Digital Commons Network^™

Gastrointestinal Fistulas-What Gastroenterologists Need To Know In 2025, Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Gastrointestinal fistulas are increasingly being encountered in our clinical practice because of the increased burden of Crohn's disease, bariatric surgeries, interventional endoscopic procedures, nonsurgical trauma, and war and disaster zones worldwide. Presentation depends on the location and specific type of the fistula. Symptomatic ones can have a tremendous impact on social life and can cause dehydration, electrolyte imbalance, malnutrition, increased morbidity, and mortality. Different imaging studies and endoscopic procedures are done to establish the diagnosis. Treatment modalities to close the fistula depend on the underlying disease and the type of fistula. They include conservative treatment, medical therapy, endoscopic interventions, and …

Cardiometabolic Outcomes In The Obese African American Population With Rheumatoid Arthritis, Cecilia Jillo Walan

Walden Dissertations and Doctoral Studies

Rheumatoid arthritis (RA) disproportionately impacts African American adults, particularly those with obesity, due to overlapping cardiometabolic risks and health care disparities. The intersection of RA, obesity, and chronic conditions such as cardiovascular disease (CVD) and hypertension underscores the need for targeted public health interventions. This study investigated the association between RA and cardiometabolic outcomes among African American adults with obesity, aiming to identify significant predictors within this high-risk population. This quantitative study employed a cross-sectional design to analyze data from the 1999–2018 National Health and Nutrition Examination Survey undergirded by the social ecological change framework with N=23644 African American adults …

Staff Education Program On Medication Reconciliation In Primary Care, Virginia Ann Bloomer

Walden Dissertations and Doctoral Studies

Medication errors represent a persistent threat to patient safety, particularly during transitions of care in outpatient settings. Despite recognition of the problem, standardized medication reconciliation practices among primary care physicians and nurse practitioners (NPs) remain inconsistent, hindered by varied workflows, unclear responsibilities, and knowledge gaps. To address these issues, a staff education program focusing on medication reconciliation was introduced to seven NPs and three physicians in a primary care clinic. Pre- and post-intervention surveys measured participants’ knowledge and confidence in conducting medication reconciliation and documenting medications in electronic medical records. The average test score improved from 68% to 92%, demonstrating …

The Effects Of Moderate-Intensity Physical Exercise And Yoga Interventions On Stress In Hispanic College Students: A Pilot Study, Hongxing Lu, Florentino Saenz, Preethi Raju, Ednia Gutierrez, Sue Anne Chew, Saraswathy Nair

Health & Biomedical Sciences Faculty Publications

Background: Hispanic college students face high stress, which may increase their risk for chronic stress-related health issues. Effective and accessible stress management strategies for this population remain limited. Objective: This pilot study filled a gap by studying the effects of psychological stress on diet and physical activity habits and evaluating the impact of moderate-intensity physical exercise (MIPE) and yoga interventions on chronic psychological stress and acute stress responses among Hispanic college students. Methods: A total of 18 Hispanic college students participated in a 6-week intervention consisting of either MIPE or yoga, conducted twice weekly. Anthropometric measurements and lifestyle data were …

Vitamin D Deficiency And Its Role In Pathologies Of Oxidative Stress: A Literature Review, Philippe Dentino, Johanna Mora, Li Zuo

School of Medicine Publications

Vitamin D (VD) is a key mineral providing critical modulation of reduction-oxidation homeostasis within biological systems. VD and the VD receptor coordinate essential cellular activities, including mitochondrial electron transport, respiration, antioxidation, gene regulation, and calcium transportation. Reactive oxygen species (ROS), a natural by-product of cellular metabolism, play a prominent role in the mechanisms of biological antioxidant systems and form the basis of antioxidant therapies. However, ROS may also perpetuate pathological processes when produced in excess secondary to inflammatory pathways. Aging processes within cells rely on this reduction-oxidation homeostasis. Thus, the interaction with VD, its receptor, mitochondria, and oxidative stress forms …

Senior Living: Filling The Gap, Katy J. Johnson

The Interactive Journal of Global Leadership and Learning

This white paper explores how colleges and universities can help address the housing crisis for Americans aged 65 and older by integrating seniors into college campuses. This approach not only helps to fill dormitories but also provides students with valuable work experience. The paper examines three key issues: the Silver Tsunami (the growing senior population), declining enrollment leading to campus housing vacancies, and the financial burden of higher education. By advocating for intergenerational living, the proposal offers an innovative solution that benefits seniors, students, and universities.

