Medicine and Health Sciences Commons^™

Extended-Release Vs Sublingual Buprenorphine In Pregnancy Through 12 Months Post Partum: A Randomized Clinical Trial, T. John Winhusen, Michelle R. Lofwall, Frankie Kropp, Daniel Lewis, Marcela C. Smid, Jessica L. Young, Candace Hodgkins, Elizabeth E. Krans, Zachary Hansen, Elisha M. Wachman, Davida M. Schiff, Constance Guille, Vania Rudolf, Tara Chowdhury, Lawrence Leeman, Mitra Lewis, Abigail G. Matthews, Gerald Cochran, Jacquie King, Christine Wilder, Carmen Rosa

Behavioral Science Faculty Publications

Importance: Treating opioid use disorder (OUD) in pregnancy with sublingual buprenorphine is an evidence-based practice, but it has disadvantages that could be addressed with an extended-release formulation.

Objective: To evaluate the effectiveness and safety of extended-release buprenorphine vs sublingual buprenorphine for OUD in pregnancy through 12 months post partum.

Design, Setting, and Participants: This 2-group, open-label, noninferiority, randomized clinical trial was conducted between July 2, 2020, and October 30, 2024, among adults with OUD and a singleton pregnancy of 6 to 30 weeks’ gestational age at 13 outpatient cross-disciplinary peripartum OUD treatment sites.

Interventions: Randomization to sublingual or extended-release buprenorphine …

Feeding The Family—A Food Is Medicine Intervention: Preliminary Baseline Results Of Clinical Data From Caregivers And Children, Gabriela Drucker, Christa Mayfield, Elizabeth T. Anderson Steeves, Sara Maksi, Tabitha Underwood, Julie Brown, Marissa Frick, Alison Gustafson

Behavioral Science Faculty Publications

Background/Objectives: Food is Medicine (FIM) programs have been shown to be effective at addressing food and nutrition insecurity among individuals. However, more evidence is needed to determine effective interventions at the household level and their impact on child health outcomes. Feeding the Family is a randomized controlled trial which aims to determine whether the amount of food provided and the ability to select foods in FIM interventions have an incremental effect on child and caregiver clinical outcomes relative to nutrition counseling alone. The objective of this paper is to describe the population at baseline among those enrolled in Feeding the …

Frequent Police Contact And Nonfatal Overdose Among People Who Use Drugs In Rural Appalachia, Javier A. Cepeda, Talia Loeb, Zach R. Salazar, Brittney D. Williams, Brooke Hiltz, Brandon Del Pozo, Eileen V. Pitpitan, Leo Beletsky, April M. Young, Jennifer R. Havens

Behavioral Science Faculty Publications

Introduction: Police contact shapes subsequent health practices and outcomes among people who use drugs (PWUD). However, the relationship between police encounters with overdose remains under-researched. We evaluated how police stop-and-search was associated with nonfatal overdose and identified correlates of frequent police contact among PWUD in rural Kentucky.

Methods: From May 2023– April 2024, 774 PWUD were enrolled in the Social Networks of Appalachian People and KyOSK studies. The exposure of interest was self-reported police stop-and-search in the past 6 months (0, 1–3, ≥4 times). The primary outcome was self-reported nonfatal overdose in the past 6 months. We evaluated the association …

The Receipt Of Psychological Services And Acceptability Of Local Follow- Up Care For Childhood Cancer Survivors: Are There Rural Vs. Urban Differences?, Tyrone F. Borders, Abigayle Feather, Jerod L. Stapleton, John A. D’Orazio, Eric B. Durbin

Psychology Faculty Publications

Purpose This study examined rural and urban parents’ reports of their children’s receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2–17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural …

A Ubiquitous Organophosphate Flame Retardant Disrupts Energy And Glucose Homeostasis In Mice, Krystal M. Sewell, Kelly Oriakhi, Sara Y. Ngo Tenlep, Megan L. Weaver, Mansura Shahad Bawa, Se-Hyung Park, Shubh Saraswat, Xiaohua D. Zhang, Robert N. Helsley, Samir Softic, Cetewayo S. Rashid

