Abstract List

Background Since robotic-assisted total joint arthroplasty became widely adopted in the mid-2010s, its advantages over traditional manual techniques have been debated. Proposed benefits include improved implant longevity, reduced postoperative pain, and lower complication rates. However, outcomes may vary depending on patient population and surgical factors. This study compares manual and robotic-assisted total joint arthroplasty with respect to implant duration, pain outcomes, and complication rates within a single health system. Methods We performed a retrospective chart review of 1,459 patients who underwent total hip or total knee arthroplasty by two orthopedic surgeons within the same health system. One surgeon performed only manual procedures, while the other transitioned from manual to robotic-assisted arthroplasty after implementation of the Mako system. Data were analyzed in two groups: an “all years” cohort (including procedures before and after robotic implementation) and a “modern” cohort (including only procedures performed after robotic implementation). This stratification was designed to reduce confounding factors from temporal advancements in surgical care. Results There was no significant difference between robot assisted and manual arthroplasties in terms of pain reduction or implant longevity in either cohort. However, specific complication rates differed. Robotic-assisted procedures demonstrated higher rates of arthrofibrosis in both the “all years” and “modern” cohorts (p < 0.05). In the “all years” cohort, robotic-assisted procedures also had higher rates of joint loosening (p < 0.05), though this difference was not observed in the “modern” cohort. Fractures requiring readmission showed no difference in the “all years” cohort but were more common in manual procedures in the “modern” cohort (p < 0.05). Conclusion In this single health system analysis, robotic-assisted arthroplasty did not demonstrate superior pain relief or implant survival compared to manual techniques. While complication patterns differed, overall outcomes were comparable. In a field often driven by technological innovation, the findings suggest that surgical expertise and patient selection may play a more critical role in outcomes than the use of robotic assistance alone.

A known and potentially catastrophic complication of arteriovenous (AV) fistulas is life-threatening hemorrhage. Although this complication is rare, the high-flow, arterialized pressure of an AV fistula can result in rapid hemorrhage if disrupted, leading to possible rapid exsanguination. We present two distinct cases of exsanguination via disruption of arteriovenous fistula, contrasted by their intentional and accidental natures. The first case is that of a 54-year-old male found deceased in a bathtub filled with blood, with a needle and attached catheter in his AV fistula. Needle punctures were identified in the exterior and interior aspects of the fistula. The cause of death was ruled exsanguination due to intentional disruption of the AV fistula. The second case is that of a 56-year-old female patient who was found unresponsive, bleeding from her right arm. Despite immediate medical intervention, the patient succumbed to the effects of acute blood loss. The cause of death was determined to be exsanguination due to an unintended disruption of the AV fistula. These cases serve to illustrate the inherent risks associated with AV fistulas and underscore the critical importance of proactive patient education and vigilant monitoring and management to prevent intentional or unintentional harm.

Chronic migraine is a disabling neurologic condition associated with significant functional impairment, reduced quality of life, and increased healthcare utilization. Preventive therapy is essential for long-term management, yet selecting the most appropriate prophylactic treatment remains challenging. OnabotulinumtoxinA is an established preventive option, while non-invasive peripheral neuromodulation has emerged as a nonpharmacologic alternative. Although both therapies are increasingly used in practice, most studies evaluate them independently rather than through direct comparison. A comprehensive search of PubMed and CINAHL identified 365 studies, with eight meeting criteria for final analysis. This literature review compares the efficacy of OnabotulinumtoxinA and non-invasive peripheral neuromodulation for chronic migraine prevention in adults. OnabotulinumtoxinA demonstrated greater and more consistent reductions in monthly headache days, with mean decreases of approximately 9–15 days from baseline. Neuromodulation therapies showed smaller but clinically meaningful reductions of 3–5 days per month, with earlier onset of benefit in some studies. Variability in study design, sample size, duration, and outcome measures limits direct comparison. Overall, current evidence supports OnabotulinumtoxinA as the more established and effective preventive therapy. However, non-invasive neuromodulation remains a valuable option for selected patients, particularly those seeking nonpharmacologic or noninjectable treatments. Further direct comparative research, including long-term and patient-centered outcomes, is needed to guide individualized treatment decisions. Keywords: Chronic migraine, OnabotulinumtoxinA, neuromodulation, migraine prophylaxis, headache prevention 

Sleep disturbances are common among the pediatric population, and it’s especially prevalent in children with neurodevelopmental and chronic medical conditions. The purpose of this literature review is to evaluate the current evidence regarding the safety and efficacy of melatonin supplementation vs placebo or nonpharmacologic interventions in pediatric patients with sleep disturbances. Specifically, this literature review evaluates whether melatonin improves sleep onset latency, total sleep time, sleep quality, behavior, cognition, and incidence of adverse effects. A systematic literature search was conducted using PubMed, Embase, and Clinical Key using key terms. Inclusion criteria included randomized controlled trials with children with multiple comorbidities who had sleep disturbances, and trials published in the last 10 years involving children aged birth to 18 years. Nine studies met final inclusion criteria. Findings across all studies showed that melatonin supplementation demonstrated improvement in sleep onset latency and, in many cases, total sleep time, specifically in children with autism spectrum disorder, attention-deficit/hyperactivity disorder, atopic dermatitis, and epilepsy. Behavioral outcomes, including reductions in hyperactivity, tantrums, and improved caregiver quality of life, were also reported in several studies. Melatonin supplementation was well tolerated. Mild adverse effects were reported including gastrointestinal upset and irritability. Limitations of the studies included small sample sizes, reliance on caregiver reported, open label designs and no representation of healthy pediatric populations. This review overall supports melatonin as a safe and effective intervention for improving sleep onset latency and in some cases total sleep time in pediatric populations with comorbid conditions. Further research is needed to evaluate the efficacy of melatonin supplementation in healthy children with sleep disturbances. Keywords: Melatonin, Pediatrics

Spontaneous bacterial peritonitis (SBP) caused by group B Streptococcus (GBS, Streptococcus agalactiae) is exceedingly rare, with few cases reported in the medical literature. We present the case of a 27-year-old man who initially presented to the emergency department with abdominal pain and was discharged despite ongoing symptoms. His medical history included methamphetamine use, cannabis use disorder, and schizophrenia. He was found deceased the following day in his shower. Autopsy examination revealed three liters of cloudy peritoneal fluid and early hepatic cirrhosis. Cultures from the peritoneal fluid, spleen, and blood all grew GBS. The cause of death was S. agalactiae sepsis secondary to SBP; the manner of death was ruled natural. SBP is most commonly caused by gram-negative aerobic bacteria, such as Klebsiella pneumoniae, with gram-positive organisms accounting for less than half of cases. When GBS causes invasive disease in adults, it typically occurs in those with significant comorbidities, including diabetes, liver disease, or malignancy. This case illustrates a rare presentation of GBS-SBP in a young adult with no prior diagnosis of liver disease, underscoring the importance of early recognition, diagnosis, and treatment of SBP, particularly when caused by rapidly progressive pathogens. It also highlights the value of forensic autopsy in identifying unexpected infectious disease processes contributing to sudden death

Introduction: E-cigarettes are the most used tobacco product among high school adolescents, poising a significant national public health issue. It is well-known that tobacco use negatively interferes with sleep. E-cigarette use has therefore also been proposed as a contributor to sleep disturbances due to its similar nicotinic composition. The aim of this study was to determine the association between e-cigarette use and sleep disturbance among high school adolescents in the United States. Methods: We conducted a retrospective analysis of e-cigarette use was conducted utilizing the 2023 National Youth Risk Behavior Surveillance System (YRBSS) biannual data set. We compared the rate of sleep disturbance between those who admitted to regular electronic vaping use and those who denied electronic vaping use. Inclusion criteria was high school adolescents (grades 9-12). Exclusion criteria were non-high school adolescents, missing grade, or electronic vaping use. Regular electronic vaping was defined as 20 or more days during the last 30 days of electronic vapor product use. Sleep disturbance was defined as an average of < 7 hours per night on a school night. SAS V9.4 was used to perform Chi-square tests with all tests being two-sided and P<.05. Institutional Review Board approval was obtained from the University of North Dakota. Results: Of the total 16,952 adolescents, 6.1% regularly used electronic vapor products. Adolescents who regularly used e-cigarettes were more likely to experience sleep disturbances than adolescents who did not use e-cigarettes (63.4% vs 46.4%, p=.000). E-vaping was significantly associated with alcohol use (p=.000), current cigarette smoking (p=.000), illicit drug use (p=.000), depression (p=.000), history of being bullied (p=.000), history of forced sex (p=.000), history of physical abuse (p=.000), and history of verbal abuse (p=.000), household mental illness (p=.000), and household substance abuse (p=.000). Conclusion: High school adolescents in grades 9-12 who regularly use e-cigarettes were less likely to get regular sleep. Additionally, e-cigarette use was associated with comorbid alcohol, cigarette, and illicit drug use, depression, bullying, and multiple adverse childhood experiences. Following the pattern of sleep disturbance with cigarette use, this study showed that adolescents who regularly use e-cigarette products have significant interferences in sleep health. Keywords: E-Cigarettes, Electronic vaping, Sleep disturbances, Adolescent health, YRBSS.

Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. Although classically associated with antidepressants and drug interactions, the syndrome may also occur with less commonly recognized serotonergic agents. Diagnosis remains clinical, guided by the Hunter Serotonin Toxicity Criteria, and early recognition is essential to prevent severe complications. We report a severe ICU case of serotonin syndrome triggered by polypharmacy involving lesser-known serotonergic medications that progressed to rhabdomyolysis and acute renal failure requiring renal replacement therapy. A 49-year-old woman with a history of asthma, depression, and pseudotumor cerebri presented to the emergency department after being found unresponsive at home. Initial evaluation revealed tachycardia, leukocytosis, and acute kidney injury. Imaging and urinalysis identified an obstructing ureteropelvic junction stone with associated urinary tract infection, and the patient developed septic shock requiring ICU admission, vasopressor support, and mechanical ventilation. She was treated with dexmedetomidine and fentanyl infusions for sedation and analgesia. Within 48 hours of ICU admission, the patient developed extreme hyperthermia (108°F), spontaneous clonus, tremor, hyperreflexia, and rigidity. Review of outpatient medications revealed chronic use of bupropion and topiramate. In the setting of serotonergic exposure and neuromuscular hyperactivity, serotonin syndrome was diagnosed using the Hunter criteria. Fentanyl was discontinued and treatment with cyproheptadine and supportive sedation was initiated, resulting in rapid improvement of hyperthermia and neuromuscular findings. Despite clinical improvement, the patient developed severe rhabdomyolysis with creatine kinase levels peaking at 29,000 U/L and worsening acute kidney injury requiring continuous renal replacement therapy followed by intermittent hemodialysis. Over the course of a prolonged 31-day hospitalization, the patient’s renal function and neurological status gradually recovered, allowing discontinuation of dialysis and eventual transfer to a long-term care facility in stable condition. This case highlights the potential for serotonin syndrome to occur in critically ill patients receiving commonly used ICU medications in combination with outpatient therapies that possess less recognized serotonergic activity. Early recognition based on clinical criteria and prompt discontinuation of offending agents are essential to prevent life-threatening complications such as rhabdomyolysis and renal failure. Increased awareness of atypical serotonergic drug combinations in the ICU setting may improve diagnostic recognition and patient outcomes.

Foreign body aspirations in pediatric patients most commonly occur between the ages of one and two years and remains a significant contributor to accidental household mortality in this age group. At this stage of development, children lack the necessary dentition and neuromuscular coordination to safely ingest foods such as popcorn and nuts, placing them at an elevated risk for airway obstruction. Despite longstanding awareness of these choking hazards, cases of fatal aspiration continue to occur, underscoring the need for ongoing vigilance and prevention efforts, especially in rural locations. We present the case of a one-and-a-half-year-old child who aspirated a popcorn kernel, leading to bronchial obstruction. The child’s mother promptly administered the Heimlich maneuver, reportedly expelling some popcorn; however, the child became unresponsive shortly thereafter. Initial resuscitation efforts were successful, and the return of spontaneous circulation was achieved, but the patient subsequently suffered cardiac arrest and could not be revived. Postmortem examination revealed a corn kernel obstructing the left lower lobe bronchus, with multiple additional kernels found within the gastric contents, confirming aspiration as the cause of death. This case highlights the critical need for early recognition and emergent bronchoscopy in known or suspected cases of pediatric foreign body aspiration to prevent irreversible hypoxic injury and death. Additionally, targeted public health interventions are necessary to reduce the incidence of these preventable tragedies. Providing parents and caregivers with accessible, clear educational materials emphasizing the risks of specific high-choking-risk foods and outlining safe feeding practices by developmental stage could serve as a valuable preventive measure. Strengthening anticipatory guidance during pediatric visits and incorporating structured mealtime safety education for caregivers of children between one and four years of age may help reduce the frequency of foreign body aspiration and its associated morbidity and mortality in the pediatric population.