Effect Of Whole-Food Plant-Based Diet On Ldl Cholesterol: A Scoping Literature Review, Joel Gregory Mueller

Nursing Capstones

Background: The whole-food, plant-based (WFPB) diet includes whole grains, whole plants, unrefined sugars, beans, and legumes. The diet excludes meat, dairy, and added fats. The diet has been popularized by documentaries .The diet claims to lower total and LDL cholesterol to a safe level as both a primary and secondary mode of prevention.

Purpose: Review existing studies to see whether the WFPB diet will lower LDL cholesterol in adult males over a 14 day or more duration.

Methods: A scoping literature review was completed of the University of North Dakota’s library system for keyword combinations. The returned 102 studies were …

Quality Improvement Project Integrating Educational Program For School Faculty In Childhood Diabetes, Sharon Anna-Marie Hill

Doctor of Nursing Practice Projects

In the United States, diabetes affects approximately 38.4 million individuals, including over 304,000 children and adolescents diagnosed with type 1 diabetes. As the most common chronic condition in children, diabetes management in school settings is critical to ensure health, safety, and academic success. However, a lack of standardized training for school faculty often results in inadequate knowledge and confidence in managing diabetes, exacerbating student health risks. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to develop and implement an educational program for school faculty, focusing on managing and treating childhood diabetes. A paired sample t-test was used …

Beyond Their Nutritional Value, School Meal Programs Support Agricultural And Food Transition Toward Sustainability By Creating Multi-Sectoral Values In France, Sylvie Avallone, Sophie Nicklaus, Céline Giner, Juliana Cohen, Stéphane Verguet

Health Sciences Faculty Publications

The COVID pandemic has highlighted the essential role of school meal programs, not only for education but also for children’s nutrition. In France, school meals are shaped by ambitious policies to ensure their safety and nutritional quality, while promoting sustainable eating practices and awareness of environmental and agricultural challenges. In this article, we used the case study of France to discuss the multi-sectoral value of these programs. The economic value of school meals in France amounts to €8.2 billion annually, of which 2.8 billion are dedicated to food purchases. Since 2022, the EGAlim and Climate and Resilience laws require canteens …

Quality Improvement Project The Impact Of Targeted Education And Training On The Use Of Rapid Mood Screener Tool On The Rate Of Mood Disorders Detection Among Psychiatric Providers, Oluwatobi Adeleke

Doctor of Nursing Practice Projects

Optimal mood disorder (MD) management outcomes are associated with accurate and timely diagnosis. Yet, MD misdiagnosis, particularly Bipolar I, is an unfortunately common problem. Rapid assessment or screening tools offer effective diagnostic assessment interventions for faster diagnosis without compromising effectiveness. Still, their administration is constrained by providers’ knowledge and competence limitations. The Rapid Mood Screener (RMS) is a rapid screener for MDs, including Bipolar I, with well-established specificity, accuracy, and reliability. Provider training and education on RMS implementation can be effective in addressing the challenges providers encounter in the tool’s administration. Here, through a pre-post quasi-experimental design, this quality improvement …

