Digital Commons Network^™

An Analysis Of Slms For Machine Translation Of Healthcare Documents, Wyatt Clausen

All Graduate Theses, Dissertations, and Other Capstone Projects

The language barrier creates significant healthcare challenges for patients who struggle with English. While large language models (LLMs) have advanced machine translation, their high computational costs, environmental impact, and risk of data breaches have raised concerns. Small language models (SLMs) can address these concerns and be further adapted to specific tasks through parameter-efficient fine-tuning (PEFT) methods, including Quantized Low-Rank Adaptation (QLoRA). This study compares the Spanish-to-English translation quality of two 7-billion-parameter SLMs, Mistral and Llama 2 7B, in the medical domain, using BLEU, chrF, and COMET as evaluation metrics. It further investigates whether QLoRA fine-tuning and Retrieval-Augmented Generation (RAG) on …

Seeing Public Health In Color: Phenomenological Perspectives Of Bipoc Women In Leadership, Jasmyn Spicer

All Graduate Theses, Dissertations, and Other Capstone Projects

Public health is a complex, ever-changing industry that holds pivotal capacity to impact society on a larger scale. For the United States, disparities and inequity in public health have had significant consequences for Black, Indigenous, and People of Color (BIPOC) communities. Effective leadership in public health has the potential to impact roles, policy development, and the overall scope of oversight regarding the quality of care that communities are provided in the industry. While BIPOC women are underrepresented in public health leadership roles, they have the capacity to advance equity in the field and contribute to culturally responsive care in foundational …

Secure Base Script Behaviors In Romantic Couples As Predictors Of Romantic Relationship Quality, Ben N. Zigelstein

Selected Full Text Dissertations, 2011-

Attachment representations guide expectations about the availability and responsiveness of attachment figures during times of need. These representations are shaped by early experiences of consistent, reliable caregiving and influence how individuals seek and receive support from close others across the lifespan. Secure base script knowledge, a temporal-causal sequence of events encompassing the essential elements of seeking and receiving support at times of need, is increasingly used to capture attachment representations. Research indicates that secure base script knowledge significantly predicts the quality of self-reported and observed romantic relationships. However, the extent to which secure base script behaviors (i.e., bidding for support, …

A Few Words From Our Staff

Digressions: Literary & Art Journal

No abstract provided.

Antelope Canyon, Auston Hsieh

Digressions: Literary & Art Journal

No abstract provided.

Full Issue

Digressions: Literary & Art Journal

No abstract provided.

Ethnoracial Disparities In Treatment-Seeking Among Suicidal Adults: Stigma As A Mediator, Yiming Huang M.S.

Selected Full Text Dissertations, 2011-

Despite the disproportionate increase in their suicide risk in recent years, ethnoracially minoritized individuals utilize mental health treatment less frequently than their non-Hispanic, White counterparts. Understanding the underlying mechanisms is crucial to identify strategies to mitigate such disparities. While mental health-related stigma has received attention as a potential mechanism, select types of stigma have been examined in isolation, leaving it unclear which forms of stigma are most relevant to the observed ethnoracial disparities in treatment-seeking among suicidal individuals. The current study assessed and examined a range of stigma constructs as potential mediators of ethnoracial differences in treatment-seeking outcomes among suicidal …

The Breaking Point: Examining Teacher Burnout And Methods To Build Resilience In A Time Of Unprecedented Challenges, Maribel Rudecindo-Mendez

Selected Full Text Dissertations, 2011-

The purpose of this qualitative phenomenological study was to gain insight into the experiences of K–12 teachers in the Hudson Valley region of New York as it relates to teacher burnout. The Job Demands-Resources model was used as a framework to understand organizational causes of burnout, how burnout impacts instruction and relationships with students, and how teachers cope with stress. Twenty full-time teachers who were involved with K–12 students in various instructional capacities were interviewed in a semi-structured format. Thematic analysis revealed that the main contributors to burnout were instability in the system, being overburdened with work, and issues related …

The Effects Of Anxiety On Adult Athletes And Approaches To Improving Performance And Well-Being, Taylor Glaspie-Walton

