Digital Commons Network^™

Whether To Offer Interventions At The End Of Life: What Physicians Consider And How Clinical Ethicists Can Help, Joelle Robertson-Preidler, Mikaela Kim, Sophia Fantus, Janet Malek

Faculty and Staff Publications

Background: Advances in life-prolonging technologies increasingly create dilemmas for physicians who must decide whether to offer various interventions to patients nearing the end of life. Clinical ethicists are often consulted to support physicians in making these complex decisions and can do so most effectively if they understand physicians' reasons for making recommendations in this context.

Methods: Semi-structured interviews were conducted with surgeons, nephrologists, intensivists, emergency physicians, and oncologists regarding the considerations they have used to make decisions about offering interventions for patients nearing the end of life. Interview transcripts were thematically analyzed.

Results: We identified six types of considerations physicians …

A Randomized Controlled Trial Of A Compassion-Centered Spiritual Health Intervention To Improve Hospital Inpatient Outcomes, Jennifer S Mascaro, Patricia K Palmer, Marcia J Ash, Marianne P Florian, Deanna M Kaplan, Roman Palitsky, Steven P Cole, Maureen Shelton, Charles L Raison, George H Grant

Faculty and Staff Publications

Background: Inpatient medical settings lack evidence-based spiritually integrated interventions to address patient care needs within a pluralistic religious landscape. To address this gap, CCSH™ (Compassion-Centered Spiritual Health) was developed to leverage the skillsets of healthcare chaplains to improve patient outcomes through spiritual consultation. Here, we report the results of a randomized, wait-list controlled, pre-registered (NCT03529812) study that evaluated the impact of CCSH on patient-reported depression and explored putative mediators of CCSH's effects.

Method: Chaplain residents were randomized to be trained in CCSH as part of their clinical pastoral education (CPE) residency in the fall (n = 8) or …

Barriers And Facilitators To Accessing Mental And Physical Health Care Among Sexual Minority Women: A Qualitative Exploration, Charlotte A. Dawson, A. Moulder, Kristin E. Heron

Department Psychiatry & Behavioral Science Faculty Publications

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18-40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders …

Employee Perspectives On Genetic Testing In The Workplace: Results From A National Survey., J Scott Roberts, Wendy R Uhlmann, Drew Blasco, Anya E R Prince, Sarah Mccain, Subhamoy Pal, Kunal Sanghavi, Elizabeth Charnysh, Charles Lee

Faculty Research 2025

INTRODUCTION: Genetic testing for health-related purposes is now offered in some workplace wellness programs, with notable ethical, legal, and social implications. However, little is known about employee perspectives on workplace genetic testing (wGT).

METHODS: We surveyed a large, diverse national sample of 2,000 employed adults (mean age = 43 years; 51% female). Survey measures assessed respondents' wGT beliefs, perceptions of employer motivations for offering wGT, and privacy concerns.

RESULTS: Most respondents (57.4%) agreed that wGT would improve employees' health, and 46.7% agreed it could aid recruitment and retention of employees. Many respondents attributed legally prohibited motivations to employers offering wGT, …

Exploring The Composition Of Placental Microbiome And Its Potential Origin In Preterm Birth., Marwa Saadaoui, Mohamed Nadhir Djekidel, Selvasankar Murugesan, Manoj Kumar, Duaa Elhag, Parul Singh, Basirudeen Syed Ahamed Kabeer, Alexandra Katharina Marr, Tomoshige Kino, Tobias Brummaier, Rose Mcgready, François Nosten, Damien Chaussabel, Annalisa Terranegra, Souhaila Al Khodor

Faculty Research 2025

INTRODUCTION: For years, the placenta was believed to be sterile, but recent studies reveal it hosts a unique microbiome. Despite these findings, significant questions remain about the origins of the placental microbiome and its effects on pregnancy and fetal health. Some studies suggest it may originate from the vaginal tract, while others indicate that oral bacteria can enter the maternal bloodstream and seed the placenta. However, research analyzing the vaginal, oral, and placental microbiomes within the same cohort is lacking. Additionally, it's unclear whether the placental microbiome differs between healthy pregnancies and those with complications like preterm birth (PTB), which …

