Digital Commons Network^™

Lived Experiences Of Polysubstance Use And Co-Occurring Mental Health Disorders: A Phenomenological Inquiry, Candee Dione Rillon

Doctoral Dissertations and Projects

This phenomenological study explored the lived experiences of individuals with co-occurring substance use disorders (SUD) and mental health disorders (MHD), with particular attention to the transition into polysubstance use. The purpose of the study was to understand how individuals experience and make meaning of these co-occurring conditions and the factors influencing substance use patterns. Data were collected through semi-structured interviews with participants who reported both mental health challenges and substance use histories. Thematic analysis revealed that participants experienced SUD and MHD as deeply interconnected and mutually reinforcing, often functioning within a cyclical pattern of distress and temporary relief. Substance use …

The Relationship Between Estimated Vo2max And Poor Mental Health: A Study Of Brfss Data, Angelina Somadina Oputa

Doctoral Dissertations and Projects

Mental health conditions are one of the leading contributors to the global burden of disease. Despite advancements in mental health therapies and psychiatric medications, significant numbers of patients continue to struggle with mental illness. Despite these challenges, exercise can serve as a powerful tool to address mental health concerns. Current literature has referenced the value of physical fitness to support mental health, however there is limited large-scale research assessing the estimated maximal oxygen uptake (VO2Max) as a predictor of poor mental health days. In response, this quantitative secondary analysis was conducted to examine the relationship between estimated VO2Max and poor …

Oral Cancer Numerical Index (Ocni): Development And Validation Of A Cytology-Based Risk Assessment For Oral Lesions, Michael P Mcrae, Nadarajah Vigneswaran, Alexander Ross Kerr, Spencer W Redding, Martin H Thornhill, Craig Murdoch, Paul M Speight, Rachelle Wolk, Kritika S Rajsri, Pooja Gaikwad, Nancy Ruel, Nicolaos J Christodoulides, John T Mcdevitt

Faculty, Staff and Student Publications

Background/Objectives: Oral potentially malignant disorders (OPMDs) require accurate risk stratification to identify patients at the highest risk for severe oral epithelial dysplasia (OED) or oral squamous cell carcinoma (OSCC). We developed and internally validated the oral cancer numerical index (OCNI), a quantitative risk score derived from clinical features and deep learning-based brush cytology measurements.

Methods: This retrospective model development and internal validation study was conducted using data from the multicenter Grand Opportunity study. Prospectively recruited subjects with OPMD with complete data were divided at the subject level into a training set (n = 384) and a holdout test set …

Detection, Persistence, And Rising Prevalence Of Oncogenic Viruses Revealed By Wastewater Metagenomics, Harihara Prakash, Ryan K Perez, Matt Ross, Michael Tisza, Sara J Javornik Cregeen, Jennifer Deegan, Joseph F Petrosino, Eric Boerwinkle, Justin R Clark, Anthony W Maresso

Faculty, Staff and Students Publications

Oncogenic viruses cause high-risk cancers in humans and are responsible for nearly 20% of all cancer cases worldwide. Currently, very limited data exist in the realm of wastewater-based viral epidemiology (WBE) for cancer-causing viruses, with existing studies using targeted approaches (i.e., PCR-based approaches) that lack genomic resolution. In this study, we used a hybrid-capture approach to detect, filter, and sequence all known oncogenic virus signals from wastewater samples collected over 3 years (May 2022-May 2025) in 16 Texas cities, covering nearly 25% of the state's population. Once sequenced, we used custom computational tools designed for wastewater metagenomics to assign reads …

Placenta Accreta Spectrum Risk In Endometriosis: A Retrospective Cohort Study With Art Subanalysis, Madeline West, Amir Alsaidi, Michael A Belfort, Hendrik A Lombaard, Yamely H Mendez, Christina C Reed, Amir A Shamshirsaz, Jessian L Munoz

Faculty, Staff and Students Publications

No abstract provided.

