University at Albany, State University of New York
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Autism Stigma And Symptoms Of Anxiety And Depression: An Exploration Of Rumination And Camouflaging As Mediating Factors
Get PDFA small body of evidence indicates autistic people experience stigma related to autism that predicts mental health outcomes. Among other stigmatized populations, use of emotion regulation process and strategies are mechanisms by which stigma leads to negative outcomes. However, these mechanisms have not yet been explored in relation to autism stigma. In a sample of autistic adults, the present study sought to evaluate whether rumination and camouflaging mediated the relationship between autism stigma and internalizing symptoms utilizing a brief longitudinal design. Participants completed measures of stigma, rumination, camouflaging, and internalizing symptoms at baseline, one month, and two month timepoints. Results did not support the mediating role of rumination or camouflaging and did not find a direct effect of autism stigma on mental health across a two month period. However, non-longitudinal relationships were found between increased autism stigma, increased rumination and camouflaging, and higher levels of internalizing symptoms. Results highlight the complex interplay of these variables and underscore the importance of studying autism stigma in relation to mental health. Implications and future directions are discussed
Implicating North American Lizards In The Borrelia Burgdorferi Sensu Stricto Sylvatic Cycle
Get PDFBorrelia burgdorferi sensu lato (B. burgdorferi s.l.) spirochetes are the causative agents of Lyme disease (LD, Lyme borreliosis), the leading cause of tick-borne illness in North America (NA), Europe, and throughout temperate zones of the Holarctic region. Ixodes ticks are the only competent genus that permit acquisition, maintenance, and successful transmission of LD bacteria to subsequent hosts. LD spirochetes are unable to effectively pass through transovarial barriers, from adults to eggs, and therefore, next generation larvae are Lyme borreliae-free. Instead, B. burgdorferi s.l. are reliant on maintenance in both vertebrate and arthropod hosts to perpetuate high prevalence in nature. Of the known reservoirs in NA and Europe, the white footed mouse (Peromyscus leucopus) and the European wood mouse (Apodemus sylvaticus) have garnered significant research attention for increasing the prevalence of Borrelia-infected ticks due to their tolerated infections and propensity to infect numerous feeding ticks. Potential strategies for controlling infection of these hosts include fipronil bait to reduce tick infestation, oral OspA vaccination of small mammal reservoirs, and CRISPR modified mice resistant to spirochete colonization. An additional eco-immunological consideration has also been suggested regarding lizards in NA. These findings regard species such as the western fence lizard (Sceloporus occidentalis) as a potential dilution host, imparting a spirochete clearance mechanism upon bloodmeals, leaving the ticks bereft of previous B. burgdorferi s.l. colonization. In this dissertation, I sought to evaluate the reservoir potential of the eastern fence lizard, Sceloporus undulatus, challenged with various B. burgdorferi s.s. ospC type K strains, and uncover underlying immune complement escape mechanisms. Previous work on the lizard’s western counterpart in NA, S. occidentalis revealed that the species contributed heavily to tick development through early bloodmeals as a preferred host, yet it was unable to harbor B. burgdorferi s.l.. Further, clearance of spirochetes in tick bloodmeals was demonstrated by lizard complement, an innate immune defense mechanism clearing pathogens. Thus, a dilution host model was proposed, indicating that S. occidentalis may contribute to the low numbers of LD cases reported from areas west of the Rocky Mountains. I hypothesized that S. undulatus was employing a dilution host effect upon Lyme borreliae laden tick populations, as evidenced by low numbers of reported LD cases in lizard’s southeast native range. And further, as the species continues expanding northward, it may continue to serve as a beneficial dilution host. However, intermittent evidence of B. burgdorferi DNA in lizards from eastern NA has come to light, and limited B. burgdorferi s.l. reservoir competence in lizards, including S. undulatus. Together, these conflicting results bolstered the need for further investigation of lizards in Lyme-endemic regions of the northeastern United States. In Chapter 3, I evaluate field-collected S. undulatus from the New Jersey pine barrens for the presence of Borrelia DNA or seropositivity, yielding low positive results confirming previous work in the area. Using sera from naïve juvenile lizards, I also observed a strain-specific survival of B. burgdorferi sensu stricto (B. burgdorferi s.s.), aligning with previous studies, while revealing a potential lizard specialist type (ospC type K). Selecting for lipoproteins involved in complement evasion, I also found that OspE from sera survival strains explicitly binds to lizard factor H, promoting survival of the innate immune response. These data thus identify complement evasion determinants by a single strain type of