Digital Commons Network^™

Using Somatic Experiencing To Mitigate Symptoms Of Secondary Traumatic Stress In Female Helping Professionals, Jillian Christie Guinta

Doctoral Dissertations and Projects

This phenomenological and quantitative study explored the lived experiences of a dozen women within the veterinary, social work, and nursing communities and how secondary traumatic stress impacts their lives. Faced with unanticipated patient illnesses, facilitating compassionate end-of-life procedures, and rapidly moving from one emotional state to the next between patients, professionals are carrying tremendous unprocessed emotional burdens that can affect them physiologically and psychologically. Somatic Experiencing (SE) indicates tremendous promise in rehabilitating practitioners’ trauma-impacted nervous systems by offering techniques to release emotional stress and re-regulate the nervous system (Kuhfuß et al., 2023). This mixed-methods study explored the world of these …

Oxygen Under Pressure: A Comparative Study Of Maximal Oxygen Uptake In Firefighters And Civilians, Jordan N. Hunt

Doctoral Dissertations and Projects

The purpose of this study aimed to investigate and compare V̇O2max levels between firefighters and age-matched individuals from the general population. This study used a quantitative, comparative, cross-sectional design to assess differences in directly measured V̇O2max with a breath-by-breath portable analyzer between firefighters and matched civilians, determine the percentage of firefighters meeting NFPA recommended fitness thresholds, and examine the accuracy of estimated V̇O2max values. A total sample size of 52 participants (26 per group) participated in this study. Firefighters exhibited significantly higher directly measured V̇O2max and V̇O2peak than age-, sex-, and BMI-matched individuals from the general population. Firefighters in this …

Exploring The Lived Experiences Of Operating Room Nurse Interns Transitioning To Practice: A Qualitative Study, Christina C. Baker

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to describe the essence of the lived experiences of new graduate nurse interns transitioning to the operating room (OR) specialty at a southeastern U.S. university hospital system. Many hospitals have nurse residency programs designed to support and facilitate new nursing graduates’ transition to practice areas. The OR is a highly specialized nursing area requiring training in addition to what is offered in nurse residency programs. The central research question was, what is the lived experience of new graduate OR nurses as they complete their transition to practice programs? The theory guiding this …

Integration Of Aged Brain Multi-Omics Reveals Cross-System Mechanisms Underlying Alzheimer’S Disease Heterogeneity, Lucas P Scheidemantel, Katia De Paiva Lopes, Chris Gaiteri, Vilas Menon, Philip L De Jager, Julie A Schneider, Aron S Buchman, Yanling Wang, Shinya Tasaki, Roberto T Raittz, David A Bennett, Ricardo A Vialle

Faculty, Staff and Student Publications

The molecular correlates of Alzheimer's disease (AD) are increasingly being defined by multi-omics. However, findings from different data types are often difficult to reconcile. Here, we apply a data-driven multi-omics framework integrating seven omics layers from up to 1,358 aged human brain samples from the Religious Orders Study and Rush Memory and Aging Project. We demonstrate sprawling cross-omics biological factors relating to AD phenotypes. The strongest AD-associated factor (factor 8) is characterized by elevated immune activity at the epigenetic level, decreased heat shock gene expression in the transcriptome, and disrupted energy metabolism and cytoskeletal dynamics in the proteome. Unsupervised clustering …

Exploring Lived Experiences Faced By Latina Breast Cancer Survivors, Deborah Fortino

Doctoral Dissertations and Projects

The purpose of the hermeneutic phenomenological study was to explore and understand lived experiences of Latina breast cancer survivors through semi-structured interviews on the Zoom Video Conferencing platform. The theory that guided the study was the Health Belief Model (HBM), a health behavior framework that explored Latina breast cancer survivors' behaviors concerning health (Rosenstock et al., 1988). Furthermore, Fleming et al.’s (2003) five steps of gathering qualitative data and Ajjai and Higgs’s (2007) six stages of data analysis were utilized to acquire the information to explore the phenomenon of Latina breast cancer survivors’ lived experiences. The sample population included nine …

