Digital Commons Network^™

Health Disparities For Pneumonia And Sinusitis Antibiotic Treatment In The Emergency Department, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Rana El Feghaly Md

Posters

Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with first-line (FL) guideline-concordant antibiotics. Differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) have not been characterized. We sought to compare differences in antibiotic choice and duration for different socioeconomic factors, and analyze changes after quality improvement (QI) efforts. Multidisciplinary QI team used multiple Plan- Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January …

Empathy, Compassion Fatigue, And Resilience In Central Florida Firefighters And Ems Personnel, Lisa M. Correll

PhD in Education

The purpose of this nonexperimental quantitative study was to determine the relationship between empathy, compassion fatigue (CF), and resilience in firefighters and EMS personnel. Career firefighters and EMS personnel (N = 76) in Central Florida participated in an online survey that included demographic information, the Empathy Assessment Index, Professional Quality of Life Scale, and the Connor-Davidson Resilience Scale-10. Participants reported high perceptions of empathy (M = 4.11), resilience (M = 3.98), and quality of life (M = 3.28), but CF was perceived at low levels (M = 2.97). Empathy was not predictive of CF, indicating that overall empathy alone does …

Unpacking Developmental Programming: A Conceptual And Historical Analysis In The Context Of Dohad, Andrea Gretchev, Heide S. Temples, Gillian England-Mason, Deborah Dewey, Sara M. Sarasua, Christopher Farrell, Vivian Haley-Zitlin

Publications

The Developmental Origins of Health and Disease (DOHaD) paradigm posits that early environmental factors may influence a child’s development and long-term health outcomes. Developmental programming (DP) is central to this paradigm, whereby specific early life exposures during critical periods of development are associated with changes to physiological and metabolic pathways, potentially predisposing individuals to disease. However, no standard definition of DP exists, and various terms have been used to describe similar processes. This analysis aimed to develop a conceptual definition for DP to inform interdisciplinary research, education, and practice. Walker and Avant’s eight-step method was employed to analyze the literature, …

Transcultural Headache Medicine: A Framework For Integrating Cultural Contexts Into Headache Science And Care - A Call To Action From The International Headache Society., Mario F. P. Peres, Giancarlo Lucchetti, Homero Vallada, Ivy L. Riso, Georgia K. Westenhofen, Marcelo Moraes Valença, Juliana Ramos De Andrade, K. C. Brennan, Morris Levin, Tsubasa Takizawa, Zhao Dong, Yonggang Wang, Wanakorn Rattanawong, Henry Riyanto Sofyan, Massimo Leone, Freda Dodd-Glover, Hsiangkuo Yuan, Abdulrazaq Albilali, Taoufik Alsaadi, Leonardo Caixeta, Anna P. Andreou, Peter J. Goadsby, Antoinette Maassenvandenbrink, Sait Ashina, Rami Burstein, Patricia Pozo-Rosich, Fayyaz Ahmed, Shuu-Jiun Wang

Department of Jefferson Headache Center Papers and Presentations

Headache disorders are among the most disabling neurological conditions, affecting over 1.5 billion people globally. Despite advances in pharmacological therapies, major inequities persist due to underdiagnosis, undertreatment and limited access to effective care, particularly in low- and middle-income countries. Social determinants of health, including cultural meanings, language and health beliefs, are increasingly recognized as key drivers of disparities in burden, diagnosis and treatment outcomes. Traditional medicine, used by more than 80% of the global population, remains first-line care in many regions and continues to influence therapeutic choices in high-income settings. Major systems such as Ayurveda, Traditional Chinese Medicine, Unani and …

Comparison Of Levels Of Bmi, Stress, And Depression Of Women During The Prenatal Period Relative To Their Activity Levels, Kalayna King

Honors Theses

This study aimed to analyze the relationships between activity levels, Body Mass Index (BMI), stress levels, and depression symptoms in obese pregnant women in Arkansas. Two separate exercise intervention studies were combined in this analysis to ultimately give a sample size of 293 pregnant women who were randomized into standard of care group (control) and an exercise group (treatment/experimental) (n = 115 and n = 178, respectively). Women in the control groups were instructed to independently continue to follow the physical activity guidelines recommended by their gynecologist, whereas the experimental groups participated in a combination of aerobic and resistance exercise …

Implementation And Impact Of The Transition Series For Senior Residents In Internal Medicine Residency, Abby Lindseth, Md

Abstracts, Posters, Presentations

No abstract provided.

