Digital Commons Network^™

A Virtual Breakthrough Series Collaborative For Missed Test Results: A Stepped-Wedge Cluster-Randomized Clinical Trial, Jennifer Sloane, Umber Shahid, Traber Giardina, Sahar A Memon, Taylor M Scott, Daniel R Murphy, Hardeep Singh

Faculty, Staff and Students Publications

IMPORTANCE: Missed test results, defined as test results not followed up within an appropriate time frame, are common and lead to delays in diagnosis and treatment.

OBJECTIVE: To evaluate the effect of a quality improvement collaborative, the Virtual Breakthrough Series (VBTS), on the follow-up rate of 2 types of test results prone to being missed: chest imaging suspicious for lung cancer and laboratory findings suggestive of colorectal cancer.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster-randomized clinical trial was conducted between February 2020 and March 2022 at 12 Department of Veterans Affairs (VA) medical centers, with a predefined 3-cohort roll-out. Each …

Pkmyt1 Is A Marker Of Treatment Response And A Therapeutic Target For Cdk4/6 Inhibitor-Resistance In Er+ Breast Cancer, Craig T Vollert, Jonathan T Lei, Diana Fandino, Meenakshi Anurag, Matthew V Holt, Xuxu Gou, Jacob B Pilcher, Matthew P Goetz, Donald W Northfelt, Susan G Hilsenbeck, C Gary Marshall, Marc L Hyer, Robert Papp, Shou-Yun Yin, Carmine De Angelis, Rachel Schiff, Suzanne A W Fuqua, Cynthia X Ma, Charles E Foulds, Matthew J Ellis

Faculty, Staff and Students Publications

Endocrine therapies (ET) with cyclin-dependent kinase 4/6 (CDK4/6) inhibition are the standard treatment for estrogen receptor-α-positive (ER+) breast cancer, however drug resistance is common. In this study, proteogenomic analyses of patient-derived xenografts (PDXs) from patients with 22 ER+ breast cancer demonstrated that protein kinase, membrane-associated tyrosine/threonine one (PKMYT1), a WEE1 homolog, is estradiol (E2) regulated in E2-dependent PDXs and constitutively expressed when growth is E2-independent. In clinical samples, high PKMYT1 mRNA levels associated with resistance to both ET and CDK4/6 inhibition. The PKMYT1 inhibitor lunresertib (RP-6306) with gemcitabine selectively and synergistically reduced the viability of ET and palbociclib-resistant ER+ breast …

Decoding Complex Inherited Phenotypes In Rare Disorders: The Decipherd Initiative For Rare Undiagnosed Diseases In Chile, Joan Orellana, Gabriela Moreno, Luz M Martín, Gonzalo Encina, Daniela Böhme, Víctor Faundes, M Jesús Zavala, Trinidad Hasbún, Sara Fischer, Florencia Brito, Diego Araya, Manuel Lira, Javiera De La Cruz, Camila Astudillo, Guillermo Lay-Son, Carolina Cares, Mariana Aracena, Esteban San Martin, Zeynep Coban-Akdemir, Jennifer E Posey, James R Lupski, Gabriela M Repetto

Faculty, Staff and Students Publications

Rare diseases affect millions of people worldwide, and most have a genetic etiology. The incorporation of next-generation sequencing into clinical settings, particularly exome and genome sequencing, has resulted in an unprecedented improvement in diagnosis and discovery in the past decade. Nevertheless, these tools are unavailable in many countries, increasing health care gaps between high- and low-and-middle-income countries and prolonging the "diagnostic odyssey" for patients. To advance genomic diagnoses in a setting of limited genomic resources, we developed DECIPHERD, an undiagnosed diseases program in Chile. DECIPHERD was implemented in two phases: training and local development. The training phase relied on international …

Detection Of Mosaic And Population-Level Structural Variants With Sniffles2, Dominic W Horner, Medhat Mahmoud, Sairam Behera, Ester Kalef-Ezra, Mira Gandhi, Karl Hong, Davut Pehlivan, Sonja W Scholz, Claudia M B Carvalho, Christos Proukakis, Fritz J Sedlazeck

