Digital Commons Network^™

The Role Of The Delta Neutrophil Index In Determining The Severity Of Intrahepatic Cholestasis Of Pregnancy, Selçuk Atalay, Melike Çaltekin, Nihal Çallıoğlu, Fırat Ersan, Verda Alpay, Yasin Anasız, Ipek Geyikoğlu

Saudi Medical Journal

Objective: This study aimed to investigate the clinical utility of the delta neutrophil index (DNI) in distinguishing patients with intrahepatic cholestasis of pregnancy (ICP) from healthy pregnant women, and to assess its potential role in evaluating disease severity. Methods: This retrospective analysis included data from 249 pregnant women. Among them, 131 were identified with ICP, based on clinical symptoms and total bile acid levels ≥ 10 μ mol/L. The remaining 118 participants served as healthy controls. The ICP cases were categorized into mild (TBA 10–39 μ mol/L; n = 90) and severe (TBA ≥ 40 μ mol/L; n = 41) …

Integrative Approaches To Gut Microbiota: Biomarkers, Dysbiosis, And Therapeutic Potential, Zeyad M. Alharbi

Saudi Medical Journal

The human gut contains bacteria, viruses, and archaea that influence health depending on age, diet, and location. An individual harbours about 150 bacterial species. An imbalance of these microorganisms, known as dysbiosis, can negatively impact health. Commensal bacteria maintain microbial homeostasis by building short chain fatty acids. The 2-way communication channel that connects the gut and the brain is referred to as the gut-brain axis. Dysbiosis of the gut leads to some autoimmune diseases. A decline of beneficial bacteria causes the progression of rheumatoid arthritis. Gut dysbiosis increases intestinal permeability, allowing toxins and cytokines to enter the bloodstream and damage …

Emerging Nanotherapy Applications In Cancer Treatment: A Comprehensive Review, Waleed H. Mahallawi

Saudi Medical Journal

This comprehensive review synthesizes recent advances in cancer nanotherapy, focusing on 6 emerging categories: immunomodulation, gene/RNA delivery, theranostics, radiosensitization, biomimetic carriers, and artificial intelligence (AI)-guided formulations. These innovative platforms demonstrate transformative potential by overcoming key limitations of conventional cancer treatments. Immunomodulatory nanoparticles reprogram tumor microenvironments and convert immunologically ``cold'' tumors to ``hot'' responsive states. Gene delivery systems enable precise editing with >50% efficiency, while theranostic platforms integrate real-time imaging with targeted therapy. Radiosensitizers amplify local radiation dose by twofold, and biomimetic carriers achieve prolonged circulation through immune evasion. An AI-driven approaches optimize personalized formulations based on patient-specific biomarkers. Clinical evidence …

Treatment Of Odontogenic Sinusitis With Oroantral Communication And Fistula: A Systematic Review And Meta-Analysis, Rana R. Alharbi, Omar F. Alnajar, Reham E. Almahdi, Salman A. Alrougi, Remas A. Alshehri, Ruyuf A. Alotaibi, Shahad S. Alharbi, Manal A Eltahir, Yahya A. Fageeh

Saudi Medical Journal

Objective: To assess the available data regarding medicinal, surgical, and combination therapy approaches for odontogenic sinusitis linked to OAC and OAF. Oroantral communication (OAC), an atypical connection between the oral cavity and maxillary sinus, commonly arises following upper jaw procedures, trauma, or infection. Chronic odontogenic maxillary sinusitis may result from OAC developing into an oroantral fistula (OAF) if treatment is not received. Recurrent infections and functional difficulties can be avoided by managing these illnesses effectively. Methods: A systematic search was conducted in National Library of Medicine's (PubMed [MEDLINE]) and Google Scholar for studies published between 2000 and 2024. A total …

Mental Health In Relation To Parental Absence: A Systematic Review, Mohammed Barry, Abdulaziz Alyahyawi, Heba Jafar Sabbagh

