Digital Commons Network^™

Enhancing Fairness In Disease Prediction By Optimizing Multiple Domain Adversarial Networks, Bin Li, Xiaoqian Jiang, Kai Zhang, Arif O Harmanci, Bradley Malin, Hongchang Gao, Xinghua Shi

Faculty, Staff and Student Publications

Predictive models in biomedicine need to ensure equitable and reliable outcomes for the populations they are applied to. However, biases in AI models for medical predictions can lead to unfair treatment and widening disparities, underscoring the need for effective techniques to address these issues. However, current approaches struggle to simultaneously mitigate biases induced by multiple sensitive features in biomedical data. To enhance fairness, we introduce a framework based on a Multiple Domain Adversarial Neural Network (MDANN), which incorporates multiple adversarial components. In an MDANN, an adversarial module is applied to learn a fair pattern by negative gradients back-propagating across multiple …

Malperfusion In Patients With Acute Type A Aortic Dissection: A Nationwide Analysis, Nicholas J Goel, John J Kelly, William L Patrick, Yu Zhao, Joseph E Bavaria, Maral Ouzounian, Anthony L Estrera, Hiroo Takayama, Edward P Chen, T Brett Reece, G Chad Hughes, Eric E Roselli, Karen M Kim, Himanshu J Patel, Michael E Bowdish, Jason S Sperling, Bradley G Leshnower, Ourania Preventza, William T Brinkman, Nimesh D Desai

Faculty, Staff and Student Publications

Background: This study describes in detail the clinical burden of malperfusion associated with acute type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.

Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions on the basis of imaging or the surgeon's evaluation. Multivariable logistic regression was used to analyze the effect of patient and treatment factors on outcomes in patients with and without malperfusion.

Results: A total of 9958 patients undergoing …

Us Infant Formulas Contain Primarily Added Sugars: An Analysis Of Infant Formulas On The Us Market, Audrey R. Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, Tera L. Fazzino

Manuscripts, Articles, Book Chapters and Other Papers

Added sugar consumption is contraindicated for infants <  2 years old; however added sugars are present in many US infant formulas. We examined whether US formulas contain primarily added sugars, or whether formulas contain primarily naturally occurring lactose (the sugar in human milk). Data were obtained from the Nutrition Data System for Research and included formulas available on the US market in 2022 (N = 73). Formulas were categorized as: standard (n = 31), gentle (n = 27), and lactose-free (n = 15). Differences across formulas were examined using Bayesian modeling. The median percent added sugars were high in standard (M=59.7 %; IQR=22.0), gentle (M=85.0 %; IQR=39.5), and lactose-free formulas (M=90.0 %; IQR=54.3). Gentle formulas had significantly lower proportional lactose (OR=0.22, 95 % HDI=[0.11,0.44], pd=99.3 %) and > 2 fold higher proportional added sugars compared to standard formulas (ORs=2.11–2.57, HDI>0, pd=99.1–99.99 …

The Effects Of Odevixibat In People With Alagille Syndrome: A Plain Language Summary, Nadia Ovchinsky, Madeleine Aumar, Alastair Baker, Philip Bufler, Mara Cananzi, Piotr Czubkowski, Ryan T. Fischer, Giuseppe Indolfi, Wikrom Karnsakul, Florence Lacaille, Way S. Lee, Philip Rosenthal, Etienne Sokal, Henkjan J. Verkade, Andrew Wehrman, Cher Bork, Roberta Smith, Jessica Ruvido, Alexander Artyomenko, Christof Maucksch, Ekkehard Sturm

Manuscripts, Articles, Book Chapters and Other Papers

This is a summary describing a phase 3 clinical trial, called ‘ASSERT’, which studied the medicine odevixibat in people with Alagille syndrome.

