Digital Commons Network^™

Use Of A Medication Management Algorithm In Depressed Youth Living With Hiv: Secondary Analysis Of A Multisite Randomized Controlled Trial, Graham J Emslie, Beth D Kennard, Kristin Baltrusaitis, Sophia M Jones, Jessica M Jones, Jaime G Deville, Kathleen Pitts, David E Shapiro, Allison Eliscu, Larry K Brown

Faculty, Staff and Students Publications

Objectives: Depression is a prevalent co-occurring condition in youth living with HIV. This report is a secondary analysis of a multisite cluster randomized trial evaluating the efficacy of a health and wellness cognitive behavioral therapy (CBT) combined with a medication management algorithm utilizing measure-based care (COMB-R) compared with enhanced standard of care (ESC). We describe and compare antidepressant prescribing strategies (i.e., antidepressant treatment, type of antidepressant) for youth living with HIV at COMB-R sites to those at ESC sites over the 24-week intervention. We also describe self-reported adherence to antidepressants.

Methods: Participants (12-24 years) were youth living with HIV diagnosed …

Simulated Oral Environment Affects Zirconia Aging And Mechanical Strength, Danyal A. Siddiqui, Smriti G. Natarajan, Bhuvana L. Chandrashekar, Danieli C. Rodrigues

School of Podiatric Medicine Publications

Background: Zirconia is an emerging alternative to titanium for dental implant systems. However, zirconia surfaces can deteriorate under aqueous conditions, thereby compromising mechanical performance. The goal of this study was to assess the impact of biological exposure or aging simulating the oral cavity on the surface integrity and mechanical strength of surface-treated zirconia.

Methods: Partially yttria- or magnesia-stabilized zirconia specimens were polished, acid-etched, or sandblasted. Zirconia disks were exposed to mammalian cells or bacteria. Surface degradation via tetragonal-to-monoclinic phase transformation was assessed by Raman microscopy. Zirconia bars were subjected to accelerated aging by exposure to autoclave steam. Surface morphology was …

Epigenetic Crosstalk In Neuroblastoma Development And Progression, Nathan Drolet, Amber Wolf, Joanna Yi, Eveline Barbieri

Faculty, Staff and Students Publications

Neuroblastoma (NB), a pediatric malignancy of the peripheral nervous system, accounts for 15% of pediatric cancer deaths and remains a major challenge for cancer therapy. NB originates from sympathoadrenal (SA) progenitors of the neural crest (NC) cell lineage, whose formation and differentiation are controlled by epigenetic mechanisms. Although signaling pathways and epigenetic factors implicated in NB tumorigenesis have been well-described, a holistic understanding of how development and epigenetics overlap to drive NB is lacking. By exploring vital interplays and co-dependencies between key pathways and their epigenetic control in NC development, we have gained novel insights into the mechanisms governing NB …

Case Report: Primed Dendritic Cell Immunotherapy For Multiple Solid Tumors, Jeffrey Jones, Aly Alrabaa, William Decker, Luis Ferbeyre, Gregorio Viramontes, Rafael Gonzalez, Elideth Angulo, Antonio Zamudio, Raul Hernandez, Stephen Noga, Susana Hernandez-Reyes, Paul Zhang, Darryl Smith, Ara Karamanian, Luis Tamara, Dalton Greenwood, Matthew Halpert

Faculty, Staff and Students Publications

Many patients with advanced solid tumors ultimately develop resistance to conventional therapies, with especially limited options for those experiencing rapid progression or poor performance status, highlighting the need for personalized immunotherapies capable of inducing durable responses. In this retrospective case series, we describe the clinical course and outcomes of five adults (4 male, 1 female; median age 51 years [range, 39-62]) with metastatic solid tumors who achieved complete and durable remission following doubly loaded autologous dendritic cell therapy after failure of standard treatments, such as immune checkpoint inhibition, radiation, surgery, or endocrine therapy. Five patients, including prostate adenocarcinoma (n=1), malignant …

Evaluating Mesothelin As An Immunotherapeutic Target For Endogenous T Cells, Kiriakos Koukoulias, Ryu Yanagisawa, Alejandro G Torres Chavez, Penelope G Papayanni, Yovana Velazquez, Hyun-Sung Lee, Spyridoula Vasileiou, Ann M Leen

Faculty, Staff and Students Publications

Background: Mesothelin (MSLN) is a GPI-anchored cell surface glycoprotein that is overexpressed in various solid tumors, including mesothelioma, triple-negative breast cancer, colon, ovarian and pancreatic cancer, with restricted normal tissue expression.

