Digital Commons Network^™

Engaging Nurses In Effective Cost Of Care Conversations To Address Cancer-Related Financial Toxicity: Results From An Exploratory Survey, Jean Edward, Amanda T. Wiggins, Louis G. Baser, Haafsah Fariduddin, Joanna F. Doran, Monica F. Bryant, John August D'Orazio, Kimberly D. Northrip

Markey Cancer Center Faculty Publications

Few evidence-based trainings exist on how to equip healthcare providers, particularly nurses, with the skills to engage in cost of care conversations with patients/caregivers to mitigate the impact of cancer-related financial toxicity. This study evaluated a pilot training developed in collaboration with Triage Cancer® to prepare oncology nurses to identify and assist patients/caregivers facing financial and/or legal barriers to care. Ten pediatric oncology nurses completed the training and pre/post-surveys on behaviors related to financial and legal need screening, frequency and comfort level of answering questions, knowledge, and behavior changes, along with training evaluation questions. At baseline, six nurses reported never …

Engaging Nurses In Effective Cost Of Care Conversations To Address Cancer-Related Financial Toxicity: Results From An Exploratory Survey, Jean Edward, Abigail Wiggins, Louis G. Baser, Haafsah Fariduddin, Joanna F. Doran, Monica F. Bryant, John A. D'Orazio, Kimberly D. Northrip

Markey Cancer Center Faculty Publications

Few evidence-based trainings exist on how to equip healthcare providers, particularly nurses, with the skills to engage in cost of care conversations with patients/caregivers to mitigate the impact of cancer-related financial toxicity. This study evaluated a pilot training developed in collaboration with Triage Cancer® to prepare oncology nurses to identify and assist patients/caregivers facing financial and/or legal barriers to care. Ten pediatric oncology nurses completed the training and pre/post-surveys on behaviors related to financial and legal need screening, frequency and comfort level of answering questions, knowledge, and behavior changes, along with training evaluation questions. At baseline, six nurses reported never …

Analysis Of Facilitators Of And Barriers To Enactment Of State Regulation Of Indoor Tanning By Minors, Carolyn J. Heckman, Anna Mitarotondo, David B. Buller, Julia Berteletti, Kevin Schroth, Jerod L. Stapleton, Robert P. Dellavalle

Markey Cancer Center Faculty Publications

Background: Indoor tanning (IT) causes skin cancers, including potentially deadly melanoma. IT often starts during youth, a critical time for deleterious skin damage. About half of the US states have enacted laws banning IT for minors under age 18.

Purpose: This study reports qualitative findings from interviews with key informants (KIs) involved in IT legislative efforts to identify/describe factors influencing law enactment, based on the multiple streams framework.

Methods: Guided by expert advisors and using snowball-sampling, KIs from 16 states with most recently enacted IT laws regulating minor access and states without restrictions were contacted. In virtual interviews, KIs shared …

Examining Associations Between Sociodemographic Characteristics And Ever Breastfed Children, Nhanes 1999–2020, Jessica Amezcua, Lindsey M. West, Camelia Malkami, Marlo M. Vernon, Elinita Pollard, Justin X. Moore

Markey Cancer Center Faculty Publications

Although breastfeeding provides health benefits to both mother and child, this study aimed to explore whether disparities in breastfeeding continue to exist, particularly among non-Hispanic Black (NHB) mothers and children. We performed a cross-sectional analysis among 19,830 children in the United States (US) using the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2020. Breastfeeding initiation and duration rates increased overall from 1999 to 2020. Children who were ever breastfed were more likely to have higher body weight, older mothers, mothers who did not smoke during pregnancy, a higher family poverty–income ratio (PIR), food security, mothers in …

Access To And Utilization Of Dental Care Services By Older Adults In Nigeria: Barriers And Facilitators, Sunkanmi Folorunsho, Victor Ajayi, Munirat Sanmori, Medinah Suleiman, Raji Abdullateef, Abdulazeez Abdulganiyu

Department of Sociology: Faculty Publications

Aims: Nigeria’s rapidly aging population presents urgent challenges for the healthcare system, particularly in oral health, which remains an overlooked aspect of well-being. While older adults are especially vulnerable to dental issues such as tooth loss, periodontal disease, and oral pain, access to care remains limited due to systemic, economic, and cultural barriers. This qualitative study explored the lived experiences of older Nigerians in accessing and utilizing dental care, with the goal of identifying key barriers, facilitators, and policy-relevant insights.

