Digital Commons Network^™

Through The Eyes Of Time, Shaneece Prince, Steven Indelicato

Publications and Research

Frames have been a staple throughout history, however in recent times, a trend of having multiple pairs of glasses opposed to one, life lasting pair, has emerged. As a result, frames have piled up in landfills contributing to the polluting of our environment. Through the analysis of previously recorded studies and statistics, conclusions of the eyewear industry's growing impact on society and the planet were formed.

Millions of frames are in constant circulation, studies show that up to 31% of spectacle wearers out of a group of 375, disposed of their eyewear in the trash. The lifespan of popular eyewear …

Influence And Excess: A Study Of Alcohol’S Governmental, Societal, Biochemical, And Enzymatic Impact In The U.S And Other Countries Around The World, Thomas W. Snider

Senior Honors Theses

The conduct of the thesis is to explore the intricacies of alcohol consumption. The thesis will outline the history of alcohol and the societal pressures and conduct of drinking with relation to the government. After the history of alcohol has been defined, the thesis will move into the chemistry portion, delineating the absorption, digestion, metabolism, and excretion of alcohol. This is the portion of the thesis that will contain the quantitative data and source material as much research has already been conducted regarding these components of alcohol consumption. The condition of the research is that the data will be collected …

Medicaid Funding And Health-Related Social Needs: A Policy Analysis, Passion Ilea

Dissertations and Theses

The U.S. has disproportionately high health care spending compared to other high-income nations and comparatively poor health outcomes. The Centers for Medicare and Medicaid Services (CMS) have recently increased emphasis on addressing Medicaid member social needs. CMS believes addressing health-related social needs (HRSN) may reduce costs and improve health outcomes for Medicaid members. CMS has begun to test theories regarding the impact of member HRSN on health care by designing federal mechanisms to address HRSN, such as in lieu of services and settings-funded services, and by encouraging state Medicaid programs to develop their own approaches, such as Flexible Services. Information …

More Girls In The Classroom Improves Adolescent Mental Health, Monica Deza, Maria Zhu

Population Health Research Brief Series

Mental health challenges are common among adolescents in the United States. This brief summarizes findings from a study using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative survey of middle and high school students conducted in 1994-1995. The analysis included over 17,000 students from 133 schools across the United States. The authors find that the mix of boys and girls in a classroom affects adolescent mental health and school satisfaction. When classes have more girls, both boys and girls experience better mental health outcomes. Boys in classes with more female peers are 10% less …

Epigenome-Wide Association Study Of Nuclear Dna Methylation In Relation To Mitochondrial Heteroplasmy, Meng Lai, Kyeezu Kim, Yinan Zheng, Christina A Castellani, Scott M Ratliff, Mengyao Wang, Xue Liu, Jeffrey Haessler, Tianxiao Huan, Kwadwo Bonsu, Charles Newcomb, Kyler Mckessy, Lawrence F Bielak, Wei Zhao, Roby Joehanes, Jiantao Ma, Xiuqing Guo, Joann E Manson, Megan L Grove, Jan Bressler, Kent D Taylor, Tuuli Lappalainen, Silva Kasela, Thomas W Blackwell, Nicole J Lake, Jessica D Faul, Kendra R Ferrier, Stephen C Ekker, Lifang Hou, Charles Kooperberg, Alexander P Reiner, Kai Zhang, Patricia A Peyser, Myriam Fornage, Eric Boerwinkle, Laura M Raffield, April P Carson, Stephen S Rich, Yongmei Liu, Daniel Levy, Jerome I Rotter, Jennifer A Smith, Dan E Arking, Chunyu Liu

Faculty, Staff and Student Publications

We analyze 10,986 participants (mean age 77; 63% women; 54% non-White) across seven U.S. cohorts to study the relationship between mitochondrial DNA (mtDNA) heteroplasmy and nuclear DNA methylation. We identify 597 CpGs associated with heteroplasmy burden, generally showing lower methylation. These CpGs are enriched in dynamically regulated island shores and depleted in CpG islands, indicating involvement in context-specific rather than constitutive gene regulation. In HEK293T cells, we introduce a truncating mtDNA mutation (MT-COX3, mt.9979) and observe a positive correlation between variant allele fraction and methylation at cg04569152, supporting a direct mtDNA-nDNA epigenetic link. Many heteroplasmy-associated CpGs overlap with known methylation-trait …

Engaging Ukrainian Tf-Cbt Therapists In A Practice Skills Course To Support Their Wellbeing, Elisabeth Pollio, Esther Deblinger, Beth Cooper, Maike Garbade, Julie P Harrison, Elisa Pfeiffer

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.

Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of …

Community Health Promoters’ Experiences In Mitigation Of Cardiovascular Diseases In Lari Sub-County - Kiambu County, Kenya, Emily Njeri Muchina

MSc in Advanced Practice Nursing

Background: Cardiovascular diseases (CVDs) are a rising public health issue in low- and middle-income countries, including Kenya, where there is an escalation of their deaths and preventable risk factors. Community health promoters (CHPs) have a crucial role in the prevention of CVDs. Yet, low knowledge of CVD prevention and low detection of CVD risk factors characterise most underserved communities in Kenya. Little has been documented about CHPs' experiences in mitigating CVDs despite the presence of multilevel barriers and facilitators that can shape their experiences.

Aim: To gain an in-depth insight into the experiences of CHPs in mitigating CVD …

Food Access And Food Insecurity Among Early Childhood Educators And Staff Prior To And During The Covid-19 Pandemic: A Mixed Methods Pilot Study, Rahel Mathews, Leah Pylate, Will Davis, Elizabeth Thorne, Jamila Taylor, Shecoya White, Bennett Pope, Emma Bryant

Journal of Human Sciences and Extension

Emerging research indicates that 40% of early childhood education (ECE) workers experience food insecurity. The purpose of this study was to describe the food insecurity and food access of Head Start teachers and staff in Mississippi before the COVID-19 pandemic and to understand how COVID-19 affected food access. A mixed-methods design was employed using cross-sectional surveys, at two different time points, and three focus groups. Three Head Start centers from the Mississippi Coast participated. Approximately 52% of teacher and staff respondents experienced food insecurity before COVID-19; during the pandemic, their level of food insecurity worsened from low to very low …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

Assessing Neurocognitive Functioning Among Adults Ageing With And Without Hiv At The Kenyan Coast: Measurement Issues And Correlates, Patrick Nzivo Mwangala, Carophine Nasambu, Ryan Wagner, Mihaela Duta, Gaia Scerif, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: Cognitive impairment is one of the most prevalent complications of HIV infection, with significant medical and functional impacts. However, valid, and reliable assessment tools are lacking for the newly emergent ageing population of people living with HIV (PLWH) in many parts of sub-Saharan Africa (SSA), including Kenya. Without these tools, critical intervention opportunities, e.g., psychoeducation, treatment and additional support, are missed. To bridge this gap in Kenya, we adapted the Oxford Cognitive Screen Plus (OCSPlus), a tablet-based cognitive assessment tool designed for low-literacy settings, with adults ageing with HIV ≥ 50 years and their uninfected peers. This study examines …

Well-Being And Quality Of Life Of Kenyan Nurses, Midwives And Community Health Volunteers: Measurement Properties And Correlates Of The Bbq And Who-5, Paul Mwangi, Sabina Odero, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Healthcare workers’ quality of life (QoL) and well-being is directly linked to the quality of services they deliver. However, there is a shortage of validated measures to assess QoL, well-being and their predictors among healthcare workers in Kenya, as in other LMICs. This study aimed to assess the reliability and validity of the Brunnsviken Brief Quality of Life Scale (BBQ) and WHO-5 well-being index (WHO-5) among nurses, midwives and community health volunteers (CHVs) in Kenya. The BBQ and WHO-5 were selected due to their established psychometric strengths, brevity, and prior use in healthcare settings. Additionally, the sociodemographic, psychological, and health …

Health Workforce Issues And Recommended Practices In The Implementation Of Universal Health Coverage In The Philippines: A Qualitative Study, Veincent Christian Pepito, Arianna Maever Loreche, Ruth Shane Legaspi, Ryan Camado Guinaran, Theo Prudencio Juhani Z. Capeding, Madeline Mae A. Ong, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

Background

The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world’s leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines.