Anatomy And Function Of Vasopressin Receptor 1a-Expressing Neurons In The Limbic Thalamus, David Joseph Kahn

Theses and Dissertations

The vasopressin (Avp) system modulates social behavior through region-specific and sex-dependent mechanisms, yet the role of Avp receptor 1a (Avpr1a) signaling in the thalamus has remained largely unexplored. This dissertation examined the distribution and functional contributions of Avpr1a-expressing neurons across the mouse thalamus using a combination of genetic labeling, anatomical quantification, and chemogenetic manipulation. Mapping of Avpr1a-expressing neurons revealed a presence in most thalamic nuclei, with highest densities in the anterior thalamic nuclei and midline nuclei. Notably, Avpr1a-expressing neuron densities did not mirror previously described patterns of Avp innervation, and no sex differences in Avpr1a-expressing neuron density were observed. Chemogenetic …

The Role Of Mitochondrial And Lysosomal Damage In Neurotoxicity From Parkinson 'S-Related Environmental Exposures, Neda Ilieva

ETDs from 2020-2029

Parkinson's disease (PD) is a progressive motor neurodegenerative disorder with a predominantly idiopathic etiology. More recently, however, the contribution of exogenous risk factors such as environmental contaminants has become of interest. Some endogenous genetic risk factors have been well characterized, but the mechanisms by which exogenous insults, such as environmental contaminants, drive dopaminergic neurodegeneration remain incompletely understood. This dissertation will address how environmental contaminants converge on mitochondrial and lysosomal dysfunction to activate parallel neurotoxic signaling pathways, with a focus on the LRRK2 kinase and the cGAS-STING innate immune pathway. Chapter 2 demonstrates that pharmacological inhibition of LRRK2 kinase activity protects …

Impact Of Race-Based And Race-Free Ckd-Epi Equations On Estimated Glomerular Filtration Rate In A Multicenter Retrospective Cohort Of Autosomal Dominant Polycystic Kidney Disease, Özgür Akin Oto, Abdulmeci̇t Yildiz, İsmai̇l Koçyi̇ği̇t, Hali̇l Yazici, Sai̇de Eli̇f Güllülü Boz, Yi̇ği̇t Kurtuluş, Alparslan Demi̇ray, Müge Doksan, Vafa Suleymanova, Ece Ük, Alper Akin, Bahar Bastani, John C. Edwards, Krista Leigh Lentine, Yaşar Kerem Çalişkan

Turkish Journal of Medical Sciences

Background/aim: The 2021 revision of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which eliminates race-based coefficients, may significantly influence disease staging and treatment in autosomal dominant polycystic kidney disease (ADPKD). This study was designed to evaluate the impact of the 2021 race-free CKD-EPI equation on estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) staging in a multi-ethnic ADPKD population.

Materials and methods: In this multicenter, retrospective cohort study, 597 ADPKD patients were evaluated, including 515 self-identified as Caucasian and 82 as African-American. eGFR values at baseline and final follow-up were calculated using both the 2009 and 2021 …

Preliminary Population Genetic Analysis Of 12 X-Str Loci In A Sample From Türkiye: Allele Frequencies, Haplotype Diversity, And Linkage Disequilibrium​, Hizir Asliyüksek, Esra Güzel Tanoğlu, Abdulkadi̇r Can, Muhammed Fevzi̇ Esen, Yusuf Atan

Turkish Journal of Medical Sciences

Background/aim: X-chromosomal short tandem repeats (X-STRs) are informative genetic markers in kinship testing and specific forensic contexts, particularly when standard autosomal approaches are less informative. This study aimed to provide preliminary allele frequency, haplotype diversity, and linkage disequilibrium (LD) data for 12 X-STR loci in a sample from Türkiye.

Materials and methods: A total of 136 unrelated individuals from Türkiye were genotyped for 12 X-STR loci. Inferential analyses of X-linked loci require diploid genotypes; therefore, allele frequencies, Hardy–Weinberg equilibrium (HWE), LD, and regional comparisons were based primarily on female samples (n = 115), whereas male haplotypes (n = 21) were …

In Silico Evaluation Of The Role Of Pea3 Subfamily Ets Transcription Factors In Chemoresistance In Ovarian Cancer, Fevzi̇ Coşkun Sökmen, Lai̇ka Kardana, Hi̇kmet Yilmaz, Ahmet Çağlar Özketen, Aynur Karadağ Gürel, Özge Atay, Hasan Hüseyi̇n Kazan

Turkish Journal of Medical Sciences

Background/aim: The E26 transformation-specific family of transcription factors regulates the cell cycle and apoptosis that are crucial for carcinogenesis. More specifically, the PEA3 subfamily—comprising ETS variant (ETV) transcription factors ETV1, ETV4, and ETV5—has been implicated in multiple oncogenic signaling pathways and chemotherapy resistance. While cisplatin is still a widely used chemotherapeutic treatment for ovarian cancer, its therapeutic efficacy is sometimes limited by the induction of resistance mechanisms. The present study investigates the potential role of PEA3 subfamily genes in cisplatin resistance in ovarian cancer through comprehensive in silico analyses.