Methods: Fifteen participants aged 50–83 years were purposively selected from urban and peri-urban areas of Ilorin, North- Central …

Study Of Maternal And Fetal Outcomes In Pregnancy Complicated By Thyroid Disorders, Sindhu Kumari, Poornima M

Digital Journal of Clinical Medicine

Background:

Thyroid disorders, particularly hypothyroidism, are common during pregnancy and can significantly impact both maternal and fetal outcomes. Despite advancements in screening and treatment, thyroid dysfunction in pregnancy often remains underdiagnosed, especially in low-resource settings. This study aimed to evaluate the prevalence, outcomes and effective management strategies of thyroid dysfunction during pregnancy.

Objectives: To evaluate the prevalence and outcomes of thyroid dysfunction, including both hypothyroidism and hyperthyroidism, during pregnancy, and their associated maternal and fetal complications.

Methods: This prospective observational study included 281 pregnant women with thyroid disorders attending antenatal care at JSS Hospital, Mysuru, from August 2022 …

Semaglutide And The Evolving Landscape Of Metabolic Dysfunction–Associated Steatotic Liver Disease, Rohan Karkra

Digital Journal of Clinical Medicine

The FDA approved Semaglutide (Wegovy™) on August 15, 2025, for adults with MASLD and moderate to advanced fibrosis (F2–F3), making it the second approved therapy after Resmetirom. MASLD affects up to 38% of adults and is now the leading cause of liver disease. In the phase 3 ESSENCE trial, Semaglutide achieved resolution of steatohepatitis without worsening fibrosis in 62.9% versus 34.3% with placebo, with additional benefits in weight loss and glycemic control. While long-term data remain pending and access barriers exist, this approval marks a significant advance in MASLD therapy with meaningful histologic and metabolic improvements.

Inpatient Dermatology Vignettes: Seborrheic Dermatitis, Garrett Furth, Henry Lim, Marshall Hall, Christian Scheufele, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Seborrheic dermatitis is a common inflammatory disorder characterized by greasy scale, itching, and erythema. It commonly affects areas of the skin that have high sebum production or are sebaceous gland-rich, including the scalp, face, sternum, axilla, groin, and other skin folds. Seborrheic dermatitis can present in infants, adolescents, and adults, and is more common in men. The etiology is not fully understood, but contributing factors include presence of the yeast genus Malassezia, androgen levels, immunosuppression, family history, and stress or lack of sleep. Interestingly, those with neurological and psychiatric conditions, including Parkinsons Disease, spinal cord injury, epilepsy, and tardive dyskinesia, …

Follicular Occlusion Syndrome: Diagnosis, Management, And Emerging Insights, Henry Lim, Reem Ayoub, Rafael Do Valle, Marshall Hall, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Follicular Occlusion Syndromes (FOS) are rare chronic relapsing skin disorders characterized by abnormal follicular hyperkeratinization, plugging, and inflammation. FOS are more commonly discussed as a ‘triad’ or ‘tetrad’ based on the patient’s clinical presentation. The triad includes hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. The tetrad in addition to the triad includes a history of pilonidal cysts. These disorders have a considerably negative effect on quality of life due to chronic pain, psychological distress, and body image concerns. Delayed or misdiagnosis can exacerbate patient outcomes, heightening the importance of timely identification and multidisciplinary treatment. We present two …

Body Dysmorphic Disorder Presenting As Alopecia Anxiety: A Case Report, Henry Lim, Paige Loux, Arianne Felicitas, Marshall Hall, Christian Scheufele, Garrett Furth, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Background: Body dysmorphic disorder (BDD) involves a preoccupation with a nonexistent or insignificant physical defect that causes clinically significant distress and impacts a patient's daily functioning. We present a case of a patient with body dysmorphia that manifested as anxiety about hair loss. Case Information: A 48-year-old otherwise healthy female presented to the dermatology clinic with the chief complaint of 8 months of hair loss. She had been seen previously by 2 other dermatologists. She brought 28 pages of paperwork to her first appointment detailing previous work-up, including four separate skin punch biopsies consistent with androgenetic, non-cicatricial (non-scarring) alopecia. Other …