Methods

We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We …

The Frontal Assessment Battery In Older Multilingual Kenyan Adults, Anne Njoki Gitere, Anne Nyambura, Karen Blackmon, Levi Muyela, Rachel Maina, Olivera Nesic Taylor,, Jasmit Shah, Dilraj Sokhi, Sylvia Mbugua, Samuel Gitau, Sheila Waa, Juzar Hooker, Zul Merali, Chinedu Momoh, Karen Blackmon

Brain and Mind Institute

Background: The Frontal Assessment Battery (FAB) was developed as a short (6-item) bedside assessment of executive dysfunction in older adults with suspected neurodegeneration. This study describes psychometric features of the FAB in multilingual Kenyan adults with and without clinical diagnosis of dementia.

Method: The FAB consists of six items assessing verbal abstract reasoning, lexical fluency, motor learning, and inhibitory control. The score on each item ranges from 0-3, with higher scores indicating better performance. Bilingual English-Swahili study personnel translated, blind back-translated, and applied consensus-driven cultural adaptations. FAB was then administered to 95 participants [71 cognitively unimpaired (CU) controls; 24 people …

Bridging The Language Gap: The Impact Of In-Person Versus Remote Interpreter Services On Medication Adherence And Patient Safety In Adult Spanish-Speaking Patients, Ashley E. Alarcon Martinez, Jocelyn N. Lopez Maradiaga

Nursing | Student Research Posters

Background: Significant health inequities are caused by language barriers between patients and health care staff, resulting in miscommunication among adult Hispanic patients with low English proficiency, reducing medication adherence, impairing patient safety, and raising the possibility of medical errors. To address this issue, interpreter services, both in-person and remote translation, have been introduced in healthcare settings to enhance communication. Objective: The purpose of this study is to investigate the differences in patient safety and medication adherence between in-person and remote translation services for adult Hispanic individuals with limited English proficiency in healthcare settings. Methods: The proposed research involves five local …

Enhancing End-Of-Life Quality In Hospice Care, Gerson Orellana Prudencio

Capstone Projects and Master's Theses

The‍‌‍‍‌ increasing demand for hospice care in Monterey County is a clear indicator of the rapid growth in the need for end-of-life services driven by the aging population. The project was developed at the Department of Hospice of the Central Coast, which is under the Montage Health Foundation, a non-profit organization. The community served consists of elderly people receiving hospice and end-of-life care, as well as volunteers who provide administrative and indirect support. The Volunteer Handbook aims to create a comprehensive procedural manual for hospice volunteers to improve administrative efficiency and ensure the quality of care. Interviews were conducted with …

Large-Scale Experimental Study On The Impact Of Air Cleaning & Ventilation On Indoor Air Quality And Student Illness-Related Absenteeism, Daud Nosham

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

This large-scale randomized experimental field study investigated the effect of portable air purifiers (PAPs) on classroom’s air quality and student’s illness related absenteeism. PAPs were installed in 317 classrooms from various school districts located in Eastern Nebraska. The classrooms were randomly assigned into four conditions: three treatment conditions (T1, T2 & T3) and one control condition (device without any filter). T1 was equipped with HEPA filters, T2 added Activated Carbon (AC) layer to HEPA, and T3 further integrated Germicidal Ultraviolet (GUV) alongside HEPA and AC filters. The measured variables were carbon dioxide (CO2), fine particles (PN2.5) and coarse particles (PNcoarse), …

Relationships Between Social Determinants Of Health And Pain Outcome Changes After Exercise In Adults With Knee Osteoarthritis, Klarissa Siebert

Open Access Theses & Dissertations

Background: Knee osteoarthritis (KOA) is a common musculoskeletal disease with pain as the primary symptom. KOA pain is a major contributor to disability and reduced quality of life and has been associated with social determinants of health (SDOH) variables. As for treatments of KOA pain, exercise such as stationary cycling is a first-line and recommended treatment. However, limited research has examined how SDOH influence pain outcomes following such interventions. Objective: This study investigated whether income level, education level, employment status, acculturative stress, and perceived ethnic discrimination are associated with changes in pain following a standardized cycling ergometer exercise in adults …

Understanding Hepatitis C Risk And Harm Reduction Needs Among People Who Smoke Drugs: A Client-Centered Qualitative Inquiry, Maxwell Gustin

Anthropology

The spread of Hepatitis C virus (HCV) via non-injectable equipment is plausible, making people who smoke drugs (PWSD) at-risk for possible infection and transmission. While much research has been conducted into injection drug use (IDU), likely due to the rising opioid epidemic, limited studies focus on the risks PWSD face. Currently, state-funded syringe service programs (SSPs) provide harm reduction education and materials to combat these risks. Safer smoking initiatives have been created and are widely used by PWSD, and have access to SSPs. To gain better insight into the HCV and non-HCV-related risks and burdens PWSD face, a qualitative study …

