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 …

Book Review - Innovative Pedagogical Practices In Sport Management Education, Mitchell Mcsweeney

Global Sport Business Journal

This review examines Innovative Pedagogical Practices in Sport Management Education, an edited collection that provides a comprehensive resource for enhancing teaching, curriculum design, and student learning in sport management. Organized across seven thematic sections, the book integrates theory with practical classroom applications, covering topics such as active learning, experiential education, diversity and inclusion, critical pedagogy, digital technologies, leadership, and emerging trends. The review highlights the collection's emphasis on actionable teaching strategies, reflective practice, and future-oriented innovation. 

Ai-Enhanced Fluorescein Angiography Detection Of Diabetes-Induced Silent Retinal Capillary Dropout And Rna-Seq Identification Of Pre-Symptomatic Biomarkers, Yiyan Peng, Huishi Toh, Dennis Clegg, Peng Jiiang

Biological, Geological, and Environmental Faculty Publications

Objective: Retinal capillary dropout, characterized by acellular capillaries or "ghost vessels," is an early pathological sign of diabetic retinopathy (DR) that remains undetectable through standard clinical imaging techniques until visible morphological changes, such as microaneurysms or hemorrhages, occur. This study aims to develop a non-destructive artificial intelligence (AI)-based method using fluorescein angiography (FA) images to detect early-stage, silent retinal capillary dropout.

Methods: We utilized 94 FA images and corresponding destructive retinal capillary density measurements obtained through retinal trypsin digestion from 51 Nile rats. Early capillary dropout was defined as having an acellular capillary density of >= 18 counts per mm2. …

Integrating Naturalistic Developmental Behavioral Interventions In Inclusive Classrooms To Support Autistic Students, Paige J. Johnson

Electronic Theses and Dissertations

The current trend of an increasing prevalence rate of autism spectrum disorder creates a growing need for evidence-based interventions that can be accessed in the natural environments, such as within inclusive educational settings. Naturalistic Developmental Behavioral Interventions (NDBIs) integrate principles of applied behavior analysis and developmental psychology, and offer effective tools for increasing social communication behaviors in autistic children that align with the neurodiversity-affirming movement. The present study sought to evaluate the effectiveness of Behavior Skills Training (BST) in teaching core NDBI skills to a preschool teacher, examine changes in teacher self-efficacy related to supporting autistic students, and assess the …

A Mixed-Methods Pilot Study Of A 10-Week Wellness Program For Resident Assistants, Emily L. Lee-Chong

Electronic Theses and Dissertations

This mixed-methods pilot study used semi-structured interviews with 15 resident assistants (RAs), complemented by descriptive pre- and post-test data from the Five Factor Wellness Inventory (FFWEL), to explore their lived experiences of participating in a 10-week wellness program grounded in the Indivisible Self Model of Wellness (IS-WEL). The purpose of this study was to examine the program's perceived influence on wellness practices and to explore the feasibility of implementing wellness-focused programming. Using a hermeneutic inquiry approach, the study identified four themes reflecting participants’ experiences throughout the program. Themes highlighted the importance of self-awareness through the IS-WEL model, the value of …

Race And Trauma: An Analysis Of Trauma Symptomology Across Diverse Youth Populations, Mara J. Niccoli

Electronic Theses and Dissertations

The adverse effects of trauma, particularly among youth who identify as Black, is a critical issue. This study investigated the relationship between race and trauma symptomology among children and adolescents who received weekly trauma therapy. With the use of clinical assessment data, this study sought to determine whether Black youth presented to treatment with higher trauma acuity than non-Black youth and if there were disparate outcomes in symptomology after treatment. The results indicated that on average, Black youth presented to treatment with lower trauma acuity than non-Black youth, and there were disparate outcomes in trauma symptomology between the two racial …

The Narrative In The Algorithm: Storytelling, World Literature, And The Smartphone, Chad Szalkowski-Ference

Electronic Theses and Dissertations

In this dissertation, I interrogate the role algorithms, artificial intelligence, and smartphone technology play in contemporary world literature. My analysis begins with the post-truth condition, which speaks to the contemporary era’s embrace of alternative facts, authoritarianism, and conspiratorial thinking. I draw on narrative theory and paradigms of world literature to show how “algorithmic reasoning” has led to a state of paranoid persecution. This reasoning has forged new collectivities across traditional borders. Additionally, I show that these new collectivities and new technologies have produced new narrative points of view: the algorithmic first- and third-person, allowing narratives to retain the intimacy and …

