Kenyan Dietitians’ Knowledge Of Ketogenic Dietary Therapies For Drug-Resistant Epilepsy, Pauline Samia, Violet Naanyu, Perry Ndila, Helen Cross, Richard Idro, Paul Boon, Jo Wilmshurst, Stanley Luchters

Paediatrics and Child Health, East Africa

Background: Ketogenic dietary therapy (KDT) has been proven to be efficacious for people with drug-resistant epilepsy. However, it is rarely utilized in low-resource settings. Due to the complexity of implementation, dietitians play a crucial role in managing KDT.

Methods: We conducted a cross-sectional survey of 253 out of the 1,000 registered dietitians. We assessed their knowledge of and interest in further training in KDT.

Results: Most participants were female (78%), with a median age of 33 years (IQR=28–38). A total of 171 (67.6%) reported knowledge of KDT. However, only 13 respondents (7.6%) answered all five knowledge-specific questions correctly. A …

Navigating Childhood Asthma Care In Kenya: Barriers Identified By Children And Their Caregivers, Joan Ahimbisibwe, Roselyter Riang’A, Angela Migowa, Samuel Otido

Paediatrics and Child Health, East Africa

Background: Asthma is one of the most common chronic conditions in children, with significant morbidity and mortality, especially in Africa. Achieving adequate asthma control in children remains challenging because of gaps between standard recommended management strategies and actual treatment practices. This study explored barriers to asthma management as perceived by children and their caregivers in a private tertiary care setting in Kenya.

Methods: An exploratory phenomenological qualitative study was conducted at Aga Khan University Hospital (AKUH), Nairobi. Children aged 6–18 years with a confirmed diagnosis of asthma and their caregivers were recruited. The participants had been receiving treatment for at …

Dissecting The Heterogeneous Effects Of Opioid Prescribing Limit Laws On Pediatric Mortality: A Multidimensional And Negative Binomial Modeling Approach, Francine R. Vega

Dissertations and Theses (Open Access)

Opioid prescribing for children and adolescents continues to be a significant health crisis in the United States. Early naïve exposure to opioid prescriptions has been linked to later misuse, opioid use disorder, and death. In response to the crisis, many states have implemented opioid prescribing limit laws (OPLLs) aimed at reducing exposure to opioids. These laws vary widely in their approach, including differences in dosage restrictions, prescription duration limits, informed consent requirements, educational provisions, and whether they offer explicit protections specifically for minors. Despite their widespread adoption, there is limited understanding of how heterogeneity in legal regulations affects outcomes for …

Rethinking Health Systems Responsiveness In Low–And Middle-Income Countries, Meesha Iqbal

Dissertations and Theses (Open Access)

Health systems responsiveness (HSR) refers to a health system’s ability to meet legitimate non-health expectations of the population. Traditionally, HSR has been conceptualized across eight domains: respect for dignity, autonomy, confidentiality, prompt attention to health needs, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. However, as the expectations of populations in high-income countries (HICs) and low- and middle-income countries (L&MICs) differ significantly due to diverse social and cultural contexts, the conceptualization of HSR also varies. We conducted a systematic review of literature to adapt and contextualize the HSR framework for L&MICs based …

Delusional Parasitosis With Depression, Hypertension And Migraine, Mouli Mandal, M Kishor, Mr Murali

Digital Journal of Clinical Medicine

Delusional Parasitosis (DP) , also known as Ekbom Syndrome, is a psychiatric disorder characterised by the unshakeable belief of infestation by parasites, insects or other organisms, despite the absence of objective medical evidence.
This case report presents a 49 year old female with a history of chronic headaches, progressively worsening insect crawling sensations. She was initiated on treatment and supportive psychotherapy.
This case highlights the importance of a thorough multidisciplinary approach in managing Delusional Parasitosis, emphasising the need to differentiate between primary and secondary forms, address the potential medical and psychiatric comorbidities, and implement appropriate pharmacological and psychotherapeutic interventions.

