Digital Commons Network^™

Referral Patterns From Primary Care To Referral Care By Icd-10 Codes In Indonesia: Cross-Sectional Analysis Of National Claims Data (2017–2024), Della Dwi Ayu, Syarif Rahman Hasibuan, Putu Erma Pradnyani, Nisrina Widyasanti

Journal of Indonesian Health Policy and Administration

Primary health care (PHC) facilities serve as gatekeepers within Indonesia’s tiered health system. However, PHC referral patterns to hospitals still show substantial variation and remain insufficiently characterized by disease groupings based on the International Classification of Diseases, 10th Revision (ICD-10). This study aimed to identify the most frequently referred diagnoses from PHC to secondary or tertiary care facilities and to determine the participant characteristics associated with referrals. This observational study employed a cross-sectional design using secondary data from the National Health Insurance (Jaminan Kesehatan Nasional – JKN) claims database for the period 2017–2024. The unit of analysis was each …

Xanthogranulomatous Osteomyelitis As A Bone Tumor Mimic: A Systematic Review Of Pre-Biopsy Diagnostic Clues And Management Decision Points, Ethan J. Sack, Max Deneroff, Austin Khau, Zubair Mohammed, Chadi Ellaham, Jared Nichols

Student Publications

Xanthogranulomatous osteomyelitis (XO) is a rare inflammatory form of osteomyelitis that can closely resemble a primary bone tumor or metastatic lesion at presentation. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and focused on pre-biopsy diagnostic clues and management decision points in published skeletal XO reports. PubMed, Embase, and Scopus were searched from January 2026 to May 2026, identifying 86 records. Eligible studies included human case reports and case series describing histologically confirmed skeletal XO or xanthogranulomatous inflammation involving bone; non-skeletal xanthogranulomatous disease, duplicate reports, review articles without extractable patient-level …

Increasing Access To Medications For Opioid Use Disorder For All Justice-Associated Populations, Edgar Rodriguez

Doctor of Nursing Practice Final Manuscripts

The purpose of this paper is to support a federal mandate requiring universal access to medication of opioid use disorder for all the justice-involved populations. The policy proposal aims to standardize evidence-based treatment across correctional systems, improve treatment initiation during incarceration, strengthen continuity of care after release, reduce overdose mortality, and address disparities in access for racial and economic groups and rural communities. This policy paper calls for the increase of access to medications of opioid use disorder across the United States for all justice-involved population. The opioid crisis has created a public health problem in the United States by …

Rural-Urban Differences In Hypertension Prevalence And Control In A Large Regional Health System Cohort, Yordanos M Tiruneh, Susan Mcbride, Huaxin Song, Matthew Decaro, Alaa Rihan, Theresa Byrd, Alex Baham, Jared W Magnani, Elmer V Bernstam, Jarett D Berry

Faculty, Staff and Student Publications

Background: Rural US populations bear a high burden of cardiovascular disease, with hypertension contributing to the rural-urban gap. We examined hypertension prevalence and control across the rural-urban continuum among patients in a large healthcare system in Northeast Texas.

Methods: We analyzed the electronic health record data from 363,539 patients with at least one outpatient encounter between September 2021 and April 2025. We defined hypertension using ICD-10-CM codes, antihypertensive prescriptions, or a blood pressure ≥ 130/80 mm Hg. We classified rurality using the Rural-Urban Commuting Area categories. Multivariable logistic regression models were adjusted for age, sex, race, ethnicity, insurance, and level …

Factors Associated With Public Health Centers’ Achievement Of Health Service Target In Yahukimo District, Highland Papua Province, Indonesia, Emaus Heluka, Venty Suryanti, Indasah Indasah, Prima Dewi Kusumawati

Kesmas

The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health …

Preparation And Characterization Of Fe2O3 And Fe2O3@Ag/Agcl Core-Shell Nps Using Mint Leaf Extract, And Study Of Their Cytotoxicity And Inhibition Of Breast Cancer Cells, Ruqayah A. Ulwali, Nada K. Abass

Baghdad Science Journal

Iron oxide nanoparticles (Fe₂O₃) and iron oxide core–silver/silver chloride shell nanoparticles (Fe₂O₃@Ag/AgCl) were green-synthesized using mint leaf extract .X-ray diffraction (XRD) results showed that Fe₂O₃ formed in two phases, γ -Fe₂O₃ and α -Fe₂O₃, while Fe₂O₃@Ag/AgCl formed in one phase, α -Fe₂O₃, with crystallite sizes increasing from 1.89 nm for Fe₂O₃ to 22.42 nm for Fe₂O₃@Ag/AgCl. Transmission electron microscopy (TEM) revealed that Fe₂O₃ had …

