Medicine and Health Sciences Commons^™

Implementation Of Standardized Mental Health Screening And Referral Protocols For Depression In Patients Aged 65 And Older In Primary Care Settings, Elizabeth Nyambura Irungu

Walden Dissertations and Doctoral Studies

No abstract provided.

Evaluating Opioid Treatment Programs’ Preparedness For Meeting The Needs Of Pregnant & Parenting Individuals, Dennis J. Hand, Taylor Carrubba, Katherine Everman, Meghan Gannon, Alie Keegan, Nicole Leighton, Martina Manfra, Melody Mcalister, Kimberly Mclaughlin, Kelliann O'Hare, Vanessa Short, Veronica Virgilio

College of Nursing Posters

Background & Aims

- Methadone has been used to treat opioid use disorder (OUD), including during pregnancy, for over 50 years.

- Pregnancy-driven increases in methadone metabolism have long been known to reduce methadone’s half-life, necessitating alternative dosing strategies including providing multiple doses of per day (split-dosing).

- Pregnant and parenting persons with OUD are often have experienced interpersonal violence and other trauma, are less likely to receive adequate reproductive health care, and would benefit from supports to improve the quality of parenting.

- It is not clear whether opioid treatment programs (OTPs) meet the above needs of pregnant and …

Nursing Staff Education On Transgender Patient Care In A Nursing Home, Cyril Shan Madera Tena

Walden Dissertations and Doctoral Studies

No abstract provided.

Neutrophil Gelatinase-Associated Lipocalin (Ngal) And Urine Albumin-To-Creatinine Ratio (Uacr) In Patients With Chronic Kidney Disease: A Cross-Sectional Study, Nurul Annisa Yunus, Puspa Wardhani, Yessy Puspitasari, Satriyo Dwi Suryantoro, Zulfian Armah

Folia Medica Indonesiana

Chronic kidney disease (CKD) remains a major global health burden with an increasing prevalence and a substantial risk of progression to end-stage renal disease. Urine albumin-to-creatinine ratio (uACR) is widely used as a conventional biomarker reflecting glomerular injury in CKD, whereas neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as a biomarker associated with tubular injury and inflammatory processes. This study aimed to determine the correlation between serum NGAL levels and uACR in patients with CKD. The authors conducted an analytical observational study with a cross-sectional design on 32 CKD patients at Universitas Airlangga Hospital. Serum NGAL levels were measured using …

Histopathological Evidence Of Irreversible Testicular Injury And Spermatogenesis Disruption In A Continuous Scrotal Hyperthermia- Induced Azoospermia Rat Model, Ageng Brahmadhi, Norina Agatri, Andi Muh. Maulana, Rahmadita Cahya Maharani, Dyanti Arisa Nurrizki

Folia Medica Indonesiana

Non-obstructive azoospermia (NOA) is a cause of male infertility characterized by impaired spermatogenesis. NOA remains a challenge for both research and treatment development. Reliable animal models are essential for better understanding its pathophysiology and evaluating therapeutic approaches. Scrotal hyperthermia induction is a cost-effective and technically feasible method for inducing NOA. However, the impact of different exposure patterns remains unsolved. In this study, a total of 30 adult male Rattus norvegicus were randomly assigned to control, discontinuous hyperthermia (every other day), and continuous hyperthermia (daily) groups. This study applied the heat exposure by immersing the scrotum in a 45°C water bath …

The Effect Of Structured Prebriefing On Pre-Simulation Anxiety In Baccalaureate Nursing Students Participating In High-Fidelity Simulation: A Quantitative Quasi-Experimental Nonequivalent Pretest-Posttest Control Group Study, Laura D. Wade

