Digital Commons Network^™

Self-Medication Experience And Healthcare Trust Among Youth: A Regionally Concentrated Digital Survey In Indonesia, Wahyudi Wahyudi, Azra Muzaiyana Nasution, Arini Dwi Rahmadani, Alysa Rahmadani Hasibuan

Patient Experience Journal

Self-medication has become a central experience for youth transitioning toward independent medical decision-making. In the digital era, young people must navigate a complex landscape of health information while seeking independent health solutions. This study investigates self-medication experiences and healthcare trust among youth, utilizing a regionally concentrated digital survey approach in Indonesia. Data were collected via a cross-sectional approach using digital platforms (Instagram, TikTok, and Twitter/X), facilitated by 76 trained enumerators. While respondents from all 38 provinces participated, the sample (N = 2,790) exhibits a major geographical concentration in the Sumatra region. The study employed a validated 16-item instrument to evaluate …

Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust In Their Inpatient Physicians—A Convergent Mixed-Methods Study, Marlise Jeanne Pierre-Wright, Ibrahim Badreldin Mokhtar, Uma Thachapuzha, Yashoswini Chakraborty, Revika Singh, Rachel O'Conor, Jing Song, Julia Lee, Maria E. Theodorou, Christine Schaeffer, Kimberly Collins, Muriel Jean-Jacques

Patient Experience Journal

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants …

From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus

Patient Experience Journal

After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

Caring But Still Hurting: Uninsured Patients' Illness And Healthcare Experiences At A U.S. Free Clinic, Danaya Amornnimit, Eda G. Christensen, Adelaida Salmeron, Kian Robison, Sofia Ampudia Arroyo, Jessica Benelli, Brenda Spearman, Akiko Kamimura

Patient Experience Journal

While free clinics provide essential healthcare to socioeconomically disadvantaged populations, patients' lived experiences in these settings remain underexplored. This qualitative study examined how uninsured patients at a U.S.-based free clinic perceive their illness experiences and interactions with healthcare providers. From October to December 2024, semi-structured interviews were conducted with 21 adult patients (ages 18–72; M = 49.14), most of whom were non–U.S.-born and primarily Spanish-speaking. Participants described illness as entangled with emotional distress, social isolation, stigma, and disruptions to identity and family roles—revealing a psychological burden that extends beyond physical symptoms. These findings highlight the need to integrate psychosocial and …

From Drifting To Anchored: How Online Health Communities Can Transform Care For Complex Chronic Illness, Mads Eggerding

Patient Experience Journal

This personal narrative recounts a 25-year diagnostic odyssey with Ehlers-Danlos syndrome, defined by medical fragmentation, dismissed symptoms, and profound isolation. It illustrates how Online Health Communities (OHCs) bridged the chasm between lived experience and a clinical system ill-equipped for complex chronic illness. For patients like me, these digital forums provide the peer validation, practical knowledge, and self-advocacy tools necessary to navigate a disjointed healthcare landscape. For providers, this story underscores a critical opportunity: proactive, non-judgmental engagement with OHCs is not a threat to expertise but a foundational strategy for patient-centered care. By acknowledging and constructively partnering with these patient-led spaces, …

Secondary Infertility: A Personal Story Of Loss And Grief, Ben Hughes

Patient Experience Journal

An increasing number of people worldwide are experiencing fertility and this trend is reflected in the data from the United Kingdom. However, most research focuses on the experiences of women and so the male perspective is largely missing from the literature. This narrative is an account of my personal journey of secondary infertility. Presenting a male perspective of infertility provides a point of view which is rarely explored and is about a topic which feels largely a societal taboo. I chart how infertility has changed me, what it has meant to me through my years of trying to come to …

When Hope Meets Harm: A Story Of Trust, Pain, And Consent In Intimate Care, Sharon I. Choe, Erin Foster

Patient Experience Journal

Transparent communication is key to building and maintaining strong patient-provider relationships. In this article, I interviewed a patient who shared her experience undergoing treatment for a chronic vulvar condition and the consequences that followed. She described a painful procedure for which she felt unprepared and later realized she had not been educated about the need for ongoing care. Years later, this gap in understanding contributed to irreversible disease progression. After re-establishing care with a dermatologist she felt comfortable confiding in, the patient expressed a desire for her story to be shared. This narrative presents her experience as she shared it …

