Digital Commons Network^™

Time Ticks Slowly For Kidney Transplant Reform: Eskd Patient Challenges And Opportunities, Gregory P. Hess

College of Population Health Faculty Papers

No abstract provided.

External Validation Of Calculator For Cesarean Delivery During Induction Of Labor, Claudia J. Ibarra, Rachel L. Wiley, Han-Yang Chen, Estefania Guthrie, Ipsita Ghose, Hector Mendez-Figueroa, Suneet P. Chauhan

School of Medicine Faculty Publications

OBJECTIVE: To validate a published risk calculator to predict cesarean delivery (CD) among singletons undergoing induction of labor. METHODS: Our retrospective cohort study included singletons undergoing induction of labor. A predicted CD score was calculated for each individual based on a previously developed calculator. External validation of the calculator was assessed by the discriminative power of the model by using the area under the receiver operating characteristic curve, and by a calibration curve. The score was categorized as less than 10%, 10% to less than 30%, and 30% or greater. The primary outcome was CD. The secondary outcomes were a …

Opioid Overdose Bystander Assistance And Harm Reduction In Pennsylvania, Walkirya Peralta

Walden Dissertations and Doctoral Studies

Bystanders play a vital role in reducing opioid overdose deaths by administering naloxone, a medication that can reverse the effects of opioids when used promptly. With opioid-related fatalities considered a public health emergency in the United States, increasing public access to naloxone and education on overdose prevention has become a key strategy in harm reduction. Research shows that these efforts effectively lower overdose deaths in affected communities. As part of this public health approach, many states allow individuals to obtain naloxone without a prescription through standing orders at pharmacies and community programs. Additionally, legal protections such as Good Samaritan laws …

The Association Between Malnutrition And Gingivitis Among Residents In St. Louis, Missouri, Alyssa Detrick

Walden Dissertations and Doctoral Studies

Malnutrition and gingivitis are common diagnoses in primary medical and dental care. The purpose of this quantitative study was to understand the association between malnutrition and gingivitis among residents in St. Louis, Missouri. The study was based on the social ecological model (SEM). The cross-sectional design involved secondary data (N = 2,553) from a Federally Qualified Health Center in St. Louis, Missouri that included de-identified patient demographic and diagnosis information of St. Louis City residents with a medical and dental visit in 2024. This study examined the relationship between malnutrition and gingivitis while controlling for ethnicity, preferred language, race, and …

Vitamin B12 Deficiency: Confidence, Perspectives, And Practices Among Registered Dietitian Nutritionists, Avery Miller Adams

Master's Theses

Vitamin B12 deficiency is common in the United States, occurring in 20% of adults aged 60 and above (Andres et al., 2004). Veterans are susceptible to B12 deficiency due to tobacco product usage, alcohol consumption, and poor diet quality. Megaloblastic anemia is the second most prevalent vitamin deficiency disorder recorded in military personnel from 1997 to 2015 (Knapik et al., 2021). This exploratory, analytic research aims to assess registered dietitian RDN nutritionists’ (RDN) knowledge, perceptions, and intentions regarding treating vitamin B12 deficiency in a clinical setting. Due to population prevalence differences, responses from VA and non-VA practicing registered dietitian-nutritionists (RDNs) …

Is There An Association Between Food Literacy And Diet Quality In Young Adult College Men?, Morgan Claire Mayeux

Master's Theses

Food literacy skills can improve dietary intake in young adults as it provides them with the tools they need to make healthier food-related decisions. The benefits of improving food literacy includes the reduction in the risk of prevalent, preventable dietrelated diseases such as obesity, T2DM, heart disease, and other chronic diseases that plague the Unites States today. Previous literature reports primarily on college female samples. Because a large proportion of the samples in the available studies are female, the current literature may not reflect young adult men’s food literacy and its comparison to their overall diet quality. The purpose of …

A Developmental Evaluation Of A Dental Hygiene Program And A Community Health Partnership, Laura Jacob

Higher Education: Doctoral Research Projects

Today, dental hygiene education commonly occurs in community college settings which are removed from dental schools thus dental hygiene students graduate with relatively little to no exposure to dentistry or directly with a clinically practicing dentist. With dental hygiene workforce shortages at an extremely high level, locally and nationally, it is imperative to matriculate students who are poised to be successful in the changing landscape of healthcare.

