Digital Commons Network^™

Incidence Vs. Prevalence, Allen Vean Dmd

Metro Denver Dental Society Articulator Magazine

Despite advances in dental technology, dental caries remain the most common chronic disease in children and adults. This reflection highlights the ongoing challenge of early childhood caries and the critical role of parental supervision, preventive care and collaboration with medical providers.

Mango Fruit Set And Drop: A Comprehensive Review, Haider Ali, Zora Singh, Mekhala Dinushi Kananke Vithana, Jugpreet Singh, Alan Niscioli, Eben Afrifa-Yamoah, Andrew Woodward, Mahmood Ul Hasan, Aman Ullah Malik

Research outputs 2022 to 2026

Insufficient fruit set and excessive fruit drop are key challenges faced within the global mango (Mangifera indica L.) industry, affecting yield consistency and grower’s income as well as adversely impacting global mango trade. Rising temperature regimes and extreme weather events at critical stages of fruit set and development are among the primary driving factors behind these extremely devastating issues in the mango industry. Scientific interventions aimed at regulating fruit set and drop have become increasingly important. Inadequate pollination and fertilisation can also cause poor fruit set, whilst self-incompatibility and stenospermocarpy can cause fruit drop in mango. Mango fruit set and …

Measuring Plantar Flexor Voluntary Activation And Maximal Voluntary Contraction In A Portable, Seated Method: A Validity And Reliability Study, Molly E. Coventry, Andrea B. Mosler, Paola T. Chivers, Brady D. Green, Ebonie K. Rio, Myles C. Murphy

Research outputs 2022 to 2026

Background: Voluntary activation testing quantifies the ability of the motor nervous system to produce maximal force. Laboratory assessment of ankle plantar flexor voluntary activation is common, but field testing in practical settings is limited by equipment portability. We aimed to compare plantar flexor voluntary activation and maximal voluntary contraction (MVC) using a portable device with a standardised laboratory method and evaluate the test–retest reliability of the portable protocol. Methods: We performed a pseudo-randomised, crossover design. Participants completed two protocols: (1) portable force plate testing and (2) a laboratory-based isokinetic dynamometer. Voluntary activation was assessed using twitch interpolation via tibial nerve …

Physical Activity And Exercise Patterns Of Submariners In Land And Sea Environments, Benjamin Kirk, Georgios Mavropalias, Anthony Blazevich, Jodie Cochrane Wilkie, Aus Molan, Kazunori Nosaka

Research outputs 2022 to 2026

Introduction: Submarine environments pose unique challenges to maintaining physical activity and exercise routines due to confined spaces, demanding schedules, and limited resources. This study investigated submariners’ physical activity patterns, sleep quality, and perceived exercise barriers in both land- and sea-based settings, with the goal of informing targeted health interventions. Materials and Methods: Ethics approval was granted by the Defence Science and Technology Group and Edith Cowan University review panels. This cross-sectional study surveyed 21 Royal Australian Navy submariners (25-48 years; 18 male) using a modified version of the International Physical Activity Questionnaire. Participants reported weekly engagement in general physical activity …

Preliminary Evidence Of Blood Dna Methylation Changes In Pregnant Women Adhering To A Mediterranean Diet, Grace Tavelli, Nikki Schultz, Joanna Brisbane, Nina Kresoje, Samantha Lodge, Jeremy K. Nicholson, Nicola J. Armstrong, Desiree Silva, Nina D’Vaz, David Martino

Research outputs 2022 to 2026

Background/Objectives: Consumption of a Mediterranean diet (MD) has been associated with reduced incidence of non-communicable diseases and reduced overall mortality, with epigenomic effects representing plausible mediators. The aim of this pilot study was to explore potential epigenetic associations between DNA methylation markers in blood and adherence to an MD in pregnancy. Methods: Fifty-two pregnant women with high or low adherence to an MD throughout pregnancy, who participated in the BioMood ORIGINS study, were selected using an extremes-of-exposure design. DNA methylation (DNAm) profiles from whole blood were generated using the TWIST human methylome panel. We conducted both genome-wide and candidate gene-based …

Prescribing Tourism: Cultivating Positive Travel Experiences For Individuals With Health Conditions, Fangli Hu, Jun Wen, Sebastian Filep