Addressing Deaths Of Despair: The Impact Of Loneliness On Excessive Alcohol Use And Alcohol-Involved Driving Deaths In Ohio, Juliana Zacher, Akshey Suresh, Dylan Timperman

Scholarship in Medicine - All Papers

Alcohol-related driving deaths and excessive alcohol consumption continue to rise across the United States. These trends have had a large impact on historically disadvantaged populations, such as Appalachia, being disproportionately affected. Previous literature suggests factors such as loneliness, mental distress, segregation, and immigration status amongst others may contribute to this increase in drinking. Although delineating a clear role of the nature of the impact at a community level still remains unclear. Our objective was to explore these very factors as well as to identify social and economic predictors to explain alcohol-related driving deaths and excessive drinking in Ohio between 2016 …

Sars-Cov-2 Genomic Surveillance Using Self-Collected Saliva Specimens During Occupational Testing Programs, Andy T. Schnaubelt, David Brett-Major, Janet Williamson, Bailey Barcal, Julie Carstens, Ashley Peer, Michael R. Wiley, M. Jana Broadhurst

Journal Articles: Epidemiology

Continually emerging SARS-CoV-2 variants pose challenges to clinical and public health interventions, necessitating sustainable approaches to real-time variant monitoring. This case study describes an innovative SARS-CoV-2 screening and surveillance program that demonstrates the utility of sequencing-based variant monitoring using self-collected saliva specimens. We conducted saliva-based SARS-CoV-2 screening in occupational settings in Omaha, Nebraska from December 2021 through November 2022. 8,372 saliva specimens collected from 1,480 participants were tested for SARS-CoV-2 RNA by extraction-free PCR, with 334 positive samples referred for whole-genome sequencing analysis. Program utilization, quality metrics, and sequencing outputs were compared across sites. Specimen quality was high across program …

Hearing Rehabilitation In Serac1 Related Megd(H)El Syndrome – Implications From A Multi-Center Retrospective Cohort Study, Sebastian Roesch, Anna O'Sullivan, Stefan Tschani, Anna Baghdasaryan, Shanti Balasubramaniam, Ivo Barić, Lonneke De Boer, Sarah C Grünert, Anna Guzek, Mirian Janssen, Zita Krumina, Mary Kay Koenig, Ashleigh M Lewkowitz, Fanny Mochel, Arianne Monge Naldi, Barbara Plecko, Kerem Öztürk, Lauren O'Grady, Gillian Riordan, Daisy Rymen, Inderneel Sahai, René Santer, Manuel Schiff, Georg M Stettner, Konstantinos Tsiakas, Sema Kalkan Uçar, Özlem Ünal Uzun, Corina Weigel, Peter Witters, Kajus Merkevicius, Johannes A Mayr, Saskia B Wortmann, Katarzyna Iwanicka-Pronicka

Faculty, Staff and Student Publications

Objective: 3-methylglutaconic aciduria (MEG), dystonia-deafness (D), (hepatopathy (H)), encephalopathy (E), and Leigh-like-syndrome (L) (MEGD(H)EL) syndrome is a rare, severely disabling progressive mitochondrial disease associated with biallelic pathogenic variants in SERAC1. Knowledge about hearing loss (HL) and hearing rehabilitation is scarce but highly sought after for best possible care in the absence of causative treatment.

Methods: Retrospective cross-sectional study.

Results: This study analyzed the audiometric data of 36 MEGD(H)EL patients (14 unpublished). Bilateral HL was diagnosed in 31 individuals (86 %). Detailed audiometric data, available for 23 of 31 patients, did not allow for general statements on site and degree of …

An Evaluation Of The Decline In Primary Care Physician Visits, 2010 To 2021, Anuradha Jetty, Marie Ezran, Alison Huffstetler, Yalda Jabbarpour

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.

