Digital Commons Network^™

Learning, Abstraction, And Creative Search For Interactive Agents, Jonathan Demke

Theses and Dissertations

Artificial intelligence systems are increasingly deployed as autonomous agents that interact directly with complex environments. Ensuring these agents remain reliable, adaptable, and useful presents an ongoing practical challenge. This dissertation studies agent-environment interactions through a progressive lens, examining behavior from foundational training stability and abstraction discovery to adaptation in unpredictable settings and open-ended creative search. The investigation begins by analyzing how hyperparameter settings affect early-stage Deep Q-Network performance, yielding practical guidelines for debugging reinforcement learning implementations. To address the challenge of long-horizon planning, the discovery of temporally extended options is formalized as the Minimum Shortcut Problem, demonstrating how agents can …

A Staff Nurse-Led Clinical Instructional Competency Program To Improve Clinical Judgement In Undergraduate Nursing Students: A Quality Improvement Initiative, Shana Skeffrey

Doctor of Nursing Practice (DNP) Manuscripts

There is increasing concern that new graduate nurses are leaving bedside roles early in favor of less stressful positions due to rising patient acuity and heightened organizational expectations, increasing the effects of the nursing shortage (McClosky et al., 2022; AACN, 2024). A standardized clinical experience, combined with fair and consistent access to skill application in the hospital setting can support a collaborative approach for undergraduate nursing students. This quality improvement project is aimed to implement a Staff Nurse-Led Clinical Instructional Competency Program that will provide a structured opportunity for clinical instructors to help fill the gap in preparing undergraduate nurses …

Feasibility And Acceptability Of A Home-Health Aide-Delivered Loneliness Reduction Program In A Small Home Care Agency: The Caring Connections Quality Improvement Project, Tontalayia L. Robinson

Doctor of Nursing Practice (DNP) Manuscripts

Loneliness is a significant public health concern that adversely affects mental, cognitive, and physical health, with consequences comparable to smoking 15 cigarettes per day. Home care recipients experience loneliness at rates of 15.9% to 24.2%, yet home-health aides (HHAs), who often have the most consistent contact with homebound clients, lack structured tools for recognizing and responding to loneliness. This gap highlights the need for practical, evidence-based strategies that can be integrated into routine home care practice. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the feasibility, acceptability, and appropriateness of a home-health aide–delivered loneliness …

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

Evaluating The Implementation And Progress Of A Bereavement Care Program In An Acute Care Adult Hospital, Nancy Abraham

Doctor of Nursing Practice (DNP) Manuscripts

Bereavement care is a significant component of patient and family centered care; however, it remains inconsistently addressed in acute adult hospital settings. Families of patients who die in hospitals frequently experience grief, anxiety, and emotional distress, which may be exacerbated by fragmented or inadequate bereavement support (Kustanti et al., 2021). Evidence supports the use of structured, interdisciplinary approaches to bereavement care to ensure timely, consistent, and compassionate support for families. To address this gap, a Bereavement Committee was established at a Level I trauma center in eastern Pennsylvania to implement a standardized Bereavement Care Program aimed at improving bereavement practices …

Maternal Microchimerism As A Mechanism Of Developmental Origins Of Health And Disease, Amy M. Boddy, Kristine J. Chua

Human Biology Open Access Pre-Prints

The in utero environment is now widely recognized as a critical determinant of health across the entire lifespan. The developmental origins of health and disease (DOHaD) framework has established that prenatal exposures, including maternal stress, infection, nutrition, and environmental toxins, can impact fetal development in profound ways associated with disease risk from infancy to old age. Yet a fundamental aspect of pregnancy, the bidirectional exchange of maternal and fetal cells, DNA, and other biological material, a phenomenon known as microchimerism, has received little attention in this context. Maternal cells and genomic material transfer to the developing fetus early in utero …

Sing Lustily And With Good Courage: Reinventing Methodist Hymns In The Context Of The Indonesian Methodist Church, Budi Taniwan

Doctor of Pastoral Music Projects and Theses

The majority of Methodist churches continue to uphold the legacy of hymn singing, a practice highly esteemed by early Methodists. John and Charles Wesley employed hymns alongside sermons as a means of teaching Methodist theology, shaping Christian discipleship, and forming Methodist identity. However, in contemporary times, Indonesian Methodist churches recite fewer doctrinal hymns. Inadequate early translations, the absence of authentically Indonesian Methodist hymns, and the emergence of contemporary Christian music have contributed to this decline. Changes in liturgy, worship culture, and technology have also transformed the way congregations learn and sing their faith. This study explores the historical and theological …

Disengagement And Reconnection: Investigating The Role Of Purpose And Identity Seeking Across Career Stages In Healthcare, Charmel Renee Jeffery

Radiologic Sciences

Purpose To examine the generational purpose gap in healthcare by identifying the psychological and environmental factors underlying early-career disengagement and late-career reconnection.

