Digital Commons Network^™

Unlocking The Power Of Cxcr2 Inhibition To Overcome Gemcitabine Resistance In Pancreatic Cancer, Caitlin Molczyk, Reegan Sturgeon, Sugandha Saxena, Esther Johnson, Rakesh Bhatia, Namita Bhyravbhatla, Sushil Kumar, Surinder K. Batra, Rakesh K. Singh

Journal Articles: Biochemistry & Molecular Biology

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related mortality, characterized by intrinsic resistance to conventional therapies and limited effective treatment options. In this study, we investigated the role of the CXCR2 axis in PDAC therapy resistance. CXCR2, a chemokine receptor, is actively involved in inflammation, tumor angiogenesis, and metastasis. Our working hypothesis is that CXCR2 contributes to PDAC chemotherapy resistance. To test this, we generated gemcitabine-resistant (GemR) lines using T3M4 and CD18/HPAF (CD18) cell lines. Baseline expression of CXCL1, CXCL5, and CXCL8 ligands was higher in GemR cells compared to parental cells. Upon gemcitabine treatment, parental cells …

Midkine (Mdk) As A Central Regulator Of The Tumor Microenvironment: From Developmental Cytokine To Therapeutic Target, Hareesh B. Nair, Ajay Nair, Ya-Guang Liu, Dileep K. Vijayan, Ramadevi Subramani, Rajkumar Lakshmanaswamy, Suryavathi Viswanadhapalli, Gangadhara R. Sareddy, Surinder K. Batra, Ratna K. Vadlamudi

Journal Articles: Biochemistry & Molecular Biology

Midkine (MDK) is an oncofetal, heparin-binding cytokine that is re-expressed across diverse cancers and correlates with aggressive disease and treatment resistance. This review synthesizes current evidence on MDK as a coordinator of tumor-intrinsic signaling and microenvironmental remodeling. We summarize MDK structural features, extracellular matrix interactions, and receptor systems that mediate MDK signaling, highlighting LRP1 and PTPRZ1 with context-dependent participation of ALK, nucleolin and integrins. Downstream, MDK engages MAPK, PI3K-AKT, STAT3 and NF-κB pathways to promote tumor cell survival, epithelial-mesenchymal plasticity, and therapeutic stress tolerance. We then focus on tumor microenvironment (TME) programs shaped by MDK, including angiogenesis, fibroblast activation and …

Mucin 5ac Modulates Cancer-Associated Fibroblast Heterogeneity Through Epigenetic Reprogramming Of Precursor Cells, Rachel J. Kehrberg, Namita Bhyravbhatla, Zahraa Wajih Alsafwani, Xiaoqi Li, Gopalakrishnan Natarajan, Imran Khan, Randall E. Brand, Maneesh Jain, Surinder K. Batra, Sushil Kumar

Journal Articles: Biochemistry & Molecular Biology

Pancreatic cancer (PC) is characterized by extensive desmoplasia, with heterogeneous cancer-associated fibroblasts (CAFs) as a major component. However, the contribution of distinct precursor cells to CAF heterogeneity remains poorly defined. This study investigated the role of Muc5ac in modulating CAF heterogeneity by maturing precursor cells, including adipose-derived mesenchymal stem cells (AD-MSCs), bone marrow-derived MSCs (BM-MSCs), and pancreatic stellate cells (PSCs), into different CAF subsets. RNA sequencing of precursor cells treated with conditioned media from Muc5ac-proficient or -deficient cancer cells revealed distinct transcriptional profiles. Muc5ac significantly modulated the expression of Dnmts and Tets in AD-MSCs, promoting the acquisition of extracellular matrix …

Addressing Obesity And Diabetes In Appalachian Kentucky, Hannah E. Orens

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Challenging Cases In Infection Prevention And Control: Proceedings From Shea Spring 2025., Jessica Seidelman, Tsun Sheng N Ku, Anna Lafountaine, Curtis J Donskey, Edo-Abasi U. Mcgee, Rachel Pryor