Materials and methods: Cisplatin response data for ovarian cancer were obtained …

Omega-3–Rich Fish Oil Lipid Emulsions Significantly Prevent Sepsis-Driven Mesenteric Hypoperfusion And Multi-Organ Injury In Murine Models, Gökşen Öz, Esi̇n Özçelebi̇, Ayşe Yeşi̇m Göçmen, Cenk Sükmensüer, Selma Yildirim, Arzu Topeli̇, Alper Bektaş İski̇t

Turkish Journal of Medical Sciences

Background/aim: Parenteral feeding is used in critically ill patients when enteral nutrition is inadequate or intolerable, and the gastrointestinal tract is not functioning properly. Lipid emulsions play a major role in parenteral nutrition because they supply necessary fatty acids and a high-calorie density. We investigated the effects of parenteral lipid emulsions on mesenteric perfusion, inflammation-induced oxidation, and organ damage in lipopolysaccharide-induced mice endotoxemia model.

Materials and methods: In septic mice, organ damage induced by lipopolysaccharide was assessed by histopathology and biochemical examination. Additionally, an ultrasonic blood flowmeter was used to measure the impact of lipid emulsions on mesenteric blood flow. …

Clinical, Hormonal, And Treatment Outcomes In 247 Patients With Acromegaly: A Single Tertiary Center Experience, Ümran Gül, Beki̇r Uçan, Hayri̇ Bostan, Hakan Düğer, Hayri̇ Kertmen, Caner Ünlüer, Hali̇l Durantaş, Oğulcan Boz, Ceren Karaçalik Ünver, Burak Menekşe, Sema Hepşen, İlknur Öztürk Ünsal, Mustafa Özbek, Erman Çakal, Muhammed Kizilgül

Turkish Journal of Medical Sciences

Background/aim: This study aimed to evaluate the demographic, clinical, and hormonal characteristics; comorbidities; surgical pathology; treatment modalities; and long-term clinical outcomes of patients diagnosed with and managed for acromegaly at our tertiary referral center over a 15-year period.

Materials and methods: Between 2010 and 2024, 247 patients with acromegaly were evaluated. Diagnosis and biochemical remission were determined according to the 2024 Acromegaly Consensus Criteria.

Results: The median follow-up duration was 8 years (IQR: 3–14). At the time of diagnosis, the most frequent pituitary hormone deficiency was secondary adrenal insufficiency, present in 17.8% of patients. The most common comorbidities were hypertension …

Vnotes High Uterosacral Ligament Suspension Versus Laparoscopic Lateral Suspension In The Management Of Vaginal Vault Prolapse: Initial Experience In A Single Tertiary Center, Ramazan Adan, Fati̇h Şahi̇n, Ulya Üskent, Mehmet Gökhan Çulha, Arzu Bi̇lge Teki̇n

Turkish Journal of Medical Sciences

Background/aim: The optimal technique for vaginal vault prolapse correction has yet to be identified. This study aimed to evaluate the anatomic and functional outcomes of women who underwent vaginal natural orifice transluminal endoscopic high uterosacral ligament suspension (vNOTES HUSLS) or laparoscopic lateral suspension (LLS).

Materials and methods: This retrospective study included symptomatic women with stage ≥2 vault prolapse who underwent vNOTES HUSLS or LLS between January 2019 and June 2022 at a tertiary center. The surgical efficacy, postoperative outcomes, complication rates, and recurrence frequencies of these procedures were compared. The primary outcomes of the study included anatomical success, patient-reported (subjective) …

A Caveat Regarding The Unfolding Argument: Implications Of Plasticity, Viknas N. O'Reilly-Shah, Alessandro Maria Selvitella, Aaron Schurger

Psychology Faculty Articles and Research

The unfolding argument in the neuroscience of consciousness posits that causal structure cannot account for consciousness because any recurrent neural network (RNN) can be “unfolded” into a functionally equivalent feedforward neural network (FNN) with identical input–output behavior. Subsequent debate has focused on dynamical properties and philosophy of science critiques. We examine a boundary condition on the unfolding argument for RNN systems with rapid plasticity in their connection weights. We demonstrate through rigorous mathematical proofs that rapid plasticity negates the functional equivalence between the RNN and the FNN. Our proofs address history-dependent plasticity, dynamical systems analysis, information-theoretic considerations, perturbational stability, complexity …

