Digital Commons Network^™

Reflections And Revisionism: Rethinking The U.S. Response To Covid-19, Wendy E. Parmet

Michigan Law Review

A review of In Covid’s Wake: How Our Politics Failed Us. By Stephen Macedo and Frances Lee.

Legends, Lies, & Rewritten Lives: After The Little Bighorn: Forgotten Struggles Of Those Who Walked Away, 2nd Edition, Thomas B. Davidson

DU Textbooks

This Story surrounds an event that occurred one summer on June 25, 1876, along the banks of the Little Bighorn River in what is now the state of Montana. Seen from a 21st century perch, it is a story of a collision between two very different civilizations or empires. Both empire’s military fought in the manner of their society. This narrative will attempt to balance the believable truth of what happened in that contest between the military representatives of both societies while also trying to tell an engaging story, without drifting into naked partisanship, purple prose, or sensationalism. The narrative …

Dementia, Advance Directives, And Second-Order Volitions, Rand Hirmiz

Research Collection School of Social Sciences

This paper contributes to the ongoing debate over the authority of advance directives in cases where patients with dementia express desires that conflict with their earlier wishes. Drawing on Harry Frankfurt’s concept of second-order volitions, I argue that the preferences of the pre-dementia self (the “then-self”) should, in most cases, take precedence over those of the post-dementia self (the “now-self”) –  particularly in instances where the now-self has lost the capacity to form second-order volitions and is no longer able to meaningfully repudiate prior values and commitments.

Global Youth Development: Challenges And Remedies, Raymond Chimezie

Faculty Publications and Presentations

Young people have enormous potential for growth and innovation, but not all have access to resources and opportunities to explore, achieve their dreams, and contribute immensely to society. Absence or limited opportunities and resources pose great challenges to young people’s aspirations. Through a review of literature and study of some countries young people globally face challenges, though at varying degrees like unemployment, limited access to healthcare, social services, and education; lack of professional support, skills acquisition and retraining, and political exclusion; judicial inequity, loneliness, and poor parenting. There still exist policies, structures, or regulations that encourage racial and ethnic or …

Assessing Aflatoxin Knowledge, Perceptions, And Related Practices, In A Rural Coastal Community: A Population-Based Cross-Sectional Survey, Rosebella Iseme, Joseph Abuodha, Anthony Ngugi, Innocent Abayo, Mansoor Saleh

Population Health, East Africa

Background

Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited access to agricultural inputs, inadequate post-harvest handling and storage, and weak regulatory enforcement alongside food scarcity and climate change heighten the risk of contamination and exposure. Human exposure is associated with serious health consequences, including hepatocellular carcinoma, immune suppression, and childhood stunting. Although aflatoxin is increasingly recognized as a global food safety concern, little is known about community-level knowledge, risk perceptions, and preventive practices. This study examined household heads’ awareness, perceptions, and behaviours related …

Ig–Microbiota Binding Patterns In Mothers And Infants: A Scoping Review, Alicia Tan Yi Jia, Christopher S. Peacock, Danielle E. Dye, Claus T. Christophersen

Research outputs 2022 to 2026

Studies characterising the immunoglobulin (Ig)-bound microbiota apply varying methodologies, making comparisons difficult. This scoping review synthesised evidence on Ig–microbiota binding patterns in maternal and infant contexts, identified recurrent Ig-bound and -unbound bacteria across studies, and highlighted knowledge gaps for further study. Nine articles investigating Ig–microbiota binding patterns in stool or breastmilk samples in mothers or infants were included. Ig–microbiota associations were influenced by sample type, Ig-subclass, genetics, and diet. The most important antibody was IgA, with partial functional redundancy with IgM, while IgG appeared more selective for pathobionts. Ig-bound taxa in early life included important commensals and pathobionts, with high …

Climate-Driven Stochastic Modelling Of Crimean-Congo Haemorrhagic Fever Transmission In Uganda, P. G. Kpatchana, J. Aduda, K. M. Agboka

All Peer-Reviewed Publications

Crimean-Congo haemorrhagic fever (CCHF) is a climate-sensitive tick-borne zoonosis that remains a significant public health concern in Uganda, where temperature and vapour pressure deficit influence tick ecology and consequently disease transmission. This study aimed to develop and analyse a climate-driven stochastic model for CCHF transmission among ticks, livestock, and humans under environmental variability in Uganda. A compartmental transmission model was formulated and extended into a stochastic differential equation framework by incorporating multiplicative environmental noise. Climate-dependent tick recruitment, development, and mortality were parameterized using district-level temperature and vapour pressure deficit data to capture spatial heterogeneity in transmission risk. Theoretical analyses based …

