Digital Commons Network^™

Oral Microbiome Profile Of The Us Population, Anil K Chaturvedi, Emily Vogtmann, Jianxin Shi, Yukiko Yano, Martin J Blaser, Nicholas A Bokulich, J Gregory Caporaso, Maura L Gillison, Barry I Graubard, Xing Hua, Autumn G Hullings, Lisa Kahle, Rob Knight, Shilan Li, Jody Mclean, Vaishnavi Purandare, Yunhu Wan, Neal D Freedman, Christian C Abnet

Faculty, Staff and Student Publications

Importance: The oral microbiome likely plays key roles in human health. Yet, population-representative characterizations are lacking.

Objective: To characterize the composition, diversity, and correlates of the oral microbiome in US adults.

Design, setting, and participants: This cross-sectional study analyzed data from the population-representative National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012. Microbiome data were made publicly available in 2024. NHANES participants were aged 18 to 69 years and provided oral rinse samples in 1 of 2 consecutive NHANES cycles (2009-2010 and 2011-2012).

Exposures: Demographic, socioeconomic, behavioral, anthropometric, metabolic, and clinical characteristics.

Main outcomes and measures: Oral microbiome …

Evolution And Strengths Of School Lunch Programs In The United States And Japan, Sarah Ritterling

Honors Program: Senior Projects (Public)

School lunches around the world perform a vital role in children’s nutritional needs and overall health. These nutritional programs provide a chance for children to learn how to create a balanced meal and about the production and serving of food. However, many countries, including the United States and Japan, have taken different approaches to meet these goals, influenced by the needs of children and communities over time. The United States provides support, funding, and nutritional standards through the National School Lunch Program. Japan promotes the Basic Act of Shokuiku (food and nutrition education) within society and outlines goals for schools …

Sermon Series Impact : Evaluating The Impact Of A Sermon Series From The Book Of James, Santosh Sharma

ATS Dissertations

No abstract provided.

Church Planting : Challenges, Opportunities, And Nurturing Healthy Churches, Michael Magar

ATS Dissertations

No abstract provided.

Deconstructing Politicism : How Multiethnic Churches Can Maintain Scriptural Unity In The Midst Of Political Diversity, Morgan Stephens

ATS Dissertations

No abstract provided.

Enteral Nutritional Practices In Extremely Preterm Infants: A Survey Of U.S. Nicus, Mar Romero-Lopez, Mamta Naik, Lindsay F Holzapfel, Jon E Tyson, Claudia Pedroza, Kaashif A Ahmad, Matthew A Rysavy, Waldemar A Carlo, Yuxin Zhang, Covi Tibe, Ariel A Salas

Faculty, Staff and Student Publications

No abstract provided.

Temporal Trends Of Subsequent Central Nervous System Malignancies Among Survivors Of Childhood Cancer, Robert T Galvin, Yan Chen, Yan Yuan, Tabitha Cooney, Rebecca Howell, Susan Smith, Michael A Arnold, Miriam Conces, Wendy Leisenring, Gregory T Armstrong, Joseph P Neglia, Lucie M Turcotte

Faculty, Staff and Student Publications

Background: It is not known whether temporal changes in childhood cancer therapy have reduced risk of subsequent malignant neoplasms of the central nervous system (CNS), a frequently fatal late effect of cancer therapy.

Methods: Five-year survivors of primary childhood cancers diagnosed between 1970 and 1999 in the Childhood Cancer Survivor Study with CNS subsequent malignant neoplasms were identified. Cumulative incidence rates and standardized incidence ratios were compared among survivors diagnosed between 1970-1979 (n = 6223), 1980-1989 (n = 9680), and 1990-1999 (n = 8999). Multivariable models assessed risk factors for CNS subsequent malignant neoplasms.

