Digital Commons Network^™

Evaluating Spect Neuroimaging In Psychiatric Diagnosis: A Critical Review And Proposed Randomized Controlled Study, Kiley Carter

Senior Honors Theses

Mental illness affects a substantial proportion of adults in the United States, yet psychiatric diagnosis remains subject to diagnostic variability. Single-photon emission computed tomography (SPECT) is a neuroimaging technique that measures cerebral blood flow and has been proposed as an adjunctive tool for psychiatric evaluation. Existing literature reports group-level perfusion patterns associated with certain psychiatric conditions, suggesting potential utility in diagnosing complex or treatment-resistant cases. However, critics of SPECT emphasize the absence of randomized controlled data demonstrating improved patient outcomes. To address this gap, a prospective randomized controlled trial comparing standard psychiatric care with SPECT-guided evaluation is proposed. The proposed …

The Relationship Between Mc1r Gene Variants For Red Hair And Clinical Responses To Anesthesia, Analgesia, And Pain: A Systematic Review Of The Literature, Mary Clark Allen

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Genetic variations of the melanocortin-1 receptor (MC1R) are commonly associated with red hair and pale skin. Research has linked MC1R variants with alterations in anesthetic response, pain perception, opioid sensitivity, and pain-related fear. Existing literature presents inconclusive findings, highlighting the need for further investigation.

Purpose: This review aims to synthesize current evidence concerning the role of MC1R variants in altering physiologic responses.

Methods: A systematic literature review was conducted by accessing CINAHL, MEDLINE, and PubMed through the University of Arkansas Libraries OneSearch platform. After applying inclusion and exclusion criteria, a total of 20 peer-reviewed articles were extracted for review. …

Seeing Skin, Seeking Evidence: Lessons From A Dermatology Internship, Isabella Floyd

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Indoor tanning exposes individuals to artificial ultraviolet (UV) radiation through devices such as tanning beds and sunlamps, increasing the risk of skin damage and malignancy. Prior research suggests associations between indoor tanning and melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC), with potential variation based on age of initiation and cumulative exposure.

Purpose: The purpose of this literature review was to examine the association between indoor tanning and skin cancer risk, with a focus on age at first exposure, frequency, and duration of tanning bed use across melanoma, BCC, and SCC outcomes.

Methodology: A structured literature review …

Choosing Death: The Moral Legitimacy Of Voluntary Active Euthanasia, Emma Rougeou

Honors Theses

During the last three decades, the issue of physician assisted suicide has captivated the interest of private citizens and state legislatures. Thinking about the matter of end-of-life concerns, particularly surrounding euthanasian (practices that hasten the deaths of suffering terminally ill people) have shifted. Views of private citizens and state-level legislation reflects a “slow shift to more permissive attitudes” (Cohen et al., 2012). Meanwhile, as recently as March 2026, state legislators in conjunction with the NY State Governor, passed a bill legalizing medical aid in dying for terminally ill patients. This thesis is intended to thoughtfully contribute to meaningful discourse on …

Beyond The Cycle: How Menstruation Influences Gender Identity And Well-Being In Binary And Non-Binary Adults, Rin Nguyen

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Approximately 1.8 billion people worldwide menstruate, including transgender and gender-diverse (TGD) people, yet their experiences remain underrepresented in research. Given that menstruation can affect gender alignment and psychological well-being, understanding its impact on TGD people is critical. Gender congruence, or alignment between one’s gender identity and expression, is a key factor influencing well-being, with research linking it to reduced depression and anxiety. Furthermore, emerging research on gender euphoria, the joy experienced when gender congruence is experienced, suggests it may serve as a protective factor for mental health and well-being. Gender euphoria has been associated with reduced psychological distress and increased …

Measuring School Anxiety In Pediatric Chronic Pain: Initial Investigation Of The Psychometric Properties Of The School Anxiety Inventory For Chronic Pain (Sai-Cp), Caitlyn Maye, Robert C. Gibler, Kristen E. Jastrowski, Dustin Wallace Phd, Cara M. Hoffart, Jenny Scheurich Phd