Research outputs 2022 to 2026

Clinical evidence of tourism's health-related benefits for people with health conditions is notably scarce. Prescribing tourism, wherein medical professionals recommend engaging in tourism activities to enhance overall health and well-being, could offer unique insights into the tourism–health nexus. This paper adopted a conceptual approach, underpinned by a state-of-the-art literature review conducted in accordance with the PRISMA framework to identify knowledge gaps in the existing literature. This paper proposed prescribing tourism as a novel research agenda at the intersection of tourism and health, and further introduced it as a promising approach for people with health conditions, aiming to potentially minimise adverse …

Preserving Residual Kidney Function In Haemodialysis: Current Practices, Challenges, And Perspectives From Renal Clinicians, Lijun Zhong, Ulrich Steinwandel, Hugh Davies, Sara Bayes, Jagadish Jamboti, Hemant Kulkarni, Doris Chan

Research outputs 2022 to 2026

Background: Residual kidney function in patients receiving haemodialysis is associated with improved survival, reduced cardiovascular risk and better quality of life. Yet, clinical guidelines on its preservation are limited, and local practices remain unclear. Objectives: To explore current practices, perceptions and challenges related to residual kidney function preservation among renal clinicians. Design: Descriptive cross-sectional survey. Participants: Renal physicians and nurses working in hospital-based haemodialysis units across Western Australia. Measurements: Role-specific questionnaires were administered to renal physicians and nurses. Results: Eighty-four completed responses were received (physicians n = 25; nurses n = 59). Over half of physicians (56%, n = 14) …

Dietary Flavonoid Intake And Psychological Well-Being – A Bidirectional Relationship, Alysha S. Thompson, Nicola P. Bondonno, Yan Lydia Liu, Farah Qureshi, Laura D. Kubzansky, Claudia Trudel-Fitzgerald, Julia K. Boehm, Eric B. Rimm, Aedín Cassidy

Research outputs 2022 to 2026

Background and aim: Higher dietary flavonoid intake has been associated with lower risks of mortality and major chronic disease, yet its relationship with psychological well-being (PWB), a key contributor to health and quality of life, remains unclear. This study aimed to investigate bidirectional associations between dietary flavonoid intake and two PWB facets: happiness (positive emotional state) and optimism (generalized expectation of positive outcomes). Specifically, we examined whether (1) overall flavonoid-rich dietary patterns (flavodiet score), (2) intake of specific flavonoid-rich foods, and (3) total flavonoid and subclass intakes were each associated with happiness and optimism over time. Methods: Data were drawn …

Neutrophil Gelatinase-Associated Lipocalin And Neutrophil-To-Lymphocyte Ratio As Indicators Of Nephropathy In Type 2 Diabetic Mellitus Patients In Ghana: A Case-Control Study, Allwell Adofo Ayirebi, Wina Ivy Ofori Boadu, Stephen Twumasi, Samuel Kwarteng, Benedict Sackey, Lilian Antwi Boateng, Joseph Boachie, Samuel Essien-Baidoo, Daniel Nii Martey Antonio, John Agyemang Sah, Afua Marfowaa, Mayfair Adwapa Mpiani, Joachim Baba Domosie, Abiba Khalifah, Emmanuel Ekow Korsah, Ebenezer Senu, Eugene Arele Ansah, Joseph Yorke, Enoch Odame Anto

Research outputs 2022 to 2026

Introduction: Serum neutrophil gelatinase-associated lipocalin (sNGAL), a renal tubular marker, and neutrophil-to-lymphocyte ratio (NLR), a hematological inflammatory marker are two biomarkers that have recently received attention, because of their association with kidney disease. This study examined the diagnostic value sNGAL and NLR in type 2 diabetes mellitus (T2DM) patients with nephropathy. Materials and Methods: In this hospital-based case-control research, 97 T2DM participants and 70 healthy subjects were included. Participants' information was documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant and early morning midstream urine samples were collected for blood and urine measurements …

Oral Ferrous Sulphate Supplementation Has Greater Efficacy, But Lower Tolerance Than Iron (Iii)-Hydroxide Polymaltose Complexes In Exercising Women With Low Iron Stores, Alannah Ka Mckay, Sophie Broome, Nicolin Tee, Kin Lui Yim, Marc Sim, Peter Peeling, Louise M. Burke

