Medicine and Health Sciences Commons^™

Advancing Cns Tumor Management: Novel Modalities In Surgery, Radiation, And Chemotherapy, Armin David Tavakkoli

Dartmouth College Ph.D Dissertations

Most tumors affecting the brain and spine are managed through a combination of surgical resection, radiation, and chemotherapy; however, operative morbidity from invasive surgery, the narrow therapeutic window of conventional radiotherapy, and poor blood-brain barrier penetration of systemic agents are critical barriers that hinder long term tumor control. This thesis presents three complementary strategies to advance brain and spine tumor therapy. First, we investigate laser interstitial thermal therapy (LITT) in the treatment of spinal tumors with metastatic epidural spinal cord compression, replacing “separation surgery” with a minimally invasive, image-guided approach that maximizes tumor ablation while preserving neurologic function. Second, we …

The Influence, Dependency, And Targeting Of Fatty Acid Uptake In Er+ Breast Cancer, Abigail E. Goen

Dartmouth College Ph.D Dissertations

Estrogen Receptor-positive/ Human Epidermal Growth Factor 2-negative, breast cancer (ER+/HER2- BC) is the most prevalent subtype of BC, impacting millions of individuals. Although early screening and treatment with endocrine therapy has greatly enhanced survival, this subtype sustains a steady increase of risk for recurrent disease for decades after diagnosis, indicating the persistence of residual cancer cells that are capable of maintaining dormancy for >20 years prior to metastatic outgrowth. Dormant cells reprogram metabolic pathways which can be profoundly influenced by the tumor microenvironment in promoting quiescence or proliferation. Fatty acid oxidation dependency has been noted as a hallmark of drug …

Low Burden Of Clinically Relevant Anaemia And Thrombocytopenia Among Adolescents Living With Hiv Receiving Tenofovir/Lamivudine Plus Dolutegravir: The Cipher-Adola Study In Cameroon, Nadine Nguendjoung Fainguem, Yagai Bouba, Rachel Kamgaing, Jeremiah Efakika Gabisa, Aude Christelle Ka’E, Michel Carlos Tommo Tchouaket, Alex Durand Nka, Cynthia Ayafor, Lum Forgwei, Upal Roy

Health & Biomedical Sciences Faculty Publications

Background: Anaemia and thrombocytopenia adversely affect adolescent HIV outcomes, yet adolescent-specific data from the tenofovir/lamivudine/dolutegravir (TLD) era remain scarce, and access to full blood count (FBC) testing is limited in Cameroon. We evaluated the prevalence, severity, and factors associated with these cytopenias among adolescents living with HIV (ADLHIV) in the TLD era.

Methods: Multicentre cross-sectional study was conducted among ADLHIV (10-19 years) receiving TLD in the CIPHER-ADOLA cohort in Cameroon. Full blood count, viral load (VL) and CD4-count were performed. Factors associated with anaemia and thrombocytopenia were ascertained.

Results: A total of 252 ADLHIV was enrolled (50.8% male, 83.3% were …

Apoe4 Drives Maladaptive Heterogeneity And Immunometabolic Responses Of Astrocytes, Danielle S. Goulding, Holden C. Williams, Amy A. Gorman, Nicholas A. Devanney, Douglas A. Harrison, Adeline E. Walsh, Tony Tuck, Diana J. Zajac, Shannon L. Macauley, Steven Estus, Julia Tcw, Lance A. Johnson, Josh M. Morganti

Sanders-Brown Center on Aging Faculty Publications

Apolipoprotein E4 (APOE4) is the strongest risk allele associated with the development of late onset Alzheimer’s disease (AD). Across the CNS, astrocytes are the predominant expressor of APOE while also being critical mediators of neuroinflammation and cerebral metabolism. APOE4 has been consistently linked with dysfunctional inflammation and metabolic processes, yet insights into the molecular constituents driving these responses remain unclear. Utilizing complementary approaches across humanized APOE mice and isogenic human iPSC astrocytes, we demonstrate that ApoE4 alters the astrocyte immunometabolic response to pro-inflammatory stimuli. Our findings show that ApoE4-expressing astrocytes acquire distinct transcriptional repertoires at single-cell and spatially-resolved domains, which …

