Digital Commons Network^™

Two Decades Of Diagnostic Safety Research: Advances, Challenges, And Next Steps, Sundas Khan, Andrea Bradford, Christina L Cifra, Hardeep Singh

Faculty, Staff and Students Publications

Since the National Academies of Sciences, Engineering, and Medicine (NASEM) report Improving Diagnosis in Health Care, various research efforts have accelerated progress to understand and improve diagnostic safety. In this opinion piece, we summarize two decades of progress in methods for identifying and learning from diagnostic errors and provide recommendations for future research. Multiple methods have been used to quantify diagnostic errors in various clinical settings, thereby facilitating a deeper understanding of the nature and magnitude of the problem and enabling studies of contributing factors. However, the use of standardized definitions of a diagnostic error and/or diagnostic safety event, …

Systemic Racism In Canadian Healthcare: A Policy And Equity Analysis, Kola Adegoke, Abimbola Adegoke, Deborah Dawodu, Temitope Kayode

Health & Biomedical Sciences Faculty Publications

Background: In Canadian healthcare, systemic racism subverts commitment to universal coverage by building inequities into the system of governance, regulation, and clinical practice. Although racial disparities have been documented, little attention has been paid to how institutional structures perpetuate these inequities.

Objective: This study critically examines the organizational aspects of racism in the Canadian healthcare system. It aims to identify structural obstacles faced by racialized patients and foreign-trained physicians and to provide policy recommendations grounded in evidence.

Methods: The authors employed a narrative review framework for qualitative analysis of documents. Public inquiries (eg, Truth and Reconciliation Commission and Viens Report), …

Supporting Clinical Identification Of Children With Sensory Integration Challenges: A Decision Guide For Primary Care Providers, Shelly J. Lane, Sarah A. Schoen, Roseann Schaaf, Anita Bundy, Zoe Mailloux, Susanne Smith Roley, Teresa A. May-Benson, L. Diane Parham

Department of Occupational Therapy Faculty Papers

Background: Children and youth often have challenges processing and integrating sensory information. These increasingly common challenges and can significantly impact development, learning, behavior, well-being, and participation in everyday activities. Since children with sensory integration challenges, with or without other concerns, are likely to present first to their primary care provider (PCP), it is important that they have resources about sensory integration challenges and their impact on the child or the need to refer these children for further assessment and intervention. Our aim is to assist PCPs in their clinical decision-making.

Methods: We conducted a narrative review of CINAHL, PsychInfo, and …

The Relationship Between Anemia, Chronic Energy Deficiency, Knowledge, And Other Factors And Anc Attendance Among Pregnant Women In Bogor City And Regency 2025, Winfried Ichtussend Hartnajaya Chrisna, Ratu Ayu Dewi Sartika, Nurul Dina Rahmawati, Daden Setiawan

Indonesian Journal of Public Health Nutrition (IJPHN)

Antenatal Care (ANC) is a comprehensive health service to optimize pregnancy outcomes. In 2023 in Bogor City, the ANC K6 coverage rate has reached the target (98.63%), but this is not the case with the coverage in Bogor Regency (62.25%). ANC visits that do not reach the standard can be influenced by predisposing factors, supporting factors, and health needs factors. The inequality that occurs can hinder efforts to reduce maternal mortality. This study aims to determine the relationship between knowledge and other factors with ANC visits in Bogor City and Regency in 2025. This study is quantitative with a cross-sectional …

Understanding Tobacco Use Among Bangladeshi Men: A Socio-Demographic Analysis Of Risk Factors, Md. Rashedus Salekin Sabbir, Helal Uddin, Md Shazid Hossain Shohan

Indonesian Journal of Public Health Nutrition (IJPHN)

Tobacco consumption remains a major public health concern in Bangladesh, where adult males represent the most affected group. Despite existing bans on public smoking, cultural norms, media influence, and limited awareness continue to sustain high prevalence. The objective of this study was to examine the socio-demographic determinants of tobacco use among Bangladeshi men, focusing on regional variation, education, media exposure, and family influence. A cross-sectional survey was conducted among 275 adult males in Dhaka Division using a structured questionnaire. Data was analyzed through descriptive statistics, chi-square tests, and binary logistic regression to identify significant predictors of tobacco consumption. Findings reveal …

