Medicine and Health Sciences Commons^™

Detection Of Dental Restorations Using No-Code Artificial Intelligence, Manal Hamdan, Zaid Badr, Jennifer Bjork, Reagan Saxe, Francesca Malensek, Caroline Miller, Rakhi Shah, Shengtong Han, Hossein Mohammad-Rahimi

School of Dentistry Faculty Research and Publications

Objectives

The purpose of this study was to utilize a no-code computer vision platform to develop, train, and evaluate a model specifically designed for segmenting dental restorations on panoramic radiographs.

Methods

One hundred anonymized panoramic radiographs were selected for this study. Accurate labeling of dental restorations was performed by calibrated dental faculty and students, with subsequent final review by an oral radiologist. The radiographs were automatically split within the platform into training (70 %), development (20 %), and testing (10 %) subgroups. The model was trained for 40 epochs using a medium model size. Data augmentation techniques available within the …

Prevalence Of Temporomandibular Disorders (Tmd) In Obesity Patients: A Systematic Review And Meta-Analysis, Giuseppe Minervini, Rocco Franco, Maria Maddalena Marrapodi, Luis Eduardo Almeida, Vincenzo Ronsivalle, Marco Cicciù

School of Dentistry Faculty Research and Publications

Objective

Obesity is a growing epidemic in the world. It increases the risk for severe health conditions, including diabetes, heart disease and stroke. Recent research has found that obesity is associated with an increased risk for temporomandibular disorders (TMDs). The purpose of this literature review with meta-analysis is to analyse the possible association between obesity and temporomandibular disorders.

Materials and Methods

Pubmed, Web of Science and Lilacs were systematically searched until 01/03/2000. Articles dealing with TMD and obesity were selected, and numbers that might be useful in the meta-analysis were extracted.

Results

Fifty articles were chosen after using all three …

Sex Differences In Fatigability And Recovery Following A 5 Km Running Time Trial In Recreationally Active Adults, Maria Solleiro Pons, Sandra K. Hunter, Paul Ansdell

Exercise Science Faculty Research and Publications

Females demonstrate greater fatigue resistance compared to males in tasks ranging from single-limb contractions to whole-body exercise, including running. Many of the studies investigating sex differences in fatigability following running, however, occur after long duration, low-intensity tasks and it is unknown whether there is a sex difference in fatigability following high-intensity running. This study compared fatigability and recovery following a 5 km running time trial in young males and females. Sixteen recreationally active participants (8 males, 8 females, age: 23 ± 4 years) completed a familiarisation and experimental trial. Knee-extensor maximal voluntary contractions (MVCs) were performed before and up to …

Gastrointestinal Distress As A Potential Mediator Between Stress And Periodontal Inflammation, Casey D. Wright, Brenda Heaton, Raul I. Garcia, Maureen M. Leonard, Alessio Fasano, Daniel W. Mcneil

School of Dentistry Faculty Research and Publications

Objectives

Periodontal disease is multifactorial in its aetiology, which encompasses biopsychosocial contributors, including psychological stress. Gastrointestinal distress and dysbiosis have been associated with several chronic inflammatory diseases yet have rarely been investigated with respect to oral inflammation. Given the implications of gastrointestinal distress on extraintestinal inflammation, this study aimed to evaluate the potential role of such distress as a mediator between psychological stress and periodontal disease.

Methods

Utilizing a cross-sectional, nationwide sample of 828 adults in the USA generated via Amazon Mechanical Turk, we evaluated data collected from a series of validated self-report psychosocial questionnaires on stress, gut-specific anxiety around …

Impact Of The Covid-19 Pandemic On U.S. Women's Mental Health, Astrida S. Kaugars, Jessica L. Zemlak, Debra L. Oswald

College of Nursing Faculty Research and Publications

Background: Women are more likely than men to be diagnosed with depression and anxiety with rates increasing since the COVID-19 pandemic. This study sought to understand how women's intersecting identities, personal strengths, and COVID-19–related stressors were associated with their anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms early in the pandemic.

