Digital Commons Network^™

Covid For One: Identifying Obstacles To Self-Management Of Covid-19 For Single Adults, Linda A. Treiber, Christie Emerson, Jenna Shackleford

Faculty Articles

Given the complexities of healthcare provision, it is imperative to understand how single adults experience their interactions with medical professionals and health care organizations, manage care and treatment, and navigate the barriers encountered. This study’s purpose is to understand physical and mental health experiences in consideration of social determinants of health, barriers, and coping strategies for single adults diagnosed with COVID-19. An interpretive phenomenology study design was used with 12 individuals who were single and living alone during the COVID-19 pandemic. Semi-structured, open-ended interviews revealed important aspects of the COVID-19 illness experience. Interviews were transcribed for coding and thematic analysis. …

Medicare To Veterans Affairs Cost Shifting-A Challenging Conundrum, Kenneth W. Kizer, Said A. Ibrahim

JeffMD Academic Affairs

No abstract provided.

Does The Mediterranean Diet Play A Beneficial Role In Managing The Health Of Overweight/Obese Breast Cancer Survivors?, Syeda Maria Yaqoob, Layla Haidar, Marlyn A Allicock, Natalia I Heredia

Faculty, Staff and Student Publications

Background: Numerous studies have established a correlation between the Mediterranean diet and a reduced risk of breast cancer, as well as its efficacy in supporting weight management. Notably, obesity is widely recognized as a significant risk factor for the development of breast cancer. The Mediterranean diet has been shown to improve health outcomes among overweight or obese breast cancer survivors. This narrative review aims to consolidate information on the existing research interventions elucidating the benefits of the Mediterranean diet for the overall health of breast cancer survivors.

Methods: Using the search terms "Mediterranean diet" and "breast cancer survivor", a total …

Effect Of School Hpv Vaccination Requirements On Pediatricians' Recommendations, Ashley Hedrick Mckenzie, Lara S Savas, Ross Shegog, Dale S Mantey, Erica L Frost, Paul Gerardo Yeh, C Mary Healy, Stanley Spinner, L Aubree Shay, Sharice M Preston, Sally W Vernon

Faculty, Staff and Student Publications

Background/objectives: Pediatrician recommendations are highly influential in parents’ decisions to vaccinate their children against HPV. Unqualified, presumptive, and bundled recommendations (UPBRs) are associated with increased HPV vaccine uptake and are considered best practice. This study analyzes pediatricians’ self-reported data to assess changes in UPBR use and the psychosocial determinants of UPBR use as a result of the implementation of a multi-level intervention, the Adolescent Vaccination Program (AVP).

Methods: We surveyed pediatricians across 51 clinics in the Houston area. Baseline surveys (n = 137) were distributed in 2015, and follow-ups (n = 120) in 2019.

Results: Pediatrician UPBR use …

Antibiotics For Acute Watery Or Persistent With Or Without Bloody Diarrhoea In Children: A Systematic Review And Meta-Analysis, Syeda Kanza Naqvi, Mustafa Bin Ali Zubairi, Ayesha Arshad Ali, Ashraf Sharif, Rehana Abdus Salam, Zain Hasnain, Sajid Bashir Soofi, Shabina Ariff, Yasir Bin Nisar, Jai K. Das

Institute for Global Health and Development

Background: The use of antibiotics in the treatment of acute and persistent watery diarrhoea has long been a subject of contention. While the advantages of using antimicrobials are acknowledged, concerns remain regarding potential adverse effects and antibiotic resistance. Therefore, we conducted a systematic review and meta-analysis to assess the efficacy of antibiotics compared to placebos for the treatment of diarrhoea.
Methods: We searched PubMed, CINAHL, the Cochrane Library, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform, and Scopus from inception until 20 July 2023 for studies published after the year 2000 assessing antibiotics vs placebo in acute …

Zinc Supplementation For Acute And Persistent Watery Diarrhoea In Children: A Systematic Review And Meta-Analysis, Ayesha Arshad Ali, Syeda Kanza Naqvi, Zain Hasnain, Mustafa Bin Ali Zubairi, Ashraf Sharif, Rehana Abdus Salam, Sajid Bashir Soofi, Shabina Ariff, Yasir Bin Nisar, Jai K. Das