A Feasibility Study Of Sexual Organ-Dose Sparing Volumetric Modulated Arc Therapy In Female Low Rectal Cancer Patients Treated With Three-Dimensional Conformal Radiation Therapy, Margaret Downes, Victoria Olsen, Andre Williams, Rendi Sheu, Maria Thor, Lucy Greenwald, Vishruta Dumane, Kristin Hsieh, Ayesha Ali, Orly Morgan, Michael Buckstein, Deborah Marshall

Department of Radiation Oncology Faculty Papers

BACKGROUND: Sexual dysfunction is a significant toxicity of pelvic radiation therapy (RT) for female rectal cancer patients and may be more common with intensity-modulated techniques compared to three-dimensional conformal radiation therapy (3D-CRT). However, limited research has evaluated dose sparing of female sexual organs at risk (OARs), particularly erectile tissues that are critical for sexual function.

PURPOSE: This feasibility study aimed to demonstrate the practicality of contouring and sparing female sexual OARs in rectal cancer RT by generating sexual organ-sparing volumetric modulated arc therapy (SO-VMAT) plans from a small 3D-CRT cohort and comparing dose distributions to guide future planning.

METHODS: Nine …

Understanding And Willingness To Participate In Dementia Clinical Trials In Kenya: An Ethnographic Study, Edna Bosire, Lucy Kamau, Chinedu Momoh, Jasmit Shah, Karen Blackmon, Caroline Kiio, Irene Meier, Vaibhav Narayan, Olivera Nesic Taylor,, Zul Merali

Brain and Mind Institute

Background: Advancements in dementia research are in part contingent on participation in clinical research. Clinical trials can help researchers determine if new drugs, devices, or diagnostic procedures for dementia are safe and effective. However, little is known about clinical trials for dementia in resource constrained settings such as Kenya. The aim of our research was to explore people’s understanding of dementia clinical trials, their attitudes and perceptions towards dementia clinical trials and what can be done to enhance enrollments on such clinical trials.

Method: This was an ethnographic study involving 8 focused group discussions (FGDs; age and gender stratified; n=81) …

Barriers To Mental Health Access Among Immigrant Populations In The U.S., Cecilia Menzinger

Capstones

No abstract provided.

Title Page Only: Nuts, Seeds, And Specific Cardiometabolic Diseases: The Adventist Health Study 2, Montry Se-Lin Suprono

Loma Linda University Electronic Theses, Dissertations & Projects

No abstract provided.

Net Effects Of Correlated Determinants Of Health Among U.S. Older Adults, Haomiao Jia, E I. Lubetkin

Publications and Research

Background

The health effect produced by a contributing factor alone may be different from the effect when other interacting factors are present. The effects of a set of contributors, estimated by regression coefficients, may be invalid or inappropriate if some of the predictors are correlated or the model has interaction and nonlinear terms. The net effect (NE) of a given contributing factor is the effect produced by the factor alone, not by other factors due to their correlations with the factor of interest. This study estimated NE of selected determinants of health for U.S. older adults.

Methods

Participants, aged ≥ …

The Road To Regulation: A Literature Review Of The Influences On The Updated Silica Standards, Skye M. Medcraft

Capstone Experience: Master of Public Health

Silica is a hazardous compound that poses a risk to human health resulting from dust creating activities across various industries. Several agencies, including OSHA (Occupational Health and Safety Administration) and MSHA (Mine Safety and Health Administration) have adopted regulatory oversight of silica exposure in the workplace. As more research has been conducted on silica exposure, the health effects are becoming better described, which has led to the creation and updating of exposure regulations to protect worker health. The objective of this literature study is to review the data presented to the Department of Labor and discuss how the factors that …

Influence Of Food Insecurity On Adolescent Mental Health: A Comprehensive Literature Review, Sarah Foss

Capstone Experience: Master of Public Health

Food insecurity is a growing public health concern with significant implications for adolescent mental health. This literature review provides an overview of current research on the relationship between food insecurity and adolescents’ mental health in the United States. A literature review was completed to identify studies examining the association between food insecurity and anxiety, depression, or attention deficit disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD). Evidence shows that the experience of food insecurity in adolescence is associated with a higher risk of developing or experiencing an exacerbation of anxiety, depression, or ADD/ ADHD. This review utilizes the socioecological model to explain …