Methods: During May–June 2020, American women (N = 398) recruited via MTurk completed an online questionnaire assessing mental health (PTSD, anxiety, and depression), demographic characteristics, personal strengths (coping, hope, social support), and experiences with COVID-19–specific stressors.

Results: Women who had a child younger than 18 years of age, …

Nurses' Experiences And Perspectives Of The Telehealth Working Environment And Educational Needs, Stacee M. Lerret, Susan A. Nuccio, Alyssa Compton, Maria Keegan, Kathryn Rapala

College of Nursing Faculty Research and Publications

Background:

The continuing evolution of health care and the nursing profession includes the exponential growth of telehealth platforms. The goal of this study was to describe nurses' experiences with and perspectives on their practice with and future need for telehealth.

Method:

A cross-sectional descriptive mixed methods study was conducted with nursing graduates from a single university. Completed survey questions focused on demographics, current work status, plans for employment participation, and telehealth experience. Descriptive analysis was conducted with statistical software, with directed content analysis for narrative responses.

Results:

A total of 305 of 5,080 participants completed the survey (6% response rate). …

Protecting Against Moral Injury Among Healthcare Missionaries, James Ritchie, Michael Toppe, Doug Lindberg, Jason Paltzer

Physician Assistant Studies Faculty Research and Publications

As mentioned in the introduction of our study in this issue, Moral injury among healthcare missionaries: a qualitative study, the setting of cross-cultural medicine inherently produces moral injury. This moral injury occurs because different cultures have different deeply held values, and medical care intersects with some of the most emotionally and spiritually powerful values. Moral injury is one of the most common reasons for distress in healthcare missionaries, and the consequences can be severe and lifelong. Our study found seven core conflicts of values that can lead to moral injury. What can be done?

Effects Of Thermocycling And Hydrolytic Aging On The Flexural Strength Of Additively Manufactured Restorative Materials, Steven Mustafa Abu Al Tamn

Master's Theses (2009 -)

Introduction: Additive manufacturing is being integrated into various aspects of clinical prosthodontics due to its potential for use in various indications and the promise of improved clinical efficiency and properties.Objective: The purpose of this in-vitro study was to evaluate the flexural strength of two 3D-printed resin composites in relation to a conventionally fabricated resin composite after being subjected to two different artificial aging methods: thermocycling and distilled water storage. Material and methods: A total of 220 samples were fabricated (N=220); 72 samples were fabricated from Integrity composite (Dentsply Sirona) and 148 samples were fabricated from two 3D-printed composite materials MFH …

Long-Term Assessment Of Skeletal And Dental Asymmetry After Conventional And Mini-Screw Assisted Rapid Palatal Expansion, Brett Barton

Master's Theses (2009 -)

Objective: To evaluate the long-term skeletal and dental asymmetry following Mini-screw Assisted Rapid Palatal Expansion (MARPE), Rapid Palatal Expansion (RPE) and controls with 3D cone beam computed tomography (CBCT) analysis. Methods: 180 CBCT scans were evaluated retrospectively for 60 patients at pre-treatment (T1), post-expansion (T2), and post-treatment (T3). The patients were randomly assigned into 3 groups – MARPE, RPE, and controls. Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), Zygomaticomaxillary Point (ZMA), Anterior Nasal Cavity Width (ANCW), Posterior Nasal Cavity Width (PNCW), External Maxillary Width (EMW), Palatal Width (PW), Maxillary Width (MMW), Maxillary Canine Width (MCW) were measured on the …

Specialized Astrocytes Mediate Glutamatergic Gliotransmission In The Cns, Roberta De Ceglia, Ada Ledonne, David Gregory Litvin, Barbara Lykke Lind, Giovanni Carriero, Emanuele Claudio Latagliata, Erika Bindocci, Maria Amalia Di Castro, Iaroslav Savtchouk, Ilaria Vitali, Anurag Ranjak, Mauro Congiu, Tara Canonica, William Wisden, Kenneth Harris, Manuel Mameli, Nicola Mercuri, Ludovic Telley, Andrea Volterra