Results: A total of 157 CNS …

Recent And Future Trends In Osteopathic Orthopedic Surgery Residency Match Rates Following The Transition To A Single Accreditation System., Morgan Turnow, Minali Nemani, Nithin Gupta, Hayden Hartman, Taylor Manes, Tyler Williamson, Arianna Gianakos

Medical Education Articles

CONTEXT: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field.

OBJECTIVES: The main objective of …

Refractive Error And Axial Length (Real) Study: Feasibility Of A Population Study In The United States, Sarah E. Singh Dr, Lisa A. Ostrin, Kristen Kerber Dr, Concepcion Cayle, Celia Gong Dr, Lal Barsha Dr, Ian Flitcroft, Síofra Harrington, James Loughman, Kathryn Saunders Prof, Fuensanta Vera-Diaz Dr

Articles

Myopia is the most common eye disease and a leading cause of blindness. A contemporary, large, and ethnically and geographically diverse study of ocular biometry and refractive error in children in the United States is needed to help better describe differences between myopic and nonmyopic eyes.

This is an initial cross-sectional report from the Refractive Error and Axial Length Growth Curve Study that includes ocular component data as a function of age, gender, and geographic location. This feasibility report will inform a planned larger longitudinal ocular growth study in children in the United States.

Cross-sectional data on children, ages 3 …

Treatment Patterns And Survival Among Veterans With De Novo Metastatic Hormone-Sensitive Prostate Cancer, Martin W Schoen, Saira Khan, Eric M Knoche, Et Al.

2020-Current year OA Pubs

IMPORTANCE: Combination therapy for metastatic hormone-sensitive prostate cancer (mHSPC) has been widely adopted, yet clinical use and outcomes are unknown. Furthermore, optimal therapy is uncertain due to lack of direct comparison of androgen receptor pathway inhibitors (ARPIs) and docetaxel in high-volume disease.

OBJECTIVE: To evaluate the use of combination therapy and its association with overall survival among patients with mHSPC and to compare ARPIs vs docetaxel doublet therapy by volume of disease.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study was conducted in the US Veterans Health Administration among 6216 US veterans with de novo mHSPC from January 1, 2013, …

Clinical Validation Of A Vaginal Cervical Cancer Screening Self-Collection Method For At-Home Use: A Nonrandomized Clinical Trial, Megan B Fitzpatrick, Colleen Mcnicholas, Lindsay Kuroki, Et Al.

2020-Current year OA Pubs

IMPORTANCE: One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening.

OBJECTIVE: To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport.

DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites …

Aiming High: A Narrative Inquiry Of Christian Music Educators’ Higher Purpose, William E. Rhoden Iii

Doctoral Dissertations and Projects

Educators in the United States may question music education’s higher purpose, considering high-stakes testing and an emphasis on non-musical subjects. This qualitative narrative study examines three American protestant Christian music educators’ perceptions of music education’s higher purpose and compares them to Martin Luther’s (1483-1546) writings. The researcher conducted interviews with three participants to record the story of how they developed their higher purpose for music education. The data was tabulated and coded for thematic analysis. This study supports a Christian defense of continued music education in America’s schools, distinguishes modern Christian perspectives, and offers a fresh understanding of the historical …

The Challenges Small And Medium-Sized Businesses Face Adopting Digital Supply Chain Technologies: A Case Study Of Firms In Traditional Industries In The United States, Michael S. Stevens

Doctoral Dissertations and Projects

This research examined the digital transformation of supply chains within small and medium-sized businesses (SMBs), focusing on the challenges firms in traditional industries in the United States face in adopting these technologies to improve performance. Through a single case study qualitative approach, the study examined why some SMBs face these challenges, digital supply chain technologies affect business performance, and which technologies they contemplate to achieve their desired outcomes. Key findings indicate that most SMBs are between the digitization and digitalization phases of the digital transformation journey and are driven to adopt digital technologies that enable operational performance for scalable profitability. …