Understanding And Enhancing Suicide Prevention Strategies In The Military: The Roles Of Culture, Leadership, And Command Climate, Kelly Johanna Pires

Dissertations

Military service members are shaped and molded to fit a military culture that emphasizes mission readiness and continuous preparedness. Countless hours are spent training for various situations that can arise. Many trainings are geared toward worst-case scenarios that can cause an increase in stressors and traumatic events. They are expected to demonstrate resilience and overcome adversity to remain mission-ready. This expectation to be mission-ready creates the space for mental health difficulties as well as stigma and avoidance of help-seeking behaviors. In many cases, the desire to stay mission-ready creates a barrier for conversations around mental health. The military emphasizes qualities …

Ai In Healthcare: Regulatory Guidelines And Judge-Made Negligence Principles For Ai Implementers, Gary K. Y. Chan

Research Collection Yong Pung How School Of Law

The use of artificial intelligence (AI) in healthcare may, notwithstanding its potential benefits, result in harm to patients from allegedly negligent acts or omissions by hospitals and medical doctors. In such circumstances, how should the principles in the tort of negligence (duty of care, breach, causation, remoteness of damage, and defences) respond to AI innovations in healthcare? In particular, how may the standard of care expected of hospitals and medical doctors be informed by regulatory guidelines? We refer to case law precedents and regulatory guidelines on the roles and responsibilities of doctors and hospitals as AI implementers. Importantly, they prompt …

Investigating Individual And Group Level Mediators Of Fear Acquisition, Rachel S. Lese

Dissertations, Theses, and Capstone Projects

The ability to discriminate between cues predictive of threat vs. safety (fear acquisition) and subsequently update fear responding when contingencies change (fear extinction) is crucial to survival for all organisms. While these processes have been the subject of intense experimental scrutiny for several decades, most human fear learning studies have focused primarily on extinction learning and fear recovery processes, with less focus on fear acquisition itself. Indeed, researchers typically aim to minimize variability during fear acquisition in order to rule out differences in extinction being driven by variability during the initial learning phase. Thus, experimental protocols are often optimized to …

Family Planning Exemplar Country Selection Methodology: Time Lag And Trends Analysis, Zahid Memon, Abeer Mian, Ira Martopullo, Narjis Hussain, Zeba Sathar, Ali Mohammad Mir, Michael Mbizvo, Marleen Temmerman, Jen Drake, Zulfiqar Bhutta

Centre of Excellence in Women and Child Health

Introduction While many countries achieved notable gains in contraceptive use levels after the 1994 International Conference on Population and Development which redefined family planning (FP) as a human right, there was a long period of 15 years when contraceptive use levels did not receive due attention. It was only later that its subsequent inclusion in the Sustainable Development Goals and the 2012 London Summit on FP renewed global commitment and a focus towards FP. This paper aims to select countries that identify as ‘exemplar’ low-middle-income countries that have achieved exceptional progress in FP. Examining these outliers can uncover actionable drivers …

Rethinking Ethics For An Era Of Trusted Computational Tools, Kristin M Kostick-Quenet, Meghan Hurley, John Herrington, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Computer perception (CP) technologies are poised to deliver near real-time behavioral insights with high precision. As technical barriers recede, our field's ethical focus must shift from "Can we trust the data?" to "Should we use it here, and how?" We propose a contextual ethics framework that: (1) defines the appropriate scope of CP integration; (2) advocates codesigned roadmaps to manage expectations and epistemic conflict; (3) expands evaluation beyond performance metrics to humanistic outcomes; and (4) anticipates future high performance systems to safeguard dignity, empathy, and shared decision-making in clinical care.

Kanak-Ish Misfits: Queer Imaginaries, Racialized Borders, And The Politics Of Care In Berlin, Germany, Faruk Seref

Dissertations, Theses, and Capstone Projects

This dissertation examines queer Muslim experiences of border politics, racialization, and care in Berlin, Germany. By formulating bordering as a domineering and oppressive practice of boundary-making, I study how global bordering mechanisms shape and disrupt structures of care, caring, and being cared for. With an intersectional focus on race, gender, sexuality, and sex, I argue that borders are simultaneously materialized and challenged in varying localities, including the nightclub, the queer scene, the diasporic neighborhoods, and households. Ultimately, viewing collective care as fundamental to survival, healing, resistance, and building non-punitive lifeworlds, I theorize the counter-hegemonic practices of queers of color through …