Biomedical Sciences Faculty Research and Publications

Multimodal astrocyte–neuron communications govern brain circuitry assembly and function. For example, through rapid glutamate release, astrocytes can control excitability, plasticity and synchronous activity of synaptic networks, while also contributing to their dysregulation in neuropsychiatric conditions. For astrocytes to communicate through fast focal glutamate release, they should possess an apparatus for Ca2+-dependent exocytosis similar to neurons. However, the existence of this mechanism has been questioned owing to inconsistent data and a lack of direct supporting evidence. Here we revisited the astrocyte glutamate exocytosis hypothesis by considering the emerging molecular heterogeneity of astrocytes and using molecular, bioinformatic and imaging approaches, together with …

Tlif Is Associated With Lower Rates Of Adjacent Segment Disease And Complications Compared To Alif: A Matched-Cohort Analysis, Xu Tao, Abhijith V. Matur, Syed Khalid, Louisa Onyewadume, Rebecca Garner, Kyle Mcgrath, Bryce Owen, Justin Gibson, Daryn Cass, Juan C. Mejia Munne, Phillip Vorster, Geet Shukla, Andrew Wu, Kelly Childress, Paolo Palmisciano, Henry Ofori Duah, Benjamin Motley, Joseph Cheng, Owoicho Adogwa

College of Nursing Faculty Research and Publications

Study Design. 

Retrospective cohort.

Objective. 

To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for the treatment of degenerative stenosis and spondylolisthesis.

Summary of Background Data. 

ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications.

Methods. 

A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010 and 2022, using the PearlDiver Mariner Database, an all-claims insurance …

A Trauma-Informed Mentoring Framework For Forensic Nurses: An Overview Of Steerr—Structure, Process, And Evaluation, Sarah J. Hoffman, Tara Dillon, Kaylen M. Moore, Ellen A. Frerich, Carolyn M. Porta

College of Nursing Faculty Research and Publications

The STEERR Mentoring Framework, grounded in decolonized and feminist mentorship approaches, integrates foundational principles of mentoring with the unique and complex characteristics of the role of the forensic nurse. The primary objective of the program is to support a competent, sustainable, and resilient forensic nursing workforce. In this article, we describe the development process, framework structure, and evaluation approach implemented within a 1-year pilot initiative focused on forensic nurses in the sexual assault nurse examiner role. We reflect on strategies for broader application and replication in forensic nursing programs across the United States.

Recent Economic Intimate Partner Violence And Posttraumatic Stress Symptoms Among A Racially And Ethnically Diverse Sample Of U.S. Women Experiencing Intimate Partner Violence, Tiara C. Willie, Kamila A. Alexander, Laurel Sharpless, Jessica L. Zemlak, Megan V. Smith, Trace S. Kershaw

College of Nursing Faculty Research and Publications

Posttraumatic stress disorder (PTSD) is a prevalent consequence of physical and sexual intimate partner violence (IPV); however, little is known about the unique contributions of economic IPV. Furthermore, women’s economic self-sufficiency may explicate the potential relationship between economic IPV and PTSD symptoms. Guided by the Stress Process Theory and Intersectionality, this study examined associations between economic IPV and women’s PTSD symptoms and assessed economic self-sufficiency as a mediator. Participants were 255 adult women experiencing IPV recruited from metropolitan Baltimore, MD, and the state of CT who participated in two different studies. Participants completed surveys on IPV, economic self-sufficiency, and PTSD. …

Early Evidence For Using A Train-The-Trainer Program To Teach Debriefing For Meaningful Learning, Aimee A. Woda, Cynthia Sherraden Bradley, Brandon Kyle Johnson, Jamie Hansen, Sylvia Peña, Nolan Cox, Kristina Dreifuerst

College of Nursing Faculty Research and Publications

Background Competent debriefers are essential to promote positive learner outcomes. While important, providing training to faculty may be difficult. The Train-The-Trainer (TTT) model is a successful approach for efficiently training large groups of individuals. Methods This study used a purposive, descriptive research design to test the feasibility and effectiveness of a TTT program for teaching debriefers how to implement and train others to use Debriefing for Meaningful Learning (DML). Results With training, assessment, and individualized feedback, trainers and trainees alike improved their ability to use DML, as well as self-assess their debriefing. Conclusion The TTT program was a successful, feasible, …

