Digital Commons Network^™

A Landscape Analysis Of Rapid Evidence Curation During The 2022 Sudan Virus Disease Outbreak In Uganda, Jemimah J. Wachap

Capstone Experience: Master of Public Health

Uganda's 2022 Sudan Virus Disease (SVD) outbreak emphasized the need for rapid and effective evidence curation in public health emergencies. This analysis examines evidence curation practices during the SVD response, identifying challenges and assessing the timeliness and effectiveness of strategies in low-resource settings. While global responses to previous outbreaks, like COVID-19, have advanced evidence synthesis, the SVD outbreak revealed infrastructure and data integration gaps. The study aims to map the evidence curation landscape, focusing on models and tools, such as data-sharing platforms, mobile Polymerase Chain Reaction (PCR) labs, and Integrated Management Systems (IMS). It will also address gaps in surveillance, …

Evaluating The Nebraska Medical Center's Repatriation Of Inter-Hospital Transfers, Natalie Crump

Capstone Experience: Master of Public Health

Background: Bed capacity challenges at large academic medical centers delay the transfer of rural patients, negatively impacting their safety and quality of care. Repatriating inter-hospital transfer (IHT) patients to referral facilities upon completing specialized care can improve tertiary hospital bed capacity and community hospital financial sustainability.

Objectives: This project aims to identify the barriers and facilitators to successful IHT repatriation and the process and outcome variables influenced by the Nebraska Medical Center’s reverse transfer program.

Study Design: A retrospective observational cohort study was conducted to identify barriers and facilitators of NM’s IHT repatriation program.

Methods: Descriptive and comparative analyses of …

A Research Report: What Are The Challenges That Refugee Women Experience When Seeking Healthcare Related To Pregnancy In The United States?, Manuela Krieger-Adi

Capstone Experience: Master of Public Health

Background

Refugees in the United States, including African refugee women, face many challenges in seeking healthcare after moving to the United States to resettle. It is urgent and essential to look into some of the health challenges the refugee community faces here in Omaha, Nebraska, that prevent them from seeking healthcare, especially when pregnant. This Capstone research project aims to focus on African refugee women, specifically in Omaha, Nebraska, and the challenges they face seeking healthcare related to pregnancy.

Methods

This research report involved five in-depth interviews conducted over Zoom. The target population was refugee mothers who had given …

Assessing The Association Between Total Cholesterol And Hospitalized Myocardial Infarction In Women Ages 32-70: An Analysis Of The Framingham Heart Study, Jolene L. Stapleton Duree

Capstone Experience: Master of Public Health

Objective

Heart disease is the leading cause of death in women that may go undiagnosed due to unexpected symptoms. The purpose of this analysis was to assess the effect of total cholesterol on the odds of hospitalized myocardial infarction (MI).

Methods

This analysis used a sample of 2,445 women from the Framingham Heart Study, an observational prospective cohort study. The exposure was total cholesterol, and the outcome was hospitalized MI. Logistic regression was used to estimate crude and adjusted odds ratios (OR). The adjusted models controlled for age, blood pressure, and diabetes. Effect modification by diabetes status was evaluated in …

Gender And Ethnic Differences In Mental Health Outcomes In Sexual And Gender Minority (Sgm) Youth And Young Adults In Texas And California, 2022-2024, Michelle Gil

Open Access Theses & Dissertations

Background: Depression and anxiety affect populations differently, particularly LGBTQ+, ethnic minorities, and youth with limited access to competent care. Risk factors include harassment, victimization, and discrimination. Purpose: To examine gender identity and ethnic differences in depression and anxiety among SGM youth in Texas and California. It is hypothesized that both Latinx and gender minority youth will report higher rates of depression and anxiety compared to non-Latinx and cisgender youth. Methods: Secondary analysis used data from the Family, Housing, and Me (FHAM) Project, following 83 LGBTQ+ youth from South Texas and California's Inland Empire over 25 months. Data includes sociodemographic characteristics, …

Finding Strength In The Struggle: The Impact Of Resilience On Life Satisfaction Among Veterans With Mental Illness, Marissa Gonzalez