Saudi Medical Journal

Objective: To evaluate the literature based on the relationship between orphaned children and mental health, compared to non-orphaned children. Mental well-being of orphaned children is a profound intricate topic that connects with broader concerns of childcare. This systematic review aims to evaluate the literature regarding the relationship between mental health and parental absence. Methods: We conducted a systematic search of PubMed, MEDLINE, and Science Direct in October 2025, with 1017 screened studies. Six studies met the inclusion criteria. Independent reviewers performed quality assessments using the Newcastle-Ottawa scale (NOS). Subsequently, a meta-analysis was performed when possible. Results: Findings indicate that orphaned …

Toward A Technology-Enhanced Project-Based Learning Curriculum For English Language Learners, Lynn Wolfe

MITESOL Journal: An Online Publication of MITESOL

Project-based learning (PBL) has been demonstrated as an effective strategy for millennial and Gen Z students, particularly in K-12 contexts, but this teaching approach is not commonly used in adult ESL classrooms. This paper suggests that a technology-enhanced PBL approach may transform otherwise teacher-centered and outdated ESL classes by helping English language learners (ELLs) develop linguistic fluency along with technological fluency that is essential for the 21st century workplace. Collaborative PBL activities involving the use of digital tools are presented in the areas of listening/speaking, reading/vocabulary, grammar, and writing, providing a foundation for a technology-enhanced PBL curriculum designed for adult …

Dynamic Routing For Multi-Agent Ai Workflows. Ai Token Cost In Metric Calculation., Roman Volkov, Yegor Kudryashov

Defensive Publications Series

This submission proposes a system that constructs multi-agent AI workflows dynamically at runtime by computing optimal paths through a live network topology of Large Language Model (LLM) providers, AI agents, humans, and services, the same way that routing protocol computes packet paths through routers. Considering Artificial Intelligence (AI) tokens as the new currency of intelligent automation, this submission embeds their cost into a routing metric. Through techniques of this submission, each LLM provider and AI agent's inference token cost for defined task can be used as part of weight in path computation.

When a routing algorithm builds a workflow, it …

What Are Elementary Phenomena? An Introduction To A Lacanian Conceptualization, Derek Hook Ph.D.

Middle Voices

What do Lacanians mean when they refer to the notion of elementary phenomena? This idea, crucial to Lacan’s (1993) theorizations of psychosis in Seminar III, refers back to the psychiatric conceptualizations of the late 19th and early 20th century. However, even while citing the influence of others when utilizing the concept, Lacan—characteristically enough— described the concept in his own distinctively psychoanalytic way. The term is particularly important to Lacan in terms of how he thinks about the development of delusions and related psychotic symptoms in relation to the initial onset of psychosis. In this short paper, I aim simply to …

A League Of Her Own: The Comeback After Collison, Ashley Otto, Do, Mbs, Carly Day, Md

Jefferson Hospital Staff Papers and Presentations

Initial History

During a college softball game, the left fielder (patient A) and center fielder (Patient B) collide while attempting to catch a fly ball. Patient A immediately lost consciousness and Patient B screamed in pain grabbing her right leg. The athletic trainer (AT) and student athletic trainer access and triage the players. Upon the AT's arrival, Patient A became conscious, appeared confused, denied distress, and complained of jaw pain. Patient B continued to have upper right leg pain. Both athletes are helped off the field and the on-call physician is asked to come to the field.

Regional And Temporal Variation In The Function Of The Castles Of The Norman Conquest, Leah A. Perdue

Departmental Honors & Graduate Capstone Projects

Following the Norman Conquest in 1066, a castle-building project of unprecedented scale transformed the landscape of England. This paper investigates how these structures supported the establishment of Norman rule over England, and how their role changed over time. Through examining case studies, the paper concludes that in the early years following the Conquest castles were primarily used in military operations, but in the following decades became essential administrative sites and seats of local government, as well as symbols of Norman power. The paper also concludes that castles on the border with Wales have a more complicated history, fluctuating in function …

Gli Weekly, April 28, 2026, Franke Global Leadership Initiative

GLI Weekly

Attention Graduates! -- Griz Gradfest -- GLI Capstone Mentor Featured in Vision Magazine -- Looking Ahead! -- National Student Exchange -- Plant an Apple Orchard at Franklin Elementary -- Volunteer for the GLI -- VolunteerUM -- Grizzly Ambassadors Wanted -- International April Event -- World Languages and Cultures Courses in English -- The Psychology of Happiness -- Senior Highlight

