Digital Commons Network^™

Nasal Microbionts Differentially Colonize And Elicit Cytokines In Human Nasal Epithelial Organoids, Andrea I Boyd, Leah A Kafer, Isabel F Escapa, Amal Kambal, Hira Tariq, Susan G Hilsenbeck, Hoa Nguyen-Phuc, Anubama Rajan, Joshua M Lensmire, Kathryn A Patras, Pedro A Piedra, Sarah E Blutt, Katherine P Lemon

Faculty, Staff and Students Publications

Nasal colonization by Staphylococcus aureus or Streptococcus pneumoniae is associated with an increased risk of infection by these pathobionts, whereas nasal colonization by Dolosigranulum species is associated with health. Human nasal epithelial organoids (HNOs) differentiated at air-liquid interface (ALI) physiologically recapitulate human nasal respiratory epithelium with a robust mucociliary blanket. Due to their natural stem-like properties, HNO lines are a long-term experimental resource that offers genetic diversity based on the different donors. To develop HNOs as a new model system for bacterial nasal colonization, we reproducibly monocolonized HNOs differentiated at ALI with S. aureus, S. pneumoniae, or Dolosigranulum …

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. …

What Drives Advanced Practice Nurses To Stay In Rural America? Insights From The 2022 National Survey Of Registered Nurses, Esita Patel, Chris Gillette, Jan Ostermann Phd, Chris Everett, Dawn Caviness, Sarah Garvick

Faculty Publications

Purpose: Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to worsen. Using a strengths-based approach, we identify factors that influence the decisions of advanced practice registered nurses (APRNs) to leave or stay in their jobs.

Methods: Secondary analysis of data from the 2022 National Sample Survey of Registered Nurses. We describe rates of turnover, retention, intention to leave, and reasons for leaving and staying by job rurality. We compare reasons by rurality using Pearson …

From Listening To Action: Building Effective Community-Academic Partnerships In Environmental Health [Lightning Talk], Dani Mcbride

University Faculty Publications and Creative Works

The slides from a lightning talk given at the Michigan Premier Public Health Conference in Muskegon, MI on October 28, 2025.

Association Of Stepping-Up To High Dose Inhaled Corticosteroids And Risk Of Future Asthma Exacerbations: Data From The Us, Trung N Tran, Marjan Kerkhof, Tham T Le, Mina Khezrian, Nicole Zubizarreta, Joshua Enxing, Kirsty Rhodes, Jonatan Hedberg, Bill Cook, Tianshi David Wu, Tim W Harrison

Faculty, Staff and Students Publications

Background: Real-world data on the benefit of high-dose inhaled corticosteroid (ICS) post-exacerbation are limited.

Objective: To investigate whether stepping-up to high-dose inhaled corticosteroid (ICS) post-severe exacerbation reduces future asthma exacerbation risk in a real-world setting.

Methods: This was a retrospective cohort study using the Optum® Clinformatics® database (October 2015-December 2023). Patients with asthma, aged ≥12 years, with ≥1 severe exacerbation and ≥2 ICS maintenance prescriptions in the 12-months pre-, and ≥1 ICS maintenance prescription in the 3-months post-exacerbation were included. Primary and secondary endpoints were annualized asthma exacerbation rate (AAER) and time to first subsequent severe exacerbation, respectively. We compared …

Screening For Trypanosoma Cruzi In Patients Living With The Human Immunodeficiency Virus (Pwh) In The Peruvian Amazon, Silvia Otero-Rodriguez, Martin Casapia-Morales, Lilia-Lorena Pinedo-Ramirez, Esperanza Merino, Eva H Clark, José-Manuel Ramos-Rincón

Faculty, Staff and Students Publications

Introduction: Chagas disease (CD) - Trypanosoma cruzi infection - in people living with HIV (PWH), particularly those with advanced CD4 T cell depletion, can lead to severe syndromes affecting the central nervous system and the heart.

Methods: We performed a cross-sectional study to screen for CD among PWH in Iquitos, Peru, between October 2023 and May 2024, with the objective of understanding the frequency of infection in this population. Adults with confirmed HIV attending outpatient services at two regional hospitals were enrolled. Two ELISA tests (lysate and recombinant) were used, and discordant results were adjudicated by indirect chemiluminescence immunoassay (CLIA). …