PCOM Scholarly Works

Hospital epidemiologists and infection prevention professionals are frequently required to make high-stakes decisions in complex clinical scenarios where evidence-based guidance is limited or absent. These decisions often carry significant implications for patient safety, healthcare worker protection, hospital operations, and legal or financial risk. This article presents three challenging cases originally featured during the "Interesting Cases" session at the Society for Healthcare Epidemiology of America (SHEA) Spring 2025 Conference, with the goal of sharing practical lessons learned and contributing to the evolving literature in healthcare epidemiology. The first case describes the intraoperative contamination of a polyethylene liner during emergency revision total …

Intermittent Androgen Deprivation Therapy For Biochemical Recurrence Or Prostate-Specific Antigen (Psa) Persistence After Radical Prostatectomy: Efficacy And Prognostic Factors, Jian Chen, Qiming Chen, Xuzhi Yan, Ziqian Wang, Yapeng Wang, Yao Zhang, Jun Zhang, Jing Xu, Junying Zhang, Dianzheng Zhang, Qiuli Liu, Wuihua Lan, Jun Jiang

PCOM Scholarly Works

Background: The optimal protocol for intermittent androgen deprivation therapy (IAD) in managing biochemical recurrence (BCR) and persistent prostate-specific antigen (PSA) levels after radical prostatectomy (RP) remains undefined. This study aimed to introduce a novel IAD protocol, conduct an initial assessment of the protocol’s effectiveness in real-world settings, and develop a risk-based model to identify patients most likely to benefit from this approach. Methods: This study included 175 post-RP patients receiving IAD, with a median follow-up of 44.77 months [interquartile range (IQR), 31.87–69.50 months] post-androgen deprivation therapy (ADT). The IAD protocol used a PSA threshold of 0.2 ng/mL to define progression …

Therapeutic Landscape Of Early Symptomatic Alzheimer's Disease Translated Into Everyday Practice For Geriatric Providers., Melissa J Bailey-Taylor, Paula Morrow, James Hendrix, Katherine E. Galluzzi, Golnosh Sharafsaleh

PCOM Scholarly Works

Alzheimer's disease (AD) accounts for 60-80% of all dementia cases. Recent advances in diagnostic biomarkers of early symptomatic AD (ie, mild cognitive impairment and mild dementia due to AD) and amyloid-targeting therapies (ATTs) have the potential to improve outcomes for patients with AD. Two ATTs (donanemab and lecanemab) are currently approved and available for use in the US. Both ATTs can slow disease progression as well as cognitive and functional decline in patients with early symptomatic AD. Treatment with ATTs is associated with specific safety concerns such as amyloid-related imaging abnormalities. Therefore, the benefit versus risk profile needs to be …

Anchoring Roots And Spreading Branches: The Growth And Regulation Of Art Therapy In Singapore, Christine Phang

Art Therapy | Doctoral Dissertations

The development of art therapy in Singapore has advanced rapidly over the last two decades. Yet, to date, there has not been a comprehensive overview of art therapy in Singapore. Additionally, more research is needed to understand how the complex component of regulation can benefit the profession of art therapy. This study therefore set out to paint a picture of art therapy in Singapore, capture the art therapy community’s thoughts and opinions concerning regulation, and identify actionable ways to advance the profession. A mixed method design was employed which utilized a survey and interviews to gather quantitative, qualitative, and arts-informed …

Creativity In A Flash: Exploring The Perceived Therapeutic Effects Of Combining Creative Arts Therapies And Flash Technique, Celia J. Gagnon

Art Therapy | Doctoral Dissertations

Since the onset of the COVID-19 pandemic, research has revealed a significant strain on mental healthcare systems and healthcare professionals. Concurrently, there has been a rapid escalation in the prevalence of anxiety, depression, loneliness, and adolescent suicide rates, all of which have reached critical levels (World Health Organization, 2025; World Health Organization, 2022; Institute for Health Metrics and Evaluation, 2025; American Psychiatric Association, 2024). Post-pandemic, these statistics continue to rise across all nations and socioeconomic groups (WHO, 2025). Consequently, there is an urgent need to intensify research that supports the enhancement of mental health services globally (Institute for Health Metrics …