Faculty, Staff and Students Publications

Calling structural variations (SVs) is technically challenging, but using long reads remains the most accurate way to identify complex genomic alterations. Here we present Sniffles2, which improves over current methods by implementing a repeat aware clustering coupled with a fast consensus sequence and coverage-adaptive filtering. Sniffles2 is 11.8 times faster and 29% more accurate than state-of-the-art SV callers across different coverages (5-50×), sequencing technologies (ONT and HiFi) and SV types. Furthermore, Sniffles2 solves the problem of family-level to population-level SV calling to produce fully genotyped VCF files. Across 11 probands, we accurately identified causative SVs around MECP2, including highly complex …

Metagenomic Study Of The Mesa: Detection Of Gemella Morbillorum And Association With Coronary Heart Disease, Xiuqing Guo, David M Herrington, W Craig Johnson, Wendy S Post, Russell P Tracy, Stephen S Rich, Shaista Malik

Faculty, Staff and Students Publications

BACKGROUND: Inflammation is a feature of coronary heart disease (CHD), but the role of proinflammatory microbial infection in CHD remains understudied.

METHODS AND RESULTS: CHD was defined in the MESA (Multi-Ethnic Study of Atherosclerosis) as myocardial infarction (251 participants), resuscitated arrest (2 participants), and CHD death (80 participants). We analyzed sequencing reads from 4421 MESA participants in the National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine program using the PathSeq workflow of the Genome Analysis Tool Kit and a 65-gigabase microbial reference. Paired reads aligning to 840 microbes were detected in >1% of participants. The association of the …

Targeting Snai1-Mediated Colorectal Cancer Chemoresistance And Stemness By Sphingosine Kinase 2 Inhibition, Jiangling Dong, Scott A Becker, Alhaji Janneh, Besim Ogretmen, E Ramsay Camp

Faculty, Staff and Students Publications

BACKGROUND: Epithelial-to-mesenchymal transition (EMT), cancer stem cells (CSCs), and colorectal cancer (CRC) therapy resistance are closely associated. Prior reports have demonstrated that sphingosine-1-phosphate (S1P) supports stem cells and maintains the CSC phenotype. We hypothesized that the EMT inducer SNAI1 drives S1P signaling to amplify CSC self-renewal capacity and chemoresistance.

METHODS: CRC cell lines with or without ectopic expression of SNAI1 were used to study the role of S1P signaling as mediators of cancer stemness and 5-fluorouracil (5FU) chemoresistance. The therapeutic ability of sphingosine kinase 2 (SPHK2) was assessed using siRNA and ABC294640, a SPHK2 inhibitor. CSCs were isolated from patient-derived …

Long-Term Efficacy And Safety Of Cannabidiol In Patients With Tuberous Sclerosis Complex: 3-Year Results From The Cannabidiol Expanded Access Program, Gary D Clark, Jerzy P Szaflarski, Laurie E Seltzer, Elizabeth A Thiele, Farhad Sahebkar

Faculty, Staff and Students Publications

OBJECTIVE: The cannabidiol (CBD) Expanded Access Program provided compassionate access to CBD for patients with treatment-resistant epilepsy, including tuberous sclerosis complex (TSC), at 35 US epilepsy centers. Here, we present the long-term efficacy and safety outcomes for add-on CBD treatment in patients with TSC.