Molecular And Cellular Characterization Of Planarian Stem Cell Microenvironments, Frederick G Mann, Carolyn E Brewster, Dung M Vuu, Mol Mir, Riley Galton, Shao-Fu Nien, Enya R Dewars, Carlos Guerrero-Hernández, Jason A Morrison, Mary C Mckinney, Lucinda E Maddera, Melainia L Mcclain, Kate E Hall, Seth Malloy, Shiyuan Chen, Brian D Slaughter, Sean A Mckinney, Stephanie H Nowotarski, Anoja Perera, Blair W Benham-Pyle, Alejandro Sánchez Alvarado

Faculty, Staff and Students Publications

Stem cell niches are essential for regulating stem cell self-renewal and differentiation during tissue repair and regeneration. However, the mechanisms supporting stem cell function in highly regenerative organisms, such as the freshwater planarian Schmidtea mediterranea, remain unclear. Using spatial transcriptomics, we identified two cell types associated with planarian stem cells: secretory cells we term "hecatonoblasts" and intestinal cells. Surprisingly, while hecatonoblasts were in close physical proximity to stem cells in the mesenchyme, they were dispensable for regeneration. In contrast, intestinal cells, despite lacking direct contact with stem cells, regulated both their position and function during regeneration. Electron microscopy revealed diverse …

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 …

Exploring Public Health Nurses’ Perceptions Of Syringe Services Programs In Southern Rural Areas, Joel Lowery

Walden Dissertations and Doctoral Studies

Public health nurses are potentially key stakeholders in syringe services program (SSP) implementation in rural areas, where they can act as liaisons between public health, private healthcare, and the community. However, little research reflects an in-depth understanding of how public health nurses perceive SSPs in rural areas. The purpose of this qualitative study was to explore the perceptions of syringe services programs held by public health nurses practicing in rural areas with no existing SSPs in southern states and ascertain their potential roles in facilitating harm reduction for people who inject drugs. This study was guided by a conceptual framework …

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 …

Hiv/Aids Among Young People In South Sudan: Assessing Misconceptions About Transmission, Healthcare Access, And Cultural/Religious Factors, John Valent Abore

Walden Dissertations and Doctoral Studies

The HIV/AIDS epidemic continues to be a significant public health challenge among young people in South Sudan (SSD). Despite global efforts to curb the spread of HIV, misconceptions about HIV transmission, barriers to access to healthcare services, and cultural/religious factors that affect the epidemic persist in South Sudan, and it is not obvious how these factors interact to impact outcomes. This quantitative cross-sectional study investigated whether there is a relationship between misconceptions about HIV transmission and HIV/AIDS status and whether access to healthcare and cultural/religious factors mediate this relationship among young people (aged 18–35) in SSD. A secondary data analysis …

Social Vulnerability Associations With Hypopharyngeal Carcinoma Treatment And Prognostic Disparities, Camaren M. Cuenca, David M. Bruss, David J. Fei-Zhang, Jill N. D'Souza, Anthony M. Sheyn, Jeffrey C. Rastatter, Daniel C. Chelius

School of Medicine Faculty Publications

Objectives: Prior studies investigating the impacts of social determinants of health (SDoH) on hypopharyngeal cancer have only assessed the impact of individual factors on patient outcomes. This study uses the CDC's Social Vulnerability Index (SVI) and a national patient cohort to examine how the interrelational influence of SDoH affect hypopharyngeal cancer prognosis, treatment, and follow-up. Methods: This retrospective cohort study analyzed patients from 1975 to 2017 with a diagnosis of hypopharyngeal carcinoma in the NCI-SEER database. Net social vulnerability and its contributions from 15 SDoH variables were ranked and scored across all US counties, yielding a SVI. SVI scores were …

Human Papillomavirus Vaccine Uptake In Ethnically Diverse Women Living With Systemic Lupus Erythematosus, Sebastian Bruera, Yinan Huang, Savannah Bowman, Maria E Suarez-Almazor, Grace H Lo, Maria A Lopez-Olivo, Elizabeth Chiao, Jennifer R Kramer, Frederick A Pereira, Sandeep K Agarwal

Faculty, Staff and Students Publications

Background: Women with systemic lupus erythematosus (SLE) are at an increased risk of infection from the human papillomavirus (HPV) and subsequently HPV-mediated malignancies and genital warts. The HPV vaccine is a highly effective intervention in preventing HPV infection and is recommended in SLE patients. We determined HPV vaccination rates and factors associated with decreased vaccination uptake in women living with SLE.