Digital Tools To Promote Or Measure Health Literacy In Children Aged 3–5 Years: Scoping Review, Caron Molster, Jennifer Irvine, Amanda Devine, Ruth Wallace, Lennie Barblett, Leesa Costello

Research outputs 2022 to 2026

Health literacy is a determinant of health that should be promoted and measured in early childhood. In the era of digitalization, this could involve digital platforms. However, little knowledge exists on the extent, range, and nature of literature on digital tools for promoting or measuring young children’s health literacy. Addressing this gap, a scoping review was undertaken to explore what digital health literacy tools for children aged 3–5 years could be identified in the literature, what their key features were, how they were designed, whether children were codesigners, and whether the tools had been evaluated. Eligibility criteria included the literature …

Reentry For Formerly Incarcerated Individuals: A Focus On Workforce Reentry And Recidivism In Appalachia, Margaret E. Francisco

Electronic Theses and Dissertations

Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.

This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted …

Advanced Interactions Of Directed Energy With Retinal Pigment Epithelial Cells And Their Photochemical And Photothermal Responses, Jin B. Ha

Theses & Dissertations

Excess optical radiation can injure the retina through either rapid heat deposition (photothermal damage) or cumulative photo‑oxidative stress (photochemical damage), yet current laser‑safety limits treat these mechanisms as independent. To test that assumption, this dissertation integrated systematic wavelength, duration and temperature‑controlled laser exposures with live/dead fluorescence imaging in a melanin‑loaded hTERT‑RPE1 monolayer model. First, concurrent 447 nm (blue) and 2 µm (infra‑red) beams delivered for 200 s demonstrated a strong thermal–photochemical synergy: each beam alone was sub‑threshold (≤25 % lethality) but together produced 100 % RPE death without exceeding 50 °C, proving that modest heating markedly lowers the photon dose …

Application Of Machine Learning In Early Childhood Development Research: A Scoping Review, Faith Benson, Daisy Chelangat, Willie Brink, Patrick Mwangala, Akbar Waljee, Cheryl Moyer, Amina Abubakar

Institute for Human Development, East Africa

Background: Early childhood development (ECD) lays the foundation for lifelong health, academic success and social well-being, yet over 250 million children in low- and middle-income countries are at risk of not reaching their developmental potential. Traditional measures fail to fully capture the risks associated with a child’s development outcomes. Artificial intelligence techniques, particularly machine learning (ML), offer an innovative approach by analysing complex datasets to detect subtle developmental patterns.

Objective: To map the existing literature on the use of ML in ECD research, including its geographical distribution, to identify research gaps and inform future directions. The review focuses on …

Social Cohesion, Trust, And Utilisation Of Maternal Health Services Among Refugee And Host Community Women In Bangladesh And Kenya, Haeun Lee, Ryan Rego, Neyat Fiseha, Ashok Barman, Nimo Sharif, Peninah Wachira, Joe Kolars, Akbar Waljee, Rubhana Raqib, Amina Abubakar

Institute for Human Development, East Africa

The global refugee crisis places significant pressure on host communities, particularly in low- and middle-income countries. Social cohesion and trust between refugee and host communities are critical for maternal health service utilisation. This study explores the relationship between host–refugee trust, social cohesion, and maternal health service use in Bangladesh and Kenya, focusing on facility-based delivery, antenatal care visits, and postnatal care attendance. To do so, a cross-sectional survey was administered among 649 refugee/displaced women and 371 host community women in the two locations. The results show high trust levels in both groups, while social cohesion is greater among refugee/displaced women. …

Evaluating What Works: A Comparison Of Five Diabetes Prevention Programs For Latino Children, Ruchi Patel

Doctor of Nursing Practice Final Project Abstract

Background: Children in the Rio Grande Valley (RGV) are at increased risk of diabetes due to limited access to effective, culturally appropriate prevention programs. Existing programs are often time-intensive, require transportation, and lack cultural relevance, reducing participation and impacting outcomes. This project aimed to evaluate diabetes prevention programs (DPPs) in the literature and identify five that may benefit children in the RGV by reducing diabetes risk.

Methodology: The Eightfold Path policy analysis approach guided this project. A literature review identified DPPs for children, and the Critical Appraisal Skills Programme (CASP) was used to assess study quality. Limitations included difficulty finding …

Improving Health Outcome Through Mobile Clinics, Spatial Access, And Overdose Management: A Data-Driven Study Of People Who Inject Drugs, Individuals With Opioid Use Disorder, And College Students, Abass A. Babatunde

All Dissertations

ABSTRACT

Background

The opioid crisis remains a critical public health challenge in the United States. Mobile Health Clinics (MHCs) have emerged as a promising solution to bridge healthcare access gaps for these vulnerable populations, particularly for PWID and individuals with OUD in underserved and rural communities. Despite their potential, geographic disparities in MHC access and knowledge gaps in opioid overdose management and related diseases, including Hepatitis C Virus (HCV), remain significant barriers to care. This dissertation addresses three key dimensions of healthcare delivery for PWID, OUD populations, and college students: (1) barriers to MHC utilization for HCV screening and treatment …

Do Finances Determine Our Fate?: Understanding The Relationships Between Socioeconomic Status, Inflammation, And Cancer Recurrence Risk, Faith Wilbourne

Master's Theses

Individuals of a low socioeconomic status (SES) are more likely to experience a cancer recurrence relative to individuals with a higher SES. This may be partially explained by the stressors of living with a low SES. These stressors can increase inflammatory markers known to elevate the risk of cancer development. Health-promoting behaviors such as exercise, adequate sleep, and a healthy diet can reduce systemic inflammation. Health behaviors may therefore moderate any potential relationship between SES and cancer recurrence risk. This study explored associations between SES (income, educational attainment) and inflammatory markers related to cancer recurrence while seeking to determine if …

Simulating The Blood Transfusion System In Kenya: Modelling Methods And Exploratory Analyses, Yiqi Tian, Bo Zeng, Jana Macleod, Gatwiri Murithi, Cindy Makanga, Hillary Barmasai, Linda Barnes, Rahul Bidanda, Tecla Chelagat, Carolyne Njoki

Anaesthesiology, East Africa

The process of collecting blood from donors and making it available for transfusion requires a complex series of operations involving multiple actors and different resources at each step. Ensuring hospitals receive adequate and safe blood for transfusion is a common challenge across low- and middle-income countries, but is rarely addressed from a system level. This paper presents the first use of discrete event simulation to study the blood system in Kenya and to explore the effect of variations and perturbations at different steps of the system on meeting blood demand at patient level. A process map of the Kenyan blood …

A Tale Of Two Toxicants: Investigating The Interaction Between Hexavalent Chromium And Perfluorooctane Sulfonic Acid., Morgan Elizabeth Delnicki

Electronic Theses and Dissertations

Hexavalent chromium [Cr(VI)] and per- and polyfluoroalkyl substances (PFAS) are environmental contaminants of major public health concern. Despite commonly being found together in contaminated drinking water, no studies have considered the concomitant health effects of Cr(VI) and PFAS, specifically perfluorooctane sulfonic acid (PFOS). In vitro studies using CHO cells assessed the cytotoxicity and genotoxicity of Cr(VI) and PFAS both individually and in combination. Intracellular and extracellular Cr levels were measured with Atomic Absorption Spectrometry. PFOS was found to exacerbate Cr(VI) induced cytotoxicity and genotoxicity. Additionally, a novel in vivo model of studying the hepatotoxicity of Cr(VI) was established. Adult Hartley …

Exploring Hexavalent Chromium Exposure And Lipid Accumulation In Liver Disease., Gabrielle Celine Griffin

Electronic Theses and Dissertations

The prevalence of MASLD has doubled over the past 20 years and continues to rise. Hexavalent chromium [Cr(VI)], a top chemical hazard in U.S. drinking water, is emerging as potential risk factor for liver disease. To study the impact of Cr(VI) and high-fat diet on MASLD, we developed an in vivo model using Sprague-Dawley rats exposed to Cr(VI) in drinking water (0, 0.05, or 0.1 mg/L) and fed normal or high-fat diet for 90 days. High-fat diet significantly increased body mass, plasma lipoproteins, cholesterol, liver injury, and hepatic triglycerides, which were exacerbated by Cr(VI) exposure. Cr(VI) alone increased hepatic chromium …

Intergenerational Family Dynamics Among Caregivers And Children’S Social-Emotional Development In China, Weiman Xu

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The early years of a child’s life are pivotal for social-emotional development. While extensive research has explored the role of family settings in fostering children's social-emotional development (Bornstein, 2005), the impact of grandparental involvement, particularly the caregiving dynamics between generations, remains less well understood. This study aims to fill this gap by examining two critical aspects of intergenerational dynamics among caregivers (i.e. parent-grandparent coparenting and parent-grandparent relationship quality) and their associations with children’s social-emotional development (i.e. social skills and problem behaviors). Two specific aims were delineated: 1) examine the unique contribution of parent-grandparent coparenting, especially the power and authority domain …