Enhancing Self-Acceptance And Reducing Anxiety Through Tree Ring Self-Portraits In Art Therapy: A Mixed-Methods Study, Stacey Kamp

Art Therapy | Doctoral Dissertations

This mixed-methods dissertation examined the therapeutic potential of the Tree Ring Self-Portrait, a novel art therapy intervention designed to enhance self-acceptance and reduce anxiety through symbol-based, life-phase self-portraiture grounded in narrative meaning-making and image-based processing (White & Epston, 1990; Moon, 2010; Hinz, 2020). Adults who self-identified with anxiety-related concerns were recruited through community and clinical referral sources and completed a standardized three-session intervention involving reflective mapping of life phases, a watercolor-based concentric-ring self-portrait process, and a guided review of the completed artwork with semi-structured interviews. The final sample (n = 20; ages 22–74) included participants with varied engagement in psychotherapy …

Improving Hypertension Management With An Educational Patient Intervention Bundle, Gertie Silva

Doctor of Nursing Practice (DNP) Scholarly Projects

Aim

Uncontrolled hypertension remains a significant risk factor for cardiovascular disease. This quality improvement project aimed to improve hypertension knowledge and blood pressure control among adults with uncontrolled hypertension by implementing lifestyle counseling, home blood pressure monitoring, and regular follow-up.

Design

This quality improvement project used a pre- and post-intervention design.

Methods

Forty-one adults with uncontrolled hypertension took part in an eight-week educational program. Outcomes measured included weight, systolic and diastolic blood pressure, and HK-LS scores. Descriptive statistics and paired-samples t-tests analyzed the results.

Results

Participants showed significant improvements in weight, blood pressure, and hypertension knowledge. Mean weight decreased from …

Reducing Live Discharges In Hospice Care Through A Bundled Intervention, Fiona P. White

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction

 Among Medicare fee-for-service hospice beneficiaries, the national live discharge rate increased from 16.9% in FY2021 to 19.1% in FY2025. At a Medicare-certified hospice agency in a southern state, the pre-intervention live discharge rate of 35.3% substantially exceeded national norms, with 68.7% of events representing patient-initiated revocations.

Methods

 A pre-post quality improvement design guided by the Plan-Do-Study-Act framework was implemented over 8 weeks at a single site with 106 newly admitted hospice patients and 15 clinical staff. The four-component bundled intervention comprised Revocation Risk Assessment administration within 24 hours of admission, structured patient and caregiver education within 72 hours of …

Toolkit To Prevent Venous Thromboembolism Among Surgical Patients, Carine Wawa

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: According to the Centers for Disease Control and Prevention, approximately 900,000 people in the United States are affected annually by venous thromboembolism (VTE) (CDC, 2025). The surgical patient population is vulnerable to VTE due to factors such as immobility, tissue injuries, and inflammatory responses. The lack of standardized protocols for surgical patients causes practice variability among healthcare providers and potentially increases the risk for preventable VTE events.

Methods: A toolkit to prevent VTE was developed utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC). A literature review was conducted, reviewed, and graded using the …

Increasing Compliance In Pain Reassessment And Documentation In An Acute Care Facilityy, Kriss S. Jones

Doctor of Nursing Practice (DNP) Scholarly Projects

Purpose: This guideline-directed project aimed to increase registered nurse (RN) compliance with documenting pain reassessment in an adult medical-surgical unit at an acute care facility.

Background: Proper documentation is crucial for clinical decision-making and legal and ethical reasons. The Joint Commission (TJC) has standardized pain documentation requirements to ensure consistent assessment, recording, and management across healthcare settings. Non-compliance can lead to misdiagnosis, inadequate treatment, patient dissatisfaction, and legal consequences. Accreditation bodies audit medical records, and non-compliance may result in penalties, financial losses, or loss of accreditation. Adherence is a clinical best practice and strategic necessity for healthcare organizations. Methodology: A …

Enhancing Breast Cancer Screening Uptake In Hispanic Women Residing In Rural Texas Through A Quality Improvement Project, Bianca Batchelor-Salazar

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Breast cancer remains a leading cause of cancer-related mortality among women in the United States. Despite the effectiveness of mammography in early detection, Hispanic women in rural communities experience lower screening rates due to socioeconomic, cultural, and access-related barriers. At a rural South Texas clinic, the baseline screening rate among Hispanic women aged 50–74 years was 70.6%, below national benchmarks.