Methods: We conducted a cross-sectional study in which we enrolled women with SLE (aged 21–45) for whom the HPV vaccine is recommended for by the US Food and Drug Administration (FDA). The primary outcome was self-reported HPV vaccination as …

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 …

Creation And Evaluation Of Standardized Electronic Health Record Templates For Transition Of Care In Sickle Cell Disease: A Pilot Study, Stephanie Howe Guarino, Mohan Madisetti, Payal C. Desai, Akshat Jain, Kenneth Rivlin, Jerome A. Osheroff, Robin Miller, Brandi Campanella, Sophie Lanzkron, Julie Kanter

Cardeza Foundation for Hematologic Research

Objective The objective of this pilot project was to create a standardized Transition Note in the electronic health record (EHR) to facilitate clinician communication during the transition process from pediatric to adult care for youth with sickle cell disease (SCD). Methods Using a modified Delphi process, consensus was reached among 78 member centers from the National Alliance of Sickle Cell Centers (NASCC) on the essential health data elements for a standardized EHR Transition Note. Templates were created in 2 different EHR systems and piloted at 2 SCD centers. Perceived clinician acceptability, appropriateness, and feasibility were assessed using the AIM-IAM-FAM measures …

Compromised Pressure-Generating Capacity Of Diaphragmatic Muscle And Its Interaction With The Lower Rib Cage At High Lung Volume During Airway Occlusion, Aladin M Boriek, Noralis Rodriguez-Santiago, Sanghyun Kim, Aubri Ford, Shari Wynd, Rolf D Hubmayr

Faculty, Staff and Students Publications

The pressure generating capacity of the diaphragm is generally thought to be compromised at high lung volume either due to loss of curvature or loss of its membrane tension. At a state of hyperinflation during airway occlusion at total lung capacity, the diaphragmatic muscle is forced to contract from an initial shorter length, the zone of apposition narrows, insertional force on the chest wall is reduced and abdominal compliance falls. We hypothesize that these altered mechanical conditions at high lung volume lead to a loss of the pressure generating capacity that is mediated by excessive muscle shortening rather than loss …

Racial Disparities In Clonal Hematopoiesis And Their Impact On Hematologic Malignancies, Zijian Zhang, Chao Cheng

Faculty, Staff and Students Publications

Clonal hematopoiesis of indeterminate potential (CHIP) is a known risk factor for hematologic malignancies (HM), but its distribution and clinical implications across diverse ancestries remain poorly characterized. In this study, we investigated CHIP and its progression to HM in a large, racially diverse cohort from the All of Us Research Program, comprising 245,388 participants. We identified 10,446 CHIP driver mutations in 9,476 individuals. Our analysis revealed clear racial disparities in CHIP prevalence and mutational profiles: African American (AA) individuals had higher odds of CHIP and exhibited distinct mutation patterns compared to White American (WA) individuals. Consistent with prior studies, CHIP …

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 …

Community Factors And County-Level Cancer Screening, Prevalence, And Mortality, Alexandra R. Drake, Eric W. Christensen, Augusto C. Ochoa, William Small, Jinel Scott, Elizabeth Y. Rula

School of Medicine Faculty Publications

IMPORTANCE Cancer screening, prevalence, and mortality vary across US counties; the broad set of community factors associated with these differences are not well understood. OBJECTIVE To assess the relative importance of diverse community measures for explaining county-level variance in cancer screening, prevalence, and mortality rates for breast, colorectal, lung, and prostate cancers. DESIGN, SETTING, AND PARTICIPANTS This geospatial cross-sectional analysis across all US counties used random forest algorithms to estimate the relative importance of 24 community measures—including health behaviors and lifestyle, socioeconomic, and environment factors—as explanatory factors for cancer screening, prevalence, and mortality. For each cancer, county-level cancer screening and …

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 …

Adverse Childhood Experiences, Positive Childhood Experiences, And Digital Media Use Among Children And Adolescents In The United States, Elizabeth L. Crouch, Emma Boswell, Monique J. Brown Ph.D., Kevin J. Bennett

Publications

No abstract provided.

Alcohol Consumption And Cervical Carcinogenesis: Time To Draw Conclusions, Vivek Kashyap, Divya B. Kenchappa, Ajay K. Singh, Bhupesh Singh, Murali M. Yallapu, Everardo Cobos, Subhash C. Chauhan

School of Medicine Publications

Cervical cancer is the fourth most common cancer among women worldwide and remains a significant cause of cancer-related mortality. Alcohol consumption is linked to an increased risk of several cancers and is a controversial risk factor for developing cervical cancer. This review updates existing information on the correlation between alcohol consumption and the risk of developing cervical cancer. Several comprehensive studies from different geographical regions have shown that moderate and heavy drinking is positively correlated with the development of cervical cancer. There is a synergistic relationship between human papillomavirus (HPV) viral load and alcohol use among drinkers with a high …

Econometric Analyses Across The Continuum Of Care For Individuals With Hearing Loss, Teresa I. Anthony