Functional dyspepsia affects millions of Americans each year, with no current FDA-approved pharmacologic therapies specifically indicated for its treatment; instead, several medications are used off-label for symptomatic management. The purpose of this literature review is to evaluate the safety, efficacy, and quality of life of peppermint and caraway oil—Menthacarin—compared to proton pump inhibitors to treat the symptoms of functional dyspepsia in adults. In this review, two databases, PubMed and Natural Medicines Professional Database, were searched using key terms. Out of 58,964 articles initially identified, 10 met the inclusion criteria, focusing on adult randomized controlled trials in PubMed. Hand searching was used in the Natural Medicines Professional Database to identify articles that met the inclusion criteria. The studies used symptom diaries and quality-of-life assessments to evaluate the efficacy of the treatments. Findings indicated that proton pump inhibitors are a safe short-term option for the treatment of symptoms. Findings for Menthacarin indicated that it was safe for both short-term and long-term treatment of functional dyspepsia symptoms. Despite these findings, no studies compared the two treatments to evaluate their safety, efficacy, and quality of life. Limitations across the studies include reliance on subjective symptom reporting and the short trial duration for proton pump inhibitors. This review emphasized the need for further investigation of the long-term use of proton pump inhibitors, compared directly with Menthacarin, to assess safety, efficacy, and quality of life for each treatment. Keywords: Functional Dyspepsia, proton pump inhibitor, peppermint and caraway oil, Menthacarin, efficacy

Alcohol and substance use disorders are chronic, relapsing conditions associated with substantial morbidity, mortality, and healthcare burden. Although pharmacological treatments exist for certain substance use disorders, they are limited in availability and efficacy. Glucagon like peptide-1 (GLP-1) receptor agonists are widely prescribed for treatment of diabetes and obesity and have a favorable safety profile. Emerging evidence suggests that these agents may also influence substance-related behaviors. This literature review evaluates current evidence of the role of GLP-1 receptor agonists in alcohol, opioid, nicotine and cocaine use disorder. A literature search was conducted using PubMed and PsychINFO databases from April 2025 through July 2025. Included studies involved adult human population treated with GLP-1 receptor agonist medication and assesses substance-related behavioral or clinical outcomes. Both randomized controlled trials and observational studies were reviewed, 9 studies met the inclusion criteria. Current literature at the time of this review suggests that GLP-1 receptor agonists use was most consistently associated with reduced alcohol consumption, decreased cravings, and lower rates of alcohol related hospitalizations. Evidence for opioid, nicotine and cocaine use disorders was more limited but suggested potential benefit in select populations. Study limitations included small sample sizes and short treatment durations. Current evidence indicates that GLP-1 receptor agonists may represent a promising adjunctive therapy for substance use disorders, particularly alcohol use disorder, though further large-scale randomized trails are needed to confirm efficacy. Keywords: glucagon-like peptide-1 receptor agonist, substance use disorder, alcohol use disorder, addiction, cocaine use disorder, nicotine use disorder, opioid use disorder

Osteoarthritis (OA) is a leading cause of disability among older adults worldwide, characterized by pain, swelling, reduced range of motion, and declining physical function. Current treatments are largely symptomatic rather than disease-modifying and include NSAIDs, acetaminophen, corticosteroid injections, and, ultimately, joint replacement. Emerging evidence suggests a possible link between gut microbiota composition and joint health through the gut-joint axis, whereby gut dysbiosis may increase intestinal permeability, allowing proinflammatory mediators to enter systemic circulation and contribute to synovial joint inflammation. The purpose of this literature review was to examine the potential role of prebiotic and probiotic supplementation in the management of adults with knee OA. A literature search of PubMed and Embase was conducted using relevant keywords and MeSH terms. This review included six randomized controlled trials published between 2017 and 2025. Overall, findings suggests that daily prebiotic or probiotic supplementation may reduce pain and inflammation and improve physical function in adults with knee OA compared with placebo, potentially through modulation of gut health and systemic inflammation. However, given the limited number of studies and small sample sizes, further large-scale trials are needed to clarify optimal dosing, strain selection, and clinical efficacy before pre- and probiotics can be widely recommended as adjunctive therapies in OA management. Keywords: prebiotics, probiotics, gut microbiome, knee osteoarthritis, gut-joint axis, inflammation

Abstract Introduction: Elevated Lipoprotein (a) [LP(a)] is an emerging cardiovascular risk factor. Data are scarce on how LP(a) behaves in pediatric patients with familial hypercholesterolemia (FH) versus metabolic syndrome (MetS). Because LP(a) is largely genetically determined, we hypothesized minimal phenotype specific differences and sought to confirm this in a pediatric cohort while assessing whether LP(a) adds incremental diagnostic value for Familial Hypercholesterolemia after adjustment for covariates. Methods: In this IRB-approved (Sanford Health) retrospective cohort study, we reviewed electronic records of 152 children (<18 y) referred to the lipid clinic between 2019 and 2024. LP(a) was measured in nmol/L and classified as low risk (<75), intermediate (75-124), or high (≥125). We compared LP(a) distributions between those meeting FH criteria (US-MEDPED thresholds or pathogenic variant) and those meeting ≥3 harmonized MetS criteria. Logistic regression adjusted for age, sex, BMI z-score, blood pressure, and liver enzymes. Power analysis showed 80% power to detect an odds ratio (OR) ≥2.2 at α=0.05. Results: Median LP(a) was 42 nmol/L (IQR 19–96) in the FH group (n = 45) and 39 nmol/L (IQR 18–91) in the non‑FH group (p = 0.68). In children with MetS (n = 37) median LP(a) was 35 nmol/L (IQR 16–84) versus 43 nmol/L (IQR 20–99) in those without MetS (p = 0.54). First‑degree family history of premature cardiovascular disease remained a strong independent predictor of FH (OR 7.05, 95 % CI 2.98–17.9). Intermediate LP(a) (75–124 nmol/L) was associated with higher odds of FH (OR 4.75, 95 % CI 1.15–20.5), whereas high LP(a) (≥125 nmol/L) was not. Model c‑statistic was 0.79. Conclusions: In this cohort, LP(a) concentrations did not differ significantly between children with FH and those with MetS. The findings support LP(a) as a risk marker independent of underlying dyslipidemia phenotype but highlight limited power to detect small differences. Routine one-time LP(a) measurement remains justified for high-risk children, but larger multicenter studies are needed to refine age-specific cut-points and clarify associations with long-term cardiovascular outcomes.

Lyme disease is the most common vector-borne illness in the United States and Europe, and timely prevention after tick exposure is critical to reduce the risk of early and late complications. This literature review examines the effectiveness and safety of antibiotic post-exposure prophylaxis in preventing Lyme disease. A search was conducted in PubMed and Embase for primary research studies published from 2000 to 2025, focusing on oral and topical antibiotics administered after Ixodes tick bites. Eight studies met inclusion criteria, including randomized controlled trials, observational studies, and experimental animal studies. Evidence consistently demonstrates that a single 200 mg dose of oral doxycycline, administered within 72 hours of tick removal, significantly reduces the risk of developing early Lyme disease, particularly erythema migrans, with relative risk reductions ranging from 67% to 87%. Adverse effects were generally mild, most commonly nausea or gastrointestinal discomfort. Topical azithromycin showed efficacy in murine models but did not reduce infection risk in human trials. Observational data support these findings, indicating rare prophylaxis failures and generally favorable safety profiles. Collectively, the evidence supports oral doxycycline as a safe and effective prophylactic strategy for adult patients following high-risk tick exposures, while topical antibiotic approaches remain unproven in humans. Further research is warranted to evaluate prophylaxis in children, pregnant individuals, and diverse populations, as well as to assess long-term prevention of disseminated Lyme disease. Keywords: Lyme disease, tick bite, antibiotic prophylaxis, doxycycline, azithromycin, post-exposure prophylaxis, erythema migrans

Purpose: Hospitalization presents significant risks for individuals with dementia, including increased behavioral and psychological symptoms (BPSD), delirium, functional decline, and reduced occupational engagement (Boltz et al., 2023; Teichmann et al., 2019; Zwingmann et al., 2020). Acute care environments are often overstimulating, unfamiliar, and task-oriented, which can exacerbate cognitive impairment and contribute to caregiver distress. Despite strong evidence supporting nonpharmacological, occupation-based interventions, structured engagement opportunities are rarely integrated into acute care workflows (Burgdorf et al., 2023; Faeder et al., 2023). This doctoral capstone project aimed to develop occupation-based dementia activities for use during hospitalization while equipping formal and informal caregivers with practical strategies to support meaningful engagement during and after discharge. Methods: A comprehensive literature review addressed dementia care in acute settings, nonpharmacological management of BPSD, delirium prevention, and caregiver support. A structured needs assessment was conducted through personal communication with occupational therapists, nurses, physicians, certified nursing assistants, activity directors, family caregivers, and individuals with dementia. Guided by the Person-Environment-Occupation (PEO) model and the Cognitive Disabilities Model (CDM), 12 themed activity kits were developed. Each kit included graded materials and caregiver instruction guides outlining setup, safety considerations, and modification strategies. Activities were designed for bedside use to promote engagement and support delirium prevention. An additional educational handout was created to guide caregivers in developing individualized activity boxes for home use, supporting continuity of care. Conclusion: Cognition-matched, occupation-based activities offer a feasible and clinically relevant approach to enhancing engagement in acute care. By integrating individualized activity design, environmental adaptation, and caregiver education, this project supports patient participation and caregiver confidence. This approach addresses a critical gap in acute dementia care and promotes continuity of meaningful engagement strategies across settings, with implications for improving patient outcomes, reducing caregiver burden, and supporting nonpharmacological management of behavioral symptoms.

Supraventricular tachycardia is the most common cardiac arrhythmia characterized by a rapid heart rate originating at or above the atrioventricular node. The current guidelines recommend using beta blockers or calcium channel blockers as first-line pharmacologic rate control in hemodynamically stable patients. The purpose of this literature review was to evaluate and compare the efficacy and safety of beta blockers versus calcium channel blockers in patients presenting with or at risk of developing supraventricular tachycardia. A literature search with defined inclusion and exclusion criteria was conducted using the electronic databases PubMed and Embase, resulting in eight studies for review. The findings of this literature review suggest that both beta blockers and calcium channel blockers may be effective for the treatment and prophylaxis of supraventricular tachycardia. With conflicting results between studies, there cannot be a definitive conclusion that beta blockers are more effective than calcium channel blockers. To gain more insight, future research should focus on directly comparing beta blockers to calcium channel blockers in patients with or at risk of supraventricular tachycardia. This literature review reveals a gap in evidence-based practice for primary care clinicians; thus, it is important for a clinician to continue to follow the current recommended guidelines, have awareness of their own prescriptive biases, and prioritize individualized treatment plans when choosing a medication for the management of supraventricular tachycardia. Keywords: Supraventricular Tachycardia, Beta Blockers, Calcium Channel Blockers

Purpose: Functional cognition plays a critical role in determining a patient’s ability to safely perform daily activities, manage medications, and discharge from acute care settings. Functional cognition refers to the integration of cognitive processes and performance skills necessary for completing real-world tasks safely and independently (American Occupational Therapy Association [AOTA], 2023). Occupational therapy practitioners are uniquely positioned to assess functional cognition using performance-based measures and support safe discharge planning. Limited awareness and understanding of functional cognition impairments among hospitalists and interdisciplinary team members may lead to inconsistent occupational therapy referrals and potential safety concerns during discharge planning (D’Cruz et al., 2021). Methods: An extensive literature review, needs assessment, clinical observation, and informal collaboration with hospitalists and interdisciplinary team members within an acute care system in a midwestern metropolitan hospital led this program. Evidence-based practices related to functional cognition and acute care were compared to observed clinical patterns through the lens of the Person–Environment–Occupation (PEO) model (Law et al., 1996). A gap analysis was conducted to identify inconsistencies in recognition and referral practices. Educational resources were then developed, trialed, and refined using formative feedback from occupational therapy practitioners and interdisciplinary staff. Results: Educational resources were developed to support hospitalists and interdisciplinary team members in understanding and identifying concerns related to functional cognition. The product includes a training module, a functional cognition overview guide, a referral support tool, and an acute care quick-reference resource. These materials emphasize performance-based assessment, common indicators of functional cognition deficits, and the role of occupational therapy in supporting safe discharge planning. Formative and summative feedback were used to refine the resources and assess perceived usefulness and clinical applicability. Conclusion: Functional cognition education and referral resources provide hospitalists and interdisciplinary team members with tools to enhance understanding of functional cognition and to improve identification of patients who may benefit from occupational therapy services. The product supports increased consistency in referral practices, improved interdisciplinary collaboration, and enhanced consideration of patient safety and occupational performance during discharge

Colorectal cancer (CRC) survivors face ongoing risks of disease recurrence, treatment-related morbidity, and long-term reductions in quality of life. As survival rates continue to improve, there is growing interest in adjunctive, non-pharmological interventions to improve clinical outcomes. Exercise has become a promising addition due to its effects on metabolic regulation, inflammation, immune function, and physical performance. The purpose of this scholarly project was to evaluate the current evidence regarding structured exercise programs as an adjunctive treatment in colorectal cancer survirovrs, with a focus on cancer recurrence and quality of life outcomes. A literature review was conducted using PubMed and Embase databases yielding a total of nine studies which met inclusion criteria. The reviewed literature demonstrates that structured exercise following the completion of treatment is consistently associated with improvements in physical functioning, fatigue, and health-related quality of life. There is also good evidence which suggests that regular exercise is associated with reduced recurrence rates and improved disease-free and overall survival, particularly in the early postoperative period. Exercise during active treatment shows mixed results, with benefits observed in physical fitness and neuropathy prevention, but potential short-term symptom exacerbation during intensive neoadjuvant therapy. Overall, the findings support structured exercise as a safe, low-risk, and potentially high-impact adjunctive therapy for colorectal cancer survivors. Further research may be needed to clarify optimal exercise timing, intensity, and modality across the various treatment stages. Keywords: colorectal cancer, exercise intervention, cancer recurrence, survival outcomes, quality of life

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder with symptoms that significantly overlap with trauma-related behavioral and emotional disturbances, complicating diagnostic accuracy. Childhood trauma and adverse childhood experiences (ACEs) can both mimic and exacerbate ADHD symptoms, increasing the risk of misdiagnosis and inappropriate treatment when trauma exposure is not assessed. This scholarly project examined the relationship between childhood trauma exposure and ADHD diagnosis, symptom severity, and risk for subsequent adversity in children ages 6-12. A literature review of primary studies published between 2020 and 2025 was conducted using PubMed, PsycINFO, EMBASE, and CINAHL databases. Eleven studies met inclusion criteria and were analyzed. Findings demonstrated a consistent association between trauma exposure and increased likelihood of ADHD diagnosis, with a dose-response relationship between cumulative ACEs and ADHD prevalence and severity. Longitudinal evidence supported a bidirectional relationship, in which trauma worsens ADHD symptoms and ADHD increases vulnerability to future adversity. Trauma-informed screening tools improved identification of trauma exposure during ADHD evaluations. Integrating trauma-informed screening into pediatric ADHD assessments may improve diagnostic accuracy and support more comprehensive, individualized care.

Introduction: Prior studies of revision total knee arthroplasty (rTKA) for arthrofibrosis have identified potential risk factors for failure, but findings are mixed and limited by small cohorts and lack of multivariable survivorship analyses. The purpose of this study was to identify patient and surgical factors associated with failure following rTKA for arthrofibrosis by evaluating 5-year reoperation- and re-revision-free survivorship. Methods: A retrospective review identified aseptic rTKA performed between August 2013 and August 2025. Of 1,153 revisions, 135 were performed for arthrofibrosis as the primary indication. Demographics, range of motion, patient reported outcomes, and subsequent reoperations and re-revisions were analyzed. A total of 76 patients comprised the final cohort with follow up of at least 1 year. Five-year reoperation-free and re-revision-free survivorship was determined via the Kaplan-Meier method and Cox regression analyses were used to determine patient and surgical factors influencing survival. Results: Seventy-six patients were included, 33 (43.4%) of whom achieved successful revision for arthrofibrosis with range of motion (ROM) greater than 90 degrees. At 5 years, reintervention-free survivorship was 66% (95% CI, 54-82%) and re-revision-free survivorship was 80% (95% CI, 69-93%). In multivariable Cox regression analysis, male sex (HR 3.85, 95% CI 1.38–10.70; p=0.01), higher BMI (HR 1.10, 95% CI 1.00-1.20; p=0.04), and isolated polyethylene exchange (HR 11.78, 95% CI 2.09–66.40; p=0.01) were independently associated with increased risk of reintervention for arthrofibrosis. Conclusions: Revision TKA for arthrofibrosis improved ROM, but reintervention rates were high, with 5-year reintervention-free survivorship of 66%. Male sex, higher BMI, and isolated polyethylene exchange were associated with increased risk of reintervention for arthrofibrosis, while only hinge prostheses [MP1.1]predicted worse re-revision-free survivorship. Overall, no specific revision construct in our cohort was associated with higher rates of successful revision for arthrofibrosis. Patients with arthrofibrosis after TKA are a high-risk cohort, and further studies are needed to identify best practices for success while minimizing complications.

