Digital Commons Network^™

Late-Onset Cobalamin C Deficiency Associated Atypical Hemolytic Uremic Syndrome – Diagnostic Pitfalls: A Case Report, Martha Stampfli, Sibylle Tschumi, Giacomo Simonetti, Corinne Benchimol, Gabriela Oesch, Alexander Lämmle, Matthias Baumgartner

Journal of Child Science

Introduction: Cobalamin C (cblC) deficiency represents a rare but treatable and potentially underrecognized cause of thrombotic microangiopathy (TMA) in both pediatric and adult populations. It is a multisystem disorder with heterogeneous clinical manifestations. TMA occurs in 10-25% of affected individuals. Case presentation: A ten-year-old girl presented with vomiting and abdominal pain, followed by generalized status epilepticus and hypertensive crisis. Neuroimaging was unremarkable. Laboratory evaluation demonstrated severe renal impairment (creatinine 506 µmol/L), microangiopathic hemolysis and thrombocytopenia. Atypical hemolytic uremic syndrome (aHUS) was suspected and treated with eculizumab and intermittent hemodialysis. Genetic analysis identified biallelic pathogenic variants in the MMACHC gene, confirming …

Prevalence And Factors Associated With Depression In Pediatric Epilepsy Patients At Maharat Nakhon Ratchasima Hospital, Paneeta Panjanya, Manachawee Maneeratchakit, Vitchayaporn Emarach Saengow

Journal of Child Science

Background: Epilepsy is a chronic neurological disorder commonly associated with depressive symptoms, which can negatively affect quality of life. Early identification through screening is therefore important in pediatric epilepsy care. Objective: To determine the prevalence of depressive symptoms and associated factors among pediatric patients with epilepsy at Maharat Nakhon Ratchasima Hospital. Methods: A cross-sectional study was conducted among patients aged 10–15 years with epilepsy attending the Pediatric Epilepsy Clinic between May 2024 and June 2025. A total of 141 participants were included. Demographic, family, and epilepsy-related data were collected. Depressive symptoms were screened using the Thai version of the Children’s …

Development Of The Toileting Habit Profile Questionnaire -2nd Revision; Assessing Sensory-Based Toileting Difficulties, Isabelle Beaudry-Bellefeuille, Eduardo Ramos-Polo

Journal of Child Science

Background: Childhood functional defecation disorders (FDD), including functional constipation and non-retentive fecal incontinence, are classified as disorders of gut–brain interaction and are increasingly recognized as a public health concern. FDD are commonly associated with challenging toileting behaviors and reduced participation in age-appropriate toileting routines, which may contribute to both the onset and maintenance of symptoms. Identifying factors underlying toileting participation difficulties is essential for effective intervention planning. Occupational therapy practitioners have developed expertise in addressing participation challenges in daily activities, including toileting, and in identifying sensory integration issues that may interfere with engagement. Aim: This paper introduces the Toileting Habit …

Physical Development Of Children Born From Adolescent Mothers: A Descriptive Evaluation Compared To World Averages, Sebahat Aydos, Aysel Köksal Akyol

Journal of Child Science

Background: Adolescent motherhood is a globally prevalent phenomenon that has been the subject of scientific research for many years. However, comprehensive scientific studies focusing on the physical development of children born to adolescent mothers remain quite limited. Objective: The aim of this study was to compare the height, weight, and head circumference development of infants and children born to adolescent mothers with the World Health Organization Multicenter Growth Reference Study (WHO MGRS) data. Methods: The study sample consisted of 2,209 infants and children born to adolescent mothers in Turkey, whose records were extracted from the Infant/Child Follow-up Data Set of …

Modeling And Forecasting Intraday Spot Volatility, Adam Clements, Daniel P. A. Preve

Research Collection School Of Economics

We propose a multiple-equation regression-based method for modeling and forecasting intraday spot volatility. In this approach, intraday intervals are treated as individual time series, deviating from the common practice of treating the data as one continuous sample. Our empirical study, which spans more than two decades and encompasses six US blue-chip stocks, employs the recent OK volatility estimator developed by Li, Wang, and Zhang (2024) to expose the dynamics of latent intraday spot volatility over time. We demonstrate that the proposed method effectively captures the intricate dynamics of intraday spot volatility and find strong evidence that it outperforms a competing …

Exploring The Relationship Between Energy Use And Sectoral Output At The Useful Stage, Daniel Chester, Ritika Susarla, Paul Brockway, Emmanuel Aramendia, Matthew Magness, Matthew Kuperus Heun

University Faculty Publications and Creative Works

1.Develop a publicly-available dataset of sectoral useful energy/exergy intensities

• And final, where not already existing

• How do global sector-level trends change when viewed from the useful stage?
• Are similar convergence patterns observed compared to previous analysis?
• How do sectoral differences explain aggregate convergence/divergence?

