Digital Commons Network^™

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Examining Biobehavioral Indicators Of Adhd In Children With Fxs, Hannah Pressler, Kayla Smith, Ramsey Coyle, Elizabeth Will, Jane E. Roberts

Caravel Undergraduate Research Journal

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity behaviors that are inconsistent with developmental age. Children with fragile X syndrome (FXS), a genetic neurodevelopmental disorder, are often diagnosed with comorbid ADHD (53–59% of males with FXS). Despite the prevalence of ADHD in FXS, little is known about the early manifestation of ADHD. The current project aims to explore group differences in play behaviors between children with FXS and typically developing (TD) children as well as the relationship between infant play behavior and heart activity to future ADHD attention outcomes. Participants included male children with FXS and …

Isass Brave New Continuing Medical Education World: The Stifling Of Innovation In Spine Surgery Through Overrestriction Of Collaboration, Morgan P. Lorio, Kai-Uwe Lewandrowski, Óscar L. Alves, Avelino Parajón, Matthew Scott-Young, Hansen A. Yuan, Alex R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: in 2020, the accreditation Council for Continuing Medical education (aCCMe) released the Standards for Integrity and Independence in Accredited Continuing Medical Education, effective january 1, 2022, to ensure that accredited activities are accurate, balanced, evidence-based, and clearly separated from marketing and sales. although these aims are broadly supported, implementation may have unintended consequences in procedure-intensive specialties such as spine surgery, where surgeon–industry collaboration often drives device innovation, clinical trials, and dissemination of new techniques.

OBJECTIVE: To examine how current interpretations of ACCME eligibility and financial-relationship standards may affect continuing medical education in spine surgery and to propose practical adaptations …

The Effect Of Stress Hormones On Memory Formation And Academic Performance, Emma L. Hooks

Senior Honors Theses

With chronic stress becoming increasingly prevalent in academic settings, researchers have identified significant effects on learning and academic performance. Cortisol, a glucocorticoid hormone, is released following the activation of the hypothalamic-pituitary-adrenal (HPA) axis and plays a vital role in the stress response. Although acute increases in cortisol can improve attention and memory, sustained activation of the stress response can impair memory, executive functioning, and academic performance. This thesis draws on neuroscience, psychology, and education research to examine how chronic cortisol exposure affects the hippocampus and prefrontal cortex, and how the effects manifest in learning and academic performance, particularly in developmental …

Measuring Disability Prevalence In Healthcare: A Study Comparing Two Disability Measures, Kristen L. Milefchik, Rhonda K. Dailey, Sharon Milberger

Developmental Disabilities Network Journal

People with disabilities experience significant health disparities and interventions are needed to address them. Measuring disability prevalence is an essential aspect of designing effective, data-driven healthcare strategies. Accurately measuring disability prevalence is challenging given disability is a complex phenomenon, with biological, social, environmental, and cultural components. Previous studies have compared a variety of disability status measurements and found that measurements were incongruent with each other. This study examines the concordance between disability status using two different measures: the nationally recognized American Community Survey (ACS-6) functional difficulty questions and one disability identity question. We used data from 3,621 adult patients participating …

Delivering Food, Exercise, And Nutrition Education For The Prevention Of Chronic Disease, Ava Caron

Human Nutrition and Hospitality Management Undergraduate Honors Theses

Chronic diseases such as diabetes, heart and respiratory diseases, cancer, and stroke pose significant health challenges in the United States, with Arkansas experiencing some of the highest rates of related mortality. This project aimed to improve health literacy related to nutrition and physical activity among adults at risk for chronic disease in Arkansas, focusing on those living independently in Ozark, Ouachita, and Delta regions, as well as cooperative extension agents in Family & Consumer Sciences. Using a mixed-methods approach involving surveys and focus groups, the study explored participants’ nutrition knowledge, health awareness, physical activity engagement, and preferred methods of receiving …

Promoting Influenza Vaccination Among College Students, Wajeeha Khan Valley

Electronic Theses, Projects, and Dissertations

Influenza remains a significant public health concern on college campuses, where high population density, shared living environments, and frequent social interaction increase the risk of viral transmission. Despite the availability of safe and effective influenza vaccines, vaccination rates among college-aged students remain consistently low. Many students underestimate their personal risk for influenza and hold persistent misconceptions regarding vaccine safety, effectiveness, and side effects. The widespread use of social media further influences these attitudes, as misinformation can rapidly spread while credible health messaging often struggles to gain visibility. It is important to eliminate vaccine hesitancy among college students through innovative, behavior-focused …