Doctoral Dissertations and Projects

The purpose of this quantitative quasi-experimental nonequivalent pretest-posttest control group study was to examine the effect of structured prebriefing on pre-simulation state anxiety among baccalaureate nursing students participating in high-fidelity simulation (HFS) at a private faith-based university in the South-Central United States (U.S.). Simulation is widely used in nursing education; however, nursing students frequently experience elevated anxiety prior to simulation that may negatively influence learning and performance. Despite recognition of prebriefing as best practice in simulation-based education, limited quantitative research has examined the effect of structured prebriefing on pre-simulation anxiety. A convenience sample of 73 baccalaureate nursing students enrolled in …

Lived Experiences Of Polysubstance Use And Co-Occurring Mental Health Disorders: A Phenomenological Inquiry, Candee Dione Rillon

Doctoral Dissertations and Projects

This phenomenological study explored the lived experiences of individuals with co-occurring substance use disorders (SUD) and mental health disorders (MHD), with particular attention to the transition into polysubstance use. The purpose of the study was to understand how individuals experience and make meaning of these co-occurring conditions and the factors influencing substance use patterns. Data were collected through semi-structured interviews with participants who reported both mental health challenges and substance use histories. Thematic analysis revealed that participants experienced SUD and MHD as deeply interconnected and mutually reinforcing, often functioning within a cyclical pattern of distress and temporary relief. Substance use …

The Relationship Between Estimated Vo2max And Poor Mental Health: A Study Of Brfss Data, Angelina Somadina Oputa

Doctoral Dissertations and Projects

Mental health conditions are one of the leading contributors to the global burden of disease. Despite advancements in mental health therapies and psychiatric medications, significant numbers of patients continue to struggle with mental illness. Despite these challenges, exercise can serve as a powerful tool to address mental health concerns. Current literature has referenced the value of physical fitness to support mental health, however there is limited large-scale research assessing the estimated maximal oxygen uptake (VO2Max) as a predictor of poor mental health days. In response, this quantitative secondary analysis was conducted to examine the relationship between estimated VO2Max and poor …

Treatment Times For Rural And Urban Patients With Aneurysmal Subarachnoid Hemorrhage In A Provincial Hub-And-Spoke Network, Alexander D. Rebchuk, Hugh Mchugh, Michael A. Rizzuto, David Chen, Kelsey Cruz, Erik N. Vu, Peter A. Gooderham

Department of Neurosurgery Faculty Papers

BACKGROUND: Following aneurysmal subarachnoid hemorrhage (aSAH), aneurysm rebleeding leads to very poor clinical outcomes. Ruptured aneurysms must be urgently secured either by open microsurgery or endovascular techniques to prevent re-rupture. The objective of this study was to compare time-to-treatment and functional outcomes following aSAH between rural and urban patients treated at a quaternary neurosurgical centre with a large geographical catchment.

METHODS: We analyzed patients enrolled in the Vancouver Ruptured Aneurysm Database (VRAD) between December 2022 and September 2025. Demographic, clinical, radiographic, treatment and functional outcomes were compared between groups. Time from ictus-to-presentation, ictus-to-neurosurgical centre, ictus-to-treatment and transfer times were collected. …

Oral Cancer Numerical Index (Ocni): Development And Validation Of A Cytology-Based Risk Assessment For Oral Lesions, Michael P Mcrae, Nadarajah Vigneswaran, Alexander Ross Kerr, Spencer W Redding, Martin H Thornhill, Craig Murdoch, Paul M Speight, Rachelle Wolk, Kritika S Rajsri, Pooja Gaikwad, Nancy Ruel, Nicolaos J Christodoulides, John T Mcdevitt

Faculty, Staff and Student Publications

Background/Objectives: Oral potentially malignant disorders (OPMDs) require accurate risk stratification to identify patients at the highest risk for severe oral epithelial dysplasia (OED) or oral squamous cell carcinoma (OSCC). We developed and internally validated the oral cancer numerical index (OCNI), a quantitative risk score derived from clinical features and deep learning-based brush cytology measurements.

