Digital Commons Network^™

Endogenous Light In The Brain: Investigating Sources, Propagation, And State-Dependent Emission, Emre Cicek

Theses and Dissertations (Comprehensive)

Ultraweak photon emission (UPE), and by extension light, has long been thought to be a modality of communication in nature. Prior studies have already identified that UPE can depend on cell type and can be used to discern between malignant and benign cells. However, besides theoretical models, not much effort has been made to identify possible biological structures that would allow for light to be used as a method of communication in the human body. According to the framework set by Shannon’s Information Theory, for communication to be possible at minimum a transmitter, a transmission channel, and a receiver are …

Sediment Redox-Driven Iron Flux And Phytoplankton Community Responses: Implications For Cyanobacterial Suppression And Functional Stability Across Boreal Lakes, Julia K. Kozak

Theses and Dissertations (Comprehensive)

Freshwater eutrophication contributes towards the development of cyanobacterial harmful algal blooms (cHABs), but nutrient availability alone does not fully explain variation in phytoplankton community composition or physiological performance. While phosphorus (P) availability has been known to regulate phytoplanktonic biomass, iron (Fe) is an important micronutrient supporting Fe-heavy processes within cyanobacteria (i.e., nitrogen fixation and photosynthetic electron transport). Sediment Fe availability in freshwater ecosystems is regulated by reduction oxidation (redox) conditions at the sediment-water interface (SWI), where nitrate (NO₃^-) has been found to maintain oxidizing conditions and prevent the reduction of Fe(III) to more readily bioavailable soluble Fe(II), …

Nourishing Births: A Program Evaluation Proposal For Community-Based Nutrition Education, Food Access, And Garden Engagement Among Black Birthing People, Naa Deedei-Vera Hammond

Master's Projects and Capstones

Black birthing people in the United States continue to experience unequal maternal health outcomes, shaped in part by racism and barriers to nutritious food, culturally relevant health education, and supportive community spaces. While prenatal nutrition education and food assistance programs can provide important resources, information alone cannot address the challenges many people face when trying to access healthy and affordable food during pregnancy. The Nourishing Births Initiative is a proposed community-based maternal health program designed to respond to these needs by bringing together prenatal nutrition education, help connecting to food resources, community gardening, and peer support for Black birthing people …

Enhancing Shipboard Safety Management Under The Ism Code: An Innovative Risk Assessment Framework With A Stern Tube Case Study, Pi-Yen Lin

Journal of Marine Science and Technology–Taiwan

The shipboard safety management system (SMS) is designed to enhance safe operations, risk management, and emergency response to improve overall ship safety and efficiency. This paper demonstrates the use of an engine room simulator (ERS) for collecting failure modes and applies it to a comprehensive failure analysis of the stern tube lubricating oil system. A new risk closeness coefficient method was developed, integrating expert background knowledge and weighted risk assessments. The analysis, based on multiple expert evaluations, covered five subsystems, eight main components, 23 failure modes, and 112 failure causes. This study presents 26 recommendations for maritime practitioners and onboard …

Robust Statistical Methods For Microbiome Abundance Data, Yiming Shi

WUSM Theses and Dissertations – All Programs

Differential abundance analysis in microbiome studies aims to identify taxa whose abundance differs across biological or clinical conditions. The observed data are typically taxon-specific sequencing read counts, representing reads assigned to different taxa within each sample. These counts are indirect measurements of the underlying microbial abundance profile and are constrained by sample-specific library sizes. Microbiome count data are also typically sparse, overdispersed, and heteroscedastic. Together, these characteristics create substantial challenges for differential abundance analysis and make the results highly sensitive to normalization procedures, model specification, and the statistical methods used for inference.