Open Access Theses & Dissertations

Background: Veterans living with mental illness often face challenges that impact their overall life satisfaction and adjustment to civilian life. While resilience is widely considered a protective factor, limited research has examined its role in conjunction with personality traits, psychosocial factors, and demographic characteristics. Purpose: This cross-sectional study examined the associations between resilience and life satisfaction among U.S. veterans with mental illnesses, while accounting for personality dimensions, demographic variables, and psychosocial factors. Methods: Secondary data from 156 veterans diagnosed with mental illness were analyzed. Hierarchical linear regression was used to assess the relationship between resilience and life satisfaction, controlling for …

Exploring Willingness To Seek Help And Well-Being In Rural Veterans With Health Conditions: A National Rural Health Study, Jimena Isabel Ortiz

Open Access Theses & Dissertations

The population of Veterans in the United States has increased significantly, with a substantial number residing in rural areas. This study aims to highlight and understand the correlation between military service members' physical and mental well-being and the quality/access to care they receive. This study also aims to explore mental health-seeking behaviors, health, and well-being in rural Veterans with health conditions. The study included 400 rural-dwelling Veterans with documented physical and mental health conditions. Data was collected through surveys distributed via various media channels, including social media platforms, and the results demonstrated that willingness to seek psychological help was positively …

Pilot Study To Compare A Therapeutic Exercise Protocol And Neuromuscular Taping On Improving Plantar Foot Pressure Among Type 2 Diabetes Patients, Sandra Rivera

Open Access Theses & Dissertations

Background: Diabetes has become one of the most prevalent non-communicable diseases worldwide. Diabetic foot ulcers (DFU) are a common complication of diabetes as it causes peripheral neuropathy. It is estimated that up to 50% of peripheral neuropathy in patients with diabetes may be asymptomatic. Justification: The purpose of this study was to determine if the therapeutic exercise protocol and/or Neuromuscular taping can delay changes in the plantar pressure of the foot in patients with Diabetes. Methods: A two-group quasi-experimental design was used in this study; data was collected at two different points in time; pre- and post-intervention. Baropodometric was used …

Testing A Benign Multi-Modal Bilingual Intervention To Increase Self-Efficacy, Intentions, And Willingness To Administer A Covid-19 Antigen Rapid Test In A Predominately Hispanic Sample, Uchenna Gbugu

Open Access Theses & Dissertations

Introduction. Testing is one of the most effective methods for reducing the spread of COVID-19. COVID-19 antigen tests can detect proteins from the COVID-19 virus called antigens and produce results within minutes, making them suitable for at-home use. Several factors have been identified as barriers to self-administering a COVID-19 antigen test, including the language of the testing instructions, the cost of testing, and access to tests. Interventions to reduce barriers to self-administering COVID-19 rapid tests are warranted to reduce the spread of COVID-19. The purpose of the present study is to test the impact of a benign multi-modal bilingual intervention …

Racial And Ethnic Differences In Knowledge Of Gender-Affirming Care Among Community And Student Participants In The Bloom Transgender Health Education Program In The Paso Del Norte Region, 2022-2024, Tandra Ghosh

Open Access Theses & Dissertations

SUMMARY OF BACKGROUND AND SIGNIFICANCE: There is a noticeable lack of training and knowledge regarding gender-affirming care (GAC) among providers and within the general community. OBJECTIVE: Assess racial and ethnic disparities in knowledge of GAC among participants in BLOOM, a quasi-experimental transgender health education program in the Paso Del Norte region. HYPOTHESES: Among community and student participants at pre-survey, assess racial and ethnic differences in sociodemographic characteristics, preparedness, attitudes, and basic knowledge regarding LGBT clients/patients and GAC. METHODS: Secondary data among community (pre: 53; post: 14) and student (pre: 29; post: 17) BLOOM participants in 2022-2024 were used. Descriptive statistics …

It's Time For Some Important Conversations About Fluoride, Jessica R. Bentoski D.D.S., M.S., F.A.A.P.D., Sam Blanchard Dds, Ms