Adversarial Robustness In Biomedical Time-Series Models, Rohan Tiwari

Bioengineering Theses

This study investigates adversarial vulnerabilities in deep learning models for biomedical time-series classification across two clinically important modalities: electrocardiography (ECG) and electroencephalography (EEG). Using the MIT-BIH Arrhythmia and CHB-MIT seizure datasets, I evaluate time-domain attacks (FGSM, PGD), Fourier-domain constrained attacks, and learned spectral perturbations designed to reveal modality-specific sensitivity patterns. Across both tasks, a consistent trend emerges low-frequency components (0–5 Hz) constitute a dominant axis of adversarial vulnerability, with perturbations in this range producing the steepest degradation in classification performance. In ECG models, protecting the physiologically relevant QRS band (5–20 Hz) significantly improves robustness, whereas EEG models remain highly sensitive …

Kinase Signaling In Liver Disease Via Clinical-Trial-On-A-Pamchip: A Distinctive Methodology For Drug Mechanisms And Personalized Medicine, Zachary A. Kipp, Evelyn A. Bates, Genesee J. Martinez, Wang-Hsin Lee, Sally N. Pauss, Terry D. Hinds, Jr.

Pharmacology and Nutritional Sciences Faculty Publications

The utilization of extensive datasets, such as those generated by DNA or RNA sequencing, has become a central focus in drug discovery and personalized medicine (PerMed). Nonetheless, these datasets are constrained by the absence of protein-functionality testing, which affects physiological responses. In this study, we employed PamGene PamStation technology to quantify protein function by kinase activity across more than 500 signaling pathways from patients with hepatocellular carcinoma (HCC). Using proteins derived from nine patients and five human HCC cell lines for drug discovery and the clinical trial-on-a-chip approach, we developed comprehensive PerMed scores from the PamStation data to differentiate individual …

“Medical Cannabis”: Advising Patients While Navigating Medical Ethics And Limited Evidence, Anna-Maria South, Shanna L. Babalonis, Laura C. Fanucchi, Michelle R. Lofwall

Internal Medicine Faculty Publications

Cannabis is increasingly legalized in more areas of the USA and marketed under the misnomer “medical cannabis.” Yet, there are no official dosing guidelines or approved medical uses for plant cannabis by the Food and Drug Administration. Due to significant federal barriers, research on efficacy, safety, and adverse effects of cannabis is limited. Patients are interested in cannabis as potential treatment of medical issues and/or symptoms and clinicians should include a discussion of the risks of cannabis consumption. However, many risks are not yet known, and clinicians might be unaware of the emerging literature. This perspective summarizes the potential harms …

Prevalence And Characteristics For Mental Health Disorder Before And After Childhood Cancer Diagnosis—A Statewide Population-Based Study Among Medicaid Beneficiaries, Feitong Lei, Laurie E. Mclouth, Eric B. Durbin, Thomas T. Tucker, John L. Villano, Bin Huang

Internal Medicine Faculty Publications

Introduction: Pediatric cancer patients suffer mental health deficits. Patients who are vulnerable with respect to socioeconomic or other sociodemographic factors may be at heightened risk for worse mental health outcomes during cancer for many reasons including entering treatment with an existing mental health disorder. The purpose of this study was to describe the prevalence and trajectory of mental health before and after a childhood cancer diagnosis in a socio-demographically at-risk sample.

Methods: Data from the Kentucky Cancer Registry was utilized to identify patients aged 19 or under with a first primary childhood cancer diagnosis during 2001–2017. Linking KCR data with …

Facilitators Of And Barriers To Implementation Of A Tablet-Based Digital Health Program For Colorectal Cancer Screening In Primary Care: Qualitative Pragmatic Implementation Study, Mark Cromo, Aliza Randazzo, David P. Miller, Kristie Foley, Ajay Dharod, Anna C. Snavely, Elena Wright, Holly Brower, Mark Dignan

Internal Medicine Faculty Publications

Background: Colorectal cancer (CRC) incidence and mortality rates continue to be elevated even though effective screening methods are widely available. To increase CRC screening in primary care practices, our team developed a tablet-based digital health program (mPATH) designed to identify patients needing CRC screening, provide education, and empower patients to request a screening test via the program.

Objective: This study aimed to qualitatively assess facilitators of and barriers to implementing and maintaining mPATH in primary care clinics.

