Digital Commons Network^™

Stanley Aristilde V. New York State Office Of The Comptroller

2026 Decisions

USDC for the Eastern District of Pennsylvania

David Hatchigian V. John Whelan

2026 Decisions

USDC for the Eastern District of Pennsylvania

Cost Analysis Of Rheumatoid Arthritis In Insured Patients And Its Determinant Factors: Data From A National Referral Hospital In Indonesia, Rudy Hidayat, Fara Fauzia, Mochammad Alfansyah Dhifanra, Aries Maulana

Kesmas

Rheumatoid arthritis (RA) leads to progressive functional impairment and considerable economic burden. This study estimated the annual (12-month) cost per patient among patients with RA and its determinant factors. A descriptive cross-sectional economic study of RA patients who had been treated for at least one year at the outpatient clinic of a national referral hospital in Jakarta, Indonesia, and met the 2010 ACR–EULAR criteria. Data collected from January 2023 to December 2024 were obtained from medical and billing records for demographic characteristics, direct medical costs, and DAS28-based disease activity, whereas non-medical and indirect costs were collected through structured patient interviews. …

Determinants Of Multimorbidity Among Stroke Patients For Epidemiological Management In Indonesia's Agro-Coastal Communities, Krish Naufal Anugrah Robby, Isa Ma'rufi, Farida Wahyu Ningtyias, Latifatul Izzah, Nurjazuli Nurjazuli, Suhartono Suhartono, Muchlis Achsan Udji Sofro, Ida Srisurani Wiji Astuti, Olivia Listiowati Prawoto, Dedek Sutinbuk, Taufik Kurrohman, Elhoussin Ouassou

Kesmas

Multimorbidity remains a major public health challenge among stroke patients, particularly in agro-coastal communities characterized by socioeconomic vulnerability, limited healthcare access, and lifestyle changes. This study aimed to analyze the determinants of multimorbidity among stroke patients in agro-coastal communities. A quantitative observational analytical design was employed, involving 45 stroke patients selected through total sampling in Jember District, Indonesia. Data were collected through structured interviews, anthropometric measurements, and secondary health records. The model included biological, socioeconomic, healthcare access, and lifestyle as exogenous variables, with multimorbidity as the endogenous variable. Data were analyzed using PLS-SEM, including evaluation of measurement and structural models …

How Do Governments Combat Jihad Online?, Noah Cook

Honors College Theses

Since the September 11th, 2001 attacks, jihadist groups like ISIS, al-Qaeda, and al-Shabaab have used the internet as a tool for recruitment, radicalization, and propaganda dissemination. Since then, governments, non-governmental organizations, and private companies have developed strategies to combat jihadism on the internet. This paper examines how these actors have worked to mitigate the digital jihadist footprint and its effects by analyzing three main approaches to countering violent Islamist extremism on the internet: counter narrative initiatives, awareness-raising programs, and content removals. This paper finds that each of these methods has its own strengths and weaknesses. Counter narrative campaigns show the …

Principals’ Experiences With Implementation Practices For School Board Policies In An Urban School District, Andrea J. Richardson

Walden Dissertations and Doctoral Studies

Effective policy implementation is crucial for improving educational outcomes and ensuring equitable learning environments. While existing literature has shown that policy implementation is influenced by factors such as leadership capacity, stakeholder engagement, communication, resource availability, organization context, and accountability, there is little known about how K-12 urban principals narrate, interpret, and make meaning of their experiences to implementing board-mandated policies. This study addressed this gap by exploring how principals in an urban school district in Ohio navigated the complexities of implementing school board policies amid resource limitations, stakeholder resistance, and accountability pressures. The purpose of this qualitative narrative inquiry study …

Relationship Between Financial Performance And Healthcare Quality Outcomes, Ela C. Lena

