Digital Commons Network^™

Implementation Of Electronic Triggers To Identify Diagnostic Errors In Emergency Departments, Viralkumar Vaghani, Ashish Gupta, Usman Mir, Li Wei, Daniel R Murphy, Umair Mushtaq, Dean F Sittig, Andrew J Zimolzak, Hardeep Singh

Faculty, Staff and Students Publications

Importance: Missed diagnosis can lead to preventable patient harm.

Objective: To develop and implement a portfolio of electronic triggers (e-triggers) and examine their performance for identifying missed opportunities in diagnosis (MODs) in emergency departments (EDs).

Design, setting, and participants: In this retrospective medical record review study of ED visits at 1321 Veterans Affairs health care sites, rules-based e-triggers were developed and implemented using a national electronic health record repository. These e-triggers targeted 6 high-risk presentations for MODs in treat-and-release ED visits. A high-risk stroke e-trigger was applied to treat-and-release ED visits from January 1, 2016, to December 31, 2020. A …

The Impact Of Quantitative Platform On Candidacy For Bronchoscopic Lung Volume Reduction: A Multi-Center Retrospective Cohort Study, Max Wayne, Suchitra Pilli, Hee Jae Choi, Nathaniel Moulton, Praveen Chenna, Allen Cole Burks, Alexander Chen

2020-Current year OA Pubs

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) can be an effective treatment for highly selected patients with severe emphysema but only half of carefully selected patients derive clinical benefit. Two commercially available platforms exist to help determine candidacy for BLVR via quantitative analysis of computed tomography (CT) scans.

OBJECTIVES: To determine if the two commercially available quantitative platforms identified the same patient population that may benefit from BLVR.

DESIGN: A multicenter, retrospective cohort study.

METHODS: Consecutive patients referred for BLVR between January 1, 2022 and March 31, 2023 at three medical centers in the United States with the same CT scan …

Social Determinants Of Occupational Injuries Among Us-Based Commercial Fishermen: A Systematic Review, Shannon Guillot-Wright, Leonard Kuan-Pei Wang, Bibiana Toro Figueira, Mary Overcash Jones, Ruhi Maredia, Nikhita Kichili

Faculty, Staff and Student Publications

BACKGROUND: Commercial fishing is a multibillion-dollar industry that supports job growth, small- to large- businesses, and port and city revenue. The commercial fishing industry continues to be one of the most dangerous in the US, with a fatality rate nearly 40 times higher than the national average. Dangers of the fishing industry are multi-faceted and include hazardous working conditions, strenuous labor, long work hours, and harsh weather. Moreover, a vast majority of fishermen suffer from economic insecurity, including safe and affordable housing and food insecurity.

METHODS: We followed the recommendations and standards set by the Campbell and Cochrane Equity Methods …

12 Cfr Part 217 -- Capital Adequacy Of Bank Holding Companies, Savings And Loan Holding Companies, And State Member Banks (Regulation Q), Federal Reserve System: Board Of Governors

Documents

No abstract provided.

Ypfs Lessons Learned Oral History Project: An Interview With Anthony Dowd, Anthony Dowd, Rosalind Z. Wiggins, Mercedes Cardona

Documents

No abstract provided.

Priority Competencies For Designated Education Officers In The Veterans Health Administration, Duane R. Bidwell, Anita Samuel, Ronald M. Cervero, Steven J. Durning, Sherri L. Stephan, Erin L. Patel, Marjorie A. Bowman, Holly S. Meyer

Population and Public Health Sciences Faculty Publications

Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that …

Associations Between Deficit Accumulation Frailty And Baseline Markers Of Lifestyle In The Us Pointer Trial, Mark A Espeland, Yitbarek N Demesie, Kayloni Olson, Samuel N Lockhart, Sarah E Tomaszewski Farias, Maryjo L Cleveland, Christy C Tangney, Lucia Crivelli, Heather M Snyder, Michele K York, Laura D Baker, Rachel A Whitmer, Rena R Wing, Katelyn R Garcia, Kathryn E Callahan

Faculty, Staff and Students Publications

BACKGROUND: Multidomain lifestyle interventions may have the potential to slow biological aging as captured by deficit accumulation frailty indices. We describe the distribution and composition of the 49-component frailty index developed by the U.S. POINTER clinical trial team of investigators and assess its cross-sectional associations with sociodemographic factors and markers chosen to be representative of behaviors targeted by the trial's multidomain interventions.