Gastrointestinal cancers are among the most common malignancies worldwide and are associated with significant morbidity and mortality despite advances in treatment. Vitamin D deficiency is prevalent in individuals with gastrointestinal cancer due to malabsorption, reduced dietary intake, limited sun exposure, and systemic illness. Vitamin D has antiproliferative properties that may influence cancer progression and patient outcomes. This literature review aims to investigate the efficacy of vitamin D₃ supplementation as an adjunct therapy in individuals with gastrointestinal cancer undergoing chemotherapy by evaluating its impact on overall survival, relapse-free survival, and patient-centered outcomes. A literature review was conducted using the electronic databases PubMed and Embase. Keywords and MeSH terms included vitamin D, gastrointestinal cancer, colorectal cancer, chemotherapy, survival, relapse-free survival, and supplementation. Seven studies met inclusion criteria and were analyzed for this review. The findings of this literature review suggest that vitamin D₃ supplementation improves serum vitamin D levels and may improve quality of life, fatigue, mood, and other supportive outcomes in patients with gastrointestinal cancer. Overall, vitamin D₃ supplementation appears to be a safe and effective intervention for correcting vitamin D deficiency and improving supportive care outcomes in individuals with gastrointestinal cancer. However, further research is needed to determine its role in improving long-term survival outcomes in individuals with gastrointestinal cancer. Keywords: Vitamin D₃, gastrointestinal cancer, chemotherapy, colorectal cancer, relapse-free survival, overall survival

Background: Autism spectrum disorder (ASD) is a neurological disorder that impacts people and their families. ASD presents with reduced safety awareness and an increased risk of drowning. There has been an increased awareness and development in aquatic therapy to reduce drowning risks for those with ASD. Occupational therapists (OTs) have developed interventions targeting water safety. OTs use skills of activity analysis, sensory modifications, and grading and adapting interventions to provide just-right challenges in and around water. After the conduction of an on-site needs assessment and a literature review, there was an identified need for increased education for swimmers, swim instructors, and caregivers. Purpose: The purpose of this scholarly project is to gain experience and understanding of OT’s role in aquatic therapy to increase water competency and reduce drowning risk in children with ASD. In addition to increased knowledge, materials using a variety of mediums, was created to increase education on the importance of swimming for children with ASD and provide educational resources to swimming instructors, caregivers, and children on the autism spectrum. Methods: A needs assessment via the literature and an initial literature review were completed before the doctoral experience in aquatic therapy. The needs assessment was completed in the context of the doctoral experience. During the experience, multiple trainings were completed to increase competency when providing aquatic lessons. Three products were made in collaboration with other OT students and OTs. The three main target audiences were children with ASD, swimming instructors, and caregivers of those with ASD. Results & Outcome: During this experience, three products were created: Swimming with Confidence: A Guide for Swimmers, Swimming with Confidence: A Guide for Swim Instructors, and Swimming with Confidence: A Guide for Caregivers. These products can be used together or as separate tools for each intended audience. The purpose of these products is to provide education materials with the overall goal of educating people about the increased risk of drowning for those with ASD, working to reduce drowning rates, and overall increasing water safety.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) accounts for 6-8% of MI cases[1] and is markedly more prevalent in younger populations. Identifying the underlying mechanism is essential for guiding management and improving prognosis. Case Presentation: We present a 42-year-old woman with a history significant for hypertension, anxiety, polysubstance use, tobacco use, and a family history of premature coronary artery disease, admitted with acute chest pain, diaphoresis, and dyspnea. Blood pressure was 209/126 mmHg. ECG showed inferolateral ST elevations. Emergent catheterization revealed anomalous origin of the left coronary artery from the right coronary cusp and non-obstructive coronary disease without a culprit lesion. High-sensitivity troponin was markedly elevated (>60,000 ng/L), and urine drug screen was positive for amphetamines and tetrahydrocannabinol. Echocardiography showed preserved ejection fraction with regional wall motion abnormalities. ST elevations resolved on repeat ECG. Discussion: The patient’s presentation was most consistent with coronary vasospasm, a recognized cause of MINOCA accounting for 20% of cases in young patients[2] and carrying meaningful long-term cardiovascular risk.[3-4] Recognizing MINOCA requires systematic evaluation to determine the underlying mechanism. Although the patient had anomalous coronary anatomy that can predispose to ischemia, no features suggested a causative role in their acute presentation. Rather, polysubstance use of methamphetamine and tobacco likely predisposed the patient to vasospasm. The patient’s hypertensive crisis, positive toxicology, absence of thrombotic obstruction, and rapid ST segment resolution following nitrate therapy strongly support vasospasm as the causative mechanism. Comprehensive management of MINOCA and vasomotor disorders emphasizes mechanism directed therapy and aggressive risk factor modification.[3-5] Absolute cessation of stimulant use is critical to reduce recurrence risk in premature myocardial infarction.[6-7] Conclusion: This case reinforces that ST elevation does not universally indicate plaque rupture, highlighting the need for individualized evaluation in young patients. Stimulant-related vasospasm can cause true transmural infarction, with markedly elevated biomarker levels. Recognizing non-atherosclerotic mechanisms is key to reducing long-term cardiovascular risk.

Introduction Contraceptives are critical to maintaining women’s autonomy, long-term reproductive goals, and managing medical conditions. Many factors are associated with overall use and efficacy of contraceptives, such as receiving sexual health education, age at first intercourse, and additional demographic factors. Residence significantly impacts reproductive health, yet there is a lack of research on how it affects contraceptive use. The purpose of this study was to determine if there is an association between rural-urban residence and female contraception use in the United States. Methodology We conducted a retrospective analysis of current contraceptive use by women, ages 15-44, using the 2017-2019 National Survey of Family Growth dataset. We compared current use and contraceptive methods among rural and urban women. Inclusion criteria was females ages 15-44. Exclusion criteria included females ≤14 and ≥45 years, and men. Urban was defined as a metropolitan statistical area (MSA) and Other MSA with Rural being non-MSA. Contraceptive use was defined as current birth control method in the month of interview. SPSS Complex Samples 31.0 was used to analyze the data with two-sided significance tests and P < .05. Institutional Review Board approval was obtained from the University of North Dakota. Results Of the estimated 62.1 million women 15-44 years old, 16.2% resided in rural areas. Rural women were more likely to be White (73.6% vs. 55.9%, p=.033) and living under the poverty line (30.2% vs 21.8%, p=.000). They were less likely to be married (32.8% vs. 35.9%, p=.011) and have a college education (50.8% vs 61.8%, p=.001). Overall, 63.9% were currently using contraception. We found no association between current contraceptive use among rural and urban women (66% vs 63.5%, p=.221). Rural women were more likely to use most effective methods (33.7% vs 29.2%, p=.031). Residence was not associated with moderately effective (p=.467), least effective (p=.155), and no contraceptive methods (p= .221). Rural women were more likely to have had intercourse by 16 (63.2% vs 37.5%, p=.006). Conclusions and Significance Rural-urban residence was not associated with current contraceptive use in women, yet rural women had significantly higher rates of using the most effective contraceptive methods. Rural women were found to have intercourse at a younger age. These findings highlight the importance of sex education and access to contraceptives regardless of rural-urban status.

Musculoskeletal injuries are one of the most common patient complaints seen by healthcare providers. Effective diagnoses and management of these complaints often requires a robust physical examination, imaging, and multiple visits. Due to this, questions remain as to telehealth’s ability to be utilized for these types of patient visits. This literature review included nine studies evaluating the effectiveness of telehealth consultations in the management of musculoskeletal complaints in regard to diagnostic ability, access to care, and patient satisfaction. Results demonstrated that these telehealth consultations significantly increased access to care through decreased travel costs, decreased distance traveled for visits, and decreased visit wait times all while showing high patient satisfaction of care. Plain radiographs were also able to help diagnose injuries through telehealth consultations, but overall diagnostic ability proved less effective due to questions regarding difficulty assessing more complex imaging types as well as inferiority in strength and stability testing portions of physical examinations. Due to this, telehealth consultations may be better suited as visits for patients with orthopedic surgery follow-ups as well as a method to triage low acuity injuries prior to traditional in-person visits with orthopedic specialists.

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, highlighting the importance of effective dietary strategies for prevention. This literature review evaluates whether adherence to a Mediterranean diet, compared to a low-fat diet, more effectively reduces cardiovascular risk in adults. A comprehensive search of PubMed (MEDLINE) and Elsevier ScienceDirect was conducted, yielding six studies that met inclusion criteria, including randomized controlled trials, mechanistic studies, and long-term adherence research. Findings consistently demonstrated that Mediterranean dietary patterns were associated with reductions in major adverse cardiovascular events, improvements in lipid profiles, decreased inflammatory markers, and better glycemic control. Additionally, evidence suggests that Mediterranean diets are more sustainable than low-fat diets, with higher adherence rates and greater patient satisfaction over time. These combined clinical, biological, and behavioral outcomes support the effectiveness of Mediterranean diets in both primary and secondary prevention of cardiovascular disease. Overall, the evidence indicates that Mediterranean dietary patterns are more effective than low-fat diets in reducing cardiovascular risk. These findings support the integration of Mediterranean diet recommendations into clinical practice, particularly for patients with elevated cardiovascular risk. Further research is needed to evaluate long-term outcomes in diverse populations and to support broader implementation in non-Mediterranean settings. Keywords: Mediterranean diet, low-fat diet, cardiovascular disease, cardiovascular risk, dietary adherence

ABSTRACT Background: Psychological readiness to return to sport and subjective knee function are critical outcomes following ACL reconstruction (ACLR), yet they do not always progress in parallel. An athlete may demonstrate high subjective knee function but low psychological readiness, suggesting a mental barrier to return, or conversely, report high readiness despite persistent functional limitations, raising concerns of overconfidence and reinjury risk. Understanding how these domains change together during recovery is essential for identifying mismatches that may require targeted intervention. Purpose: The purpose of this study is to examine the relationship between changes in psychological readiness (ACL-RSI) and subjective knee function (IKDC) from early to late recovery following ACLR. Study Design: Secondary analysis of prospectively collected data. Methods: Athletes (N = 48, Age at ACLR = 17.7 ± 1.8 y) aged 15-25 years who underwent ACLR with an ipsilateral autograft, had a pre-injury MARX score > 8, and completed the ACL-RSI and IKDC questionnaires at 3.5 ± 1 and 7 ± 1 months post-ACLR were included. Percent changes in ACL-RSI and IKDC scores between early and late recovery were calculated. Spearman’s rank correlation was used to examine the association between changes in psychological readiness and subjective knee function. Significance was set to p < .05. Results: The mean percent change in ACL-RSI was 40.7 ± 57.1% and the mean percent change in IKDC was 24.8 ± 18.1% from 3.5 ± 1 months to 7 ± 1 months post-ACLR. The percent changes in ACL-RSI and IKDC scores from 3.5 ± 1 months to 7 ± 1 months post-ACLR were moderately correlated (ρ = 0.350 (95% CI [0.089, 0.584]), p = 0.012). Discussion: The main finding of this study was that subjective knee function and psychological readiness to return to sport changed in parallel from 3.5 to 7 months following ACLR. Clinicians can use this information regarding the concordant progression of psychological readiness to return to sport and subjective knee function to personalize ACL rehabilitation for future patients. Overall, clinicians can understand that if psychological readiness improves, subjective knee function will likely improve over the 3.5- to 7-month post-ACLR time frame, and vice versa. Therefore, focusing on both of these components at multiple time points during the recovery process may be influential to ensure the greatest likelihood of returning to sport in athletes following ACLR.

Title: Pathways to Participation: Enhancing Inclusion for Individuals with IDD Background: Youth with intellectual and developmental disabilities (IDD) continue to experience barriers to meaningful community participation despite policies promoting inclusive community-based services (Friedman, 2017). Sensory sensitivities, difficulty with transitions, and overstimulating environments frequently limit engagement and increase anxiety or behavioral responses when appropriate supports are not present (Bagatell et al., 2022; Dean et al., 2018; Tint et al., 2017). Research indicates that inclusion requires intentional programming that incorporates structured supports, consistent routines, and opportunities for meaningful engagement (Edwards et al., 2021; Hall, 2016). Methods: The purpose of this scholarly project was to develop a week long sensory exploration camp for youth ages 6 to 12 with IDD designed to support participation in community-based recreation. The project was guided by the Model of Human Occupation (MOHO), which breaks down participation as the interaction of volition, habituation, performance capacity, and environment (Kielhofner, 2008). A comprehensive literature review and needs assessment informed the development of a structured camp manual incorporating sensory informed activities, predictable routines, and environmental supports. Results: The resulting product is an intentionally designed five-day sensory exploration camp manual organized around the five sensory systems including touch, hearing, sight, smell, and taste to promote engagement, self-regulation, and social participation in an inclusive setting (Breslin et al., 2019; Opalinski & Martinez, 2021; Yang et al., 2021). Conclusion: Using occupation-based, intentional programming, and targeted sensory interventions can support inclusive social participation can enhance the lives of those with IDD.

Background: Upper-extremity fractures are a common reason for emergency department (ED) visits and often require analgesia. Prior studies have shown disparities in opioid prescribing for fractures between rural-urban EDs, but none have examined upper-extremity fractures. This study evaluated rural-urban ED opioid prescribing for upper-extremity fractures in the United States. Methods: We compared opioid prescribing for adult (18-64 years) upper-extremity fractures between rural and urban EDs using the 2013-22 National Hospital Ambulatory Medical Care Survey Emergency Department datasets. EDs were categorized by metropolitan statistical area (MSA) status, with non-MSA classified as rural and MSA as urban. Prescribing was defined as a medication given in the ED or at discharge. SPSS Complex Samples 31 was used to perform two-sided test with p < .05. Institutional Review Board approval was obtained from the University of North Dakota. Results: Of the estimated 9. 8 million adult ED visits for upper-extremity fractures, 17.5% occurred in rural EDs. Rural ED visits were older (42.2 vs. 39.6 yrs, p=.019), had shorter wait time to be seen (25.1 vs. 32.3 mins, p=.040) and total visit (130.0 vs. 207.2 mins, p=.000). Rural ED visits were less likely to be triaged as immediate/emergent (2.9 vs. 10.9, p=.010) and have substance abuse/dependence (0.9 vs. 7.0, p=.000). Rural EDs were less likely to use CT imaging (6.5% vs. 16.2%, p=.000), involve consulting physicians (6.6% vs. 14.0%, p=.010), physician assistants (12.7% vs. 23.1%, p=.049), and residents/interns (0.5% vs. 10.8%, p=.000). Rural EDs had lower rates of opioid prescribing than urban EDs (51.8% vs. 66.1%, p=.019) and medications given in the ED (1.3% vs. 1.8%, p=.035), but higher utilization of muscle relaxants (9.2% vs. 1.8%, p=.001) and antidepressants (4.4% vs. 0.8%, p=.019). Other medications were utilized at similar rates including any medication (p=.111), total medications (p=.937), at discharge (p=.222), NSAIDs/acetaminophen (p=.458), and anticonvulsants (p=.381). Rural and urbans EDs had similar rates of admission (p=.526) and length of stay (p=.671). Conclusions and Significance: Rural EDs had lower opioid prescribing rates for adult upper-extremity fracture visits than urban EDs. Identifying these differences is important for promoting equitable pain management across ED settings. Further research is needed to clarify factors underlying these prescribing differences.

