Medicine and Health Sciences Commons^™

Evaluation Of A No-Code Ai Model For Detecting Periapical Radiolucencies: Impact Of Anatomical Region On Diagnostic Performance, Manal Hamdan, Kevin W. Yu, Marguerite Miller, Stephanie J. Sidow, Zaid Badr, Sergio E. Uribe

School of Dentistry Faculty Research and Publications

Background

To develop a no-code artificial intelligence (AI) model for the detection of apical radiolucent lesions and to assess how lesion location influences the model’s diagnostic performance.

Methods

312 periapical radiographs were retrospectively collected, each accompanied by a corresponding cone-beam computed tomography (CBCT) scan obtained within six months and a radiology report authored by board-certified oral and maxillofacial radiologists. These reports served as the reference standard, and all findings were cross-verified by the primary investigator through CBCT review. The dataset included 181 images with at least one apical radiolucent lesion and 131 lesion-free controls. Using the no-code AI platform LandingLens …

The Accuracy Of Occlusal Splint Fabricated By The Different Materials With Different 3d Printers., Supisara Thamrongsak

Master's Theses (2009 -)

Aim: The purpose of this study is to evaluate the accuracy of occlusal splints fabricated by the different materials with different 3D printers in four different orientations (0°, 15°, 25°, 40°) using surface matching software. Materials and Methods: Occlusal splints were printed in 4 different orientations including 0°, 15°, 25°, and 40° based on the STL file of the designed occlusal splint with 3 different printers (Carbon® M3Max, SprintRay Pro S, Asiga Pro4K). A total of 120 occlusal splints were printed for the present study, 10 occlusal splints were printed for each group. Then all occlusal splints were scanned using …

Understanding Adult Patients’ Experiences Of Trauma-Informed Care In Outpatient Healthcare, Jayme Aguero

Dissertations (1934 -)

Trauma is recognized as a universal human experience. Well-established evidence demonstrates the negative impact of trauma on health outcomes. In 2014, following a recommendation from SAMHSA, trauma-informed care (TIC) was implemented across human service sectors, including healthcare. While TIC has been in use for the past decade, adults’ experiences of receiving TIC in outpatient healthcare remain largely unknown. The purposes of this study were (a) to explore and describe how adults’ healthcare experiences aligned with the principles of TIC being implemented in outpatient healthcare settings and (b) to understand the perceived usefulness and meaning of TIC for adult patients. A …

Be Trauma Informed: A Pilot Evaluation Of A Podcast Intervention To Improve Trauma-Informed Care Knowledge, Attitudes, And Practices Among Pediatric Critical Care Nurses, Elizabeth Devries

Dissertations (1934 -)

Trauma-informed care (TIC) is integral to pediatric critical care (PCC) but accessible, scalable education is limited. This mixed-methods pilot study developed and evaluated Be Trauma Informed, a two-episode podcast educational series designed to increase PCC nurses’ TIC knowledge, attitudes, and trauma-informed practices while also assessing implementation outcomes of feasibility, necessity, acceptability, fidelity, safety, and beginning effectiveness. The curriculum for the podcast series was developed by the primary investigator with stakeholder input from PCC and TIC experts. The podcast was professionally produced, and episodes were distributed on major podcast platforms. Using purposive convenience sampling, PCC nurses within the United States completed …

Using Chatgpt Ai To Analyze Clinical Judgment In Immersive Virtual Reality Simulation From Prelicensure Nursing Students, Shari Ann Fehrenbach

Dissertations (1934 -)

This retrospective, descriptive study examined how clinical judgment was demonstrated across two immersive virtual reality simulation (IVRS) experiences in a cohort of Direct Entry Master of Science in Nursing (DEMSN) students using a generative large language model artificial intelligence, ChatGPT, for categorization of clinical judgment cognitive processes. The National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (CJMM) guided the study (NCSBN, 2022). Nurse expert-derived CJMM-aligned scoring rubrics were applied to deidentified, developer-generated IVRS performance reports, and ChatGPT categorized whether rubric actions were demonstrated and generated case-level, scored excel files. Total CJMM and cognitive component scores were …

Patient Perception Of Pain Following Extraction And Bone Graft With Or Without Preemptive Ibuprofen: A Randomized Clinical Trial, Samah Rady

Master's Theses (2009 -)