Ai As A Physician Companion In Enhancing Trust In Healthcare, Saria Gouher

Patient Experience Journal

Trust remains a fundamental pillar of the physician–patient relationship, ensuring care that is safe, evidence-based, and grounded in shared decision-making; however, the increasing use of artificial intelligence tools such as ChatGPT has introduced a new dynamic in how patients interpret symptoms and seek medical advice. This narrative describes a clinical encounter involving an elderly patient with multiple myeloma whose caregiver used ChatGPT to evaluate new-onset slurred speech suggestive of stroke, resulting in an urgent recommendation driven by incomplete clinical information. Through comprehensive history-taking, physical examination, and careful review of the Artificial Intelligence (AI)-generated response, the physician reassured the caregiver, contextualized …

Rebuilding Trust After Bondi Beach: Healing Patients, Protecting Caregivers, And The Sacred Work Of Care, Anne Marie Hadley

Patient Experience Journal

The Bondi Beach tragedy of December 14, 2025 profoundly disrupted Australia's collective sense of safety, belonging, and trust. Beyond the immediate loss of life and injury, such events exert lasting impacts on healthcare systems and the people who work within them. This article explores how trust can be rebuilt not only for patients and communities, but also for caregivers themselves. Drawing on trauma-informed care, psychological safety, and human experience design, it examines the often-overlooked dimensions of staff safety, the essential role of pastoral care and chaplaincy, and the particular vulnerabilities experienced by faith-based caregivers during periods of social fracture and …

Co-Designing Trust: Patient Experience, Relationships, And The Design Of Care, Toni Land

Patient Experience Journal

Trust can have a positive or negative impact on patients, families, and community healthcare experience. Although important, it is often treated as something soft and intangible rather than something intentionally measured and designed. Currently, healthcare organizations collect and report patient experience data related to communication, courtesy, respect, and responsiveness. But these measures do not capture the specific behaviors that influence whether trust builds or whether it stalls. This commentary explores trust as a foundational behavioral and environmental element in healthcare and challenges that improving trust requires more than good intentions; it requires bringing voices to the table through co-design. Starting …

Healing The Social Covenant: Rebuilding Trust And Re-Humanizing Healthcare, Cynda Hylton Rushton

Patient Experience Journal

Violence against healthcare workers continues to escalate despite substantial investments in security measures, workplace violence prevention programs, and legislative protections. Although these interventions are necessary, they have not produced sustained improvements in workforce safety or retention, suggesting that workplace violence is more than a behavioral or security problem. This commentary argues that it also reflects a deeper erosion of trust within healthcare. Drawing on evidence linking workplace violence to burnout, moral injury, psychological distress, and turnover intention among nurses, we propose that repairing trust is essential to sustaining the workforce and healthcare.Building on our earlier work, Rebuilding a Foundation of …

Gci Oncology Suite V2.1 — Multi‑Modal Non‑Invasive Solid Tumor Therapy Platform (Trl‑4/5 Research‑Validated Edition), Michael Victor Caldwell Mr.

Defensive Publications Series

GCI Oncology Suite v2.1 is a unified, open‑hardware therapeutic research platform combining five validated subsystems to achieve 6.2× therapeutic bio‑delivery over standard acoustic vortex therapy (AVT) baselines while maintaining strict safety limits (PCD/TI < 0.7). The platform integrates:

• Acoustophoresis blood preparation

• Protein aggregate reduction

• Fermat spiral structural resonance alignment

• Microbubble vortex clustering (λ=1)

• Focused ultrasound (FUS) pre‑focus sequencing

This final integrated edition also incorporates FDMS‑1.0 and MMRA‑2.0, the only two inventions in your entire portfolio that meaningfully improve real‑world viability:

• FDMS‑1.0 → real‑time acoustic/thermal/cavitation mapping

• MMRA‑2.0 → resonance alignment for vortex stability and delivery precision

All fabrication, assembly, operational, sensing, safety, cleaning, and phantom‑testing procedures …