An Evaluation Of Leading Indicators In The Construction Industry And Their Relationship With Incident Rates, Kitti Miller Whalen

All-Inclusive List of Electronic Theses and Dissertations

Improving safety programs has been a focus of organizations for decades. Historically, focus has been directed towards lagging indicators such as recordable incident rates and experience modification rate (EMR). While these remain beneficial, they are only one component of the broader framework. In recent years, companies have started to examine what occurs prior to an incident, which are known as leading indicators. The research into leading indicators is promising, however research into the area is limited. The focus of this study is to identify which leading indicators are most strongly associated with improved incident rates in the construction industry specifically. …

Intimate Partner Violence In The Queer Community, Kathleen A. Oslé

Capstone Projects and Master's Theses

Queer college students face unique barriers to receiving intimate partner violence (IPV) prevention services, of note the instability of emerging adult life. At question is whether or not targeted intervention services appropriately serve the queer community in this regard. A new digital media landscape for the romantic world creates potentially harmful life goals by glorifying unhealthy behaviors and ostracizing survivors, all for the sake of money. Previous research shows that early intervention and education provides a preventative factor in IPV. Data from an in-person intervention workshop is used to determine the feasibility of targeted intervention services, and provides means-tested results. …

Leading With Hope: A Clinical Communication Campaign To Promote Partner Hiv Testing In Assisted Partner Notification And Antenatal Care Programs In Uganda., Emily A. Hurley, Violet Gwokyala, Linda Kisaakye Nabitaka, Jolly Beyeza Kashesya, Mercylynn Agasha, Florence Namaganda, Nikolaus Schuetz, J Nalubega Ross, Joseph K B Matovu, Rhoda Wanyenze, Glenn Wagner, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

Among heterosexual couples in sub-Saharan Africa, fears of relationship dissolution and inability to bear healthy children following an HIV-positive result remain barriers to HIV testing. Recently expanded availability of pre-exposure prophylaxis (PrEP) affords a critical opportunity to promote HIV testing with reassuring communication that highlights use for relationship preservation and healthy childbearing. We aimed to develop a theoretically-grounded communication intervention to promote partner HIV testing within assisted partner notification (APN) and antenatal care (ANC) programs in Uganda. Through an 18-month iterative co-creation process, we developed the HOPE Clinical Communication Campaign (HOPE-CCC) in collaboration with a project advisory board (PAB) of …

The Undergraduate Education And Scientific Literacy: Exploring How College Influences Student Perception Of Covid-19 Events, Peyton Brooking

Theses/Capstones/Creative Projects

Current undergraduate students received much of their education following the events of the COVID-19 pandemic. Many of these students experienced pandemic events before receiving any or most of their science-based higher education. Exploring their progress through higher education, and how it retroactively influenced their perception of pandemic events, serves as an informative research area. This study explores how undergraduate education in the sciences influences student engagement with complex recent events in science. In addition, this study asked how higher education builds confidence in interpreting this information. Additionally, students were surveyed to understand their scientific literacy baseline at the beginning of …

Factors Affecting Pedestrian-Vehicle Conflicts: An Empirical Analysis, Christo D. Jamo

Honors Scholar Theses

The number of pedestrian deaths increased by 78% between 2009 and 2023, while other motor vehicle crash deaths increased by 13% in the same period [1]. To identify potential pedestrian safety measures, this study analyzed the effects of location-based demographics, pedestrian phasing type, and other physical infrastructure and behavior variables on the probability of pedestrian-vehicle conflicts at signalized intersections, which is a surrogate measure of crash risk. Data were collected from 55 intersections in Connecticut, and the pedestrian-vehicle interactions were classified by severity based on the Swedish Traffic Conflict Technique: undisturbed passage, potential conflict, minor conflict, or serious conflict. Because …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Assessing The Needs Of Public Health Professionals In The Inland Empire, Esteban Silva-Garcia