METHODS: We draw baseline data from the 2 111 volunteers enrolled in U.S. POINTER who were ages 60-79 years and at increased risk for cognitive decline. Frailty components were grouped into 9 domains. Associations that frailty index scores …

Cannabis Use Characteristics And Associations With Problematic Use Outcomes, Quitting-Related Factors, And Mental Health Among Us Young Adults, Carla J Berg, Cassidy R Loparco, Katelyn F Romm, Yuxian Cui, Darcey M Mccready, Yan Wang, Y Tony Yang, Hannah S Szlyk, Erin Kasson, Rishika Chakraborty, Patricia A Cavazos-Rehg

2020-Current year OA Pubs

OBJECTIVE: Given the changes in trends of cannabis use (e.g., product types), this study examined latent classes of young adult use and associations with use-related outcomes.

METHODS: We analyzed 2023 survey data among 4,031 US young adults (M

RESULTS: LCA identified 4 classes of cannabis use frequency and types used: 'infrequent-herb/edibles' (41.4%), 'frequent-herb' (16.8%), 'moderate-herb' (28.0%), and 'moderate-oil/other' (13.8%). In multivariable analyses (referent group: 'moderate-herb' class), 'frequent-herb' reported less problematic use (B=-0.18, 95%CI=-0.30, -0.07), while 'moderate-oil/other' reported greater (B = 0.39, 95%CI = 0.27, 0.51). 'Infrequent-herb/edibles' had lower odds of driving post-use of cannabis (aOR = 0.28, 95%CI = 0.22, …

Cancer-Related Health Behaviors During The Covid 19 Pandemic In Geographically Diverse Samples Across The Us, Breanna B Greteman, Bettina F Drake, Kia L Davis, Et Al.

2020-Current year OA Pubs

BACKGROUND: The COVID-19 pandemic involved business closures (e.g., gyms), social distancing policies, and prolonged stressful situations that may have impacted engagement in health behaviors. Our study assessed changes in cancer-related health behaviors during the pandemic, specifically physical activity, fruit/vegetable intake, smoking/tobacco use, and alcohol consumption.

METHODS: Eight cancer centers administered mailed/web-based/telephone surveys between June 2020 and March 2021. Surveys assessed demographics, perceptions on social distancing, and self-reported changes of behaviors (less/same/more) associated with cancer prevention or risk, e.g., physical activity, fruit/vegetable intake, tobacco/smoking use, and alcohol consumption. Descriptive analyses and logistic regression models assessed association of variables with behavior change. …

Buprenorphine And Postpartum Contraception Utilization Among People With Opioid Use Disorder: A Multi-State Analysis, Kevin Y Xu, Jennifer K Bello, Joanna Buss, Hendrée E Jones, Laura J Bierut, Dustin Stwalley, Hannah S Szlyk, Caitlin E Martin, Jeannie C Kelly, Ebony B Carter, Elizabeth E Krans, Richard A Grucza

2020-Current year OA Pubs

BACKGROUND: The postpartum period provides an opportunity for birthing people with opioid use disorder (OUD) to consider their future reproductive health goals. However, the relationship between the use of medication for opioid use disorder (MOUD) and contraception utilization is not well understood. We used multistate administrative claims data to compare contraception utilization rates among postpartum people with OUD initiating buprenorphine (BUP) versus no medication (psychosocial services receipt without MOUD (PSY)) in the United States (US).

METHODS: In this retrospective cohort study, we analyzed data from the Merative™ MarketScan

RESULTS: Our sample consisted of 11,118 postpartum people with OUD. Among those, …

Us Military Veterans’ Perceived Concordance With Their Providers Regarding Persistent Physical Symptoms Prospectively Predicts Satisfaction With Care And Adherence To Care Plans, L Alison Phillips, Laura M Lesnewich, Katharine Bloeser, Yong Lin, Rachel L Boska, Justeen K Hyde, Peter J Bayley, Helena K Chandler, Matthew J Reinhard, Susan L Santos, Rachel Stewart, Drew A Helmer, Lisa M Mcandrew

Center for Medical Ethics and Health Policy Staff Publications

Background: Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.

