Digital Commons Network^™

Detecting Stigmatizing Language In Clinical Notes With Large Language Models For Addiction Care, Rohan Sethi, John Caskey, Yanjun Gao, Matthew M. Churpek, Timothy A. Miller, Anoop Mayampurath, Elizabeth Salisbury-Afshar, Majid Afshar, Dmitriy Dligach

Computer Science: Faculty Publications and Other Works

Intensive care units (ICU) produce numerous progress notes that may contain stigmatizing language that perpetuate negative biases and punitive approaches against patients. Patients with substance use disorders are particularly vulnerable to stigma. This study examined the performance of Large Language Models (LLMs) in the identification of stigmatizing language. We annotated a dataset with over 77,000 stigmatizing and non-stigmatizing notes from the MIMIC-III database. We utilized Meta's Llama-3 8B Instruct LLM to run the following experiments for stigma detection: zero-shot; in-context learning; in-context learning with a selective retrieval; supervised fine-tuning (SFT); and keyword search. All approaches were evaluated on a held-out …

Amyloidosis Of Bridging Veins Is A Pathologic Feature Of Alzheimer's Disease, Leon C D Smyth, Daan Verhaege, Elio Standen-Bloom, Yue Wu, Steffen E Storck, Pavle Boskovic, Benjamin A Plog, Tornike Mamuladze, Jose A Mazzitelli, Zhuoying Wang, Daniel D Lee, Gwendalyn J Randolph, Katherine E Schwetye, Song Hu, Jonathan Kipnis, Et Al.

2020-Current year OA Pubs

Alzheimer's disease (AD) is characterized by the accumulation of extracellular aggregated amyloid beta, resulting from impaired waste clearance. We recently identified new cerebrospinal fluid (CSF) efflux structures termed arachnoid cuff exit (ACE) points and speculated that these may be impacted in AD, leading to impaired waste clearance function. Using 5XFAD mice, we found progressive amyloidosis of bridging veins at ACE points. Indeed, in 5XFAD mice, there is impaired CSF efflux to the dura mater, impaired CSF flow along bridging veins, and impaired blood flow through bridging veins. These observations suggest that ACE point amyloidosis plays a role in waste clearance …

Demographic And Clinicopathologic Factors Associated With Colorectal Adenoma Recurrence, Usman Ayub Awan, Qingyuan Song, Kristen K Ciombor, Adetunji T Toriola, Jungyoon Choi, Timothy Su, Xiao-Ou Shu, Kamran Idrees, Kay M Washington, Wei Zheng, Wanqing Wen, Zhijun Yin, Xingyi Guo

2020-Current year OA Pubs

IMPORTANCE: Current colorectal surveillance guidelines emphasize adenoma characteristics but overlook temporal, racial, and sex-based heterogeneity in recurrence risk, a gap that limits equitable and personalized care.

OBJECTIVE: To evaluate the associations of demographic factors, obesity, and adenoma features with recurrence risk over time in a large longitudinal surveillance cohort.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center.

EXPOSURES: Demographic variables included race and ethnicity, sex, obesity (body mass index >30), family history of colorectal cancer (CRC) or polyps, and age at …

Unitary Rational Functions: The Scaled Quaternion Case, Daniel Alpay, Ilwoo Choo, Mihaela Vajiac

Mathematics, Physics, and Computer Science Faculty Articles and Research

We develop the theory of minimal realizations and factorizations of rational functions where the coefficient space is a ring of the type introduced in our previous work, the scaled quaternions, which includes as special cases the quaternions and the split quaternions. The methods involved are not a direct generalization of the complex or quaternionic settings, and in particular, the adjoint is not the classical adjoint and we use properties of real Hilbert spaces. This adjoint allows to define the counterpart of unitarity for matrix-rational functions, and we develop the corresponding theories of realizations and unitary factorizations. We also begin a …