Electronic Theses, Projects, and Dissertations

An effective public health system relies on the need for highly trained professionals with degrees or certifications within the field of public health. As public health continues to evolve, professionals are required to improve and evolve with the pace of technology and knowledge advancements. This project focuses on reviewing literature on the current ongoing needs of public health professionals and providing them with resources that are available at low to no cost. It surveys the needs of public health professionals in the Inland Empire and the solutions created by organizations and federal agencies to support professional development for current and …

A Literature Review Of Estrogen Synthesis And Metabolizing Enzymes Produced By The Human Gut Microbiome And Their Correlation With Cancer, Rebecca Cederberg

Capstone Experience: Master of Public Health

The link between estrogen and cancer initiation or progression has been well established; such that the World Health Organization’s International Agency for Research on Cancer (WHO IARC) has classified several estrogen therapies and estrogenic compounds as group 1 carcinogens. Estrogen and/or its receptors have been associated with reproductive cancers such as breast, ovarian, endometrial, and prostate, as well as lymphomas, lung, and colon cancers. Additionally, elevated levels of estrogen and altered gut microbiomes are also associated with increased rates of breast cancer. More recently, microbial genes that are capable of synthesizing estrogen and deconjugating estrogen metabolites have been identified, and …

Human Papillomavirus (Hpv) Vaccine Acceptance: A Mixed-Methods Study And Randomized Controlled Trial Examining Messengers Of Hpv Vaccine Information Among Hispanic Parents, Alyssa Andrea Martinez

Open Access Theses & Dissertations

Hispanics make up 19.5% of the U.S. population, making them the nation's largest ethnic minority. Hispanics are disproportionately impacted by health outcomes, including many different types of cancers that are caused by the Human Papillomavirus (HPV). An HPV vaccine is available that can prevent 90% of HPV associated cancers. The purpose of this mixed-methods study and randomized experiment is to develop and test data-driven digital health messages to promote the HPV vaccine in Hispanic parents. Four specific aims were conducted among three major studies. Aim 1 (Study 1): A cross-sectional survey was conducted to obtain preliminary evidence on trusted messengers …

Miserly Thinking: Understanding The Factors Shaping Public Support Towards Project Wolbachia In Singapore, Shirley S. Ho, Agnes S. F. Chuah, Fiona J. W. Goh, Nova Mengxia Huang, Mengxue Qu, Hye Kyung Kim, Sonny Rosenthal

Research Collection College of Integrative Studies

Project Wolbachia is a vector control method that releases male Wolbachia-infected Aedes mosquitoes to curb dengue transmission in Singapore. While research has primarily focused on its efficacy, few studies have examined public opinion. This study draws upon the cognitive miser model and scientific literacy model to examine the factors shaping public support for Project Wolbachia. A nationally representative door-to-door survey was conducted in Singapore (N = 1,000) using multi-stage stratified random sampling. Our findings revealed that while knowledge about Project Wolbachia explains public support, laypeople may often rely on cognitive shortcuts, such as value predispositions, media attention, and pre-existing perceptions, …

Alcohol Awareness, Prevention, And Education In Greek Life, Vivian J. Mcmechen, Kara Ann Lasater, Page Dobbs

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Alcohol consumption is normalized in Greek Life culture, and this social standard can lead to risky health behaviors and overconsumption. At the University of Arkansas, approximately one-third of students are members of Greek Life; there is a need for prevention methods that understand students’ lived experiences. Purpose: The purpose of this study is to examine students’ experiences with alcohol prevention, awareness, and education as current members of Greek Life at the University of Arkansas. Through student interviews and surveys, this project aims to inform and provide recommendations for relatable and student-centered alcohol prevention and education efforts. Methodology: This study …

Ligand-Based Pharmacophore Modeling And Structure-Based Virtual Screening For Identifying Potential Therapeutic Agents Targeting The Sars-Cov-2 Spike Protein-Ace2 Receptor Interaction, Timoteo Delgado-Maldonado, Gilberto Vargas-Salas, Debasish Bandyopadhyay, Adriana Moreno-Rodriguez, Eyra Ortiz-Pérez, Gildardo Rivera-Sanchez

School of Integrative Biological & Chemical Sciences Faculty Publications

Coronavirus disease (COVID-19) remains a global health concern due to its high mortality and morbidity. In this study, we combined ligand-based pharmacophore modeling (LBPM) with structure-based virtual screening (SBVS) to identify novel inhibitors targeting the SARS-CoV-2 spike protein. Ligands from the MolPort database were screened via docking and molecular dynamics simulations at the receptor-binding domain (RBD). Four compounds showed promising docking scores (-8.7 to -6.4 kcal/mol) and dynamic stability (root mean square deviation < 5 Å). In vitro assays confirmed that compounds C3 (IC50 = 0.03 µM) and C4 (IC50 = 10.4 µM) effectively inhibited spike-ACE2 binding with low cytotoxicity (CC50 > 100 µM). These findings show the efficacy of the LBPM technique and highlight 1H-pyrazol-5-ol derivatives as potential building blocks for developing new antiviral agents against SARS-CoV-2.

