Digital Commons Network^™

The Impact Of Insurance On Adolescent Transition To Adult Care, Diane V Murrell, Cassandra J Enzler, Lauren Bretz, Beth H Garland, Albert C Hergenroeder, Christine Markham, Constance M Wiemann

Faculty, Staff and Student Publications

Background: This study sought to examine how adolescents and young adults with special health care needs (AYA) prepare for managing medical insurance (private and public) as an adult and the role of insurance in locating an adult provider and engaging in care.

Methods: Twenty-eight AYA aged 18-24 years with renal, inflammatory bowel, or rheumatologic diseases completed individual semi-structured interviews designed to evaluate the impact of insurance (private vs. public) on their health care transition experiences. An interdisciplinary team of coders analyzed transcripts using The Framework Method.

Results: Three themes emerged: continuum of accepting health insurance responsibility; the impact of insurance …

Single-Cell Multiome Characterizing Intercellular Communication And Intracellular Regulation Of Epithelium And Mesenchymal During Secondary Palate Development In Mice, Usama Hussein, Yulin Dai, Andi Liu, Toshiyuki Itai, Fangfang Yan, Lukas M Simon, Zhongming Zhao

Faculty, Staff and Student Publications

Cell-cell communication between adjacent tissues is fundamental to orchestrating organ morphogenesis. During secondary palate development, interactions between epithelial and mesenchymal cells regulate epithelial-mesenchymal signaling, thereby controlling cell proliferation, differentiation, and tissue patterning. However, the precise molecular mechanisms underlying these interactions remain largely unexplored. In this study, we employed single-cell multiome sequencing to simultaneously profile chromatin accessibility and gene expression in 35,150 individual cells isolated from the developing mouse secondary palate at embryonic days E12.5, E13.5, E14.0, and E14.5. Our analysis revealed that intercellular signaling plays a pivotal role in directing secondary palate morphogenesis, with WNT, BMP, and PDGF pathways emerging …

Survey And Improvement Strategies For Gene Prioritization With Large Language Models, Matthew B Neeley, Guantong Qi, Guanchu Wang, Ruixiang Tang, Dongxue Mao, Chaozhong Liu, Sasidhar Pasupuleti, Bo Yuan, Fan Xia, Pengfei Liu, Zhandong Liu, Xia Hu

Duncan NRI Faculty and Staff Publications

Motivation: Rare diseases remain difficult to diagnose due to limited patient data and genetic diversity, with many cases remaining undiagnosed despite advances in variant prioritization tools. While large language models have shown promise in medical applications, their optimal application for trustworthy and accurate gene prioritization downstream of modern prioritization tools has not been systematically evaluated.

Results: We benchmarked various language models for gene prioritization using multi-agent and Human Phenotype Ontology classification approaches to categorize patient cases by phenotype-based solvability levels. To address language model limitations in ranking large gene sets, we implemented a divide-and-conquer strategy with mini-batching and token limiting …

Talking About Suffering In The Intensive Care Unit, Brent M Kious, Judith B Vick, Peter A Ubel, Olivia Sutton, Jennifer Blumenthal-Barby, Christopher E Cox, Deepshikha Ashana

Center for Medical Ethics and Health Policy Staff Publications

Background: Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients' families.

Methods: We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012-2017 to look at how the term "suffering" and its variants were used. A coding guide was developed by consensus-oriented discussion …

A Hybrid Cloud Data Lake Architecture Supporting The Integration Of Clinical And Genomics Data, Apollo Mcowiti, Heidi Dowst, Fei Zheng, Susan Hilsenbeck, Christopher Amos

Center for Medical Ethics and Health Policy Staff Publications

Objective: Cancer centers must quickly integrate clinical genomics data from different vendors for oncology operations and research. Clinical data warehouse architectures are costly to construct and brittle, and they are not readily amenable to the rapid changes in oncology research. We introduce a cost-effective hybrid cloud Data Lake architecture for storing clinical genomic data from different vendors, aiding both clinical and research workflows.