Institute for Global Health and Development

Background: Zinc is a micronutrient that plays a role in immune system strengthening and regulation of intestinal epithelial cells, and can reduce the duration and severity of diarrhoea. We conducted a systematic review of randomised controlled trials (RCTs) to assess the effectiveness of zinc compared to no zinc for the management of acute and persistent diarrhoea in children.
Methods: We searched PubMed, the Cochrane Library, Scopus, CINAHL, ClinicalTrials.gov, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception until 31 July 2023 for studies published from year 2000 onwards that assessed the use of zinc in the management …

Low-Osmolarity Oral Rehydration Solution For Childhood Diarrhoea: A Systematic Review And Meta-Analysis, Mustafa Bin Ali Zubairi, Syeda Kanza Naqvi, Ayesha Arshad Ali, Ashraf Sharif, Rehana Abdus Salam, Zain Hasnain, Sajid Bashir Soofi, Shabina Ariff, Yasir Bin Nisar, Jai K. Das

Institute for Global Health and Development

Background: Oral rehydration solution (ORS) is crucial in the management of diarrhoea. Until the early 2000s, the standard formulation of glucose-based ORS with a total osmolarity of 311 mmol/L was being used for this purpose. However, due to concerns about sodium levels and cases of hypernatremia, a low-osmolarity ORS solution (LORS) with an osmolarity of 245mmol/L or less was developed to replace the standard ORS. With this systematic review, we aimed to assess the effectiveness of LORS compared to standard ORS for the treatment of acute and persistent diarrhoea.
Methods: We comprehensively searched PubMed, CINAHL, the Cochrane Library, ClinicalTrials.gov, the …

Machine Learning Approaches For Predicting Dental Caries In Permanent Molars Of Children And Adolescents Using Nhanes 2011-16 Data, Pritam Deb, Christina Scherrer Phd, Lin Li Phd

Symposium of Student Scholars

Dental caries remains a prevalent chronic disease among children, significantly affecting their quality of life, educational outcomes, and school attendance. Between 2011 and 2016, caries affected 17.4% of children aged 6-11 and 56.8% of adolescents aged 12-19, with higher incidences among non-Hispanic Black and Mexican American youth, and those from lower-income families. This study aims to develop a robust machine learning model to predict the presence of decayed, missing, or filled permanent molars (DMFT) in children and adolescents using demographic, dietary, and oral health examination data from the National Health and Nutrition Examination Survey (NHANES) for the years 2011 to …

Ai-Enabled Wearable Cameras For Assisting Dietary Assessment In African Populations, Frank P-W Lo, Jianing Qiu, Modou L Jobarteh, Yingnan Sun, Zeyu Wang, Shuo Jiang, Tom Baranowski, Alex K Anderson, Megan A Mccrory, Edward Sazonov, Wenyan Jia, Mingui Sun, Matilda Steiner-Asiedu, Gary Frost, Benny Lo

Children’s Nutrition Research Center Staff Publications

We have developed a population-level method for dietary assessment using low-cost wearable cameras. Our approach, EgoDiet, employs an egocentric vision-based pipeline to learn portion sizes, addressing the shortcomings of traditional self-reported dietary methods. To evaluate the functionality of this method, field studies were conducted in London (Study A) and Ghana (Study B) among populations of Ghanaian and Kenyan origin. In Study A, EgoDiet's estimations were contrasted with dietitians' assessments, revealing a performance with a Mean Absolute Percentage Error (MAPE) of 31.9% for portion size estimation, compared to 40.1% for estimates made by dietitians. We further evaluated our approach in Study …

Prepared To Protect: Improving Cardiac Emergency Response In Youth Club Sports, Melissa Garcia

Nursing | Student Research Posters

Sudden cardiac arrest (SCA) is a medical emergency where the heart unexpectedly stops beating due to an electrical malfunction. A person experiencing a cardiac arrest collapses, loses consciousness, and ceases breathing (American Heart Association, 2022).

Exercise offers numerous benefits to the cardiovascular system and a person’s overall health. However, there are incidents of sports-related cardiac arrest in apparently healthy athletes, including children and young adults. Athletes may be exposed to dehydration, adrenic surges, electrolyte imbalances, acid/base disturbances, and trauma which increases their risk of experiencing a cardiac event (Wasfy et al., 2016).