Pharmacology and Nutritional Sciences Faculty Publications

Organophosphate flame retardants (OPFRs) are used in many consumer products, and their presence in our environment raises concerns about potential health dangers. In humans, exposure to OPFRs, such as tris(1,3-dichloro-2-propyl) phosphate (TDCPP) is associated with metabolic disorders such as obesity, hyperglycemia, and insulin resistance. Our current study seeks to determine how TDCPP exposure affects body composition, glucose homeostasis, and energy balance in a rodent model. C57Bl/6 J mice were divided into two weight-matched groups and fed purified low phytoestrogen diets containing either 0.1 % DMSO (control) or TDCPP 415 mg/kg resulting in an approximate exposure of 50 mg/kg/day. Both male …

Contribution Of Metabolism-Independent Glucose Sensing To Metabolic Homeostasis, Nadia Rashid, Kavaljit H. Chhabra

Pharmacology and Nutritional Sciences Faculty Publications

Glucose sensing and signaling are central to cellular metabolic machinery for the regulation of metabolic homeostasis. Glucose sensing has been almost always assumed to be coupled with glucose metabolism; however, recent findings have unraveled metabolism-independent sensing mechanisms. Here, we discuss whether glucose transporters (GLUTs) and sodium-glucose co-transporters (SGLTs) may also function as glucose sensors independent of their roles in transporting glucose. Moreover, we review the emerging roles of G protein-coupled receptors (GPCRs) in sensing glucose and, consequently, initiating its signaling pathways in a cell-specific manner. Altogether, this review offers insights into the newly identified glucose sensing mechanisms and highlights the …

Anatomical Atlas Of Kinase Responsiveness To Weight Gain: Adipose Depot Reprogramming In Diet-Induced Adiposity, Wang-Hsin Lee, Zachary A. Kipp, Sally N. Pauss, Genesee J. Martinez, Mei Xu, Terry D. Hinds, Jr.

Pharmacology and Nutritional Sciences Faculty Publications

Background/Objectives: Adipose tissue depots located at different anatomical sites exert differential functions in response to adiposity and glucose intolerance. These fat depots exhibit distinct metabolic signaling patterns that may influence pathological fat accumulation, thereby affecting the efficacy of anti-obesity interventions. Nonetheless, the mechanisms underpinning depot-specific signaling and pathway responsiveness remain insufficiently understood.

Methods: Kinase activity was characterized during the progression of adiposity across five adipose tissue depots in obese versus lean mice using the advanced PamGene kinome technology. Furthermore, kinase pathways in human preadipocytes and mouse 3T3-L1 preadipocytes were analyzed and compared with those in their differentiated, mature adipocytes. The …

Social Engagement Moderates The Relationship Between Cognitive Functioning, Depressive Symptoms, And Restless Sleep In Older Black Adults, Sunkanmi Folorunsho, Olufunmilola Abraham, Darlingtina K. Esiaka

Pharmacy Practice and Science Faculty Publications

INTRODUCTION: Older Black adults face higher dementia risk, but it is unclear whether social engagement offsets the effects of depression and restless sleep.

METHODS: We analyzed 1,905 Black adults aged 50+ from the 2016-2020 Health and Retirement Study (HRS). Linear mixed-effects models tested how depressive symptoms, restless sleep, and social engagement predicted baseline cognition and cognitive decline.

RESULTS: Higher depressive symptoms and restless sleep were associated with lower baseline cognition (about 0.2 and 0.5 points lower) and faster decline (β×time ≈ −0.07 and −0.05). Greater social engagement predicted higher baseline cognition (about 0.6 points higher) and slower decline (β×time ≈ …

A Deimplementation Framework For Curricular Hoarding In Pharmacy Education, Mary E. Fredrickson, Ashleigh Barrickman, Krista L. Donohoe, Angela L. Goodhart, Caroline Lindsay Ko, Daniel R. Malcom, Frank Romanelli, Marissa C. Salvo

Pharmacy Practice and Science Faculty Publications

Objective: To propose a holistic approach to managing curricular transformation that addresses various curricular obligations, incorporates the emotional component of curricular overload, and utilizes deimplementation science to reframe curricular change decisions. Findings: Given the need to codify processes and interventions that continually seek to ensure curricula are modernized, contemporary, and free of outdated teaching materials, we have developed a systematic deimplementation approach to address curricular overload. Its intent is to free space for more impactful learning and practices within pharmacy curricula that can lead to measurable improvements in workload, satisfaction, and learning outcomes for both students and faculty. Summary: By …