Characteristics Of People Who Inject Drugs Approached For Injection Assistance In Rural Kentucky, April Young, Ryli Hockensmith, Preston T Tolbert, Susan Westneat, Peter Vickerman, Jack Stone, Hilary L Surratt, Kayo Fujimoto, Hannah K Knudsen, Rachel Vickers-Smith, Katherine L Thompson, Laura Fanucchi, Julia Kollitz, Jennifer R Havens, Melvin D Livingston

Faculty, Staff and Student Publications

Objective: This study aims to understand the characteristics of people who inject drugs approached by others for injection assistance.

Method: Peer-referral and outreach were used to recruit rural adults who recently injected drugs in Appalachian Kentucky (n=435). Interviewer-administered questionnaires elicited data on participant characteristics and injection assistance. Descriptive statistics and generalized estimating equations clustered on peer-referral recruitment chain were used for analysis.

Results: Nearly one-third (30.1%) reported others had come to them for injection assistance. People approached for assistance were slightly younger (prevalence ratio [PR]: 0.91, 95% confidence interval [CI]: 0.85-0.99) but otherwise, demographically similar to their counterparts. Those approached …

The 2026 Fifa World Cup: Communicable Disease Risks And Advice For Visitors To Canada, The United States, And Mexico, Alfonso J Rodriguez-Morales, Ivan Arturo Rodríguez-Sabogal, Beatriz Elena Porras-Pedroza, Álvaro A Faccini-Martínez, Daniel Grisales-Nieto, Florencia Escarrá, Pasesa Pascuala Quispe-Torrez, Francisco Javier Membrillo, Tomás Orduna, Susana Lloveras, Tânia S S Chaves, Miguel M Cabada, Cecilia Perret, René Echavarría, Ana F Ribeiro, Melinda Tanabe, Fernando Bazzino, Maximiliano Ramirez, Baruch Diaz, Karen Mirna Loro Morejón, Karen Daly, Reinaldo Rosas, Maria Belen Lopez, Cristina Miranda, Marisa Liliana Fernandez, Yasemin Özsürekçi, Wasin Matsee, Yenddy Carrero, Cristian Biscayart, Sergio Cimerman, Maria L Avila-Aguero, Roberto Debbag, Jose Brea, Alejandro Risquez, Jaime David Acosta-España, Rolando Ulloa-Gutierrez, Carlos Espinal, Carlos N Torres-Martinez, Marta González-Sanz, Aula Abbara, Jill Weatherhead, Mario Masana

Faculty, Staff and Students Publications

No abstract provided.

Seaweed-Derived Bioactives: A Promising Source Of Novel Therapeutics, Aida H. Shobier, Sahar W.M. Hassan, Safaa A. Abdel Ghani

Blue Economy

The marine environment provides bioactive natural products with unique structures that are absent in terrestrial compounds. This review aims to provide a thorough overview of key studies on bioactives derived from seaweeds. It focuses on their potential to address common diseases such as microbial infections, diabetes, oxidative stress, inflammation, viral infections, cancer, immune disorders, and Alzheimer's disease as well as their potential use in drug delivery systems. The bioactive compounds found in seaweeds belong to various chemical classes, with the largest proportion being polysaccharides, lipids, proteins, phenolics, pigments, terpenoids, alkaloids, and sterols. These compounds possess significant pharmacological potential. …

Modeling The Impact Of Treatment During An Ongoing Tuberculosis Outbreak, Bach Le, Anna Robicheaux, Jude Shive, Alana Wells, Erin N. Bodine

Spora: A Journal of Biomathematics

In response to a significant tuberculosis outbreak in Wyandotte and Johnson Counties, Kansas, this study presents a compartmental model of ordinary differential equations to evaluate the impact of standard antibiotic treatment. The model incorporates latent, active, and treated disease states. Parameter values were informed by epidemiological data and uncertain parameter value ranges were explored systematically through uncertainty analysis using constrained Latin hypercube sampling. Cumulative infections and deaths, and the basic reproduction number, were computed over a five-year simulation period. Sensitivity analyses using partial rank correlation coefficients identified symptomatic treatment rate and transmission rate as primary drivers of cumulative infections and …

Traveling Wave Fronts For Sir Epidemic Models With Nonlocal Dispersal And Delayed Effects, Ashley Evette Embry

