Digital Commons Network^™

An Assessment Of Kentucky Birth Records, Focusing On Early-Onset Hypertensive Disorders Of Pregnancy, Environmental Metal Exposures, And Geocoding Precision, 2008-2017, Courtney J. Walker

Theses and Dissertations--Epidemiology and Biostatistics

Using live and stillbirth records from Kentucky (2008-2017), this dissertation assessed the county-level prevalence and geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP); examined the geocoding precision of addresses recorded on birth records, and evaluated the association between individual risk factors and environmental metal exposures on eHDP prevalence. After adjusting for maternal demographic factors and pre-existing health conditions, we observed that eHDP prevalence was 38% higher (aPR=1.38, 95%CI:1.16, 1.64) in counties with the highest prevalence of married women (> 53.8%) compared to lower prevalence areas (31.6%) had a 20% higher prevalence of eHDP(aPR=1.20, 95%CI:1.00, 1.44) compared to counties with …

Mapping Heat Vulnerability Index Based On Different Urbanization Levels In Nebraska, Usa, Babak Jalalzadeh Fard, Rezaul Mahmood, Michael Hayes, Clinton Rowe, Azar M. Abadi, Martha Shulski, Sharon J. Medcalf, Rachel Lookadoo, Jesse E. Bell

Journal Articles: Epidemiology

Heatwaves cause excess mortality and physiological impacts on humans throughout the world, and climate change will intensify and increase the frequency of heat events. Many adaptation and mitigation studies use spatial distribution of highly vulnerable local populations to inform heat reduction and response plans. However, most available heat vulnerability studies focus on urban areas with high heat intensification by Urban Heat Islands (UHIs). Rural areas encompass different environmental and socioeconomic issues that require alternate analyses of vulnerability. We categorized Nebraska census tracts into four urbanization levels, then conducted factor analyses on each group and captured different patterns of socioeconomic vulnerabilities …

Thinking Ethically About Hiv Pre-Exposure Prophylaxis: Retention In Care And Sexually Transmitted Infection Testing In A Southeastern United States Local Health Department In The Time Of Covid-19, Ellie Purdy

College of Graduate Studies: Theses & Dissertations

Local Health Departments (LHDs) are critical providers of Human Immunodeficiency Virus (HIV) and sexually transmitted infection (STI) prevention efforts. HIV Pre-Exposure Prophylaxis (PrEP) is an evolving public health initiative and practitioners should consider PrEP interventions in context of ethical decision-making and a broad STI prevention strategy as global incidence of bacterial STIs remains high and those at-risk for HIV are generally at-risk for other STIs. An evaluation of the Thinking Ethically framework and LHD PrEP services was performed to fill a gap in the literature and support program decision-making. A retrospective review of PrEP user medical records from a LHD …

The Relationship Between Social Vulnerability And Covid-19 Incidence Among Louisiana Census Tracts, Erin N. Biggs, Patrick M. Maloney, Ariane L. Rung, Edward S. Peters, William T. Robinson

Journal Articles: Epidemiology

Objective: To examine the association between the Centers for Disease Control and Prevention (CDC)'s Social Vulnerability Index (SVI) and COVID-19 incidence among Louisiana census tracts. Methods: An ecological study comparing the CDC SVI and census tract-level COVID-19 case counts was conducted. Choropleth maps were used to identify census tracts with high levels of both social vulnerability and COVID-19 incidence. Negative binomial regression with random intercepts was used to compare the relationship between overall CDC SVI percentile and its four sub-themes and COVID-19 incidence, adjusting for population density. Results: In a crude stratified analysis, all four CDC SVI sub-themes were significantly …

Applied Methodologies Demonstrated Through Three Independent Studies For Assessing The Effects Of Socioeconomic, Environmental Chemical Exposure, And Therapeutic Factors On Oncological Diseases And Covid-19, Bayarmagnai Maggie Munkhjargal

Legacy Theses & Dissertations (2009 - 2024)