Alagille syndrome is a rare disease that can affect different parts of the body, but mainly affects how well the liver works. Symptoms usually start at a young age, but the age of first symptoms and seriousness of the disease can vary, and the disease can affect both children and adults. People who have Alagille syndrome may have a build-up of bile acids in the liver and this can lead to organ damage. People with Alagille syndrome …

Justification, Margin Values, And Analysis Populations For Oncologic Noninferiority And Equivalence Trials: A Meta-Epidemiological Study, Troy J Kleber, Alexander D Sherry, Andrew J Arifin, Gabrielle S Kupferman, Ramez Kouzy, Joseph Abi Jaoude, Timothy A Lin, Esther J Beck, Avital M Miller, Adina H Passy, Zachary R Mccaw, Pavlos Msaouel, Ethan B Ludmir

Faculty, Staff and Student Publications

Background: Noninferiority and equivalence trials evaluate whether an experimental therapy's effect on the primary endpoint is contained within an acceptable margin compared with standard of care. The reliability and impact of this conclusion, however, is largely dependent on the justification for this design, the choice of margin, and the analysis population used.

Methods: A meta-epidemiological study was performed of phase 3 randomized noninferiority and equivalence oncologic trials registered at ClinicalTrials.gov. Data were extracted from each trial's registration page and primary manuscript.

Results: We identified 65 noninferiority and 10 equivalence trials that collectively enrolled 61 632 patients. Of these, 61 (81%) …

Enhancing The Safety And Efficacy Of Cell Therapy With Programmed Sense-And-Respond Function, Andrew J Walters, Xiaoyu Yang, Scott D Olson, Caleb J Bashor

Faculty, Staff and Student Publications

No abstract provided.

Investigating The Role Of School Leaders’ Feedback In Texas Noncertified Teachers’ Professional Growth And Self-Efficacy, Sonja R. Long

Electronic Theses and Dissertations

The problem addressed in this study was that the role of school leaders’ feedback in noncertified teachers’ professional growth and self-efficacy is unknown. The purpose of this case study was to investigate the perspectives of noncertified teachers’ understanding of their school leaders’ feedback and how those practices contributed to their professional growth and self-efficacy. A qualitative case study approach was used, with data collected from 12 participants across six Texas school districts through semistructured interviews, questionnaires, and classroom observation documents. Data were transcribed, coded, and analyzed thematically, with triangulation and member-checking ensuring credibility. Two key findings emerged. First, supporting professional …

Why Teachers Stay: A Multiple Case Study Of Retention In Small To Midsized Schools, Karen Shaw Ewton

Electronic Theses and Dissertations

Teacher retention presents a critical challenge for small to midsized school districts, often compounded by limited resources and unique community dynamics. Using Herzberg’s twofactor theory, this qualitative study explored factors influencing teacher retention in districts with retention rates exceeding 85%. Semistructured interviews with nine teachers examined the impact of hygiene factors, such as administrative support and compensation, and motivators, like autonomy and professional growth. Thematic analysis revealed that administrative support and equitable workloads prevent dissatisfaction, while motivators such as meaningful relationships, recognition, and relevant professional development drive commitment. Professional development emerged as both a motivator and a hygiene factor based …

From Self To Society: How Threat Type And Message Mode Affect Environmental Intentions Among Young Audiences, Lucas Vogt

Electronic Theses and Dissertations

This study examined the influence of threat type (personal vs. societal) and message mode (narrative vs. utilitarian) on young adults’ environmental intentions. Using the extended parallel process model (EPPM), this study argued for expanding the theory to include threat type (societal vs. personal) to clarify how threat is understood. A 2 x 2 factorial design was utilized to test the effects of threat type and message mode on environmental behavioral intentions. A sample of 266 university students participated in an online survey. Based on prior research, this study hypothesized that personal threats would yield the highest levels of environmental behavioral …

Intimate Partner Violence's Impact On Subsequent Relationships, Aurora Sloan

Electronic Theses and Dissertations

Intimate partner violence (IPV) negatively impacts relationships and the partners who engage in them. There has been research done into many facets of IPV relationships, such as risk factors and conflict. However, this thesis aims to answer the question, “How does IPV victimization affect subsequent partner selection, conflict management, experience of safety, and overall perception of the relationship?” In order to answer this question, I surveyed and interviewed previous victims of domestic violence and analyzed the content of their responses to identify common themes.