The Journal of the Michigan Dental Association

The guest editorial by the Michigan Academy of Pediatric Dentistry's Drs. Jessica Bentoski and Sam Blanchard, addresses growing public debate surrounding community water fluoridation and emphasizes the vital role of dental professionals in providing evidence-based guidance to parents. As pediatric dentists, the authors highlight that fluoride remains a cornerstone in preventing childhood caries—still the most common chronic disease in children. They stress the need to understand and address parental beliefs, misinformation, and concerns through respectful, informed dialogue. Removing fluoridation could exacerbate oral health disparities and misperceptions about fluoride safety. The authors call on colleagues to initiate important conversations, advocate for …

Improving Nutrition Outcomes Through Enhanced Allocative Efficiency Of Investments In 24 High Risk Counties In Kenya: An Optima Nutrition Modelling Study, Morris Ogero, Nick Scott, Veronica Kirogo, Anthony Ngugi

Population Health, East Africa

Introduction ;Undernutrition remains a significant global challenge, severely impacting children’s development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up …

Insights Into Cancer Awareness And Health Practices In Rural Kenya: A Cross-Sectional Study Of Esophageal, Breast, Prostate, Cervical, And Colorectal Cancers, Rosebella Iseme-Ondiek, Joseph Abuodha, Anthony Ngugi, Mansoor Saleh, Innocent Abayo

Population Health, East Africa

PURPOSE; In sub-Saharan Africa (SSA), there has been an epidemiologic transition from infectious diseases to noncommunicable diseases, including a projected doubling in incidence of cancer. Understanding the underlying factors driving this surge is crucial for designing effective strategies to mitigate the cancer burden. This study focuses on assessing knowledge, attitudes, screening practices, and health behaviors related to five most prevalent cancers in SSA: prostate, breast, cervical, esophageal, and colorectal—among a predominantly rural coastal population in Kenya.

MATERIALS AND METHODS ;We used a cross-sectional study design targeting 1,500 adult respondents randomly selected from an existing community health and demographic surveillance system. …

Educational Leadership In A Vuca World: The Crisis Management Experiences Of Rural School Superintendents, Lucas J. Grossnicklaus

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

The job of both urban and rural superintendents is challenging, but it is the rural school superintendency that comes with unique challenges that aren’t always faced by their urban and suburban counterparts. The COVID-19 Pandemic brought about a number of crises for school superintendents such as school closures, mask mandates, and navigating positions taken by governors, teachers unions, and school boards. While concerns about school closures and mask mandates has dissipated, conflict within school districts has only seemed to grow since the pandemic.

This multi-case study explored the lived experience of rural superintendents in the Midwest who have experienced a …

T2-Weighted Imaging Of Rectal Cancer Using A 3d Fast Spin Echo Sequence With And Without Deep Learning Reconstruction: A Reader Study, Dan Nguyen, Sarah Palmquist, Ken-Pin Hwang, Jingfei Ma, Usama Salem, Jia Sun, Xinzeng Wang, Jong Bum Son, Randy Ernst, Peng Wei, Harmeet Kaur, Nir Stanietzky

Faculty, Staff and Student Publications

Purpose: To compare image quality and clinical utility of a T2-weighted (T2W) 3-dimensional (3D) fast spin echo (FSE) sequence using deep learning reconstruction (DLR) versus conventional reconstruction for rectal magnetic resonance imaging (MRI).

Methods: The study included 50 patients with rectal cancer who underwent rectal MRI consecutively between July 7, 2020 and January 20, 2021 using a T2W 3D FSE sequence with DLR and conventional reconstruction. Three radiologists reviewed the two sets of images, scoring overall SNR, motion artifacts, and overall image quality on a 3-point scale and indicating clinical preference for DLR or conventional reconstruction based on those three …

Refractive Error And Axial Length (Real) Study: Feasibility Of A Population Study In The United States, Sarah E. Singh Dr, Lisa A. Ostrin, Kristen Kerber Dr, Concepcion Cayle, Celia Gong Dr, Lal Barsha Dr, Ian Flitcroft, Síofra Harrington, James Loughman, Kathryn Saunders Prof, Fuensanta Vera-Diaz Dr

Articles

Myopia is the most common eye disease and a leading cause of blindness. A contemporary, large, and ethnically and geographically diverse study of ocular biometry and refractive error in children in the United States is needed to help better describe differences between myopic and nonmyopic eyes.