Normalization defines the scale on which samples are …

Port And Vessel Communication Traffic Intrusion Detection: A Variational Autoencoder‑Enhanced Multilayer Perceptron Approach, Chien-Lin Chiang, Hsien-Cheng Chou, Ming-Yuan Peng, Yi-Yuan Chiang, Yu-Shun Liu

Journal of Marine Science and Technology–Taiwan

Port and vessel networks increasingly operate on IP/Ethernet backbones with high‑noise, high‑dimensional traffic. We present a lightweight hybrid intrusion‑detection model that couples a variational autoencoder (VAE) with a multilayer perceptron (MLP) and augments training with a boundary‑oriented latent‑space mixup strategy. The VAE models the distribution of normal traffic and identifies anomalies through reconstruction errors. Subsequently, it generates robust latent vectors, enabling the MLP to perform highly accurate supervised classification. On the UNSW‑NB15 dataset, the proposed pipeline attains ≥97% accuracy and an outstanding recall of 99.56% in binary intrusion detection, and visualization of the latent space (PCA) together with reconstruction‑error analyses …

Sar Ship Detection Based On Shallow Feature Guidance, Chenxu Xia, Peng Chen, Ya Zhang, Ying Li

Journal of Marine Science and Technology–Taiwan

Maritime ship detection is of great significance for both military security and civilian applications. Synthetic Aperture Radar (SAR), with its all-weather and all-day imaging capability, plays a vital role in maritime surveillance. Nevertheless, SAR ship targets typically appear small in scale, embedded in complex backgrounds, blurred at boundaries, and easily confused with near-shore features, which pose substantial challenges for accurate detection. To address these issues, we propose a SAR ship detection network that integrates dual enhancements of small-object representation and edge information. The network introduces two key components: the Small Target Refine Pyramid (STRP) to strengthen shallow feature representation for …

Kinesiology Department Chairs’ Perceptions Of Their Training And Preparation, Kason O’Neil

Electronic Theses and Dissertations

Department chairs are responsible for leading academic departments in higher education.  These individuals regularly make important decisions regarding such things as managing faculty and academic programming, overseeing budgets, and supporting student needs. Despite these responsibilities, many people become department chairs without receiving formal leadership training. This study explored how kinesiology department chairs across the United States viewed their preparation for the role and the importance of leadership training. A total of 111 department chairs completed an online survey about their background, previous training, and the importance of training for different administrative responsibilities. The results showed that most chairs had little …

Wildfire And Fuel Treatments In Utah: A Practical Guide And Outcomes From An Oak-Maple Ecosystem, Annie E. Prescott

All Graduate Theses and Dissertations, Fall 2023 to Present

Wildfire is a natural part of Utah’s landscapes, but as wildfires become more extreme and communities continue to expand into wildland areas, it is increasingly important to understand how wildfires behave and how their negative effects can be mitigated. One way to reduce wildfire risks and protect life, property, and ecosystem services is through fuel treatments — actions that reduce the amount and arrangement of flammable vegetation through mechanical removal, wildland fire, or other methods.

Information on wildfire behavior and fuel treatments is abundant but often scattered, ecosystem-specific and difficult to access. In addition, most research in the Western U.S. …

Toward Optimizing Fruit Production In Utah Soils: Apple Salt Tolerance Screening And Tart Cherry Fertility Management, Kaitlin Dabbs

All Graduate Theses and Dissertations, Fall 2023 to Present

Fruit production in Utah can be challenging due to local climate and soil conditions. Tart cherries and apples are major fruit crops in Utah, and improvements to these cropping systems would be beneficial for farmers and local consumers. Two experiments were conducted to evaluate desired improvements for these crops. The first study looked for salt tolerance in ten new apple rootstocks. Salty soils can be found throughout the state limiting the land suitable for apple production. When grown in salty soils apple trees often have reduced growth and production potential. A specialized drip irrigation system was constructed in a greenhouse …

The Willing And The Compelled: How Power And Place Shape Human-Bison Coexistence In Poland And The United States, Patrick Orville Kelly

All Graduate Theses and Dissertations, Fall 2023 to Present

Wildlife recovery programs depend not just on animals, but on how people feel about living with them. The degree to which people accept the disruptions wildlife brings to their lives, known as social tolerance, can determine whether a recovery program succeeds or fails, yet it remains understudied and underapplied in management plans. This dissertation studies how people in Poland and the western United States feel about living with the two living species of bison, the largest land animals in Europe and North America. In Poland, we surveyed 242 residents living at different distances from European bison habitat. Surprisingly, the most …

In Adults Older Than 18 Years With Obesity Living In Massachusetts, Can Engaging In A Weight Loss Program Help Them Lose Weight After Insurance Stops Covering Their Weight Loss Medications?, Angel Nagawa

Capstones

Executive summary

The Problem

Obesity rates continue to rise sharply across the United States. Weight loss medications have high compliance but face major insurance restrictions. Strict clinical criteria leave many patients without accessible treatment options.

