Digital Commons Network^™

Tracking Towards Zero: Implementing A Picc Team Tracker To Prevent Clabsis, Carolina Maria Gerodias Cayetano

Master's Projects and Capstones

Background: Central line-associated bloodstream infections (CLABSIs) remain among the most serious and costly healthcare-associated infections in acute care settings, with each event associated with significant excess mortality, prolonged hospital stays, and avoidable healthcare costs. At Hospital A, a 239-bed acute care facility, two of six total CLABSI events over a 12-month period were associated with peripherally inserted central catheters (PICCs), representing 33% of all facility CLABSIs and exposing a critical gap in standardized PICC line surveillance and maintenance bundle monitoring.

Problem: The PICC team lacked a systematic, real-time tracking mechanism to monitor central line maintenance bundle adherence across seven adult …

The Correlation Between Ankle Proprioception And Lower Extremity Muscle Reactions In Response To Simulated Ankle Sprains, Erin Carroll, Justin Stanek, Abby Salvadore

Clinical Practice in Athletic Training

Context: Neurological structures of the somatosensory system provide proprioceptive and neuromuscular input regarding joint positioning to the brain. Lower extremity motor control relies on local proprioceptive input to the central nervous system and neuromuscular control of individual joints to produce coordinated, global responses to external events. The purpose of this study was to investigate the relationship between ankle proprioception and lower extremity muscle reaction time in response to an unexpected ankle inversion perturbation.

Methods: Twenty healthy college-aged volunteers were recruited to participate by word of mouth. Absolute and exact errors for passive joint position sense (PJPS) were assessed using a …

The Evaluation Of A Soft Skills Curriculum In Athletic Training Education: A Mixed Methods Study, Emily A. Duckett, Heather Schugar, Alison Gardiner-Shires, Jacqueline S. Hodes

Clinical Practice in Athletic Training

Context: Developing athletic training students’ soft skills to effectively engage in patient-centered care is integrated throughout multiple Commission on Accreditation of Athletic Training Education Curricular Content Standards. Despite evidence supporting the importance of compassionate care, there is currently data to suggest that health care is experiencing a compassion crisis. The purpose of this study was to investigate the ways pre-professional athletic training students transfer knowledge from a soft skills curriculum to clinical experiences as students in an entry level master’s program.

Methods: This study is an explanatory sequential mixed methods design. Phase 1 includes participants (n = 19) enrolled in …

Association Between Athletic Trainers And Frequency Of Pediatric Orthopedic Visits, Abaigeal Field, James M. Mensch, Courtney Meyer, Susan W. Yeargin

Clinical Practice in Athletic Training

Context: There is sparse research on the relationship between athletic trainer (AT) employment and the number of athletes presenting to orthopedic clinics with sports-related injuries. The purpose of this study is to determine if athletic training services are associated with the frequency of first-time orthopedic office visits for sports-related injuries.

Methods: A retrospective chart review collected injuries between January 1, 2018 and December 31, 2020 from the electronic health records system for a hospital network in the Southeast United States with 6 orthopedic clinics and included 48 high schools hosting 20 sports with at least 1 AT per school. Patients …

Validation Of A Home-Based Tool For Preschool Children Fall Prevention: A Rasch Analysis, Devie Fitri Octaviani, Fatma Lestari, Indang Trihandini, Dadan Erwandi

Kesmas

Unintentional falls are a leading cause of injury among preschool children, primarily occurring in home environments, yet validated tools to assess household fall prevention capacity in low- and middle-income countries remain limited. This study aimed to develop and psychometrically validate the Home-Based Preschool Fall Prevention Instrument using the Rasch Measurement Model. A cross-sectional validation study was conducted in Depok City, Indonesia, involving 167 primary caregivers of preschool children enrolled in kindergartens selected through multistage cluster random sampling. The instrument was developed based on an etiological injury model, socio-ecological perspectives, and risk management principles, and comprised four main factors: child, home, …