Trust And Success: Franchisee Perspective On Relational Trust With The Franchisor And Impact On Unit Growth, Giovannie M. Hoff

Electronic Theses and Dissertations

Abstract

The problem addressed in this study was that it is unknown how franchisees perceive trust and its influence on unit growth and contractual control within the franchisor and franchisee relationship. The purpose of this case study was to explore the franchisee’s perspective of trust within the franchisor and franchisee relationship and its impact on growth and contractual control. A qualitative case study approach was used, with data collected from 13 participants from one franchise organization in the United States through semistructured interviews and questionnaire. Data were transcribed, coded, and analyzed thematically, with triangulation and member-checking ensuring credibility. Two key …

Sacred Connections In Cartoonish Places: Exploring The Implications Of Teotl In Avatar: The Last Airbender (2008), Makenzie P. Morrison

Electronic Theses and Dissertations

Taking Avatar: The Last Airbender (2008) seriously, Sacred Connections in Cartoonish Places explores the animated children’s series and how it is understood through the monistic Nahua (Aztec) concept of teotl. Relying on James Maffie’s text Aztec Philosophy: Understanding a World in Motion (2014), this thesis determines that Avatar: The Last Airbender benefits from monistic analysis. This analysis results in a breakdown of the show into four body chapters. These chapters respectively explore Aang’s role as a monistic representative, the differences between the physical and spirit worlds presented in the show, the kind of relationships that appear in the series, and …

Proactive Semantic Suppression As A Form Of Linguistic Control In Bilinguals, Anna V. Chen

Electronic Theses and Dissertations

Current literature is divided on the topic of the bilingual advantage, or the question of whether bilingualism confers a distinct advantage in executive control, specifically in cognitive processes like inhibitory control and task-switching (Bialystok et al., 2005; Paap & Greenberg, 2013). This study seeks to provide more insight into underlying mechanisms of cognitive control in bilinguals compared to monolinguals by investigating proactive linguistic control, the bilingual ability to activate one linguistic system while suppressing irrelevant semantic information in the other (Declerck & Koch, 2023; Rainey et al., 2021). The Stroop task, a widely used test for executive functioning, was employed …

A Qualitative Study Exploring Senior Leaders’ Experiences And Perceptions In Addressing Workplace Sexual Harassment In The U.S. Federal Government: A Systems Perspective, Karen Jane Dean

Electronic Theses and Dissertations

Sexual harassment (SH) is a prevalent, costly, and often unreported problem in the U.S. Federal Government. Despite decades of research from multiple perspectives and recommendations to address SH, the problem persists and remains complex. While some researchers and U.S. Government agencies have called upon leaders to commit to eliminating workplace SH, others have suggested using an integrated conflict management system (ICMS) to manage the complexity, nuances, and conflicts. Even though there is a call for leadership to address SH, there is limited documentation in the literature about leaders’ experiences and perceptions in addressing the problem. Therefore, this qualitative study was …

Bridging The Digital Skills Gap: Positive Leadership In The Aerospace Industry 4.0, James Richard Robinson Ii

Electronic Theses and Dissertations

This qualitative study explores how employees and leaders in a major aerospace manufacturing organization experience digital transformation in the context of Industry 4.0. As emerging technologies reshape manufacturing processes, organizations face a growing digital skills gap, particularly across a multigenerational workforce. This research focuses on how generational differences influence digital adaptation and how leadership approaches either support or hinder that process. Guided by the diffusion of innovations theory, the study involved semistructured interviews with 15 participants from four generational cohorts, representing IT, engineering, manufacturing, and operations roles. Findings reveal that trust, leadership style, and tailored training significantly shape how individuals …

The Lived Experience Of New Graduate Nurses Implementing Evidence-Based Practice In A Clinical Setting, Kimberly A. Mcfarland

Electronic Theses and Dissertations

The purpose of this qualitative interpretive phenomenological analysis study was to explore the perceptions and lived experiences of new graduate nurses (NGNs) as they implemented evidence-based practice (EBP) in clinical settings. This study addressed the problem that NGNs often lack the skills and confidence to effectively apply EBP, despite its critical role in improving patient outcomes. The research aimed to provide insight into the challenges, support systems, and strategies that influence EBP integration during the transition from student to practicing nurse. The study utilized the interpretive phenomenological analysis methodology to analyze data collected through semistructured interviews conducted via the Teams …