"Chinese" And Chinoiserie: Exoticization And Orientalism In The West During The 19th And 20th Century And Its Effects On Museum Practices, Janine Salapantan

Honors Capstones

During the 19th and 20th centuries, the west experienced a keen interest in the lives of the east. In an era of mystery, the people of the west relied on furniture, textiles, and objects to fill in the gaps of their fantasy of the mystical east and its people. This led to the boom of East Asian export and attempts of replication through Chinoiserie, the west’s interpretation of East Asian aesthetics. Chinoiserie and exportquickly filled the homes of affluent families in the west, such as the Ellwood family in Dekalb. This study aims to investigate the origins of various East …

Impact Of Provider Confidence And Psychiatric Referrals Through Education And Implementation Of The Gad-7 Anxiety Screening Tool In An Outpatient Family Clinic, Maceline E. Check

Doctor of Nursing Practice Projects

Gaps in provider and nurse confidence in identifying and managing anxiety disorders in outpatient family clinic settings contribute to underdiagnosis, delayed intervention, and reduced psychiatric referrals. This quality improvement project evaluated the impact of provider education and implementation of the Generalized Anxiety Disorder-7 (GAD-7) screening tool on provider and nurse confidence and appropriate psychiatric referral rates, with the goal of improving clinical decision-making and standardizing anxiety screening practices. The project was guided by Lewin’s Change Theory and the Iowa Model of Evidence-Based Practice. Using a quasi-experimental pre- and post-intervention design, providers and nurses in an outpatient family clinic received structured, …

Psycho-Pathology And Links Between Neurosis And Psychosis, B. Mason Judy, John Dall'aglio

Middle Voices

Commentary

The Secretary Of Alienation: Metaphor And Metapsychology, Anna Kreienberg

Middle Voices

Commentary

Happiness And Development Through Socialization, Dinmukhamed Shermakhanbetuly

Language Study as a Gateway to the Humanities

No abstract provided.

Moving Toward Standardization Of Breast Cancer Screening: A Scoping Review Comparing Uspstf And Acs Recommendations For Women Aged 40–74, Gerita F. Perry, Krystal D. Hester-Smith, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose 

To compare U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) breast cancer screening guidelines for women aged 40–74, and to recommend adopting one consistent, standardized guideline in practice. Standardization can improve care continuity, patient adherence, reduce anxiety, support early detection, and lower mortality.

Background 

Breast cancer is the second leading cause of cancer-related death amongst women. The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The ACS recommends an annual mammogram. Differences between the two organizations for screening emphasize the need for a common alignment to reduce breast cancer mortality. As breast …

Staff Educational Impact On School-Based Mental Health Services: A Scoping Review, Daniel J. Kim, Di'yana Fisher, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

            Trends are consistently increasing among adolescents in regard to mental health diagnoses and suicide risks, which emphasizes the necessity for early identification via school-based psychiatric screenings. The Patient Health Questionnaire-9 (PHQ-9) has proven effective in uncovering symptoms of depression; variable application and limited staff knowledge continue to be substantial hurdles. This scoping review examined the influence of staff education and training on the efficacy of school-based psychiatric screening.

Methods

            PubMed, CINAHL, Medline, Elsevier, Google Scholar, and JAMA were utilized to conduct this scoping review. Peer-reviewed studies published between 2020 and 2025 were included if they involved adolescents aged 13-18, …

Charlotte Ku, Charlotte Ku

Faculty CVs

No abstract provided.

