Digital Commons Network^™

Congenital Syphilis: From Near-Elimination To Crisis, Chad J Abresch, Irene A Stafford, Regan M Johnson, Kayode Olabanji, Ashleigh M Sutphen, Helen E Cejtin, Ashley Hoover

Faculty, Staff and Student Publications

This analytic essay examines the transformation of congenital syphilis (CS) in the United States from near-elimination to crisis. Drawing from the January 2025 Congenital Syphilis Summit in Atlanta, Georgia-convening public health leaders, Tribal health departments, the National Coalition of STD Directors, and Centers for Disease Control and Prevention experts-we contrast prevention systems during near-elimination (1998-2005) with the current crisis (2018-2025). Evidence revealed how dismantling public health infrastructure produced dramatically different outcomes, with CS cases increasing 937% over the past decade and racial/ethnic disparities worsening. American Indian/Alaska Native communities face rates up to 100 times higher than White populations in some …

Physical Activity, Telomere Length, And Cardiometabolic Syndrome In Older Women: The Cardiovascular Health Study, Jeni Page, Melissa Richard, Elizabeth Lyons, Elizabeth Baumler, M Terese Verklan, Michelle C Odden, Elizabeth Lorenzo

Faculty, Staff and Student Publications

Background: Cardiometabolic syndrome (CMS) affects approximately 39% of US women and increases risk for cardiovascular disease, diabetes, and stroke. Telomere length, a biomarker of cellular aging, is associated with CMS and may be influenced by physical activity (PA), potentially mitigating telomere shortening. Black women have higher CMS prevalence compared to white women and may exhibit distinct telomere length dynamics influenced by interactions between CMS and PA.

Methods: Data were drawn from the Cardiovascular Health Study and included black and white women who provided data on PA, CMS risk factors, and telomere length (N = 417). Linear regression models examined the …

A Wound Upon The Union: John Quincy Adams And The Treaty Of Indian Springs, Spencer Peacock

Honors Theses and Capstones

This thesis examines the crisis that developed after US president John Quincy Adams signed, then disavowed (allegedly over moral concerns), the fraudulent 1825 Treaty of Indian Springs with the Creek Indian Nation. The thesis probes Adams' motives during the Treaty of Indian Springs crisis, and seeks to connect the crisis to the evolution of US federal Indian policy in the 1820s, prior to the mass Indian removal of the 1830s.

Immigration Securitization And Educational Access: The Impact Of U.S. Immigration Policy On International Students, Cossir Carter

Honors Undergraduate Theses

This study examines the securitization of international students within the broader transformation of United States immigration policy from the post-9/11 era to the present administration. Following the September 11 attacks, immigration governance was increasingly reorganized under a national security framework, significantly altering the regulatory environment surrounding student visas. Subsequent policy shifts have intensified monitoring mechanisms and administrative controls that directly shape international students’ access to education and mobility. Given the sensitivity of immigration-related participation in the current political climate, this research employs qualitative policy analysis rather than direct student surveys. Under the Trump administration, this securitization intensified through stricter visa …

Workforce Review Of Health Information Technology Associate-Degree Graduates: 2017-2024, Debra Hamada, Karima Lalani, Melanie Brodnik, Susan H Fenton, Angela Kennedy, David T Marc, Velma L Payne, Rebecca Reynolds

Faculty, Staff and Student Publications

Background: The career path of associate-degree health information technology (HIT) graduates continues to change quickly as quality and payment regulations, technology requirements, and workforce expectations evolve to meet the demands of the changing health care environment. Although HIT professionals play an essential role in accuracy, regulatory compliance, and the overall function of health information systems, there is limited research describing HIT workforce trends.

Methods: A mixed-methods approach was used with 587 survey responses. Quantitative data were standardized by job category, including a newly developed "health information management (HIM) operations" group, and career movement was visualized using a Sankey diagram. Qualitative …

Factors Associated With Opioid And Antibiotic Prescribing At Us Academic Dental Institutions: 2011 To 2020, S Tungare, A-I Yansane, S Gantela, K K Kookal, S Mccurdy, T M Krause, S Sharma, M Walji

Faculty, Staff and Student Publications

Introduction: In the United States, dentists are one of the leading prescribers of opioids and antibiotics. Because dental schools are the training grounds for future dentists, it is crucial to understand how prescribing has changed and why these medications are being prescribed in academic settings.