Purpose: To increase breast cancer screening compliance among Hispanic women aged 50–74 years in a rural South Texas family practice clinic.

Methods: Guided by the Lean A3 quality improvement framework, this project implemented a multifaceted intervention bundle that included …

Early Pressure Injury Identification And Intervention In Emergency Department Older Adults Who Are Admitted Into A Community Hospital Intensive Care Unit, Lisa M. Britt

Doctor of Nursing Practice (DNP) Scholarly Projects

A clinical gap was identified when reviewing a hospital acquired pressure injury (HAPI) dashboard from a 369- bed, acute care community hospital located in North Texas. Fifty percent of HAPIs acquired occurred in older adults, aged 60 or higher, who were admitted into the intensive care unit (ICU) from the emergency department (ED). A retrospective review of the electronic health records (EHR) demonstrated that none of the patients had received HAPI prevention interventions while they were in the ED and the inconsistent document of skin assessments resulted in identification of few HAPIs present on admission (POA). The purpose of this …

Front Matter

Lewis & Clark Law Review

Front Matter contains Table of Contents, Masthead, and faculty for Lewis & Clark Law Review, Volume 29, Issue 4.

Let Them Hear It: Peaceful Protests Near The Homes Of Supreme Court Justices, Srikanth Reddy

Lewis & Clark Law Review

All of us—not just attorneys and politicians—need to be more critical and skeptical of the Supreme Court. Criticism by ordinary people is good and appropriate, even if it hurts the Justices’ feelings. That includes public protests. When a case matters enough to them, members of the public can and should criticize the Court and its Justices, including by peacefully gathering and protesting near a Justice’s home, or when a Justice appears out in the world.

Oregon’S History Of Using The Law To “Stack The Deck” In Favor Of White Males, Janet Steverson

Lewis & Clark Law Review

The United States has a sordid, racist history that permeates society still today. The State of Oregon has its own racist history, systematically excluding persons of Black African ancestry in its early years. This Essay explains this history and how seemingly historical practices continue to provide advantages to some, while detrimentally impacting others. This history is put in context by providing explanations of particular terms and this Essay further explains why examining these historical laws are critical in moving forward.

Catching The Forgotten: Repairing The Safety Net For Cofa Migrants In The United States, Brian Aguilar

Lewis & Clark Law Review

Citizens of the Freely Associated States—the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Belau—are permitted to live and work in the United States without a visa under the Compacts of Free Association (COFA). Yet, for nearly three decades, COFA migrants were excluded from the federal public benefits safety net. This exclusion, a product of legislative oversight in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, devastated communities like the Marshallese in Springdale, Arkansas, who endured dangerous working conditions, poverty, and severe health vulnerabilities without access to critical federal benefits programs. While …

Taking Off The “Blindfold”: Exploring Montana’S Public Trust Doctrine And The Right To A Clean And Healthful Environment After Held V. Montana, Lizzy Gazeley

Lewis & Clark Law Review

As global average temperatures continue to rise, the threat of climate change looms closer. To evade climate catastrophe, greenhouse gas emissions will need to be substantially reduced. Despite climate change’s imminent risks, in the United States, both the federal government and states remain resistant to transitioning away from fossil fuel energy sources. To combat this government inaction, some litigants have turned to an ancient doctrine. The public trust doctrine provides that sovereigns must protect natural resources from substantial impairment to ensure the public’s right to use those resources.

In Held v. Montana, youth plaintiffs alleged that the State of Montana …

Front Matter

Lewis & Clark Law Review

Front Matter contains Table of Contents, Masthead, and faculty for Lewis & Clark Law Review Volume 30, Issue 1.