METHODS: Patients received plant-derived, highly purified CBD (Epidiolex® 100 mg/mL, oral solution), increasing from 2 to 10 mg/kg/d to tolerance or maximum of 25-50 mg/kg/d. Efficacy endpoints were percentage change from baseline in median monthly convulsive, focal, and total seizure frequency and ≥ 50%, ≥75%, and 100% responder rates across 12-week visit windows through 144 weeks. …

Stress, Obesity, Depression, And Codependency As Predictors Of Unmitigated Communion In African American Pastors, Troy Tyrone Johnson

Walden Dissertations and Doctoral Studies

Many pastors spend significant time tending to their congregants’ needs while disregarding their own needs. They may not know how to ask for or receive help and may look to others for self-worth and value. Inappropriate self-sacrificing behaviors could result in pastors' compromised emotional and physical health. The purpose of this study was to determine whether stress, obesity, depression, and codependency, individually or in a linear combination, were adequate predictors of unmitigated (UC) among African American senior pastors who pastor congregationally led churches without the benefit of paid support staff. The social cognitive learning theory was the theoretical framework in …

Replacing Traditional Labs With Virtual Labs For First-Year Biology Nonmajors, Tyjuanna R. Strickland Labennett

Walden Dissertations and Doctoral Studies

The problem addressed through this study was the absence of a critical examination of laboratory exercises used with first-year nonbiology majors and the deployment of virtual laboratories in the biology department at the project site university without critical analyses associated with the efficacy of virtual labs. Grounded in Mayer’s cognitive theory of multimedia learning, this quantitative, correlational study was conducted to investigate the comparative effectiveness of virtual versus traditional face-to-face (F2F) laboratories for first-year nonbiology majors as measured by final course grade. A cohort of 184 students in an introductory biology course for non-majors formed the dataset, procured from the …

Parental Knowledge And Perception Of Obesity And Effect On Feeding Behavior And Child's Weight Status, Fidelia Senayah

Walden Dissertations and Doctoral Studies

Childhood obesity is a significant public health problem that leads to poor health outcomes in affected children, including the potential for developing chronic diseases in adulthood if not addressed at an early stage. While there are several studies on childhood obesity, data on parental obesity knowledge and risk perception as it relates to feeding behavior and child weight outcome is inadequate. No data were found on the topic in Ohio, which has a high rate of childhood obesity and overweight. This study examined how parental obesity risk knowledge and risk perception influenced parental feeding behavior and children’s weight status in …

Executive Summary: Clinical Practice Guideline, Bona Eze

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed a gap in practice in an outpatient clinic in the Northeastern United States. The gap in practice was a lack of standardized patient education on self-care management strategies for adult patients with diabetes, leading to increased rates of noncompliance, readmission, and poor health outcomes. The guiding question asked whether an expert panel could evaluate and validate a clinical practice (CPG) developed from current, evidence-based literature and recommendations from the American Association of Clinical Endocrinologists and the American Diabetes Association on self-care management strategies for the adult patient with diabetes. The project followed …

Demographic Characteristics As Moderators For The Association Between Cigarette Smoking And Type 2 Diabetes Mellitus, Aregash Tewoldeberhan Kidane

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a major public health problem and is associated with increased morbidity, mortality, and healthcare expenditure in the United States. Several studies have been conducted that showed cigarette smoking is associated with an increased incidence and prevalence of diabetes mellitus (DM); however, there is no published information in the literature on the moderating effects of gender/sex and race/ethnicity on this association. The purpose of this quantitative, cross-sectional study was to address this gap in the literature and examine the association between cigarette smoking and DM and the moderating effect of sex and race/ethnicity on the association between cigarette …

Financial Management Knowledge For Small And Medium Enterprise Sustainability In Ethiopia, Hon Gew

Walden Dissertations and Doctoral Studies

Though small and medium enterprises (SMEs) impact Ethiopia’s socioeconomic and political progress, most of these SMEs terminate their operations ahead of reaching their fifth anniversary. A significant number of owners require the enhancement of their comprehension of financial management knowledge, which is essential for the continuous functioning and growth of their company. An in-depth analysis of the financial strategies that SME owners in Ethiopia may use to enhance the long-term sustainability of their business operations was the objective of this qualitative multiple-case study. The present study was grounded in financial literacy theory and the leadership skill model. Data were collected …

Perceptions Of Non-Using College Students’ Likelihood To Use Nonprescription Or Prescription Stimulants, Judith Frazier