Hp1bp3 Loss Links Chromatin Reorganization To Metabolic Vulnerability In Glioma, Brittney Lozzi, Taylor A Gatesman, Pushan Dasgupta, Debosmita Sardar, Yeunjung Ko, Chenyu Mao, Hsiao-Chi Chen, Rachel N Curry, Dongjoo Choi, Carrie A Mohila, Melissa L Bondy, Ganesh Rao, Marco Gallo, Sameer Agnihotri, Benjamin Deneen

Duncan NRI Faculty and Staff Publications

High-grade gliomas (HGGs) are aggressive brain tumors with poor prognosis, driven in part by metabolic and epigenetic adaptations. Methionine metabolism supports HGG growth by supplying S-adenosylmethionine for methylation reactions, yet how nutrient availability influences chromatin organization in HGG remains incompletely understood. Using an immunocompetent mouse model of HGG, we found that dietary methionine restriction reduced tumor proliferation, extended survival, and induced partial nuclear inversion. We identified Hp1bp3 as a key regulator of tumor growth that functions by interacting with nuclear tethering proteins to mediate chromatin reorganization. Loss of Hp1bp3 results in the upregulation of histone demethylases leading to selective depletion …

Comprehensive Geriatric Assessment Identifies Multidimensional Vulnerabilities In Older Adults With Heart Failure, Ci̇han Kiliç, Rengi̇n Demi̇r, Özlem Yilmaz Aykent, Zerri̇n Yi̇ği̇t, Pinar Küçükdağli, Banu Özulu Türkmen, Güli̇stan Bahat, Mehmet Aki̇f Karan

Turkish Journal of Medical Sciences

Background/aim: Heart failure (HF) in older adults is frequently accompanied by geriatric syndromes that remain unrecognized in conventional cardiac evaluations. The vulnerabilities of older adults with and without HF in terms of muscle strength, physical performance, functional capacity, frailty, nutritional status, cognition, mood, anxiety, polypharmacy, and comorbidity were investigated using comprehensive geriatric assessment (CGA).

Materials and methods: A cross-sectional study was conducted in two academic outpatient clinics, enrolling 420 adults aged ≥60 years, including 92 (21.9%) with HF. Data included sociodemographic characteristics, anthropometric measurements, and CGA parameters: handgrip strength, the Five-Times Sit-to-Stand Test (FTSST), the Short Physical Performance Battery (SPPB), …

Bridging The Methodological Gap In Multitrauma Literature: A Competency-Based Educational Framework And Clinical Appraisal Filter, Şaki̇r Hakan Aksu, Burcu Doğan, Merve Yazla

Turkish Journal of Medical Sciences

Background/aim: The statistical complexity of contemporary multitrauma literature has increased considerably in recent years, which may pose challenges for clinicians seeking to interpret high-impact research and apply evidence-based practices. Characterizing this methodological landscape and exploring education-oriented approaches may help to improve the interpretability of the literature and support informed clinical decision-making.

Materials and methods: A cross-sectional analysis was conducted on the 100 most-cited multitrauma studies published in Science Citation Index Expanded journals indexed in the Web of Science database between January 2018 and November 2025. The statistical methods used in each article were categorized into the three competency levels of …

Postoperative Normocalcemic Hyperparathyroidism: A Comprehensive Analysis Of 510 Cases, Alparslan Ertenli̇ce, İbrahi̇m Kilinç, Mustafa Oruç

Turkish Journal of Medical Sciences

Background/aim: Postoperative normocalcemic hyperparathyroidism (NC-HPT) is defined as elevated parathyroid hormone (PTH) levels despite normal calcium levels after parathyroidectomy for primary hyperparathyroidism (PHPT). This study investigates the demographic, biochemical, and histopathological factors associated with NC-HPT in a large patient cohort and presents the follow-up outcomes.