An Unusual Case Of Indolent Systemic Mastocytosis: Diagnostic Insights In The Absence Of Classic Systemic Symptoms, Henry Lim, Jonah Gutierrez, Rafael Do Valle, Reem Ayoub, Marshall Hall, Christian Scheufele, Garrett Furth, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Introduction: Mastocytosis is a disorder characterized by an abnormal clonal accumulation and subsequent activation of mast cells within one or more organs. It is generally classified as either cutaneous, with or without systemic involvement, or systemic without cutaneous disease based on major and minor criterion. Indolent systemic mastocytosis (ISM) is a subclass of systemic mastocytosis with generally good prognosis. While the etiology of ISM is not completely understood, those who are affected typically have the KIT D816V mast cell receptor mutation. Given that ISM is mast cell mediated, patients predominantly present with a wide range of symptoms related to mast …

A Case Of Biopsy-Proven Atopic Dermatitis Perpetuated By Psychosomatic Factors, Henry Lim, Jamie Y. Choe, Marshall Hall, Arianne Felicitas, Christian Scheufele, Garrett Furth, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Introduction: Psychodermatology is an interdisciplinary branch of psychosomatic medicine that addresses interactions between the psyche and skin. Stress is often a key exacerbating factor and highlights the bidirectional relationship between psychological factors and skin disorders. Atopic dermatitis (AD) is a chronic skin condition affecting pediatric and adult populations with an estimated global prevalence of approximately 2.6%, or approximately 204 million people. AD classically presents with a red, scaly, pruritic rash. Here, we present a case of biopsy-proven AD induced by stress-associated behaviors related to patient-identified obsessive-compulsive habits. Case Presentation: A 61-year-old female presented for persistent itching and white discoloration in …

Clinical Evaluation And Management Of Terra Firma-Forme Dermatosis: Insights From Two Diverse Cases, Henry Lim, Rafael Do Valle, Reem Ayoub, Marshall Hall, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Terra Firma-Forme Dermatosis (TFFD), also known as Duncan’s dirty dermatosis is a benign, asymptomatic dermatologic condition characterized by well-demarcated brown patches to hyperkeratotic papules or plaques. It most commonly affects the neck, trunk, and face but can appear on other body regions. A key diagnostic feature is that these lesions persist despite routine washing with soap and water but can be removed by forcibly wiping the affected area with 70% isopropyl alcohol, revealing normal underlying skin. The exact etiology of TFFD remains unknown, though it is thought to involve abnormal keratinization or delayed desquamation. This condition is often underdiagnosed or …

Integrating Lifestyle Medicine Into Undergraduate Nursing Education, Lyndsay Wright

DNP Research Projects

Abstract 

Objective: Lifestyle Medicine (LM) effectively addresses the lifestyle-related diseases that contribute most to global morbidity, mortality, and healthcare spending. However, nurses and nursing students struggle with maintaining healthy lifestyles themselves, with LM and health behavior change strategies insufficiently taught in nursing education. Method: A quasi-experimental study with a pre-test and post-test design examined the effects of an LM educational intervention on undergraduate nursing students’ knowledge of LM and intentions for health behavior change. Data were collected using demographic questions, an LM knowledge (LMK) questionnaire, the Lifestyle Medicine Assessment (LMA), and a modified Intention to Change Behavior Scale …

The Potential Of Vitamin D As An Adjunct Therapy For Eczema, Kimberly Hill

Graduate Research Projects

No abstract provided.

Isapa 2025: Program Guide, Catherine Carty, Gerard Masdeu Yelamos

Publications

ISAPA 2025 is a landmark international event that brings together global leaders, researchers, practitioners, and advocates in Adapted Physical Activity to ignite systemic change under the unifying theme “Shifting the Dial: From Awareness to Transformation.” Hosted in Kerry, Ireland, under the patronage of UNESCO, the symposium integrates five major events into one dynamic platform.

