Digital Commons Network^™

Trends Among Suspected Opioid Overdose Emergency Medical Service (Ems) Incidents In Georgia From 2019-2023, Ashton Harris

College of Graduate Studies: Theses & Dissertations

Opioid overdoses remain a problem in the United States, underscoring the need for additional surveillance tools to monitor trends in opioid overdoses. Emergency Medical Services (EMS) data is a timely surveillance method that captures more potential overdoses than hospitals by representing the pre-hospital setting. Research questions in the study assess EMS responses to suspect opioid overdose incidents from 2019-2023 in Georgia to encompass the following characteristics: timeframe (pre, during, post-pandemic), urban versus rural counties, race/ethnicity, categorical type of first responder, mean dosage of naloxone in milligrams administered, and death. 84,359 records meeting the inclusion criteria were initially retrieved from the …

A Regime Of Fear: Barriers To Healthcare Access In Times Of Intensifying Anti-Immigrant Rhetoric And Immigration Enforcement, Kathryn F. Masetti

Honors Theses

The U.S. immigration regime produces the conditions that deny immigrants equitable access to healthcare. The Trump administration’s second term, characterized by aggressive immigration enforcement and anti-immigrant rhetoric, continued to intensify these conditions, contributing to a widespread decline in healthcare utilization by immigrant patients throughout the United States. This thesis investigates how policies and rhetoric from the Trump Administration, including immigration enforcement, shape the barriers that immigrants with and without status encounter when accessing healthcare services in Maine, and how the fear of surveillance, detention, or deportation influences how immigrant communities perceive and utilize healthcare services. Two in-depth semi-structured qualitative interviews …

Addressing Obesity And Diabetes In Appalachian Kentucky, Hannah E. Orens

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

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in …

Use Of Preference Signals In Family Medicine Residency Recruitment, John E. Snellings, Hanwen Miao, Daniel L. Meyer, Miranda A. Moore

Department of Family and Community Medicine Faculty Publications

Background and Objectives: Increases in graduate medical education application volume led to the introduction of preference signaling—a tool within the Electronic Residency Application Service that allows applicants to signal their sincere interest to a limited number of programs. This study aims to evaluate how family medicine program directors used preference signals during the 2023–2024 recruitment season, the first year this tool was available to family medicine programs. Understanding program director perspectives on preference signal utility is crucial for determining the tool’s impact on the residency selection process.

Methods: Data were collected through the Council of Academic Family Medicine Educational Research …

Enhancing Hospital Length Of Stay Using Ai Agent Modular Capabilities, Dami Fred

Theses and Dissertations

Hospital Length of Stay (LOS) analysis is essential for managing hospital efficiency and financial performance, yet the analytical depth required remains inaccessible to many organizations due to technical and resource constraints. This thesis introduces the AI Agent Modular Capabilities (AIAM) framework, which decomposes LOS analysis into discrete, codifiable capabilities integrated into a single skill activatable with one prompt. Seven AI Agent Modular Capabilities were developed using a Work Breakdown Structure and tested against a simulated hospital scenario across three successive skill versions. Results demonstrate that the packaged AIAM skill produces comprehensive, consistent, multi-section LOS analyses from a single interaction, outperforming …

Perceived Barriers And Recommendations To Improve Well-Child Visits Among Medicaid Enrollees: An Explanatory Sequential, Mixed-Methods Study, Shawnda Schroeder, Keona Manuelito

Indigenous Health Faculty Publications

Despite the critical role of well-child visits (WCVs) in preventive care, many Medicaid-enrolled children miss these appointments, leading to gaps in early intervention and immunization. Existing research has largely focused on either quantitative analyses of visit rates and predictors or qualitative insights into patient and provider experiences. This study employs a mixed-methods, community-based approach to examine barriers to WCV attendance among Medicaid-enrolled families in North Dakota who missed all WCVs in 2021. Through administrative data analysis (n=64,364), surveys (n=1,294), and focus groups (n=40), findings reveal structural, economic, and cultural obstacles, including cost concerns, lack of Medicaid transparency, and logistical challenges. …

Health Disparities In Cardiovascular Care: The Impact Of Diabetes Education And Post-Discharge Interventions For African American Adults At Risk For And After Myocardial Infarction, Trinity L. Billingsley

Nursing | Senior Theses

Background: Cardiovascular disease is the leading cause of death in the United States, affecting African American adults at higher rates compared to other racial and ethnic groups. Diabetes as a comorbidity is one of the risk factors of experiencing a myocardial infarction, remaining one of the leading causes of death among individuals with diabetes. Objective: To examine the effectiveness of structured diabetes education tailored to African American adults who are at risk for and after a myocardial infarction. Additionally assessing the complications of a myocardial infarction, the outcomes associated with structured education will be compared to the outcomes of …