Mosquito Classification And Explainability From Image Data Via Deep Learning Techniques, Farhat Binte Azam

USF Tampa Graduate Theses and Dissertations

According to the World Health Organization (WHO), mosquitoes are the deadliest animals on Earth, responsible for more human deaths annually than any other species. Mosquito-borne illnesses continue to pose severe risks to global health. In 2015 alone, there were an estimated 214 million malaria cases worldwide. Similarly, a 2016 report from the Centers for Disease Control and Prevention (CDC) revealed that Puerto Rico’s Department of Health received over 62,500 suspected cases of Zika, with 29,345 confirmed positive cases. In 2019, Southeast Asia experienced its worst dengue outbreak in recorded history. Of the approximately 4,500 mosquito species distributed across 34 genera, …

Sexual Activity And Functioning After Breast Cancer Treatment: Perspectives On The Importance Of Pleasure From A Radiotherapy Cohort, Melanie Besculides, Lauren Carney, Ksenia Gorbenko, Sheryl Green, Melissa Brito, Jezelle Lynch, Carly Feldman, Cindy Munoz, Madhu Mazumdar, Deborah C. Marshall

Student Papers, Posters & Projects

BACKGROUND: Breast cancer affects millions of women and while treatment can be lifesaving, it also has numerous side effects, including those related to sexual function, which often impact the ability to experience pleasure from sex. This study aimed to understand how breast cancer survivors define sexual activity, identify important aspects, and ascertain perceived impacts of treatment on sexual activity and function, particularly related to pleasure.

METHODS: Semi-structured interviews were conducted with women who were breast cancer survivors at least one-year post-radiation. Priority populations were oversampled (racial/ethnic/sexual/gender minorities, those aged over 65 or under 45). The sample included 23 participants: 11 …

Does Motor Skill Competence Influence Physical Activity Behavior? Focusing On Sport-Specific Skills, Yubing Wang, Yaogang Han, Pan Li, Bin Zhang

International Journal of Physical Activity and Health

The purpose of this study was to investigate the widely held belief that motor skill competence positively affects physical activity behavior (PA), considering the task-specific nature of motor skill competence and the context-specific nature of PA. Specifically, we examined the effects of students’ jump rope (JR) and basketball (BB) competence on their PA in six contexts. A total of 134 sixth grade students participated in this study. All variables were assessed using appropriate tools. A series of hierarchical regression analyses were conducted to address the research questions. Students’ JR competence did not significantly influence their PA in either JR-related or …

Adherence To Integrative Care, Oncology Healthcare Utilization, Opioid Use And Hospitalization, Eran Ben-Arye, Dan Greenberg, Noah Samuels, Ana Maria Lopez, Tzahit Simon-Tuval

Kimmel Cancer Center Faculty Papers

Research on the relationship between integrative oncology (IO) programs and dispensing of chemotherapy agents and supportive care drugs, and hospitalization rates is limited. The present study examined these outcomes in chemotherapy-treated patients with cancer, comparing patients highly adherent to integrative care (high-AIC) to those with low adherence (low-AIC). Data from patients with cancer treated with taxane and/or platinum-based agents participating in an ongoing prospective, controlled pragmatic trial were examined retrospectively. Patients were referred to an IO consultation and weekly treatments at 3 medical centers in Northern Israel, with high-AIC defined as attending ≥4 sessions at 6 weeks; low-AIC, 0-3 sessions. …

Advancing Sex Education And Health Outcome: The Impacts Of Education And Support Program In Cambodia, Natepy Vann

Public Health: Student Scholarship & Creative Works

Abstract

Context:

In most countries, early pregnancies are one of the most public health issues, particularly in a developing country like Cambodia. This problem is leading those young mothers to face mental health breakdowns and limited socioeconomic opportunities. Beyond that, they also face the disruption of education and overall health risks in the long term. This research paper answers and delves into doubts related to the question: How does early pregnancy affect the mental health and future socioeconomic opportunities, including education, career prospects, and social mobility, of teenage mothers in Cambodia?