Walden Dissertations and Doctoral Studies

Hospital leaders face increasing pressure to improve quality outcomes while controlling costs. The evidence is limited on whether hospital financial performance predicts overall quality star ratings. Grounded in the general contingency theory, this quantitative, correlational project examined the predictive relationship between operating margin, current ratio, and a composite of quality metrics represented by the overall hospital Quality Star Rating (QSR). Data included the population of acute care hospitals in Massachusetts with 25 or more beds, yielding a final analytic sample of 54. Four year-specific multiple linear regression models were performed from 2021 through 2024. The analyses did not indicate a …

U.S. Rural And Frontier Stakeholders’ Use Of Storytelling To Advocate For Competency Development, Aliza Ruby Quinlan

Walden Dissertations and Doctoral Studies

Although rural advocacy is widely recognized as important to community change, the experiences of rural and frontier advocates, particularly in regard to their use of storytelling to support skill acquisition, relational trust, and asset-focused advocacy competencies, have been understudied. The purpose of this constructivist grounded theory qualitative study was to understand how rural and frontier community advocates describe their experiences and how sharing lived experiences may inform advocacy competency development. Semistructured interviews were conducted with nine advocates across the Pacific Northwest region of the United States, including caregivers, health care professionals, educators, nonprofit leaders, and individuals with lived experience working …

Revictimization Of Female Sexual Assault Survivors During Cross-Examination From The Perspective Of Criminal Prosecutors, Robyn Fuchs

Walden Dissertations and Doctoral Studies

Sexual assault is a heinous crime that remains one of the most underreported crimes. Victims of sexual assault face scrutiny for reporting and may be revictimized by the process. The intent of this study was to examine how cross-examination has the potential to revictimize female sexual assault survivors from the perspective of criminal prosecutors. This study may provide insight on whether defense attorneys intentionally cause harm to victims or if there is an automatic level of trauma in testifying. Ten interviews were conducted with criminal prosecutors across the United States. After the interviews, the transcripts were manually analyzed to identify …

Staff Education On Standardized Suicide Risk Assessment In An Outpatient Clinic For Behavioral Health, Fanta Haja Cabah

Walden Dissertations and Doctoral Studies

Suicide risk assessment is a high-priority nursing safety responsibility in outpatient behavioral health. The practice gap was a variation in nurses’ knowledge of validated suicide screening, direct inquiry, risk escalation, referral, and related documentation expectations working in an outpatient behavioral health clinic located on the Eastern Atlantic Coast. To address this problem, I developed, implemented, and evaluated a staff education program on a standardized suicide risk assessment. The practice question focused on whether staff knowledge increased following participation in the education program. Ten nursing staff members participated in a 60-minute education program. Pretest and posttest questionnaires included 20 multiple-choice questions. …

Staff Education On Teach- Back Communication Method For Psychiatric Nursing Staff, Adanma Violet Ebere

Walden Dissertations and Doctoral Studies

Summary Patient education delivered without a standardized communication protocol for patients with serious mental illness (SMI), especially for those who face disproportionate health literacy deficits, cognitive challenges, and stigma, may increase the risk of medication misunderstanding and non-adherence. An outpatient psychiatric practice lacked a standardized patient education protocol. This quality improvement staff education initiative equipped all clinical nursing staff with the 5Ts for Teach Back framework, an evidence-based, five-step method endorsed by the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission (TJC), and the American Hospital Association (AHA), and grounded with evidence in 13 sources at Levels I …

The Impact Of Inclusive Leadership And Leader Cultural Intelligence On The Work Engagement Of Migrant Employees, Dena Semonia Whittle

Walden Dissertations and Doctoral Studies

With the rise of globalization and the growing demand for skilled workers, the number of foreign-born employees in the American workforce has grown significantly over the last 20 years. These numbers continue to grow, as the upward trend of foreign-born employees has been even more significant over the last 5 years. However, despite having a now more diverse workforce, there are still signs of discrimination and unequal treatment of migrants in the workplace. Such mistreatment has been linked to health-related, occupational, and psychological consequences and has been negatively associated with work engagement. The purpose of this quantitative study was to …

Comparison Between The Tooth Coronal Index And Kvaal’S Method In Age Estimation In The Indonesian Population, Astika Swastirani, Nabilah Shafiyyah Rahmayati, Sari Kurniawati, Ferdy Jonathan Walelang

Journal of Dentistry Indonesia

Background: Age estimation in adults is important in forensic odontology, and radiographic approaches such as the Tooth Coronal Index (TCI) and Kvaal's method are commonly applied to panoramic radiographs. This study aimed to compare the agreement of TCI and Kvaal age estimates with chronological age in adults.