Cd8+ T Cells In The Tumor Microenvironment Modulate The Response To Endocrine Therapy In Breast Cancer, Fabiana Napolitano, Yunguan Wang, Dhivya R Sudhan, Paula I Gonzalez-Ericsson, Luigi Formisano, Shahbano Shakeel, Khushi Ahuja, Lei Guo, María Rosario Chica-Parrado, Yuki Matsunaga, Pamela Luna, Chang-Ching A Lin, Yasuaki Uemoto, Kyung-Min Lee, Hongli Ma, Nathaniel J Evans, Alberto Servetto, Saurabh Mendiratta, Spencer D Barnes, Roberto Bianco, Yisheng V Fang, Lin Xu, Jeon Lee, Tao Wang, Justin M Balko, Gordon B Mills, Marilyne Labrie, Ariella B Hanker, Carlos L Arteaga

Faculty, Staff and Student Publications

The role of the tumor immune microenvironment (TIME) in modulating responses to antiestrogen therapy in hormone receptor-positive (HR+) breast cancers remains unclear. We analyzed pre- and on-treatment biopsies from patients with HR+ breast cancer treated with letrozole to induce estrogen deprivation (ED). Stromal tumor-infiltrating lymphocytes, assessed by H&E staining, and immune-related gene sets, including IFN-γ signaling genes, measured by RNA-Seq, were increased in ED-resistant tumors. Cyclic immunofluorescence and spatial transcriptomics revealed an abundance of CD8+ T cells and enhanced antigen processing and immune gene signatures in ED-resistant tumors. In this group, the expression of CXCL9, CXCL10, and CXCL11 - chemokine …

Fedda-Tsformer: Federated Domain Adaptation With Vision Timesformer For Left Ventricle Segmentation On Gated Myocardial Perfusion Spect Image, Yehong Huang, Chen Zhao, Rochak Dhakal, Min Zhao, Guang-Uei Hung, Zhixin Jiang, Weihua Zhou

Michigan Tech Publications

BACKGROUND: Accurate assessment of left ventricular function is essential for diagnosing and managing cardiovascular disease. Gated myocardial perfusion SPECT (MPS) enables simultaneous evaluation of perfusion and function, but reliable contour extraction is challenged by image noise, resolution limits, and anatomical variability. Multi-center validation is further restricted by data privacy concerns, underscoring the need for robust and privacy-preserving contouring methods. METHODS: In this study, we propose a novel approach, FedDA-TSformer, which integrates Federated Domain Adaptation with the TimeSformer model for the task of left ventricle segmentation using MPS images. The proposed model captures spatial and temporal features through a Divide-Space-Time-Attention mechanism, …

Nanomedicine Meets Immunotherapy: Transforming Chimeric Antigen Receptor T Cell Treatment For Solid Tumors, Stephen O'Rourke, Nuo Xu, Hongjun Wang, Hexin Chen

Faculty Publications

The emergence of effective immunotherapies has drastically revolutionized clinical management of many cancer types. Among them, chimeric antigen receptor (CAR)-T cell therapy (CTT), as a groundbreaking approach, has been considered as a “living drug,” displaying unprecedented clinical outcomes with hematological malignancies, including B cell leukemia and lymphomas, and multiple myeloma. Despite the high remission rates and improved survival achieved with hematological cancers, the effectiveness of CTT in solid tumors remains largely unsatisfactory. The efficacy of CTT in solid tumors is significantly challenged by multiple factors, including tumor-antigen heterogeneity, limited T cell trafficking and infiltration, a highly immunosuppressive tumor microenvironment, and …

A Solution To The Tension Of Burning On Neutron Stars And Nuclear Physics, Yuri Cavecchi, D. K. Galloway, A. Heger, P. Santillán-Ortega, M. Nava-Callejas, F. M. Vincentelli, Liliana E. Rivera Sandoval, A. Goodwin, Z. Johnston