The Tree That Would Not Fall: An Educator’S Autoethnographic Journey Of Healing Through Words, Raeanna Marie Carlson

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

To say the world has changed since the 2020 COVID-19 shut down is to minimize the micro and macro social changes that infiltrated the school system. In the wake of it all, we find a landscape marred by a both rising teacher attrition and struggling student motivation. This autoethnographic dissertation explores the deeply personal experience tethered to a deeply problematic system that contributes to not only teacher burnout but what I came to know as teacher demoralization. Personal traumas of teachers profoundly impact their experience in the classroom, and as I examined my own near departure from the classroom, I …

Adolescent E-Cigarette Expectancies: Measure Development And Preliminary Validity Of The Electronic Nicotine Vaping Outcomes Measure For Youth, Paul T. Harrell, Kelli J. England, Tracey E. Barnett, Vani N. Simmons, Richard W. Handel, Amy C. Paulson

Department of Pediatrics Faculty Publications

BACKGROUND: Electronic nicotine delivery systems (“e-cigarettes”) are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure.

METHODS: A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17 years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% …

Adolescent Online Leisure, Media Literacy, Online Victimization, And Multifaceted Well-Being During Covid-19: The Role Of Parental Support, Yunqi Wang

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The rapid advancement of the internet and digital technology has provided opportunities for adolescents to conduct leisure activities online on a daily basis. However, research on adolescent technology use and mental health often highlights negative effects without carefully examining the specific mechanisms, which overlooks the complexity of effects of online behaviors on adolescent well-being and the importance of developing adolescents’ media literacy skills. Moreover, despite the crucial role of family dynamics in adolescent development, research on how parental support and involvement might affect adolescent technology use and well-being is still limited. The current study retrieved data from Programme for International …

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

The Impact Of Culture And Language On Internal Communication And Patient Care In Small To Medium-Sized Black Immigrant-Owned Healthcare Practices In Texas., Chisom Nwosu

Dissertations

This qualitative phenomenological study explored how cultural competency in small to medium-sized Black immigrant-owned healthcare practices in Texas affects internal communication and patient care. Through semi-structured interviews with nine clinical and administrative leaders in Dallas and Houston, five themes emerged: culturally competent leadership, intentional communication structures, language and interpretation practices, patient-centered cultural sensitivity, and the use of technology for adaptation. Findings suggest that culturally aware leadership and inclusive communication strategies foster team cohesion and improve patient trust and care. Participants reported adapting workflows to meet religious, language, and communication needs through human and technological tools. The study underscores embedding cultural …

The Inside Scoop: Elucidating The Three-Way Relationship Between Schistosoma Mansoni, The Gut, And Vaccines, Mariam A. Mhanna

Biomedical Sciences Theses & Dissertations

Schistosomiasis is a neglected tropical disease that affects over 250 million people worldwide. This blood fluke infection burdens communities and areas with limited to no access to clean fresh water. When a host is exposed to cercariae, the infectious agent, in a body of water, it matures in the host’s circulation into adult female and male worms. Copulated adult worms migrate to the mesentery, in the case of Schistosoma mansoni, and produce eggs that can cross the intestinal barrier and get excreted in the feces to continue the lifecycle. The effects of S. mansoni infection on the host …

Honoring Childhood Agency In Developmental Research: Best Practices, Applications, And Insights, Amanda N. Howery, Olivia J. Lashley, Hanna R. Wright, Julia L. Williams, Olivia K. Nomura, Eline Lenne, Elizabeth K. Wood, Hanna C. Gustafsson, Elinor L. Sullivan

School of Social Work Faculty Publications and Presentations

Pediatric research requires caregivers to provide informed consent on behalf of their children. While not a formal requirement for children under the age of seven, it is important to involve child participants in the assent and decision-making processes in developmentally appropriate ways. This is especially important in longitudinal research, where the extent to which a developing child understands study tasks evolves over time. Although there is consensus that assent procedures are important and necessary, limited resources synthesizing strategies for pediatric researchers to encourage positive and respectful research experiences for young children exist. We describe methods used in an ongoing longitudinal …