Developing Endpoints For The Cardiac Burden In Myotonic Dystrophy Type 1: A Workshop Report, Julia M Hartman, Samuel Carrell, William J Groh, Thomas A Cooper, Jordana Kron, Greg Hundley, Jennifer Jordan, Amy Ladd, Man Hung, Nicholas E Johnson

Faculty, Staff and Students Publications

Cardiac disease is a well-established manifestation of myotonic dystrophy type 1 (DM1), characterized by progressive cardiac conduction slowing with increased risk of atrial and ventricular arrhythmias, heart block, and sudden cardiac death. Multiple disease modifying therapies are in clinical trials for DM1 and show promise in improving skeletal muscle weakness and myotonia. Testing the effects of these medicines, or others, in the heart is of critical importance, but requires identification of endpoints of cardiac function that accurately reflect the state of DM1 cardiac disease. To better define cardiac endpoints, the Myotonic Dystrophy Clinical Research Network (DMCRN) and the Myotonic Dystrophy …

Versatile Smad2 And Smad3 Epitope-Tagged Mouse Models For Genomic Profiling Of Tgfβ Signaling: Uncovering Gdf9-Smad2/3 Targets, Zian Liao, Qian Zhang, Keisuke Shimada, Kaori Nozawa, Suni Tang, Masahito Ikawa, Diana Monsivais, Martin M Matzuk

Faculty, Staff and Students Publications

Transforming growth factor β (TGFβ) signaling pathways are integral for a plethora of biological processes. SMAD2 and SMAD3 are the principal transcriptional effectors of TGFβ superfamily ligands, yet quantitative, genome-wide mapping of their DNA-associated complexes under physiological contexts has remained limited due to the lack of specific, robust models. Here, we generated two versatile epitope-tagged mouse models in which endogenous SMAD2 and SMAD3 proteins are globally tagged with hemagglutinin (HA) and podoplanin (PA) sequences, respectively, enabling high-fidelity profiling of SMAD2 and SMAD3 binding across tissues. To demonstrate the broad application of our models, we exemplified the usage of our lines …

Structure-Preserving Multivariate Hypothesis Testing For Mass Spectrometry Imaging And Single-Cell Data, Keziah E Liebenberg, Erin Craig, Robert Tibshirani, Livia S Eberlin

Faculty, Staff and Students Publications

Motivation: Mass spectrometry imaging (MSI) and single-cell RNA sequencing (scRNA-seq) offer high-resolution views into tissue and cellular heterogeneity. However, conventional statistical analyses often treat sub-measurements (pixels or cells) as independent, ignoring their nested origin from individual samples. This assumption inflates the effective sample size, increases false discoveries, and undermines biological interpretation. Pixel- or cell-level averaging avoids this but sacrifices spatial or cellular resolution.

Results: We evaluated block-SAM on both simulated and real-world datasets. In DESI-MSI data from kidney, lung, and ovarian tumors, block-SAM consistently identified fewer-but more reliable-differential features compared to traditional-SAM. For example, in the kidney dataset, traditional-SAM identified …

Ex Vivo Effect Of Apixaban On Hemostatic Biomarkers In Children With Heart Disease: A Saxophone Trial Substudy, Ghada A Aborkhees, Amy J Barr, Kevin Dietrich, Christoph Male, Zhaoqing Wang, Chen Yao, R Mark Payne, Andrew C Glatz, Paul Monagle, Kristin M Burns, Alison M Reedy, Joshua L Dyme, Peter H Schafer, Antoinette Ajavon-Hartmann, Lesley G Mitchell

2020-Current year OA Pubs

BACKGROUND: The SAXOPHONE (Safety of Apixaban on Pediatric Heart Disease on the Prevention of Embolism) trial demonstrated the safety of apixaban for thromboprophylaxis in children with heart disease. Included a priori in the trial design was an exploratory biomarker substudy to evaluate the effects of apixaban on surrogate biomarkers of efficacy, thrombin generation capacity, and hemostatic proteins. The study assessed changes in d-dimer, thrombin generation assay parameters, factor VIII, fibrinogen, protein C, and protein S in children receiving apixaban compared with standard-of-care vitamin K antagonists (VKAs) or low-molecular-weight heparin.