Physics & Astronomy Faculty Publications

When neutron stars accrete matter from a companion star, this matter forms a disk around them and eventually falls on their surface. Here, the fuel can ignite into bright flashes called Type I bursts. Theoretical calculations based on state-of-the-art nuclear reactions are able to explain many features of the bursts. However, models predict that the bursts should cease at high accretion rates, whereas in many sources they disappear at much lower rates. Moreover, their recurrence times also show strong discrepancies with predictions. Although various solutions have been proposed, none can account for all the observational constraints. Here, we describe a …

Lysine Demethylase 4a (Kdm4a) Maintains Basal Body Architecture And Protects Against Ciliary Destabilization, Xiaoli Wang, Yuya Nakatani, Sofia Vargas-Hernandez, Sung Y Jung, Menuka Karki, Cheryl Walker, Anna-Karin Gustavsson, Ruhee Dere

Faculty, Staff and Students Publications

Primary cilia are sensory organelles essential for signaling and defects in formation, maintenance or structure underlie diverse ciliopathies. Here, we identify lysine demethylase 4A (KDM4A) as a previously unrecognized mediator of ciliogenesis. Using genetic depletion and pharmacologic inhibition, we show that KDM4A is required for cilia assembly and maintenance. Super-resolution imaging reveals KDM4A localization at the basal body, where it distinctively wraps around the centrioles. We uncover a direct interaction between KDM4A and Rootletin (CROCC), a structural protein mediating centriole cohesion, and demonstrate that KDM4A loss increases inter-centriolar distances, implicating basal body architecture in ciliary failure. Together, these findings define …

The Use Of Acupuncture To Address Health Disparities In The Treatment Of Low Back Pain, Vivian Li, Alexander Reals, Deepa Manda, Elizabeth Loomis

Advances in Clinical Medical Research and Healthcare Delivery

Low back pain (LBP) is a leading cause of disability, and treatment often involves a combination of pharmacological and non-pharmacological therapies. Acupuncture is a medical treatment and ideology rooted in traditional Chinese medicine that utilizes applying small needles or pressure to specific points in the body. Utilized as an adjunct to supplement standard medical care, acupuncture is a procedure that can be done in a primary care setting. Multiple studies have shown efficacy in treating acute or chronic back pain, with up to 1.5% of the US population having used acupuncture at one point.

In the pursuit of holistic health, …

Evidence Based Management Of High Ldl-C For Prevention Of Atherosclerotic Cardiovascular Disease In Adult Patients In Resident Run Clinic: A Qi Project, Astha Prasai, Sahej Manesh Singh Arora, Hafsa Jawaid, Aakriti Jain, Omofolarin Babayale, Nauman Naeem, Hina Ukrani, Nawid Latifi, Binita Neupane, Soon-Il Song, Gaurav Sharma

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide and in the United States, with significant healthcare and economic burden. Despite clear guideline recommendations, the implementation of ASCVD risk assessment and statin use for primary prevention remains suboptimal.

Methods:

A quality improvement project was conducted at a resident run clinic with an objective to improve ASCVD risk documentation and guideline-based lipid management. A total of 600 patients aged 40-75 years without a history of cardiovascular disease were randomly selected- 300 in the pre-intervention group and 300 in the post-intervention group. The intervention included didactic sessions and quick …

Transient T-Wave Inversions In A Pregnant Patient: Normal Variant Or Cause For Concern?, Muhammad Hammad Sharif, Madeeha Khaleeque, Muhammad Hassan Jan, Atif Ahmed, Aniket-Vijay Rao, Aditya Sanjeevi, Bipul Baibhav

Advances in Clinical Medical Research and Healthcare Delivery

Pregnancy can cause physiological changes in various body systems, including the cardiovascular system. This manifests as physiological changes in the electrocardiogram (EKG) in the form of sinus tachycardia, a change in the QRS axis, a short PR interval, the development of Q waves, a prolonged QT interval, T-wave inversions, and ST-segment depression. These changes are typically benign and reflect the body's adaptation to pregnancy. Physiological T-wave inversions can occur during pregnancy because of an increased workload on the heart due to expanding blood volume. It is important to identify these physiological EKG changes to avoid unnecessary invasive cardiac work-up and …

