Digital Commons Network^™

On The Empirical Power Of Goodness-Of-Fit Tests In Watermark Detection, Weiqing He, Xiang Li, Tianqi Shang, Li Shen, Weijie Su, Qi Long

Faculty, Staff and Student Publications

Large language models (LLMs) raise concerns about content authenticity and integrity because they can generate human-like text at scale. Text watermarks, which embed detectable statistical signals into generated text, offer a provable way to verify content origin. Many detection methods rely on pivotal statistics that are i.i.d. under human-written text, making goodness-of-fit (GoF) tests a natural tool for watermark detection. However, GoF tests remain largely underexplored in this setting. In this paper, we systematically evaluate eight GoF tests across three popular watermarking schemes, using three open-source LLMs, two datasets, various generation temperatures, and multiple post-editing methods. We find that general …

Privacy-Preserving Verification Of Ml Preprocessing Via Model Behavior Indicators, Wenbiao Li, Anisa Halimi, Jaideep Vaidya, Xiaoqian Jiang, Erman Ayday

Faculty, Staff and Student Publications

We present a privacy-preserving framework to verify whether a declared data preprocessing pipeline was correctly applied before training a machine learning model on sensitive data. The verifier has only black-box query access to the model and combines three behavior indicators: shift in prediction accuracy, Kullback-Leibler (KL) divergence between output distributions, and explanation vectors from Local Interpretable Model-agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP). The method requires neither the original training records nor ground-truth labels. It supports two tasks: (i) a binary decision on correctness and (ii) a multi-class diagnosis identifying which step is missing. Experiments on three tabular datasets …

Safeguarding Privacy In Genome Research: A Comprehensive Framework For Authors, Maryam Ghasemian, Lynette Hammond Gerido, Erman Ayday

Faculty, Staff and Student Publications

As genomic research continues to advance, sharing of genomic data and research outcomes has become increasingly important for fostering collaboration and accelerating scientific discovery. However, such data sharing must be balanced with the need to protect the privacy of individuals whose genetic information is being utilized. This paper presents a bidirectional framework for evaluating privacy risks associated with data shared (both in terms of summary statistics and research datasets) in genomic research papers, particularly focusing on re-identification risks such as membership inference attacks (MIA). The framework consists of a structured workflow that begins with a questionnaire designed to capture researchers' …

Not Fully Synthetic: Llm-Based Hybrid Approaches Towards Privacy-Preserving Clinical Note Sharing, Atiquer Rahman Sarkar, Yao-Shun Chuang, Xiaoqian Jiang, Noman Mohammed

Faculty, Staff and Student Publications

The publication and sharing of clinical notes are crucial for healthcare research and innovation. However, privacy regulations such as HIPAA and GDPR pose significant challenges. While de-identification techniques aim to remove protected health information, they often fall short of achieving complete privacy protection. Similarly, the current state of synthetic clinical note generation can lack nuance and content coverage. To address these limitations, we propose an approach that combines de-identification, filtration, and synthetic clinical note generation. Variations of this approach currently retain 36%-61% of the original note's content and fill the remaining gaps using an LLM, ensuring high information coverage. We …

Enhancing Cross-Domain Generalizability In Social Determinants Of Health Extraction With Prompt-Tuning Large Language Models, Cheng Peng, Zehao Yu, Kaleb E Smith, Wei-Hsuan Lo-Ciganic, Jiang Bian, Yonghui Wu

Faculty, Staff and Student Publications

The progress in natural language processing (NLP) using large language models (LLMs) has greatly improved patient information extraction from clinical narratives. However, most methods based on the fine-tuning strategy have limited transfer learning ability for cross-domain applications. This study proposed a novel approach that employs a soft prompt-based learning architecture, which introduces trainable prompts to guide LLMs toward desired outputs. We examined two types of LLM architectures, including encoder-only GatorTron and decoder-only GatorTronGPT, and evaluated their performance for the extraction of social determinants of health (SDoH) using a cross-institution dataset from the 2022 n2c2 challenge and a cross-disease dataset from …