METHODS: SAXOPHONE participants aged >1 year (n=182) had blood samples for …

Reference Proteins To Improve Core 1 And Core 2 Alzheimer's Disease Csf And Plasma Biomarkers, Linda Karlsson, Nicolas R Barthélemy, Kanta Horie, Suzanne E Schindler, Brian A Gordon, Cyrus A Raji, Tammie L S Benzinger, John C Morris, Randall J Bateman, Et Al.

2020-Current year OA Pubs

Concentration-based fluid biomarkers represent an informative and cost-effective way to detect and monitor Alzheimer's disease (AD) pathology. However, non-AD-related interindividual variation in biofluids can also affect biomarker concentrations. Here, we investigated whether normalization of CSF and plasma biomarkers to reference proteins, such as amyloid-β40 (Aβ40) and non-phosphorylated mid-region tau (np-tau), improves their robustness and reliability of representing AD pathology load. Using the Swedish BioFINDER-2 cohort [n = 1702, 50.7% male, mean (standard deviation) age 68.4 (12.2) years], we compared the associations between tau/Aβ-PET load and fluid biomarkers alone versus biomarkers in a ratio with a reference protein (Aβ40 or np-tau) …

Editorial: Publishing Impact Awarded, Frazer Underwood

South West Clinical School Journal

No abstract provided.

Exploring The Experiences Of Undergraduate Nursing Students Using E-Workbooks: A Qualitative Study, Jo Boote

South West Clinical School Journal

#400words: reasearch report

Interferon-Induced Protein Ifit3 As A Molecular Nexus Of Neuroinflammation In Alzheimer’S Disease And Hiv-Associated Neurocognitive Disorders, Ranjit Kumar Das, Nirakar Sahoo, Deepa Roy, Lauren Nguyen, Hansapani Rodrigo, Asim K. Duttaroy, Jerel Adam Fields, Upal Roy

Health & Biomedical Sciences Faculty Publications

Alzheimer’s disease (AD) and HIV-associated neurocognitive disorder (HAND) are significant global health concerns characterized by cognitive impairment and shared pathological features, including chronic neuroinflammation, amyloid deposition, and immune dysregulation. However, the precise molecular connections between these disorders remain unclear. Here, we identify IFIT3 as a critical shared mediator of neuroinflammatory responses in both AD and HAND. Using complementary approaches, including neuronal and microglial cell cultures, the APP/PS1 mouse model, and human postmortem brain tissues, we demonstrate consistent IFIT3 upregulation in response to amyloid-beta (Aβ) and HIV-1 exposure, with notably enhanced expression under combined conditions. Treatment with combination antiretroviral therapy (cART) …

Emerging Paradigms In Connectome-Guided Neurosurgery For Central Nervous System Tumors: A Narrative Review Of Structural And Functional Connectomics, Tirath Patel, Hamza Yousuf Ibrahim, Muhammad Abbas, Muzna Amir Ali, Sana Sohrab, Kinza Nawaz, Syeda Ramish Zehra Kazmi, Bhumi Daishik Patel, Nikhilesh Anand

School of Medicine Publications

Connectomics is a comprehensive mapping of structural and functional brain networks. It has introduced a paradigm shift in neurosurgery by redefining brain tumors as network disorders rather than isolated lesions. Unlike traditional surgeries, connectome-guided neurosurgery conceptualizes brain tumors as network disorders and aims to preserve brain function in resection. The objective was to study the role of connectome-guided neurosurgery in the management of Central Nervous System tumors and the use of structural and functional connectomics in tumor resection while preserving neurological function. Articles have been identified by searches of PubMed, Scopus and Google scholar from January 2000 to May 2025, …

Correction: The Formation Of Tau Pore-Like Structures Is Prevalent And Cell Specific: Possible Implications For The Disease Phenotypes, Cristian A Lasagna-Reeves, Urmi Sengupta, Diana Castillo-Carranza, Julia E Gerson, Marcos Guerrero-Munoz, Juan C Troncoso, George R Jackson, Rakez Kayed

Faculty, Staff and Students Publications

This corrects the article "The formation of tau pore-like structures is prevalent and cell specific: possible implications for the disease phenotypes" in volume 2, 56.