USF Tampa Graduate Theses and Dissertations

Hearing loss affects individuals across the age span and, if left untreated, can lead to developmental delays and health and well-being concerns. This dissertation applies econometric analyses to investigate factors influencing diagnostic outcomes in the neonatal intensive care unit (NICU), intervention enrollment rates among babies with permanent childhood hearing loss (PCHL), and utilization and hospitalization outcomes among adults with sensory impairment (SI). The first study evaluates the cost-effectiveness of automated auditory brainstem response (aABR) versus transient evoked otoacoustic emissions (TEOAE) for newborn hearing screenings in a Thailand hospital NICU. Decision tree modeling and economic evaluation suggested that although aABR is …

Association Between Diabetes Mellitus, Hypertension, Obesity, And Diagnosis Of Covid-19 In Puerto Rico, Julian Rene Rivera Rodriguez

Walden Dissertations and Doctoral Studies

The population of Puerto Rico has been heavily affected by chronic diseases; however, data remains limited on the influence of diabetes mellitus (DM), hypertension, and obesity on the probability of COVID-19 diagnosis. The purpose of this quantitative study was to evaluate the association between non-communicable diseases that included DM, obesity, hypertension, and COVID-19 diagnosis, controlling for age and sex and person exposure in Puerto Rico. The sample consisted of 1,463 participants who underwent a polymerase chain reaction (PCR) test for COVID-19 from April 1, 2020, to March 31, 2021. Results from adjusted multivariable logistic regression analyses established that obesity OR …

A Cross-Sectional Study On Teenage Pregnancy And Its Associated Factors In A District Of Eastern India, Ashifa Sultana, Jayita Pal, Purnashree Mandal, Manoj Ghosh

Internet Journal of Allied Health Sciences and Practice

Introduction: Teenage pregnancy is a global public health concern with wide-ranging consequences for adolescent mothers, their families, and society at large. By investigating sociodemographic factors, contraceptive knowledge, and family dynamics, this study aimed to gain a comprehensive understanding of the factors contributing to teenage pregnancy in Nadia district, West Bengal, India.

Materials & method: A cross-sectional study was conducted among 232 pregnant women of Chakdaha block. The study participants were selected by simple random sampling from the line list available at the sub-centres. The Chakdaha block of Nadia district was chosen by multistage sampling. All the pregnant women thus included …

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 …

Managing User Conflicts In A Water Aerobics Program On Behalf Of A Veteran’S Group: A Short Case Study, Hadley Blankenship, Steven N. Waller Ph.D., Jason L. Scott

International Journal of Aquatic Research and Education

This article captures an experience in conflict management that happened during the summer of 2024 as a recreational therapy intern with an adaptive sport and recreation organization located in the Southeastern United States. The backdrop to the case is that a recreational therapy intern worked with various special needs populations – mainly with paraplegic (adult and youth) athletes and veterans. In many organizations, user conflicts and poor communication regarding service provision and scheduling hinder the implementation of programs for special populations, such as veteran groups. In this case, a problem occurred with the scheduling of a water aerobics program for …

Curbing Fatal And Non-Fatal Drowning Deaths: An Effort To Reach Under-Resourced Children In Baltimore, Maryland, Ashton P. Christo, William D. Ramos

International Journal of Aquatic Research and Education

Drowning remains a significant public health problem in the United States, with The Centers for Disease Control and Prevention (CDC) reporting approximately 4,000 drowning deaths annually. Children aged 1-4 face the highest risk, and African American children are disproportionately affected–7.6 times more likely to drown than white children (CDC, 2024). In a city on the East Coast that is predominantly African American, limited access to swimming lessons heightens the risk. To reduce drowning rates, a collaborative swimming program was established between a city high school and a public school enrichment program. The initiative provided essential water safety and swimming skills …

Diversity In Aquatics:4th Special Issue, Tiffany M. Quash Ph.D., Angela K. Beale-Tawfeeq, Steven N. Waller Ph.D.

International Journal of Aquatic Research and Education

The theme of this special issue is “Building a Community of Champions.” The purpose of this theme is to highlight and promote a civic engagement perspective that engages, advocates, and supports communities of Black, Indigenous, People of Color (BIPOC) in addressing the national, regional, and local evolving health-related issue of drowning. Aquatic Settings have been a pivotal focal point of social justice, water safety, and public health, not only in the past but also in our present day (Beale-Tawfeeq, Quash, et al, 2023 and Waller and Bemiller, 2023). Diversity In Aquatics (DIA) strives to positively impact the field of aquatics …