METHODS: The Medical Expenditure Panel Survey data (2010-2021) …

Readiness To The Privatization Of The Health System In Saudi Arabia: Translation And Factor Analysis Of Readiness To Organizational Change (Roc) Scale, Ahmed Ali Alasiri, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

The Kingdom of Saudi Arabia (KSA) began a major transformation as a part of version 2030 for its health system. These reform initiatives aim to privatize health services and improve efficiency. Despite this meaningful change, there is a knowledge gap in how healthcare providers prepare for or perceive this shift. Specifically, there has been a lack of validation of Arabic instruments that gauge the individual readiness to this change. This study bridges the gap by localizing and validating the Readiness to Organizational Change scale (ROC) to provide empirical evidence and to understand adaptability for the KSA context.

Method

The …

Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

Methods

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …

Ambulatory Arterial Stiffness Index: Regression Method Comparison And Its Association With Pulse Pressure And Circadian Patterns, José R. Ayala-Hernández, Cristina López-Sánchez, Orlando M. Ayala, Camilo E. Palencia-Tejedor

Engineering Technology Faculty Publications

The Arterial Stiffness Index (AASI) is a calculation obtained through Ambulatory Blood Pressure Monitoring (ABPM), and is an indirect measure of the elastic properties of the arterial wall; but there is heterogeneity in its scope as a predictor of vascular wall health. A comparison is made between linear regression and exponential regression of the AASI, as well as an analysis of variance, according to circadian patterns and pulse pressure (PP) values. This work is an analytical observational study in 106 individuals, most of them women (63%) with a mean age of 53 ± 17.32 years. The coefficient of determination (r2) …

Prevention Of Substance Related Deaths Through Mental Health Counseling, Lindsey Tout, Camille Zonfa

Scholarship in Medicine - All Papers

Background: Substance abuse, particularly alcohol and drug use, remains a critical public safety issue in Ohio. Those suffering with abuse disorders are likely to often have accompanying mental health disorders, however, there lies a significant gap in treatment.
Objective: This study examines trends in alcohol-related driving deaths, drug overdose deaths, excessive drinking, and mental health provider availability from 2016 to 2023 in rural and urban counties of Ohio.
Methods: Data collected from the public source, County Health Rankings and Roadmaps, was analyzed using statistical methods to assess changes between 2016 to 2023 for the 88 counties of Ohio. Urban versus …

Factors Driving Potentially Preventable Hospitalizations In Ohio And Surrounding States, Ann Walter, Andy Russell

Scholarship in Medicine - All Papers

No abstract provided.

Examining Low Mammogram Rates In Native American Populations In Arizona And New Mexico, Mason Berges, Ayesha Ahmad

Scholarship in Medicine - All Papers

Introduction: Despite improvements in technology over the last several decades, breast cancer incidence and mortality rates have remained steady among the Native American population. This is in direct contrast to the general United States population which has seen substantial decreases in these incidence and mortality rates. A key factor in eliminating breast cancer and saving lives is undergoing mammogram screenings. While mammogram screenings are of crucial importance, many Native American women lack equitable access to healthcare resources and as a result face unnecessary health challenges. Several social determinants of health could be playing a key role in these mammogram screening …

Reliability Of Popliteal Artery Flow-Mediated Dilation In The Seated Position, Taskina Akhter, Patrick B. Wilson, J. David Branch, Leryn J. Reynolds

Exercise Science Faculty Publications

Flow-mediated dilation (FMD), a noninvasive measure of endothelial function, is commonly measured in the popliteal artery in the supine and upright body positions. However, reliability studies of the measurement in these positions are not well studied. This study aimed to examine the trial-retrial and visit-to-visit reliability of popliteal artery FMD in the seated position. Popliteal artery FMD was measured in 20 healthy adults across two visits in the seated and prone positions to assess visit-to-visit reliability. Two measurements were taken for each body position at each visit to assess trial-retrial reliability. %FMD was calculated as the percent change from baseline …

The Lack Of Mental Health Support In Caribbean Households, Arnoudly Bossicot

LEAD Scholars Academy Showcase

Growing up in a Caribbean household, mental health, amongst other topics, was something no one dared to speak about. Seeking therapy or talking to a trusted family member is not an option since you will look weak. When mental health issues are left untreated, long-term adverse effects on the emotional, social, physical, and behavioral aspects of life. In some instances, it may result in suicide. This research will explore the different elements that affect a person’s willingness to receive mental health treatment in Caribbean households. Would teenagers and young adults seek mental help if given the right resources and support? …