This is an initial cross-sectional report from the Refractive Error and Axial Length Growth Curve Study that includes ocular component data as a function of age, gender, and geographic location. This feasibility report will inform a planned larger longitudinal ocular growth study in children in the United States.

Cross-sectional data on children, ages 3 …

Using A Transformer Language Model To Curate A Pulmonary Embolism Dataset From The Medical Information Mart For Intensive Care Iv: Mimic-Iv-Ext-Pe, Barbara D Lam, Shengling Ma, Iuliia Kovalenko, Peiqi Wang, Omid Jafari, Ang Li, Steven Horng

Faculty, Staff and Students Publications

Background: Pulmonary embolism (PE) is a leading cause of preventable in-hospital mortality. Advances in diagnosis, risk stratification, and prevention can improve outcomes. Large, publicly available datasets are needed to move research forward, but are lacking in the field of hemostasis and thrombosis.

Objectives: In this study, we experiment using a machine learning language model to automatically add PE labels to a large dataset.

Methods: We extracted all computed tomography pulmonary angiography radiology reports (N = 19,942) from the Medical Information Mart for Intensive Care IV, a database of adult patients who presented to the emergency room or were admitted …

Racial And Geographic Disparities In Primary Care Transitions For Postpartum Women With Gestational Diabetes And Hypertension In South Carolina, Kajol Dahal

Electronic Theses and Dissertations

Introduction Gestational diabetes (GDM) and gestational hypertension (GH) are significant public health issues with lasting implications for maternal and child health (MCH). Despite clinical guidelines recommending postpartum care for all women, especially those with chronic conditions, less than 50% receive a visit within 12 months of childbirth. Recent policy changes extend postpartum Medicaid coverage from 60 days to 12 months. This study assessed differences in postpartum care visits by race/ethnicity and geography after the extension of postpartum coverage in South Carolina. Methods A retrospective cohort of 27,056 women (aged 20-44) who gave birth in 2021 were analyzed using Medicaid claims …

Memory Matters: Cognitive Screenings For Dementia Detection In Monterey County, Cintia Gonzalez

Capstone Projects and Master's Theses

The rates of Alzheimer’s disease in Monterey County are increasing. The Healthy Aging program from the Monterey County Health Department strives to promote the well-being and health of older adults and caregivers in Monterey County by offering education on brain health, support in adopting healthy lifestyles, and connecting to community services. Memory Matters is an example of a training or educational intervention. The purpose of Memory Matters is to bridge the gap of insufficient access to early detection of dementia by bringing awareness to brain health, and facilitating the conversation of cognitive exams with older adults, their caregivers, and their …

“It's Easier To Deal With The Vaccines You Know Than The Ones You Don't Know”: A Qualitative Study On Healthcare Workers' Vaccine Confidence In Nigeria, Ayobami A. Bakare, Elisa Gobbo, Kofoworola O. Akinsola, Carina King, Julius Salako, Damola Bakare, Halima Usman, Claudia Hanson, Adegoke G. Falade, Sibylle Herzig Van Wees

Centre of Excellence in Women and Child Health

Vaccination is a cost-effective public health intervention that has saved many lives and improved well-being [1]. Between 2011 and 2020, over 20 million deaths were believed to have been averted due to vaccinations in GAVI supported countries [2]. Moreover, globally, Carter et al. estimated additional 51 million deaths are expected to be prevented from vaccines between 2021 and 2030 [3]. Yet, despite the importance of vaccines, there have been concerns about low uptake of vaccines globally [4,5]. This concern was accentuated during the COVID-19 pandemic. Waning vaccine confidence has been recognized as a leading threat to global health [[6], [4], …

