Digital Commons Network^™

Acute Aortic Dissection Masquerading As Testicular Torsion: A Case Report, Bruce M. Lo, Megyn K. Christensen, Coral E. Byrns, Benjamin Chidester

Department of Emergency Medicine Faculty Publications

Introduction: Aortic dissection is a rare but life-threatening condition with a high mortality rate if diagnosis is delayed. Aortic dissection classically presents with sudden-onset, sharp pain in the chest or back. However, atypical presentations can also occur, which could lead to a delay in diagnosis.

Case Report: A patient initially presented to the emergency department (ED) with left testicular pain ongoing for several hours. On examination, he had tenderness in the left lower quadrant abdomen and left testicle. A testicular ultrasound revealed decreased blood flow to the left testicle, raising concern for testicular torsion. The patient was taken to the …

The Effects Of Antidepressant Medications On Sleep Quality In Dominican University Of California Students, Natalie L. Davis, Kenna Wohlford, Stephanie Lee

Physician Assistant Studies | Graduate Research Papers

We spend approximately one third of our life time sleeping or attempting to sleep. The quality of our sleep is equally, if not more important than the amount of sleep we get. This study assesses the effects that medications, specifically antidepressants, can have on sleep quality in Dominican University of California students. 118 participants completed a Qualtrics survey including questions regarding stress, sleep quality, medication lists, and demographics. This study utilized the Pittsburgh Sleep Quality Index (PSQI) to quantify participants’ sleep quality as the outcome. Participant stress levels were assessed with a Likert scale question asking for stress levels on …

Improving Pediatric Emergency Department Lethal Means Safety Documentation Rates For Adolescents With Mental Health Concerns, Cassandra L. Stegall, Ana-Maria Mcgill, John Fanton, Paul C. Mullan

Department Psychiatry & Behavioral Science Faculty Publications

Introduction:

Lethal means safety counseling (LMSC) is recommended for children presenting to the emergency department (ED) for a mental health (MH) evaluation. Currently, no gold-standard guidelines exist for documenting LMSC in the ED.

Methods:

This quality improvement project was conducted in the ED of a tertiary children's hospital. Baseline data were analyzed for access to any LMSC documentation (ALD) for "firearms/guns," "sharps," or "medication," and for complete LMSC documentation (CLD) if access to all 3 types was documented. The first intervention period added open-ended screening questions about access to lethal means to the MH-licensed clinical social worker note template. Intervention …

Associations Between Accelerometer-Measured Physical Activity And Sleep Duration And Health Indicators In Children And Adolescents With Attention-Deficit Hyperactivity Disorder: A Systematic Review And Meta-Analysis, Xiao Liang, Hui Qiu, Justin A. Haegele, Xiao Li, Minghui Li, Jiayue Li, Shirley Xin Li

Human Movement Studies & Special Education Faculty Publications

Objective

This systematic review and meta-analysis synthesized available studies to explore relationships between accelerometer-measured physical activity (PA) levels or sleep duration and health-related outcomes in children and adolescents with attention-deficit hyperactivity disorder (ADHD).

Methods

Following the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, the six databases APA PsychInfo, CINAHL Ultimate, Embase, MEDLINE, SPORTDiscus with Full Text and Web of Science were searched from inception through July 2024. The correlation coefficient (r) was employed to determine the effect size in the meta-analysis. A random-effects model was utilised to estimate the potentially heterogeneously distributed effect sizes with a 95 % …

The Relationship Between Physical Activity, Sleep, And Hallucinations In Adults With Charles Bonnet Syndrome, Jarrod Hollis, Rohit Narayan, Eldre W. Beukes, Rosie Lindsay, Aliyah Bharwani, Umair Mughal, Ikra Yaqoob, Justin A. Haegele, Scott Muriden, Peter M. Allen

Human Movement Studies & Special Education Faculty Publications

Physical activity levels, hallucination experiences, sleep quality, and perceived stress were assessed using a survey administered to 57 adults with a confirmed diagnosis of Charles Bonnet Syndrome (CBS). Physical activity demonstrated a significant negative correlation with hallucination severity (r = –0.335, p = 0.011, two-tailed). A significant negative correlation was also observed between physical activity and perceived stress (r = –0.497, p < 0.001, two-tailed). In contrast, no significant association was identified between hallucination frequency and sleep disruption or insomnia. These findings suggest that engaging in appropriate levels of physical activity may help reduce the severity of hallucinations and mitigate stress among individuals with CBS. The observation that higher levels of physical activity are associated with reduced hallucination burden may help the development of evidence-based management strategies for CBS. Additionally, the finding that physical activity was significantly related to hallucination severity, whereas sleep disruption was not, merits deeper exploration in future research.

Real-World Anti-Amyloid Therapy Beyond Traditional Symptomatic Populations: A Longitudinal Case Series, Jayoung Han, Yuan Fang, Darlingtina Esiaka, Olufunmilola Abraham

Mathematics & Statistics Faculty Publications

Introduction: Anti-amyloid monoclonal antibodies are approved as disease-modifying therapies for early Alzheimer’s disease (AD), but real-world evidence remains limited, particularly among individuals treated during preclinical or minimally symptomatic stages. This study characterized clinical and biomarker trajectories among anti-amyloid therapy recipients across disease stages.

Method: We conducted a longitudinal retrospective case series of three biomarker-positive individuals from the Alzheimer’s Disease Neuroimaging Initiative who received lecanemab or donanemab. Clinical, cognitive, cerebrospinal fluid, plasma biomarker, and amyloid PET data were examined.

Results: In all three cases, most of the observation period preceded anti-amyloid therapy initiation. Clinical trajectories varied by biomarker profile and treatment …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

The Current State Of Behavioral Health Curriculum Within Professional Athletic Training Programs, Bethany R. Rohl

Graduate Research Theses & Dissertations

Behavioral health concerns among adolescents and young adults have increased in recent years, placing greater expectations on athletic trainers (ATs) to recognize and respond to these conditions in clinical practice. Although accreditation standards require behavioral health competencies within professional athletic training education, variability may exist in how faculty are prepared to teach this content. This study examined athletic training faculty preparation for teaching behavioral health, how programs implement and assess behavioral health content, and faculty perceptions of student satisfaction with behavioral health education.

Consensual qualitative research method was used. Eleven athletic training faculty (9 females, 2 males; age = 37.91 …

Suicidality, Self-Neglect, And Medical Refusal In Advanced Illness: An Ethical Case Report, Austin Supak, Sarah Greene, Madeline Adelman, Whitney Snyders

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Panacos Procedure For Treatment Of Uncooperative Warts, Val Haddon, Joel Santana, Andra Achim

West Florida Division GME Research Day 2026

No abstract provided.

Efficacy Of Zuranolone In The Treatment Of Postpartum Depression: An Evidence-Based Review, Shana-Kay Lambert-Johnson, Tasaduq Mir

North Texas GME Research Forum 2026

BACKGROUND: Postpartum depression (PPD) is a common and potentially severe condition frequently managed in primary care, where delayed treatment adversely affects maternal and infant outcomes. Neuroactive steroid therapies targeting γ-aminobutyric acid type A receptors represent a novel therapeutic class. Brexanolone, the first FDA-approved treatment for PPD, required prolonged inpatient administration and was withdrawn from the U.S. market in 2025. Zuranolone is currently the only FDA-approved medication specifically indicated for PPD, offering a short-course oral treatment suitable for outpatient use. This review evaluated the efficacy of zuranolone and its applicability in primary care practice.

METHODS: This evidence-based review was conducted in …

Harmonizing Healing: Examining Music Therapy As An Adjunctive Treatment For Mental Health, Shalin Patel, Karen Foote

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Child Exploitation Through Online Sharing: “Sharenting” And The Role Of The Pediatric Provider, Stacey Steinberg, Cameron Rosenthal

UF Law Faculty Publications

The alarming trend of “sharenting” highlights the need for increased vigilance in protecting children from online exploitation. When parents share intimate details about children’s lives on social media, they may inadvertently expose them to danger. Pediatricians are equipped to safeguard children from parental abuse and neglect; however, they are less prepared to protect children from harm caused by parents online.

When parents exploit children on social media, pediatricians face challenges in protecting patients while also following laws that maintain parental autonomy. Using a child welfare framework, this article defines these online harms and proposes strategies for protecting children from exploitative …

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore

Nursing | Senior Theses

Background: Childbirth has become heavily reliant on pharmacological management and obstetric interventions such as epidural use, labor induction, and cesarean deliveries (C-sections) even among low-risk pregnancies. While necessary in some cases, excessive reliance on pharmacological interventions can negatively impact the experience of birthing as a whole. Non-pharmacological interventions (NPIs) such as breathing techniques, positioning, hydrotherapy, massage, aromatherapy and continuous support have shown to be effective in reducing pain and supporting physiologic labor. The gaps in education and lack of standard implementation result in inconsistent application in practice. Purpose: This research proposal aims to evaluate the effectiveness of nurse-led NPIs compared …

Tele-Psychiatry Adoption And Its Effect On Rural Mental Health Service Availability, Anna Heineman, Kaylee Canterbury, Taylor Carpenter

Theses, Dissertations and Capstones

Purpose of study: This study examined the association between tele-psychiatry implementation and mental health service availability in rural healthcare settings. The analysis compared tele-psychiatry to traditional in-person psychiatric care among rural populations, focusing on access and utilization outcomes, including time to first psychiatric appointment, number of completed visits, and appointment no-show rates.

Methods: A qualitative literature review following a systematic approach was conducted using peer-reviewed articles published between 2016-2026. Databases included PubMed, ProQuest Health, CINAHL, Journal of Medical Internet Research, and the National Library of Medicine, with Google Scholar used as a supplemental source. The review followed PRISMA …

The Receipt Of Psychological Services And Acceptability Of Local Follow- Up Care For Childhood Cancer Survivors: Are There Rural Vs. Urban Differences?, Tyrone F. Borders, Abigayle Feather, Jerod L. Stapleton, John A. D’Orazio, Eric B. Durbin

Psychology Faculty Publications

Purpose This study examined rural and urban parents’ reports of their children’s receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2–17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural …

Developing Curcumin Analogues For Treating Breast Cancer, Tulasi Laxmi Nutalapati

Theses, Dissertations and Capstones

Breast cancer is still one of the most common types of cancer and one of the most common causes of cancer-related deaths in women around the world. Despite significant advances in early detection and treatment strategies, drug resistance, systemic toxicity, and poor outcomes in aggressive subtypes continue to limit the overall effectiveness of cancer therapy. Natural compounds have become promising anticancer agents because they can target many different things and are not very toxic. Curcumin has shown promise as an anticancer drug, but it cannot be used in the clinic because it does not absorb well, breaks down quickly, and …

Dementia Incidence In Patients With Prurigo Nodularis: An Observational Retrospective Cohort Study, Madison P. Olexson, Ana Ormaza Vera, Chunghwan Ro, Clinton W. Enos

Department Dermatology Faculty Publications

[Introduction] Prurigo nodularis (PN) is a chronic neuroinflammatory dermatosis of unknown etiology characterized by severely pruritic, symmetrically-distributed nodules with a negative impact on quality of life [1]. While some consider PN a primary idiopathic disorder, it often arises as a secondary manifestation of underlying conditions, including atopic dermatitis (AD), chronic kidney disease (CKD), human-immunodeficiency-virus (HIV), and thyroid disorders [2]. Although patients with PN are at higher risk for psychiatric comorbidities including depression, anxiety, and suicidal ideation [3] research which investigates associations between PN and neurodegenerative disorders is limited [4]. Moreover, emerging evidence implicating sustained systemic inflammation, characteristic of psoriasis and …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Sexual Dysfunction In Women With Endometriosis In A Low-Middle-Income Country, Edna Chacha, Charles Muteshi, Felix Oindi, Elsie Wandera

Obstetrics and Gynaecology, East Africa

Background Endometriosis affects up to 10% of reproductive-age women and significantly impairs quality of life including sexual function, intimate relationships, fertility, and psychological wellbeing. While its impact has been extensively studied in Western populations, there is limited Sub-Saharan African data exploring how the disease affects female sexual health and distress. This study aimed to assess sexual function and sexual distress among women with endometriosis at a tertiary hospital in Kenya.

Methods A cross-sectional study was conducted involving 108 women aged 18 to 49 with confirmed endometriosis from January to June 2022. The study used validated self-administered questionnaires: Female Sexual Function …

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

Internal Medicine Faculty Publications

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

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

Internal Medicine Faculty Publications

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

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

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

Markey Cancer Center Faculty Publications

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

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

Cost Effectiveness Of Lifestyle Program For Diabetes Remission In The Era Of Glp-1, Prasanthi Tondapu, Haasini Sunkavalli, Micaela C. Karlsen, Kara L. Staffier, Kathryn J. Pollard, Surabhi Naik

North Texas GME Research Forum 2026

BACKGROUND: GLP-1 receptor agonists are popular for managing type 2 diabetes (T2D) and obesity but are costly and can result in side effects including weight rebound. Intensive therapeutic lifestyle change (ITLC) programs present an effective alternative, facilitating an HbA1C (A1C) less than 6.5% for 3 months without medication and long-term weight control.