Posters

Introduction: School anxiety is common among adolescents with chronic pain and often impacts academic and social functioning. Existing anxiety measures lack specificity for capturing the unique sources and symptoms of school-related anxiety in this population. To address this gap, a bank of new potential measure items (the School Anxiety Inventory for Chronic Pain [SAI-CP]), was developed based on the original School Anxiety Inventory (SAI), qualitative interviews with adolescents with chronic pain, and expert clinician input. The objective of this study was to evaluate the construct validity and internal consistency of the SAI-CP and identify avenues for future measure refinement. Method: …

Eptinezumab In Treatment-Resistant Chronic Migraine: Four-Year Real-World Effectiveness And Treatment Persistence, Wan-Jen Hsieh, Kelly Nicol, Chai Ching Ng, Tsung-Wei Hou, Phillip Phan, Scott W. Keith, Brittany Heckel, Michael J. Marmura, Hsiangkuo Yuan

Department of Neurology Faculty Papers

AimTo evaluate 48-month real-world outcomes of eptinezumab users in chronic migraine (CM), including longitudinal effectiveness, treatment persistence, reasons for discontinuation, and post-discontinuation anti-calcitonin gene-related peptide (CGRP) treatment patterns.MethodsWe conducted a retrospective cohort study of 112 CM subjects initiating eptinezumab at a tertiary headache center between 2019 and 2021. Monthly headache days (MHD), migraine disability assessment (MIDAS), and average pain intensity (API) were extracted at baseline and every 6 months for up to 48 months using a predefined outcome form at each visit. Longitudinal changes were analyzed using generalized estimating equations (GEE) with an unstructured correlation matrix, adjusting for age, sex, …

Diagnostic Ability Of Rate Of Torque Development For Patellofemoral Pain, Arun Loganathan, Neal R. Glaviano Phd, Sungwan Kim Phd

Honors Scholar Theses

Context: Patellofemoral pain (PFP) is a highly prevalent condition (22.7% in general population) that significantly impacts the quality of life of those who suffer from it. However, there is no gold standard test to diagnose it yet, leading to inconsistencies with treatment as well as delayed intervention. Rate of torque development (RTD) is a neuromuscular measure that has shown strong connections to PFP.

Objective: The purpose of this study is to determine the diagnostic ability of RTD for PFP.

Design: Cross-sectional.

Setting: Laboratory.

Participants: Thirty-five individuals with PFP (24 males and 11 females, 22.7 ± 3.7 years, 1.67 ± 0.1 …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …

A Systematic Review And Meta-Analysis On The Levels Of Supportive Care Needs In Adults With Cancer, Caroline B. Silveira, Rech, Maria Petropoulou, Pietro S. Rössler, Francine F. De Souza, Helena B. Böhmer, Amanda L. Giacomet, Richard Alejandro B. De Barros, Lucélia De C. De Barros, Vagner R.Z.B. Pereira, Nanci Da S.T. Junqueira, Pedro Lopez

Research outputs 2022 to 2026

Objective: To estimate the levels of supportive care needs among adults with cancer using the Supportive Care Needs Survey–Short Form 34 (SCNS-SF34) and to examine demographic, clinical, and treatment-related determinants. Methods: A systematic review and meta-analysis was conducted (CRD42024604977). Studies reporting SCNS-SF34 scores in adults with cancer were included. Searches were performed across six different databases (November 2024; updated August 2025). Random-effects meta-analyses were undertaken to estimate the pooled mean scores across the five SCNS-SF34 domains and total score. Subgroup and meta-regression analyses explored potential determinants. Results: Ninety-five studies (n = 32,493) were analysed. The unmet needs observed tended to …

The First Cut Is The Deepest: Understanding Learner Trauma In The Emergency Medicine Clerkship, Dimitrios Papanagnou, Leela Raj, Karen E. Watkins, Xiao C. Zhang, Andres Fernandez, Md, Victoria J. Marsick

Department of Emergency Medicine Faculty Papers

BACKGROUND: As third-year medical students transition into high-stakes, high-stress clinical environments like the emergency department (ED), they may experience significant personal trauma. However, little is known about how this trauma is experienced early in their training - specifically during the transition from preclinical to clinical learning environments. This study addresses that gap by exploring third-year medical students' experiences of trauma during the emergency medicine (EM) clerkship through the lens of Trauma-Informed Care (TIC) and identifies workplace factors and intersectional demographics influencing these experiences.

