Digital Commons Network^™

Psychosocial Predictors Of Depression And Anxiety In Thai Stroke Caregivers, Chanatip Tongyonk, Sorawit Wainipitapong, Chavit Tunvirachaisakul, Aurauma Chutinet, Michael Maes, Thitiporn Supasitthumrong

Chulalongkorn Medical Journal

Background: Caregivers of stroke survivors often face significant psychological challenges, yet limited research in Thailand has explored how patient and caregiver characteristics jointly influence caregiver mental health outcomes.

Objective: To identify characteristics of ischemic stroke patients and their caregivers that may predict distress, sadness, and anxiety symptoms in the caregivers.

Method: To measure caregivers' burden, stress, depression, and anxiety symptoms, the Hospital Anxiety and Depression Scale (HADS), Zarit Burden Interview (22-item ZBI), and Perceived Stress Scale (PSS-10) were utilized. To define a multi-step mediation model, we used partial least squares structural equation modelling (PLS-SEM).

Result: 97 stroke patients and their …

The Association Between Sarcopenia And Functional Outcomes After Bipolar Hemiarthroplasty In Elderly Patients With Displaced Femoral Neck Fracture. Structural Equation Modeling., Sanzhar Artykbay, Stephen J. Kerr, Saran Tantavisut

Chulalongkorn Medical Journal

Background: Sarcopenia is an underrecognized condition that may impair recovery after hip fracture surgery in older adults.

Objectives: This study aimed to assess the impact of sarcopenia on functional outcomes and hip muscle strength in elderly individuals with femoral neck fractures while accounting for other potential confounding factors through a structural equation model (SEM).

Methods: Between January 2023 and October 2024, a prospective cohort study at a tertiary university hospital enrolled patients aged 60 and older undergoing bipolar hemiarthroplasty for displaced femoral neck fractures. Functional recovery was evaluated at 3-months follow-up using the Barthel Index (BI), Short Physical Performance Battery …

Factors Influencing Outcomes In Neonatal Abdominal Surgery: Surgeons’ Perspectives, Nimmita Srisan, Kanyarat Olarachin, Pattamon Sutthatarn, Katawaetee Decharun, Prapapan Rajatapiti, Somboon Reukvibunsi, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Neonatal abdominal surgery was often indicated by congenital conditions, presenting significant risks of morbidity and mortality. However, comprehensive surgical data and identification of complication-related risk factors still receive little attention.

Purpose: Our objectives were to characterize neonatal patients undergoing abdominal surgery and to identify prognostic factors influencing complications and mortality in those patients.

Methods: A retrospective study was conducted on newborn patients aged between 0-30 days undergoing index surgery at a university hospital from 2013 to 2021. Categorical data were compared between the without-complication group and the with-complication group using the Chi-square tests and Fisher-Exact tests. Continuous data were analyzed …

Male Pelvic Health In Saudi Arabia: Knowledge–Practice Gap In Pelvic Floor Muscle Exercises And Implications For Preventive Physiotherapy And Health Policy, Wael A. S. Alghamdi

Saudi Medical Journal

No abstract provided.

Demographic Profiles, Clinical Characteristics, And Meteorological Context Of Heat-Related Illnesses Among Hajj Pilgrims In 2023, Ghadah Alsaleh, Majed Alsalamah, Fahad Alamri, Fatemah Alsaleh, Anas Khan

Saudi Medical Journal

Objective: To describe the demographic profiles, clinical characteristics, and meteorological context of heat-related illnesses among Hajj pilgrims in 2023.

Methods: A retrospective cross-sectional study was conducted using data from 1,129 pilgrims diagnosed with HRIs across healthcare facilities in Mecca, Mina, and Arafat. Demographic and clinical data were extracted from the Hajj Health Information System, while temperature, humidity, wind speed, and rainfall records were obtained from the National Center for Meteorology.