The purpose of this program evaluation was to investigate via the developmental program evaluation model, the perceived benefits of a potential collaboration between the Colorado Mountain College (CMC) dental hygiene program and a …

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

Causes Of Symptoms And Symptom Persistence In Long Covid And Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Anthony L Komaroff, Robert Dantzer

Faculty, Staff and Student Publications

Debilitating symptoms for many years can follow acute COVID-19 ("long COVID"), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and various post-acute infection syndromes (PAISs). Together, long COVID and ME/CFS affect 60-400 million individuals, globally. Many similar underlying biological abnormalities have been identified in both conditions including autoantibodies against neural targets, endothelial dysfunction, acquired mitochondrial dysfunction, and a pro-inflammatory gut microbiome. Each of these abnormalities may directly cause some of the symptoms. In addition, the symptoms also may be caused by ancient, evolutionarily conserved symptomatic and metabolic responses to vital threats-sickness behavior and torpor-responses mediated by specific, recently discovered neural circuits. These neural …

Changes In Self-Reported Excessive Daytime Sleepiness Are Associated With 5-Year All-Cause Mortality Risk Among Veterans, Katherine G Bay, Arash Maghsoudi, Amin Ramezani, Drew A Helmer, Amir Sharafkhaneh, Javad Razjouyan

Faculty, Staff and Students Publications

Excessive daytime sleepiness (EDS) is linked to adverse clinical outcomes. This study evaluated changes in a validated tool to assess EDS, the Epworth Sleepiness Scale (ESS) and mortality risk. This retrospective cohort study included Veterans receiving sleep-related services in the Department of Veterans Affairs (VA) from October 4, 1999 to August 18, 2018, with two qualifying ESS measures. ESS values were extracted from patient notes using a validated natural language processing (NLP) pipeline (96% accuracy). ESS scores were categorised as Normal (0-10) or Abnormal (11-24). Patients were grouped based on ESS changes: Normal-Normal, Normal-Abnormal, Abnormal-Abnormal and Abnormal-Normal. Cox proportional hazards …

The Silent Epidemic: Equipment Maintenance Failures And Patient Outcomes In Ghana's Healthcare System, Ramseyer Adekorang Asamoah, Celene Dzreke, Evans Dzreke, David Kanzin

Health & Biomedical Sciences Faculty Publications

Broken tools indicate a broken system. This new study reveals how medical equipment failures destroy Ghana's public hospitals, turning life-saving technologies into silent murderers that disproportionately affect rural areas. Moving beyond technical diagnostics, we study the cascading systemic failures, chronic underfunding, critical staff shortages, and fragmented supply chains that leave 40% of vital equipment, such as ventilators, MRI scanners, and dialysis machines, inoperable at any given time. We quantify the devastating human toll through rigorous mixed-methods analysis of equipment downtime records across ten regional hospitals (2018-2023) and profound narratives from 50 frontline stakeholders, doctors forced to improvise without working incubators, …

A Feasibility Study To Mitigate Arsenic Exposure In Well Water In Oregon, Christine Lucas-Woodruff, Veronic L. Irvin, Laura Nielsen, Meghan Megowan, Lilly Anderson, Julia Pavlosek, Molly Kile

Journal of Extension

Approximately 13 million households in the United States rely on private wells for their drinking water. It is the homeowner’s responsibility to manage the quality of water in their private wells. There are many toxic contaminants that can be present private wells that can negatively impact health. Extension Agents are well positioned to assist homeowners in understanding how to manage toxics in private wells. This study demonstrated the feasibility that motivational education provided by an Extension Agent’ trained in motivational interviewing techniques is able to help homeowners with private wells mitigate their exposure to arsenic by adopting appropriate water treatment.

The Association Of Adult Medicaid Beneficiaries’ Characteristics And Their Experience During The Covid-19 Pandemic, Frank R. Tortorella

Dissertations and Theses (Open Access)

Background: The COVID-19 pandemic disrupted the United States’ safety net program, Medicaid, for low-income individuals affecting access to care, increasing enrollment, and requiring new approaches to care delivery. The literature shows that beneficiaries’ personal characteristics influence their healthcare experience. This study investigated the association between Medicaid beneficiary characteristics and experience with their Medicaid health plan, examined if COVID-19 negatively impacted experience, and tested if COVID-19 moderated the relationship between beneficiary characteristics and experience.