Method An integrative literature review was conducted using four academic databases. An artificial intelligence (AI)-assisted thematic synthesis was applied to extract and organize findings within a standardized analytic matrix. To ensure accuracy and rigor, all AI-generated outputs were validated against the original source data.

Results Two primary themes emerged. Early-career healthcare workers commonly experienced disengagement associated with destiny beliefs, while later-career professionals demonstrated renewed purpose and resilience despite ongoing stressors.

Discussion The findings revealed a pronounced generational divide …

Ai-Driven Multi-Modal Mr For Precision Oncology, Maneet K. Marwaha

Radiologic Sciences

Purpose To examine the role of artificial intelligence (AI) in multiparametric magnetic resonance (MR) imaging for precision oncology, with a focus on automated tumor segmentation, treatment response prediction, and workflow efficiency.

Method A literature review was conducted to examine current evidence on AI applications in multiparametric MR imaging for oncology. Studies evaluating deep learning models for tumor segmentation, longitudinal imaging analysis, and treatment response prediction were synthesized using a thematic analysis approach.

Results Three primary themes emerged: (a) AI-driven tumor segmentation improved accuracy, reproducibility, and efficiency across multiparametric MR sequences; (b) deep learning models enhanced prediction of treatment response through …

Mr-Linac Technology, Katherine Orellana

Radiologic Sciences

Purpose To examine the clinical advantages of magnetic resonance-guided linear accelerator (MR-Linac) technology in radiation therapy, with a focus on treatment accuracy, adaptive planning, and patient outcomes.

Method A literature review was conducted using peer-reviewed articles identified through The University of Texas MD Anderson Cancer Center Research Medical Library. Studies published between 2022 and 2026 were included if they addressed the clinical advantages of MR-Linac technology. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) superior soft-tissue visualization improved tumor delineation and treatment accuracy; (b) daily adaptive treatment planning and real-time tumor tracking enhanced precision by accounting …

Psychosocial Experiences Of Secondary School Students Living With Sickle Cell Disease While In School In Lagos State, Nigeria, Toluwalope Yetunde Onuwe

Walden Dissertations and Doctoral Studies

Sickle cell disease (SCD) is a lifelong genetic condition significantly impacting the physical, emotional, and social health of those affected. Nigeria has one of the highest global burdens of SCD, yet there is limited research on the psychosocial experiences of secondary school students living with SCD in educational settings. This qualitative study explored these experiences among students in Lagos State, Nigeria. Using the social ecological model and interpreted through the social model of disability, the study examined how school environments, educational practices, and institutional support influenced students' psychosocial well-being and perceived health. Twenty secondary school students participated in 4 in-person …

Kindergarten Teachers’ Challenges Embedding Play-Based Learning In A Standards-Based Curriculum, Anna Catalan

Walden Dissertations and Doctoral Studies

The problem addressed in this study was that kindergarten teachers in a Western United States elementary school were challenged by standards that have become heavily focused on teaching academic skills at a younger age, instead of teaching with developmentally appropriate practices that allow for play-based learning (PBL). Framed by Vygotsky’s theory of PBL, the purpose of this basic qualitative study was to explore what challenges local kindergarten teachers had when embedding PBL in a standards-based curriculum. Data were collected through 15 semistructured interviews with Kindergarten teachers who had at least 2 years' experience embedding PBL in instruction. Using thematic analysis …

English Language Arts Remedial Teachers’ Perspectives On Strategies To Close The Academic Achievement Gap Of Minority High School Students, Barbara Williams