The program reflects IFAPA’s mission to advance inclusion, research, professional excellence, and international cooperation, while also contributing meaningfully to the implementation of global frameworks such as the UN Convention on the Rights of Persons with Disabilities (CRPD), the Sustainable Development Goals (SDGs), the Paris 2024 Call …

Decoding Tattoo And Permanent Makeup Pigments: Linking Physicochemical Properties To Absorption, Distribution, Metabolism, And Elimination Profiles Using Quantitative Structure-Activity Relationship (Qsar)-Based New Approach Methodologies (Nams), Girija Bansod, Ajay Vikram Singh, Preeti Bhardwaj, Tulika Rai, Sweta Vijay Nakhale, Amruta Shelar, Rajendra Patil, Peter Laux, Andreas Luch, Christopher J. Osgood, Michael W. Stacey

Biological Sciences Faculty Publications

The safety and quality of tattoo and permanent makeup (PMU) pigments are subject to increased scrutiny due to their potential to cause adverse effects like anaphylaxis, photoallergic responses, and long-term toxicity. These undesirable reactions governed by their chemical structure possess varied physicochemical properties and absorption, distribution, metabolism, and elimination (ADME) characteristics. These properties control the pigment behavior during application, stability, and interaction with human tissue. The correlation between these physicochemical characteristics and ADME parameters of tattoo/PMU pigments remain under-explored despite the current advances in toxicology. Our study aims to address and bridge the gap by leveraging open-access QSAR computational toxicology …

Screening For The Unseen: Depression Detection Through Phq-9 And Provider Education In Pain Management, Veronica Shaw

DNP Projects

Background: Depression leads to significant economic and health burdens, causing 200 million lost workdays and costing employers $17 to $44 billion annually (CDC, 2022). It accounts for 4.3% of the global disease burden and is a leading cause of disability worldwide (WHO, 2021). Chronic pain, affecting 20.9% of United States adults, often exacerbates depression, creating a vicious cycle of physical and emotional suffering (Rikard et al., 2023). Despite the availability of effective treatments, depression is frequently missed in primary care settings, with 50% of cases undiagnosed (Hawkes, 2019). Addressing both depression and chronic pain through improved screening and holistic care …

Introducing An Eating Disorder Protocol In The Pediatric Primary Care Setting, Brandi Bozarth

DNP Projects

Background: The incidence of eating disorders has been on the rise, often beginning in adolescence and continuing well into adulthood. Consequences of untreated disrupted eating patterns can affect multiple body systems and are responsible for thousands of deaths annually. Despite these facts, research and data regarding eating disorders in adolescent patients are severely deficient. There is also a lack of standardization regarding assessing eating disorders in the pediatric primary care setting, as there are no specific guidelines or screening processes recommended by the American Academy of Pediatrics for the detection of eating disorders.

Purpose: The purpose of this project is …

Fecal Glucocorticoid Metabolite And T3 Profiles Of Orphaned Elephants Differ From Non-Orphaned Elephants In Zambia, Daniella E Chusyd, Janine L Brown, Steve Paris, Nicole Boisseau, Webster Mwaanga, Moses Kasongo, Lisa Olivier, Stephanie L Dickinson, Bailey Ortyl, Tessa Steiniche, Steven N Austad, David B Allison, Michael D Wasserman

Children’s Nutrition Research Center Staff Publications

Background: Elephants provide valuable insight into how early-life adverse events (ELAEs) associate with animal health and welfare because they can live to advanced ages, display extensive cognitive and memory capabilities, and rely heavily on social bonds. Although it is known that African savanna elephants that experienced ELAEs, such as being orphaned due to human activities, have altered behavioral outcomes, little is known regarding the physiological consequences associated with those stressors.

Methods: We compared fecal glucocorticoid (fGCM) and thyroid (fT3) metabolites as well as body condition scores (BCS) in rescued and rehabilitated orphaned (early-dry season: n = 20; late-dry season: n …

Prevalence Of Depression And Its Coping Strategies Among Rural And Urban Geriatric Population, Mohit Negi, Smitha M C

Digital Journal of Clinical Medicine

Background: Aging is a natural process, and older age is a period in which most aspects of life require support from others. Globally, Depression is a serious public health concern among elderly populations. The aim of this study was to estimate the prevalence of depression and its coping strategies among geriatric population and to evaluate the association between socio-demographic factors and level of depression.