Small But Mighty: Strengthening The Value Of Local Pocket Parks, Makana Sm Higa

Capstone Projects and Master's Theses

In Monterey County, youth obesity rates are climbing at an alarming rate. Ventana Wildlife Society, and Wellness Through Nature program seek to help lower these rates. Ventana looks to achieve this through outdoor education and family trips with migrant farm working families in the cities of Soledad and Salinas. These trips attempt to increase environmental stewardship and improve community health. The project aims to evaluate the effectiveness and community engagement in regards to pocket parks. The parks visited were Bataan Memorial Park, Harden Neighborhood Park, Cesar Chavez Park, Joe Ledesma Park and San Antonio Park. The research seeks to increase …

Testing For Bleeding Disorders In Child Abuse: Aap Recommendation Adherence And Testing Results, Lyndsey Hultman, Angela Doswell, Henry T Puls, Shannon L Carpenter, Angela Bachim, Caitlin R Mcnamara, Farah W Brink, Lori D Frasier, Nancy S Harper, Natalie Laub, Kristine A Campbell, Daniel M Lindberg, Joanne N Wood, James Anderst

Faculty, Staff and Students Publications

Objectives: Using a multicenter child abuse pediatrics research network (CAPNET), the study objectives were to characterize the adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification.

Methods: We performed a descriptive study of bleeding disorder evaluations among children younger than 10 years of age who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse from February 2021-May 2022 utilizing CAPNET. Cases were classified as bruising without ICH or ICH with or without bruising. Based on AAP guidance, testing was not recommended in cases with concomitant suspicious injuries, inflicted injury …

A Multivariate Analysis Of Reported Quality Of Life Among Medical Students In Jordan Using The Whoqol-Bref, Mohammad Hamad, Saba Al Smadi, Diana Arabiat

Research outputs 2022 to 2026

BACKGROUND: Low quality of life (QoL) in university students is often associated with unhealthy lifestyle and negative impacts on students' ability to learn and succeed. To date, no research has examined the QoL of medical students in Jordan or the demographic factors that may associate with lower QoL. MATERIALS AND METHODS: A quantitative, cross-sectional study with a descriptive design was chosen for this study. Participants were 512 medical students from one public university in Jordan. The Arabic version of the World Health Quality of life-brief survey (WHOQOL-BREF) was used to collect data online from students. RESULTS: Regarding the overall QoL, …

Changes In The Contributions Of Risk Factors To Under-Five Mortality In Low- And Lower-Middle-Income Countries (1997-2022): An Analysis Of Demographic And Health Survey Data, Bereket Kefale, Jonine Jancey, Amanuel T. Gebremedhin, Gavin Pereira, Gizachew A. Tessema

Research outputs 2022 to 2026

Background: Under-five mortality (U5M) is a critical public health challenge in low- and lower-middle-income countries (LLMICs), where over 90% of global deaths occur. Despite progress, the changing contributions of risk factors to U5M in LLMICs remain unexplored.

Mrthods: We analysed Demographic and Health Survey (DHS) data from 24 LLMICs across two periods: 1997-2005 and 2016-2022. We included 139,890 live births in 1997-2005 and 319,034 in 2016-2022. A mixed-effects robust Poisson regression model with a log link function was employed to identify risk factors of U5M in each period. Population-attributable fractions (PAFs) were calculated and compared to investigate changes in the …

Cdc’S Core Elements To Promote Diagnostic Excellence, Daniel J Morgan, Hardeep Singh, Arjun Srinivasan, Andrea Bradford, L Clifford Mcdonald, Preeta K Kutty

Faculty, Staff and Students Publications

Nearly a decade after the National Academy of Medicine released the "Improving Diagnosis in Health Care" report, diagnostic errors remain common, often leading to physical, psychological, emotional, and financial harm. Despite a robust body of research on potential solutions and next steps, the translation of these efforts to patient care has been limited. Improvement initiatives are still narrowly focused on selective themes such as diagnostic stewardship, preventing overdiagnosis, and enhancing clinical reasoning without comprehensively addressing vulnerable systems and processes surrounding diagnosis. To close this implementation gap, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of …