Cochlear Implantation With Sporadic Inner Ear Schwannomas: Outcomes In 106 Patients From An International Multi-Institutional Study, John P. Marinelli, Torsten Rahne, James R. Dornhoffer, Christine M. Lohse, Justin Cottrell, J. Thomas Roland, Nicholas J. Thompson, Kevin D. Brown, Jacob C. Lucas, Seilesh C. Babu, Nathan R. Lindquist, Elizabeth L. Perkins, Donald Tan, John I. Lane, Jacob B. Hunter, Erin Harvey, Nicholas L. Deep, Samantha Y. Cerasiello, Matthew L. Kircher, Mana Espahbodi, Evan L. Tooker, Niels Cramer West, Per Caye-Thomasen, Matthew L. Carlson, Stefan K. Plontke

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate cochlear implant speech perception among patients with sporadic inner ear schwannoma who underwent ipsilateral implantation.

STUDY DESIGN: Retrospective multi-institutional cohort study.

SETTING: Eleven tertiary academic medical centers across Germany, Denmark, and the United States.

PATIENTS: One hundred six patients with sporadic inner ear schwannoma who received an ipsilateral cochlear implant from 2011 to 2022.

INTERVENTIONS: Ipsilateral cochlear implantation with observation, stereotactic radiosurgery, or microsurgery for tumor management.

MAIN OUTCOME MEASURES: Monosyllabic speech perception testing scores and rates of open-set speech perception.

RESULTS: Among 106 patients studied, 101 (95%) achieved open-set speech perception with a median of 24 …

Treatment Sequence With Tebentafusp And Immune Checkpoint Inhibitors In Patients With Metastatic Uveal Melanoma And Metastatic Gna11/Gnaq Mutant Melanocytic Tumors, Florentia Dimitriou, Marlana Orloff, Erica Koch Hein, Phil Cheng, Isaac Hughes, Ester Simeone, Kamaneh Montazeri, Piyush Grover, Inderjit Mehmi, Camille Gerard, Caroline Gaudy-Marqueste, Jean-Jacques Grob, Olivier Michielin, Omid Hamid, Georgina Long, Ryan Sullivan, Ellen Kapiteijn, Douglas Johnson, Paolo Ascierto, Anthony Joshua, Richard Carvajal, Marcus Butler, Jessica Hassel, Reinhard Dummer

Kimmel Cancer Center Faculty Papers

BACKGROUND: Metastatic uveal melanoma (mUM) is rare. Immune checkpoint inhibitors (ICIs) have shown modest efficacy in mUM. Tebentafusp prolonged overall survival (OS) in a phase 3 study. We aimed to investigate the efficacy and safety of the sequence of tebentafusp and ICIs.

METHODS: Patients with HLA-A * 02:01 positive mUM, or metastatic GNA11/GNAQ mutant melanocytic tumors treated with tebentafusp followed by ICIs (group 1) or the inverse sequence (group 2) at any treatment line were retrospectively identified. The primary objective was OS rate at 2 years.

RESULTS: 131 patients were included; 51 in group 1 and 80 in group 2. …

“No One Told You Life Was Gonna Be This Way”: A Qualitative Exploration Of Friendship Expectations And Reality In University Life, Michael Priestley, Hannah Rachael Slack, Miss Madiha Islam, Delia Fuhrmann, Emily Long, Sarah Crook, Juliet Foster, Sophie Homer, Nicola Byrom

School of Psychology

Introduction: Young adulthood (ages 18–25) is a high-risk period for loneliness, particularly during educational transitions. Loneliness has negative consequences for mental health, physical health, and educational achievement. Psychologists conceptualize loneliness as emerging from a discrepancy between expected and experienced social connection, but this has been under-explored during young adulthood. Method: Drawing on thematic analysis of eight focus groups with 21 young adults in the UK, this paper explores the differences between retrospective expectations and experience of social connection during the transition into university and the implications for loneliness. Results: Whilst social expectations, experiences, and preferences vary considerably, young adults' perception …

Match Accuracy Of Burned Teeth: A Pilot Study Of Allied Dental Professionals, Brenda T. Bradshaw, Marsha A. Voelker, Samantha C. Vest, Sinjini Sikdar

Dental Hygiene Faculty Publications

Purpose: The purpose of this pilot study was to assess allied dental professionals' match accuracy of burned teeth; a skill required by disaster victim identification (DVI) team members.