Purpose: This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.

Methods: Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War …

Covid-19 Vaccine Hesitancy Among Black Women In The Us, Brittany C Slatton, Farrah G Cambrice, Serwaa S Omowale

Faculty, Staff and Student Publications

IMPORTANCE: COVID-19 vaccine hesitancy among Black women is a critical public health concern, potentially exacerbating existing health disparities and impacting community-wide vaccination efforts.

OBJECTIVE: To explore the factors associated with COVID-19 vaccine hesitancy among Black women in the US and identify the specific concerns and experiences shaping hesitant attitudes toward vaccination.

DESIGN, SETTING, AND PARTICIPANTS: Qualitative study using in-depth, semistructured interviews conducted virtually between June and November 2021. Thematic analysis was used to identify key themes from the interview data. Participants were recruited through social media platforms and word-of-mouth referrals from various regions of the US. Interviews were conducted remotely …

Cardiovascular Disease And Breast Cancer Stage At Diagnosi\S, Ivan Angelov, Allen M Haas, Elizabeth Brock, Lingfeng Luo, Jing Zhao, Benjamin D Smith, Sharon H Giordano, Nicholas J Leeper, Kevin T Nead

Faculty, Staff and Student Publications

Importance: Cardiovascular disease (CVD) and cancer are the leading causes of mortality in the US. Large-scale population-based and mechanistic studies support a direct effect of CVD on accelerated tumor growth and spread, specifically in breast cancer.

Objective: To assess whether individuals presenting with advanced breast cancers are more likely to have prevalent CVD compared with those with early-stage breast cancers at the time of diagnosis.

Design, setting, and participants: This population-based case-control study used data from the Surveillance, Epidemiology, and End Results-Medicare linked databases from 2009 to 2020. The analysis was completed from May 2023 to August 2024. Participants were …

Adverse Prehospital Events And Outcomes After Traumatic Brain Injury, Amelia W Maiga, Hsing-Hua Sylvia Lin, Stephen R Wisniewski, Joshua B Brown, Ernest E Moore, Martin A Schreiber, Bellal Joseph, Chad T Wilson, Bryan A Cotton, Daniel G Ostermayer, Brian G Harbrecht, Mayur B Patel, Jason L Sperry, Francis X Guyette, Henry E Wang

Faculty, Staff and Student Publications

Importance: While national guidelines recommend avoidance of hypoxia, hypotension, and hypocarbia in the prehospital care of traumatic brain injury (TBI), limited data validate the association of these adverse physiologic events with TBI outcomes.

Objective: To validate the associations of prehospital hypoxia, hypotension, and hypocarbia with TBI outcomes in a US national trauma network.

Design, setting, and participants: This cohort study examined data from 8 level I trauma centers and their affiliated ground and air emergency medical services (EMS) agencies in the Linking Investigations in Trauma and Emergency Services (LITES) Network from January 1, 2017, to June 30, 2021. Adult patients …

Utility Of Candidate Genes From An Algorithm Designed To Predict Genetic Risk For Opioid Use Disorder, Christal N Davis, Alexander S Hatoum, Arpana Agrawal, Et Al.

2020-Current year OA Pubs

IMPORTANCE: Recently, the US Food and Drug Administration gave premarketing approval to an algorithm based on its purported ability to identify individuals at genetic risk for opioid use disorder (OUD). However, the clinical utility of the candidate genetic variants included in the algorithm has not been independently demonstrated.

OBJECTIVE: To assess the utility of 15 genetic variants from an algorithm intended to predict OUD risk.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study examined the association of 15 candidate genetic variants with risk of OUD using electronic health record data from December 20, 1992, to September 30, 2022. Electronic health record …

Covid-19 Pandemic And Racial And Ethnic Disparities In Long-Term Nursing Home Stay Or Death Following Hospital Discharge, Laurent G Glance, Karen E Joynt Maddox, Patricia W Stone, Jingjing Shang, E Yoko Furuya, Ashley M Chastain, Ji Won Lee, Bridget Morse-Karzen, Andrew W Dick

2020-Current year OA Pubs

IMPORTANCE: Long-term nursing home stay or death (long-term NH stay or death), defined as new long-term residence in a nursing home or death following hospital discharge, is an important patient-centered outcome.

