Digital Commons Network^™

Geographic Disparities In Birth Outcomes: County-Level Investigation On Pm2.5 And Low Birth Weight In The United States, Eunice Y. Park, Ranju Mainali

Department of Public Health Scholarship and Creative Works

Exposure to air pollution adversely affects health and is highly associated with birth outcomes. This study analyzes the relationship between air pollution and low birth weight (LBW; less than 2,500 g at birth) at the county level in the United States. Using the latest publicly available data from the County Health Rankings and Roadmaps across 3,027 counties and equivalents, simple and quantile regression analyses were conducted to test the association between the average daily density of fine particulate matter (PM2.5) and LBW. The LBW data were from 2016 to 2022 from the National Center for Health Statistics and PM2.5 data …

Integrative Analysis Of Lung Adenocarcinoma Across Diverse Ethnicities And Exposures, Shankha Satpathy, Natalie M Clark, Yi-Ju Chen, Noshad Hosseini, Ya-Hsuan Chang, Yi Hsiao, Jonathan T Lei, Francesca Petralia, Jin-Shing Chen, Yifat Geffen, David I Heiman, Indranil Paul, Hanbyul Cho, Michelle Hollenberg, Giacomo B Marino, Kuen-Tyng Lin, Rahul Mannan, C Jackson White, Joe Allen, Shayan C Avanessian, M Harry Kane, Ashley Wolfe, Miloni Kinarivala, Wenke Liu, Shankara Anand, Mong-Wei Lin, Moe Haines, Erik J Bergstrom, Grant Hussey, Ginny Xiaohe Li, Deepak C Mani, Hao Fang, Eric J Jaehnig, Hasmik Keshishian, Brecca Miller, Kang-Yi Su, Yi-Jing Hsiao, Hsao-Hsun Hsu, Min-Shu Hsieh, Kuo-Hsuan Hsu, Alexi Monovoukas, Simone Gohsman, John R Thorup, Yamei Deng, Yo Akiyama, Eden Deng, Eric Sheng-Wen Chen, Azra Krek, Rodrigo Espinoza, Weiping Ma, Daniel Charytonowicz, Robert Sebra, Jyun-Hong Lin, Yan-Si Chen, Yin-Chen Hsu, Ze-Shiang Lin, Kun-Chieh Chen, Chang-Wei Yeh, Yu-Tai Wang, Alexander J Lazar, Mehdi Mesri, Eunkyung An, Xu Zhang, Karl R Clauser, David Fenyö, Arul M Chinnaiyan, Bing Zhang, Li Ding, Kelly Ruggles, Chelsea Newton, Hui Zhang, Pei Wang, Galen Hostetter, Gilbert S Omenn, Chandan Kumar-Sinha, Mathangi Thiagarajan, Ramaswamy Govindan, Paul Paik, Abhijit Parolia, Qing K Li, Avi Ma'ayan, Gad A Getz, Saravana M Dhanasekaran, Ana I Robles, Gee-Chen Chang, Pan-Chyr Yang, Sung-Liang Yu, Hsuan-Yu Chen, Alexey I Nesvizhskii, Steven A Carr, D R Mani, Marcin P Cieslik, Yu-Ju Chen, Michael A Gillette, Taiwan Cancer Moonshot Program, Clinical Proteomic Tumor Analysis Consortium

Faculty, Staff and Students Publications

Lung adenocarcinomas (LUAD) are a pressing global health problem with enduring lethality and rapidly shifting epidemiology. Proteogenomic studies integrating proteomics and post-translational modifications with genomics can identify clinical strata and oncogenic mechanisms, but have been underpowered to examine effects of ethnicity, smoking and environmental exposures, or sex on this heterogeneous disease. This comprehensive proteogenomic analysis of LUAD tumors and matched normal adjacent tissues from 406 patients across diverse geographic and demographic backgrounds explores the impact of understudied driver mutations, prognostic role of chromosomal instability, patterns of immune signaling, differential and sex-specific effects of endogenous mutagens and environmental carcinogens, and pathobiology …

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Establishing Best Practices Guidelines For Collaborative Research In Global Surgery: Developing A Delphi Survey, Ramitha Eshan Ruwanpathirana, Swati Deshpande, Sophia Abdulhai, Mathilde Djeneba Billau, Sumeja Catic, Theresa L Chin, Julia N Harrison, Pratyush Kumar, Maria Cecilia T Leyson, Helen W Li, Katayoun S Madani, Arthur Serumaga, Margaret Tarpley, Grayson Wright, Nia N Zalamea, Joshua S Ng-Kamstra

Faculty, Staff and Students Publications

Background: Collaborative research in global surgery has resulted in the rapid development of the field via knowledge creation and dissemination, research capacity building, and direct improvements in the delivery of clinical care. Yet the establishment and maintenance of trans-boundary collaborations carries significant risk to health systems, clinicians, patients, and researchers, particularly if such collaborations are not developed thoughtfully and with appropriate guardrails. In recent years, there has been significant growth in the literature on the pervasiveness and impact of neocolonialism on global health research.

Methods: To harness the benefits of global surgery research collaboration while mitigating these risks, we reviewed …

Resilience, Elapsed Time Since Exposure To Workplace Violence, And Job Satisfaction Among Emergency Nurses In The United States, Ginny Glisson Ennis

Walden Dissertations and Doctoral Studies

The emergency nursing profession faces a critical challenge with a declining workforce and a high prevalence of workplace violence (WPV), which negatively impacts nurse job satisfaction. This quantitative study examined the relationships among nursing resilience, time elapsed since WPV exposure, and job satisfaction among emergency nurses (ENs) in the United States. Grounded in resilience and Herzberg’s two-factor theories, this study used a cross-sectional, correlational design. A national, anonymous online survey was distributed via social media, using a sharable QR code to recruit participants. The survey consisted of a total of 52 items, and collected demographic data, and time elapsed since …

Improving The Reporting On Health Equity In Observational Research (Strobe-Equity): Extension Checklist And Elaboration, Omar Dewidar, Larissa Shamseer, G J. Melendez-Torres, Elie A. Akl, Jacqueline Ramke, Xiaoqin Wang, Oyekola Oloyede, Taryn Young, Stuart G. Nicholls, Zulfiqar Ahmed Bhutta

Institute for Global Health and Development

Data on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate. The STROBE-Equity extension addresses this gap by providing a structured set of criteria to enhance the reporting of health equity data and considerations.

Bridging Gaps In Breast Cancer Care: A Breast Cancer Care Quality Index To Improve Outcomes Worldwide, Eduardo Cazap, Benjamin Anderson, Giuseppe Curigliano, Sandeep Sehdev, Fatima Cardoso, Ana Gonzalez, Emad Shash, Cheng-Har Yip, André Mattar, Miriam Mutebi

General Surgery, East Africa

Background: Breast cancer (BC) care faces challenges in early detection, timely diagnosis and comprehensive management. Disparities persist, with underserved populations facing the greatest barriers. Addressing these requires policies that support consistent, evidence-based practices and enhance healthcare capacity and technology advancements. This document presents the development of the Breast Cancer Care Quality Index (BCCQI), supported by evidence to promote equitable care and improve BC outcomes globally, and discusses its adoption as a strategic tool within National Cancer Control Plans.

Methods: A two-part methodology identified challenges in BC care and defined dimensions, targets and indicators for the BCCQI, aligned with …

Changes In Child Placement After Child Abuse Pediatrics Consultation For Suspected Physical Abuse., Kristine A. Campbell, Antoinette L. Laskey, Daniel M. Lindberg, M Katherine Henry, Porcia Vaughn, James Anderst, Megan M. Letson, Angela N. Bachim, Nancy S. Harper, Carmen M. Coombs, Lori D. Frasier, Joanne N. Wood

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The association between child abuse pediatric (CAP) assessments and child welfare outcomes is unknown.

OBJECTIVE: To determine the association between a CAP determination of the likelihood of physical abuse and change in child placement. We hypothesized that child race would be associated with CAP determination of abuse likelihood and child welfare outcomes.

PARTICIPANTS AND SETTING: Children under age ten years with in-person CAP consultation and referral to child protective services for suspected physical abuse at a U.S. pediatric referral center participating in CAPNET, a CAP research network, from 02/2021 to 01/2023.

METHODS: We created a series of generalized estimating …

Distribution Of Block Grant Funding: Considerations For Rural Communities, Kate E. Beatty, Casey P. Balio, Margaret M. Francisco, Michael B. Meit, Stephanie M. Mathis

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

A Rural Lens On Federal Block Grant Distribution, Casey P. Balio, Stephanie M. Mathis, Margaret M. Francisco, Michael Meit, Kate E. Beatty

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Racial Moderation Of Infant Mortality Risk And Protective Factors In The United States, Temitope Oluwaseun Akinsola

Walden Dissertations and Doctoral Studies

The rate of infant mortality is a pressing health issue in the United States, as ethnic minorities are disproportionately affected. This study addressed how race controls the predictive power of demographic, socioeconomic, and geographic factors on infant mortality. Using a quantitative correlational design, secondary data from 181 individuals listed in the CDC-National Vital Statistics System database were used, which contains nationally aggregated data related to infant mortality rates. Bronfenbrenner’s social ecological model guided the study, and multiple regression and moderation models were used to examine socioeconomic status and access to healthcare on infant mortality outcomes. Results indicated that race significantly …

Isatuximab Plus Bortezomib, Lenalidomide, And Dexamethasone For Transplant-Ineligible Newly Diagnosed Multiple Myeloma Patients: A Frailty Subgroup Analysis Of The Imroz Trial, Salomon Manier, Meletios-Athanasios Dimopoulos, Xavier P Leleu, Philippe Moreau, Michele Cavo, Hartmut Goldschmidt, Robert Z Orlowski, Muriel Tron, Christina Tekle, Marie-France Brégeault, Andrea T Shafer, Meral Beksac, Thierry Facon

Faculty, Staff and Student Publications

Patients with multiple myeloma (MM) meeting frailty criteria have worse outcomes than those identified as non-frail. Here, we present a post hoc subgroup analysis of IMROZ, a global, phase III, open-label study investigating isatuximab (Isa) with bortezomib, lenalidomide, and dexamethasone (VRd) followed by Isa-Rd (N=265) versus VRd followed by Rd (N=181) in newly diagnosed transplant-ineligible MM (Ti NDMM) patients using the simplified International Myeloma Working Group (sIMWG) frailty score. Although patients aged >80 years were excluded, there was no exclusion for patients meeting frailty criteria. All patients received standard VRd/Rd dosing; Isa-VRd patients received intravenous Isa (cycle 1, 10 mg/kg …

Iot Sensors As A Tool For Assessing Spatiotemporal Risk To Extreme Heat, Kijin Seong, Seung Jun Choi, Junfeng Jiao

Research Collection College of Integrative Studies

The safety of urban populations sensitive to extreme heat is under increasing threat. Few studies examine the potential benefits of deploying IoT environmental sensors in the urban context and their integration with large-scale human activity data. This paper examines the deployment of IoT sensors in high-resolution extreme heat risk assessment in the case of Seoul, South Korea. This study conducted spatiotemporal analysis on heat exposure with IoT sensors, compared it with an existing land surface temperature map for validation, combined it with human activity data for risk assessment, and finally discussed the benefits of IoTs in detecting abnormal weather events. …

Old Frames On New Media: Health Misinformation In Black Digital Communities, Merriah Croston

Brown School Graduate Student Theses and Dissertations

Growing evidence suggests that health misinformation has the potential to proliferate on social media. However, our understanding of the problem’s magnitude continues to evolve. Despite several studies on health misinformation and Black communities in the United States (U.S.), few of these studies characterize misinformation within digital settings. This dissertation seeks to address this gap by: 1) synthesizing the literature on health misinformation and Black communities to identify prevalent misinformation topics and claims, characteristics of exposure to and belief in these topics and claims, and successful intervention strategies; 2) quantifying and characterizing the volume of COVID-19 misinformation on Black Twitter during …

Society Of Vascular And Interventional Neurology (Svin) Stroke Interventional Laboratory Consensus (Silc) Criteria For Training Standards And Maintenance Of Certification In Neurointervention, Ossama Y. Mansour, Kaiz S. Asif, Roberta Novakovic-White, Boris Pabon, Santiago Ortega-Gutierrez, Atilla Ozcan Ozdemar, Alicia Castonguay, Brijesh Mehta, Dileep R. Yavagal, Ameer E. Hassan

School of Medicine Publications

The global shortage of neurointerventionalists presents a challenge to timely stroke care, particularly in low‐ and middle‐income countries. The Society of Vascular and Interventional Neurology Stroke Interventional Laboratory Consensus criteria aim to standardize training and certification in neurointervention to address these disparities. This white paper reviews existing training standards in various regions, identifies gaps, and proposes a structured framework encompassing entry requirements, program structure, and certification processes. The Stroke Interventional Laboratory Consensus criteria further outline requirements for training centers and program directors. By establishing global standards, the Stroke Interventional Laboratory Consensus criteria seek to improve patient outcomes and expand access …

Changes In Child Placement After Child Abuse Pediatrics Consultation For Suspected Physical Abuse, Kristine A Campbell, Antoinette L Laskey, Daniel M Lindberg, M Katherine Henry, Porcia Vaughn, James D Anderst, Megan M Letson, Angela N Bachim, Nancy S Harper, Carmen M Coombs, Lori D Frasier, Joanne N Wood

Faculty, Staff and Students Publications

Background: The association between child abuse pediatric (CAP) assessments and child welfare outcomes is unknown.

Objective: To determine the association between a CAP determination of the likelihood of physical abuse and change in child placement. We hypothesized that child race would be associated with CAP determination of abuse likelihood and child welfare outcomes.

Participants and setting: Children under age ten years with in-person CAP consultation and referral to child protective services for suspected physical abuse at a U.S. pediatric referral center participating in CAPNET, a CAP research network, from 02/2021 to 01/2023.

Methods: We created a series of generalized estimating …

Opiate Addiction Crisis In The United States, Autumn Joy Collins

Doctoral Dissertations and Projects

This research investigates how fentanyl has influenced drug trafficking trends and the corresponding response from law enforcement in New York State. It aims to explore the changes in drug trafficking pathways, organizational structures, and methods in this region since fentanyl's emergence and how state law enforcement has adjusted to this new challenge. The study uses a quantitative methodology, analyzing various data from law enforcement records, court documents, and state government reports. The focus is on fentanyl-related drug trafficking cases in New York State over five years. Methods include examining case records and analyzing trafficking patterns statistically. The study will assess …

Predicting Cardiovascular Mortality In Hampton Roads Using Social Determinants Of Health, Mohan D. Pant, Aditya Chakraborty, Prachi P. Chavan, George Mcleod, Brett J. Sierra, Glenn A. Yap, Brian C. Martin, Ebbie Kalan, Gregory T. Scott

Cardiovascular Research Symposium

Background: In Virginia’s Hampton Roads (HR) region, minority populations experience notably higher mortality rates than white populations. Despite abundant research on the association between social determinants of health (SDOH) and cardiovascular mortality rates at the state and national levels, there is a lack of research examining this association in the HR region.

Objective: The main objective of this study is to train and validate a geospatial-temporal predictive model to examine the association between SDOH and cardiovascular mortality, in the HR region.

Methods: Utilizing a longitudinal dataset (2010–2021) from the Virginia Department of Health and the U.S. Census Bureau, we trained …

It Takes A Village: Addressing Community Needs To Implement Firearm Prohibitions For Domestic Violence Protective Order Respondents, Kellie R Lynch, Michael K Gusmano, Jeff R Temple, Sarah Lane

Faculty, Staff and Student Publications

Prohibiting domestic violence protective order (DVPO) respondents from firearms is an effective strategy to prevent intimate partner homicide. However, DVPO gun laws vary considerably across states, and the implementation of such laws is inconsistent across localities. Local context, such as resource availability, priorities, and politics, differs across types of communities and impacts the implementation of laws. We conducted in-depth key informant interviews with victim service and criminal justice professionals (N = 27) working in urban communities, rural communities, and statewide organizations to better understand: (a) what communities need to effectively prohibit DVPO respondents from firearms (i.e., the DVPO gun …

Opioid Overdose Bystander Assistance And Harm Reduction In Pennsylvania, Walkirya Peralta

Walden Dissertations and Doctoral Studies

Bystanders play a vital role in reducing opioid overdose deaths by administering naloxone, a medication that can reverse the effects of opioids when used promptly. With opioid-related fatalities considered a public health emergency in the United States, increasing public access to naloxone and education on overdose prevention has become a key strategy in harm reduction. Research shows that these efforts effectively lower overdose deaths in affected communities. As part of this public health approach, many states allow individuals to obtain naloxone without a prescription through standing orders at pharmacies and community programs. Additionally, legal protections such as Good Samaritan laws …

A Developmental Evaluation Of A Dental Hygiene Program And A Community Health Partnership, Laura Jacob

Higher Education: Doctoral Research Projects

Today, dental hygiene education commonly occurs in community college settings which are removed from dental schools thus dental hygiene students graduate with relatively little to no exposure to dentistry or directly with a clinically practicing dentist. With dental hygiene workforce shortages at an extremely high level, locally and nationally, it is imperative to matriculate students who are poised to be successful in the changing landscape of healthcare.

The purpose of this program evaluation was to investigate via the developmental program evaluation model, the perceived benefits of a potential collaboration between the Colorado Mountain College (CMC) dental hygiene program and a …

Organizational Climate And Decision Aid Sustainability In Lupus Care: Mixed Methods Study, Aizhan Karabukayeva, Larry R Hearld, Nathan W Carroll, Reena Kelly, Jasvinder A Singh

Faculty, Staff and Students Publications

Background: Digital decision aids (DAs) are increasingly used in health care to support shared decision-making and promote patient engagement. In the context of systemic lupus erythematosus (SLE), a complex autoimmune disease characterized by diverse symptoms and uncertain prognoses, DAs offer guidance to patients in navigating treatment risks and benefits. Although numerous studies have examined the initial implementation of evidence-based tools, there is limited evidence on the organizational factors that influence their long-term sustainability in clinical practice. This gap is particularly salient for digital interventions, where integration into routine workflows and ongoing use require alignment with clinic readiness and culture. This …

Unrecognized And Unreported Concussions Among Community Rugby Players, Rachael Wittmer, Thomas A. Buckley, Charles Buz Swanik, Katelyn M. Costantini, Lisa Ryan, Ed Daly, Regan E. King, Arryana J. Daniels, Katherine J. Hunzinger

Department of Exercise Science Faculty Papers

This study examined the prevalence of intentionally unreported and potentially unrecognized concussions in community rugby players and whether nondisclosure reasons vary by sex, position, or playing history. An online survey was completed by 1037 players (41.0% female; mean age 31.6 ± 11.3 years; 10.1 ± 8.1 years playing) who reported diagnosed, unreported, and unrecognized concussions. Poisson regression models estimated prevalence ratios (PRs), and Fisher's exact tests compared reasons for nondisclosure. The diagnosed, unreported, and unrecognized concussion rates were 66.5%, 32.4%, and 42.2%, respectively. Players with diagnosed concussions had a 7.2-fold higher prevalence of nondisclosure and a 2.3-fold higher prevalence of …

Analyzing Food Access: An Investigation Of Food Insecurity Amongst Latinos In Rural Nebraska, Natalia Santos

Theses & Dissertations

Background: Food insecurity is a public health issue in the United States, with disproportionately higher rates among Latino/Hispanic households. Rural communities face unique geographical, socioeconomic, and systemic barriers that often exacerbate food access disparities. Despite the growing Latino population in rural areas, particularly in Midwestern states like Nebraska, there remains a critical gap in comprehensive research that integrates both objective and subjective understandings of their food environments. Understanding these multifaceted influences is crucial for developing effective, culturally sensitive interventions.

Problem Statement: This dissertation aims to answer the central question: How does food access and food insecurity manifest amongst Latinos in …

An Evidence-Based Intervention To Increase Trypanosoma Cruzi, A Neglected Parasitic Infection, Diagnosis In Rural And Moderate-Size-City Us Clinics, M K. Lynn, Hunter M. Boehme, Jeffrey Hall, Patrick Kent, Alain H. Litwin, Quang H. Pham, Melissa Nolan Ph.D., Mph, Prisma Chagas Team

Faculty Publications

Background

Chagas disease is a chronic, insidious parasitic infection (Trypanosoma cruzi) that slowly develops to irreversible organomegaly over several decades. The disease is traditionally acquired in endemic Latin American countries during childhood; < 1% of foreign-born adult residents in the United States have been diagnosed or treated with this potentially fatal disease. Low physician knowledge is a primary factor leading to misdiagnosis.

Methods

Starting in April 2022, a 4-part T cruzi clinical education intervention began, which included (i) 2 grand rounds presentations to >100 internal medicine providers; (ii) implementation of a “clinical Chagas champions program” incorporating 14 key clinical staff at varying departments and administrative levels educated on their specific role related to T cruzi screening, diagnosis confirmation, clinical management, and medical billing; ( …

Bacteria Recovered From Ear Swab Samples Of Cats With Otitis Externa And Their Antimicrobial Resistance Profiles In Kayseri, Türkiye, Emre Karakaya, Doğancan Yarim, Özgür Güran, Cansu Güran, Umut Alpman, İzzet Burçi̇n Saticioğlu, Gülteki̇n Atalan, Seçi̇l Abay, Fuat Aydin

Turkish Journal of Veterinary & Animal Sciences

This study aimed to isolate and identify bacteria from ear swab samples from cats with otitis externa and to detect the antimicrobial resistance profiles of the recovered isolates. For this purpose, ear swab samples from 100 domestic cats that were detected to have otitis externa were used. The samples collected from the animals were inoculated onto 7% defibrinated sheep blood agar and MacConkey agar, and the media were incubated at 37°C for 24-72h under aerobic/microaerobic conditions. The definition of the isolates was carried out by phenotypic tests, MALDI-TOF MS analysis, and 16S rRNA gene sequencing. Antimicrobial susceptibilities of the obtained …

Beyond Smoking: A Geospatial Investigation Of Factors Associated With Lung And Bronchus Cancer Risk In Pennsylvania, Tesla D. Dubois, Daniel Wiese, Kevin A. Henry, Shannon M. Lynch

Kimmel Cancer Center Faculty Papers

INTRODUCTION: While smoking is the leading cause of lung and bronchus cancer (LBC), additional exposures have been implicated and may explain the rise in LBC among never-smokers. To better understand the spatial distribution of LBC incidence and associated risk factors, this study aims to identify geographic areas with significantly elevated incidence rates in Pennsylvania and investigate the potential underlying risk factors.

METHODS: Using cancer registry data aggregated to the census tract level, spatial scan statistics were applied to detect areas of higher-than-expected LBC incidence across the state. Associations were then tested between census tract inclusion in a high-incidence area and …

Planetary Health: At The Crossroads Of Cvd Prevention, Tasveer Khawaja, Sanjay Rajagopalan

Faculty Scholarship

Purpose of Review: To highlight important recent findings demonstrating the interconnectedness of planetary and human health with a focus on cardiovascular disease. Recent Findings: Data continue to demonstrate a clear interconnectedness between the health of the planet and human health, with cardiovascular disease as an important outcome. The central roles of air pollution, non-optimal temperatures, water/waste management, and food/biodiversity are highlighted. We also highlight the clear opportunity for healthcare organizations to facilitate change that will yield positive environmental and patient outcomes. Summary: The undeniable interconnectedness of the health of the planet and human health serves as a call to action …

Volume Ii | Issue I | 2025

Dartmouth Undergraduate Journal of Politics, Economics and World Affairs

No abstract provided.

Inflation Targeting And Inertial Rules, Araha Uday

Dartmouth Undergraduate Journal of Politics, Economics and World Affairs

No abstract provided.