B. burgdorferi s.s. in lizard hosts. Previous studies on NA lizards as potential reservoir hosts only explored a limited number of NA B. burgdorferi s.s. strains, all within the ospC type A group, and therefore limited their assessment of genomic divergence. With the support of in vitro results, produced in Chapter 3, which supported both camps toeing the line between lizards as dilution hosts, or as potential reservoirs, I also hypothesized that ospC type K B. burgdorferi s.s. strains could survive and disseminate in lizards in a genotypic manner. I explicitly demonstrated that nonpathogenic strains of B. burgdorferi s.s. transformed with constitutively expressed OspE from B. burgdorferi s.s. B379 (ospC type K) provided a distinct survival phenotype and binding affinity to lizard factor H, allowing the spirochetes to survive the complement alternative pathway. I explored B. burgdorferi s.s. survival in S. undulatus by needle inoculation in Chapter 4, challenging with ospC type K strains, and demonstrated persistence and dissemination. I hypothesized that type K strains would exhibit low levels of survival, while type A would be cleared and unable to migrate from the inoculation site, aligning with previous work. Interestingly, I found that all three strains could disseminate, although B31-5A4 at very low levels. I also showed that only B379 and 297 could be cultured after four weeks of incubation, indicating that B31-5A4 qPCR results were artifacts of escape survival, but eventual clearance. Further, it appeared that B379 yielded robust amplification at distal tissues, and consistent isolation from tissues, while 297 appeared to be weaker. Finally, I sought to examine the immune response of lizards inoculated with these B. burgdorferi s.s. strains, taking a survey of actively expressed immune related genes and comparing cohort profiles by comparing differentially expressed genes between inoculated lizard cohorts. This revealed that 297 and B31-5A4 share a striking resemblance in pathogen inflammatory response. However, B379 colonized lizards elicited a remarkable immune response profile, divergent from the other Borrelia challenged lizard cohorts, aligning closely with the negative control group. These data suggests that B379 inoculation yields a tolerogenic immune response, a host toleration of the pathogen with a diminished induction of triggers that would otherwise lead to clearance. The results of this dissertation highlights my goal of implicating NA lizards in the B. burgdorferi s.s. sylvatic cycle. Interestingly, S. undulatus appears to simultaneously clear strain-specific B. burgdorferi s.s., while tolerating a select type, ospC type K. This supports previous results on standard lab stocks of B. burgdorferi s.s., generally B31 derivatives, were readily cleared by the western US counterpart S. occidentalis, while also providing compelling data reinforcing field surveillance and low lizard competence findings. This also infers that lizards can act as a dilution host for most ospC type strains, but may amplify type K, which is particularly human pathogenic. These findings provide compelling evidence that lizards are quite involved in the Lyme borreliae enzootic cycle and require further attention to explore defined reservoir competence. Collectively, this work serves as a foundation for defining the public health significance of lizard expansion into Lyme-endemic areas and yields insight into mechanisms behind strain-specific survival of B. burgdorferi s.s. in diverse hosts
Focal Concerns In China\u27S Misdemeanor World: An Empirical Investigation Of Prosecutorial Dismissal Of Misdemeanor Cases
Get PDFDrawing on the focal concerns perspective, this dissertation attempts to answer three research questions: (a) What are the prosecutorial considerations most relevant to dismissal decisions in misdemeanor cases? (b) How are those considerations relevant to dismissal? (c) What are the variations of dismissals in misdemeanor cases with respect to individual-level characteristics? An exploratory sequential mixed methods design is used and proceeds in the following manner: (a) focal concerns relevant to the Chinese context are derived from qualitative thematic analysis on 324 public hearings on misdemeanor cases under the prosecutorial consideration of dismissal, and the original focal concerns perspective has been modified according to the findings from the qualitative thematic analysis; (b) measurement on the modified focal concerns is developed based on a dictionary generated by a natural language processing tool, Word2Vec, that combines findings from qualitative thematic analysis and natural language processing on 300,000 legal documents of misdemeanor cases; (c) the effects of modified focal concerns on prosecutorial dismissal of misdemeanor cases are tested by logistic regression models of over 70,000 misdemeanor cases. The qualitative thematic analysis has discovered three focal concerns under the Chinese context – blameworthiness, social stability, and system efficiency, each of which contains multiple sub-dimensions with different meanings from the original perspective. The logistic regression models have shown that variables used to measure the modified focal concerns are significant predictors of prosecutorial decisions to charge or dismiss. Individual disparities by age, education, employment status, and corporate ownership are discovered. However, several contradictory findings suggest directions for future research in China. The dissertation concludes with a brief discussion on the limitations of the focal concerns perspective and the utility of a cultural inquiry from the perspective of the sociology of punishment to understand the embeddedness of decision-making
