Digital Commons Network^™

The Expansion Of Language Interpretation Services Post-Executive Order 13166: Effects On Maternal And Fetal Outcomes Of Non-English-Speaking Patients, Lilly Annabelle Smith

Honors Theses and Capstones

Over 69 million people older than the age of 5 in the U.S. speak a language other than English at home (U.S. Census, 2022). Of this population, around 38% report speaking English less than "very well" or limited English proficiency, “LEP”. Research has shown patient-provider communication quality in healthcare settings to be directly linked to the provider's ability to deliver safe and suitable care for LEP patients (Au et al., 2009). Executive Order (EO) 13166, signed into law in 2000, requires all federal agencies to implement and document language interpretation services in their establishments (Basu et al., 2017). LEP mothers …

Investigating The Relationship Between Politics And Education, Alaina M. Winrow

Honors Theses and Capstones

This paper looks into how politics plays a role in the public K-12 education system in the United States, specifically looking at the state of New Hampshire. Federal, state, and local governments provide important resources through funding to schools and create the laws that govern them. However, educational politics can be controversial at times. Within the past several years, there have been more tense school board meetings and divisive laws being passed or considered around the nation. Overall, the divisive political climate has influenced much of the discussion surrounding education and has created more stress for educators, administrators, school staff, …

The Lighthouse Keepers Daughter: The Life And Work Of Celia Laighton Thaxter, Haley J. Parker

Honors Theses and Capstones

Living on the edge of the American empire, Celia Thaxter explored the dimensions of her life in ways that transcended, yet never fully abandoned traditional gender boundaries by cultivating her lifelong relationship with nature through creative expression. The lighthouse keeper's daughter constructed her identity based on the experiences that shaped her on the very edge of civilization. Coming of age on the Isles of Shoals, Celia reveled in flexibility and unrestricted freedom of her natural environment isolated from the cultural spheres on the mainland that reinforced the ideology of domestic femininity. This ideology was dominant in the 19th century in …

The Economic Impacts Of Digital Nomads In Medellin, Colombia, Bernadette Patricia Farmer

Honors Theses and Capstones

As a result of increasing internet accessibility and the rise in popularity and possibility of remote work following the COVID-19 pandemic, workers from advanced economies have applied the work-from-home routine while visiting different countries. These destination cities have lower living costs and remote workers can experience increased purchasing power and new cultures. To fully take advantage of their professional autonomy, these workers, known as digital nomads, stay in each international location for one to three months before traveling elsewhere – conveying their propensity for nomadism. Digital nomads (hereafter referred to as DNs) have economic impacts on their host cities in …

Judging Our New Judges: Why We Must Remove Artificial Intelligence From Our Courtrooms Now, Kieran Duffy Newcomb

Honors Theses and Capstones

In this paper, I explore some of the ways in which artificial intelligence might enhance the sentencing process through recidivism prediction technology. Notably, this technology can increase the accuracy of risk predictions and the speed with which sentencing decisions are reached. I then show, however, that the recidivism prediction technology is likely to turn into what data scientist Cathy O’Neil calls a Weapon of Math Destruction. The potential harmfulness of this technology is due not to the inherent nature of the technology, but the symbiotic relationship it will have with our already harmful criminal justice system. I argue that the …

Artificial Intelligence And The Entertainment Industry, Caroline Rae Mccarthy

Honors Theses and Capstones

Artificial intelligence is a fast-growing technology that is quickly taking over many industries, such as the entertainment industry. Artificial intelligence has the capability to replicate voices, create fake videos and photos, called deepfakes, of just about anything, and can practically bring people back to life. This technology, as it stands now, is similar to the wild west because in the vast majority of places, it’s lawless. Artificial intelligence is growing so rapidly that lawmakers haven’t had a chance to keep up. This paper explains more of what AI does in everyday life, and how its abilities can impact the entertainment …

Developing A Gender Diverse Stimulus Set For Emotion Expressions, Amir Robertson

Honors Theses and Capstones

Much past research has demonstrated that gender plays an important role in emotion perception, such that gendered stereotypes about emotion seem to shape how we perceive and interpret the emotion expressions of men and women. However, the stimulus sets that are typically used in the vast majority of this research have been based on binary ideas of gender, and purposefully limit common elements of gender presentation, with models posing with limited accessories or personal aesthetic choices. In everyday life, however, individuals’ gender and gender presentation are not limited in these ways and likely contribute in important ways to how we …

Abrams, Sebastian B. - Volume 1, Carter County Genealogical Society

Carter County Genealogy Collection

Genealogy of the Sebastian Basil Abrams family in Carter County, Kentucky.

