboratorium UM through the implementation of the Game-Based Learning model using the Secret Mission game in science learning on the topic of Physical and Chemical Changes. The study was motivated by the low level of students’ collaboration skills, as indicated by previous classroom assignments that were mostly completed individually rather than collaboratively in groups. The study employed the Lesson Study approach, which consisted of three stages: Plan, Do, and See. During the planning stage, the Lesson Study team collaboratively designed learning modules, game scenarios, instructional …