Non-Isolated Tetralogy Of Fallot (Tof+): Exome Sequencing Efficacy And Phenotypic Expansions, Julia Volpi, Xiaonan Zhao, Nichole Owen, Tia Evans, Muriel Holder-Espinasse, Nayana Lahiri, Eleanor Sherlock, Gemma Poke, Jeroen Breckpot, Koen Devriendt, Bjorn Cools, Alfredo Brusco, Giovanni Battista Ferrero, Enrico Grosso, Pradeep Vasudevan, Sara Loddo, Antonio Novelli, Maria Cristina Digilio, Aafke Engwerda, Marrit Hitzert, Alison Male, Lucy Bownass, Ruth Newbury-Ecob, Zosia Miedzybrodzka, Ruth Armstrong, Sally Ann Lynch, Gunnar Houge, Shiyi Xiong, Seema R Lalani, Jill A Rosenfeld, Pamela N Luna, Chad A Shaw, Daryl A Scott

Faculty, Staff and Students Publications

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect (CHD). TOF may present in isolation or in conjunction with one or more non-cardiac congenital anomalies or neurodevelopmental disorders (TOF+). Uncertainty regarding the efficacy of various genetic testing strategies, and an incomplete understanding of the genetic causes of TOF+, may lead to hesitancy in recommending genetic testing, particularly, clinical exome sequencing (cES). Here, we analyzed cES data from 131 individuals with TOF+. A definitive or probable diagnosis was made for 31 individuals, yielding a diagnostic rate of 23.6% (31/131). One individual received three diagnoses. Commercially available CHD panels …

The Interplay Of Oxidative Stress, Mitochondrial Dysfunction, And Neuroinflammation In Autism Spectrum Disorder: Behavioral Implications And Therapeutic Strategies, Ansab Akhtar, S K. Rahaman

School of Medicine Faculty Publications

Autism spectrum disorder (ASD) deals with several symptoms, including language and speech impairment and developmental delays. The main brain regions affected could be the prefrontal cortex (PFC) or the temporal lobe. The detrimental features could include oxidative stress, mitochondrial dysfunction, and neuroinflammation. Most often, these phenomena are interrelated and can lead to one another, creating a vicious cycle. They also influence the regulation of certain genes involved in the pathogenesis of ASD or related behavior. In the brain regions prone to these detrimental features, a cascade of free radicals, inflammatory cytokines, and mitochondrial energy disruptions is initiated. These actions during …

Mental Distress And Resource Insecurity In The Kingdom Of Tonga After The 2022 Volcanic Eruption: Associations Of Water And Food Insecurity With Mental Distress, Hilary J. Bethanancourt, Indira Bose, Lupe Moala Tupou, Melissa Meinhart, Edward A. Frongillo Jr. Ph.D., Amelia Greaves, Sera L. Young

Faculty Publications

Background Water and food insecurity can harm mental health; all 3 may, in turn, be exacerbated by humanitarian crises. The linkages between food insecurity, water insecurity, and mental health are gaining attention but have not been investigated after a natural disaster.

Objective To investigate the associations between food insecurity, water insecurity, and mental distress, and how these relationships may differ between women and men, in the aftermath of the January 15, 2022, volcanic eruption in the Kingdom of Tonga.

Design Secondary analysis of nationally representative cross-sectional data from the Equality Insights Rapid survey collected 4 to 5 months after the …

Digital-Based Nutrition Interventions Employing The Dietary Approaches To Stop Hypertension (Dash) Diet: A Systematic Scoping Review, Elizabeth Dodge, Patricia J. Kelly, Basil H. Aboul-Enein

College of Nursing Faculty Papers & Presentations

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is an internationally recognized anti-hypertensive dietary model. This systematic scoping review examines the effectiveness of digital-based interventions utilizing the DASH dietary pattern. Methods: A search was conducted using 14 databases to include relevant studies from 1997 to January 2025 using PRISMA guidelines for scoping reviews. Results: The review included 24 studies with almost 7000 participants, including randomized controlled trials and cohort studies conducted in several countries. Interventions using the DASH dietary pattern positively affected blood pressure (BP), nutrition behavior, and weight. Some studies also reported secondary outcomes such as reduced healthcare …

