Digital Commons Network^™

Retrospective Analysis Of A Washu-Based Knowledge-Based Planning (Kbp) Model For Breast And Chest Wall Planning In Guatemala: Compliance With American Society For Radiation Oncology (Astro) 2026 Guidelines, Milton E Ixquiac Cabrera, Erick O Montenegro, Matthew Schmidt, Baozhou Sun, James A Kavanaugh, Taoran Li, Angel Velarde, Vicky De Falla, Francisco Reynoso

Faculty, Staff and Students Publications

Background/purpose

Breast cancer is among the most prevalent malignancies treated at the Liga Nacional Contra el Cáncer (LNCC) in Guatemala, representing a significant proportion of annual radiotherapy cases. Access to high-quality, standardized treatment planning in resource-constrained settings remains a critical challenge. This study evaluates the dosimetric performance of knowledge-based planning (KBP) models adapted from Washington University (WashU) in St. Louis for breast and chest wall radiotherapy at LNCC, validated against a retrospective 2025 clinical cohort, and benchmarked against the ASTRO 2026 Practical Radiation Oncology guidelines.

Materials and methods

A retrospective analysis of 84 treatment plans (40 left, 44 right) for …

Role Of Households With Children In Community Spread Of Multidrug-Resistant Enterobacterales, St. Louis, Missouri, Usa, Barrett Breeze, Ahmed Babiker, Sreenivas Konda, Alaina L Robinson, Stefan J Green, Catherine C Babbs, Federico Cunha, Katherine Y Shen, India Shepherd Hammond, Stephanie A Fritz, Latania K Logan

2020-Current year OA Pubs

Community-acquired multidrug-resistant (MDR) Enterobacterales bacteria are an increasing public health concern, yet whether households play a role in community spread remains unclear. We investigated 150 households with children in St. Louis, Missouri, USA, for MDR Enterobacterales. We cultured swab specimens from household members and environmental surfaces for identification and antimicrobial susceptibility testing. We also performed whole-genome sequencing in the 53 (35%) households where >1 MDR Enterobacterales species were recovered. Enterobacter hormaechei predominated, followed by Klebsiella pneumoniae and Pantoea species. Whole-genome sequencing revealed closely related strains shared between persons and environmental surfaces, suggesting potential intra-household transmission. We identified >1 horizontal gene …

Exploring The Influence Of Ear-Level Devices On Adult Perceptions Across Professional, Social, And Educational Settings, Lucia R. Berry

Dissertations, Theses, and Capstone Projects

Background: The hearing aid market is continuously advancing to address the increasing prevalence of hearing loss and the barriers to obtaining hearing aids. The Food and Drug Administration (FDA) approved Apple AirPods Pro 2 devices to function as over-the-counter (OTC) hearing aids. This is an alternative option to manage hearing difficulties; however, it presents secondary complications related to headphone use and stigma.

Objective: Limited research is available regarding attitudes towards individuals wearing Apple AirPods Pro 2 as OTC hearing aids. This study intended to analyze if people’s pre-established perceptions of Apple AirPods shift once they learn they are being used …

Implicit Attitudes Toward Hearing Aid Visibility: Conspicuous Versus Inconspicuous Hearing Aid Colors, Orly R. Ames

Dissertations, Theses, and Capstone Projects

Hearing aid stigma remains a significant barrier to treatment uptake, with device visibility frequently identified as a contributing factor. Although prior research has examined visibility in relation to hearing aid size and style, the role of color as a distinct aesthetic dimension has not been systematically investigated. The present study assessed whether hearing aid color affects implicit and explicit attitudes toward hearing aids and whether such evaluations differ across contexts. Twenty-six adults who were not current hearing aid users participated in an online quantitative multi-method study consisting of an Implicit Association Test (IAT) and self-report questionnaires. The IAT measured implicit …

A Comparison Of Manufacturers’ Claims Of Attenuation Rates In Non-Custom Earplugs, Skyler M. Shipley

Dissertations, Theses, and Capstone Projects

Recreational and social environments frequently expose individuals to high intensity noise environments; however, the use of hearing protection devices (HPDs) remains limited. This study evaluated whether non-custom, over-the-counter musicians’ earplugs provide attenuation consistent with manufacturers’ claims and whether cost is associated with performance. Six commercially available earplug models were tested using both human participants and a KEMAR manikin system. Attenuation was measured across frequencies from 250–8000 Hz (octave and inter-octave frequencies) and were tested using different ear tip sizes. Results indicated that several earplugs achieved attenuation levels comparable to or exceeding their advertised noise reduction ratings (NRR), though consistency varied …

Kanak-Ish Misfits: Queer Imaginaries, Racialized Borders, And The Politics Of Care In Berlin, Germany, Faruk Seref

Dissertations, Theses, and Capstone Projects

This dissertation examines queer Muslim experiences of border politics, racialization, and care in Berlin, Germany. By formulating bordering as a domineering and oppressive practice of boundary-making, I study how global bordering mechanisms shape and disrupt structures of care, caring, and being cared for. With an intersectional focus on race, gender, sexuality, and sex, I argue that borders are simultaneously materialized and challenged in varying localities, including the nightclub, the queer scene, the diasporic neighborhoods, and households. Ultimately, viewing collective care as fundamental to survival, healing, resistance, and building non-punitive lifeworlds, I theorize the counter-hegemonic practices of queers of color through …

A 2-Year Randomized Trial Of Pitavastatin Calcium Vs Placebo To Treat Combined Dyslipidemia In Adolescents With Overweight And Obesity., Brian W. Mccrindle, Silva Arslanian, Michele Mietus-Snyder, Elaine M. Urbina, Adam L. Ware, Jessica E. Teng, Felicia Trachtenberg, Mark W. Russell, Amy S. Shah, Mark Cartoski, Julie A. Brothers, Christine San Giovanni, Justin P. Zachariah, Sandra Pena, William T. Mahle, Amy L. Peterson, Sheela N. Magge, Geetha Raghuveer, Binu Sharma, Valiantsina Kazlova, Craig A. Sponseller, D'Andrea Freemon, Mario Stylianou, Sarah D. De Ferranti, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Combined dyslipidemia of overweight/obesity (CDO) is prevalent in youth and is associated with an increased risk of early cardiovascular disease.

OBJECTIVE: We sought to determine the impact and safety of statin therapy for CDO in adolescents.

METHODS: A double-blind, randomized trial was performed across 18 North American sites. Participants aged 10 to 19 years with body mass index ≥85th percentile and CDO defined as non-high-density lipoprotein cholesterol (non-HDL-C) ≥120 mg/dL (3.10 mmol/L) and either low HDL-C or high triglyceride:HDL-C ratio were randomized centrally to receive either pitavastatin calcium 4 mg/d or placebo for 2 years. The primary outcome was …

Ilae-Yes Global Webinar Series: Integrating Clinical And Basic Science In Epilepsy Research, Cecilie G Nome, Parthvi Ravat, Fabrice Bartolomei, Marco De Curtis, Rossella Di Sapia, Marian Galovic, Maria Gogou, Lukas Imbach, Julia Jacobs, Katja Kobow, Alice D Lam, Christos Panagiotis Lisgaras, Elisa Micalizzi, Eleni Nikalexi, Jeffrey L Noebels, Jeanne T Paz, Avtar Singh Roopra, Sally Shaaban, Laurent Sheybani, Shobi Sivathamboo, Ana Suller Marti, Adam Williamson, Naoto Kuroda

Faculty, Staff and Students Publications

Bridging clinical and basic research is increasingly recognized as a priority in the epilepsy field, yet opportunities for integration remain limited by the time, space, and financial constraints of scientific meetings. To address this gap, the Research Task Force of the Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES) organized a free global webinar series designed to promote translational dialogue and provide accessible research education for early-career clinicians, researchers, and physician-scientists. Based on a preliminary ILAE-YES community survey, eight topics of high interest were selected: (1) epigenetics, (2) EEG biomarkers, (3) ictogenesis, (4) thalamo-cortical network, (5) sudden unexpected …

Matching-Adjusted Indirect Comparison Of Acoltremon Ophthalmic Solution 0.003% And Cyclosporine 0.05% Ophthalmic Emulsion For Increased Tear Production In Patients With Dry Eye Disease, Stephen Pflugfelder, Tony Okoro, Margaret Ainslie-Garcia, Anja Haltner, Emily K Prentiss, Elizabeth M Salvo-Halloran, Nikethana Srikanth, Michelle Senchyna, Esen K Akpek

Faculty, Staff and Students Publications

No abstract provided.

A Phase 4, Open-Label, Non-Randomized, Multicenter Study To Evaluate Efficacy (And Safety) Of Intravenous Administration Of Optison For Contrast-Enhanced Echocardiography In Pediatric Patients, Arash Sabati, Shuo Wang, Pushpa Shivaram, Joshua Hawley, David Thompson, Francine Erenberg, Shelby Kutty, Aparna Kulkarni, Tam T Doan, Joshua D Robinson

Faculty, Staff and Students Publications

Contrast-enhanced echocardiography (CE-echo) is commonly used in adult patients to optimize endocardial border delineation (EBD) but there is limited experience in children. A prospective, open-label, non-randomized, multicenter study was performed to evaluate the efficacy of intravenous Optison for CE-echo in pediatric patients and determine the optimal dose of Optison. Subjects ≥ 9 and <  18 years with suboptimal echocardiograms (defined as ≥ 2 contiguous segments that could not be adequately visualized) were enrolled. After a baseline non-contrast echocardiogram (NC-echo), CE-echo was performed with 2 dose levels of Optison based on patient weight. The primary endpoint was visualization of the LV wall segments (LVWS) in apical 2- and 4-chamber views. An EBD score was calculated by assigning a value from 0 (no visualization) to 3 (optimal visualization) for 12 LVWS. 37 subjects across 8 sites completed the study. 30 had complete echocardiograms at both dose levels. 2 patients had usable images at dose 2 only. Mean age was 13.4 years (± 2.6) with 23 males (62%). Mean weight was 73.9 kg (± 36.8) with wide distribution of weight (interquartile range of 42-102 kg). There were 8 patients under 40 kg. Most subjects had a prior medical/surgical history (n = 33, 89%). Both dose levels of Optison CE-echo improved the number of LVWS visualized from 3.7 ± 1.1 on NC-echo to 10.0 ± 0.1 with dose 1 (p <  0.001) and 10.5 ± 0.1 with dose 2 (p <  0.001). EBD score also improved at both dose levels from 11.9 ± 2.5 for NC-echo to 28.5 ± 1.7 for dose 1 (p <  0.001) and 30.2 ± 8.4 for dose 2 (p <  0.001). The number of suboptimal echocardiograms improved from 92.3% ± 10.7 in NC-echo to 26.2% ± 9 with dose 1 (p <  0.001) and 30.8% ± 4.5 with dose 2 (p <  0.001). CE-echo with intravenous Optison in pediatric patients improved the number of LVWS visualized, improved EBD score, and reduced the number of suboptimal echocardiograms at both dosages used in this study. Intravenous Optison can improve LV visualization in pediatric patients with suboptimal echocardiograms.

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Text Message Delivery Of Pre-Procedural Recommendations Prior To Lip Augmentation With Hyaluronic Acid Filler: An Evidence-Based Pilot Project, Jenna De Jonge

Doctor of Nursing Practice Final Manuscripts

Patients seeking lip augmentation procedures commonly experience self-resolving soft-tissue complications such as swelling and bruising. There are many widely accepted pre-procedural recommendations available to help patients minimize the risk of these undesirable outcomes. At a Medical Aesthetics practice in Southern California, lip augmentation patients often arrived to their appointment non-adherent to pre-procedural recommendations that were available on the practice website. Text message delivery systems have been used to improve patient adherence to healthcare instructions across a variety of healthcare settings. To address this gap, I implemented text message delivery of pre-procedural recommendations to lip augmentation patients prior to their appointment. …

Accessibility And Daily Cigarette Consumption Among Indonesian Adolescents: A Descriptive Study, Noviana Lathifah, Istiqomah Hanifah Rachman, Anisa Isnaini, Gloria Threesia Piliphinsa Simatupang

Journal of Indonesian Health Policy and Administration

Despite restrictive regulations, Indonesia faces a high prevalence of adolescent smoking, facilitated by easy access to tobacco products. This descriptive study aims to describe cigarette accessibility patterns and daily consumption trends among Indonesian adolescents. A cross-sectional study was conducted using secondary data from the 2019 Global Youth Tobacco Survey (GYTS) involving 9,208 respondents. Descriptive analysis was performed to examine the distribution of age at smoking initiation, daily cigarette consumption, and purchasing accessibility. The majority of respondents started smoking at ≥14 years of age. Daily cigarette consumption showed an increasing trend with age, with older adolescents more likely to consume more …

Optimizing Vitamin A Intervention: Strengthening Supplementation With Targeted Biscuit Fortification, Mayfa Yemima Simanjuntak, Nadia Amanda, Yuli Berliana Simanjuntak, Carissa Wityadarda, Lesta Livolina Simamora

Journal of Indonesian Health Policy and Administration

Vitamin A deficiency (VAD) remains a persistent public health challenge in Indonesia, particularly among children under five and breastfeeding mothers. This study aimed to analyze the distribution of vitamin A interventions and assess the potential of biscuit fortification as a complementary strategy. This study employs a literature review using the Health Policy Triangle (HPT) framework, examining policy context, content, key actors, and implementation processes related to vitamin A interventions. The analysis was conducted using secondary data from government reports, international agencies, and peer-reviewed literature published between 2018 and 2025, with comparative evidence from Vietnam, Bangladesh, and Ghana. The findings show …

Trends Of Pediatric Psychotropic Polypharmacy In Massachusetts Before And During The Covid-19 Pandemic, Gianna D'Ambrozio

Graduate Doctoral Dissertations

Youth in the U.S. and internationally are increasingly being diagnosed with depression and related psychiatric conditions (Murthy, 2021) many of whom are being subjected to non-evidence-based, or what has been termed irrational, psychotropic polypharmacy (Barnett & Concepcion Zayas, 2019). Psychotropic polypharmacy can be defined as “the use of 2 or more psychiatric medications in the same patient,” (Zito et al., 2021) though definitions can vary. Using data from the Center for Health Information Analysis’ Massachusetts All-Payer Claims Database, this study examined the sociodemographic factors associated with high rates of polypharmacy, a hypothesized increase in pediatric psychotropic polypharmacy rates in Massachusetts …

Enhancing Physiological Complexity Through Mindfulness: A Wearable-Based Intervention For First Responders And Their Partners, Thurmon Lockhart, Rahul Soangra, Christopher W. Frames, Sun-Kyung Lee, Amberlee Martin, Susanne Lee, Abigail H. Gewirtz

Physical Therapy Faculty Articles and Research

Background/Objectives: First responders frequently encounter high-stress environments that challenge physiological resilience and autonomic regulation. Heart rate variability (HRV) complexity is a critical marker of adaptive capacity and stress regulation. This study assessed the impact of a wearable-based mindfulness intervention on HRV complexity among first responders using a smartwatch. Methods: A total of 87 first responders participated in a one-month wearable-based intervention. Participants wore Garmin Vivosmart 5 devices to continuously collect PPG data (photoplethysmogram), focusing on beat-to-beat intervals (BBIs). The intervention involved daily Ecological Momentary Assessments (EMAs) and individual randomization to either a mindfulness message, a prompt to access an audio …

Increasing Access To Medications For Opioid Use Disorder For All Justice-Associated Populations, Edgar Rodriguez

Doctor of Nursing Practice Final Manuscripts

The purpose of this paper is to support a federal mandate requiring universal access to medication of opioid use disorder for all the justice-involved populations. The policy proposal aims to standardize evidence-based treatment across correctional systems, improve treatment initiation during incarceration, strengthen continuity of care after release, reduce overdose mortality, and address disparities in access for racial and economic groups and rural communities. This policy paper calls for the increase of access to medications of opioid use disorder across the United States for all justice-involved population. The opioid crisis has created a public health problem in the United States by …

The Importance Of Socialization: Family, School, Peer, And Media Influence On White Identity Development, Miandria Erickson

Honors Projects

This study aims to explore the different aspects of socialization that can impact one’s White racial identity development, in order to analyze why White individuals struggle to describe their racial identity. Acknowledging an individual’s White identity is an imperative aspect to understanding diversity and race, and yet, White individuals will often have difficulty recognizing and explaining their racial identity. This qualitative study used data collected from semi-structured interviews of 60 young White college participants (ages 18-25) in two different geographical locations, the Northwest and Southeast of the U.S.^[1] Several themes were extracted from these interviews, among them were family, …

Navigating Trust: The Impact Of Social Media Influencers On Gen Z Health Behaviors, Abigail Stelling

Honors Thesis

Social media plays a defining role in the daily lives of Gen Z, influencing how people communicate, access information, and make decisions. More than a form of entertainment, social media is a powerful source that shapes identity, perceptions, and behaviors. As the first generation to grow up fully immersed in a digital world, Gen Z is uniquely impacted by the content and interactions that occur on social media platforms. Within this digital landscape, social media influencers have emerged as powerful figures. These individuals use large online platforms to promote lifestyles, products, and behaviors. Influencers often have the ability to shape …

Evaluating The Market Withdrawal Of Andexanet Alfa, Jordyn Linfield, Addisyn Cooper, Alexander Defranco, Emma Gerding, Jessica Kelley, Tyler Henney, Connor Dains, Brenna Hissong, Brittany Bates

Pharmacy and Wellness Review

The coagulation cascade comprises intrinsic, extrinsic, and common pathways that converge when thrombin converts fibrinogen (factor I) into fibrin, leading to fibrin mesh formation, stabilization of the platelet plug, and ultimately thrombus formation. Inhibition of the coagulation cascade can be achieved with a variety of anticoagulant medications, including direct oral anticoagulants (DOACs). The mechanism of action of DOACs is to inhibit either factor Xa or thrombin. Reversal of anticoagulation remains an important clinical consideration when managing patients on DOACs who experience serious bleeding events. Andexanet alfa is a recombinant, modified human factor Xa protein previously indicated for patients receiving rivaroxaban …

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

When The Therapist Is An Algorithm: Understanding Autism Spectrum Students’ Acceptance Of Generative Ai As A Mental Well-Being Tool Through The Technological Acceptance Model, Jossy P. George, Peter Muttungal, Benny Jeyekumar Davidson, Nishi Priya

Northeast Journal of Complex Systems (NEJCS)

This study examines the psychological and technological factors of the acceptance and emotional well-being of 349 college students with autism who use generative artificial intelligence tools as sources of psychological and emotional support. Grounded on the model of Technology Acceptance Model (TAM), the research studies relationships among perceived empathy, perceived usefulness, ease of use, emotional trust, continuance intention, and overall well-being. Structural equation modelling found that the perceived empathy was a significant predictor of ease of use and usefulness, while emotional trust and continuance intention proved to be significant predictors of emotional well-being. To reinforce these results, predictive modelling performed …

Gastrointestinal Symptoms After Sport-Related Concussion: Prevalence And Patterns In A Multi-Cohort Analysis, Emma Finnegan, Ed Daly, Katherine J. Hunzinger, Lisa Ryan

Department of Exercise Science Faculty Papers

Background/Objectives: Concussions occur across all sports globally; however, inconsistent symptom recognition continues to challenge diagnosis, management, and recovery. Although concussion effects extend beyond neurological dysfunction, gastrointestinal (GI) symptoms remain insufficiently captured within current assessment frameworks and may influence athletes’ fuelling choices and food tolerance during recovery. This study aimed to describe the prevalence and patterns of GI symptoms reported among athletes with a history of concussion and to explore whether symptom prevalence and burden differed by sex and country. Methods: A total of 401 adult athletes (225 males; mean age 32.4 ± 11.3 years) with a history of concussion were …

Misconduct Among Nurses And Midwives: A Retrospective Descriptive Study Of Cases Handled At The Uganda Nurses And Midwives Council From 2017 To 2021, Barbara Okiror, Christine Nimwesiga, Patience Muwanguzi, Tom Ngabirano, Mercy Muwema

School of Nursing & Midwifery, East Africa

Background: Media reports on the misconduct of nurses and midwives, including cases of fake credentials, drug theft, and incompetence, are on the rise. However, there are no published studies currently addressing this issue in Uganda. Therefore, to inform effective regulation of the profession, we analysed the misconduct cases involving nurses and midwives reported to the Uganda Nurses and Midwives Council between 2017 and 2021.

Methods: The study retrospectively described misconduct cases received and handled at UNMC from 2017 to 2021 and their outcomes. Following total population sampling, data were extracted from case files and then input into a …

Characteristics Of People Who Inject Drugs Approached For Injection Assistance In Rural Kentucky, April Young, Ryli Hockensmith, Preston T Tolbert, Susan Westneat, Peter Vickerman, Jack Stone, Hilary L Surratt, Kayo Fujimoto, Hannah K Knudsen, Rachel Vickers-Smith, Katherine L Thompson, Laura Fanucchi, Julia Kollitz, Jennifer R Havens, Melvin D Livingston

Faculty, Staff and Student Publications

Objective: This study aims to understand the characteristics of people who inject drugs approached by others for injection assistance.

Method: Peer-referral and outreach were used to recruit rural adults who recently injected drugs in Appalachian Kentucky (n=435). Interviewer-administered questionnaires elicited data on participant characteristics and injection assistance. Descriptive statistics and generalized estimating equations clustered on peer-referral recruitment chain were used for analysis.

Results: Nearly one-third (30.1%) reported others had come to them for injection assistance. People approached for assistance were slightly younger (prevalence ratio [PR]: 0.91, 95% confidence interval [CI]: 0.85-0.99) but otherwise, demographically similar to their counterparts. Those approached …

Resilience And Social Support On Depression Risk For Chronic Obstructive Pulmonary Disease Patients In South Tangerang, Indonesia, Adhityawarman Menaldi, Sali Rahadi Asih, Farah Ainul Mardhiyyah

Kesmas

Chronic obstructive pulmonary disease (COPD) is a major public health concern with psychosocial impacts, such as reduced resilience and depression. This study examined the moderating role of perceived social support on the relationship between resilience and depression among individuals diagnosed with COPD in South Tangerang, Indonesia. A quantitative cross-sectional study was conducted between January and February 2024 using self-administered questionnaires. Participants were adult patients with clinically diagnosed COPD, recruited from all public health centers (PHC) in South Tangerang. A total of 125 participants met the inclusion criteria and were included in the analysis. Participants had a mean age of 41.46±15.69 …

Development And Validation Of An Indonesian Questionnaire For Assessing Paracetamol Self-Medication Knowledge, Attitude, And Practice, Widyana Sagita Putri, Rani Sauriasari, Priharika Septyowati

Kesmas

Paracetamol is a widely used over-the-counter medicine for self-medication and is often perceived as completely safe. However, inappropriate use may result in hepatotoxicity and other adverse effects, particularly at high doses. This study aimed to develop and validate a questionnaire to assess the general Indonesian population’s knowledge, attitude, and practice (KAP) regarding paracetamol self-medication. The validation procedure consisted of three stages: content, face, and construct validation. Three experts assessed the relevance of the items using the Content Validity Index, and five respondents were interviewed to assess the linguistic clarity and comprehensibility of the questions. Construct validity and reliability were assessed …

Determinants Of Behavioral Intention To Change Sexual And Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis, Md Mizanur Rahman, Gerraint Gillan Ahi, Rafazila Ramli, Rasitasam Safii, Jacey Lynn Minoi, Stephanie Chua Hui Li, Ahmad Sofian Bin Shminan, Lee Jun Choi

Kesmas

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, …

Environmental Contamination Of Methicillin-Resistant Staphylococcus Aureus And Vancomycin-Resistant Enterococcus In Primary Care Clinics: Implications For Occupational Safety, Subki Ahmad, Normah Awang, Ermie Abdull Hamid, Anuar Ithnin, Nurul Farahana Kamaludin, Noraizah Muhd Nor

Kesmas

Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) are major contributors to healthcare-associated infection, yet data from primary care clinics remain limited. This study assessed environmental contamination in eight clinics in the Klang Valley, Malaysia, and evaluated associated environmental factors. Samples were collected from environmental surfaces and equipment in Medical Officer and Patient Treatment Rooms, then cultured and tested for antimicrobial susceptibility. Environmental parameters, including temperature, relative humidity, air movement, and room density, were measured. Data were analyzed using Kruskal–Wallis, Mann–Whitney, and multiple linear regression analyses. MRSA was detected on 19.8% of environmental surfaces (patient treatment beds (47.3%) and side …

Projected U.S. Cardiovascular Disease Burden From Heat Exposure For Future Greenhouse Gas Scenarios, Gokul Parmeswaran, Sai Rahul Ponnana, Santosh Kumar Sirasapalli, Niketh Surya, Tong Zhang, Zhuo Chen, Jean-Eudes Dazard, Salil V. Deo, Sanjay Rajagopalan

Faculty Scholarship

Importance: Climate change may reverse decades of improvements in cardiovascular disease (CVD) mortality in the US; however, comprehensive regional projections of heat-related CVD burden in the US are unavailable. Objective: To use the county-level observed (2010-2016) heat-related CVD burden in the US to obtain the projected rates through 2050 according to the mean (shared socioeconomic pathway [SSP] 2-4.5) and high (SSP5-8.5) greenhouse gas (GHG) emission pathways. Design, Setting, and Participants: This cross-sectional ecological analysis used county-level summary data including all counties in the contiguous US from 2010 through 2016 as baseline data with projections to 2030 and 2050 under SSP …