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Exploring The Influence Of Contextual Factors And The Caregiving Process On Burden, Quality Of Life, And Outcomes Of Heart Failure (Hf) Dyads After A Hospital Discharge Guided By The Individual And Family Self-Management Theory (Ifsmt): A Mixed Method Study, Tamara Bernard

Theses & Dissertations

ABSTRACT The purpose of this study is to explore the influence of contextual factors and caregiving process characteristics on proximal outcomes of the patient and caregiver after discharge from the hospital. The long-term goal of this research is to reduce caregiver burden and improve patient outcomes. Heart failure (HF) is an increasingly common chronic illness with unique caregiving needs and a high rate of hospital readmissions. Caregiver burden has been researched extensively in other areas of medicine such as oncology and dementia and has been reported for stable chronic HF patients in an outpatient setting. However, there is little research …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

The Association Of Lower Medication Adherence And Increased Medical Spending, Ryan A. Fuchs

Capstone

Medical prescribing is a common occurrence in daily clinical practice. According to the Centers for Disease Control and Prevention, in 2015-2016 45.8% of the U.S. population used prescription drugs in the past 30 days. (CDC, 2019) Although drug therapy can be effective in treating disease, full benefits are often not realized because many patients do not take their medications as prescribed. There is quite a bit of research out there about non-adherence to medication. Some studies focus on the financial impacts of non-adherence, but most of the studies examine the reasons for medication non-adherence. A gap exists in research about …

Assessing The Methodology, Prevalence, And Associated Factors For Adverse Childhood Experiences (Aces) Among Children And Adolescents In The United States, Kiara L. Lyons

Theses & Dissertations

To comprehensively capture the risk and protective factors of ACE exposure and ACE-related outcomes, we propose to consider a social-ecological model framework. The concept of the Social-Ecological Model was originally introduced in the 1970s by psychologist Urie Bronfenbrenner and designed to theoretically capture the multifaceted influence different personal, social, and environmental factors have on health behaviors and outcomes. Additionally, this would help to determine what prevention and intervention methods would be more appropriate to implement. This conceptual framework had five system levels: microsystem (individual), mesosystem (interpersonal), exosystem (community context), macrosystem (societal and cultural influences), and chronosystem (internal and external elements …

Grip Characterization Of Protective Gloves, Doris Burns

Theses & Dissertations

In 2014, ASTM International (ASTM), one of the world's largest international standards developing organizations, published a new test method on glove grip performance. This method was adopted by the National Fire Protection Association (NFPA) in some of their specification standards. The method utilized hand torque instead of the pull method previously used by the NFPA to determine the Percent Bare Hand Control Value (%BHCV). The %BHCV, compares torque results of a gloved hand versus a bare hand. In developing this new test method, only four males and one female participated; therefore, it is unclear if statistical significance was attained. In …

Polymeric Chloroquine In Metastatic Pancreatic Cancer Therapy, Rubayat Islam Khan

Theses & Dissertations

Hydroxychloroquine (HCQ) is an established drug that has been used for the treatment of multiple diseases, including malaria, rheumatoid arthritis, and lupus erythematosus. Several recently published studies have highlighted its beneficial use in various types of cancers, and a plethora of clinical trials are currently evaluating its use in cancer therapies, wherein some of the results look promising. The preclinical studies to date suggest HCQ can work effectively in conjunction with traditional cancer treatments, as it has been shown to sensitize tumor cells to a wide range of chemotherapeutic agents. Polymeric HCQ (PCQ), a macromolecular multivalent version of HCQ, has …

Identifying & Addressing Barriers To Child Care For Formerly Incarcerated Mothers, Joanne Bird

Capstone Experience

As women’s incarceration rates have risen significantly in recent decades, gender-specific programs are needed to meet the needs of formerly incarcerated mothers (FIM). Although child care can be difficult to access for many families, this marginalized population faces unique obstacles to accessing child care. In order for FIM to be employed and reintegrate, they must be able to access child care; however, FIM experience unique barriers to securing child care services. This policy brief aims to identify the special considerations FIM face, as well as to explore why existing programs are not meeting their specific needs. A literature review was …