Objectives: The objective of this research was to describe the prescribing trends and factors associated with opioid and antibiotic medication prescribing at US academic dental institutions between 2011 and 2020.

Methods: Data from electronic dental records collected through the BigMouth data repository from 9 anonymized dental institutions between 2011 and 2020 were used. Prescribing rates …

How Historical Experiences Shaped The Italian Constitution: A Comparative Perspective With The United States, Kaitlin M. Rocca

Honors Theses and Capstones

No abstract provided.

Debt Decisions: The Effects Of Paying For College In The United States With Student Loans, Kim E. Bullington, David J. Thomas, Minghui Hou, William L. Nuckols, Dennis E. Gregory, Joshua L. Howell, Kaycee L. Bills, Amy-Leah Joaquim

Educational Leadership & Workforce Development Faculty Publications

Student loans have increasingly become a burden on individuals. This qualitative analysis explores how structural inequities and financial literacy gaps influence US student loan borrowers’ decisions to finance postsecondary education. The study highlights racial and economic disparities, examining participants’ reflections on debt aversion and systemic barriers to equitable access. We asked why participants took out federal student loans, asked about their decision processes when taking on debt, whether participants took any action to reduce accumulated debt, and if they’d made any discoveries about their decisions to take on student loan debt. After coding and a thematic analysis, five themes and …

Predictors Of Inpatient Rn Turnover In Rural And Urban Vha Hospitals, Katherine G Bay, Chase S Eck, Melissa K Knox, Paras Mehta, Laura A Petersen

Faculty, Staff and Students Publications

Background: The rising demand for health care delivery and an aging workforce is of particular concern in rural areas, where health care access depends upon an adequate nursing workforce. To address this shortage and optimize care, it is essential to measure when registered nurses (RN) leave inpatient direct care positions (ie, inpatient RN turnover) and identify modifiable factors correlated with RN turnover.

Objectives: Apply a novel method for characterizing inpatient RN turnover to understand factors associated with variation in RNs leaving inpatient positions at rural and urban Veterans Health Administration (VHA) hospitals.

Project design: Retrospective cohort study.

Subjects: Direct care …

Findings And Recommendations From The State Of The Art (Sota) Conference On Nursing Research To Improve Veteran Outcomes, Amelia E Schlak, Sarah Krein, Laura A Petersen, David Atkins, Catherine Battaglia, Elizabeth Burkhart, Renee Colsch, Marguerite Daus, Heather Gilmartin, Nipa Kamdar, Melissa Knox, Ann Kutney-Lee, Christine M Olney, Kathryn Rugen, Tracy Weistreich, Sheila Cox Sullivan, On Behalf The Nursing Sota Planning Committee

Faculty, Staff and Students Publications

The Veterans Health Administration (VHA), the largest employer of nurses in the United States, has more than 120,000 nursing personnel providing care to over 9 million Veterans across diverse settings. Despite nursing's central role in delivering and sustaining care, research on strengthening the nursing workforce and optimizing nursing practice has remained underdeveloped in VHA. To address this gap, VHA's Office of Research and Development, in partnership with the Office of Nursing Services, convened a State of the Art (SOTA) conference in November 2023 focused on nursing. The Nursing SOTA brought together nurses, researchers, operational leaders, and other stakeholders to review …

Strategies And Challenges For The Recruitment Of Young Healthy Participants In The Dietary Approaches To Longevity And Health (Dial Health) Pilot Trial, Hannah E Cabre, Courtney M Peterson, Gareth R Dutton, Kimberly L Drews, Stephanie T Broyles, Robert Dubin, Laura Q Rogers, Catherine Champagne, Dennis T Villareal, Daniel S Hsia, Leanne M Redman, Corby K Martin

Faculty, Staff and Students Publications

Background: Understanding the impact of nutrition on human aging requires long-term trials in young, healthy, unmedicated adults. As part of the Dietary Approaches for Longevity and Health (DiAL Health) pilot project, we evaluated strategies for recruiting this population for aging-related dietary intervention studies.