Factors Associated With The Use Of Combined Nutritional Complementary And Alternative Medicine Among Southern Us Older Adults: Results From The Study Of Aging Ii, Kristen Allen-Watts, Deanna Rumble, Taylor Taylor, Andrew Sims, Lisa H. Antoine, Georgiana Logan, Cynthia J. Brown, Thomas W. Buford, Burel R. Goodin, Andrea Cherrington, Richard Kennedy

School of Medicine Faculty Publications

Background: Older adults use nutritional complementary and alternative medicine (CAM) to reduce the risk of (or treat) non-communicable conditions and diet deficiencies. While prior research has explored the individual use of dietary supplements, vitamins, and minerals among older adults, few studies have examined factors influencing the combined use of these modalities, especially among Southern, older adults in the United States. Methods: Data were extracted from 419 participants from the University of Alabama at Birmingham Study of Aging II, a population-based longitudinal study of mobility among community-dwelling older adults. Self-reported data, including insurance and rural residence status, was collected. Comorbidity burden …

Waking Up The Youth: Sleep Is Essential For Health, Mansoor A. Rahman Mr

Manipal Journal of Medical Sciences

Letter to editor:

Waking Up The Youth: Sleep Is Essential For Health

According to the World Sleep Society, sleep, like good food and exercise, is a behavior essential to physical, mental and social well-being. Adequate sleep at appropriate time is necessary for optimal health and safety, while changes in sleep time and duration are intertwined with a variety of metabolic, cardiovascular, endocrine, and neurological disorders^1,2.Therefore,sleep, which is directly related to health and quality of life, is considered a basic human need to maintain his/ her bio-psycho-social and cultural functions³.

The timing and duration of sleep for …

Polo-Like Kinase 1 Inactivation Enhances Pi3k Inhibition-Mediated Apoptosis Of Notch1-Mutant Head And Neck Squamous Cell Carcinoma, Pooja A Shah, Tuhina Mazumdar, Soma Ghosh, Lacin Yapindi, Reid T Powell, Yong S Park, Li Shen, Anne M Fernandez, Clifford C Stephan, Jing Wang, Andrew G Sikora, Jawad Kazi, Mitchell J Frederick, Faye M Johnson

Children’s Nutrition Research Center Staff Publications

PI3K inhibition causes apoptosis selectively in NOTCH1-mutant head and neck squamous cell carcinoma (HNSCC), but modest single-agent responses and acquired resistance (AR) limit the clinical efficacy of targeted agents. To address these limitations, we investigated novel combination therapies. We tested the efficacy of 5768 compounds as single agents and 139 in combination with PI3K inhibitors in sensitive and AR NOTCH1-mutant HNSCC cell lines. We generated synergy/efficacy classifications for the combinations using multiple metrics of statistical drug synergy and growth rate indices. The PLK1/PI3K combination's efficacy was validated using orthogonal in vitro methods and in two HNSCC xenograft models. Compound efficacy …

Impact Of A Multi-Strain L. Crispatus-Based Vaginal Synbiotic On The Vaginal Microbiome: A Randomized Placebo-Controlled Trial, Jacques Ravel, Sheri Simmons, Eleni Greenwood Jaswa, Sara Gottfried, Miriam Greene, Susan Kellogg-Spadt, Dirk Gevers, Diane M. Harper

Institute of Emerging Health Professions Faculty Papers

A clinical trial of a multi-strain vaginal synbiotic (NCT05659745, registered 12/19/2022 at clinicaltrials.gov) led to an optimal vaginal microbiome dominated by L. crispatus (CST I). The synbiotic led to a significant increase in L. crispatus compared to placebo (p <  0.05), and conversion to CST I was significantly higher with the vaginal synbiotic than with placebo (90 vs 11%; p <  0.002). Mechanistically, the synbiotic reduced Gardnerella vaginalis and Candida, clinically important microbes.