A Single-Dose Intravenous-Contrast Enhanced 4-Dimensional Computed Tomogram Facilitated Accurate Delineation And Tracking Metastatic Tumor Motion Within A Cardiac Chamber In All Breathing Phases For Cardiac Metastasis-Directed Radiation Therapy., Whoon Jong Kil, Wyatt Smith, David Cousins, Eugene Muchnik, Renee Muchnik, Craig Herndon, Haejin Kang

Oncology Articles

No abstract provided.

Development Of A Dendritic Cell Model To Unravel The Secrets Of Cards Toxin, Lizbeth Gomez

Posters - 2026

Dendritic cells (DCs) are derived from hematopoietic stem cells of the bone marrow. They are the most efficient antigen presenting cell, presenting antigens to T cells to initiate clonal expansion and differentiation of the T cells into memory and effector cells. Thus, activating the effector functions of T cells in cell-mediated and humoral immune responses (2). Community-acquired respiratory distress syndrome (CARDS) toxin is produced by Mycoplasma pneumoniae that causes acute and chronic lung infections (4). Dendritic cells play a key role in the immune response to respiratory mycoplasmas (3). However, the mechanism underlying in DC and CARDS toxin interactions are …

Evaluating The Effects Of Akt Knockdown And Everolimus Treatment On Ewing Sarcoma, Arisha Arif, Alfie Barcenez, Nicole Vanegas-Riddick

Posters - 2026

The purpose of this study is to use the gene AKT1, due to the interest in AKT1’s role in cancer cell proliferation, and the drug Everolimus, to determine if combined targeted therapy works as a more efficient therapeutic approach. We hypothesize that the knockdown of AKT1 will increase the sensitivity of Ewing sarcoma cells to Everolimus, resulting in reduced proliferation and/or survival compared to drug treatment alone. This would suggest that AKT1 normally protects cells from drug-induced stress. Ewing Sarcoma has been connected to chromosomal translocations and most common in pediatric patients. It is most often treated with chemotherapy and …

Sirna Knockdown Of Rptor Alters Gene Expression In Ewing Sarcoma Cells, Sergio Cipriano, David Leavitt, Michael Oliva, Liam Valdez

Posters - 2026

Ewing sarcoma is a highly aggressive cancer that primarily affects children and young adults. Although treatment options exist, many patients do not respond effectively, showing the need for improved targeted therapies¹. RPTOR is a key in mTORC1 complex which regulates cell growth, proliferation, and survival². LY2874455 is a selective pan-FGFR inhibitor that targets growth factor signaling pathways involved in tumor progression³, and FGFR signaling interacts with pathways such as mTOR, making it a potential target for combination therapies. We hypothesized that silencing RPTOR in Ewing sarcoma cells would disrupt mTOR signaling and alter expression of genes linked to cell survival …

Gene Expression And Apoptotic Responses To Panobinostat Treatment And Yap Knockdown In Ewing Sarcoma Cells, Luna Collazo-Garcia, Alejandra Favela Santos, Madeline Torres-Salazar, Isabella Toscano

Posters - 2026

Ewing sarcoma is an aggressive pediatric cancer driven by abnormal gene expression caused by the EWS-FLI1 fusion protein

Usually treated with intensive treatments such as chemotherapy and radiation

Outcomes remain poor for metastatic disease, highlighting the need for new therapeutic strategies

The Hippo signaling pathway regulates cell proliferation and survival through the transcriptional co-activator YAP1

Prevalence Of Plasmodium Ovale And Plasmodium Malariae Mixed Infections And Associated Mortality In Children With Severe Falciparum Malaria, Giselle Lima-Cooper, Dibyadyuti Datta, Caitlin Bond, Kagan Mellencamp, Ruth Namazzi, Mahesh Gupta, Andrea Conroy, Robert Opoka, Chandy John