Application Of The Social Determinants Of Health To Geriatric Patients By Nurse Practitioner Students, Theresa Marie Gruenke Schnable

Dissertations (1934 -)

ABSTRACT APPLICATION OF THE SOCIAL DETERMINANTS OF HEALTH TO GERIATRIC PATIENTS BY NURSE PRACTITIONER STUDENTS Patient outcomes are influenced by the social determinants of health (SDOH), which influence differing exposures to opportunities or health risks. Holistic care of geriatric patients includes considering SDOH in patient assessment, diagnosis, and care delivery. Understanding how NP students care for geriatric patients using a SDOH lens provides insight into their practice behaviors and helps educators understand how to strengthen NP programs to achieve better patient outcomes and advance health equity for the geriatric population. The purpose of this study was to describe how NP …

Underrepresentation Of Women In Exercise Science And Physiology Research Is Associated With Authorship Gender, Jessica J. James, Emilie A. Klevenow, Mira A. Atkinson, Emma E. Vosters, Elizabeth P. Bueckers, Meagan E. Quinn, Samantha L. Kindy, Azara P. Mason, Sophia K. Nelson, Kennedy A. H. Rainwater, Petra V. Taylor, Elena P. Zippel, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Historically, low representation of women participants in exercise science and physiology studies has led to a lack of understanding in the response of women to exercise and therapeutic interventions. We hypothesized that 1) the number of women authors, participants, and editorial board members increased over 30 years (1991–2021) and 2) larger representation of women as editors and authors is associated with more women participants. Gender (man/woman) of editorial board members (n = 394), authors (n = 5,735), and participants (n = 2,984,883) of 972 original research articles with human participants published in 1991 and 2021 …

The Biological Basis Of Sex Differences In Athletic Performance: Consensus Statement For The American College Of Sports Medicine, Sandra K. Hunter, Siddhartha S. Angadi, Aditi Bhargava, Joanna Harper, Angelica Lindén Hirschberg, Benjamin D. Levine, Kerrie L. Moreau, Natalie J. Nokoff, Nina S. Stachenfeld, Stéphane Bermon

Exercise Science Faculty Research and Publications

Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%–30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, …

Temporomandibular Disorders And Physiotherapy, Luis Eduardo Almeida

School of Dentistry Faculty Research and Publications

No abstract provided.

A Scoping Review Of Diagnosis Of Autism Spectrum Disorder In Primary Care, Norah L. Johnson, Alissa V. Fial, Amy V. Van Hecke, Kim Whitmore, Katie Meyer, Sylvia Peña, Mary E. Carlson, Kathleen A. Koth

College of Education Faculty Research and Publications

Introduction

This scoping review was performed to collect, examine, and present literature on interventions promoting the diagnosis of Autism Spectrum Disorder (ASD) in U.S. primary health care settings.

Method

The literature searched was from 2011–2022, in the English language, in PubMed, CINAHL, Psych INFO, Cochrane, and Web of Science, for persons with autism or ASD aged ≤ 18 years.

Results

Six studies met the search criteria, including a quality improvement project, a feasibility study, a pilot study, and three primary care provider (PCP) intervention trials. Measured outcomes included: accuracy of diagnosis (n = 4), practice change maintenance (n …

Testing The Impact Of An Asynchronous Online Training Program With Repeated Feedback, Aimee A. Woda, Cynthia Sherraden Bradley, Brandon Kyle Johnson, Jamie Hansen, Ann Loomis, Sylvia Peña, Maharaj Singh, Kristina Dreifuerst

College of Nursing Faculty Research and Publications

Background:

Learning to effectively debrief with student learners can be a challenging task. Currently, there is little evidence to support the best way to train and evaluate a debriefer's competence with a particular debriefing method.