Methods: This cross-sectional analytic study evaluated 100 panoramic radiographs (50 males, 50 females) of adults aged 23–45 years. Measurements were performed on mandibular first premolars using ImageJ. Accuracy was operationalized as the closeness of the estimated age to the chronological age and assessed using mean differences and Wilcoxon signed-rank tests.

Results …

Morphometric Evaluation Of The Styloid Process Using Cone-Beam Ct In A Central Anatolian Population, Melda Misirlioglu, Aslı Atacan Aslan

Journal of Dentistry Indonesia

Background: Accurate evaluation of craniofacial anatomy is essential for diagnostic planning. Variations of the styloid process (SP) provide anatomical data that guide evidence-based clinical and surgical decisions in the head and neck region.

Methods: Retrospective cone-beam computed tomography (CBCT) scans retrieved from the Department of Oral and Maxillofacial Radiology were examined. SP length, medial angles, calcification patterns, and the radiomorphometric index were assessed.

Results: Middle-aged adults represented the majority of the sample. Gender had a statistically significant effect on SP morphology Type 1 was the most common bilaterally, followed by Type 2. Calcification patterns varied between genders …

Clinical Outcomes Of Adjunctive Use Of Oxygen-Releasing Formula In Non-Surgical Treatment Of Periodontal Abscess Associated With Type 2 Diabetes Mellitus, Anil Kumar Kanakamedala, Laxmi Kavya Gangireddy, Gautami S Penmetsa, Sruthima Gottumukkala, Mohan Kumar Pasupuleti, Konathala Santhosh Venkata Ramesh

Journal of Dentistry Indonesia

Background: This study aimed to evaluate the effectiveness of oxygen-releasing formula (ORF) as an adjunct in the non-surgical management of periodontal abscess in patients with type 2 diabetes mellitus.

Methods: This split-mouth clinical trial was conducted on 14 patients with periodontal abscess with type 2 diabetes mellitus (T2DM), who were divided into a control group, nonsurgical periodontal therapy (NSPT) alone, and a test group (NSPT+ORF). Parameters such as Landry's healing index (HI) were evaluated at 1 week, 2 weeks, and 1 month. Probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing presence or absence (BOP) …

Diode Laser And Conventional Ferric Sulfate Pulpotomy In Deciduous Molars: Comparative Outcomes In Myanmar Children, Moe Myat Noe Phyu Dr, Ei Ei Myo, Soe Naing

Journal of Dentistry Indonesia

Background: Pulpotomy is a widely accepted treatment for carious exposure of vital primary molars, using various medicaments. Currently, lasers have emerged as a non-pharmacologic pulpotomy technique. However, comparative clinical studies in Myanmar remain limited. This study aimed to compare the effectiveness of diode laser and conventional ferric sulfate pulpotomy in deciduous molars among children in Myanmar.

Methods: A total of 40 deciduous mandibular molars requiring pulpotomy treatment were selected from children between 4 and 8 years of age. The subjects were randomly assigned to the diode laser group (Group A) or the ferric sulfate group (Group B) using …

The Association Between Hypodontia, Supernumerary Teeth, Cleft Type, And Cleft Side In Pediatric Non-Syndromic Cleft Patients In Malaysia, Tan Hwa En, Mohammad Majduddin Sulaiman, Norsamsu Arni Samsudin, Nurhafizah Ghani

Journal of Dentistry Indonesia

Background: Cleft lip and palate are the fourth most common congenital facial anomalies worldwide. Cleft patients have a higher prevalence of dental anomalies than the general population. This study aimed to evaluate the prevalence of hypodontia and supernumerary teeth among the permanent teeth of pediatric patients with clefts at Hospital Pakar Universiti Sains Malaysia (USM).