Objective: The purpose of this randomized clinical trial is to investigate the effects of preemptive analgesia on postoperative pain following extraction and ridge preservation and to evaluate the association between dental care-related fear and anxiety, health literacy, fear of pain, and pain catastrophizing with post-operative pain and swelling perception as well as Oral Health Impact Profile-14 (OHIP-14). Materials and Methods: Ibuprofen 600mg (test; n=9) or placebo (n=13) were randomly given one hour prior to extraction and ridge preservation. Preoperatively, patients completed the following questionnaires: Modified Dental Anxiety Scale (MDAS), Oral health-related quality of life (OHIP-14), Fear of Pain (FPQ-III), Pain …

The Influence Of The Timing Of Definitive Restoration Placement After Root Canal Completion: A 22-Year Retrospective Study, Shikha Gupta

Master's Theses (2009 -)

Objective: To evaluate how the time interval between root canal obturation and the placement of a definitive restoration impacts the incidence of tooth failure, defined as non-surgical retreatment, apical surgery, or extraction. Methods: This 22-year-retrospective cohort study utilized electronic health records from the Marquette University School of Dentistry (MUSoD) axiUm database, analyzing 11,002 teeth treated between 2004 and 2026. Inclusion criteria required patients to be at least 18 years of age, categorized as established patients of record, with all non-surgical root canal treatments (NSRCT) meeting the 2020 AAE quality standards. The interval between obturation and restoration was categorized into seven …

Occupational Therapy And Periodontics Collaboration To Improve Hand Health And Fine Motor Skills In Dental Student, Zainab Alsuwaiyan

Master's Theses (2009 -)

Background: A study conducted in 2023 by the Occupational Therapy (OT) Department and Marquette University school of dentistry (MUsoD) demonstrated that many student participants scored below average on hand function testing, indicating a need for occupational therapy intervention. Objective: The purpose of this study was to evaluate the effectiveness of occupational therapy–led training for periodontics and registered dental hygienist faculty on the performance of dental students in the Introduction to Clinical Practice course (DEIN 7114). Methods: Faculty teaching in DEIN 7114 were recruited for this study. They participated in educational sessions led by occupational therapy faculty focusing on musculoskeletal disorders …

Dna Methylation Of Slc6a4 And Nr3c1 In Term And Preterm Infants: A Pilot Study Of Nicu-Associated Stress, Kathryn J. Malin, Yvette P. Conley, Aleigha Barry, Rosemary White-Traut

College of Nursing Faculty Research and Publications

Background: Preterm infants requiring prolonged hospitalization in the neonatal intensive care unit (NICU) are often exposed to early-life stress, which may contribute to long-term health consequences. Epigenetic markers, particularly DNA methylation (DNAm) of stress-related genes such as SLC6A4 and NR3C1, have been identified as potential biomarkers of early-life stress. Limited research has compared DNAm patterns between term and preterm infants or examined associations between NICU-related stress and DNAm in preterm populations. Objectives: This pilot study aimed to (1) compare DNAm patterns between preterm and term infants, (2) examine relationships between NICU-related stress and DNAm alterations in preterm infants, and …

Predictors Of Opioid Misuse And Abuse Among Pregnant Women In The Us, Henry Ofori Duah, Diane Von Ah, Ethan Morgan

College of Nursing Faculty Research and Publications

Introduction

Opioid misuse and abuse during pregnancy can adversely affect maternal and infant outcomes. Factors that drive the burden of opioid misuse and abuse are multifaceted and understudied. This study sought to explore predictors of opioid misuse and abuse among pregnant women in the United States.

Methods

Secondary data analysis of the National Survey on Drug Use and Health (NSDUH) data from 2015-2019 was performed. The primary outcomes were past-year opioid misuse, past-month misuse, and past-year opioid abuse. Data analysis included weight-adjusted univariate, bivariate, and multivariable logistic regression.

Results

The pooled weighted sample comprised 2,258,599 pregnant women. The prevalence of …

Long-Term Effect Of Ammonia- And Water-Based Silver Fluoride On Dentin Collagen Matrix, Merve Uctasli, Roda Seseogullari-Dirihan, Thiago Henrique Scarabello Stape, Mustafa Murat Mutluay, Arzu Tezvergil-Mutluay

School of Dentistry Faculty Research and Publications

Objective

To evaluate the long-term effect of ammonia- and water-based silver fluoride treatments on the degradation of the dentin collagen matrix.