Methods: The research sample was 76,976 adult Medicaid beneficiaries who voluntarily completed the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) health plan surveys in 2018 …

Hot Spring Associated Infectious Diseases In The Great Basin And Southwest, Matthew Bentz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Like all bodies of freshwater, natural hot springs can harbor pathogenic microorganisms that carry the threat of infectious disease. The unique chemistry, increased temperature, and popularity for bathing may alter the risk profile of hot springs compared to other natural bodies of water. Despite this risk, the role of hot springs as a reservoir for infectious diseases remains understudied, particularly within the context of regional public health. Nevada and the Great Basin/Southwest have increasingly promoted hot springs for the purposes of tourism, and they share a strong link to the cultural heritage of the region. The unknown risk profile and …

More Than A Feeling: A Mixed-Methods Examination Of Transgender Community Connectedness And Associations With Suicidality, Erin Rook

UNLV Theses, Dissertations, Professional Papers, and Capstones

Transgender adults experience significantly higher rates of suicidal ideation than the general population. A sense of transgender community connectedness (STCC) may reduce this risk, but predictors of STCC and its association with suicidal ideation are understudied. This cross-sectional mixed methods study examined STCC and past-year suicidal ideation in relation to dimensions of transgender community connectedness (TCC) at each level of the Social Ecological Model using data from a U.S. survey of transgender adults (n = 126). About half (52.4%) felt connected to the transgender community, and 27.0% reported past-year suicidal ideation. Hierarchical logistic regression models for both outcomes showed good …

Nevada Hpv Vaccine Completion Time And Adherence Among 9-14-Year-Olds From 2017-2023, Emily Sandoval

UNLV Theses, Dissertations, Professional Papers, and Capstones

The HPV (Human Papillomavirus) is one of the most common sexually transmitted infections, in the United States. Since its development in 1991, the HPV vaccine has been proven to be highly effective against the infection (Centers for Disease Control and Prevention [CDC], 2024). In order for an individual to receive optimal protection, the CDC has given guidelines dependent on age. It is important to understand changes in HPV vaccine completion for future public health immunization campaigns and objectives. To analyze how HPV completion and adherence has changed from 2017-2023 among the 9-14-year-old population, a retrospective cohort study was conducted utilizing …

Beyond The Bruise: Understanding Injury Risk Factors Among Livestock Workers In Cattle Feedyards And Animal Handling Farms And Ranches, Rishad Ahmed

Theses & Dissertations

Cattle feeding and livestock production are central to U.S. agriculture and represent some of the most hazardous occupational environments. Workers in feedyards and on cattle farms and ranches face elevated risks of injury due to physically demanding labor, frequent animal handling, and exposure to environmental and ergonomic hazards. Many feedyard workers are Hispanic/Latino immigrants who may experience additional barriers related to language, healthcare access, and job security. Similarly, injury risks among cattle producers are compounded by seasonal workload fluctuations, limited rest opportunities, and psychosocial stressors. Beyond individual impacts, agricultural injuries also pose a substantial economic burden. Recent estimates indicate that …

An Evidence-Based Intervention To Increase Trypanosoma Cruzi, A Neglected Parasitic Infection, Diagnosis In Rural And Moderate-Size-City Us Clinics, M K. Lynn, Hunter M. Boehme, Jeffrey Hall, Patrick Kent, Alain H. Litwin, Quang H. Pham, Melissa Nolan Ph.D., Mph, Prisma Chagas Team

Faculty Publications

Background

Chagas disease is a chronic, insidious parasitic infection (Trypanosoma cruzi) that slowly develops to irreversible organomegaly over several decades. The disease is traditionally acquired in endemic Latin American countries during childhood; < 1% of foreign-born adult residents in the United States have been diagnosed or treated with this potentially fatal disease. Low physician knowledge is a primary factor leading to misdiagnosis.

