Digital Commons Network^™

Enhancing Clinical Care Quality Through 1-On-1 Quality Improvement Education In Family Medicine, Jude K A Des Bordes, Shira K. Goldstein, Nahid J. Rianon

HCA Healthcare Journal of Medicine

Background

Ongoing improvement and evaluation of clinical care are essential to maintaining high standards. The Accreditation Council for Graduate Medical Education (ACGME) requires all accredited family medicine programs to provide quality improvement (QI) education. Given competing educational demands, residency programs must adopt innovative approaches to teaching QI. This article describes an individualized approach to QI education that we implemented in our family medicine residency program and the outcome of its evaluation.

Methods

Guided by a logic model and evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, this quasi-experimental 1-group pre-test-post-test study (July 2022-June 2023) involved all second-year …

Assessment And Intervention For Health Behavior Change In Primary Care Across The Lifespan: A Guide For Residents In Primary Care Specialties, Stacy A. Ogbeide, Alexis Ramos, Bridget Murphy, Angel Ogbeide

HCA Healthcare Journal of Medicine

More than 45% of Americans have at least 1 chronic disease, with chronic disease also being a leading cause of death in the United States. In primary care settings, about 75% of visits are for management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Clinicians (PCCs) to manage these conditions alone and point to the need for innovative solutions to chronic disease care. One evidence-based innovation is team-based care to improve the treatment of these conditions. Clinicians such as clinical pharmacists, registered …

Autoimmune Hemolytic Anemia Associated With Leptospirosis: A Rare Complication, Anum Waqar, Furqan Mazhar, Mahrukh Afzal, Sadia Razzaq, Sana Ijaz

HCA Healthcare Journal of Medicine

Introduction

Autoimmune hemolytic anemia (AIHA) is rare but potentially life-threatening complication of leptospirosis, a zoonotic infection caused by the Leptospira species. Autoimmune hemolytic anemia occurs when the immune system targets red blood cells, resulting in hemolysis and anemia. The relationship between leptospirosis and AIHA is uncommon and often under-recognized, which can delay diagnosis and management. This case highlights the importance of considering hematologic complications in leptospirosis.

Case Presentation

A 23-year-old male presented with low-grade fever, productive cough, shortness of breath, jaundice, and pallor for 15 days. On examination, he was pale and icteric with bilateral chest crepitations. Laboratory studies showed …

A Case Report Of Mesalazine-Induced Pulmonary Injury In A Patient With Ulcerative Colitis, Vasileios Paraschou, Vasileios Papavasileiou, Ilektra Voulgareli, Vasilios Tzilas

HCA Healthcare Journal of Medicine

Introduction

Mesalazine (5-aminosalicylic acid) is widely used as a first-line therapy for ulcerative colitis (UC) due to its efficacy and safety profile. Rarely, it can cause pulmonary toxicity with variable clinical and radiologic manifestations, making diagnosis challenging.

Case Presentation

We report the case of a 52-year-old woman with UC who developed persistent fever and progressive exertional dyspnea following escalation of mesalazine dosage. Imaging revealed diffuse bilateral ground-glass opacities, while infectious and UC-related pulmonary causes were excluded. Pulmonary function testing demonstrated restriction and markedly reduced diffusing capacity. Following mesalazine discontinuation and initiation of corticosteroid therapy, the patient experienced rapid symptomatic, functional, …

An Unusual Case Of Bilateral Upper And Lower Oral Cavity Cysts In A Newborn, Frances Rodriguez Lara, Jillian L. Chen, Jennifer N. Shehan, Jessica R. Levi

HCA Healthcare Journal of Medicine

Background

Oral mucosal lesions in newborns have a broad differential diagnosis, ranging from benign, transient conditions to potential early signs of systemic disease. Most of these lesions are resolved without intervention, but delayed recognition can lead to complications, such as airway obstruction. Early identification is crucial for appropriate management. This case report discusses an unusual presentation of multiple oral mucosal cysts in a newborn, emphasizing the challenges of diagnosis and management.