Theses and Dissertations

This systematic review examined the complex relationship between anxiety and sports performance in adult athletes, along with exploring effective approaches for enhancing both performance and psychological well-being. Through analysis of 18 studies spanning diverse sports and competitive levels, this research identifies key factors that influence anxiety responses and performance outcomes. Findings revealed that competition level, performance-goal discrepancies, and injury recovery significantly impact anxiety levels, with athletes' interpretations of anxiety symptoms proving more influential than symptom intensity alone. The research demonstrates that mental toughness and self-efficacy function as fundamental psychological resources, though their impact appears to plateau at elite competitive levels. …

A Neurophenomenological Perspective On The Self And Spirituality: The Role Of The Affective Core Self, Michael J. Winkleman, Andrew B. Newberg

Marcus Institute of Integrative Health Faculty Papers

The self is central to spirituality because the self is necessary for consciousness, and spiritual relations are fundamentally about the self. Diverse research illustrates the role of the downregulation of the right parietal lobe (rPL) in the spontaneous manifestation of spiritual experiences and during meditative practices. The functions of the rPL are central to the self, especially the embodied self. Disturbances of the rPL and embodied self-functions are associated with spiritual experience, exemplified in their association with “selflessness.” Many forms of self appear incompatible with spiritual and mystical experiences. An exception is the affective core self, the most ancient form …

Trauma Symptoms Predict Student Course Experiences: Undergraduate Ptss And Learning About Trauma-Related Content, Jessica Cless, Carol A. Johnston, Brian S. Nelson Goff, Olivia K. Edwards

Human Development and Family Science Faculty Publications

Objective:  Previous research indicates a risk for student distress and secondary traumatic stress in college courses containing sensitive, trauma-related content. There is a need to understand how students with various levels of posttraumatic stress symptoms (PTSS) respond to sensitive material. Participants: Ninety undergraduates enrolled in a traumatic stress course. Methods: Students completed a survey assessing trauma-related symptoms and self-reported experiences with and reactions to trauma-related course content. Results: Regardless of PTSS levels, students responded to the course in a similar manner. However, results from a multivariate regression a moderation analysis indicated significant associations between PTSS levels and emotional reactivity, perceived …

"Federal Court, Blocking Hhs Anti-Transgender Policies, Calls Secretary Kennedy An “Unserious Leader”", Arthur S. Leonard

Other Publications

No abstract provided.

Civil Litigation Notes, Arthur S. Leonard

Other Publications

No abstract provided.

Modeling Heterogeneous Trajectories Of Chronic Kidney Disease Progression With Finite Mixture Models Using The All Of Us Dataset, Yahaya Mumuni Musah

Electronic Theses and Dissertations

Background: Chronic kidney disease (CKD) does not progress uniformly across patients, and a single average trajectory often fails to capture this heterogeneity. Understanding variation in disease progression is important for improving risk stratification and clinical management. 
Objectives: This study aims to characterize the heterogeneity of chronic kidney disease (CKD) progression using longitudinal estimated glomerular filtration rate (eGFR) data and to identify factors associated with distinct progression trajectory patterns. 
Methods: A longitudinal cohort study was conducted using data from the All of Us} Research Program collected between April 23, 2002, and October 1, 2023. Adult participants with repeated eGFR measurements were …

Enzyme Susceptibility And Functionality Of High Protein Retentates And Reconstituted Ingredients, Khushi Dubey

Electronic Theses and Dissertations

This thesis explores the effects of processing history on the enzymatic susceptibility and functional properties of high-protein dairy ingredients, with a specific focus on ultrafiltered (UF) and microfiltered (MF) retentates and spray-dried powders. While retentates and powders are often used interchangeably in industrial applications, processing steps, such as drying, can induce structural and physicochemical changes that affect protein functionality and enzyme accessibility. Milk protein concentrates (MPC) and micellar casein concentrates (MCC) were standardized to 10% protein and subjected to enzymatic treatments, including proteolysis (Alcalase and rennet) and crosslinking (transglutaminase and laccase). Structural modifications were evaluated using capillary gel electrophoresis, non-protein …

Workforce Review Of Health Information Technology Associate-Degree Graduates: 2017-2024, Debra Hamada, Karima Lalani, Melanie Brodnik, Susan H Fenton, Angela Kennedy, David T Marc, Velma L Payne, Rebecca Reynolds

Faculty, Staff and Student Publications

Background: The career path of associate-degree health information technology (HIT) graduates continues to change quickly as quality and payment regulations, technology requirements, and workforce expectations evolve to meet the demands of the changing health care environment. Although HIT professionals play an essential role in accuracy, regulatory compliance, and the overall function of health information systems, there is limited research describing HIT workforce trends.