A Method And A System For Provisioning Virtual And Physical Card Accounts On Digital Wallets, Sushma Shetty, Manab Das, Mitchell L. Wright, Rohini Suren

Defensive Publications Series

Systems and methods are disclosed for provisioning virtual and physical card accounts onto digital wallets. Upon receiving a provisioning request, a server computer identifies an account type using internal database indicators and routes tokenization requests to an appropriate entity-an issuer for physical card accounts, and an issuer token service provider for virtual accounts. The invention eliminates a need for issuers to provide dedicated account ranges for virtual cards, supports provisioning on existing BIN ranges, and enhances issuer flexibility and commercial offerings in electronic payment systems. The system utilizes internal logic for the account type identification and routing, streamlining the provisioning …

An Adaptive Geometric Vector Encoding Language And Spatial-Harmonic Compiler For Topological Computing Engines, Christopher L. Eckes

Defensive Publications Series

This disclosure establishes a non-textual, multi-dimensional machine language and compiling framework optimized for two-dimensional quantum fluid and topological computing substrates. By replacing linear, binary assembly instruction sets (e.g., QASM) with spatial-harmonic vector topologies, programming commands are encoded directly as geometric phase deformations and wave-packet configurations. A bi-directional, reversible semantic compiler architecture is defined to eliminate information erasure latency and satisfy thermodynamic zero-emission constraints during algorithmic runtime execution.

Longitudinal Behavioral Delta Detection System And Method For Passive Multi-Modal Audio Analysis, Eric Zavesky

Defensive Publications Series

A system and method for passive longitudinal behavioral delta detection through multi-modal audio analysis is disclosed. The system comprises an edge audio capture device for continuously capturing ambient audio, an on-device multi-modal feature extraction pipeline extracting acoustic features as semantic-level representations, topic-level natural language embeddings without retaining specific words, behavioral graph topology interaction data, and classified non-verbal sound event frequency vectors, and a longitudinal delta detection engine computing temporal deltas at multiple resolutions against a historical baseline. A privacy architecture ensures on-device processing with content obliteration and hashed entity identity. A model adaptation layer provides supervised, unsupervised membership testing, and …

Pipeline-Based Data Processing Method, System, And Hardware Apparatus, Jinhui Wu

Defensive Publications Series

Existing data processing systems universally adopt a centralized computing paradigm that relies on
complex operations, resulting in high computational resource consumption and significant bandwidth
redundancy. This paper proposes a data processing method, system, and hardware apparatus based on a
Pipeline Array, wherein input data is distributed across multiple independent Pipelines. Each Pipeline
independently maintains a state value, compares the input against its state, outputs upon change, Blocks
when unchanged, and independently updates its state value. Founded on the Zero-Computation Property
(core operations are comparison and assignment only), the system comprises Pipeline, State Storage,
Compare, Output Control, and State Update modules. …

A Fluid-Dynamic Architecture For Topological Qubit Protection Against Phononic Decoherence, Christopher L. Eckes

Defensive Publications Series

This disclosure formalizes a non-particle engineering framework for stabilizing quantum states against environment-induced decoherence using topological surface harmonics. By reinterpreting qubits as localized vertical tension fields on a discrete two-dimensional information fluid substrate (\(z=0\)), phase stability is established via passive geometric vortex compaction and time-periodic (Floquet) symmetry protection fields rather than active physical isolation. Real-world laboratory verification testing protocols using fractional quantum Hall two-dimensional electron gases (2DEGs), topological acoustic metamaterials, and cascaded superconducting waveguides are explicitly defined to provide prior art for scalable quantum computing architectures.