Research outputs 2022 to 2026

Background & Aims: Iron deficiency (ID) is a global health condition that predominately affects women. Although oral iron supplementation is an effective treatment strategy for this issue, gastrointestinal complaints are common, and if persistent, may lead to poor compliance. The efficacy of different iron formulations which claim to improve tolerance is unclear. This study assessed the efficacy and tolerability of ferrous sulphate (FS) and iron (III)-hydroxide polymaltose complex (IPC) supplementation in three different cohorts of women.. Methods: This study implemented a 12-week, single-blind, randomized controlled trial. Eligible participants had a serum ferritin concentration of <50 μg/L and met specific inclusion criteria to be enrolled to either the athlete, pre-menopausal or post-menopausal groups. Participants were randomized to receive FS (equivalent to 105 mg elemental iron) plus sodium ascorbate or IPC (equivalent to 100 mg elemental iron) daily. Venous blood samples were collected at baseline, 4-, 8- and 12-weeks of supplementation. A daily questionnaire was completed throughout the study period, documenting supplement tolerance (number and severity of symptoms), exercise load, menstrual characteristics, and supplement compliance. Results: Fifty-seven participants completed the intervention with a compliance rate of 94.9 % [range: 74.8-100 %]. A significant interaction between supplement and time was evident for ferritin (p < 0.001), where FS increased after 12 weeks (+109 %; p < 0.001) but no change was evident in IPC (+7 %; p = 0.727). No differences were detected between cohorts (p > 0.05). The IPC group had a …

Made New Again: Refining Cal Poly Made For The Next Generation, Audrey Yae-Ji Malia Kong

Graphic Communication

For my senior project, I aim to focus on how graphics and packaging can positively affect and attract consumers to the product. During this project, I will be taking California Polytechnic State University, San Luis Obispo’s very own products, curated by Cal Poly MADE, and refine their current design and branding. This plan will involve meeting the guidelines of Cal Poly SLO’s branding while creating a more modern design for the Cal Poly MADE products to be appealing to consumers. In order to guarantee the success of this project, I aim to conduct tests centered around the direct customers of …

Mel’S: A Modern Soup Brand Reshaping The Industry, Melody Chaerin Braunstein

Graphic Communication

My senior project focuses on the primary stages of creating a soup brand through market/trend research and branding. During this project, I aim to better understand the process of creating a brand, and the organization needed to flow through different stages.

My project hopes to analyze the current market and determine what it takes to create a successful product that stands out. My goal is to have a cohesive vision of the brand that creates a better baseline for later steps, such as graphic and packaging design, social media, and marketing.

Early Insights From A Multi-Centre National Stroke Surveillance Initiative In Tanzania, Sarah Shali Matuja, Azan Nyundo, Emmanuel Assey, Joel Bwelemo, Marieke Dekker, Sarah Urasa, Emanuel Makarius, Peter Kishimbo, Philip Adebayo, Paschal Ruggajo

Internal Medicine, East Africa

Background: Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry.

Methods: From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality.

Results: A total of 1000 patients were …

Disseminated Iatrogenic Upper Gastrointestinal Kaposi Sarcoma Following Prolonged Steroid Use In A Patients With Crohn's Disease: A Case Report, Glory Makupa, Furaha Serventi, Leila Mwakipunda, Godwin Nnko, Edwin Liwa, Salum Lidenge, Ayesiga Herman, Lilian Gasper, Amos Mwasamwaja, Beatrice Kombole

Internal Medicine, East Africa

Background Kaposi sarcoma is a malignant vascular neoplasm caused by human herpesvirus-8. It is mostly seen in immunocompromised individuals, particularly those with human immunodeficiency virus/acquired immunodeficiency syndrome or organ transplants. Cutaneous and mucosal Kaposi sarcoma manifestation is common; however, Kaposi sarcoma may involve the visceral organs. Iatrogenic or drug-induced Kaposi sarcoma may develop in immunocompromised patients undergoing immunosuppressive medication. It is quite uncommon for patients with inflammatory bowel diseases on immunosuppressive medication to develop intestinal Kaposi sarcoma. This case report describes the clinical presentation of steroid-induced disseminated upper gastrointestinal Kaposi sarcoma in a patient with underlying Crohn’s disease and examines …