Walden Dissertations and Doctoral Studies

The Substance Abuse and Mental Health Services Administration has highlighted the risk of non-users among college students using illegal prescription stimulants due to misinformation and incorrect assumptions. This qualitative study aimed to explore the perspectives of college students who do not use stimulants on perceived risks, social acceptability, opportunity experiences, and likelihood of using stimulants. The study addressed factors that either encourage or discourage students from using stimulants, as well as the internal and extrinsic incentives associated with this activity, using a phenomenological paradigm. Twelve southern Ohioan students who were not users were interviewed using a structured interviewing technique, which …

Effective Strategies Healthcare Leaders Use To Retain Nursing Staff, Palupcia V. Alcindor

Walden Dissertations and Doctoral Studies

Nursing turnover in healthcare negatively impacts patient care and organizational performance. Healthcare leaders are concerned with retaining nursing staff to maintain a competitive advantage and continue providing high-quality patient care. Grounded in the job embeddedness theory, the purpose of this qualitative single case study was to identify and explore effective strategies that seven healthcare leaders in southern Florida used to retain nursing staff. Data were collected using semistructured interviews and a review of documents. Using Yin’s five-step data and thematic analysis process, four themes were identified: (a) foster a positive work environment, (b) employ effective and open communication, (c) demonstrate …

Using Pay-For-Performance Payment Methodology Framework For Medicaid Reimbursement Rate In State Government, Motunrayo S. Dindi

Walden Dissertations and Doctoral Studies

Medicaid Home Community Based Services (HCBS) program reimbursement rate policy plays a critical role in the rate determination and influences the type of care services received by program recipients. This qualitative case study evaluated the impact of the reimbursement rate policy on the quality of care received by Medicaid HCBS program beneficiaries. The practice-focused question for this study was from the Office of Rates and Reimbursements management perspective on how the state can implement an effective alternative reimbursement rate policy to achieve value-based care services that would result in better healthcare outcomes. To achieve the desired result, thematic and narrative …

The Relative Strength Of Emotion Regulation, Distress Tolerance, And Self-Care In Predicting Resilience Among First Responders, Corey Norton

Walden Dissertations and Doctoral Studies

Given the situations confronted daily by first responders, many experience symptoms of posttraumatic stress disorder. Anxiety, depression, and substance abuse, often triggered by exposure to traumatic events, can be so debilitating that the first responder can no longer travel, spend time with family, or enjoy hobbies, a self-isolating state of affairs that diminishes quality of life. Therefore, the purpose of this quantitative study was to determine the relative strength of emotion regulation, distress tolerance, and self-care in predicting resilience among first responders. Emotion regulation theory described how individuals experience, express, and control their emotional reactions when faced with life and …

Mammography Screening Behavior Among Black Women In The United States, Muinat Oseni

Walden Dissertations and Doctoral Studies

Breast cancer is the second leading cause of cancer death among women in America. The prevalence of breast cancer is higher in White women than Black women; however, death rates are higher among Black women than White women due to late detection and treatment. This quantitative study used the multi-theory model to examine factors affecting mammography screening among Black American women. Data were collected using Qualtrics. An independent t-test was used to compare mammography screening behavior among Black women who had mammograms with those who had not. Multiple linear regression was used to predict the initiation and sustenance of mammography …

Gmm Estimation With Brownian Kernels Applied To Income Inequality Measurement, Jin Seo Cho, Peter C.B. Phillips

Cowles Foundation Discussion Papers

In GMM estimation, it is well known that if the moment dimension grows with the sample size, the asymptotics of GMM differ from the standard finite dimensional case. The present work examines the asymptotic properties of infinite dimensional GMM estimation when the weight matrix is formed by inverting Brownian motion or Brownian bridge covariance kernels. These kernels arise in econometric work such as minimum Cramer-von Mises distance estimation when testing distributional specification. The properties of GMM estimation are studied under different environments where the moment conditions converge to a smooth Gaussian or non-differentiable Gaussian process. Conditions are also developed for …