OBJECTIVE: To examine whether the COVID-19 pandemic was associated with changes in long-term NH stay or death among older adults with sepsis, and whether these changes were greater in individuals from racial and ethnic minoritized groups.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used patient-level data from the Medicare Provider Analysis and Review File, the Master Beneficiary Summary File, and the Minimum Data Set. Community-dwelling individuals aged at least …

Factors Impacting Undergraduate Student Use Of Mental Health Care In The U.S. And France, Samantha Lamontagne

CISLA Senior Integrative Projects

No abstract provided.

“God’S Image Carved In Ebony” : African-American Women In The Holiness Movement, Robert A. Danielson

Academic Books

No abstract provided.

Part 5: Silver Tsunami For The Third Sector, Dragas Center For Economic Analysis And Policy, Old Dominion University

State of the Region Reports: Hampton Roads

Affordable housing is only one of several societal stressors predicted to have nationwide impacts in conjunction with what has been dubbed the “Silver Tsunami,” a significant demographic shift occurring in the United States. According to Pew Research, every day, 10,000 members of the baby boomer generation—born between 1946 and 1964—reach retirement age. The implications of this demographic shift will impact every facet of life in Hampton Roads. This chapter explores how an aging population impacts nonprofits in Hampton Roads.

U.S. - China Technological Rivalry And The Future Of International Scientific Norms, Tatum Mosley

McNair Summer Research Program

This study is investigating how technological competition between the United States and China is reshaping international norms of scientific cooperation, with a particular focus on the semiconductor and computing sectors. Drawing on constructivist international relations theory, this research evaluates changes in norms of openness, academic exchange, multilateral governance, and ethical convergence. Using sector specific case studies, it compares the current U.S. - China dynamics to Cold War era science diplomacy. The analysis highlights growing fragmentation, norm divergence, and institutional strain as the global scientific order enters an era of techno-nationalist rivalry. It also considers whether new norms are emerging in …

The State Of Local Anaesthetic Systemic Toxicity In 2025: The Emergence Of Lidocaine As Our Next Challenge, Eric Schwenk, J Robert Sneyd, Christopher Wu

More Faculty of Health Research

Local anaesthetics are an integral part of surgical and medical practice, but their systemic uptake can result in local anaesthetic systemic toxicity (LAST). A recent study by Fettiplace and colleagues examined the US Food and Drug administration’s Adverse Events Reporting System between 1968 and 2023. Although the reporting of death from longacting local anaesthetics decreased after the publication of relevant practice advisories, Fettiplace and colleagues also found that deaths from lidocaine remained essentially unchanged. The emergence of lidocaine as the leading reported cause of deaths attributable to LAST was unexpected, and the reasons behind the relatively higher number of deaths …

The Potential For Albedo-Induced Climate Mitigation Using No-Till Management In Midwestern U.S. Croplands, Xian Wang, Mallory Barnes, Landon Yoder, Christopher A. Williams, Jennifer Tank, Todd Royer, Shellye Suttles, Kim Novick

Geography

No-till management is often recognized for its environmental and economic benefits, but its potential to reduce climate warming is still uncertain. Beyond ongoing debate over its effects on soil carbon storage, no-till also leaves plant residue on the surface, which can reflect more sunlight. This increase in surface reflectivity, called albedo, may help mitigate climate change by reducing the energy absorbed by the land. Here, we assessed this climate benefit of no-till across the U.S. Corn Belt using conservation survey records, county-level tillage data, and satellite observations. We found that no-till increased land surface brightness during the dormant season, reducing …

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 U.S. 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 …

Lower Electronic Health Record Adoption And Interoperability In Rural Versus Urban Physician Participants: A Cross-Sectional Analysis From The Cms Quality Payment Program, Alfred J. Anzalone, Carol R. Geary, Ran Dai, Shinobu Watanabe-Galloway, James C. Mcclay, James Campbell

Journal Articles: Epidemiology

BACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 introduced the Meaningful Use program to incentivize the adoption of electronic health records (EHRs) in the U.S. This study investigates the disparities in EHR adoption and interoperability between rural and urban physicians in the context of federal programs like the Medicare Access and CHIP Reauthorization Act of 2015 and the 21st Century Cures Act.