Enhancing Medical Coding Efficiency Through Domain-Specific Fine-Tuned Large Language Models, Zhen Hou, Hao Liu, Jiang Bian, Xing He, Yan Zhuang

Faculty, Staff and Student Publications

Medical coding is essential for healthcare operations yet remains predominantly manual, error-prone (up to 20%), and costly (up to $18.2 billion annually). Although large language models (LLMs) have shown promise in natural language processing, their application to medical coding has produced limited accuracy. In this study, we evaluated whether fine-tuning LLMs with specialized ICD-10 knowledge can automate code generation across clinical documentation. We adopted a two-phase approach: initial fine-tuning using 74,260 ICD-10 code-description pairs, followed by enhanced training to address linguistic and lexical variations. Evaluations using a proprietary model (GPT-4o mini) on a cloud platform and an open-source model (Llama) …

Using Digitally Delivered Measurement-Based Care In Substance Use Disorder Treatment: Qualitative Analysis Of Patients’ Perspectives, Tessa Frohe, Eliza B Cohn, Madeline C Frost, Tascha R Johnson, Kevin A Hallgren

Faculty, Staff and Student Publications

Background: Measurement-based care (MBC) is a clinical practice where patients complete standardized outcome measures throughout treatment to monitor clinical progress and inform clinical decision-making. However, MBC is rarely adopted in routine substance use disorder (SUD) treatment. We developed a digital MBC system and pilot tested it in an outpatient adult community SUD treatment setting.

Objectives:The current study aims to characterize qualitative feedback from the pilot participants about their experiences using the MBC system in SUD treatment, focusing on perceived benefits, drawbacks, and suggestions for improvement.

Methods: Participants (N=30; n=11 female 37%) completed weekly MBC questionnaires via smartphone for 6 …

Medication Prescribing Checklists And Their Impact On Patient Safety: A Scoping Review, Yilei Liu, Tate W Miner, Kawtar Zouaidi, Anika N Roy, Muhammad F Walji, Kristin N Ray, Donald B Rindal, Elsbeth Kalenderian, Katie J Suda

Faculty, Staff and Student Publications

Background: Medication prescribing checklists and the impact on patient safety remain unexplored.

Objectives: This scoping review aimed to identify key elements of these checklists and evaluate their impact on patient safety outcomes.

Methods: We searched PubMed and Embase for studies reporting checklists in medication prescribing practices and the impact on patient safety outcomes as of October 23, 2024. We applied Fisher's exact test to evaluate the association between checklist effectiveness (based on patient safety outcomes) with study design (randomized controlled trials [RCTs] vs non-RCTs) and intervention type (bundled intervention vs checklist-only intervention).

Results: After full-text review, 53 articles met inclusion …

Daily Movement Activities Are Associated With Within-Person Instability Of Cognitive Function In Older Adults: Evidence From An Ambulatory Assessment Study, Chih-Hsiang Yang, Donald Hedeker, Jongwon Lee, Halle Prine, Donna Coffman, Jingkai Wei, Jonathan George Hakun

Faculty, Staff and Student Publications

Background and objectives: Physical inactivity and excessive sedentary time (ST) are associated with poor cognitive health in older adults. However, current literature largely relies on cross-sectional designs or in-lab cognitive assessments, which do not adequately reflect cognitive function in naturalistic settings. Further, existing studies have largely overlooked the variability or the instability in daily cognitive function, which represents a critical marker of cognitive decline. This ambulatory assessment study examined the temporal associations of daily movement behaviors with the mean levels and the variability of cognition among older adults at risk of dementia.

Research design and methods: 96 older adults from …

Association Of Cardiovascular Disease With Dementia: A Longitudinal Analysis Using National Alzheimer’S Coordinating Center Data, Diana Summanwar, Hyena Kim, Jingkai Wei, Malaz Boustani, Alvaro Alonso, Ambar Kulshreshtha

Faculty, Staff and Student Publications

We analyzed how cardiovascular disease subtypes influence the prevalence and incidence of dementia among 30,582 individuals aged 50 and older in the National Alzheimer's Coordinating Center cohort. We calculated prevalence ratios (aPR) and hazard ratios (aHR), using models adjusted for age, sex, race, years of education, hypertension, diabetes, and dyslipidemia. Stroke (aPR: 1.26; 95% CI: 1.20-1.32) and history of arrhythmias (aPR: 1.17; 95% CI: 1.09-1.24) were associated with higher dementia prevalence. In survival analysis, stroke was associated with a 55% increased risk of incident dementia (aHR: 1.55; 95% CI: 1.36-1.77).