Walden Dissertations and Doctoral Studies

The problem that was addressed throughout this study is that 53% of minority students do not reach proficiency on the English Language Arts (ELA) portion of the Florida Assessment of Student Thinking test compared to the 42% of other student populations at Grover High School (GHS, a pseudonym), a large and diverse high school, despite targeted school improvement interventions each school year. Grounded in Ladson-Billings’s culturally relevant pedagogy, the purpose of this basic qualitative study was to investigate ELA remedial teachers’ perspectives on reading strategies and instructional planning tools that might help minority students close the academic achievement gap. Semistructured …

Effective Leadership Strategies To Retain For-Profit Education Employees After A Leadership Change, Kimberly Keene

Walden Dissertations and Doctoral Studies

Ineffective leadership transitions in for profit higher education erode employee morale, trust, and retention. Higher education business leaders recognize that ineffective leadership transitions can contribute to employee disengagement, reduced organizational commitment, and increased turnover, undermining institutional stability, workforce continuity, and organizational performance. Grounded in transformational leadership theory, the purpose of this qualitative pragmatic inquiry was to identify and explore the effective leadership strategies used by for-profit education institution leaders to retain key employees after a change in leadership. The participants were 10 leaders employed at for-profit higher education institutions in the southern United States who had successfully implemented leadership strategies …

Cinematic Architecture: A Method For Experiencing And Designing Space Through Time, Byounggul Lim

International Programs

No abstract provided.

Strategic Asset Management, Mahasetra Mikaela Randrianarijaona

International Programs

Manufacturing industries rely on physical assets to produce goods and services. When any asset fails, it could cause production disruption. This research explores how asset management improves operational effectiveness

Navigating Errors: Voice Assistants And Aging Users, Bea Marithe V. Pulido

Theses

This study examined how age relates to usability, cognitive load, and affect when using voice-user interfaces (VUIs). VUIs such as Siri, Alexa, and Google Home are increasingly common and allow users to complete tasks through voice commands. While these systems can be convenient and accessible, especially for older adults, they often provide brief or unclear feedback when errors occur, making it difficult for users to understand what went wrong and how to continue the interaction. The current study compared older and younger adults (n = 40) to examine group differences in perceived usability, cognitive load, and affective change during VUI …

The Impact Of A Structured Education Program On Artificial Intelligence Use For Nursing Faculty On Teaching Practices, Katy White

Doctor of Nursing Practice Projects

Artificial intelligence (AI) is increasingly integrated into nursing education; however, nursing faculty report inconsistent preparedness, including gaps in AI knowledge and self-efficacy for responsible AI integration. This quality improvement project addressed inconsistent faculty preparedness through an asynchronous AI educational program. The purpose was to address gaps in AI knowledge and self-efficacy, and the aim was to evaluate changes in AI self-efficacy and AI knowledge while supporting AI integration into nursing education. Rogers' Diffusion of Innovations Theory served as the change theory, the Technology Acceptance Model served as the theoretical framework, and the Plan-Do-Study-Act framework guided implementation. A quantitative one-group pretest-posttest …

Restoring Control: How Occupational Therapy Improves Quality Of Life And Pelvic Pain, Taryn Ritchie

Occupational Therapy Doctorate Capstone Posters

This capstone project was completed at PT Solutions Physical Therapy LLC in Lexington, KY. This project focused on women seeking and receiving pelvic health therapy for pelvic pain. The goals the capstone were to increase awareness of pelvic health Occupational Therapy and evaluate the impact of therapy on QoL and participation in ADLs and IADLs. The capstone also aimed to expand knowledge and increase competence of medical professionals and clients regarding pelvic health therapy. Lastly, the capstone intended to create deliverables that can be utilized for education purposes. Pelvic floor dysfunction can cause debilitating symptoms such as pelvic pain, dyspareunia, …

Developing Comprehensive Resources For Caregivers: Facilitating The Transition Of Nicu Patients To Home Care, Taysha M. Gonzalez, Cynthia Haynes

Summer 2026 OTD Capstone Symposium

This doctoral capstone project developed a comprehensive, occupational therapy-informed NICU Caregiver Transition Toolkit to support families as they transition from the neonatal intensive care unit (NICU) to home. The project used clinical observations at the AdventHealth Daytona Beach NICU and AdventHealth Orlando NICU Graduate Clinic, a review of evidence-based literature and existing caregiver education materials, and interdisciplinary collaboration to identify caregiver education needs and guide toolkit development. Educational materials were created in English and Spanish using caregiver-friendly language, visual supports, step-by-step instructions, and QR-code access to digital resources. Draft materials were reviewed by occupational therapists, physical therapists, nurses, and other …