Stamper, Andrew Jackson - Volume 5, Carter County Genealogical Society

Carter County Genealogy Collection

Genealogy of the Andrew Jackson Stamper family in Carter County, Kentucky.

Andrew Jackson Stamper is the fifth child of John R. 'Pewter John' and Sarah 'Sallie' Stamper

Anemia, Iron Deficiency, And Cause-Specific Mortality: The Atherosclerosis Risk In Communities Study, Ethan J Cannon, Jeffrey R Misialek, Leo F Buckley, Iman A F Aboelsaad, Christie M Ballantyne, John Leister, James S Pankow, Pamela L Lutsey

Faculty, Staff and Students Publications

Introduction: Anemia is a risk factor for all-cause mortality in older adults. Iron deficiency may also be associated with adverse outcomes, independent of its role in causing anemia. This study tested the hypotheses that anemia, and low ferritin among non-anemic participants, were associated with all-cause and cause-specific mortality in a community-based cohort of older adults.

Methods: Fasting blood was obtained from 5,070 ARIC participants (median age: 75 years) in 2011-2013. Anemia was defined by hemoglobin concentrations < 12 g/dL in women and < 13 g/dL in men. We classified 4,020 non-anemic participants by quartiles of plasma ferritin, measured by the SomaScan proteomics platform. Cox proportional hazards regression was used. Mortality was ascertained via phone calls with proxies as part of twice-yearly cohort follow-up, surveillance of local hospital discharge indexes, state death records, and linkage to the National Death Index.

Results: Of the total participants, 21% had anemia at baseline. Over a median of 7.5 years, there were 1,147 deaths, including 357 due to …

Editorial: Sex Differences In Cancer Incidence, Mortality, And Survival: Methodological Perspectives, Syed Ahsan Raza, Wilson Luiz Da Costa, Aaron P Thrift

Faculty, Staff and Students Publications

No abstract provided.

Health Care Transition Quadruple Aim Outcomes For Idd: Scoping Review, Ellen Fremion, Kathleen Irby, Sophia Jan, Carlie Stein Somerville, Susan Shanske, Dava Szalda, Ahmet Uluer, Parag Shah

Faculty, Staff and Students Publications

Purpose: Structured HCT models addressing planning, transfer, and integration into adult care for adolescents and young adults with childhood-acquired chronic conditions are becoming more prevalent. However, consensus on outcome measures to assess health care transition (HCT) interventions particularly for intellectual and developmental disabilities (IDD) population is lacking. This scoping review identified potential HCT outcome measures for young adults (aged 18-26) with IDD using the Quadruple Aim Framework.

Methods: On August 6, 2021 and April 27, 2023, Medline Ovid, Embase, Web of Science, PsycINFO, and Cochrane databases were searched using the terms "young adult," "intellectual disability," "developmental disability, "cognitive dysfunction," "autism," …

P2y12 Inhibitor Monotherapy Versus Long-Term Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Meta-Analysis Of Randomized Controlled Trials, Mushood Ahmed, Areeba Ahsan, Priyansha Singh, Adeel Ahmad, Hritvik Jain, Asad Rahman, Sohail Q Khan, Raheel Ahmed, Mahboob Alam, Farhan Shahid

Faculty, Staff and Students Publications

No abstract provided.

Hepatocellular Carcinoma Surveillance May Be Associated With Potential Psychological Harms In Patients With Cirrhosis, Manasa Narasimman, Ruben Hernaez, Vanessa Cerda, Minjae Lee, Anubha Sood, Sruthi Yekkaluri, Aisha Khan, Lisa Quirk, Yan Liu, Jennifer R Kramer, Simon Craddock Lee, Caitlin C Murphy, Jasmin A Tiro, Amit G Singal

Faculty, Staff and Students Publications

Background and aims: The value of HCC surveillance is determined by the balance between benefits and harms; however, no studies have enumerated psychological harms.

Approach and results: We fielded surveys measuring psychological harms to patients with cirrhosis in a multicenter randomized trial of HCC surveillance outreach. All patients with positive or indeterminate surveillance results and matched patients with negative results were invited to complete surveys measuring (1) depression through the Patient Health Questionnaire-ninth version, (2) anxiety through State-Trait Anxiety Inventory, (3) HCC-specific worry through Psychological Consequences Questionnaire, and (4) decisional regret. Patients were classified into 4 groups: true positive (TP), …

Self-Correcting Method For Highly Effective Office-Based Helicobacter Pylori Therapy Using Cumulative Test Of Cure Data, Maria Pina Dore, Ruben Hernaez, David Y Graham

Faculty, Staff and Students Publications

Background and aim: Helicobacter pylori infections have become resistant to many previously highly effective antimicrobial regimens resulting in clarithromycin, metronidazole, or fluoroquinolone-containing therapies becoming unsuccessful. Pretreatment susceptibility testing is only widely available in the United States but is still rarely done. Here, we propose a framework to monitor H. pylori eradication in small clinical settings by routinely assessing the effectiveness of therapy.