Methods:

This literature review focuses on psychological …

Cancer Screening Disparities Among Women With Disabilities In The United States, Kathleen Young

Walden Dissertations and Doctoral Studies

Breast and cervical cancer screening reduces mortality; however, women with disabilities and mental health challenges experience persistent disparities in access to preventive services. The purpose of this quantitative study was to examine the relationships between self-reported serious difficulty hearing, serious difficulty seeing, and frequent mental distress with breast (mammogram) and cervical (Pap test) cancer screening use among women in the United States (mammogram model, n = 844; Pap model n = 774), using the 2023 Behavioral Risk Factor Surveillance System dataset. The social-ecological model provided the framework. Two logistic regression models were conducted, adjusting for age, race/ethnicity, education, income, marital …

Decreasing Barriers To The Utilization Of Cryopreserved Sperm In Male Cancer Survivors: An Expert Review And Guide, Megan V Alexander, Hailie Ciomperlik, Anna Claire Reynolds, Allyson Nevins, Luwam Ghidei, Jordan Kassab, Kevin Campbell, John Sullivan, Michael D Jochum, Laura Detti, Terri L Woodard, Larry I Lipshultz, Laurie J Mckenzie

Faculty, Staff and Students Publications

Cryopreservation of sperm offers male cancer patients a critical opportunity to preserve fertility prior to gonadotoxic treatments. Despite its increasing availability, utilization rates remain modest at typically less than ten percent. This expert review provides a framework for an optimal Oncofertility Patient Care Pathway, explores the multifaceted barriers to cryopreserved sperm use, and proposes specific solutions. We focus on key timepoints for intervention, including the post-treatment fertility care return visit, continued sperm cryopreservation while remote from family building, eventual readiness for family building, and posthumous considerations. Patients often face difficulty engaging in post-treatment reproductive follow-up, with one-third of patients missing …

Subjective Excessive Daytime Sleepiness And Frailty Progression In Veterans Over 50 With Insomnia, Mona Amirmazaheri

Walden Dissertations and Doctoral Studies

Frailty is common in aging veterans and linked to adverse outcomes. This retrospective cohort study of 6,824 veterans with insomnia examined whether excessive daytime sleepiness, sleep treatments, and PTSD affected frailty progression over four years. Frailty was measured using a validated index, with models adjusted for demographics and comorbidities, including chronic coronary insufficiency. Manuscript 1 showed that a higher Epworth Sleepiness Scale (ESS) score (range 0-24) was independently associated with a higher frailty index (FI) (p < .001). A clinical threshold of ≥11 indicated EDS and greater odds of frailty worsening compared to scores <11 (adjusted odds ratio (aOR) = 1.16, 95% CI [1.02, 1.32], p = .021). There was no significant interaction between ESS and time, suggesting that sEDS reflects persistently elevated frailty levels rather than accelerated decline. Manuscript 2 showed that nonpharmacologic sleep interventions were protective, while pharmacotherapy was associated with increased frailty risk. Cognitive behavioral therapy for insomnia was associated with lower odds of frailty worsening (aOR = 0.31, 95% CI [0.19, 0.53], p < .001), and continuous positive airway pressure therapy also reduced risk (aOR = 0.55, 95% CI [0.39, 0.76], p < .001). In contrast, sleep medications were associated with increased odds of frailty progression (aOR = 1.16, 95% CI [1.02, 1.32], p = .021). Manuscript 3 showed that PTSD was not associated with baseline frailty levels but showed a significant time interaction (B = 0.001, p = .008), indicating modest acceleration of frailty progression among affected veterans. Findings support positive social change through early sEDS screening and trauma-informed, nonpharmacologic sleep care to reduce frailty in veterans.