Methods

Dentin beams (0.3x3x7mm) were demineralized (10 % H₃PO₄), rinsed and randomly distributed into six groups. Groups (n = 10 beams/group) were treated with (1) ammonia-based silver fluoride = SDF; (2) SDF + potassium iodide = KI (3) water-based silver fluoride = SF (4) SF + KI (5) KI (6) untreated demineralized dentin beams served as control. Following treatments, dry mass, modulus of elasticity and enzymatic activity were assessed. Dentin beams were incubated in calcium- …

Educating To Exhaustion: Intention To Leave Among Us Full-Time Nursing Faculty, Jacqueline Christianson, Kathryn J. Malin, Jessica Leiberg, Lisa M. Grabert, Stephanie E. Moser, Jessica L. Zemlak

College of Nursing Faculty Research and Publications

AIM 

The aim of this study was to examine the relationships between work efforts and rewards with intention to leave and burnout among full-time nurse educators.

BACKGROUND 

The nursing faculty shortage is a contributor to the nursing shortage. Poor balance between work efforts and rewards may contribute to intention to leave.

METHOD 

A cross-sectional survey of US nurse faculty examined work efforts, rewards, burnout, and intention to leave. Structural equation modeling was used to evaluate the relationships among variables.

RESULTS 

Among 588 participants, efforts and rewards both had significant effects on burnout. Burnout and rewards had significant effects on intention …

Stroke Increases Motor Output Variability During Maximal Voluntary Isometric Contractions Of Knee Extensor Muscles In Adults, Zhilun Zhou, Stephanie Christine Wolfe, Brian Schmit, Matthew J. Durand, Sandra Hunter, Allison Hyngstrom

Physical Therapy Faculty Research and Publications

Greater motor output variability (MOV, inconsistency and unsteadiness) during submaximal tasks post stroke is associated with poorer motor performance. However, little is known about MOV during maximal tasks and relationships with clinical measures of motor performance among stroke survivors. This study determined inconsistency (across discrete attempts) and unsteadiness (within a single attempt) during knee extension maximal voluntary isometric contractions (MVICs) in stroke survivors and neurotypical controls. Forty-three stroke survivors (28 female) and 31 age-matched neurotypical controls (15 female) performed a minimum of five knee extension MVICs with paretic and non-paretic legs (stroke) or dominant leg (controls). Inconsistency was calculated as …

An Exploratory Bayesian Network Analysis Of Weight And Feeding Outcomes In 6-Month-Old Infants With Complex Congenital Heart Disease, Amy Delaney, Mary Taylor, Julie Ann Lavoie, Roger Brown, Karen Pridhame

Speech Pathology and Audiology Faculty Research and Publications

Purpose: We aimed to explore with a Bayesian network how clinically important factors related to feeding infants with complex congenital heart disease (CCHD) are associated with each other and influence feeding outcomes. Our goal was to raise questions for further study.

Method: This descriptive study included data from 19 infants on severity of neonatal illness, early oral-motor (OM) and swallowing skills, feeding patterns, liquid and solid intake, and weight-for-age at 2 and 6 months. Bayesian network analysis was used to estimate the conditional probabilities of these variables in relation to each other and predict the 6-month weight-for-age z score and …

Caregivers' Experiences Of Assessment And Treatment For Their Child With Childhood Apraxia Of Speech: An International Questionnaire Study, Donna Claire Thomas, Maryane Gomez, Angela Muis, Nathan Trezise, Eliza Williamson, Julie Case, Elizabeth Murray, Maria Irene Grigos, Jenya Iuzzini-Seigel, Shelley L. Velleman

Speech Pathology and Audiology Faculty Research and Publications

Purpose: The aim of this study was to understand caregivers' preferences and experiences with diagnosis and treatment of childhood apraxia of speech (CAS).

Method: Caregivers of children with CAS completed a 70-item online survey that explored demographics, initial concerns, the CAS diagnostic process, speech therapy goals, and preferred and received speech therapy service delivery (session frequency, length, and context). Quantitative data were analyzed descriptively and with inferential statistics; qualitative data were analyzed using content analysis.