Results: Heat exhaustion (48.2%) and heatstroke (37.4%) were the most common diagnoses, with 24.9% of the cases requiring hospitalization. Males represented 55.4% of cases and accounted for 51.2% of …

Obesity's Role In Stroke Incidence Among Smokers: An Assessment Of Confounding, Interaction, And Mediation Effects, Saeed Awad M. Alqahtani, Moutasem Salih Aboonq

Saudi Medical Journal

Objectives: To examine the association between body mass index (BMI) category and history of stroke among current smokers, while assessing potential confounding, effect modification by age, and mediation by cardiovascular comorbidities. Methods: Data were analyzed from 53,939 current adult smokers participating in the 2021 Behavioral Risk Factor Surveillance System (BRFSS). Survey-weighted logistic regression estimated the association between BMI categories (underweight, normal, overweight, obese) and self-reported stroke history. The study assessed multicollinearity and adjusted for sociodemographic and health variables. Interaction terms were tested to evaluate effect modification by age, and exploratory decomposition analysis was used to assess mediation by conditions such …

From Early Adversity To Adult Health: Quality-Of-Life Consequences In A Mental Illness In Saudi Arabia, Rawan Saad Alghamdi, Ahmad A. Mirza, Ibrahim Fae Asiri, Fatemah Samir Alghamdi, Nawaf Abdulaziz Alharthi, Shaymaa A. Abdalal, Iman K. Ramadan

Saudi Medical Journal

Objectives: Childhood trauma (CT) is prevalent among bipolar disorder (BD) patients and exacerbates clinical outcomes, which may impact the quality of life (QoL). This study explores the prevalence of CT and its association with QoL among BD patients in Saudi Arabia. Methods: Cross-sectional study conducted among adults with BD during the euthymic phase. Sample size was estimated using a single-proportion approach (target n=141), and participants recruited by convenience sampling of eligible outpatients. CT was assessed using the Childhood Trauma Questionnaire (CTQ), and QoL using the the Brief Quality of Life in Bipolar Disorder (Brief QoL.BD). Results: The CT prevalence was …

A Retrospective Cohort Study Of Uterine Cancer Epidemiological Analysis And Age-Based Disparities In Saudi Arabian Population Across 32 Years, Sallwa M. Alshehre, Mohammad A. Althubiti

Saudi Medical Journal

Objectives: To investigate the burden of uterine tumour in Saudi Arabia during the past 32 years (1990–2021), with an emphasize on the prevalence, incidence, mortality, and disability-adjusted life years (DALYs). Knowing these patterns strengthen the national aims of cancer control under Kingdom of Saudi Arabia (KSA) Vision 2030. Methods: A retrospective study was performed using data retrieved from the Global Burden of Disease (GBD) database. The work included population from Saudi Arabia between 1990 and 2021 and tested standardization age-specific metrics, involving uterine tumour incidence, prevalence, mortality, and DALYs. Results: Uterine tumour cases raised from 507 in 1990 to 6,366 …

Post-Stroke Fatigue In Saudi Arabia: A Call To Action, Saad Z. Alqahtani

Saudi Medical Journal

Post-stroke fatigue (PSF) is a major consequence of stroke, with a prevalence of approximately 42–53% among stroke survivors. However, over the last 2 decades, only a few studies have explored PSF in Kingdom of Saudi Arabia (KSA). Findings from these studies show that PSF negatively impacts the quality of life of individuals with stroke. Furthermore, they emphasize the need for education for both health care providers and patients regarding PSF. This call-to-action mini narrative review identifies knowledge gaps and provides recommendations for both researchers and policymakers, including the need for standardized management and the exploration of hospital environment settings. Specifically, …

Impact Of Treatment On The Health-Related Quality Of Life Of Children With Cancer In Saudi Arabia, Fayzah Hussain Alhussain, Amany Anwar Saeed Alabdullah

Saudi Medical Journal

Objective: The impact of cancer on health-related quality of life (HRQOL) is considerable, particularly for children undergoing oncological treatment. While research has addressed HRQOL in childhood cancer survivors, less attention has been given to those actively undergoing treatment, including in Saudi Arabia. This systematic review aimed to address this gap by quantitatively evaluating studies reporting on the HRQOL of children in Saudi Arabia during their active cancer treatment phase. We also compare these findings with studies from around the world, emphasising demographic, medical and parental predictors of HRQOL. Methods: A comprehensive search of relevant databases (MEDLINE, CENTRAL, Embase, PsycINFO and …

Tiered Energy Storage Architecture For Next-Gen Low Voltage Direct Current Data Centers, N/A