Large-Scale Dna Barcoding Reveals Highly Distinct Insect Distribution Patterns Across Costa Rican Ecosystems, José A. Hernández Ugalde, Daniel H. Janzen, Winnie Hallwachs, Bert Kohlmann, Paul D.N. Hebert, Brian V. Brown, James Whitfield, José. L. Fernández-Triana, Roberto Fernández Ugalde, Eugenie Phillips Rodriguez, Ronald Zúñiga, M. Alex Smith, Dirk Steinke, Michael Sharky, Donald Quicke, Ramya Manjunath, Robert Puschendorf

School of Biological and Marine Sciences

Although insects are fundamental to understanding and conserving global biodiversity, they are vastly understudied. Here, we present a national inventory of Costa Rican insects based upon 3.78 million DNA barcodes representing 152 891 Barcode Index Numbers (BINs, proxies for species) from 28 localities sampled from 2017 to 2023 through the national BioAlfa program of Costa Rica. Although only 3.6% of BINs are linked to Linnean species, barcode-based community analyses revealed strong, consistent ecogeographic structure. Clustering of BIN data using bootstrapped Jaccard distances revealed seven distinct mainland assemblages and a distinct island cluster, shaped primarily by Costa Rica’s mountain ranges, elevation, …

S.A.S.B. Corp V. Johnson & Johnson Health Care Systems Inc

2026 Decisions

USDC for the District of New Jersey

Implementation Of A Cognitive Aide To Guide The Use Of Non-Invasive Hemodynamic Monitoring For Goal-Directed Fluid Therapy During Cesarean Deliveries, Ashley George, Ashley Walbert

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, with delayed recognition contributing to adverse outcomes during cesarean delivery. In cesarean deliveries, traditional intermittent non-invasive blood pressure monitoring may not detect early hemodynamic instability, creating a need for more structured interpretation of continuous hemodynamic data. This Doctor of Nurse Anesthesia Practice quality improvement project implemented a cognitive aid to support anesthesia providers using the Edwards EV1000/ClearSight platform during goal-directed fluid therapy. A pre–post implementation design using provider surveys evaluated feasibility, usability, confidence, and perceived impact. By organizing continuous values such as stroke volume, cardiac output, and systemic …

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 …

Improving Chlamydia Testing For Females Through Universal Screening In Outpatient Pediatric Primary Care: An Adolescent Quality Improvement Initiative, Christina Howard

Doctor of Nursing Practice (DNP) Manuscripts

Chlamydia is the most common sexually transmitted infection in the United States in adolescents and young adults (Dutra & Lazenby, 2023). Per Smith, Reirden, and Nyquist (2022), adolescents and young adults between the ages of 15 and 24 account for more than 60% of new chlamydia infections each year. Testing for chlamydia is not standardized, and it is estimated that only 50% of those who qualify receive a yearly screening American Sexual Health Association. (2021). If outpatient testing and treatment is not improved these asymptomatic cases will be missed, infections in general will increase, and reinfections may occur leading to …

Enhancing New Graduate Nurse Confidence And Patient Safety Through Clinical Development Coach Integration, Megan T. Kramer

Doctor of Nursing Practice (DNP) Manuscripts

The transition from student to professional nurse is a critical developmental stage often marked by heightened stress, emotional exhaustion, and uncertainty in clinical judgment. These challenges frequently contribute to lower confidence levels, increased anxiety, and higher risks for patient safety events among new graduate nurses. This program evaluation project aims to assess the effectiveness of integrating a Clinical Development Coach (CDC) role to enhance new graduate nurse’s confidence, comfort, and overall competence while reducing patient safety incidents on a trauma/surgical inpatient unit in a medical center on the East coast. The CDC role is a structured mentorship and resource position, …

Implementation Of A Deteriorating Patient Simulation For New Graduate Nurses To Improve Clinical Judgment: A Quality Improvement Project, Kasey Mundell

Doctor of Nursing Practice (DNP) Manuscripts

New graduate nurses (NGNs) often have trouble recognizing and responding to patient deterioration because of limited clinical judgment and confidence during the transition to practice. This quality improvement project evaluated the implementation of a high-fidelity deteriorating patient simulation within a new graduate nurse orientation program at a Level I trauma center. Guided by the Plan-Do-Study-Act framework and the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice, the simulation focused on the assessment and management of a patient experiencing pulmonary embolism. Eight NGNs participated in the simulation and completed the Attitudes Toward Recognizing Early and Noticeable …