Case Presentation

A 1-day-old male was evaluated at Boston Medical Center for cystic oral lesions identified during newborn screening. The infant was born at 36 weeks and 2 days’ …

Navigating Complex Esophageal Perforations: A Case-Specific Approach To Successful Outcomes, Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S. Brar

HCA Healthcare Journal of Medicine

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the …

Using Mohs Micrographic Surgery To Treat A Large, Pedunculated Trichoblastoma On The Upper Cutaneous Lip, Richard G. Bindernagel Jr., Addie Walker, Richard Miller

HCA Healthcare Journal of Medicine

Trichoblastomas are uncommon adnexal tumors that usually occur on the face. We report a case of a 62-year-old White man with a large, asymptomatic, slow-growing lesion that had been on his right upper cutaneous lip for 15 years. A 2 cm pink, pedunculated nodule with telangiectasia was seen on examination. A shave biopsy was consistent with trichoblastoma: a circumscribed-appearing dermal tumor of basaloid cells arranged in cords and islands within a cellular stroma, focal epidermal connection, and papillary mesenchymal bodies. The patient elected for treatment with Mohs micrographic surgery (MMS) given the length of time that the tumor had been …

Impact Of Pre-Existing Psychiatric Conditions On Trauma Outcomes: A National Analysis, Kelly Mckenney, Marie Ugo, Sindhura Kompella, Clara Alvarez, Ilko Luque

HCA Healthcare Journal of Medicine

Background

Understanding the impact of psychiatric pre-existing conditions (PsyPECs) on trauma outcomes is crucial, as trauma is the leading cause of mortality for Americans aged 1-45. Although previous regional studies have shown higher mortality rates and longer hospital length of stay (H-LOS) for injured patients with PsyPECs, this has not been studied at the national level. The purpose of this study is to identify the PsyPECs associated with mechanism of injury and other outcomes in adult patients admitted for trauma in the United States’ trauma centers.

Methods

Data were extracted from the National Trauma Data Bank (NTDB). There were 5301 …

Time For A New Whole-Person Care Pathway For Chest Pain Admissions, Dana Kajan, Sabbir Mirza, Alexander M. Ruiz, Anthony Degennaro, Mohamad S. Saad

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) visits for chest pain are common and costly, and ED workup often shows no clear cardiac etiology in low-risk patients. Emerging evidence suggests that social determinants of health (SDOH) such as loneliness, social isolation, and food insecurity contribute to cardiovascular outcomes and chest pain presentations.

Methods

We interviewed 114 patients (>18 years) presenting with chest pain and a thrombolysis in myocardial infarction (TIMI) score less than 4 at our community teaching hospital ED. Structured questionnaires assessed the SDOH triad of loneliness, social isolation, and food insecurity. Dependent variables included systolic blood pressure (SBP) at admission, …

Does Staff Education Increase Sequential Compression Device Utilization: A Retrospective Study, Devin Q. John, Vincent Lee, Akshay V. Daji, Hans Lapica, Connor Donley, Matthew J. Mccrosson, Nino Coutelle, Carlos Fernandez, Diego Lima

HCA Healthcare Journal of Medicine

Background

Venous thromboembolism (VTE) is a significant perioperative safety concern among orthopedic patients, with an incidence of 0.4%-1.0% and a substantial risk of chronic complications. Sequential compression devices (SCDs) are recommended for VTE prophylaxis, yet compliance remains suboptimal due to staff misconceptions. This study evaluates the impact of a resident-led educational intervention on SCD utilization among nursing staff in orthopedic postoperative care.

Methods

This retrospective study was conducted at 2 hospitals (HCA Florida JFK Hospital and HCA Florida Palms West Hospital). Nursing staff participated in a single educational session addressing SCD benefits, application techniques, and operational protocols. Data on SCD …

Trends In Emergency Department Utilization After Metabolic And Bariatric Surgery In The United States, Andrew Sanders, Isabella Moncada, Sabrina Avanzato, Michelle Fakler, Michael Dombek, R. Wesley Vosburg

HCA Healthcare Journal of Medicine

Background

In this article, we sought to understand the factors associated with emergency department (ED) utilization by patients after metabolic and bariatric surgery (MBS). The hopes were that modifiable risk factors could be identified to reduce ED visits after MBS.

Methods

We analyzed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (MBSAQIP) which is comprised of data from all nationally accredited bariatric centers in the United States. For our study, we included a population of 681 743 patients having undergone the 2 most common MBS procedures: sleeve gastrectomy (SG) and gastric bypass (GBP). Using logistic …

Organizational Psychology Theories In Graduate Medical Education: A Narrative Review, Mohamad S. Saad, Naim El-Aswad, Zeina Ghossoub, Relly Nadler, Serena Wasilewski

HCA Healthcare Journal of Medicine

Physicians and educators tend to be more versed in recognizing disease patterns and medical problems than in identifying malfunctioning patterns in the psychological aspects of their mentees and work environments. Just as hypertension and diabetes are the common soil for many acute medical problems, agency problems and organizational silos can lead to many acute managerial problems in graduate medical education (GME) settings.