Defensive Publications Series

High-density artificial intelligence and machine learning workloads introduce rapid and extreme power transients, which traditional data center power distribution and energy storage systems struggle to manage, leading to voltage and frequency oscillations. To address this, a tiered energy storage architecture is described for low-voltage direct current (LVDC) data centers. This architecture precisely maps specific energy storage technologies to distinct physical locations and time scales. Rack-level storage, utilizing high-power capacitors or supercapacitors, is placed immediately adjacent to the payload to mitigate sub-millisecond power fluctuations. Bus and row-level storage, including lithium-ion batteries or supercapacitors, functions as a critical intermediary buffer for seconds …

Dream-State Consolidation Transformers For Long-Horizon Artificial Intelligence, Johny Manuel-Devadoss, Joanna Johnson, Jayden Jack Johnson

Defensive Publications Series

Contemporary transformer architectures achieve strong performance through large-scale parameterization, retrieval augmentation, and extended context windows. However, persistent token-level retention scales poorly for lifelong or long-horizon cognition due to increasing computational cost, retrieval interference, context fragmentation, and memory saturation. This paper proposes a speculative but computationally grounded framework termed Dream-State Consolidation Transformers (DSCT), in which artificial systems alternate between online inference phases and offline consolidation phases. During online operation, systems process high-resolution episodic information from external environments. During offline consolidation, episodic traces are replayed under stochastic perturbation and compressed into semantically stable latent representations.

Unlike conventional persistent-memory systems, DSCT prioritizes abstraction …

Defensive Publication: Ble Peripheral Mitigations For Adaptivity Requirements, Braxton Davis

Defensive Publications Series

A method and system are provided for ensuring regulatory compliance for Bluetooth Low Energy (BLE) peripheral devices operating in a wireless communication environment. The approach addresses scenarios where a central device may not cooperate with peripheral-driven interference reporting or adaptive frequency hopping spread spectrum (AFHSS) requirements. The method involves identifying interfered channels and, for transmissions on such channels, limiting transmissions to short control signals (SCS-Only Transmissions) or adjusting transmit power to a reduced level, such as 10 dBm. For compliant channels, higher transmit power may be maintained. This allows for independent peripheral compliance, improved range, and enhanced link quality without …

Learning‑Based Framework For Secondary Power Grid Effective Resistance Prediction, Prateek Pendyala, Sandeep Gajbhare

Defensive Publications Series

Secondary power grid resistance verification in integrated circuit design may be hindered by the iterative nature of traditional sign‑off extraction tools. These tools may require compute time for each iteration, creating a bottleneck during the identification of resistance violations in low‑power architectures. A hierarchical machine learning framework is disclosed for the early estimation of effective resistance. In the framework, spatial tile‑based partitioning is combined with adaptive piecewise linear regression to analyze instance‑specific and spatial‑neighborhood attributes. Additionally, resistance is categorized into data‑driven zones, and zone‑specific regressors are employed to provide continuous resistance predictions. For design modifications, an incremental update scheme allows …

Effects Of A Basketball Match On Heart Rate Variability In Collegiate Intramural Players, Unobatsha Mbaiwa

Master's Theses

Heart rate variability (HRV) is a standard non-invasive physiological marker used to asses the autonomic nervous system (ANS) function and cardiovascular adaptability. HRV reflects the natural variations in time between successive heartbeats (R-R intervals), which come as a result of the interaction between sympathetic and parasympathetic branches of the ANS (Shaffer & Ginsberg, 2017). Higher HRV compared to an individual's baseline is normally considered an indicator of greater parasympathetic (rest/digest) influence and more effective physiological recovery, whereas lower HRV relative to baseline is associated with sympathetic (fight/flight) dominance, fatigue, and increased physiological strain. Since the standardized HRV measurement criteria were …

Millard Freeman "Mid" Mcknight Papers,1950s-1970s, Millard F. Mcknight

Center for Restoration Studies Archives, Manuscripts and Personal Papers Finding Aids

No abstract provided.

The Political Economy Of Fashion Sustainability Regulation, Meital Peleg Mizrachi, Rachel Chambers

UC Law Business Journal

The global fashion industry is one of the world’s most polluting and exploitative sectors, emitting more greenhouse gases than all international flights and maritime shipping combined, driving extensive water contamination and waste, and relying on labor conditions that remain chronically unsafe and underpaid. Regulation has attempted to respond, but with limited success. Existing sustainability oversight—ranging from import bans and human rights due diligence statutes to environmental taxes and voluntary industry frameworks—remains fragmented and unevenly enforced, shaped by geopolitical tensions, protectionist agendas, and shifting policy priorities. This Article reviews the rapidly evolving landscape of fashion sustainability regulation over the past decade …