METHODS: This qualitative study used the critical incident technique to explore emotionally-significant events encountered by third-year medical …

Factors Associated With Postpartum Depression Symptoms Following Antepartum Hospitalization, Alison N Goulding, Daniel Palacios, Sukru Aras, Hu Chen, Sasidhar Pasupuleti, Marika Toscano, Nicole Cirino, Israel C Christie, Zhandong Liu, Emily S Miller, Terri L Fletcher

Duncan NRI Faculty and Staff Publications

Background: Hospitalized antepartum patients are at increased risk for postpartum depression (PPD). Developing approaches to identify those at highest risk for PPD would enable timely and targeted intervention.

Objective: We aimed to identify factors associated with the development of PPD symptoms in hospitalized antepartum patients and to assess their predictive utility.

Study design: This retrospective cohort study included pregnant individuals hospitalized in a regional referral center due to medical or obstetric complications between 2012 and 2025. Data were extracted from the electronic health record, including demographics, medical and obstetric history, hospitalization characteristics, and postpartum Edinburgh Postnatal Depression Scale (EPDS) scores …

Hepatopulmonary Syndrome As Presentation Of Pediatric Metabolic Dysfunction-Associated Steatohepatitis, Shruti Sakhuja, Stacey S Beer, Kalyani R Patel, Alexiss M Williams, Nhu Thao Galvan, John A Goss, Krupa R Mysore

Faculty, Staff and Students Publications

Childhood obesity is rising and leading to serious co-morbidities, among which is metabolic dysfunction-associated steatotic liver disease (MASLD) predisposing individuals to cirrhosis. We describe a young 11-year-old Hispanic male who presented with hepatopulmonary syndrome secondary to cirrhotic portal hypertension from metabolic dysfunction-associated steatohepatitis (MASH), necessitating liver transplantation. Despite lifestyle modifications post-transplantation, the patient experienced persistent weight gain and recurrence of steatosis, emphasizing challenges of managing pediatric MASLD. The burden of childhood obesity is increasing and impacting children significantly earlier than previously believed. Our case is one of the few to report the severe complications of MASH in a young, pre-teen …

Plasma Proteins Associated With Psychosocial Factors And Heart Disease: The Jackson Heart Study, Sara N O'Brien, Madeline G Gillman, Michael D Green, Daniel E Cruz, James S Floyd, Susan Hankinson, Daniel H Katz, Xiaojuan Liu, Michelle C Odden, Bruce M Psaty, Alexander P Reiner, Jerome I Rotter, Stephen S Rich, Robert E Gerszten, Amil Shah, Mario Sims, Usman A Tahir, Lesley F Tinker, Alexis C Wood, Bing Yu, Anthony S Zannas, Laura M Raffield, Láshauntá M Glover

Faculty, Staff and Students Publications

Background: Knowledge of proteomic mechanisms explaining the link between psychosocial stress and cardiovascular disease is limited. This study aimed to (1) identify plasma proteins associated with psychosocial factors and (2) assess associational pathways between psychosocial factors, identified proteins, and incident cardiovascular disease events in a discovery cohort, JHS (Jackson Heart Study), and 2 replication cohorts, the CHS (Cardiovascular Health Study), and the MESA (Multi-Ethnic Study of Atherosclerosis).