Clinical Supervision Through A Multicultural Lens: Burnout, Vigor, And Supervisee Quality Of Life
Get PDFThe present study sought to replicate and extend existing research (Hutman & Ellis, 2020; McNamara et al., 2023) on the relations among perceived clinical supervisor multicultural competency, and physical and psychological quality of life outcomes for supervisees. Utilizing a serial mediation analysis with a sample of 285 mental health supervisees, this study tested the predictive role of multicultural competency (MC) on supervisee quality of life (QoL), as mediated by the supervisor working alliance (SWA) and burnout/vigor (B/V) of the supervisee as a multivariate set, respectively. Multivariate multiple regression analysis was conducted to test the serial mediation hypotheses. Results indicated that supervisory multicultural competency predicted supervisee psychological and physical quality of life which was mediated by the supervisory working alliance and burnout/vigor, thus supporting the hypothesized serial mediation model. Theoretical and practical implications and suggestions for future research are explored
Martin Luther King Jr.\u27S Leadership Philosophy And The Political Crisis In The Democratic Republic Of Congo
Get PDFThe ongoing crisis in the Democratic Republic of Congo has its origins in several socio-political and economic events, including colonization, dictatorship, institutionalized corruption, misuse of authority for personal interest, illicit trade of mineral resources, and tribalism. In addition to armed conflicts, there are violent crimes, such as armed robbery and armed home invasion, as well as the failure of the country’s leadership to unite the people and promote the dignity of its citizens, all of which have reached a critical level ( Kama Funzi, p.146). The Democratic Republic of Congo seems to be a country in misery, but it is a “beggar sitting on a mountain of gold” (Kama Funzi, p.5). Additionally, Congo is one of the potentially rich nations in Africa but since the so-called independence, it has never had a good model of leadership or a government that functions correctly for the common good. Liberty, equality, peace, and solidarity are still among the unrealized dreams of the Congolese. In this thesis, I argue that Martin Luther King Jr.’s model of leadership and social protest can meet these challenges and provide a perspective to respond effectively to the situation. To show this, I will first expound on King’s philosophy of leadership; then, after briefly reviewing the history and contemporary situation in Congo, I will discuss why his theory is applicable there. Our concern can be summarized in these questions: What kind of leader was King? What was his vision? What method did he adopt to accomplish his goal? What is the theory of leadership that originates from King’s political philosophy? Why, how, and to what extent is King’s view suitable for Congo? In response to these questions, I will argue that Martin Luther King Jr’s leadership and advocacy of nonviolent protest, with its principles of love, integrity (Shelby & Terry, 2018, p.128), and integration creates the basis for a model of leadership suitable to the Congo’s situation. King was committed to the promotion of social justice and human dignity and was a protagonist of ethical servant leadership theory. This view is ethical because it is about transparent inspiration rather than manipulation, and it posits a leader who aims not at the empowerment of him or herself but of the people. Following this approach, I believe that leadership is not about power, but the empowerment of others; it is not control, but the capacity to serve others; and it is not about manipulation, but inspiration, all in the service of social justice and human dignity. Thus, I will demonstrate that King’s ethical servant leadership approach can serve as the basis for a positive response to the political crisis in Congo
Substance Use & Systems Impact: A Mixed-Methods Community-Based Participatory Action Study
Get PDFIndividuals, families, and communities who use drugs or have a history of substance use have been highly criminalized, stigmatized, and their perspectives marginalized in research and policy. Furthermore, trajectories of research on this community tend to focus on pathologizing individuals and focus on prevention or abstinence-based outcomes, failing to embrace a broader critique of societal forces that marginalize communities and contribute to substance use. Despite the increase in deaths due to drug toxicity, policy and practice at large have failed to embrace the expertise of those with lived experience using substances, and instead continued to rely on carceral logics to police, surveillance, and marginalize people who use drugs or have a history of substance use. Harm from these tactics are further multiplied by marginalized