Methods: In a pragmatic implementation trial, clinics were randomized to receive only in-person training and technological support via phone or email (low touch) …

Adipose Tissue-Derived Small Extracellular Vesicles In Plasma Reveal Molecular Circuitries Underlying Glucose Intolerance, Shalini Mishra, Yixin Su, Ashish Kumar, Sangeeta Singh, Brian S. Finlin, Fang-Chi Hsu, Jingyun Lee, Cristina M. Furdui, Philip A. Kern, Swapan K. Das, Gagan Deep

Internal Medicine Faculty Publications

Objective: Glucose tolerance (GT) is a major effector for adipose tissue (AT) remodeling in obesity, yet its molecular mechanisms remain incompletely defined. We hypothesized that the biophysical and molecular profiles of AT-derived small extracellular vesicles (sEV^AT) change in response to glucose availability and differ by GT status.

Methods: sEV^AT were isolated from plasma of individuals with normal GT (NGT) and impaired GT (IGT) (n = 5/group) at fasting (0 h) and 1 h post glucose challenge during oral glucose tolerance test (OGTT). sEV^AT were characterized for size, concentration, surface expression of insulin receptor-α (INSRα), proteome, …

Smarter Nutrition: Right-Sizing Nutritional Monitoring In Patients On Crrt, David Zolezzi, Elizabeth Journey, Jayne Walters

2026

No abstract provided.

Discrimination Distress And Current Combustible And Non-Combustible Tobacco Product Use Among Us Youth, 2023, Meman Diaby, Osayande Agbonlahor, Maggie K. Richardson, Joy L. Hart, Shyanika W. Rose, Delvon T. Mattingly

Markey Cancer Center Faculty Publications

Introduction: Discrimination is the unfair treatment of people based on their identity. Youth who experience discrimination may cope with associated distress by using tobacco products, with amplified health consequences depending on the type of product.

Methods: We used data from the 2023 National Youth Tobacco Survey (n = 22 069) and derived an overall continuous measure from the 15-item Adolescent Discrimination Distress Index, as well as three continuous discrimination distress sub-indices: educational, institutional, and peer (range for each: 0–5). We defined current tobacco use as two outcomes: any past 30-day use of combustible (cigarettes, cigars, hookah, roll- your-own, pipe, bidis) …

Epilepsy, Children's Health School Services

School Guides

Educator guide about how to support students with epilepsy.

Cystic Fibrosis, Children's Health School Services

School Guides

Educator guide about how to support students with cystic fibrosis.

End Stage Renal Disease, Children's Health School Services

School Guides

Educator guide about how to support students with end stage renal disease.

Anorexia-Bulimia, Children's Health School Services

School Guides

Educator guide about how to support students with anorexia and bulimia.

Arfid, Children's Health School Services

School Guides

Educator guide about how to support students with avoidant restrictive food intake disorder or ARFID.

Brain Tumors, Children's Health School Services

School Guides

Educator guide about how to support students with brain tumors.

Congenital Heart Defects, Children's Health School Services

School Guides

Educator guide about how to support students with congenital heart defects.

Acute Disseminated Encephalomyelitis (Adem), Children's Health School Services

School Guides

Educator guide about how to support students with acute disseminated encephalomyelitis or ADEM.

Artificial Intelligence–Enabled Revenue Cycle Management And Financial Performance In Healthcare Organizations, K’Reesa Webster

Theses, Dissertations and Capstones

The purpose of this review was to examine how artificial intelligence–enabled revenue cycle management (AI-enabled RCM) systems have been associated with financial performance outcomes in healthcare organizations. A literature review following a systematic process consistent with PRISMA 2020 guidelines was conducted to identify quantitative studies published between 2015 and 2026. Eligible studies were required to report at least one financial outcome related to claim denial rate, days in accounts receivable, or operating margin. Twenty-seven studies met all inclusion criteria. Findings across these studies indicated that AI-enabled RCM systems have been associated with lower denial rates, shorter accounts receivable timelines, and …

Bridging Clinic To Home: The Development Of A Caregiver Education Program To Support Home Carryover Of Feeding Interventions, Rachel Adams

OTD Capstones

Abstract

Objective Caregivers of children with pediatric feeding disorders or difficulties face stressful emotions within the context of feeding. There is an identified gap in pediatric outpatient occupational therapy and the educational resources they provide to caregivers related to feeding. To address this, the capstone project aimed to develop and integrate an evidence-based caregiver education program into the capstone site’s feeding therapy model to make a more well-rounded and all-inclusive feeding therapy program. Methods Two caregiver surveys were sent out along with a staff survey to identify the needs of the site and the caregivers of the clients and to …

Sickle Cell Disease, Children's Health School Services

School Guides

Educator guide about how to support students with sickle cell disease.