Sudden cardiac arrest is the leading cause of …

Accuracy In Measurement Of Infant Formula Powder And Water With And Without A Crying Baby Present, Richard R. Rosenkranz, Chris Acosta, Ana Gonzalez-Alvarez, Andrew Hooyman, Jose R. Hidalgo, Romina Ballasteros-Paniagua, Sara K. Rosenkranz

Physical Therapy Faculty Articles and Research

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Infant formula provides a safe, nutritious alternative to breastfeeding but caregivers may use unsanitary methods or make substantial errors with formula dilution and jeopardize infant health.1 Underdiluting formula can result in health problems, such as hypernatremic dehydration, gastroenteritis, other digestive problems, or long-term excess weight gain.2 Overdiluting infant formula, sometimes used to reduce expense by low-income caregivers,2 can also lead to serious health problems for babies, including diarrhea, water intoxication, nutrient deficiencies, malnutrition, and even death.2,3

Previous studies have assessed common measurement inaccuracy of infant formula preparations in relation to bottle characteristics, package instructions, caregiver experience, and target amount, …

Review Of The Diagnosis, Pathophysiology, And Treatment Of Naegleria Fowleri-Induced Primary Amoebic Meningoencephalitis, Terrance Zhang

MCB Articles

Naegleria fowleri is a thermophilic, ubiquitous, free-living amoeba, but is also known as the “brain-eating” amoeba. This is the etiological agent of a rare and fulminant waterborne disease known as Primary Amoebic Meningoencephalitis (PAM) that is acutely fatal in 90-99% of reported cases. Those who come into contact with infested waters are at risk of introducing the amoeba into their upper nasal canal, whence the trophozoite form is known to migrate along the olfactory nerve, through the cribriform plate, and enter the central nervous system. Although the exact pathogenesis of N. fowleri is not known, studies have demonstrated contact-dependent and …

The Challenge Of Regulating Pharmaceutical Clinical Trials In The 21st Century With A Focus On Guatemala, Alejandro Cerón, Antonio Ricafort, Carter Saccocio, Maria Delmonte, Jordan Vasquez, Amarri Bishop, Julia Atwood, Addison Bucsko, Jordan Lewis, Alexandra Welch, Itzael Garcia, Ella Wald, Selena Johnson, Crystal Jin, Talya Riciputi, Lindsey Speer, Vanessa Udo-Obong, Soren Engberg, Tessa Lindstrom

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students and instructor of the "Right to Health in Theory and Practice" class taught in the fall of 2024 at the University of Denver. The report was prepared for 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: What can a country like Guatemala do to regulate international pharmaceutical clinical trials in the context of research commercialization? In other words, the work was guided by three important elements. First, the regulatory aspect of clinical trials. Second, …

Coph Professors Advocate For First-Gen Students, Dustin Roberto

HSC Newsroom

More than half of U.S. undergraduates are first-generation college students. University of New Mexico College of Population Health professors Claudia Pratesi, PhD, and Tammy Thomas, PhD, held focus groups to learn about first-generation students' experiences. Many students in the groups balance school with caring for family and find systems like financial aid difficult to navigate. The professors are developing recommendations, including peer mentoring and connections to scholarships, and will share findings with university leadership.

A Latent Class Assessment Of Healthcare Access Factors And Disparities In Breast Cancer Care Timeliness, Matthew Dunn, Didong Li, Marc Emerson, Caroline Thompson, Hazel Nichols, Sarah Van Alsten, Mya Roberson, Stephanie Wheeler, Lisa Carey, Terry Hyslop, Jennifer Elston Lafata, Melissa Troester

Kimmel Cancer Center Faculty Papers

BACKGROUND: Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing).