The Proposed Solution

Launch structured, lifestyle-focused clinical weight loss programs. Provide an effective, accessible alternative to restricted pharmaceutical therapies.

Supporting Evidence

Evaluated data from three distinct randomized controlled trials. Findings confirm successful long-term weight management for program participants. Results prove effective control over serious obesity-related comorbidities.

Policy recommendation

Implement structured lifestyle programs as a primary, frontline intervention modality. Improve broad-scale patient health outcomes across clinical …

Methods For Tagging Whale Sharks: Insights Into Performance And Best Practices With A Focus On Clamp Attachments, Freya C. Womersley, Sofia Green, Alberto Garcia-Baciero, Ronan Conlon, Amy L. Jeffries, Matt J. Waller, Sara S. Ratão, Nuno Queiroz, Pedro Afonso, Gonzalo Araujo, Adam Barnett, Christine Barry, Michael L. Berumen, Farukhkha Bloch, Ginevra Boldrocchi, Camrin D. Braun, Ryan Caillouet, Constance Chapman, Jesse E.M. Cochran

Faculty Publications

Background: Biologging and telemetry have transformed our understanding of marine megafauna movement ecology. Yet, methodological constraints continue to limit data quality and deployment duration. Devices recording whale shark (Rhincodon typus) behaviours and movements have been used for decades, but they remain challenging to deploy and vary in success. Recently, spring-loaded clamp-based systems have emerged as one of the most widely used approaches to attach electronic tags to the fins of this globally endangered species. Currently, however, no consensus guidelines exist as to how to optimise this approach, potentially leading to continued underperforming deployments limiting analysis potential. Here, we synthesise experiences …

A Global High-Resolution Comprehensive Heat Indices Dataset From 1950 To 2024, Abdul Malik, Sateesh Masabathini, Mohsin Ahmed Shaikh, Qinqin Kong, Muhammad Usman, Dasari Hari Prasad, Ibrahim Hoteit

All Works

Heatwaves are becoming more intense and frequent as global temperatures rise, affecting vulnerable populations, particularly in low-income communities. Addressing the impacts of heatwaves requires high-resolution data to assess their influence on labour productivity, public health, and climate risk. We introduce the Comprehensive Heat Indices (CHI) dataset, a high-resolution (0.1° × 0.1°) hourly dataset from 1950 to 2024, derived from the ERA5 and ERA5-Land reanalyses. The CHI dataset encompasses thirteen heat stress indices, including wet-bulb temperature, universal thermal climate index, mean radiant temperature, wind chill, and lethal heat stress index (Ls). Thresholds for Ls are empirically linked to mortality, enabling the …

Exploring Competitive Dynamics Between Pseudomonas Baetica And Salmonella In A Polymicrobial System, Braxton E.M. Stout

Electronic Theses and Dissertations

The global rise in antimicrobial resistance has catalyzed a greater focus on polymicrobial research aimed at characterizing microbial interactions and uncovering new therapeutic strategies. Though it has long been of interest, environmental soil-derived bacteria remain largely under-represented in research and thus uncharacterized in this field. This project aimed to identify soil microbes that display inhibitory mechanisms to potential nosocomial pathogens. Soil sample S1S3-2 displayed inhibitory phenotypes toward numerous bacteria and was identified as Pseudomonas baetica. In both planktonic and biofilm growth, P. baetica was able to inhibit Salmonella arizonae through a contact-dependent and temperature-dependent manner. Screening of a transposon insertion …

Long-Term Analysis Of Pm2.5 Elemental Composition And Source Contributions In Coastal Urban Environments Of Corpus Christi And Houston In Texas, Sai Deepak Pinakana, Jeremy A. Sarnat, Amit U. Raysoni

School of Earth, Environmental, & Marine Sciences Faculty Publications

Long-term assessments of fine particulate matter play a key role in identifying persistent and emerging emission contributors. Coastal urban areas are highly susceptible to transboundary dust and wildfire events in addition to local pollution sources. Multi-decadal assessments in these regions using chemical speciation data could offer insights into major pollutant sources and their trends. This study utilizes nearly two decades of PM2.5 elemental composition data at two major coastal cities in Texas: Houston and Corpus Christi. Fourteen trace elements were analyzed to characterize the seasonal variability and long-term source evolution using a combination of Spearman’s correlation analysis, principal component analysis, …

