SACM - United States of America
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Item Restricted Centering Decolonial and Environmental Counternarratives in Selected British, American, and African Literary Works(Saudi Digital Library, 2025) Alatawi, Majed; Wisnicki, AdrianThis study engages with a selection of African, British, and American literary works that represent various spaces, histories, and positionalities. Some of these works are Mary Shelley’s Frankenstein (1818), E. M. Forster’s A Passage to India (1924), María Ruiz de Burton’s Who Would Have Thought It? (1872), Pauline Hopkins’s Of One Blood (1902), Sophia Alice Callahan’s Wynema: A Child of the Forest (1891), Mohamed Al-Fayturi’s Diwan Al-Fayturi (1979), and Yvonne Vera’s Nehanda (1994). In reading such texts, the study explores the representations of the different manifestations of othering as a normalized sociopolitical phenomenon and the otherers’ dominant narratives in the diverse contexts of these texts and how minoritized voices respond to and take to task such narratives. Drawing on the frameworks of decoloniality, postcolonial ecocriticism, and environmental justice, the study argues that the works it examines present decolonial/environmental counternarratives. These counternarratives question, critique, and challenge the dominant narratives and the imbalanced power structures built on them by centering othered voices and worldviews and underscoring the suppressive strategies and oppressive structures that result from such dominant narratives. The study’s utilization of such critical lenses to read a diverse group of literary texts can help illuminate how silencing the voices of marginalized communities is central to building and maintaining oppressive power structures, especially in colonial and settler-colonial contexts where normalized othering impacts not only the othered human, but also the nonhuman world. Moreover, the human other in such contexts is often considered a part of the environment that the colonizers aim to commodify and dominate. In this light, the study examines the texts’ representations of the ways in which centering dominant worldviews and imposing their narratives reinforce oppressive power structures rooted in ideologies such as Eurocentrism and anthropocentricism. This has also entailed decentering indigenous worldviews, which tend to give more space to the nonhuman and consider humans a part of the ecological system instead of believing in their superiority to the natural world. As such, centering decolonial and environmental counternarratives makes possible a multivocality that resists the silencing and oppression of both the human and nonhuman others.19 0Item Restricted EXPLORING VIRTUAL REALITY IN PREOPERATIVE CLINICAL CARE: IMPACTS ON PATIENT ANXIETY, PARENTAL ANXIETY, AND NURSE SATISFACTION(Saudi Digital Library, 2025) Abu Rukbah, Walaa S; Wijesinghe, Dayanjan SAbstract EXPLORING VIRTUAL REALITY IN PREOPERATIVE CLINICAL CARE: IMPACTS ON PATIENT ANXIETY, PARENTAL ANXIETY, AND NURSE SATISFACTION By Walaa Abu Rukbah, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2025 Major Director: Dayanjan S Wijesinghe, Ph.D. Associate Professor, Department of Pharmacotherapy and Outcomes Sciences Director, Laboratory of Pharmacometabolomic and Companion Diagnostics Introduction: Preoperative anxiety affects up to 65% of pediatric surgical patients, leading to increased stress responses, difficult anesthesia induction, and adverse postoperative outcomes. While pharmacological premedication remains standard practice, non-pharmacological alternatives like virtual reality (VR) show promise for anxiety reduction. This study evaluated the effectiveness and implementation feasibility of a custom-designed VR intervention for managing preoperative anxiety in pediatric patients, while assessing impacts on parental anxiety and healthcare provider satisfaction. Methods: A retrospective analysis was conducted using data from a nine-month quality improvement initiative (October 2023-June 2024) at VCU Children's Hospital. Eighty pediatric patients (ages 6-15 years) undergoing elective surgery received a custom VR intervention during preoperative waiting. Primary outcomes included changes in patient-reported distress (0-10 numerical rating scale) and fear (Children's Fear Scale 0-4) measured pre- and post-VR intervention. Secondary outcomes included physiological measures (heart rate, systolic blood pressure), parental anxiety (STAI-6), and stakeholder satisfaction ratings from patients, parents (n=65), and nurses (n=29). Logistic regression models identified predictors of clinically significant anxiety reduction (≥30% and ≥50% thresholds). Thematic analysis examined qualitative parent feedback to understand intervention mechanisms and stakeholder perspectives. Results: VR intervention demonstrated significant reductions in both patient distress (median change: -2.0 points, 95% CI [-2.00, -1.00], p<0.001) and fear (median change: -1.0 point, 95% CI [-1.00, 0.00], p<0.001). A majority of patients achieved a clinically significant reduction (≥30%) in both distress (66.2%) and fear (52.5%). Physiological measures showed significant decreases in heart rate (-5.8 bpm, p<0.001) and