Digital Commons Network^™

Asian Reference Values For Handgrip Strength, Gait Speed, Five-Times-Sit-To-Stand Test, Muscle Mass And Calf Circumference, Jozo Grgic, Siew Ling Tey, Dieu Thi Huynh, Yen Ling Low, Zeljko Pedisic, Nina Schaller, Vanessa Kristina Wazny, Weilan Wang, Yasuhiko Saito, Ravindra P. Rannan-Eliya, Hala Ghattas Ph.D., Monique Chaaya, Carlos Mendes De Leon, Preeti Gupta, Ecosse L. Lamoureux, Mythily Subramaniam, Edimansyah Abdin, Rahul Malhotra, Angelique Chan, Bayasgalan Tumenbayar, Et. Al.

Faculty Publications

Background:

Handgrip strength, gait speed, Five-Times-Sit-to-Stand Test (FTSST) performance, skeletal muscle mass and calf circumference are important health outcomes, particularly useful for diagnosing sarcopenia. The aim of this study was to establish reference (normative) values for handgrip strength, gait speed, FTSST performance, skeletal muscle mass and calf circumference by pooling individual participant data from national cohorts in Asia.

Methods:

We conducted a pooled analysis of individual participant data from 20 national cohorts representing 12 Asian countries (China, India, Indonesia, Israel, Japan, Lebanon, Malaysia, Mongolia, Philippines, Republic of Korea, Singapore and Sri Lanka). We included cohorts with data on at least …

Staff Education Project Staff Education To Integrate Nutrition Into Mental Health Care In An Acute Medical Setting, Yolene Auguste

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education initiative designed to support the implementation of a protocol that integrates nutrition and mental health screening in an acute medical setting. The practice problem addressed inconsistent identification of nutrition-related needs and mental health concerns, along with variable follow-through on referral pathways, limiting holistic care and contributing to unmet needs during and after hospitalization. Nutrition and mental health are bidirectionally related, with dietary quality and lifestyle factors influencing mental health outcomes and overall well-being (Dubois & Giroux, 2025). The practice-focused question guiding this project was: In adult patients receiving care …

Association Between Environmental Exposures To Perfluoroalkyl And Polyfluoroalkyl Substances And Military Veterans Cancer Determination, Stephen A. Pereira Jr

Walden Dissertations and Doctoral Studies

This study involved evaluating whether cumulative exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) was associated with kidney cancer, bladder cancer, and adult leukemia among U.S. veterans. Pooled National Health and Nutrition Examination Survey (NHANES) data from 2005–2015 were analyzed for sample of 2,500 veterans with available serum PFAS measurements and physician-diagnosed cancer histories. This study employed a cross-sectional, correlational design grounded in a post-positivist paradigm. Inclusion required complete data for (a) serum PFAS concentrations, (b) kidney cancer, bladder cancer, and adult leukemia, and (c) covariates age, sex, race/ethnicity, smoking status, and body mass index. Cumulative PFAS was modeled as a …

Community Participatory Co-Design And Development Of A Digital Diabetes Prevention Education Program For Hispanic Families With Obesity: Mixed Methods Study, Sandra Mihail, Marbelly Partida, Lizette Villanueva, Debbe Thompson, Teresia M O'Connor, Salma M Musaad, Maria J Redondo, Erica G Soltero

Children’s Nutrition Research Center Staff Publications

Background: Digital health interventions (DHIs) can extend the reach of disease prevention interventions; however, few are evidence-based, theoretically grounded, or developed for high-risk youth and families. Co-design approaches engage end users in the design and development of the DHI, which can lead to increased accessibility and engagement.

Objective: This study aimed to describe the adaptation of an evidence-based diabetes prevention program for remote, digital delivery.