Methods: To explore the immunogenicity and immunotherapeutic potential of MSLN to T cells with native receptor specificity, 29 individuals of diverse HLA backgrounds were interrogated for T cell activity against MSLN.

Results: Twenty one (72%) subjects (21/29) mounted a specific T cell response when repetitively challenged with MSLN antigen. Reactive cells were Th1-polarized, polyfunctional, predominantly detected in the CD8+ T cell compartment and cytotoxic toward autologous and MSLN+/HLA-matched tumor …

Pd-L1-Centric Whole Blood-Based Immune Signature Profiles Of Tuberculosis Patients During Therapy, Johanna Eggeling, Martina Sester, Christoph Lange, Jan Heyckendorf, Barbara Kalsdorf, Anna M Mandalakas, Andrew R Dinardo, David Lewinsohn, Dagmar Schaub, Tina Schmidt, Eva Tolosa, Maja Reimann, Patricia M Sánchez Carballo

Faculty, Staff and Students Publications

This prospective study investigated whole blood-based immune cell biomarkers for pulmonary tuberculosis (TB) immunoprofiling. Blood samples from 34 healthy controls and 51 tuberculosis patients were analyzed at three timepoints: Prior to therapy (T0), after 14 days of therapy (T1), and at the end of treatment (Te). Using multiparameter flow cytometry, 386 immune cell populations were analyzed. Predictive models were developed using two machine learning algorithms. A TB5LF change score, which was based on five cell populations, effectively distinguished tuberculosis patients from controls (AUC = 0.89) and tuberculosis patients before and at the end of treatment (AUC = 0.92). Similarly, the …

Utilizing A Culture System For Horizontal Cells To Study Neural Circuit Assembly In The Developing Mouse Retina, Ross M Perez, Yong H Park, Ajeet Singh, Collin Todora, Marlon F Mattos, Daniela Becerril, Rajashree Venkatraman, Arlene A Hirano, Nicholas C Brecha, Rinki Ratnapriya, Benjamin J Frankfort, Elizabeth Zuniga-Sanchez

Faculty, Staff and Students Publications

The precise wiring of the nervous system relies on neurons extending their processes at the right time and place to find their appropriate synaptic partner. The mechanisms that determine when and where neurons extend their neurites during synaptogenesis remains a central question in the field. In the present study, we used a cell culture system coupled with live imaging to investigate the wiring mechanisms in the developing mouse retina. We focused on horizontal cells which are a class of interneurons in the outer mouse retina known to synapse selectively to the distinct types of photoreceptors. Previous research has shown horizontal …

Using Lotilaner Ophthalmic Solution, 0.25% To Treat Demodex Blepharitis In Patients Who Were Initially Misdiagnosed: A Case Series, Laura M Periman, Richard Lindstrom, Paul Karpecki, Brandon Ayres, Eric Donnenfeld, Marjan Farid, Ian Benjamin Gaddie, Preeya K Gupta, Selina Mcgee, Kelly K Nichols, Stephen Pflugfelder, Christopher E Starr, Nandini Venkateswaran, Elizabeth Yeu, Cecelia Koetting

Faculty, Staff and Students Publications

Introduction: Demodex blepharitis (DB) is a chronic ocular inflammation caused by Demodex mite infestation of the eyelid. DB is often misdiagnosed, as some of its clinical findings and patient-reported outcomes overlap with those of other ocular surface diseases. The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) has reached consensus on the symptomatology, diagnosis, and treatment of DB. Consensus findings from the DEPTH group include that collarettes are pathognomonic for DB and that lotilaner ophthalmic solution, 0.25%, the first and only FDA-approved treatment for DB, should be the first-line treatment for the disease. This case series highlights two instances …