Paediatrics and Child Health, East Africa

The prevalence and clinical significance of mixed Plasmodium infections in children with severe Plasmodium falciparum (P. falciparum) malaria are not well characterized. In a cohort of 440 Ugandan children hospitalized with severe malaria who were diagnosed with Plasmodium species via microscopy, nested polymerase chain reaction (nPCR) testing was used to detect P. falciparum, Plasmodium ovale (P. ovale), Plasmodium malariae (P. malariae), and Plasmodium vivax (P. vivax) infections and assess their association with adverse clinical outcomes during hospitalization. Using nPCR testing, the Plasmodium 18S small-subunit ribosomal RNA gene was detected in 440 children. Plasmodium falciparum mono-infection was identified in 329 (74.8%) …

Hemodialysis Access-Related High-Output Heart Failure: From Mechanisms To Multidisciplinary Management, Chukwuemezie Mamanu, Estefania Oliveros, Yevgeniy Brailovsky

Department of Medicine Faculty Papers

No abstract provided.

The 2025 Accra Declaration On Upskilling And Cost- Effective Cardiac Surgery In Africa, Charles Yankah, Jonathan Nwiloh, Carlos Mestres, Abdelmalek Bouzid, Tom Mwambu, Andrew Duncan, Mohamed Debieche, Samuel Omokhodion, Uvie Onakpoya, Matthias Angres

General Surgery, East Africa

The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart …

Une Com Spring Research Bulletin May 2026, Une Com Research & Scholarship

Osteopathic Student Research Symposia

Bulletin including abstracts from the University of New England College of Osteopathic Medicine’s 2026 inaugural Spring Research Update and Lightning Talk event.

Rearfoot Realignment As A Prophylactic Strategy For Recurrent Lateral Column Ulcers In Diabetic Foot: A Case-Based Hypothesis, Christopher I. Anjorin Ms Dpmc, Ali-Abdul Kareem Dpm

School of Podiatric Medicine - Student Research

Lateral column ulcerations remain a persistent and complex challenge in diabetic foot management. Although procedures such as tailor’s bunionectomy may provide localized pressure relief, they often fail to address the underlying biomechanical contributors, most notably rearfoot deformities such as calcaneal varus or pes cavovarus frequently observed in diabetic patients. These structural abnormalities shift the weight‑bearing axis laterally, increasing ground reaction forces along the fifth metatarsal and predisposing individuals with diabetic peripheral neuropathy and impaired proprioception to recurrent ulceration. This case explores the hypothesis that prophylactic rearfoot realignment may offer superior long‑term outcomes by correcting the mechanical etiology of lateral column …

Population Trends In Infant Mortality Before, During, And After Implementation Of Therapeutic Hypothermia Across Racial And Ethnic Groups: United States Period-Linked Data, 2000-2017, Janardhan Mydam, Nitin Chouthai

Conference Presentation Abstracts

Background: Moderate to severe hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and lifelong morbidity. Following publication of the NICHD Neonatal Research Network trial in 2005, therapeutic hypothermia (TH) became the standard of care for infants with moderate to severe HIE. However, national trends in HIE-related infant mortality before, during, and after TH implementation across racial and ethnic groups have not been comprehensively evaluated.

Objective: To assess the impact of therapeutic hypothermia on HIE-related infant mortality by comparing mortality rates before (2000-2005), during (2006-2009), and after (2010-2017) implementation of TH among different racial and ethnic groups in the …

Comparison Of Gene Up Regulation Between A Mouse Model Of Rop And Extremely Premature Newborns From Days 7 To 14 Of Life, Nitin Chouthai, Nikhlesh K. Singh

Conference Presentation Abstracts

Background: Severe ROP is linked to considerable morbidity in extremely premature newborns. To our knowledge, there are currently no early-phase biomarkers for ROP.