Methods: This retrospective model development and internal validation study was conducted using data from the multicenter Grand Opportunity study. Prospectively recruited subjects with OPMD with complete data were divided at the subject level into a training set (n = 384) and a holdout test set …

Safety Evaluation Of Dofetilide Administration Per Enteral Tube., Megan E Labreck, Katherine Crawford, David M Nemer, Auroa Badin, Anish Amin

Heart and Vascular Articles

No abstract provided.

Design And Development Of Foot Arch Diagnosis Application, Arif Wicaksono, Arta Farmawati, Neni Trilusiana Rahmawati, Herianto Herianto

Folia Medica Indonesiana

The foot is a part of the lower extremity that has several characteristics, namely foot length, width, height, and arch. Foot arch is a characteristic that has not been widely researched in Indonesia, but it plays a crucial role in movement and daily life. A normal foot arch facilitates physical activities, work, and overall human health, whereas an abnormal foot arch can hinder physical activities, work, and negatively affect health. Foot-arch diagnosis is commonly performed using footprint creation and foot-arch determination. Foot arch diagnosis can be established through conventional examinations, which are relatively more time-consuming, and examinations using scanning devices, …

Differences In The Effects Of Multicomponent Vivifrail Training And Senam Lansia On Physical Performance And Fall Risk In Pre-Frail Elderly, Nadia Ovianti, Annisa Susilowati, Endang Ambarwati, Robby Tjandra Kartadinata, Tanti Ajoe Kesoema, Erna Setiawati

Folia Medica Indonesiana

Pre-frailty is a condition where individuals experience early signs of frailty. Frailty is a geriatric syndrome associated with falls and reduced physical performance, which will impact the health and well-being of the elderly population. To mitigate the harmful effects, the WHO recommends Vivifrail, a multicomponent exercise that is effective in preventing frailty. In Indonesia, the most common program for the elderly community is Senam Lansia (elderly exercise). No studies have compared the effects of these two exercises on the pre-frail elderly community. This study aims to assess differences between Vivifrail training and Senam Lansia on physical performance and fall risk, …

Effectiveness Of Cadre Training In Improving Knowledge On The Completion Of The Elderly Health Book In Sidoarjo, Lilik Djuari, Sulistiawati Sulistiawati, Linda Dewanti, Muhammad Izhar Yuliantama, De Farras King, Minarni Wartiningsih

Folia Medica Indonesiana

Primary healthcare in Indonesia faces challenges due to an ageing population since 2021. An elderly health book, published by Ministry of health, is an essential tool for recording, monitoring, and following up elderly health status. However, Health cadres have not yet fully understood how to fill in and use the book, resulting in suboptimal data quality. The objective of this study was to evaluate the effectiveness of cadre training to complete the Elderly Health Book (before and after training) in Sidoarjo Regency. A quasi-experimental study with a one-group pre-test and post-test design was conducted among 50 elderly health cadres which …

Detection, Persistence, And Rising Prevalence Of Oncogenic Viruses Revealed By Wastewater Metagenomics, Harihara Prakash, Ryan K Perez, Matt Ross, Michael Tisza, Sara J Javornik Cregeen, Jennifer Deegan, Joseph F Petrosino, Eric Boerwinkle, Justin R Clark, Anthony W Maresso

Faculty, Staff and Students Publications

Oncogenic viruses cause high-risk cancers in humans and are responsible for nearly 20% of all cancer cases worldwide. Currently, very limited data exist in the realm of wastewater-based viral epidemiology (WBE) for cancer-causing viruses, with existing studies using targeted approaches (i.e., PCR-based approaches) that lack genomic resolution. In this study, we used a hybrid-capture approach to detect, filter, and sequence all known oncogenic virus signals from wastewater samples collected over 3 years (May 2022-May 2025) in 16 Texas cities, covering nearly 25% of the state's population. Once sequenced, we used custom computational tools designed for wastewater metagenomics to assign reads …

Placenta Accreta Spectrum Risk In Endometriosis: A Retrospective Cohort Study With Art Subanalysis, Madeline West, Amir Alsaidi, Michael A Belfort, Hendrik A Lombaard, Yamely H Mendez, Christina C Reed, Amir A Shamshirsaz, Jessian L Munoz

Faculty, Staff and Students Publications

No abstract provided.