Real-Time Temporal-Consistent Virtual Attire Synthesis And Occlusion Handling In Video Communication Interfaces, Richa Gupta

Defensive Publications Series

Professionals in hybrid and remote work environments frequently face challenges transitioning between casual attire and business-appropriate clothing for unexpected or back-toback video calls. Existing solutions such as virtual try-on engines, three-dimensional (3D) avatars, and facial augmented reality (AR) filters suffer from limitations including offline processing requirements, loss of authentic human presence, and inability to handle body apparel dynamics. The disclosed technology provides a digital wardrobe system integrated into video communication pre-call interfaces, utilizing edge-based neural rendering to synthesize realistic clothing over live video streams. The system employs neural fabric anchoring with pose estimation for temporal stability, and a real-time depth-based …

The Registered Dietitian Nutritionist’S Implementation Of Dysphagia Screening In Clinical Practice: A Commentary, Nicole Wiksten, Holly Estes-Doetsch, Laura C. Boucher, Sarah Rusnak, Kristen M. Roberts

Journal of Dietetic Education

Background: The Accreditation Council for Education in Nutrition and Dietetics (ACEND) amended the competencies for the future education model (FEM) in dietetic education to include competency 3.6 stating that the Registered Dietitian Nutritionist (RDN) must be able to "Initiate and conduct bedside swallow screenings". There is no clear process for RDNs to implement dysphagia screening in practice or academia. The aim of this review is to inform clinicians and educators on current literature discussing current RDN and speech language pathology approaches to dysphagia screening and to provide a proposed curriculum for implementation of competency 3.6 in clinical practice and academia.

Disability-Related Educational Content In Nutrition And Dietetic Programs: An Exploratory Study, Wendy Medunick, Allison Gomes, Joachim Sackey, Laura Byham-Gray, Jane Ziegler

Journal of Dietetic Education

Background: Health disparities experienced by people with disabilities (PWD) are partly attributed to inadequate knowledge, training, confidence and competence regarding disabilities among health professionals. While registered dietitian nutritionists (RDNs) are key members of the healthcare team, it is unclear how pre-professional nutrition and dietetics (ND) programs prepare future RDNs to care for PWD. This study examined the status of disability-related education within ND programs in the United States. Methods: A descriptive cross-sectional electronic survey was distributed to 570 directors of accredited ND programs. The survey, which adapted questions from a previously validated instrument and published studies, included questions assessing disability-related …

Assessing And Addressing Cultural Competence And Cultural Humility In Dietetic Education, Zoe Duran, Nicholas Slagel, Lisa Caldwell, Katie Kage

Journal of Dietetic Education

Limited theory-informed, dietetic-specific resources are available to guide the development, evaluation, and refinement of culturally competent (CC) curricula. This pilot study used a mixed-methods, theory-informed approach to evaluate CC integration within an undergraduate dietetics curriculum and examine the applicability of existing CC self-assessment tools for dietetic students. A senior-level undergraduate community nutrition curriculum was evaluated using the Tool for Assessing Cultural Competence Training (TACCT), guided by the Campinha-Bacote Model of Cultural Competence in Healthcare Delivery. James Banks’ Model of Multicultural Curriculum Reform was then applied to refine curricular content and learning activities. In addition, 74 students enrolled in a didactic …

Virtual Reality: The Future Of Didactic And Experiential Education For Nutrition And Dietetics, Michael Holik, Dexter Richardson

Journal of Dietetic Education

The integration of virtual reality (VR) into nutrition and dietetics education provides an innovative answer to challenges in accessing experiential learning. This study examined student perceptions of immersive VR experiences designed to simulate hospital foodservice operations and nutrition counseling sessions, guided by the Diffusion of Innovation Theory (DOI). A quasi-experimental design involved 55 participants who engaged with 360° VR modules featuring interactive elements, avatars representing key healthcare roles, and embedded critical-thinking questions. Results demonstrated strong support for VR’s educational value across DOI’s five key attributes: relative advantage, compatibility, complexity, trialability, and observability. Participants reported enhanced understanding of registered dietitian roles, …

How Philip K. Dick Used The Unreliable Narrator To Transport Unwitting Acolytes, Michael Barros, Jordi Smith

Dialogue: The Interdisciplinary Journal of Popular Culture and Pedagogy

This essay examines the use of the unreliable narrator to transport the reader into narrative worlds, specifically in Philip K. Dick's fiction. By exploring the phenomenon of narrative transportation and the role of emotions in engagement with fiction, we argue that Dick's use of the unreliable narrator significantly engages and transports readers into his narrative worlds. Subsequently, we contend that his belief in the fundamental reality of those worlds is effectively positioning himself as a gatekeeper and mediator between the narrative world and the real world, which sets him, in his mind, as a prophet, using fiction as a tool …