Cost Analysis Of Rheumatoid Arthritis In Insured Patients And Its Determinant Factors: Data From A National Referral Hospital In Indonesia, Rudy Hidayat, Fara Fauzia, Mochammad Alfansyah Dhifanra, Aries Maulana

Kesmas

Rheumatoid arthritis (RA) leads to progressive functional impairment and considerable economic burden. This study estimated the annual (12-month) cost per patient among patients with RA and its determinant factors. A descriptive cross-sectional economic study of RA patients who had been treated for at least one year at the outpatient clinic of a national referral hospital in Jakarta, Indonesia, and met the 2010 ACR–EULAR criteria. Data collected from January 2023 to December 2024 were obtained from medical and billing records for demographic characteristics, direct medical costs, and DAS28-based disease activity, whereas non-medical and indirect costs were collected through structured patient interviews. …

Understanding Oral Habits And Malocclusion In School-Aged Children: Insights From Parental And Child Knowledge, Attitudes, And Practices, Maria Laurentia Sanjaya, Evan Raditya Pratomo, Markus Santoso, Agrippine Putricia Asaeli, Eveline Yulia Darmadi, Joy Janny Thenarianto, Jennifer Regina Putri Purwono, Eunike Jacquelyn Widarto

Kesmas

Malocclusion is a prevalent oral health problem in children associated with oral bad habits, yet the extent to which parental and child knowledge, attitudes, and practices (KAP) influence orthodontic status remains insufficiently understood. This cross-sectional study investigated relationships between parental and child KAP, oral habits, and malocclusion in school-aged children, involving 67 child–parent pairs from an elementary school in Surabaya, Indonesia. Parental and child KAP as well as child-reported oral habits were assessed using a validated questionnaire. Children subsequently underwent standardized clinical orthodontic examinations, including alginate jaw impressions to produce dental study models, which were evaluated using the Index of …

Determinants Of Multimorbidity Among Stroke Patients For Epidemiological Management In Indonesia's Agro-Coastal Communities, Krish Naufal Anugrah Robby, Isa Ma'rufi, Farida Wahyu Ningtyias, Latifatul Izzah, Nurjazuli Nurjazuli, Suhartono Suhartono, Muchlis Achsan Udji Sofro, Ida Srisurani Wiji Astuti, Olivia Listiowati Prawoto, Dedek Sutinbuk, Taufik Kurrohman, Elhoussin Ouassou

Kesmas

Multimorbidity remains a major public health challenge among stroke patients, particularly in agro-coastal communities characterized by socioeconomic vulnerability, limited healthcare access, and lifestyle changes. This study aimed to analyze the determinants of multimorbidity among stroke patients in agro-coastal communities. A quantitative observational analytical design was employed, involving 45 stroke patients selected through total sampling in Jember District, Indonesia. Data were collected through structured interviews, anthropometric measurements, and secondary health records. The model included biological, socioeconomic, healthcare access, and lifestyle as exogenous variables, with multimorbidity as the endogenous variable. Data were analyzed using PLS-SEM, including evaluation of measurement and structural models …

Provincial Disparities In Adolescent Fertility In Indonesia: An Ecological Analysis Of Child Marriage, Median Age At First Marriage, And Family Development Index, Andi Nisa Fathimiyah Afidah, Milla Herdayati

Kesmas

Adolescent fertility remains a public health concern in Indonesia, with substantial variations across provinces. However, the evidence explaining provincial disparities using population-level indicators remains limited. This study aimed to examine provincial disparities in adolescent fertility and assess the association of child marriage, median age at first marriage among women, and the Family Development Index called iBangga with adolescent fertility across Indonesia. This ecological, cross-sectional study used aggregated data from 34 Indonesian provinces. Descriptive statistics, spatial visualization, Pearson’s correlation, and multiple linear regression analyses were performed. The mean adolescent fertility rate was 25.0 births per 1,000 female adolescents aged 15–19 years, …