Management Algorithm For Vasoplegic Shock After Cardiac Surgery: An Interdisciplinary Collaboration, Subhasis Chatterjee, Jamel Ortoleva, Rakesh C Arora, Kelci R Dalton, Daniel T Engelman, Natalia Ivascu Girardi, Michael C Grant, Travis J Miles, Marc R Moon, Orlando R Suero, Erica Wittwer, Patrick M Wieruszewski

Faculty, Staff and Students Publications

Background: Vasoplegic shock is distributive shock that follows cardiopulmonary bypass, characterized by hypotension, low systemic vascular resistance, and catecholamine resistance despite preserved or elevated cardiac output. Reported incidence ranges from 5% to 50%. Associated adverse outcomes include acute kidney injury, prolonged intensive care unit stay, and mortality. A single, universally accepted consensus definition is lacking, and few evidence-based best-practice management strategies exist.

Methods: A panel of 12 clinicians-cardiac surgeons, anesthesiologists, intensivists, and pharmacists-from 6 institutions conducted a structured expert review. PubMed and Embase were searched for research studies, including clinical trials, retrospective analyses, and mechanistic studies covering epidemiology, risk factors, …

The Prevalence Of Moral Injury Among Veterans Diagnosed With Post-Traumatic Stress Disorder (Ptsd): Analyses By Combat Exposure, Gender, Age Group, And Military Service, Carl B. Forkner

Doctoral Dissertations and Projects

The attacks on the United States on September 11, 2001, and the ensuing wars in Afghanistan and Iraq, heralded in a new concept affecting our combat and support military personnel. This concept is known today as moral injury. Military personnel were already familiar with post-traumatic stress disorder (PTSD), whether from personal experience or from reading and training on the subject, but no training addresses the prevalence or effects of moral injury. The term moral injury (MI) was first coined by psychiatrist Jonathan Shay and his colleagues based on feedback from military and veteran patients in 1998; however, it remains that …

Moving Beyond Occupational Health: Lessons From Implementing Integrated Worker Health Programs Among Informal Workers In Thailand, Orrapan Untimanon

Journal of Health Research

Background: This paper aims to present practical experiences and lessons learned from applying an integrated worker health approach among informal workers in Thailand. The approach draws on the concept of Total Worker Health (TWH) and is implemented through Primary Care Units (PCUs).

Methods: This is an invited commentary.  

Results: Key steps included: (1) identification of occupational health (OH) services provided by PCUs; (2) development and refinement of an integrated worker health assessment tool based on TWH principles; (3) assessment and problem identification among informal workers, highlighting combined occupational and lifestyle-related risks; (4) design and implementation of integrated interventions; and (5) …

Preoperative Low-Intensity Blood Flow Restriction Training Does Not Improve Quadriceps Strength Or Hypertrophy After Anterior Cruciate Ligament Reconstruction, Daniel Mcgurren, Kaycee Glattke, Molly Klanderman, Jedediah Lee, Anikar Chhabra, Arthur De Luigi

Journal for Sports Neuroscience

Objectives: To investigate the efficacy of a preoperative low-intensity blood flow restriction (LI-BFR) training intervention for patients undergoing anterior cruciate ligament reconstruction (ACLR).

Design: Pilot study

Methods: Twenty-eight patients undergoing primary ACLR participated in either a LI-BFR training or sham intervention at a rate of 2 sessions per week for 2 weeks before surgery. Quadriceps strength and cross-sectional area were measured via handheld dynamometry and leg press test before and after the intervention before surgery and at 5 different time points after surgery, through 24 weeks after surgery.