Methods: A retrospective record review study was conducted using dental records and panoramic radiographs from 64 non-syndromic cleft patients aged 6 to 17 years who attended Hospital Pakar USM between 2019 and 2024. Inter-examiner reliability for the assessment of hypodontia was strong, with …

Psychosocial And Functional Impact Of Temporomandibular Disorder Subtypes Among Adults: A Cross-Sectional Study In Indonesia, Ni Luh Dewi, Wita Anggraini, Maria Valiente-Lopez, Carolina Marpaung

Journal of Dentistry Indonesia

Background: Temporomandibular disorders (TMDs) affect psychological, functional, and pain-related aspects of oral health-related quality of life (OHRQoL). However, the differential impact of pain-related and non-pain-related TMDs remains limited. This study aimed to evaluate the impact of different TMD subtypes on psychological distress, jaw function, and OHRQoL in young adults and to determine whether pain-related TMDs exert a greater effect than non-pain-related TMDs.

Methods: In this cross-sectional study, 278 university students (aged 18–24 years) were categorized into no TMD (NT), pain-related TMD (PT), intra-articular TMD (IT), and combined TMD (CT). Diagnoses were made using the 5Ts Questionnaire screening tool …

Adverse Drug Reaction Reporting In Dental Practice And The Importance Of Pharmacovigilance In Dental Education, Radhakrishna Lagishetty, Lakshmi Ramya T, Kvr Barath Raju, Mohan Kumar Pasupuleti

Journal of Dentistry Indonesia

Background: Adverse drug reactions (ADRs) are a critical component of patient safety; however, ADR monitoring remains underutilized in dentistry. This study aimed to assess knowledge, attitudes, and practices regarding ADR reporting among undergraduate and postgraduate students and practicing dentists.

Methods: A cross-sectional observational study was conducted using a structured, validated 19-item questionnaire covering socio-demographics, knowledge (6 items), attitude (4 items), and practice (5 items), which was distributed both in person and online. A total of 258 complete responses were analyzed out of 300 individuals contacted (response rate: 86%). Descriptive statistics and Chi-square tests were applied, with p < 0.05 considered statistically significant.

Results …

Investigation Of Patients' Use Of Non-Pharmacological Substances In Dental Pain Management, Neslihan Yılmaz Çırakoğlu, Özgenur Kaya

Journal of Dentistry Indonesia

Background: Dental pain is a complex condition influenced by biological, biochemical, environmental, and psychological factors. Before seeking professional care, many patients attempt to relieve dental pain using self-administered, non-medical agents. This study aimed to investigate patients’ use of non-pharmacological substances in dental pain management and to identify factors influencing these practices.

Methods: The questionnaire consisted of four sections addressing demographic characteristics, oral hygiene habits, pain characteristics, and pain-relief agents. Categorical variables were analyzed using Pearson’s chi-square test. Categorical data are presented as frequencies and percentages, while continuous data are expressed as mean ± standard deviation and median values. …

Flaxseed Ethanolic Extract Modulates Β-Catenin And Dkk1 Expressions During Osteoblast Differentiation Of Dental Pulp-Derived Stem Cells, Nur Sazwi Nordin, Khairani Idah Mokhtar, Omar Abdul Jabbar Abdul Qader, Basma Ezzat Mustafa, Widya Lestari, Deny Susanti Darnis, Thirumulu Ponnuraj Kannan, Azlina Ahmad, Solachuddin Jauhari Arief Ichwan

Journal of Dentistry Indonesia

Background: WNT signaling regulates osteogenic differentiation of mesenchymal stem cells (MSC) through the canonical WNT pathway. β-catenin; an important molecule of WNT pathway, and DKK1; a WNT antagonist, play important roles in regulating bone formation. Although flaxseed (Linum usitatissimum) has various health benefits, including promoting bone health, our previous study showed that flaxseed ethanolic extract (FEE) reduced the osteoblast differentiation potential of stem cells from human exfoliated deciduous teeth (SHED). This study aimed to determine the effects of FEE on WNT pathway-related molecules, β-catenin and DKK1, during osteoblast differentiation of SHED.