Human Milk Feeding And Its Impact On The Incidence Of Necrotizing Enterocolitis, Maya C. Kern

Nursing | Senior Theses

One of the leading causes of morbidity and death for preterm and very low birth weight (VLBW) newborns is still necrotizing enterocolitis (NEC). Existing literature consistently shows that the bioactive, anti-inflammatory, and microbiome-supporting components of human breast milk, including donor human milk, significantly lower the incidence of NEC. However, a lot of infants are forced to rely on formula and nutrient fortifiers because they cannot obtain maternal or donor milk. A critical gap persists regarding whether human milk derived fortifiers offer greater NEC protection than bovine derived fortifiers in infants who must receive formula. This thesis examines three interconnected themes; …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

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

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

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

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

Occupational Therapy In Rural North Dakota Schools To Enhance Transition Planning, Kyra M. Schwartz

Occupational Therapy Capstones

Background: Access to services does not guarantee participation. Youth with disabilities, particularly in rural communities, continue to experience disparities in postsecondary outcomes related to employment, education, and independent living. While transition services are available, barriers related to awareness, coordination, and usability limit effective engagement. These challenges highlight a gap between service availability and access within rural systems and contribute to reduced participation outcomes.

Purpose: The purpose of this scholarly project was to develop an occupational therapy– informed, advocacy-driven approach to improve access to and navigation of transition services for youth with disabilities in rural communities.

Methodology: A multi-method, iterative approach …

Socio-Spatial Patterns Of Suicide Mortality In The United States, Kushagra Tiwari, M. Amin Rahimian, Marie-Laure Charpignon, Philippe J. Giabbanelli, Praveen Kumar

VMASC Publications

Suicides cause more than 49,000 deaths per year in the United States, including 55% associated with the use of a firearm. Across states and counties in the US, suicide mortality exhibits substantial geographical and sociodemographic heterogeneity. However, the role of large-scale social networks in shaping this variation remains underexplored. To assess how both the risk of suicide mortality and the effect of firearm restriction policies propagate through inter-county social ties, we integrate data on county-level suicide mortality (2010–2022) and the Facebook Social Connectedness Index (SCI), a continuous measure of the strength of social ties between counties used to derive weighted …

Digital Technology And Women’S Health In Nigeria: A Feminist Sts Walkthrough Analysis Of Mdoc Digital Health, Edith Michael Ogbodo

Dissertations, Master's Theses and Master's Reports

This thesis critically examines how a Nigerian digital health platform, mDoc, represents and constructs women’s health. Drawing on Feminist Science and Technology Studies (STS) and Light et al.’s (2018) walkthrough method, the study interrogates the values, assumptions, and power relations embedded in mDoc’s design, language, and governance structures. The analysis reveals that mDoc, despite positioning itself as an equitable solution to Nigeria’s health crisis, reproduces and depoliticizes the structural inequalities it claims to address. Through its neoliberal emphasis on self-care, the individualization of structurally produced suffering, and the datafication of women’s bodies, the platform encodes gendered, colonial, and class-based assumptions …

Differences In Biologic Clinical Trials For Chronic Rhinosinusitis With Nasal Polyps—Are We Comparing Apples With Oranges?, Marjolein Cornet, Peter W. Hellings, Martin Desrosiers, Martin Wagenmann, Richard Follows, Laura Walrave, Luz Adriana Jimenez, Lee Tombs, Dawn Edwards, Peter Howarth, Joseph K. Han

Department of Otolaryngology (ENT) Faculty Publications

In recent years, several biologics targeting Type 2 inflammation have been developed for treating chronic rhinosinusitis with nasal polyps (CRSwNP). These have been studied in registrational randomized controlled trials (RCTs), which vary in their patient populations, trial design, endpoints, geography, timing, or data-handling processes. While (in)direct treatment comparisons and meta-analyses have been carried out to compare efficacy results from RCTs, often these fail to properly account for these between-study differences. Here, we summarize the key between-study differences that can influence trial outcomes and highlight the resulting challenges faced when comparing outcomes from different Phase III RCTs of biologics in CRSwNP.

Adult Tobacco Product Use Patterns Across The Urban–Rural Continuum: The Longitudinal Population Assessment Of Tobacco And Health (Path) Study, 2016–2023, Jing Zhang, Shyanika W. Rose, Ellen J. Hahn, Megan E. Roberts, Bethany Shorey Fennell, Jenny E. Ozga, Seth Himelhoch, Saber Feizy, W. Jay Christian, Amanda Thaxton Wiggins, Melissa Abadi, Delvon T. Mattingly, Mary Kay Rayens

Nursing Faculty Publications

Purpose: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics.

Methods: Data from Waves 4–7 (2016–2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products).