Methods: We analyzed recruitment costs to enroll 70 participants (ages 25-49, BMI 22.0-29.9 kg/m2) across two DiAL Health sites and used NHANES data (2017-March 2020) to estimate the proportion of U.S. adults meeting partial trial eligibility. Additionally, a formative study surveyed 492 U.S. adults (≥18 years) to assess interest in aging-focused dietary trials.

Results: Of 2049 applicants …

[Introduction To] Shakers At The Center : Manifesting Spirits & Spectacles In Nineteenth-Century America, Douglas L. Winiarski

Bookshelf

Edited by Douglas WIniarski.

"Exploring the theological, social, and cultural dimensions of one of America’s most ambitious prophetic movements

The Shakers’ Era of Manifestations ranks among the most astounding events in American religious history. During the 1840s, members of the United Society of Believers in Christ’s Second Appearing embarked on an audacious project of receiving visions, revelations, and other manifestations from the spirit world and convincing both themselves and the world’s people of their reality. Gifted Shakers known as “instruments” surrendered their bodies to possessing spirits and celestial beings who, in turn, provided the Believers with an unimaginable number of …

Anything But Endo: Diagnostic Buck-Passing In Endometriosis Diagnosis, Rita Dexter, Megan Kitts, Heather Welty, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

People living with endometriosis, a disease in which tissue similar to the lining of the uterus grows elsewhere in the body, often experience prolonged diagnostic journeys because of symptom variability, normalisation of period pain and other symptoms, and lack of awareness of the condition. In this article, we analyse the endometriosis diagnostic journey through the lens of epistemic injustice. Drawing on in-depth interviews with 52 people living with endometriosis in the United States, we introduce the concept of diagnostic buck-passing to characterise the phenomenon wherein individuals who seek treatment for their symptoms end up stuck in a cycle of seeing …

Differences Between Government, Consortium, And Private Database Stewards Impacting The Genomic Data Market: A Survey Of U.S. Academic Genetic Researchers., Amanda K Greene, J Denard Thomas, Kaitlyn Jaffe, Luyun Chen, Kerry A Ryan, Brian J Zikmund-Fisher, J Scott Roberts, Amy L Mcguire, Katherine Hendy, Kayte Spector-Bagdady

Center for Medical Ethics and Health Policy Staff Publications

Background: Despite major shifts in U.S. federal government data sharing requirements, their impact, and relation to researcher choice of database, are underexplored. This study surveyed genetic researchers regarding trends, priorities, perceptions of quality, impact on research outcomes, and genomic data sharing and use across government, consortium, and private databases.

Methods: As part of an exploratory sequential mixed methods project, we surveyed 294 U.S.-based genomic academic researchers.

Results: Genetic researchers generally have a choice between databases, which allows them to prioritize data quality. This might explain recent trends toward the use of government and consortium databases away from private ones. Respondents …

From Aid To Looting: Justice And Sovereignty Issues In The Ukraine–U.S. Mineral Deal, Petra Gümplova

Emancipations: A Journal of Critical Social Analysis

This essay identifies three central moral and political issues with the the Ukraine–U.S. Mineral Deal. First, by linking financial and military assistance to access to Ukraine’s natural resources, the deal entrenches a form of resource conditionality that is highly problematic from the moral standpoint of international justice and other ethical principles. Second, the absence of a commitment to a just peace—including the restoration of territorial integrity, reparations, and security guarantees—renders the conditions for secure, long-term investment in Ukraine’s extractive economy a distant prospect, while raising the risk that a substantial portion of Ukraine’s resource wealth unlawfully seized by Russia will …

The Impact Of Pasifikas In Medicine On Pacific Islander Medical Student Experiences, Devon Hori Harvey, Micah Ngatuvai, Siale Vaitohi, Paige E. Faasuamalie, Maegan Tupinio, Lisa H. Smith

Student Papers, Posters & Projects

BACKGROUND: Pacific Islanders experience significant health disparities. One contributing aspect to these disparities is the lack of racial concordance as Pacific Islanders are underrepresented in the U.S. physician work force. Several factors contribute to this underrepresentation including lack of support systems for Pacific Islander premed and medical students. Pasifikas in Medicine (PiM) is a recently established national student organization founded to provide support for Pacific Islander premed students, medical students, residents, fellows and attending physicians. This study seeks to understand the impact of PiM on medical student experiences.