A Literature Review: Back Injuries Affecting Certified Nursing Assistants In Nursing Facilities, Nesta Nsembene-Ntoutoume

Capstone Experience: Master of Public Health

Certified nursing assistants (CNAs) are at a higher risk of back injuries in healthcare, particularly in long-term care settings. This literature review assessed the primary causes of these injuries and the efficacy of current interventions, particularly Safe Patient Handling and Mobility (SPHM) programs. A total of 26 peer-reviewed articles were published between 2014 and 2025, including experimental simulations, cross-sectional and longitudinal studies, quasi-experimental training interventions, and evaluations of SPHM programs. Across the literature, the primary contributors to back injuries included high physical workload, inadequate ergonomic design, limited access to assistive devices, and staff shortage.

Experimental and biomechanical studies have demonstrated …

Linking Training To Confidence: A Literature Review On Advancing Nutrition Environments In Child Care Programs, Jeanne M. Vanorsdal

Capstone Experience: Master of Public Health

This comprehensive literature review examined child care nutrition training interventions using the Health Belief Model (HBM) to understand how to increase providers’ ability to serve nutritious food. By analyzing HBM constructs such as perceived severity, benefits, and barriers, the review assessed how training influences provider abilities and identified barriers and facilitators to consistently offering healthy meals and snacks. Studies were 1) published in English; 2) research conducted in the United States; 3) population involved home-based or center-based child care providers caring for children from birth to age 5; 4) articles published from January 1, 2015, to October 5, 2025; 5) …

Infectious Disease Crisis Communication After The Covid-19 Pandemic, Macy Lloyd

Capstone Experience: Master of Public Health

Since the COVID-19 pandemic, the United States has experienced a proliferation of mis- and disinformation, an increasing politicization of health and science, and growing distrust in government, science, and institutions. While these trends present challenges for normal public health communications, during a public health emergency, such as an infectious disease outbreak, these challenges are even more acute. To address challenges at the local level, health departments need plans, products, and tools that adapt health crisis communications to the current media environment and meet community members where they are across the trust continuum. To develop an infectious disease incident communication plan, …

Middle Meningeal Artery Embolization Of Septated Chronic Subdural Hematomas, Juan Carlos Martinez-Gutierrez, Salvatore A D'Amato, Hussein A Zeineddine, Michael I Nahhas, Matthew J Kole, Hyun Woo Kim, Youngran Kim, Bryden H Dawes, Peng Roc Chen, Spiros L Blackburn, Sunil A Sheth, Gary Spiegel, Ching-Jen Chen, Ashutosh Mahapatra, Ryan S Kitagawa, Mark J Dannenbaum

Faculty, Staff and Student Publications

Introduction

Middle meningeal artery embolization (MMAE) has emerged as a promising new treatment for patients with chronic subdural hematomas (cSDH). Its efficacy, however, upon the subtype with a high rate of recurrence—septated cSDH—remains undetermined.

Methods

From our prospective registry of patients with cSDH treated with MMAE, we classified patients based on the presence or absence of septations. The primary outcome was the rate of recurrence of cSDH. Secondary outcomes included a reduction in cSDH thickness, midline shift, and rate of reoperation.

Results

Among 80 patients with 99 cSDHs, the median age was 68 years (IQR 59–77) with 20% females. Twenty-eight …

Healthcare Professionals’ Awareness Of And Barriers To Shared-Clinical-Decision-Making For Hpv Vaccination Among Adults 27–45 Years, Manali Desai, Shreela V Sharma, Joel Fokom Domgue, Onyema Chido-Amajuoyi, Robert Yu, Wenyaw Chan, Charles Darkoh, Sanjay Shete

Faculty, Staff and Student Publications

The Advisory Committee on Immunization Practices recommends human papillomavirus (HPV) vaccination for inadequately vaccinated adults aged 27–45 based on shared clinical decision-making (SCDM). However, little is known about awareness and barriers to SCDM among US healthcare providers (HCPs), especially in Texas, where HPV vaccination rates are below the national average. Between January and April 2021, we conducted a population-based cross-sectional survey (12% response rate) of HCPs licensed in Texas to assess the prevalence and factors associated with awareness of the SCDM recommendation. HCPs were asked if they were aware and if they foresaw any barriers in implementing SCDM for HPV …