Educational Lifecycle: Transitioning From Undergraduate To Graduate-Level Expectations, Khalil A. Mrabe, Rosie Defeo, Arlenys Loffredo

Internet Journal of Allied Health Sciences and Practice

The World Health Assembly has recognized the current and future place of education, training, and development within their 2030 global strategy. While education in allied health professions continues to evolve, limited information is known about the challenges graduate students face when transitioning into these programs. In response to recent societal and educational shifts, a systematic review was conducted to explore the academic, psychological, social, and professional barriers affecting first-term allied health students. Utilizing the SPIDER framework along with searching across different platforms (Psychinfo, Web of Science, and ProQuest) to locate peer-reviewed studies published within the last five years. Forty-seven studies …

Dietary, Behavioral, And Psychosocial Factors Related To Cardiovascular Disease Risk Among South Asian Americans: A Scoping Review, Lakshmi Meyyappan, Peggy A. Ursuy, Olivia S. Anderson

Internet Journal of Allied Health Sciences and Practice

Purpose: South Asian Americans disproportionately represent the world’s prevalence of cardiovascular disease. This scoping review assessed the dietary and psychosocial factors associated with cardiovascular disease risk that South Asian Americans encounter and concluded with considerations for health professionals who encounter this population in practice. Method: Inclusion criteria included studies with the primary population as South Asian Americans and investigated diet or psychosocial factors as variables and cardiovascular disease as an outcome variable. Results: Thirteen studies were included. Analysis of nutritional factors showed that South Asian Americans have high dietary quality yet eating non-vegetarian diets and high alcohol consumption is associated …

Preventing Nurse Burnout Through Self-Care Strategies, Doris Iwuh

Walden Dissertations and Doctoral Studies

Executive Summary: Staff Education Project Preventing Nurse Burnout through Self-Care Strategies by Doris Iwuh MS, Walden University, 2022 BSN, Grand Canyon University, 2020 ADN, Radiance College, 2016 Executive Summary Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2025 Summary An outpatient mental health clinic identified a rise in burnout among psychiatric nurse practitioners, licensed therapists, and social workers. A gap in practice revealed that staff lacked knowledge of self-care strategies to manage burnout, leading to the project question: Does implementing an educational program for nurses and mental health specialists on …

Chew On It: A Pilot Study Of A Multimodal Assessment Of Mastication Protocol, Michelle Catão

Electronic Theses and Dissertations

Despite its subconscious nature, deglutition is an elaborate and multifaceted process, contingent on the activation of specific neural pathways and muscles. The inherent complexity gives rise to a wide array of potential complications and difficulties, known as dysphagia. Screening and assessment for dysphagia aid in determining the presence and etiology of swallowing difficulties, providing information that is critical for maintaining and improving the health status of vulnerable populations from the standpoint of nutrition, hydration, and socialization (Dziewas et al., 2017). Previous studies surrounding dysphagia assessment have prioritized formulating clinical protocols to evaluate the nonvolitional stage, often failing to address the …

Exploring The Self-Efficacy And Experiences Of Caregivers Using Thickened Liquids To Manage Pediatric Dysphagia, Jaimee E. Conmy

Electronic Theses and Dissertations

Pediatric dysphagia affects 1 in 37 typically developing children under five, with increased prevalence in at-risk populations. Thickened liquids are often used as an intervention despite limited evidence supporting their effectiveness in the pediatric population. Caregivers play a critical role in managing their child’s dysphagia, yet their experiences, self-efficacy, and challenges with thickened liquids remain underexplored. This mixed-methods study surveyed 57 caregivers of children on thickened liquid diets, to assess their self-efficacy, education, perceptions of effectiveness, and overall impact on their quality of life. Findings highlight gaps in caregiver training, concerns about preparation, and benefits and/or challenges experienced by caregivers. …

The Effects Of A Breastfeeding Educational Program On Nurses’ Self-Efficacy And Knowledge, Amanda Quinn