Materials and methods: The initial study sample included 571 patients who underwent surgery for PHPT between January 2018 and January 2024, 510 of whom were analyzed retrospectively after the application of the exclusion criteria. Preoperative and postoperative biochemical parameters, bone mineral density, pathological findings, and follow-up data were evaluated. NC-HPT was defined as postoperative PTH …

Alterations In Gut Microbiota Composition In Adult Patients With Familial Mediterranean Fever: A Pilot Case–Control Study, Nazi̇fe Şule Yaşar Bi̇lge, Vicente Pérez Brocal, Ti̇muçi̇n Kaşi̇foğlu, Uğur Bi̇lge, Ni̇lgün Kaşi̇foğlu, Andres Moya, Ener Çağri Di̇nleyi̇ci̇

Turkish Journal of Medical Sciences

Background/aim: Although familial Mediterranean fever (FMF) is a monogenic disease, recent evidence suggests that the gut microbiota may play a role in its pathogenesis or phenotypic expression. We conducted a pilot exploratory study to evaluate the intestinal microbiota composition in patients with FMF and compare it to that of healthy controls.

Materials and methods: In this prospective cohort study, 10 adult patients with FMF receiving colchicine and 10 age- and sex-matched healthy controls were enrolled. Fecal samples were collected and stored at –80 °C until DNA extraction. The V3–V4 region of the 16S rRNA gene was amplified and sequencing was …

Hla Allele And Haplotype Diversity In Central Anatolia: A Comparative Analysis Of Donors And Transplant Candidates Across Six Hla Loci (Hla-A, Hla-B, Hla-C, Hla-Drb1, Hla-Dqb1, And Hla-Dpb1), Emel Yantir, Eren Gündüz, Ertuğrul Çolak

Turkish Journal of Medical Sciences

Background/aim: Human leukocyte antigen (HLA) polymorphisms play a central role in immune recognition, disease susceptibility, and transplant success. The distribution of HLA alleles and haplotypes varies among ethnic and geographic populations. Despite several regional studies conducted in Türkiye, large-scale and comprehensive investigations comparing HLA profiles between healthy individuals and transplant candidates remain limited. The aim of this study was to compare the distribution of HLA profiles among donors, hematopoietic stem cell transplantation (HSCT) candidates, and solid organ transplant candidates.

Materials and methods: A total of 8472 individuals were included in the study, comprising 6422 donors and 2050 transplant candidates. HLA …

Association Of Vitamin D, Oxidative Stress Markers, And Hormonal Factors With Male Infertility: A Case-Control Study In Pakistan, Muhammad Tayyab Ihsan, Ayesha Ali Malick, Sher Khan, Sher Khan, Muhammad Tahir Khan, Haq Nawaz Khan, Rehana Rehman

Turkish Journal of Medical Sciences

Background/aim: Infertility impacts around 15% of couples worldwide, with male factors accounting for approximately 50% of cases. Despite this significant share, male infertility remains understudied, particularly in developing nations such as Pakistan. The present study explores the association between male infertility and seminal plasma concentrations of oxidative stress markers, inhibin B, and vitamin D, along with their relationship with sperm parameters.

Materials and methods: The dataset of the study consisted of seminal plasma levels from 30 fertile and 60 infertile males. Total antioxidant capacity (TAC), Vitamin D, malondialdehyde (MDA), 4-hydroxynonenal (4-HNE), lipid peroxide (LPO), superoxide dismutase (SOD), and inhibin B …

Meningioma Detection From Mri: A Comparative Study Of Deep Learning Models, A. H. Doha, Sandi Jennifer, Fatima Alabdaly

AUIQ Complementary Biological System

This study compares several deep learning models including DenseNet20, CNN, ResNet50, VGG19, EfficientNet-B3, MobileNetV2, NASNetMobile, Xception to automatically classify brain meningiomas from MRI scans. A public dataset was used to evaluate the proposed model. All models were trained, validated, and tested on this dataset. Because meningiomas are common and manual reads, the goal is to speed and standardize diagnosis. Our main contribution is pairing a high-accuracy classifier with deep learning models. Among all models, DenseNet201 performed best, reaching 0.991% accuracy and reliably separating tumorous from non-tumorous MRIs. Future work will expand the dataset and incorporate stronger segmentation to further boost …

Pa Dent J May 2018

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J Mar 2018

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J Nov 2017

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J Mar 2017

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J Nov 2016

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J Jan 2020

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J July 2019

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.

Pa Dent J March 2019

Pennsylvania Dental Journal

The Pennsylvania Dental Journal is produced by the Pennsylvania Dental Association six times a year, in January, March, May, July, September and November. Issues include regular columns with regional news impacting the Pennsylvania membership including editorial and government relations news, association activities, member updates, continuing education opportunities, and classifieds.