Climate Change Impacts On Fish-Related Ecosystem Services: Synthesis, Network Analysis, And Strategic Pathways For Coordinated Adaptation, Ebenezer Afrifa-Yamoah, Awuah-Mensah, Stephen Bradshaw, Ute Mueller

Research outputs 2022 to 2026

Climate change is rapidly disrupting fish-related ecosystem services that underpin global food security, economic livelihoods, and cultural identity across both marine and freshwater systems. While impacts are increasingly recognised, disciplinary fragmentation has hindered integrated understanding of how climate-driven changes in fish populations affect ecosystem service delivery. This review makes two integrated contributions: a hierarchical synthesis tracing causal pathways from physical climate drivers through biological and ecological responses to socioeconomic outcomes, and a qualitative network analysis that maps the interconnections, implementation readiness, and strategic sequencing of seven major adaptation strategies. Ocean warming, acidification, deoxygenation, and their increasingly frequent co-occurrence as compound …

Evaluating The Transformation Of Land Cover, Land Surface Temperature, And Urban Heat Island In Sylhet Division Through Geospatial Analysis, Md Fazle Rabbi Joy, Md Abdur Rahim, Md Mahfuzar Rahman, Sumiaya Amin Preota, Mohammed Mahathee Hossain

School of Earth, Environmental, & Marine Sciences Faculty Publications

Rapid and unplanned urbanization has significantly transformed land use/land cover (LULC), contributing to increased land surface temperature (LST) and the emergence of urban heat islands (UHIs), especially in ecologically fragile regions. This study focuses on the Sylhet Division of Bangladesh, assessing LULC changes, LST dynamics, and UHI expansion from 1994 to 2024 using Landsat satellite imagery, normalized difference vegetation index (NDVI), normalized difference water index (NDWI) indices, and field-based LST validation. Unsupervised classification reveals a 191.75% increase in settlement areas and a 25.65% loss in forest cover. Correspondingly, the highest LST zones (> 30 °C) were absent in 1994 but …

A Journey To The Midwest For Migrant Farmwork: Women's Testimonies Examining Their Lived Experiences Using Autoethnography And Plática Research Methodologies, Yesenia G. Alcalá

Theses & Dissertations

A JOURNEY TO THE MIDWEST FOR MIGRANT FARMWORK: WOMEN’S TESTIMONIES EXAMINING THEIR LIVED EXPERIENCES USING AUTOETHNOGRAPHY AND PLÁTICA

RESEARCH METHODOLOGIES

Yesenia Garza Alcalá, Master of Business Administration

University of the Incarnate Word 2026

The purpose of my research was to share the stories of five women who experienced a yearly migratory routine from Del Rio, Texas, to work in farms and factories in the Midwest, and how that annual journey shaped and educated us. The women are four of my older sisters and me, all of whom traveled and worked in the Princeville, Illinois, migrant camp, where we experienced the …

Harnessing Digital Twin (Dt) Technology For Food Security And Climate Resilience In Sub-Saharan Africa (Ssa), Henri E.Z. Tonnang, Francis Chianu, Siyabusa Mkuhlani, Francis Muthoni, John Michael Humphries Choptiany, Franck B.N. Tonle, Bonoukpoe M. Sokame, Mercy Lung’Aho

All Peer-Reviewed Publications

Sub-Saharan Africa (SSA) faces chronic food insecurity despite possessing approximately 60% of the world’s uncultivated arable land. Field trials generate evidence but are costly and insufficiently scaled to address accelerating climate and demographic pressures. Digital twin (DT) technology, defined as the continuous, bidirectional virtual replication of physical systems using real-time data, supports monitoring, modelling, and optimisation of agrifood systems. To our knowledge, however, no published synthesis has examined DT agriculture research through the lens of SSA food systems or smallholder farming realities. A PRISMA-compliant systematic review was conducted across bibliographic databases using a pre-defined Boolean search and adapted PICOS eligibility …

Evaluating The Pulse Of Exercise Programs: Developing And Validating The Intervention Usability Scale For Exercise (Iuse) To Enhance Implementation And Adherence, Anne Inger Mørtvedt, Eva Ageberg, Steven Elmer, Kevin Trewartha, Erich Petushek