Purpose:

The purpose of this study was to develop and test an asynchronous online distributed modular training program with repeated doses of formative feedback to teach debriefers how to implement Debriefing for Meaningful Learning (DML).

Methods:

Following the completion of an asynchronous distributed modular training program, debriefers self-evaluated their debriefing and submitted a recorded debriefing for expert evaluation and feedback using the DML Evaluation Scale …

Home Health Nurses For Children With Invasive Mechanical Ventilation (Imv): Perspectives On Gaps And Opportunities For Recruitment, Sarah A. Sobotka, Emma Lynch, Sarah Laudon, Kim Whitmore

College of Nursing Faculty Research and Publications

Background

Children with medical complexity (CMC) dependent on invasive mechanical ventilation (IMV) often require private duty home nursing; however, there are ubiquitous shortages. Home health is an especially vulnerable nursing sector because of less competitive wages and less prominence during nursing education. We sought to understand nurses' perspectives on gaps and opportunities for recruiting home care nurses for children with IMV.

Methods

Home health nurses experienced with children with IMV were recruited for semi-structured interviews. The interview guide served as the initial codebook which was iteratively modified as themes emerged. This study presents an analysis of quotes related to field …

Sports Drinks Effect On Salivary Volume And Ph In Children After Exercise: A Randomized Clinical Study, Matina V. Angelopoulou, Alicia Malak-Santaga, Andreas Agouropoulos, Cesar D. Gonzalez

School of Dentistry Faculty Research and Publications

BACKGROUND: The aim of this study was to examine the sports’ related oral health behavior and the effect of sports drinks on the salivary volume and acidity of 6 to 14 years old children.

METHODS: Sixty-eight children with a median age of 8 years old from Waterford Tennis Association camp participated in the study. Each child was randomly assigned to either the control group that consumed water or the experimental group that consumed a sports drink. Salivary volume and acidity were measured for all groups before exercise, right after exercise and after consuming the rehydrating agent. Salivary volume was measured …

Patient-Reported Outcomes Following Guided Bone Regeneration: Correlation With Clinical Parameters, Vrisiis Kofina, Morvarid Monfaredzadeh, Swati Y. Rawal, Andrew R. Dentino, Maharaj Singh, Dimitris N. Tatakis

School of Dentistry Faculty Research and Publications

Objectives

Postoperative oral health-related quality of life is procedure-dependent and may vary during early healing. There is scarce evidence on patient-reported outcome measures (PROMs) after extraction and guided bone regeneration (GBR) or on the clinical parameters influencing PROMs. This prospective observational study aimed to evaluate PROMs during the first 2 weeks following extraction and GBR and correlate them with clinical parameters.

Methods

Patients undergoing extraction and GBR (bone graft and resorbable membrane) at a single tooth-bound site were recruited. PROMs (pain, swelling, difficulty of mouth opening, and OHIP-14) were recorded immediately preoperatively, and at 2, 7, and 14 days postoperatively. …

Mandibular Condylar Hyperplasia And Its Correlation With Vascular Endothelial Growth Factor, Luis Eduardo Almeida, Marco Cicciù, Andrea Doetzer, Matthew L. Beck, Gabriele Cervino, Giuseppe Minervini

School of Dentistry Faculty Research and Publications

Background

Condylar hyperplasia (CH) is a rare condition characterised by excessive unilateral growth of the mandibular condyle after cessation of growth on the contralateral side causing facial asymmetry, being more prevalent in the second and third decades.

Objective

The aim of this study was to determine the utility of vascular endothelial growth factor (VEGF-A) as a diagnostic and prognostic factor in condylar hyperplasia, and to determine its potential viability as a therapeutic target.