Methods: The adaptation of the in-person intervention was guided by a modified Inclusive Digital Health Intervention Design to Promote Health Equity framework and conducted in collaboration with Hispanic adolescents (n=23) with obesity (BMI ≥95th percentile) …

Prevalence Of Premenstrual Syndrome, Premenstrual Dysphoric Disorder, And Dysmenorrhea In Nursing Students: A Systematic Review, Meta-Analysis, And Evidence-Based Recommendations, Sabyasachi Maity, Bharathi Gadad, Hansapani Rodrigo, Seham Noorani, Ayesha Usman, Chloe Lark, Mona Attarpour, Ivy Mageto, Lucas Schwartz, Nikhilesh Anand

School of Medicine Publications

Introduction: Menstrual disorders—including premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea—are highly prevalent among women of reproductive age and are associated with impaired academic performance, psychological distress, and reduced social functioning. Nursing students are particularly vulnerable due to the combined demands of intensive academic schedules and clinical training, yet prevalence estimates and institutional responses remain inconsistent.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251109363). PubMed, Scopus, Web of Science, CINAHL Ultimate, and APA PsycINFO were searched for studies published between 2016 and 2025. Eligible studies reported prevalence or …

Magnesium Intake And Periodontal Health In Adults, Dana Faghih, Man Hung, Amir Mohajeri

Annual Research Symposium

No abstract provided.

Adolescent Drug Use Prevention Programs Published 2013-2023: A Systematic Review Of Literature Reviews And Meta-Analyses, Marilyn A. Rhames, Jon Eckert, William L. Sterrett, Grant Morgan

Journal of Organizational & Educational Leadership

Background: This systematic review of reviews and meta-analyses provides education leaders with ten years of evidence-based strategies for effective adolescent substance use prevention. Methods: Following the PRISMA 2020 protocol for systematic reviews, we searched the PubMed and PsychINFO databases on October 19, 2023, and identified 96 systematic literature reviews and meta-analyses involving adolescent drug use prevention from 2103-2023. Twenty-four papers met the criteria for final inclusion. Results: Educational leaders should know three areas to deliver effective evidence-based adolescent substance prevention: 1) foundational understanding of risk and protective factors, 2) components of effective prevention programs, and 3) drug-specific …

A Framework For Assessing The Trustworthiness Of Scientific Research Findings, Brian A Nosek, David B Allison, Kathleen Hall Jamieson, Marcia Mcnutt, A Beau Nielsen, Susan M Wolf

Children’s Nutrition Research Center Staff Publications

Vigorous debate has erupted over the trustworthiness of scientific research findings in a number of domains. The question "what makes research findings trustworthy?" elicits different answers depending on whether the emphasis is on research integrity and ethics, research methods, transparency, inclusion, assessment and peer review, or scholarly communication. Each provides partial insight. We offer a systems approach that focuses on whether the research is accountable, evaluable, well-formulated, has been evaluated, controls for bias, reduces error, and whether the claims are warranted by the evidence. We tie each of these components to measurable indicators of trustworthiness for evaluating the research itself, …

Performance Of An Automated Sleep Scoring Approach For Actigraphy Data In Children And Adolescents, Pin-Wei Chen, Erica C Jansen, Christopher M Cielo, Ariel A Williamson, Margaret Banker, Michael Kaye, Peter X K Song, Karen E Peterson, Alejandra Cantoral, Martha María Téllez-Rojo, Cathy Goldstein, Khadija Zanna, Akane Sano, Jennette P Moreno, Heidi Kalkwarf, Babette S Zemel, Jonathan A Mitchell

Children’s Nutrition Research Center Staff Publications

Study objectives: GGIR is an R package for processing raw acceleration data to estimate sleep health parameters. We aimed to (1) assess the performance of three sleep algorithms within GGIR against PSG for detecting sleep/wake in clinically referred, typically-developing children (criterion validity); and (2) describe GGIR-derived sleep estimates from typically developing children enrolled in multiple cohort studies (face validity).

Methods: For criterion evaluation, children (8-16 years, N = 30) wore an actigraphy device for one night during in-lab polysomnography with performance assessed using epoch-by-epoch analyses. For face validity evaluation, four community/free living datasets were used: (1) Bone Mineral Accretion in …

Associations Between Overt And Subclinical Hypothyroidism In Pregnancy And Adverse Maternal And Neonatal Outcomes: A Cohort Study, Rahma Al Kindi, Noof Al Ghammari, Amina Al Malki, Aida Al Ismaili, Hana Al Sumri

Sultan Qaboos University Medical Journal

Objectives: This study aimed to determine associations between hypothyroidism during pregnancy and selected maternal and neonatal outcomes. Methods: A retrospective, cohort study was conducted between January 2018 and December 2020 at the two main tertiary hospitals in Muscat, Oman. The study included 408 Omani pregnant women aged 18–45 years. Participants were divided into two groups: those diagnosed with overt or subclinical hypothyroidism (n = 201; exposed group) and those with normal thyroid function (n = 207; unexposed group), matched for relevant variables. Data were collected from electronic medical records to assess maternal and neonatal outcomes. Results: Most exposed women …