Methods: A cross-sectional study was conducted among 410 study participants in both rural and urban areas. Geriatric Depression Scale (GDS-15) was used to measure the depression and brief-COPE (28-items) scale was used to measure the coping …

Establishing Psychiatry Clubs: Novel Approach To Enhance Psychiatry Teaching Learning In India, Akuti Khanna, Kishor M

Digital Journal of Clinical Medicine

Despite the fact that over 150 million Indians suffer from psychiatric disorders, the country faces a severe shortage of mental health professionals, with less than 1,300 psychiatrists graduating annually. One such solution is the establishment of Psychiatry Clubs in medical colleges, which can significantly enhance awareness, education, and community engagement in mental health. The Psychiatry Club at JSS Medical College, Mysuru, established on October 10, 2023, aims to promote mental well-being, provide peer support, as well as foster professional development through workshops, seminars, and collaborations with other mental health professionals and other student led organisations. These clubs offer a sustainable …

Assessment Of Effectiveness And Evaluation Of Perception Among Students Towards Flipped Classroom Learning: A Prospective Study., Nagaraja Prasad Sai, Vedavathi Hanumaiah, Shreenivas Prabhakar Revankar, Shruthi S. Lingesh, Avanthi Eshwar

Digital Journal of Clinical Medicine

BACKGROUND: Flipped learning (FL) is a teaching learning approach in andragogy. In FL students are involved in self-directed learning with the teacher acting as a facilitator and a moderator. Introduction of Competency Based Medical Education led many educators to shift from traditional teaching to blended teaching learning methods. This study was conducted to assess effectiveness and evaluate students’ perception towards FL.

AIM AND OBJECTIVES: To assess effectiveness of FL teaching in improvement of student scores and to evaluate student’s perception towards FL teaching.

MATERIALS AND METHODS: Pre-class activities included study materials in the form of PowerPoint slides …

Changing Climate, Changing Health: Perspectives From General Population In Mysuru, Lekhashree A, Manirsha P V, Paranthaman Chinnasamy, Srishti Arya, Sunil Kumar D

Digital Journal of Clinical Medicine

Background: Climate change has emerged as a major public health concern, contributing to rising morbidity and mortality worldwide. In India, increasing heat waves, unpredictable rainfall, and deteriorating air quality have intensified climate-sensitive health conditions. This study aims to assess the health impacts of climate change among the general population of Mysuru.

Methodology: A community-based cross-sectional study was conducted among 400 residents of Mysuru (April–June 2024). Participants were recruited through simple random sampling. Data were collected using a pre-tested semi-structured questionnaire via Google Forms. Analysis was performed using SPSS v26, with descriptive and inferential statistics.

Results: Among 400 participants, …

A Cross-Sectional Study Of The Correlation Between Working Models, Work-Life Balance And Psychological Distress In It Professionals In An Urban Setting., Neeharika Krishna Kumar, Ponnammal Sundar Lakshmi, Vathsalya S. Gowda, Kshamaa Haradanahalli Giriprakash, Manju Aswath

Digital Journal of Clinical Medicine

Background: India makes up more than 19% of the global Information Technology (IT) Market. The health and well-being of the population employed in this sector will affect their productivity at work and, in turn, the economic outcome. Changes in working models and altered work-life balance can lead to increased distress in IT Professionals, hence the current study.

Methodology: The current cross-sectional descriptive study assessed 247 IT professionals. A semi-structured questionnaire was used for socio-demographic details, working models and work-life balance. Kessler Psychological Distress Scale (K10) Plus was used to assess psychological distress. Statistics and correlations were done using SPSS 20. …

A Study Of Electrocardiogram And Echocardiography Parameters Of Post Covid – 19 Patients, Venkateswararao K, Durga Prasad Sadhupati

Digital Journal of Clinical Medicine

Background: Coronavirus Disease – 2019 [COVID-19] infection is multisystem disease not restricted to the lungs it has negative impact on Cardiovascular system by activation of ACE-2 receptors causing plaque stability, vascular inflammation and MI. ECG and 2D ECHO is a simple bed side diagnostic test can be used to assess cardiovascular disease involvement in such patients. We aimed to find out ECG and 2D ECHO abnormalities of Covid – 19 patients. To Study relation of SARS-COV-2 infection and Prevalence of Cardiovascular disease.