Methods

Starting in April 2022, a 4-part T cruzi clinical education intervention began, which included (i) 2 grand rounds presentations to >100 internal medicine providers; (ii) implementation of a “clinical Chagas champions program” incorporating 14 key clinical staff at varying departments and administrative levels educated on their specific role related to T cruzi screening, diagnosis confirmation, clinical management, and medical billing; ( …

Disentangling The Effect Of Criminal Legal System Involvement On Mental Health In The United States, Pui Ying Chan

Dissertations and Theses

BACKGROUND: Interactions with the criminal legal system (CLS), such as through arrest or incarceration, are relatively common in the United States (US) and are increasingly recognized as social risk factors for poor mental health. Previous studies have reported a positive association between CLS involvement and poor mental health, with some theoretical frameworks, including the ecosocial theory and the stress process paradigm, supporting a plausible causal relationship. However, prior research has significant limitations in providing casual evidence given possible reverse causation in cross-sectional studies and insufficient consideration for the dynamics between CLS exposures, mental health status, and related confounders over time …

Role Of Perceived Social Support And Knowledge Of Postpartum Depression Among Women In Anambra State, Eastern Nigeria, Raphael Oluwasina Babatola Folorunsho

Walden Dissertations and Doctoral Studies

Postpartum depression (PPD) is an increasingly pressing public health issue, particularly in low-resource settings like Nigeria, where maternal mental health tends to receive limited attention. This study explored the relationship between maternal awareness of PPD, perceived social support, and prevalence of depressive symptoms among postpartum women in the Nnewi North Local Government Area (LGA) of Anambra State. Grounded in the social support theory, health belief model, and socioecological model, the study used a descriptive cross-sectional research design. A total of 406 postpartum women attending primary healthcare centers were surveyed using validated instruments, including the PHQ-9 and MSPSS. Statistical analyses included …

Cardiometabolic Outcomes In The Obese African American Population With Rheumatoid Arthritis, Cecilia Jillo Walan

Walden Dissertations and Doctoral Studies

Rheumatoid arthritis (RA) disproportionately impacts African American adults, particularly those with obesity, due to overlapping cardiometabolic risks and health care disparities. The intersection of RA, obesity, and chronic conditions such as cardiovascular disease (CVD) and hypertension underscores the need for targeted public health interventions. This study investigated the association between RA and cardiometabolic outcomes among African American adults with obesity, aiming to identify significant predictors within this high-risk population. This quantitative study employed a cross-sectional design to analyze data from the 1999–2018 National Health and Nutrition Examination Survey undergirded by the social ecological change framework with N=23644 African American adults …

Kind Kids, Healthy Teens: Child Prosociality And Fruit And Vegetable Intake, Farah Qureshi, Krista P. Woodward, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Methods

The Lived Experience Of In-Home Social Distancing And Other Preventative Measures Among Covid-19-Positive Individuals And Other Household Members, Jimmette Naytwain Brooks

Walden Dissertations and Doctoral Studies

The novel Coronavirus Disease 2019 (COVID-19), first detected in Wuhan, China, is caused by a new virus strain: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 11, 2020, COVID-19 was classified as “the second pandemic of the 21st century” by the World Health Organization. To better control the spread of the virus, governments and communities adopted several established public health protocols to quell the spread of the disease and decrease the resulting morbidity and mortality. Specific measures included masking, hand hygiene, social distancing and disinfection. Though these are proven measures, not much was known about adherence in the home …

Exploring The Self-Efficacy And Experiences Of Caregivers Using Thickened Liquids To Manage Pediatric Dysphagia, Jaimee E. Conmy

Electronic Theses and Dissertations

Pediatric dysphagia affects 1 in 37 typically developing children under five, with increased prevalence in at-risk populations. Thickened liquids are often used as an intervention despite limited evidence supporting their effectiveness in the pediatric population. Caregivers play a critical role in managing their child’s dysphagia, yet their experiences, self-efficacy, and challenges with thickened liquids remain underexplored. This mixed-methods study surveyed 57 caregivers of children on thickened liquid diets, to assess their self-efficacy, education, perceptions of effectiveness, and overall impact on their quality of life. Findings highlight gaps in caregiver training, concerns about preparation, and benefits and/or challenges experienced by caregivers. …

Effects Of Mode And Transitioning To A Mixed-Mode (Web/Phone) Design On Categorical Survey Estimates: Do Question Characteristics Matter?, Mengyao Hu, Vicki A Freedman, Justin Kamens

Faculty, Staff and Student Publications

An increasing number of telephone surveys are introducing a web option. Limited experimental research has explored the implications of such design changes and how they vary by question characteristics. Using an experimental design and propensity score matching techniques, this study examines the effects of mode (web vs. telephone) and transitioning to a mixed-mode design (from telephone-only to the choice of web or telephone) on survey estimates and how effects differ by question characteristics. We draw upon an experiment embedded in the National Study of Caregiving (NSOC), in which half of NSOC-eligible caregivers were randomized to a telephone-only design and the …