Neuroinflammation And Its Role In Depression– A Review Of Emerging Biomarkers And Therapeutic Targets, Sophia M. Valerino

Advances in Clinical Medical Research and Healthcare Delivery

Major depressive disorder (MDD) is a prevalent and debilitating mental illness that affects millions globally. Traditionally, the pathophysiology of MDD was thought to be due primarily neurotransmitter imbalances. However, emerging research highlights the role of neuroinflammation in MDD pathogenesis. Elevated levels of pro-inflammatory cytokines, microglial activation, and blood-brain barrier dysfunction have been implicated in the etiology of MDD. Additionally, biomarkers such as C-reactive protein and neuroimaging findings further support the neuroinflammatory hypothesis. This growing body of evidence has led to increased interest in novel treatment approaches, including anti-inflammatory medications and lifestyle interventions, as potential therapeutic strategies. While selective serotonin reuptake …

A Rare Case Of Gastrointestinal Stromal Tumor Outside The Gastrointestinal Tract, Ashton I. D'Souza, Jasdeep S. Bajwa, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Extra-gastrointestinal stromal tumors are rare mesenchymal tumors occurring outside the gastrointestinal tract, comprising ~5% of all gastrointestinal stromal tumors. A 65-year-old man undergoing evaluation for nephrolithiasis was incidentally found to have a 7.2 cm mesenteric mass proven to be gastrointestinal stromal tumors on biopsy. After limited response to imatinib, the patient underwent successful surgical resection. Mesenteric gastrointestinal stromal tumors often present larger and more aggressive, but in this instance, early incidental detection permitted effective intervention. This case highlights the diagnostic challenges posed by extra-gastrointestinal stromal tumors due to their atypical location and nonspecific symptoms. Extra-gastrointestinal stromal tumors should be considered …

Gabapentin Induced Seizures: A Rare Presentation Of Toxicity, Muhammad Umer Mukhtar, Akaansha Varma, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Gabapentin is a medication used for the management of neuropathic pain, focal seizures, and several other medical conditions. We report a case of a young male who experienced generalized tonic clonic seizures following the intentional ingestion of 31 grams of gabapentin. This case describes an unusual manifestation of gabapentin toxicity, namely seizures, and highlights the overdose of gabapentin for recreational purposes. Furthermore, this report emphasizes the rising misuse of gabapentin and underscores the importance of providers remaining vigilant in recognizing potential substance use disorders.

Idiosyncratic Drug Induced Liver Injury Secondary To Ciprofloxacin: A Reminder To Always Check Medication History, Xavier Zonna, Conor Banta, Erika Anson Md

Advances in Clinical Medical Research and Healthcare Delivery

A 38-year-old Caucasian male with no significant past medical history presented to the emergency department with complaints of nausea, vomiting, abdominal pain, and jaundice of 2 days duration. He noticed this in addition to pruritus, fever, and malaise. He had severe transaminitis and hyperbilirubinemia on laboratory evaluation. He was admitted for acute liver injury of an unknown etiology. He had taken a course of ciprofloxacin days prior to presentation for UTI at an outlying facility. Serologies were also concerning possible autoimmune liver disease with elevated Anti-Nuclear Antibody and equivocal Anti Smooth Muscle Antibody. Liver biopsy was negative for any autoimmune …

Rare Presentation Of Omental Tuberculosis With Drug-Induced Jaundice In A Teenage Female: A Case Report, Archana Venkatesan, Krishna Ravi

Advances in Clinical Medical Research and Healthcare Delivery

Omental tuberculosis (TB) is a rare form of abdominal TB, often presenting with nonspecific symptoms that mimic malignancies. We report a case of a 16-year-old female from India who presented with abdominal distension, vomiting, weight loss, and amenorrhea. Imaging revealed an abdominal mass, and a diagnosis of omental TB was confirmed via histopathology. This case highlights the diagnostic challenge posed by such atypical presentations, especially in TB-endemic regions. The patient also developed rifampicin-induced jaundice, which resolved upon drug cessation and supportive care. Anti-TB therapy was cautiously reintroduced at a modified dose. This report underscores the need for high clinical suspicion, …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