Data show that most workers are lonely at work, which leads to negative emotions and undermines performance. Organizational problems seem to stem from an individual’s inability to align one’s motivation with the organization’s shared value. This can cause …

Aspirational Mirrors: A Conceptual Model Of Alumni-Led Near-Peer Outreach For Precollege Engagement In Ocean Engineering, Habibi Palippui, Juswan Sade

Journal of Pre-College Engineering Education Research (J-PEER)

Precollege students in Indonesia, especially in rural and coastal regions, often lack exposure to engineering disciplines due to social, geographic, and informational barriers. This essay proposes a conceptual model of alumni-led near-peer outreach as an affective and culturally grounded mechanism to engage high school students in ocean engineering. Drawing from theories of social similarity, possible selves, and engineering identity, the model conceptualizes alumni as “aspirational mirrors” who influence students not merely through information but also through identification. The model outlines four primary mechanisms—social connection, narrative engagement, aspirational mirroring, and early identity activation—and also accounts for contextual variables such as school …

Fintech And Disruptive Business Models In Financial Products, Intermediation And Markets-Policy Implications For Financial Regulators, Iris H-Y Chiu

Journal of Technology Law & Policy

A recent Financial Times survey indicates that the financial services sector (in mainstream terms) is concerned about the disruptive potential of several digital-based technologies as applied to financial services, such as blockchain, big data and robo-advisers. Not to mention that we have already of late witnessed the emergence of high frequency algorithmic trading, novel consumer payment devices, online crowdfunding and peer-to-peer lending. Financial technology, which seems to be ushering in an order for upheaval, is defined by Price Waterhouse Coopers as "a dynamic segment at the intersection of the financial services and technology sectors where technology-focused start-ups and new market …

You Can't Hack This: The Regulatory Future Of Cybersecurity In Automobiles, Liz Allison

Journal of Technology Law & Policy

This Note argues that any new legislation imposing new safety regulations on car manufacturers is unnecessary, and will ultimately create more problems than it solves. First, there are numerous established laws that either already require what some of these propose, or address the issues involved in car hacking. Secondly, as vehicular technology becomes more advanced, so too will the methods available to fix the vulnerabilities within their systems. Finally, the government's inefficiencies and inability to stave off its own cyberattacks makes any type of federal regulations requiring minimum safety protocols a cumbersome option. For these reasons, this Note argues private …

Creator Incentive Preservation System Under Agent-Mediated Consumption In Recommendation Platforms, Anonymous

Defensive Publications Series

Systems and methods are described for operating a recommendation platform with creator-incentive preservation under agent-mediated consumption. The platform computes a per-creator Creator Activity Index combining production trends, quality trends, response sensitivity indicative of gaming, return-on-effort trajectory, and churn risk estimated via survival modeling. A platform Ecosystem Diversity Score is computed from active creator count, traffic concentration, topic entropy, and new-creator entry success. An inverse-relationship monitor estimates an effective recommendation-accuracy parameter from traffic distributions and identifies operation relative to a threshold regime in which increasing accuracy corresponds to decreasing creator production volume. A policy controller updates ranking using constrained optimization, including …

Reactance-Aware Adaptive Personalization Intensity With Behavioral Detection And Dynamic Modulation In Recommendation Systems, Anonymous

Defensive Publications Series

A recommendation system detects psychological reactance using explicit, implicit, and contextual behavioral signals and computes a per-user reactance score with temporal decay. A personalization intensity is determined per user and per content domain based on a domain-specific base intensity, the reactance score, and a context multiplier, subject to a minimum floor. The system modulates ranking in accordance with the intensity by adjusting feature-group weights and/or masking tiers of features. The system also generates an explanation whose framing corresponds to the computed intensity and truthfully reflects factors used for selection, including personal behavioral framing at higher intensities, neutral interest-based framing at …

Privacy-Preserving Structured Logging Architecture For Semantic Artifacts In Machine Learning Inference Systems, Anonymous