METHODS AND FINDINGS: The Carolina Breast Cancer Study (CBCS) Phase 3 is a population-based, case-only cohort (n = 2,998, 50% black) of patients with invasive breast cancer diagnoses (2008 to 2013). We used latent class analysis (LCA) to group participants based on patterns of factors within 3 separate domains: socioeconomic status ("SES"), "care barriers," and …

Adiposity Throughout Adulthood And Risk Of Young-Onset Breast Cancer Tumor Subtypes In The Young Women's Health History Study, Lydia Marcus Post, Dorothy R. Pathak, Ann S. Hamilton, Kelly A. Hirko, Richard T. Houang, Emily H. Guseman, Dan Sanfelippo, Nicole Bohme Carnegie, L. Karl Olson, Hallgeir Rui, Ann G. Schwartz, Ellen M. Velie

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

BACKGROUND: The role of adult adiposity in young-onset breast cancer (YOBC) subtype risk is not well understood.

METHODS: In this population-based case (n = 1812)-control (n = 1,381) study of invasive YOBC (ages <50 >years), cases were identified from the Los Angeles County and Metropolitan Detroit Surveillance, Epidemiology, and End Results registries, 2010 to 2015. Area-based, frequency-matched controls were sampled from the 2010 Census. General adiposity [body mass index (BMI)] and central adiposity (waist circumference and waist-to-height ratio) across adulthood and covariates were collected from in-person interviews and measurements. ORs and 95% confidence intervals (CI) for adiposity and YOBC tumor subtypes …

Screensafefuture: A Parent-Empathetic And Pragmatic Mhealth Application For Toddlers' Brain Development Addressing Screen-Addiction Challenges, Nafisa Anjum, Md. Mehedi Hasan, Syeda Umme Salma, Liang Zhao, Maria Valero, Nazmus Sakib

Faculty Articles

The surging incidents of infants and toddlers screen addiction in the United States are becoming a pressing concern, given its compound impact on cognitive, mental, and physical growth. To address this era's critical child health and development problem, in this paper an innovative mHealth application—ScreenSafeFuture—is proposed. ScreenSafeFuture provides practical solutions that seamlessly fit into parents' busy lifestyles, acknowledging the effectiveness and convenience of smartphones as a healthcare tool. The solution includes essential features designed to enhance the experience between parents and their children under 3 years old encompassing an alternative activity advocator for a personalized parent-offspring scenario, screen time tracking …

Predictors Of Mortality In African Americans With Alzheimer’S Disease-Related Dementias, Latrice Camille Noonan

Walden Dissertations and Doctoral Studies

Alzheimer’s disease-related dementia (ADRD) is a leading cause of death worldwide. There is a need to identify the link between modifiable risk factors and the association with ADRD mortality. This study addresses the disproportionately high burden of ADRD among African Americans, aiming to inform targeted prevention strategies and promote health equity. In this study, the longitudinal relationship between ADRD mortality and the presences of diabetes, smoking, and obesity among older African Americans residing in the United States was examined, while controlling for age, gender, education, and socioeconomic status. The biopsychosocial model served as the theoretical framework for this study. The …

Estimated Vaccine Effectiveness For Pediatric Patients With Severe Influenza, 2015-2020., Kelsey M. Sumner, Leila C. Sahni, Julie A. Boom, Natasha B. Halasa, Laura S. Stewart, Janet A. Englund, Eileen J. Klein, Mary A. Staat, Elizabeth P. Schlaudecker, Rangaraj Selvarangan, Christopher J. Harrison, Geoffrey A. Weinberg, Peter G. Szilagyi, Monica N. Singer, Parvin H. Azimi, Benjamin R. Clopper, Heidi L. Moline, Emma K. Noble, John V. Williams, Marian G. Michaels, Samantha M. Olson, New Vaccine Surveillance Network Collaborators

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Increasing the understanding of vaccine effectiveness (VE) against levels of severe influenza in children could help increase uptake of influenza vaccination and strengthen vaccine policies globally.