Impact Of Chatgpt And Large Language Models On Radiology Education: Association Of Academic Radiology-Radiology Research Alliance Task Force White Paper, David H Ballard, Alexander Antigua-Made, Emily Barre, Elizabeth Edney, Emile B Gordon, Linda Kelahan, Taha Lodhi, Jonathan G Martin, Melis Ozkan, Kevin Serdynski, Bradley Spieler, Daphne Zhu, Scott J Adams

2020-Current year OA Pubs

Generative artificial intelligence, including large language models (LLMs), holds immense potential to enhance healthcare, medical education, and health research. Recognizing the transformative opportunities and potential risks afforded by LLMs, the Association of Academic Radiology-Radiology Research Alliance convened a task force to explore the promise and pitfalls of using LLMs such as ChatGPT in radiology. This white paper explores the impact of LLMs on radiology education, highlighting their potential to enrich curriculum development, teaching and learning, and learner assessment. Despite these advantages, the implementation of LLMs presents challenges, including limits on accuracy and transparency, the risk of misinformation, data privacy issues, …

Multiregional Implementation Initiative's Impact On Guideline-Based Performance Measures For Patients Hospitalized With Heart Failure: Implement-Hf, Andrew J. Sauer, Nancy Sweitzer, Et Al.

2020-Current year OA Pubs

BACKGROUND: Despite randomized data for survival benefit (with class 1 recommendations) for treating heart failure (HF) with reduced ejection fraction using quadruple medical therapy (QMT)-defined as evidence-based β-blockers, sodium-glucose cotransporter 2 inhibitor, preferably angiotensin receptor/neprilysin inhibitor, and mineralocorticoid receptor antagonist-it is underutilized. IMPLEMENT-HF is a multiregional HF quality improvement initiative to improve care and outcomes for patients with HF by enhancing the use of QMT in routine practice.

METHODS: This analysis of HF with reduced ejection fraction treatment in patients from hospitals participating in the American Heart Association's Get With The Guidelines-HF who volunteered to participate in IMPLEMENT-HF in 7 …

Trends In Urology Residency Applications: Results From The American Urological Association Medical Student Survey From 2022 To 2024, Michael Creswell, Kirsten Greene, Lee Richstone, Simone Thavaseelan, Erica Traxel, Aaron Tverye, Casey Kowalik, Gina Badalato, Thomas Jarrett, Kate Kraft, Mathew Sorensen, Moben Mirza

2020-Current year OA Pubs

OBJECTIVE: To provide a comprehensive overview of the American Urological Association Medical Student Surveys and includes data 2022, 2023, and 2024.

METHODS: Data collected through surveys distributed prior to match day and were distributed to all medical students who submitted a rank list for urology residency. Questions consisted of various topics, including applicant demographics, application metrics, and experiences with preference signals and virtual interviews.

RESULTS: 440 (79%), 428 (84%), and 387 (77%) applicants participated in surveys for the years 2022, 2023, and 2024, respectively. Applicants continue to participate in research at a high level. Additionally, United States Medical Licensing Exam …

Prevalence And Patterns Of Opioid Use In Chronic Pancreatitis, Anna Evans Phillips, Darwin L Conwell, Shuang Li, Jami L Saloman, Phil A Hart, Evan L Fogel, Santhi Swaroop Vege, Dana K Andersen, William E Fisher, Christopher E Forsmark, Stephen Pandol, Walter G Park, Mark D Topazian, Stephen K Van Den Eeden, Jose Serrano, Liang Li, Dhiraj Yadav

Faculty, Staff and Student Publications

Introduction: Opioids are used to treat pain in chronic pancreatitis (CP), but little is known about current use patterns. The aim of this study was to characterize the utilization of opioids and associations with clinical characteristics in adult patients with CP.