Non-Congenital Hsv-1 Keratitis In An Immunocompetent 9-Month-Old Infant, Caleb A Casanova, Stephanie Trejo Corona, Stephen F Pflugfelder

Faculty, Staff and Students Publications

Isolated, non-congenital herpes simplex virus type 1 (HSV-1) keratitis in immunocompetent infants is exceedingly rare and may be easily misdiagnosed, leading to delays in appropriate antiviral therapy. This case is unique in that it describes HSV-1 keratitis in a healthy 9-month-old infant presenting without systemic illness, initially treated as bacterial conjunctivitis. The patient presented with unilateral eye pain, redness, and corneal opacification. Subsequent evaluation revealed HSV-1 keratitis, and the patient was treated with intravenous acyclovir in combination with topical moxifloxacin and topical ganciclovir, resulting in complete resolution of symptoms within one week. This case adds to the limited literature on …

Updates In Mycobacterial Keratitis Diagnosis And Treatment, Uma L Balakrishnan, Ryan T Wallace, Patricia Chévez-Barrios, Alejandro Arboleda, Masih U Ahmed

Faculty, Staff and Students Publications

Mycobacterial keratitis is an uncommon but challenging form of infectious keratitis, often associated with postsurgical eyes. Clinical presentation is variable and may be difficult to recognize, resulting in delays in diagnosis and challenges in management. Traditional diagnostic techniques from corneal scrapings are limited by slow organism growth and may yield negative results. Treatment is challenging due to antimicrobial resistance and typically requires prolonged multidrug therapy. Advances in diagnostic modalities, antimicrobial therapies, surgical approaches, and adjunctive treatments such as corneal crosslinking have improved clinicians' ability to mitigate or avoid severe visual consequences. Despite these developments, optimal management strategies remain incompletely defined, …

Common And Recurrent Dysregulated Molecular Network Of Placental Hypoxia And Associated Vasculogenesis And Angiogenesis In Fetal Growth Restriction, Wei Li, Xiaoyi Bai, Oi Ka Chan, Maran Bo Wah Leung, So Ling Lau, Chi Chiu Wang, Tak Yeung Leung

Faculty, Staff and Students Publications

Fetuses with fetal growth restriction (FGR) and selective FGR (sFGR) face elevated health risks both before and after birth. Although the underlying pathomechanisms remain unclear, placental dysfunction is recognized as a major contributing factor. By integrating untargeted transcriptomic data from FGR/sFGR placentae, this study identified 69 differentially expressed mRNAs (DEmRs) and eight differentially expressed miRNAs (DEmiRs). Functional enrichment analysis demonstrated significant enrichment in the angiogenesis and vasculogenesis pathways, with the hypoxia-related genes

The Rise Learning Theory: A New Paths-Way For Teaching Social Emotional Learning Curricula, Rebecca L. Demeo

Scripps Senior Theses

This study aims to look at the effectiveness of the Promoting Alternative THinking Strategies (PATHS) Social Emotional Learning curriculum when taught through the second and fourth principles of the RISE learning theory. The implementation will take effect within United States elementary schools, and consenting students will participate in the quasi-experimental design where classrooms will either be assigned to the control group, PATHS program taught as normal, or the experiment, PATHS taught with the RISE principles. During the study, participants will complete pre-experiment, post-experiment, and follow-up assessments to measure differences in mean scores of competence and application throughout the implementation. I …

"Chatcbt”: Understanding The Implications Of Artificial Intelligence In Cognitive Behavioral Therapy, Esther R. Goldberg

Scripps Senior Theses

The proposed study is intended to explore the impacts of artificial intelligence (AI) tools when used in cognitive behavioral therapy (CBT) to treat anxiety in American adults. The research is designed to measure whether AI systems such as large language models (LLMs) provide sufficient therapy through the factors of empathy, coping skills, and anxiety symptom reduction. Human therapists are hypothesized to surpass chatbots in all three. Through an experimental design, participants will be placed in either an AI therapy condition or human therapy condition. Participants will undergo a 12-week CBT program, after which they will measure anxiety reduction, perceived empathy …

Roots To Recovery: How Therapeutic Horticulture Can Heal Sexual Trauma, Fiona E. Larsen-Teskey