Smart-Twin: Systematic Modeling And Real-Time Transportation With Digital Twins, Hovannes Kulhandjian

Mineta Transportation Institute

Urban transportation networks are increasingly affected by everyday congestion, non-recurring disruptions, and limited real-time visibility into what is happening on the road. Transportation agencies require advanced tools that support faster, proactive management and data-driven infrastructure decisions rather than passive monitoring. This report presents SMART-TWIN, an Artificial Intelligence (AI)–driven Digital Twin framework designed for real-time traffic operations, disruption detection, and performance-based decision-making support. The SMART-TWIN architecture integrates microscopic traffic simulation (detailed traffic modeling), long-horizon synthetic demand generation simulating real travel patterns, supervised machine learning, and performance analysis within a unified and reproducible workflow. A corridor-scale Digital Twin was developed for the …

Cultivating Narratives: A Critical Discourse Analysis Of Higher Education Student-Led Farms And Gardens, Maximilan Sherard, Marc T. Sager

Publications

Despite extensive research on community agriculture, little attention has been paid to student-led farms or gardens (SFGs) in higher education contexts. SFGs represent a unique site for community agriculture due to their diverse stakeholders, academic affiliations, and the institutional policies they navigate. This study examines online promotional materials from 42 SFGs located on land-grant higher education campuses across the United States. Using critical discourse analysis, we (1) map these organizations’ practices and (2) identify competing discourses about community and agriculture within their promotional narratives. We identify and explain four core practices (membership, growing, distribution, and purpose) and connect these practices …

Fair + Equitable July 2026, International Association Of Assessing Officers

Fair + Equitable

The July F+E issue reviews how eliminating the property tax would impact local budgets.

Also in this issue:

• An updated Annual Conference session schedule
• The President’s Column
• IAAO launches national campaign to explain the value of the property tax
• Longtime IAAO director retires
• The 2026 conference charity
• IAAO Library hot topics
• New IAAO designees
• Meet A Rep

Standardized Infection Prevention Protocol To Reduce Surgical Site Infections In Pediatric Neurosurgery, Pisey Kareth

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Surgical site infections (SSIs) are a significant concern in the pediatric neurosurgical patient population and are associated with increased morbidity, longer hospital stays, and increased medical expenses. The absence of a standardized preoperative infection prevention process led to variability in perioperative care practices and infections at the practicum site.

Aim of the Project: The aim of the project was to reduce the incidence of SSIs among pediatric patients undergoing neurosurgical procedures who were initially evaluated in an ambulatory setting.

Review of the Evidence: Evidence supports the implementation of bundled infection prevention strategies as a more effective approach to reducing …

Increasing Referrals To The Lung Cancer Screening Program, Megan Randall

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Lung cancer is the leading cause of cancer-related deaths worldwide and is frequently diagnosed at advanced stages when treatment options are limited. A Veterans Administration (VA) primary care clinic demonstrated lower referral rates to the lung cancer screening (LCS) program than a comparable VA clinic despite having a higher prevalence of tobacco users. Existing electronic health record reminders focused on smoking cessation and did not systematically assess eligibility for LCS, contributing to underutilization of the screening program.

Aim of the Project: The aim of this quality improvement project was to increase referrals to the LCS program by improving identification …

Timing Matters: Safe And Timely Insulin Administration, Katlyn Lenox

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely insulin administration is essential for safe inpatient diabetes management and is strongly associated with improved glycemic control and fewer adverse events. Despite ADA recommendations to administer insulin within 30 minutes of point‑of‑care (POC) glucose testing, internal data showed only 44% compliance, with an average delay of 44 minutes. These delays increased the risk of hypo‑ and hyperglycemia and highlighted the need for workflow redesign and strengthened nursing processes.