Methods: Because of the small sample size in individual practice's, we assume an acceptable cure rate of ≥80% (preferred cure rate ≥85%) in adherent patients, with a dichotomous outcome (cured vs. failed) and consecutive patient enrollment. To obtain …

Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention For Stent Thrombosis Elevation Myocardial Infarction: An Updated Systematic Review And Meta-Analysis, Jasmeet Kalsi, John M Suffredini, Stephanie Koh, Jing Liu, Mirza U Khalid, Ali Denktas, Mahboob Alam, Waleed Kayani, Xiaoming Jia

Faculty, Staff and Students Publications

Introduction: Intravascular ultrasound (IVUS) provides intra-procedural guidance in optimizing percutaneous coronary interventions (PCI) and has been shown to improve clinical outcomes in stent implantation. However, current data on the benefit of IVUS during PCI in ST-elevation myocardial infarction (STEMI) patients is mixed. We performed meta-analysis pooling available data assessing IVUS-guided versus angiography-guided PCI in STEMI patients.

Methods: We conducted a systematic search on PubMed and Embase for studies comparing IVUS versus angiography-guided PCI in STEMI. Mantel-Haenszel random effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs) for outcomes of major adverse cardiovascular events (MACEs), death, …

Contemporary Functional Coronary Angiography: An Update, Josiah Bennett, Sanjay Chandrasekhar, Edward Woods, Patrick Mclean, Noah Newman, Brett Montelaro, Hafeez Ul Hassan Virk, Mahboob Alam, Samin K Sharma, Hani Jned, Muzamil Khawaja, Chayakrit Krittanawong

Faculty, Staff and Students Publications

Functional coronary angiography (FCA) is a novel modality for assessing the physiology of coronary lesions, going beyond anatomical visualization by traditional coronary angiography. FCA incorporates indices like fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), which utilize pressure measurements across coronary stenoses to evaluate hemodynamic impacts and to guide revascularization strategies. In this review, we present traditional and evolving modalities and uses of FCA. We will also evaluate the existing evidence and discuss the applicability of FCA in various clinical scenarios. Finally, we provide insight into emerging evidence, current challenges, and future directions in FCA.

Sex-Specific Outcomes Of Lbbap Versus Biventricular Pacing: Results From I-Clas, Faiz A Subzposh, Parikshit S Sharma, Óscar Cano, Shunmuga Sundaram Ponnusamy, Bengt Herweg, Francesco Zanon, Marek Jastrzebski, Jiangang Zou, Mihail G Chelu, Kevin Vernooy, Zachary I Whinnett, Girish M Nair, Manuel Molina-Lerma, Karol Curila, Kenneth A Ellenbogen, Pugazhendhi Vijayaraman

Faculty, Staff and Students Publications

Background: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) has been associated with greater clinical improvement in women than men. Recently, left bundle branch area pacing (LBBAP) has been shown to be an alternative form of CRT.

Objectives: The purpose of this study was to investigate sex-specific outcomes for death and heart failure events in a large, international, multicenter, cohort of patients undergoing CRT with BVP or LBBAP.

Methods: In this international study of 1,778 patients (575 female and 1203 male), sex-specific survival analysis was performed to compare the effect of LBBAP-CRT relative to BVP-CRT on the combined endpoint of …

Group-Based Interventions In Lifestyle Medicine, Viet T Tran, Elizabeth M Vaughan, Stephanie Kim, Craig A Johnston

Faculty, Staff and Students Publications

Group-based interventions in health care have demonstrated a positive influence on patient outcomes by strengthening patient-healthcare professional relationships and providing an avenue for patient empowerment through shared experiences and belongingness. Groups have been shown to enhance social and psychological support, improve self-management behaviors, and encourage peer-support. However group settings also present challenges, such as discomforts in sharing within a group context and managing diverse group dynamics. We outline the efficacy and dynamics of group-based activities in health care settings. This includes key behavioral components of groups, such as creating a safe, supportive, and cohesive environment in group activities where confidentiality …

Health, Salud, : Individualizing Behavioral Needs In A Multicultural World, Madeline Rock, Dustan Watkins, Elizabeth M Vaughan, Craig A Johnston

Faculty, Staff and Students Publications

Diversity within the United States continues to increase, making it imperative that health care providers understand the impact of cultural background on health behaviors and perceptions. These practices promote trusting patient-provider relationships, improve outcomes, and increase patient satisfaction. In this article, we discuss the 3 largest ethnic or racial minority groups in the United States, Hispanics, African Americans, and Asians, and the intersection of culture and health care through the lens of these distinct communities. We also offer behavioral recommendations to increase awareness and knowledge regarding vast cultural variations within our communities while embracing cultural humility.