Theses and Dissertations

This dissertation investigates traveling wave solutions for two classes of delayed nonlocal dispersal susceptible--infected--recovered (SIR) epidemic models incorporating biologically realistic mechanisms such as delayed infectivity, delayed dispersal, nonlocal transmission, demographic turnover, and nonlinear incidence effects. These models extend classical spatial epidemic frameworks by allowing long-range population movement through nonlocal dispersal operators and incorporating temporal memory into both diffusion and transmission processes. The primary objective is to establish the existence of traveling wave solutions connecting disease-free equilibria to endemic states and to characterize threshold conditions governing epidemic propagation. The simultaneous presence of nonlocal dispersal, multiple delays, and non-monotone nonlinear incidence terms …

Increased Neural Activity In The Bed Nucleus Of The Stria Terminalis Of Uninfected Canaries After Observation Of Infected Conspecifics, Madeleine Chang, Sophia Santangelo, Devon Comito, Bennett Hardy, Patricia C. Lopes

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Recent evidence suggests that the immune system may be upregulated in anticipation of pathogen exposure, yet the neural mechanisms that respond to and signal impending infection risk remain poorly understood. We investigated neural responses to infection risk in uninfected hosts observing infected conspecifics, using the canary (Serinus canaria domestica)—Mycoplasma gallisepticum host–parasite system. We focused on five brain regions of interest, comprising three nodes of the social decision-making network—preoptic area, bed nucleus of the stria terminalis (BNST) and hippocampus—a stress modulatory region (paraventricular nucleus) and a visual processing region (nucleus rotundus). After 1 h of observing infected canaries, …

Oxo Made With Milk: The Trials Of The Colonial Housewife, Igor Cusack

Dublin Gastronomy Symposium

Colonisation may be seen as an essentially male process, imposing Western notions of household organization and gender on native women and on the colonial housewife. This is all part of the ideology of domesticity which permeated British colonial societies from the late nineteenth century until the independence of African states in the mid twentieth century. In this paper I will examine how food was used to combat various medical crises in British colonial Africa. The paper considers cookery books from South Africa, Rhodesia, Bechuanaland, Kenya, Nyasaland, Ghana and West Africa, focussing on sections entitled “for the invalid,” “invalid dishes” or …

Wastewater Epidemiology: A Surveillance Tool For Camp?, Linda Ebner Erceg

CompassPoint

No abstract provided.

New Products, New Ideas, Paula Lauer

CompassPoint

No abstract provided.

Expert Recommendations To Strengthen Chikungunya Outbreak Surveillance And Reporting For Traveler Health Protection, Daniel C. Payne, Karoun H. Bagamian, Jeffery Goad, Nathan D. Grubaugh, Michael A. Johansson, Moritz U. G. Kraemer, Eyal Leshem, Francesca F. Norman, Alfonso J. Rodríguez-Morales, Henrik Salje, Stephen Thomas, Scott C. Weaver, Lindsey A. Laytner, Rebecca Sturgis, Suzanne K. Scheele, Davidson H. Hamer

Pharmacy Faculty Articles and Research

Chikungunya, a debilitating mosquito-borne disease caused by chikungunya virus, has surged dramatically in the past two decades. Chikungunya outbreaks can intensify rapidly, with infections posing a significant endemic health burden in tropical/subtropical areas and for travelers. Health professionals require timely and accurate outbreak information to adequately protect travelers and assess chikungunya risk. However, detection is often insufficient in the areas most susceptible to outbreaks, leading to diagnostic and reporting delays. Consequently, travelers are often unaware of increased chikungunya infection risk at their destination. We assessed chikungunya surveillance and reporting resources, and we developed expert recommendations for traveler health protection. Because …

Internalized Homophobia As An Influence On Participation In Hiv Prevention Among Young Men Who Have Sex With Men (Ymsm), Kasey I. Brazee

Honors Scholar Theses

Stigma is a known barrier to accessing preventative services for human immunodeficiency virus (HIV), however, the types of stigmas involved in this relationship remain not well defined. Homophobia, or negative attitudes directed towards homosexuality, is a particularly important type of stigma considering the disproportionate effect of HIV on men who have sex with men (MSM). Young MSM (YMSM) are especially impacted, making them a key population in the context of HIV prevention research.  Internalized homophobia, which refers to homophobia that one directs towards themselves, is under researched regarding its role in participating in HIV prevention. In this study, we aimed …