Scripps Senior Theses

Sexual assault is one of the most prevalent sources of trauma among females. While still requiring more research, therapeutic horticulture (TH), also known as gardening therapy, has so far shown promising results regarding trauma recovery. In this study, I seek to discover how TH can aid in female sexual assault recovery. To determine its impact, I will conduct a three-month experiment with two groups: those who receive cognitive behavioral therapy (CBT) and those who receive CBT plus TH. I will specifically measure three common side effects survivors face: dissociation, shame, and PTSD. These categories will be measured through surveys and …

Pervasive Policing: The Psychological Effects Of Overcriminalization Of Black And Latino Youth, Chloe Gonzalez

Scripps Senior Theses

Recent years have brought increased awareness to the discriminatory treatment of Black and Latino individuals by the police, but a gap in the literature remains at the intersection of the study of criminalization and psychology. The proposed study will attempt to bridge this gap by investigating the extent to which the overcriminalization of Black and Latino high schoolers contributes to the internalization of racialized stereotypes and the development of depressive symptoms. The research will implement a correlational approach combining quantitative and qualitative methods to gather data from a sample of Black and Latino high schoolers ages 14 to 18. Participants …

Art Therapy’S Effect On The Social And Emotional Skills Of Children With Autism: A Naturalized Parent Mediated Design, Abigail Adell

Scripps Senior Theses

This study examines the effect of art therapy on the social and emotional skills of children with autism. Using sensitive design and language, participants will take the CARS2 and ADOS-2 and then undergo an eight-week art therapy program. Families will attend weekly training sessions at the autism center their child already attends for eight consecutive weeks, with each session lasting approximately 90 minutes. Parents will implement the assigned art activity at home five times per week between training sessions, with each home session lasting fifteen to twenty minutes. The program uses a naturalized parent-mediated design so topics and projects can …

Boredom And Creativity: The Effects Of Unstructured Play Versus Screen Time On Creative Performance, Vivienne J. Swenson

Scripps Senior Theses

Children today spend increasing amounts of time engaged with digital media, raising questions about how screens may displace developmental experiences that support creativity. Although research suggests that unstructured play and even mild boredom can facilitate divergent thinking, few studies have directly compared unstructured, self-directed play with passive screen use in early childhood. The present study proposes an experimental design to examine whether 20 minutes of unstructured play leads to higher creativity scores on the Thinking Creatively in Action and Movement (TCAM) than an equivalent period of passive screen engagement among children ages 3–5. Using matched-group assignment based on demographic, cognitive, …

Bilingual Beginnings: Expressive Language And Socio-Emotional Development In Early Childhood, Molly C. Mccormick

Scripps Senior Theses

Although research on bilingualism has expanded rapidly in recent years, the majority focuses on cognitive advantages or receptive vocabulary, or the words children understand. Far less attention has been given to how expressive language, the words children produce, and its potential role as the mechanism linking bilingual exposure to socio-emotional development. Although dual-language learners sometimes appear to have relatively limited expressive vocabularies in one language, these differences tend to reflect patterns of language use and input quality rather than true developmental delays. Even so, temporary differences in expressive skills can be especially meaningful during children’s formative years, when they rely …

Resilience As A Pathway From Openness To Eustress In College Students, Karis H. Choi

Scripps Senior Theses

College students experience high levels of stress, yet not all stress leads to negative outcomes. This study examines how personality and coping resources contribute to eustress—a positive, motivating form of stress—by investigating whether resilience mediates the relationship between openness to experience and eustress. Undergraduate participants completed baseline measures of openness and resilience before engaging in either a high-demand mental arithmetic task or a low-demand control task. Following the task, participants reported their emotional and behavioral responses using the Measure of Emotional, Physical, and Behavioral Markers of Eustress and Distress (MEDS). Consistent with expectations, individuals higher in openness were predicted to …

Exploring The Moderating Role Of Ethnic Identity In Asian American Multi-Ethnic Youths’ Sense Of Purpose And Life Satisfaction, Grace Cheung