Methods: RNA at Day 7, 14, …

Orthodontic Camouflage Treatment Of A Severe Class Iii Skeletal Pattern With Anterior Open Bite: A Case Report, Dikeledi Maureen Letsholo, Mandla Dominic Nyakale, Mosimane Peter Silas Sethusa

Journal of Dentistry Indonesia

Background: Class III malocclusion combined with anterior open bite (AOB) is one of the most challenging occlusal problems to treat. The objective of this article was to report a case of an adult female patient diagnosed with Class III malocclusion combined with an anterior open bite and a hyperdivergent facial pattern.

Case Report: Camouflage orthodontic treatment with the extraction of maxillary and mandibular first premolars was used to treat the patient. Anterior teeth were retracted maximally against the Nance holding arch and fixed lingual arch appliances, and box elastics were used to close AOB. At the end of …

Loralee Clark, Loralee Clark, Loralee Clark

Virginia Poets Database: A Literary and Educational Resource

No abstract provided.

The Correlation Between Medication Adherence, Blood Glucose Levels, And Quality Of Life In Patients With Type 2 Diabetes Mellitus At Ciamis Regional Hospital, Amyla Putri Nurul Nazmi, Nur Rahayuningsih, Lusi N

Pharmacology and Clinical Pharmacy Research

Type 2 diabetes mellitus is a chronic condition requiring continuous treatment, including patient adherence to prescribed medication. This study aimed to explore the relationship between medication adherence, blood glucose levels, and quality of life in patients with type 2 diabetes mellitus at Ciamis Regional Hospital, conducted from January to March 2025, the research employed a quantitative, prospective cross-sectional design involving 49 hospitalized patients. Data included blood glucose levels (RPG, FPG, 2hPG), medication adherence measured using the Medication Adherence Report Scale (MARS-5), and quality of life assessed via the Diabetes Quality of Life-Brief Clinical Inventory (DQOL-BCI). The chi-square test was used …

The Phytochemical Content And Antibacterial Activity Of Purified Extract Of Mangifera Indica L. Against Gram Positive Pathogen, Dewi Andini Kunti Mulangsri, Masduki Faqih, Sugar Arifin, Mutiara Trie Sieya Agustin

Pharmacology and Clinical Pharmacy Research

The purified extract of arum manis mango leaves contained flavonoid compounds by TLC methods and antibacterial activity against Gram-positive and negative pathogens. This research aimed to identify and determine the phytochemical content (mangiferin and flavonoids content) and antibacterial activity against other Gram-positive pathogens. Purification of ethanol extract of arum manis mango leaves by liquid-liquid fraction method. Determination of total flavonoid content and identification of mangiferin used respectively by aluminum chloride and Thin Layer Chromatography method. The disk diffusion method was used to assay antibacterial activity against S. epidermidis, and B. subtilis bacteria with the concentration of the sample such …

Cost Effectiveness Analysis Of Psychopharmaca Therapy Combination Compared With Psychopharmaca Therapy And Ect Combination In Schizoaffective Inpatients At The Rsj Provinsi Jawa Barat, Yasmin Fadillah, Sani Asmi Ramdani Lestari, Ardilla Kemala Dewi

