Digital Commons Network^™

Occupational Therapy’S Role In Low Vision Throughout The Lifespan, Ka Ki Tse

Graduate Theses, Dissertations, and Problem Reports (ETD)

Low vision and blindness significantly affect individuals' engagement in occupational performance. While West Virginia (WV) offers low vision rehabilitation programs to enhance occupational performance, several challenges remain unresolved. This doctoral capstone project aimed to collaborate with low vision professionals to deliver comprehensive low vision services and advocate for the integration of occupational therapy practitioners (OTPs) in the low vision field. A needs assessment and literature review were conducted to identify gaps and develop strategies for addressing the gaps. A qualitative study design was chosen to explore the perspectives of current low vision providers regarding the role of OTPs. The study …

Visit North Carolina: Trail Accessibility, Hannah Caitlyn Guschel

Graduate Theses, Dissertations, and Problem Reports (ETD)

This paper focuses on the perceived barriers to travel from marketing material for individuals with disabilities compared to those without disabilities and the direct impact on leisurely travel participation, particularly in outdoor spaces. Employing a cross-sectional study design encompassing both quantitative and qualitative data collection methods, this research investigates the experiences and transparency of trail accessibility in the state of North Carolina. Quantitative data were gathered through trail assessment accessibility checklists, while qualitative insights were obtained via in-depth interviews. The findings reveal an improved understanding of accessibility and the application of an accessibility checklist. Moreover, the study underscores the importance …

Prevalence And Incidence Of Parkinson's Disease In Latin America: A Meta-Analysis, Dani J. Kim, Ana L Isidro-Pérez, Michelle Doering, Juan J. Llibre-Rodriguez, Isaac Acosta, Ana M. Rodriguez Salgado, Gabriel D. Pinilla-Monsalve, Caroline Tanner, Jorge J. Llibre-Guerra, Matthew Prina

2020-Current year OA Pubs

BACKGROUND: Parkinson's disease (PD) is a rapidly growing neurodegenerative disorder, but up-to-date epidemiological data are lacking in Latin America. We sought to estimate the prevalence and incidence of PD and parkinsonism in Latin America.

METHODS: We searched Medline, Embase, Scopus, Web of Science, Scientific Electronic Library Online, and Literatura Latino-Americana e do Caribe em Ciências da Saúde or the Latin American and Caribbean Health Science Literature databases for epidemiological studies reporting the prevalence or incidence of PD or parkinsonism in Latin America from their inception to 2022. Quality of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal …

Metagenomic Characterisation Of The Gut Microbiome And Effect Of Complementary Feeding On Bifidobacterium Spp. In Australian Infants, Kimberley Parkin, Debra J. Palmer, Valerie Verhasselt, Nelly Amenyogbe, Matthew N. Cooper, Claus T. Christophersen, Susan L. Prescott, Desiree Silva, David Martino

Research outputs 2022 to 2026

Complementary feeding induces dramatic ecological shifts in the infant gut microbiota toward more diverse compositions and functional metabolic capacities, with potential implications for immune and metabolic health. The aim of this study was to examine whether the age at which solid foods are introduced differentially affects the microbiota in predominantly breastfed infants compared with predominantly formula-fed infants. We performed whole-genome shotgun metagenomic sequencing of infant stool samples from a cohort of six-month-old Australian infants enrolled in a nested study within the ORIGINS Project longitudinal birth cohort. Infants born preterm or those who had been administered antibiotics since birth were excluded. …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

Foreword From Editor - 14th Edition, Yandi Andri Yatmo

ASEAN Journal of Community Engagement

This edition of AJCE brings together discussions on the various roles and effectiveness of research and community engagement programs in strengthening local identity, developing skills, and enhancing quality of life towards a resilient society. Expanding such roles, this issue consists of four research articles, one review article, and three case-based articles. The authors of this edition emerge from the background of language, engineering, economy, policy, education, and health, providing different outlooks and methods in overseeing the processes of community-related programs.

