Digital Commons Network^™

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 …

Choline Counteracts Pregnancy Undernutrition-Associated Colitis In Sheep By Restoring Microbiota Driven Bile Acid Metabolism, Weibin Wu, Peng Jiao, Yamei Gu, Huizhen Lu, Caiyun Fan, Zheng Sun, Lizhuang Hao, Shengyong Mao, Jianbo Cheng, Yanfeng Xue

Faculty, Staff and Students Publications

High-fertility sheep experience undernutrition during late gestation, which induces body metabolic disruption and intestinal inflammation. Crucially, the gut microbiota-bile acid axis is a promising intestinal inflammation target, but how choline modulates this axis in livestock enteritis is unknown. This study investigated choline's protective mechanisms against undernutrition-induced intestinal inflammation in sheep, focusing on gut microbiota and bile acid regulation. Choline consistently alleviates colitis severity, restores epithelial barrier integrity, and suppresses intestinal inflammation. These protective effects are accompanied by pronounced remodeling of the colonic microbial ecosystem, characterized by the enrichment of Clostridiales bacterium to elevate bile salt hydrolase activity and regulate bile …

Can Behavioral Interventions Promote Health Equity In Pediatric Type 1 Diabetes? A Narrative Review Of Promising Treatments, Paul T. Enlow, Jaquelin Flores Garcia, Julia Price, Kristen A. Torres, David V. Wagner

Department of Pediatrics Faculty Papers

Purpose of review: Synthesize data on whether existing behavioral interventions can improve health equity among youth with type 1 diabetes.

Recent findings: While existing behavioral interventions demonstrated efficacy in improving health and/or psychosocial outcomes, evidence that these same interventions may improve health equity were lacking. Most interventions were evaluated using predominantly White and affluent samples and some studies did not report on racial, ethnic, or sociodemographic characteristics of their sample. Only a few interventions have been adapted for youth from minoritized backgrounds. Recent multisystemic and technology/mHealth interventions recruited samples that were sociodemographically representative of youth experiencing disparities, suggesting that these …

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 …

Rural-Urban Differences In Hypertension Prevalence And Control In A Large Regional Health System Cohort, Yordanos M Tiruneh, Susan Mcbride, Huaxin Song, Matthew Decaro, Alaa Rihan, Theresa Byrd, Alex Baham, Jared W Magnani, Elmer V Bernstam, Jarett D Berry

Faculty, Staff and Student Publications

Background: Rural US populations bear a high burden of cardiovascular disease, with hypertension contributing to the rural-urban gap. We examined hypertension prevalence and control across the rural-urban continuum among patients in a large healthcare system in Northeast Texas.

Methods: We analyzed the electronic health record data from 363,539 patients with at least one outpatient encounter between September 2021 and April 2025. We defined hypertension using ICD-10-CM codes, antihypertensive prescriptions, or a blood pressure ≥ 130/80 mm Hg. We classified rurality using the Rural-Urban Commuting Area categories. Multivariable logistic regression models were adjusted for age, sex, race, ethnicity, insurance, and level …

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 …

Assessing Impact Of Heat Waves On Pregnancy And Lactation Amidst Climate Change: A Scoping Review., Susan Anyango, Grace Nakate

School of Nursing & Midwifery, East Africa

Background: The escalation of heat waves, attributed to climate change, represents a global public health concern, with pregnant
and lactating women identified as particularly vulnerable due to Physiological and hormonal changes.

Aim: To review the existing research on the effects of heat waves on pregnancy and lactation, identifying potential health risks and outcomes.

Methods: A structured search across PubMed, Scopus, Web of Science, and Google Scholar was conducted using terms related
to heat waves, pregnancy, lactation, and climate change. Inclusion criteria focused on peer-reviewed empirical
studies in English.

Results: Heat waves are linked to increased risks of preterm labor, low …

Associations Among Pork Intake, Weight-Loss, And Diet Quality Outcomes In A Commercial Weight-Management Program, Ana M Palacios, Grace Anderson, Beate Henschel, Alexandra M Lee, Kelli M Richardson, Chelsie Parker, Stephanie L Dickinson, Jing X Kersey, David B Allison, Gary D Foster, Michelle I Cardel

Faculty, Staff and Students Publications

Background: Pork is a common source of high-quality protein. However, it is typically recommended in moderation due to its saturated fat content, especially as its role in weight management, weight-loss (WL) programs, and overall diet quality is not well understood. This study aimed to identify associations among pork intake, WL, and diet quality among adults with overweight or obesity participating in a weight management program (WMP).