Pharmacology and Clinical Pharmacy Research

Mental disorders constitute an economic burden on health, estimated at USD 2.5 trillion in 2010 and expected to increase to USD 6 trillion by 2030. Treatment of schizoaffective disorder involves a combination of medication and psychotherapy. Pharmacoeconomics is an important consideration in drug selection. This study aims to determine the cost-effectiveness of psychopharmaca therapy combination compared with psychopharmaca therapy and ECT combination in schizoaffective inpatients at the RSJ Provinsi Jawa Barat. Data collection was conducted retrospectively from patient medical records for the period December 2023–December 2024. Total costs, based on a health perspective, include psychopharmaca drug costs, inpatient care costs, …

Evaluation Of Antibiotic Use Using The Gyssens Method On Clinical Outcomes In Ischemic Stroke Patients, Juniarto Mende, Graciano A. Maturbongs, Yohana K. A. Mbulang

Pharmacology and Clinical Pharmacy Research

Ischemic stroke is a health problem that causes death and neurovascular disability worldwide. The inflammatory response due to infection can increase ischemic stroke and increase brain damage through changes in blood pressure, coagulation, immune response, and endothelial function. This study aims to evaluate the rationality of antibiotic use on clinical outcomes in ischemic stroke patients. This study used a cross-sectional design. Retrospective data were taken from the medical records of Jayapura Regional Hospital for the period January 1, 2023, to May 31, 2025. The study subjects were all patients who suffered ischemic stroke and received antibiotics. Evaluation of the rationality …

Retrospective Analysis Of Antimicrobial Resistance Patterns In Gram-Positive And Gram-Negative Blood Isolates, Helman Kurniadi, Timbul Partogi Haposan Simorangkir, Ros Sumarny, Fitria Heldiana

Pharmacology and Clinical Pharmacy Research

Bloodstream infections are an important cause of morbidity and mortality, while antimicrobial resistance limits treatment options. This retrospective study evaluated bacterial distribution and antimicrobial susceptibility in blood cultures at RSPAD Gatot Soebroto, Jakarta, using microbiology and medical record data from January-December 2019. Clinically significant isolates were included, while duplicates and contaminants were excluded. Identification and susceptibility testing followed standard procedures and CLSI 2019 guidelines. Data were analyzed descriptively. Among 482 isolates, 246 (51.0%) were Gram-positive and 236 (49.0%) were Gram-negative. The Gram-positive isolates were mainly coagulase-negative staphylococci, including Staphylococcus epidermidis (62, 25.2%), S. hominis (61, 24.8%), and S. haemolyticus (50, …

Analysis Of Pharmacotherapy And Non-Pharmacotherapy Burden From The Ina-Cbgs Package For Cesarean Section Surgery At The Regional General Hospital Dr. Soedarso In 2023, Ananda Rizky Awwaliyah, Nurmainah Nurmainah, Ridha Ulfah

Pharmacology and Clinical Pharmacy Research

The prevalence of cesarean sections has been increasing each year. Previous studies show that the cost of medications and medical supplies for cesarean patients accounts for one-third of the total care costs. In the era of National Health Insurance (NHI), medications and medical supplies are considered operational expenses for hospitals rather than sources of income. This condition requires proper medication management and the use of medical supplies. This study aims to analyze the percentage of pharmacotherapy and non-pharmacotherapy, including the types and quantities of medications as well as disposable medical supplies used on patients undergoing cesarean section procedures at the …

Alexithymia In Substance Use Disorders: A Scoping Review Of Therapeutic Approaches, Pratami Diah Herliani, Shelly Iskandar, Angela Vera Herman Efendi

Pharmacology and Clinical Pharmacy Research

Alexithymia, defined as the inability to recognize and express emotions, has a high prevalence (40–50%) among individuals with substance use disorders (SUD), particularly alcohol use disorder, and is associated with poorer clinical outcomes. Despite this, comprehensive mapping of psychotherapeutic interventions targeting this condition within the SUD population remains limited. This study aimed to systematically map the therapeutic approaches investigated to address alexithymia among individuals with substance use disorders and to summarize the reported outcomes. A scoping review was conducted in accordance with the PRISMA-ScR guidelines using systematic literature searches in the PubMed and Scopus databases. Relevant studies were screened based …