Ruff: Resource Usage Fuzzing Framework, Gavin Black

Masters Theses & Doctoral Dissertations

Modern computer security is greatly enhanced through the use of fuzzing to uncover problems in underlying program logic. Traditional fuzzing primarily targets code coverage and crashing error conditions, which are inadequate for detecting other non-desired behaviors. This dissertation introduces a comprehensive, multi-dimensional fuzzing framework that extends conventional approaches to include resource usage metrics. By integrating rigorous statistical methods and leveraging multiple sources of fuzzing data, this framework offers a novel and theoretically robust means of identifying and evaluating complex program behaviors that impact system performance and security. The contributions of this dissertation include a generalized framework for resource usage fuzzing, …

Factors Influencing Blockchain Implementation In Supply Chain Management: An Exploratory Study, Aravindh Sekar

Masters Theses & Doctoral Dissertations

This exploratory study investigates the key factors influencing blockchain technology implementation in supply chain management, employing a qualitative research approach based on grounded theory. Using semi-structured interviews with sixteen participants, including blockchain consultants and supply chain professionals, the study identifies twelve critical factors essential for successful blockchain implementation. These factors—Strategic Leadership, Organizational Strategy, Future Readiness, Infrastructure Readiness, Supportive Ecosystem, Data Management Practices, Change Management, Training and Education, User Acceptance, Decentralized System Vitality, Decentralized Security and Encryption, and Decentralized Governance—were uncovered through open, axial, and selective coding of the data. The study highlights the significance of these key factors, showing how …

The Role Of Privacy In The Intention To Disclose Personal Driving Data Using Internet-Of-Vehicle Technology In Consumer Automobiles, Steven Bradley Fowler

Masters Theses & Doctoral Dissertations

The rise of network connectivity has spurred the growth of Internet connected devices. In the modern era of technology, manufacturers are using Internet connectivity to advance their product offerings and development. These development efforts have allowed manufacturers to offer new features to existing products. Many car buyers seem to be enticed by the new features that are possible with this technology, such as advanced infotainment systems, real time data, and instant software updates and upgrades. Internet of Vehicle (IoV) technology is an area of Information Systems (IS) that is rapidly expanding. This technology provides the ability for vehicles and drivers …

Effects Of Low-Cycle Fatigue Fracture Of Longitudinal Reinforcing Steel Bars On The Seismic Performance Of Reinforced Concrete Bridge Piers, Yu-Fu Ko, Jessica Gonzalez

Mineta Transportation Institute

Earthquakes, which can cause tremendous local stress and strain on infrastructure, can cause reinforced concrete (RC) bridges to collapse due to the concrete cracking and fracture of the steel reinforcement rebars. The fracture of longitudinal reinforcing steel due to low-cycle fatigue is one of the main causes of failure in RC structures under earthquake loading. The purpose of this research is to include the effects of low-cycle fatigue fracture of longitudinal reinforcing steel bars on the seismic performance of reinforced concrete bridge piers. To obtain a greater understanding of low-cycle fatigue failure of steel reinforcement of RC bridge piers subjected …

Artificial Intelligence For Pedestrian And Bicyclist Safety: Using Ai To Detect Near-Miss Collisions, Mohammad Pourhomayoun

Mineta Transportation Institute

Near-Miss Collisions are events that, with a slight change in position or timing, could have resulted in a collision, which could have caused severe injury or property damage. Understanding near-miss collisions can help identify risks and potentially improve road safety. In this project, we developed an effective end-to-end system based on advanced artificial intelligence (AI) models and computer vision algorithms to detect and report near-miss collisions as an important indicator to identify and measure safety risks, especially in specific circumstances such as a right turn on a red light. The main objective is to improve the safety of pedestrians and …

2024 Quality Of Life Survey - Orleans And Jefferson Parishes, Edward E. Chervenak, Anthony Liciardi

Survey Research Center Publications

The University of New Orleans Survey Research Center (SRC) conducted a live interviewer telephone survey of active registered voters in Orleans Parish and Jefferson Parish. Four hundred and ninety-one randomly selected respondents from Orleans Parish and 487 randomly selected respondents from Jefferson Parish were interviewed from September 9th through October 1st, 2024. Each survey yields a margin of error of +/- 4.4% at a 95% confidence level.

