Digital Commons Network^™

Parkinson’S Disease Phenotype Stratification Using Multiple Correspondence Analysis, Kelly Astudillo

Dissertations, Theses, and Capstone Projects

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, with over 12 million people projected to be affected by 2040 (Dorsey et al., 2018). Deep phenotyping and stratification can provide useful information regarding PD pathogenesis and can aid in the  development of disease modifying therapies that aim to delay the progression or prevent the onset of neurodegeneration (Blandini et al., 2019; Smith & Schapira, 2022). Utilizing multivariate methods such as multiple correspondence analysis (MCA) permits for the simultaneous analysis of distinct data modalities. To the best of our knowledge, MCA has not been previously used to explore phenotype patterns …

Investigating Individual And Group Level Mediators Of Fear Acquisition, Rachel S. Lese

Dissertations, Theses, and Capstone Projects

The ability to discriminate between cues predictive of threat vs. safety (fear acquisition) and subsequently update fear responding when contingencies change (fear extinction) is crucial to survival for all organisms. While these processes have been the subject of intense experimental scrutiny for several decades, most human fear learning studies have focused primarily on extinction learning and fear recovery processes, with less focus on fear acquisition itself. Indeed, researchers typically aim to minimize variability during fear acquisition in order to rule out differences in extinction being driven by variability during the initial learning phase. Thus, experimental protocols are often optimized to …

Radiotheranostics For Gynecological Pathologies, Joni Sebastiano

Dissertations, Theses, and Capstone Projects

Molecular imaging, specifically positron emission tomography (PET), is vital for detecting disease and understanding its biological makeup. The exploitation of radiolabeled antibodies for PET imaging has proven to be indispensable to the field of molecular imaging over the last several decades. The development of radioimmunoconjugates for use in immunoPET has not only allowed for the sensitive, specific, and high-resolution detection of disease, but has also enabled a deeper understanding of the disease biology, ultimately guiding more personalized therapeutic strategies. Most typically, this technology is harnessed for the diagnosis and treatment of cancer, however more recently, the field has explored the …

Music Appreciation In Cochlear Implant Users: A Questionnaire, Hanna Davidson

Dissertations, Theses, and Capstone Projects

Cochlear implants provide significant benefits for speech perception in individuals with severe to profound hearing loss; however, music perception and appreciation remain challenging due to limited spectral and temporal resolution. This study examined music appreciation in post lingually deafened adult cochlear implant users, focusing on changes in enjoyment, listening behaviors, and subjective experiences following implantation. Sixteen adults completed a 36-item questionnaire assessing pre- and post-implant music engagement, perceived sound quality, and emotional responses to music. Quantitative data were analyzed using descriptive statistics and inferential statistics, and qualitative responses were analyzed thematically.

Results indicated a moderate decline in music enjoyment following …

Neural Correlates Of Recognition Memory And Metamemory In Breast Cancer Survivors: An Event-Related Potential Study, Dishari Zaman Azad

Dissertations, Theses, and Capstone Projects

Breast cancer survivors (BCS) often report noticeable cognitive difficulties despite showing limited impairment on standardized neuropsychological tests. Some have theorized that this is simply an insensitivity of standardized testing to subtle cognitive changes (test-insensitivity hypothesis), whereas others have suggested there are early neural changes that are detected by patients but precede detection by these tests (early signal hypothesis) or that when they achieve normal performance, it is through saliently effortful compensatory processes (compensation hypothesis). The present study tested these theories by assessing metamemory and recognition memory retrieval in BCS and non-cancer controls (NCC) using both behavioral and event-related potential (ERP) …

Enhancing Ecological Validity In Speech-In-Noise Testing: Integrating Virtual Reality For A Multisensory Audiological Experience, Paulina Lee

Dissertations, Theses, and Capstone Projects

Despite the remarkable advances in hearing healthcare technology, the speech recognition tests used in routine clinical audiological assessment have remained essentially the same for decades.  Monosyllabic word recognition tests in quiet, such as the Northwestern University Auditory Test No. 6 (NU-6; Tillman & Carhart, 1966), have served as the audiology field’s default measure of speech understanding.  Modern speech-in-noise (SIN) tests, such as the QuickSIN (Killion et al., 2004), have emerged, yet they remain auditory-only, leaving an unignorable gap between what clinical tests measure and how patients communicate in daily life.  The present study examined whether pairing a standard SIN test …