Methods: A mixed-methods approach was used with 587 survey responses. Quantitative data were standardized by job category, including a newly developed "health information management (HIM) operations" group, and career movement was visualized using a Sankey diagram. Qualitative …

Ai Privacy And Security In Healthcare: A Systematic Literature Review, Diane Dolezel, Karima Lalani, Valerie Watzlaf, Kerryn Butler-Henderson, Elise V Z Lambert, Mary Morton, Jamie Sand, David Gibbs, Susan Fenton

Faculty, Staff and Student Publications

Background: Artificial intelligence is expanding into telemedicine and telerehabilitation, yet significant privacy and security concerns persist.

Scope: To synthesize empirical evidence on privacy and security approaches in health care, particularly those relevant to distributed home care.

Methodology: A systematic review identified 80 studies (2019 to 2025), and Latent Dirichlet Allocation (LDA) topic modeling characterized the privacy and security themes.

Results: Sixty-six studies addressed privacy, only seventeen addressed security, and three studies addressed both. LDA identified four themes: patient data privacy, federated learning for medical imaging, encrypted training and secure computation, and healthcare data governance. Most studies emphasized privacy-preserving approaches, like …

A Structured Review Of Emerging Prompt Instability Indices (Piis) To Evaluate The Reproducibility Of Prompt-Driven Image Segmentation Models., Adib Shafipour, Deevakar Rogith, Zulfiia Ditto, Hien V Tran, Katie Stinson, Toufeeq Ahmed Syed

Faculty, Staff and Student Publications

Prompt-aware image segmentation has introduced new flexibility by allowing models to incorporate user-provided cues, such as points, boxes, or text prompts, to guide object delineation across diverse imaging domains. This flexibility introduces a fundamental challenge: ensuring segmentation results remain reproducible when prompts are altered. Minor variations in prompts produce substantially different outputs, raising concerns about the reliability and scientific validity of research and clinical applications. This paper conducts a structured review of emerging Prompt Instability Indices (PIIs), quantitative measures developed to assess the reproducibility of prompt-driven segmentation models. A systematic search of PubMed and arXiv (2020-2025) identified relevant studies, analyzed …

Simple Guide To Research Integrity For Undergraduate Researchers, Julie Simpson

Integrity in Research and Scholarship

Involving undergraduates in research is valuable for their education and important for their career development, vital for science, and rewarding for supervisors. Instilling the importance of research integrity as fundamental to the advancement of knowledge may be challenging, particularly for first time trainees, as they learn the research process and their attendant responsibilities. This simple guide was developed to assist researchers who oversee the work of undergraduate trainees address basic concepts and topics. After the core values which establish the basis for the integrity of research and scholarship broadly, the ordering of concepts/topics does not represent a hierarchy; the sequence …

A Simple Guide For Researchers And Institutional Review Boards (Irbs) To Protect Data Integrity In Online Human Subjects Survey Research, Julie Simpson

Integrity in Research and Scholarship

Researchers have used the internet to collect data for over two decades. More recently, however, online research has become a target for fraudulent respondents, particularly when researchers offer monetary incentives for participation in a study. This guide will briefly outline the evolution of internet-based human subjects research, explore the current environment for online data collection from human participants, outline strategies for researchers and Institutional Review Boards (IRBs) to help minimize and identify fraudulent responses and protect data integrity in online surveys, and discuss the challenges of balancing data integrity with research participant welfare.

Advancing Virus-Associated Lymphoma Research In Latin America: A Global Opportunity For Cancer Science, Irene Tamí-Maury, Bryan Valcarcel, Maria Alejandra Torres, Arlett Hernandez Chavez, Luis Malpica

Faculty, Staff and Student Publications

No abstract provided.

Food Delivery Services For Enhancing Participation In The Special Supplemental Nutrition Program For Women, Infants, And Children (Wic) In The United States: Bridging The Wic-Eligible Access Gap, Jingjing Gao, Muinat Abolore Idris, Lilian O Ademu, Bryan Colby Griffin, Yue Zhang, Yun Hang, Gabriela A Gallegos

Faculty, Staff and Student Publications

Background: Diet-related health disparities among U.S. children persist despite the availability of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits to eligible women, infants, and children. Participation remains suboptimal: only 51.2% of eligible individuals were enrolled in 2021. Transportation and food-environment constraints pose salient barriers, especially for caregivers of infants in food deserts. Emerging online ordering and delivery options may reduce access frictions, but grocery delivery coverage is limited, and fees are often not covered by benefits.