systolic blood pressure (-4.1 mmHg, p<0.0001). Baseline anxiety severity emerged as the strongest predictor of clinical response, with higher initial fear scores associated with increased odds of achieving ≥50% reduction (OR=1.80, 95% CI [1.11, 2.92], p<0.017). Stakeholder satisfaction was exceptionally high: 95.4% of parents would recommend VR to other families, 91.2% of children expressed willingness to use VR again, and 100% of nurses recommended VR for pediatric procedures. Parental anxiety significantly decreased following their child's VR intervention (P<0.0015), with 53.8% of parents experiencing improved anxiety levels. Qualitative analysis revealed predominant themes of engagement/distraction (52.4% of responses), emotional impact (34.9%), and clinical utility recognition (31.7%). Implementation was feasible with minimal workflow disruption (6.9% of nurses reported interference). Conclusion: Custom-designed VR interventions can be successfully integrated into pediatric preoperative care with significant clinical benefits and stakeholder acceptance. The intervention achieved meaningful anxiety reduction across multiple measures while demonstrating implementation feasibility in a busy clinical environment. Children with higher baseline anxiety levels experienced the greatest benefits, providing data-informed recommendations for targeted implementation strategies. The consistent of positive outcomes across patients, families, and healthcare providers, combined with minimal adverse effects (3.8%), supports VR integration as a valuable non-pharmacological approach to pediatric preoperative anxiety management. These findings add to the growing support for digital therapeutics in pediatric care and provide real-world guidance for healthcare systems considering VR implementation. Keywords: Virtual reality, pediatric anxiety, preoperative care, implementation science, non-pharmacological intervention, digital therapeutics13 0Item Restricted Effect of Artificial Aging and Cyclic Loading on Reverse Torque Values and Survival of Zirconia Implants with Carbon Fiber-Reinforced PEEK Polymer Screw(Saudi Digital Library, 2024) Alamri, Hassan Bilal A; Shereen, AzerStatement of problem: The introduction of carbon fiber-reinforced PEEK polymer screw in two-piece zirconia implants, facilitated the development of “metal-free" implant solutions. However, the literature lacks studies on the performance of such a screw joint assembly, particularly regarding reverse torque values. Purpose: To evaluate the effect of artificial aging and cyclic loading on reverse torque values and survival rates of carbon fiber-reinforced PEEK polymer screws in two-piece zirconia. Materials and Methods: A total of 20 implants were divided into two main groups. The testing group utilized 10 zirconia implants (NobelPearl Tapered RP 4.2 x 10 mm, Nobel BioCare, Kloten, Switzerland) with carbon fiber-reinforced polymer screws (VICARBO®, NobelPearl, Nobel BioCare, Kloten, Switzerland) to retain the zirconia crown cemented on zirconia abutments (NobelPearl abutment straight IX RP 1). The control group used 10 titanium implants (NobelReplaceTM Conical Connection, RP 4.3 x 10 mm, Nobel BioCare, Kloten, Switzerland) with titanium alloy screws (Clinical Screw Conical Connection, Nobel BioCare, Kloten, Switzerland) to retain zirconia crowns cemented on titanium abutments (Snappy abutment 5.5 CC RP 1.5, Nobel BioCare, Kloten, Switzerland). Implants were cemented into twenty glass cloth reinforced epoxy resin cylinders (G10, National Electrical Manufacturers Association, Rosslyn, Virginia, USA) using a dual-cured resin (Rock Core, Zest dental solutions, California, USA). All zirconia crowns were digitally designed to an identical shape maxillary central incisors, milled from zirconia blanks (IPS e.max ZirCAD Prime 25 x 98.5mm, Ivoclar, Vivadent USA), sintered, and then cemented with resin cement (Panavia V5, Kuraray Noritake, Okayama, Japan). A total of 60 screws were used in 6 groups. In the first two groups (T24 and Z24) a torque limiting wrench (NobelPearl Manual Torque Wrench, Nobel BioCare, Kloten, Switzerland) was used to deliver the manufacture's recommended torque values to all the samples, followed by another torque after 20 minutes. After 24 hours, a digital torque gauge (Chatillon Model DFS2-R-ND, Ametek, Largo, FL) was used to record the reverse torque values for all the samples. A new set of screws was then used for the next two groups (Tth and Zth). The same torque protocol was followed, and samples were subjected to thermocycling in 5 C, 55C distilled water baths for 10,000 cycles, and a dwelling time of 2 minutes. The reverse torque values were recorded again using the same digital torque gauge. The last two groups (Tcl and Zcl) received another new set of screws, and the same torque protocol was followed. After that, the samples were mounted at a 30° to the cyclic loading machine to be subjected to one million cycles of 200N load at a rate of (2 cycles/second (Hz)). When a failure was detected, the number of cycles at the time of discovery and failure mode were recorded. Preload efficiency values were calculated to standardize the reverse torque values of groups (T24,Z24,Tth