Lymph Node Dissection And Postoperative Complications After Lung Cancer Resection, Isheeta Madeka, Khaled Noueihed, Jacob Woodroof, Shale Mack, Hamza Rshaidat, Gregory L Whitehorn, Sneha Alaparthi, Scott H. Koeneman, Tyler R. Grenda, Nathaniel R. Evans, Iii, Olugbenga T. Okusanya

Department of Surgery Faculty Papers

Importance: Current lung cancer guidelines recommend lymph node sampling (LNS) with the 3 + 1 rule, which recommends station-based sampling with at least 3 N2 (mediastinal) and 1 N1 (hilar) nodal stations. Although there is oncologic benefit to rigorous LNS, potential negative impacts on surgical outcomes have not been well investigated. As adoption of the 3 + 1 rule increases given its formalization as guideline-concordant care, associations with adverse outcomes are crucial to characterize.

Objective: To evaluate whether satisfying the 3 + 1 rule is associated with increased postoperative complications.

Design, setting, and participants: This retrospective cohort study used the …

Early Neurodevelopmental Outcomes In Children With Congenital Heart Disease., Mike Seed, Dawn Ilardi, Valerie Rofeberg, Cynthia Ortinau, Caren Goldberg, Garrett Reichle, Lauren Bush, Justin Elhoff, Amy Jo Lisanti, Jennifer Butcher, Caitlin Rollins, Andrew Van Bergen, Shabnam Peyvandi, Emily Bucholz, Stephanie Cox, Lyla Hampton, Jacqueline Sanz, Sonia Monteiro, Shruti Tewar, Kiona Allen, Caroline Lee, Kristi Glotzbach, Nneka Alexander, Laurel Bear, Corinne Anton, Renee Sananes, Linh Ly, Gina Boucher, Kelly Wolfe, Lindsay Edwards, Elizabeth J. Willen, Alexander Tan, Christina Ortega, Erica Sood, Anjali Sadhwani, Kari Crawford Plant, Lauren Quigley, Jessica Pliego, Elizabeth Valles, Abbey Hines, David Wypij, Thomas Miller

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Neurodevelopmental impairments are common in children with congenital heart disease.

OBJECTIVES: To compare neurodevelopmental outcomes by cardiac diagnosis and identify associations between medical and social factors and early neurodevelopmental outcomes among children with congenital heart disease.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used neurodevelopmental follow-up data obtained between May 1, 2019, and June 30, 2022, and entered into the Cardiac Neurodevelopmental Outcome Collaborative (CNOC) registry, with linkage to the Pediatric Cardiac Critical Care Consortium registry. Children younger than 30 months from 25 CNOC sites were studied. Data analysis was performed between January 2023 and December 2024.

EXPOSURES: Patients …

Early Neurodevelopmental Outcomes In Children With Congenital Heart Disease, Mike Seed, Cynthia Ortinau, Caroline Lee, Et Al.

2020-Current year OA Pubs

IMPORTANCE: Neurodevelopmental impairments are common in children with congenital heart disease.

OBJECTIVES: To compare neurodevelopmental outcomes by cardiac diagnosis and identify associations between medical and social factors and early neurodevelopmental outcomes among children with congenital heart disease.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used neurodevelopmental follow-up data obtained between May 1, 2019, and June 30, 2022, and entered into the Cardiac Neurodevelopmental Outcome Collaborative (CNOC) registry, with linkage to the Pediatric Cardiac Critical Care Consortium registry. Children younger than 30 months from 25 CNOC sites were studied. Data analysis was performed between January 2023 and December 2024.