Methods: We linked USDA Food and Nutrition Service state-level WIC participation data (November 2024 vs. September 2025) with demographic, …

“I Can’T Just Talk It. I Have To Live It”: The Roles, Needs, And Recruitment Of Recovery Home House Managers, I Niles Zoschke, Kathryn R Gallardo, Hannah L N Stewart, Serena A Rodriguez, Danielle Gillespie, Sheryl A Mccurdy, J Michael Wilkerson

Faculty, Staff and Student Publications

Introduction: Recovery homes are an increasingly important recovery support service for people with substance use disorders, yet limited research has examined the roles of house managers or how individuals are recruited into these positions. This study examines how house managers understand and enact their roles, how recovery home operators recruit for these positions, and how the demands and sustainability of the role are perceived in practice.

Methods: We conducted a qualitative thematic analysis of interviews with 29 operators and staff working in 10 Level II and Level III recovery homes across five Texas cities.

Results: Findings indicate that house managers …

Impact Of A Culinary Medicine Intervention On Diet And Health Metrics In Patients With Type 2 Diabetes And Elevated Body Mass Index, Natalia I Heredia, Logan R Thornton, Diana C Guevara, Natalia Williams, Grace Marcelo-Ramirez, Joanne Chow, Lorna H Mcneill, Karen Basen-Engquist, Ruth Rechis, Deanna M Hoelscher

Faculty, Staff and Student Publications

Purpose: Culinary Medicine (CM), an educational approach blending the art of cooking with the science of medicine, has shown promise in improving diet and health outcomes. We conducted a mixed-methods, quasi-experimental evaluation of a CM program to promote cooking and healthy dietary intake.

Methods: Patients with type 2 diabetes and elevated body mass index (>25) were recruited from primary care clinics in low-income neighborhoods. The program, delivered by a dietitian, includes five weekly 90-minute sessions on basic cooking skills with behaviorally-based nutrition education. An explanatory sequential mixed-methods pilot study with a pre-post survey design and post-program interviews was used …

Nasal Cavity Microbial Makeup And The Influence On Psychiatric Symptoms Following Fire Exposure In Firefighters, Paul Grunsted, Chao Xu, Amanda Janitz, Jessica Reese, Janis Campbell, Tasha M Santiago-Rodriguez, Sara J Javornik Cregeen, Joseph F Petrosino, Jooyeon Hwang

Faculty, Staff and Student Publications

Background: Firefighters experience high levels of occupational stress and trauma, increasing their risk of depression, anxiety, and post-traumatic stress disorder (PTSD). Although microbial communities may influence brain function and behavior through neural pathways, the nasal microbiome remains understudied. This study examined associations between nasal microbiome characteristics and psychiatric symptoms among firefighters.

Methods: We conducted a cross-sectional study of 34 firefighters recruited from Texas fire stations. Participants completed validated questionnaires assessing depression, anxiety, and PTSD. Nasal swabs were collected before and after fire suppression and 16S rRNA sequencing was used to characterize microbial communities. Alpha and beta diversity, relative abundance, and …

What Do Youth Need To Know About Puberty? A Scoping Review Protocol To Identify Puberty Education Competencies, Marie A Brault, Nanki Singh, Nikita Kakkad, Melissa Peskin, Anthony Betori, Gregory Laynor, Emily Naiser

Faculty, Staff and Student Publications

INTRODUCTION: Puberty is a key transition point in adolescents' lives that plays a foundational role in shaping health behaviors and outcomes across one's life course. This period holds significant potential to empower adolescents and support autonomy in health and well-being, but limited puberty education curricula exist for early adolescents (age 8-14), and those that do exist vary in content. There is a paucity of evaluations of puberty competencies and limited consensus on what competencies should be measured to assess effectiveness or even how to measure these competencies.

OBJECTIVE: The objective of this scoping review is to systematically map and characterize …

Building The Infection Prevention Workforce: Development, Implementation And Evaluation Of Texas Epidemic Public Health Institute Infection Prevention And Control 300 Series, Kayla E Ruch, Janelle Rios

Faculty, Staff and Student Publications

Background: The Texas Epidemic Public Health Institute (TEPHI) was established to strengthen infectious disease preparedness across Texas. The Infection Prevention and Control (IPC) 300 Series represents the third year of a multi-tiered educational initiative designed to provide free, accessible, evidence-based IPC training and continuing education credits for the healthcare workforce.