Results: One hundred sixty-one caregivers participated, mostly from the United States, Australia, and Canada. A total of 72% of caregivers had concerns about their child's …

Three-Dimensional Displacement Of Upper Cervical Vertebrae In Severe Mandibular Deviation Caused By Condylar Hyperplasia: A Tomographic Segmentation Study, Claudia Milena Ramírez, Rodrigo Cárdenas-Perilla, Luis Eduardo Almeida, Diego Fernando López

School of Dentistry Faculty Research and Publications

Objective: To evaluate the three-dimensional (3D) angular displacement (Roll, Yaw, and Pitch) of the upper cervical vertebrae (C1, C2, and C3) in patients with severe mandibular deviation (MD) due to condylar hyperplasia (CH), utilizing a computed tomography (CT)-based segmentation approach. Methods: This retrospective cross-sectional study included 50 patients with MD ≥ 6 mm caused by hemimandibular elongation (HE) or a hybrid form (HF) of CH. The skull, mandible, and cervical vertebrae (C1–C3) were segmented using 3D Slicer software. Angular deviations (Pitch, Yaw, Roll) were measured relative to the Frankfurt plane. Patients were categorized by the side of CH (right or …

Cytotoxicity Of Ammonia- And Water-Based Silver Fluoride Treatments, Merve Uctasli, Roda Seseogullari-Dirihan, Mustafa Murat Mutluay, Arzu Tezvergil-Mutluay

School of Dentistry Faculty Research and Publications

This study aims to investigate the trans-dentinal and direct cell viability of ammonia- and water-based silver fluoride treatments. Deep dentin discs were prepared, balanced for permeability and autoclaved. Three-dimensional cultures of odontoblast-like cells were transferred to the pulpal aspect of the dentin slices inside perfusion split chambers designed for dentin-barrier cytotoxicity test, following ISO 7405. An experimental resin-based glass ionomer cement and a polyvinylsiloxane impression material served as positive and negative controls, respectively. The experimental treatments included: (i) ammonia-based silver fluoride = SDF, (ii) SDF + potassium iodide = KI, (iii) water-based silver fluoride = SF, and (iv) SF + …

Impacts Of Artificial Intelligence On Computed Tomography In Endodontics: An Integrative Review, Camila Da Silva Fagundes, Ana Ligya Monteiro Soares, Fabiofederal University Of Paraíba Luiz Cunha D'Assuncao, Elsbeth Kalenderian, Claudia Batista Melo

School of Dentistry Faculty Research and Publications

Background. Artificial Intelligence (AI), defined as systems capable of replicating human tasks aimed at performing complex tasks and supporting decision-making, is entering the field of Dentistry, standing out with its application in research and clinical practices, such as diagnosis using Cone Beam Computed Tomography. The objective of this study is to identify and organize scientific evidence related to the use of Artificial Intelligence in computed tomography as an advanced resource in Endodontics.

Materials and methods. This study is an integrative review, structured in well-defined steps, namely: formulation of the guiding question, selection of inclusion and exclusion criteria, identification of descriptors …

Independence Of Spectral Contrast Effects Across Different Frequency Regions In Speech Perception, Christian E. Stilp, Matthew B. Winn

Speech Pathology and Audiology Faculty Research and Publications

Identification of speech sounds is influenced by spectral contrast effects (SCEs), the perceptual magnification of spectral differences between successive sounds. SCEs result in the categorization of a target sound being biased away from spectral properties in the preceding acoustic context. Given remarkable consistency in the magnitudes of these contrast effects within the same frequency region, it was hypothesized that they would also show stable relationships across different frequency regions. In this study, normal-hearing listeners’ phoneme categorization and contrast effects were assessed where phonetic contrasts were driven by changes in low-frequency F₁ (“big”-“beg” continuum), mid-frequency F₃ (“dot”-“got”), or high-frequency …

An Educational Intervention On Mutual Goal Setting For Hospital Nurses: A Mixed-Methods Study, Teresa Jerofke-Owen, Kristi Opper, Joseph Beiler, Maharaj Singh

College of Nursing Faculty Research and Publications

Background:

Including patients in mutual goal setting is one mechanism to personalize care delivery and improve patient outcomes.

Objective:

The purpose of this study was to examine the impact of a nurse educational intervention about mutual goal setting on nurse engagement and self-efficacy for goal setting and the nurse/patient experience of goal setting.

