Medicine and Health Sciences Commons^™

Aversion-Induced Dopamine Reductions Predict Drug-Taking And Escape Behaviors, Elaine M. Grafelman, Bridgitte E. Côté, Lisa Vlach, Ella Geise, G. Nino Padula, Daniel S. Wheeler, Matthew C. Hearing, John R. Mantsch, Robert A. Wheeler

Biomedical Sciences Faculty Research and Publications

Dopamine release in the nucleus accumbens core (NAcC) has long been associated with the promotion of motivated behavior. However, inhibited dopamine signaling can increase behavior in certain settings, such as during drug self-administration. While aversive environmental stimuli can reduce dopamine, it is unclear whether such stimuli reliably engage this mechanism in different contexts. Here we compared the physiological and behavioral responses to the same aversive stimulus in different designs to determine if there is uniformity in the manner that aversive stimuli are encoded and promote behavior. NAcC dopamine was measured using fiber photometry in male and female rats during cocaine …

Student Described Importance Of Nurse Educator Caring Actions In Various Class Settings, Jessica Leiberg

Dissertations (1934 -)

Caring pedagogy is a well-known and proven nurse educator instructional approach resulting in improved student attrition, enhanced attitude towards the students’ nursing program, and a caring approach extending into professional practice. Despite much research and development of nurse educator caring actions, the possible effect of different class settings on the student perception of these nurse educator caring actions is unknown. The purpose of this study aimed to identify how students’ rate and rank order the importance of nurse educator caring actions within the different class settings. A descriptive quantitative design was conducted to explore student perceptions of the importance of …

Role For Astrocytes In Complex Cognition: An Evolutionary, Behavioral And Computational Perspective, Gregory Simandl

Dissertations (1934 -)

The human brain has more computational power than modern supercomputers by utilizing only a few signaling systems, rendering it the most efficient computational device ever created. Evolution, though not prospective, has iteratively constructed neural networks of increasing complexity that have ultimately endowed humans with extraordinary cognitive abilities. Through an evolutionary lens, there is a clear correlation between organismal sophistication and network signaling complexity Astrocytes, a non-neuronal cell that makes up approximately half the cells in the human brain, show dramatic increases in morphological and signaling complexity in higher-order species. This co-evolution is likely not coincidental but rather represents the development …

The Impact Of Electronic Health Record Training: How Students Utilize The Electronic Record To Inform Clinical Judgment, Sarah Marie Calonder

Dissertations (1934 -)

Nurses practice within a complex healthcare environment and must make well-informed judgments about their patients to provide safe, quality care. The electronic health record (EHR) is a piece of healthcare and informatics technology which houses important patient information that nurses utilize frequently while making clinical judgments surrounding patient care. The importance of entry-level nurse competency with the EHR and similar healthcare and informatics tools has been outlined by the American Association of Colleges of Nursing (AACN) Essentials and other nursing organizations concerned with the preparation of future nurses (AACN 2021; QSEN, 2020). Currently, there are limited established best practices for …

Treatment Of Osteoporosis And Osteoarthritis In The Oldest Old, Daniel Pinto

Physical Therapy Faculty Research and Publications

Osteoporosis and osteoarthritis are key diseases of musculoskeletal ageing and are increasing in prevalence and burden with the progressively ageing population worldwide. These conditions are thus particularly common in ‘the oldest old’, and there are complexities of managing them within the context of extensive multimorbidity, physical and mental disability, and polypharmacy, the rates for all of which are high in this population. In this narrative review, we explore the epidemiology of osteoporosis and osteoarthritis in the oldest old before examining trials and real-world data relating to the pharmacological treatment of these diseases in older adults, including anti-resorptives and bone-forming agents …

Does Social Media Increase Perioperative Anxiety In Patients Undergoing Impacted Third Molar Surgery?, Ufuk Tatli, Tahayasin Kalkan

School of Dentistry Faculty Research and Publications

Background

In anticipation of third molar surgery, patients may experience increased anxiety. Patients frequently access social media platforms and view content about surgical treatments.

Purpose

The study purpose was to measure the level of perioperative anxiety of patients scheduled for third molar surgery exposed to social media and identify factors associated with patient anxiety.

Study Design, Setting, Sample

This is a prospective cohort study of patients undergoing impacted mandibular third molar surgery from September 2021 to August 2022 at the outpatient clinic of Cukurova University School of Dentistry.