Phenological Plasticity Provides Limited Resilience To Climate Warming In A Sea Turtle Species With Temperature-Dependent Sex Determination, Blair P. Bentley, Lisa M. Komoroske, Cintia M. Santos, Armando J. B. Santos, Estefany Argueta, Vic Quennessen, Christina M. Coppenrath, Camille Kynoch, Vincent S. Saba, Claudio Bellini, Rafaely N. M. S. Ventura, J. Wilson White, Mariana M. P. B. Fuentes

Biological Sciences: Faculty Publications

Anthropogenic climate change is threatening global biodiversity, with sea turtles particularly vulnerable as offspring sex and developmental success are strongly influenced by incubation temperature. Behavioral plasticity, including the seasonal distribution of reproductive output, may provide short-term mechanisms for mitigating these impacts. Here, we investigated season-wide hatchling sex ratios and emergence success in a small population of green turtles (Chelonia mydas), tracking individual females across their nesting seasons. Sex ratios varied markedly through the nesting season, with later nests producing a greater proportion of male hatchlings. Moreover, sex ratios were relatively consistent among nests laid by individual females. Overall, females producing …

Ai-Enhanced Ct Reconstruction: Effects On Image Quality Across Dose Levels And Implications For Radiation Dose Optimization: A Systematic Review, Matthew R. Alberto

Radiologic Sciences

Purpose To evaluate how deep learning image reconstruction (DLIR) affects diagnostic image quality and noise characteristics at different radiation dose levels and how it influences dose optimization compared with conventional reconstruction methods.

Method A systematic review was conducted using major databases for studies published between 2020 and 2026. Eligible studies assessed DLIR across multiple dose levels, reported radiation dose, included quantitative image quality metrics, and compared DLIR with filtered back projection or iterative reconstruction.

Results Thirty‑seven studies met criteria, and 15 were synthesized. Three themes emerged: (a) DLIR reduced noise by 15–82% and often improved signal-to-noise and contrast-to-noise ratios while …

Reducing Mr Acquisition Times Using Artificial Intelligence: A Systematic Review, Fatin M. Arief

Radiologic Sciences

Purpose To synthesize existing evidence on artificial intelligence (AI) applications for reducing magnetic resonance (MR) imaging acquisition time, evaluate their impact on image quality, and identify challenges in clinical implementation.

Method A systematic literature review was conducted using PubMed, CINAHL, and Scopus including peer reviewed, English-language articles published between 2020 and 2026. Both qualitative and quantitative primary research were eligible and had to be on AI use in MR processes. Findings were analyzed through thematic synthesis, and the quality of each study was appraised using relevant critical appraisal tools.

Results Three major themes emerged: AI methods in MR procedures, perceived …

Work-Related Musculoskeletal Disorders In Sonography: Impact On Career Longevity And Evidence-Based Interventions For Workforce Retention, Aileen Gonzalez

Radiologic Sciences

Purpose To synthesize current evidence on work-related musculoskeletal disorders (WRMSDs) among sonographers, examine their impact on career longevity and job satisfaction, and identify leadership-driven interventions that support workforce retention.

Method A scoping review was conducted using PubMed, Google Scholar, and The University of Texas MD Anderson Cancer Center Research Medical Library to identify peer-reviewed studies published between 2020 and 2026. Eligible studies examined WRMSDs in sonographers and reported outcomes related to career longevity, job satisfaction, workplace retention, or injury prevention interventions. Findings were synthesized thematically.

Results Three primary themes emerged: (a) WRMSDs are highly prevalent across sonography specialties and represent …

High-Definition Healing: Investigating Ai-Driven Mr Reconstruction Methods, Jerell R. Jones

Radiologic Sciences

Purpose To analyze recent artificial intelligence (AI)-driven magnetic resonance (MR) reconstruction methods aimed at addressing long acquisition times, image artifacts, and workflow inefficiencies.