Evaluation Of Morphologic And Morphometric Characteristics Of The Mental Foramen And Anterior Loop In A Turkish Subpopulation Using Cone Beam Computed Tomography, Fatma Büşra Doğan, Faruk Akgünlü

Journal of Dentistry Indonesia

Objective: Before a surgical intervention in the mandibular interforaminal area, it is important to have a full understanding of the anatomy of the mandibular anterior segment. The evaluation of anatomical structures, variations and pathologies is performed with radiological imaging methods. Today, cone beam computed tomography (CBCT) is an imaging method which offers all the features necessary for this. In addition to its importance in surgical applications, it is also valuable in terms of anatomical studies thanks to the reliability of its measurements and the fact that it allows for a three-dimensional evaluation. The mental foramen and anterior loop are …

Improving Transparency In The Residency Application Process: Survey Study, Lindsey Ulin, Simone A Bernstein, Julio C Nunes, Alex Gu, Maya M Hammoud, Jessica A Gold, Kamran M Mirza

2020-Current year OA Pubs

BACKGROUND: Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process.

OBJECTIVE: This study aims to determine the information applicants find most beneficial from residency …

Health Insurance Determinants Of The Working-Class, Lall Ramroo

Student Theses

Abstract:

This research delves into healthcare coverage disparities within the working class, spotlighting challenges in accessing essential services. Leveraging data from the 2021 American Community Survey, we scrutinize coverage intricacies for those above Medicaid eligibility yet unable to afford private insurance. Findings unveil a worrisome trend: the working class faces limited healthcare access due to income thresholds, placing them in precarious situations. Those earning too much for Medicaid but lacking private insurance means or employer-sponsored coverage grapple with significant obstacles. This paper underscores the need for targeted policies to bridge healthcare gaps for the working class, advocating for equitable access …

Technology And Mental Health Counseling, Hanna Cespedes, Elizabeth Robey, Tyler Wilkinson

Journal of Technology in Counselor Education and Supervision

The use of technology in the field of mental health has been an increasing interest of study and utilization in recent years, especially during and after the Covid 19 pandemic in which social distancing practices were encouraged to limit the spread of the virus. During this time, the use of technology for health-related appointments became vital as many offices shut down and/ or had limited in-person access. Furthermore, technology has already been integrated and researched significantly in other areas of the healthcare fields such as psychiatry and nursing. However, there is a lack of understanding of the role of technology …

Metagenomic Analysis Unveils The Microbial Landscape Of Pancreatic Tumors, Sheema Khan, Goutam Banerjee, Saini Setua, Daleniece Jones, Bhavin Chauhan, Anupam Dhasmana, Pratik Banerjee, Murali M. Yallapu, Stephen Behrman, Subhash C. Chuahan

School of Medicine Publications

The composition of resident microbes in the human body is linked to various diseases and their treatment outcomes. Although studies have identified pancreatic ductal adenocarcinoma (PDAC)-associated bacterial communities in the oral and gut samples, herein, we hypothesize that the prevalence of microbiota in pancreatic tumor tissues is different as compared with their matched adjacent, histologically normal appearing tissues, and these microbial molecular signatures can be highly useful for PDAC diagnosis/prognosis. In this study, we performed comparative profiling of bacterial populations in pancreatic tumors and their respective adjacent normal tissues using 16S rRNA-based metagenomics analysis. This study revealed a higher abundance …

Rapidiron Trial Follow-Up Study - The Rapidiron-Kids Study: Protocol Of A Prospective Observational Follow-Up Study, Richard Derman, Roopa Bellad, Mrutyunjaya Bellad, Jesse Bradford-Rogers, Michael Georgieff, Zubair Aghai, Simal Thind, Michael Auerbach, Rupsa Boelig, Benjamin Leiby, Vanessa Short, S. Yogeshkumar, Umesh Charantimath, Manjunath Somannavar, Ashalata Mallapur, Ramesh Pol, Umesh Ramadurg, Radha Sangavi, Basavaraj Peerapur, Nasima Banu, Praveen Patil, Amaresh Patil, Subarna Roy, Phaniraj Vastrad, Dennis Wallace, Hemang Shah, Shivaprasad Goudar