A Predictive Coding Account Of Spatial Working Memory Following Prophylactic Levetiracetam Administration Prior To Traumatic Brain Injury, Omeima Mutwali

Dissertations, Theses, and Capstone Projects

Traumatic brain injury (TBI) symptom prevention and remediation is an important area of research that would benefit vulnerable groups, including active-duty and veteran soldiers. These patients can sustain penetrative forces in fields of combat or in training, which result in focal lesions that trigger inflammatory and degenerative processes in the brain. Both primary and secondary injuries are associated with changes to cognition, behavior and affective state. This disease poses increased risk of epileptogenesis, as well. Given these outcomes, prior research has evaluated levetiracetam (LEV) as a prophylactic treatment for seizures, cognitive deficits and negative emotionality. LEV acts as a presynaptic …

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Implementation Of Comprehensive Checklist For Opioid Use Disorder Treatment In Primary Care, Sophia R. Madden

Doctor of Nursing Practice Final Manuscripts

Background: The escalating opioid crisis demands a comprehensive approach to Opioid Use Disorder (OUD) management. Patients often face comorbid mental illnesses, infectious diseases, concurrent substance use, and social determinants of health (SDOH)—all of which increase the risk of treatment attrition. Standardizing care through evidence-based clinical practice guidelines and tools is essential for improving treatment quality and consistency.

Purpose: This project aimed to increase comorbidity screenings and improve resource access for OUD patients at a San Diego Internal Medicine primary care office by implementing a comprehensive care checklist based on the American Society of Addiction Medicine (ASAM) guideline.

Methods: The ASAM …

Transcranial Ac Modulation Of Cerebellar Nuclear Activity In Awake Animals, Nuran Kavakli

Dissertations

Entrainment of cerebellar nuclear (CN) cells via cerebellar transcranial alternating current stimulation (ctACS) has been reported in animals under ketamine/xylazine anesthesia. Our main objective was to demonstrate modulation of CN activity in unanesthetized, freely moving animals using ctACS. Multi-channel carbon-fiber electrodes were implanted into the interpositus nucleus for recording multi-unit (MU) activity, and thin-film electrodes were implanted subcutaneously over the posterior cerebellum for stimulation. A frequency-domain-based metric was developed to quantify modulation from MU signals. The results demonstrated modulation in a wide range of frequencies (4 Hz-300 Hz) as in anesthetized animals. In contrast, the amplitude of the peak in …

Intervention Levers For Stunting Reduction In Indonesia: Evidence From The 2023 Indonesian Health Survey Data, Iwan Ariawan, Hafizah Jusril, Zahra Izza Afifa, Azka Fitri, Elmarizha Sekar Utami, Mikail Hasan, Dwi Puspasari

Kesmas

Stunting remains the largest public health challenge among macro-nutrition problems in Indonesia, affecting almost a quarter of children under five in 2023. The prevalence is considered high according to the World Health Organization standard. This study analyzed 15 aggregated provincial variables from the 2023 Indonesian Health Survey using Structural Equation Modeling (SEM), focusing on determinants of stunting among children under two to identify primary intervention levers. Findings indicated that intervention urgency should focus on the first 1,000 days, particularly the steep increase in stunting prevalence observed in the 12–24-month age range. While the highest prevalence is in Eastern provinces (e.g., …

Deadline-Chasing In Digital Health: Forecasting Emr Adoption Dynamics And Regulatory Impact In Indonesian Primary Care, Suryo Satrio, Bukhori Muhammad Aqid

Journal of Indonesian Health Policy and Administration

Indonesia is accelerating digital health adoption under Minister of Health Regulation No. 24/2022, which mandates the use and integration of Electronic Medical Records (EMRs) with SATUSEHAT. However, evidence on how quickly primary health care facilities (Fasilitas Kesehatan Tingkat Pertama – FKTP) are adopting EMRs and what the adoption curve looks like remains limited. Survey findings also suggest key barriers and enablers, including security and data migration concerns, as well as human resource and infrastructure constraints. This observational study used provider-network data from a single EMR vendor. Key measures included cumulative registered facilities, monthly registrations, same-month activation (total_active/monthly inflow) as …

Factors Associated With The Performance Of Essential Public Health Efforts At Primary Health Centers In Jember Regency, Griselda Ardelia Hibatullah, Nuryadi Nuryadi, Yennike Tri Herawati

Journal of Indonesian Health Policy and Administration

Performance assessment of primary health centers is essential to ensure the quality of healthcare services, including the delivery of essential public health efforts. The performance target for essential public health efforts in Jember Regency is set at ≥82%. This study aimed to analyze factors associated with the performance of essential public health efforts. The study employed an analytical cross-sectional design conducted from April to May 2025, with a sample of 37 out of 50 units selected through simple random sampling. Primary data were collected using questionnaires, while secondary data were obtained from primary health center (Pusat Kesehatan Masyarakat – …

Increasing Access To Medications For Opioid Use Disorder For All Justice-Associated Populations, Edgar Rodriguez

Doctor of Nursing Practice Final Manuscripts

The purpose of this paper is to support a federal mandate requiring universal access to medication of opioid use disorder for all the justice-involved populations. The policy proposal aims to standardize evidence-based treatment across correctional systems, improve treatment initiation during incarceration, strengthen continuity of care after release, reduce overdose mortality, and address disparities in access for racial and economic groups and rural communities. This policy paper calls for the increase of access to medications of opioid use disorder across the United States for all justice-involved population. The opioid crisis has created a public health problem in the United States by …

Rocatinlimab As A Novel Treatment Strategy For Atopic Dermatitis, Haylee Whyde, Evan Blazek, Macy Davis, Parker George, Alex Lowery, Connor Dains, Brenna Hissong, David Koh

Pharmacy and Wellness Review

Atopic dermatitis is a common chronic inflammatory skin disease that affects millions of children and adults in the United States. Atopic dermatitis is characterized by recurrent pruritus, erythema, and relapsing symptoms that can significantly impair quality of life. The pathophysiology of atopic dermatitis involves epidermal barrier dysfunction, immune dysregulation, and genetic susceptibility. Atopic dermatitis guidelines follow a stepwise approach that begins with a severity assessment, trigger avoidance, and nonpharmacologic and pharmacologic treatments. First-line therapies include topical corticosteroids (TCSs), topical calcineurin inhibitors (TCIs), and emollients. Crisaborole and topical ruxolitinib are used for mild-to-moderate disease when prior therapy has been inadequate. Monoclonal …

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 …

Patient-Reported Outcomes Following Operative And Nonoperative Management Of A3 Versus A4 Thoracolumbar Burst Fractures, Barry T. S. Kweh, Charlotte Dandurand, Alex R. Vaccaro, Klaus J. Schnake, Mohammad El-Sharkawi, Richard J J. Bransford, Andrei Fernandes Joaquim, Harvinder Singh Chhabra, Ulrich J. A. Spiegl, Dimitri Hauri, F. Cumhur Öner, Gregory D. Schroeder, Jin Wee Tee

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: The aim of this study was to compare patient-report outcome measures in patients with thoracolumbar burst fractures managed either operatively or nonoperatively.

METHODS: A prospective multicenter observational study was conducted of neurologically intact patients who sustained traumatic thoracolumbar burst fractures managed operatively or nonoperatively. Outcome measures included scores on the EQ-5D index, EQ-5D visual analog scale (VAS), pain numerical rating scale (NRS), and AO Spine Patient Reported Outcome Spine Trauma (PROST) tool and patient satisfaction with follow-up up to 2 years. The Wilcoxon rank-sum test and Cochran-Armitage test were used to evaluate differences between continuous and ordinal variables, respectively. …

Resilience And Social Support On Depression Risk For Chronic Obstructive Pulmonary Disease Patients In South Tangerang, Indonesia, Adhityawarman Menaldi, Sali Rahadi Asih, Farah Ainul Mardhiyyah

Kesmas

Chronic obstructive pulmonary disease (COPD) is a major public health concern with psychosocial impacts, such as reduced resilience and depression. This study examined the moderating role of perceived social support on the relationship between resilience and depression among individuals diagnosed with COPD in South Tangerang, Indonesia. A quantitative cross-sectional study was conducted between January and February 2024 using self-administered questionnaires. Participants were adult patients with clinically diagnosed COPD, recruited from all public health centers (PHC) in South Tangerang. A total of 125 participants met the inclusion criteria and were included in the analysis. Participants had a mean age of 41.46±15.69 …

Determinants Of Musculoskeletal Disorder In Formal And Informal Workers In Indonesia, Herlina J. El-Matury, Nabila Syahlan, Mohd Rafee B. Baharuddin

Kesmas

Musculoskeletal disorders (MSDs) are a leading cause of disability globally and are strongly influenced by occupational conditions. Evidence comparing MSD risk between formal and informal workers remains limited, particularly in developing countries. This study examined the association between individual and job-related factors with MSD symptoms among formal and informal workers in Indonesia. A cross-sectional study was conducted among 1,089 workers in North Sumatra Province, Indonesia, from August 2024 to December 2025. Participants were recruited using stratified convenience sampling from both the formal (office and health workers) and informal (drivers, traders, and farmers) sectors. MSD symptoms were assessed using the Nordic …

Factors Associated With Public Health Centers’ Achievement Of Health Service Target In Yahukimo District, Highland Papua Province, Indonesia, Emaus Heluka, Venty Suryanti, Indasah Indasah, Prima Dewi Kusumawati

Kesmas

The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health …

Misconduct Among Nurses And Midwives: A Retrospective Descriptive Study Of Cases Handled At The Uganda Nurses And Midwives Council From 2017 To 2021, Barbara Okiror, Christine Nimwesiga, Patience Muwanguzi, Tom Ngabirano, Mercy Muwema

School of Nursing & Midwifery, East Africa

Background: Media reports on the misconduct of nurses and midwives, including cases of fake credentials, drug theft, and incompetence, are on the rise. However, there are no published studies currently addressing this issue in Uganda. Therefore, to inform effective regulation of the profession, we analysed the misconduct cases involving nurses and midwives reported to the Uganda Nurses and Midwives Council between 2017 and 2021.

Methods: The study retrospectively described misconduct cases received and handled at UNMC from 2017 to 2021 and their outcomes. Following total population sampling, data were extracted from case files and then input into a …

Unbiased Niche Labeling Maps Immune-Excluded Niche In Bone Metastasis, Zhan Xu, Fengshuo Liu, Yunfeng Ding, Tianhong Pan, Yi-Hsuan Wu, Yujiao Han, Jun Liu, Igor L Bado, Weijie Zhang, Ling Wu, Yang Gao, Xiaoxin Hao, Liqun Yu, Xuan Li, David G Edwards, Hilda L Chan, Sergio Aguirre, Michael Warren Dieffenbach, Elina Chen, Siyue Wang, Yichao Shen, Dane Hoffman, Luis Becerra Dominguez, Charlotte Helena Rivas, Xiang Chen, Hai Wang, Yibin Kang, Zbigniew Gugala, Robert L Satcher, Xiang H-F Zhang

Faculty, Staff and Students Publications

Metastatic cancer cell fate is shaped by the local microenvironment niches. To unbiasedly define the cellular and molecular features of metastatic niches, we developed sortase A-based microenvironment niche tagging (SAMENT), which selectively labels cells encountered by cancer cells during metastasis. Applying SAMENT across multiple cancer models and target organs revealed shared niche features, including macrophage enrichment and T cell depletion, alongside marked organ-specific phenotype heterogeneity in niche macrophages. In bone, metastatic niches are enriched for macrophages expressing estrogen receptor alpha (ERα) with active ERα signaling. Conditional deletion of Esr1 in macrophages significantly impaired bone colonization by enabling T cell infiltration. …

Icam1high Neutrophils Sculpt Tumor Evolution And Metastasis Through Symbiotic Adhesion And Reverse Migration, Ling Wu, Zhan Xu, Jun Wang, Fengshuo Liu, Yunfeng Ding, Yang Gao, Siyue Wang, Jun Liu, Hilda L Chan, Weiguo Wu, Yi-Hsuan Wu, Liqun Yu, Xiaoxin Hao, Xuan Li, David G Edwards, Cher Sha, Tobie D Lee, Nan Guan, Sergio Aguirre, Luis Becerra-Dominguez, Dane Hoffman, Xiang Chen, Charlotte Helena Rivas, Xiaoyuan G Yan, Igor L Bado, Weijie Zhang, Qian Zhu, Arun Sreekumar, Robert L Satcher, Xiang H-F Zhang

Faculty, Staff and Students Publications

Neutrophils are a prominent component of the tumor microenvironment that can have both pro- and anti-tumor functions. By analyzing neutrophils across different human cancers, we revealed an ICAM1high subset enriched in the tumor microenvironment, which were also observed in murine triple negative breast cancer (TNBC) models. ICAM1high neutrophils exhibited an enhanced capacity for cell-cell adhesion specifically with tumor cells retaining epithelial features, and this adhesion conferred mutual advantages to both cell types. In contrast, cancer cells with mesenchymal-like phenotypes were vulnerable to neutrophil-mediated cytotoxicity due to decreased cell adhesion and elastase resistance. These opposite effects drove tumor evolution toward a …