Predictor Variable

The predictor variable was level of exposure to viewing third …

Bilateral Condylar Hyperplasia: Importance Of Its Diagnosis In The Treatment And Long-Term Stability Of Skeletal Class Iii Correction, Diego Fernando Lopez, Martin Fernando Orozco, Sofia Ochoa Gomez, Santiago Herrera Guardiola, Luis Eduardo Almeida

School of Dentistry Faculty Research and Publications

Background: Condylar hyperplasia (CH) leads to mandibular overgrowth with anatomical, aesthetic, and functional consequences, particularly affecting facial harmony. It is characterized by severe mandibular prognathism (MP) in bilateral cases. This study aims to propose a therapeutic algorithm for diagnosing and treating bilateral condylar hyperplasia (BCH) based on demographic, clinical, craniofacial growth, and clivus ratio uptake conditions. Methods: Ten patients with severe skeletal Class III by MP, whose alteration was clinically associated with BCH, were consecutively evaluated in a specialized dentofacial deformity center between the period of 2019 and 2024. A detailed protocol was followed to gather clinical history, assess anatomical …

Outpatient Physical Therapy Attendance By Older Adults After Emergency Department Discharge Was A Predictor For Lower 30-Day Revisits—But Demographic Factors Affected Attendance, Suzanne Ryer, Michelle Simpson, Maharaj Singh

College of Nursing Faculty Research and Publications

Objective

Given the high risk of functional loss and revisits among older adults presenting to the emergency department (ED), there is a need to understand how post-ED discharge outpatient physical therapy affects outcomes. This study sought to examine patient demographics and their association with outpatient physical therapy utilization after ED discharge and physical therapy attendance with 30-day ED revisits among older adults discharged to home.

Methods

In this retrospective cohort study, we analyzed data from 1395 older adults (65 years old and older) who had a referral to outpatient physical therapy upon discharge from 15 EDs between January 2021 and …

Integrated Mental Health Care In Specialty Clinics For Children With A Diagnosis Of Asthma Or Diabetes: A Mixed Methods Study, Joan P. Totka, Maria Peña, Joshua A. Steinberg, Peter M. Wolfgram

College of Nursing Faculty Research and Publications

Introduction

Using patient-reported outcome measures (PROM) in a shared-space mental health-integrated specialty clinic, we explored the feasibility, acceptance, and experience of youth with asthma and diabetes, their families, and the healthcare team.

Method

Using mixed methods, we examined feasibility, acceptability, and experience of PROM inclusion in caring for youth with asthma (n = 7) and diabetes (n = 11), their families (n = 18), and healthcare providers (n= 13). Completion and receipt of PROM (feasibility), postvisit surveys (acceptance), and structured interviews (experience) between June 2019 and February 2020.

Results

Targeted PROM met feasibility goals (80%) …

To Address The Nursing Faculty Shortage, Start With The Salary Gap, Jacqueline Christianson, Christine A. Schindler, Lisa M. Grabert

College of Nursing Faculty Research and Publications

Nurses must advocate with policymakers for meaningful change.

There is a national shortage of nursing faculty to educate the future nurse workforce. The biggest barrier to recruiting and retaining nursing faculty is the salary gap between the faculty and clinical nursing roles. Many full-time nursing faculty earn a lower salary than the new graduate nurses they educate. According to our recent research (American Nurse, July 2024), NPs who have a comparable education level to nursing faculty take an average $43,000 pay cut if they leave clinical practice to teach full-time. Even the salaries of PhD-prepared faculty often lag …

Implant Placement-Associated Tissue Swelling: A Digital Three-Dimensional And Patient-Based Assessment, Vrisiis Kofina, Juan Valencia Rincon, Swati Y. Rawal, Andrew R. Dentino, Shengtong Han, Dimitris N. Tatakis

School of Dentistry Faculty Research and Publications

Objectives

There is scarce evidence on immediate soft tissue and patient-reported outcome measures (PROMs) following implant surgery. This prospective study aimed to quantify post-implant placement intraoral swelling and to correlate it with PROMs.