Assessing And Addressing Financial Risk In Capitated Primary Care Contracts, Michael R. Wieck Dba, Laurence Smith, Steven R. Stout Dba

Engaged Management ReView

We employ multivariate statistical modeling and Monte Carlo simulation to study systematic and unsystematic financial risk faced by physician groups under capitated contracts with Medicare Advantage Organizations (MAOs). We use mixed methods and a standard reimbursement formula for risk-sharing contracts with primary care physicians (PCPs). We find that diversifying risk simply by increasing the size of a practice is insufficient to mitigate risks of large negative cash flows from capitation contracts and can result in financial failure. However, if use of costly medical services by patients is reduced from levels typically experienced under traditional Medicare to the levels of patients …

Letter From The Professor

Scientific Kenyon: The Neuroscience Edition

No abstract provided.

An Architecture Of Vanishing: Toward A Protocol Of Archival Disappearance, Edgardo Civallero

Journal of Contemporary Archival Studies

This article rethinks the preservationist reflex that equates archival care with permanence. Drawing on post- and decolonial theory, it provincializes endurance as a historically situated ideal and foregrounds global traditions where disappearance, opacity, and cyclical renewal structure memory. It reframes vanishing as custodianship rather than neglect, introducing a taxonomy of protocols of epistemic disappearance—temporal, spatial, relational, semantic, and material—and a grammar of vanishing that operationalizes them as design tools. Extending to institutions, it outlines seasonal, dismantling, shadow, and nomadic archives as forms that measure success by their capacity to end well. A concluding framework articulates five principles—vanishing as care, duration …

Exploring The Situation Of Health Literacy Promotion To Delay Kidney Disease Progression In Older Adults With Chronic Kidney Disease: A Convergent Parallel Mixed-Method Study, Kritanon Janthasri, Ladawan Panpanit, Khanitta Nuntaboot

Journal of Health Research

Background: Health literacy (HL) is crucial for delaying chronic kidney disease (CKD) progression, yet evidence on HL promotion among older adults with early-stage CKD is limited. This study examines HL level and explores the situation of HL promotion for delaying kidney progression among older adults with CKD.

Methods: A convergent parallel mixed-methods design was employed. The quantitative phase, 297 older adults with CKD complete a questionnaire. The qualitative phase, 50 participants then took part in interviews to explore their experiences. Quantitative data were analyzed using descriptive statistics, and qualitative data through content analysis. Findings were integrated to identify …

Wildfire Risk & Preparedness For Urban Rail Operators Supporting Large Stadium Events, Karl Kim, Eric Yamashita, Daniele Spirandeli, David Rother

Mineta Transportation Institute

The project team, in collaboration with partners and stakeholders, developed a four-hour training course designed to build a foundational understanding of how wildfire hazards affect rail systems infrastructure operations and how this knowledge can help equip urban rail operators with tools and best practices for proactive risk management. Led by the University of Hawaiʻi and the National Disaster Preparedness Training Center, in partnership with Haley & Aldrich, Inc., this technical report presents an overview of the four modules and scenario planning exercise that together make up the four-hour Wildfire Risk & Preparedness for Urban Rail Operators Supporting Large Stadium Events …

Enhancing Wildfire Resilience In The Rail Industry: Developing A Community Resilience Extreme Events Portal (Creep), Karl Kim, Eric Yamashita, Daniele Spirandeli, David Rother, Chris Chiesa, Greg Hampe, Michele Toner

Mineta Transportation Institute

The Community Resilience Extreme Events Portal (CREEP) provides a centralized platform for accessing wildfire danger indices, critical asset locations, and vulnerability scores for rail segments. The project team developed a data-driven, indicator-based vulnerability assessment framework that defines vulnerability as a function of exposure, sensitivity, and adaptive capacity. To build this framework, the team selected publicly available datasets, prioritizing national datasets whenever possible to ensure transparency, reproducibility, and scalability. The portal allows users to analyze and visualize vulnerability across 1-kilometer segments of Class I freight and passenger rail lines in California, supporting planning and mitigation prioritization to help reduce rail-related fatalities, …