Methods: JHS participants from exam 1 (2000-2004) with SomaScan 1.3k platform proteomics data were included (n=2143, mean age=55.3). Depressive symptoms and perceived stress scores were measured via the 20-item Center for Epidemiological Studies …

Development And Pilot Testing Of Transdiagnostic Exposure Therapy/Behavioral Activation For Autistic Adolescents With Internalizing Disorders, Andrew G Guzick, Elizabeth A Kaplan-Kahn, Jessica Szu-Chi Cheng, Callie Murphy, Ogechi C Onyeka, David Riddle, Tracy Dibbs, Leandra N Berry, Robin P Goin-Kochel, Eric A Storch

Faculty, Staff and Students Publications

Internalizing disorders disproportionately affect autistic adolescents, though limited research has focused on tailoring therapy for this population. The purposes of this paper were (1) to describe the development of a transdiagnostic exposure therapy/behavioral activation intervention for autistic adolescents with internalizing disorders, and (2) to present a pilot test of feasibility, acceptability, and efficacy of the intervention. The development of this therapy is described in detail, which prioritized the following domains: (1) building on the existing evidence base of exposure-based cognitive behavioral therapy for autistic youth with anxiety disorders, (2) involving caregivers considerably, (3) incorporating autism-specific considerations into case conceptualization and …

Protecting Minors From Medical Malpractice Act: Implications For Otolaryngology-Head & Neck Surgery, Shiven Sharma, Margo K Mckenna, Julina Ongkasuwan, Michael J Brenner

Faculty, Staff and Students Publications

No abstract provided.

Building A Better Clinical Competency Committee: A Multi-Institutional Approach To Improving The Quality Of Resident Feedback Through Appreciative Inquiry, Nikita Khetan, Emma Omoruyi, Elizabeth Hanson

HCA Healthcare Journal of Medicine

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires pediatric faculty to convene twice yearly as a Clinical Competency Committee (CCC) to review resident performance and provide feedback. Variability in review processes and limited feedback quality remain common challenges. Incorporating Appreciative Inquiry within a Deliberate Practice framework may enhance the quality of summative feedback provided to residents.

Methods

This project was conducted with pediatric residents and faculty during the 2019–20 academic year at The University of Texas Health Science Center at Health San Antonio (UTHSA) and during the 2021-22 academic year at The University of Texas Health Science Center …

Enhancing Resident Preparedness For The American Board Of Surgery Certifying Exam Through Low-Stakes Mock Oral Sessions, Camila R. Guetter, Taylor Locklear, Omar Haque, P Nina Scalise, Saptarshi Biswas, R. Wesley Vosburg

HCA Healthcare Journal of Medicine

Background

The American Board of Surgery (ABS) requires trainees to pass both a written qualifying examination (ABSQE) and oral certifying examination (ABSCE) to achieve board certification. The high-stakes nature of the ABSCE, which assesses knowledge, clinical judgment, and decision-making, necessitates extensive preparation. To address the challenges of the ABSCE format and associated trainee stress, structured mock oral programs have been developed. Here we evaluate the impact of structured mock oral sessions on residents' comfort levels and familiarity with the ABSCE at a single institution.

Methods

A mixed-methods survey was given to 50 general surgery residents in different training years who …

Occupational Stressors And Health Impacts Among First Responders, Mason N. Roach

Honors College Theses

The United States 911 emergency response system is an interconnected web of public services that seeks to provide its community with care, resources, and safety in times of need. However, the impact of this support on the employees providing the service often goes unnoticed. This review identifies and analyzes the unique strains on first responders' physical and mental health using the Job Demand-Control Model and the Allostatic Load Model. A review of available research literature supports the conclusion that occupational-related stress, including trauma exposure, shift work, poor leadership, and inadequate communication, can have long-lasting negative impacts on provider health.

From Pages To Practice: Course Design For Integrative And Connected Learning, Prutha Deshpande

UNLV Best Teaching Practices Expo

The poster provides resources for the design of courses to incorporate considerable reading, paired with purposeful activities and reflection questions that deepen understanding of key points of learning, support knowledge transfer, and encourage dialogue and connection.