Oral Microbiome Brain Axis And Cognitive Performance In Older Adults, Darbaz Adnan, Phillip A Engen, Michelle Villanueva, Shohreh Raeisi, Vivian Ramirez, Ankur Naqib, Stefan J Green, Faraz Bishehsari, Lisa L Barnes, Ali Keshavarzian, Klodian Dhana, Robin M Voigt

Faculty, Staff and Student Publications

The human oral microbiota is a community of microorganisms that reside in the oral cavity, including lingual, buccal, and saliva, each niche with a distinct microbial composition. Alterations in oral microbiota have been associated with an increased risk of Alzheimer’s disease (AD). This study used data from 143 older adults in the MIND trial to evaluate the association between oral microbiome and cognitive function. Oral niche-specific differences (saliva, buccal, and lingual), as well as the microbiome composition differences (α and β diversity), were associated with cognitive function. A lower abundance of Gemella and a higher abundance of anaerobic pro-inflammatory bacteria …

How Different Is Invasive Coronary Physiology In The Left Anterior Descending Artery?, Nils P Johnson, K Lance Gould

Faculty, Staff and Student Publications

Given the large amount of myocardium supplied by the left anterior descending (LAD) artery, it understandably receives additional scrutiny during coronary angiography. However, these same features make the interpretation of pressure wire physiology more nuanced to avoid overtreatment. This review provides case examples to underpin an extensive literature review supporting the argument that a "positive" fractional flow reserve (FFR) in the LAD needs to be approached with caution. A large hyperemic gradient, or low FFR, can arise from either a severe and focal lesion in conjunction with low flow or diffuse disease coupled with intact or normal flow. Separating these …

The Symptom Burden Of Women With A Known Risk Of Breast Cancer Receiving Risk Reducing Medication, Meagan S Whisenant, Jessica Treviño Jones, Anneliese O Gonzalez, Therese Bartholomew Bevers, Kelly Brassil, Darcy A Ponce, Sharvari Kamat, Emily Solis, Ann Maliackal, Hannah Warlick, Amie Walters, Chloe Denham, Loretta A Williams

Faculty, Staff and Student Publications

Background: For the estimated 10 million women in the United States who meet the high-risk criteria for breast cancer, evidence-based interventions may reduce the risk of breast cancer by 50-65 %. Even with substantial evidence supporting preventive medication for risk reduction, there is significant lack of uptake and adherence. The purpose of this study was to characterize the experience of women at high risk for breast cancer and define the content domain for a patient-reported outcomes (PRO) measure of symptom burden from breast cancer risk and risk reducing medication.

Methods: Thirty women at high risk for breast cancer and receiving …

Steroids For Viral Meningitis: A Foe Or A Friend?, Rodrigo Hasbun

Faculty, Staff and Student Publications

No abstract provided.

Radiographic Axial Spondyloarthritis (Ankylosing Spondylitis) Commencing Late In Life, Mark C Hwang, Karim Doughem, Minjae Lee, Lianne S Gensler, Mariko L Ishimori, Michael M Ward, Matthew A Brown, Amirali Tahanan, Michael H Weisman, Mohammad H Rahbar, John D Reveille

Faculty, Staff and Student Publications

No abstract provided.