identities, with individuals possessing non-dominant identities facing harsher forms of state violence. This three-paper dissertation aims to disrupt this harmful trajectory of practice, policy, and research, by understanding the perspectives of individuals who have a substance use history and have been impacted by a system (criminal justice, juvenile justice, or family policing). Further, this research hopes to integrate the perspectives of these individuals into social work practice, policy, and research. This dissertation also aims to explore this community\u27s experience within drug and alcohol treatment settings. A final aim was to identify alternative mechanisms of healing and empowerment, outside of mainstream recovery models. The first paper explores quantitative data surrounding the experience and impact of system(s) impacted individuals in a traditional drug and alcohol treatment setting. Findings from this paper include a regression analysis which highlighted that system(s) impact was a predictor for shorter lengths of stay in treatment and not completing treatment. Findings further reinforce the need for researchers, policymakers, and practitioners to explore, understand, and work to resist the long-lasting harms perpetuated by punitive and carceral policy. The second paper explores the impact of system(s) on the community\u27s overall well-being from their perspective, elucidating those individuals felt harmed, exploited, and not rehabilitated by system involvement. These findings highlight the need for exploration of alternative mechanisms of healing and rehabilitation. This paper calls for a more critical and emancipatory approach to substance use treatment and working with communities that have been impacted by the drug war. The third and final paper creates space for further exploration of different aspects of stigma felt by this community. Using a photography method known as photovoice, participants explored individual, public, and systemic forms of stigma that they experienced as a result of being system(s) involved and having a substance use history. Furthermore, participants explored what healing and recovery looked like to them, challenging medical model norms and abstinence-only-based theories. Findings from this study highlight the vast, intersectional, and harmful forms of oppression that communities face because of the criminalization of substance use and the carceral response. This project amplifies the expert knowledge of community members themselves about this experience, as well as adds to the discourse surrounding the need for more expansive conceptions of healing and recovery. This work fills the gap in the literature of lived experience and expert knowledge and adds to the call for ending punitive and disciplinary responses to substance use in our society at large. It challenges the social work profession as a whole to reconceptualize its relationship with policing and surveillance agencies and demands a shift in social work approaches to education, practice, and policy, to have meaningful inclusion of community voice
Characterizing The Role Of Temperature On West Nile Virus Evolution And Vector-Virus Interactions
Get PDFWest Nile virus (WNV) is the most common mosquito-borne disease in the contiguous U.S. WNV is a member of the Flaviviridae family which is group of single stranded positive sense RNA genome viruses. It is commonly vectored by Culex mosquitoes and is found in a transmission cycle between its amplifying hosts of birds. Incidental hosts of WNV include people and animals. WNV is known to cause flu-like illness and in rare cases can become neuroinvasive. There are currently no approved therapeutics on the market for WNV. Since the beginning of the 20th century the earth’s average temperature has increased by 1°C. Ectothermic organisms, such as mosquitoes, are uniquely susceptible to such increases. Increases in temperature are known to alter mosquito life history traits, viral replication, and vector competence, all of which play a role in WNV transmission. The influence of temperature on West Nile virus transmission is multifaceted. Unique interactions among mosquito population, mosquito life history traits, viral evolution, and virus strain are key in determining temperature-dependent WNV transmission. In order to gain a better understanding of the relationship between temperature and transmission, unique WNV strains and Culex pipiens populations were utilized for experimental infection and passage studies under distinct thermal conditions. To gain a better understanding of the population specific effects of temperature and WNV transmission, field acquired Culex pipiens populations from upstate and downstate New York (NY) were utilized. Life history traits were recorded from egg hatch to death at geographically relevant and future predicted temperature. These data were then used to generate thermal performance curves and calculate the relative basic reproduction number (R0) of WNV. Results indicated differences in peak transmission temperature between upstate and downstate Cx. pipiens, demonstrating the importance of thermal sensitivity on a population level when predicting temperature-dependent vector-borne disease risk. To probe the influence of temperature on WNV evolution and adaptation serial passage