A Systematic Review And Meta-Analysis Finds That Psychological Well-Being Predicts All-Cause Mortality Independently Of Psychological Ill-Being., Max Genecov, David Yeager

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND: Does psychological well-being (e.g. life satisfaction, happiness, meaning in life) predict the length of a person’s life, or are measures of well-being simply assessing the absence of ill-being (depression, loneliness, sadness) and are therefore redundant with ill-being measures? Individual studies have examined this question by measuring and controlling for both well-being and ill-being, but inconsistent findings have been reported. METHODS: A systematic review and random-effects meta-analysis was conducted on the literature of prospective longitudinal studies linking all-cause mortality to well-being. Studies that controlled for ill-being were compared to studies that did not control for ill-being to identify the unique …

The Current Landscape Of Remote Patient Monitoring Regarding Diabetes Mellitus And Hypoglycemia: Protocol For A Scoping Review, Mathew J. Stephen, Baylor Akhavan, Melinda B. Chu, Kavita Batra, Roberto Sagaribay

Department of Medical Education Faculty Research

Background: Diabetes mellitus is characterized by impaired glucose regulation, predisposing patients to both hyperglycemia and hypoglycemia. Hypoglycemia, particularly frequent in insulin-treated individuals, remains a serious but underrecognized complication. Remote patient monitoring (RPM) technologies, such as continuous glucose monitors, smartphone apps, and hybrid closed-loop systems with remote monitoring capabilities, have emerged as promising tools to improve glycemic control and prevent hypoglycemia in nonclinical settings. Evidence examining the use of RPM technologies has expanded rapidly; however, the scope, characteristics, and reported outcomes of these interventions remain fragmented across modalities and settings. Objective: This scoping review aims to systematically map and describe the …

Reliability And Validity Of The Arabic Version Of The Nose-Perf Scale, Rayan M. Alfallaj, Abdullah I. Binghaith, Mohammed Y. Alyoussef, Ahmed S. Alsaleh, Saad A. Alsaleh, Abdulaziz A. Alqahtani, Ahmad S. Alroqi

Saudi Medical Journal

Objectives: To assess the psychometric validity of the Arabic adaptation of the nasal obstruction symptom evaluation–perforation (NOSE-Perf) scale. To assess how reliable and valid the Arabic adaptation of the NOSE-Perf questionnaire is. Patients with septal perforations, particularly Arabic speakers, lack validated self-assessment tools for subjective symptom evaluation. Methods: Conducted between May 2024 and June 2025, the study included 100 participants—20 patients with septal perforation and 80 controls. Participants filled out a questionnaire consisting of demographic data as well as the Arabic forms of the Sino-Nasal Outcome Test-22 (SNOT-22), NOSE, and NOSE-Perf scales. Cronbach's alpha was applied to determine internal consistency, …

Mental Health In Relation To Parental Absence: A Systematic Review, Mohammed Barry, Abdulaziz Alyahyawi, Heba Jafar Sabbagh

Saudi Medical Journal

Objective: To evaluate the literature based on the relationship between orphaned children and mental health, compared to non-orphaned children. Mental well-being of orphaned children is a profound intricate topic that connects with broader concerns of childcare. This systematic review aims to evaluate the literature regarding the relationship between mental health and parental absence. Methods: We conducted a systematic search of PubMed, MEDLINE, and Science Direct in October 2025, with 1017 screened studies. Six studies met the inclusion criteria. Independent reviewers performed quality assessments using the Newcastle-Ottawa scale (NOS). Subsequently, a meta-analysis was performed when possible. Results: Findings indicate that orphaned …

Feasibility Of Nationwide Remote Chronic Neural Data Collection From Recording-Enabled Deep Brain Stimulation Systems, Kasra A Mansourian, Ajay D Gandhi, Jonathan H Bentley, Kalman A Katlowitz, Danika L Paulo, Nisha Giridharan, Mohammed A Hasen, Tommy B Liu, Zain U Naqvi, Sarah S Soubra, Thomas A Hamre, Rick R Hanish, Eric A Storch, Wayne K Goodman, Sameer A Sheth, Nicole R Provenza

Faculty, Staff and Students Publications

Introduction: Bidirectional deep brain stimulation (DBS) devices can continuously record neural activity while delivering stimulation. Due to memory limitations on the implanted device on which data are stored, frequent data downloads are required to prevent data loss. In this study, we present a novel collaborative data collection method utilizing a nationwide network of device representatives to allow frequent data transfer that reduces data loss without imposing travel burden on patients.