Michigan Tech Publications

Background: Adherence to exercise interventions is often suboptimal, despite numerous studies documenting barriers and facilitators. Usability may be a critical yet underexplored determinant of adherence. This study aimed to develop and assess the psychometric properties of the Intervention Usability Scale for Exercise (IUSE). Methods: Item generation and content validation involved cognitive interviews and feedback from eight exercise intervention stakeholders and ten target users from the general public. Subsequently, 526 target users from University, Qualtrics and Prolific participant panels assessed exercise programs through an online survey. Dimensionality was assessed using Principal Component Analysis (PCA), Exploratory Factor Analysis (EFA), and bifactor models. …

Exploring Burnout Among Ncaa Collegiate Athletes: The Impact Of Gender, Sport, Seasonal Demands, And Other Contributing Factors, Anneliese Wong

Undergraduate Honors Theses

The purpose of this study was to examine burnout among NCAA Division I student-athletes at one mid-sized University in the Rocky Mountains region of the United States and determine whether differences existed based on gender, sport type, competitive season stage, and burnout dimension. A quantitative, cross-sectional survey design was used and data was collected from 76 student-athletes across 11 varsity sports. Burnout was assessed using items adapted from the Athlete Burnout Questionnaire (ABQ; Raedeke & Smith, 2001), along with additional items assessing fatigue and seasonal experiences.

Descriptive results showed the student-athletes reported the highest mean level of physical burnout, followed …

In-Hospital Mortality Patterns And Readmissions In Patients With Chronic Obstructive Pulmonary Disease: An Analysis Of The Role Of Pulmonary Hypertension, Saad Afzal Khan, Trishna Parikh, Adishwar Rao, Akriti Agrawal, Aarohi Parikh, Farah Kazzaz, Sarah Shin, Harry Karmouty-Quintana, Maulin Patel, Kha Dinh, Bela Patel, Bindu Akkanti

Faculty, Staff and Student Publications

Chronic obstructive pulmonary disease (COPD) may be complicated by pulmonary hypertension (PH). We aimed to understand the impact of PH on in-hospital mortality and quantify the 30-day readmission rate among patients with COPD. For this cross-sectional study, we used the Nationwide Readmissions Database from 2017-2020 to identify adults ≥18 years with COPD. Patients were stratified according to PH diagnosis. Baseline characteristics between groups were compared using the Pearson chi-square test and two-sample t-test. Predictors of in-hospital mortality were determined using multivariate logistic regression analysis adjusted for demographics and confounders. The 30-day readmission rate and prevalence of PH subgroups by baseline …

Managing Collaboration Under Conservation Crisis: Trust, Risk, And Control In The Gulf Of Maine Fishery Management Network, Evelyn Roozee, Owen Temby, Dongkyu Kim, Antonia Sohns, Anthony Rocha Lima, Jasper R. De Vries, Gordon M. Hickey

School of Earth, Environmental, & Marine Sciences Faculty Publications

Transboundary fishery management and the intertwined conservation of critically endangered species represent significant governance challenges that require ongoing inter-organizational communication, collaboration, and collective action to achieve shared objectives. Previous research suggests that inter-organizational collaborative performance depends heavily on different dimensions of trust and complementary control mechanisms to mitigate the perceived risks of collaborating and enable the reciprocal sharing of resources and the coordination of activities. However, it is unclear how proposed relationships between trust, risk, and control are shaped by disruptions to established transboundary management networks. This study presents the results of survey research conducted in the Gulf of Maine …

Laboratory Study Of A Waste Anesthetic Gas Mask Scavenging System To Reduce Airborne Pathogen Exposure For Health Care Workers In Post Anesthesia Care Units, Josh Horton, Trevor Lim, Andrew Kanach, John Moenning, James Mcglothlin, Bruce M. Applegate Sr.

HCA Healthcare Journal of Medicine

Introduction

A scavenging oxygen mask system (SOMS) utilizing house vacuum has been demonstrated to significantly reduce exposure of post anesthesia care unit (PACU) health care workers (HCWs) to waste anesthetic gases (WAGs). Therefore, it was proposed that the same system could also be used to protect HCWs in the PACU by reducing Infectious Respiratory Particles (IRPs) spread from patients who may harbor airborne infective pathogens, such as Mycobacterium tuberculosis, certain strains of influenza, and SARS-CoV-2.