Objective: The objective of this retrospective study was to compare the retinal RNA expression in mouse pups exposed to oxygen-induced retinopathy with the blood RNA profile of extremely premature newborns during the first two weeks of life, specifically from days 7 to 14 of life.

Design/Methods: Bulk RNA transcriptome analysis was conducted using peripheral blood samples from 21 extremely preterm newborns who were born at less than 26 weeks’ gestation and were between 7 and 14 days …

Selective Retention Of Birdshot Pellets In The Rearfoot: A Case Demonstrating Tissue Preservation And Functional Recovery, Yasim Zafar, Steven Bolton, Alexandria Armstrong, Hooman Mir

School of Podiatric Medicine - Student Research

Level of Evidence: III (Case Study)

Statement of Purpose: Gunshot wounds to the foot pose a unique surgical dilemma—whether to pursue aggressive foreign body removal or to preserve soft tissue integrity. This case highlights the management of a birdshot injury to the rearfoot where selective non-removal of pellets near the neurovascular bundle led to complete healing and full functional recovery. The purpose is to emphasize tissue preservation over aggressive exploration in complex ballistic foot injuries.

Case Study: A 26-year-old female sustained a birdshot gunshot wound to the right rearfoot. Multiple small entry wounds were noted on the posterior and plantar …

Postmarketing Safety Of Bimekizumab For Hidradenitis Suppurativa: An Early Pharmacovigilance Analysis Using The United States Food And Drug Administration Adverse Event Reporting System, Simona A. Alomary, Nicole J. Baker, Temitayo Ogunleye, Susan C. Taylor

Student Papers, Posters & Projects

No abstract provided.

Detection And Quantification Of Allergen Cross-Contact In Shared Frying Oil Using Targeted Mass Spectrometry, Francisca Asigri

Department of Food Science and Technology: Dissertations, Theses, and Student Research

Cow’s milk and egg allergies are prevalent IgE-mediated food allergies that pose significant public health concerns worldwide. Although strict avoidance remains the primary management strategy, unintended exposure can still occur through allergen cross-contact, particularly in commercial and industrial food operations that utilize shared frying oils. The objective of this study was to identify and quantify allergen transfer in shared frying oil and assess the robustness of existing targeted mass spectrometry methods (LC-MS/MS) for detecting milk and egg proteins in heated oil matrices.

Heated oil spikes were developed by incorporating non-fat dry milk (NFDM) and whole egg powder (WEP) into oil …

Clinical And Non-Clinical Factors Associated With Early Discharge In Pediatric Non-Trauma Patients Transported By Rotor Wing, Jordon Mitzelfelt, Lisa Pruitt, Amy Papa, Ashley K. Sherman, David Juang, Sarah Brunner, Asdis Finnsdottir Wagner, Jennifer Flint

Posters

Objective: Helicopter emergency medical services (HEMS) are crucial for transporting critically ill children to definitive care, however, rising costs and relative risks of this type of transportation necessitate careful evaluation of potential over-utilization. Current literature primarily focuses on pediatric trauma patients, leaving a significant gap in data regarding non-trauma pediatric HEMS transports and the influence of non-clinical factors such as referral hospital distance, resources, and capabilities on transport decisions. This study aims to address these gaps by examining non-trauma pediatric HEMS patients and identifying associated clinical and non-clinical factors related to early hospital discharge (< 24 hours). Methods: This retrospective, single-center study includes pediatric patients with medical and non-trauma surgical diagnoses transported by HEMS between April 1, 2021 and March 31, 2024. Clinical data were extracted from transport team records and the hospital’s electronic health records. Analyses were performed to identify factors associated with discharge within 24 hours of admission. To identify predictors of early discharge, we analyzed clinical factors including chief complaint, pre-transport vascular access, transport crew interventions (medication administration and procedures), respiratory assistance, and Pediatric Age-Adjusted Shock Index (SIPA) scores. Additionally, we examined the impact of the initial admit unit, and medical support required within the first 24 hours of hospitalization. Non-clinical predictors included the referring hospital’s status (critical access and/or rural designation) and the time of transport. Results: A total of 568 patients were transported by HEMS, of whom 88 (15%) were discharged within 24 hours. Patients in the early discharge group were more likely to present with neurologic chief complaints (40%), whereas those remaining hospitalized beyond 24 hours more frequently presented with respiratory complaints (40%). Normal SIPA scores both prior to and at the conclusion of transport were significantly associated with early discharge (p=0.012 and p=0.011, respectively). Furthermore, patients requiring no medications or respiratory assistance during transport, or no respiratory support within the first 24 hours of admission, were significantly more likely to be discharged early (p< 0.001). Notably, all patients with central access prior to transport remained admitted for more than 24 hours (p=0.004). Regarding non-clinical factors, patients transported from designated rural hospitals were more likely to experience early discharge (p< 0.001). Conclusion: These results characterize the pediatric non-trauma HEMS population and identify key predictors of early hospital discharge. This data is essential for developing standardized dispatch criteria to mitigate over-utilization and ensure high-acuity transport is reserved for the most appropriate patients.