Methods: We created a Data Lake architecture based on the zone architecture, with four layers: ingestion, storage, transformation, and interaction. The layers are implemented with a hybrid cloud architecture. Rich metadata created from patient and genomic data …

Moving Beyond Simplistic Research Design In Health Professions Education: What A One-Group Pretest-Posttest Design Will Not Prove, S Beth Bierer, Gary Beck Dallaghan, Nicole J Borges, Sam Brondfield, Cha Chi Fung, Kathryn N Huggett, Cayla R Teal, Satid Thammasitboon, Colleen Y Colbert

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Educational research presents unique study design challenges. Novice researchers in health professions education (HPE) frequently misuse the one-group pretest-posttest design, highlighting the need for improved training in research design. This workshop aimed to enhance understanding of research design among novice HPE researchers, specifically addressing the inherent limitations of the one-group pretest-posttest design and offering alternative approaches.

Methods: Experienced HPE researchers developed this workshop to address common misunderstandings of research design. Leaders from the AAMC Medical Education, Scholarship, Research, and Evaluation section facilitated 60-75-minute workshops conducted at the four 2024 regional meetings hosted by the AAMC Group on Educational Affairs …

Different Responses Involving Tfh Cells Delay Parasite-Specific Antibody Production In Trypanosoma Cruzi Acute Experimental Models, Ana Carolina Leão, Maria Jose Villar, Rakesh Adhikari, Cristina Poveda, Leroy Versteeg, Gregório Almeida, Peter J Hotez, Maria Elena Bottazzi, Kathryn M Jones

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Chagas disease (CD), caused by the parasite Trypanosoma cruzi, affects millions globally. Despite treatment options in the acute phase, most infections progress to a chronic indeterminate form or develop severe cardiac/gastrointestinal complications. Understanding the immune response is crucial for the development of vaccines and more efficient drugs for the disease control.

Methods: This work investigates the immune response to T. cruzi H1 K68 strain infection in female BALB/c and C57BL/6 mice to characterize differences in Tfh and B cell responses that may be involved in the poor parasite-specific antibody production during acute infection. For this, mice were euthanized …

A Landscape Analysis Of Psychedelic Retreat Organizations Advertising Online, Logan Neitzke-Spruill, Caroline S Beit, Jill Oliver Robinson, Nikita Singh, Srijith Kambala, Rishi Ramesh, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Research into psychedelics' clinical potential has corresponded to a growth in public interest and adult use. One common pathway to accessing psychedelics is through psychedelic retreats. While individual retreats have been characterized in the anthropological literature, no systematic evaluation of the psychedelic retreat industry exists. Assessing the characteristics of the psychedelic retreat industry is critical to understanding the associated ethical, legal, and social implications and ensuring consumer safety. To this end, we conducted a landscape analysis of online, publicly available information to capture and characterize a broad range of organizations offering psychedelic retreats and marketing to English-speaking consumers. From July …

Advancing Medical Applications Of Cancer Nanotechnology: Highlighting Two Decades Of The Nci's Nanotechnology Characterization Laboratory Service To The Research Community, Rachael M Crist, Yechezkel Barenholz, Ahuva Cern, Kate N Clark, Pieter R Cullis, Cheryl Dean, Neil Desai, Mauro Ferrari, Matthieu Germain, Carmen A Giacomantonio, Emma Grabarnik, Piotr Grodzinski, Atara Hod, Barry E Kennedy, Ruvanthi N Kularatne, Glen S Kwon, Emmanuel Loeb, Erin B Noftall, Len Pagliaro, Morteza Rasoulianboroujeni, Alexander Roth, Darren Rowles, Kulbir Singh, Nicole F Steinmetz, Zhanna Yehtina, Yao Zhang, Daniel Zilbersheid, Jeffrey D Clogston, Stephan T Stern, Marina A Dobrovolskaia

Center for Medical Ethics and Health Policy Staff Publications

The Nanotechnology Characterization Laboratory (NCL) is a US federally funded resource providing characterization and expertise to the cancer nanomedicine research community. Founded as a formal partnership among the US National Cancer Institute (NCI), the US Food and Drug Administration (FDA), and the US National Institute of Standards and Technology (NIST), the NCL has spent two decades developing a one-of-a-kind service with broad multidisciplinary expertise to meet the needs of a rapidly evolving drug development field. To mark the 20th anniversary of the lab's founding, the NCL hosted a symposium to highlight the achievements of the cancer nanomedicine field, showcase novel, …