Occupational Stressors And Health Impacts Among First Responders, Mason N. Roach

Honors College Theses

The United States 911 emergency response system is an interconnected web of public services that seeks to provide its community with care, resources, and safety in times of need. However, the impact of this support on the employees providing the service often goes unnoticed. This review identifies and analyzes the unique strains on first responders' physical and mental health using the Job Demand-Control Model and the Allostatic Load Model. A review of available research literature supports the conclusion that occupational-related stress, including trauma exposure, shift work, poor leadership, and inadequate communication, can have long-lasting negative impacts on provider health.

The Effect Of Education Using The Lecture Method And Puzzle Games On The Level Of Knowledge And Attitude Toward Balanced Nutrition Among Students Of Sdn Pakintelan 01 In Gunung Pati District, Semarang City, Erlin Nurlina, Syifa Qolbiyah Nasir

Indonesian Journal of Public Health Nutrition (IJPHN)

Fulfilled nutritional needs play an important role at school age. The beginning of nutritional problems occurs due to knowledge factors, so it is necessary to implement efforts to provide information about balanced nutrition. Nutrition education research using lecture and puzzle game methods was conducted at SDN Pakintelan 01 aimed at determining changes in the level of knowledge and attitudes of students regarding balanced nutrition. The type of research is Quasy Experiment and uses a pretest-post test design with control group design. The sampling technique uses stratified random sampling. The number of samples of the control group given education (lecture method) …

Food Fortification Strategies To Address Micronutrient Deficiencies In Cambodia: A Scoping Review Of Policy Implementation, Industry Capacity, And Public Health Outcomes, Sokha Yem, Sreypeov Tun, Sokunthea Kem

Indonesian Journal of Public Health Nutrition (IJPHN)

Background: Micronutrient deficiencies remain a major public health challenge in Cambodia, with iron deficiency anaemia, iodine deficiency disorders, zinc deficiency, and vitamin A deficiency disproportionately affecting women of reproductive age and children under five. Food fortification—the deliberate addition of essential micronutrients to commonly consumed foods—has been widely recognised as a cost-effective population-level intervention to address nutritional gaps. Objective: To systematically map and synthesise existing evidence on food fortification strategies in Cambodia, focusing on policy implementation, industry production capacity and compliance, regulatory enforcement, and public health outcomes. Methods: A scoping review was conducted following the Arksey and O’Malley methodological framework and …

Documentation And Dashboard Driven Quality And Safety Improvement In Interpreter Services For Limited English Proficient Patients, Richard T. Dillehay, Samuel Verkhovsky, Andrew Bohm, Harley Friedman, Dawn Welshman, Ann Morong, Vidya Karthikeyan, Jessica Dampier, Amanda Racine, Brant Oliver

Patient Experience Journal

Limited English Proficiency is known as an independent driver of disparities in patient's access to healthcare and their healthcare outcomes. The Joint Commission standards require that health systems document language services delivery to patients with limited English proficiency in a systematic way. Our health system had not historically utilized a methodical system for documenting language services utilization prior to the launch of this initiative. By utilizing a Lean Six Sigma approach, a project team comprised of leaders from interpreter services, operations, data analytics, and data informatics codesigned an Epic SmartForm data collection instrument and series of Tableau dashboards to monitor …

Utilization Of Visual Metaphors For Improving Health Literacy, Kadir Alp Özler, Morgan Dressel, Madeline Weiner, Robert D Lucito, Alice Fornari