The Wear-Bot Checklist: A Risk Of Bias Tool For Evaluating Validity And Reliability Research In Wearable Technology, Bryson Carrier, Jennifer A. Bunn, Chris Eschbach, Joel D. Reece, Gregory J. Welk, Brett A. Dolezal, James W. Navalta

Kinesiology and Nutrition Sciences Faculty Research

This paper proposes an innovative tool designed to standardize the evaluation of validity and reliability studies in the rapidly evolving field of wearable technology. We introduce the WEArable Technology Risk of Bias and Objectivity Tool (WEAR-BOT), a tool that addresses the need for a comprehensive and systematic way to assess bias in studies examining consumer-grade and research-grade wearable devices. This is the first tool designed to evaluate the risk of bias in validation and reliability studies. Other risk of bias tools like the Cochrane ROB, COSMIN, or the many other risk of bias tools are designed for different study methodologies …

Oral Health Related Quality Of Life In A Group Of Egyptian Preschool Children With Early Childhood Caries: A Cross-Sectional Study, Sara Adel Botros, Sara Magdy, Asmaa Abou Bakr, Ola Abdel Geleel

Dentistry

No abstract provided.

The Vipeholm Experiments: A Case Study Of Unethical Dental Research, Lainie Ross Md, Phd

Journal of the American College of Dentists

Modern-day research ethics training often begins with a discussion of the medical research atrocities committed by Nazi health care professionals and the resulting 10-principle Nuremberg Code, which is often considered to be the beginning of modern-day medical research regulations. It is occasionally mentioned that Nazi dentists also conducted unethical research in the concentration camps, and a few were brought to trial. In this manuscript, I compare two studies (one medical and one dental) conducted after World War II that violated the Nuremberg Code.

I describe and compare the well-known Willowbrook Hepatitis studies conducted by infectious disease doctors on vulnerable institutionalized …

Restoring Trust: A Fair Chance At A Bright Smile And The Human Side Of School-Based Dentistry, Rubin Sorrell Ii, Mph, Dds

Journal of the American College of Dentists

The Fair Chance at a Bright Smile (FCAABS) program represents a humanistic, community- centered approach to dentistry that redefines access, education, and dignity in oral health. Developed and refined through a year-long pilot partnership with the San Francisco Unified School District, FCAABS integrates preventive dental care, oral health education, and career exposure for students from pre-kindergarten through high school. This manuscript argues that beyond clinical outcomes, FCAABS reveals a deeper truth: oral health is intrinsically social, emotional, and moral. It examines the program through the lens of the humanities and ethics, exploring how narrative, empathy, and cultural context inform both …

Integrating Music Therapy Into Dental Clinics For Whole Person Care, Dana Osterling Benoit Mba, Mt-Bc, Nisreen Al Jallad Dds, Ms2, Shasha Cui Ed.D. Mba, Mandy Fraser, Gaelen Mccormick Mm1, Rosemary Oliva Obi Ms, Lcat, Mtbc1, Adela Planerova Dds, Ms2, Madeline Vinolus Mt-Bc1, Angela Valeria Perez Pita Dds, Ms2

Journal of the American College of Dentists

This case study describes the integration of a board-certified music therapist into two specialty dental clinics at the University of Rochester Medical Center’s Eastman Institute for Oral Health. Initiated in collaboration with the Eastman Performing Arts Medicine Center, the effort reflects a humanistic and biopsychosocial approach to dentistry that leverages music therapy to reduce anxiety, improve patient experience, and support better clinical outcomes.

Before implementation, monthly interdisciplinary planning meetings were held, bringing together dental faculty, research and administrative staff, and the music therapy team. These meetings built a shared understanding of each clinic’s unique patient population, workflow, and clinical priorities, …

Impaired Arginine, Citrulline And Glutamine Metabolism In Type 2 Diabetes: Insights From A Stable Isotope Study, Mustafa Tosur, Raven A Wierzchowska-Mcnew, Nicolaas E P Deutz, Mariëlle P K J Engelen

Children’s Nutrition Research Center Staff Publications

Context: Arginine (Arg) is an important amino acid in T2D as a potent insulin secretagogue and precursor for nitric oxide (NO). Citrulline (Cit), the substrate for de novo Arg synthesis, is mostly produced from glutamine (Gln).

Objective: We aimed to investigate their metabolism in T2D using novel stable isotope tracer approach.

Methods: We studied 42 individuals (21 with T2D, 21 controls). After overnight fasting, blood samples were collected following pulse administration of stable amino acid tracers. Plasma concentrations and isotopic enrichments were measured by LC-MS/MS, and compartmental analyses were performed to calculate their whole-body production (WBP) rates and kinetics.

Results: …

Early Prediction And Diagnosis Of Peripheral Neuropathy In Type 2 Diabetes Using Biochemical Parameters, Eman Naim Taher, Narjis Hadi Al – Saadi

Al-Ameed Journal for Medical Research and Health Sciences

Background: Type II diabetes mellitus is commonly related to diabetic peripheral neuropathy (DPNP), which manifests as a gradual progression of damage to the peripheral nerves after excluding other causes. As initial alterations may lie hidden, focus has moved to easy crude markers. Neuron-specific Enolase (NSE) was chosen since it increases early after axonal injury, Whereas, Nerve Growth Factor (NGF) reflects neurotrophic activity. Material and Methods: A case control study was done on 45 cases of DPNP after diagnosing through a nerve conduction study (NCS), 48 diabetics without neuropathy DWNP and 45 healthy individuals. Ages ranged from 35 to 60. …

Individual Characteristics And National Income Modify The Association Between Cognitive Social Capital And Food Insecurity: Evidence From The Gallup World Poll, 2014–2021, Sejla Isanovic, Kegan O'Connor, Audrey L. Richards, Edward A. Frongillo Jr. Ph.D.

Faculty Publications

Background: Food insecurity affects >2.4 billion people globally and persists across income levels. Characteristics such as low income, low education, and unstable employment do not fully explain this persistence. Social resources embedded in networks, specifically cognitive social capital involving trust, reciprocity, and support, may offset constraints and buffer characteristics associated with a higher probability of food insecurity.

Objectives: This study examined whether social capital was associated with a lower probability of food insecurity and whether this as sociation varied by individual characteristics and country contexts, consistent with buffering and compensation.

Methods: Data were drawn from the Gallup World Poll (2014–2021), …

The Outcome Of Snare Loop Catheter For Foreign Body Removal In Superior Vena Cava: An Evidence-Based Case Report, Hutomo Rezky Noorsukma, Patrianef Darwis

The New Ropanasuri Journal of Surgery

Introduction. In recent years, the utilization of central venous catheters (CVC) in medical practice has become increasingly common. One of the complications associated with central venous catheterization is embolization of catheter fragments, which arefound in 1% of cases. Currently, endovascular techniques, such as snare loop catheter, have been developed for the extraction of intravascular foreign bodies. However, there is no strong evidence regarding this method. Thisliterature review aims toevaluate the efficacy and safety of snare loop catheters for foreign body removal within the superior vena cava (SVC).

Method. We searched four databases, that is Cochrane, PubMed, EBSCO, and …

Roux-En-Y Duodenojejunostomy As Surgical Treatment For Congenital Duodenal Obstruction: A Case Report, Ahmad Yani, Albireza Ruhimat

The New Ropanasuri Journal of Surgery

Introduction. Congenital duodenal obstruction is an anatomical abnormality in newborns. Various intrinsic and extrinsic etiologies can cause duodenal obstruction. The surgical treatment that is commonly performed on duodenal obstruction in neonates is duodenoduodenostomy. However, several etiological conditions, such as preduodenal portal vein (PDPV) and pancreatic annulare cause duodenoduodenostomy nearly impossible to perform, so an alternative surgery procedure with a good outcome is necessary.

Case Illustration. A female neonate had been suspected congenital duodenal obstruction since pregnancy due to polyhydramnios. An OGT was inserted with greenish yellow residue after the baby was born. Based on abdominal x-ray examination, a …

Whipple Procedure For High-Grade Pediatric Pancreatic Injury After Blunt Trauma: A Case Report, David C. El Gah, Tri H. Rahayatri, Asri D. Rachmawati, Adianto Nugroho

The New Ropanasuri Journal of Surgery

Introduction: Pediatric pancreatic injury isuncommon but carries significant morbidity. While non-operative management is standard for low-grade injuries, the optimal approach for high-grade trauma (AAST grade III–V) remains debated. Pancreaticoduodenectomy (Whipple procedure) is rarely performed due to high procedural risks and is typically reserved for severe pancreatic head injury with concomitant duodenal damage.

Case presentations: A 13-year-old boy presented three days after blunt abdominal trauma with epigastric pain and bilious vomiting. CT imaging revealed free fluid, a large retroperitoneal hematoma, and suspected pancreatic head injury. Despite initial stability and conservative management in the High Care Unit, worsening abdominal distension prompted an …

Locoregional Management In Breast Cancer With Brca1/2 Mutation: Evidence Based Case Report, Adlina Karisyah, Sonar S. Panigoro

The New Ropanasuri Journal of Surgery

Introduction. Breast cancer is still one of the top health issues worldwide. Hereditary predisposition is linked with morbidity and mortality of breast cancer patients. BRCA 1/2 genetic mutation, one of mutations in breast cancer that has been extensively observed, has tremendous effects on the carrier. Studies showed that patients with BRCA1/2 mutation are often associated with poor pathological characteristics. Further research isyet to identify the effect of the mutation with prognosis including locoregional recurrences. This study aims to understand the risk of locoregional recurrences on the patients with breast cancer and BRCA 1/2 genetic mutation who had BCT or …

Staff Education To Improve Tirzepatide Education And Lifestyle Counseling, Daisy Asemota

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a practice-focused staff education initiative designed to improve clinical staff knowledge, confidence, and readiness to educate adult patients enrolled in a Tirzepatide weight-management program. Tirzepatide has demonstrated superior weight-loss outcomes compared to other glucagon-like peptide-1 (GLP-1) receptor agonists; however, inconsistent staff education practices related to medication administration, adverse-event management, and lifestyle counseling present a gap in practice. Variability in staff knowledge and teaching approaches may reduce confidence, contribute to inconsistent patient education, and limit the effectiveness of evidence-based care delivery. The purpose of this DNP project was to address this practice gap …

Fructosamine And Hba1c For Monitoring Diabetes In Pregnancy: Complementary Or Competing?, Yosra Htira, Chaima Jemai, Emna Fennira, Zohra Hadj Ali, Olfa Lajili, Imen Hedfi, Jihene Bettaieb, Faika Ben Mami

Sultan Qaboos University Medical Journal

Objectives: This study aimed to perform a comparative evaluation of glycaemic control using fructosamine and glycated haemoglobin (HbA1c) and to investigate the correlations between the means of these biomarkers and mean glycaemia in pregnant women. Methods: This prospective longitudinal study was conducted from January to December 2020 and included pregnant women with pregestational diabetes, recruited at the National Institute of Nutrition of Tunis, Tunis, Tunisia, before 12 weeks of amenorrhoea and followed-up until delivery. Results: A total of 71 pregnant women were included in this study. Glycaemic values decreased over the course of pregnancy and patients achieved …

Staff Education On Implementing Exercise For The Management Of Depression In Adults In A Comprehensive Mental Health Facility, Afolasade Jarrett

Walden Dissertations and Doctoral Studies

In a comprehensive mental health facility, patients diagnosed with major depression continue to experience depressive symptoms despite treatment. Despite using standard treatment with antidepressants and psychotherapy, facility data showed that 40% of these patients are still experiencing depression symptoms that negatively impact their overall functioning and quality of life. There is evidence supporting exercise as an effective strategy for depression treatment. Therefore, a staff education project was proposed to educate staff about exercise for depression management in adults. A thorough literature search in four databases yielded 12 articles with high quality evidence supporting educating staff to use exercise for depression …

Early Postnatal Polymerase Chain Reaction Testing In The Identification Of Perinatal Transmission Of Hepatitis C Virus, Mona Prasad, Grecio J Sandoval, George R Saade, Brenna L Hughes, Rebecca G Clifton, Uma M Reddy, Anna Bartholomew, Ashley Salazar, Edward K Chien, Alan T N Tita, John M Thorp, Torri D Metz, Ronald J Wapner, Vishakha Sabharwal, Hyagriv N Simhan, Geeta K Swamy, Kent D Heyborne, Baha M Sibai, William A Grobman, Yasser Y El-Sayed, Brian M Casey, Samuel Parry, George A Macones

Faculty, Staff and Student Publications

In this study, a single hepatitis C virus (HCV) RNA at 2-6 months was sensitive and specific (86.7% and 95% confidence interval [CI], 62.1%-96.3% and 100% and 95% CI, 98.8%-100%, respectively) in identifying perinatal transmission of HCV. No cases of perinatal infection requiring treatment were missed.

Fathers, Futures, And Fragile Contexts: Men’S Intergenerational Perspectives On Pregnancy In A Low-Income South African Setting, Urlridge A. Thompson, Johanni Beukes, Michelle Leal, Stephanie Alcock, Stephen Lye, Shane A. Norris, Catherine Draper

Journal of Social, Behavioral, and Health Sciences

Men’s involvement in their partner’s pregnancy in low-income South African settings is influenced by a complex interplay of contextual factors that influence the nature and extent of their participation. The confluence of these factors contributes to limiting men’s adoption of an intergenerational perspective of their partner’s pregnancy. The adoption of an intergenerational perspective by men may enhance outcomes for maternal and child health, but it remains understudied. This qualitative study explored intergenerational perspectives of men in Soweto, South Africa, regarding their partners’ pregnancies. An exploratory descriptive qualitative approach was employed. We conducted in-depth individual interviews with 19 male partners (fathers …

An Autopsy Case Of Extensive Aortic Thrombosis With Acute Kidney Injury As The Sole Clinical Manifestation, Risa Suenaga, Makoto Fukuda, Atsuhiko Suenaga, Yuki Ikeda, Maki Yoshihara, Megumi Nishiyama, Seiichi Kato, Motoaki Miyazono

Children’s Nutrition Research Center Staff Publications

Aortic thrombosis is a rare but life-threatening condition. It typically presents with abdominal or lower-limb ischemia. Although acute kidney injury (AKI) can accompany aortic thrombosis, AKI as the sole clinical manifestation has not been previously reported. A 69-year-old man with extensive atherosclerotic disease and chronic kidney disease presented with severe oliguria. Initial evaluation, including non-contrast computed tomography (CT), did not reveal any aortic abnormalities. Renal Doppler ultrasonography findings and markedly elevated D-dimer levels prompted contrast-enhanced CT, which demonstrated extensive thrombus formation extending from the descending thoracic aorta to the bilateral iliac arteries, with complete occlusion of both renal arteries and …

Nci-Designated Cancer Centers' Policies And Practices With Regard To Alcohol And Cancer: A Call To Lead, Ernest T Hawk, Stephanie L Martch, Meghan Si, Sanjay Shete

Faculty, Staff and Student Publications

Background: Alcohol, a known carcinogen since 1988, increases risk of cancers of the mouth, pharynx, larynx, esophagus, liver, breast, and colorectum. More than one half of US adults consume alcohol whereas about two thirds are unsure whether or unaware that alcohol intake is linked to cancer risk.

Methods: Our objective was to survey awareness, beliefs, intentions, policies, practices, and goals/perceived responsibilities related to establishing/promoting actions to reduce alcohol-related cancer risks from leaders of 72 NCI-Designated Cancer Centers.

Results: Sixty-one percent responded. Forty-three percent either believed in or were uncertain about alcohol's purported health benefits. Nevertheless, 86% considered it part of …

Intercalated Bacterial Biofilms Are Intrinsic Internal Components Of Calcium-Based Kidney Stones, William C Schmidt, Henry L Schreiber, Rachael E S Hammann, Chloe L P Obernuefemann, Karla Bergeron, Aleksandra Klim, Daniel Wong, Kefu Du, Scott J Hultgren, Et Al.

2020-Current year OA Pubs

Calcium oxalate stones comprise greater than 70% of all kidney stones. In the current conceptual framework, the initial stone nidus is thought to include the aggregation of inorganic crystallites, the formation of which is favored by elevated concentrations of dissolved constituents. Here, we show that this highly prevalent stone type comprises a form of organic-inorganic polycrystalline biocomposite with integrated bacterial biofilms. Evidence from electron microscopy and fluorescence microscopy reveal the unanticipated internal structure of kidney stones from human patients, where bacterial biofilms are intercalated between polycrystalline mineral layers, even in stones identified as "noninfectious" clinically, including those in patients without …