When trying to understand risk factors for a disease, even before we know the causal agents, it is necessary to create a surveillance data set that answers the questions of who, when, and where, and includes any potential covariates which may either promote or prevent the disease. There are a wide variety of surveillance data. For example, hospital discharge data, such as the New York Statewide Planning and Research Cooperative System (SPARCS) data, encompass all hospitalized cases in the state, while clinical datasets cover a specially constructed population in pursuit of research of a certain disease type. Analysis of surveillance …

Targeted Teacher Education To Improve Primary Preservice Teachers’ Knowledge And Understanding Of Uv And Effective Sun Protection Measures For Children, Joseph J. Scott, Robyn S. Johnston, Natasha Bear, Sonia Gregory, Sally Blane, Mark Strickland, Jill Darby, Elin S. Gray

Australian Journal of Teacher Education

Teachers are responsible for children at school during peak ultraviolet (UV) times of the day. It is paramount that teachers have knowledge and understanding of UV to effectively protect themselves and their students. The aim of this pilot study was to investigate the effect of a short intervention on preservice teachers’ sun protective behaviours, knowledge and perceived skill to teach sun safety. Participants (n =161; median age=20 years) attended a 45-minute preservice teacher sun safety intervention and completed pre- and post-test surveys. Post-intervention, most participants indicated they felt: i) more informed about the dangers of UV and risks of developing …

The Impact Of Midwifery On Infant And Maternal Outcomes Among Black Mothers, Joann Honoré

Walden Dissertations and Doctoral Studies

According to recent studies, disparities are prevalent in maternal and fetal outcomes between Black and White mothers in the United States. Researchers have established that using a midwife versus other healthcare practitioners can elicit positive maternal and fetal outcomes for Black mothers. However, no within-race research has been conducted exploring midwifery as an insulating factor against these disparities. The purpose of this quantitative retrospective cohort study was to explore the impact of midwifery on infant and maternal outcomes compared to outcomes associated with other prenatal care models/caregivers among Black mothers in California using secondary data. The ecological model was used …

Farmer Suicide: Rates, Trends, And Associations To Commodity Production Among States Reporting Violent Deaths, 2003-2017, Paul Norrod

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Occupational studies show that farmers are at higher risk for suicide with rates at least two-fold those of the U.S. population.2-4 Therefore, the purpose of this study was to (1) determine age- and sex-specific farmer suicide rates, (2) evaluate rate trends, and (3) assess the relationship between commodity production and farmer suicide using the National Violent Death Reporting System (NVDRS) and quinquennial Census of Agriculture. We identified 1,652 farmer suicide cases from the NVDRS. Age-specific rates showed the highest rates among male farmers over 64 at 14.03 per 100,000. Annual rates for the 15-year study period peaked during 2013 at …

Prevalence And Exacerbation Of Asthma Within Two Counties In Eastern Kentucky, Rachid Souleye

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Central Appalachia residents have one of the highest rates of serious respiratory diseases in the nation. Appalachian Kentuckians are 50% more likely to be diagnosed with adult asthma compared to the overall U.S. population. Yet, few epidemiologic studies have assessed risk factors for respiratory disease in this population. Using a community-based approach, the investigators of the Mountain Air Project (MAP), one of the largest adult cohorts from two disadvantaged communities in Central Kentucky, collected data to estimate the prevalence of asthma and assess various socioeconomic and environmental risk factors to determine their effect on asthma.

Methods: A cross-sectional epidemiologic …

Environmental Respiratory Exposures And Pulmonary Function Among Residents Of Rural Appalachia, Kentucky, John C. Flunker

Theses and Dissertations--Epidemiology and Biostatistics

Introduction

Resource extraction exposures are hypothesized to promote adverse respiratory health outcomes among residents of rural Appalachia, yet no studies to date have simultaneously quantified small-scale geographic variation in residential exposure, individual level health factors, and respiratory health outcomes.

Methods

The Mountain Air Project (MAP) is a community engaged cross-sectional study based in Harlan and Letcher counties of Southeastern Kentucky. MAP utilized a novel small-scale method to define residential exposure boundaries: hydrologic unit code (HUC), which represents distinct drainages (AKA “hollows”) where residents cluster. We assigned the HUC level density of active and abandoned surface and underground mining, oil/gas wells, …

Equine West Nile Virus In Kentucky: Characteristics Of Historical Testing And Analysis Of Causal Factors, Kaelyn Short

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

As the arbovirus with the highest incidence in both humans and horses in the United States, West Nile Virus (WNV) presents a significant risk to the equine population of Kentucky. Widespread infection has the potential to cause a significant economic impact to the state and long-term health complications for the horses. To better understand the burden of equine WNV, historical diagnostic testing archives the University of Kentucky Veterinary Diagnostic Lab were analyzed along with environmental and census data collected from additional sources. A total of 2146 test results were analyzed utilizing descriptive statistics, chi-square tests of independence, and binary logistic …

Evidence On The Effectiveness Of Small Unmanned Aircraft Systems (Suas) As A Survey Tool For North American Terrestrial, Vertebrate Animals: A Systematic Map Protocol, Jared A. Elmore, Michael F. Curran, Kristine O. Evans, Sathishkumar Samiappan, Meilun Zhou, Morgan B. Pfeiffer, Bradley F. Blackwell, Raymond B. Iglay

United States Department of Agriculture Wildlife Services: Staff Publications

Background: Small unmanned aircraft systems (sUAS) are replacing or supplementing manned aircraft and groundbased surveys in many animal monitoring situations due to better coverage at finer spatial and temporal resolutions, access, cost, bias, impacts, safety, efficiency, and logistical benefits. Various sUAS models and sensors are available with varying features and usefulness depending on survey goals. However, justification for selection of sUAS and sensors are not typically offered in published literature and existing reviews do not adequately cover past and current sUAS applications for animal monitoring nor their associated sUAS model and sensor technologies, taxonomic and geographic scope, flight conditions and …

Living In An Oil-Polluted Region In Nigeria As A Risk Factor In Colorectal Cancer Development, Steve Nwachi Onya

Walden Dissertations and Doctoral Studies

Due to differences in exposure to various risk factors, colorectal cancer (CRC) rates differ in regions of Nigeria. Although the people living in the Southsouth, an oil-producing region, are concerned that they are most affected, there is insufficient research to address these concerns. The purpose of this quantitative ecological study was to investigate whether living in the oil-polluted region in Nigeria is associated with an excess CRC incidence rate. The potential spatial autocorrelation of CRC incidence among the contiguous regions was also examined. The study was grounded in the ecosocial theoretical framework. Data were extracted from the Nigeria National System …

Spatial Transferability Of Expert Opinion Models For American Beaver Habitat, Isidro Barela, Leslie M. Burger, Guiming Wang, Kristine O. Evans, Qingmin Meng, Jimmy D. Taylor

United States Department of Agriculture Wildlife Services: Staff Publications

Species distribution models and habitat suitability models (HSMs) have become a popular tool in the conservation of biodiversity. However, the ability to predict species spatial distributions at sites beyond the data source sites (i.e., spatial transferability) is critical for the applications of HSMs in the management and conservation of rare or endangered species. The main objective of our study was to assess the predictive performance and spatial transferability of expert opinion models (EOMs). To build EOMs, we identified through extensive literature reviews 17 key landscape variables to characterize habitat use by American beaver (Castor canadensis). We developed 31 pairwise opinion …

Anthraquinone Repellent Seed Treatment On Corn Reduces Feeding By Wild Pigs, Nathan P. Snow, Joseph M. Halseth, Scott J. Werner, Kurt C. Vercauteren

United States Department of Agriculture Wildlife Services: Staff Publications

Wild pigs (Sus scrofa) are a destructive invasive species that cause extensive damage to agriculture throughout many regions of the world. In particular wild pigs damage corn more than any other crop, and most of that damage occurs immediately after planting when wild pigs excavate and consume planted seeds. We evaluated whether anthraquinone (AQ), a repellent, could be useful for protecting seed corn from consumption by wild pigs. Specifically, we conducted cafeteria-style tests at 16 bait sites for 6 nights using concentrations of: untreated, 0.5, 1.5, and 3.0% AQ by weight sprayed on whole-kernel corn in AL and …

Modeling Mongoose Rabies In The Caribbean: A Model-Guided Fieldwork Approach To Identify Research Priorities, Caroline C. Sauvé, Erin E. Rees, Amy T. Gilbert, Are R. Berentsen, Agathe Allibert, Patrick A. Leighton

United States Department of Agriculture Wildlife Services: Staff Publications

We applied the model-guided fieldwork framework to the Caribbean mongoose rabies system by parametrizing a spatially-explicit, individual-based model, and by performing an uncertainty analysis designed to identify parameters for which additional empirical data are most needed. Our analysis revealed important variation in output variables characterizing rabies dynamics, namely rabies persistence, exposure level, spatiotemporal distribution, and prevalence. Among epidemiological parameters, rabies transmission rate was the most influential, followed by rabies mortality and location, and size of the initial infection. The most influential landscape parameters included habitat-specific carrying capacities, landscape heterogeneity, and the level of resistance to dispersal associated with topography. Movement …

Social Structure Defines Spatial Transmission Of African Swine Fever In Wild Boar, Kim M. Pepin, Andrew J. Golnar, Tomasz Podgórski

United States Department of Agriculture Wildlife Services: Staff Publications

The spatial spread of infectious disease is determined by spatial and social processes such as animal space use and family group structure. Yet, the impacts of social processes on spatial spread remain poorly understood and estimates of spatial transmission kernels (STKs) often exclude social structure. Understanding the impacts of social structure on STKs is important for obtaining robust inferences for policy decisions and optimizing response plans. We fit spatially explicit transmission models with different assumptions about contact structure to African swine fever virus surveillance data from eastern Poland from 2014 to 2015 and evaluated how social structure affected inference of …

Geocoding Cryptosporidiosis Cases In Ireland (2008–2017)—Development Of A Reliable, Reproducible, Multiphase Geocoding Methodology, Lisa Domegan, Patricia Garvey, Paul Mckeown, Howard Johnson, Paul Hynds, Jean O'Dwyer, Coilín Óhaiseadha

Articles

Background: Geocoding (the process of converting a text address into spatial data) quality may affect geospatial epidemiological study findings. No national standards for best geocoding practice exist in Ireland. Irish postcodes (Eircodes) are not routinely recorded for infectious disease notifications and > 35% of dwellings have non-unique addresses. This may result in incomplete geocoding and introduce systematic errors into studies.

Aims: This study aimed to develop a reliable and reproducible methodology to geocode cryptosporidiosis notifications to fine-resolution spatial units (Census 2016 Small Areas), to enhance data validity and completeness, thus improving geospatial epidemiological studies.

Methods: A protocol was devised to utilise …

Caesarean Delivery Among Women Of Color Is Associated With Risk Of Early Childhood Developmental Delays In Brazil, Haley Case

Public Health Theses

Background. Poverty, racism, and other sources of oppression threaten children’s nurturing environments and associated early childhood development (ECD). Women of Color and their children are disproportionately exposed to risk factors for poor ECD in Brazil. There is a growing body of evidence supporting the claim that unnecessary cesarean section (CS) is associated with poor maternal health outcomes and ECD delays. There is an existing gap in the literature on risk factors, including obstetric factors, of poor ECD among children of Women of Color in Brazil.

Objective. The objective of this thesis was to investigate factors, including obstetric characteristics of CS …

Co-Distribution Of Ambient Light At Night And Incidence Of Human Cancers And Covid-19, Yidan Meng

Public Health Theses

Introduction and BackgroundThere are increasing concerns about the effects of artificial lights on human health, including hormone-related disease and immune functions. In January 2020, the outbreak of COVID-19 disrupted everyone’s life, and people who infected have various severity. Thus, we want to analyze whether people exposed to different ambient light at night (LAN) levels make them more susceptible to COVID-19 for our summer research. Besides the effects of LAN on immune functions, we also discussed the association of LAN and multiple cancers in seven states of Northeastern U.S. We used similar statistical and geographic analysis methods and separate them into …

Examining Social Vulnerability And The Association With Covid-19 Incidence In Harris County, Texas, Guillermo A Tortolero, Marcia De Oliveira Otto, Ryan Ramphul, Jose-Miguel Yamal, Alison Rector, Michael Brown, Melissa F Peskin, Dania Mofleh, Eric Boerwinkle

Faculty, Staff and Student Publications

Studies have investigated the association between social vulnerability and SARS-CoV-2 incidence. However, few studies have examined small geographic units such as census tracts, examined geographic regions with large numbers of Hispanic and Black populations, controlled for testing rates, and incorporated stay-at-home measures into their analyses. Understanding the relationship between social vulnerability and SARS-CoV-2 incidence is critical to understanding the interplay between social determinants and implementing risk mitigation guidelines to curtail the spread of infectious diseases. The objective of this study was to examine the relationship between CDC's Social Vulnerability Index (SVI) and SARS-CoV-2 incidence while controlling for testing rates and …

Reproductive Health Factors And Maternal Mortality Of Internally Displaced Women In Nigeria, Fatima Mahmood Jibirilla

Walden Dissertations and Doctoral Studies

Approximately 529,000 women die from pregnancy-related causes every year, with 99% of these maternal deaths occurring in developing countries. Each year, about 59,000 maternal deaths occur in Nigeria, with a mortality rate of 576 deaths per 100,000 births. Women constitute about half of the 33.2 million internally displaced persons (IDPs) worldwide. The purpose of this retrospective cross-sectional study was to explore the association between the reproductive health factors and maternal mortality of internally displaced women in Borno state, Nigeria. McCarthy and Maine’s model for determinants of maternal mortality informed this study. A secondary dataset of 400 women (age 14-49 years) …

A Time-Series Ecological Study Protocol To Analyze Trends Of Incidence, Mortality, Lethality Of Covid-19 In Brazil, Luiz C De Abreu, Khalifa Elmusharaf, Carlos Eduardo Siqueira

Gastón Institute Publications

Introduction: since the first case of COVID-19 was confirmed in February 2020, Brazil has reported more than 20 million cases and more than 600,000 deaths on October 31, 2021. The behavior of the pandemic was also different in the various states, from the less developed to the more developed, such as the state of São Paulo. Objective: to describe step-by-step time series for analyzing trends in mortality, lethality and incidence of COVID-19 in Brazil. Methods: a protocol for an ecological study of time series, covering the 26 states and the federal district (Brasilia). Results: the descriptions have the potential to …

Analysis Of Covid 19 Mortality And Case Fatality In A Low Income Region Of Brazil, Carlos Eduardo Siqueira, Luiz C De Abreu

Gastón Institute Publications

Introduction: Inserted in the vulnerable context of the Brazilian Amazon, the state of Tocantins has suffered damages with the dissemination of COVID-19 in its territory; however, little evidence is published from this state. Objective: This study aims to analyze the case-fatality, mortality, and incidence of COVID-19 in Tocantins. Methods: This is an ecological study, population-based, time- series analysis of COVID-19 cases and deaths in the state of Tocantins from March 2020 to August 2021. Results: During the examined period, 219,031 COVID-19 cases, and 3,594 deaths were registered due to disease. Two possible occurrence peaks were characterized in this time- series …

The Impact Of Rurality, Underlying Cardiovascular Disease, And Socioeconomic Vulnerability On Covid-19 Outcomes In Georgia, Michael C. Morgan, Lavannya Atri, Jennifer L. Waller, Douglas Miller, Adam E. Berman

Journal of the Georgia Public Health Association

Background: COVID-19 related illnesses have been associated with an increased prevalence of cardiovascular disease sequelae and worsened socioeconomic variables. We sought to investigate the relationship between COVID-19 outcomes, underlying cardiovascular disease, and socioeconomic determinants of health in rural and non-rural counties in the state of Georgia.

Methods: COVID-19, demographic, and socioeconomic data were acquired from publicly available databases including the Center for Disease Control and Prevention’s Social Vulnerability Index (SVI). The relationship between COVID-19 outcomes and markers of cardiovascular disease burden, rurality, and socioeconomic determinants of health was assessed at the county level in Georgia through the beginning of …

Climate Change And Antibiotic Resistance: A Deadly Combination, Jason P Burnham

2020-Current year OA Pubs

Climate change is driven primarily by humanity's use of fossil fuels and the resultant greenhouse gases from their combustion. The effects of climate change on human health are myriad and becomingly increasingly severe as the pace of climate change accelerates. One relatively underreported intersection between health and climate change is that of infections, particularly antibiotic-resistant infections. In this perspective review, the aspects of climate change that have already, will, and could possibly impact the proliferation and dissemination of antibiotic resistance are discussed.

