Digital Commons Network^™

Mexico’S Ngos: Medical Mission Network Mexico Red Materno Infantil’S Effectiveness And Strategy Employed To Combat Maternal Mortality In Mexico., Yadira Gonzalez

Switzerland: Global Health and Development Policy

This qualitative case study investigates the role of two non-governmental non-profit organizations. Medical Mission Mexico is a non-profit civil association in Chetumal, Quintana Roo and Red Materno Infantil is a civil society organization in Mexico City. Through expert interviews and case study analysis this research explores how each organization implements strategies tailored to the distinct needs of urban and rural populations. The findings reveal that while both organizations work toward the same maternal health outcomes, their methods are different but still focus on education, community trust, and advocacy. This paper emphasizes the value of these organizations, their strategies, and the …

Are Hcc Risk Scores A Reliable Health Status Indicator Across Rural And Urban Areas?, Craig D. Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Facilitators, Barriers, & Recommendations For Pediatric Research Sites Conducting Decentralized Clinical Trials (Dcts), Abby Kietzman

Posters

The COVID-19 pandemic drastically altered the way clinical research is conducted through a widespread adoption of telemedicine practices to continue clinical trial procedures during peak periods of global COVID-19 spread. Using telehealth/telemedicine services allows researchers to conduct “decentralized clinical trials”, or DCTs, for all or portions of study protocol procedures while maintaining safety measures implemented for pandemic control. However, research sites are hesitant to adopt DCT policies due to concerns around digital health technology, data safety and quality, and limited information in the literature specifically assessing telemedicine use for pediatric clinical research via DCTs or how equipped pediatric research sites …

Rural Access To Multidisciplinary Cancer Care Center For Patients With Pancreatic Ductal Adenocarcinoma, Irene Gielen

Doctor of Nursing Practice

Background
Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer and among the most aggressive malignancies. It is projected to be the second leading cause of cancer related mortality in the United States by 2030. Due to its nonspecific early symptoms, PDAC often remains undetected until advanced stages, limiting treatment options and reducing survival rates.

Purpose
This project evaluated the impact of geographic distance on diagnostic staging and treatment initiation for patients with PDAC referred to the Providence Cancer Institute of Oregon (PCIO) from 2018-2023.

Methods
A retrospective chart review assessed the relationship between geographic distance, demographics, …

Evaluating The Relocation Of A Rural Hospital’S Helipad, Jamie M. Hammer

Doctor of Nursing Practice

Background
Island Hospital, a 43-bed Level III Trauma and Stroke Center in rural northwest Washington, manages over 170 annual helicopter EMS landings from Airlift Northwest, Life Flight, and the U.S. Navy. Serving as a critical hub, it provides essential care for the San Juan Islands and surrounding Salish Sea communities.

Purpose
The purpose of this project was to evaluate the impact of relocating the helipad from the parking lot to the roof of the inpatient building on patient time to treat, safety, and staff workflow satisfaction. The previous helipad was located 360 feet opposite the ED entrance, while the new …

Developing A Pandemic-Related Mental Health Micro-Collection For An Academic Library, Dee Anna Phares

Faculty Articles, Papers, and Other Scholarship

Academic library patrons dealing with the impact of trauma, depression, anxiety, or addiction spawned or exacerbated by the COVID-19 pandemic require materials that address the unique conditions that have shaped mental health since late 2019. This paper demonstrates how one academic library endeavored to address patrons’ needs for mental health resources by developing a “Coping and COVID-19” micro-collection.

Worldwide Policy, Surveillance, And Research On Physical Education And School-Based Physical Activity: The Global Observatory For Physical Education (Gope!) Conceptual Framework And Research Protocol, João Martins, Andrea Ramirez Varela, João Costa, Marcos Onofre, Dean Dudley, Rafael Cristão, Michael Pratt, Pedro C Hallal, Rafael Tassitano

Faculty, Staff and Student Publications

Introduction: The Global Observatory for Physical Education (GoPE!) builds on the Global Observatory for Physical Activity (GoPA!) to address gaps in surveillance, policy, and research on physical education (PE) and activity (PA). GoPE! is a worldwide surveillance system of quality PE and school-based PA that informs policy and interventions and allows comparative analysis so that each country and region can check their status and progress. This paper presents GoPE!'s conceptual framework and describes the research protocol as a cross-continental and evidence-based surveillance system.

Methods: Based on GoPA!'s framework and informed by the European Physical Education Observatory, as well as framed …

Environmental Health Disparities In Pediatric Cancer: A Report From The Fourth Symposium On Childhood Cancer Health Disparities, Thanh T Hoang, Zdenko Herceg, Don W Coulter, Adam De Smith, Manish Arora, William E Funk, David Haynes, Stephen H Linder, Leticia M Nogueira, Amy E Hughes, Lindsay A Williams, Jeremy M Schraw, Michael E Scheurer, Philip J Lupo

Faculty, Staff and Student Publications

The 4th Symposium on Childhood Cancer Health Disparities was held at Texas Children's Hospital in Houston, Texas, on September 26, 2023. The symposium registered 94 attendees from different backgrounds (e.g. clinicians, epidemiologists, exposure assessment scientists, geospatial experts) with an interest in environmental health disparities of pediatric cancer susceptibility and treatment outcomes. The focus of the symposium was to provide an overview of the role of environmental risk factors in studies of pediatric cancer, introduce novel exposure assessment tools that can be applied to the field, and highlight opportunities to study the impact of environmental health disparities in pediatric cancer susceptibility …

Epigenome-Wide Association Study Of Incident Type 2 Diabetes In Black And White Participants From The Atherosclerosis Risk In Communities Study, Sowmya Venkataraghavan, James S Pankow, Eric Boerwinkle, Myriam Fornage, Elizabeth Selvin, Debashree Ray

The Brown Foundation: Institute of Molecular Medicine

Aims/hypothesis: DNA methylation studies of incident type 2 diabetes in US populations are limited and to our knowledge none include individuals of African descent. We aimed to fill this gap by identifying methylation sites (CpG sites) and regions likely influencing the development of type 2 diabetes using data from Black and White individuals from the USA.

Methods: We prospectively followed 2091 Black and 1029 White individuals without type 2 diabetes from the Atherosclerosis Risk in Communities study over a median follow-up period of 17 years, and performed an epigenome-wide association analysis of blood-based methylation levels with incident type 2 diabetes …

Barriers To Telehealth Uptake And Use: A Scoping Review, Mackenzie Kemp, Kristin L. Rising, Gregory Laynor, Jessica Miao, Brooke Worster, Anna Marie Chang, Andrew J. Monick, Amanda Guth, Tracy Esteves Camacho, Kiana Mcintosh, Grace Amadio, Lindsey Shughart, Tingann Hsiao, Amy E. Leader

Jefferson Center for Connected Care Faculty Papers

OBJECTIVES: We conducted a scoping review to identify barriers to telehealth use and uptake from the perspective of patient, provider, and system that were documented in the literature. In addition to identifying and categorizing the barriers, we aimed to assess how barriers differed for studies conducted during the COVID-19 pandemic, as well as how barriers differed between the United States vs internationally based studies.

MATERIALS AND METHODS: Comprehensive searches of the PubMed/MEDLINE, CINAHL, and Scopus databases conducted on December 29, 2021 yielded 17 887 results, with 11 221 potentially eligible documents after duplicates were removed. The team conducted an initial …

Symptom Documentation In Unstructured Palliative Care Notes Of Children And Adolescents With Cancer., Katherine Bernier Carney, Jacob Wilkes, Tumilara Aderibigbe, Kristin Stegenga, Holly Spraker-Perlman, Lauri A. Linder

Manuscripts, Articles, Book Chapters and Other Papers

CONTEXT: Children and adolescents with cancer experiencing complex symptoms can benefit from subspeciality palliative care. However, standardized methods of symptom documentation by pediatric palliative care teams are lacking. Understanding current approaches to symptom documentation will inform next steps to optimize symptom support.

OBJECTIVE: To explore the documentation of symptom prevalence and characteristics in unstructured clinical notes by pediatric palliative care clinicians caring for children and adolescents with cancer.

METHODS: We reviewed unstructured clinical notes documented by the pediatric palliative care team for 115 children and adolescents with cancer. Symptom-related data were abstracted and evaluated using content analysis based on the …

The Association Between County-Level Social Determinants Of Health And Cardio-Kidney-Metabolic Disease Attributed All-Cause Mortality In The Us: A Cross Sectional Analysis, Antoinette Cotton, Pedro Rvo Salerno, Salil V Deo, Salim S Virani, Khurram Nasir, Ian Neeland, Sanjay Rajagopalan, Naveed Sattar, Sadeer Al-Kindi, Yakov E Elgudin

Faculty, Staff and Students Publications

Background: The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions.

Methods: We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 - 25, II: 26 - 50, III: 51 …

Time Tracking And Comparison Of Genetic Counseling Tasks In Inpatient And Outpatient Settings, Alexandra Osborne, Emily Magness Bland, Callie Diamonstein, Kristen Fishler

Faculty, Staff and Students Publications

Genetic counselors (GCs) practice in critical care settings. Some GCs have full-time inpatient roles, while most GCs who see inpatients do so as needed or on a rotating schedule in addition to seeing patients in an outpatient setting. Few studies have tracked and compared the amount of time it takes GCs to perform tasks in the inpatient and outpatient settings. Genetic counselors were invited to participate in this study via the National Society of Genetic Counselors research listserv. Participants completed an online survey asking how their role is structured and what types of support are available to them while seeing …

Alert Design In The Real World: A Cross-Sectional Analysis Of Interruptive Alerting At 9 Academic Pediatric Health Systems, Swaminathan Kandaswamy, Julia K W Yarahuan, Elizabeth A Dobler, Matthew J Molloy, Lindsey A Knake, Sean M Hernandez, Anne A Fallon, Lauren M Hess, Allison B Mccoy, Regine M Fortunov, Eric S Kirkendall, Naveen Muthu, Evan W Orenstein, Adam C Dziorny, Juan D Chaparro

Faculty, Staff and Students Publications

Objective: To assess the prevalence of recommended design elements in implemented electronic health record (EHR) interruptive alerts across pediatric care settings.

Materials and methods: We conducted a 3-phase mixed-methods cross-sectional study. Phase 1 involved developing a codebook for alert content classification. Phase 2 identified the most frequently interruptive alerts at participating sites. Phase 3 applied the codebook to classify alerts. Inter-rater reliability (IRR) for the codebook and descriptive statistics for alert design contents were reported.

Results: We classified alert content on design elements such as the rationale for the alert's appearance, the hazard of ignoring it, directive versus informational content, …

Patients' Attitudes To Magnetic Resonance Imaging In Perianal Fistulizing Crohn's Disease: A Global Survey, Easan Anand, Jalpa Devi, Anna Antoniou, Shivani Joshi, Jaap Stoker, Phillip Lung, Ailsa Hart, Phil Tozer, David H Ballard, Parakkal Deepak

2020-Current year OA Pubs

BACKGROUND: There is limited patient involvement in radiological research for perianal fistulizing Crohn's disease (pfCD), despite magnetic resonance imaging (MRI)'s critical role in diagnosis and management. Patient and public involvement is essential for aligning research with patient priorities. This study aimed to gather patient perspectives on the use of MRI in pfCD.

METHODS: A mixed-methods approach was used, following Guidance for Reporting Involvement of Patients and the Public (GRIPP2) guidelines. An online survey, co-developed with a patient representative, included open and closed questions on MRI experiences, advantages, challenges, and the potential for Artificial Intelligence (AI)-generated reports. This was followed by …

Introduction Of Clinical Pastoral Education In Ukraine: The Experience Of The Volyn Orthodox Theological Academy, Vladyslav Fulmes, Volodymyr Vakin, Oleksandr Khoroshko

Occasional Papers on Religion in Eastern Europe

Medical chaplaincy is an important component in many countries, as it helps to ensure a holistic approach to treatment, taking into account the spiritual needs of patients. The relevance of this direction was due to the invasion of russian troops on the territory of Ukraine back in 2014, and in the conditions of a full-scale war in Ukraine, the role of medical chaplaincy has increased significantly. This article reveals the experience of the Volyn Orthodox Theological Academy (Lutsk, Ukraine) in training medical chaplains, which was the first in Ukraine, responding to social challenges, in particular health care institutions, to develop …

Addressing Diabetic Retinopathy Prevalence In Low-Income Communities: Barriers To Quality Healthcare And Strategies For Equitable Treatment Access, Morkeia A. Mutchelknaus

Honors Thesis

Studies have shown a strong correlation between diabetes and individuals in low-income communities, which often lack access to equitable healthcare for a variety of reasons. This honors thesis will focus on diabetic retinopathy, its prevalence, prevention, and treatment strategies in both low- and high-income communities. A comprehensive literature review was conducted to define diabetic retinopathy, assess its prevalence, and review past and present approaches to its treatment and prevention. This paper aims to identify strategies to improve healthcare accessibility in low-income communities by analyzing current strategies in place to prevent and treat diabetic retinopathy and proposing potential solutions that will …

Fogarty-Funded Research Ethics Education In Latin America And The Caribbean: Progress Despite Ongoing Challenges, Timothy Daly, Ignacio Mastroleo, Luis L García Valiña, Irene Melamed, María Florencia Santi, Theresa J Ochoa, Manuela Fernández Pinto, Paul J Cummins, Bernardo García Camino, Cheryl Macpherson, Elizabeth Heitman, Florencia Luna

Faculty, Staff and Student Publications

Ten years have passed since the last regional assessment of the state of Fogarty International Center-funded research ethics education and challenges facing research ethics in Latin America and the Caribbean basin. Program directors and faculty from four international research ethics education programs met in Spring 2024 to discuss their progress, challenges, and future priorities. The themes that emerged from these discussions were the structural difficulties faced by regional ethicists, the use of pedagogical innovations to mitigate different barriers faced by fellows, and the need to anticipate future challenges for the region including climate change.

The Impact Of Covid-19 On The United States Higher Education System, Phoenix Daniel Van Wormer

University Honors Theses

In the spring of 2020, colleges across the United States rapidly transitioned to online/remote learning during the COVID-19 global pandemic. Since then, online and remote learning have evolved into an integral component of higher education. This thesis examines the extent to which COVID-19-mandated remote and online learning impacted students pursuing higher education in the United States. By utilizing research that compares academic structures before and after the pandemic, I demonstrate how the shift to online and remote learning has changed teaching and learning methods. I also evaluate the impact of these changes on student performance and engagement, with particular focus …

Identifying And Defining The Healthcare Needs Of A Rural Missouri Community: A Case-Study, Maggie Maria Finley

Doctoral Dissertations and Projects

The purpose of this case study is to understand and describe the healthcare needs of the citizens of a rural community in Missouri. The study was completed using the case study theory developed by Kathleen Eisenhardt. Eisenhardt follows a “no theory first” approach in which the research is used to both develop a theory and elaborate on the developed theory. This theory used the gaps in research to develop a research question and establish its relevance. Current research on rural healthcare provides evidence that rural citizens face healthcare disparities. While this research establishes that there are healthcare gaps in rural …

An Exploration Of Potential Gaps Between The Expectations Formed In Local Nursing Programs And The Lived Work Experience Of Newly Licensed Nurses, Melissa Low

Doctoral Dissertations and Projects

Understanding how expectations formed while in nursing school affect one's successful transition as a newly licensed nurse allows educators to identify curriculum changes to align expectations between academic and healthcare settings to improve the transition to professional nursing. A descriptive-hermeneutic phenomenological study utilized interviews, observations, and journal activities to identify variances between student nurses' expectations and the professional nurse work environment. A purposeful, criterion-based sampling of newly licensed nurses within four and 12 months of orientation identified 11 individuals to interview, observe, and gather journal entries to detail specific gaps between their expectations formed in nursing school and their lived …

Neighborhood Disadvantage And Inequities In Access To Preemptive And Living Kidney Transplantation, Brandon M Fairless, Oluwatunmise A Fawole, Duc T Nguyen, Ankona Banerjee, Kenneth J Nobleza, Abiodun O Oluyomi, Omar Rosales, Jayna M Dave, Elizabeth A Onugha

Children’s Nutrition Research Center Staff Publications

Key Points:

1. Pediatric patients residing in low-resource neighborhoods experienced lower rates of preemptive and living donor kidney transplantation.

2. Household-level factors (single-parent, non-English primary language, and receiving government assistance) may also affect the type of transplant received.

3. Area Deprivation Index scores offer an objective way to quantify neighborhood-level disadvantage and can enhance pretransplant screening.

Background: Living donor kidney transplant (LDKT) generally results in better outcomes than deceased donor kidney transplant (DDKT). Preemptive kidney transplant (KT) allows patients to bypass undergoing maintenance dialysis and is associated with improved patient and graft survival. Studies in the US pediatric population have shown racial-ethnic disparities …

A Geospatial Analysis Of The Lung Cancer Burden In Philadelphia, Using Pennsylvania Cancer Registry Data From 2008-2017, Russell K. Mcintire, Katherine Senter, Christine S. Shusted, Rickisa Yearwood, Julie Barta, Scott W. Keith, Charnita Zeigler-Johnson

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

(1) Background: Lung cancer is the deadliest and second most prevalent cancer in Pennsylvania (PA), and African American patients are disproportionately affected. Lung cancer morbidity and mortality in Philadelphia County are among the highest in PA. Geographic information systems (GIS) are useful to explore geospatial variations in the cancer burden and risk factors. Therefore, we used GIS to analyze the lung cancer burden in Philadelphia to assess which areas of the city have the highest morbidity and mortality, identify potential clusters, and determine which census tract-level characteristics were associated with higher tract-level cancer burden. (2) Methods: Using secondary data from …

Consanguinity: The Innocent Culprit In Autism Severity, Watfa Al-Mamari, Ahmed B. Idris, Najat Jalees, Saquib, Muna Al-Jabri, Halima Al-Shehhi, Maha Mohammed, Abeer Alsayegh

Sultan Qaboos University Medical Journal

Objectives: This study aimed to investigate the relationship between consanguinity and the severity of autism spectrum disorder (ASD), a neurodevelopmental condition influenced by both genetic and environmental factors. Methods: This retrospective study, conducted at the Genetic & Developmental Medicine Clinic at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, examined the records of 139 children aged 1.5 to 14 years who were diagnosed with ASD between June 2011 and May 2024. The study analysed the correlation between consanguinity, homozygosity and ASD severity. Results: Of the 139 cases evaluated, 74.1% were male, with an average age of diagnosis of …

Nutritional Status, Social Determinants Of Health And Clinical Outcomes In Critically Ill Children, Yash Desai, Andrea Marroquín, Paola Hong-Zhu, Nicole Knebusch, Stephanie Vazquez, Marwa Mansour, Thomas P Fogarty, M Hossein Tcharmtchi, Fernando Stein, Jorge A Coss-Bu

Faculty, Staff and Students Publications

Introduction: Childhood malnutrition remains a risk factor for morbidity and mortality. Children admitted to the Pediatric Intensive Care Unit (PICU) are at a higher risk of worsening nutritional status with adverse clinical outcomes. The burden of malnutrition is strongly linked to various well-defined social determinants of health, including race, socioeconomic status, and geography, as these factors influence household food insecurity. This study aimed to analyze the interrelationships of nutritional status, social determinants of health, and health outcomes in critically ill children.

Methods: Retrospective cohort study of 6418 critically ill children admitted to PICU from January 2014 to December 2017. Demographic …

The Perceived Benefits Of And Barriers To Open-Water Swimming: A Mixed-Methods Examination, David Elliott Ph.D, Mark A. Christie Ph.D

International Journal of Aquatic Research and Education

This study set out to determine the perceived benefits of, and barriers to, open-water swimming (OWS). Adopting a mixed-methods approach, six hundred and sixty-five open-water swimmers responded to an online survey consisting of the Exercise Benefits and Barriers Scale (EBBS) and a series of open-ended questions. Data from the EBBS revealed the strongest perceived benefits to be ‘Psychological Outlook’ and ‘Life Enhancement.’ In terms of barriers, those presented in the EBBS received low ratings with only ‘Physical Exertion’ considered as being somewhat problematic. Content analysis performed on the open-ended responses showed social aspects, mental well-being, and connection to nature as …

Exploring Health Equity With Culturally Specific Providers Of Permanent Supportive Housing, Judith Solomon

University Honors Theses

Chronic homelessness is an important public health issue. Permanent Supportive Housing (PSH) is a promising opportunity for transitioning people experiencing homelessness into housing, however there remain unaddressed racial inequities in service provision and outcomes. The aim of this study is to better understand the role of culturally specific (CS) providers of PSH in improving health equity. I analyzed interviews with CS PSH providers for themes related to health and healthcare. Providers spoke about the importance of connecting clients to healthcare. Providers stressed the importance of honesty and lived experience, highlighting the strong sense of responsibility to the community. Providers also …

In Case I Make It: An Autoethnographic Argument For Care, Space, And Utopia, Faelyn T. Cowan

USF Tampa Graduate Theses and Dissertations

Taking an autoethnographic and autotheoretical approach I examine within this project TomboloBooks’ Queer Comic Book Club. Drawing from José Esteban Mun֮oz’s ideas of queer utopia and Jen Jack Gieseking’s framework of constellations, and analyzing my own experiences, I present the Queer Comic Book Club (QCBC) as a moment of utopic queer worldmaking and argue for it’s potential as a site of alternative mental health care. Though I cannot provide here a generalizable model of book clubs as care, what I offer here is a series of possibilities, arguing for the potential of these spaces as community resources and sites of …

Alcohol Use Disorder Medication Coverage And Utilization Management In Medicaid Managed Care Plans, Maureen T. Stewart, Sage R. Feltus, Christina Andrews Ph.D., Andrea Acevedo, Cindy Parks Thomas, Jeffrey Bratberg, Constance M. Horgan, Dominic Hodgkin, Rachel Sayko Adams

Faculty Publications

IMPORTANCE Evidence-based, patient-centered treatment for alcohol use disorder (AUD) can include pharmacotherapy with naltrexone, acamprosate, or disulfiram; however, these medications are rarely used. Medicaid managed care plans (MCPs) manage health services for nearly 80% of Medicaid enrollees and are the largest payer for addiction treatment services. Little is known about Medicaid MCP policies for AUD medications.

OBJECTIVES To describe Medicaid MCPs’ coverage and management of acamprosate, naltrexone, and disulfiram for AUD and examine associations of plan characteristics and state policies with medication coverage.

DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, a content analysis was performed of 2021 insurance benefit …

Alcohol Use Disorder Medication Coverage And Utilization Management In Medicaid Managed Care Plans, Maureen T. Stewart, Sage R. Feltus, Christina M. Andrews Ph.D., Andrea Acevedo, Cindy Parks Thomas, Jeffrey Bratberg, Constance M. Horgan, Dominic Hodgkin, Rachel Sayko Adams

Faculty Publications

Importance: Evidence-based, patient-centered treatment for alcohol use disorder (AUD) can include pharmacotherapy with naltrexone, acamprosate, or disulfiram; however, these medications are rarely used. Medicaid managed care plans (MCPs) manage health services for nearly 80% of Medicaid enrollees and are the largest payer for addiction treatment services. Little is known about Medicaid MCP policies for AUD medications. Objectives: To describe Medicaid MCPs' coverage and management of acamprosate, naltrexone, and disulfiram for AUD and examine associations of plan characteristics and state policies with medication coverage. Design, Setting, and Participants: In this cross-sectional study, a content analysis was performed of 2021 insurance benefit …