Giant Cell Tumor Of The Bone With Fatal Pulmonary Metastasis: A Case Report, Mohamad Taha, Saadia A Faiz, Pushan Jani, Jing Liu, Yasir D Ali, Mohammad Asim Amjad

Faculty, Staff and Student Publications

Giant cell tumors of the bone are typically benign, locally aggressive lesions that rarely metastasize. In this report, we describe the case of a 48-year-old woman presenting with a giant cell tumor of the bone of the hip joint, which demonstrated aggressive histological features and recurrent behavior. The patient developed multiple unresectable pulmonary metastases despite several wide local excisions. Although pulmonary metastases from giant cell tumors of the bone are usually associated with a relatively favorable prognosis, guidelines for the optimal treatment of metastatic giant cell tumors of the bone remain limited. This case highlights the unpredictable nature of giant …

Use Of Hookah And Age Of Asthma Onset Among Us Adults, Adriana Pérez, Sarah Valencia, Pushan P Jani, Melissa B Harrell

Faculty, Staff and Student Publications

Objective: To explore the association of hookah use on the age of asthma onset among adults who were asthma/COPD free and who did not use cigarettes, cigars, electronic cigarettes or smokeless tobacco prior to asthma onset.

Methods: Secondary data analyses were conducted of the waves 1-6 (2013-2021) of the US nationally representative Population Assessment of Tobacco and Health Study among adults (>18 years). The four hookahs use exposures evaluated were (1) past 30-day (P30D) hookah use at the first wave of participation, (2) total number of waves before asthma onset in which adults reported P30D hookah use, (3) total …

Thrombotic Storm With Antiphospholipid Syndrome In The Setting Of Relapsing Evans Syndrome And Systemic Lupus Erythematosus: A Case Report, Som Singh, Sergio Abraham Candiales, Zachary Hunzeker, Cristina Olivo Freites, Modupe Idowu

Faculty, Staff and Student Publications

Background: There are few cases that report the presence of lupus anticoagulant and antiphospholipid antibodies between Evans syndrome and the presence of lupus anticoagulant. However, differentiating between primary and secondary causes of Evans syndrome remains challenging.

Case description: A 31-year-old female with a medical history of autism spectrum disorder, antiphospholipid syndrome (APS), complete systemic lupus erythematosus (SLE), and Evans syndrome was admitted for cholecystitis requiring laparoscopic cholecystectomy. In the setting of her acute illness, her thrombocytopenia worsened. Her hospital course was then complicated by the development of a left adrenal hematoma and venous thrombosis. Anticoagulation therapy was conservatively held due …

Changes In Medication Complexity And Post-Hospitalization Outcomes In Older Adults Hospitalized For Heart Failure, Aayush Visaria, William Mcdonald, John Mancini, Andrew P Ambrosy, Min Ji Kwak, Ashkan Hashemi, Mark S Lachs, Andrew R Zullo, Monika Safford, Emily B Levitan, Parag Goyal

Faculty, Staff and Student Publications

Introduction: Medication regimen complexity may be an important risk factor for adverse outcomes in older adults with heart failure. However, increasing complexity is often necessary when prescribing guideline-directed medical therapy at the time of a heart failure hospitalization. We sought to determine whether increased medication regimen complexity following a heart failure hospitalization was associated with worse post-hospitalization outcomes.

Methods: This retrospective cohort study included Reasons for Geographic and Racial Differences in Stroke (REGARDS) participants aged at least 65 years hospitalized for heart failure between 2003 and 2014. We calculated changes between hospital admission and discharge in medication count (Δcount) and …

Editorial: Women In Brain Imaging And Stimulation, Volume Ii: 2024, Molly S Hermiller, Ruogu Fang, Wen Li

Faculty, Staff and Student Publications

No abstract provided.

An Ontology-Based Method For Formalizing And Encoding Patient Colonoscopy Preparation Using Bpmn And Owl2 For Automated Tool Development, Muhammad Amith, Yue Yu, Yuheng Shi, Brooks Cash, Barani Mayilvaganan, Anirudh Babu, Yang Gong

Faculty, Staff and Student Publications

Colonoscopy is a proven procedure for mitigating the incidence of colorectal cancers in late adulthood. Despite its effectiveness, colonoscopy preparation presents several challenges for patients, including issues with adherence and misunderstanding. Information and communication technology (ICT) tools may offer valuable support for modern patients. To enable such tools, computable knowledge bases are essential. In this paper, we describe the development of an ontology-based knowledge graph representing four laxative-based pre-colonoscopy procedures. We used the business process modeling and notation and OWL2 formalisms to manifest machine-readable artifacts that model processes of colonoscopy preparation. Future work will focus on integrating extended knowledge bases …