EXPOSURES: Patients …

Quantitative Assessment Of Cardiac Phosphocreatine Metabolism Under Physiological And Pharmacological Stress Using Chemical Exchange Saturation Transfer Magnetic Resonance Imaging, Qi Huang, Caleb Berberet, Ryan Wahidi, Todd Pavek, Cihat Eldeniz, Liya Dai, Rong Guo, Yang Yang, Scott Bugenhagen, Linda R Peterson, Thomas H Schindler, Pamela K Woodard, Jie Zheng

2020-Current year OA Pubs

BACKGROUND: Phosphocreatine (PCr) exhibits a distinct chemical exchange saturation transfer (CEST) resonance at ∼2.5 ppm with slower exchange kinetics and lower pH sensitivity than creatine. This pilot study evaluated the feasibility of quantifying myocardial PCr-dominated concentration ([PCr]

METHODS: Phantoms with varied concentrations of PCr and Cr were scanned to characterize PCr CEST signals under physiological conditions. Experiments were conducted at both room temperature and 37 °C with full Z-spectra acquisition. For the study in vivo, CEST imaging was performed in normal canines (n = 13), at rest and after regadenoson vasodilation, and during dobutamine stress (n = 5). In addition, …

Expanding The Omop Common Data Model To Support Extracorporeal Life Support Research, Clemens Rieder, Ahmed Said, Et Al.

2020-Current year OA Pubs

OBJECTIVE: Despite the increased availability of electronic health records, open-source standardized data collection to facilitate high-resolution data during extracorporeal life support (ECLS) is lacking. This project aimed to assess the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) for interoperability to store data sufficiently generated in the context of ECLS and to develop a custom data model expansion in case the OMOP CDM proved insufficient.

DESIGN AND SETTING: The OMOP CDM was analyzed qualitatively by expert consensus for its capability to capture data relative to ECLS as well as the presence of fitting ECLS-related concepts. Database entries necessary to …

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Optimizing Lactation Support: Enhancing Patient-Centered Care And Breastfeeding Self Efficacy Through Data-Driven Survey Analysis, Jessica L. Doshay

Doctor of Nursing Practice Final Manuscripts

Objective: The objective of this project was to implement evaluation of an integrated lactation support model within a multi‑site pediatric primary care organization to assess patient experience and breastfeeding confidence associated with a lactation consultation.

Background: Optimizing the patient experience is an indicator of healthcare quality. Improving breastfeeding outcomes remains a national priority. Structured lactation support delivered by International Board-Certified Lactation Consultants (IBCLCs) enhances breastfeeding outcomes, the impact of this is often undocumented in primary care settings.

Methods: This quality improvement project was conducted within the lactation department of a multicenter pediatric clinic in Southern California. Pediatric clinicians who were …

Enhancing Emergency Department Preparedness For Amniotic Fluid Embolism Through Evidence-Based Simulation Training, Olivia M. Smoak

Doctor of Nursing Practice Final Manuscripts

Maternal mortality in the United States remains a significant and worsening public health concern, with increasing reliance on emergency departments (EDs) as access points for maternal care. Emergency clinicians are therefore more likely to encounter high-acuity obstetric emergencies, including maternal cardiac arrest and amniotic fluid embolism (AFE), yet often receive limited formal training in these conditions. Simulation-based education, interdisciplinary training, and cognitive aids have been identified as effective strategies to improve performance in high-risk, low-frequency events.

The purpose of the evidence-based practice project was to evaluate whether an interdisciplinary simulation with obstetric-led debrief and introduction of the AFE checklist improves …

Sleep Tight: A Sleep Hygiene Bundle For Adults To Improve Sleep Quality In A Skilled Nursing Facility, Meaghan Corbin

Doctor of Nursing Practice Final Manuscripts

Abstract

Nearly two thirds of skilled nursing facility (SNF) residents report poor sleep. Negative consequences of poor sleep are depressed mood, anxiety, pain, cognitive impairment, increased risk for dementia, fatigue, decreased concentration, and lower activity participation. A review of literature has shown that implementation of non-pharmacological sleep interventions can significantly improve sleep quality. The aim to screen SNF residents on current self-reported sleep quality and provide non-pharmacological sleep interventions. The evidence-based project utilized the 8 A’s Model. Using the Pittsburg Sleep Quality Index (PSQI), a resident with a score above 0, received the non-pharmacological sleep hygiene bundle: eye mask, earplugs, …

Improving Transition To Adult Care: Assessing Health Insurance Literacy In Adolescent Patients With Congenital Heart Disease, Kaitlyn V. Mudge