of WNV at 25°C and 30°C was performed. Growth kinetics of pass 1 and pass 12 viruses were performed to measure replicative fitness and virus passage at 30°C was found to have increased replicative fitness at 25°C and 30°C, demonstrating broad adaptation. Additionally, passaging virus at 30°C resulted in an increased number of amino acid changes. These data suggest WNV has the ability to adapt to increasing temperature. Rising temperatures could drive diversification and emergence of high fitness strains in nature, which is likely to result in increased transmission. WNV was first identified in New York State (NYS) in 1999. Given that temperature has increased in NYS it was hypothesized that contemporary WNV may have increased fitness at higher temperatures compared to historic WNV strains. Here Cx. pipiens vector competence of eight WNV strains was measured at 20°, 24°C, and 28°C. Cx. pipiens were found to have increased vector competence for contemporary strains across temperature. Utilizing previously published mosquito life history trait data, vectorial capacity (VC) was calculated. Contemporary strains were found to have increased VC at 20°C, 24°C, and 28°C. These results are consistent with temperature facilitating adaptation in nature and highlight the importance of strain specific differences of WNV risk under climate change. Current R0 calculations utilize adult life history traits from non-infectious studies, excluding the measurements of vector competence and extrinsic incubation period. Here, the role of infection status in WNV transmission was investigated by performing a modified transmission assay where lifespan, host feeding rate, and fecundity were compared among unexposed and WNV exposed Cx. pipiens. Strain-specific differences were additionally compared using representative WN02 genotype and NY10 genotype strains. Results demonstrate reduced VC of WN02 and NY10 disseminated mosquitoes from 20°C - 30°C compared to that of unexposed mosquitoes. These data demonstrate the importance of considering infection status when modeling WNV risk across temperature. Together, these studies outline the complex influence of temperature on WNV transmission, demonstrating the importance of unique vector-virus interactions in temperature-dependent vector-borne disease risk. These data can be utilized to refine WNV R0 predictions under climate change in order to inform public health interventions for the prevention of WNV transmission
Extreme Temperature And Other Environmental Factors On Diabetes Admissions
Get PDFBackground: Although total environmental factors have been linked with adverse health outcomes, the impacts of temperature and other total environmental factors on diabetes-related hospitalizations and emergency department (ED) visits remain inconclusive.Objective: This dissertation aims to Aim 1) test the associations between extreme heat and diabetes hospitalizations in the summer and its transitional months, identify populations vulnerable to extreme heat’s effects, and examine the modification effects of greenness on the heat-diabetes associations in warm months (Chapters 3 and 4); Aim 2) investigate the associations between extreme cold and diabetes hospitalizations in the winter and its transitional months, identify populations vulnerable to extreme cold’s effects, and assess the modification effects of ultrafine particles (UFP) on the cold-diabetes associations in cold months (Chapters 5); and Aim 3) develop predictive models for high prevalence of diabetes admissions, determine the effect responses by numbers and combinations of selected risk factors for diabetes hospitalizations, and assess the fact-diabetes associations (Chapter 6). Methods: We conduct a time-stratified case-crossover study at individual-level in Aim 1 and 2. These aims use conditional logistic regressions to estimate the associations of interest while controlling for air pollutants and time variant variables. Multiplicative and additive scales of interactions between extreme cold exposure (ECE) and UFP are evaluated, while only multiplicative interaction between extreme heat exposure (EHE) and greenness is assessed. Aim 3 utilizes machine learning methods to develop predictive models and examine effect responses by numbers and combinations of selected risk factors for diabetes hospitalizations in an ecological study conducted at census-tract level. We utilize univariate and multivariate regression models to estimate the factor-diabetes associations. Results: Aim 1) A significantly increased risk of diabetes hospitalizations is associated with per interquartile increase of temperature in May (ranges of excess risk: 3.1%-4.8%) and in July (ranges of excessive risk: (4.1%-4.2%). Females, patients aged 65 years and older, urban residents, and patients with heart diseases are vulnerable to heat’s effects. Additionally, the immediate risks of diabetes hospitalizations associated with EHE significantly increase in low greenness areas with a dose-response effect related to the levels of greenness; Aim 2) ECE significantly increases diabetes hospitalizations in winter months (January and February, ranges of odds ratios (ORs): 1.099-1.242, P \u3c 0.05) and in March (ranges of ORs: 1.068-1.177, P \u3c 0.05), but the risks increase more consistently in March. Females, patients