Methods

This is a case–control study, where 17 mandibular condyles specimens were collected from 17 patients treated for active mandibular condyle hyperplasia and three unaffected human mandibular …

Effectiveness Of A Postpartum Breastfeeding Protocol For Avoiding Pregnancy Data, Mary Schneider, Richard Fehring, Thomas Paul Bouchard

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

The uses of cervical mucus and basal body temperature as indicators of return to fertility postpartum have resulted in high unintended pregnancy rates. In 2013, a study found that when women used urine hormone signs in a postpartum/breastfeeding protocol this resulted in fewer pregnancies. To improve the original protocol's effectiveness, three revisions were made: (1) women were to increase the number of days tested with the Clearblue Fertility Monitor, (2) an optional second luteinizing hormone test could be done in the evening, and (3) instructions were given to manage the beginning of the fertile window for the first six cycles …

Preoperative Hba1c And Postoperative Outcomes In Spine Surgery: A Systematic Review And Meta-Analysis, Tao, Abhijith V. Matur, Paolo Palmisciano, Fatu S. Conteh, Louisa Onyewadume, Henry Ofori Duah, Geet Shukla, Phillip Vorster, Sahil Gupta, Sai S. Chilakapati, Owoicho Adogwa

College of Nursing Faculty Research and Publications

Study Design. 

Systematic review and meta-analysis.

Objective. 

To perform a systematic review and meta-analysis of previous studies on HbA1c in preoperative risk stratification in patients undergoing spinal procedures and provide an overview of the consensus recommendations.

Summary of Background Data. 

Diabetes mellitus (DM) and hyperglycemia have been shown to be independent risk factors for increased surgical complications. Glycated Hemoglobin A1C (HbA1c), a surrogate for long term glycemic control, is an important preoperative parameter that may be optimized to reduce surgical complications and improve patient-reported outcomes. However, comprehensive systematic reviews on preoperative HbA1c and postoperative outcomes in spine surgery have been …

"Evidence That The Woman's Ovarian Cycle Is Driven By An Internal Circamonthly Timing System" Data, Mary Schneider

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

No abstract provided.

Palliative Care Interventions Among Adolescents And Young Adults With Serious Illness: A Scoping Review, Amy R. Newman, Ansley E. Kenney, Elizabeth Witkowski, Jeffrey Karst, Stacee Lerret, W. Hobart Davies, Charles B. Rothschild

College of Nursing Faculty Research and Publications

Objective:

To map the range of multidisciplinary palliative care interventions that are available to adolescents and young adults (AYAs) with serious illness.

Methods:

Scoping review methodology as outlined by Arksey and O’Malley.

Results:

Twenty-two articles describing nine specific AYA-focused, multidisciplinary palliative care interventions were included in this review. Interventions focused on supporting advance care planning, facilitating treatment decision making, managing pain, and promoting resilience, psychosocial well-being, and quality of life. Interventions were delivered face-to-face and via different eHealth platforms and were targeted to AYAs with cancer, HIV/AIDS, and cystic fibrosis in both inpatient and outpatient settings.

Conclusions:

Few evidence-based multidisciplinary …

Identification Of Child Survivors Of Sex Trafficking From Electronic Health Records: An Artificial Intelligence Guided Approach, Aaron Murnan, Jennifer J. Tscholl, Rajesh Ganta, Henry Ofori Duah, Islam Qasem, Emre Sezgin

College of Nursing Faculty Research and Publications

Survivors of child sex trafficking (SCST) experience high rates of adverse health outcomes. Amidst the duration of their victimization, survivors regularly seek healthcare yet fail to be identified. This study sought to utilize artificial intelligence (AI) to identify SCST and describe the elements of their healthcare presentation. An AI-supported keyword search was conducted to identify SCST within the electronic medical records (EMR) of ∼1.5 million patients at a large midwestern pediatric hospital. Descriptive analyses were used to evaluate associated diagnoses and clinical presentation. A sex trafficking-related keyword was identified in .18% of patient charts. Among this cohort, the most common …

Implementing An Integrated Psychology, Social Services, And Pediatric Diabetes Clinic, Joan P. Totka, Jacquelyn Smith, Sandra Brown, Maharaj Singh, Elaine Parton, Dawn Cvecko, Heather Fortin, Peter M. Wolfgram

College of Nursing Faculty Research and Publications

Objective:

Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families.

Methods:

Using the Iowa Model of implementation, we redesigned the “Regular Engagement And Connection for Health” (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social …