Methods:

During this explanatory, sequential mixed-methods study, nurse engagement in goal setting and goal quality was assessed through chart audits 1-month pre-intervention (n = 173) and 1 and 3-months (n = 144, n = 137) post-intervention. Nurse self-efficacy was measured with the Appraisal Inventory Tool. Patient experience …

From The Goodness Of Our Hearts: A Scoping Review Of Qualitative Literature On Altruism As A Reward Mechanism For Nursing, Jacqueline Christianson, Madaline Mccarthy, Bonnie Sommers-Olson, Emily Horner, Norah L. Johnson

College of Nursing Faculty Research and Publications

Introduction

Altruism, the desire to help others, is a common motivation for choosing a career in nursing. Improved understanding of the role of altruism as a reward or motivation for currently-practicing nurses may inform future interventions to improve effort-reward balance among practicing nurses. Therefore, the purpose of this study was to collect, examine, and present literature on how altruism has been described as a reward mechanism or motivation for engaging in professional nursing.

Methods

This scoping review of literature used the Arksey & O’Malley method, PRISMA-ScR reporting checklist, and Rayyan review management platform. PubMed, Web of Science, and CINAHL were …

Beyond Numbers: Bridging Statistical Significance And Clinical Relevance In Healthcare Research, Maharaj Singh, Waheeda Khan, Mehreen Fatima

College of Nursing Faculty Research and Publications

Objective: This study aims to bridge the gap between statistical significance and clinical relevance using rigorous statistical methodologies applied to simulated healthcare data, thereby enhancing the translational value of research outcomes for patient‑centered care. Methods: A synthetic dataset representing 10,000 patients was generated, and descriptive statistics were applied to compare two treatment groups. Binary outcomes were predicted using both a logistic regression model and a neural network. Two‑tailed tests with a significant level of 0.05 were employed, utilizing SAS version 9.4 and IBM SPSS Statistics, Version 29.0 (IBM Corp., Armonk, New York, United States of America). Results: The simulated dataset …

The Performance Of Machine Learning Algorithms In Predicting Under-Five Anaemia In Tanzania, Henry Ofori Duah, Derrick Nyantakyi Owusu, Godwin G. Duah, Paul Shidende

College of Nursing Faculty Research and Publications

Aim

Anaemia in children under five remains a major public health concern, contributing significantly to global child morbidity and mortality. With the rise of machine learning (ML), novel opportunities exist to model and predict anaemia more effectively. This study aimed to evaluate and compare the performance of five ML algorithms in predicting anaemia among under-five children in Tanzania.

Methods

We conducted a secondary data analysis using the 2017 Tanzania Malaria Indicator Survey (TMICS). The dataset (n = 5906) was randomly split into training (70%) and test (30%) sets. Five ML algorithms, Linear Discriminant Analysis (LDA), Logistic Regression, Random Forest (RF), …

Comparing Us Medicare Coverage Options As A Contributing Mechanism To Sticking Or Switching To An Insurance Plan, Lisa M. Grabert, Brian J. Miller, Kathryn L. Wagner

College of Nursing Faculty Research and Publications

Background

In 2025, the US Medicare program is expected to spend over $1.1 trillion taxpayer dollars. A growing trend in the US Medicare program is more beneficiaries electing a private insurer, referred to as Medicare Advantage (MA), to manage their care. Since 2023, a slight majority of Medicare beneficiaries have elected to enroll in MA, yet little is understood about the mechanisms that drive beneficiaries toward their choices.

Methods

Our objective was to examine the association between comparing coverage options and ‘switching’ or ‘sticking’ with Fee-for-Service (FFS) Medicare or Medicare Advantage (MA). We conducted a panel study, using data from …

Sox11 Overexpression Restores Embryonic Pro-Growth Transcription In Mature Corticospinal Tract Neurons, Eliazbeth Batsel, Zimei Wang, Elizabeth Otten, Syed Roshan, Rabia Mohammad, Paula Pascual, Darby O'Shea, Jose Rosas, Pantelis Tsoulfas, Murray G. Blackmore