Scripps Senior Theses

The rapid increase of interracial and interethnic families globally creates a need for researchers to understand the unique experiences and development of multi-ethnic youths’ sense of identity and purpose as they relate to well-being. Emerging research in Asian American psychology also suggests the urgency and need to reexamine the experiences of individual ethnic groups. The current study will examine the moderating role of ethnic identity in Asian American multi-ethnic youths’ sense of purpose and life satisfaction through a mixed methods approach that includes an online survey followed by an interview for a subgroup of participants. Anticipated results will show how …

An Analysis Of Eating Disorders As A Comorbidity Of Autoimmune Diseases, Madeleine Shore

Scripps Senior Theses

For many autoimmune disease patients, psychiatric conditions are a common comorbidity. Although there are many shared mechanisms between autoimmune disease and psychiatric conditions, current research surrounding mental health among autoimmune disease patients often focuses on mood disorders rather than eating disorders. Despite the high risk for developing psychiatric conditions, most autoimmune disease patients are not screened for eating disorders. This lack of screening is significant, because if an eating disorder is missed by a healthcare provider, the autoimmune or eating disorder condition could be exacerbated, resulting in severe illness or even fatality. Given an existing link between comorbid psychiatric disorders, …

Effects Of Teacher Training On Identifying Inattentive Type Adhd In Afab Students, Gabrielle A. Boles

Scripps Senior Theses

Teachers are more likely to detect hyperactive ADHD symptoms than inattentive ones, which often results in students, especially girls with inattentive symptoms, being under-referred (Willcut, 2012). This study evaluates whether a targeted, inattentive-focused, and gender responsive teacher training reduces gendered and symptom-based biases in referral decisions. K-5 teachers will be randomly assigned to receive either standard general ADHD identification training or an inattentive-focused, gender-responsive training, and will then be asked to review vignettes depicting children with hyperactive and inattentive symptoms, with varying student genders. Referral accuracy and knowledge of ADHD will be measured. Training condition, symptom presentation, and student gender …

Assessing Diagnostic Overshadowing For Co-Occurring Autism Spectrum Disorder (Asd) And Eating Disorders (Ed), Eden Sweet

Scripps Senior Theses

Significant behavioral overlaps in feeding patterns are observed among individuals with eating disorders (EDs) and autism spectrum disorder (ASD). These behavioral similarities can blur diagnostic boundaries, contribute to diagnostic overshadowing, and consequently increase the risk of misdiagnosis and the implementation of ineffective treatment approaches. The proposed study addresses the risk of diagnostic overshadowing as it relates to the ambiguous distinction between autism-driven feeding behaviors and clinically significant eating disorders (ED) within the autistic population. Although the literature has acknowledged behavioral similarities between ASD and EDs, limited research has systematically examined how they impact diagnostic practices and influence the likelihood of …

The Effects Of The Opioid Crisis On Contraceptive Decisions And Fertility In Pakistan, Simren R. Khan

Scripps Senior Theses

This paper examines how the opioid epidemic influences household fertility behavior in Pakistan by analyzing contraceptive use and fertility outcomes across regions with differing levels of opioid prevalence. Using household-level data from the 2017–18 Pakistan Demographic and Health Survey (DHS) and estimating OLS regression models, the study compares households in high-prevalence regions with those in low-prevalence regions. The results show that exposure to high-opioid regions is associated with lower fertility outcomes and a higher likelihood of respondents wanting their last child. These patterns suggest that households may respond to opioid-related economic and caregiving burdens by limiting family size and treating …

The Economics Of Accountability: Learning From German Holocaust Reparations, Grace I. Gates

Scripps Senior Theses

Drawing on microdata from the Survey of Health, Aging, and Retirement in Europe, this study compares European Holocaust survivors who received reparations with similar Europeans who did not. It finds that, decades on, recipients are not systematically better or worse off on core outcomes like life satisfaction, savings, and debt. This is consistent with the argument that reparations restore parity rather than create new advantages. Where differences emerge, they point to stabilization in more vulnerable settings (e.g., lower likelihood of high debt in parts of Eastern Europe). The main takeaway from effective reparations is applicable to the United States debate: …

Assessing Elemental Composition In Dry, Canned, And Fresh Dog Food Using Icp-Oes And Xrf Analysis, Lyla M. Johnston