Methods: This secondary analysis used data from a 6-month randomized controlled trial (NCT05648344) evaluating the effectiveness of a WMP on diet quality. Data were collected through online surveys and the Automated Self-Administered …

Target Trial Of Glucagon-Like Peptide-1 Agonists Versus Dipeptidyl Peptidase-4 Inhibitors And Mortality In Hemodialysis, Dustin Le, Duncan Kilpatrick, Walter K. Kraft, Morgan E. Grams, Bernard G. Jaar, Jung-Im Shin

Division of Nephrology Faculty Papers

INTRODUCTION: The comparative effectiveness of glucagon-like peptide-1 (GLP-1) agonists (GLP-1s) versus dipeptidyl peptidase-4 (DPP-4) inhibitors (DPP-4s) in hemodialysis is unknown.

METHODS: Using 2011 to 2021 US Renal Data System and Medicare claims data, we emulated a target trial comparing new users of GLP-1s versus DPP-4s with patients who survived ≥ 90 days on in-center hemodialysis before medication initiation. We used inverse probability of treatment weighting (IPTW) and Cox proportional hazards models to estimate hazard ratios (HRs).

RESULTS: We identified 3671 GLP-1 and 12,039 DPP-4 users. After IPTW, mean age was 63 years, 52% male, 63% White, and mean body mass …

Do Rural-Urban Disparities Translate Into Nursing Complexity At Hospital Admission? Evidence From A Single Tertiary-Care Pediatric Hospital In Italy, Manuele Cesare, Gianfranco Damiani, Gloria Anderson, Jessica Preziosi, Rosemary Frasso, Leonardo Villani, Nursing And Public Health Group, Vittorio Maio, Antonello Cocchieri

College of Population Health Faculty Papers

BACKGROUND/OBJECTIVES: Rural-urban disparities are well documented in pediatric healthcare, influencing access, service organization, and outcomes. However, whether these differences extend to the domain of nursing care remains unclear. This study examined the association between degree of urbanization and nursing complexity among children admitted to a single tertiary-care pediatric hospital, comparing clinical, organizational, and nursing characteristics across geographic groups.

METHODS: Routinely collected electronic nursing documentation and hospital administrative records were retrospectively examined in a tertiary-care pediatric hospital in Rome, Italy. Children aged 2 to < 18 years were consecutively included. Degree of urbanization was defined using the ISTAT-derived DEGURBA classification. The study outcome for nursing complexity corresponded to the number of nursing diagnoses documented at hospital admission. Descriptive analyses and a multivariable negative binomial regression model assessed the association between urbanization and nursing complexity, adjusting for age, sex, DRG weight, number of medical diagnoses, and chronic conditions.

RESULTS: Among 1652 pediatric hospitalizations, those from rural areas showed a higher clinical burden, with significantly higher …

Food Insecurity And At-Home Vegetable And Sugar-Sweetened Beverage Availability: Tx Sprouts Randomized Controlled Trial, Keally Haushalter, Shreela V Sharma, Marissa Burgermaster, Natalie S Poulos, Erin A Hudson, Jennifer M Daspin, Mariela Jimenez Rivero, Jaimie N Davis

Faculty, Staff and Student Publications

Food insecurity and the at-home availability of vegetables and sugar-sweetened beverages both influence dietary intake. However, most research on food insecurity and the at-home availability of vegetables and sugar-sweetened beverages is cross-sectional, which is problematic as both change frequently. Therefore, this study assessed how changes in food insecurity were associated with changes in the at-home availability of vegetables and sugar-sweetened beverages among those in the intervention and control groups of TX Sprouts. Parents who participated in TX Sprouts, a gardening, cooking, and nutrition cluster-randomized trial conducted with primarily Hispanic, low-income 3rd-5th-grade students, completed surveys at baseline and at the nine-month …

Food Insecurity And Mental Health Among High School Students: Evidence From National And Virginia Youth Risk Behavior Surveillance Data, Nigel C. James, Asef Raiyan Hoque, Jada Pedersen, Huong Doan, Liam Hayes, Leah Suggs

Health Studies Faculty Publications

Background

Youth mental health problems are rising nationally. Virginia ranks among the lowest states in youth mental health access and has concentrated pockets of food insecurity (FI), underscoring the urgency of policy responses. FI is a known risk factor, yet surveillance often relies on single-item measures. We introduce a multidimensional Food Insecurity Index (FII) to examine associations with adolescent mental health.