Defensive Publications Series

Structured logging techniques are described for natural-language reasoning artifacts produced during inference in LLM-based recommendation systems. A reasoning chain may be decomposed into structured fields at multiple sensitivity levels, including non-sensitive numerical fields, low-sensitivity categorical fields, a scrubbed rationale, and a raw rationale. Sensitivity classification may include a first layer detecting explicit personal identifiers using pattern matching and a second layer detecting semantically sensitive categories using a sensitive-category dictionary. Scrubbing replaces sensitive sentences with category-level abstractions. The structured fields are routed to different storage tiers with differential access controls, including audit-logged access for restricted tiers. A retention policy engine enforces …

Cross-Platform Agent Contamination Detection And Containment, Anonymous

Defensive Publications Series

Cross-platform agent contamination detection and containment is disclosed for autonomous agents that operate across multiple recommendation platforms while sharing preference memory. Preferences are stored with structured provenance metadata identifying an origin platform and interaction context, optionally including cryptographic signatures, confidence tiers, influence tracking, and quarantine status. Cross-platform monitoring computes temporal and categorical correlation metrics, including influence scoring and causality-oriented tests, to determine whether acquisition on one platform predicts behavior change on another. When suspected contamination is detected, affected preferences are quarantined with platform-differentiated influence control, optionally including recursive quarantine of influenced preferences, while enabling independent local verification and cross-verification to …

Write-Amplification-To-Cache-Warming Conversion For Collaborative Memory Propagation In Recommendation Systems, Anonymous

Defensive Publications Series

Systems and methods are described for converting collaborative memory propagation write activity into selective cache warming for recommendation-serving data. Upon a propagation event that writes preference information for a target user, a controller estimates a warming value based on a return probability for the target user, cache hit probability, storage latency, and request frequency. The return probability may be elevated using social clustering signals including co-activity, tie strength, and temporal patterns. Subject to a storage bandwidth warming budget (e.g., token-bucket limited and traffic-health adaptive), the controller issues an asynchronous warming read that loads the target user embedding or profile data …

Automated Service Case Triage Using Real-Time Sentiment And Sensitivity Analysis, Parnika Singhal, Deep Raithatha

Defensive Publications Series

Systems and methods are described to address potential challenges in enterprise service management that can arise from delayed feedback and manual case routing. A described technology can utilize a processing pipeline to perform near real-time analysis of service interactions. This pipeline can ingest text-based communication data, sanitize it to remove personal information, and apply a computational linguistic model to classify user sentiment and identify predefined sensitive topics. Based on this analysis, a system may enable automated workflows, for example, the intelligent routing or escalation of cases that meet certain sentiment or sensitivity criteria. The system can also provide real-time sentiment …

Are Combat Athletes Different Sleepers? A Pittsburgh Sleep Quality Index-Based Comparative Survey Across Athletic Populations, Zofia Tkocz, Małgorzata Hołda Dr, Michał Spieszny, Adam Zając, Robert Trybulski, Aleksandra Filip-Stachnik

Baltic Journal of Health and Physical Activity

Background: Sleep plays an important role in athletic performance, recovery, and cognitive function. The aim of this study was to compare sleep quality and selected sleep-related  variables in combat sports athletes and athletes from other sport disciplines . Materials and Methods: Ninety-eight competitive athletes participated in the study, including 52 combat sports athletes and 46 athletes  representing other sport disciplines. Sleep quality was assessed using the modified Pittsburgh Sleep Quality Index (PSQI) with a weekly recall period, global PSQI score and additional  variables, such as sleep duration, sleep latency, and habitual sleep-wake times, were analyzed using general linear models adjusted …

World Literature According To Its Poster Children, Jernej Habjan

CLCWeb: Comparative Literature and Culture

Some of the most influential pronouncements on world literature have been made by the kind of authors who are most likely to emerge as representatives of world literature once we agree on a definition, including Goethe, the young Marx, Tagore, Gorky, Hesse, Kundera, and the distinguished signatories of the manifesto for a world-literature in French. Breaking out of this vicious circle by referring to the authority of pure theorists of world literature is not the solution, as this would only pull us into a new vicious circle where most of these theorists would mostly remind us of the names that …

An Arc Stretched Between East And West: World (Or Universal?) Literature In Maxim Gorky’S Publishing Utopias, Francesca Lazzarin

CLCWeb: Comparative Literature and Culture

The Vsemirnaia Literatura publishing house was founded in Petrograd by Maxim Gorky less than a year after the October Revolution. Aligned with the objectives of the new regime, its mission was to translate and publish a substantial body of European and Asian poetry and prose, thereby contributing to the broad cultural education of the emerging Soviet generations. These ambitions clearly reflect a key element of Gorky’s conception of culture as well: for Gorky, culture in its broadest sense (encompassing literature, art, music, and science) had the potential to unite humanity under the ideals of peace and harmony. Within this new …

Introduction: World Literature As World Crisis, Jernej Habjan

CLCWeb: Comparative Literature and Culture

No abstract provided.