Methods: This cross-sectional analysis used baseline data from participants with definite CP enrolled in a cohort study in the United States (PROspective Evaluation of CP for EpidEmiologic and Translational StuDies). Data on demographics, pain medication use, healthcare utilization, disability, and pain patterns were systematically collected in case report forms while quality of life was assessed with patient-reported outcome instruments. …

Testing For Bleeding Disorders In Child Abuse: Aap Recommendation Adherence And Testing Results, Lyndsey Hultman, Angela Doswell, Henry T Puls, Shannon L Carpenter, Angela Bachim, Caitlin R Mcnamara, Farah W Brink, Lori D Frasier, Nancy S Harper, Natalie Laub, Kristine A Campbell, Daniel M Lindberg, Joanne N Wood, James Anderst

Faculty, Staff and Students Publications

Objectives: Using a multicenter child abuse pediatrics research network (CAPNET), the study objectives were to characterize the adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification.

Methods: We performed a descriptive study of bleeding disorder evaluations among children younger than 10 years of age who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse from February 2021-May 2022 utilizing CAPNET. Cases were classified as bruising without ICH or ICH with or without bruising. Based on AAP guidance, testing was not recommended in cases with concomitant suspicious injuries, inflicted injury …

The Influence Of The American Association For Thoracic Surgery On Clinical Trial Development By Cardiothoracic Surgeons, Adishesh K Narahari, Taylor M Horgan, Anirudha S Chandrabhatla, Abhinav Kareddy, Ajami Gikandi, Marco A Zenati, David Harpole, David Jones, Leora T Yarboro, Bryan Burt, A Sasha Krupnick, J Hunter Mehaffey

Faculty, Staff and Students Publications

Objective: Clinical trials play a critical role in the rapidly evolving field of cardiothoracic surgery and the American Association for Thoracic Surgery Clinical Trials Methods Course has provided a biannual symposium led by preeminent surgeons with vast experience in planning, conducting, and analyzing surgical clinical trials. This study hypothesizes that participation in the course is associated with future success in clinical trial leadership.

Methods: A list of course attendees (2014-2022) was queried in ClinicalTrials.gov, a database of clinical trials funded by the US Department of Health and Human Services and the National Institutes of Health. The type of clinical trial …

Cdc’S Core Elements To Promote Diagnostic Excellence, Daniel J Morgan, Hardeep Singh, Arjun Srinivasan, Andrea Bradford, L Clifford Mcdonald, Preeta K Kutty

Faculty, Staff and Students Publications

Nearly a decade after the National Academy of Medicine released the "Improving Diagnosis in Health Care" report, diagnostic errors remain common, often leading to physical, psychological, emotional, and financial harm. Despite a robust body of research on potential solutions and next steps, the translation of these efforts to patient care has been limited. Improvement initiatives are still narrowly focused on selective themes such as diagnostic stewardship, preventing overdiagnosis, and enhancing clinical reasoning without comprehensively addressing vulnerable systems and processes surrounding diagnosis. To close this implementation gap, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of …

How To Use Social Media And Artificial Intelligence To Promote Mental Health Among Chinese And Chinese American College Students In The U.S., Ni Zhang, Jingru Guan, Terry Zou, Tianqin Shi, Kaikai Liu

Faculty Research, Scholarly, and Creative Activity

This study explored the potential of using social media and artificial intelligence (AI) to tackle language and cultural barriers in order to promote mental health among Chinese and Chinese American college students. Ten bilingual (Chinese Mandarin and English) focus group sessions were conducted over Zoom with 26 Chinese and Chinese American students at a university on the west coast of the United States between October 2023 and February 2024. Thematic analysis of the focus group meeting transcripts was conducted via deductive coding and then inductive selection of quotes on Google Document and Nvivo. Social media provides a platform for providing …

Functional Vision Assessment Over 4 Years In Ush2a Using The Veteran Affairs Low-Vision Visual Functioning Questionnaire, Bela Parekh, Nicholas Peck-Dimit, Jacque L Duncan, Lassana Samarakoon, Maria Fernanda Abalem, Chris A Andrews, Isabelle Audo, Allison R Ayala, Chris Bradley, Janet K Cheetham, Gislin Dagnelie, Todd A Durham, Rachel M Huckfeldt, Gabrielle D Lacy, Brett Malbin, Michel Michaelides, David C Musch, Katarina Stingl, Christina Y Weng, Alex Z Zmejkoski, Michele Melia, K Thiran Jayasundera, Foundation Fighting Blindness Clinical Consortium Investigator Group

