Digital Commons Network^™

Obesity's Role In Stroke Incidence Among Smokers: An Assessment Of Confounding, Interaction, And Mediation Effects, Saeed Awad M. Alqahtani, Moutasem Salih Aboonq

Saudi Medical Journal

Objectives: To examine the association between body mass index (BMI) category and history of stroke among current smokers, while assessing potential confounding, effect modification by age, and mediation by cardiovascular comorbidities. Methods: Data were analyzed from 53,939 current adult smokers participating in the 2021 Behavioral Risk Factor Surveillance System (BRFSS). Survey-weighted logistic regression estimated the association between BMI categories (underweight, normal, overweight, obese) and self-reported stroke history. The study assessed multicollinearity and adjusted for sociodemographic and health variables. Interaction terms were tested to evaluate effect modification by age, and exploratory decomposition analysis was used to assess mediation by conditions such …

Prevalence And Antimicrobial Susceptibility Patterns Of Nosocomial Bacteria Across Different Units At King Faisal Complex Hospital, Taif, Kingdom Of Saudi Arabia, Nahed Hawsawi, Renad N. Al-Jaiud, Layal L. Khyyat, Kholoud Alsulimany, Manhal Shabat

Saudi Medical Journal

Objectives: Nosocomial infections significantly impact patient morbidity, mortality, and healthcare costs. To determine the prevalence, bacteriological profiles, antimicrobial susceptibility patterns, and resistance distribution of pathogens causing nosocomial infections at King Faisal Medical Complex, Taif, Kingdom of Saudi Arabia. Methods: This cross-sectional study was conducted between September 2023 and March 2024 at different hospital units following ethical approval. Samples (n = 667) were collected from patients (both genders; all ages) exhibiting infection symptoms ≥ 48 h post-admission and pre-antibiotic administration. Bacterial identification involved culture, Gram staining, and biochemical tests. Antimicrobial susceptibility was tested using the Phoenix100 system. Results: Of 667 patients, …

From Early Adversity To Adult Health: Quality-Of-Life Consequences In A Mental Illness In Saudi Arabia, Rawan Saad Alghamdi, Ahmad A. Mirza, Ibrahim Fae Asiri, Fatemah Samir Alghamdi, Nawaf Abdulaziz Alharthi, Shaymaa A. Abdalal, Iman K. Ramadan

Saudi Medical Journal

Objectives: Childhood trauma (CT) is prevalent among bipolar disorder (BD) patients and exacerbates clinical outcomes, which may impact the quality of life (QoL). This study explores the prevalence of CT and its association with QoL among BD patients in Saudi Arabia. Methods: Cross-sectional study conducted among adults with BD during the euthymic phase. Sample size was estimated using a single-proportion approach (target n=141), and participants recruited by convenience sampling of eligible outpatients. CT was assessed using the Childhood Trauma Questionnaire (CTQ), and QoL using the the Brief Quality of Life in Bipolar Disorder (Brief QoL.BD). Results: The CT prevalence was …

Re-Emergence Of Pertussis In The Pediatric Population: A Tertiary Care Center's Experience, Haya S. Alshaibani, Tahir K. Hameed, Khaled H. Alsager, Mohammed A. Alshaalan, Syed F. Jamil

Saudi Medical Journal

Objectives: To describe the 2024 surge in pertussis cases in the pediatric population in a large tertiary care center in Riyadh, Saudi Arabia. Methods: A retrospective observational study was conducted on children aged 0–14 years with PCR-confirmed Bordetella pertussis infection diagnosed at a tertiary hospital in Riyadh between January and December 2024. Patients older than 14 years, with negative or indeterminate PCR results, or diagnosed outside the study period were excluded, and demographic, immunization, clinical, and outcome data were analyzed. Results: A total of 36 children were diagnosed with pertussis, with 35 (97.2%) requiring hospital admission. The median age was …

A Retrospective Cohort Study Of Uterine Cancer Epidemiological Analysis And Age-Based Disparities In Saudi Arabian Population Across 32 Years, Sallwa M. Alshehre, Mohammad A. Althubiti

Saudi Medical Journal

Objectives: To investigate the burden of uterine tumour in Saudi Arabia during the past 32 years (1990–2021), with an emphasize on the prevalence, incidence, mortality, and disability-adjusted life years (DALYs). Knowing these patterns strengthen the national aims of cancer control under Kingdom of Saudi Arabia (KSA) Vision 2030. Methods: A retrospective study was performed using data retrieved from the Global Burden of Disease (GBD) database. The work included population from Saudi Arabia between 1990 and 2021 and tested standardization age-specific metrics, involving uterine tumour incidence, prevalence, mortality, and DALYs. Results: Uterine tumour cases raised from 507 in 1990 to 6,366 …