Materials and methods

Twenty-six patients undergoing standardized single implant placement (two-stage protocol) were recruited. Soft tissue swelling was recorded by intraoral scans immediately pre-surgery (PS) and post-operatively (IP), and at 2 (2d), 7 (7d) and 14 days (14d) and 2 months (2 m). Ridge width, height, and volume changes from IP were recorded. PROMs (pain, swelling, difficulty of mouth opening, and OHIP-14) were recorded pre- and post-operatively. …

Walking Performance Is Worse In Black Than White People With Multiple Sclerosis, Robert W. Motl, Deborah Backus, Jeffrey R. Hebert, Alexander V. Ng, Kevin K. Mccully, Whitney N. Neal, Hollie Schmidt, Robert Mcburney, Prudence Plummer, Francois Bethoux, John Lowman, Gary R. Cutter

Exercise Science Faculty Research and Publications

Background

There is emerging evidence for poor health outcomes among Black people with MS, and Black people with MS may have worse walking performance than White counterparts.

Purpose

The current study examined if Black participants with MS had slower walking speed (timed 25-foot walk, T25FW) and shorter walking distance (six-minute walk, 6MW) than White participants, and if these differences were accounted for by demographic variables, physical activity, disease/clinical characteristics, and Social Determinants of Health (SDOH).

Method

The analysis included samples of Black (N = 105) and White (N = 246) participants with MS who completed the T25FW and 6MW, underwent …

A Simple, Low-Cost Implant For Reliable Diaphragm Emg Recordings In Awake, Behaving Rats, Taylor C. Holmes, Jesus D. Penaloza-Aponte, Alyssa R. Mickle, Rachel L. Nosacka, Erica A. Dale, Kristi A. Streeter

Physical Therapy Faculty Research and Publications

Breathing is a complex neuromuscular process vital to sustain life. In preclinical animal models, the study of respiratory motor control is primarily accomplished through neurophysiologic recordings and functional measurements of respiratory output. Neurophysiologic recordings that target neural or muscular output via direct nerve recordings or respiratory muscle electromyography (EMG) are commonly collected during anesthetized conditions. While offering tight control of experimental preparations, the use of anesthesia results in respiratory depression, may impact cardiovascular control, eliminates the potential to record volitional nonventilatory behaviors, and can limit translation. Since the diaphragm is a unique muscle which is rhythmically active and difficult to …

Pain Is Modulated Differently Between Females With And Without Patellofemoral Pain: Factors Related To Sensitization, Kemery J. Sigmund, Marie K. Hoeger Bement, Wendy E. Huddleston, Kyle T. Ebersole, Jennifer E. Earl-Boehm

Physical Therapy Faculty Research and Publications

Context

Patellofemoral pain (PFP) has poor long-term recovery outcomes. Central sensitization describes central nervous system changes altering pain modulation, which can complicate recovery (poorer prognosis and worse function). Signs of central sensitization include amplified pain facilitation, pain hypersensitivity, and impaired pain inhibition, which can be measured with temporal summation of pain (TSP), pressure pain thresholds (PPTs), and conditioned pain modulation (CPM), respectively. Sex differences exist for these test responses, but female-only PFP investigations of sensitization are uncommon. Understanding pain modulation in females with PFP could improve treatment protocols.

Objective

To determine whether females with PFP exhibit signs of central sensitization …

Beliefs Regarding The Use Of Imaging Among Patients With Low Back Pain: A Cross-Sectional Study In The Context Of A Middle-Income Country, Leandro M. Diniz, Ítalo R. Lemes, Ana P. C. F. Freire, Ana F. Guimarães, Lucas A. C. Ferreira, Marcia R. Franco, Arianne P. Verhagen, Guy Simoneau, Rafael Z. Pinto

Physical Therapy Faculty Research and Publications

Introduction: Patients with low back pain may play an active role in the pre-scription of excessive spine imaging.

Objective: To determine the proportion of patients with low back pain who have beliefs not aligned with current evidence regarding the use of imaging and to identify factors associated with these beliefs.

Design: Secondary analysis of baseline data of a previously published randomized clinical trial.

Setting: Outpatient physical therapy clinic in a middle-income country.

Patients: Individuals with non-specific low back pain.