Mold Exposure And Cognitive Health During Menopausal Transitions: A Quantitative Analysis Using Secondary Data, Holly Jeannette Burns

Walden Dissertations and Doctoral Studies

Mold exposure and menopausal transition have been independently linked to cognitive decline, yet their interaction among socioeconomically disadvantaged populations has not been well examined. This quantitative study is an exploration of how menopausal transition influences the relationship between mold exposure and cognitive health outcomes among women aged 40 to 60 living in low-income housing in the United States. Bronfenbrenner’s ecological systems theory was used to guide the cross-sectional design using secondary data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES; N = 149). Weighted logistic regression and Hayes’ PROCESS (Models 2 and 4) were used to test associations …

Mental Health Amongst African American Healthcare Workers And Covid Vaccine Mandates, Christopher Brandlin

Walden Dissertations and Doctoral Studies

This qualitative case study investigated vaccine hesitancy among African American healthcare workers in Los Angeles County, California in light of employment loss following the State Public Health Officer Order of August 5, 2021. The literature indicated that vaccination policies have impacted the psychological health of healthcare workers, especially those with vaccine doubts. The research problem addressed in this study was that the mental health effects among African American hospital workers who lost employment as a result of vaccine hesitancy was not known. The purpose of this generic qualitative case study was to explain the factors contributing to vaccine hesitancy in …

Implicit Bias Training Standards In Health Care: Did Michigan Get It Right? A Policy And Ethical Framework Analysis, Megan Gailliard, Kieran Fogarty, Mary Lagerwey

The Open Journal of Occupational Therapy

In 2022, Michigan joined a handful of states requiring implicit bias training for its health care professionals. In its ideal application, implicit bias training of health care professionals will result in a reduction of the implicit biases held by health care providers. This bias reduction will, in theory, contribute to improved equity in the delivery of health care services. Ultimately, the less biased health professional, now delivering health care services with a more equitable hand, will help reduce health disparities in the State of Michigan.

This analysis of Mich. Admin. Code R.338.7004 - Implicit bias training standards for licensed and …

Promising Practices For Increasing The Number Of Equity-Owed Lifeguards In Canada And The United States Of America, Sofia Pantano, Audrey R. Giles

International Journal of Aquatic Research and Education

Currently a shortage of lifeguards exists in Canada and the United States (US) (Frommer, 2023; Santucci, 2024), and those who are working as lifeguards often do not reflect the diversity of the communities they serve (Martinez, 2020). Increasing the number of lifeguards from equity-owed groups is a potential way of increasing the lifeguard workforce and decreasing the shortage of workers in these important roles, as well as a moral imperative. In this paper I explore challenges to and promising practices aimed at increasing the representation of members equity-owed groups in lifeguarding. I begin with an overview of lifeguarding in Canada …

Adopting Stuart Hall’S “Race, The Floating Signifier” As A Conceptual Framework Within Aquatic Research And Education, Kurt J. Cordice

International Journal of Aquatic Research and Education

During his 1997 lecture at Goldsmiths College in London, Stuart Hall, renowned for his contributions to sociology and cultural studies, offered his argument that the concept of race functions as a Floating Signifier. In this essay, Stuart Hall’s Race, the Floating Signifier is presented as a strong conceptual framework to support more accurate and effective positioning of race as an important consideration within aquatic research and education. Evidence from a range of disciplines, including historical research, is presented to establish both the importance and challenge of race within aquatic research and education. This evidence is also used to demonstrate …

Silent Signals: Human Trafficking And The Dental Professional’S Duty To Act, Pamela Zarkowski

Journal of the American College of Dentists

Human trafficking is a global public health and human rights crisis that includes forced labor and commercial sexual exploitation. Dental professionals are uniquely positioned to recognize signs of trafficking, as many victims encounter healthcare settings, including dental offices, during their exploitation. This article introduces the types and prevalence of trafficking, outlines legal and ethical responsibilities, and provides clinical red flags, case scenarios, and actionable strategies for screening and reporting. Myths that hinder detection are also addressed. By recognizing their ethical duty to protect vulnerable patients, dental professionals can become vital allies in the identification and support of trafficking survivors.

J Am Coll Dent 2025 92 1

Journal of the American College of Dentists

The Journal of the American College of Dentists (JACD) publishes scholarly articles, editorials, essays, and reflections addressing the ethical, professional, and social dimensions of dentistry. The Journal serves as a forum for advancing ethics, professionalism, leadership, and excellence within the dental community. By fostering dialogue across disciplines and perspectives, JACD provides readers with insights that encourage ethical, professional practice, lifelong learning, and service to the public, reinforcing dentistry’s commitment to advancing oral healthcare and the common good.