Doctor of Nursing Practice Final Manuscripts

Background: With advances in surgery and medical management, 95% of children with congenital heart disease (CHD) survive into adulthood. Transition to adult care is an intricate process. Up to 60% of adolescents fail to follow through with cardiology care, facing three times the risk of needing emergency services. Only 25% of young adults with CHD knew of the need to change their care to an adult provider and to acquire health insurance as an adult. One barrier to successful transition is a lack of insurance coverage and limited insurance health literacy. Higher insurance literacy is associated with increased utilization …

Narrative Roots - What We Inherit, What We Tell, What We Become: Intergenerational Storytelling, Meaning-Making, And Mental Health, Adam Sholder

Critical and Creative Thinking Capstones Collection

This capstone synthesis explores how the family stories we inherit and the stories we tell across generations shape who we become, with particular attention to their impact on identity and mental health. Drawing on narrative identity theory, reflective practice, and relational understandings of family life, it introduces the Recursive Narrative Integration Model, which positions intergenerational storytelling as both a method of inquiry and a mechanism of meaning-making. Informed by a recursive process of creative and reflective writing, this synthesis approaches storytelling not only as an object of study, but as a lived and generative practice through which experience and narrative …

Vergence Task-Based Neural Pathways With Binocularly Normal Vision And Comorbid Persistent Post-Concussive Symptoms -Convergence Insufficiency, Ayushi Sangoi

Dissertations

Binocular dysfunctions are more prevalent in the persistent post-concussive symptoms (PPCS) population than in the general population. The most prevalent binocular disorder is convergence insufficiency (CI), affecting 3-17% of the general population and up to 10 times as many people with PPCS. CI makes it difficult to fuse or maintain fusion on targets at near, and its symptoms include double or blurry vision and headaches when performing close-range tasks such as reading, which can exacerbate PPCS symptoms. Given controversy over the subjectivity and effectiveness of diagnostic tools and symptom surveys for both PPCS and CI, understanding why CI has high …

Enhancing Physiological Complexity Through Mindfulness: A Wearable-Based Intervention For First Responders And Their Partners, Thurmon Lockhart, Rahul Soangra, Christopher W. Frames, Sun-Kyung Lee, Amberlee Martin, Susanne Lee, Abigail H. Gewirtz

Physical Therapy Faculty Articles and Research

Background/Objectives: First responders frequently encounter high-stress environments that challenge physiological resilience and autonomic regulation. Heart rate variability (HRV) complexity is a critical marker of adaptive capacity and stress regulation. This study assessed the impact of a wearable-based mindfulness intervention on HRV complexity among first responders using a smartwatch. Methods: A total of 87 first responders participated in a one-month wearable-based intervention. Participants wore Garmin Vivosmart 5 devices to continuously collect PPG data (photoplethysmogram), focusing on beat-to-beat intervals (BBIs). The intervention involved daily Ecological Momentary Assessments (EMAs) and individual randomization to either a mindfulness message, a prompt to access an audio …

The Effects Of Osha State Plans And State Gdp On Occupational Injuries And Illnesses In The United States, Ahmad Abdel Rahman Mohammad Amoorah

Theses

Workplace safety in the United States is governed by a system in which some states operate under federal OSHA oversight, while others administer their own OSHA-approved safety and health plans. This duality raises questions about whether state-level control leads to variation in safety and health outcomes. Economic conditions have also been shown to influence workplace injury rates, yet the interaction between safety and health regulations and local economies remains underexplored. Understanding these relationships is critical to protecting workers in occupational settings. The effects of OSHA state-plan status and state-level economic activity on occupational injury and illness rates across the United …

Artificial Intelligence In Healthcare: Ethical Frameworks, Challenges, And Global Approaches To Responsible Implementation: A Perspective, Vikas Vaibhav, Arwinder Singh, Yashpal S, Raviprakash Meshram, Varun Chandran A, Kshitiza Sharma

Graduate Medical Education Research Journal

Major advancements in domains like diagnosis and personalised treatment will be seen because of the rapid growth of artificial intelligence (AI) in healthcare. But this shift additionally presents significant ethical concerns that need to be carefully considered at every stage of AI's research, use, and impact on society in medical settings.