Relative Impact Of Multidomain Lifestyle Interventions On Deficit Accumulation Frailty Over 24 Months In The U.S. Pointer Trial, Mark A Espeland, Kayloni Olson, Christy C Tangney, Darren R Gitelman, Maryjo Cleveland, Amber A Thro, Yitbarek N Demesie, Heather M Snyder, Rachel A Whitmer, Pankaja Desai, Rifat Alam, Lucia Crivelli, Thomas M Holland, Olivia Preissle, Rema Raman, Michele K York, Laura D Baker

Faculty, Staff and Students Publications

Background: Multidomain lifestyle interventions hold promise as approaches to slow aging. Deficit accumulation frailty indices (FIs) are increasingly used to capture aging processes. Frailty is highly associated with increased mortality and chronic disease risk, but the degree to which multidomain lifestyle changes impact frailty is not clear.

Methods: The U.S. Study to Protect Brain Health through Lifestyle Intervention to Reduce Risk (U.S. POINTER) was a 2-year randomized clinical trial to compare two multidomain lifestyle interventions designed to increase exercise, improve diet, and promote social and cognitive stimulating activities and health monitoring. The Structured intervention incorporated greater structure, intensity, and accountability …

The Gut Microbiota Shapes The Human And Murine Breath Volatilome, Ariel J Hernandez-Leyva, Amalia Z Berna, Maggie H Bui, Yang Liu, Anne L Rosen, Michael A Lint, Samantha A Whiteside, Natalia Jaeger, Ryan T Mcdonough, Nikhilesh Joardar, Jesús Santiago-Borges, Christopher P Tomera, Wentai Luo, Audrey R Odom John, Andrew L Kau

2020-Current year OA Pubs

The gut microbiota is crucial to health, yet implementation of microbiota-based therapeutics is limited by the lack of rapid diagnostics. We hypothesize that breath contains gut microbe-derived volatile organic compounds (VOCs) reflecting microbiota composition and metabolism. In healthy children, we found that breath VOC composition (or volatilome), assessed by gas chromatography-mass spectrometry, correlates with gut microbiome composition and function. By capturing exhaled breath from human-stool-colonized and monocolonized gnotobiotic mice, we profiled breath VOCs and discovered that murine breath is also significantly influenced by the gut microbiome. VOCs from cultured gut microbes were identified in vivo in monocolonized gnotobiotic colonized mice. …

Validate-Perianal: An International Real-World Multi-Centre Exploratory Validation Of The Topclass Definition Of A Radiologically Healed Fistula In Perianal Fistulising Crohn's Disease, Easan Anand, Thirza J Van Croonenburg, Sami Samaan, Phil Tozer, Ailsa Hart, Parakkal Deepak, David H Ballard, Jaap Stoker, Phillip Lung

2020-Current year OA Pubs

OBJECTIVES: Radiological healing on MRI is the ultimate therapeutic goal in Class 2a perianal fistulising Crohn's disease (pfCD). The TOpClass consortium recently defined radiological healing (TOpClass-RH) by the absence of T2 hyperintensity, a completely fibrotic fistula tract, and the absence of contrast enhancement when used. This study aimed to validate TOpClass-RH in real-world clinical practice.

MATERIALS AND METHODS: VALIDATE-PERIANAL was a retrospective, multi-centre international study. Patients with pfCD with a baseline MRI scan showing active disease and follow-up MRI evidence of radiological fistula healing between 2021 and 2023 were identified. Paired scans were independently reviewed by three gastrointestinal radiologists using …

Phip Suppresses Nurd To Enable The Growth Of Swi/Snf-Mutant Cancers, Hayden A Malone, Francisca N De Luna Vitorino, Benjamin A Garcia, Et Al.