Methods

We analyzed 2023 Youth Risk Behavior Surveillance System data from Virginia (n = 1866) and the United States (n = 10,724). The FII combined five indicators capturing acute scarcity and chronic dietary compromise. Survey-weighted logistic regression …

Recognizing Early Eating Disorder Signs In Pediatrics, Sarah Gubara, Sara R. Gould

Pediatrics in Practice: A CME Podcast

A concise guide for frontline clinicians on early physical and behavioral red flags — changes in growth trajectory, micronutrient concerns, exam‑time anxiety or sudden “healthy” eating shifts. Dr. Sara Gould emphasizes practical 24‑hour recalls, when to order labs/EKG and how to use longitudinal data from well visits to detect problems sooner.

Click here to stream the podcast episode.

Probiotic Intake Related To Hemoglobin A1c Among U.S. Veterans With Type 2 Diabetes Mellitus, Maryann Martin

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education To Reduce The Incidence Of Pressure Injury In Medical-Surgical Inpatients, Francis Omelu

Walden Dissertations and Doctoral Studies

No abstract provided.

Caring For The Carers: Exploring The Mental Wellbeing Of Informal Palliative Caregivers Of Cancer Patients In Kenya, James Kariuki, Rose Njiraini

Journal of Global Awareness

Cancer cases have been on the increase globally, and this has led to economic burden on the affected households. One way of reducing the cost of care is through home-based care by informal palliative caregivers who include family members, friends, and other people assigned by the family members to take care of the patient. The objectives of this study were to assess the status of the mental wellbeing of palliative caregivers of cancer patients; to examine the relationship between the ability of the patient to cope with cancer diagnosis and the mental wellbeing of the caregiver; and to investigate the …

Exploring The Role Of Magnesium Deficiency In Inflammatory Bowel Disease, Victor A. Bob-Yellowe, Shaunte Hadnot, Sonya Bhatia, Anesu K. Murambadoro

MEDI 9331 Scholarly Activities Clinical Years

Inflammatory Bowel Disease (IBD) is a group of chronic gastrointestinal disorders, including Ulcerative Colitis and Crohn’s disease. As of 2020, it was estimated that IBD significantly impacts the lives of approximately 2.39 million Americans. Magnesium (Mg) is an essential mineral involved in many bodily functions, including immune response and gut health. Recent studies suggest that Magnesium levels may be linked to IBD. Therefore, this review aims to explain how Magnesium might play a role in the development or progression of IBD. Additionally, this article discusses the overall role that Magnesium’s plays in gut health and whether Magnesium supplementation could be …

Improving Nursing Compliance With Pressure Injury Prevention In Postoperative Patients In The Cardiovascular Intensive Care Unit, Chingyi Lam

Doctor of Nursing Practice Final Project Abstract

Pressure injuries acquired in the hospital continue to be a major concern in patient safety among critically ill populations. The purpose of the quality improvement project was to improve nursing compliance with pressure injury prevention strategies among postoperative patients in a cardiovascular intensive care unit (CVICU). Patients who undergo cardiovascular surgery are at a high risk of developing pressure injuries due to immobility, sedation, vasopressors, and prolonged positioning on their backs. The quality improvement project was carried out in a 37-bed CVICU using the Institute for Healthcare Improvement (IHI) Model for Improvement and Plan–Do–Study–Act (PDSA) cycles. Data on nursing repositioning …