Methods: Outcome variables were two statements assessing the extent of patient agreement on the need for imaging in the management of …

The Influence Of A Deep Learning Tool On The Performance Of Oral And Maxillofacial Radiologists In The Detection Of Apical Radiolucencies, Manal Hamdan, Sergio E. Uribe, Lyudmila Tuzova, Dmitry Tuzoff, Zaid Badr, Andre Mol, Donald A. Tyndall

School of Dentistry Faculty Research and Publications

Objectives

This study aimed to assess the impact of a deep learning model on oral radiologists’ ability to detect periapical radiolucencies on periapical radiographs. The secondary objective was to conduct a regression analysis to evaluate the effects of years of experience, time to diagnose, and specialty.

Methods

This study used an annotated dataset and a beta version of a deep learning model (Denti.AI). The testing subset comprised 68 intraoral periapical radiographs confirmed with cone-beam computed tomography for the presence/absence of apical radiolucencies. Four oral radiologists participated in a cross-over reading scenario, analysing the radiographs under 2 conditions: initially without AI …

Single-Nuclei Sequencing Reveals A Robust Corticospinal Response To Nearby Axotomy But Overall Insensitivity To Spinal Injury, Zimei Wang, Manojkumar Kumaran, Elizabeth Bastel, Sofia Testor-Cabrera, Zac Beine, Alicia Alvarez Ribelles, Pantelis Tsoulfas, Ishwariya Venkatesh, Murray G. Blackmore

Biomedical Sciences Faculty Research and Publications

The ability of neurons to sense and respond to damage is crucial for maintaining homeostasis and facilitating nervous system repair. For some cell types, notably dorsal root ganglia and retinal ganglion cells, extensive profiling has uncovered a significant transcriptional response to axon injury, which influences survival and regenerative outcomes. In contrast, the injury responses of most supraspinal cell types, which display limited regeneration after spinal damage, remain mostly unknown. In this study, we used single-nuclei sequencing in adult male and female mice to profile the transcriptional responses of diverse supraspinal cell types to spinal injury. Surprisingly, thoracic spinal injury induced …

A Personalized Periodontitis Risk Based On Nonimage Electronic Dental Records By Machine Learning, Laura Swinckels, Ander De Keijzer, Bruno G. Loos, Reuben Joseph Applegate, Krishna Kumar Kookal, Elsbeth Kalenderian, Harmen Bijwaard, Josef Bruers

School of Dentistry Faculty Research and Publications

Objective: This study aimed to develop a machine-learning (ML) model to predict the risk for Periodontal Disease (PD) based on nonimage electronic dental records (EDRs).

Methods: By using EDRs collected in the BigMouth repository, dental patients from the US were included. Patients were labeled as cases or controls, based on PD diagnosis, treatment and pocketing. By learning from their data, a model was trained. The ability of the developed model to predict PD was evaluated by the accuracy, sensitivity, specificity and area under the curve (AUROC) and the most important features were determined. The best-performing model was applied …

Efficacy Of 3d-Printed Chitosan-Cerium Oxide Dressings Coated With Vancomycin-Loaded Alginate For Chronic Wounds Management, Sharareh Shahroudi, Amir Parvinnasab, Erfan Salahinejad, Shaghayegh Abdi, Sarah Rajabi, Lobat Tayebi

School of Dentistry Faculty Research and Publications

Multifunctional wound dressings with antibacterial and antioxidant properties hold significant promise for treating chronic wounds; however, achieving a balance of these characteristics while maintaining biocompatibility is challenging. To enhance this balance, this study focuses on the design and development of 3D-printed chitosan-matrix composite scaffolds, which are incorporated with varying amounts of cerium oxide nanoparticles (0, 1, 3, 5, and 7 wt%) and subsequently coated with a vancomycin-loaded alginate layer. The structure, antibiotic drug delivery kinetics, biodegradation, swelling, biocompatibility, antibacterial, antioxidant, and cell migration behaviors of the fabricated dressings were evaluated in-vitro. The findings reveal that all of the formulations …

Effects Of Ischemic Conditioning On Microvascular Reactivity To Single Passive Limb Movement In Young Adults: A Pilot Study, Alicen A. Whitaker-Hilbig, Jennifer N. Nguyen, Amanda E. Wietrzny, Gabriel R. Merkow, Sergey Tarima, Emilie A. Klevenow, Luke Nelson, Allison S. Hyngstrom, Matthew J. Durand

Physical Therapy Faculty Research and Publications

Purpose

Single passive limb movement (sPLM) of the lower extremity is a simple and clinically relevant measure of the microvascular vasodilatory response to movement. A promising stimulus to improve microvascular health is ischemic conditioning (IC). We examined whether a single session of IC could improve microvascular reactivity to sPLM in young adults.