and Zth). To compare the means of preload efficiency, a two-way analysis of variance was done followed by Tukey-Kramer post hoc analysis. The difference in number of cycles to failure between groups (Zcl and Tcl) was evaluated using the LIFEREG procedure of SAS. Results: Preload efficiency was 74.96% for T24, 72.17% for Z24, 76.4% for Tth and 63.96% for Zth. Results of the 2-way analysis of preload efficiency showed that the interaction was statistically significant (P = 0.0010), therefore, the pairwise comparisons between the 4 subgroups (T24, Z24, Tth and Zth) were adjusted by Tukey testing, which indicated that the preload efficiency of the zirconia group after thermocycling (Zth) was statistically significantly different from all other groups. The LIFEREG procedure of SAS did not detect a statistically significant difference in the number of cycles to failure between the groups (Tcl and Zcl). Furthermore, three zirconia implants, eight zirconia abutments, and two PEEK screws fractured during cyclic loading. One titanium implant exhibited minor deformation, while four titanium abutments and five titanium screws fractured. Conclusion. The preload efficiency of zirconia implants with PEEK screws was comparable to the titanium group after 24-hours of initial torque. However, after artificial aging, zirconia implants with PEEK screws exhibited a statistically significant decrease in preload efficiency compared to all other groups. No statistically significant difference was found in the number of cycles to failure between the zirconia and titanium systems.15 0Item Restricted Assessment of Wind Power Integration into the Synthetic Electric Grid of Saudi Arabia(Saudi Digital Library, 2025) Alonize, Mishal; Li, FangxingSaudi Arabia is working to reduce its dependence on oil and diversify its economy by incorporating renewable energy into its plans, as part of the initiative Vision 2030. A significant challenge in this change is the integration of renewable energy, particularly wind energy, into the existing Saudi Arabian electricity grid. Wind energy offers significant economic and environmental benefits, including reducing carbon emissions and providing a cost-effective energy source. However, integrating wind power presents challenges, particularly in maintaining grid frequency stability during different disturbances and ensuring that wind farms comply with grid codes to operate efficiently within the system. To perform tests for the effectiveness of wind integration, an adaptive synthetic Saudi electric grid model was built based on data of the Saudi power grid collected from open source data, designed to simulate the transient dynamics of a Saudi power grid, in order to enable simulation and assessment of wind energy integration into the electricity system of Saudi Arabia. For higher accuracy and details, the model created by CURENT Large-scale Testbed (LTB) and its ANDES package.12 0Item Restricted PHYSIOLOGICAL AND NEUROIMMUNE EFFECTS OF MANUAL THERAPY(Saudi Digital Library, 2025) Alanazi, Murdi; Reed, WilliamManual therapy (MT) is widely used across healthcare disciplines for the management of musculoskeletal conditions. Emerging evidence indicates that MT may also influence broader physiological systems such as the nervous and the immune systems. However, the mechanisms underlying these effects are still not well understood, and limited evidence exists regarding the neuroimmune effect of MT in neurologically impaired populations such as multiple sclerosis (MS). The overall aim of this dissertation was to investigate the physiological effects of MT, synthesizing current evidence across mechanistic domains, and generating pilot data to inform future research. This dissertation was structured around four manuscripts. The first manuscript provides a narrative review of autonomic nervous system (ANS) and visceral responses to MT, summarizing evidence of sympathetic-parasympathetic modulation and highlight- ing methodological challenges. The second manuscript reviews neuromuscular responses to high-velocity, low-amplitude spinal manipulation (HVLA-SM), identifying potential peripheral, spinal, and cortical changes but also notes the considerable variability across studies. The third manuscript offers an evidence-based guide for rehabilitation physicians, outlining the clinical effectiveness of manual therapy for common musculoskeletal conditions and emphasizing its growing integration into guideline-based practice. The fourth manuscript presents a pilot randomized sham-controlled trial in people with relapsing-remitting MS (RRMS), evaluating the effects of thoracic spinal manipulation on inflammatory cytokine profiles, neurodegenerative biomarkers, and clinical/performance- based outcomes. The narrative reviews (Chapters 2 & 3) highlighted that MT elicits ANS and neuromuscular responses, but overall findings are inconsistent due to methodological variability and small sample sizes. The quick guide to clinical evidence pertaining to the use of MT summarized (Chapter 4) the recommended, and clinically effective MT techniques for musculoskeletal conditions, while underscoring the importance of mechanistic re- search. The pilot study (Chapter 5) demonstrated