Scripps Senior Theses

Pet food safety has become a concern due to recurring contamination incidents and limited federal regulation of toxic metal concentrations. This study investigates the elemental composition of 15 commercial dog and cat foods. Representing dry, canned, and fresh dog food types, using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) and portable X-Ray Fluorescence (XRF) analysis. The primary objective was to quantify concentrations of potentially harmful heavy metals (Cr, Pb, As, Hg, Cd) and assess the presence of abundant elements such as aluminum (Al), silicon (Si), and sodium (Na). All five target heavy metals were below instrument detection limits, suggesting that …

Photographic Perceptions: Reconstructing The Life And Career Of Dody Weston Thompson, Virginia Carroll

Scripps Senior Theses

This thesis reconstructs the life and career of photographer Dody Weston Thompson (1923-2012), presenting a narrative that has been absent from photographic history. Dody trained beneath significant figures like Edward Weston and Josef Albers, exhibited among some of the most canonical figures in photographic history, and served as a founding member of Aperture magazine—one of the foremost photographic journals to this day. Despite this, there has been no academic scholarship on Dody’s life or career, leaving her largely absent from the art-historical record.

Through the analysis of The Dody Weston Papers at the Ella Strong Denison Library and photographs held …

Mindfulness As A Potential Facilitator Of Self-Forgiveness?, Isabella S. Lindsay Castelli

Scripps Senior Theses

Despite clinicians’ attestation to self-forgiveness’ relevance in clinical practice, as well as research suggesting its positive relationship to well-being, most clinicians are not familiar with models for facilitating self-forgiveness. The present study draws on theoretical overlap between mindfulness theory and three prominent models of the self-forgiveness process, as well as empirical research showing a positive association between dispositional mindfulness and dispositional self-forgiveness. Participants were adults in the United States, randomly assigned to a mindfulness exercise or control (progressive muscle relaxation exercise). Participants were asked to think of a transgression they committed, report their self-forgiveness for that transgression, and retake the …

The Silent Language Of Trauma: Defendant Behavior, Juror Bias, And Expert Testimony, Jensen Goldman

Scripps Senior Theses

Trauma can profoundly influence behavioral presentation, yet jurors often rely on demeanor as a diagnostic cue for guilt, credibility, and remorse. Such reliance poses risks within a legal system that seldom equips jurors to interpret trauma related behaviors accurately. The proposed study will examine how two trauma-linked affective presentations– overemotionality and flat affect– shape juror perceptions of credibility and guilt, and whether expert psychological testimony about trauma-related affect can mitigate these biases. Online survey participants will read one of five trial vignettes with varying defendant conditions (flat affect vs. overemotional) and varying expert testimony conditions (present or not present) and …

Transition To Tenecteplase Is Associated With Shorter Door-To-Puncture Times: A Retrospective Study From The Lone Star Stroke Consortium Tnk Registry, Anqi Luo, Sujani Bandela, Gretchel Gealogo-Brown, Mark P Goldberg, Andrew Slusher, Reza Behrouz, Alibay Jafarli, Siddarth Prasad, Daiwai Olson, Maria Denbow, Mehari Gebreyohanns, Asmiet Techan, Chethan P Venkatasubba Rao, Jane A Anderson, Barbara Kimmel, Anette Ovalle, Michele Patterson, Sean I Savitz, Salvador Cruz-Flores, Steven Warach, Lee Birnbaum

Faculty, Staff and Students Publications

Background: Intravenous thrombolytic (IVT) and mechanical thrombectomy (MT) therapies are the current standard of care for large vessel occlusion (LVO) stroke. Multiple studies emphasized the impact of time metrics on patient outcomes, particularly door-to-needle (DTN) and door-to-puncture (DTP) times. Tenecteplase (TNK) offers potential advantages over alteplase (ALT), including a simplified one-time bolus administration, which may reduce DTP time. Results suggest TNK is non-inferior to ALT in terms of clinical outcomes, but few large cohort studies have compared DTP time for patients receiving TNK vs. ALT prior to thrombectomy. This real-world study aimed to compare DTP times and discharge outcomes in …