The Effects Of Food Insecurity And Child Health On Educational Achievement In Virginia Counties, Peyton T. Randall

Honors Projects

This study examines the relationship between county-level socioeconomic and demographic factors and student performance on Virginia Standards of Learning (SOL) math and reading assessments in 2023. Using data from 127 of Virginia’s 133 independent counties and cities, this study conducts an ordinary least squares (OLS) regression. The analysis shows a strong negative association between food insecurity, measured by the Identified Student Percentage eligible for free school lunch (ISP), and chronic absenteeism with SOL pass rates. These findings show food insecurity and absenteeism as key drivers for achievement disparities, suggesting a need for further interventions and broader research using school-level and …

College Algebra With Review, Lanee Young Ph.D., Jayme Goetz

All Open Educational Resources

This text is disseminated via the Open Education Resource (OER) LibreTexts Project (https://LibreTexts.org) and like the thousands of other texts available within this powerful platform, it is freely available for reading, printing, and "consuming." The LibreTexts mission is to bring together students, faculty, and scholars in a collaborative effort to provide an accessible, and comprehensive platform that empowers our community to develop, curate, adapt, and adopt openly licensed resources and technologies; through these efforts we can reduce the financial burden born from traditional educational resource costs, ensuring education is more accessible for students and communities worldwide. Most, but …

Automating The Precision Measurements Of Higgs Boson Couplings In The H → Zz* → 4l Decay Channel, Sully Billingsley

Physics Theses and Dissertations

As a way to test the Standard Model of Physics, the couplings of the Higgs boson to other particles is studied by measuring the production cross-sections of the Higgs boson using the ATLAS detector at the Large Hadron Collider. The cross-sections are measured in the \HZZ  decay channel, where $\ell = e, \mu$. Two sets of measurements were performed on increasing amounts of data collected from proton-proton collisions and a center-of-mass energy of 13.6 TeV. The first set of measurements was collected between 2022 and 2023 corresponding to an integrated luminosity of 56 fb$^{-1}$ while the second set adds data …

Building A Road To Mitigate Ambulance Patient Offload Time (Apot), William J. Manguil

Doctoral Projects

Emergency departments (EDs) worldwide are experiencing increased utilization resulting in care delays for patients seeking urgent treatment. Despite critical circumstances that warrant emergency medical services (EMS) response, patients arriving to the ED via ambulance remain vulnerable to delays in care due to prolonged ambulance patient offload times (APOTs). The amount of health care providers and treatment space necessary to initiate care are both limited and often strained resources which dictate the need for innovative interventions to prevent patient harm. The following project outlines the interventions implemented at the project site to improve APOT as a means to enhance patient safety …

2026 May 21 - Tennessee Weekly Drought Summary, Tennessee Climate Office, East Tennessee State University

Tennessee Climate Office Weekly Drought Summaries

No abstract provided.

School-Based Teen Dating Violence Prevention Programs: A Systematized Review, Chloe L. Marsh

Educational Specialist, 2020-current

Teen Dating Violence (TDV) is a prevalent issue for many adolescents and can be defined as physical, sexual, and psychological aggression and harm that can occur in-person, online, or through technology. TDV victimization can have devastating impacts for youth, and school-based TDV prevention efforts have been highlighted as a means of addressing this issue. However, there is limited research on how prevention programming influences student beliefs and behavior. This study sought to reveal how programming influences student outcomes and which elements of highlighted prevention efforts are associated with greater benefits. A systematized review was conducted to address these research questions. …

Lgbtqia+ Inclusion In K-12 Education: A Systematized Review Of U.S. South Atlantic Region Educational Policy, Benjamin Little

Educational Specialist, 2020-current

LGBTQIA+ students experience disproportionate rates of discrimination, bullying, and mental health challenges within their educational settings, while educational policies shaping school climate vary considerably across jurisdictions. The purpose of this systematized review was to identify trends in the structure and implementation of LGBTQIA+ inclusion policies across K-12 state-level public education systems within the U.S. South Atlantic region and to examine how these policies addressed the needs of transgender youth and LGBTQIA+ students of color. This review synthesized publicly available state education documents, legislative materials, and nonprofit policy reports using a systematized review methodology guided by PRISMA principles and qualitative theme …