Methods: We collected chronic neural data from nine patients with severe obsessive-compulsive disorder who received ventral capsule/ventral striatum DBS treatment between May 2023 and August 2024. We included patients implanted …

Handgrip Strength, Handgrip Endurance And Bmi: A Comprehensive Approach To Health Assessment Among The General Population Of Madikeri, Dr Asha S. Das, Dr Ravikiran Kisan, Dr Suhas Y. Shirur, Dr Narasimha Rai K, Dr Sanjay Bhagoji

Digital Journal of Clinical Medicine

Introduction: Being physically fit is essential for lowering the risk of illness and enhancing longevity. While Body Mass Index (BMI) is frequently used to evaluate body composition, Hand Grip Strength (HGS) and Hand Grip Endurance (HGE) are important indicators of general well-being. Goal: To assess BMI, HGS, and HGE and ascertain how they correlate in a selected group of subjects. Methods: Fifty participants between the ages of 20 and 40 years participated in a comparative cross-sectional study at the Department of Physiology, Kodagu Institute of Medical Sciences, Madikeri. Participants were divided into three BMI groups after anthropometric measurements were taken. …

Sudden Cardiac Arrest & Newly Diagnosed Arrhythmogenic Cardiomyopathy In A High School Athlete, Jacob Rolfes, Brent Holtgrewe, Mike Tzianos

2026 Student Academic Showcase

A high school soccer player experienced sudden cardiac arrest during competition and required immediate CPR and AED use. Following resuscitation, physicians ruled out commotio cordis and identified findings consistent with arrhythmogenic cardiomyopathy, supported by a prolonged T-wave on EKG while all other laboratory and catheterization results were normal. The athlete later received an ICD and pacemaker, prompting significant physical, emotional, and lifestyle adjustments. This capstone project examines the emergency response, the role of trained medical personnel at sporting events, and the implications of early cardiac screening for adolescent athletes. Through consented family interviews, structured questionnaires, and case-based data collection, the …

Psychological Safety In Health Care: A Prerequisite For High Reliability, Sonali Thosani

Advances in Cancer Education and Quality Improvement

This paper presents a viewpoint on how psychological safety contributes to patient safety, teamwork, and high reliability.

Genetic Predispositions To Cancer: What Pediatricians Need To Know, Sarah Gubara, Nicole Wood

Pediatrics in Practice: A CME Podcast

Pediatric hematology/oncology physician Nikki Wood, DO, explains how pediatricians can recognize genetic cancer risk, refer to genetics appropriately, and support families through long‑term surveillance.

Click here to stream the podcast episode.

Out-Of-Pocket Costs And Antihypertensive Medication Use Among Veterans: A Natural Experiment, Alexander R. Zheutlin, Alexander Chaitoff, Daniel Addo, Joshua A. Jacobs, Catherine G. Derington, Eric L. Stulberg, Peter A. Glynn, Bernardo Modenesi, Jordana B. Cohen, Adam P. Bress

Department of Neurology Faculty Papers

BACKGROUND: Blood pressure (BP) control remains suboptimal in the United States despite available low-cost antihypertensive medications. Even small out-of-pocket medication costs may contribute to adherence. We determined whether $0 versus >$0 out-of-pocket costs for antihypertensive medications is associated with differences in adherence, discontinuation, BP control, and cardiovascular outcomes.

METHODS: We included veterans with newly diagnosed hypertension who initiated antihypertensive medication in the Veterans Health Administration from 2004 to 2022. A fuzzy regression discontinuity design with 2-stage residual inclusion leveraged differences in medication copay policy at a 50% service-connected disability threshold (≥50% service-connected disability: $0 out-of-pocket cost versus < 50%: $8 monthly cost). Outcomes included 1-year medication nonadherence (proportion of days covered < 80%), 1-year medication discontinuation (no medication in the final 90 days of the study year), 1-year BP control (systolic BP/diastolic BP < 140/90 mm Hg and < 130/80 mm Hg) and cardiovascular disease events (myocardial infarction, coronary revascularization, peripheral artery disease, or stroke).

RESULTS: Among 417 …