Role Of Apolipoprotein B In The Clinical Management Of Cardiovascular Risk In Adults: An Expert Clinical Consensus From The National Lipid Association, Daniel E Soffer, Nicholas A Marston, Kevin C Maki, Terry A Jacobson, Vera A Bittner, Jessica M Peña, George Thanassoulis, Seth S Martin, Carol F Kirkpatrick, Salim S Virani, Dave L Dixon, Christie M Ballantyne, Alan T Remaley

Faculty, Staff and Students Publications

This National Lipid Association (NLA) Expert Clinical Consensus provides an overview of the physiologic and clinical considerations regarding the role of apolipoprotein B (apoB) measurement to guide clinical care based on the available scientific evidence and expert opinion. ApoB represents the total concentration of atherogenic lipoprotein particles in the circulation and more accurately reflects the atherogenic burden of lipoproteins when compared to low-density lipoprotein cholesterol (LDL-C). ApoB is a validated clinical measurement that augments the information found in a standard lipoprotein lipid panel; therefore, there is clinical value in using apoB in conjunction with a standard lipoprotein lipid profile when …

Understanding Prescribing Practices And Patient Experiences With Renin Angiotensin System Inhibitors Use In Chronic Kidney Disease: A Qualitative Study, Jennifer Arney, L Parker Gregg, Sheena Wydermyer, Michael A Herrera, Peter A Richardson, Michael E Matheny, Julia M Akeroyd, Glenn T Gobbel, Adriana Hung, Salim S Virani, Sankar D Navaneethan

Faculty, Staff and Students Publications

Introduction: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) improve outcomes but are underutilized in patients with chronic kidney disease (CKD). Little is known about reasons for discontinuation and lack of reinitiating these medications. We aimed to explore clinicians' and patients' experiences and perceptions of ACEI/ARB use in CKD.

Methods: A multi-profession sample of health care clinicians and patients with documented ACEI/ARB-associated side effects in the past 6 months. Participants were recruited from 2 Veterans Affairs healthcare systems in Texas and Tennessee. A total of 15 clinicians and 10 patients completed interviews. We used inductive and deductive qualitative data …

Severity-Adjusted Evaluation Of Initial Dialysis On Short-Term Health Outcomes In Urea Cycle Disorders, Matthias Zielonka, Stefan Kölker, Sven F Garbade, Florian Gleich, Sandesh C S Nagamani, Andrea L Gropman, Ann-Catrin Druck, Nesrine Ramdhouni, Laura Göde, Georg F Hoffmann, Roland Posset, Urea Cycle Disorders Consortium (Ucdc)

Faculty, Staff and Students Publications

Objective: In individuals with urea cycle disorders (UCDs) and neonatal disease onset, extracorporeal detoxification by continuous kidney replacement therapy is considered the therapeutic method of choice in addition to metabolic emergency treatment to resolve hyperammonemic decompensation. However, the indications for the initiation of dialysis are heterogeneously implemented transnationally, thereby hampering our understanding of (optimal) short-term health outcomes.

Methods: We performed a retrospective comparative analysis evaluating the therapeutic effects of initial dialysis on survival as well as neurocognitive outcome parameters in individuals with UCDs in comparison to a severity-adjusted non-dialyzed control cohort. Overall, 108 individuals with a severe phenotype of male …

Bloody Lips - Gluing Bleeding Lower Lip Spider Angioma In Decompensated Cirrhosis, Akash Gandotra, Sunil Taneja, Madhumita Premkumar, Nipun Verma, Arka De, Sahaj Rathi, Ajay Duseja

Faculty, Staff and Students Publications

Spider angiomas are dilated vascular channels in the skin. They have a central arteriole with surrounding vascular channels resembling legs of a spider, hence the name. They are frequently associated with liver cirrhosis, thyrotoxicosis, and pregnancy.

We present the case of a 49-year-old gentleman who was referred to our liver clinic with complaints of jaundice and ascites of one-month duration. The patient was a chronic alcohol consumer, consuming country-made liquor, 80–100 grams/day for past 8–10 years. He was diagnosed with Acute on chronic liver failure with a model for end-stage liver disease score of 38. During his hospital stay, he …

Editorial: Sars-Cov-2: Implications For Maternal-Fetal-Infant And Perinatal Mortality, Morbidity, Pregnancy Outcomes And Well-Being, Cheryl K Walker, Balaji Govindaswami

Faculty, Staff and Students Publications

No abstract provided.

Current Insight Into The Transient X-Zone In The Adrenal Gland Cortex, Yuan Kang, Karly Laprocina, Huifei Sophia Zheng, Chen-Che Jeff Huang

Faculty, Staff and Students Publications

Mouse models have been widely used in the study of adrenal gland development and diseases. The X-zone is a unique structure of the mouse adrenal gland and lineage-tracing studies show that the X-zone is a remnant of the fetal adrenal cortex. Although the X-zone is considered analogous to the fetal zone in the human adrenal cortex, the functional significance of the X-zone has remained comparatively more obscure. The X-zone forms during the early postnatal stages of adrenal development and regresses later in a remarkable sexually dimorphic fashion. The formation and regression of the X-zone can be different in mice with …

An Innovation Bootcamp Model For Developing Youth-Led Hiv Self-Testing Delivery Strategies In Nigeria: Post-Designathon Capacity Building, Ucheoma Nwaozuru, Titilola Gbaja-Biamila, David Oladele, Olufunto Olusanya, Temitope Ojo, Juliet Iwelunmor, Et Al.

2020-Current year OA Pubs

INTRODUCTION: Many designathons, hackathons, and similar participatory events suffer from minimal training and support after the events. Responding to this need, we organized a health innovation bootcamp: an intensive, team-based apprenticeship training with research and entrepreneurial rigor among young people in Nigeria to develop HIV self-testing (HIVST) delivery strategies for Nigerian youth. The purpose of this paper was to describe an innovation bootcamp that aimed to develop HIVST delivery strategies for Nigerian youth.

METHODS: The four-week, in-person innovation bootcamp, informed by youth participatory action research and comprised a series of workshops, took place in Lagos, Nigeria. The goal was to …

Centering Intersectional Breast Cancer Screening Experiences Among Black, Latina, And White Women: A Qualitative Analysis, Sienna Ruiz, Kamilah Abdur-Rashid, Rachel L Mintz, Maggie Britton, Ana A Baumann, Graham A Colditz, Ashley J Housten

2020-Current year OA Pubs

OBJECTIVE: Mammography screening guidelines in the United States highlight the importance of informing and involving women when making their breast cancer screening decisions. However, the complexity of interpreting and applying these population-level guidelines can contribute to patient burden. Patient-centered communication strategies can alleviate patient burden, but few consider perspectives from racially and ethnically marginalized populations. We examine diverse women's perspectives on screening to characterize patient-centered experiences.

METHODS: We conducted 28 focus groups with 134 non-Latina Black (

RESULTS: We identified three themes: (1) personal relationships with primary care providers, (2) potential impacts of cancer on families, and (3) interactions with …

Generation And Characterization Of In Vitro Transcribed Mrna, Cristina Poveda, Yi-Lin Chen, Ulrich Strych

Faculty, Staff and Students Publications

Here we describe the in vitro preparation of mRNA from DNA templates, including setting up the transcription reaction, mRNA capping, and mRNA labeling. We then describe methods used for mRNA characterization, including UV and fluorescence spectrophotometry, as well as gel electrophoresis. Moreover, characterization of the in vitro transcribed RNA using the Bioanalyzer instrument is described, allowing a higher resolution analysis of the target molecules. For the in vitro testing of the mRNA molecules, we include protocols for the transfection of various primary cell cultures and the confirmation of translation by intracellular staining and western blotting.

Self-Rectifying Magnetoelectric Metamaterials For Remote Neural Stimulation And Motor Function Restoration, Joshua C Chen, Gauri Bhave, Fatima Alrashdan, Abdeali Dhuliyawalla, Katie J Hogan, Antonios G Mikos, Jacob T Robinson

Faculty, Staff and Students Publications

Magnetoelectric materials convert magnetic fields into electric fields. These materials are often used in wireless electronic and biomedical applications. For example, magnetoelectrics could enable the remote stimulation of neural tissue, but the optimal resonance frequencies are typically too high to stimulate neural activity. Here we describe a self-rectifying magnetoelectric metamaterial for a precisely timed neural stimulation. This metamaterial relies on nonlinear charge transport across semiconductor layers that allow the material to generate a steady bias voltage in the presence of an alternating magnetic field. We generate arbitrary pulse sequences with time-averaged voltage biases in excess of 2 V. As a …