that six cytokines IL-8, IL-17A, GM-CSF, MIP-1β, IFNγ, and Fractalkine showed moderate to large effect sizes at multiple timepoints post-spinal manipulation, while neurodegeneration biomarkers and most clinical/performance-based outcomes exhibited small or negligible changes. Collectively, this doctoral dissertation provides an integrated evaluation of the physiological effects of manual therapy, advances mechanistic understanding across multiple physiological systems, and identifies key biomarkers to prioritize in future randomized controlled trials.9 0Item Restricted THREE ESSAYS ON ENTREPRENEURIAL STRATEGY AND PERFORMANCE: EXPLORING ARTIFICIAL INTELLIGENCE (AI)-DRIVEN METHODS AND EMPIRICAL PATTERNS(Saudi Digital Library, 2025) Alrubaiaan, Omar; Chari, MuraliThis dissertation consists of three essays on entrepreneurial strategy and performance. Entrepreneurship is inherently risky, and understanding the factors that shape entrepreneurial outcomes remains a central concern in the field. The three essays highlight complementary themes: strategic adaptation through pivots and the use of advanced AI to detect them, the role of entrepreneurial experience in shaping performance, and the contextual conditions under which immigrant entrepreneurs achieve superior outcomes. The first essay introduces a novel approach to measuring post-launch pivots in startups using Large Language Models (LLMs). By systematically analyzing changes in firm descriptions over time, the study develops an automated method to capture strategic redirection at scale. While pivoting is widely discussed in entrepreneurship, prior research has largely relied on case studies of individual or small groups of ventures. This study advances the literature by leveraging CrunchBase data and prompting LLMs to assess description changes and benchmarking their performance against human raters. Results show that the top-performing LLM outperforms human accuracy (84% versus 79%), demonstrating the promise of LLMs as scalable tools for systematically studying pivots across large samples. Moreover, when human raters were subsequently exposed to the LLM’s assessments, their accuracy increased to 85%, demonstrating the potential of LLMs not only as scalable analytical tools but also as valuable decision-support systems that enhance human judgment. The second essay examines the performance of serial versus novice entrepreneurs, distinguishing between survival and financial outcomes. Using panel data, the study develops and tests hypotheses on differences in venture performance, arguing that survival and financial performance—often treated interchangeably—reflect distinct dimensions of entrepreneurial success. Findings reveal that the first ventures of serial entrepreneurs generate higher financial performance but shorter survival relative to those of novices. Furthermore, subsequent ventures of serial entrepreneurs survive longer than earlier ones, though their financial performance does not significantly improve. These results shed light on the nuanced relationship between entrepreneurial experience and venture outcomes. The third essay investigates the performance of self-employed immigrant entrepreneurs in the United States, asking when and under what conditions they outperform their non-immigrant counterparts. Drawing on longitudinal panel data from the PSID, the study tests four hypotheses, including the moderating roles of family size, wealth, and industry context. Findings show that immigrant entrepreneurs outperform their native-born counterparts on average, with family size strengthening this advantage and wealth diminishing it. Industry dynamics also matter: immigrants excel in blue-collar sectors but are less competitive in white-collar industries, reflecting both constraints and opportunities embedded in immigrant entrepreneurship. Taken together, these three essays contribute to entrepreneurship research by advancing methodological tools for measuring pivots, clarifying the performance implications of entrepreneurial experience, and uncovering the contextual factors that shape immigrant entrepreneurs’ outcomes. Collectively, they provide a multidimensional perspective on entrepreneurial strategy and performance.11 0Item Restricted Occupational Performance and Movement Disorders and the Use of the Canadian Occupational Performance Measure in Individuals With Parkinson Disease(Saudi Digital Library, 2025) ALSaeed, Abdullah Saad; Pickett, KristenMovement disorders (MDs) include a range of neurological conditions that affect both voluntary and involuntary movement, including Parkinson disease (PD), dystonia, essential tremor, and Huntington disease. MDs include hyperkinetic disorders that produce excessive movements, and hypokinetic disorders that reduced or slowed movements. MDs also involve non-motor symptoms which frequently appear before motor symptoms and significantly affect quality of life, daily activities, and caregiver burden. Occupational therapists (OT) play an important role in providing holistic, client-centered care through frameworks like the Person-Environment-Occupation (PEO) model. OT assess how motor and non-motor symptoms interact with environmental factors to effect