Aim of the Project: To increase the percentage of insulin doses administered within 30 minutes of POC glucose testing, reduce adverse glycemic events, enhance patient safety, and align practice with …

Mindfulness To Reduce Psychotropic Prescriptions In Home-Based Elderly Patients, Mojisola Akinola Olusegun

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Home-based adults aged 65 years and older receiving care at a community behavioral health center exhibited high psychotropic polypharmacy, with over 80% prescribed two or more psychotropic medications, exceeding The Center for Medicare and Medicaid services (CMS) guidance for safe use. This pattern heightened risks for adverse drug events, functional decline, and avoidable healthcare utilization, while exposing a practice gap characterized by underuse of non-pharmacologic interventions.

Aim of the Project: The Doctor of Nursing Practice (DNP) project aimed to determine whether integrating a structured Mindful Breathing and Meditation (MBM) program into routine services could reduce psychotropic medication burden …

Optimizing Daily Central Line Review: A High-Reliability Qi Project, Heather Khan

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Prolonged central line use increases the risk of infection. At baseline, central line utilization in a 21-bed medical intensive care unit exceeded organizational goals and the national median. Gaps in the central line review process and variation in staff knowledge contributed to overutilization.

 Aim of the Project: The project team aimed to improve patient outcomes by reducing the central line standardized utilization ratio (SUR) from 0.93 to the national median of 0.79 over 12 weeks.

Review of the Evidence: Evidence supports standardization, use of decision-support tools, measurement, and auditing to reduce central line utilization. Leadership engagement, safety culture, and …

Poor Adherence To Established Clinical Guidelines In Outpatient Bladder Cancer Management, Melanie Boren

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The outpatient urology practice encountered challenges with adherence to Clinical Practice Guidelines (CPGs), primarily due to unfamiliarity and lack of operational accountability. This led to a low adherence rate of only 40% among patients with bladder cancer. Key issues included inadequate training and knowledge gaps regarding CPGs.

Aim of the Project: The project aimed to improve patient care and outcomes in bladder cancer treatment by enhancing patient retention and adherence to treatment protocols. Evidence-based interventions were implemented to optimize care delivery and support adherence to prescribed treatments.

Review of Evidence: A literature review highlights the effectiveness of nurse navigator …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

A Quality Improvement Approach To Reducing Chronic Obstructive Pulmonary Disease Readmissions, Florwisse Rubio

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

The problem identified at the project site is that care transitions for patients with COPD lack standardized discharge processes, leading to inconsistent education, limited follow-up, and poor coordination of care.

Aim of the Project:

The primary aim was to improve patient outcomes by reducing the 19.6% 30-day readmissions among older adults diagnosed with COPD at the selected project site by implementing a standardized discharge intervention over 12 weeks, measuring progress, and ensuring appropriate workflow. The initiative of this project sought to foster a sense of proper continuity of care through timely follow-up, interprofessional communication among patients and providers, and …

Implementing The Walking Impairment Questionnaire For Peripheral Artery Disease Screening And Referral, Lisa Doyle

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity, mortality, and lower extremity amputation. At a Level 1 veterans medical center, the absence of a standardized screening and referral process contributed to delayed identification of symptomatic PAD and underutilization of supervised exercise therapy (SET). Between August 2024 and July 2025, only four veterans completed SET despite a large high-risk population, demonstrating a significant gap in evidence-based recommendations and clinical practice.

Aim of the Project: The aim of this project was to improve patient outcomes by standardizing screening for symptomatic PAD using the Walking Impairment Questionnaire (WIQ) to …

Improving Medication Reconciliation Compliance In Home Health Admissions, Paula A. Petrie-Rivas

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Clinician compliance with medication reconciliation at a home health agency was below regulatory expectations, with agency performance significantly lower than state and national averages. Workflow inefficiencies, inconsistent clinician practices, and limited training contributed to noncompliance, increasing the risk of medication discrepancies, preventable rehospitalizations, and Medicare reimbursement penalties.

Aim: This quality improvement project implemented a standardized medication reconciliation workflow using the Agency for Healthcare Research and Quality’s MATCH toolkit to improve clinician compliance during admission to home health.