Behavioral And Transcriptomic Markers Of Susceptibility To Escalate Fentanyl Intake, Jack V. Keady, Richard Charnigo, Jakob D. Shaykin, Emily Prantzalos, Mengfan Xia, Emily D. Denehy, Cody Bumgardner, Justin Miller, Pavel I. Ortinski, Michael Thomas Bardo, Jill R. Turner

Pharmacy Practice and Science Faculty Publications

The “loss of control” over drug consumption, known as escalation of intake in opioid use disorder (OUD), is well-established in preclinical rodent models. However, little is known about how antecedent behavioral characteristics, such as valuation of hedonic reinforcers prior to drug use, influence fentanyl intake trajectories. Moreover, it is unclear if distinct escalation phenotypes are driven by transcriptomic markers predictive of OUD susceptibility. Male and female Sprague-Dawley rats (n = 72) were trained in a sucrose reinforcement task using a progressive ratio schedule. Individual differences in responsivity to sucrose were hypothesized to predict escalation of fentanyl intake. Rats underwent daily …

Developing Curcumin Analogues For Treating Breast Cancer, Tulasi Laxmi Nutalapati

Theses, Dissertations and Capstones

Breast cancer is still one of the most common types of cancer and one of the most common causes of cancer-related deaths in women around the world. Despite significant advances in early detection and treatment strategies, drug resistance, systemic toxicity, and poor outcomes in aggressive subtypes continue to limit the overall effectiveness of cancer therapy. Natural compounds have become promising anticancer agents because they can target many different things and are not very toxic. Curcumin has shown promise as an anticancer drug, but it cannot be used in the clinic because it does not absorb well, breaks down quickly, and …

Successful Anesthetic Management Of Patient With Marfan Syndrome: Optimizing Cardiovascular Stability And Maternal Outcomes, M Roberts, C Cox, K Leavitt

South Atlantic Division GME Research Days 2026

No abstract provided.

Comparative Evaluation Of R134a And Hfo‐1234ze Cryogen Spray Cooling Using A Mouse Model With Controllable Epidermal Pigmentation, Wangcun Jia, Yurie Jeong, Crystal Huynh, Oswald Lai, Emily Nguyen, Grant Swajian, Jade Niu, Ayana Kashikar, Joshua Khaw, Hong Pu, Bernard Choi, John August D'Orazio, J. Stuart Nelson, Bahman Anvari

Pediatrics Faculty Publications

Objectives: Cryogen spray cooling (CSC) is critical for protecting the epidermis during laser dermatologic procedures. The widely used cryogen, R134a, has a high global warming potential (GWP), motivating interest in environmentally favorable alternatives such as HFO-1234ze. This study evaluated whether HFO-1234ze provides epidermal protection comparable to R134a during laser exposure and investigated the mechanistic basis underlying any differences in cooling performance.

Methods: Laser-induced epidermal injury in conjunction with two cryogens was assessed in K14-SCF Mc1r^e/e mice with pharmacologically controllable interfollicular epidermal pigmentation. Laser treatment sites were assigned fluences relative to baseline skin lightness (L*) to span subthreshold …

The Effects Of Childhood Maltreatment On Executive Functioning: The Difference Between Cumulative Trauma, Abuse Severity, And Neglect, Kelly Krehbiel

Master's Theses or Doctor of Nursing Practice

Childhood maltreatment is prevalent in the United States with around 558,899 children being victims of abuse in 2022 (U.S Department of Health & Human Services, 2024). Neglect is the most common form of abuse with around 74 percent of abused children being neglected; however, neglect tends to be the least researched form of abuse. Childhood maltreatment has long-term effects on a person’s mental, physical, and cognitive health. Previous research suggests that childhood maltreatment leads to severe deficits in executive functioning skills such as working memory and cognitive flexibility. Executive functioning skills are important for almost every aspect of life including …

Increasing Mental Health Literacy In An African Immigrant Community In The United States, Dominic T. Nchamukong

Master's Theses or Doctor of Nursing Practice

Abstract

Introduction: The aim of this quality-improvement project was to assess the impact of an educational intervention on mental health literacy, attitudes, stigma, and help-seeking behaviors among members of an African immigrant community in Maryland.

Framework: The Health Belief Model (HBM) guided implementation of the project. The intervention was delivered using HBM constructs to promote increased mental health literacy.

Methods: The study was conducted in four phases: pre-project preparation, recruitment, educational intervention, and post-intervention evaluation. The six-week program was delivered both online and in person. Participants completed pre- and post-surveys measuring knowledge, attitudes, stigma, and willingness to seek professional mental …

Protecting Your Largest Organ: A Journey In Skin Cancer Education, Prevention, And Early Detection, Krista Schneider

Master's Theses or Doctor of Nursing Practice

Rates of skin cancer diagnoses continue to increase globally, making skin cancer one of the most commonly diagnosed malignancies. Despite rising incidence, many individuals lack knowledge of risk factors, warning signs, and effective prevention strategies. This quality improvement project aimed to improve skin cancer awareness by providing targeted skin cancer education to young adults enrolled at a university in the Midwestern United States. Conducted from August 18 to December 1, 2025, this project followed the Plan-Do-Study-Act framework. Educational presentations were delivered to students enrolled in freshman seminar courses over a two-day period, accompanied by distribution of digital flyers and pamphlets. …

A Painful Diffuse Rash, Bruce M. Lo, Melanie Shoemaker, Kiersten Potter, Katherine Schaffer

Department of Emergency Medicine Faculty Publications

[Patient presentation]

A 41-year-old male with no past medical history presented with 1 week of ulcers to the left side of his face, followed by several days of a painful rash to the trunk and back after a sexual encounter. The patient denies any fever or previous rash and any illicit drug use. Initial vital signs included a temperature of 97 °F, a heart rate of 89 beats per minute, and blood pressure of 135/79 mm Hg. Physical examination revealed a macular papular rash across his trunk and back (Fig 1) and facial ulcerations with eschar (Fig 2) at the …

Bridging The Gap In Patient Attendance: A Dnp-Led Quality Improvement Project To Reduce No-Show Rate By Implementing Text Message Reminders, Charles D. Rogers

Master's Theses or Doctor of Nursing Practice

Missed medical appointments contribute to revenue loss, workflow inefficiencies, increased staff burden, and reduced patient access to care in primary care settings. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the impact of an automated text message (SMS) reminder system on no-show rates in a privately owned, medium-sized family practice in a rural setting, aiming to reduce the baseline no-show rate of 11.4% to 10% or less. Guided by the Model for Improvement and the Plan-Do-Study-Act (PDSA) framework, automated SMS reminders were sent 48 hours prior to scheduled appointments. Existing 24-hour phone call reminders were maintained. Formative assessments …

Acceleration Battery Predictive Model Utilizing Field-Based Testing, Peterson Bohannon

Master's Theses or Doctor of Nursing Practice

Sprint performance is a foundational determinant of success across multiple track and field events, yet many of the biomechanical and physiological factors underlying performance are typically assessed using laboratory-based tools that are not accessible to most coaches. The purpose of this study was to develop and evaluate a practical, field-based testing model capable of predicting 60 m sprint performance and identifying key performance determinants in sprint and jump athletes.

A cohort of 40 collegiate track and field athletes (ages 18–24) completed a comprehensive testing battery including 30 m acceleration, 30 m fly sprint, standing long jump, standing five-bound, vertical jump, …

Advanced Practice Workforce: ​Drivers Of Satisfaction & Retention​, Stephanie Bork, Amber Balzer, Sally Russell, R. K. Elswick Jr., Terry Jone, Kimberlee Ketchersid, Joseph Deranieri

School of Nursing Publications

Problem

The turnover of advanced practice registered nurses (APRNs) is costly for institutions and creates gaps in care for organizations. The aims of this study are to describe the characteristics of the APRN and PA workforce in a large, integrated academic medical center and examine relationships between APRN and PA workforce characteristics and organizational outcomes.

Background

APRNs encompass a diverse group of licensed clinicians and are integral to healthcare delivery. As APRNs roles expand to support healthcare needs, turnover is costly and adversely affects patient care. The APRN role remains constrained in many healthcare institutions, contributing to burnout and job …

Embracing The Green Thumb: Occupation-Based Resources For Stroke Recovery, Brianna Padovano

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2026

Stroke recovery requires ongoing effort from survivors, caregivers, practitioners, and communities to promote meaningful participation in long-term engagement in daily life. Despite the growing amount of evidence supporting continued recovery beyond the acute stages of stroke, accessible resources that address the needs of these stakeholder groups remain limited (Chen et al., 2019). This doctoral capstone experience aimed to bridge these gaps through the development and dissemination of educational, clinical, and advocacy-based resources designed to support stroke rehabilitation across various stakeholders. An evidence-informed, occupation-based stroke recovery guide, which includes relevant theories, decision-making flowcharts, sample protocols, and resources, was created for new …

Breaking Barriers In Bariatric Care, Morgan Lapshanski

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2026

The doctoral capstone project titled Breaking Barriers in Bariatric Care was established to promote equitable care and increase the quality of healthcare services provided to bariatric patients. Breaking Barriers in Bariatric Care was implemented to address the areas of education, research, and advocacy. With the focus being on these areas, the student worked to promote levels of accessibility and inclusivity within the healthcare system. The capstone project included an asynchronous virtual educational program for healthcare students at Misericordia University to enhance knowledge in the areas of bias reduction, safe handling, and providing appropriate care to bariatric patients. The student conducted …

Harmony In Healing: Addressing The Psychosocial Needs Of Individuals Living With Lymphedema, Bria K. Brombacher

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2026

Lymphedema is a chronic and incurable condition associated with significant physical and psychosocial challenges, including depression, anxiety, social isolation, and reduced quality of life. Despite increasing recognition of these concerns, limited interventions exist that specifically address the psychosocial needs of individuals living with lymphedema. Additionally, individuals within this population often report limited provider awareness of lymphedema within the healthcare system. The purpose of this doctoral capstone project, Harmony in Healing: Addressing the Psychosocial Needs of Individuals Living with Lymphedema, was to promote well-being, improve quality of life, and increase awareness of the psychosocial implications of lymphedema through occupational therapy intervention. …

Effectiveness Of Occupational Therapy-Inspired Educational Sessions For Mothers Accessing Women, Infants, And Children (Wic) Services, Samantha Annette Merew

Graduate Theses, Dissertations, and Problem Reports (ETD)

This doctoral capstone project examined the effectiveness of occupational therapy (OT)-inspired group and one-on-one educational sessions designed to support the emotional, mental, and social well-being of pregnant and postpartum mothers accessing Women, Infants, and Children (WIC) services in Onslow County, North Carolina. Grounded in the Model of Human Occupation and Cognitive Behavioral Frame of Reference, the program aimed to address gaps in holistic maternal health support, particularly among low-income and at-risk populations. Eight structured group sessions and five one-on-one sessions were developed, implemented, and evaluated, focusing on topics such as stress management, emotional regulation, self-care, role transition, and self-advocacy. A …

Impact Of Occupational Therapy Within The Rosenbaum Family House: How Program Development Supports Health And Well-Being For Caregivers And Care Recipients, Zaccardi P. Muniz

Graduate Theses, Dissertations, and Problem Reports (ETD)

Healthcare hospitality houses (HHH) are designed to accommodate patients and caregivers receiving medical treatment far from home. The Rosenbaum Family House (RFH) acts as the HHH adjacent to J.W. Ruby Memorial Hospital in Morgantown, West Virginia. The RFH offers amenities that meet the basic needs of guests; However, there is an opportunity for occupational therapy-based program development to help further assist caregivers and care recipients both inside and outside the RFH. During the doctoral capstone experience (DCE), a three-phase project was developed to support the health and well-being of guests and WVUMedicine clients through group programming, resource guide development, and …

Absolute Quantification And Identification Of Rna From Rna-Lipid Nanoparticles Using High Resolution Mass Spectrometry, Jason C. Funderburk, Yasir A. Alshehry, Matthew S. Halquist Phd, Sandro R.P. Da Rocha Phd