Bilateral Congenital Radioulnar Synostosis - Case Report, Derek A. Diangelis, Matthew J. Hudson

Advances in Clinical Medical Research and Healthcare Delivery

A 2-year-old male presented to an orthopedic outpatient office due to a supination defect in both of his upper limbs. X-rays of the affected limbs revealed fusion of the proximal radioulnar joints indicating congenital radioulnar synostosis (CRUS). CRUS is abnormal development of the upper limbs occurring during weeks 3—7 of embryological development. Causes of CRUS include genetic syndromes and spontaneous mutations. Treatment options include nonoperative and surgical treatments, however, treatment is controversial due to a lack of clinical evidence. Proposed screening methods could help improve detection rates and improve clinical management. This report aims to increase awareness of CRUS and …

Pembrolizumab-Induced Primary Adrenal Insufficiency: A Rare But Life-Threatening Endocrine Irae, Syeda Sarah Raza, Mehr A. Orakzai, Abdullah A. Orakzai

Advances in Clinical Medical Research and Healthcare Delivery

Pembrolizumab, a PD-1 checkpoint inhibitor, is widely used in the treatment of various malignancies. While it improves overall survival, it can lead to immune-related adverse events (irAEs), including rare endocrine disorders such as primary adrenal insufficiency (PAI). We present a case of PAI induced by Pembrolizumab in a 75-year-old man, emphasizing the importance of early recognition and timely management.

‘Is The Patient Clear For Surgery?’ Takotsubo Cardiomyopathy Presenting As T-Wave Inversions In A Pre-Operative Ekg: A Case Report, Muhammad Hammad Sharif, Madeeha Khaleeque, Syed Faiz Abbas, Gaurav Sharma, Aditya Sanjeevi, Muhammad Hassan Jan, Atif Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Takotsubo cardiomyopathy (TC) can cause dynamic changes in the electrocardiogram (EKG) and troponin elevation which can be misinterpreted as an acute coronary event that can cause an unnecessary delay in the surgery and affect the outcomes of a non-cardiac surgery. We present a case of a patient with pre-operative T-wave inversions diagnosed with TC. A 90-year-old female presented with a femur fracture. Pre-operative EKG showed symmetric T-wave inversions in the inferior and pre-cordial leads. Delta troponin was unremarkable and she remained chest pain-free. Transthoracic echocardiogram (TTE) showed an ejection fraction of 60% with apical ballooning and basal hyperkinesis concerning for …

A Case Of Fatal Herpes Zoster Ophthalmicus And Encephalitis In An Immunocompetent Host With A Review Of Literature, Kellyn E. Wilkes, Rutwik Pradeep Sharma, Laurie Proia

Advances in Clinical Medical Research and Healthcare Delivery

Herpes zoster is a common disease that can have several complications. Here, we present a case of herpes zoster ophthalmicus with coexisting encephalitis that unfortunately resulted in patient mortality. A 70-year-old male with a past medical history of Parkinson’s disease and schizophrenia presented to the emergency department after being found altered at home. Physical exam was notable for left-sided crusted facial rash, left conjunctival injection, and purulent drainage coming from the right eye. Given the location and appearance of his rash, he was diagnosed with herpes zoster ophthalmicus. There was suspicion for encephalitis given his altered mental status but unfortunately, …

Analysis Of Superior Economic Potential In South Tangerang City With Banten Province Comparator Using Location Quotient, Dynamic Location Quotient, And Shift Share Analysis Methods, Muhammad Qabus Abid Khairullah, Rastika Widiastuti, Cindy Adria Ananda Putri, Hayuning Anggrahita

Jurnal Geografi Lingkungan Tropik (Journal of Geography of Tropical Environments)