Three Essays In Political Economy, Thomas Ryan Johnson

Arts & Sciences Graduate Student Theses and Dissertations

Markets, institutions, and borders shape political behavior. Geography influences why markets form, how institutions flourish, and where nations draw borders. As a consequence, empirical studies of political behavior frequently struggle to disentangle spatial effects from quantities of interest. This dissertation makes a methodological advancement in this problem area and conducts a spatial study with these concerns in mind. The dissertation studies bias in spatial regressions, how natural disasters impact political participation, and the political economy of espionage. It introduces a flexible machine learning methodology to mitigate bias in spatial regressions, it identifies spatial and demographic factors associated with changes to …

Molecular Mechanism Of Wdfy4-Mediated Cross-Presentation By Type 1 Conventional Dendritic Cells, Ray Andrew Ohara

Arts & Sciences Graduate Student Theses and Dissertations

Type 1 conventional dendritic cells (cDC1s) are a subset of antigen-presenting cells required for the activation of T cells during anti-viral and anti-tumoral immune responses. cDC1s specialize in cross-presentation (XP), or the MHC-I presentation of exogenous antigens, which allows them to prime antigen-specific CD8+ T cells. In classical MHC-I presentation, cytosolic antigens are processed through the endoplasmic reticulum (ER), relying on both proteasomes and transport associated with antigen processing (TAP). In contrast, the molecular mechanism of XP remains less understood, especially in regard to how the antigens are processed, how the peptides are loaded, and why this function is specialized …

Covid Minds: A Thematic Review Of The Pandemic On Neural Mechanisms And Political Polarization, Madison Jeffries

Honors Projects

This paper analyzes how the COVID-19 pandemic influenced political polarization in the United States by examining the interactions between social system disruption, psychological stress, and underlying neurological behaviors. While previous research has extensively discussed pandemic's influence on public health and societal breakdowns, studies fail to examine how these disruptions shaped political divisions. This study synthesizes interdisciplinary literature on pandemic-induced stressors and analyzes factors, including institutional mistrust and social isolation, and how these experiences shape political behavior and perspectives. Applying research from psychology and neuroscience, the paper argues that prolonged exposure to pandemic-related stressors changed neurological and behavioral patterns in response …

Cultivating The Dream In African American Men Through Black Excellence And Success, Sylvia Lawan Branch

LMU Theses and Dissertations

Achieving Black Excellence has been a goal for African American men for several decades; yet this movement has been hindered by social, emotional, and discriminatory life experiences from early childhood through adulthood. Black Excellence has been a phrase used in recent years to highlight achievements for African American men in wealth, mental health, well-being, fatherhood, and academic achievement. The main objective of this dissertation was to define and examine dimensions of Black Excellence among African American men, including elements that contributed to personal fulfillment and broader social impact. To determine recommendations to achieve Black Excellence (Scott, 2017), 10 semistructured interviews …

Transesophageal Echocardiogram Training For Student Registered Nurse Anesthetists, Sophie Hesse, Annie Krippene, Christian Shelton

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Transesophageal echocardiography (TEE) is a vital diagnostic tool in perioperative care. At Barnes-Jewish College Goldfarb School of Nursing (GSON), Student Registered Nurse Anesthetists (SRNAs) formerly received limited TEE instruction, consisting primarily of didactic content. This quality improvement project aimed to enhance SRNA proficiency in TEE by integrating online and simulation-based training.

Review of Literature Findings: Simulation-based education has been shown to improve knowledge, skill, and confidence compared to lecture-only methods (Bloch et al., 2017; Chenkin et al., 2023; Pezel et al., 2023; Weber et al., 2019; Zhao et al., 2021).

Methods: Guided by the Iowa Model and …

Preventing Information Loss During Icu To Or Handoff, Jenna Alfeldt, Kristen Hoffer, Ashley Miles, Amanda Schwarztrauber

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Inconsistent ICU to OR handoff practices create conditions for information loss, threatening patient safety and continuity of care. Communication errors contribute to an estimated 250,000 fatalities and $20 billion in annual U.S. healthcare costs.

Review of Literature Findings: A thorough literature review revealed that standardized handoff procedures are shown to improve communication and team dynamics.

Methods: This quality improvement (QI) project implemented a standardized handoff process using the Handoff Reference Tool when transferring patients from the Intensive Care Unit (ICU) to the Operating Room (OR) in a large academic medical center. Pre- and post-implementation …

Do-Not-Resuscitate Orders In The Perioperative Period: A Quality Improvement Project, Brooke Popejoy, Connor Lebsack, Rena Bish

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Management of do-not-resuscitate (DNR) orders during the perioperative period presents ongoing ethical and clinical challenges. Variability in provider knowledge and documentation can compromise patient autonomy and safety. Despite institutional policies, such as Barnes-Jewish Hospital’s “Goals of Care Directive,” inconsistent adherence remains common.