Esomeprazole Inhibits Proliferation Of Scleroderma Fibroblasts Via Cell Cycle Regulation, Mohammad A Khan, Shaheer Koniyan, Manisha Ahir, Anil G Jegga, Maureen D Mayes, David Gius, Justin Leung, Mark D Bonnen, Sydney B Montesi, Yohannes T Ghebre

Faculty, Staff and Student Publications

Background: Scleroderma is a complex autoimmune disease characterized by abnormal fibroblast proliferation and excessive collagen deposits in the skin and internal organs. We previously showed that esomeprazole, an FDA-approved drug for gastric disorders, may prevent dermal fibrosis.

Methods: To test this, we evaluated the antiproliferative effect of esomeprazole and the underlying molecular mechanisms using primary fibroblasts derived from patients with scleroderma. BrdU incorporation, flow cytometry, immunofluorescence, Western blot analysis, RNA sequencing, and functional enrichment analysis were performed.

Results: Esomeprazole inhibited the proliferation of scleroderma fibroblasts in a dose-dependent manner, as measured by BrdU incorporation and Ki-67 marker. Intriguingly, esomeprazole arrested …

Invasive Fungal Disease In Solid Organ And Hematopoietic Cell Transplant Recipients, United States, Jeremy A W Gold, Kaitlin Benedict, Elizabeth Sajewski, Tom Chiller, Meghan Lyman, Mitsuru Toda, Jessica S Little, Luis Ostrosky-Zeichner

Faculty, Staff and Student Publications

Background: Updated benchmark data on invasive fungal disease (IFD) in solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT) recipients are necessary to increase clinical recognition and inform treatment and prevention strategies. We estimated IFD incidence and potential risk factors in transplant recipients in a large US commercial health insurance database.

Methods: We observed patients who received SOT or HCT during 2018-2022 until IFD development, disenrollment, or database end date (July 31, 2023). We calculated incidence (per 1000 person-years) and time to IFD development, comparing demographic features and underlying conditions for IFD versus non-IFD patients.

Results: Overall, 9143 patients received …

Rezafungin For Suppressive Therapy Of Candida Auris In A Patient With A Left Ventricular Assist Device (Lvad), Matthew A Stack, Luis Ostrosky-Zeichner, Rodrigo Hasbun, Sun O Park, Jessica Babic, Mona Kapadia

Faculty, Staff and Student Publications

Introduction: Invasive candidiasis is a common healthcare-associated infection with significant morbidity and mortality. Candida auris in particular has emerged as a problematic and challenging healthcare-associated infection, especially with regards to infections involving left ventricular assist devices (LVADs). There is a paucity of evidence on the best management of these particular types of infections. Rezafungin is a newly-approved echinocandin and an important new tool in the management of invasive candidiasis. We report the novel use of rezafungin for suppressive therapy in a patient with an LVAD-associated C. auris infection.

Case: The patient is a 57-year-old male with a past medical history …

National Healthcare Safety Network… We Need To Talk…., Misti Ellsworth, Luis Zeichner Ostrosky, Bela Patel, Robert Yetman, Phillip Chang

Faculty, Staff and Student Publications

No abstract provided.

Long-Term Dynamic Profiles Of Cognitive Kinases Induced By Different Learning Protocols, Yili Zhang, Rong-Yu Liu, Paul Smolen, John H Byrne

Faculty, Staff and Student Publications

Learning is associated with activation of multiple protein kinases, but few details are known about the activation dynamics in response to different learning protocols. We addressed this issue by examining the long-term dynamics of kinases critical for long term synaptic facilitation (LTF) of the Aplysia sensorimotor synapse. Three serotonin (5-HT) protocols have been found to induce LTF with distinct effectiveness: the five-pulse regular-spaced Standard protocol; the five-pulse irregular-spaced Enhanced protocol; and the two-pulse protocol with an interval of 45 min. We previously compared long-term dynamics of the mitogen-activated protein kinase (MAPK) isoform ERK after these protocols. Here we examined the …