Updated Trends In The Global Prevalence And Burden Of Mental Disorders, 1990–2023: A Systematic Analysis For The Global Burden Of Disease Study 2023, Damian F. Santomauro, Paul Anthony Miller, Jamileh Shadid, Sarah Wulf Hanson, Anh Vo, Darius Jake Roy, Hailey Hagins, Ana M. Mantilla Herrera, James G. Scott, Holly E. Erskine, John J. Mcgrath, Hasan Aalruz, Hedayat Abbastabar, Nadin M.I. Abdel Razeq, Ahmed Abdelrahman Abdelgalil, Ali Abdolizadeh, Deldar Morad Abdulah, Abisola Esther Abdulmalik, Meklit Girma Abebe, Mesfin Abebe, Habtamu Abebe Getahun, Roberto Ariel Abeldaño Zuñiga, Olifan Zewdie Abil, Richard Gyan Aboagye, Shady Abohashem, Abdullahi Tunde Aborode, Moaz Elsayed Abouelmagd, Mohammad T. Abuawwad

All Works

Background The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Methods Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual …

Examining The Ligands, Location, And Function Of Toll-Like Receptor 10, Kiefer Keanu Tam

Master's Theses

Toll-like receptors are a class of innate immune pattern recognition receptors that detect pathogen-associated molecular patterns and regulate downstream inflammatory responses. Toll-like receptor 10 remains the only human TLR whose ligand specificity, cellular localization, and immunological function are not fully defined. Emerging evidence suggests that TLR10 may play an anti-inflammatory role and can heterodimerize with TLR2 to modulate immune signaling. Previous studies from our laboratory demonstrated that stimulation with heat-killed Mycobacterium tuberculosis promotes TLR2-TLR10 heterodimerization and trafficking to the cell surface. In this study, we expanded our ligand panel to include additional gram-positive bacteria, particularly anti-inflammatory probiotic species, to further …

Psychological Strain And Infrastructure Deficit And The Decision To Migrate Among Healthcare Workers From Lagos, Nigeria, Fatima Adeboye

Walden Dissertations and Doctoral Studies

No abstract provided.

The Parent Phone Use Regulation Efficacy Scale (P-Pure): Initial Validation And Associations With Problematic Smartphone Use, Self-Regulation, Impulsivity, Mindfulness, And Self-Efficacy, Brandon T. Mcdaniel, Sabrina Uva, Adam M. Galovan

Health Services and Informatics Research

Parents often rely on smartphones in daily life. While smartphones offer benefits, they also present challenges, such as potential distraction and delayed responsiveness. It is also possible that problematic smartphone habits may develop, such as repeated checking or difficulty controlling use. Furthermore, self-efficacy around regulating one’s phone use is tied to the ability to change, meaning self-efficacy could be a key mechanism impacting the effectiveness of interventions regarding problematic phone use. Thus, we developed and explored the validity of the Parent Phone Use Regulation Efficacy Scale (P-PURE) to assess parents’ self-efficacy in managing phone use around their children. We developed …

Slouching Towards Inefficiency? The Cardiometabolic And Cognitive Costs Of Poor Posture, Ava Mae Fitzenrider

Honors Projects

Posture affects all of our lives. It is both static and dynamic, adapting continuously to environmental demands. One postural alteration frequently observed in occupational settings is hyperkyphosis, which can be induced by sitting position. During computer use, individuals commonly adopt a slouched posture, which can exacerbate hyperkyphosis, and contribute to dis-ease within the body. Previous research has demonstrated that such postural deviations can negatively affect pulmonary function, as well as other bodily functions. Despite these findings, the effects of acute hyperkyphosis (“slouching”) on cardiometabolic function and cognition remain largely unexplored. Therefore, the purpose of this study was to examine the …

Advancing School-Based Sexual Reproductive Health Education Through A Fifth-Grade Educator Toolkit, Emira Romero

Doctor of Nursing Practice (DNP) Projects

Background: Although sexual and reproductive health (SRH) education is a critical component of early health literacy and health promotion, educators remain underprepared to deliver this education. Local Problem: A gap analysis conducted at School A, a public elementary school in the San Francisco Bay Area, revealed the absence of a SRH curriculum for their fifth graders. Methods: A Doctor of Nursing Practice (DNP) student-led quality improvement project to introduce a SRH educator toolkit to increase educator confidence and self-efficacy was conducted at School A among fifth grade teachers. Pre- and post-intervention data were collected on implementation day to evaluate the …

Soft Power, Arab Media And Sports Mega Events: Coverage Of Fifa 2022 And Lessons For Future Arab Hosting, Lynne Kennedy, Maaira Shahbaz, Ala Al Rajabi