The Association Between Rapid Growth In Children Under The Age Of Five And Adolescent Obesity, Ratu Ayu Dewi Sartika, Fadila Wirawan, Iche Andriyani Liberty, Nurul Husna Mohd Shukri, Siti Arifah Pujonarti, Edy Purwanto, Munaya Fauziah

Kesmas

Early-life nutrition is a critical predictor of long-term health, yet the association between rapid early-childhood growth and adolescent obesity, particularly in relation to the “double burden of malnutrition,” remains under-researched in Indonesia. This study aimed to analyze the association between rapid growth and adolescent obesity. Data were obtained from the 1997, 2000, and 2014 waves of the Indonesian Family Life Survey (IFLS). This study included 641 children (aged 0–23 months at baseline) with complete anthropometric measurements across all three waves. Rapid growth was defined as an increase in z-scores of >0.67 in weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) between …

Self-Management Interventions For Adults With Type 2 Diabetes Mellitus In Thai Primary Care And Community Settings: A Scoping Review, Sansanee Seetangkham, Supaluk Seetunya, Subhawan Yodprong

Kesmas

Diabetes mellitus is a leading cause of mortality and economic burden, with significant impacts on health outcomes and quality of life. Effective self-management is crucial for controlling Type 2 Diabetes Mellitus (T2DM). Thailand has implemented diverse self-management interventions for adults with T2DM in primary care and community settings, but the components, delivery, duration, and outcomes of these interventions have not been synthesized. Following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR, five databases were searched from inception to June 2025. Eligible English-language intervention studies involved Thai adults with T2DM in primary care or community settings. Study characteristics …

Environmental Perspective For System Dynamics Modeling Of Stunting Mitigation To Achieve The Sustainable Development Goals In West Sumatra, Indonesia, Elsa Yuniarti, Nabila Azzahra, Yulhendri Yulhendri, Heldi Heldi, Mery Delvina, Saskia Putri Azeli

Kesmas

This study developed a system dynamics model to simulate stunting reduction in West Sumatra Province, Indonesia, by integrating infant and toddler health, maternal health, and environmental determinants. Secondary data from 2020–2024 on low birth weight, immunization, malnutrition, exclusive breastfeeding, maternal chronic energy deficiency, iron and folic acid supplement distribution, sanitation, and safe drinking water access were compiled from West Sumatra Provincial Health Office and Statistics Indonesia, and validated through consultation with five stakeholder institutions. Causal Loop Diagrams mapped feedback relationships among determinants and were translated into Stock Flow Diagrams using Powersim Studio 10. The model was validated through structural verification, …

Gamclust: Identification Of Regulated Metabolic Modules In Bulk, Single Cell And Spatial Gene Expression Data, Anastasiia Gainullina, Evgeniia Chikina, Maxim N Artyomov, Alexey Sergushichev

2020-Current year OA Pubs

MOTIVATION: Metabolism operates as a highly interconnected biochemical network, and its regulation emerges from coordinated changes across many reactions and metabolites. The integration of gene expression profiling data with organism-scale metabolic networks has proven to be a valuable tool for understanding cellular metabolic regulation. However, the increasing complexity of profiling technologies and experimental designs requires the development of specialized tools.

RESULTS: Here, we present GAMclust, an R package implementing and extending the previously published GAM-clustering pipeline for identifying transcriptionally regulated metabolic modules in complex gene expression datasets. GAMclust supports bulk, single-cell, and spatial gene expression profiling. It includes built-in KEGG …

Searching The Druggable Genome Using Large Language Models, Lars Schimmelpfennig, Matthew Cannon, Quentin Cody, Joshua Mcmichael, Adam C Coffman, Susanna Kiwala, Kilannin Krysiak, Alex H Wagner, Malachi Griffith, Obi L Griffith

2020-Current year OA Pubs

SUMMARY: The druggable genome encompasses the genes that are known or predicted to interact with drugs. The Drug-Gene Interaction Database (DGIdb) provides an integrated resource for discovering and contextualizing these interactions, supporting a broad range of research and clinical applications. DGIdb is currently accessed through structured web interfaces and API calls, requiring users to translate natural-language questions into database-specific query patterns. To allow for the use of DGIdb through natural language, we developed the DGIdb Model Context Protocol (MCP) server, which allows large language models (LLMs) access to up-to-date information through the DGIdb API. We demonstrate that the MCP server …

“When I’M Not Heard, I Feel Like I Don’T Matter”: Advancing Equity In Disability Policy Through Critical Participatory Action Research With People With Intellectual Disability, Cris Marchionne

Student Theses

People with intellectual disability deserve a system that offers flexible, timely, and person-centered support — one that is innovative, sustainable, and holistic in enabling them to live fulfilling lives. This qualitative study, grounded in Critical Participatory Action Research (CPAR), examines how people with intellectual disability experience participation in decision-making within New York State's disability service system. By centering lived experience, the study identifies factors that facilitate or hinder participation in decision-making and examines structural, social, and policy-related barriers that limit agency. Through six focus groups and a Photovoice project with self-advocates receiving OPWDD services, participants described systemic barriers that limited …

Regional Plantar Pressure In The Transmetatarsal Amputation Limb Under Different Contralateral Limb Conditions: An Exploratory Case-Comparison, Hafizur Rahman, Sidketa Fofana, Gerrard Farrell, Luis Venegas, Javier La Fontaine

School of Podiatric Medicine Publications

Background: Transmetatarsal amputation (TMA) alters foot biomechanics and is associated with abnormal plantar loading that may contribute to plantar tissue breakdown. Although plantar pressure abnormalities following TMA have been reported, the potential role of contralateral limb status in regional plantar loading patterns remains incompletely understood. This exploratory case-comparison study examined plantar loading under two different contralateral limb conditions. Methods: This exploratory case-comparison evaluated in-shoe plantar pressure in two individuals with unilateral TMA: one with an intact contralateral limb and one with a contralateral transtibial prosthesis. Plantar pressure data were collected using a Pedar-X system during overground walking at a self-selected …

Genomic Characterization Of Er-Positive Primary Tumors And Corresponding Relapses Identifies Potentially Targetable Alterations, Caroline Schagerholm Stanev, Stephanie Robertson, Hosein Toosi, Emmanouil G. Sifakis, Jens Lagergren, Johan Hartman

Faculty, Staff and Students Publications

The majority of breast cancer patients have tumors expressing estrogen receptor α (ER) and receive endocrine therapy. However, around one-third relapse in their disease, predominantly with retained ER expression. Molecular alterations are proposed to be contributors to the resistance mechanisms. Patients with ER-positive, human epidermal growth factor receptor 2 (HER2)-negative primary breast cancer with an ER-positive relapse <  5 years of ongoing endocrine therapy were retrospectively assessed. Extracted DNA was analyzed through panel sequencing, and RNA by microarray, from patients’ primary (n = 58), and paired relapse tumors (n = 54), and tumor-free lymph nodes (DNA germline controls, n = 62). Several single-nucleotide variations and copy number variations showed nominal exploratory associations with worse overall survival. Copy number correlations with intrinsic subtypes and …

The Impact Of Partner Support On Vaginismus Treatment Outcomes: A Mixed Methods Study, Anna R. Ames, Alisha H. Redelfs, Nana Mensah

ScholarsArchive Data

A mixed-methods design was used to gain a nuanced understanding of how partner support affects the experiences of people with vaginismus.

Study aim: To guide partners of people with vaginismus in understanding how they can best help their partners with their vaginismus experience. 

• Quantitative Data: cross-sectional survey to reveal correlations in the relationship between vaginismus treatment outcomes and partner support [Available]
• Qualitative Data: Individual interviews to explore specific ways that people with vaginismus receive, or want to receive, support from their partners and the significance that they place on partner support  [Not Available]

Survey Data
Survey participants were recruited in …

Mitochondrial Trna-Derived Fragments As Candidate Metastasis-Modifying Rna, Katy L. Swancutt, R. Mckinnon Walsh, Sydney Quijano, Emily Schueddig, Devin C. Koestler, Adam D. Scheid, Tony Vanden Bush, Yi Jing, Isidore Rigoutsos, Danny R. Welch

Computational Medicine Center Faculty Papers

UNLABELLED: How mitochondrial DNA (mtDNA) polymorphisms influence complex phenotypes remains poorly understood. Using mitochondrial-nuclear exchange mice, we previously showed that mtDNA single-nucleotide polymorphisms (SNP) modify metastasis, cardiovascular disease, and epigenetic marks independently of metabolic differences. The only mtDNA SNP correlating with these phenotypes resides in the gene encoding mitochondrial transfer RNA (tRNA)-arginine [mt-tRNAArg (UCG), mt-TR], suggesting a role for non-protein-coding loci. In this study, we identify and preliminarily characterize previously undescribed tRNA-derived fragments (tRF) generated from mt-TRs. Northern blotting revealed distinct tRF that are differentially expressed among mtDNA SNPs, between lung and liver, and between sexes. Surprisingly, small RNA sequencing …

Nicotine Pouches: Harm Reduction Or Initiation Pathway? A Pharmacy-Focused Review, Emmanuel Fashesin Souza, Keykavous Parang

Pharmacy Faculty Articles and Research

Background

Nicotine pouches (NPs) are a rapidly growing category of tobacco-free oral nicotine products increasingly available in the community, including pharmacies. Whether NPs primarily function as harm-reduction tools for existing tobacco users or as a novel initiation pathway into nicotine and tobacco use, particularly among youth, remains a critical and unresolved clinical and public health question.

Objectives

To synthesize current evidence on the pharmacology, harm-reduction potential, and initiation risk of NPs; to compare NPs with U.S. Food and Drug Administration-approved nicotine replacement therapy and combustible cigarettes; and to identify implications and counseling priorities for pharmacy practice.

Methods

A narrative evidence …

Independent Associations With Research Productivity Among U.S. Academic Ophthalmologists Using The Us-Aofd, Brenton T. Bicknell, Josephine Rudd Zhong Manis, Yejin Heo, Haley Chishom, Lance Dzubinski, Taylor L. Aaserud, Alvina Liang, Shayan Massoumi, Thanushri Srikantha, John Stoffer, Guihua Zhai, Basil K. Williams Jr, Steven E. Brooks, Robert Tauscher

Journal of Academic Ophthalmology

Background: Scholarly productivity is a key marker of achievement in academic ophthalmology, influencing promotion, research support, and leadership opportunities. Prior studies have reported variation by gender, subspecialty, and rank, but few applied regression methods to identify independent predictors.

Purpose: To evaluate demographic, academic, and subspecialty factors associated with research productivity among U.S. academic ophthalmologists and to identify independent predictors through multivariable regression.

Methods: This cross-sectional study included 4,028 ophthalmologists across 126 accredited U.S. residency programs using the U.S. Academic Ophthalmology Faculty Database (US-AOFD). Faculty demographics and academic information were obtained from institutional websites, and bibliometric data (publications, …

Do Social Determinants Of Health Affect Tooth Retention For American Indian/Alaska Native (Ai/An) Adults?, Vae Day

Summer Research Showcase

American Indian/Alaska Native (AI/AN) adults face severe dental disparities due to social determinants of health (SDOH). This study examines how socioeconomic, functional, and cognitive factors influence access to dental care. Quantitative analysis was conducted using SPSS Statistics. Chi-square testing and logistic regression evaluated relationships between variables. Using a strengths-based approach to this research, the outcome variable was recoded to measure “teeth retained” instead of “teeth removed due to tooth decay or gum disease”. Analyses revealed that tooth retention and healthcare access significantly increase with favorable SDOH, including reliable transportation, household income, ability to complete errands independently, having insurance, and retained …

Contextualizing Second Language Anxiety In Multilingual Higher Education: Classroom Conditions And Clinical Settings, Busayo O. Ige

International Journal of Teaching and Learning in Higher Education

In South African universities, multilingual students whose first language is not English face distinct challenges that impact academic participation and success. This qualitative study examines how second language (L2) anxiety shapes first-year students’ classroom and clinical experiences at the University of Cape Town. Drawing on open-ended survey data, the study reveals that fear of negative evaluation, communicative apprehension, and prevailing language ideologies contribute to students’ reluctance to speak, feelings of invisibility, and withdrawal from engagement. Although anxiety tends to lessen over time, it rarely disappears completely. Notably, students experienced anxiety differently across settings: classroom discussions elicited greater fear and self-censorship, …

A Language We Built Together: A Physician Assistant’S Reflection On A Renal Transplant, Oviya Mahendran, Sampathkumar Sakthi Selvakumar

Journal of Wellness

This is not just a story of kidney transplantation in a tertiary care hospital in a tier-2 city of South India. It is all about a true clinical journey of resilience, where a young woman with congenital hearing loss, battling chronic kidney disease, discovered hope, understanding, and companionship through a physician assistant's compassionate communication.

Reducing Inpatient Falls Through Staff Education, Courage Duin Chiangeh

Walden Dissertations and Doctoral Studies

Patient falls remain a major patient safety concern, particularly among hospitalized stroke patients who are at increased risk because of impaired mobility, neurological deficits, and cognitive changes. The inpatient stroke unit selected for this quality improvement project consistently reported the highest fall rates within the hospital system, highlighting the need for evidence-based interventions. The purpose of this project was to determine whether a structured fall-prevention education program incorporating evidence-based practices and the 4Ps of purposeful rounding (pain, potty, position, and possessions) would improve staff knowledge, increase compliance with fallprevention practices, and reduce patient falls over a 2-month period. Guided by …

Sexual Harassment In Dentistry: Understanding The Issue And Steps To Prevent It From Happening

Journal IDA

The #MeToo Movement in 2017 shone a light on how widespread sexual abuse and sexual harassment were in the workplace.1 A survey completed in 2020 reported that 38 percent of women experienced different forms of sexual harassment in the workplace, while approximately 15 percent of men reported similar experiences.2 The data indicate, that sexual harassment was not unique to women as men, as well as nonbinary people also reported facing sexual harassment.

An Annotated Walkthrough Of Dental And Dental Hygiene Professional Oaths

Journal IDA

Most of the information contained in this article was taken using AI search engines. It is meant to be a refresher for dentists and dental hygienists as it relates to the oaths we took when we graduated from our training programs. It is also meant to be an opportunity for practitioners to reflect on their journeys since graduation as to have true they stayed to the oaths that they took. Dental assistants are not required to take a professional oath in Indiana.

Ethical Considerations In Cosmetic Dentistry

Journal IDA

Dentistry is both an art and a science. Patient care revolves around treatment for pain, missing teeth while also ensuring that appearances or the esthetic outcomes are maintained or enhanced. These two facets are not contradictory, but are intertwined for optimal, complete and customizable care for each patient. Dentists are often faced with requests from patients for a stereotypical “perfect” smile, which includes perfectly aligned teeth that are white in color resembling the image commonly conveyed by the media. As clinicians, we respond in our own way to these increasingly demanding esthetic demands. Some specialize in developing “esthetic” treatments; others …

Dental Treatment: Who Has The Final Say On Oral Health Care?

Journal IDA

Is a patient's autonomy really his or her own? Or like an onion with many skins, is it buried under layers of financial factors, insurance coverage, quality of discussion with the dentist, family obligations and emotional health, and so much more!

Safeguarding Ethics: The Work Of The Indiana State Board Of Dentistry, Kathy Walden

Journal IDA

Dentists pride themselves on belonging to a profession that maintains high standards, strong patient satisfaction and professional excellence. At the heart of these guiding principles of dentistry in our state is the Indiana State Board of Dentistry (ISBD), which focuses on establishing and enforcing ethical conduct and adherence to state law for Indiana’s 4,769 dentists and 5,500 hygienists.