INTRODUCTION: Flow-diverting (FD) stents play a critical role in the management of complex intracranial aneurysms. Successful FD stent deployment requires precise planning to minimize peri- and post-procedural complications. This traditionally relied on physician expertise for precise planning; however, software simulations now offer estimative modeling. This systematic review and meta-analysis compares physician and software simulations for predicting stent deployment and assesses the clinical impact of software integration on procedural metrics. METHODOLOGY: We searched PubMed, Embase, Web of Science, and Scopus (articles through July 18, 2025) using Nested Knowledge AutoLit. The search combined MeSH terms and keywords, and followed updated PRISMA guidelines. A manual review of the references identified grey literature. Fourteen studies were included. All studies that involved comparative data, a physician and software/simulation tool, regarding intracranial aneurysms with outcomes relating to accuracy metrics, interobserver agreement or apposition, or procedural metrics were included. All data were analyzed using R, version 4.5.2, and the ‘meta’ package. Risk-of-bias assessment was completed using ROBINS-I tool for procedural metric-related studies and COSMIN-based checklist for accuracy/agreement-related studies. RESULTS: The pooled analysis found software predicted stent length to be shorter than the physicians’ predicted length (MD 2.88 mm; [1.25, 4.51]), without significant statistical difference in diameter (MD 0.0 mm; [-0.09, 0.09]); software-chosen dimensions are accurate to the post-implantation length (MD –1.40 mm; [–3.56, 0.76]) and diameter (MD 0.17 mm; [-0.63, 0.97]); software-assisted cases were associated with shorter procedure duration (MD 9.91 min; [1.23, 18.58]), lower radiation dose (MD 305.52 mGy; [172.14, 438.90]), and fewer corrective interventions (OR 3.44; [1.78, 6.64]); and no significant difference in hemorrhagic complications (OR 1.67; [0.65, 4.28]) and postoperative aneurysm occlusion (OR 0.52, [0.07, 3.78]). LIMITATIONS: Given the retrospective nature and bias limitations of current literature, further prospective, randomized studies are warranted to better assess the clinical impact of simulation software in the endovascular treatment of intracranial aneurysms. CONCLUSIONS: The findings in this paper provide preliminary evidence to support integration of virtual simulation software in the preprocedural FD treatment planning.

Introduction: Multiligament knee injuries involving anterior cruciate ligament (ACL) rupture with lateral-sided instability, including lateral collateral ligament (LCL) deficiency and proximal tibiofibular joint (PTFJ) instability, present a complex clinical challenge. These injuries are often underrecognized and can result in persistent instability, pain, and poor functional outcomes if not comprehensively addressed. The purpose of this study is to describe a reproducible surgical technique for combined ACL, LCL, and PTFJ reconstruction to restore multiplanar knee stability. Methodology: This Technical Note outlines a stepwise surgical technique for anatomic ACL reconstruction using a bone–patellar tendon–bone (BTB) autograft combined with simultaneous LCL and PTFJ reconstruction using a single semitendinosus allograft. Key steps include thorough lateral exposure with peroneal nerve neurolysis, anatomic tunnel placement at the femoral and fibular LCL insertions, and creation of a tibial tunnel for PTFJ stabilization. The ACL reconstruction is performed prior to final lateral graft fixation, with sequential graft tensioning to optimize restoration of knee stability. Results: This technique enables restoration of anterior-posterior, medial-lateral, and rotational stability of the knee through a single-stage, anatomically based reconstruction. Use of a single semitendinosus allograft for lateral-sided reconstruction minimizes donor site morbidity while maintaining structural integrity. Proper graft orientation, tunnel placement, and fixation sequencing are critical to achieving stable, reproducible outcomes. Conclusions and Significance: Combined ACL, LCL, and PTFJ reconstruction represents a comprehensive solution for complex multiligament knee injuries. This technique provides a reproducible approach to address multiplanar instability and may reduce the risk of persistent symptoms and functional limitations associated with isolated ligament reconstruction. Its application is particularly relevant in high-demand patient populations requiring reliable restoration of knee stability.

Purpose: The purpose of this project was for an occupational therapy doctoral student to collaborate with the staff of a maternity home in rural North Dakota. The goal of this collaboration was to provide the residents of the maternity home with education on safety and caring for their child as well as information regarding pregnancy, postpartum, and bonding with their child. This will help to support the mother in her newfound role as well as the child in their various occupations as an infant. Women face many barriers in pregnancy that may lead to them being in maternity homes. The purpose of the educational booklet was to provide base knowledge on the pregnancy and postpartum processes for the women and support them in their role as a mother. Methods: An ecological model was utilized to guide the literature review process and ensure that all components of the person, task, and context were addressed through the review. In examination of the literature, information gathered revealed the demographics of women residing in maternity homes, experiences of mothers residing in maternity homes, and occupational challenges in transitioning into the role of a mother. The product was built in collaboration with and observation of staff and residents at a Catholic-based maternity home in rural North Dakota to support the population served by the organization. Results: The product built throughout the doctoral experience is an educational packet of information on motherhood-related occupations intended for use by residents. Information provided in the product includes education on maternal health in each trimester of pregnancy, what to expect postpartum from physical and psychological standpoints, general safety regarding the care of an infant, and milestones for children from birth to age three. Integrated into the product are spiritual considerations of the organization as well as cultural considerations of the residents. Conclusion: The product was built for use by maternity home residents to support them as they progress through pregnancy and enter motherhood in the postpartum stage. This will increase confidence in caring for their child and knowledge in maternal health as it applies to physical and psychological aspects of motherhood.

Introduction Telehealth offers increase access to medical care among individuals with mental health conditions. However, limited research exists regarding telehealth usage in rural vs. urban areas. This study aimed to determine the association between rural-urban residence and telehealth among adults with common mental health conditions. Methodology We conducted a retrospective analysis of adults (18-64 years old) with depression/anxiety utilizing the 2024 National Health Interview Survey. We compared telehealth utilization between rural-urban adults with these conditions. SPSS Complex Samples 31.0 was used to perform chi-square two-sided tests with p<.05. Institutional Review Board was obtained from the University of North Dakota. Results Of the estimated 199 million adults, 25.9% had depression/anxiety. Among adults with depression/anxiety, 16.0% resided in rural areas. Rural adults with depression/anxiety were more likely to be older (41-64 yrs; 49.0% vs 42.4%, p=.000), White (85.1% vs. 67.3%, p=.000), a high school graduate (49.4% vs. 31.7%, p=.000), be below the poverty threshold (12.6% vs. 6.9%, p=.000), and on government insurance (35.6% vs. 24.7%, p=.000). Rural adults with depression/anxiety reported similar rates of mental health measures, including serious psychological distress (K6 scale, p=.235), feelings of sadness (p=.192), hopelessness (p=.102), worthlessness (p=.396), nervousness (p=.276), restlessness (p=.865), or everything being an effort (p=.515). Rural adults were less likely to have received counseling or therapy in the past 12 months (30.4% vs. 45.9%, p=.000), although current counseling rate was similar (p=.727). Rural adults with depression/anxiety were less likely to participate in virtual medical appointments within the past 12 months (29.5% vs. 45.2%, p=.000), use the internet for health information (68.0% vs. 78.9%, p=.000), communicate with a doctor’s office electronically (51.3% vs. 66.8%, p=.000), and access test results online (52.1% vs. 65.4%, p=.000). Rural individuals had lower rates of home internet access (97.3% vs. 98.6%, p=.002), although internet access was similar (97.0% vs. 97.4%, p=.397). Conclusions and Significance Over 25% of U.S. adults reported having depression/anxiety. Rural adults suffers reported lower utilization rates of telehealth-related services and mental health counseling. Despite this, rural and urban adults had similar rates of mental health distress measures. Keywords: Telehealth, mental health, rural, NHIS

Introduction: Glucagon-like peptide-1 (GLP-1) agonist and combined GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist use has dramatically increased in recent years. While their side effect profile is often manageable, they can lead to serious complications. Case Presentation: We present a case of colonic ischemia in a young patient who experienced significant nausea, vomiting, and abdominal pain after initiation of semaglutide. Imaging was unremarkable, but after an episode of hematochezia, a colonoscopy was performed, which grossly showed signs of colonic ischemia with biopsied tissue demonstrating changes consistent with ischemic mucosa. A comprehensive hematology, cardiology, and gastrointestinal workup was performed, which did not elucidate a cause for the colonic ischemia. The likely cause was deemed to be hypovolemia resulting from the recent initiation of semaglutide. Conclusions: Following the initiation of semaglutide, other GLP-1 agonists, or GLP-1/GIP dual agonists, practitioners should be aware of the potential severe complications, such as colonic ischemia, and properly educate their patients about these risks.

Background The transition from high school to adulthood is a critical period influencing independence, employment, and community participation for students with disabilities (Carroll et al., 2025; Rosner et al., 2020). Despite mandates under the Individuals with Disabilities Education Act (IDEA), many students experience poor postsecondary outcomes, including limited employment and increased reliance on caregivers (Benson et al., 2021; U.S. Department of Education, 2020). Effective transition planning should begin early, be individualized, and emphasize real-world skill development such as daily living, vocational skills, and self-advocacy (Cleary & Persch, 2020). However, school-based programs often lack consistency, structure, and performance-based outcome measures, reducing their effectiveness (Rosner et al., 2020; Schaaf et al., 2021). Occupational therapy remains underutilized despite its ability to address person–task–context interactions and support successful adult outcomes (Pierce et al., 2020). Methods A comprehensive literature review was conducted to examine current school-based transition planning practices, identify evidence-based approaches, and explore the role of occupational therapy in supporting transition outcomes. An informal needs assessment was also completed to better understand the school’s existing transition planning processes and identify gaps in knowledge and resources. The ecology of human performance (EHP) model guided this project, emphasizing the dynamic interaction between the person, task, and context in shaping performance outcomes (Dunn, 2017). This framework supported analysis of student factors, transition-related tasks, and environmental influences within school and community settings. Findings from the literature review, needs assessment, and application of the EHP model directly informed the development of the product. Results The product is a school-based transition resource guide designed to support staff in providing clear, accessible information to families of transition-aged students with disabilities. It includes key information on transition timelines, adult services, and community resources, and is intended for use during Individualized Education Plans (IEP) meetings and transition planning discussions. This guide enhances staff knowledge, promotes consistency in information sharing, and helps families better navigate the transition to adulthood, ultimately supporting improved postsecondary outcomes for students. Conclusion This project highlights the importance of providing structured, accessible transition resources to support both school staff and families. By improving knowledge and promoting consistent information sharing, the developed guide aims to enhance transition planning and better prepare students with disabilities for adult life. Ultimately, this approach supports more informed decision-making and improved postsecondary outcomes.

Purpose: The World Health Organization states there are more than 65 million wheelchair users worldwide with the number expected to grow (Gilani, 2023). Many wheelchair users run into challenges with not knowing how to properly maintain their equipment or complete the necessary skills needed to navigate their environments (Boccardi et al., 2022; Morgan et al., 2015; Smith et al., 2016; Toro et al., 2017). This product aims to provide practitioners with an accessible form of educational materials addressing commonly faced barriers that can be used in the clinic setting or provided for patients and caregivers to access from a distance. ​ Methods: A needs assessment was conducted, which included a literature review, skilled observation of wheelchair evaluations, and fittings/ adjustments interventions at an outpatient clinic in the Midwest, and informal interviews with practitioners working with wheelchairs. The Ecology of Human Performance was used as a theoretical guide to better understand the relationship between the person, context, and task which wheelchair maintenance and mobility are addressed (Dunn, 2017). ​ Results: A product containing 13 Videos and 14 Handouts was created to support practitioners working in the area of wheelchair seating and mobility in providing materials to support education on wheelchair maintenance and functions. The product addresses areas in general wheelchair maintenance for a variety of chairs, cushion cleaning and maintenance for a variety of cushions, benefits and use of different functions found on tilt-in-space and power chairs, prevention of pressure injuries, and a tracking sheet for users to utilize for yearly part replacements. The product will serve as an accessible resource for practitioners to share with patients and caregivers to access from a distance. ​ Conclusions: This product will serve as a quick and accessible resource for practitioners to share with their patients and caregivers who receive a new chair or are current users to inform on basic maintenance and features on a variety of wheelchairs. Continued updating of the materials and discussion of common barriers are needed to better understand the effectiveness of current educational materials.

Introduction: The true rate of nonunion (NU) and malunion (MU) after traumatic rib fractures is underexplored in current literature, as are contributory patient and injury factors. Methods: We conducted a retrospective cohort study of hospitalized patients with multiple traumatic rib fractures managed nonoperatively between August 2014 and April 2025 at a level I trauma center. Patients were included if they had documented computed tomography (CT) imaging of the chest obtained six months or later from the date of injury. Three independent reviewers assessed follow-up CT imaging for the presence of NU, defined as a persistent fracture gap, and MU, defined as abnormal angulation with cortical irregularity. Multivariate logistic regression was used to evaluate the effects of fracture characteristics on the likelihood of developing NU/MU. Results: NU/MU was present in 40 of 219 patients (18.3%) and in 96 of 1229 individual fractures (7.8%). Cohorts were similar regarding demographic factors and injury mechanisms. Regression analysis showed bicortical displacement and flail rib predisposed to NU/MU with respective odds ratios of 21.8 (95% CI 10.7–44.9, p<0.001) and 5.71 (95% CI 2.77–12.0). Posterior and offset fractures were also significantly more likely to develop NU/MU. Fracture comminution and rib height on the chest wall (high, middle, or low) were not significant predictors. Patients with NU/MU initially presented with more rib fractures (median 6 vs. 4, p < 0.001) and concomitant clavicular fractures (20.0% vs. 8.4%, p = 0.043). Of 19 comorbidities, only cigarette smoking was associated with NU/MU (67.5% vs. 46.9%, p = 0.019). Conclusions: NU/MU was common after severe chest wall trauma and was strongly associated with bicortical displacement. Flail segment, posterior fracture location, cigarette smoking were also associated with NU/MU. Whether surgical stabilization can reduce the incidence in these settings is unclear

Intravesical Bacilli Calmette-Guerin (BCG) therapy is a cornerstone of treatment for non-muscle-invasive urothelial carcinoma. Severe complications from this therapy are not common, and osteomyelitis and discitis represent a rare complication of therapy. We present a case of a male in his 80s who developed Mycobacterium bovis BCG T12-L1 vertebral osteomyelitis and discitis after treatment with intravesical BCG therapy following transurethral resection of high-grade papillary urothelial carcinoma. The patient had been experiencing increasing back pain for several months. Imaging revealed findings suggestive of osteomyelitis/discitis at the T12-L1 level with epidural abscess, however routine microbiological evaluation at that time was negative for an active infection. Interval worsening of the lesion was seen on repeat imaging so a repeat biopsy of the T12-L1 disc space was obtained and sent for mycobacterial cultures which ultimately grew Mycobacterium tuberculosis complex that was eventually identified as Mycobacterium bovis BCG.