Free To Be You But Not Me?, Leah Litman

Reviews

In Gendered Liberty, Prof. Laura Portuondo presents a doctrinal puzzle: While claims to individual liberty are in decline in some spaces, they are ascendant in others. As Portuondo describes things, constitutional law has become increasingly hostile to claims by people who seek to defy gendered stereotypes. That includes the women who, for whatever reason, do not want to become mothers when they are pregnant, as well as the women whose lives, health, or fertility would be in jeopardy if they became mothers. The Supreme Court overruled their claims to liberty in Dobbs v. Jackson Women’s Health Organization.

Commentary: Impact Of Resistance Training Intensity On Body Composition And Nutritional Intake Among College Women With Overweight And Obesity: A Cluster Randomized Controlled Trial, Joshua L Keller, Sarah E Deemer, Gian Luca Di Tanna, Sherri L Pals, Kevin R Fontaine, David B Allison

Children’s Nutrition Research Center Staff Publications

No abstract provided.

Federal Open Data As An Artificial Intelligence Resource, Erik Stallman, Aniket Kesari

Faculty Scholarship

In the 2010s, the open government data movement—a confluence of government transparency and open source advocacy—succeeded in making most federal data disclosed by default and free of restriction on downstream use. However, keen-eyed observers noted a “new ambiguity” in open government data policies.

Drosophila Models Uncover Substrate Channeling Effects On Phospholipids And Sphingolipids In Peroxisomal Biogenesis Disorders, Michael F Wangler, Yu-Hsin Chao, Mary Roth, Ruth Welti, James A Mcnew

Duncan NRI Faculty and Staff Publications

Peroxisomal Biogenesis Disorders Zellweger Spectrum (PBD-ZSD) disorders are a group of autosomal recessive defects in peroxisome formation that produce a multi-systemic disease presenting at birth or in childhood. Well documented clinical biomarkers such as elevated very long chain fatty acids (VLCFA) are key biochemical diagnostic findings in these conditions. Additional, secondary biochemical alterations such as elevated very long chain lysophosphatidylcholines are allowing newborn screening for peroxisomal disease. In addition, a more widespread impact on metabolism and lipids is increasingly being documented by metabolomic and lipidomic studies. Here we utilize Drosophila models of pex2 and pex16 as well as human plasma …

Reframing Stigma In Tourette Syndrome: An Updated Scoping Review, Kelly Pring, Melina Malli, Brandy W Hardy, Stephen R Rapp, Eric A Storch, Jonathan W Mink, Jaclyn M Martindale

Center for Medical Ethics and Health Policy Staff Publications

Persistent tic disorders (PTD) such as Tourette's syndrome (TS) are common childhood-onset neurodevelopmental disorders. Stigmatization of individuals with these disorders remains an ongoing problem. The purpose of this scoping review is to serve as an updated review of the research regarding stigmatization in youth with PTD since the publication of the original systematic review about this topic in 2016. The electronic databases Embase, Web of Science, PubMed, PsycINFO, and CINAHL were searched. Of the 4751 initial articles screened after removing duplications, 47 studies met the inclusion criteria. The studies were examined under the social-ecological stigmatization model, which helps categorize stigmatization …

Early Structural Valve Deterioration And Cusp Tear Leading To Acute Heart Failure In A Second-Generation Trifecta Glide Technology Heart Valve, Akiyoshi Yamamoto, Kenji Kuwaki, Hidekazu Furuya, Yasunori Cho

The Texas Heart Institute Journal

This report highlights a case of early structural valve deterioration with a cusp tear in a second-generation Abbott Trifecta Glide Technology bioprosthetic heart valve. A 70-year-old man had undergone aortic valve replacement with a Trifecta Glide Technology valve 30 months earlier for severe bicuspid aortic valve stenosis. He suddenly developed acute heart failure with dyspnea resulting from severe aortic valve regurgitation, with a cusp tear in the Trifecta Glide Technology valve, as demonstrated by transthoracic echocardiography. The patient was successfully treated with urgent repeat aortic valve replacement.