Quantitatively Assessing The Impact Of The Quality Of Snomed Ct Subtype Hierarchy On Cohort Queries, Xubing Hao, Xiaojin Li, Yan Huang, Jay Shi, Rashmie Abeysinghe, Cui Tao, Kirk Roberts, Guo-Qiang Zhang, Licong Cui

Faculty, Staff and Student Publications

Objective: SNOMED CT provides a standardized terminology for clinical concepts, allowing cohort queries over heterogeneous clinical data including Electronic Health Records (EHRs). While it is intuitive that missing and inaccurate subtype (or is-a) relations in SNOMED CT reduce the recall and precision of cohort queries, the extent of these impacts has not been formally assessed. This study fills this gap by developing quantitative metrics to measure these impacts and performing statistical analysis on their significance.

Material and methods: We used the Optum de-identified COVID-19 Electronic Health Record dataset. We defined micro-averaged and macro-averaged recall and precision metrics to assess the …

In-Hospital Mortality And Hemorrhagic Risks In Traumatic Brain Injury Patients With Early Vs. Late Venous Thromboembolism, Sophie Samuel, Jalon Barnes, Lynn Yamane, Eugene Uh, Cyprian C Afunugo, Bosco Seong Kyu Yang, Huimahn Alex Choi

Faculty, Staff and Student Publications

Objective: This study reviewed the management and outcomes of traumatic brain injury (TBI) patients who developed venous thromboembolism (VTE) during hospitalization, focusing on the timing of VTE diagnosis and anticoagulation initiation.

Methods: This retrospective, single-center study utilized data from the University of Texas Trauma Database. Patients were categorized based on VTE diagnosis timing (early ≤7 days, late >7 days). The primary outcome was in-hospital mortality. Secondary outcomes included mortality specifically among patients who were receiving anticoagulation treatment, hemorrhagic complications, predictors associated with early anticoagulation initiation (defined as ≤ 7 days from VTE diagnosis), and whether anticoagulation timing influenced mortality.

Results: …

Polygenic Scores Contribution To Parkinson’S Disease Comorbidities, Carlos F Hernández, Camilo Villaman, Cristian Tejos, Gabriela M Repetto, Costin Leu, Dennis Lal, Ignacio F Mata, Andrés D Klein, Eduardo Pérez-Palma

Faculty, Staff and Student Publications

Comorbidities are common in Parkinson’s disease and significantly impact the disease progression and management. While polygenic scores have been widely used to assess genetic risk for complex diseases, their role in comorbidity presentation in Parkinson’s disease remains unclear. This study investigates whether genetic predisposition to comorbidities, as measured by polygenic scores, differs between individuals with Parkinson’s disease and the general population and explores how genetic risk influences disease onset and sex-related differences. We analysed data from 4144 individuals with Parkinson’s disease and 370 480 individuals from the general population in the UK Biobank, focusing on four comorbidities with high-quality genome-wide …

What Time Is It? It Is 8 And 1/2 Time: A Rare Case Of Ischemic Stroke Consistent With Eight-And-A-Half Syndrome, Jessica Daza, Marcelo Bedoya-Sommerkamp, Eunbee Cho, Celia Daza, Francisco Gomez, Fatimah Bello, Jia Lin

Faculty, Staff and Student Publications

Eight-and-a-half syndrome is a rare neuro-ophthalmic syndrome characterized by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia, and ipsilateral facial nerve palsy. It results from a lesion affecting the paramedian pontine reticular formation, the medial longitudinal fasciculus, and the abducens nucleus of the same side, at the level of the lower pons. We present a case of a 49-year-old man with 2-week diplopia and 3-day right-sided facial droop, drooling, and dysarthria. CT angiography of the head and neck revealed atherosclerotic disease, with decreased caliber of the basilar artery at the level of the pons. Brain MRI showed a subacute ischemic lesion …