Patient Experience Journal

Health education is practiced in patient encounters via verbal communication and educational pamphlets. However, these techniques are faulty and do not provide true patient comprehension of their conditions and treatments reform is necessary to prevent the mortality and hospitalization rates that are linked to poor health literacy. Visual aids and metaphors are individually known to be powerful educational tools. A student organization at Stony Brook University, Artists in Medicine, has sought to synergize these tools to create visual metaphors artwork that links everyday concepts to patient illnesses to facilitate comprehension of this information. For example, one project “Aortic Dissections” depicts …

Patient Experience (Px) In Low- And Middle-Income Countries (Lmics): A Scoping Review, Yara Abou Harb, Geoffrey A. Silvera

Patient Experience Journal

Patient Experience (PX) is a growing subject in the healthcare industry due to its association with improved clinical outcomes, patient safety, and business motives. While PX is well studied in high income countries, little is known about the state of PX in Low and Middle-income countries (LMICs). Objective: The study aims to examine literature on PX and related concepts in LMICs. Methods: This study executes a PRISMA literature review of academic databases (Ovid Medline, CINAHL, EMBASE and Google Scholar) as well as hand searching of PX related websites from 2005 to 2024. Results: 67 references met search criteria. Four themes …

Multilevel Factors Shaping The Patient Experience With Health Services In Torbat Heydarieh, Iran, Fatemeh Pourhaji, Mohammad Hossein Delshad

Patient Experience Journal

Background: One of the main aims of public health is to ensure that health services are used and available. However, access alone does not guarantee a positive patient experience, which is critical to achieving optimal health outcomes and ensuring health equity. Aims: The objective of this study is to analyse in a comprehensive way the multiple factors influencing the patient experience and subsequent use of healthcare services by households in Torbat Heydarieh, Iran, by examining the independent and interactive contributions of individual, household and environmental (community) determinants using THUMS data. Methods: This analytical study, which covered a 1-year period, looked …

Exploring Patient Satisfaction: Descriptive And Predictive Insights From Hcahps Surveys In U.S. Hospitals, Naveen Gudigantala, Tanush Sistla, Ramu Gudigantala, Naga Vemprala

Patient Experience Journal

This study analyzes patient experience data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys across three time periods: 2020–21, 2021–22, and 2022–23. Utilizing both descriptive and predictive analytics, we examined ten key variables related to patient communication, hospital environment, discharge information, and overall hospital ratings. Descriptive analytics using longitudinal data analysis revealed that while patient experience metrics were strong in 2020–21, a significant downturn was observed in 2021–22, followed by a marked recovery in 2022–23. These results suggest that while COVID-19 pandemic negatively impacted patient satisfaction metrics in 2021–22, the emerging evidence suggests U.S. healthcare system …

Patient Satisfaction And Perceived Quality Of Care: A Population-Based Cross-Sectional Study Of United States Adults, Samuel Ofei-Dodoo, Carter Altenbernt, Yessin Wael, Hayrettin Okut, Alex Watkins, Nola Tran, Alishka Rojas-Addari

Patient Experience Journal

Patient satisfaction and perceived quality of care are key indicators of health care performance, yet the relative influence of demographic versus communication-related factors remains underexplored. Using data from 7,278 non-institutionalized United States adults in the nationally representative Health Information National Trends Survey, descriptive statistics summarized respondent characteristics and experiences with health care professionals, and survey-weighted multinomial logistic regression identified predictors of perceived health care quality. Respondents generally reported positive experiences, with communication-related factors emerging as the strongest predictors of excellent ratings. Patients who were always included in decisions (OR = 3.44; 95% CI, 1.11-10.69), received clear explanations (OR = 11.24; …

System-Level Barriers To Patient Engagement With Electronic Medical Records, Corey Adams, Reema Harrison, Guncag Ozavci, Kathleen Gray, Nilmini Wickramasinghe, Vicky Yuan, Tracey Bucknall, Elizabeth Manias

Patient Experience Journal

Objective: Electronic medical records (EMRs) can support patient-centered care, but system-level barriers often limit how patients engage with EMR systems. This study explored the system-level barriers and enablers to patient engagement with EMRs from the perspectives of healthcare leaders. Methods: Semi-structured interviews were conducted with 20 participants in senior EMR-related roles across healthcare organizations in two Australian states. Data were analyzed using reflexive thematic analysis to identify key system-level influences on patient engagement. Results: Seven themes were identified: 1) EMRs for digital storage, not connection, 2) Privacy rules create challenges to accessing information, 3) Communication barriers when using EMRs, 4) …