Increased Visual Response Delay Impact On Sensorimotor Control In Persons With Multiple Sclerosis, Julie C. Wagner, Frankie M. Ingram, Vincenzo Daniele Boccia, Matilde Inglese, Maura Casadio, Camilla Pierella, Andrea Canessa, Robert A. Scheidt, Scott A. Beardsley

Biomedical Engineering Faculty Research and Publications

Multiple Sclerosis negatively affects hand function in 60% of cases. Upper extremity dysfunction in persons with Multiple Sclerosis (PwMS) has previously been linked to slower, more variable movement, increased visual response delays (T_v), and neuroimaging evidence of altered brain activity; yet no one knows how these aspects relate to each other. This work combines clinical, kinematic, sensorimotor control, and neural imaging techniques to gain a more complete understanding of how upper extremity dysfunction arises in PwMS. Twenty PwMS and 20 Controls completed a reach and hold task with simultaneous electroencephalography recorded to determine if increased T_v in …

Lung Uptake Of Two Spect Markers Identifies Sensitivity To Hyperoxia-Induced Acute Respiratory Distress Syndrome In Rats, Anne V. Clough, Taheri Pardis, Guru P. Sharma, Ming Zhao, Elizabeth R. Jacobs, Said H. Audi

Biomedical Engineering Faculty Research and Publications

Introduction: Exposure of adult rats to hyperoxia is a well-established model of human Acute Respiratory Distress Syndrome (ARDS). Although rats exposed to 100% O₂ display clinical evidence of lung injury after ∼40 h and death by 72 h, rats exposed to 60% O₂ for up to 7 days show little sign of injury. However, when subsequently exposed to hyperoxia, these pre-exposed rats become more susceptible to ARDS. The objective of this study is to evaluate the ability of imaging biomarkers to track this hyperoxia susceptibility and to elucidate underlying mechanisms.

Methods: Sprague-Dawley rats were exposed to either room …

Scoping Review Of Machine Learning Techniques In Marker-Based Clinical Gait Analysis, Kevin N. Dibbern, Maddalena G. Krzak, Alejandro Olivas, Mark V. Albert, Joseph J. Krzak, Karen M. Kruger

Biomedical Engineering Faculty Research and Publications

The recent proliferation of novel machine learning techniques in quantitative marker-based 3D gait analysis (3DGA) has shown promise for improving interpretations of clinical gait analysis. The objective of this study was to characterize the state of the literature on using machine learning in the analysis of marker-based 3D gait analysis to provide clinical insights that may be used to improve clinical analysis and care. Methods: A scoping review of the literature was conducted using the PubMed and Web of Science databases. Search terms from eight relevant articles were identified by the authors and added to by experts in clinical gait …

Autonomic Dysfunction In Gastroesophageal Reflux Disease. The Neurogastro-Cardiac Axis: Friend Or Foe?, Sergio Sobrino-Cossio, Jorge Cossío-Aranda, Elymir S. Galvis-García, Gualberto Mateos-Pérez, Óscar Teramoto-Matsubara, Jesús A. González-Hermosillo, Juan C. Lopez Alvarenga, Mustafa Azizoglu, José M. Remes-Troche

School of Medicine Publications

Gastroesophageal reflux disease (GERD) is a complex and highly prevalent entity. Impaired gut-brain communication is associated with autonomic dysfunction. Modulation of the autonomic nervous system controls gastrointestinal functions. In GERD, a decrease in vagal tone (parasympathetic activity) and an increase in sympathetic activity with autonomic balance shifted towards the sympathetic system have been reported. Clinical questionnaires and non-invasive measurement of heart rate variability may be useful in patients with GERD to detect autonomic dysfunction. Restoration of parasympathetic system activity (mainly neuromodulation), with subsequent improvement of parasympathetic activity, will reduce the intensity of autonomic symptoms and GERD, improving quality of life. …

Disability Awareness And Inclusion, Claudia C. Gonzalez, Raquel C. Vasquez, Bruce J. Reed

School of Rehabilitation Services & Counseling Faculty Publications

The Centers for Disease Control and Prevention (2021) reported an increase in the prevalence of persons with disabilities affecting one in four people in the United States. Disability awareness and inclusion describe how a combination of understanding, acknowledgment, compassion, and acceptance can allow persons with disability the same opportunities as those without disabilities. This can be seen with the increase in persons with a disability graduating from postsecondary institutions, about 14% from 2012 to 2022 of persons over 25. This chapter covers foundational material regarding disability awareness and inclusion, including the prevalence of disability in general and in educational settings, …

Navigating The Path: Understanding And Overcoming Challenges For College Students With Disabilities, Nahal Salimi, Bryan Gere, Elaine Mora, Roy K. Chen

School of Rehabilitation Services & Counseling Faculty Publications

Higher education can be challenging for many students, but for those with disabilities, it presents additional hurdles. Oftentimes, students with disabilities must navigate both their academic responsibilities and the unique challenges posed by their disabilities. This chapter provides a comprehensive overview of the most frequently reported challenges and barriers to academic success for students with disabilities in higher education. The chapter focuses on several key issues, including but not limited to societal attitudes surrounding disability and provision of academic accommodation, students' willingness to disclose their disabilities in their institutes, and difficulties with social integration. Each of these challenges is explored …

Integrating Technology To Support Learning And Accessibility In Counselor Education And Supervision, Yung-Chen Jen Chiu, Heekyung Lee, Junfei Lu, Kayi Ntinda, Roy K. Chen, Yuleinys A. Castillo

School of Rehabilitation Services & Counseling Faculty Publications

The rapid evolution of technology has profoundly impacted the delivery of counseling services and the field of counselor education. This transformation has introduced both opportunities and challenges for students from underrepresented backgrounds, including students with disabilities. This chapter delves into the integration of technology in counselor education and supervision, highlighting considerations of diversity, equity, inclusion, and accessibility. It explores strategies to enhance accessibility, including improved access to program information, optimized class preparation, and enhanced quality of clinical supervision. Key implications for counselor educators and supervisors include bolstering their own technological proficiency, familiarity with legal and ethical considerations, enhancing disability awareness, …

2025-2026 Craft Academy Student Handbook, Morehead State University. Office Of Communications & Marketing.

Communications and Marketing Publications Archive

The 2025-2026 Craft Academy Student Handbook.

Moving Beyond Traditional Multiculturalism: Dis/Ability Awareness In Counselor Education, Alicia B. Becton, Eunae Han, Leeza Ong, Amber Johnson, Roy K. Chen, Gabriela Rangel, Stephanie Lusk

School of Rehabilitation Services & Counseling Faculty Publications

This chapter explores the experiences of individuals with disabilities, emphasizing how they navigate educational and societal norms while balancing various identities. It emphasizes the impact of societal issues, such as racism and sexism, on individuals with disabilities. The authors delve into current multiculturalism trends, advocating for culturally responsive approaches in counselor education and rehabilitation services. The goal is to advance discussions on the future directions of multiculturalism by exploring the following key areas (a) the sociopolitical aspects of disability, (b) the inclusion of disability in counselor education, (c) accessibility and the universal design for learning (UDL), (d) culturally competent counselor …

Disability Community-Engaged Learning For Counselor Education Students, Kayi Ntinda, Bruce J. Reed

School of Rehabilitation Services & Counseling Faculty Publications

Community-engaged learning approaches utilize experiential learning by which participant students, disability community, and instructors are knowers and actors contributing to practical, real-world applications. This chapter explores the integration of community-engaged learning in counselor education programs, with a focus on its significance for developing practice-led skills respecting communities with and of disability. Second, the chapter proposes community-engagement pedagogical methods for critical thinking and real-world problem-solving skills by counselor education students. The chapter then addresses how community-engaged learning approaches meet CACREP standards for preparing counselor education students bridging the theory and practice gaps in their clinical rehabilitation counseling competencies. With community-engaged learning …

Collaborative Governance And Hydrosocial Territorialization: Reaching Consensus On Salmon Restoration Goals In The Columbia River Basin, Thien-Kim Bui, Rebecca Mclain

Geography Faculty Publications and Presentations

Across the Cascadia bioregion, salmon and steelhead are ecological and cultural keystone species that contribute to and illustrate riverine health. Due to complex social, economic, and ecological relations over the past 150 years, many Columbia River Basin salmon and steelhead populations are now listed as threatened or endangered in the United States. This research uses the 2017–2020 Columbia Basin Partnership Task Force as a case study to understand how this collaborative governance effort of sovereign entities and nonsovereign stakeholders navigated competing water claims to reach consensus on aspirational qualitative and quantitative goals for salmon and steelhead restoration. Using semistructured interviews …

Social Justice In Higher Education: The Forgotten Needs Of Students With Visual Impairments In Bangladesh, Mohammed Mozadded Hossen, Roy K. Chen, Nahal Salimi, Jane L. Nichols

School of Rehabilitation Services & Counseling Faculty Publications

Students with disabilities face myriad barriers and hurdles to success in higher education settings. Institutions in developing nations often lack the necessary resources to provide accessible instruction, and the absence of clearly defined policies further impedes upholding the educational rights of such a special population. The purpose of this study was to examine how undergraduate students with visual impairments in Bangladesh felt about their experiences related to social justice and challenges in learning during the COVID-19 pandemic. A convenience sample of 133 students was recruited from two public universities. The authors developed two instruments, namely, the Social Justice Experiences in …

Demographic And Clinical Characteristics Of Patients With Charcot Neuro-Osteoarthropathy In People With Diabetes Mellitus In Six Countries: A Multicenter Observational Study From 1996 To 2022, E. B. Jude, C. Siafarikas, A. Rastogi, R. Bem, T. Tankova, M. -F. Kong, Javier La Fontaine, J. Pappachan, N. Tentolouris

School of Podiatric Medicine Publications

Aim: To describe the demographic and clinical characteristics of patients with Charcot neuro-osteoarthropathy (CNO) and to examine for differences between participants with Type 1 diabetes mellitus (DM) (T1DM) and Type 2 diabetes mellitus (T2DM).

Materials and Methods: Multicenter observational study in eight diabetic foot clinics in six countries between January 1, 1996, and December 31, 2022. Demographic, clinical, and laboratory parameters were obtained from the medical records. Analyses were performed using parametric or nonparametric statistical tests for variables with normally or nonnormally distributed values, respectively. Comparisons of the qualitative data were performed using the chi-square test.

Results: Seven hundred seventy-four …

Improving The Emotional Wellbeing Of Healthcare Workers In A Homecare Agency, Crystal U. Okafor

Doctor of Nursing Practice Projects

Healthcare workers (HCWs) often have traumatic experiences in the course of care delivery, and these experiences negatively impact their well-being, affecting them emotionally, psychologically, and physically. With the COVID-19 pandemic, healthcare workers have had indelible experiences questioning their choice of profession. This project aimed to teach the factors affecting the emotional well-being of healthcare workers and develop strategies to improve emotional distress in a home care agency. The implementation site was Carolina Homecare Solutions, with 21 participants, including nursing assistants and registered nurses. Sample selection was via a convenient strategy, selecting the most conveniently available participants. The project leader used …

Enhancing Sleep Quality: The Interrelationship Between Sleep Hygiene And Comprehensive Well-Being, Marissa Strenkert

Doctor of Nursing Practice Projects

In North Carolina, many adults face sleep loss, negatively impacting cognitive functioning, mental health, and physical well-being. This project aimed to educate the public about sleep hygiene techniques and their benefits. An informational session was conducted on sleep hygiene. The informational session included 31 participants, who then completed a voluntary survey to assess their likelihood of adopting the techniques and their satisfaction with the session. Out of 31 participants, 18 completed the survey. The survey consisted of 10 questions, scored on a scale from 1 (strongly disagree) to 5 (strongly agree), allowing for total scores between 0 and 50. Higher …