Does Variation In Systemic Steroid Use Impact Outcomes In Preschoolers Hospitalized With Viral Respiratory Tract Infection?, Smit Shah, Kathryn Kyler, Matt Hall, Jessica Markham

Posters

Background: Systemic corticosteroids (SCS) are a cornerstone of treatment for acute asthma exacerbation. However, the role of SCS in preschool-aged children hospitalized with viral respiratory tract infection (vRTI), including viral induced wheezing, remains uncertain. Clinical trials have reported conflicting results about the benefits of SCS in this population. Objectives: To evaluate hospital-level variation in inpatient management of preschool-aged children admitted with vRTI and to compare clinical and utilization outcomes based on hospital-level SCS use. Methods: We conducted a retrospective cohort study of children aged 24-59 months admitted to US children’s hospitals with vRTI from July 2022-July 2024 using the Pediatric …

Reducing Waste And Cost By Utilizing Tap Water For Laceration Irrigation In The Emergency Department: A Quality Improvement Approach, Alison L. Fowler, Rohan Akhouri, Josaih Galdean, Isabella Dunt, Christopher Kaberline, Viktoriya Stoycheva Mha, Rn, Cpn, Sarah Nienhaus, Leslie Hueschen

Posters

Purpose/Objective: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water decreases cost and waste without increasing rates of infection compared to sterile fluids. Currently, only 3.5% of lacerations closed in our ED are irrigated with tap water. This project aims to increase the percent age of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by March 2026 in a freestanding pediatric emergency department across two sites (ED 1, ED 2). Design/Methods: A multidisciplinary team (physicians, nurses, QI consultant, parent advisors) formed in November 2024. …

Impact Of Gender Trends On Plastic Surgery Fellowship Match: Implications For Surgical Education, Irene Helenowski, Emily Miller, Bridget Foley, Victoria Hodkiewicz, Christopher Kujalowicz, Parinaz Jila Siemers, Bianca Di Chiaro, Eleanor Bucholz

Biostatistics Collaborative Core: Faculty Publications and Other Works

Background:

No prior study has evaluated gender trends within the plastic surgery subspecialty fellowship match. The purpose of this study is to examine gender trends across fellowship trainee demographics to assess and characterize existing disparities between male and female plastic surgeon counterparts.

Methods:

A review of the new board diplomates listed in the annual newsletter to diplomates of the American Board of Plastic Surgery from 2015 to 2019 was used to identify physicians who pursued various plastic surgery subspecialties. Fellowship match data, including sex, practice type, and prior residency training, were obtained from publicly accessible institutional and private practice websites, …

Differential Effects Of Veratridine And 5-Fluorouracil On Ubxn2a-Targeted Mortalin And Rictor Proteins In Patient-Derived Colorectal Cancer Cells, Kate S. Schraufnagel

Honors Thesis

Colorectal cancer (CRC) is a leading cause of cancer-related mortality, particularly in patients with metastatic CRC and/or those who have developed resistance to conventional chemotherapy. There has been a significant rise in early-onset CRC (EOCRC) incidences in patients under age 50. Due to lack of screening, these patients are commonly diagnosed in the later stages where there is a lack of effective therapies. This highlights the need for targeted therapies that address the molecular drivers of tumor progression and treatment resistance. UBXN2A is a tumor suppressor protein that regulates key oncogenic pathways in CRC, including Mortalin-2 (mot-2)-mediated p53 suppression and …