Wake-On-Anomaly Federated Architecture For Privacy-Preserving Poultry Health Early Warning, Mahmoud Aziz Louati

Masters Theses

Highly pathogenic avian influenza outbreaks, respiratory disease, heat stress, and silent equipment failures share one operational reality: they are detected too late because today’s poultry-health workflow is reactive, manual, and dependent on producers volunteering commercially sensitive data. This thesis presents a wake-on-anomaly federated architecture that addresses both the detection-latency problem and the privacy–adoption deadlock that has so far prevented cross-farm collaboration. The architecture is organized in two tiers. Tier 1 is a lightweight LSTM autoencoder that continuously screens four routine telemetry channels (water, feed, house temperature, activity proxy) and emits a per-window reconstruction-error score. A debounced k-of-m trigger with cooldown …

Evaluation Of Serum Eotaxin And Related Biomarkers In Focal And Generalized Epilepsy, Fenik Ahmed Nadir, Firas Shawqi Algburi, Zeyan Abdullah Ali, Shaima Ahmed Nadir

Baghdad Science Journal

Epilepsy is a common brain disorder, characterized by spontaneous recurrent seizures, with associated neuropsychiatric and cognitive comorbidities and increased mortality. Assessment of serum Eotaxin and related biomarkers offers useful information about neuroinflammatory activity and metabolic imbalance in epilepsy, and may have potential value as diagnostic and prognostic tools. The aim of this study was to evaluate the association between Eotaxin, Intelectin-1, Kynurenine, and Proprotein Convertase-1 and epilepsy. The study consisted of 90 subjects who were classified into three groups: 30 healthy controls, 31 patients with focal epilepsy, and 30 patients with generalized epilepsy. Serum samples were obtained, and biomarker concentrations …

Impact Of Covid-19 On Employee Well-Being In Healthcare Organizations, Tim Duy Dole

Walden Dissertations and Doctoral Studies

No abstract provided.

Updated Trends In The Global Prevalence And Burden Of Mental Disorders, 1990–2023: A Systematic Analysis For The Global Burden Of Disease Study 2023, Damian F. Santomauro, Paul Anthony Miller, Jamileh Shadid, Sarah Wulf Hanson, Anh Vo, Darius Jake Roy, Hailey Hagins, Ana M. Mantilla Herrera, James G. Scott, Holly E. Erskine, John J. Mcgrath, Hasan Aalruz, Hedayat Abbastabar, Nadin M.I. Abdel Razeq, Ahmed Abdelrahman Abdelgalil, Ali Abdolizadeh, Deldar Morad Abdulah, Abisola Esther Abdulmalik, Meklit Girma Abebe, Mesfin Abebe, Habtamu Abebe Getahun, Roberto Ariel Abeldaño Zuñiga, Olifan Zewdie Abil, Richard Gyan Aboagye, Shady Abohashem, Abdullahi Tunde Aborode, Moaz Elsayed Abouelmagd, Mohammad T. Abuawwad

All Works

Background The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Methods Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual …

Examining The Ligands, Location, And Function Of Toll-Like Receptor 10, Kiefer Keanu Tam

Master's Theses

Toll-like receptors are a class of innate immune pattern recognition receptors that detect pathogen-associated molecular patterns and regulate downstream inflammatory responses. Toll-like receptor 10 remains the only human TLR whose ligand specificity, cellular localization, and immunological function are not fully defined. Emerging evidence suggests that TLR10 may play an anti-inflammatory role and can heterodimerize with TLR2 to modulate immune signaling. Previous studies from our laboratory demonstrated that stimulation with heat-killed Mycobacterium tuberculosis promotes TLR2-TLR10 heterodimerization and trafficking to the cell surface. In this study, we expanded our ligand panel to include additional gram-positive bacteria, particularly anti-inflammatory probiotic species, to further …

Words Matter: The Rhetoric Of National Security And The Reality Of Individual Rights, Christopher J. Borgen

Journal of Civil Rights and Economic Development

(Excerpt)

While the meanings of words can be flexible or contested, they are not infinitely pliable. These limits on words and their uses help define the outer bounds of legitimate state action. However, even the written law is only as stable as our interpretation of what those words mean. There is the risk that a deliberate and persistent misuse of words by states and other actors can eventually change our understanding of the law it.

Some of my work has analyzed the use of words and phrases such as “self-determination,” “sovereignty,” and “secession.” But, in this Essay, I focus on …

Psychological Strain And Infrastructure Deficit And The Decision To Migrate Among Healthcare Workers From Lagos, Nigeria, Fatima Adeboye

Walden Dissertations and Doctoral Studies

No abstract provided.

Resistant Silence Engraved Trauma, Silence In Domestic Spaces, & Acts Of Resistance, Priyanka Kumar

Masters Theses

This thesis argues that silence surrounding trauma within domestic spaces is not merely an absence of speech or a condition of voicelessness, but it functions as an act of resistance. Focusing on domestic abuse within patriarchal structures, this research examines the ways trauma is embodied, negotiated, and concealed in everyday life. Central in this inquiry is the figure of the “sole witness” to abuse, those who live in close proximity to violence, endure its aftermath and negotiate survival through subtle and often unseen acts of resistance.

I am not attempting to define trauma, but the thesis explores the traces trauma …

The Ethics Of Infection Control, Tonya A. Parris-Wilkins Dds, Joseph D. Wilkins Dpt, Msha

Virginia Dental Journal

No abstract provided.

A Rare Case Of Adolescent Epiglottitis Secondary To Streptococcus Dysgalactiae, Kedar Tilak, Mohamed Aashiq Abdul Ghayum, Douglas Swanson, Rana El Feghaly

Research Showcase

Introduction:

Streptococcus dysgalactiae causes pharyngitis, cellulitis, necrotizing soft tissue infections, sepsis, and streptococcal toxic shock syndrome. It can lead to both toxin-mediated and immune-mediated diseases. Mostly seen in adults, rare in pediatric patients. Here we present a 15-year-old with S. dysgalactiae- associated septicemia, and epiglottitis with extensive neck infection.

Case:

A previously healthy 15-year-old male, recently immigrated from Egypt

Presented with fever and sore throat

Initial tests for influenza and Group A streptococcal infection were negative

Rapid overnight decompensation - CT scan revealed extensive neck inflammation, cellulitis, epiglottitis, and cervical lymphadenopathy

Blood cultures confirmed S. dysgalactiae septicemia

Worsened clinically …

Neonatal Early‑Onset Sepsis: It’S Not Always What You Think, Kedar Tilak, Douglas Swanson, Gabriela M. Henriquez Luthje, Susana Chavez-Bueno

Research Showcase

Background:

Neonatal early‑onset sepsis (EOS) remains a significant cause of morbidity and mortality in the immediate postnatal period. While Group B Streptococcus and Escherichia coli account for most EOS cases, Streptococcus pneumoniae is a rare but highly aggressive pathogen associated with mortality rates as high as 20–60%. In this case, a term newborn experienced fulminant multi‑organ failure within hours of birth despite minimal perinatal risk factors and negative maternal GBS screening. 

Objectives 

This report aims to (1) identify the unusual etiologic agent responsible for severe EOS in a term neonate, (2) outline the diagnostic and clinical course marked by respiratory …

Environmental Mercury Alters Immune Pathways Linked To Autoimmune Risk In Mice Mirroring Humans, Maurgan Lee, Paul Stemmer, Randall Gill, Allen Rosenspire, Anil Aranha, Heather Gibson

Medical Student Research Symposium

Background and Purpose: Mercury is a pervasive environmental contaminant, and human epidemiologic studies have linked chronic low-level exposure to increased autoimmune disease-risk. Dysregulated lymphocyte activation and impaired signaling tolerance are central mechanisms in human autoimmunity. Protein phosphorylation governs lymphocyte differentiation and function, alterations in phosphoproteomic networks may represent a signature of immune disruption. This study evaluates how low dose mercury exposure modifies B and T cell abundance and intracellular signaling patterns in BALB/c and Diversity Outbred (DO) mice.

Methods: BALB/c and DO mice were exposed to low dose HgCl2 in their water for two weeks or provided standard water controls. …

From Bench To Publication: The Hidden Crisis Of Reproducibility In Biomedical Research, Punnya. V. Angadi

Indian Journal of Health Sciences and Biomedical Research KLEU

Reproducibility serves as a fundamental aspect of biomedical research, guaranteeing that findings are reliable, precise, and relevant to clinical applications. The growing difficulty in replicating research outcomes has led to what is known as the ``reproducibility crisis.'' This issue has a profound impact on the biomedical field, affecting pharmaceutical research, guiding medical treatment decisions, and influencing public health results. This editorial aims to examine the extent, root causes, and consequences of irreproducibility in biomedical research, with a focus on the contributions of methodological errors, publication biases, and the pressures exerted by academic systems. Additionally, it will propose possible solutions to …