Methods

This was a blinded, crossover, randomized clinical trial. Participants were seated in an isokinetic dynamometer that passively moved the knee 90° at a frequency of 1 Hz while superficial femoral artery leg blood flow (LBF) was measured. The absolute and the relative peak changes in LBF were …

Validating At-Home Urinary Hormone Measurements In Postpartum And Perimenopause Fertility Transitions, Thomas Bouchard, Patricia K. Doyle-Baker, Paul J. Yong, Richard Fehring, Mary Schneider

College of Nursing Faculty Research and Publications

Background: Measuring quantitative menstrual cycle hormones at home may help women better understand their postpartum and perimenopause fertility transitions, but these quantitative fertility monitors require validation.

Materials and Methods: This study included 16 North American women, aged 28–51, during either the postpartum (n = 8, cycles = 18) or perimenopause (n = 8, cycles = 35) fertility transitions testing daily firstmorning urine testing with both the Mira Monitor and ClearBlue Fertility Monitor (CBFM) along with menstrual cycle parameter tracking. The main outcome measures were a rise in estrone-3-glucuronide (E₁3G) and luteinizing hormone (LH) urine hormone values from the …

Factors Associated With Health Decision-Making Autonomy On Own Healthcare Among Tanzanian Women: A 2022–2023 Demographic Health Survey Study, Tausi Seleman Haruna, Henry Ofori Duah, Rebecca Lee

College of Nursing Faculty Research and Publications

Background

Women’s health decision-making autonomy is fundamental for the health and well-being of women and their children. It empowers women to make health decisions and exercise their rights and choices surrounding their health. Like most parts of Africa, women’s autonomy in Tanzania remains contentious, with an estimated 19% prevalence of health decision-making autonomy in 2015. Given the impact of women’s health decision-making autonomy on women’s health outcomes and the fact that women’s health decision-making autonomy is an ongoing process affected by advancements in technology, economic growth, and social and cultural shifts, understanding the sociodemographic correlates of women’s autonomy is imperative. …

Rebuttal: Reduced Oxidative Capacity Of Skeletal Muscle Is Not An Inevitable Consequence Of Adult Ageing, Ian R. Lanza, Christopher W. Sundberg, Jane A. Kent

Physical Therapy Faculty Research and Publications

We thank Drs Marcinek and Ferrucci for their perspective on the inevitability of age-related declines in skeletal muscle oxidative capacity (Marcinek & Ferrucci, 2025). We agree that mitochondria have numerous roles in the cell beyond provision of chemical energy, many of which may be altered by ageing, but our focus in this debate is entirely on its role in energy production.

Whole Body Angular Momentum Characterizes Reactive Balance Adaptations And Perturbation Intensity, Mitchell D. Adam, Delaney Mcelvain, T. George Hornby, Allison S. Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Identifying measures which accurately quantify reactive balance adaptation during walking is essential to understand how emerging perturbation-based gait paradigms impact stability over the course of an intervention. These perturbation paradigms have shown promise in reducing falls for numerous clinical populations, however tracking progress in objective terms throughout an intervention remains challenging. Whole body angular momentum (H) may be particularly suited to detect subtle adaptations in the reactive balance response and is applicable within numerous perturbation environments. We assessed the ability of young healthy adults to adapt to varying intensities of discrete, unexpected, treadmill-based perturbations directed mediolaterally, anteriorly, and posteriorly during …

Perspectives Of Midwives And Nurse Practitioners In Kentucky On Exercise Counseling During Pregnancy: A Qualitative Study, Madhawa Perera, Taniya S. Nagpal, Maire M. Blankenship, Dano Tolusso, Jordyn Cox, Dilini Prashadika, Mark Schafer, Rachel A. Tinius

Physical Therapy Faculty Research and Publications

Introduction

Healthcare professionals are in an optimal position to deliver exercise information to pregnant women, yet previous research suggests this seldom happens. Midwives and nurse practitioners, who may have more time with pregnant women, are particularly well suited for this role.

Objectives

This qualitative study examined the exercise advice and counseling provided by midwives and nurse practitioners in Kentucky, focusing on the barriers they face.