Associations Of Moderate-To-Vigorous Physical Activity Timing With Type 2 Diabetes Incidence In Uk Biobank And Prevalent Glycemic Measures In Nhanes, Qiuyu Feng, Gali Albalak, Linjun Ao, Qian Xiao, Heming Wang, Jeroen H P M Van Der Velde, Jessica C Kiefte-De Jong, Martin K Rutter, Charles E Matthews, Joshua R Freeman, Ko Willems Van Dijk, Diana Van Heemst, Raymond Noordam

Faculty, Staff and Student Publications

Objective: We assessed the association between timing of moderate-to-vigorous physical activity (MVPA) with incident type 2 diabetes (T2D) and glycemic measures.

Research design and methods: Regression models were used to assess associations between accelerometer-derived MVPA timing and incident T2D in UK Biobank (UKB) (n = 84,528, prospective), prevalent diabetes, and glycemic measures in the National Health and Nutrition Examination Survey (NHANES) (n = 6,998, cross-sectional).

Results: In UKB, with early morning (0500-0959) MVPA as reference and before adjustment for total MVPA, "variable-timing" MVPA was associated with the lowest incident T2D risk; while after adjustment, afternoon-evening MVPA (1500-2400) showed the lowest …

Barriers To Occupational And Physical Therapy Utilization For Children With Cancer, Maria C Swartz, Shiming Zhang, Donna Kelly, Clark R Andersen, Keri Schadler, Alakh P Rajan, Eduardo Gonzalez Villarreal, Stephanie J Wells, Amy Heaton, Karen Moody

Faculty, Staff and Student Publications

Introduction: Occupational and physical therapy (OT/PT) referrals and utilization barriers for childhood cancer patients have not been adequately examined. The current study investigated factors influencing referrals to and utilization of OT/PT services among children with cancer at an NIH-designated cancer center.

Methods: This retrospective cohort study included pediatric cancer patients (up to 18.99 years) presenting to the center over a 33.5-month period. Variables that could influence referrals to OT/PT were extracted from the electronic medical record (EMR) including OT and PT referrals (inpatient and outpatient), OT and PT consult completion, age at diagnosis, cancer type, sex, race/ethnicity, insurance, cancer treatment, …

Physical Activity In Osteosarcoma Patients During And Post Therapy: A Single Site Prospective Observational Study, Elysia R Cohen, Clark Andersen, Karen Moody, Maria C Swartz, Michael C Robertson, Alakh Rajan, Theresa Honey, Sandra Lugo, Grace Waterman, Keri Schadler

Faculty, Staff and Student Publications

PURPOSE: Osteosarcoma is the most common primary bone tumor in childhood and adolescence. Many patients face long-term impairments in their mobility and function after treatment, leading to a decrease in their quality of life. Exercise has been shown to improve functional recovery and improve quality of life in patients with cancer, though data specific to children with osteosarcoma are sparse. Exercise has also been shown to be feasible in patients undergoing chemotherapy, with numerous potential benefits to health and quality of life. To design the most effective exercise interventions for children and adolescents with osteosarcoma, we must first understand the …

Seeking Traditional Health Practitioners And Use Of Complementary/Alternative Medicines In The Management Of Movement Disorders In Africa: A Multicenter Continental Study, Ali Shalash, Tamer Roushdy, Samia Sassi, Oluwadamilola Ojo, Yusuf Jamnagerwalla, Ahmed Sheikh, Yasser Mecheri, Maouly Fall, Juzar Hooker, Dilraj Sokhi

Internal Medicine, East Africa

Background Traditional health practitioners (THP) and complementary and alternative medicines (CAM) play a well-recognized role in Africa. However, their role in treating movement disorders (MD) remains poorly studied.

Objective This large multicenter continental study aimed to investigate the prevalence of seeking and consulting THPs and using CAMs among people with MDs in different African countries and the associated factors of their use.

Methods This study involved 12 sites within 11 African countries. We developed and distributed a structured questionnaire that documented frequency, attitudes, beliefs, and factors related to patients' engagement with THPs and use of CAMs.