Immigration Federalism And The Promise Of State Constitutions, Joanne Gottesman

Lewis & Clark Law Review

This Article explores state constitutions’ promises and pitfalls for immigrant rights advocacy. This is a particularly urgent endeavor, given the anti-immigrant measures of President Trump’s second term and a U.S. Supreme Court that is willing to reverse longstanding precedent. Even cases like Plyler v. Doe, with its guarantee of free public education to undocumented children, could be vulnerable. While U.S. Supreme Court opinions protecting immigrant rights are the gold standard because they apply nationwide, state courts and state constitutions provide critical alternative avenues for relief that should not be overlooked.

This Article considers some state constitutional provisions that may help …

Law And The Moral Geography Of Urban Education, Rebecca Horwitz-Willis

Lewis & Clark Law Review

In contemporary discussions, urban schools are often labeled as “bad,” while suburban schools are generally regarded as “good.” These assessments are typically based on achievement metrics, resource allocations, and the demographics of student populations. However, this Article offers a new lens through which to analyze the valuation of urban schools: the relationship between local vice regulation and what I term “educational geographies” in urban areas. Specifically, it argues that the location of vice institutions in cities has disproportionately impacted Black neighborhoods, thereby devaluing the educational geographies within these communities. These distributions do not just impact market value, but rather, also …

A Scope For Survival: Creating A Path For The Pregnant Workers Fairness Act Under A Conservative Administration And Supreme Court Bench, Emily Easton

Lewis & Clark Law Review

The Pregnant Workers Fairness Act (PWFA) requires employers to provide reasonable accommodations for known limitations related to pregnancy, childbirth, or related medical conditions, representing a bipartisan congressional effort to fill the gaps in workplace protections afforded to pregnant workers. However, the Equal Employment Opportunity Commission’s (EEOC) final rules interpreting the PWFA have generated significant legal and political controversy—especially around the broad interpretation of the definition of related medical conditions to include lactation, “elective” abortions, menstruation, infertility, and contraception.

Given the current political and legal climate presented by a conservative federal administration and Supreme Court bench, this Note proposes a pragmatic …

Truth And Consequences: What Catastrophe Teaches Us About Homeownership And Underinsurance, Kenneth S. Klein

Lewis & Clark Law Review

The firestorms enveloping Los Angeles in January 2025 made yet more inescapable the reality of the increasingly overwhelming impacts that climate change is having on communities. Many thousands of owner-occupied homes were destroyed. Most homes have insurance, but many homeowners will be surprised to find themselves underinsured, meaning their insurance proceeds will be materially less than the insurer-reported, incurred cost of rebuilding their destroyed home. The human consequences on these homeowners, each of whom has lost everything in a single week, are a now sadly all too imaginable tragedy in real time.

How underinsurance happened and what could have been …

Anything For Views Parenting, Bahar Tarighi

Lewis & Clark Law Review

Children who appear in monetized family vlogs are the product. Without them, the content would not exist, and the revenue would not follow. Yet unlike child actors in traditional entertainment, these children receive no guaranteed wages, no mandated trust accounts, and no right to control the digital record created in their name. This gap is a product of a legal framework that has simply not kept pace: the Fair Labor Standards Act, enacted in 1938, expressly exempted child performers from its protections, and neither Congress nor the majority of states have updated their child labor frameworks to account for the …

Shared Decision-Making To Improve The Vaccination Rate Among Older Patients, Muxian Chen

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Vaccines recommended for patients over the age of 50 include those for influenza (Flu), COVID-19, respiratory syncytial virus (RSV), pneumococcal disease, shingles, hepatitis A, hepatitis B, and a booster dose of the Tetanus, diphtheria, and pertussis (Tdap) vaccine every 10 years (American Association of Retired Persons, 2025). Unfortunately, these vaccines are often not adequately discussed during patient visits or are mentioned only briefly, without a clear plan for administration (American Association of Retired Persons, 2025). A vaccination bundle, which included resources for all vaccines and the opportunity to receive vaccines such as flu, COVID-19, RSV, Pneumococcal, Tdap, shingles, and …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …