Digital Commons Network^™

Surge Scramble: An Evaluation Of Combining The Medical Response And Surge Exercise With The Centers For Disease Control And Prevention’S Pan Flu Scramble, Rebecca L. Thompson

Capstone Experience: Master of Public Health

This report analyzes how Hospital Preparedness Program funding recipients in Nebraska adapted the Center for Disease Control’s Pan Flu Scramble format to meet Medical Response and Surge Exercise (MRSE) requirements in the 2023-2024 fiscal year. By combining the MRSE and Pan Flu Scramble, the recipients created an in-person functional exercise format for the six Nebraska health care coalitions to test their respective chemical plans and the Health Care Crisis Protocol for the State of Nebraska. The report explains the design and conduct of the exercises and provides a comprehensive evaluation of the exercise design and conduct. This report will outline …

The State Of Abortion Training In Medical School And Family Medicine Residency Curricula: A Scoping Literature Review, Eric James Reece

Capstone Experience: Master of Public Health

This project aims to assess how abortion education has been integrated into medical training over the past decade, with a particular focus on understanding its current state in medical schools and family medicine residencies, including those offering specialized programs affiliated with RHEDI (Reproductive Health Education in Family Medicine) and TEACH (Training in Early Abortion for Comprehensive Healthcare). Given the ever-evolving legal landscape following the June 4^th, 2022 Supreme Court case of Dobbs v. Jackson Women’s Health Organization, this review explores how both federal- and state-level legal restrictions impact access to abortion training and attempts to identify gaps …

Evaluating The Nebraska Medical Center's Repatriation Of Inter-Hospital Transfers, Natalie Crump

Capstone Experience: Master of Public Health

Background: Bed capacity challenges at large academic medical centers delay the transfer of rural patients, negatively impacting their safety and quality of care. Repatriating inter-hospital transfer (IHT) patients to referral facilities upon completing specialized care can improve tertiary hospital bed capacity and community hospital financial sustainability.

Objectives: This project aims to identify the barriers and facilitators to successful IHT repatriation and the process and outcome variables influenced by the Nebraska Medical Center’s reverse transfer program.

Study Design: A retrospective observational cohort study was conducted to identify barriers and facilitators of NM’s IHT repatriation program.

Methods: Descriptive and comparative analyses of …

Virtual Reality In Trauma Therapy: Clinicians Treating Posttraumatic Stress Disorder (Ptsd) With Technological Resources In Minneapolis, Minnesota, Thomas E. Covington

Doctoral Dissertations and Projects

This dissertation aims to establish how virtual reality (VR) integrated with other technological devices in the management of posttraumatic stress disorder (PTSD). The technology will lay the foundation for how it can establish controlled and safe VR contexts that can help patients address traumatizing occurrences. I will also stress the use of virtual therapists through online tools and applications, giving access to those who cannot attend meetings in person. Also, I will examine the individualization of the treatment process through the application of digital technologies and their potential effects on the outcomes of the therapeutic process. The research also examines …

Improving Nutrition Outcomes Through Enhanced Allocative Efficiency Of Investments In 24 High Risk Counties In Kenya: An Optima Nutrition Modelling Study, Morris Ogero, Nick Scott, Veronica Kirogo, Anthony Ngugi

Population Health, East Africa

Introduction ;Undernutrition remains a significant global challenge, severely impacting children’s development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up …

Disparities In Guideline-Directed Medical Therapies In Rural And Underserved Heart Failure Patients, Shawn Mcclaughry

Physician Assistant Scholarly Project Papers

Heart failure with reduced ejection fraction (HFrEF) continues to be a substantial public health challenge, thus optimal management through guideline-directed medical therapy (GDMT) continues to be vital. Evolving GDMT has established four pillars of first-line optimal treatment with expeditious and maximized titration of established target dosing of pillar medications. GDMT has been shown to decrease mortality among HF patients. Although continuing advancements in treatment efficacy prevail, studies demonstrate that vulnerable populations, particularly rural, Black and Hispanic individuals, exhibit significantly lower rates of GDMT optimization, leading to increased hospitalization and mortality. This literature review evaluates disparities in GDMT implementation among urban, …

Introducing Social Determinants Of Health To The Alzheimer's Disease Research Center Network: Development And Implementation In The Uniform Data Set, Megan Zuelsdorff, Erin L. Abner, Joyce E. Balls-Berry, Gregory A. Jicha, Serggio Lanata, Gladys Maestre, Monica Rosselli, Shana D. Stites, Rachel A. Whitmer, Consuelo H. Wilkins

School of Medicine Publications

The Alzheimer's Disease Research Centers (ADRCs) consortium represents a critical locus of research on Alzheimer's disease and related disorders (ADRD) prevention, diagnosis, and intervention. Through the National Alzheimer's Coordinating Center's (NACC) standardized protocol, the Uniform Data Set (UDS), ADRCs have collected rich, harmonizable clinical and cognitive data. However, the collection of social data has been sparse and Center specific, constraining ADRD science that addresses research priorities on social determinants of health (SDOH) and health equity. Capitalizing on the transition to a revised UDS version 4, an interdisciplinary committee representing 10 ADRCs reviewed the literature and instrumentation, ultimately creating a brief …

Clinical Validation Of A Vaginal Cervical Cancer Screening Self-Collection Method For At-Home Use: A Nonrandomized Clinical Trial, Megan B Fitzpatrick, Colleen Mcnicholas, Lindsay Kuroki, Et Al.

2020-Current year OA Pubs

IMPORTANCE: One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening.

OBJECTIVE: To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport.

DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites …

Small But Mighty: Strengthening The Value Of Local Pocket Parks, Makana Sm Higa

Capstone Projects and Master's Theses

In Monterey County, youth obesity rates are climbing at an alarming rate. Ventana Wildlife Society, and Wellness Through Nature program seek to help lower these rates. Ventana looks to achieve this through outdoor education and family trips with migrant farm working families in the cities of Soledad and Salinas. These trips attempt to increase environmental stewardship and improve community health. The project aims to evaluate the effectiveness and community engagement in regards to pocket parks. The parks visited were Bataan Memorial Park, Harden Neighborhood Park, Cesar Chavez Park, Joe Ledesma Park and San Antonio Park. The research seeks to increase …

Patient Perspectives On Health Care Utilization At Two Free Clinics – A Qualitative Study, Patrick Fagan, Danny Guillen Perez, Roberta D. Baer, John Petrilli

Patient Experience Journal

Millions of uninsured Americans access health care through free clinics, but their experience with the medical system is understudied. This study sought to understand patterns in free clinic patients' experience with healthcare utilization through qualitative and descriptive analyses. Data were collected through face-to-face, open-ended interviews at two free clinics in an urban Florida community. The clinics included one student-run free clinic and one community-based free clinic. Survey questions were developed based on prior literature and validated through expert consensus and pilot interviews. The interviewers conducted 74 interviews between May 7 and June 10, 2022. Responses were coded by the authors, …

Impact Of Medication Opioid Use Disorder (Moud) Programs In Emergency Departments, Mechelle A. Zima

Nursing Capstones

The purpose of this paper is to provide a discussion of how a medication opioid use disorder (MOUD) programs integrated into the emergency department (ED) can improve patient’s outcomes compared to standard ED discharges. This study utilized a systematic literature review using PubMed, CINAHL and Google Scholar. The initial literature search identified 594 articles. After applying the predefined inclusion and exclusion criteria, 18 articles were selected. Inclusion criteria included peer reviewed articles that focused on opioid use disorder (OUD) patients treated in the ED with OUD medications while exclusion criteria involved articles with OUD patients treated in ED without OUD …

Effect Of A Digital Health Exercise Program On The Intention For Spinal Surgery In Adult Spinal Deformity: Exploratory Cross-Sectional Survey, Marsalis Christian Brown, Christopher Quincy Lin, Christopher Jin, Matthew Rohde, Brett Rocos, Jonathan Belding, Barrett I. Woods, Stacey J. Ackerman

Rothman Institute Papers

BACKGROUND: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic's (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD.

OBJECTIVE: This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users' intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery.

METHODS: Individuals …

Supreme Court Case Study: The Variation In Rates Of Miscarriage Management Care And Post-Abortion Care Across The Us Before And After The Supreme Court Decision, Ted Sibrian Jr.

MUSC Theses and Dissertations

The paper examines abortion care and the management of miscarriages following the Roe v. Wade decision in restrictive states that do not allow medical intervention due to the vague legal terms. This research evaluates the need to establish protocols for providers when faced with nonviable pregnancies requiring medical intervention. Additionally, the paper highlights the impact across the US on women’s health outcomes by emphasizing the care for miscarriage management. This multi-method paper reviews the current literature on miscarriage management and spontaneous abortion MarketScan® data from commercially insured individuals with an age range of 18-50 years old by regions across the …

Stereotype, Stigma, And Discrimination And Prep Use Among Black And Latino Men And Women, Aieshia Brooks Poole

Walden Dissertations and Doctoral Studies

HIV infections continue to rise in the Southern United States, with Black and Latino men who have sex with men (MSM), bisexual men, and women experiencing disproportionate impacts. Although pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for reducing HIV transmission, disparities in its uptake remain due to healthcare stereotype threat, felt stigma, and everyday discrimination. This quantitative cross-sectional study analyzed secondary data from the Generations: A Study of the Life and Health of LGB People in a Changing Society (2016–2019) to examine the relationship between these psychosocial barriers and PrEP use among Black/Latino MSM, bisexual men, and women aged …

Differences In Hepatocellular Carcinoma Incidence Trends Across Us Census Divisions, 2001 To 2021, Itunu O Sokale, Omar Rosales, Aaron P Thrift, Hashem B El-Serag, Elyse Burgess, Abiodun O Oluyomi

Faculty, Staff and Students Publications

Background/Objectives: Hepatocellular carcinoma (HCC) is a leading cause of cancer diagnoses and deaths in the United States. This study serves as an update on secular trends in national HCC incidence rates while exploring potential geographic and racial/ethnic differences across all nine US census divisions.

Methods: We analyzed HCC incidence data reported to the United States Cancer Statistics (USCS) database from 2001 to 2021 (excluding 2020 data, based on the Centers for Disease Control and Prevention's cautionary recommendations for COVID-19 pandemic data usage for trend analysis). We performed trend analyses of age-adjusted incidence rates in the US overall, by census …

Pandemic Mythmaking: Covid-19 And Mythological Symbolism In Indian Folk Art, Ishani Anwesha Joshi, Sathyaraj Venkatesan

Mythlore: A Journal of J.R.R. Tolkien, C.S. Lewis, Charles Williams, and Mythopoeic Literature

Through a comprehensive analysis of Durga Bai Vyam’s “Samura Manthan” and Rupsona and Bahadur Chitrakar’s “Corona Rakshasa,” this article aims to investigate how mythological stories and themes have been used in the Indian context in folk art during the COVID-19 pandemic. The investigation will offer insights into how artists have leveraged mythological symbolism to infuse their works with richer layers of meaning, thereby engaging readers in a deeper exploration of the pandemic’s impact on society and the human psyche. By close-reading the aforementioned paintings, this study aims to illustrate the evolving visual representation of cultural narratives …

Using The Healthy Native Youth Implementation Toolbox To Provide Web-Based Adolescent Health Promotion Decision Support To American Indian And Alaska Native Communities: Implementation Study, Amrita Sidhu, Ross Shegog, Stephanie Craig-Rushing, Nicole Trevino, Michelle Singer, Cornelia Jessen, Gwenda Gorman, Sean Simpson, Melissa Peskin, Belinda Hernandez, Christine Markham

Faculty, Staff and Student Publications

Background: American Indian and Alaska Native (AI/AN) youth experience numerous health inequities, including those in sexual, reproductive, and mental health. Implementation of culturally relevant, age-appropriate evidence-based programs may mitigate these inequities. However, numerous barriers limit the adoption and implementation of evidence-based adolescent health promotion programs in AI/AN communities.

Objective: This study examines user reach and engagement from 2022 to 2024 of web-based decision support (the Healthy Native Youth [HNY] website and the embedded HNY Implementation Toolbox), designed to increase the implementation of evidence-based adolescent health promotion programming in AI/AN communities.

Methods: Promotional strategies were designed for optimal geographic reach to …

Developing An Online Community Advisory Board (Cab) Of Parents From Social Media To Co-Design An Human Papillomavirus Vaccine Intervention: Participatory Research Study, Regan M. Murray, Shawn C. Chiang, Ann C. Klassen, Jennifer A. Manganello, Amy E. Leader, Wen-Juo Lo, Philip M. Massey

Department of Medical Oncology Faculty Papers

BACKGROUND: Social media health interventions have grown significantly in recent years. However, researchers are still developing innovative methods to meaningfully engage online communities to inform research activities. Little has been documented describing this approach of using online community advisory boards (CABs) to co-create health communication interventions on social media.

OBJECTIVE: This study describes the formation, engagement, and maintenance of an online CAB focused on co-creating a health education intervention for parents regarding the human papillomavirus (HPV) vaccine. The study provides guiding principles for public health researchers implementing such CABs in future digital health interventions.

METHODS: In May 2020, Twitter was …

Hexasodium Fytate (Snf472 Or Csl525) Inhibits Ectopic Calcification In Various Pseudoxanthoma Elasticum And Calcinosis Cutis Animal Models, Miguel Ferrer, Maria Pérez-Ferrer, Marc Blasco, Ida Jacobs, Qiaoli Li, Olivier Vanakker, Lisa Dangreau, Andrea López, Gianluca Malagraba, Firas Bassissi, Joan Perelló, Carolina Salcedo

Department of Biochemistry and Molecular Biology Faculty Papers

Background/Objectives: Ectopic calcification is a pathological condition characterized by the mineralization of soft tissues due to the deposition of calcium phosphate crystals. Hexasodium fytate (CSL525, previously known as SNF472) is a crystallization inhibitor being developed for the treatment of ectopic calcification-related disorders. Our aim was to investigate CSL525 for the treatment of soft-tissue calcification disorders in animal models of pseudoxanthoma elasticum and calcinosis cutis. Methods: In a first study, abcc6^-/- zebrafish larvae were exposed to 1 mM CSL525 for 7 days or kept under the same conditions without CSL525, and spinal mineralization was quantified. In a second study, abcc6 …

Relationship Between Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Inflammatory Biomarkers, And Hospital Length Of Stay Among Covid-19 Patients., Alice Aghamie Osuji

Walden Dissertations and Doctoral Studies

COVID-19 has put immense pressure on healthcare facilities, especially in managing patients with comorbidity. This study addressed the association between two important coinfections, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), and their effect on hospital length of stay (LOS) among COVID-19 patients. The study also explored the predictive role of the inflammatory biomarker C-reactive protein (CRP) in prolonged hospitalization, also considering the influence of age and race. This study applied the Biopsychosocial Model and Chronic Care Model (CCM) to examine health outcomes and resource use. A retrospective cohort research design was used to examine medical records of …

Universal Health Care, Oregon, Jennifer S. Arnold, Bethany Clouse, Alec Martin

OHSU-PSU School of Public Health Annual Conference

Historically, the US has chosen not to fund universal health care at every opportunity, leaving our nation as the only industrialized country without some system of health coverage for our citizens and with the worst health care outcomes of any high-income nation in the world. Health care in Oregon is no exception. Our current health care system is financially unsustainable, harmfully complex, and socially unjust, as well as inequitably delivered. Too many Oregonians, because of their race, age, income, geography, or insurance, endure vastly different health care access, varied health care quality, and wide-ranging health outcomes. In 2019, the Oregon …

Policy And Practice: Analyzing Abortion Laws And Their Relationship To Competent Women’S Health Services In Ohio, Daija Smith

MUSC Theses and Dissertations

This study examines the relationship between abortion policy changes and women’s health services, focusing specifically on the state of Ohio’s evolving abortion laws and their implications. Using a qualitative approach, the research explores competency's role in addressing mental health disparities among diverse populations and marginalized communities. Through analyzing state policies and interviews with healthcare advance practice providers, this study completed a thematic analysis that identified opportunities such as shaping access and quality of care. The findings aim to inform strategies that reduce health disparities and improve competent care in women’s health services.

Caffeine-Free Plant-Based Nootropics: The Evolving Science And Regulatory Journey Of Alpinia Galanga., Deshanie Rai

Oxford ICSB

Consumer interest in using botanicals as complementary medicine to help address a variety of health benefits is rooted in the traditional use of botanicals to support for example vision performance, joint health, and mental wellbeing. With increasingly busy lifestyles, consumers are seeking ways to support their mental energy. While caffeine is a widely used nootropic, consumers are wary of consuming too much caffeine and/or it’s associated “caffeine-crash” effects, and therefore looking for plant-based nootropic alternates. Plant-derived nutraceutical research is now on the research agendas in academic and industry settings. At OmniActive Health Technologies, we are helping to address consumer health …

Prenatal Exposure To Pm2.5 Concentration And Risk Of Preterm Birth In New Mexico; A Seasonal Pattern And Spatio-Temporal Modeling., Onyedikachi J. Okeke

Mathematics & Statistics ETDs

This study investigates the association between prenatal PM2.5 exposure and preterm birth risk in New Mexico (2014–2021). Using descriptive statistics, time series models, and spatial analyses, findings show an average preterm birth rate of 14.87 per 1,000 live births, with moderate correlation (r = 0.727) between PM2.5 levels and very preterm births. While traditional models revealed no significant global effect, spatial methods such as Geographically Weighted Regression (GWR) and Multiscale GWR uncovered strong spatial heterogeneity. PM2.5 effects varied by county (coefficients: -0.00154 to 0.00150), with clustering evident in 2018–2019 (Moran’s I = 0.155–0.174). Results highlight the limitations of global models …

Protecting Global Health Partnerships In The Era Of Destructive Nationalism, Maya Adam, Desiree Labeaud, Nokwanele Mbewu, Jennifer Gates, Randall Waechter, Mercy Borbor-Cordova, Lydiah Kibe, Sonia Alvarez, Annie Dori, Anil Bilimale, Meggie Mwoka, Jessica Deffler, Michele Spring, Avriel Diaz, Rachael Farquhar, Willy Dunbar, Comfort Phiri, Valerie Luzadis, Nicole Redvers, Cristina Alonso, Rosemary Rochford, Rachel Lowe, Kareem Coomansingh, Moses Laman, Rebeca Sultana, Sadie Ryan, Amaya Bustinduy, Anita Hargrave-Bouagnon, Shazia Ruybal-Pesántez, Zebedee Kerry, Trevor Kelebi, Samuel Mcewen, Leanne Robinson, Maritza Salazar Campo, Till Bärnighausen

Department of Family & Community Medicine Faculty Papers

No abstract provided.

Association Of Age, Sex And Education With Access To The Intravenous Thrombolysis For Acute Ischemic Stroke, Yoona Ko, Beom Joon Kim, Youngran Kim, Jong-Moo Park, Kyusik Kang, Jae Guk Kim, Jae-Kwan Cha, Tai Hwan Park, Kyungbok Lee, Jun Lee, Keun-Sik Hong, Byung-Chul Lee, Kyung-Ho Yu, Dong-Eog Kim, Joon-Tae Kim, Jay Chol Choi, Jee Hyun Kwon, Wook-Joo Kim, Kyu Sun Yum, Sung-Il Sohn, Hyungjong Park, Sang-Hwa Lee, Kwang-Yeol Park, Chi Kyung Kim, Sung Hyuk Heo, Moon-Ku Han, Anjail Z Sharrief, Sunil A Sheth, Hee-Joon Bae

Faculty, Staff and Student Publications

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients.

Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed …

Social Support And Treatment Outcomes Among Multi-Drug Resistant Tuberculosis And Persons Living With Hiv In Nigeria, Abiodun Olusegun Hassan

Walden Dissertations and Doctoral Studies

An estimated 40% of people with tuberculosis (TB) are missed due to underdiagnosis, and among those previously treated TB cases, about a quarter develop drug-resistant TB in Nigeria. The emergence of multi-drug-resistant TB (MDR-TB) is stalling the effort towards TB’s control and eradication. Few studies have examined the impact of the psychosocial effect and support systems for TB, particularly for MDR-TB. In this quantitative, cross-sectional study, the predictive relationship between social support given to MDR-TB patients and their treatment outcomes was examined using secondary data of 594 MDR-TB cases enrolled between January 2018 and December 2021. The theoretical framework for …

Protecting Female Workers Amidst The Controversy Of Cheap Labor Market: A Comparative Advantage Analysis In Southeast Asia, Dita Nur Safitri

Jurnal Ilmu Kesejahteraan Sosial

In Southeast Asia, the cheap labor market is frequently mentioned as one of the comparative advantages that drive growth in the economy. However, this market frequently employs harmful labour practices against female workers. This study investigates the intersection of gender, labour practices, and economic advantages in the region, concentrating on the obstacles and protective measures for female workers. The key objective of this study is to examine how female workers are protected in Southeast Asia's low-wage labour markets, as well as to assess the effectiveness of these safeguards in preventing exploitation and improving working conditions. This study uses a comparative …

Dental Disparities: An Analysis Of Dental Caries Risk Factors Promoting Disparities Between Rural And Urban Communities In Nebraska, Nick Lounsbery

Honors Program: Senior Projects (Public)

The prevalence of dental caries in the United States remains a public health concern, as it is one of the most common chronic conditions across people of all ages. Research shows that preventative measures including brushing, fluoridated water, and regular checkups are effective strategies to mitigate tooth decay. However, there appears to be a divide between rural and urban populations, as the presence of dental cavities is significantly greater in remote areas in the State of Nebraska. Research methods used in this analysis included analyzing accredited academic literature to illustrate how cavities form from a biochemical perspective. Research methods also …

Comparative Analyses Of Neurorehabilitation Regulations And Health Equity In The U.S., Switzerland, And China: Implications For Universal Health Coverage, Linyue Lu

Switzerland: Global Health and Development Policy

Introduction: As populations age and the burden of neurological conditions rises, equitable access to neurorehabilitation has emerged as a critical yet under-addressed component of Universal Health Coverage (UHC). This comparative study examines how healthcare structures in the United States, Switzerland, and China shape neurorehabilitation equity. Methods: This analysis combines semi-structured interviews with seven healthcare experts (neurorehabilitation clinicians, health economists, and scholars) and a systematic review of peer-reviewed literature, policy documents, and demographic data. Results: In the U.S., fragmented insurance models and high out-of-pocket costs disproportionately limit access for low-income and rural populations. Switzerland’s universal coverage masks the inequities driven by …