2020-Current year OA Pubs

SWI/SNF chromatin remodeling complexes are perturbed in 20% of all cancers and in several developmental disorders, yet the mechanisms by which these mutations dysregulate transcription and drive disease are poorly understood. To both elucidate these mechanisms and identify vulnerabilities caused by these mutations, we leverage genome-wide CRISPR-Cas9 screening in hundreds of cancer cell lines and identify the chromatin reader protein PHIP as a specific dependency in cancers with broadly disrupted SWI/SNF function. Mechanistically, we reveal that PHIP cooperates with SWI/SNF to facilitate transcriptional activation by ubiquitinating and suppressing subunits of the repressive Nucleosome Remodeling and Deacetylase (NuRD) complex. We demonstrate …

The Effect Of Livelihood Capital Accessibility On The Financial Security And Financial Well-Being Of Sheep Farming Households (Survey In Wanaraja Subdistrict, Garut Regency), Suhendarsyah Suhendarsyah, Unang Yunasaf, Sondi Kuswaryan

Jurnal Ilmu Ternak Universitas Padjadjaran

This study analyzed the influence of livelihood capital accessibility on the financial security and financial well-being of sheep-farming households in Wanaraja Subdistrict, Garut Regency. A quantitative approach was used through a survey with organized interviews of 95 sheep farmers. The research variables include livelihood capital accessibility (X), financial security (Z), and financial well-being (Y). The livelihood capital accessibility construct was built as a Higher-Order Construct with five dimensions: human, natural, financial and physical capital. Data analysis used Partial Least Square Structural Equation Modeling (PLS_SEM) with a two-stage approach. The results evince that social capital are the most influential dimensions in …

Reproductive Performance Of Friesian Holstein Crossbred Dairy Cattle After A Foot-And-Mouth Disease Outbreak In Lembang, Indonesia, Hanunghanindito Pamungkas, Septiyani Septiyani, Nurcholidah Solihati

Jurnal Ilmu Ternak Universitas Padjadjaran

Foot-and-mouth disease (FMD) is a highly contagious viral disease that may impair reproductive efficiency in dairy cattle. This study aimed to evaluate changes in the reproductive performance of Friesian Holstein crossbred dairy cows following an FMD outbreak at UPTD BPTSP and HPT Cikole, Lembang, West Java, Indonesia. A retrospective study was conducted using reproductive records collected from 2019 to 2023. The reproductive parameters analyzed were calving interval, service per conception, conception rate, service period, and first mating postpartum. Differences between the pre- and post-FMD periods were assessed using paired sample t-tests. The results showed significant differences in calving interval, service …

Polymorphism Of The Mx Gene In Riau Kampung Chickens, Elfawati Elfawati, Restu Misrianti, Sadarman Sadarman

Jurnal Ilmu Ternak Universitas Padjadjaran

One of the genetic markers for avian influenza is the Mx gene. The purposed of this study was to determine the polymorphism of the Mx gene of kampung chicken in Riau Province. A total of 61 samples from three subpopulations have been genotyped using PCR-RFLP. Allele and genotype frequencies have been calculated using PopGene. The Mx gene was amplified, producing a DNA fragment measuring 299 base pairs. This fragment was digested with the Hpy81 enzyme, which yielded three genotypes: the AA genotype showed by a single 299 bp band; AG showed by 299, 200, and 99 bp bands; and GG …

The Potency Of Inulin Extraction Waste Fermentation From Local Tubers As A Feed Additive, Mohamad Septian, Danes Suhendra, Mikael Sihite, Dyah Saputri

Jurnal Ilmu Ternak Universitas Padjadjaran

This study aims to determine the potential of inulin extraction waste fermentation as a feed additive based on the content of lactic acid, dry matter, pH, and Fleigh points. This research was conducted from March to June 2022 at the Animal Husbandry and Fisheries Laboratory, Tidar University. The experimental design used in this study was a Completely Randomized Design with 4 treatments (fermentation of inulin extraction waste: T1 Dioscorea alata (uwi), T2: ganyong (Dioscorea alata discolor), T3: gadung(Dioscorea hispida), and T4: umbi ungu (Ipomoea batatas). Each treatment was replicated 5 times. The variables …

The Potential Of Bioactive Peptides From Goat Milk Kefir With Antibacterial Activity As An Antibiotic Substitute, Dhea Athillah, Jajang Gumilar, Eka Wulandari

Jurnal Ilmu Ternak Universitas Padjadjaran

This study aims to determine the optimal incubation time for goat milk kefir that produces the highest antibacterial peptides, and to determine the antibacterial activity of purified goat milk kefir. Protein levels were determined using the microassay method. Kefir, which is known to have the best incubation time for producing the highest antibacterial activity when ultrafiltered with a 10 kDa cut-off membrane, was analyzed for its molecular weight using SDS-PAGE. The antibacterial activity was tested against pathogenic bacteria E. coli and S. aureus. The highest soluble protein content was found in kefir incubated for 36 hours, with a soluble …