Results We surveyed 1158 …

Human-Centered Design Of Patient Interviews: Capturing The Experiences Of Patients Recovering From Emergency Abdominal Surgery, Jenna L Marquard, Christie L Martin, Elizabeth C Wick, Amanda C Trofholz, Matthew S Loth, Suhyun Park, Genevieve B Melton

The Brown Foundation: Institute of Molecular Medicine

Objectives: Recognizing the challenges of at-home recovery following a truncated presurgical pathway for emergency laparotomy (EL) patients, we sought to identify barriers and facilitators to optimal recovery. This study aimed to develop a human-centered interview guide to capture the experiences of patients recovering at home after EL.

Methods: We employed an iterative human-centered design (HCD) approach to interview guide development, structured across 3 cycles. Each cycle refined the interview guide based on mock interviews and feedback from an interdisciplinary team. In cycle 1, we focused on creating a patient-centered, understandable guide. In cycle 2, we introduced a preinterview survey to …

Exploring Non-Conventional Substrates: The Role Of Hibiscus And Whey In Kombucha Fermentation, Benjamin J. Lee

Master's Theses

This study evaluated the impact of hibiscus and whey as alternative fermentation substrates on the physicochemical, phytochemical, and microbial properties of kombucha. A 2 × 2 full factorial design was used to compare four treatments: black tea + water (BW), black tea + whey (BH), hibiscus + water (HW), and hibiscus + whey (HH). The fermentation solvents (water or whey) were heated to 88 °C, infused with 0.6% (w/v) black tea or hibiscus for 10 minutes, sweetened with 10% (w/v) sucrose, cooled to 22 °C, and inoculated with 20% (v/v) kombucha starter culture. Fermentations were carried out at 22 °C …

Associations Between Nutrition-Related Chronic Disease And Food Insecurity: Data From The California State University, Elizabeth Ochoa

Master's Theses

Food insecurity is a growing public health concern consistently associated with elevated rates of nutrition-related chronic disease (NRCD) across the general population. Despite young adulthood being a critical window for dietary pattern formation, this relationship remains minimally explored among college students. This thesis examined associations between food insecurity and NRCD diagnosis, including hypertension, diabetes, hyperlipidemia, and cardiovascular disease, among undergraduate students across the California State University (CSU) system. Cross-sectional data were drawn from the Spring 2021 CSU National College Health Assessment, administered across all 23 campuses. After exclusions, the analytical sample comprised 13,762 students. Bivariate analyses assessed relationships between key …

Rural Voices On The Opioid Epidemic In Deep East Texas, Jose Carbajal, H. Stephen Cooper

Journal of Human Services: Training, Research, and Practice

Opioid use is a major concern in the United States. Rural communities face even greater difficulties in addressing opioid use and related challenges. An appreciative inquiry was employed to assess the degree to which the opioid crisis has affected the rural region of Deep East Texas and to develop recommendations for a regional action plan. One hundred and eight participants attended eleven conversation cafés across the region. Response analysis revealed eight primary themes and 11 sub-themes. Community awareness and education are crucial in combating the opioid crisis, as some participants were unaware of the prevalence of prescription opioid abuse in …

Undergraduate Health And Wellbeing Course And Study Away Program To Alaska, Lorraine S. Wallace, Steven J. Mousetes, Jennifer Bickley

Journal of Global Education and Research

High-impact practices, such as diversity/global education, have been shown to positively contribute to student development, engagement, and success. As the US is both culturally and linguistically diverse, domestic study away programs can offer students impactful multicultural educational experiences without leaving the country. The purpose of this study was to describe the design of a health and well-being academic course and accompanying study away program to Alaska for undergraduates at The Ohio State University (OSU). The authors (1) describe the application of the backward design process in guiding ELOs development, (2) provide a sample of course assignments and student responses, and …

Aurora – Autonomous Urban & Rural Optimization And Resilience Architecture, Ninad Pandit

Shelby Hall Graduate Research Forum Posters

Problem statement: Undetected systemic “leaks” within large-scale food distribution networks result in severe post-harvest perishable losses and critical nutrient degradation.