Osteosarcoma, Children's Health School Services

School Guides

Educator guide about how to support students with osteosarcoma.

Multiple Sclerosis, Children's Health School Services

School Guides

Educator guide about how to support students with multiple sclerosis.

The Impact Of Hot V. Cold Water Immersion On Post-Exercise Recovery, Cameron Moss, Aaron Krukemeyer

Williams Honors College, Honors Research Projects

Muscle recovery following exercise-induced soreness has been the focus of extensive research and debate, with Cold Water Immersion (CWI) and Hot Water Immersion (HWI) emerging as two of the most widely used modalities. The purpose of this study was to compare the effects of CWI and HWI on muscle recovery by determining changes in maximal force production of knee extension, range of motion (ROM) of the hip joint in flexion, extension, and abduction, and subjective muscle soreness using a validated Likert scale. Seven male recreational athletes participated in hot and cold-water immersion, and passive recovery. Despite thorough data collection, the …

Empowering Women Through Surf Therapy: A Trauma-Informed Facilitation Toolkit, Ashlie Steppe

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

Women who have experienced trauma often face challenges with emotional regulation, sense of safety and daily functioning. Additionally, one in three women experience trauma throughout their lifetime and this can lead to difficulty with connection, body awareness, and engagement in meaningful activities. A local non-profit surf therapy organization was established to provide women with a supportive community and meaningful, nature-based activity to promote healing and connection. The purpose of this quality improvement capstone experience was to address and develop a sustainable trauma-informed wellness toolkit to support facilitators in delivering structured wellness activities within the program. The toolkit specifically addressed key …

Psilocybin-Assisted Therapy And Alcohol Use Disorder, Zoe R. Evans

Theses, Dissertations and Capstones

This current paper has studied whether the psilocybin-assisted treatment has been linked with meaningful shifts in three clinical outcomes among adults 18 years old and above diagnosed with alcohol use disorder (AUD): percentage of heavy drinking days, abstinence rates, and neural responsiveness to alcohol-related cues. A literature review following a systematic approach was performed using guidelines from PRISMA 2020 based on four databases, namely PubMed and PsycINFO, and Scopus and CINAHL, where peer-reviewed articles published between 2015 and 2026 were included. A semi-structured professional interview with a clinical researcher in the Division of Addiction Sciences of Marshall University was also …

The Divide Of Women’S Health: Systematic Thinking Of Women, Tasfia T. Howlader

Honors Theses

Women’s health has constantly been changing- from public health infrastructure to health policies, and even medical advancements. Yet, the struggles are persistent within the gaps present in women’s health. The Socio-Ecological Model (SEM) explains interactions between different levels of relationships, which result in health outcomes that vary from individual factors to environmental factors. Applying the SEM to describe health disparities can help explain how the relationships an individual has influenced their health. This project serves to exemplify these different levels while discussing the tailoring of services to the needs and the importance of populations based on their experiences. Specifically, adhering …

Persistence Of Pet Scan Positivity After Chemoimmunotherapy For Dlbcl, James O. Armitage, Matthew A. Lunning, Julie M. Vose, Dan L. Longo

Journal Articles: Oncology and Hematology

Approximately 80% of patients with diffuse large B-cell lymphoma achieve a complete response after chemoimmunotherapy as defined by positron emission tomography (PET) scan. However, not all patients who fail to achieve a metabolic complete response are destined to relapse. In a number of these patients, the PET scan is falsely positive (ie, 20%-40% in several large series), particularly when the PET scan has a Deauville score of 4. Reflexively intervening with salvage systemic therapy or radiotherapy in these patients is potentially harmful. It seems that very sensitive measurements of circulating tumor DNA might be able to differentiate between patients who …