Readiness Of Universitas Indonesia To Be An Inclusive Campus For People With Disabilities, Dumilah Ayuningtyas, Tri Auri Putri Ayuningtyas, Anita Pebrina Lubis, Anindya Naila Sabahat, Ratih Oktarina, Afaf Jauhar

Masyarakat: Jurnal Sosiologi

Ensuring equal education rights remains a challenge in Indonesia, despite constitutional mandates and the global commitment to “no one left behind.” The Disability Participation Rate remains low; in 2023, only 21.03% of individuals aged 19–23 were included. This reflects, among other factors, the limited preparedness of educational institutions. This study evaluates Universitas Indonesia’s readiness to develop inclusive education for persons with physical, sensory, mental, and intellectual disabilities. Using the capability approach, it assesses whether institutional resources can be translated into capability-enhancing conditions for students with disabilities. The study draws on literature review, targeted document searches, SWOT analysis, IFE-EFE matrices, and …

What Is Clinical Excellence, And How Do Healthcare Companies Achieve It?, Lorena R. Muller

Electronic Theses, Projects, and Dissertations

Clinical excellence is the benchmark for quality in modern healthcare organizations, encompassing safe, effective, patient-centered, timely, efficient, and equitable care. For organizations to develop excellent care facilities, they must clearly define the roles and responsibilities of their healthcare teams. These necessities include strong leadership, a structured staff, a functioning clinical support system, and finally, a focus and strategy to help their community's population health needs. By examining existing programs and developing them in response to the needs of healthcare organizations and communities, this article explores various ways to achieve excellence.

Medical Surveillance In Custodial Jsas: Preventing Bloodborne Pathogen Exposure, Kiara Gadea

Electronic Theses, Projects, and Dissertations

Custodians play an important role in maintaining our surroundings safe and sanitary. However, in doing so, they are their exposure to health hazards that put them at risk, yet these exposures are often overlooked. One major risk they face is contact with bloodborne pathogens, which put custodial staff at risk for infections such as hepatitis B. While Job Safety Analyses (JSA’s) outline various protective measures, many fail to incorporate medical surveillance as part of their risk management program. Overlooking this important detail leaves custodians vulnerable to health risks that can be prevented.

Adding a medical surveillance section to custodial JSA’s, …

Bilingual Budget-Friendly Hispanic Cookbook And Resource Guide For Food Pantries In San Bernardino County, Anasofia Garay Guzman

Electronic Theses, Projects, and Dissertations

San Bernardino County is faced with a significant issue of food insecurity with its residents relying on food pantries to meet their food and nutritional needs. However, the food items offered at food pantries are often limited in quantities and the variety is inconsistent, which makes it a challenge for families wanting to prepare healthier budget friendly meals while maintaining its cultural relevance. This project consists of two main key components: a bilingual, culturally relevant budget-friendly Hispanic cookbook and a comprehensive resource guide about ways and ingredient substitutions adaptable to the recipe based on what is available.

The cookbook included …

Exploring Factors Influencing Care And Outcome Among Stroke Patients In Tennessee, Omodele Agbejimi

Electronic Theses and Dissertations

Introduction: Stroke is the fifth leading cause of death in Tennessee. Socioeconomic variables influence the delivery of stroke treatment and its outcomes. Despite advances in acute stroke care, the burden of stroke keeps increasing. This study aimed to explore literature on factors contributing to stroke care and outcomes in the U.S., assess the determinants of stroke patients’ outcomes, and examine the geographical disparities in stroke hospitalization and stroke death rate and their association with stroke care accessibility in Tennessee.

Methods: A scoping review was conducted using socio-ecological models to explore literature on factors contributing to stroke care and outcomes. A …

Did California's Mental Health Services Act Improve Mental Health? Evidence From Self-Reported Data, Bennett Rider

All Theses

This analysis evaluates the impact of California’s Mental Health Services Act (MHSA), which was implemented in 2006 to increase access and improve quality of mental health care for Californians. Difference-in-differences analyses were applied to evaluate the impact of the MHSA on the number of poor mental health days in the past month (PMHDs) that survey respondents had self-reported, relative to a control group with similar pre-policy trends. Using survey data from the Behavioral Risk Factor Surveillance System (BRFSS), this study found that the MHSA’s full implementation is associated with California respondents reporting 0.118 fewer poor mental health days in the …