Improving Anesthetic Management Of Pheochromocytoma: ​ ​An Educational Initiative Led By Student Registered Nurse Anesthetists​, Kerryn Nicholls

Scholars Week

Anesthetic management of pheochromocytoma presents challenges to experienced nurse anesthetists and recent graduates alike due to the rarity and complex pathophysiology. The purpose of this DNP project was to provide information and education informed by an extensive literature review regarding the anesthetic management of pheochromocytoma for the benefit of future nurse anesthesia practice. The project was accomplished through an educational presentation and novel clinical care flow chart focused on perioperative anesthetic care of pheochromocytoma excision to an audience of practicing certified registered anesthetists (CRNA’s) in two rural Kentucky hospitals. The findings of this project demonstrated that student nurse anesthesia students …

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …

Exploring The Impact Of A Multifaceted Standardized Wellness Program On Physical, Mental, Emotional, And Spiritual Health In Nurse Anesthesia Students, Lauren Kulaszewski, Amber Hurt

Scholars Week

Abstract

Purpose

Nurse anesthesia students experience substantial academic and clinical stress, placing them at increased risk for anxiety, depression, burnout, and suicidal ideation. Despite this risk, there is limited guidance on the effectiveness of standardized, programmatic wellness initiatives in nurse anesthesia education. The purpose of this project was to evaluate whether implementation of a standardized wellness program, compared with reliance on independent student-initiated practices, could improve mental, physical, emotional, and spiritual well-being among second- and third-year nurse anesthesia students.

Methodology

A pre–post intervention design was used over a six-month period at a large academic institution. Second- and third-year nurse anesthesia …

Assessing The Impact Of Interprofessional Simulation Training On Perioperative Staff's Confidence In Managing Maternal Hemorrhage, Mallory Duncan, Lidia Vazquez

Scholars Week

Globally, maternal mortality rates remain a critical public health challenge, often related to inadequate healthcare infrastructure in low-income countries. Yet according to the American Journal of Obstetrics and Gynecology (ACOG), maternal mortality rates in the United States are also on the rise, with nearly 32.9 deaths per 100,000 live births. These deaths are largely contributed to maternal hemorrhage (PPH), defined by ACOG as cumulative blood loss of at least 1,000 mL accompanied by symptoms of hypovolemia within 24 hours of the birth process. These findings underscore an urgent need to strengthen the training for perioperative staff in the management of …

Occupational Sevoflurane Exposure And Awareness Of Health Effects Among Anesthesia Providers, Hayden Fell

Scholars Week

Key words:

Sevoflurane exposure Occupational safety CRNAs Anesthetic gas exposure Workplace hazard

The anesthetic gas sevoflurane is of unique interest amongst anesthesia providers as a potential workplace hazard. This project aimed to evaluate CRNA knowledge, clinical practices, symptoms, and perceptions related to occupational sevoflurane exposure amongst Certified Registered Nurse Anesthetists (CRNAs) at a regional hospital in Kentucky.

This quality improvement project used a pre- and post-intervention survey design. Ten CRNAs participated in the project. A pre-survey was given, followed by an educational session informing participants of guidelines regarding Sevoflurane exposure and literature findings of Sevoflurane as a potential workplace …

Redesigning A Fitness App Interface For Physiological Constrained Users*, Joseph E. Manzanillo

Campus Research Month

As fitness tracking converges with medical monitoring, inclusive design becomes a matter of health equity. This research utilizes a Polar Beat redesign to address exclusionary "sporty" aesthetics that can exclude 300 million colorblind users. Based in Human-Computer Interaction (HCI), the study implements WCAG AA standards and color-blind-verified filters to mitigate data loss during Situational Induced Impairment (SIID), when high-intensity exercise compromises cognitive and visual processing. By optimizing user journeys for Paralympic and geriatric archetypes, this work demonstrates that accessibility is the essential bridge transitioning mobile fitness apps into viable, inclusive instruments for clinical medical use.