The Burden Of Care: A Phenomenological Inquiry Into The Lived Experiences Of Homeless Shelter Administrators Leading Through The Pandemic And Lasting Implications On Program Operations, Marie Adele Wilson

Doctoral Dissertations and Projects

The theories guiding this study are Maslow's Hierarchy of Needs, conflict theory, and complex systems theory, which explain the relationship between the theory and resource limitations and acquisition, systems, and nature of acquiring human needs. The purpose of this phenomenological study is to describe homeless shelter administrators'/directors' experiences delivering services during the COVID-19 pandemic on the Eastern Coast of the United States and Texas. It further seeks to unravel how the pandemic informed the delivery of services and program administration related to homeless shelters and its impacts. The research questions sought to understand the impact of COVID-19 on delivering services …

Commencement Program 2025, Loma Linda University

Commencement Programs

CONTENTS

2 | Message from the President

3 | 2025 Events of Commencement

5 | The Academic Procession

6 | Institutional Administration

7 | Board of Trustees

8 | Significance of Academic Regalia

9 | University History Highlights

11 | Criteria for Institutional Awards

13 | Loma Linda University Health and Loma Linda University Honorees

The Programs, The School Honorees, and The Speakers

29 | School of Medicine

50 | School of Pharmacy

63 | School of Dentistry

81 | School of Public Health

94 | San Manuel Gateway College

101 | School of Allied Health Professions - Allied Health …

Repeat Ascaris Challenge Reduces Worm Intensity Through Gastric Cellular Reprograming, Yifan Wu, Charlie Suarez-Reyes, Nina L Tang, Alexander R Kneubehl, Jill E Weatherhead

Faculty, Staff and Students Publications

Ascariasis (roundworm) is the most prevalent parasitic nematode infection worldwide, impacting approximately 500 million people predominantly in low- and middle-income countries (LMICs). While people of all ages are infected with Ascaris, infection intensity (defined by worm burden) paradoxically peaks in pre-school and school-aged children but then declines with age. The cause of age-dependent Ascaris worm intensity is not well understood but may be dependent on cellular changes in mucosal barrier sites. We have previously found that the gastric mucosa is a critical barrier site for Ascaris infection as ingested Ascaris larvae use acidic mammalian chitinase (AMCase) secreted by gastric chief …

The Small Gtpase Rap1 In Pomc Neurons Regulates Leptin Actions And Glucose Metabolism, Kentaro Kaneko, Weisheng Lu, Yong Xu, Alexei Morozov, Makoto Fukuda

Faculty, Staff and Students Publications

The hypothalamic leptin-proopiomelanocortin (POMC) pathway is critical for regulating metabolism. POMC neurons in the arcuate nucleus respond to leptin and play a pivotal role in mediating energy and glucose balance. However, during diet-induced obesity (DIO), these neurons often develop resistance to exogenous leptin. Recently, the small GTPase Rap1 has been implicated as an inhibitor of neuronal leptin signaling; however, its specific role within POMC neurons remains unexplored. We generated tamoxifen-inducible, POMC neuron-specific Rap1 knockout mice to selectively delete both Rap1a and Rap1b isoforms in POMC neurons. By analyzing these mice through metabolic phenotyping, immunohistochemistry, and biochemical assays, we show that …

Interventions To Improve Timely Cancer Diagnosis: An Integrative Review, Mark L Graber, Bradford D Winters, Roni Matin, Rosann T Cholankeril, Daniel R Murphy, Hardeep Singh, Andrea Bradford

Faculty, Staff and Students Publications

Cancer will affect more than one in three U.S. residents in their lifetime, and although the diagnosis will be made efficiently in most of these cases, roughly one in five patients will experience a delayed or missed diagnosis. In this integrative review, we focus on missed opportunities in the diagnosis of breast, lung, and colorectal cancer in the ambulatory care environment. From a review of 493 publications, we summarize the current evidence regarding the contributing factors to missed or delayed cancer diagnosis in ambulatory care, as well as evidence to support possible strategies for intervention. Cancer diagnoses are made after …