METHODS: An anonymous survey was distributed to the PiM listserv and to …

Us Drug Policy Does Not Align With Experts’ Rankings Of Drug Harms: A Multi-Criteria Decision Analysis, Michael Broman, Alan K Davis, Stacey Armstrong, Adam Levin, Kaltum Ahmed, Gustavo A Angarita, Brooke J Arterberry, Cecilia Bergeria, Mitch Earleywine, Kathryn S Gex, Tom Gregoire, Jamey J Lister, David S Mathai, Nicky J Mehtani, Nathan Menke, Charles D Nichols, Hillary Shaub, Alayna P Tackett, Brandon Weiss, Nefize Yalin, Lawrence D Phillips

Faculty, Staff and Students Publications

Background: United States drug policy is primarily based on the Controlled Substances Act of 1970 and largely contradicts scientific evidence about how to mitigate drugs’ harms. Expert consensus on drug harms could inform policy that improves the health of people who use drugs while reducing negative societal impacts of drug use. Therefore, this study adapted and extended the relevant 2010 United Kingdom multi-criteria decision analysis, rating drug harms by criteria comprising health and social impacts to people who use drugs and their families, communities, and society.

Methods: Seventeen experts on drug use in the US, including three with lived experience …

Star Wars And Gender In 1980s America, Melissa Ulmer

Rushton Journal of Undergraduate Humanities Research

This research paper examines the role of gender in the franchise Star Wars. With the first installment of the trilogy released in 1977, many expected this film would turn out like many before. However, the world that George Lucas created was an instant hit and continues to be today. This paper focuses on how the franchise was set apart from other science fiction films based on a defiance of typical gender roles that were prevalent in the late twentieth century, specifically focusing on the two leading roles, Luke Skywalker and Leia Organa, and employing analysis of the films, cast …

China's Spy Network In America: A People's War Against An Open House: America Needs To Confront The Reality Of The New Cold War, Shaomin Li

Management Faculty Publications

The article discusses China's extensive espionage activities in the United States, framing it as part of a broader "people's war" strategy employed by the Chinese Communist Party (CCP). It highlights historical cases of espionage, such as those involving Qian Xuesen and Bo Jiang, to illustrate the ongoing threat posed by Chinese intelligence efforts, which leverage both state-sponsored and civilian participation. The article contrasts the CCP's ruthless approach to espionage with the U.S. legal system's more restrained response, emphasizing the asymmetry in their respective strategies. It concludes by urging the U.S. to recognize and confront the realities of this new Cold …

Perspectives On The Future Of The Profession Of Microbiology, Todd L Kelson, Heidi B Kaplan, Michelle Dziejman, Shilpa Gadwal, Irene Hulede, Jennifer Bennett, Roger Greenwell, Shelley Payne, Kyle Maclea, Eric Miller, Diana L Vullo, Rebecca Sparks-Thissen, Astral Bertolio, Jorge Cervantes

Faculty, Staff and Student Publications

The Profession of Microbiology (POM) embodies the bulk of the American Society for Microbiology (ASM) members and represents the career preparation arm of the ASM for academia, industry, and clinical lab professions. The ASM Council on Microbial Sciences hosted a virtual retreat in 2025 to identify the future of the POM. The retreat presentations centered on workforce development, professional development, innovations in technology, and interdisciplinary collaborations. Various aspects were identified, such as the need to prepare for careers in industry, as an important goal of future training. It was also clear that scientists, in all walks of life, need professional …

Updating The Epidemiology Of Blastomycosis And Histoplasmosis In The United States, Using National Electronic Health Record Data, 2013-2023., Juliana G E Bartels, Simon K. Camponuri, Theo T. Snow, Brittany L Morgan Bustamante, Natalie J. Kane, Rose Reynolds, Aidan Lee, Mark A. Hoffman, Theodore C. White, Justin V. Remais, Jennifer R. Head

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Where surveillance data are limited, nationally representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis.