Results: Adjusting for sex, time, and strength/hypertrophy at baseline, there were no …

The Readiness Reset: Sleep, Stress, And Pain Management For Tactical Performance, Lauren Fried

Tactical & Occupational Performance Conference

Tactical professionals operate in high-demand environments where sleep disruption, chronic stress, and persistent pain are often normalized, but these factors significantly affect readiness, resilience, and long-term performance. This session explores how sleep, stress, and pain interact at the physiological and neurological levels to influence decision-making, recovery, injury risk, and operational effectiveness in first responders and military personnel.

Participants will gain a deeper understanding of how nervous system regulation, circadian rhythms, and pain perception affect both physical and cognitive performance under stress. Drawing on current research and applied human performance principles, this session highlights practical, field-applicable strategies that tactical professionals and …

"In Hog Hollow", Kendall Thurman

Cumberland Medica

"In Hog Hollow" is a poem I wrote in the fall while walking through a trail of the same name. A few days before, I had cared for a patient in the ER who was on hospice for end-stage liver cancer. The smells and sights of fall evoked my emotions as I contemplated his death.

Mobility And Flexibility For The Tactical Athlete, Nancy Henderson, Haley Worst, Michelle Geter, Mikal Mascarello, Josie Stirling

Tactical & Occupational Performance Conference

Mobility and Flexibility for the Tactical Athlete

Anatomy And Function Of Vasopressin Receptor 1a-Expressing Neurons In The Limbic Thalamus, David Joseph Kahn

Theses and Dissertations

The vasopressin (Avp) system modulates social behavior through region-specific and sex-dependent mechanisms, yet the role of Avp receptor 1a (Avpr1a) signaling in the thalamus has remained largely unexplored. This dissertation examined the distribution and functional contributions of Avpr1a-expressing neurons across the mouse thalamus using a combination of genetic labeling, anatomical quantification, and chemogenetic manipulation. Mapping of Avpr1a-expressing neurons revealed a presence in most thalamic nuclei, with highest densities in the anterior thalamic nuclei and midline nuclei. Notably, Avpr1a-expressing neuron densities did not mirror previously described patterns of Avp innervation, and no sex differences in Avpr1a-expressing neuron density were observed. Chemogenetic …

Electronic Health Record Alerts To Improve Lipid Lowering After A Recent Myocardial Infarction, Dean G. Karalis, Benjamin Richter, Scott Hessen, Patrick Moeller, Laney K. Jones

Division of Cardiology Faculty Papers

BACKGROUND: This observational, quality initiative evaluated the impact of changing from a passive (dismissible) to an active (nondismissible without action) electronic health record alert on guideline-recommended lipid-lowering therapy (LLT) prescriptions in patients with recent myocardial infarction at risk for secondary events.

METHODS: We sequentially recruited a retrospective passive-alert (February 2018-July 2019; n=733) and a prospective active-alert (August 2020-January 2022; n=587) cohort of patients who triggered an alert to intensify LLT or order a low-density lipoprotein-cholesterol (LDL-C) test if they had a recent myocardial infarction (within 12 months) and elevated (≥70 mg/dL) or missing LDL-C. Prescribed LLTs and cumulative percentages of …

Broadly Reactive Human Monoclonal Antibodies Targeting Influenza A Nucleoprotein Lack Protective Activity In Vivo, Walter N Harrington, David C Brice, Aaron J Schmitz, Jackson S Turner, Rafael Brent, Philip A Mudd, Ali H Ellebedy, Richard J Webby

2020-Current year OA Pubs

The antibody response to influenza virus infection targets numerous viral proteins, with those specific for the hemagglutinin (HA) and neuraminidase (NA) surface glycoproteins being the most extensively studied. Antibodies to HA and NA function as independent immune correlates of protection and form the basis of most vaccine approaches. In contrast, the contribution of antibodies to other viral proteins such as the nucleoprotein (NP) remains unclear, and existing studies have reached conflicting conclusions. In this work, we examined three human monoclonal NP antibodies isolated from plasmablasts of two individuals naturally infected with influenza A virus (IAV) during the 2018-2019 influenza season. …

Sicker Americans Are More Likely To Misuse Prescription Medications, Esther Oshaji, Andrew S. London

Population Health Research Brief Series

Prescription medication misuse is a long-term population health problem in the United States. This data slice uses data from the National Wellbeing Survey (N=32,789, 2021–2025) of U.S. adults ages 18–64 to examine how the number of chronic health conditions a person has is related to their misuse of prescription opioids, tranquilizers, sedatives, or stimulants in the past 12 months. The authors find a dose-response pattern: misuse rises from 2.8% among those with no chronic conditions to 11.7% among those with three or more conditions. Mental health conditions show stronger associations with misuse than physical health conditions.

The Role Of Mitochondrial And Lysosomal Damage In Neurotoxicity From Parkinson 'S-Related Environmental Exposures, Neda Ilieva

ETDs from 2020-2029

Parkinson's disease (PD) is a progressive motor neurodegenerative disorder with a predominantly idiopathic etiology. More recently, however, the contribution of exogenous risk factors such as environmental contaminants has become of interest. Some endogenous genetic risk factors have been well characterized, but the mechanisms by which exogenous insults, such as environmental contaminants, drive dopaminergic neurodegeneration remain incompletely understood. This dissertation will address how environmental contaminants converge on mitochondrial and lysosomal dysfunction to activate parallel neurotoxic signaling pathways, with a focus on the LRRK2 kinase and the cGAS-STING innate immune pathway. Chapter 2 demonstrates that pharmacological inhibition of LRRK2 kinase activity protects …

Pregnancy Outcomes In Systemic Sclerosis Before And After Diagnosis: A Retrospective Nationwide Cohort Study, Alper Doğanci, Serdar Can Güven, Nuray Yilmaz Çakmak, Rifat Bozkuş, Sali̇h Başer, Eki̇n Doğanci, Nesli̇han Öztürk, Şuayi̇p Bi̇ri̇nci̇, Nai̇m Ata

Turkish Journal of Medical Sciences

Background/aim: Pregnancy outcomes in women with systemic sclerosis (SSc) were evaluated in a nationwide cohort study. The impact of the disease on pregnancy outcomes was further assessed by comparing outcomes before and after the diagnosis of systemic sclerosis.

Materials and methods: A retrospective, nationwide, multicenter study was conducted under the supervision of the Ministry of Health. A nationwide cohort was between 1 January 2018, and 31 October 2025, including female patients with at least two recorded ICD codes for SSc (M34 subcategories) at an interval of at least 1 month, who were identified as pregnant before (pre-SSc) or after SSc …

Effects Of Repetitive Peripheral Magnetic Stimulation On Poststroke Ankle Spasticity: A Double-Blind Randomized Controlled Trial, Hüseyi̇n Oğuzhan Aslantaş, Şehi̇m Kutlay, Haydar Gök, Semra Özkan, Seçi̇lay Güneş, Ati̇lla Hali̇l Elhan

Turkish Journal of Medical Sciences

Background/aim: Repetitive peripheral magnetic stimulation (rPMS) is a noninvasive, painless therapy aimed at improving spasticity, with a proposed mechanism that involves neuromodulation through somatosensory and proprioceptive afferent stimulation. The present study evaluates the effectiveness of rPMS on ankle plantar flexor spasticity in participants with stroke.

Materials and methods: Included in this prospective, double-blind, randomized, sham-controlled study were 50 participants with poststroke ankle plantar flexor spasticity graded 1–3 according to Modified Ashworth Scale (MAS). Participants were randomized into rPMS (n = 25) and sham (n = 25) groups. All participated in a conventional rehabilitation program, while the rPMS group received 10 …