aged 65 years and older, urban residents, and patients with hyperlipidemia and myocardial infarction are susceptible to cold’s effects. Moreover, significant ECE-UFP interactions on diabetes are at both multiplicative (P \u3c 0.05 for product terms) and additive scales; and Aim 3) The prevalence ratios (PRs) range from 1.4 (95% CI: 1.15-1.7) to 3.87 (95% CI: 3.18-4.71) for the associations between risk factors and diabetes. We found effect responses of numbers and combinations of selected risk factors on predictability of diabetes hospitalizations. Having 20 or more risk factors and two high-risk combinations (non-Whites/low tree canopy coverage/no interest dividends or net rental income/never married/live alone and public health insurance/chromium/using public transportation to work/live alone) show 100% predictability for diabetes hospitalizations. Conclusions: EHE and ECE significantly increase the burden of hospitalizations for diabetes in the transitional months of May and March, respectively. This study finds synergistic interactions between ECE and UFP on diabetes. In addition, vulnerability to heat/cold varies by demographics and comorbidities. Furthermore, the census tracts with 20 or more risk factors or having certain high-risk combinations are particularly vulnerable to diabetes hospitalizations
Bias-Aware Gaze Uniformity Assessment in Group Images
Get PDFToday, more than 5 billion photos are captured every day, with smartphones generating over 94\% of these images. However, despite advancements in technology, achieving aesthetically pleasing group photos remains challenging, especially when it comes to aligning the direction of everyone’s gaze. While current methods focus on facial features, they often fail to ensure consistent gaze direction. The introduction of the iPhone\u27s Live mode, which captures a 1.5-second video snippet along with still images, complicates the selection of the best key photo due to its subjective nature and a lack of publicly available data, especially during the pandemic.
To address these issues, this thesis outlines three primary goals: First, to detect and improve the aesthetic quality of group instant and live images by enhancing gaze uniformity. Second, to investigate and reduce biases in the gaze uniformity algorithm to ensure fairness across different demographic groups. Lastly, to create a diverse Live Photos dataset, containing images captured with various cameras and in different settings, to support future research efforts.
To accomplish these goals, the thesis makes several key contributions. It identifies gaze uniformity as a crucial aspect of group photo aesthetics and introduces a novel method for assessing gaze uniformity, an approach not previously explored in the literature. Additionally, it highlights that Apple’s proprietary algorithm overlooks gaze uniformity when selecting representative frames for Live Photos. A method for determining a Gaze-Aware Representative Group Image (GARGI) is proposed, along with a user-friendly iOS application that assesses gaze uniformity and categorizes photos as GOOD, BAD, or OK, thus enhancing group photo quality in both instant and live modes. Furthermore, the thesis conducts an audit of gaze uniformity detection algorithms to evaluate fairness concerning gender and presents a multi-stage framework to address identified biases. Finally, it compiles a unique dataset of Live Photos, called LivePics-24, to fill a significant gap in available resources by including diverse groups and settings.
Through these contributions, the thesis aims to improve the user experience in smartphone photography while also addressing the societal implications of algorithmic biases
Literature Review: Parkinson\u27s Disease and Non-Motor Symptoms, with a Focus on Constipation and Potential Therapeutics
Get PDFParkinson’s Disease (PD) is a progressive neurodegenerative disorder that tends to affect elderly individuals and is most commonly associated with the emergence of motor symptoms such as tremors, stiffness, and bradykinesia. However, non-motor symptoms (NMS), such as gastrointestinal (GI) issues, namely constipation, are also prevalent, and deeply affect the lives of individuals suffering with the disease. Among these, constipation stands out as one of the most common and frustrating problems for patients, typically arising from a variety of interrelated factors including disruptions in the autonomic nervous system (ANS), diminished dopamine activity, gut microbiota imbalances, inflammation, and side effects from PD medications. Constipation can worsen other PD symptoms by slowing medication absorption (significantly reducing its’ effectiveness), whilst also increasing fatigue and depression, thus highlighting the need for a comprehensive approach to PD treatment that includes addressing this issue. Promising options for managing constipation are offered by emerging therapies such as vagus nerve stimulation (VNS) and focused ultrasound stimulation (FUS), but further research is still needed to fully understand the mechanisms and to confirm their safety and efficacy. This review highlights the importance of early detection and management of constipation in PD to improve symptoms, better manage the disease, and ultimately enhance the quality of life for patien