All Works

Sport mega-events (SMEs) increasingly transcend athletic competition, functioning as strategic instruments for national identity formation, statecraft, and soft power projection. This dynamic is particularly pronounced in the Gulf, where Qatar’s successful hosting reignited regional rivalries and attracted unprecedented global scrutiny. While existing scholars have extensively examined Western media portrayals of SMEs, a notable gap remains for academic engagement with Gulf media. Dismissed as state-controlled and analytically lacking, we contend that such media offer a rich site for exploring how small states use media as soft power, to construct and contest legitimacy, identity, and global influence. This analysis suggests how state-aligned …

Staff Education To Emergency Department Professional Nurses, Florence Chukwuneke Chukwuneke

Walden Dissertations and Doctoral Studies

No abstract provided.

Malnutrition At The Time Of Surgery Predicts Increased Morbidity After Distal Femur Fracture Fixation: A Propensity-Matched Analysis, Jawad Saad, Amir Ghafarian, Tyler Forbes, Muaaz Wajath, Noor Saad, Khaled Saleh

Medical Student Research Symposium

Abstract

Background: Distal femur fractures (DFF) are serious injuries most often affecting older adults with multiple medical comorbidities. Malnutrition is known to worsen outcomes in elective orthopedic surgery, but its impact in urgent DFF fixation, where optimization time is limited, remains unclear. This study evaluated whether preoperative malnutrition predicts 90-day morbidity after DFF fixation and whether implant choice influences risk among malnourished patients.

Methods: Adults undergoing operative DFF fixation from 2005–2025 were identified using the TriNetX U.S. Collaborative Network. Malnutrition was defined as serum albumin ≤3.5 g/dL or leukocyte count ≤1.5×10³/µL within one year preoperatively. After 1:1 propensity matching for …

Impact Of Dietician Counseling On Outcomes In Newly Diagnosed Celiac Disease, Andreas Mozny B.A., Alyusuf Elnaggar B.A., James Mo M.D., Suraj Suresh M.D.

Medical Student Research Symposium

Title: Impact of Dietician Counseling on Outcomes in Newly Diagnosed Celiac Disease

Background: Dietician counseling is routinely recommended for newly diagnosed celiac disease (CD), yet its measurable impact is not well defined. This study examined whether early dietician involvement improves clinical symptoms or serologic outcomes.

Methods: We retrospectively reviewed adults with biopsy-confirmed CD at a single center from 2020–2024. Demographics, symptoms, and laboratory data were collected by chart review with ≥6 months of follow-up. Patients who met with a dietician formed the dietician group; all others were assigned to the non-dietician group. Fisher's Exact tests evaluated abdominal …

Twice As Long, Half The Risk: Piccs Outperform Cvcs In Pediatric Burn Patients, Christian Hudson-Bradford Md, Megan Zacarias Bs, Samantha Carranza Bs, Elika Ridelman Phd, Christina Shanti Md

Medical Student Research Symposium

Title: Twice as Long, Half the Risk: PICCs Outperform CVCs in Burn Patient

Christian Hudson-Bradford MD, Megan Zacarias BS, Elika Ridelman PhD, Samantha Carranza BS, Christina Shanti MD

Background: Venous access is critical in burn care for fluid resuscitation, medication delivery, and nutritional support. While central venous catheters (CVCs) are traditionally used, peripherally inserted central catheters (PICCs) offer an alternative option with a potentially favorable safety profile, longer dwell time, and reduced need for re-insertion. This study compares patient characteristics, complication rates, and catheter duration between PICC and CVC lines in pediatric burn patients, advocating for early PICC …

Effect Of Spry Of Potassium Ratio And Cycocel On Physiological Traits Of Maize (Zea Mays L), Asmaa Mohammed Hussein, Eabdallah Yasin Ali

AUIQ Complementary Biological System

The aim of this work was to investigating the effect of foliar application of potassium (K) and the growth regulator Cycocel (CCC) on the physiological traits of maize (Zea mays L). The experiment was designed using a split-plot arrangement within a randomized complete block design (RCBD) with three replicates. The treatments included foliar application of potassium at concentrations of 500, 1000, and 1500 mg.L^–1, as well as three concentrations of the growth regulator Cycocel (0, 150, and 200 mg.L^–1). The results indicated a significant increase in Protein (P), phosphorus, and carbohydrate contents at the concentration of …