Gross Regional Domestic Product (GRDP) is a key indicator for understanding regional economic structure and dynamics. Differences in sectoral contributions reflect levels of specialization, competitiveness, and growth potential, making comparative and dynamic sectoral analyses essential for regional development planning. This study aims to identify leading, supporting, potential, and lagging economic sectors using Location Quotient (LQ), Dynamic Location Quotient (DLQ), and Shift Share Analysis by comparing the economic performance of South Tangerang City with Banten Province. The analysis is based on GRDP at constant prices by industrial sector for the period 2019-2023. LQ is applied to identify sectoral comparative advantages, DLQ …

Proceeding Book Of The 17th Indonesian Occupational Medicine Updates (Iomu), Perdoki .

Occupational and Environmental Medicine Journal of Indonesia

Bali, Indonesia, 16th - 18th May 2025

Biomechanical Trade-Offs Between Root Tensile Strength And Porosity In Coastal Marshes, M. O. Hassan, N. H. Jafari, A. S. Rovai, R. R. Twilley

Faculty Publications

Root biomechanics play a fundamental role in stabilizing wetland soils and sustaining coastal ecosystems under increasing environmental stress. This study investigates the tensile strength (TS) and internal porosity (n) of roots from two dominant marsh grasses, Spartina alterniflora and Spartina patens, across four sites in the Mississippi River Delta Plain (MRDP), spanning active (Atchafalaya) and inactive (Terrebonne) basins. Through approximately 300 tensile strength tests conducted on live roots across diameter classes and depths, we observed a consistent decline in strength with increasing root diameter and depth. Fine roots (< 2 mm), particularly those in the upper 15 cm, showed the highest tensile resistance, reinforcing their critical role in erosion control. To assess morphological drivers, we employed high-resolution scanning electron microscopy (SEM) with a machine learning (ML) segmentation pipeline to quantify porosity and visualize aerenchyma. Coarse roots exhibited significantly higher porosity due to large central lumens and expanded aerenchyma, while fine roots maintained denser tissue structures. An exponential decay relationship emerged between porosity and tensile strength, indicating a trade-off: increased void space enhances oxygen diffusion in waterlogged soils but compromises mechanical integrity. This inverse relationship was most pronounced in saline environments, suggesting that stress amplifies structural compromises in root traits. This integrative approach, combining precision mechanical testing, advanced imaging, and ML-based analysis, provides a scalable and reproducible framework for characterizing root biomechanics. Findings advance understanding of plant contributions to belowground stability in coastal wetlands and offer practical insights for restoration strategies to enhance shoreline resilience.

A Multicultural Mosaic: Stillbirth And Healing Among Asian Women, Ederlina Co

Vanderbilt Law Review En Banc

No abstract provided.

Fy2025 Association Of College And Research Libraries (Acrl) Statistical Survey: University Of Rhode Island Data, Julia Lovett

University Libraries Reports & Statistics

The report contains FY2025 data as submitted by the University of Rhode Island Libraries for the 2025 Association of College and Research Libraries (ACRL) Annual Survey.

Motivating And Retaining Student Assistants: A Case Study, Catherine Paolillo, Christopher Marcum

Copley Library: Faculty Scholarship

This paper offers specific recommendations for effectively motivating and retaining student employees at an academic library that practitioners may consider as they develop and implement programs for hiring, training, and retaining student assistants at their institutions. It describes a methodology that can be replicated for similar studies at other universities. This paper contributes new knowledge to the subject of academic library employee retention by reporting on the opinions of library student assistants at a small private liberal arts university in Southern California to gain insight into the kinds of retention program elements that students recommend. This study used an online …

Final 2022 Insufficiently Reclaimed Sites Sampling: Bres No. 37 – Josephine Shaft Site Evaluation Summary Report, Pioneer Technical Services, Inc.

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

Anty 101h.51: Anthropology & The Human Experience, Erin D. Rosenkrance

University of Montana Course Syllabi, 2026-2030

No abstract provided.