Methods: This cross-sectional study used a convenience sample of registered dental hygienists (RDH) (n=15) and dental assistants (DA) (n=15) to assess their match accuracy of burned teeth with simulated antemortem (AM) and postmortem (PM) images. Fifteen human teeth were heated at 400°C for 15 minutes. Prior to and following heat alteration, each tooth was photographed and radiographed. Images were presented to participants in randomized order, and they were instructed to correctly match …

Improving Dental Hygiene Students' Knowledge, Attitudes, And Confidence Toward Prenatal Oral Health Through Experiential Learning, Denise C. Mckinney, Sinjini Sikdar, Shillpa Naavaal

Dental Hygiene Faculty Publications

Purpose Maintaining optimal oral health is essential for maternal health as well as the health of their child. The purpose of this pilot study was to examine dental hygiene (DH) students' knowledge of prenatal oral health before and after receiving an asynchronous prenatal oral health care training (POHCT), and their attitudes and self-perceived confidence before and after receiving an experiential learning opportunity with a pregnant and/or post-partum client at a Women's Infants and Children nutrition program (WIC) clinic.

Methods A one-group pre/post-test design was used. This IRB-approved study (#2027439-4) utilized a convenience sample of DH student participants (n=37) in their …

Prevalence Of Sexuality Implicit Bias In Entry-Level Dental Hygiene Students, Monica Drew, Emily Ludwig, Jessica Suedbeck, Adaira Howell

Dental Hygiene Faculty Publications

Purpose Bias and discrimination may create barriers and affect the delivery of culturally competent care to sexual minorities. An awareness of biases early in education may promote more equitable oral health care delivery to diverse populations. The purpose of this study was to determine the prevalence of sexuality-implicit attitudes in entry-level dental hygiene students at one university.

Methods This cross-sectional survey study included a convenience sample of dental hygiene students from one university (n=74). The Implicit Associations Test (IAT), a validated tool for measuring implicit bias, was modified for use in dentistry with permission from Project Implicit(®) The IAT requires …

Frequency And Perceived Influence Of Menopausal Symptoms On Training And Performance In Female Endurance Athletes, Heather M. Hamilton, Natalie M. Yarish, Kristin E. Heron

Rehabilitation Sciences Faculty Publications

Menopause is associated with several negative health concerns and common menopausal symptoms. Physical activity is essential to mitigate these negative effects, but menopausal symptoms may interfere with participation in physical activity. The purpose of this study was to determine the frequency and the perceived negative effect of menopausal symptoms among female endurance athletes. Female runners, cyclists, swimmers, and triathletes 40–60 years of age were recruited (N = 187). Participants completed an online, anonymous survey that included self-reported menopausal status; the Menopausal Rating Scale (MRS), a validated measure for assessing menopausal symptoms; and the perceived effect of menopausal symptoms on …

Newly Credentialed Athletic Trainers' Onboarding Process During The Transition To Practice, Ashley B. Thrasher, Stacy E. Walker, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context: As new athletic trainers (ATs) transition into their roles, some employers provide orientation and onboarding to assist with the transition to practice. Research in which authors outline the ideal onboarding process for new ATs transitioning to practice is lacking.

Objective: To examine the onboarding process for new ATs.

Design: Grounded theory.

Setting: College or university, secondary school, and hospital or clinic.