Evidence: Literature supports structured medication reconciliation as an effective strategy to improve safety during transitions of care. The MATCH toolkit provides a …

Identifying Palliative Care Needs In The Emergency Department, James Sullivan

All Doctor of Nursing Practice (DNP) Scholarly Projects

This quality improvement project evaluated the implementation of the Palliative Care and Rapid Emergency Screening (P‑CaRES) tool to improve early identification of unmet palliative care (PC) needs among adults with advanced, life‑limiting illnesses presenting to a community emergency department (ED). The problem addressed was the absence of a standardized PC screening process, resulting in delayed recognition, missed referral opportunities, fragmented care, and repeated ED utilization. Guided by Plan‑Do‑Study‑Act cycles and the OhioHealth Change Management Model, the project integrated P‑CaRES into ED workflows, provided staff education, and established structured referral pathways. Over 12 weeks, clinicians completed 65 screenings; 57 patients met …

Enhancing Medication Timeliness Through Structured Handoff In A Mental Health Facility, Belinda Zinhu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Delayed medication administration in an adult inpatient mental health facility exceeded organizational benchmarks and posed risks to patient safety, treatment effectiveness, and continuity of care. Baseline electronic health record (EHR) audits showed that about 30% of scheduled medications were administered outside the organization's acceptable timeframe, and inconsistent nurse shift handoffs contributed to the delays.

Aim of the Project: The aim of the quality improvement project was to improve patient outcomes by implementing the I-PASS standardized handoff communication tool to reduce late medication administration from 30% to 15% within 12 weeks.

Review of the Evidence: Evidence supports structured handoff frameworks …

Fall Tailoring Interventions For Patient Safety: A Program Evaluation, Shirley Morrison

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls with injury rates had increased for over two years at the project hospital until nurse leaders implemented a new fall-prevention intervention. Patient falls are the most common preventable adverse event in acute care hospitals, with approximately 700,000 to 1 million occurring annually in the United States. Before implementing the Fall Tailoring Interventions for Patient Safety (TIPS) toolkit, the hospital’s program lacked an evidence-based approach and a fall communication board to alert staff, patients, and families about the individual fall risk status, leaving a significant gap in patient-centered care.

Aim of the Project: The aim of the project was …

Pressure Injury Prevention Bundle Implementation In An Acute Care Unit, Hannah K. Pobi

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Pressure Injuries are quality indicators that reflect the quality of care delivered to patients. With a hospital-acquired pressure injury rate above 12%, the project site exceeded the national benchmark average of 5-8% for acute inpatient settings. The cost of managing hospital acquired pressure injury ranges from $20,900 to $151,700 per patient, compounded by complications in a patient’s treatment plan.

Aim of the Project: To reduce the prevalence of HAPIs in a step-down unit to below 8% by implementing the Pressure Injury Prevention bundle. The PIP bundle, an evidence-based intervention, primarily aimed to educate the nursing team on its …

Selene And Pleiades Labor To Keep Watch Over A Lonely Night - Sappho, Maksim Astashinskiy

Faculty Papers and Publications

The title is the translator’s; the poem is popularly referred to as the “Midnight poem,” Wikipedia, accessed July 19, 2026, https://en.wikipedia.org/wiki/Midnight_poem; the Greek text is transcribed from The Digital Sappho: Text and Commentary, accessed July 17, 2026, https://digitalsappho.org/fragments/fr118-168/. For an expansive compilation of translations of this poem, see: “Sappho’s Moon and Pleiades,” Brief Poems: An irregular anthology of tweet-size poems (blog), November 22, 2015, https://briefpoems.wordpress.com/2015/11/22/sapphos-moon-and-pleiades/. The unattributed two-line poem text is featured in Hephaestion (ca. 2nd century C.E.), see: Hephaestionis Enchiridion, cum commentariis veteribus edidit Maximilianus Consbruch. Accedunt variae metricorum graecorum reliquiae (Lipsiae: B.G. …

Clinical Document Metadata Extraction: A Scoping Review, Kurt Miller, Qiuhao Lu, William Hersh, Kirk Roberts, Steven Bedrick, Andrew Wen, Hongfang Liu

Faculty, Staff and Student Publications

Objectives: Clinical document metadata, such as document type, structure, author role, medical specialty, and encounter setting, is essential for accurate interpretation of information captured in clinical documents. However, vast documentation heterogeneity and drift over time challenge harmonization of document metadata. Automated extraction methods have emerged to coalesce metadata from disparate practices into target schema. This scoping review aims to catalog research on clinical document metadata extraction, identify methodological trends and applications, and highlight gaps warranting further investigation.