Barriers And Bridges: Exploring Factors That Shape Mental Health Service Utilization In Rural America, Margaret Wiwuga

Educational Specialist, 2020-current

Despite disproportionately higher suicide mortality rates and comparable prevalence of mental illness across urban and rural communities in the United States, rural populations across the nation experience significantly lower access to and utilization of mental health services, naturally leading to worse comprehensive outcomes. This literature review examines multifaceted factors shaping mental health service use in rural America, taking note of both barrier and enabling factors that impede or enable these unique populations’ willingness and ability to access and use mental health services. Ten articles published prior to September 9, 2025, were selected from the James Madison University Libraries’ Psychology and …

Black Maternal Mental Health: Counseling Considerations For Prenatal Depression And Anxiety, Morgan Renee Williams

Educational Specialist, 2020-current

The maternal mortality rate of Black women in the United States is four times higher than white women (Centers for Disease Control and Prevention, 2020). The CDC defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy… but not from accidental or incidental causes” (Centers for Disease Control and Prevention, 2024, para. 1). This statistic is a consequence of the inequality within and outside of the American healthcare system (National Academies of Sciences, Engineering, and Medicine, 2020). For the purposes of this research, Black women are defined as any women …

Neurodiversity In Counseling: Counseling Strategies For Supporting Neurodiverse Clients, Emily R. Plowright

Educational Specialist, 2020-current

Neurodiversity recognizes the natural differences in human functioning, including the unique ways that individuals think, learn, and process information. The neurodiversity movement views these differences as valuable, challenging historical beliefs that label them as deficits. Despite growing awareness of neurodiversity, counseling research and practice have largely overlooked the unique needs of neurodiverse clients, resulting in barriers to accessing mental health care. This paper addresses the concept and models of disability to provide context for understanding neurodiversity. Neurodiverse identities, such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), specific learning disorders (SLDs), and tic disorder, are explored through their diagnostic criteria …

What’S Behind The Mask: The Diagnostic Divide In The Female Autism Phenotype, Shelley Gies Alston

Educational Specialist, 2020-current

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication and restrictive, repetitive behaviors; however, women are diagnosed at significantly lower rates than men. This study examined whether DSM-5-TR diagnostic practices may contribute to the underdiagnosis and delayed identification of ASD in individuals assigned female at birth (AFAB), with attention to masking behaviors, gendered social expectations, and clinician interpretation of symptoms. Grounded in the Female Autism Phenotype (FAP), a retrospective mixed-methods study surveyed 12 AFAB individuals aged 18–24 who self-identified or were formally diagnosed with ASD. Participants completed a 44-item online survey including Likert-scale and open-ended …

Effects Of Nurse-Led Standardized Kangaroo Mother Care (Kmc) Protocol On Nicu Length Of Stay, Physiological Stability, And Bonding: Evidence-Based Recommendation For Translation Into Practice, Madison Capul, Maria Bejarano, Tionette Kirk-Banks, Kelly Mcmillin, Onyinyechukwu Ubaezuonu, Amabelle Simsuangco, Charity Msamalia Chimwala-Selico

General Submissions: Clinical Settings Materials

Background: Preterm and low birth weight infants in the neonatal intensive care unit (NICU) are at high risk for physiological instability, prolonged hospitalization, impaired bonding and breastfeeding, and increased mortality, with costs reaching up to $233,000 per stay (Broughton et al., 2022). The Kangaroo Mother Care (KMC) protocol improves thermoregulation, stability, bonding, breastfeeding, and survival; however, its implementation remains inconsistent due to the lack of standardized nurse-led protocols.

Purpose: The purpose of this study was to evaluate whether implementation of a standardized nurse-led Kangaroo Mother Care protocol, compared to current inconsistent practice, would improve NICU length of stay, physiological stability, …

Keeping Families Together: Companion Animals As A Public Health Imperative, Lori R. Kogan, Rebecca Niemiec

Journal of One Health Systems

Contemporary US public health frameworks emphasize social, economic, and environmental determinants of health, yet largely overlook the reality that most households include companion animals regarded as family members. This omission has tangible consequences during crises such as housing instability, illness, domestic violence, or disasters, when families are often forced to choose between their own safety and the safety of their animals. We argue that this represents a significant public health failure. Drawing on interdisciplinary evidence, we propose that companion animals function as a social determinant of health, that forced separation constitutes a public health harm, and that Human-Animal Support Services …