Cardiac Resynchronization Therapy (CRT) is used in patients diagnosed with heart failure with reduced ejection fraction. CRT is used to artificially pace both ventricles with the intent of one synchronous contraction of the right and left ventricle. The synchrony of contraction aims to increase left ventricular ejection fraction to alleviate heart failure symptoms and morbidities. Traditional bi-ventricular pacing utilizes lead placement in the coronary sinus to pace and electrically capture the posterior myocardium of the left ventricle. Current trends in research reveal the emergence of a novel pacing technique of pacing leads implanted into the septum of the right ventricle with the intent of electrical capture of the heart’s natural conduction system leading to resynchronization of the right and left ventricles. The purpose of this literature review is to examine the effectiveness of a novel pacing technique for CRT. The electronic databases Pubmed and EMBASE were searched; five studies were chosen for review comparing traditional bi-ventricular pacing to the novel conduction system pacing. Conduction system pacing encompassed both techniques of his-bundle pacing and left bundle branch pacing. Current findings from research suggest that the novel conduction system pacing leads in greater improvements in LVEF, narrower paced QRS complex, and further reduction of NYHA classification of heart failure symptoms when compared to traditional Bi-ventricular pacing with a coronary sinus lead. Future research should focus on large cohort randomized control trials comparing the two pacing techniques.

Background: An estimated 2.77 million pregnant patients present to United States emergency departments (EDs) annually. Access to healthcare during pregnancy is critical, as many pregnancy-related complications are preventable. Prior research suggests patients in rural settings have a 9% higher risk of severe maternal morbidity and mortality compared to urban populations. We examined the association between rural-urban EDs and utilization among pregnant patients in the United States. Methods: We conducted a retrospective analysis of ED visits by pregnant women utilizing the 2013-22 National Hospital Ambulatory Care Survey Emergency Department datasets. We compared the utilization rate and factors associated with pregnancy-related visits between rural and urban emergency departments in the United States. Inclusion criteria were visits with pregnancy-related diagnoses by women of reproductive age (15-44 years old). SPSS Complex Samples 31 was used to perform chi-square two-sided tests with P< .05. Institutional Review Board approval was obtained from the University of North Dakota. Results: Of the estimated 28 million ED visits by pregnant patients from 2013 to 2022, 10.3% occurred in rural settings. Rural visits were younger (24.9 vs. 27.0 years, p=.000) with a higher rate of teen pregnancies (16.7% vs 10.7%, p=.017) and a lower rate of advanced maternal age (6.1% vs 12.6%, p=.000). Rural visits were more likely to be White (80.3% vs 59.6%, p=.002). There was no association between ED location and private residence (p=.622), insurance (p=.590), weekend (p=.874), season (p=.435), and region (p=.244). Rural EDs had a significantly lower pregnancy-related visit rate than urban EDs (6.2% vs. 9.2%, p=.000). Also, rural ED visits had a lower rate of an ED visit within 72 hours (6.1% vs 12.6%, p=.000), wait time to be seen (25.4 vs. 40.5 minutes, p=.000), length of visit (204.3 vs. 261.8 minutes, p=.037) and utilization of ultrasound (33.3% vs. 47.3%, p=.012). Conclusions: We found rural EDs had a lower pregnancy-related visit utilization rate. Rural visits had higher rates of teen pregnancy, while urban visits involved more advanced maternal age patients. Differences in ultrasound use and wait time suggest disparities in resource availability, highlighting ongoing gaps in access to obstetric care.

Introduction Headache disorders, including migraine and tension-type headache, are among the most prevalent neurological conditions globally, contributing substantially to disability and economic burden in the United States and worldwide. Despite advances in pharmacologic and non-pharmacologic management, significant disparities persist in the diagnosis and treatment of headache disorders. This study aimed to determine the association between rural and urban clinics and management of headache in the U.S. Methods We conducted a retrospective analysis of adult visits for headaches using the 2011-2019 National Ambulatory Medical Care Survey (NAMCS) datasets. We compared management practices (imaging, medication use, counseling, and referrals) for headache disorder visits between rural and urban clinics in the United States. SPSS Complex Samples 31.0 was used to perform chi-square two-sided tests with p<.05. Institutional Review Board approval was obtained from the University of North Dakota. Results Of the estimated 89.3 million adult headache visits, 7.5% were in rural clinics. Rural headache patients were less likely to see a medical specialist (17.4% vs 39.3%, p=.000), but more likely to see their own primary care physician (78.6% vs. 52.6%, p=.000) and to be an established patient (92.3% vs 81.4%, p=.003). Referral rates for the index visit were similar between rural and urban clinics (p=.591). Also, there was no association between rural-urban clinics and age (p=.416), sex (p=.818), race (p=.080), or region (p=.062). Rural visits had higher rates of opioid/barbiturate prescribing (28.0% vs. 18.9%, p=.031) and lower rates of corticosteroid prescribing (prednisone and/or dexamethasone) compared to urban visits (1.0% vs. 3.0%, p = .031). Other medication classes were prescribed at similar rates in rural and urban clinics, including antimigraine agents (p=.165), preventives (p=.490), antiemetics (p=.442), muscle relaxants (p=.105), antidepressants (p=.585), and anticonvulsants (p=.773). There were no significant differences in rates of advanced imaging (p=.393), lifestyle counseling (p=.341), or referral to another physician (p=.780) between rural and urban clinics. Conclusions Rural headache visits were managed by primary care physicians and had higher rates of opioid therapy compared to their urban counterparts. However, urban visits had higher corticosteroid therapy. This was despite similar patient demographics and physician workups in the rural-urban clinics.

Introduction: Diabetes affects over 1 in 10 individuals in the United States, with many more undiagnosed or prediabetic. It is characterized by impaired insulin production/utilization, resulting in chronic hyperglycemia. Persistent hyperglycemia damages multiple organ systems, particularly the cardiovascular, neurologic, and immune systems, leading to increased susceptibility to severe and atypical infections. One rare but serious complication is pyogenic hepatic abscess, which often presents with nonspecific symptoms such as fever, chills, malaise, right upper quadrant pain, GI symptoms, jaundice, and weight loss. These abscesses are frequently polymicrobial and may rapidly progress to rupture, peritonitis, sepsis, and death. We present two fatal cases of pyogenic hepatic abscesses diagnosed on autopsy to help facilitate early recognition and intervention for patients. Case #1: The first case was a 65-year-old female with obesity, hypertension, prediabetes, and depression who presented with GI symptoms and bleeding. Endoscopy revealed a Mallory-Weiss tear and ulcers, while imaging identified a liver lesion initially interpreted as benign. After psychiatric admission, she acutely decompensated five days later with septic shock, acute kidney injury, and severe metabolic derangements. Despite aggressive treatment, she died. Autopsy revealed a ruptured hepatic abscess in the right lobe with purulent peritonitis. Cultures grew Klebsiella oxytoca, and cause of death was septic shock with multiorgan failure. Case #2: The second case involved a 65-year-old male with diabetes found to have a large hepatic abscess at autopsy. Cultures grew Streptococcus anginosus and Escherichia coli. Additional findings included acute splenitis, severe atherosclerosis, metabolic abnormalities, and markedly elevated glucose. Death was attributed to complications of the pyogenic liver abscess. Discussion: Pyogenic hepatic abscesses are more common in diabetic and prediabetic patients due to immune dysfunction from chronic hyperglycemia, including impaired neutrophil and macrophage activity and increased inflammation. These cases demonstrate how nonspecific presentations and misleading imaging can delay diagnosis, resulting in rapid deterioration and fatal outcomes. Management includes prompt antibiotics and drainage, along with close monitoring. Increased clinical suspicion is essential in at-risk populations to improve early detection and outcomes.

Introduction: Elevated intracranial pressure (ICP) is a key complication of traumatic brain injury (TBI). Hyperosmolar therapy is commonly used in severe cases to counteract this. However, its role in mild to moderate TBI remains unclear, with limited and conflicting evidence. This study aimed to evaluate clinical outcomes associated with hypertonic saline use in patients with non-severe TBI. Methodology: We conducted a retrospective cohort study of adult patients presenting with mild to moderate TBI (Glasgow Coma Scale [GCS] 9–15) at a single Level I trauma center between May 2021 and June 2024. Patients with severe TBI, penetrating injury, or significant polytrauma were excluded. Patients were stratified by receipt of 3% hypertonic saline. Demographics, injury characteristics, and outcomes including mortality, ICU admission, ICU length of stay (LOS), and discharge disposition were collected. Multivariable logistic and linear regression analyses were performed to adjust for potential confounders. Results: A total of 190 patients met inclusion criteria, including 78 who received hypertonic saline and 112 who did not. Hypertonic saline use was associated with significantly increased odds of mortality (OR 5.28, 95% CI 1.36–20.46, p = 0.016) and ICU admission (OR 22.92, 95% CI 7.89–66.57, p < 0.001). Patients receiving hypertonic saline also had longer ICU length of stay (mean difference 2.61 days, 95% CI 1.91–3.31, p < 0.001). Favorable discharge disposition was more common in the non-hypertonic saline group, but this did not reach statistical significance. Conclusion: In patients with mild to moderate TBI, hypertonic saline administration was associated with increased mortality and resource utilization. These findings suggest that hyperosmolar therapy may not provide benefit in non-severe TBI and should be used cautiously. Further prospective multicenter studies are needed to better define its role in this population.

Introduction: Klebsiella pneumoniae (KP) can lead to various infections including bacteremia. The most common source of KP bacteremia is a urinary tract infection; however, metastatic disease is mostly commonly caused by a primary liver abscess. Diabetes is a known risk factor for increased burden of illness in those with KP bacteremia. KP liver abscess is also associated with endogenous endophthalmitis. Here we report a case of KP bacteremia of unclear source with pneumonia, liver abscesses, perirenal abscesses and endophthalmitis. Case report: A 47-year-old male with past medical history of type 2 diabetes mellitus on insulin presented with upper respiratory congestion, fevers, headache and conjunctival injection. Labs significant for white blood cell 17,400, and elevated liver enzymes. Blood cultures were positive for Klebsiella pneumoniae sensitive to ceftriaxone. Chest x-ray showed infiltrates concerning for pneumonia. CT abdomen/pelvis showed possible pyelonephritis without hydronephrosis. MRI abdomen/pelvis showed liver abscesses and bilateral perinephric abscesses. Patient was initiated on ceftriaxone, azithromycin and erythromycin eye ointment for potential bacterial conjunctivitis. He initially improved, however, on day 3 he developed right eye pain with vision changes and right sided headache. Ophthalmology discovered the patient had a large subretinal abscess. Patient underwent right eye phacoemulsification washout. Six days later, eye pain worsened and patient returned to OR for additional washout which showed total retinal detachment, subretinal abscess and extensive retinal necrosis. Ophthalmology recommended enucleation but patient declined. Repeat MRI after 6 weeks of antibiotics showed substantial reduction in the hepatic abscesses and perinephric abscesses had resolved. Patient followed up with ophthalmology and again recommended enucleation, but patient declined despite risk of sympathetic ophthalmia. Vision had not improved at that time. Discussion: Klebsiella pneumoniae has known virulence to multiple organs. The source of our patient's metastatic disease is difficult to conclude. His pneumonia and perirenal abscesses were felt to be metastatic in nature. The endophthalmitis was likely endogenous. The liver abscess could have been the primary source but difficult to conclude. Despite early appropriate antibiotics, visual outcome was still poor. Physicians should be aware of Klebsiella’s virulence and thoroughly investigate all presenting symptoms and abnormal lab results.

Iron deficiency anemia (IDA) is typically treated with daily or intermittently dosed oral iron supplementation, though gastrointestinal adverse effects can limit medication adherence. This literature review aimed to evaluate the effects of daily versus intermittent oral iron dosing on hemoglobin, ferritin levels, and adverse effects in individuals with IDA. A search of PubMed and Embase (2010–2025) identified six randomized controlled trials comparing daily and intermittent regimens in adults and children with ferritin-confirmed IDA. Overall, intermittent dosing was generally non-inferior to daily dosing for hemoglobin improvement and was consistently associated with fewer adverse effects. While some studies demonstrated faster ferritin repletion or early hemoglobin rise with more frequent dosing, these differences were not consistent in longer-term studies. Current evidence suggests that intermittent dosing may be an effective and better-tolerated alternative to daily therapy, though further research is needed to determine optimal dosing regimens across populations and anemia severity. Keywords: Iron deficiency anemia, oral iron supplementation, daily dosing, alternate day dosing, intermittent dosing, hemoglobin, ferritin, hepcidin, medication adherence, iron repletion.

Background: There have been no large comparisons of the clinical and laboratory features of familial neonatal hemophagocytosis (f-nHLH) and infectious neonatal hemophagocytosis (i-nHLH). Objectives: (1) Describe the demographic, diagnostic, and clinical features of patients with familial nHLH (F-nHLH) and infectious HLH (i-nHLH). (2) Compare key variables between f-nHLH and i-nHLH. (3) Compare the clinical outcomes of f-nHLH and i-nHLH. (4) Summarize literature on cytokine levels in patients with nHLH. Methods: Data from a previously published nHLH meta-analysis report were used to describe and compare features of infants with f-nHLH versus i- nHLH. Variables were tested with the chi-square test or Fisher’s exact test, Cochran-Armitage test, independent two-sample t-test, or Wilcoxon rank-sum test as appropriate. Odds ratios were calculated for any comparison with a p value of <0.05. Results: Data extracted from 99 cases of f-nHLH and 54 cases of i-nHLH were included in this analysis. Infants with f-HLH met HLH criteria at the following rates: fever (84%); organomegaly (100%); pancytopenia (75%); hypofibrinogenemia (84%); hypertriglyceridemia (48%); hypofibrinogenemia or hypertriglyceridemia (82%); hemophagocytosis (81%); hyperferritinemia (99%); low or absent NK cell activity (91%); and elevated soluble CCD25 (91%). Infants with i-nHLH had higher median ferritin levels (22537 ng/mL) than infants with f-nHLH (7587 ng/mL) (p=0.072). Infants with f-nHLH had higher rates of symptoms in utero, preterm birth, family history of HLH, and family history of infant death. The overall survival among infants with familial nHLH was lower than infectious nHLH (p=0.037). Conclusions: Management of nHLH requires rapid diagnosis and prompt treatment as current literature suggests nHLH has high mortality rates. Distinguishing between familial and infectious causes of nHLH can aid in determining the correct treatment of choice.