Methods

Twenty-one midwives and nurse practitioners were recruited until the sample size reached saturation. A survey with open-ended questions was distributed to potential participants in regional hospitals, universities, and professional associations. The framework method was …

Age-Related Differences In Eye Movements And The Association With Archimedes Spiral Tracing Performance In Young And Older Adults, Brittany Heintz Walters, Wendy E. Huddleston, Kristian M. O'Connor, Jinsung Wang, Marie K. Hoeger Bement, Kevin G. Keenan

Physical Therapy Faculty Research and Publications

Age-related hand motor impairments may critically depend on visual information though few studies have examined eye movements during tasks of hand function in older adults. The purpose of this study was to assess eye movements and their association with performance while tracing on a touchscreen in young and older adults. Eye movements of 21 young (age 20–38 years; 12 females, 9 males) and 20 older (65–85 years; 10 females, 10 males) adults were recorded while performing an Archimedes spiral tracing task, a common clinical assessment sensitive to age-associated impairments in hand function. Participants traced an Archimedes spiral template on a …

Prediction Of Snatch And Clean And Jerk Performance From Physical Performance Measures In Elite Male Weightlifters, Ingo Sandau, Kristof Kipp

Exercise Science Faculty Research and Publications

This study aimed to build a valid model to predict maximal weightlifting competition performance using ordinary least squares linear regression (OLR) and penalized (Ridge) linear regression (penLR) in 29 elite male weightlifters. One repetition maximum (1RM) or 3RM test results of assistant exercises were used as predictors. Maximal performance data of competition and assistant exercises were collected during a macrocycle in preparation for a competition. One repetition maximum snatch pull, 3RM back squat, 1RM overhead press, and body mass were used to predict the 1RM snatch; and 1RM clean pull, 3RM front squat, 1RM overhead press, and body mass were …

Evaluation Of A Quality Cpr Coach Simulation-Based Competency Training: From Learning Outcomes To Patient Outcomes, Katie L. Mcdermott, Kari L. Rajzer-Wakeham, Jennifer M. Andres, Christine A. Schindler

College of Nursing Faculty Research and Publications

Background

Variability in cardiopulmonary resuscitation (CPR) quality and skill decay result in suboptimal application of CPR, which impacts patient outcomes following an arrest. Quality CPR Coach is a supplementary code team role that provides real time, verbal feedback directly to chest compressors to cognitively offload the team leader and ensure high-quality, goal-directed CPR delivery.

Methods

Design, implementation, and evaluation of a simulation-based Quality CPR Coach competency curriculum. Multi-modal assessment and evaluation methods were used.

Results

Statistically significant increase in confidence, perceived ability to verbalize Coach responsibilities, and knowledge. Participants demonstrated accurate Coach role performance across progressively scaffolded simulated compression event …

Resilience As Accusation: A Critical Examination Of Individual Resilience Training For Burnout Mitigation, Jacqueline Christianson, Bonnie Sommers-Olson, Jessica Leiberg, Dana Kaminstein

College of Nursing Faculty Research and Publications

Burnout, a syndrome of work-related exhaustion and cynicism, is prevalent among nurses and is associated with workplace stressors. Resilience training programs are a prevalent method of burnout mitigation employed by healthcare institutions that aim to improve or alter how individuals respond to chronic stressors. Through the lens of General Systems Theory, we describe resilience training as a method of individualizing a systemic problem by problematizing a response to chronic stress exposure. Resilience training may furthermore serve as a mechanism which allows subversion of institutional responsibility for nurses’ well-being in the workplace. We describe several suggestions for nurses to resist being …

Health Equity And Children With Medical Complexity/Children And Youth With Special Health Care Needs: A Scoping Review, Elizabeth A. Flasch

College of Nursing Faculty Research and Publications

Children with medical complexity (CMC) and children and youth with special health care needs (CYSHCN), compared with the general population, engage with the health care system at increased rates, at multiple life stages, and for a myriad of reasons (Berry et al., 2015). Operational definitions of CMC and CYSHCN are very limited, with the terms conflated and differentiated across the literature. Because of the lack of standardized definitions and general conflation of the two terms across the literature, CMC and CYSHCN will be used interchangeably for this review. Allshouse et al. (2018) defined CMC as a subset of CYSHCN “as …