Discharge Practice Variability In Pediatric Chronic Home Invasive Ventilation, Guillermo Beltran-Ale, Ryne Simpson, Terri Magruder, Ajay S Kasi, Amit Agarwal, Jake A Kaslow

Faculty, Staff and Students Publications

Introduction: The Pediatric Mechanical Ventilation Society is a collaboration of pediatric pulmonologists with a focus on pediatric chronic home invasive ventilation (PCHIV). Since the initial discharge on PCHIV is not always directed by pediatric pulmonologists, we sought to understand how this variability between centers impact adherence to American Thoracic Society (ATS) guidelines for PCHIV.

Methods: A survey was distributed to pediatric pulmonologists across multiple platforms inquiring about discharging practices for PCHIV and adherence to six of the nine ATS recommendations for PCHIV. Two subgroups were created based on common practices - discharge by pediatric pulmonologists from a non-ICU unit (pulmonary …

An Exploration Of The Influence Of Occupational Mentorship On The Success Of Black Female Executive Leaders In Educational Sales, Bashelia H. Ward

Electronic Theses and Dissertations

The dearth of Black women in executive-level leadership roles within U.S. business organizations persists due to numerous barriers such as tokenism; racial fatigue; stereotypes; a lack of identity; and the intersection of race, gender, and social injustices impeding their upward mobility in the educational sales industry. Despite recognizing the potential for change through tools and programs, the absence of robust occupational mentorship emerges as a pivotal barrier hindering the transformation of Black women’s roles in these educational sales environments. The sample size for this hermeneutical qualitative study was seven Black women in the K–12 educational sales industry. Data collection methods …

Bmal1-Hif2a Heterodimer Modulates Circadian Variations Of Myocardial Injury, Wei Ruan, Tao Li, In Hyuk Bang, Jaewoong Lee, Wankun Deng, Xinxin Ma, Cong Luo, Fang Du, Seung-Hee Yoo, Boyun Kim, Jiwen Li, Xiaoyi Yuan, Katherine Figarella, Yu A An, Yin-Ying Wang, Yafen Liang, Matthew Deberge, Dongze Zhang, Zhen Zhou, Yanyu Wang, Joshua M Gorham, Jonathan G Seidman, Christine E Seidman, Sary F Aranki, Ragini Nair, Lei Li, Jagat Narula, Zhongming Zhao, Alemayehu A Gorfe, Jochen D Muehlschlegel, Kuang-Lei Tsai, Holger K Eltzschig

Faculty, Staff and Student Publications

Acute myocardial infarction is a leading cause of morbidity and mortality worldwide1. Clinical studies have shown that the severity of cardiac injury after myocardial infarction exhibits a circadian pattern, with larger infarcts and poorer outcomes in patients experiencing morning-onset events2–7. However, the molecular mechanisms underlying these diurnal variations remain unclear. Here we show that the core circadian transcription factor BMAL17–11 regulates circadian-dependent myocardial injury by forming a transcriptionally active heterodimer with a non-canonical partner—hypoxia-inducible factor 2 alpha (HIF2A)12–16—in a diurnal manner. To substantiate this finding, we determined …

Robust Privacy Amidst Innovation With Large Language Models Through A Critical Assessment Of The Risks, Yao-Shun Chuang, Atiquer Rahman Sarkar, Yu-Chun Hsu, Noman Mohammed, Xiaoqian Jiang

Faculty, Staff and Student Publications

Objective: This study evaluates the integration of electronic health records (EHRs) and natural language processing (NLP) with large language models (LLMs) to enhance healthcare data management and patient care, focusing on using advanced language models to create secure, Health Insurance Portability and Accountability Act-compliant synthetic patient notes for global biomedical research.