Methods: We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to identify articles from Ovid …

Sex Differences In The Protective Effect Of Brain Volume: Age Attenuates Protection In Women, Javier Gomez-Farias, Ngoc Mai Le, Joseph N Samaha, Bruna Kfoury, Hussain M Azeem, Ritesh Bajaj, Mahnoor Khalid, Freya Kanakhara, Shikha Tripathi, Shayan Shams, Luca Giancardo, Eunyoung A Lee, Robert W Regenhardt, Louise D Mccullough, Sunil A Sheth

Faculty, Staff and Student Publications

Background: Sex differences in outcomes after acute ischemic stroke are well recognized, but mechanisms remain unclear. This study evaluates whether parenchymal brain volume (PBV), age, and final infarct volume explain sex-specific differences in poststroke disability.

Methods: We analyzed a prospectively collected multicenter registry of acute ischemic stroke patients treated between 2015 and 2024. Automated pipelines quantified PBV from noncontrast computed tomography and diffusion-weighted imaging-derived final infarct volume from 24- to 48-hour magnetic resonance imaging. With the primary outcome being 90-day functional independence (modified Rankin Scale score 0-2), sex-stratified logistic regression models evaluated its association with PBV. Stratified logistic and linear …

Medadl: High-Throughput Information Extraction Of Functional Status From Electronic Health Records To Advance Frailty Assessment In Older Adults, Sunyang Fu, Zhiyi Yue, Jennyly T Nguyen, Huipeng Liu, Jaerong Ahn, Vanessa Ramirez, Jude Des Bordes, Hongfang Liu, Min Ji Kwak, Nahid J Rianon

Faculty, Staff and Student Publications

Background: Functional status is essential for assessing frailty and planning care in older adults but is often under-documented in the structured fields of electronic health records. Manual chart review can capture functional status information but is labor-intensive and time-consuming. In this study, we developed and validated a scalable natural language processing (NLP) model to extract functional status information from unstructured electronic health record (EHR) notes.

Methods: This retrospective cohort study included 110 older adults seen at a geriatric osteoporosis clinic. A large language model-augmented symbolic NLP pipeline (MedADL) was developed to extract activities of daily living (ADL) and instrumental activities …

Implementation And Evaluation Of The Owll Intervention To Improve The Quality And Safety Of Pediatric Dental Sedation: A Mixed-Methods Approach, Kawtar Zouaidi, Jan Yeager, Sayali Tungare, Suhasini Bangar, Janelle Urata, Alfa-Ibrahim Yansane, Jungsoo Kim, Emily Sedlock, Krishna K Kookal, Yan Xiao, Oluwabunmi Tokede, Heiko Spallek, Amy Franklin, Gregory Olson, Joel White, Elsbeth Kalenderian, Muhammad F Walji

Faculty, Staff and Student Publications

Background: The OWLL (Open-Wide Learning Lab) intervention was developed using Human-Centered Design to improve the quality and safety of pediatric dental sedation. The intervention includes a patient-facing informational sedation brochure and video, and an enhanced set of clinical sedation records. Here, we report on the process evaluation 6 months after implementation in daily clinical practice.

Methods: This study was conducted at the outpatient pediatric dental clinics of 2 large US academic dental institutions. We used a mixed-methods design to assess the fidelity, acceptability, appropriateness, and feasibility of the OWLL intervention. Quantitative data were gathered through chart reviews, while qualitative data …

Few-Shot Prompting Strategies For Improving Large Language Model-Based Cardiovascular Disease Risk Prediction, Tiemar Semere Berhe, Senay Gebreab, Ahmad Musamih, Walaa Alkhader, Khaled Salah, Samer Ellahham, Raja Jayaraman

Industrial Engineering: Faculty & Staff Publications

No abstract provided.

Herbaceous Plants In Forest Ecosystems: One Hundred Fundamental And Applied Questions, Harikrishnan Venugopalan Nair Radhamoni, Michelle Elise Spicer, Marlyse C. Duguid, Liza S. Comita, Emilio Bruna, Andrew J. Andrade, Julia I. Burton

Michigan Tech Publications

Aims: Herbaceous plants (herbs) found in the understory of forests contribute substantially to the biodiversity of these ecosystems, as well as being important socio-culturally, economically, and for advancing ecological theory. However, the ecology of herbs is less well understood compared with woody plants, despite evidence that herbs are physiologically and ecologically different. Similarly, herb research has focused on north temperate forests, with less information from forests in the tropics and Global South. Understanding this knowledge gap, and recognizing the critical importance of expanding and streamlining the scope of research on forest herbs, we set out to identify 100 fundamental and …