Introduction Thyroid cancer has increased substantially in the United States, with lifestyle factors such as obesity and physical activity implicated in its development and survivorship. However, limited research exists on the role rural-urban residence may have on these factors. We aimed to determine the association between rural-urban residence and obesity among thyroid cancer survivors in the United States. Methods We conducted a retrospective analysis of adults with thyroid cancer using the 2023–24 Behavioral Risk Factor Surveillance System datasets. We compared obesity rates between rural-urban thyroid cancer survivors. Rural-urban status was defined by nonmetropolitan vs metropolitan counties. Demographic characteristics, clinical health indicators, and comorbidities were compared between urban and nonurban populations. SPSS Complex Samples 31 was used to perform Chi-square two-sided tests with p<.05 significant. Institutional Review Board approval was obtained from the University of North Dakota. Results Of the estimated 217,500 thyroid cancer survivors, 17.0% resided in rural areas. Rural individuals were more likely to be older (≥65 years: 54.6% vs 31.0%, p.000) and White (92.2% vs 79.7%, p=.000). However, they were less likely to have private insurance (26.5% vs 57.2%, p=.000), attend college (58.6% vs 73.4%, p=.023), or have higher income (≥$100,000: 21.7%% vs 44.7%, p=.000). There was no association between residence and sex (p=.232), married (p=.591), or tobacco use (p=.462). Rural and urban cancer survivors had similar rates of obesity (53.9% vs 44.1%, p=.070) and physical activity in the past 30 days (67.1% vs 71.8%, p=.306). This was despite rural individuals being less likely to have majority of care from a specialist (26.7% vs 48.6%, p=.001) and a routine checkup in the past 12 months (88.0% vs 92.7%, p=.023). However, rural individuals were more likely to report zero days of poor mental health (70.5% vs 55.0%, p=.003). There was no association between residence and having a personal healthcare provider (p=.265), cardiovascular disease (p=.074), or diabetes (p=.515). Conclusion Rural and urban thyroid cancer survivors had similar rates of obesity and physical activity, despite rural individuals being less likely to have private insurance, an annual checkup and specialist care. These findings highlight that factors beyond social determinants and access to care may be impacting chronic disease management among thyroid cancer survivors.

Introduction: Mental health status contributes to engagement in preventive health behaviors, including cancer screenings. This study examined the association between mental health status and adherence to women’s cancer screenings in the U.S., with attention to demographic characteristics and behavioral risk factors. Methods: A cross-sectional analysis was conducted using 2024 Behavioral Risk Factor Surveillance System (BRFSS) data. The study population included women aged 20–65 years. Mental health was categorized as normal or poor (≥14 days of poor mental health in the past 30 days and/or a history of depressive disorder). Primary outcomes included adherence to breast and cervical cancer screenings based on recommended intervals. SAS V9.4 was used to perform bivariate comparisons with two-sided and P < .05 being significant. Institutional Review Board approval was obtained from the University of North Dakota. Results: Of the estimated 96 million women, 36.9% reported poor mental health. Poor mental health was associated with younger age (52.7% vs. 45.8%, p=.000), less likely to have graduated from college/technical school (30.0% vs. 37.6%, p=.000), not being married (61.0% vs. 46.8%, p=.000), living in rural areas (6.1% vs. 5.1%), p=.000), and having insurance (91.3% vs. 90.3%, p=.007). Women with poor mental health had a higher prevalence of behavioral risk factors, such as smoking (15.8% vs. 7.0%, p=.000), binge drinking (17.4% vs. 12.6%, p=.000), and obesity (41.2% vs. 32.2%, p=.000). Also, they were more likely to have a primary care provider (85.5% vs. 82.9%, p=.000), but less likely to have had a check-up in the last year (76.9% vs. 79.1%, p=.000). Women with poor mental health were less likely to adhere to mammography screening guidelines (54.8% vs. 61.8%, p =.000), while no significant difference was observed for pap smear adherence (p = 0.576). Conclusion: Poor mental health among women was associated with lower adherence to breast cancer screening recommendations. Additionally, women with poor mental health had higher rates of behavioral risk factors. These findings suggest that mental health may influence engagement in preventive behaviors requiring coordination beyond a routine visit and highlight the importance of considering mental health in efforts to improve cancer screening uptake and reduce disparities in preventive care. Keywords: mental health, cancer screenings, women’s health, mammogram, pap smear

Dementia is a leading cause of disability in older adults, and type 2 diabetes mellitus (T2DM) is a major modifiable risk factor for cognitive decline. Metformin, the first-line therapy for T2DM, has demonstrated anti-inflammatory, vascular, and neuroprotective properties that may influence cognition beyond glycemic control. This literature review evaluated whether metformin improves cognitive outcomes in adults compared with placebo or alternative antidiabetic medications. A search of PubMed and Embase identified eight studies meeting inclusion criteria, including observational cohorts, comparative effectiveness analyses, Mendelian randomization, and one randomized crossover trial. Most studies reported that metformin use was associated with reduced dementia risk and slower cognitive decline compared with untreated diabetes, independent of HbA1c. Comparative studies suggested potential cognitive advantages of SGLT2 inhibitors and thiazolidinediones, while sulfonylureas were linked to higher risk. Genetic analyses supported non-glycemic mechanisms, and limited randomized data demonstrated short-term improvement in executive function. Overall, evidence suggests metformin may contribute to cognitive preservation, though definitive conclusions require large randomized trials with standardized cognitive outcomes.

Background: Bioelectrical impedance spectroscopy (BIS) provides a precise measure of hydration status and body water distribution. However, its ability to detect meaningful changes in field settings, such as in athletes, has not been previously demonstrated. Purpose: This study aimed to assess typical changes in whole-body and segmental water compartments before and after games in NCAA Division I ice hockey players, using the SOZO device to validate its use in a sport-specific environment. Methods: Twenty-three male athletes participated in this study, with BIS measurements taken the mornings before and the mornings after the first game of a two-game series across nine home games. Individual-level changes were averaged to estimate typical shifts in body water following a game. Statistical significance and effect sizes were determined using 95% confidence intervals and calculated to assess the magnitude of change. Results: Statistically significant changes were observed in all body water variables, except for whole-body intracellular water (ICW) in the post-game morning evaluations. Medium (e.s.=-.60) and large (e.s.= -0.89) reductions in TBW and Hy-Dex, a proprietary hydration measure, were observed on Saturday mornings. Body water loss mainly came from the ECW compartment, shown by the medium, negative change in ECW %TBW (e.s.=-0.73) and the medium positive change in ICW/ECW (e.s.=0.75). Additionally, a significant reduction in leg ECW (e.s.=-0.83) was noted on Saturday morning after the game, along with a small but significant reduction in leg ICW (e.s.=-0.35) and small positive changes in the leg ICW/ECW (e.s.=0.41). Conclusion: BIS is sensitive enough to detect small changes in whole-body and leg segment body water compartments in ecologically valid sports settings and the body water compartment losses observed in this study emphasize the importance of effective post-game rehydration strategies. Hypohydration is linked to meaningful endpoints in sport (e.g., exercise performance, heat illness, recovery), and the ability to monitor whole-body and segmental compartment water with BIS non-invasively will likely improve our understanding of the factors influencing compartment water changes and evaluate the implications of those changes, making the technology appealing to sports staff and researchers.

Background: A recent report found that 1 out of 8 US adults have been prescribed a GLP-1 agonist and 1 out of 4 US adults with diabetes used this medication. Although commonly indicated for chronic conditions, including diabetes, there is growing demand for their use in weight loss. The NCHS data brief reported on GLP-1 injectable use among adults with diagnosed diabetes in 2024 which considered gender, age, race, BMI, income and medication status but did not include native versus naturalized citizen status. Based on data collected from the American Community Survey, immigration status is associated with a lack of health insurance coverage compared to US-born citizens. Considering this discrepancy, our goal of this study was to determine an association between nativity status and GLP-1 injectable use among individuals with type 2 diabetes mellitus. Methods: A cross-sectional analysis included adults with type 2 diabetes mellitus (DM) that were using GLP-1 injectables, identified through the 2024 National Health Interview Survey dataset. Participants were categorized as US born and US naturalized citizens. Odds ratios were estimated adjusting for sex, ethnicity, health insurance coverage and region of country. Results: This study included 2856 adults, representing around 19.3 million individuals after adjusting for weighting. Among these 2856 adults, 336 (16.8%) were non-US born, and 2520 (83.2%) were US-born. GLP-1 agonist use did not differ significantly between groups. Among non-US born adults, 27.3% reported GLP-1 use while 28.8% of US-born adults reported use (p=0.616). Non-US born adults had a significantly lower rate of obesity (34.7% vs 58.2%, p<0.0001) and a significantly higher prevalence of a healthy weight (25.9% vs 13.0%, p<0.0001). Conclusion: US-born adults are more likely to be classified as obese compared to non-US born adults. However, despite this higher prevalence of obesity, there is no difference in GLP-1 use between these groups. These findings suggest a discrepancy in medication utilization for an FDA indication. Further research into the prescription of GLP-1 agonists may make this difference more apparent.

Abstract Major depressive disorder (MDD) is common, disabling, and frequently managed in primary care. Standard antidepressant prescribing often relies on trial-and-error, which can delay remission and increase adverse effects. This literature review aims to evaluate the clinical utility of pharmacogenomic-guided antidepressant treatment in adults with depression compared with the usual trial-and-error prescribing approach, with emphasis on remission, treatment response, and overall symptom improvement. A literature review of PubMed and Embase (2015–2025) was conducted using terms related to depression, antidepressants, pharmacogenomics, and treatment outcomes. Seven studies met final inclusion criteria, including randomized controlled trials and prospective comparative studies. Across included studies, pharmacogenomic-guided care generally demonstrated improved outcomes versus treatment as usual. Remission benefits were reported in both large and smaller randomized trials, response rates were also higher in pharmacogenomic-guided groups. Symptom improvement findings were mixed at early endpoints, but several studies showed greater or sustained improvement over longer follow-up. Evidence from this review suggests pharmacogenomic-guided antidepressant treatment may improve remission, response, and longer-term symptom outcomes compared to trial-and-error prescribing. Pharmacogenomic-guided testing appears most clinically relevant as an adjunctive tool in primary care and psychiatric practice when prior treatment failure, adverse effects, or delayed response are present. Further independent, multiethnic, adequately powered trials with health-economic analyses are needed to strengthen implementation guidance and insurance coverage decisions. Keywords: Major Depressive Disorder, Pharmacogenomics, Antidepressants, Remission, Response, Symptom Improvement

Abdominal pain is among the most common presenting symptoms for pediatric emergency department (ED) visits, comprising an estimated 5-10% of all pediatric ED cases. The often-vague presentation of abdominal pain poses a diagnostic challenge, as providers must rely heavily on history and physical examination to distinguish emergent from non-emergent causes. We present the case of a 4-year-old female who was brought to the ED with ‘stomach’ problems and was initially discharged with a diagnosis of gastroenteritis based largely on her father’s history of recent gastroenteritis. The patient returned several hours later due to abdominal distention and deterioration of her condition. She was transferred to a tertiary care center for surgical intervention. Upon laparotomy, extensive bowel infarction was identified; the patient died intraoperatively prior to resection. Autopsy revealed midgut volvulus with infarction of the small and large bowels with bacterial peritonitis. Additionally, anatomical variations, including a longer mesentery and Meckel diverticulum, were identified as possible contributions. The cause of death was determined to be intestinal infarction due to volvulus, classified as a natural death. This case underscores the importance of maintaining a high index of suspicion for life-threatening causes of abdominal pain in pediatric patients with seemingly benign clinical histories.

Introduction: Formal caregivers play an essential role in supporting residents’ physical, emotional, and social needs which contribute to overall health and well-being (Spilsbury et al., 2024). Due to these responsibilities, caregivers need to be properly equipped with the knowledge and skills necessary to perform clinical duties with confidence. The purpose of this scholarly project is to develop a product that increases caregiver confidence by providing caregivers with occupational therapy informed education. By enhancing caregivers’ knowledge and skill set, this product may contribute to a supportive environment that fosters resident engagement in meaningful occupations and promotes improved quality of life (QoL) of residents. Methodology: A literature review was conducted to analyze current evidence-based literature regarding formal caregiver training and the QoL of residents within assisted living facilities (ALF). The Model of Human Occupation (MOHO) (O’Brien, 2017) was used to guide the development of the toolkit. It also was developed to complement existing continuing education initiatives of the ALF. Product: An OT-informed toolkit, Providing Care with Confidence was developed for ALFs to provide education to formal caregivers that address key areas in caregiving. It will also engage caregivers in practical hands-on experiential learning activities designed to increase their confidence. Included are eight structured modules such as understanding occupation-based care, graded assistance, environmental modification, communication strategies, resident dignity, energy conservation techniques, understanding behaviors in dementia, and recognition of functional decline. Conclusion: Providing Care with Confidence: An OT-Informed Skills Lab Toolkit was developed to provide evidence-based education to support formal caregivers in ALFs. This toolkit is designed to promote a supportive facility culture and improve residents’ engagement in meaningful occupations to support their overall QoL.

Introduction: The Oncotype Dx assay is a genomic assay used to determine if chemotherapy can be avoided in early stage hormone receptor positive (HR+) breast cancer (BC). The Breast Cancer Index (BCI) is another genomic assay used to evaluate the necessity of extending adjuvant endocrine therapy (ET) beyond 5 years. This study aims to evaluate if patients with early-stage HR+ BC who have received the Oncotype Dx Assay can avoid receiving the BCI 5 years after endocrine therapy.   Methods:  This is a retrospective chart review utilizing data from Sanford’s EPIC EMR. Participants include early stage female BC patients, ≥ 18 years of age, HR+ Her2 negative, who have received both the Oncotype Dx Assay and the BCI , diagnosed on or after January 1st, 2014.  Results:  Of the 107 eligible patients, 28 (26.17%) belonged to the low risk category by oncotype dx assay recurrence score (RS), 61(57.01%) belonged to the intermediate risk and 18(16.82%) to the high risk category for breast cancer recurrence. The BCI predicted benefit for extended ET in 41 (38.32%) patients. Patients who received chemotherapy were more likely to have a BCI result predicting benefit from extending ET (p=0.0220) as compared to patients who did not receive chemotherapy. Also, patients with an oncotype Dx assay RS which was high risk were more likely to have a BCI result predicting benefit from extending ET when compared to those in the low and intermediate risk groups combined (p=0.0247). The Spearman correlation coefficient between the risk of distant recurrence within 9-10 years after 5 years of endocrine therapy as determined by the Oncotype DX Assay and the risk of cumulative distant recurrence from year 0-10 with 5 years of endocrine therapy as determined by the BCI was 0.55006 with a p value of <0.0001.  Conclusions and Significance:  Our analysis showed that among patients who received adjuvant chemotherapy for early stage, HR+ Her2 negative BC, who have received the Oncotype Dx Assay, and those with a high risk RS by oncotype dx assay had a BCI result predicting benefit from extending ET. This finding could potentially exclude use of the BCI in a subset of patients and help providers determine if extended endocrine therapy is needed based on the Oncotype Dx Recurrence Score alone. 