Seroprevalence Of Hepatitis B And Hepatitis C In Patients Hospitalized In Palliative Care Service, Meryem Betos Koçak, Burcu Güler

Saudi Medical Journal

Objectives: Patients receiving palliative care often have complex comorbidities and frequent healthcare exposure, which may place them at risk for blood-borne infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV). However, data on the seroprevalence and prognostic impact of these infections in palliative populations remain limited. This study aimed to determine the seroprevalence of HBV and HCV markers in patients hospitalized in a palliative care unit and to assess their association with mortality. Methods: This retrospective study conducted on 545 adult patients a tertiary palliative care unit between 2018 and 2024. Demographic characteristics, comorbidities, nutritional support, mobility, …

Artificial Intelligence In Dialysis Therapies: Applications In Hemodialysis And Peritoneal Dialysis For Managing Infectious Diseases And Complications, Waleed H. Mahallawi

Saudi Medical Journal

This narrative review synthesizes evidence from a systematic literature search (2019–2025) on artificial intelligence (AI) applications in hemodialysis and peritoneal dialysis for managing infections and complications. Dialysis patients face infection rates 100-fold higher than the general population and sepsis mortality exceeding 35%. The AI, utilizing machine learning algorithms such as XGBoost, deep neural networks, and explainable AI tools, revolutionizes care through precise diagnostics, prognostics, and therapeutics. Key models demonstrate high accuracy in predicting bloodstream infections (area under the curve [AUC] 0.914), classifying peritonitis (F1 0.93), detecting SARS-CoV-2 (AUROC 0.82), and forecasting mortality (AUC 0.979). Therapeutically, AI guides antibiotic stewardship, reducing …

Post-Stroke Fatigue In Saudi Arabia: A Call To Action, Saad Z. Alqahtani

Saudi Medical Journal

Post-stroke fatigue (PSF) is a major consequence of stroke, with a prevalence of approximately 42–53% among stroke survivors. However, over the last 2 decades, only a few studies have explored PSF in Kingdom of Saudi Arabia (KSA). Findings from these studies show that PSF negatively impacts the quality of life of individuals with stroke. Furthermore, they emphasize the need for education for both health care providers and patients regarding PSF. This call-to-action mini narrative review identifies knowledge gaps and provides recommendations for both researchers and policymakers, including the need for standardized management and the exploration of hospital environment settings. Specifically, …

Contribution Of Interleukin-6 (Il-6) To Body Defense And Healing In Pulmonary Tuberculosis, Hasrah Junaidi, Annis C. Adi, Soedarsono Soedarsono, Soetjipto Soetjipto, Chatarina U. Wahyuni, Fariani Syahrul, Mahmudah Mahmudah, Zakiyuddin Zakiyuddin, Iskandar Arfan, Abdullah A. Mamun, Rubia Sari

Saudi Medical Journal

Objective: To examine the contribution of IL-6 to host defense and healing in pulmonary tuberculosis (TB). Pulmonary tuberculosis continues to pose a significant global health challenge, with disease outcomes determined by complex host–pathogen interactions. Interleukin-6 (IL-6), a multifunctional cytokine, has been implicated in immune regulation and tissue recovery during TB, but its specific role is not fully established. This review aimed to examine the contribution of IL-6 to host defense and healing in pulmonary TB. Methods: A comprehensive literature search was performed across PubMed, Scopus, Web of Science, ScienceDirect, and Medline following PRISMA guidelines, covering publications from 2015 to 2025. …

Impact Of Treatment On The Health-Related Quality Of Life Of Children With Cancer In Saudi Arabia, Fayzah Hussain Alhussain, Amany Anwar Saeed Alabdullah

Saudi Medical Journal

Objective: The impact of cancer on health-related quality of life (HRQOL) is considerable, particularly for children undergoing oncological treatment. While research has addressed HRQOL in childhood cancer survivors, less attention has been given to those actively undergoing treatment, including in Saudi Arabia. This systematic review aimed to address this gap by quantitatively evaluating studies reporting on the HRQOL of children in Saudi Arabia during their active cancer treatment phase. We also compare these findings with studies from around the world, emphasising demographic, medical and parental predictors of HRQOL. Methods: A comprehensive search of relevant databases (MEDLINE, CENTRAL, Embase, PsycINFO and …

Effects Of A Basketball Match On Heart Rate Variability In Collegiate Intramural Players, Unobatsha Mbaiwa

Master's Theses

Heart rate variability (HRV) is a standard non-invasive physiological marker used to asses the autonomic nervous system (ANS) function and cardiovascular adaptability. HRV reflects the natural variations in time between successive heartbeats (R-R intervals), which come as a result of the interaction between sympathetic and parasympathetic branches of the ANS (Shaffer & Ginsberg, 2017). Higher HRV compared to an individual's baseline is normally considered an indicator of greater parasympathetic (rest/digest) influence and more effective physiological recovery, whereas lower HRV relative to baseline is associated with sympathetic (fight/flight) dominance, fatigue, and increased physiological strain. Since the standardized HRV measurement criteria were …

Building A Road To Mitigate Ambulance Patient Offload Time (Apot), William J. Manguil

Doctoral Projects

Emergency departments (EDs) worldwide are experiencing increased utilization resulting in care delays for patients seeking urgent treatment. Despite critical circumstances that warrant emergency medical services (EMS) response, patients arriving to the ED via ambulance remain vulnerable to delays in care due to prolonged ambulance patient offload times (APOTs). The amount of health care providers and treatment space necessary to initiate care are both limited and often strained resources which dictate the need for innovative interventions to prevent patient harm. The following project outlines the interventions implemented at the project site to improve APOT as a means to enhance patient safety …

Barriers And Bridges: Exploring Factors That Shape Mental Health Service Utilization In Rural America, Margaret Wiwuga

Educational Specialist, 2020-current

Despite disproportionately higher suicide mortality rates and comparable prevalence of mental illness across urban and rural communities in the United States, rural populations across the nation experience significantly lower access to and utilization of mental health services, naturally leading to worse comprehensive outcomes. This literature review examines multifaceted factors shaping mental health service use in rural America, taking note of both barrier and enabling factors that impede or enable these unique populations’ willingness and ability to access and use mental health services. Ten articles published prior to September 9, 2025, were selected from the James Madison University Libraries’ Psychology and …

Black Maternal Mental Health: Counseling Considerations For Prenatal Depression And Anxiety, Morgan Renee Williams

Educational Specialist, 2020-current

The maternal mortality rate of Black women in the United States is four times higher than white women (Centers for Disease Control and Prevention, 2020). The CDC defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy… but not from accidental or incidental causes” (Centers for Disease Control and Prevention, 2024, para. 1). This statistic is a consequence of the inequality within and outside of the American healthcare system (National Academies of Sciences, Engineering, and Medicine, 2020). For the purposes of this research, Black women are defined as any women …

What’S Behind The Mask: The Diagnostic Divide In The Female Autism Phenotype, Shelley Gies Alston

Educational Specialist, 2020-current

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication and restrictive, repetitive behaviors; however, women are diagnosed at significantly lower rates than men. This study examined whether DSM-5-TR diagnostic practices may contribute to the underdiagnosis and delayed identification of ASD in individuals assigned female at birth (AFAB), with attention to masking behaviors, gendered social expectations, and clinician interpretation of symptoms. Grounded in the Female Autism Phenotype (FAP), a retrospective mixed-methods study surveyed 12 AFAB individuals aged 18–24 who self-identified or were formally diagnosed with ASD. Participants completed a 44-item online survey including Likert-scale and open-ended …

Keeping Families Together: Companion Animals As A Public Health Imperative, Lori R. Kogan, Rebecca Niemiec

Journal of One Health Systems

Contemporary US public health frameworks emphasize social, economic, and environmental determinants of health, yet largely overlook the reality that most households include companion animals regarded as family members. This omission has tangible consequences during crises such as housing instability, illness, domestic violence, or disasters, when families are often forced to choose between their own safety and the safety of their animals. We argue that this represents a significant public health failure. Drawing on interdisciplinary evidence, we propose that companion animals function as a social determinant of health, that forced separation constitutes a public health harm, and that Human-Animal Support Services …

Staff Education To Improve Mental Health Prescribers’ Knowledge On Polypharmacy And Deprescribing Strategies For Older Adults, Mercy Oluchi Eke

Walden Dissertations and Doctoral Studies

No abstract provided.

Reducing Catheter-Associated Urinary Tract Infections Through Staff Education In A Nursing Home Setting, Aderonke Abimbola Abatan

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education To Improve Staff Knowledge And Confidence In Delivering Sleep Education And Administering Sleep Quality Assessment Tools, Beverly Britton

Walden Dissertations and Doctoral Studies

No abstract provided.

Thrombin-Induced Myofibroblast Differentiation Is Regulated By Myocardin And Novel Effector Genes In Ipf Fibroblasts, Christiana Okeke

Biotechnology Theses

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease characterized by fibroblast activation, excessive extracellular matrix (ECM) deposition, and irreversible respiratory decline. In this study, we investigated the role of myocardin and its downstream effectors, RGS5, DLGAP5, and TAGLN, in thrombin-induced myofibroblast differentiation and ECM remodeling using primary human IPF fibroblasts. Myocardin knockdown significantly attenuated thrombin-induced expression of profibrotic genes, including FN1, COL1A1, PAI-1, ACTA2, and CNN1, as well as the novel effectors RGS5, DLGAP5, and TAGLN, confirming myocardin as a central regulator of fibrotic signaling. Silencing RGS5 produced minimal effects on gene and protein expression despite minor downward …

Identification Of Proteins With Immune Stimulatory Activities From The Culture Filtrates Of Nontuberculous Mycobacteria, Christian Albert Agyei Acheampong

Biotechnology Theses

Nontuberculous mycobacteria (NTM) are the mycobacterial species other than Mycobacterium tuberculosis, which causes tuberculosis, and Mycobacterium leprae, which causes leprosy. Diseases caused by NTM are on the rise in the United States and are steadily becoming a significant public health problem globally, particularly in developed countries. Despite the ability of NTM pathogens to interact with the host immune system, the proteins responsible for eliciting host immune responses remain unidentified, making the accurate and timely diagnosis of the disease a challenge. In this study, we tested the hypothesis that NTM strains secrete proteins that stimulate immune responses. Our study …

From Evidence To Practice: Improving Diabetic Patient Outcomes By Increasing Statin Utilization, Elizabeth Mcfalls

Evidence-Based Practice Project Reports

Cardiovascular disease (CVD) prevention in patients with diabetes is essential, as heart disease remains the leading cause of death within this population (American Diabetes Association, n.d.). The purpose of this evidence-based project is to improve patient outcomes by enhancing adherence to statin therapy. A thorough literature review yielded 246 pieces of moderate-to-high-quality evidence; of these, eight articles were appraised in detail and selected for project inclusion. The strongest evidence identified four meaningful interventions. Thus, a multimodal approach was indicated for this project. This included addressing barriers to therapy, creating practice nudges, implementing a shared decision-making (SDM) tool, and utilizing clinical …

Efficacy Of Continuous Pegcetacoplan Treatment For Subfoveal Geographic Atrophy In Age-Related Macular Degeneration: 36-Month Results From Oaks, Derby, And Gale Open-Label Extension, Dilsher S. Dhoot, Sunir J. Garg, David M. Brown, Ivan J. Suñer, Ehsan Rahimy, David S. Boyer, Kineta Naidu, Chao Li, Caroline R. Baumal, Robyn H. Guymer

Wills Eye Hospital Papers

PURPOSE: To report efficacy of intravitreal pegcetacoplan treatment over 36 months in eyes with subfoveal geographic atrophy (GA).

PATIENTS AND METHODS: The GALE (NCT04770545) open-label extension trial adds 12 months of results to the 24-month Phase 3 OAKS (NCT03525613) and DERBY (NCT03525600) trials, representing up to 36 months of continuous pegcetacoplan treatment. They included a heterogeneous population of eyes with subfoveal GA (63%). Pegcetacoplan-treated eyes enrolling in GALE continued at the same interval of pegcetacoplan monthly (PM) or every other month (PEOM). Patients' eyes in sham monthly or every-other-month arms crossed over to receive pegcetacoplan in GALE at the same …

Family Quality Of Life And Infant Language Development: A Pilot Study Of Infants Without A History Of Chronic Otitis Media, Aubreigh Cartwright

Dissertations, 2020-current

Chronic otitis media (COM) is a condition associated with hearing fluctuations, recurrent medical interventions, and speech-language concerns. While the audiological impacts for children are well documented, there is less research pertaining to parents’ and caregivers’ experiences. The goal of the overall line of inquiry was to examine the impact of chronic otitis media on parent and caregiver quality of life. Parents and caregivers of ten typically developing infants from six to twelve months of age without COM were administered parent-proxy instruments to determine quality of life, as well as expressive and receptive lexicon. The parents were administered a family intake …

A Measure Of Spatial Orientation In Healthy Adults, Lauren Maloney

Dissertations, 2020-current

Spatial orientation is essential for effective navigation and movement, relying on the integration of sensory inputs from systems such as proprioception, vision, audition, and the vestibular system. The vestibular system, responsible for detecting rotational and linear movements, plays a crucial role in maintaining balance and spatial awareness. However, its specific influence on spatial orientation remains underexplored. This study investigates how vestibular input influences spatial orientation accuracy by examining participants' ability to estimate angular displacement during rotational stimuli. Twenty participants underwent testing using a rotational chair, with stimuli at varying rotational amplitudes (5-400 degrees). Along with their perceived angular displacement (i.e. …

The Effect Of Head Coverings On Directional Microphone Performance, Mariam Mohamed

Dissertations, 2020-current

Background: Directional microphones in hearing aids are a well-established strategy for enhancing speech intelligibility in background noise. While previous studies have examined the effects of hair, spectacles, and earmold venting, no systematic research has addressed whether head coverings, commonly worn for cultural, religious, or personal reasons, affect directional performance.

Objective: This study aimed to determine whether a thin cotton head covering alters the directivity index (DI) of premium receiver-in-canal hearing aids from four leading manufacturers, using laboratory-controlled conditions. 

Methods: A Knowles Electronics Manikin for Acoustic Research (KEMAR) was positioned within a sound-treated room to measure DI for both omnidirectional and …

How Audiologists Are Using Adapted Cognitive Behavioral Therapy For Tinnitus Management: A Preliminary Study, Katherine M. Mueller

Dissertations, 2020-current

Audiologists interact with patients reporting bothersome tinnitus frequently, however there is no standardized protocol to follow when treating/counseling these patients. Cognitive Behavioral Therapy (CBT) is highly researched and has been proven to alleviate bothersome tinnitus symptoms, yet audiologists are not clinically trained in this tinnitus management. Specific forms of CBT that were analyzed in this study include Attention Shifting, Neurophysiological Education, and Progressive Muscle Relaxations. This study surveyed current audiologists to determine how they are using adapted CBT techniques (aCBTt) for tinnitus management. This questionnaire aimed to investigate a) the effect of audiologists’ practice duration on their frequency to recommend …

Stigma Predicts Participation And Autonomy In Chronic Vestibulopathy: An Explanatory Mixed Methods Study, Brandy L. Hollins

Dissertations, 2020-current

Many vestibular disorders are “invisible”, not widely recognized, and challenging for patients to describe. However, its impact is visible and leads to significant challenges. Research has shown that stigma associated with other chronic health conditions can detrimentally affect patient outcomes, suggesting a greater need in this area. The World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) elucidates the role of physical, social, and cultural factors in the manifestation of health conditions within a universal framework. A critical aspect of the ICF’s contextual factors for individuals with vestibular loss is societal perception. Few studies have reported stigmatization …

Enhancing Access Through Integrated Behavioral Healthcare: Expanding Counselor Identity And Social Determinants Of Health Competency, Tiffany N. Snow

Dissertations, 2020-current

Abstract

The counseling profession has historically differentiated its identity by emphasizing a wellness-oriented approach. However, this has often led to the exclusion of counselors from integrated behavioral healthcare (IBH). With the 2024 enactment of the Mental Health Access Improvement Act, counselors now have unprecedented opportunities to serve as behavioral health providers in federal medical settings. This three-manuscript dissertation explores the intersection of counselor professional identity, social determinants of health (SDoH) competency, and interprofessional collaboration within IBH.

Manuscript 1 presents a conceptual framework for reconciling traditional counselor identity with the "medical model" of Primary Care Behavioral Health (PCBH), arguing that this …

Novel Paradigm For Assessing Vestibular Perception In Children, Nicole Kirk

Dissertations, 2020-current

While objective vestibular reflexive testing has been heavily researched, there are few studies analyzing subjective vestibular perception and to date no progress has been reported on motion perception in children. It is unknown if children perceive motion like adults creating a need for research comparing these age groups for thorough clinical profiles. This study adapted an adult psychophysics protocol for school-aged children and collected data on ten typically developing children and ten healthy adults. Participants rotated at various peak velocities and frequencies in a rotary chair and were asked to report their spatial orientation (i.e., how far around they rotated) …