Etdsuite: A Toolkit To Mine Electronic Theses And Dissertations To Enrich Scholarly Big Data Using Natural Language Processing And Computer Vision, Muntabir Hasan Choudhury

Computer Science Theses & Dissertations

In the past decades, there has been a growing interest in mining scientific documents to obtain domain knowledge automatically. One of the understudied types of scientific documents is Electronic Theses and Dissertations (ETDs), as ETDs have distinct features compared with conference proceedings and journal articles. ETDs usually serve as partial requirements of academic degrees for students pursuing higher education. They are book-length documents (i.e., 100 – 400 pages long), and the topics may shift across chapters, exhibit the significant contribution of a student’s research over the entire degree pursuing period, and have unique metadata schema and page layouts. However, the …

How Multilingual Writers Talk About, Write About, And Engage With Sources In First-Year Composition, Mary Ann Zehr

English Theses & Dissertations

This study makes a contribution to the rhetoric and composition field by documenting the research and writing processes of a diverse group of 15 multilingual writers in first-year composition (FYC) at a small private southeastern university. I collected and analyzed data from three assignments: 1) a video think-aloud capturing participants’ first online search for sources, 2) a two-page reflection on the use of sources in the first full draft of students’ research paper, and 3) their first full draft of the research paper. The study is the first to systematically examine how multilingual writers in FYC at a U.S. university …

A Retrospective Study Of Virtual Hospital Experiential Learning Across Clerkship And Pre-Clerkship Doctor Of Osteopathic Medicine Students At A Medical School Based In The United States., Lydia Kersh, Anthony Sciuva, Jennifer H. Shaw

PCOM Scholarly Works

INTRODUCTION: During the COVID-19 pandemic, a medical institution in the United States implemented a virtual clerkship rotation to replicate the skills that students would develop during an in-person clinical site rotation. The primary objective of this study was to identify the efficacy and benefits following the implementation of the Virtual Hospital Experiential Learning (VHEL) model, as demonstrated by increased perceived confidence and skill growth among medical students.

METHODS: Cases were presented to five to six medical students each week. On the Monday of the week, students entered a virtual conference platform for a standardized patient encounter. Staff and faculty randomly …

Assessing Functional Abilities In A Memory Disorder Population: A Comparison Of Self-Report, Informant-Report, And Performance-Based Measures, Kevin Andrew Murray

Theses and Dissertations

Objective: Accurate assessment of daily functioning is critical for deriving a correct diagnosis and facilitating effective patient care. While collateral reports from a reliable informant can elucidate patients’ functional capacities, they may be susceptible to misappraisals of functional status. Similarly, patients with limited insight may be prone to misjudging their functional abilities. Performance-based measures of adaptive functioning may detect subtle declines in daily functioning overlooked by self- and informant-report measures. However, these measures may be limited in terms of ecological validity. The current study investigated the association between a performance-based measure of daily functioning and patients’ and informants’ ratings of …

Childhood Adversity's Impact On Criminal Behavior, Isobel Marie Avento

Theses and Dissertations

Adverse childhood experiences (ACEs), such as abuse, neglect, and family criminal history, have been identified as potential risk factors for negative physical, psychological, and behavioral health outcomes. Emerging literature suggests that ACEs are also among the primary factors leading to delinquency and adult criminal behavior. However, there is limited applied research that provides practitioners with appropriate insight to intervene when ACEs are identified among juvenile delinquents to reduce recidivism risk. This study adds to the existing literature by examining how cumulative ACEs shape criminal behavior of individuals from the onset until its desistance over the span of twenty years. Using …