Introduction: Dupuytren’s disease (DD) is a disease of the fibrous tissue called the fascia of the palm and fingers of the hand (Eckhaus, 2016). It develops over time, thickening the palmar fascia and leading to nodules and cords that flex the fingers (Pineda et al., 2024; Salari et al., 2020). The disease occurs mostly in men, with individuals of Northern European descent having a higher likelihood of disease development, alongside family history increasing the risk. This disease can result in disability for individuals, including difficulty performing certain activities such as picking up objects, donning and wearing gloves, putting hands in pockets, and holding objects (Salari et al., 2020). The treatment options that are available for individuals with DD include both surgical interventions, such as fasciotomy and partial fasciectomy, and non-surgical interventions, such as collagenase injections and needle aponeurotomy (American Society for Surgery of the Hand [ASSH], 2021). Individuals who undergo medical intervention for the treatment of DD are often referred to occupational therapists who specialize in hand therapy to regain functional use. This scholarly project aims to develop an evidence-based, occupation-focused rehabilitation guideline for certified hand therapists (CHTs) and occupational therapists (OTs) who specialize in hand therapy on the conservative management of DD and treatment following medical intervention. Methodology: The development of this scholarly project was guided by the Ecology of Human Performance (EHP) model (Dunn, 2017). An informal needs assessment was conducted with occupational therapists at an outpatient physical therapy clinic in Casper, WY to determine what was needed in the rehabilitation guideline. A comprehensive literature review, guided by EHP, was then conducted to evaluate the available best-practice interventions for DD. Electronic databases searched included CINHAL and PubMed, as well as the archives of the Journal of Hand Therapy. Collaboration with OTs and skilled observation took place on-site. Results: The product of this scholarly project is a rehabilitation guideline that provides patient education and step-by-step, phase-based instruction for treating DD conservatively and following medical intervention. The outcome of this product is to provide a single document guideline for practitioners to use when treating DD, reducing the need to refer to multiple sources.

Introduction: Accessible healthcare is essential for farmers due to their limited available time and hazardous job duties (Hildebrand et al., 2019; Hopkins et al., 2023; Salmon et al., 2025; U.S. Department of Agriculture, 2023). Due to the high incidence of injuries that occur within the profession, it is crucial that farmers seek appropriate healthcare services to address these concerns. However, a significant barrier for seeking healthcare assistance is the limited cultural competence among healthcare professionals in understanding the unique needs within farming communities (Gordon et al., 2024; Hildebrand et al., 2019; Hopkins et al., 2023; Purc-Stephenson et al., 2024). The purpose of this study is to explore the lived experiences of farmers who have encountered health professionals who may or may not understand farming culture, to better inform healthcare professionals to improve the quality of care provided to this population. Methods: A literature review was conducted as a means of a needs assessment. The phenomenological design was used to enable conversations about individualized lived experiences with participants who are farmers and completion of an environmental assessment to understand the farm as the subjects home and work environment. A combination of convenience and purposive sampling was used. The chosen environmental assessment was the On Farm Check List for OSHA Compliance, a farm safety screening tool that was created by The University of Nebraska (University of Nebraska Medical Center, College of Public Health, n.d.). Interview questions were created with the use of the Person-Environment-Occupation model to ensure all aspect of a farmer were addressed (Law et al., 1996). Interviews were scheduled for 60 minutes via Zoom once subjects completed an informed consent form. Results: The On Farm Check List for OSHA compliance resulted in 11 out of 23 items within regulation. Codes were created based on subjects’ phrases identified from interviews. Categories that have immersed from the data include good qualities of healthcare providers, attitudes of healthcare providers, description of farming, and community impact. The final assertion is still pending. Conclusion: The categories and themes that have emersed thus far, indicate that farmers require an integrated approach. All factors within their lives are interconnected, and for the farming population, agriculture is almost always at the center of their concern.

Background: Access to services does not guarantee participation. Youth with disabilities, particularly in rural communities, continue to experience disparities in postsecondary outcomes related to employment, education, and independent living. While transition services are available, barriers related to awareness, coordination, and usability limit effective engagement. These challenges highlight a gap between service availability and access within rural systems and contribute to reduced participation outcomes. Purpose: The purpose of this scholarly project was to develop an occupational therapy–informed, advocacy-driven approach to improve access to and navigation of transition services for youth with disabilities in rural communities. Methodology: A multi-method, iterative approach was used for this scholarly project. A literature review and needs assessment were conducted to identify gaps in service access, coordination, and awareness. Stakeholder consultation, observations, and informal interviews informed the development of project components. Guided by the Canadian Model of Occupational Participation (CanMOP), three interconnected scholarly products were developed: (1) a literature review and needs assessment, (2) a plain-language resource guide with multimedia supports, and (3) a grant proposal and rural dissemination article. Video materials were evaluated using the Patient Education Materials Assessment Tool (PEMAT) to assess understandability and actionability. Results: The outcomes of this work include the development of an accessible resource guide and supporting videos designed to improve usability and navigation of transition services for students, families, and educators. Dissemination materials were also developed to support sustainability and systems-level implementation. PEMAT evaluation indicated strong accessibility and clarity of multimedia components, with high understandability and moderate actionability. Conclusion: Improving accessibility and communication of existing services may enhance participation outcomes without requiring the development of new programs. Findings support the role of occupational therapy in addressing contextual barriers, promoting health literacy, and advancing advocacy efforts to improve transition outcomes for youth with disabilities in rural settings.

The postpartum period is characterized by significant physical, emotional, and occupational changes that can disrupt daily functioning, routines, and role transition into motherhood1,3. These changes impact a mother’s ability to engage in meaningful daily activities, including self-care, infant care, and participation in family and community roles. Despite these challenges, postpartum care often emphasizes infant health, leaving gaps in support for maternal occupational performance, routine development, and environmental adaptation4,7. Occupational therapy is uniquely positioned to address these needs through its focus on functional performance, role adaptation, and occupational balance; however, its role in postpartum care remains underutilized. This Doctoral Experiential Capstone (DEC) project aimed to address these gaps through the development of an occupational therapy-informed postpartum resource guide implemented within a Women’s Resource Center. A literature review, synthesis of evidence, and informal on-site needs assessment identified key areas of need, including fatigue management, role transition, environmental supports, routine establishment, and engagement in meaningful activities. The resulting guide provides accessible, basic literacy educational materials and practical, occupation-based strategies to support maternal well-being and improve daily functioning during the postpartum period. The guide incorporates evidence-based, client-centered interventions2 and emphasizes interdisciplinary collaboration with providers such as nurses, lactation consultants, and mental health professionals to support a comprehensive approach to care. By addressing both personal and environmental factors, the project promotes occupational engagement, role satisfaction, and quality of life6. This work highlights the value of occupational therapy in postpartum care and supports continued advocacy, education, and integration of OT services within maternal health settings.

Unhoused individuals experience compounded barriers beyond housing access and are often underserved within occupational therapy practice. This doctoral capstone project partnered with a nonprofit residential program to develop a research-informed onboarding manual grounded in the holistic occupational therapy framework, Model of Human Occupation (MOHO, O’Brien, 2017). The manual was designed to clarify expectations of the supportive housing program, address diverse resident needs, and promote independence as the organization expands. Development was informed by a comprehensive literature review and informal needs assessment of the organization, identifying anticipatory barriers and supports commonly experienced prior to program entry. Key areas of need including physical health, mental health, spiritual/social participation, and employment/financial/legal support were organized into a self-paced residential manual. Although direct intervention was not feasible due to site constraints, the occupational therapy lens was used to guide creation of a resource to enhance individualized support and promote independence along a pathway toward permanent housing. Survey measures were developed to support long-term evaluation and program sustainability, demonstrating the value of occupational therapy in an underserved practice area.

Introduction: Trauma is ubiquitous and can negatively impact many life outcomes. Though trauma can occur across the lifespan, particular emphasis has been placed on the outcomes of experiences that occur in childhood. Adverse childhood experiences (ACEs), as coined by Felitti et al. (1998), pertain to traumatic events that occur before the age of 18, and the correlation between the number of ACEs and poor health outcomes is significant. Children can begin demonstrating unfavorable symptoms upon becoming exposed to trauma. Current literature has illustrated particular differences in sensory systems and social skills for young children. These challenges can lead to hardship with occupational performance in important areas including play, education, and social participation. Thus, this product was created to address these needs for children by providing trauma-informed education and sensory activities to staff members in an early education setting and at-home caregivers. Methodology: A literature review was conducted and guided by the person-environment-occupation (PEO) model (Law et al., 1996). A needs assessment was then performed at the capstone site through informal interviews with the occupational therapists and other staff members. Observation of early education classrooms and early intervention sessions within the community contributed to the development of this product. Resources for trauma-informed care and regulation were also consulted to ensure the accuracy of the information presented in the guidebook. The resource was written according to appropriate literacy levels for both staff members and caregivers. Results: Regulation Creations: A Trauma-Informed Resource Addressing Sensory and Socio-Emotional Childhood Challenges was created for the capstone site. Its contents address trauma-informed care, self-regulation for staff members and caregivers, co-regulation activities for children, and educational considerations and handouts for caregivers. It is anticipated that this resource will assist staff members in providing trauma-informed services to children who have encountered ACEs and other traumatic events. Conclusion: Children with trauma experience difficulties or differences within their sensory processing systems and socio-emotional skills, thus impacting their ability to participate in important occupations. This guide was created to address these areas in hope of helping young children joyfully engage in their most desired occupations.

Introduction Abdominal pain accounts for up to 10% of all emergency department (ED) visits. Previous studies associate adverse outcomes with prolonged time between presentation and surgical intervention. However, there is limited research on sex-based management of abdominal pain and time to surgery. This study examined sex and time to operating room for adult abdominal pain in United States EDs. Methods We compared men and women time to admission to the operating room for abdominal pain visits using the 2013-22 National Hospital Ambulatory Care Survey Emergency Department datasets. Inclusion criteria adults (≥18 years) who present with abdominal pain and were admitted to the operating room. SPSS Complex Samples 31 was used to perform two-sided test with p < .05. Institutional Review Board approval was obtained from the University of North Dakota. Results Of the estimated 3.7 million abdominal pain ED visits, 54.4% were women. There was no association between sex and age category (p=.602), race (p=.989), insurance (p=.571), location (p=.563), and region (p=.583). Men and women had similar comorbidity rates including hypertension (p=.690), diabetes (p=.338), hyperlipidemia (p=.588), obesity (p=.095), CAD (p=.180), depression (p=.750), and COPD (p=.052). Also, vital signs were similar including fever (p=.465), pulse (p=.950), respiratory rate (p=.628), normal BP (p=.136), low BP (p=.274), and 95% O2 (p=.186). When comparing management factors, men were more likely to have liver function tests (22.8% vs. 10.3%, p=000), CT scans (65.5% vs. 50.1%, p=.024), and CT-Abdomen (58.4% vs 40.1%, p=.006), while women an ultrasound (27.3% vs. 15.4%, p=.025). Other tests including CMP (p=.153), urinalysis (p=.249), prothrombin (p=.477), BMP (p=.302), glucose (p=.186), creatinine (p=.757), urine culture (p=.694), and EKG (p=.595). Men and women had similar time to be admitted to the operating room (411.1 vs 530.0 mins, p=.141). Also, similar wait time 1st seen by provider (38.4 vs. 36.6 mins, p=.838), ED boarding time (175.9 vs. 182.7 mins, p=.918), and length of hospital stay (5.7 vs. 5.2 days, p=.612). Conclusion Men and women with abdominal pain ED visits had similar wait times to see a provider, discharged to the operating room, and length of hospital stay. ED management varied, with men more likely to have a CT scan and women an ultrasound. These results demonstrate an opportunity for further investigation into care standardization and factors predictive of wait times.

Visual dysfunction is highly prevalent across the lifespan and can significantly limit occupational performance and participation. Despite this, vision-related impairments are addressed inconsistently within occupational therapy (OT) practice, with documented gaps in standardized evaluation, occupation-based intervention, and practitioner confidence (Kaldenberg et al., 2023; Weisser-Pike et al., 2023a). The purpose of this doctoral capstone project was to develop an evidence-informed resource to support OT practitioners in the evaluation and intervention of visual dysfunction across the lifespan. A comprehensive literature review and needs assessment were conducted to examine current evidence and identify gaps in practice, including limitations in practitioner confidence, access to structured resources, and clarity in scope of practice and referral processes. The person-environment-occupation model and Warren’s hierarchical model of visual perceptual skills guided project development and clinical reasoning (Baptiste, 2017; Warren, 1993). The resulting product is an educational guidebook designed for entry-level occupational therapy practitioners. Anticipated outcomes of guidebook use include increased foundational knowledge, improved consistency in evaluation and intervention, and enhanced clinical decision-making through the integration of evidence-informed and occupation-based vision care. This project addresses identified gaps in vision rehabilitation within occupational therapy by providing a structured, evidence-informed resource to support practitioner competence and promote consistency in care delivery.