OBJECTIVE: To investigate VE in children by severity of influenza illness.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study with a test-negative design used data from 8 participating medical centers located in geographically different US states in the New Vaccine Surveillance Network from November 6, 2015, through April 8, 2020. Participants included children 6 months through 17 years of age who were hospitalized or presented to an emergency department (ED) with acute respiratory illness. …

Delinquency And Inadvertent Neglect As Byproducts Of Work-Addicted Parents, Shelley Sasser

Bridges: A Journal of Student Research

Over the past decade, discussions of work addiction throughout academic literature have increased substantially. However, the relationship between childhood outcomes and parental work addiction has yet to be explored. In this study, I set out to identify functions of parent-child relationships and comparisons of situational outcomes stemming from work addiction in relation to social determinants such as income, ethnicity, and gender, along with resulting stratification. The degree to which children benefit from features of lifestyles typically associated with high household incomes, such as financial security, health care benefits, access to educational resources, and neighborhood socioeconomic advantage, wherein parental work-addiction might …

Determining An Optimal Case Definition Using Mid-Upper Arm Circumference With Or Without Weight For Age To Identify Childhood Wasting In The Philippines, Lyle Daryll Dimaano Casas, Jhanna Uy, Eldridge Ferrer, Charmaine Duante, Paluku Bahwere, Rene Gerard Galera, Alice Nkoroi, Behzad Noubary, Mueni Mutunga, Sanele Nkomani, Roland Kupka, Valerie Gilbert Ulep

Health Sciences Faculty Publications

In resource-limited areas, where accurate weight-for-height Z-scores are hard to obtain, Mid-Upper Arm Circumference (MUAC) is a simple tool to identify wasted children. MUAC alone, however, may miss identification of many wasted children, leading to untimely intervention and potentially death. Our study aimed to identify the best-performing case definition to detect wasting by Weight-for-Height z-scores (WHZ) in Filipino children aged 6-59 months. We analyzed the 2018-2019 Expanded National Nutrition Survey to assess the diagnostic performance of MUAC cutoffs and a case definition combining MUAC and weight-for-age z-score (WAZ) in identifying moderate and severe wasting compared to the WHZ criterion. The …

Perceived Patient-Centered Care In Marching Band Artists, A L. Merrill, Z K. Winkelmann, N A. Uriegas

Bakerman Student Research Awards

Objective: Approximately 27,000 college marching band (MB) artists in the United States could benefit from access to healthcare services and patient-centered clinicians. The purpose of this study was to explore HCPs MB artists have access to and their perceptions of patient-centered care (PCC). Methods: We used a cross-sectional web-based survey of MB artists (n=751, age=20±8 years). MB directors from 242 colleges were emailed a survey link to forward to MB artists. Participants indicated which HCPs they could access. Those who reported no access or unsure were prompted to describe what they would do if an injury or illness occurred. Participants …

Association Between Teaching Clinic Structure And The Readiness Of Ophthalmology Residents To Enter Independent Practice, T. Michael Kashner, Marjorie A. Bowman, Catherine P. Kaminetzky, Andrea D. Birnbaum, John M. Byrne, Paul B. Greenberg, Steven S. Henley, Karen M. Sanders

Population and Public Health Sciences Faculty Publications

Our objective is to determine if the structure of Graduate Medical Education teaching clinics is associated with how well ophthalmology residents are prepared to meet the workload demands of independent clinical practice. Resident preparedness to enter independent practice was measured by the Readiness Index. Part of the Department of Veterans Affairs’ new Workload-based Resident Academic Performance measures (WRAP), resident readiness is computed from electronic health records for residents by clinic and service-date. The index compares resident productivity net of supervision and adjusted for care quality to the average productivity of non-supervising ophthalmologists. Readiness comprises a Workload component (ratio of resident …

Public Health Implications Of State-Level Public Health Organizational And System Structures, Cameron Ferguson Hays

Dissertations

Public health thought leaders such as the Institute of Medicine and National Academies of Science, Engineering, and Medicine have long been concerned about the lack of standardization among state-level public health systems (IOM, 1988; NASEM, 2023). However, little research studies these systems, their structures, and whether structural constructs affect population health outcomes.

This study attempted to examine the structural constructs that make up these systems and the impact of those constructs using an exploratory sequential mixed-methods design. Variables from management science were qualitatively extracted from materials describing all 50 state-level public health systems. Those variables were then analyzed using a …

A011: Effects Of Aerobic Exercise On Microbiota: Gut-Brain Axis And Hippocampal Neurotransmitters In Aging Mice, Yuqian Liu, Wenqian Yang, Haitao Wang

International Journal of Physical Activity and Health

Background/Objective: Gut flora plays an important role in host stress response, anxiety, depression and cognitive function through the gut-brain axis. Microbial diversity decreases with age, which in turn affects the function of the nervous system. The role of exercise in the prevention and treatment of age-related diseases and neurodegenerative diseases has received increasing attention. The purpose of this study was to elucidate the regulatory role of intestinal flora, gut-brain axis and nervous system function in the prevention of nervous system function decline in the elderly.