This review summarises the findings of multiple systematic and scoping reviews, as well as studies of specific AI applications published between 2013 and 2025. Additionally, it examines ethical norms from different countries and international organisations objectively. Consistent ethical challenges identified include the "black box" problem (lack of transparency and …

Knowledge And Perception Of Patients Regarding A Postpartum Standardized Hypertensive Disorder Educational Program, Arin Everett, Niranjana Balu, Santiago Ortiz Barragan, Marly Azzi, Sanela Potchileev, Courtney Bisson, Ariel Mueller, Lea Runesha, Sajid Shahul, Sarosh Rana

Graduate Medical Education Research Journal

Background. Hypertensive disorders of pregnancy (HDP) are a major contributor to rising maternal mortality in the United States. The postpartum period represents a critical window to provide education aimed at reducing the risks of complications. This study evaluates the patients’ understanding of HDP and their retention of key education concepts during the first six weeks postpartum after participation in a structured quality improvement program.

Methods. Prospective cohort study of patients diagnosed with HDP were enrolled in the remote blood pressure monitoring program (RPM) and delivered between June 2023 and January 2024. Baseline surveys were administered prior to discharge and repeated …

Evaluating The Market Withdrawal Of Andexanet Alfa, Jordyn Linfield, Addisyn Cooper, Alexander Defranco, Emma Gerding, Jessica Kelley, Tyler Henney, Connor Dains, Brenna Hissong, Brittany Bates

Pharmacy and Wellness Review

The coagulation cascade comprises intrinsic, extrinsic, and common pathways that converge when thrombin converts fibrinogen (factor I) into fibrin, leading to fibrin mesh formation, stabilization of the platelet plug, and ultimately thrombus formation. Inhibition of the coagulation cascade can be achieved with a variety of anticoagulant medications, including direct oral anticoagulants (DOACs). The mechanism of action of DOACs is to inhibit either factor Xa or thrombin. Reversal of anticoagulation remains an important clinical consideration when managing patients on DOACs who experience serious bleeding events. Andexanet alfa is a recombinant, modified human factor Xa protein previously indicated for patients receiving rivaroxaban …

Increasing Access To Medications For Opioid Use Disorder For All Justice-Associated Populations, Edgar Rodriguez

Doctor of Nursing Practice Final Manuscripts

The purpose of this paper is to support a federal mandate requiring universal access to medication of opioid use disorder for all the justice-involved populations. The policy proposal aims to standardize evidence-based treatment across correctional systems, improve treatment initiation during incarceration, strengthen continuity of care after release, reduce overdose mortality, and address disparities in access for racial and economic groups and rural communities. This policy paper calls for the increase of access to medications of opioid use disorder across the United States for all justice-involved population. The opioid crisis has created a public health problem in the United States by …

Mri-Based Deep Learning Radiomics Model For Automated Classification Of Disc Degeneration In The Lumbar Spine, Shiv Patil, Om Gandhi, Mert Karabacak, Matthew Carr, Konstantinos Margetis

Student Papers, Posters & Projects

Disc degeneration in the lumbar spine is a major cause of low back pain (LBP). The accurate grading of disc degeneration on magnetic resonance imaging (MRI) is critical for clinical management and patient selection for spine surgery. This study aims to develop and evaluate machine learning (ML) models that combine features from deep learning (DL) and radiomics for the automated prediction of Pfirrmann grade (PG), a measure of disc degeneration, using multi-parametric lumbar spine MRI. Sagittal T1, T2, and T2 SPACE MRIs of 218 patients with LBP were acquired from the SPIDER dataset. For each intervertebral disc and available sequence, …

Effects Of A 10-Day Remote Ischemic Preconditioning Protocol On Anaerobic And Aerobic Performance And Post-Exercise Cytokine Responses, Paulina Brzezińska, Jan Mieszkowski, Madalena Kochanowicz, Andżelika Borkowska, Jędrzej Antosiewicz, Andrzej Kochanowicz