Method A systematic literature review was conducted using PubMed, Scopus, and Scopus AI, targeting peer‑reviewed studies published between 2015 and 2026. Search terms included “MRI,” “magnetic resonance imaging,” “artificial intelligence,” “deep learning,” and “machine learning.” Eligible studies included methodology, validation, and review papers. Extracted data included algorithm type, study design, key findings, and limitations. Themes were identified through content analysis and generative AI use.

Results Prominent themes identified were the emergence of generative adversarial networks, advanced neural …

Administrative And Clinical Impacts Of Theranostic Program Expansion In Nuclear Medicine, Karmela Kljajic Pascual

Radiologic Sciences

Purpose To synthesize current evidence on theranostic trials, nuclear medicine clinical workflow models, and organizational readiness, with a focus on how healthcare organizations and medical imaging leaders are adapting to the rapid expansion of theranostic services.

Method A comprehensive search was conducted across Scopus, PubMed, MEDLINE, and Google Scholar. Inclusion criteria required peer‑reviewed articles published between 2002 and 2026 addressing nuclear medicine leadership, theranostic implementation, workflow design, and organizational factors influencing theranostic program development. Exclusion criteria removed editorials, blog posts, and nonpeer‑reviewed sources.

Results Four major themes emerged: workforce and staffing demands, infrastructure and resource requirements, regulatory and administrative pressures, …

Evaluating The Safety Of Mr Exposure For Electronic Devices And Implants: A Literature Review, Molly O'Dowd

Radiologic Sciences

Purpose To review literature examining the factors that determine magnetic resonance (MR) compatibility of electronic implants and wearable devices, including device materials, engineering design, regulatory approval processes, and clinical monitoring requirements.

Method An integrative literature review was conducted using peer-reviewed literature addressing MR safety and device compatibility. Databases searched included PubMed, Wiley Online Library, ScienceDirect, and Google Scholar. Studies were selected based on relevance to MR safety classifications, device design considerations, regulatory labeling, and monitoring requirements.

Results The literature demonstrated that MR compatible devices are engineered and tested to meet regulatory safety standards and approved for use under specific scanning …

Assault Vs. Assistance: Radiologic Technologist Decision-Making When Fall-Risk Patients Decline Assistance, Pamela O'Dowd

Radiologic Sciences

Purpose To explore how radiologic technologists experience and respond to situations involving fall-risk patients who decline assistance during imaging procedures.

Method A cross-sectional survey design was used to collect data from practicing radiologic technologists recruited through the American Society of Radiologic Technologists. Descriptive statistics, including frequencies and percentages, were analyzed using SPSS to summarize participant responses, and a thematic analysis was conducted on open-ended responses.

Results A total of 87 respondents completed the survey. Results indicated that encounters with fall-risk patients who refuse assistance are common in clinical imaging practice. Sixty-three (72.4%) technologists reported having experienced situations in which a …

National Pacs And Electronic Health Records: Considerations, Challenges, And Implications For Radiomics, Darchelle Scott

Radiologic Sciences

Purpose To examine the considerations, challenges, and implications of implementing a national picture archiving and communication system (PACS) integrated with electronic health records (EHRs), with particular emphasis on interoperability, radiomics, and patient-centered data sharing.

Method A systematic literature review was conducted using books, peer-reviewed articles, original research studies, and government publications addressing radiomics, TEFCA, blockchain technology, PACS, and EHR integration. Literature was analyzed to evaluate national health information exchange, radiomics applications, and implementation challenges associated with a connected healthcare infrastructure.

Results Three primary themes emerged: (a) interoperable national PACS and EHR systems have the potential to improve continuity of care …

Quality Improvement Project: Experienced Nurse To Novice Adjunct Educator: Bridging The Gap, Karen Liddy

Doctor of Nursing Practice Projects

A formal mentoring program is an effective approach for enhancing mentee satisfaction and self-efficacy and decreasing turnover rates. Although evidence supports the benefits of mentoring, many universities lack formal mentoring programs for adjunct faculty. Utilizing the PDSA framework, this quality improvement Doctor of Nursing Practice (DNP) project executed and evaluated a structured adjunct faculty mentoring program to improve faculty self-efficacy and mentee satisfaction. The project was led by Bandura's Social Cognitive Theory and the Theory of Change and used a pre- and post-test design involving adjunct nursing faculty members with fewer than three years of academic teaching experience. Mentors and …