Findings: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Imagined Afterlives: Anti-Black Medical Violences In Contemporary Black Arts, Katie Schadler

Honors Theses

“Imagined Afterlives: Anti-Black Medical Violences in Contemporary Black Arts” is a multi-genre exploration that studies the following works: Venus (1996) by Suzan Lori Parks, Get Out (2017) by Jordan Peele, and Dawn (1987) by Octavia Butler. I respectively study an experimental play, a psychological horror film, and a speculative novel to understand how Black creatives are depicting and responding to anti-Black violences, particularly medical violences. This work brings together Black art spanning from the late 1980s to 2017 as well as historical events and figures from the eighteenth century all the way to a not-so-distant future. While these works defamiliarize …

If I Only Had The Words (To Tell You): Billy Joel Lyrics In Legal And Medical Scholarship, Seuli Bose Brill, Christian H. Brill

Touro Law Review

Law and medicine are often considered to be among the least accessible professions, partly because of the heavy use of non colloquial jargon. This article examines more than 150 instances in which Billy Joel’s lyrics have been used to improve the accessibility of legal and medical scholarship. Legal and medical professionals have used the words of the “Piano Man” to discuss a variety of topics—everything from civil procedure to property rights and the COVID-19 pandemic to colorectal surgery. Nontraditional communications techniques of this type do not just contribute to the body of legal and medical scholarship; they also help professionals …

Albuminuria Screening Among Egyptian Patients With Cardiovascular Diseases, Regardless Of Their Diabetic Condition, Amira Fawzy Soliman, Khaled Shelbaya, Wael Abdelatief Mohamed Elhakeem, Osama Louis, Basheer Hafez, Wael Ali, Tarek M.Abdelaziz Elkholy, Baher Emil Ibrahim, Mahmoud M Abdou, Bassem Zarif

Journal of Medicine in Scientific Research

Even in the absence of overt kidney disease, albuminuria is increasingly recognized as a marker of systemic endothelial dysfunction and heightened cardiovascular risk. This prospective cohort study aimed to evaluate whether baseline urinary albumin-tocreatinine ratio (UACR) predicts subsequent incident cardiovascular outcomes among Egyptian adults with cardiovascular disease, regardless of diabetic status.

Pancreatic Cancer Detection Consortium Biomarker Bakeoff: A Phase Ii Blinded Biomarker Validation And Panel Discovery Study, Ann L. Oberg, William R. Bamlet, Grant Izmirlian, Seetharaman Balasenthil, Surinder K. Batra, Masataka Hayashi, Daniel S. Herman, Michael A. Hollingsworth, Maneesh Jain, Ann M. Killary, Brianna M. Krusen, Suyu Liu, Shounak Majumder, Gopalakrishnan Natarajan, Subrata Sen, Lynette M. Smith, Sudhir Srivastava, Brian M. Wolpin, Kenneth S. Zaret, Michael G. Goggins

Journal Articles: Biochemistry & Molecular Biology

PURPOSE: The Pancreatic Cancer Detection Consortium (PCDC) performed a blinded Early Detection Research Network-defined phase II biomarker bakeoff study of blood-based biomarker panels. The aims were to evaluate panel performance, to compare the panels' performance with that of cancer antigen 19-9 (CA19-9) alone, and to evaluate the performance of new combinations of the individual biomarkers.

EXPERIMENTAL DESIGN: Ten biomarkers representing eight biomarker panels and CA19-9 were evaluated using plasma, serum, and germline DNA from 140 stage I to IV pancreatic ductal adenocarcinoma (PDAC) cases and 140 controls from three tertiary care institutions, with controls frequency matched to cases on age …

Perceived Use Of Web-Based Videoconferencing For Social Connectedness Among Older Adults Living In Long-Term Care: Qualitative Study, Anna Garnett, Halyna Yurkiv, Denise M. Connelly, Richard Booth, Lorie Donelle Phd, Rn, Fcan, Faan

Publications

Background:

The COVID-19 pandemic highlighted how restrictions on in-person interactions within long-term care homes (LTCHs) severely compromised social connectedness among older adults and their families. Post pandemic, despite policy changes supporting greater in-person family engagement, frequent outbreaks continue to disrupt face-to-face interactions, and factors such as geography, life circumstances, and health can constrain family members’ ability to make regular in-person visits. Research suggests that web-based videoconferencing technology (WVT) may be a practical solution to help older adults within LTCHs to maintain social connection in the absence of physical gathering. However, increased understanding of end user experience is lacking, and more …

Healthcare Access And Community Nursing Outreach Effectiveness In Underserved Zip Codes In Central Florida, Miah Sanchez

Honors Undergraduate Theses

Access to healthcare depends on more than whether healthcare services are available. A person’s ZIP code, income, education, transportation options, health literacy, and neighborhood resources can all affect whether care is reached at the right time and in an appropriate setting. This literature review examines healthcare access and the role of community nursing outreach in underserved ZIP codes across Central Florida. The review synthesizes current literature on social determinants of health, geographic disparities, medically underserved populations, and community-based nursing interventions to better understand how these factors shape access to care. Across the literature, poverty, limited transportation, lower educational attainment, neighborhood …