participation in meaningful activities. However, most standardized assessment tools rely on predetermined task lists that fail to capture each person's unique priorities. The Canadian Occupational Performance Measure (COPM) fills this gap by allowing individuals to identify and rate their own performance and satisfaction in self-care, productivity, and leisure activities. Although the COPM has been used across various neurological populations, its use in MDs, particularly in individuals with PD, is limited. This dissertation systematically examined COPM application in MDs through two studies. Study one conducted a systematic review using PRISMA guidelines, identifying nine studies: seven in PD with 367 participants and two in functional neurological disorders (FNDs) with 144 participants. The review revealed heterogeneous COPM use with varying evidence levels. Study two compared COPM and MDS-UPDRS in twenty-nine individuals with PD identified 88 occupational problems across self-care, productivity, and leisure domains. Only 43 problems (48.9%) were captured by the MDS-UPDRS. These findings demonstrate that client-centered assessments like the COPM capture meaningful occupational problems that were overlooked by the traditional PD measure, emphasizing the need for comprehensive evaluation approaches in MDs.9 0Item Restricted Electrolyte-Driven Advances in pH Sensor Development, CO2 Conversion, and Concentrated Electrolyte Modeling(Saudi Digital Library, 2025) Bahdad, Abdullah Omar; Leonard, KevinElectrolytes are critical yet underexplored factors in electrochemical systems. This dissertation advances mechanistic understanding of electrolyte behavior at or near electrochemical interfaces, for improved control and design of electrochemical processes. The dissertation is organized into three research chapters. Chapter 2 focuses on developing potentiometric solid-state pH sensors. Anodically grown platinum oxide ultramicroelectrodes fabricated under alkaline conditions exhibited a near-Nernstian response and excellent stability in aqueous electrolyte environments, with fast temporal resolution when fabricated on nanoelectrodes. These findings highlight the crucial roles of electrolyte synthesis conditions and geometric scaling in enabling fast and reliable pH sensing, especially in challenging aqueous environments. Chapter 3 investigates the mechanistic role of ion pair formation in the electroreduction of CO2 to formate in KHCO3/KCl electrolytes. Through cathodic linear sweep voltammetry, bulk electrolysis, and Tafel analysis, KHCO3 ion pairs, not free bicarbonate or dissolved CO2, serve as the dominant electroactive species toward formate production. Electrolyte optimization led to the identification of 1.75 M KHCO3/2 M KCl as the optimum electrolyte, exhibiting the highest formate current density on planar tin electrodes (~20 mA.cm-2) at reduced overpotentials. These findings establish a new framework for electrolyte design, showing that ion pair speciation directly impacts selectivity and activity in CO2 electroreduction. Chapter 4 presents a modified Debye-Hückel framework that quantitatively links microscopic ion structuring with macroscopic properties in symmetrical and asymmetrical concentrated electrolytes. The derived mean ionic activity coefficients and effective water activities enable accurate prediction of electromotive force and conductivity over a wide concentration range. This analytically tractable, non-empirical model overcomes century-old limitations of classical theory, providing a unified, predictive foundation for electrolyte design and optimization. These contributions advance both the mechanistic and applied understanding of electrolyte role in electrochemical systems. They establish critical principles that guide innovation in electrolyte-driven technologies, including electrochemical sensing, selective electrosynthesis, and electrolyte design and control across diverse scientific and engineering applications.10 0Item Restricted Behavioral intentions of Saudi female students in the College of Computer Science and Engineering at Taibah University in Saudi Arabia toward using mobile computer devices in their learning(Saudi Digital Library, 2025) Alnehari, Naif Nasser; Goodson, Todd; Taylor, Kay AnnThe Kingdom of Saudi Arabia is making crucial progress and development in all fields, including education, as it develops higher education to compete globally. Among these strategies is the effective integration of technology into the educational environment, a key goal of Vision 2030. The spread of mobile computer devices among students has proven effective in student learning. However, there is still a lack of studies about the effectiveness of these mobile computer devices in higher education, especially among Saudi female students. Therefore, processes are involved before integrating any technology into the educational environment; one is to understand students' acceptance of these devices in their learning journey. Thus, the purpose of this study is to predict the behavioral intention of Saudi female students in the College of Computer Science and Engineering at Taibah University in Saudi Arabia to learn with mobile computer devices