Methods

A life-like adult manikin head equipped with a bio-aerosol Collison nebulizer was set up to simulate patients exhausting pathogenic droplets. Further evaluation of …

Cropland Change And Prime Farmland In Calloway County, Kentucky, 2015–2025: A Gis Analysis Of Corn And Soybean Fields, Shiba Hari Dhakal Shiba

Scholars Week

Understanding where cropland change occurs relative to soil quality helps indicate whether farmland is being used on the most productive land. This study used GIS-based change detection analysis to evaluate changes in corn and soybean fields in Calloway County, Kentucky, between 2015 and 2025 and to test whether new corn and soybean fields were located on prime farmland. USDA Cropland Data Layer maps for 2015 and 2025 (30 m resolution) were reclassified into seven classes and compared in ArcGIS Pro, and the results were overlaid on USDA NRCS gSSURGO farmland classification. Combined corn and soybean area declined about 19% from …

Designing With, Not For Youth: Reframing Participatory Techniques As Civic Learning Tools For Urban Greening And Natural Resources Programming, Mayra I Rodriguez Gonzalez, Dorelys Oyola Remigio, Kevin G Torres Garrido

Journal of Extension

Here, we present four participatory techniques—visioning, mapping, photovoice, and codesign—with practical recommendations for their effective implementation in fostering civic learning and engagement in urban greening among BIPOC and Hispanic youth. With examples of culturally responsive, hands-on activities and an AI-assisted synthesis of youth ideas, drawn from application with over 100 youth in Connecticut, we illustrate their use in informing local urban planning processes. We highlight the role of these techniques in positioning youth as active civic agents and collaborative designers in the creation of urban green spaces, with application for Extension professionals, educators, and planning officials.

Factors Associated With The Incidence Of Hypertension In Young Adults (20–24 Years) In Central Kalimantan Province (Analysis Of Ski 2023 Data), Indira Paramesti, Ratu Ayu Dewi Sartika, Diah Mulyawati Utari, Kusharisupeni Joko Suyono

Indonesian Journal of Public Health Nutrition (IJPHN)

Hypertension has been identified as a major public health problem leading to premature death and contributing to the development of various non-communicable diseases. In recent years, it has occurred not only among older populations but also among young adults. Hypertension at a young age can result in earlier organ damage, leading to a more rapid decline in quality of life and productivity. This study aimed to determine the risk factors associated with the incidence of hypertension among young adults aged 20–24 years in Central Kalimantan Province in 2023. A cross-sectional design was employed, utilizing secondary data from the 2023 Indonesian …

A Comparison Of Iron-Folic Acid Supplement Consumption Among Female Undergraduate Students In Health And Non-Health Majors At The University Of Indonesia In 2026, Naila Afifah, Ratu Ayu Dewi Sartika, Triyanti Triyanti, Deasy Martini

Indonesian Journal of Public Health Nutrition (IJPHN)

Iron-Folic Acid Tablets (IFAT) are recommended to prevent anemia among adolescent girls and women of reproductive age. However, IFAT consumption remains a concern among female college students, with previous research reporting differences in non-adherence between female health and non-health students at the University of Jember. This study aimed to analyze IFAT consumption behavior and its associations with residential status, attitudes, mother’s education, IFAT side effects, IFAT accessibility, media, family support, peer support, and healthcare provider support among female undergraduate students in health and non-health majors at the University of Indonesia in 2026. A cross-sectional study with purposive sampling was conducted …

Association Of Chrononutrition Behaviors And Other Factors With Nutritional Status Among Dormitory Students Of Universitas Indonesia In 2026, Hana Maulani Putra, Ratu Ayu Dewi Sartika, Trini Sudiarti, Fathimah Sulistyowati Sigit

Indonesian Journal of Public Health Nutrition (IJPHN)

Overweight and obesity remain major public health concerns in Indonesia and may be influenced by various factors, including chrononutrition behaviors related to meal timing and eating frequency, snacking habits, physical activity, sleep patterns, stress levels, ultra-processed food (UPF) consumption, allowance, and sex. Students living in dormitories may experience lifestyle changes associated with greater independence, which can affect their nutritional status. This study aimed to analyze the association between chrononutrition behaviors and other factors with the nutritional status of dormitory students at Universitas Indonesia in 2026. This cross-sectional study was conducted from April to May 2026. Participants were recruited using purposive …