Doctor of Nursing Practice Projects

Breastfeeding, a cornerstone of maternal and infant health, faces barriers due to inadequate healthcare provider education, contributing to low exclusive breastfeeding rates. The purpose of this quality improvement project was to evaluate the impact of a four-week educational program on clinical staff’s knowledge and self-efficacy in supporting breastfeeding in a rural OB/GYN clinic in central Florida. This project evaluated a four-week educational program’s effect on clinical staff’s knowledge and self-efficacy in supporting breastfeeding in a rural OB/GYN clinic in central Florida. Using a quasi-experimental pre-post design, nine licensed/certified staff (medical assistants, licensed practical nurses, registered nurses, advanced practice registered nurses) …

Sociodemographic, Neighborhood-Level, And Health-Related Factors Associated With Progression To Bariatric Surgery: A Retrospective Chart Review., Angela Godwin

Electronic Theses and Dissertations

Background: Bariatric surgery is the most effective treatment for patients with Class 3 obesity. However, of individuals who start the bariatric surgical process, only about half undergo surgery. Factors associated with completion, including race, have been described; however, consistent evidence on obstacles remains to be identified.

Objectives: To explore variables based on the Social Ecological Model (SEM) that may be related to bariatric surgery completion.

Setting: A large, private hospital with a Bariatric Center of Excellence in New York City

Methods: This retrospective chart review utilized data from adults who established an initial bariatric surgery visit from April 1, 2012, …

Describing Latent Tuberculosis Infection And Treatment Completion In Virginia: A Social Determinants Of Health Approach, Amber N. Harmon

Electronic Theses and Dissertations

While the treatment of latent tuberculosis infection is a key strategy in tuberculosis elimination nationally and globally, there is a limited understanding of the general prevalence of latent tuberculosis as well as factors related to successful treatment. This dissertation describes the known landscape of latent tuberculosis in Virginia and explores possible factors related to latent tuberculosis infection treatment through three manuscripts. The first manuscript, Chapter 1, outlines the overall proposal for this dissertation research in the style of a National Institute of Health grant proposal. The second manuscript, Chapter 2, describes the current understanding of the factors related to latent …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Dietary Protein’S Effect On The Gut Microbiome And Its Metabolites: Protocol Description And Virtual Recruitment Efforts For A Remote Randomized Controlled Trial, Karyn M. Gallivan, Kristin S. Ondrak, Denise M. Danos, Meng Luo, Christopher M. Taylor, Lauren E. Meyer, Ann M. Byerley, Alexander W. Nguyen, Sabyasachi Chatterjee, Jiri Adamec, Lauri O. Byerley

School of Medicine Faculty Publications

Fiber’s effect on our gut microbes has been studied extensively, while knowledge of the effect of protein is sparse. Colonic putrefaction of dietary protein is known to produce several potentially detrimental compounds. This randomized controlled trial (RCT) uses a pre- and post-study design to investigate the effect of consuming higher levels of dietary protein on the gut microbiota and the metabolites it produces. Here, we describe our virtual recruitment efforts and RCT protocol. Potential participants lived throughout the contiguous US. Several recruitment methods were employed, of which email reached the largest group of people (approximately 9,100) and generated a 0.3% …

Demographic And Clinical Predictors Of Metabolic Dysfunction-Associated Steatotic Liver Disease And Advanced Fibrosis In The United States, Gail Fernandes

Walden Dissertations and Doctoral Studies

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly nonalcoholic fatty liver disease-related liver fibrosis) is a growing public health problem in the United States. The purpose of this study was to assess the prevalence of MASLD-related advanced fibrosis in the United States and assess whether type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) were independent risk factors for MASLD-related advanced fibrosis. This study was a quantitative cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to 2020, grounded in the social ecological theory. Participants (N = 21,829) were included if they were ≥18 years, excluded if …

The Role Of Occupational Therapy In Addressing Physical & Psychosocial Health Needs Within The Dance Community To Optimize Artist-Athlete Longevity, Krista Narvasa Antonio

Occupational Therapy Student Capstones

Purpose: This capstone project seeks to advocate for holisitc and sustainable training approaches in dance by creating a system of improving awareness of current evidence-based protocols and practices surrounding dancer health.