Review of Literature Findings: Evidence reveals that limited provider education contributes to uncertainty in managing perioperative DNRs. Studies by Baumann et al. (2017), Chappell et al. (2023), and Crowe and Marsh (2023) support targeted educational interventions to improve provider competence and consistency with national guidelines regarding required reconsideration.

Methods: Preintervention and postintervention surveys will be …

Riding The End-Tidal Wave: Enhancing Nurse Confidence And Clinical Competence On Capnography Waveform Interpretation, Megan Monda, Kirk Wallis, Rachel Zehner

Doctor of Nursing Practice (DNP) Student Projects

This quality improvement project addressed inconsistent use of end-tidal carbon dioxide (ETCO2) monitoring among nurses in the Cardiac Procedure Center (CPC) at Barnes-Jewish Hospital. Although capnography detects respiratory compromise earlier than pulse oximetry, limited staff education contributed to variability in waveform interpretation and clinical response. Guided by Kurt Lewin’s Change Model and the Plan-Do-Study-Act cycle, four structured one-hour educational sessions were delivered to CPC nurses and supplemented with hands-on practice and visual cognitive aids. Pre-, immediate post-, and two-week post-education surveys evaluated changes in knowledge, confidence, and clinical skill. Mean knowledge scores improved from 65% at baseline to 75% immediately …

Enhancing Anesthesia Clinicians’ Knowledge And Confidence In Prophylactic Antibiotic Selection For Patients Receiving Concomitant Therapeutic Antimicrobials, Nicholas Rangel, Michela Williams, Amber Theisen

Doctor of Nursing Practice (DNP) Student Projects

: Background and Review of Literature: Antibiotics are essential for preventing surgical site infections (SSIs), but improper selection can contribute to antimicrobial resistance, increased costs, and patient harm. Studies show that clinical decision support (CDS) tools can improve antibiotic prescribing practices using evidence-based guidelines.  Purpose: This project aimed to integrate a revised CDS tool into the workflow of a anesthesia clinicians at a midwestern academic medical center, incorporating allergy-specific guidelines and antimicrobial substitution recommendations for patients on concomitant therapeutic antimicrobials (CTA) to improve decision-making. Methods: This project used pre- and post-surveys to assess clinicians’ knowledge, confidence, and satisfaction in selecting …

Quality Improvement Project: Evaluating The Effectiveness Of Chlorhexidine Gluconate Bathing Education On Staff Perceived Knowledge, Kaonta Spencer

Doctor of Nursing Practice Projects

A community hospital set strategic goals to achieve Vizient top-decile performance and drive continuous improvement by reducing surgical site infection (SSI) rates. The purpose of this quality improvement project was to support this goal by implementing an evidence-based educational intervention to improve nurses' perceived knowledge and self-reported ability with the chlorhexidine gluconate (CHG) bathing protocol for hysterectomy patients. Guided by Lewin's Change Theory, the Iowa Model Revised, and the Iowa Implementation Framework, the educational intervention applied a structured approach to address behavioral and organizational barriers contributing to protocol noncompliance. A quantitative, quasi-experimental pre- and post-intervention design was used to evaluate …

Quality Improvement Project: Improving Interdisciplinary Care In Nursing Education Through Simulation, Anna Williams

Doctor of Nursing Practice Projects

Interprofessional education (IPE) is essential in preparing nursing students for effective teamwork and communication in clinical practice and is supported by the literature as improving these outcomes. However, limited faculty training in interprofessional simulation design contributes to reduced IPE opportunities within nursing curricula. A needs assessment at the project site identified a lack of structured, hands-on training for simulation faculty, resulting in decreased faculty confidence and limited implementation of IPE simulations. The purpose of this quality improvement project was to evaluate whether a structured training intervention improved simulation faculty self-efficacy in developing and implementing IPE simulations. Bandura’s Self-Efficacy Theory guided …