Methods: Registration and attendance data were collected through Zoom™ and Microsoft Teams™. Knowledge assessments, post-module surveys, and mid- and end-of-series evaluations were administered through QuestionPro™. Module content was informed by guidance from APIC, CDC, CMS, and OSHA. Descriptive statistics and the Kirkpatrick Model of Training Evaluation were used to assess …

Safety And Efficacy Of 6% Hydroxyethyl Starch In Patients Undergoing Major Surgery: The Randomised Controlled Phoneics Trial, Wolfgang Buhre, Óscar Díaz-Cambronero, Simon Schaefer, Martin Novacek, Marina Soro Domingo, Bjorn Stessel, Aurelio Rodríguez-Pérez, Torsten Richter, Georg Rohe, Bernard Cholley, Matthias Gruenewald, Gerhardus Kuiper, Samir Jaber, Dianne De Korte, Javier Belda, Marcelo Gama De Abreu, Robert Baronica, Thomas Scheeren, Carlos Ferrando-Ortolá, Wojciech Szczeklik, Dana Tomescu, Tomas Vyzamal, Zejka Gavranovic, María Pilar Argente-Navarro, Guido Mazzinari, Sarah Thaler, Nuria García-Gregorio, Jeroen Vandenbrande, Diane Zlotnik, Jakob Wittenstein, Sonja Schmier, Susanne Rohn, Christoph Glasmacher, Martin Holler, Cornelius Jungheinrich, Ulf Niess, Daniel I Sessler, Martin Westphal

Faculty, Staff and Student Publications

Abstract

Background: Hydroxyethyl starch (HES) is often used for maintaining vascular volume during major surgery. Long-term high-dose HES in septic patients promotes renal injury, whereas meta-analyses of current HES products in surgical patients do not show such effects.

Objective: We studied if the peri-operative use of HES is noninferior to crystalloids in terms of acute kidney injury. Secondary outcome was the noninferiority of HES on worsening of renal injury and/or the incidence of a composite endpoint of major complications and mortality until postoperative day 90.

Design: Randomised double-blind trial in patients undergoing elective abdominal surgery with expected blood loss at …

Feasibility And Preliminary Outcomes Of A Remotely-Delivered Exercise Training Intervention For English-Speaking Hispanics/Latinos With Multiple Sclerosis: Results From The Ferla Ms Study, Victoria A Flores, Stephanie L Silveira, David X Marquez, Dominique Kinnett-Hopkins, Augusto Miravalle, Fabian Sierra-Morales, Robert W Motl

Faculty, Staff and Student Publications

Background: There is limited evidence on the feasibility of remotely delivered exercise interventions for English-speaking Hispanics/Latinos with MS.

Objectives: To evaluate the feasibility and exploratory efficacy of a remotely-delivered, home-based exercise program for English-speaking Hispanics/Latinos with MS and to explore associations among feasibility metrics, outcomes, and social determinants of health (SDOH).

Results: Of 340 individuals contacted, 112 were eligible (33%), 33 enrolled (9.7%), 30 randomized, and 26 completed (87% retention). Adherence averaged 81% (exercise) and 89% (control). No serious adverse events occurred. Exploratory within-group improvements were observed in the exercise group for physical activity (p = 0.03, d = …

Heart Failure Hospitalization In Patients With And Without Type 2 Diabetes: A Population-Based Retrospective Cohort Study, Allison K Shay, Wei Tao, Soumya Patnaik, Delaney K Sullivan, Angelo Nascimbene, Xueying Wang, Joseph B Mccormick, Hulin Wu

Faculty, Staff and Student Publications

Purpose: Type 2 diabetes mellitus (T2DM) is a common comorbidity among patients with heart failure (HF). This study aims to describe how T2DM relates to HF hospitalization patterns across demographic groups and HF subtypes.

Methods: We conducted a population-based retrospective cohort study using 19 years of clinical data from Cerner Health Facts®, a nationwide electronic health record (EHR) database. Adult patients hospitalized with HF were identified using ICD-9/ICD-10 diagnosis codes and HF-related medications and were stratified by T2DM status. Measures included HF-related hospitalization count, length of first HF hospitalization, and age at first HF hospitalization. Comparisons were examined across HF …