Faculty, Staff and Students Publications

Purpose: The purpose of this study was to evaluate the validity of the Veterans Affairs Low Vision Visual Functioning Questionnaire (VALVVFQ-48) functional vision scores (FVS) in patients with USH2A-associated retinal degeneration. In addition, to correlate the change in the VALVVFQ-48 FVS with the change in visual function (VF) measurements.

Methods: The VALVVFQ-48 was administered verbally to participants ≥18 years of age at baseline, and after 2 and 4 years. Associations among changes in FVS and changes in VF measures were assessed using the Spearman correlation coefficients. Mixed effects regression models with a random intercept were used to estimate annual rates …

Heterosexual-Identified Men Who Have Sex With Men And Men Of Diverse Sexual Identities: Protocol For An International, Multilingual, Online, Comparative Sexuality Study, Andrew D. Eaton, Megan Rowe, Salem Rao, Oliver Beer, Paul Shuper, Tyrone Curtis, Adam Busch, Lauren B. Mcinroy

School of Health Professions

Background: Sexuality is multidimensional and complex, comprised of identity development, attraction, and behaviour. Heterosexual-identified men who have sex with men (H-MSM) experience sexual identity and behaviour discordance yet it is unknown how H-MSM compare to concordant heterosexual men as well as gay, bisexual, and queer (GBQ+) men regarding sexuality constructs.Objective: To survey adult cisgender men in Canada, the United States, and the United Kingdom to gain greater insight into how different demographics, identity development, attractions, behaviours, technology use, relationship negotiation and communication skills, and PrEP and life satisfaction relate to each other, and then to interview H-MSM for in-depth follow-up …

Trends In Medicare Payments Within The First Year Of Cervical Cancer Diagnosis, 2010–2019, Mohammad A Karim, Ning Zhang, Hui Zhao, Ya-Chen Tina Shih, Lakshmi S M Kodali, Sharon H Giordano, Sanjay Shete

Faculty, Staff and Student Publications

Assessing Medicare payment trends for cervical cancer care is important to mitigate the financial impact on Medicare. This multiyear cross-sectional study included 65 years and older cervical cancer patients in SEER registries diagnosed between 2010 and 2019 who had continuous Part A and B Medicare coverage at least 6 months before diagnosis and at least within the first year of diagnosis and were not enrolled in any Health Maintenance Organization (HMO) in this duration. The main outcomes were trends in total and service-specific mean monthly Medicare payments within the first year of a cervical cancer diagnosis. This study included 2147 …

Synergies, Partnership Outcomes, And Lessons Learned: A Qualitative Evaluation Of Cancer Center-Coalition Engagement, Aubrey Villalobos, Sarah Chavez, Bettina Drake, Et Al.

2020-Current year OA Pubs

BACKGROUND: Nine National Cancer Institute-Designated Cancer Centers received supplemental funding to expand community outreach and engagement activities through a partnership with Centers for Disease Control and Prevention-funded comprehensive cancer control coalitions. This article reports on an evaluation of these awards focused on organizational relationships and partnership outcomes.

METHODS: The National Cancer Institute, community outreach and engagement, and coalition representatives co-designed the evaluation, which involved document review and 18 semistructured interviews with 16 community outreach and engagement and 19 coalition representatives. Artificial intelligence-generated interview transcripts were dual-coded in NVivo, version 20/R1, software.

RESULTS: The funding generated a diverse collection of projects …

Effect Of A Digital Health Exercise Program On The Intention For Spinal Surgery In Adult Spinal Deformity: Exploratory Cross-Sectional Survey, Marsalis Christian Brown, Christopher Quincy Lin, Christopher Jin, Matthew Rohde, Brett Rocos, Jonathan Belding, Barrett I. Woods, Stacey J. Ackerman

Rothman Institute Papers

BACKGROUND: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic's (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD.

OBJECTIVE: This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users' intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery.

METHODS: Individuals …

Whither Leviathan? The Seepage Of Constitutional Law Into Public-Private Arbitration In The United States, Peter B. Rutledge

Scholarly Works

The chapter analyses how constitutional law influences private-public arbitration in the United States. Its central thesis is that constitutional law exerts a powerful indirect influence on arbitration law. While the US Constitution does not directly regulate arbitration, its underlying norms—such as separation of powers, federalism, and individual rights—impact arbitration law indirectly. The chapter explores the ways in which these constitutional principles influence public-private arbitration through statutory interpretation, treaty design, and private protocols reflecting constitutional norms. This pattern of influence manifests itself in public arbitration (i.e. arbitration involving states or state-owned entities) just as it does in private arbitration. Highlighting how …

Rural-Urban Disparities In Hospitalisation For Myocardial Infarction In Systemic Lupus Erythematosus In The Usa, Jasvinder A Singh, Sumanth Chandrupatla

Faculty, Staff and Students Publications

Objective: To assess whether rural-urban disparities exist in people with SLE for hospitalisation with myocardial infarction (MI).

Methods: We used the 2016-2019 US National Inpatient Sample data that contain all hospitalisation data. In people with a diagnosis of SLE, we assessed the multivariable adjusted ORs (aORs) to examine the association of rural patient residence with MI hospitalisation, while adjusting for demographics, payer, income, hospital characteristics and the Deyo-Charlson Comorbidity Index.

Results: We found that the crude rates of patients hospitalised with MI per 100 000 area specific SLE hospitalisations were higher in rural versus urban residents with SLE, 2265 versus …

Physical Activity Measurement Reactivity Among Midlife Adults With Elevated Risk For Cardiovascular Disease: Protocol For Coordinated Analyses Across Six Studies., Kiri Baga, Gabrielle M Salvatore, Iris Bercovitz, Amanda L Folk, Ria Singh, Laura M König, Meghan L Butryn, Jacqueline A Mogle, Danielle Arigo

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death in the United States, and adults aged 40-60 years with specific health conditions are at particularly elevated risk for developing CVD. Physical activity (PA) is a key cardioprotective behavior and many interventions exist to promote PA in this group. Effective promotion requires accurate assessment of PA behavior; as PA is often estimated by averaging across multiple days, a threat to accurate assessment is measurement reactivity, or an atypical increase in PA behavior at the start of measurement periods that may bias conclusions. Evidence for PA measurement reactivity is equivocal, though …

Impact Of Antidiabetic Medication Type On A New Episode Of Depression: A Retrospective Cohort Study In Texas, Usa, Lin-Na Chou, Mukaila A Raji, Holly M Holmes, Yong-Fang Kuo

Faculty, Staff and Student Publications

Objectives: To examine the associations between antidiabetic medication type and a new episode of depression using 100% Texas Medicare database during 2009 and 2018.

Design: A retrospective cohort study.

Setting: A population-based study using the Texas Medicare data.

Interventions: 11 common antihyperglycaemic medication types, alone and in combinations: metformin-only, five non-metformin-containing regimens (dipeptidyl peptidase-4 inhibitor (DPP4i) only, sulfonylureas (SU) only, thiazolidinediones (TZD) only, SU/DPP4i and SU/TZD) and five metformin-containing combination treatments (metformin/DPP4i, metformin/SU, metformin/TZD, metformin/SU/DPP4i and metformin/SU/TZD).

Participants: This study included 59 057 type 2 diabetes (T2D) patients from a cohort of Texas Medicare beneficiaries who were aged ≥66 years, …