The Effects Of Body Mass Index On Fertility And In Vitro Fertilization, Morgan R. Kidd

Honors College Theses

In-vitro fertilization (IVF) is the most widely used type of assisted reproductive technology for treating infertility arising from a number of conditions. As obesity rates continue to climb in the United States, infertility has been discovered to have a direct correlation. Individuals that fall below or above the healthy body mass index range are found to have disrupted regulation of the hypothalamic-pituitary-gonadal axis, resulting in diminished reproductive health. Those that are diagnosed as infertile due to conditions caused by the effects of low body mass index or high body mass index may seek assisted reproductive technologies to intervene in achieving …

Resilience Factors For Physical Activity After Completion Of Intensive Interdisciplinary Pain Treatment: A Qualitative Analysis., William R. Black, Lora L. Black, Jennifer Christofferson, Liesbet Goubert, Cara M. Hoffart, Dustin Wallace

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: This study explored potential resilience factors that facilitate engagement in physical activity (PA) among adolescents with chronic musculoskeletal pain after completing intensive interdisciplinary pain treatment.

METHODS: Ten adolescents aged 13 to 17 years with a history of chronic musculoskeletal pain from a mid-western pediatric hospital in the United States participated in this qualitative study. Participants provided demographic information and completed semistructured virtual interviews. The interviews focused on their pain experiences, resilience, and engagement in PA. Transcripts were analyzed using primarily directed content analysis based on a pain resilience framework.

RESULTS: Participants highlighted several key resilience factors that influenced their …

Cardiac Medication Use In Action For Duchenne Muscular Dystrophy Cardiomyopathy., Carol A. Wittlieb-Weber, Brian Birnbaum, Chesney D. Castleberry, Tyler W. Cunningham, Paul Esteso, Katheryn E. Gambetta, Emily A. Hayes, Daphne T. Hsu, Beth D. Kaufman, Benjamin Kroslowitz, Ashwin K. Lal, Angela Lorts, Hugo Martinez, Deepa Mokshagundam, Deipanjan Nandi, John J. Parent, Frank Raucci, Nelia Soares, Jonathan H. Soslow, Renata Shih, Svetlana Shugh, Chet R. Villa, Sarah J. Wilkens, Bethany L. Wisotzkey, Jennifer Conway

Manuscripts, Articles, Book Chapters and Other Papers

This study seeks to understand cardiac medication use in a large cohort of males with Duchenne Muscular Dystrophy (DMD) followed prospectively with focus on current practices and adherence to consensus directed medical therapy (CDMT). DMD patients have been enrolled in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Dystrophinopathy Registry since 2021. Cardiac medication use was analyzed at enrollment and most recent follow-up. CDMT was defined as concurrent use of angiotensin-converting-enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) /angiotensin receptor-neprilysin inhibitor (ARNI) plus beta-blocker (BB) plus mineralocorticoid receptor antagonist (MRA). Two hundred sixty-five males with DMD (median age 17.5 (IQR 14.5-21.5) …

Proximal And Distal Factors Associated With Obesity In Childhood: An Exploratory Structural Equation Model., Joseph A. Skelton, Erinn T. Rhodes, Sarah Hampl, Ihuoma Eneli, Edward H. Ip, Sit Study Research Group

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Obesity in childhood is complex; structural equation modeling (SEM) offers an approach to ascertain complicated relationships between weight and proximal (health behaviors, child health) and distal (family/household, community) variables. The objective of the study was to use SEM to map the influence of different etiological clusters on obesity in childhood.

METHODS: Secondary analysis of baseline data from patients and parents enrolled in a multi-site study of pediatric weight management was conducted. The primary outcome was weight status (utilizing percentage above the 95th percentile BMI, %95BMI). SEM was used to evaluate the influences of variables proximal and distal to child …