Materials and methods: The study used de-identified and re-identified versions of the MIMIC III dataset with GPT-3.5, GPT-4, and Mistral 7B to generate synthetic clinical notes. Text generation employed templates and keyword extraction for contextually relevant notes, with One-shot generation for comparison. Privacy was assessed by analyzing protected health …

Longevity Humans Have Youthful Erythrocyte Function And Metabolic Signatures, Fang Yu, Changhan Chen, Wuping Liu, Zhixiang Zhao, Yuhua Fan, Zhenjiang Li, Weilun Huang, Tingting Xie, Cheng Luo, Zhouzhou Yao, Qi Guo, Zhiyu Yang, Juan Liu, Yujin Zhang, Rodney E Kellems, Jian Xia, Ji Li, Yang Xia

Faculty, Staff and Student Publications

Longevity individuals have lower susceptibility to chronic hypoxia, inflammation, oxidative stress, and aging-related diseases. It has long been speculated that "rejuvenation molecules" exist in their blood to promote extended lifespan. We unexpectedly discovered that longevity individuals exhibit erythrocyte oxygen release function similar to young individuals, whereas most elderly show reduced oxygen release capacity. Untargeted erythrocyte metabolomics profiling revealed that longevity individuals are characterized by youth-like metabolic reprogramming and these metabolites effectively differentiate the longevity from the elderly. Quantification analyses led us to identify multiple novel longevity-related metabolites within erythrocytes including adenosine, sphingosine-1-phosphate (S1P), and glutathione (GSH) related amino acids. Mechanistically, …

Donor Age Matters For Haploidentical Hct Patients Even After Adjusting For Hla Factors: A Machine Learning Approach, Rohtesh S Mehta, Rodney Sparapani, Tao Wang, Stephen Spellman, Stephanie J Lee, Effie W Petersdorf

Faculty, Staff and Student Publications

No abstract provided.

Enteral Nutritional Practices In Extremely Preterm Infants: A Survey Of U.S. Nicus, Mar Romero-Lopez, Mamta Naik, Lindsay F Holzapfel, Jon E Tyson, Claudia Pedroza, Kaashif A Ahmad, Matthew A Rysavy, Waldemar A Carlo, Yuxin Zhang, Covi Tibe, Ariel A Salas

Faculty, Staff and Student Publications

No abstract provided.

Targeting Discrepancies In Linear Growth Measurements In The Neonatal Intensive Care Unit Through Nursing Interventions: A Quality Improvement Initiative, Gail Snyder, Rebekah Wilkinson, Raina Evans, Meagan Owen, Akram Yazdani, Covi Tibe, Catherine Perez, Lindsay F Holzapfel

Faculty, Staff and Student Publications

Objective: Accurate length measurements are essential for infants to identify growth deficiencies and adjust nutrition accordingly. The gold standard for length measurement in infants is using a length board with two people to obtain an accurate clinical assessment. We aimed to improve the number of measurements with the desired minimal difference, defined as a discrepancy ≤1 cm between nurse and audit measurements, in our center. Our secondary aim was to increase and maintain the number of length boards available.

Methods: This quality improvement (QI) study used a before-and-after intervention comparison design in a single-level IV neonatal intensive care unit between …

Randomized Controlled Trial Of "Bounce Back Now," A Mobile App To Reduce Post-Disaster Symptoms Of Posttraumatic Stress, Depressed Mood, And Sleep Disturbance, Kenneth J Ruggiero, Arthur Andrews, Tatiana M Davidson, Yulia Gavrilova, Brian E Bunnell, Jennifer Dahne, Matthew Price, Zoe M F Brier, Gregory Cohen, Dean Kilpatrick, Ron Acierno, Sandro Galea

Faculty, Staff and Student Publications

Objective: There is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC).

Methods: A population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance …

Adherence To Life’S Essential 8 Is Associated With Delayed White Matter Aging, Li Feng, Zhenyao Ye, Yezhi Pan, Rozalina G Mccoy, Braxton D Mitchell, Peter Kochunov, Paul M Thompson, Jie Chen, Menglu Liang, Thu T Nguyen, Edmond Shenassa, Yan Li, Travis Canida, Hongjie Ke, Hwiyoung Lee, Song Liu, L Elliot Hong, Chixiang Chen, David K Y Lei, Shuo Chen, Tianzhou Ma

Faculty, Staff and Student Publications

Background: The American Heart Association introduced Life's Essential 8 (LE8) to promote cardiovascular health and longevity. However, its impact on brain ageing and interactions with genetic risk factors of dementia, such as APOE4, remains unclear. This study investigates the relationship between LE8 and white matter brain ageing and evaluates the moderating effects of the APOE4 allele.