Graduate Research Posters

Background

RNA therapeutics are a rising drug category with potential use for a range of conditions encompassing infectious diseases to therapies for cancer, diseases, and genetic disorders. RNA-lipid nanoparticles (RNA-LNPs) are the prominent delivery method for these therapeutics approved products include mRNA vaccines and polyneuropathy treatments. The emergency use authorizations and orphan drug status of current RNA-LNP drugs has allowed approval without finalization of the regulatory analytical procedures for quality monitoring. The objective of the study was to develop an LC-MS assay to simultaneously measure identity and concentration of two therapeutically relevant intact RNA constructs extracted from RNA-LNPs to enhance …

Management Of Seroma After Posterior Lumbar Spine Decompression, Ayman Mohamed Basha, Ahmed Anas Zahra

Mansoura Medical Journal

Background: Postoperative seroma formation represents a significant complication following posterior lumbar spine decompression (PLSD) that can compress neural structures, cause radiculopathy, and serve as potential infection sources. This study evaluated the clinical characteristics and therapeutic approaches for seroma formation after posterior lumbar decompression procedures.

Methods: An observational study was conducted on 140 patients aged 18 years and older who underwent elective PLSD. Patients were systematically evaluated at predetermined intervals using clinical examination and diagnostic imaging when seroma was suspected. Management protocols were stratified according to seroma size, symptom severity, and clinical progression, ranging from conservative compression dressings to percutaneous aspiration …

Computed Tomographic Assessment Of Morphological Parameters Of The Normal Vermiform Appendix In Adults: A Prospective Cross-Sectional Study, Asmaa Mohamed Mansour Mahmoud, Magdy El-Sayed Mohamed Steen, Ahmed Mohamed Tawfik

Mansoura Medical Journal

Background: The vermiform appendix is a hollow tubular structure arising from the cecum, typically located in the right lower quadrant of the abdomen. Aim: This study aimed to estimate the visualization rate of CT scan in the detection of normal appendix, along with its characteristics (length, diameter, and site). Methods: For this prospective cross-sectional investigation, 56 individuals were included who were scheduled to have abdominal CT. The helical scanner was used to acquire CT images with 5 millimeters of collimation and reconstruction for each 2.5 millimeters. The CT films were reviewed by an experienced radiologist, who was unaware of the …

Assessment Of Serum Adropin In Erectile Dysfunction Patients And Its Correlation With Disease Severity, Ahmed M. Eltohami, Sh. Fouad, Khadiga M. El-Hamaky, Abdel Khabir A.

Mansoura Medical Journal

Background Erectile dysfunction (ED) may be considered an indicator of cardiovascular disease (CVD). Adropin is identified to be accompanied by insulin sensitivity, and lipid metabolism, so we aimed to investigate serum adropin levels in ED cases compared to healthy controls (HC). Methods This case control study included 50 men with ED and and control group of 25 agematched, sexually active healthy men with normal erectile function. Cases group was divided into two groups (25 each) as ED patients with and without type 2 Diabetes Mellitus (T2DM). Validated Arabic version of International Index of Erectile Function (IIEF)-5 was used to evaluate …

Impact Of Autonomic Dysfunction On Quality Of Life In Patients With Parkinson's Disease: A Single-Center Exploratory Study, Hadeer Elsaeed Aboelfarh, Ahmed S. Alkotami, Mohamed Galal Elkhateeb, Aya Zhran

Mansoura Medical Journal

Background: Autonomic dysfunction represents one of the major non-motor manifestations of Parkinson’s disease (PD) and can negatively influence patients’ health-related quality of life (QoL). This study investigated the frequency and severity of autonomic symptoms in individuals with PD and examined their relationship with QoL in a single-center cohort.

Methods: Thirty patients with idiopathic PD were assessed for autonomic dysfunction, quality of life, and motor severity using validated PD–specific rating scales.

Results: Among the autonomic subdomains, urinary symptoms demonstrated the greatest degree of impairment (median score 41.67%) and showed the strongest correlation with overall PDQ-39 scores (r=0.605, p≤0.001). Higher …