Medical Marijuana And Opioids (Memo) Study: Protocol Of A Longitudinal Cohort Study To Examine If Medical Cannabis Reduces Opioid Use Among Adults With Chronic Pain, Chinazo O. Cunningham, Joanna L. Starrels, Chenshu Zhang, Marcus A. Bachhuber, Nancy L. Sohler, Frances R. Levin, Haruka Minami, Deepika E. Slawek, Julia H. Arnsten

School of Medicine Faculty Publications

Introduction In the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study's overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events. Methods and …

Core Commitments For Field Trials Of Gene Drive Organisms, Kanya C. Long, Luke Alphey, George J. Annas, Cinnamon S. Bloss, Karl J. Campbell, Jackson Champer, Chun-Hong Chen, Amit Choudhary, George M. Church, James P. Collins, Kimberly L. Cooper, Jason A. Delborne, Owain R. Edwards, Claudia I. Emerson, Kevin Esvelt, Sam Weiss Evans, Robert M. Friedman, Valentino M. Gantz, Fred Gould, Sarah Hartley, Elizabeth Heitman, Janet Hemingway, Hirotaka Kanuka, Jennifer Kuzma, James V. Lavery, Yoosook Lee, Marce Lorenzen, Jeantine E. Lunshof, John M. Marshall, Philipp W. Messer, Craig Montell, Kenneth A. Oye, Megan J. Palmer, Philippos Aris Papathanos, Prasad N. Paradkar, Antoinette J. Piaggio, Jason L. Rasgon, Gordana Rašić, Larisa Rudenko, J. Royden Saah, Maxwell J. Scott, Jolene T. Sutton, Adam E, Vorsino, Omar S. Akbari

United States Department of Agriculture Wildlife Services: Staff Publications

We must ensure that trials are scientifically, politically, and socially robust, publicly accountable, and widely transparent.

Gene drive organisms (GDOs), whose genomes have been genetically engineered to spread a desired allele through a population, have the potential to transform the way societies address a wide range of daunting public health and environmental challenges. The development, testing, and release of GDOs, however, are complex and often controversial. A key challenge is to clarify the appropriate roles of developers and others actively engaged in work with GDOs in decision-making processes, and, in particular, how to establish partnerships with relevant authorities and other …

Maternal Mortality In Six Low And Lower-Middle Income Countries From 2010 To 2018: Risk Factors And Trends, Melissa Bauserman, Vanessa R. Thorsten, Tracy L. Nolen, Jackie Patterson, Adrien Lokangaka, Antoinette Tshefu, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Saleem Jessani

Community Health Sciences

Background: Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time.
Methods: We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative …

Ozanimod To Treat Relapsing Forms Of Multiple Sclerosis: A Comprehensive Review Of Disease, Drug Efficacy And Side Effects, Grace Lassiter, Carlie Melancon, Tyler Rooney, Anne Marie Murat, Jessica S. Kaye, Adam M. Kaye, Rachel J. Kaye, Elyse M. Cornett, Alan David Kaye, Rutvij J. Shah, Omar Viswanath, Ivan Urits

School of Pharmacy Faculty Articles

Multiple sclerosis (MS) is a prevalent and debilitating neurologic condition characterized by widespread neurodegeneration and the formation of focal demyelinating plaques in the central nervous system. Current therapeutic options are complex and attempt to manage acute relapse, modify disease, and manage symptoms. Such therapies often prove insufficient alone and highlight the need for more targeted MS treatments with reduced systemic side effect profiles. Ozanimod is a novel S1P (sphingosine-1-phosphate) receptor modulator used for the treatment of clinically isolated syndrome, relapsing–remitting, and secondary progressive forms of multiple sclerosis. It selectively modulates S1P1 and S1P5 receptors to prevent autoreactive lymphocytes from entering …