METHODS: A cross-sectional analysis was conducted using the 2021 Quality Payment Program Experience Report Public Use File to compare EHR adoption and Promoting Interoperability scores (PISs) between urban and rural physician participants. Data …

Representing Climate Wreckers, Camila Bustos

Elisabeth Haub School of Law Faculty Publications

In recent years, lawyers have become increasingly aware of the implications of the climate crisis for legal practice. Amidst this context, United Nations Secretary General Ant6nio Guterres has urged recent graduates to decline work on behalf of "climate wreckers." This Article examines how professional responsibility rules and principles in the United States should be interpreted on a warming planet, particularly in the context of attorneys representing so-called "climate wreckers" in civil matters. I use the term "climate wrecker" to refer to fossil fuel corporations and trade associations that have engaged in public disinformation campaigns to stall climate action and sow …

Abundance And Other Food Fixations, Margot J. Pollans

Elisabeth Haub School of Law Faculty Publications

Although most people in the United States no longer devote the majority of their time to food production, processing, and distribution, food remains a daily fixation. This Article explores three driving food fixations--abundance, thinness, and health--and situates each against an inverse fear--scarcity, fatness, and illness, respectively. Mapping these threats onto U.S. food policy, this Article examines, among other policy arenas, food waste policy, nutrition and health claim labeling law, and food additive regulations. Across food policy, these fixations feed what this Article calls the “politics of abundance.” This politics helps to insulate the food industry from deeper systemic reform aimed …

Relationship Partners’ Experiences Of Managing Conflict With Individualist And Collectivist Cultural Perspectives: A Reflexive Thematic Analysis, Rebecca Alithia Payan

Department of Conflict Resolution Studies Theses and Dissertations

In the United States, the increasing number of multicultural marriages leads to the individualistic traditional American nuclear family colliding with ideals from a collective culture. This conflict over individualistic and collective nature can lead to martial conflict, including divorce. In this context, this study seeks to answer an important question: How do relationship partners experience managing conflict, considering individualist and collectivist perspectives in the United States? The methodology utilized the Medium-Q of Reflexive Thematic Analysis of data gathered from qualitative open-ended interview questions and a brief survey. Findings reveal engaging themes, leading us to understand that individualism and collectivism influence …

Cronyism In Creating Chronic Disease—A Path To Food Justice, Martha Leonard

St. Thomas Law Review

Central to this discussion is a quote often attributed to the ancient Greek physician Hippocrates: “Let food be thy medicine, and medicine be thy food.” Today, physicians recognize the crucial role of diet in maintaining good health and preventing chronic disease, but U.S. laws fail to reflect this understanding. The health field has seen significant progress in scientific research on pathology; however, nutritional research presents a challenging and contradictory landscape. Corporate influence in scientific research leads to a lack of consensus on the most optimal diet for promoting general health, presenting a challenge for policymaking. The dark reality is that …

The New World's Pandemic: Sexual Exploitation In The Digital Age, Rocio Iglesias Gonzalez

St. Thomas Law Review

Mary is a fifteen-year-old who is excited about starting her sophomore year of high school. Unbeknownst to Mary, George, a classmate whose romantic advances Mary had rejected, created a sexually explicit image generated by artificial intelligence, most commonly known as a deepfake, of Mary and started sending it to other classmates. Once Mary discovered the deepfaked pictures, she and her parents sought legal advice on available remedies. Unfortunately, Mary lives in Nevada, a state that has no legislation addressing the issue of nonconsensual sexually explicit deepfakes. Similarly, at the federal level, Mary has no course of action against her offender. …

No Remedy For Colonization, Sigrid Vendrell-Polanco

Faculty Articles

The United States purports to maintain a democratic relationship with its inhabited territories, yet the Supreme Court continues to uphold twentieth century laws that affirm rather than abrogate colonial policies. The gap between how the United States idealizes democracy and its real world application, especially in its five colonized territories (Puerto Rico, American Samoa, Guam, the Northern Mariana Islands, the United States Virgin Islands, and American Samoa), is not just growing—it is becoming a chasm. These colonies are currently referred to as United States territories. In 2023, the U.S. territory of Puerto Rico experienced a controversial sovereignty challenge surrounding the …