Awarded Research Grants As A Pathway To Sustainable Development Goals, Maha Inam, Salim S. Virani, Melaine D'Cruze, Veronica Robi, Peter Gatiti, Anil Khamis

Population Health, East Africa

The United Nations Sustainable Development Goals (SDGs) are a set of global goals that provide an agenda for sustainable growth and development across all sectors and disciplines. However, the contribution of academic institutions from the developing world towards the SDGs has not received adequate attention from the scientific community. A review of all the awarded grants in 2022 and 2023 at an international academic institution was conducted. The objectives outlined in the grant proposals were used to map the SDGs accordingly. A quantitative frequency analysis was conducted to tabulate the results. A total of 293 grants obtained in 2022 and …

Urinary Cotinine Cut-Offs For Tobacco Smoke Exposure In Pregnancy And Associations With Child Intelligence Quotient: A Multi-Cohort Analysis, Yu Ni, Logan C Dearborn, Adam A Szpiro, Christine T Loftus, Qi Zhao, Nicole R Bush, Kaja Z Lewinn, Marnie F Hazlehurst, Thomas F Northrup, Penelope J E Quintana, Eunha Hoh, Georg Matt, Catherine J Karr

Faculty, Staff and Student Publications

Background: Prenatal exposure to tobacco smoke may impair neurodevelopment in children. However, accurately characterizing this exposure remains challenging.

Methods: We pursued two objectives in this large population study. First, in 1708 pregnant women from the Environmental Influences on Child Health Outcomes (ECHO) cohort, we constructed Receiver Operating Characteristic (ROC) curves to determine urinary cotinine cut-offs to classify firsthand (FHS), environmental (ETS), and no exposure, and further distinguished secondhand (SHS) from thirdhand smoke (THS) exposure within ETS. Second, among 1593 participants in three pregnancy cohorts nested in ECHO, we fit multivariable linear regressions to examine the association between the newly defined …

Pharmacogenetics Of Cyp3a5 In Pediatric Patients With Eosinophilic Esophagitis., Janelle R. Noel-Macdonnell Phd, Norah Almahbub, Erin C. Boone, Wendy Y. Wang, Dilyara Cheranova, Lisa Harvey, Valentina Shakhnovich, Rachel Chevalier

Manuscripts, Articles, Book Chapters and Other Papers

Eosinophilic esophagitis (EoE) is an atopic inflammatory disease with limited treatment options. Though swallowed topical steroids are commonly used, they are not effective in all patients. We investigated the presence of CYP3A4/5 and ABCB1 (P-glycoprotein) mRNA in esophageal tissue and its differential expression by genotype in pediatric patients. Esophageal tissue biopsies were obtained from pediatric patients undergoing standard of care endoscopy. Levels of CYP3A4, CYP3A5, and ABCB1 mRNA were measured using droplet digital PCR and compared across patients with and without EoE. Genotypes for common, clinically relevant CYP3A5 variants were evaluated in a cohort of individuals with and without EoE. …

Fare-Free Public Transportation: A Systematic Review Of Outcomes, Joseph S. Lightner, Nancy Ziegler, Tyler Prochnow, Sammi Ford, Jordan A. Carlson, Mallory Moon, Jannette Berkley-Patton, Steven Chesnut, Amanda Grimes

Manuscripts, Articles, Book Chapters and Other Papers

Introduction

Methods

Wayne E. Sabbe Arkansas Soil Fertility Studies 2025, Nathan A. Slaton

Arkansas Agricultural Experiment Station Research Series

Rapid technological changes in crop management and production require that the research efforts be presented in an expeditious manner. The contributions of soil fertility and fertilizers are major production factors in all Arkansas crops. The studies described within will allow producers to compare their practices with the university’s research efforts. Additionally, soil-test data and fertilizer sales are presented to allow comparisons among years, crops, and other areas within Arkansas.

Optimizing Feasibility And Acceptability Of An Online Expressive Writing Intervention For Survivors Of Adolescent And Young Adult Cancer: A Pilot Randomized Trial Of Iterative Modifications And Outcomes, Eunju Choi, Yusi Aveva Xu, Celia Cy Wong-Meli, Michael E Roth, Yisheng Li, Qian Lu

Faculty, Staff and Student Publications

Objective: To evaluate the feasibility of an online expressive writing (EW) intervention for survivors of adolescent and young adult (AYA) cancer and determine whether iterative, theory-driven modifications can enhance response, adherence, and completion rates.

Methods: In this randomized pilot trial, survivors of AYA cancer were recruited through a hospital-based AYA oncology clinic and an online community. Forty participants were randomly assigned to the EW intervention or control group. To improve on lower-than-expected adherence and completion rates in a previous cohort, the protocol was iteratively revised using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Modifications included …