Global Health Articles

BACKGROUND: Anemia is a worldwide problem with iron deficiency being the most common cause. When anemia occurs in pregnancy, it increases the risk of adverse maternal, fetal, and postnatal outcomes. It induces preterm births and low birth weight (LBW) deliveries, long-term neurodevelopmental sequelae, and an increased risk of earlier onset of postnatal iron deficiency. Anemia rates are among the highest in South Asia, and India's National Family Health Survey (NFHS-5) for 2019-2021 indicated that over half of pregnant women, and more than 65% of children, in the country are classified as anemic (Sciences IIfP, National Family Health Survey-5, 2019-21, India …

Prt543, A Protein Arginine Methyltransferase 5 Inhibitor, In Patients With Advanced Adenoid Cystic Carcinoma: An Open-Label, Phase I Dose-Expansion Study, Renata Ferrarotto, Paul Swiecicki, Dan Zandberg, Robert Baiocchi, Robert Wesolowski, Cristina Rodriguez, Meredith Mckean, Hyunseok Kang, Varun Monga, Rajneesh Nath, Neil Palmisiano, Naveen Babbar, William Sun, Glenn Hanna

Department of Medical Oncology Faculty Papers

OBJECTIVES: Currently, no systemic treatments are approved for patients with recurrent and/or metastatic (R/M) adenoid cystic carcinoma (ACC). PRT543, a protein arginine methyltransferase 5 inhibitor that downregulates NOTCH1 and MYB signalling in tumours, is a potential candidate for R/M ACC treatment. We report the safety, tolerability and preliminary efficacy of PRT543 in a dose-expansion cohort of patients with R/M ACC.

MATERIALS AND METHODS: This phase I multicentre, open-label, sequential-cohort, dose-escalation and dose-expansion study (NCT03886831) enrolled patients with advanced solid tumours and select haematologic malignancies. Dose-escalation study design and results were reported previously. In the dose expansion, patients with R/M ACC …

The Effect Of Postoperative Naloxone In Certain Otolaryngologic Surgeries, Natalie M. Perlov, Sohan S. Shah, Joann Bluj, Zachary D. Urdang, Rebecca C. Chiffer

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate the association of postoperative naloxone with the development of new substance use disorder (SUD), overdose, and death within 6 months of otolaryngologic surgery.

STUDY DESIGN: Retrospective cohort database study on TriNetX.

METHODS: Adult patients who underwent tonsil surgery (noncancerous), thyroid/parathyroid, septorhinoplasty, otology/neurotology, sinus/anterior skull base, and head and neck cancer surgeries between January 2003 and April 2023. Patients were excluded if they had an instance of SUD or overdose recorded in their charts prior to surgery, or had undergone another surgery within that 6-month time frame. We hypothesized that patients prescribed naloxone postoperatively would have decreased odds …

Feasibility Of Using Podcasts For Knowledge Dissemination To Reduce Health Disparities For Women Targeting Preventative Initiatives And Lifestyle Medicine Interventions, Kristin Stovern

Doctor of Nursing Practice Scholarly Project

The purpose of this feasibility project was to look at podcasts to shed light on the issues that affect the well-being of women with gender-based disparities in healthcare. Women face persistent obstacles when it comes to the quality of healthcare they receive. One of the barriers that has been ever-present is with failure of the medical system to rigorously study the effects of diseases and drugs on women or to fund studies on women’s health conditions. Implicit biases and lack of access to care inhibit the quality of healthcare. Collectively, these issues result in unnecessary sickness, disability, and decreased quality …

Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik

Doctor of Nursing Practice (DNP) Projects

Developing and Implementing an Infection Prevention Practice Fellowship Program

Abstract

Background: The COVID-19 pandemic placed huge demands on infection prevention programs (Blanchard et al., 2022), seriously taxing a profession already mired with progressively increasing workload and responsibilities (Bryant et al., 2016).

Local Problem: In a rapidly changing environment, infection preventionists (IPs) contend with pandemic surges, emerging infections, and supply chain disruptions. The NCAL Region of an integrated health system experienced IP turnover, and in the absence of a formal training program, newly hired IPs experienced variable to no opportunities to develop their competencies.

Methods: A literature review on infection prevention …

The Contribution Of Principlism To Foster Ethical And Clinical Reciprocity In Resolving Healthcare Dilemmas, Dominic Glorioso

Electronic Theses and Dissertations

Principlism is an ethical method that uses an analytical framework based on a set of principles that can function as guidelines for healthcare professionals. The term was made

famous by the work of two bioethicists, Tom L. Beauchamp and James F. Childress. Their book, Principles of Biomedical Ethics and its multiple editions described a set of norms that are basic

for biomedical ethics. The first edition of their book was published in 1979, and the ninth edition in 2019. Its persistence and durability speak for themselves. In addition, their writings made

famous the four bioethical principles of respect for Autonomy, …

Does Probiotic Supplementation Help Decrease Symptoms In Adults Previously Diagnosed With Major Depressive Disorder?, Alexa Hammock, Hayley Loiselle

Physician Assistant Capstones, 2020-current

Objective: To assess the effect of probiotic supplementation on clinical symptoms of major depressive disorder in adults. Design: Systematic literature review. Methods: Searches were performed on PubMed using the terms “adults with depression and probiotics”. The limits on PubMed were set to include randomized control trials, studies on adults, studies done within the last 10 years, studies done on patients that did not have depression, studies that did not use the Beck Depression Inventory, and studies that focused on other conditions. Results: Three studies were found that met search criteria: Reninghaus et al., Schaub et al., and Chahwan et al. …

Inequality In Opportunities And Outcomes: Indicators To Inform Data-Driven Community Systems For Youth Physical Activity, Ann Essay

Theses & Dissertations

Indicators illuminating whole-of-community and setting system physical activity (PA) outcomes and drivers are needed to inform population health improvement efforts. This multi-study dissertation examines inequalities in PA resources, opportunities, and outcomes and the factors influencing inequalities across multiple temporal and geospatial scales (e.g., community, setting). First, a scoping review examined community-level variability in PA resource and opportunity availability by community sociodemographic characteristics (e.g., race). Across 46 included studies, 41 unique indicators characterizing community PA systems were identified, and 29.8% of relationships assessed indicated greater resource/opportunity availability in communities of higher socioeconomic status or lower minority population prevalence. The indicators synthesized …

Diversity And Dissemination Of Viruses In Pathogenic Protozoa, Senne Heeren, Ilse Maes, Mandy Sanders, Lon-Fye Lye, Vanessa Adaui, Jorge Arevalo, Alejandro Llanos-Cuentas, Lineth Garcia, Philippe Lemey, Stephen M Beverley, James A Cotton, Jean-Claude Dujardin, Frederik Van Den Broeck

2020-Current year OA Pubs

Viruses are the most abundant biological entities on Earth and play a significant role in the evolution of many organisms and ecosystems. In pathogenic protozoa, the presence of viruses has been linked to an increased risk of treatment failure and severe clinical outcome. Here, we studied the molecular epidemiology of the zoonotic disease cutaneous leishmaniasis in Peru and Bolivia through a joint evolutionary analysis of Leishmania braziliensis and their dsRNA Leishmania virus 1. We show that parasite populations circulate in tropical rainforests and are associated with single viral lineages that appear in low prevalence. In contrast, groups of hybrid parasites …

Resting-State Eeg Power Differences In Autism Spectrum Disorder: A Systematic Review And Meta-Analysis, Weisi Siong Neo, Dan Foti, Brandon Keehn, Bridgette Kelleher

Purdue University Libraries Open Access Publishing Fund

Narrative reviews have described various resting-state EEG power differences in autism across all five canonical frequency bands, with increased power for low and high frequencies and reduced power for middle frequencies. However, these differences have yet to be quantified using effect sizes and probed robustly for consistency, which are critical next steps for clinical translation. Following PRISMA guidelines, we conducted a systematic review of published and gray literature on resting-state EEG power in autism. We performed 10 meta-analyses to synthesize and quantify differences in absolute and relative resting-state delta, theta, alpha, beta, and gamma EEG power in autism. We also …

Patterns And Predictors Of Racial/Ethnic Disparities In Hiv Care Continuum In The Southern Usa: Protocol For A Population-Based Cohort Study, Xueying Yang Ph.D., Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Zhenlong Li, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Introduction Health disparities exist at every step of the HIV care continuum (HCC) among racial/ethnic minority population. Such racial/ethnic disparities may have significantly delayed the progress in HCC in the Southern US states that are strongly represented among geographic focus areas in the 2019 federal initiative titled 'Ending the HIV Epidemic: A Plan for America'. However, limited efforts have been made to quantify the long-term spatiotemporal variations of HCC disparities and their contributing factors over time, particularly in the context of COVID-19 pandemic. This project aims to identify the spatiotemporal patterns of racial disparities of each HCC outcome and then …

Oral Lactoferrin Administration Does Not Impact The Diversity Or Composition Of The Infant Gut Microbiota In A Peruvian Cohort, Luis González, Jose Luis Paredes Sosa, Susan Mosquito, Yesenia Filio, Pedro E Romero, Theresa J Ochoa, Pablo Tsukayama

Faculty, Staff and Student Publications

Previous studies have suggested that oral lactoferrin enhances diversity in the gut microbiota in infants while inhibiting the growth of opportunistic pathogens. However, the effect of lactoferrin on infant gut microbiota over time has yet to be thoroughly studied. Our study suggests that lactoferrin oral treatment in infants aged 12-18 months does not affect gut microbiome diversity and composition over time. to our knowledge, this is the first study to report the effect of lactoferrin on infant gut microbiome composition over time and helps elucidate its impact on infant health and its therapeutic potential.

Employing Telepsychiatry Services To Assess The Prevalence And Identify Mental Health Disorders Using The Phq-9 And Gad-7 In Resource-Constrained Regions Of Dadar Mansehra, Pakistan: An Observational Cross-Sectional Study, Iffat Zafar Aga, Sara Saeed Khurram, Mahek Karim, Muhammad Muzzamil, Shahkamal Hashmi, Kashif Shafique

Medical College Documents

Objective: This study aims to measure the prevalence of mental health disorders in low-resource settings through telepsychiatry and evaluate data from Pakistan's Sehat Kahani nurse-assisted online clinics serving low-income communities. This will help to understand the magnitude and nature of the demand for contextual therapies to promote mental health. The paper will discuss the challenges faced in these settings, such as limited access to mental health facilities, stigma and opportunities telemedicine brings.
Design: An observational cross-sectional study of telepsychiatry consultations using Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7 to screen for depression and anxiety was conducted between October and December …

Detection Of Suicide Clusters Using Small-Area Geographic Data From The Virginia Violent Death Reporting System, 2010 – 2015, Kurtis M. Anthony, Allison Ertl, Rachel A. Leavitt, Alexander E. Crosby, Ryan M. Diduk-Smith, Kevin A. Matthews

Virginia Journal of Public Health

Introduction: From 1999 to 2020, the suicide rate in Virginia increased from 13.1 to 15.9 per 100,000 persons aged 10 years and older. Few studies have examined spatial patterns of suicide geographies smaller than the county level.

Methods: We analyzed data from suicide decedents aged ≥10 years from 2010 through 2015 in the Virginia Violent Death Reporting System. We identified spatial clusters of high suicide rates using spatially adaptive filtering with standardized mortality ratio (SMR) significantly higher than the state SMR (p < 0.001). We compared demographic characteristics, method of injury, and suicide circumstances of decedents within each cluster to decedents outside any cluster.

Results: We identified 13 high-risk suicide clusters (SMR between 1.7 and 2.0). Suicide decedents in the clusters were …

Sutterella And Its Metabolic Pathways Positively Correlate With Vaccine-Elicited Antibody Responses In Infant Rhesus Macaques, Danting Jiang, Ria Goswami, Maria Dennis, Holly Heimsath, Pamela A. Kozlowski, Amir Ardeshir, Koen K.A. Van Rompay, Kristina De Paris, Sallie R. Permar, Neeraj K. Surana

School of Graduate Studies Faculty Publications

Introduction: It is becoming clearer that the microbiota helps drive responses to vaccines; however, little is known about the underlying mechanism. In this study, we aimed to identify microbial features that are associated with vaccine immunogenicity in infant rhesus macaques. Methods: We analyzed 16S rRNA gene sequencing data of 215 fecal samples collected at multiple timepoints from 64 nursery-reared infant macaques that received various HIV vaccine regimens. PERMANOVA tests were performed to determine factors affecting composition of the gut microbiota throughout the first eight months of life in these monkeys. We used DESeq2 to identify differentially abundant bacterial taxa, PICRUSt2 …

Effects Of A Preventive Mental Health Curriculum Embedded Into A Scholarly Gaming Course On Adolescent Self-Esteem: Prospective Matched Pairs Experiment., Christopher Jenson, Sharon Fitzgerald Wolff, Libby Milkovich

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Positive self-esteem predicts happiness and well-being and serves as a protective factor for favorable mental health. Scholarly gaming within the school setting may serve as a channel to deliver a mental health curriculum designed to improve self-esteem.

OBJECTIVE: This study aims to evaluate the impact of a scholarly gaming curriculum with and without an embedded preventive mental health curriculum, Mental Health Moments (MHM), on adolescents' self-esteem.

METHODS: The scholarly gaming curriculum and MHM were developed by 3 educators and a school-based health intervention expert. The scholarly gaming curriculum aligned with academic guidelines from the International Society for Technology Education, …

From Mother To Infant, From Placenta To Gut: Understanding Varied Microbiome Profiles In Neonates, Riadh Cheddadi, Venkata Yeramilli, Colin Martin

2020-Current year OA Pubs

The field of human microbiome and gut microbial diversity research has witnessed a profound transformation, driven by advances in omics technologies. These advancements have unveiled essential connections between microbiome alterations and severe conditions, prompting the development of new frameworks through epidemiological studies. Traditionally, it was believed that each individual harbored unique microbial communities acquired early in life, evolving over the course of their lifetime, with little acknowledgment of any prenatal microbial development, but recent research challenges this belief. The neonatal microbiome's onset, influenced by factors like delivery mode and maternal health, remains a subject of intense debate, hinting at potential …

Role Of Sex In The Association Of Socioeconomic Status With Cardiovascular Health In Black Americans: The Jackson Heart Study, Joshua J Joseph, Amaris Williams, Rosevine A Azap, Songzhu Zhao, Guy Brock, David Kline, James B Odei, Randi Foraker, Mario Sims, Laprincess C Brewer, Darrell M Gray Ii, Timiya S Nolan

2020-Current year OA Pubs

BACKGROUND: Socioeconomic status (SES) is associated with cardiovascular health (CVH). Potential differences by sex in this association remain incompletely understood in Black Americans, where SES disparities are posited to be partially responsible for cardiovascular inequities. The association of SES measures (income, education, occupation, and insurance) with CVH scores was examined in the Jackson Heart Study.

METHODS AND RESULTS: American Heart Association CVH components (non-high-density-lipoprotein cholesterol, blood pressure, diet, tobacco use, physical activity, sleep, glycemia, and body mass index) were scored cross-sectionally at baseline (scale: 0-100). Differences in CVH and 95% CIs (Estimate, 95% CI) were calculated using linear regression, adjusting …

Developing A Blueprint For Health Equity Programs And Investigating Interventions And Metrics, Belita Strudwick

MUSC Theses and Dissertations

Racial and ethnic minority groups and rural and low-income populations are examples of populations who continue to experience health disparities despite policy mandates to eliminate them. This doctoral project will provide a foundational blueprint to aid health plans in addressing and improving health equity internally and with external stakeholders. The blueprint will be based on research comparing the robust health equity initiatives of four states to the NCQA national guidelines. The barriers to achieving and recommendations for advancing the field of health equity by implementing and analyzing policies and data that target health disparities through improved access to quality care …