Biomedical Sciences Faculty Research and Publications

Neurons in the central nervous system (CNS) display a high capacity for axon growth during early development but lose this ability at a pivotal differentiation stage marked by synaptic maturation, circuit integration, and a profound shift in gene transcription. Once mature, most CNS neurons fail to reverse this transcriptional switch after axon injury, fundamentally constraining their intrinsic capacity for axon regeneration. Here, we show with single-nucleus RNA sequencing that forced expression of the transcription factor Sox11 in mature corticospinal tract (CST) neurons produces large-scale and stable changes in gene expression that are highly enriched for growth-relevant processes, and which strongly …

Intermittent Phrenic Afferent Activation Induces Phrenic Motor Plasticity, Nicole M. Popp, Taylor C. Holmes, Elizabeth A. Rozycki, Kristi A. Streeter

Physical Therapy Faculty Research and Publications

Approaches such as electrical stimulation of the phrenic neuromuscular system are currently used in humans to manage breathing impairments. We recently showed that electrical stimulation of the diaphragm muscle induces phrenic afferent-dependent plasticity. These findings highlight the need to better understand the mechanisms of afferent-mediated plasticity to guide and improve the development of novel therapies using electrical stimulation. Here, we tested the hypothesis that intermittent activation of large-diameter phrenic afferents induces phrenic motor plasticity, which, like other forms of plasticity, is pattern sensitive. We delivered inspiratory-triggered electrical stimulation using a narrow pulse width (0.1 ms) to preferentially activate large-diameter afferents, …

Transitioning To Life After Sport: Empowering Former College Varsity Athletes To Live More Healthfully, Linda Piacentine, Taylor L. Wolf, Jacob J. Capin

Physical Therapy Faculty Research and Publications

Introduction: 

The transition out of competitive sport comes with a range of psychosocial challenges for athletes, particularly when retirement is involuntary (e.g., due to injury). Little is known about the health of former athletes who often manage prior injuries and changing biopsychosocial factors.

Purpose: 

Identify the unique experiences of varsity athletes during college and as they transition to life after college sports and determine the facilitators, barriers, and needs of college varsity athletes to engage in a physically active and healthy lifestyle after competitive sport retirement.

Methods: 

Thirty former college varsity athletes (15F, 15M; mean age 23 ± 1 yrs; …

Beyond Mean Length Of Utterance: Novel Measures For Characterizing The Spoken Language Of Autistic Children, Janine Mathee-Scott, Courtney E. Venker

Speech Pathology and Audiology Faculty Research and Publications

Purpose:

Mean length of utterance (MLU) is a common measure of expressive language complexity in young children, including autistic children. However, means, by nature, obscure some information about spread and variability in data. Thus, we aimed to examine a new approach to characterizing linguistic complexity in autistic children by investigating the validity of two novel measures—range of length of utterance (RLU), standard deviation of length of utterance (SDLU)—alongside established measures: MLU and total utterances (TU).

Method:

Participants were 40 autistic children (12 girls, 28 boys; M_age = 41.78 months). Children participated in 10-min, play-based language samples with their caregivers. …

Sport Training Day Affects Adolescent Athletes’ Sleep Schedules, Abigail Larson, Jena Heck Street, Roman De Guia, Jacob J. Capin

Physical Therapy Faculty Research and Publications

Introduction: Sufficient sleep is integral to overall health whereas suboptimal sleep puts athletes at greater risk for injury, lengthens their recovery time, and decreases their performance. Our purpose was to compare sleep across training days (i.e., competition, practice, and rest) in adolescent athletes, specifically identifying differences between nights before and after training.

Methods: Participants [n = 33 (14 male, 19 female), aged 15.6 ± 1.0 years] wore an activPAL accelerometer continuously for 14 consecutive days and completed a sleep log noting training day status (i.e., competition, practice, rest).

Results: Athletes slept less on the day after competition compared to …

Artificial Intelligence And Mental Health: Promise, Pitfalls And Ethical Priorities, Maharaj Singh

College of Nursing Faculty Research and Publications

Mental health conditions are prevalent across the lifespan, yet workforce shortages, long waiting times, and fragmented systems mean many people never receive timely, evidence‑based care. Artificial intelligence (AI), including machine‑learning classifiers and large language models (LLMs), is being explored to support earlier detection, closer symptom monitoring and scalable psychoeducation. Early studies suggest AI can surface risk signals from language, sleep/activity traces and clinical notes; summarise complex records for clinicians; and deliver structured self‑help at scale. At the same time, safety, bias, privacy and accountability concerns remain salient.