Predictors Of Parental Behavior And Child Weight Status, Fidelia Senayah, Heba M. Athar, Allison G. Litton

Journal of Social, Behavioral, and Health Sciences

Childhood obesity is a major health issue globally. The prevalence rate remains high in Ohio, with associated complications among affected children and adolescents. The current study examined the association among obesity risk knowledge, risk perception, feeding behavior, and child weight outcome while controlling for race, gender, income, and education. We collected quantitative data through an online survey of parents in Northwest Ohio (n = 71) using the obesity risk knowledge scale and factors from the Child Feeding Questionnaire. We analyzed data using multiple linear regression. The primary outcome measures were feeding behavior and child weight status. Parental obesity risk …

Assessing The Impact: Cerebral Palsy On Domains Of Quality Of Life, Sheetal Malhan

Journal Of Indian Physician Associates

Introduction Cerebral palsy (CP) is characterized by a group of permanent movement and posture disorders resulting from nonprogressive disturbances in the developing fetal or infant brain. CP is a chronic condition affecting approximately 1.2–2.5 per 1000 school-aged children, often accompanied by comorbidities such as visual, auditory, and feeding impairments, delayed language development, and epilepsy. These related challenges can markedly reduce a child’s quality of life (QoL), particularly when compounded by social and environmental limitations. Despite the importance of understanding QoL outcomes in this population, limited region-specific data exist. Understanding domain-specific QoL can guide targeted rehabilitation planning.

Methods A cross-sectional survey …

Problem-Solving Training To Improve Caregiver Burden And Depressive Symptoms Among Dementia Caregivers: Personal And Clinical Factors Of Responders Vs. Non-Responders, Shannon B. Juengst, Matthew Lee Smith, Kristin Wilmoth, Brittany Wright, Gang Han, Charlene Supnet, Gladys Maestre

School of Medicine Publications

Introduction: Metacognitive strategy training interventions, like Problem-Solving Training/Descubriendo Soluciones Juntos (PST/DSJ), have efficacy for improving caregiver burden and depressive symptoms. We previously demonstrated that PST/DSJ improved caregiver burden and depressive symptoms among caregivers of adults with Alzheimer’s Disease and related dementias (ADRD), regardless of the number of sessions or boosters received. However, these results did not examine factors characterizing those who responded (improvement in caregiver burden or depressive symptoms) or did not respond to the intervention.

Objective: To identify key personal and clinical factors associated with response to PST/DSJ. Personal factors included age, gender, race, Hispanic ethnicity, education, and employment …

Failure To Rescue After Surgery For Pancreatic Cancer: A Systematic Review And Narrative Synthesis Of Risk Factors And Safety Strategies, Masashi Uramatsu, Yoshikazu Fujisawa, Paul Barach, Hiroaki Osakabe, Moe Matsumoto, Yuichi Nagakawa

College of Population Health Faculty Papers

Background: Failure to rescue (FTR), defined as death after major postoperative complications, is a critical quality indicator in pancreatic cancer surgery. Despite advances in surgical techniques and perioperative care, FTR rates remain high and vary across institutions. Methods: This systematic review uses a narrative synthesis followed by PRISMA 2020. A PubMed search (1992-2025) identified 83 studies; after screening, 52 studies (2010-2025) were included. Eligible designs were registry-based, multicenter, single-center, or prospective audits. Given substantial heterogeneity in study designs, FTR definitions, and outcome measures, a narrative synthesis was performed; no formal risk-of-bias assessment or meta-analysis was conducted. Results: …

Perceptions Of Whole Plant-Based Diets And Weight Among Hispanics In Miami, Florida, Zoraida Powell

Walden Dissertations and Doctoral Studies

Being overweight or obese poses major public health concerns and contributes to the development of chronic illnesses. While researchers have explored how a total plant-based diet impacts excess body weight or obesity, there is still a lack of clarity about how Hispanics living in Miami, FL, perceive or understand this diet concerning overweight and obesity. Using a generic qualitative approach, this study was conducted on how Hispanics in Miami, FL, understand and view a whole plant-based diet (WPBD) for preventing and reducing overweight and obesity. Through interviews with 14 diverse Hispanic participants, the study revealed that they see WPBD as …