based on the constructs of the Unified Theory of Acceptance and Use of Technology (UTAUT) (Venkatesh et al., 2003). This study employed a quantitative, non-experimental survey design to collect data. The number of responses received was 134; 127 were valid. The multiple linear regression analysis was administered to answer the research questions. The results revealed that effort expectancy and social influence were significantly associated with the female Saudi students' behavioral intentions toward using mobile computer devices in their learning (β = 0.444, p < 0.001; β = 0.174, p = 0.033). Performance expectancy had no statistically significant relationship with the behavioral intentions of Saudi female students regarding the use of mobile computer devices (β = 0.108, p = 0.232). In addition, multiple linear regression results were presented, showing that the model accounted for 39% of the variance in the behavioral intentions of Saudi female students regarding the use of mobile computer devices in their learning. The current study also revealed some challenges students face when using mobile computer devices for learning. These include classroom infrastructure issues, such as limited Internet access and low-quality hardware, as well as battery and device performance problems when downloading files and applications. Additionally, some educational websites and content were incompatible with these devices. Based on these findings, the current study provides recommendations for future research and for improving educational practices when integrating mobile computer devices.18 0Item Restricted FLUORIDE CONTENT OF INFANT FORMULA COMMERCIALLY AVAILABLE IN CENTRAL INDIANA(Saudi Digital Library, 2025) Altamimi, Ayman; Lippert, FrankBACKGROUND Fluorides have a well-established role in dental caries prevention. Fluoride content in infant formula has raised concerns about whether it is within safe levels for the developing teeth. There is a large number of products on the market with likely varying fluoride concentrations, and these products’ fluoride content will differ depending on whether, for example, fluoridated water was used during manufacturing or reconstitution. Several studies have been published on infant formula containing fluoride and the associated risk of developing enamel fluorosis. However, few recent studies in the US have determined whether liquid or powder infant formula fall within safe/recommended levels. Purpose: This study measured the fluoride content of infant formula sold in grocery stores in central Indiana, prepared using three types of water (Purified, Nursery, and Tap) to determine if they fall within safe levels. Alternative hypotheses: There is a significant difference in the concentration of fluoride between different brands of infant formula. Material & Methods: We analyzed twenty different infant formula products sold in grocery stores in the Indianapolis, Indiana area for their fluoride content. Samples were reconstituted with Nursery water (containing approx. 1.0 ppm fluoride), Tap water (approx. 0.7 ppm fluoride) and Purified water (negligible fluoride content). A sample for the tests was taken from each preparation and the concentrations of fluoride of all samples was determined using the fluoride microdiffusion method. The statistical analysis of results was carried out using two-way ANOVA. Results: When comparing the mean (SD) fluoride concentration among the three types of infant formula reconstitution with water, tap water had significantly higher fluoride concentration mean than both Nursery water and purified water (P <.001 at α=.050 level). Nursery water also had significantly higher fluoride concentration mean than purified water (P <.001 at α=.050 level). When the three types of water were used for reconstitution of the 20 infant formula brands, the overall highest fluoride concentration mean was seen when tap water was used for reconstitution (0.950) followed by nursery water (0.789) while the least fluoride concentration was in purified water (0.102). Conclusion: Within the study's limitations, it can be concluded that apart from one formula none of the tested infant formulas sold in central Indiana grocery stores when reconstituted with purified water were found to decrease the chance of infants exceeding UL levels for both age groups but were found to increases the chance exceeding the AI levels for infants aged 0–6 months. All tested infant formulas reconstituted with nursery and tap water were found to increase the chance of infants exceeding the UL, and the AI levels for both groups resulted in increasing the chance of fluoride concentrations exceeding the recommended/safe levels. Thus, the type of water used for reconstitution rather than the type of formula appears to be the determining factor for the levels of fluoride intake associated with infant formula. Clinical Significance: With the recent increase in the utilization of infant formula, different brands with varying fluoride concentrations and the different modes of reconstitution must be evaluated to determine if their fluoride concentrations will fall within safe/recommended levels and thus increase the risk of enamel fluorosis development.34 0