Patients or other participants: Seventeen newly credentialed, employed ATs who recently graduated from professional masters' programs (11 female, 6 male; 25.6 ± 2.2 years) and 12 employers (6 female, 6 male; years in role supervising new ATs: 8.5 …

'I Did Not Know We Could Exercise This Small Premature Baby': Challenges Experienced By Parents While Implementing Early Intervention For Their Preterm Infants-A Qualitative Perspective, Manasa Kolibylu Raghupathy, Selim Jahangir, Sonia Khurana, Leslie Edward S. Lewis, Bhamini Krishna Rao

Rehabilitation Sciences Faculty Publications

Background

Preterm birth is a highly stressful experience for both parents and infants. Parental participation in care enhances developmental outcomes, fosters parent-infant interactions and builds parental confidence. However, low parental adherence has always been a challenge in the successful implementation of intervention programs both in the NICU and at home. It is imperative to understand parents' perspectives and view the challenges that they experience through their lens while providing early intervention to their infants born preterm. This study is aimed at identifying new parents' challenges when implementing early intervention programs for their infants during the transition from hospital to home. …

Clinician Perspectives On Virtual Reality Use In Physical Therapy Practice In The United States, Danielle T. Felsberg, Jared T. Mcguirt, Scott E. Ross, Louisa D. Raisbeck, Charlend K. Howard, Christopher K. Rhea

Rehabilitation Sciences Faculty Publications

The primary goal of physical rehabilitation is to assess movement impairments and restore function to improve overall quality of life. Virtual reality (VR) may provide the optimal environment to promote these goals due to its motivating and modifiable nature which can be difficult to accomplish through traditional real-world therapeutic methods. Current research of VR for rehabilitation has demonstrated that VR interventions can produce clinically meaningful change in motor outcomes. Despite this, adoption and usage of VR by physical therapy professionals is unclear due to the limited research in this area. Thus, the purpose of this study was to identify the …

Differential Plasma Carotenoid Profiles In Hypertensive Disorders Of Pregnancy, Colman Freel, Jonah Scheffler, Rebecca Drakowski, Elizabeth Lyden, Matthew Van Ormer, Melissa K. Thoene, Paras K. Mishra, Corrine K. Hanson, Ann Anderson-Berry

Journal Articles: Pediatrics

Background: Hypertensive disorders of pregnancy (HDP) affect one in six pregnancies globally. The etiology of HDP remains unclear but is known to involve oxidative stress. While the body produces endogenous antioxidants, antioxidative nutrients, like carotenoids, remain critical in modulating oxidative stress. The statuses of several carotenoids have been linked to hypertension in both pregnant and non-pregnant populations. However, their associations with the spectrum of HDP, including gestational hypertension (GH), chronic hypertension (CH), and preeclampsia (PE), remains unclear. Our objective was to quantify and compare carotenoid intake and plasma levels among HDP. Methods: We conducted a prospective cohort study …

Exploring Factors Contributing To Patient Decision-Making In The Care Journey To Elective Hernia Care In Kenya, Helen W. Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A. Blatnik, Joanna Hunter-Squires, Ivan Seno Saruni

2020-Current year OA Pubs

BACKGROUND: Capacity for elective general surgical care is an important reflection of a health system's ability to meet a population's surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system. …

Novel Loci For Triglyceride/Hdl-C Ratio Longitudinal Change Among Subjects Without T2d, Lihua Wang, Siyu Wang, Jason A Anema, Vaha A Moghaddam, Yanli Lu, Shiow Lin, E Warwick Daw, Allison L Kuipers, Iva Miljkovic, Michael Brent, Gary J Patti, Bharat Thygarajan, Joseph M Zmuda, Michael A Province, Ping An

2020-Current year OA Pubs

Triglyceride (TG)/HDL-C ratio (THR) is a surrogate predictor of hyperinsulinemia. To identify novel genetic loci for THR change over time (ΔTHR), we conducted genome-wide association study (GWAS) and genome-wide linkage scan (GWLS) among nondiabetic Europeans from the Long Life Family Study (n = 1,384). Subjects with diabetes or on dyslipidemia medications were excluded. ΔTHR was derived using growth curve modeling and adjusted for age, sex, field centers, and principal components. GWAS used a linear mixed model accounting for familial relatedness. GWLS employed haplotype-based identity-by-descent estimation with 0.5 cM average spacing. Heritability of ΔTHR was moderate (46%). Our GWAS identified a …