METHODS: We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize spatiotemporal incidence trends, we used generalized estimating equations weighted for nonrepresentativeness of electronic health record-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates between regions, race/ethnicity, gender, and age subgroups and the national population.

RESULTS: National incidence rates in 2023 were …

A Comparative Analysis Of Domestic Violence Legislation In India And The United States: Understanding Protection Of Women Against Violence Act 2005 And Violence Against Women Act 1994, Deon Rodrigues

2025 Fall Honors Capstones Projects - Archive

Domestic violence continues to affect millions of individuals worldwide, yet legal systems respond to it in very different ways. This research compares how India’s Protection of Women from Domestic Violence Act (2005) and the United States’ Violence Against Women Act (1994; 2021) protect victims and hold offenders accountable. Using a comparative legal analysis, the study examines both laws’ language, enforcement mechanisms, and effectiveness through court cases, government reports, and statistical data. By identifying the strengths of the United States model such as mandatory arrest provisions and victim support systems, the study aims to propose practical reforms for India’s legal framework. …

Investigating The Polygenic Relationship Between Heavy Cannabis Use And Schizophrenia In The All Of Us Research Program, Isabelle Austin-Zimmerman, Hayley H A Thorpe, John J Meredith, Jibran Y Khokhar, Tian Ge, Marta Di Forti, Arpana Agrawal, Emma C Johnson, Sandra Sanchez-Roige

2020-Current year OA Pubs

BACKGROUND: Decades of research have identified a strong association between heavy cannabis use and schizophrenia (SCZ), with evidence of correlated genetic factors. However, many studies on the genetic relationship between cannabis use and psychosis have lacked data on both phenotypes within the same individuals, creating challenges due to unmeasured confounding. We aimed to address this by using multimodal data from the All of Us Research Program, which contains genetic data as well as information on SCZ diagnosis and cannabis use.

METHODS: We tested the association between cannabis use disorder (CUD) and SCZ polygenic scores (PGSs) with SCZ and heavy cannabis …

Leaving The Fold: Young Adult Disaffiliation From Protestantism In Political And Cultural Context, Kimberly S. Johnson

Doctoral Dissertations and Projects

This study investigated the lived experiences of young adults who have disaffiliated from a Protestant church, focusing on political, national, and religious dynamics, including reflections on Christian Nationalism. The study also examines how these meaning-making processes informed participants’ retrospective accounts of disaffiliation. Building on the quantitative research that has dominated prior studies, this study employed interpretative phenomenological analysis to investigate how encounters with Christian Nationalism have shaped perceptions of organized religion. The study’s ten participants ranged in age from 21 to 29 years old and identified as having been part of the Protestant Church prior to disaffiliating from organized religion. …

Energy Input–Output Meta-Analysis Reveals Algal Diesel Struggles To Break Even, Michelle M. Arnold, David J. R. Murphy, Christopher L. Lant

Environment and Society Student Research

Algal biofuels have been investigated as an alternative to fossil fuels and first-generation biofuels for transportation in the United States since the 1970s. Yet after five decades of development, scalability and implementation remain limited—largely due to persistent barriers such as low biomass productivity, modest lipid yields, and energy-intensive processing methods. These technical challenges significantly constrain the feasibility of large-scale commercialization despite substantial research and investment. To evaluate progress toward commercial viability, this study harmonized energy inputs and outputs across 508 observations on the production of algal biofuel energy return on energy investment (EROEI) in the United States. While bioethanol achieves …

Comparative Study Of Vocal Pedagogy Systems In South Korea And The United States: Developmental Strategies For Classical Voice Education In South Korea, Dongmin Byeon

UNLV Theses, Dissertations, Professional Papers, and Capstones

This dissertation presents a comparative study of vocal pedagogy systems in South Korea and the United States, with the aim of identifying deficiencies in Korean higher education and proposing strategies for reform. While South Korean university voice programs are deeply rooted in the traditional master–apprentice model and rely heavily on anecdotal teaching methods, U.S. institutions have developed structured, evidence-based pedagogical frameworks informed by anatomy, physiology, acoustics, and voice science. This research explores the historical evolution of vocal pedagogy in both countries, highlighting how traditional practices in Korea, though culturally significant, have not sufficiently adapted to contemporary scientific standards.

Employing qualitative …

Transdiagnostic Links Of Reward Processing In Obsessive-Compulsive Disorder And Depression, Kevin M Wagner, Matti Cervin, Jessica S C Cheng, Jasmine Arriaga, Vanessa Zavala Cruz, Dayan Berrones, Josselyn S Muñoz, Renee M Frederick, Jacey L Anderberg, Belinda E Núñez Bracho, Victor R Adorno, Leonardo F Fontenelle, Andrew D Wiese, Latin American Trans-Ancestry Initiative For Ocd Genomics (Latino), Brazilian Obsessive-Compulsive Spectrum Disorder Working Group (Gttoc), James J Crowley, Eric A Storch

Faculty, Staff and Students Publications

Objectives: Transdiagnostic models aim to uncover shared mechanisms across mental disorders. Reward responsiveness (the ability to experience pleasure from rewarding stimuli) is a plausible, yet underexplored, transdiagnostic mechanism linking obsessive-compulsive disorder (OCD) and depression. This study used network analysis to (1) examine how key reward responsiveness domains are interlinked in individuals with OCD and (2) explore how each domain is uniquely associated with OCD and depression.

Methods: A total of 1345 individuals with a history of OCD symptoms (ages 18-88, 71 % women) from Latino communities in the United States (including Puerto Rico) and nine Latin American countries completed validated …

Ticking Away: A Study On How Multiple Sclerosis Patients In The Us And Australia Navigate Their Day, Ella M. Stahl

Honors Theses

Multiple Sclerosis (MS) is an autoimmune disease that damages the nervous system. Individuals diagnosed with MS experience a wide variety of symptoms, the most common being fatigue and numbness in the hands and feet. This disease affects close to three million people worldwide. Current research shows that individuals with chronic conditions spend more time managing their medical issues, therefore impacting their quality of life. This study compares time use of Multiple Sclerosis patients in the US and Australia. The central investigative question is: what are the differences and similarities in time use of those diagnosed with MS in the United …

An Analysis Of Policies Impacting Ex-Offenders And The Barriers Created In Their Transition Into Society: A Qualitative Metasynthesis, Thomas A. Ayala

Theses & Dissertations

In 2018, more than six million people in the United States were under correctional supervision, including incarceration, probation, or parole, equivalent to 1 in 40 adults (Maruschak & Minton, 2020). While this reflects a decline from previous years, prison populations reversed course in 2022, increasing by 2% nationwide, with 36 states and federal facilities reporting higher inmate counts (Nellis, 2024). Since 1973, policy shifts have fueled the rise of mass incarceration (Nellis, 2021; O’Brien, 2020). According to the Pew Center, the United States remains a global outlier, holding 5% of the world’s population, but incarcerates 25% of the 9 million …

Introducing The Outpace Framework For Health Care Quality Improvement, Michele Bolles, Heather M. Alger, Mitchell S. V. Elkind, Howard Haft, Sabra C. Lewsey, Mariell Jessup, Karen E. Joynt Maddox, Chiadi E. Ndumele, Clyde W. Yancy, Christine Rutan, Michelle Congdon, Katherine Overton, Lynn Serdynski, Kathie Thomas, Gregg C. Fonarow

2020-Current year OA Pubs

Equitable, timely, and evidence-based care remains a central goal across health care ecosystems, yet significant quality gaps, care variability, and health disparities persist. Professional societies, including the American Heart Association, have long developed clinical practice guidelines to provide standardized, evidence-based recommendations across the cardiovascular care continuum. These guidelines are operationalized into quality measures to monitor care, identify gaps, and guide improvement. Professional societies, agencies, and health systems have applied implementation science strategies, such as education, data sharing, and evaluation, to improve care quality and achieve quality measures defined in the clinical practice guidelines. American Heart Association's Get With The Guidelines …