Individuals living in rural Wyoming experience significant barriers to accessing specialized hand therapy services, including geographic isolation, limited availability of certified hand therapists, and inconsistent healthcare infrastructure, resulting in delayed rehabilitation and reduced functional outcomes (Hirth et al., 2022; Rural Health Information Hub, 2025). Although telehealth has emerged as a potential solution to improve access, challenges related to clinician training, safety, and adaptation of interventions to virtual environments persist (Feldhacker et al., 2022; Morris, 2024). The purpose of this scholarly project was to develop an evidence-based telehealth hand therapy program to improve access to upper extremity rehabilitation services in rural Wyoming. A comprehensive literature review, contextual needs assessment, and theory-driven program development process were utilized. The Ecology of Human Performance model guided examination of the interaction among person, task, and environmental factors influencing occupational performance, while the PRECEDE–PROCEED model informed identification of barriers, facilitators, and implementation strategies (Dunn, 2017). Ongoing collaboration with a rural outpatient clinic and mentor feedback supported clinical relevance and feasibility. The resulting product is a structured telehealth hand therapy program that includes workflows, clinical tools, and training resources to support consistent and effective service delivery. This program has implications for improving therapist confidence, increasing patient engagement, and reducing disparities in access to care, ultimately supporting improved functional outcomes for individuals in rural and underserved communities. Keywords: telehealth, hand therapy, rural health, occupational therapy, program development

Introduction: Research experience throughout medical school training is becoming increasingly important, helping students become more competitive for residency and better prepared for research-focused residency programs. However, students at community-based medical schools often face more barriers, including limited mentors, less hands-on experience, and fewer structured research opportunities. The Research Experience for Medical Students (REMS) elective at the University of North Dakota School of Medicine was developed to address these gaps through structured mentorship, research training, and opportunities for scholarly dissemination. This study evaluates the impact of the REMS elective on overall research confidence, scholarly productivity, and residency-related outcomes in comparison to students who did not participate. Methodology: A mixed-methods study was conducted using Qualtrics surveys distributed to REMS participants, non-participants, and faculty mentors. Quantitative data included Likert-scale assessments of research confidence, program satisfaction, perceived impact on residency applications, and scholarly output, such as abstracts, posters, publications. UND SMHS Interdependent student Analysis (ISA) reports from 2020-2022 were evaluated using 2020 as pre-implementation baseline and 2021-2022 as post-implementation comparisons. Qualitative responses that explored participant experiences, perceived benefits, and program improvements underwent thematic analysis. Results: A total of 66 respondents participated, and 87.9% were REMS participants. REMS students demonstrated significantly higher scholarly output, producing an average of 4.22 research products compared to 0.57 among non-participants (p = 0.004). Participants also reported increased research confidence (mean 3.67/5), with 63.8% indicating improved research skills. Mentorship was the highest-rated component (mean 3.69/5), with 63.8% reporting positive experiences. Among graduates, 81.3% reported discussing their research during residency interviews. Additionally, satisfaction with access to research opportunities increased from 47% pre-program to 57% post-implementation. Conclusions and Significance: Participation in the REMS elective is associated with increased research products, improved confidence in research skills, and meaningful integration of research into residency applications and interviews. These findings support the value of structured, mentorship-driven research programs, particularly within community-based medical schools. REMS provides medical students a practical way to become involved in research, strengthen their residency applications, and build confidence in their research skills.

Introduction Diabetes mellitus (DM) represents a significant health burden in the United States with rural populations experiencing greater disease burden and worse outcomes. DM education combined with literacy-appropriate materials and goal setting is recommended at every visit and has been shown to improve outcomes. This study aimed to determine the association between rural and urban clinics and receiving DM education. Methods We compared DM education on diabetes, diet/nutrition, weight reduction, and exercise among adult (≥18 years) Type 2 DM in rural and urban clinics utilizing the 2011-19 National Ambulatory Medical Care Survey datasets. Pre/post-surgery visits and pregnant women were excluded. SPSS Complex Samples 31 was used to perform chi-square two-sided tests with p<.05. Institutional Review Board approval was obtained from the University of North Dakota. Results Of the estimated 534 million Type 2 DM visits, 9.6% were in rural clinics. Rural visits were more likely to be White (88.5% vs 76.0%, p=.000), use government insurance (66.9% vs. 59.6% p=.003), and occur in the South (49.8% vs. 37.5% p=.000). Rural visits were more likely to be seen by a primary care provider (79.4% vs 63.7% p=.000), see their own primary care physician (79.8% vs 61.3% p=.000), be an established patient (94.1% vs. 91.4% p=.046) and have more visits (5.2 vs. 4.7, p=.045). Rural Type 2 DM visits less likely to receive a retinal eye exam (10.0% vs 16.9%, p=.012), however, general physical exam, skin exam rates were similar. Also, rural and urban visits had similar rates of tests within the past year including, HbA1c, fasting blood glucose, total cholesterol, HDL, LDL, triglycerides, and creatinine. At the visits, similar rates of CBC and CMP were ordered, but rural visits were less likely to receive a urinalysis (8.0 vs. 12.3, p=.012). Rural and urban visits received education at similar rates, including diabetes (14.4% vs 14.6%, p=.942), diet/nutrition (18.8% vs 24.5%, p=.121), weight reduction (6.5% vs 7.9%, p=.379), and exercise (12.6% vs 17.3%, p=.134). Rural visits were less likely to advise a return visit (60.2% vs 69.7%, p=.039) or refer to another physician (7.1% vs 11.9%, p=.010). Conclusion Rural and urban Type 2 DM visits had similar rates of DM education and laboratory testing despite rural patients being more likely to be managed by primary care physicians. However, DM education and laboratory testing specific to DM were low across both clinic settings.

Purpose Children with autism spectrum disorder (ASD) frequently experience sensory processing differences that impact participation in daily activities, social engagement, and family routines. These challenges often extend beyond the child, influencing caregiver well-being and overall family functioning. Although occupational therapy (OT) plays a critical role in addressing sensory processing needs through sensory-based interventions and environmental modifications, caregivers often report limited access to clear, practical, and evidence-based resources. The purpose of this scholarly project was to develop caregiver-friendly educational materials that translate sensory-based strategies into accessible and practical tools for everyday use. Methods This project was guided by the Ecology of Human Performance (EHP) model to emphasize the dynamic interactions among the child, the environment, and daily occupations. A comprehensive literature review examined sensory processing challenges and effective OT interventions across multiple sensory systems, including visual, auditory, tactile, gustatory, olfactory, proprioceptive, vestibular, and interoceptive domains. Information was gathered from peer-reviewed databases, including PubMed, CINAHL, and Google Scholar. Additional informal discussions with caregivers and OT practitioners informed the development of clinically relevant and practical materials. Results The final product consists of a series of handouts, each focused on a specific sensory system. Each handout includes a simplified description of the sensory system along with practical calming and alerting strategies that can be incorporated into daily routines at home, school, and in the community. The materials were designed to be concise, visually organized, and accessible to caregivers with varying levels of knowledge. These resources support consistent implementation of sensory strategies and reinforce education provided during OT services. Summary The project addresses a gap between research and practice by providing accessible, family-centered resources that support both child participation and caregiver well-being. These materials aim to enhance caregiver knowledge, improve confidence in implementing strategies, and promote consistency across environments. The project also promotes improved occupational performance, increased participation, and enhanced quality of life for children with sensory processing differences and their families.

BACKGROUND: Sweetwater County (SWC) is a rural region in southwest Wyoming that plays a major role in national and international extraction and mining industries. At the same time, these industries report some of the highest rates of work-related upper extremity injuries (WUEI), significantly impact productivity, lost workdays, and long-term health outcomes including functional performance, occupational engagement, and psychosocial well-being. These injuries arise from a dynamic interaction of person, context, and task-related factors, including fatigue, experience, workplace policies, repetition, awkward positioning, and vibration exposure. Current approaches are largely reactive, emphasizing rehabilitation after injury occurs. However, literature supports primary prevention strategies to decrease the development of cumulative WUEI. Occupational therapy practitioners are able to address WUEI risks through activity analysis, ergonomic assessment, and injury training. PURPOSE & METHODOLOGY: The purpose of this project was to develop an occupational therapy-guided, population-based primary prevention program aimed at decreasing WUEI risk for extraction and mining industries in SWC. The ecology of human performance (EHP) model guided a needs assessment and program development emphasizing the influence of person, context, and task factors on performance range. The assessment included a comprehensive literature review synthesizing multiple levels of evidence and informal interprofessional collaboration. RESULTS: Findings indicate that WUEI risk is influenced by the interaction of person, context, and task factors. Person factors included fatigue, sensorimotor skills, psychosocial skills, and limited symptom awareness. Task factors included repetition, sustained force, and awkward positioning. Contextual factors included workplace culture, productivity demands, exposure risk, and organizational policies. Effective primary prevention strategies sought to increase early symptom awareness, ergonomic and task modification use, job-specific strengthening, and incorporate organizational support for recovery and safety practices. DISCUSSION: Findings support multilevel theory-driven primary prevention strategies addressing both behavior and organizational factors. This project highlights the role of occupational therapy in primary prevention through use of ergonomics, activity analysis, and education. The resulting product is a two-part community in-service program addressing both employers and employees across extraction and mining industrial settings.

Introduction: Cerebral small vessel disease (CSVD) is a major contributor to cognitive decline, with emerging evidence suggesting that covert CSVD may cause subtle cognitive dysfunction prior to overt clinical events such as stroke or transient ischemic attack. Vascular risk factor burden may serve as an indicator for identifying individuals at risk. This study evaluates the association between vascular risk factor burden and subjective cognitive complaints in older adults without prior stroke or TIA. Methodology: We conducted a cross-sectional analysis of the 2022–2024 National Health Interview Survey (NHIS), including 2,489 respondents representing an estimated 13,307,106 U.S. adults aged ≥65 years. Individuals with a prior history of stroke or TIA were excluded. High-risk status for CSVD was defined as the presence of ≥3 vascular risk factors (hypertension, hyperlipidemia, diabetes, and smoking), while low risk was defined as 0–2 factors. Subjective cognitive complaints were assessed using a composite score derived from self-reported difficulty with memory and concentration. Chi-square analyses were used to evaluate associations between CSVD risk status and cognitive complaints, as well as demographic, clinical, and healthcare access variables. Results: In this dataset, 19.0% were at high risk and 81.0% were at low risk for CSVD. High risk status was associated with higher cognitive complaint scores. High CSVD risk was also associated with non-White race, male sex, and poverty. The high-risk group was more likely to report fair or poor general health, obesity, depression, and anxiety. They were also more likely to report a healthcare visit within the past year and having a usual place of care. Conclusion: Greater vascular risk factor burden was associated with increased subjective cognitive complaints in older adults without prior stroke or TIA. These findings support the hypothesis that subjective cognitive complaints may represent an early sign of underlying CSVD in patients with vascular multimorbidity. Given the association between high-risk status and socioeconomic and health-related factors, early interventions may need to extend beyond clinical care to address broader determinants of health. Future prospective studies incorporating neuroimaging, standardized cognitive assessments, and controls for confounders are needed to further investigate this association.

Introduction The opioid epidemic remains a great public health challenge in the United States, particularly in Emergency Departments (ED). While prior studies show rural vs. urban residence plays a role in higher opioid prescription rates, narrow data exists on how presence of a mental health disorder (MHD) impacts prescription rates in different residence groups. This study aims to define opioid prescription rate variability between rural and urban EDs when psychiatric comorbidity is present. Methods We conducted a retrospective analysis of adults aged ≥18 with the diagnosis of a mental health disorder using the 2013-2022 National Hospital Ambulatory Care Survey Emergency Department datasets. The primary outcome was percent visits with opioid prescription in rural vs. urban settings; secondary outcomes were the demographic, clinical, and management factors in the visit. SPSS Complex Samples 31.0 for Windows was used to analyze the NHAMCS-ED complex sample survey design. Chi-square and GLM testing were performed two-sided test and p<.05. The University of North Dakota IRB approved this study. Results Of an estimated 117,737,400 ED visits from 2013-22 with MHD, 12.5% were rural. Rural MHD patients were more likely to be ≥65 years (16.6% vs 12.0%, p=0.002), female (52.9% vs 47.8, p=.010), and white (87.4% vs 71.6%, p=.000), but without difference in mean age or insurance status. Clinically, rural-urban triage category and pain scale were similar. Rural patients had shorter mean wait times and length of visits (25.9 ± 2.5 vs 39.8 ± 2.1 mins, p=.000; 240.8 ± 15.3 vs 374.7 ± 11.7 mins, p=.000). Although total imaging frequency was similar, rural patients were less likely to receive CT (16.1% vs 20.2%, p=.007), MRI (0.2% vs 1.0%, p=.000), or ultrasound (1.6% vs 3.2%, p=.018). The prescription frequency was similar between groups except that rural patients were less likely to receive these while in the ED (1.6 ± 0.1 vs 2.0 ± 0.1, p=.000). Utilization rates were similar for opioids (12.6% vs 15.4%, p=.148) as well as other selected non-opioid analgesics. Dispositions did not vary. Conclusion Opioid prescription rates did not differ geographically in ED visits for patients with MHD, suggesting that there may be more care standardization than previously thought. Even so, notable differences in advanced imaging use and care times suggest possible rural resource limitations, practice variability, or population differences that warrant further investigation.

This scholarly project describes the development of Feed in Context, a clinician-focused pediatric feeding guide designed to support occupational therapy practitioners working in rural practice settings. Pediatric feeding challenges can significantly impact participation in daily routines across home, school, and community environments. In rural areas, limited access to specialized services and the need to provide care across multiple systems contribute to fragmentation in feeding intervention approaches. A qualitative, practice-based methodology was used to guide development of the guide, including a contextual needs assessment through clinical observation, practitioner consultation, workflow review, and environmental analysis across outpatient, early intervention, and school-based settings. Findings from the needs assessment were integrated with a focused review of literature on pediatric feeding and occupational therapy service delivery. The Ecology of Human Performance model served as the theoretical framework for interpreting findings and structuring the resource. The resulting product, Feed in Context, supports context-responsive clinical reasoning by organizing feeding evaluation and intervention considerations across service environments. The guide integrates key conceptual principles of feeding development with practical application across real-world contexts, allowing practitioners to adapt interventions based on environmental demands and available resources. This approach promotes continuity of care and supports participation-focused feeding intervention for children across settings.

Purpose: The nature of agricultural work is physically demanding and associated with an increased risk of musculoskeletal injury due to repetitive movements, heavy lifting, awkward postures, and prolonged physical labor. Despite the importance of agriculture as a meaningful occupation and major contributor to the workforce, limited resources address the unique physical demands of agricultural labor. The purpose of this scholarly project was to develop a video-based educational resource to promote safety and continued occupational participation in agricultural workers. Additionally, the project aims to assist therapy professionals in implementing ergonomic and task modifications through an accompanying resource guide. Methodology: A literature review was conducted with the use of the model of human occupation (MOHO) to guide resource development. The determination of site-specific needs was achieved through a review of literature and an on-site needs assessment. This included observing the orthopedic and therapy care process, discussions with orthopedic and therapy practitioners, as well as agricultural workers, and obtaining expert feedback to ensure the developed resource to examine agricultural work demands, injury risks, and ergonomic strategies met the discovered needs. Results: A resource was created titled From Field to Function: A Video Resource for Agricultural Task Modification and was designed to support agricultural workers in workplace safety and occupational longevity using task modification demonstrations. The program includes videos depicting tasks such as safely mounting and dismounting equipment, proper body mechanics when lifting heavy items such as seed, and recommendations for prolonged overhead work. The companion therapist guide supports therapy professionals in introducing, presenting, and implementing the video resource. The resource was designed to be self-paced and modified according to client needs to allow for individualized care and client-centered intervention. Conclusion: It is anticipated that the From Field to Function resource will support the safety and physical health of agricultural workers. The goal of this product is to support workplace safety and occupational longevity among agricultural workers by providing practical video demonstrations of task modifications for common agricultural duties that may contribute to pain or injury. This project contributes to occupational therapy practice by offering an accessible, occupation-based educational tool to support injury prevention and continued participation in agricultural work.