Cardiovascular Disease Risk Profiles Among Metropolitan And Nonmetropolitan Young Adults - A Cross-Sectional Analysis Of The 2024 National Health Interview Survey (Nhis), Steven Dimitrakakis

Honors Undergraduate Theses

Cardiovascular disease (CVD), a group of disorders affecting the heart and blood vessels, is one of the leading causes of death worldwide, driven by genetic, lifestyle, and environmental factors. Young adults, although not a common group at risk for CVD, can face reduced health quality due to physical limitations and other environmental factors that can increase their risk for development of CVD. Depending on where young adults live, their risk of developing CVD varies. Young adults fall within the category of individuals ranging in age from 18-24 years old, the average between all ages for young adults between the research …

Nanoparticle Carriers Enhance The Prophylactic Antiviral Effects Of Dsrna In Vitro And Ex Vivo, Shayne Oberhoffner, Stephanie Dewitte-Orr, Starla Richardson, Leah Haile, Dominique Daniels, Erin Cooper, Aizah Ijaz, Janet Velasquez Perez, Mathilde Peruzzi, Bertrand Collet, Paul Craig, Kristof Jenik

Theses and Dissertations (Comprehensive)

Aquaculture now outpaces traditional capture fisheries as the world population and demand for sustainable protein sources increases. Wild and farmed species are increasingly susceptible to pathogen spread as global temperatures rise and stocking densities increase. Despite the devastating losses experienced by aquaculture due to viral infections, there remain few effective prophylactic antiviral therapeutics. Long double-stranded (ds)RNA is a uniquely viral molecule produced by nearly all viruses during their replication cycle, and its detection by salmonids like rainbow trout (Oncorhynchus mykiss) and chinook salmon (Oncorhynchus tshawytsha) leads to the establishment of a defensive antiviral state. Previous in vitro studies demonstrated a …

Aging With A Chronic Illness: Symptom Burden, Everyday Challenges, And Quality Of Life Among Older Adults With Multiple Sclerosis, Swasati Handique

Social Work Dissertations

This three-article study examined the quality of life and everyday lived experience of older adults living with multiple sclerosis (MS). The first article is a scoping review of 14 peer-reviewed studies published between 2012 and 2025, conducted in accordance with Arksey and O’Malley’s five-stage framework and the PRISMA checklist. The second article is a cross-sectional study using the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) Phase II data set of 60 older adults living with MS. Multiple linear regression and moderation analysis was conducted to examine the association between physical symptom burden and quality of life, and whether participation …

Understanding Ehlers-Danlos Syndrome: A Claims-Based Analysis Of Healthcare Cost Patterns, Samson A Oyediran, Youngran Kim, Zhanna Novikov, Trudy M Krause

Faculty, Staff and Student Publications

Background: Ehlers-Danlos Syndrome (EDS) is a rare connective tissue disorder associated with substantial clinical complexity and healthcare utilization. Despite increasing recognition of EDS, little is known about its economic burden in the United States.

Objective: To assess the all-cause healthcare costs for individuals with newly diagnosed EDS during the pre-diagnosis year and the first 2 years post-diagnosis.

Methods: A retrospective cohort study was conducted using the Merative™ MarketScan® Commercial Claims and Encounters Database (2016-2022). Newly diagnosed patients were identified using ICD-10-CM codes, with the first observed diagnosis defined as the index date. Continuous enrollment for 12 months pre-index and 24 …

Adapting A Smartphone-Based Auricular Point Acupressure Self-Management Program For Rural Chronic Musculoskeletal Pain: Qualitative Study, Jungkyung Min, Peiyin Hung, Jane N Bolin, Rupsikha Bora, Sarah Pace, Patricia Pitones, Hulin Wu, Jennifer Kawi

Faculty, Staff and Student Publications

Background: Chronic musculoskeletal pain is more prevalent in rural areas where access to pain interventions, including complementary approaches like Auricular Point Acupressure (APA), remains limited. APA is a non-invasive, needle-free approach, and its smartphone-based self-management delivery model has not been optimized for rural contexts.

Objectives: To explore the perspectives of rural partners on adapting a smartphone-based Auricular Point Acupressure-Self-Management (APA-SM) program to better meet rural needs. Study objectives were to: (1) refine the APA-SM program for rural adults, (2) identify implementation barriers, (3) understand practice workflows and engagement, and (4) identify strategies to integrate the APA-SM program into rural pain …

Prehospital Time Disparities For Rural Patients: Analysis Of Dekalb County, Al, Lee Reagan, David Bramm

UAB Huntsville Research Day - All Presentations

2026 research poster