Methods: This cross-sectional study utilized data from the UK Biobank, including genetic, neuroimaging, and health-related data from touchscreen questionnaires, physical examinations, and biological samples. Participants were non-pregnant whites with LE8 variables, diffusion tensor imaging (DTI) data, and APOE4 genetic information available, excluding those with …

Development Of A Treatment Decision Aid For Patients With Dysplastic Nevi Who Are Candidates For Re-Excision, Jaclyn N Roland-Mcgowan, Steven Caleb Freeman, Wenelia Baghoomian, Bryan T Carroll, Caroline Choi Kim, Clara Curiel-Lewandrowski, Emily Y Chu, Erin L Foster, Kelly Carter Nelson, Kevin P White, Michael E Ming, Rebecca I Hartman, Sancy A Leachman, Stephanie Mengden-Koon, Suephy C Chen, Susan M Swetter, Victor G Prieto, Elizabeth Berry, Wesley Y Yu

Faculty, Staff and Student Publications

No abstract provided.

Blood Pressure Misclassification Among Stroke Survivors Followed In A Comprehensive Stroke Prevention Clinic, M Carter Denny, Maha Almohamad, Emmanuel Ebirim, Adriana Morell, Munachi Okpala, Kevin O Hwang, Sean Savitz, Anjail Sharrief

Faculty, Staff and Student Publications

Background: Hypertension is the most important modifiable risk factor for secondary stroke prevention; however, blood pressure (BP) remains uncontrolled for at least 50 % of stroke survivors following an incident stroke. Accurate in-clinic assessment of BP is important for appropriate medication titration. We evaluated misclassification of clinic BP control in a racially diverse stroke clinic population using two BP measurement methods.

Observations: We followed ischemic stroke, intracerebral hemorrhage, and transient ischemic attack patients after hospital discharge in a comprehensive stroke clinic. Casual BP was obtained using a standard office automated machine, attended by a medical assistant. BP was also measured …

Rna Sculpting By The Primordial Helix-Clasp-Helix-Strand-Loop (Hch-Sl) Motif Enforces Chemical Recognition Enabling Diverse Kh Domain Functions, John A Tainer, Susan E Tsutakawa

Faculty, Staff and Student Publications

In all domains of life, the ancient K homology (KH) domain superfamily is central to RNA processes including splicing, transcription, posttranscriptional gene regulation, signaling, and translation. Proteins with 1 to 15 KH domains bind single-strand (ss) RNA or DNA with base sequence specificity. Here, we examine over 40 KH domain experimental structures in complex with nucleic acid (NA) and define a novel Helix-clasp-Helix-Strand-Loop (HcH-SL) NA recognition motif binding 4 to 5 nucleotides using 10 to 18 residues. HcH-SL includes and extends the Gly-X-X-Gly (GXXG) signature sequence "clasp" that brings together two helices as an ∼90° helical corner. The first helix …

Air Embolism After Percutaneous Lung Biopsy Or Ablation: A Report Of Six Cases, Rebecca Choi, Haylie Kieu-Mi Phan, Varshana Gurusamy, Rahul A Sheth, Bruno C Odisio, Kelvin Hong, Alda L Tam

Faculty, Staff and Student Publications

Systemic air embolism is a rare but potentially life-threatening complication of percutaneous lung biopsy and ablation. This report describes six patients (four male, two female) with air embolism following CT-guided lung interventions at two institutions between January 2021 and March 2024. Air embolisms were identified in locations such as the pulmonary vein, left ventricle, and coronary arteries, with clinical presentations ranging from asymptomatic to life-threatening events. Prompt intervention, including oxygen therapy, patient repositioning, and intravenous administration of epinephrine in cases of cardiac arrest, resulted in favorable outcomes. This series highlights the importance of early detection of systemic air embolism and …