Methods: We perform Cross Sectional study among 500 Post Covid – 19 patients [>20 and

Results: Out …

Subclinical Myocardial Disease: The Next Frontier In Cardiovascular Prevention., Param Darpan Sheth, Chandana S., Nimrah Rehman

Digital Journal of Clinical Medicine

Subclinical myocardial disease refers to pathological cardiac changes that precede overt symptoms. It represents an emerging frontier in cardiovascular disease prevention; wherein early detection of myocardial dysfunction could allow timely intervention to avert heart failure (HF) and other outcomes. This narrative review summarizes the current and emerging tools for detecting subclinical myocardial disease, including advanced cardiac imaging and circulating biomarkers, and discusses their potential to improve risk stratification and preventive care in asymptomatic high-risk individuals. Novel echocardiographic measures such as global longitudinal strain (GLS) can unmask subtle systolic dysfunction despite preserved ejection fraction, while cardiac magnetic resonance (CMR) tissue mapping …

Development Of A Mediation Model Of Pain Cognition In Adult Patients With Sickle Cell Disease, Daniel M. Sop

Theses and Dissertations

Pain is a hallmark of Sickle Cell Disease (SCD), a genetic hemoglobinopathy characterized by chronic hemolytic anemia, vaso-occlusion, and organ damage. While acute vaso-occlusive crises (VOC) have been extensively studied, the mechanisms underlying chronic pain and its interplay with brain function remain unclear. This dissertation investigates the relationships between cerebral blood flow (CBF), fluid cognition, and pain sensitivity in adults with SCD, utilizing advanced imaging techniques and validated assessment tools.

Arterial spin labeling (ASL) and functional magnetic resonance imaging (fMRI) were employed to measure CBF and brain activity, respectively. Pain sensitivity was assessed using the Pain Sensitivity Questionnaire (PSQ), and …

Extension For Community Healthcare Outcomes-Palliative Care In Africa And Quality Of Life, Symptoms, Patient Experience, And Caregiver Distress Among Patients With Cancer, Sriram Yennurajalingam, Olaitan Soyannwo, John Weru, Edwina Beryl, Henriette Burger, Esther Nafulah, Oladayo Aikomo, Adeniyi Adenipekun, Irene Botchway, Mary Ocansey

Haematology and Oncology, East Africa

Purpose: In this study, we aimed to evaluate the association between the Extension for Community Healthcare Outcomes-Palliative Care (ECHO-PC; ECHO Model–Based comprehensive educational and telementoring intervention) for health care professionals (HCPs) and change in patient-reported quality-of-life (QOL; Functional Assessment of Cancer Therapy-General [FACT-G]) among patients with advanced cancer. We also examined the association between ECHO-PC and changes in symptom distress (Edmonton Symptom Assessment Scale [ESAS]), patient experience and satisfaction, and caregiver distress scores.

Methods: ECHO-PC Clinic sessions were conducted twice a month for 1 year by an interdisciplinary team of PC clinicians at the MD Anderson Cancer Center, with participation …

Juvenile Arthritis, Body Image, And Disordered Eating: An Exploration Of Experiences, Katelyn Ann Melcher

Graduate Student Theses, Dissertations, & Professional Papers

This qualitative study examined eating and body experiences among youth with juvenile arthritis (JA). JA, an autoimmune condition affecting nearly 300,000 youth in the United States, poses significant challenges including chronic pain, disability, and psychological concerns such as anxiety and depression. Adolescence is a critical developmental time for body image and disordered eating concerns to emerge. However, no qualitative research has explored the interactions of JA, body image, and eating behaviors among youth. Twelve youth with a JA diagnosis participated in a semistructured qualitative interview examining their experiences with JA and their feelings about their bodies and food as they …