Baltic Journal of Health and Physical Activity

Background: Remote ischemic preconditioning (RIPC) consists of brief cycles of limb is-chemia and reperfusion and has been proposed as an ergogenic strategy. This study examined whether a 10-day lower-limb RIPC protocol affects anaerobic and aerobic performance and post-exercise cytokine responses in physically active men. Materials and methods: Sixty healthy, physically active men were assigned to anaerobic (Wingate Anaerobic Test (WAnT), n = 29) or aerobic (Bruce treadmill test (BTT), n = 28) protocols and completed a 10-day lower-limb RIPC (220 mmHg) or SHAM (20 mmHg) intervention. Serum IL-6, IL-10, and IL-15 were measured at baseline and immediately post-exercise before and …

Choline Counteracts Pregnancy Undernutrition-Associated Colitis In Sheep By Restoring Microbiota Driven Bile Acid Metabolism, Weibin Wu, Peng Jiao, Yamei Gu, Huizhen Lu, Caiyun Fan, Zheng Sun, Lizhuang Hao, Shengyong Mao, Jianbo Cheng, Yanfeng Xue

Faculty, Staff and Students Publications

High-fertility sheep experience undernutrition during late gestation, which induces body metabolic disruption and intestinal inflammation. Crucially, the gut microbiota-bile acid axis is a promising intestinal inflammation target, but how choline modulates this axis in livestock enteritis is unknown. This study investigated choline's protective mechanisms against undernutrition-induced intestinal inflammation in sheep, focusing on gut microbiota and bile acid regulation. Choline consistently alleviates colitis severity, restores epithelial barrier integrity, and suppresses intestinal inflammation. These protective effects are accompanied by pronounced remodeling of the colonic microbial ecosystem, characterized by the enrichment of Clostridiales bacterium to elevate bile salt hydrolase activity and regulate bile …

When The Therapist Is An Algorithm: Understanding Autism Spectrum Students’ Acceptance Of Generative Ai As A Mental Well-Being Tool Through The Technological Acceptance Model, Jossy P. George, Peter Muttungal, Benny Jeyekumar Davidson, Nishi Priya

Northeast Journal of Complex Systems (NEJCS)

This study examines the psychological and technological factors of the acceptance and emotional well-being of 349 college students with autism who use generative artificial intelligence tools as sources of psychological and emotional support. Grounded on the model of Technology Acceptance Model (TAM), the research studies relationships among perceived empathy, perceived usefulness, ease of use, emotional trust, continuance intention, and overall well-being. Structural equation modelling found that the perceived empathy was a significant predictor of ease of use and usefulness, while emotional trust and continuance intention proved to be significant predictors of emotional well-being. To reinforce these results, predictive modelling performed …

Cognitive Predictors Of Functional Recovery After Traumatic Brain Injury, Disha A. Thakkar, Charles J. Golden

Archives of Assessment Psychology

This study examined whether the Brief Test of Adult Cognition by Telephone (BTACT), administered during acute rehabilitation, improved the prediction of 5-year functional outcomes after traumatic brain injury (TBI) beyond standard demographic and injury-severity variables. Data were obtained from the Traumatic Brain Injury Model Systems (TBIMS) National Database (N = 6,880; enrolled 2017 onward). Missing data were handled using multiple imputation (20 datasets). Hierarchical multiple regressions were conducted with the Functional Independence Measure (FIM) and the Glasgow Outcome Scale–Extended (GOS-E) as outcome measures. Demographics (age, sex, education, race) were entered in Block 1, injury severity indicators (post-traumatic amnesia [PTA] duration, …

Prior Traumatic Brain Injury As A Predictor Of Cognitive Deficits After Moderate-To-Severe Injury, Disha A. Thakkar, Charles J. Golden

Archives of Assessment Psychology

Prior traumatic brain injuries (TBIs) are common among individuals who later sustain a moderate-to-severe TBI (msTBI), and cumulative injury models suggest repeated TBIs may worsen long-term cognitive outcomes. This study tested whether prior TBI history independently contributes to cognitive performance one year after an index msTBI beyond demographic and injury-severity factors. Data were drawn from the Traumatic Brain Injury Model Systems National Database (N = 6,880 enrolled since 2017). 2,773 participants completed the Brief Test of Adult Cognition by Telephone at one-year follow-up. Hierarchical regression models evaluated whether prior TBI history accounted for incremental variance in overall cognitive status and …