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 …

From Novice To Competent: Enhancing Orientation And Readiness For Post-Anesthesia Care Nurses, Gerri Y. Young

Doctor of Nursing Practice (DNP) Manuscripts

Post-anesthesia care unit (PACU) nurses are responsible for managing complex postoperative patients requiring advanced clinical judgment, airway management, hemodynamic monitoring, and rapid recognition of complications. Many nurses transition into the PACU without formal perianesthesia education, resulting in variability in orientation practices, competency validation, and preparedness for independent practice. At a military treatment facility (MTF) in Mississippi, 78% of newly assigned PACU nurses had only one to two years of medical-surgical experience, and a standardized orientation program was not available.

This quality improvement project aimed to implement and evaluate a standardized, evidence-based PACU orientation program designed to improve nurse knowledge, confidence, …

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 …

Pcom Doctor Of Osteopathic Medicine Class Of 2030 White Coat Ceremony, Philadelphia College Of Osteopathic Medicine

White Coat Ceremony

Program of PCOM Philadelphia Campus 2026 White Coat Ceremony Program for the Class of 2030.

Guest Speaker: Michael A. Becker, DO '87, Senior Associate Dean of Clinical Education, Professor, Department of Family Medicine.

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 …

Fast Mr Imaging: Reducing Sedation And Improving Patient Experience, Hajir Aljumaily

Radiologic Sciences

Purpose To examine the impact of fast magnetic resonance (MR) protocols on sedation requirements, patient tolerance, workflow efficiency, and diagnostic accuracy in musculoskeletal and brain imaging.

Method An integrative literature review was conducted using PubMed, CINAHL, and Google Scholar to identify peer-reviewed, original research articles published between 2019 and 2026. Studies were selected for relevance, human subjects, and outcomes related to sedation, patient experience, or diagnostic effectiveness.

Results Fast MR protocols were consistently associated with reduced sedation use, improved patient comfort, and increased exam completion rates. Workflow efficiency improved due to shorter scan times. Although minor reductions in image quality …

Ai Integration In Radiotherapy Workflows: Emerging Trends And Best Practices, Vi T. Dinh

Radiologic Sciences

Purpose To synthesize current evidence on artificial intelligence (AI) integration in radiotherapy workflows, identify emerging application trends, and examine best practices for clinical implementation.

Method A structured literature review was conducted using PubMed, Scopus, and Google Scholar to identify peer-reviewed studies published between 2015 and 2025. Eligible studies evaluated AI applications in radiotherapy workflows, including segmentation, treatment planning, and clinical decision-making. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) AI-based segmentation improved contouring efficiency and reduced interobserver variability; (b) AI-assisted treatment planning enhanced dose prediction consistency and workflow reproducibility; and (c) workflow integration supported clinical decision-making …

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 …

Impact Of Music On Patient Comfort During Mr Scans: A Literature Review, He Yan

Radiologic Sciences

Purpose To investigate the influence of auditory stimuli on patient comfort levels during magnetic resonance (MR) imaging, with particular emphasis on indicators of distress, duration of patient positioning, and utilization of emergency signaling devices.

Method An integrative literature review was undertaken utilizing peer-reviewed research articles sourced from journals within the fields of radiology, music therapy, and clinical practice. A comprehensive search was conducted across databases such as PubMed, ScienceDirect, SpringerLink, and Oxford Academic employing keywords including MR anxiety, music therapy, and patient comfort.

Results The body of literature consistently indicated that auditory stimuli significantly mitigate patient anxiety and distress in …

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 …

Improving Recognition And Communication Of Early Patient Condition Changes Through An Evidence-Based Staff Education Program, Raymond Mwanje

Walden Dissertations and Doctoral Studies

This doctoral project is a staff education project aimed at enhancing recognition and communication of early changes in patients' conditions in a long-term care rehabilitation environment. Delayed recognition of patient deterioration is a major challenge in nursing practice, as subtle changes in a patient's condition may go unnoticed, leading to delayed intervention, avoidable complications, and unnecessary hospital transfers. Poor communication among staff can also hinder the escalation of care, impacting patient safety and quality of care. There is evidence that structured communication strategies and education interventions can help enhance communication between clinicians and aid earlier detection of patient deterioration. Resolving …

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 …