CASE PRESENTATION: We present a 69-year-old Black man with T2D, hypertension, chronic kidney disease, obesity, and sleep apnea. In 2023, he was hospitalized with a blood glucose of 800 mg/dL and A1C 10.8% and discharged on insulin. And, with a BMI of 32 kg/m2 and weight of 238.6 …

Pulse Check: Im Resident Wellness Initiative -- A Continuous Qi Project, Jacqueline Bekhit, Ngoc Vu, Yasasvi Sabbineni, Nihar Raju, Parth Patel, Teena Mathew

North Texas GME Research Forum 2026

Background Burnout is a psychological syndrome that arises from chronic workplace stress that has not been effectively managed. It is characterized by emotional exhaustion, increased mental distance or cynicism toward one’s work, and a sense of reduced professional efficacy (WHO, 2019). Due to the long work hours, high workload, and extensive training demands, medical residents are particularly vulnerable to experiencing burnout, contributing to higher rates of anxiety and depression. Burnout typically emerges mid-intern year and progresses through the remainder of residency. Burnout can contribute to higher medical errors, decreased work efficiency, and poor patient-physician interactions.

Methods This QI is a …

Too Young For A Broken Heart: Stemi At Twenty, Shana-Kay Lambert-Johnson, Jason Thompson

North Texas GME Research Forum 2026

Background: ST-elevation myocardial infarction (STEMI) is exceptionally rare in young adults, accounting for less than 1% of acute coronary syndromes in individuals younger than 35 years. When it occurs in early adulthood, particularly among women, it introduces diagnostic uncertainty and exposes gaps in post-discharge continuity of care. This case of a 20-year-old female with STEMI highlights the role of primary care in preserving evidence-based therapy while addressing psychosocial determinants of recovery.

Case Presentation: A 20-year-old female presented to her primary care clinic for post-discharge follow-up after hospitalization for an anterior STEMI that began with sudden-onset substernal chest pain radiating to …

Ultrasound-Derived Liver Composition And Metabolic Flexibility Under Exercise Stress, Rhodes Van Houten

All Master's Theses

Metabolic Associated Fatty Liver Disease (MAFLD) is characterized by abnormal liver fat accumulation in conjunction with metabolic syndromes. MAFLD affects 33% of individuals worldwide, though little is known about how increased liver fat impacts physiological responses to exercise. This study aimed to analyze the relationship between liver composition and metabolic flexibility during a graded exercise test.  Body composition was analyzed via dual-energy X-ray absorptiometry. Liver ultrasound was evaluated for echogenicity, where elevated mean gray volume (MGV) indicates abnormal liver tissue. Rates of fat (FATox) and carbohydrate (CHOox) oxidation (g/min), respiratory exchange ratio (RER), and blood lactate concentrations ([LA^-], …

A Pragmatic Guide To Data Integration For Pediatric Researchers: The Nuts And Bolts Of Mixed Methods Analysis, Kathleen A Knafl, Janet A Deatrick, Veronica M Swallow, Yelena P Wu, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Objective: To provide pragmatic guidance on data analysis, integration, and reporting guidance for investigators new to mixed methods research.

Methods: Three core mixed methods designs (convergent, explanatory sequential, and exploratory sequential) are described. Key decision points related to data integration-specifying intent, data selection, data preparation, integration strategies, use of analysis software, reporting-are explained, including comparison of decision points across the different mixed methods designs.

Results: Recommendations for addressing key decisions during analysis are provided and supported with published examples from mixed methods studies focused on pediatric populations.

Conclusions: Integration of qualitative and quantitative data is the defining characteristic of mixed …

The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza

Honors Undergraduate Theses

Obesity has become one of the largest global health concerns of the 21^st century, correlating with numerous associated diseases. To help address the growing prevalence and burden of obesity, sleeve gastrectomy and Roux-en-Y gastric bypass have become two commonly performed surgical procedures done to promote weight loss by altering the anatomical structure of the stomach and surrounding organs of the gastrointestinal system. Although the benefits of improved metabolism linked to these surgical procedures are well studied, their impact on the physiology of gastric cells, and more specifically chief cells as they relate to protein digestion post-surgery, is yet to …

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …