Digital Commons Network^™

Management-Driven Shifts In The Bison Fecal Microbiome And Its Relationship To Stec Prevalence, Ritesh Ray

Graduate Research Theses & Dissertations

Contamination of meat samples from pathogens such as Shiga toxin-producing E. coli (STEC), especially in ruminants, is an ever-growing issue for the safety of global meat production. Recent studies have reported STEC in the livestock and food industry with a limited focus on wildlife. Although cattle serve as the primary reservoir for STEC, American bison (Bison bison bison) is the largest ruminant inhabiting North America, sharing similar genetics, and grazing habits, making them an ideal alternative STEC reservoir. Re-introduction for prairie conservation and meat farming has brought bison herds closer to anthropic environments than before. Recently bison meat has become …

Examining Preoperative Health And Lifestyle Risk Factors In Patients Awaiting Surgery During Covid-19 In Western Australia, Nadine Radin

Theses

This study investigated the prevalence of modifiable preoperative lifestyle risk factors among patients undergoing upper gastrointestinal and colorectal surgery at a metropolitan hospital in Perth, Western Australia (WA). It aimed to characterise behaviours such as smoking, alcohol and drug use, nutritional risk, physical fitness, frailty, and body mass index (BMI), and to examine whether these changed during the early phase of the COVID-19 pandemic in 2020 compared to 2019.

A retrospective audit of 2,340 patient medical records was conducted, with data extracted from routinely collected preadmission documentation. Regression models compared the prevalence of risk factors across matched calendar periods, adjusting …

Velocity Based Training In Athletic Development, Ross Martin Sangalang

Graduate Student Theses, Dissertations, & Professional Papers

The foundation of high-level sport performance is the ability to produce and express force rapidly across the task-specific temporal demands of sport. Traditional percentage-based prescription methods have long been used to develop hypertrophy, maximal strength, and power; however, fixed %1RM prescriptions fail to account for daily undulations in athlete readiness, accumulated fatigue, and changes in neuromuscular capacity. Velocity based training (VBT) offers a practical framework to regulate training through measurement of concentric velocity, allowing coaches to more accurately prescribe loads, stringently monitor repetition quality, and precisely regulate fatigue. This review discusses the neuromuscular qualities underpinning success in athletic endeavors, limitations …

Latent Classification Of Time-Dependent Transition Rates In Longitudinal Binary Outcome Data, Joonha Chang, Wenyaw Chan

Faculty, Staff and Student Publications

Continuous-time Markov chain (CTMC) models and latent classification methods are commonly used to analyze longitudinal categorical outcomes in medical research. While CTMC models are popular for their simplicity and effectiveness, their assumption of constant transition rates presents limitations in capturing dynamic behaviors. To address this, non-homogeneous continuous-time Markov chains (NH-CTMCs) have been developed, incorporating time-varying transition rates to enhance model flexibility. In this study, we leverage closed-form transition probabilities for a fully ergodic two-state NH-CTMC model and propose a latent class clustering approach to identify heterogeneous transition rate patterns within the population. We emphasize the potential advantages of these models …

Pregnancy And Breastfeeding Are Associated With Less Later-Life Cognitive Decline In A Longitudinal, Prospective Cohort, Molly M Fox, Jennifer E Bramen, Dayoon Kwon, Mark A Espeland, Yijia Sun, Li Zhang, Aladdin H Shadyab, Ramon Casanova, Joann E Manson, Marcus Y Chang, Verna R Porter, Leslie V Farland, Qian Xiao, Robert A Wild, Prabha Siddarth, Carolyn J Crandall

Faculty, Staff and Student Publications

Introduction: The brains of female mammals evolved to undergo structural and functional changes during pregnancy and lactation, equipping them for motherhood. However, long-term cognitive health implications of these adaptations in women are poorly understood.

Methods: In the Women's Health Initiative (WHI) Memory Study (WHIMS; n = 7427) and WHI Study of Cognitive Aging (WHISCA; n = 2304), postmenopausal women completed reproductive history interviews, annual global cognitive assessment from mean age 70 for up to 13 years, and multi-domain cognitive testing for up to 8 years.

Results: Each additional month pregnant was associated with higher scores of global cognition. Each additional …

Plasma Proteomic Profile Of Dietary Potassium And Incident Ckd, Jiaqi Yang, Lauren Bernard, Jingsha Chen, Valerie K Sullivan, Bing Yu, Eugene P Rhee, Paul A Welling, Casey M Rebholz

Faculty, Staff and Student Publications

Background:: There is a need for objective biomarkers of dietary potassium. The mechanisms through which dietary potassium influences kidney health are incompletely understood.

Methods:: Atherosclerosis Risk in Communities study participants at visit 3 (1993–1995) with dietary and proteomics data were randomly divided into discovery (N=6,814) and replication (N=3,380) sets. We examined associations between dietary potassium and 4,955 aptamers using multivariable linear regression, adjusting for sociodemographic factors, health behaviors, and estimated glomerular filtration rate, with a false discovery rate of 0.05. Then, we tested the prospective associations between potassium-related proteins and incident chronic kidney disease (CKD).

Results:: …

A Gut-Wrenching Battle Within: An Unusual Case Of Pancreatic Desmoid Fibromatosis, Ahmed Qaedi, Ali Hachem, Farrah Ibrahim

UAB Huntsville Research Day - All Presentations

2026 clinical vignette poster

Preventing G-J Tube Dislodgement - A Device And Communication Innovation, Sarah Clark

2026

Abstract

The Problem: G/J tube dislodgement is a frequent complication in pediatric patients.

Leads to:

• Emergency department visits
• Hospital admissions
• Delays in nutrition/medication

Impact on Patients & Families:

• IV placement (traumatic)
• Radiation exposure
• Overnight hospital stays

Impact on Nurses & System:

• Increased workload (admissions, coordination)
• Occupied inpatient beds for stable patients
• Inefficient care processes

Aims/Objectives Aim: Reduce unplanned G/J tube dislodgements and related hospital utilization.

Objectives: Develop a breakaway connector prototype

Implementation and Evaluation:
Setting: Pediatric inpatient & outpatient system
Participants: Nurses (bedside, GI, IR), caregiver, innovation team
Process: Roundtable discussions → identified workflow gaps Communication/workflow audit Developed …

Investigating The Role Of Traditional Chinese Herbal Medicine For Cancer Symptom Management In Older Adults: A Rapid Review, Isabelle C. Karshner

Honors Undergraduate Theses

Background: Patients with cancer often experience symptoms related to disease, complications, and treatment. One potential method of alleviating these symptoms is traditional Chinese herbal medications (TCHM). This rapid review explores the role of traditional Chinese herbal medications in treating cancer-related symptoms in older adults.

Purpose: The purpose of this rapid review is to gain and provide a better understanding of the effects of TCHM on cancer-symptom management in the older adult population. This review explores the association between TCHM and effects on cancer symptoms in older adults, including interactions, toxicity, and signs/symptoms of TCHM use that may be useful information …

When Fever And Thrombocytopenia Are Not Infectious: A Case Of Vitamin B12 Deficiency Mimicking Tropical Fever, Ram Arvind Viswanathan Dr

Digital Journal of Clinical Medicine

Vitamin B12 deficiency is classically associated with megaloblastic anaemia and neurological manifestations; however, atypical presentations continue to pose diagnostic challenges. Fever in association with thrombocytopenia often prompts evaluation for infectious aetiologies such as dengue, malaria, or sepsis, particularly in tropical settings. We report a case of vitamin B12 deficiency presenting with pyrexia and isolated thrombocytopenia, initially suspected to be an infectious illness. Extensive evaluation failed to reveal an infective cause, and subsequent haematological workup demonstrated megaloblastic changes with low serum vitamin B12 levels. Remarkably, the patient showed rapid defervescence and normalisation of platelet counts following parenteral vitamin B12 therapy. This …

Dietary Micronutrients And The Risk Of Gestational Diabetes: Evidence From A Tertiary Care Setting In India, Sujatha Mahadevarao Premnath, Moneesh Sivasoupramaniane, Maghida S

Digital Journal of Clinical Medicine

Background: Gestational Diabetes Mellitus (GDM) is a significant health concern in India, affecting nearly 22.4% of pregnant women. While macronutrient roles are well explored, the impact of micronutrients on GDM risk, particularly with the Indian ethnic phenotype, requires exploration

Objectives: To compare the micronutrient intake between GDM and non-GDM pregnancies and evaluate the association between specific dietary micronutrients and GDM risk

Methods: An observational cross-sectional study was conducted among 115 South Indian pregnant women. Dietary history was taken using 24-hour recalls on two occasions and analysed via the Indian Food Composition Table (IFCT). GDM was diagnosed using International Association of …

Dietary Acculturation, Dietary Inflammatory Potential, And Metabolic Syndrome Among Immigrants In The United States: A Mixed-Methods Approach Using Nhanes And Qualitative Data, Esse G. Foka Nzaha

Theses and Dissertations

Background and Objectives: Immigrants in the United States undergo acculturation — a process of sociocultural and behavioral adaptation to the host country. Increasingly, behavioral adaptations have been associated with cardiometabolic health and chronic disease risk. Metabolic syndrome (MetS), a cluster of conditions including abdominal obesity, elevated blood pressure, impaired fasting glucose, elevated triglycerides, and reduced HDL cholesterol, is a major risk factor for type 2 diabetes mellitus, cardiovascular diseases and other chronic diseases, including cancer. Despite the growing immigrant population in the U.S., the role of diet and dietary acculturation in MetS development remains poorly understood in this population. This …

24-H Circadian Rest-Activity Rhythms And Physical Frailty In Older Adults: A Biopsychosocial Perspective On Sex Differences And Social Capital, Jisu Kim

Theses and Dissertations

Physical frailty is a prevalent geriatric syndrome characterized by age-related decline across multiple physiological systems. Physical frailty is associated with an elevated risk of adverse health outcomes, including chronic disease progression and all-cause mortality, representing a significant and growing public health concern. Disrupted circadian rest-activity rhythms (RARs) are increasingly recognized as clinically meaningful markers of physical frailty in older adults. However, the extent to which biological sex and social determinants of health (SDoH), particularly social capital, contribute to or modify the associations between RARs and physical frailty remains underexplored.

Therefore, this dissertation summarizes the existing literature on age-related changes in …

Creative Works By Ed Fehringer, M.D., Ed Fehringer

The Art of Medicine

• Ode to a Skeleton
• Progress

Targeting Nuclear Receptors In Muscular Dystrophies And Regenerative Myogenesis, Eira Mann, Hoang Vu, Vihang A Narkar, Yu Liu

The Brown Foundation: Institute of Molecular Medicine

Skeletal muscle is a highly plastic tissue with a robust capacity for regeneration, largely driven by resident satellite cells. Muscular dystrophies comprise a heterogeneous group of inherited disorders characterized by progressive muscle degeneration, chronic inflammation, and impaired regenerative capacity. Despite well-defined genetic etiologies, effective disease-modifying therapies for these disorders, as well as many acquired myopathies, remain limited. Emerging evidence identifies nuclear receptors (NRs) as key regulators of skeletal muscle homeostasis, integrating hormonal, metabolic, and environmental signals to control transcriptional programs governing mitochondrial function, metabolism, inflammation, and myogenesis. In this review, we summarize the diverse roles and mechanisms of action of …

Food Delivery Services For Enhancing Participation In The Special Supplemental Nutrition Program For Women, Infants, And Children (Wic) In The United States: Bridging The Wic-Eligible Access Gap, Jingjing Gao, Muinat Abolore Idris, Lilian O Ademu, Bryan Colby Griffin, Yue Zhang, Yun Hang, Gabriela A Gallegos

Faculty, Staff and Student Publications

Background: Diet-related health disparities among U.S. children persist despite the availability of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits to eligible women, infants, and children. Participation remains suboptimal: only 51.2% of eligible individuals were enrolled in 2021. Transportation and food-environment constraints pose salient barriers, especially for caregivers of infants in food deserts. Emerging online ordering and delivery options may reduce access frictions, but grocery delivery coverage is limited, and fees are often not covered by benefits.

Methods: We linked USDA Food and Nutrition Service state-level WIC participation data (November 2024 vs. September 2025) with demographic, …

Impact Of A Culinary Medicine Intervention On Diet And Health Metrics In Patients With Type 2 Diabetes And Elevated Body Mass Index, Natalia I Heredia, Logan R Thornton, Diana C Guevara, Natalia Williams, Grace Marcelo-Ramirez, Joanne Chow, Lorna H Mcneill, Karen Basen-Engquist, Ruth Rechis, Deanna M Hoelscher

Faculty, Staff and Student Publications

Purpose: Culinary Medicine (CM), an educational approach blending the art of cooking with the science of medicine, has shown promise in improving diet and health outcomes. We conducted a mixed-methods, quasi-experimental evaluation of a CM program to promote cooking and healthy dietary intake.

Methods: Patients with type 2 diabetes and elevated body mass index (>25) were recruited from primary care clinics in low-income neighborhoods. The program, delivered by a dietitian, includes five weekly 90-minute sessions on basic cooking skills with behaviorally-based nutrition education. An explanatory sequential mixed-methods pilot study with a pre-post survey design and post-program interviews was used …

Safety And Efficacy Of 6% Hydroxyethyl Starch In Patients Undergoing Major Surgery: The Randomised Controlled Phoneics Trial, Wolfgang Buhre, Óscar Díaz-Cambronero, Simon Schaefer, Martin Novacek, Marina Soro Domingo, Bjorn Stessel, Aurelio Rodríguez-Pérez, Torsten Richter, Georg Rohe, Bernard Cholley, Matthias Gruenewald, Gerhardus Kuiper, Samir Jaber, Dianne De Korte, Javier Belda, Marcelo Gama De Abreu, Robert Baronica, Thomas Scheeren, Carlos Ferrando-Ortolá, Wojciech Szczeklik, Dana Tomescu, Tomas Vyzamal, Zejka Gavranovic, María Pilar Argente-Navarro, Guido Mazzinari, Sarah Thaler, Nuria García-Gregorio, Jeroen Vandenbrande, Diane Zlotnik, Jakob Wittenstein, Sonja Schmier, Susanne Rohn, Christoph Glasmacher, Martin Holler, Cornelius Jungheinrich, Ulf Niess, Daniel I Sessler, Martin Westphal

Faculty, Staff and Student Publications

Abstract

Background: Hydroxyethyl starch (HES) is often used for maintaining vascular volume during major surgery. Long-term high-dose HES in septic patients promotes renal injury, whereas meta-analyses of current HES products in surgical patients do not show such effects.

Objective: We studied if the peri-operative use of HES is noninferior to crystalloids in terms of acute kidney injury. Secondary outcome was the noninferiority of HES on worsening of renal injury and/or the incidence of a composite endpoint of major complications and mortality until postoperative day 90.

Design: Randomised double-blind trial in patients undergoing elective abdominal surgery with expected blood loss at …

Feasibility And Preliminary Outcomes Of A Remotely-Delivered Exercise Training Intervention For English-Speaking Hispanics/Latinos With Multiple Sclerosis: Results From The Ferla Ms Study, Victoria A Flores, Stephanie L Silveira, David X Marquez, Dominique Kinnett-Hopkins, Augusto Miravalle, Fabian Sierra-Morales, Robert W Motl

Faculty, Staff and Student Publications

Background: There is limited evidence on the feasibility of remotely delivered exercise interventions for English-speaking Hispanics/Latinos with MS.

Objectives: To evaluate the feasibility and exploratory efficacy of a remotely-delivered, home-based exercise program for English-speaking Hispanics/Latinos with MS and to explore associations among feasibility metrics, outcomes, and social determinants of health (SDOH).

Results: Of 340 individuals contacted, 112 were eligible (33%), 33 enrolled (9.7%), 30 randomized, and 26 completed (87% retention). Adherence averaged 81% (exercise) and 89% (control). No serious adverse events occurred. Exploratory within-group improvements were observed in the exercise group for physical activity (p = 0.03, d = …

Understanding Practices Of Lactation And Infant Feeding Together With Women With Hiv: The Uplift Observational Study Protocol, Christiana Smith, Emily Anne Barr, Karen Hampanda, Mark Trumbull, Hulin Wu, Jennifer Mckinney, Sarah Buisson, Carly Hoffmann, Ciarra Brown, Angela B Hutchinson, K Rivet Amico, Ifeyinwa V Asiodu, Elizabeth J Mcfarland, Margaret A Lampe, Preetam A Cholli, Olga Varechtchouk, Allahna Esber, Athena P Kourtis, Lisa Abuogi

Faculty, Staff and Student Publications

Introduction: There is a limited understanding of infant feeding decisions, practices, and outcomes for women living with HIV (WLHIV) and their infants since U.S. guidelines were updated in 2023 to support breastfeeding for virally suppressed women on antiretroviral treatment.

Methods and analysis: The Understanding Practices of Lactation and Infant Feeding Together with women with HIV (UPLIFT) study is a convergent mixed-methods, multisite, observational study designed to address key knowledge gaps. Twelve US sites will begin enrollment in early 2026 to accomplish three core activities (CA). In CA1, we explore infant feeding decision-making and experiences via in-depth interviews with pregnant/postpartum WLHIV …

Evaluating Differences In Nonsyndromic Orofacial Clefts By Infant Sex: National Birth Defects Prevention Study, 1997-2011, Victoria A Salinas, Natalie P Archer, Layla R Lustri, Katherine L Ludorf, Timothy Ihongbe, Wei Yang, Eva M Williford, Marilyn L Browne, Adrian M Michalski, Lindsay A Williams, Wendy Nembhard, Eirini Nestoridi, Gary M Shaw, Andrew F Olshan, A J Agopian, National Birth Defects Prevention Study

Faculty, Staff and Student Publications

Objective: To investigate nongenetic factors that may contribute to observed differences in nonsyndromic orofacial clefts by infant sex.

Study design: Using data for 1997-2011 deliveries from the National Birth Defects Prevention Study, a case-control study, we separately examined associations between 23 maternal factors and cleft lip with or without cleft palate (CL/P) and cleft palate alone (CP) using multivariable logistic regression stratified by infant sex.

Results: We compared 2986 infants with CL/P and 1557 with CP to 11 271 control infants without birth defects. After adjusting for maternal age at conception and education, lower odds of nonsyndromic orofacial clefts were …

Predicting Tilt In Esports: A Psychophysiological Approach To Understanding Player Emotional Regulation, Nathan Rhea

University of the Pacific Theses and Dissertations

Emotional regulation and stress management are important to both casual and competitive esports players. When players become dysregulated, they experience a phenomenon known as “tilt” within the gaming community, where they often lose control of their emotions and their performance declines. This study aimed to investigate whether a psychophysiological variable in heart rate variability could predict tilt in college-age esports players. Additionally, the relationship between heart rate variability and emotions predicted by the Tiltometer system with gameplay performance and winning or losing was tested.

This study used a quantitative correlational research design. Participants for this study were college-age players (N=23) …

Transitioning To Life After Sport: Empowering Former College Varsity Athletes To Live More Healthfully, Linda Piacentine, Taylor L. Wolf, Jacob J. Capin

Physical Therapy Faculty Research and Publications

Introduction: 

The transition out of competitive sport comes with a range of psychosocial challenges for athletes, particularly when retirement is involuntary (e.g., due to injury). Little is known about the health of former athletes who often manage prior injuries and changing biopsychosocial factors.

Purpose: 

Identify the unique experiences of varsity athletes during college and as they transition to life after college sports and determine the facilitators, barriers, and needs of college varsity athletes to engage in a physically active and healthy lifestyle after competitive sport retirement.

Methods: 

Thirty former college varsity athletes (15F, 15M; mean age 23 ± 1 yrs; …

Genomic Determinants Of Appetite Regulation And Their Role In Obesity Risk, Timothy J. Renier

Dartmouth College Ph.D Dissertations

Over 40% of US adults and 20% of children live with obesity. It is related to increased risks of diseases including type II diabetes and cancer, is a source of harmful stigma, and impairs child development. Appetitive traits describing patterns of food approach and avoidance behaviors may serve as windows into the underlying pathophysiology of obesity. As both obesity and appetitive traits are heritable, common genetic drivers of obesity may lead to phenotypic obesity through appetitive traits as a disease mechanism. Additionally, GLP-1 receptor agonists (GLP-1RAs) have been shown to exert their profound clinical effects in part by modulating appetite. …

The Structure, Dynamics, And Impact Of An Interbacterial Weapon Encoded By Human Gut Bacteria, Casey John Latario

Dartmouth College Ph.D Dissertations

The human gut is densely colonized by diverse bacteria. Over a human’s growth, the GI tract becomes a dynamic community that is subjected to a continual in-flow of nutrients and would-be colonizers and an out-flow of microbes and waste products. Despite these dynamics, the bacterial community often displays stability, with particular strains persisting over decades. These stable colonizers have evolved mechanisms to bolster their colonization, resist disruption by other microbes, and persist through environmental flux.

Both interbacterial competition and horizontal gene transfer (HGT) contribute to colonization and survival within the GI tract. A major mechanism for interbacterial competition is the …

Health And Nutrition In The First 1000 Days Of Life, Yaojiang Shi, Qi Zhang, Yiliang Zhu, Jingchun Nie

Health Behavior, Policy & Management Faculty Publications

Malnutrition and health issues remain persistent global crises, with developing regions bearing the brunt of the burden. According to the World Health Organization, nearly half of under-five deaths in low-and middle-income countries are linked to malnutrition, while stunting, wasting, and micronutrient deficiencies impair the development of millions of children annually. The studies in this special issue focus on countries facing distinct yet interconnected challenges: Sub-Saharan African nations grapple with high rates of stunting and maternal high-risk fertility behaviors; China confronts rural-urban disparities in dietary diversity and grandparenting practices; Colombia struggles with intersectional inequalities driving infant mortality; and Zambia faces unique …

Advancing Food Equity Through Explainable Ai (Xai): Identifying Place-Based Factors And Conditions Of Food Security, Leslie Hoglund, Hyoshin Park

Health Behavior, Policy & Management Faculty Publications

Food behaviors, food security, and their association with socioeconomic factors constitute a critical area of study with implications for public health, economic stability, and social equity. Understanding these relationships are essential for developing effective policies and interventions that promote sustainable, healthy food systems and greater food equity. This paper employs explainable artificial intelligence (XAI) methods to identify key features influencing household food behaviors. The insights gained from the XAI analysis are further utilized in conjunction with inverse reinforcement learning (IRL) to examine expert behaviors related to eating habits satisfaction. The XAI results reveal that household health conditions, spending patterns, and …

Recognizing Excellence: Key Traits, Qualities, And Behaviors Of The Exceptional Fieldwork Educator In Occupational Therapy, Piper Hansen, Lydia H. Schallenberg, Jayde M. Kahn, Jacqueline Rizzi, Ariel Torres

Journal of Occupational Therapy Education

All students of occupational therapy enrolled in accredited programs are required to complete Level I and Level II fieldwork experiences. A critical factor in shaping successful fieldwork experiences is the fieldwork educator, who guides clinical learning, models professional behaviors, and supports skill development for practice readiness. Despite the importance of the fieldwork experience, the fieldwork educator, and the impact of the supervisory relationship, there is limited understanding of the unique attributes and strategies that distinguish exceptional occupational therapy fieldwork educators. This study sought to investigate the key traits, qualities, and behaviors of the exceptional fieldwork educator in occupational therapy and …

Association Between A Lifestyle Medicine Score And Stroke In U.S. Adults With Hyperglycemia: 2007- 2010 Nhanes, Swarnima Naithani

UNF Graduate Theses and Dissertations

The relationship between glycemic control and cardiovascular disease (CVD) is well- established, however, lifestyle modifications to prevent CVD warrant further investigation. Purpose: This study aimed to evaluate the relationship between adherence to the six lifestyle medicine pillars promoted by the American College of Lifestyle Medicine and stroke in U.S. adults with hyperglycemia. A lifestyle medicine composite score (LMS) was developed to quantify adherence with the hypothesis that a higher LMS (greater adherence to lifestyle recommendations) correlates with lower odds of stroke in adults with hyperglycemia. Methods: The study sample (n=2,079) included adult (≥ 40 years of age) participants in the …

Stress Dynamics Between Clinical Supervisors And Allied Health Students: A Scoping Review, Piao Wang, Laurie Peebles, Aine O'Connor, Xinrong Li, Yongsheng Wang

Funded Scholarship

Stress within clinical supervision in allied health education functions as a reciprocal and relational process that shapes both learning and professional development. This scoping review synthesizes findings from 54 studies published between 1980 and 2024 to examine how stress is experienced, transmitted, and managed between students and clinical supervisors. Four interconnected domains were identified through the synthesis: the supervisory relationship, systemic and contextual pressures, personal factors, and the placement environment. Together these domains illustrate how organizational demands and supervisory strain influence student engagement, feedback processes, and educational outcomes. The literature provides valuable descriptive insight but remains fragmented, methodologically inconsistent, and …