Methods: The sample consisted of 16, 52-week-old SPF C57BL/6 male mice that were randomly divided …

A067: Latent Profile Analysis Of The Development Characteristics Of Fundamental Motor Skills In Children, Qinping Xu, Xiaozan Wang

International Journal of Physical Activity and Health

Focusing on the sensitive period of motor development, the current study used TGMD-3 to assess the development level of fundamental motor skills in 4833 children aged 3-6 years in Shanghai. The potential categories of children's fundamental motor skill development characteristics and their interrelationship with demographic variables were analyzed using potential profile analysis and Chi-squared test, aiming to provide references for the construction of motor development interventions for children with different motor development levels. The results revealed that: 1) The developmental level of fundamental motor skills in 3-6-year-old children in Shanghai can be categorized into five latent categories, from low to …

Examining The Risk Of Cardiovascular Disease Among African American College Students At The University Of Texas At Arlington, Esha Kashyap

2024 Fall Honors Capstone Projects - Archive

Many studies examine the risk of cardiovascular disease in the general population of African Americans adults compared with other racial and ethnic groups; however, there is limited research that explores the risk factors, discrimination, and food behavior that impact this group. Cardiovascular disease develops over time and certain practices or experiences can increase the risk of this disease; thus, studying the behavior and perceptions of college students is important. Therefore, this research examined whether food behavior and perceived discrimination was higher in African American college students than in other racial or ethnic student groups. Utilizing a survey containing both qualitative …

Building Community Resilience Through Community Participatory Asset Mapping For Emergency Preparedness, Cassandra Y. Davila

2024 Fall Honors Capstone Projects - Archive

A community's capacity to prepare, manage, and recover from a disaster determines its level of resilience. The Federal Emergency Management Agency recommends engaging community members in resilience planning to ensure sustainable strategies are implemented. This project uses community-based asset mapping to identify how community participatory methods influence community resilience to combat emergency events. An asset map documents a community’s existing resources, highlighting its strengths. Focus group discussions in the urban area will be conducted to obtain feedback about existing assets and suggestions for additional resources to include. The expected result of this project is to build a comprehensive map of …

Genomic Analysis Of The Sars-Cov-2 Variants Circulated In The Philippines, 2020–2024, Arnie Dimaano, Kiana Dominique Carreon, Giselle Sophia Camaya, Irvin Rondolo, Jarel Elgin Tolentino

Biology Faculty Publications

Purpose

Genomic sequencing has been an invaluable tool to determine the evolution of SARS-CoV-2. In the present study, we provided a comprehensive description of the SARS-CoV-2 variants circulated in the Philippines.

Methods

The dataset from the human COVID-19 infections was acquired by downloading the sequences and their associated metadata spanning from March 2020 to April 2024. Then, we executed several filtering criteria to acquire the final dataset for the Philippine samples and performed spatial distribution analysis and phylogenetic tree construction of the reported SARS-CoV-2 sequences.

Results

A total of 16,679,203 SARS-CoV sequences were obtained, of which 17,393 (0.10 %) were …

Exposing The Disaster Disparities And Experiences On College Campuses, Deleanor Kirkpatrick Murray

All-Inclusive List of Electronic Theses and Dissertations

Challenges in higher education continue to arise, providing administrators with insights into how prepared—or unprepared—their institutions may be for future crises. The purpose of the study is to examine how mid-level leadership, staff, and students perceived the disaster response to Hurricane Ida during the 2021–2022 academic year. Using the theoretical frameworks of the Four-Frame Model (Bolman & Deal, 2021), Critical Race Theory (Delgado & Stefancic, 2017), and Institutional Theory (Manning, 2018), this case study employed interviews with 8 participants. Data analysis resulted in the emergence of 7 major themes and 11 sub-themes. The findings from the study suggest that participants …