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Micbg406a Polymorphism Reduces Risk Of Mechanical Ventilation And Death During Viral Acute Lung Injury, Harry Pickering, Narges Alipanah-Lechner, Ernie Chen, Dylan Duchen, Holden T Maecker, Seunghee Kim-Schulze, Ruth R Montgomery, Chris Cotsapas, Hanno Steen, Florian Krammer, Charles R Langelier, Ofer Levy, Lindsey R Baden, Esther Melamed, Lauren Ir Ehrlich, Grace A Mccomsey, Rafick P Sekaly, Charles B Cairns, Elias K Haddad, Albert C Shaw, David A Hafler, David B Corry, Farrah Kheradmand, Mark A Atkinson, Scott C Brakenridge, Nelson I Agudelo Higuita, Jordan P Metcalf, Catherine L Hough, William B Messer, Bali Pulendran, Kari C Nadeau, Mark M Davis, Ana Fernandez Sesma, Viviana Simon, Monica Kraft, Chris Bime, David J Erle, Joanna Schaenmann, Al Ozonoff, Bjoern Peters, Steven H Kleinstein, Alison D Augustine, Joann Diray-Arce, Patrice M Becker, Nadine Rouphael, Matthew C Altman, Steve Bosinger, Walter Eckalbar, Carolyn S Calfee, Oscar A Aguilar, Elaine F Reed, John R Greenland, Daniel R Calabrese

Faculty, Staff and Students Publications

MHC class I polypeptide-related sequence B (MICB) is a ligand for NKG2D. We have shown NK cells are central to lung transplant acute lung injury (ALI) via NKG2D activation, and increased MICB in bronchoalveolar lavage predicts ALI severity. Separately, we found a MICB polymorphism (MICBG406A) is associated with decreased ALI risk. We hypothesized this polymorphism would protect against severe SARS-CoV-2 respiratory disease. We analyzed 1,036 patients hospitalized with SARS-CoV-2 infection from IMPACC. Associations between MICBG406A and outcomes were determined by linear regression or Cox proportional hazards models. We also measured immune profiles of peripheral blood and the upper and lower …

Demographic And Clinical Predictors Of Metabolic Dysfunction-Associated Steatotic Liver Disease And Advanced Fibrosis In The United States, Gail Fernandes

Walden Dissertations and Doctoral Studies

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly nonalcoholic fatty liver disease-related liver fibrosis) is a growing public health problem in the United States. The purpose of this study was to assess the prevalence of MASLD-related advanced fibrosis in the United States and assess whether type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) were independent risk factors for MASLD-related advanced fibrosis. This study was a quantitative cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to 2020, grounded in the social ecological theory. Participants (N = 21,829) were included if they were ≥18 years, excluded if …

Enumerating Escherichia Coli (E. Coli) Concentrations And Evaluating Optical Brighteners As A Potential Indicator Of Human Wastewater Contamination In La Nana Bayou, Banita Creek, And Their Tributaries, Nacogdoches, Texas, Swastika Acharya, Matthew Mcbroom, Yuhui Weng, Yanli Zhang

Electronic Theses and Dissertations

La Nana Bayou was added to the Texas 303(d) list in 2000 after it failed to meet water quality standards set by the Texas Commission on Environmental Quality (TCEQ) for primary contact recreation due to elevated Escherichia coli (E. coli) levels. E. coli is a bacterial species commonly found in the intestines of humans and warm-blooded animals. It serves as an indicator of fecal contamination in freshwater, though its presence alone cannot identify the contamination source. Optical brighteners (OBs), chemicals found in laundry detergents, cleaning agents, toilet papers, and clothing, are unique to human wastewater. This study aimed …

The Implementation Of A Telehealth Patient Advisory Council In A Network Of Federally Qualified Health Centers, Jessica Korins, Lisa Schaffer, Nandini Shroff

Patient Experience Journal

Patient input is recognized across the healthcare field as essential for tailoring innovations and quality improvement initiatives to meet the needs of intended patient populations. This paper describes the implementation of a patient advisory council (PAC) established to provide feedback on telehealth innovations and quality improvement initiatives at a network of federally qualified health centers (FQHCs) in New York State (NYS). We report on the implementation process, success and challenges, and reflections shared by PAC members regarding their experiences.