Detection And Diagnostic Screening Of Breast Cancer: A Systematic Review And Future Frontiers, Lama Yassine, Amira J. Zaylaa

BAU Journal - Science and Technology

A comprehensive evaluation of current and novel diagnostic techniques is necessary since the diagnosis of breast cancer is essential for improving treatment efficacy and raising long-term survival. Evidence from conventional imaging methods including mammography, ultrasonography, and magnetic resonance imaging is combined in this systematic review with advancements in liquid biopsies and current AI-based diagnostic tools. Using specific keywords related to breast cancer, early detection, imaging, biomarkers, and artificial intelligence, a thorough search was conducted in PubMed, Scopus, Web of Science, and IEEE Xplore. Reviews, case reports, and studies unrelated to breast cancer were excluded; only clinical, experimental, and computational research …

A Robust Hybrid Security Framework: Integrating Multi-Layered Text Encryption With Barcode-Based Steganography, Mohamed Sayed, Talaat M. Wahbi, Farooq Abdalwahab Haboub

BAU Journal - Science and Technology

The widespread use of the Internet is causing increasing security concerns regarding online communications. One method for achieving secure communication between authorized parties is steganography. We herein employ multilevel technologies, including compression, encryption, barcoding, and steganography to secure a secret text message. Type I multilevel steganography is used with a two-level setup. The first level uses enhanced least significant bit (secure LSB-L1) image steganography; the output is a stego-image file, the cover is an image file, and the secret data in this level is English text. The output from the first level is encrypted using the RSA algorithm, and the …

Can Gingival Crevicular Fluid Help In Diagnosing Pulp Inflammation? A Systematic Review, Wael Kassamany, Roula Abiad

BAU Journal - Science and Technology

This review aims to find if there’s a positive correlation between biological markers detected in human gingival crevicular fluid and pulp inflammation.

An electronic search of three databases; PubMed, EBSCOhost and Google Scholar was conducted using the keywords “tooth or teeth or pulp” AND “gingival crevice fluid or gingival crevicular fluid” for English articles published between the year 1990 and 2026. Information regarding study design, patients age range and gender distribution, sampling method used, types of biomarkers studied, assay test used, and key findings of each article were extracted and analyzed.

Biomarkers studied were substance P “SP”, neurokinin A “NKA”, …

Emerging Technologies For Safety Risks Management On Nigerian Road Construction Projects, Ranti Taibat Adebiyi, Mujidat Olubola Babalola, Richard Olushola Olupeka, Ganiyu Amuda Yusuf, Lukman Olarewaju Olorunoje, Amina Damola Amuda

BAU Journal - Science and Technology

High level of safety risk on road construction projects remains a major concern for all industry stakeholders, as safety of workers is paramount to achieving project success. Managing construction safety requires a more comprehensive approach. New technologies have recently emerged to enhance construction safety. This study examines the level of adoption and barriers to the implementation of these technologies in safety risk management on road construction sites in Lagos, Nigeria, with a view to improving the safe delivery of the road projects. A questionnaire was designed and administered to two engineers and one worker randomly selected on each of sixty-one …

Enhanced E-Commerce Recommendation Experience With Collaborative Sentiment Analysis And Ranked Content-Based Filtering, Sandi El Zein, Farah Hamze, Amani Merhi, Lynn Noureddine, Lama Affara

BAU Journal - Science and Technology

The rise of online shopping has made informed purchasing decisions increasingly difficult, as consumers face an overwhelming number of product choices and struggle to manually evaluate specifications and user reviews. This paper presents an AI-powered, sentiment-aware product recommendation tool that effectively aligns user preferences with real-world customer feedback from online reviews. The proposed system utilized Instruct ABSA deep learning models for feature extraction and DeBERTa-v3 for sentiment analysis to turn reviews into interpretable scores that would nominate optimal products. An interactive Rasa-based chatbot interface, TopPickAI, was developed to give a seamless user experience, educate users on product features, and conversationally …