Lived Experiences Of Obese Women In Mississippi Concerning The Role Of Psychosocial Factors In The Development Of Obesity, Temitope Olabode

Walden Dissertations and Doctoral Studies

One of the highest rates of obesity in the United States is in Mississippi, where middle- aged obese women deal with a variety of social, cultural, and personal issues, including shame, discrimination, and stigma based on weight, mental anguish, cultural norms, financial limitations, and restricted access to healthcare. This study investigated the psychosocial factors that contribute to obesity in women aged 40- 60 years, and the effects of obesity on body image, self-esteem, health behaviors, and quality of life. A qualitative phenomenological study using the social ecological model (SEM) framework looked at the individual, interpersonal, and policy levels of the …

Alternative And Traditional Schooling On Sexual Risk Behaviors Among Alaska Native Youth In The Lower Kuskokwim, Nathaniel Hebert

Walden Dissertations and Doctoral Studies

Alaska Native youth experience disproportionately high rates of sexual risk, yet disaggregated data and school-contextual analyses remain limited. Understanding how school type (alternative vs. traditional) and individual factors influence sexual risk among Alaska Native youth is essential for informing targeted, culturally responsive health interventions and addressing ongoing health disparities. This quantitative study aimed to examine the association between three behaviors (condom use, multiple sexual partners, and substance use) by school type, controlling for gender, grade level, body mass index, and afterschool activity. Guided by the social-ecological model, this cross-sectional study provided new insights into the relationship between school type and …

Household Dysfunction And Dating Violence Perpetration: The Moderating Effects Of Parental Monitoring And Closeness Among Middle School Adolescents In Southeast Texas, Sumaita Choudhury, Emily T Hébert, Timothy J Walker, Christine M Markham, Ross Shegog, Robert C Addy, Melissa F Peskin

Faculty, Staff and Student Publications

Background: Adolescent dating violence (DV) perpetration is a significant public health issue affecting millions of adolescents in the United States. Adverse childhood experiences such as household dysfunction (HD) have been exhibited to be risk factors for DV perpetration during adolescence and adulthood. Furthermore, the literature is scant regarding how positive parent-child relationships can mitigate these risk factors and decrease HD-related consequences among sixth-grade adolescents. Thus, our study examined the moderating effects of parental monitoring and closeness regarding the association between HD and DV perpetration among middle schoolers in Southeast Texas.

Methods: In our cross-sectional study, we used the baseline data …

Determinant Factors Of Completeness Of Medical Resume Filling By Doctors At Pesawaran Regional General Hospital, Achmad Deza Farista, Aila Karyus, Abikusno Djamaluddin

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

A medical resume serves as a vital document that compiles essential information related to a patient’s clinical management. In 2019, the completeness rate of medical resume documentation at Pesawaran Regional General Hospital was only 37.4%. This study aimed to identify factors influencing the completeness of medical resume documentation by doctors through a quantitative, cross-sectional design involving 37 inpatient care doctors. Data were collected via questionnaires and direct observation, then analyzed using univariate, bivariate (Chi-Square), and multivariate (Logistic Regression) methods. Observation showed that 56.8% of medical resumes were incomplete. Questionnaire results indicated that 54.1% of respondents had negative perceptions of Standard …

The Impact Of Cooperative Extension Programs On Late Life Mental Health Outcomes: A Systematic Review, Naomi R. Meinertz, Kate Perepezko, Jeong Eun Lee, Mary E. Dozier Phd

Journal of Human Sciences and Extension

Rural-dwelling older adults have greater mental health disparities with higher rates of depression and anxiety compared to their urban counterparts; however, reaching these communities to understand and address the specific psychological needs of rural-dwelling older adults remains a barrier for gerontologists. Due to the extensive reach of the Cooperative Extension System, university Extension systems are primed to facilitate connections between researchers and rural communities to improve mental health outcomes for older adults. Despite the potential benefits of such partnerships, Extension is largely unknown and underutilized by gerontological researchers, leaving many older adults disconnected from resources available through land-grant universities that …