The Merit Of Inclusion: A Policy Review Examining The Convergence Of Special Education And Inclusions Policies With Compensatory Medicaid Policies In The Wake Of The Covid-19 Pandemic, Corbyn Baggett

Capstone Experience

On March 11, 2020, the World Health Organization (WHO) formally recognized the novel coronavirus (COVID-19) outbreak as a global pandemic. This global issue compelled governments to announce careful virus containing policies in order to prevent further spread and control of the disease. Although it has been proven that measures like social isolation could aid in scaling the spread of illness, the resulting extended school closures that occurred in response to an increased number of COVID-19 outbreaks posed significant challenges for all students, but especially those students with special needs. The unpredictable nature of COVID-19 at the outset of the pandemic …

The Risk Factors Of Long Covid In The Acute Covid And Solid Organ Transplant Retrospective Cohorts, Ahmed Nyandemoh

Capstone Experience

Background: Coronavirus disease 2019 (COVID-19) in solid organ transplant (SOT) patients is associated with more severe outcomes than non-immunosuppressed hosts. The risk factors for developing the long COVID in acute COVID remain unknown, and the survival outcomes of long COVID in SOT patients remain understudied.

Methods: We developed several retrospective cohorts. This project included all patients identified with acute COVID in the National COVID Collaborative Cohort Registry from July 1, 2020, to June 30, 2022.

Patients with long COVID were compared to those without long COVID in the acute COVID cohorts. Similarly, we compared the patient demographic with long COVID …

The Association Of Lower Medication Adherence And Increased Medical Spending, Ryan A. Fuchs

Capstone Experience

Medical prescribing is a common occurrence in daily clinical practice. According to the Centers for Disease Control and Prevention, in 2015-2016 45.8% of the U.S. population used prescription drugs in the past 30 days. (CDC, 2019) Although drug therapy can be effective in treating disease, full benefits are often not realized because many patients do not take their medications as prescribed. There is quite a bit of research out there about non-adherence to medication. Some studies focus on the financial impacts of non-adherence, but most of the studies examine the reasons for medication non-adherence. A gap exists in research about …

Urban/Rural Disparities Of Thyroid Cancer Using The Integrated Cancer Repository For Cancer Research (Icare2), Sunita Regmi

Capstone Experience

Abstract:

Background and objective: Multiple studies have shown that the place of residence and the distance to travel from one's residence to nearby health care providers impact cancer diagnosis and treatment. The stage of cancer at the time of diagnosis is paramount for cancer treatment and affects survival. Disparities in cancer treatment exist which affect the outcome disproportionately to certain segments of the population. To date, much of the focus has been on the racial and socioeconomic disparities in the management of thyroid cancer. The effect of geography and location (urban-rural status) on thyroid cancer stage diagnosis has …

Descriptive Epidemiology Of West Nile Virus In Nebraska, 2005-2021, Luke Murphy

Capstone Experience

Objectives: West Nile virus (WNV) is a mosquito-borne flavivirus that is naturally sustained in a Culex mosquito-bird-mosquito transmission cycle and can cause disease in birds, equines, and humans. Most human infections with WNV are asymptomatic; however, West Nile fever (WNF), or West Nile neuroinvasive disease (WNND) can develop and be fatal in some circumstances. Between 2005 and 2021 there have been over 1,800 cumulative cases of WNV in Nebraska, which currently ranks as fourth in the United States for reported cases. WNV cases are a mandatory reportable disease in Nebraska through an electronic reporting system managed by the Nebraska Department …

Evaluating How Physical Activity Affects The Perception Of Resilience In Box Butte County, Nebraska, Eric Pulver

Capstone Experience

Physical activity is one of the modern hallmarks for good health in individuals and the public, in general. Resiliency is a growing concentration in all levels of disaster preparedness where the focus is on how to deal with the growing number of disasters stemming from global climate change. This research project’s aim is to look at the possible relationships between physical activity and resiliency in a rural Nebraska population. This was done with the use of a cross-sectional study utilizing a fifteen-question survey to gather demographics, assess the amount of physical activity, and then apply a perception of resilience tool …

Orthopaedic Physical Therapy Residency And Fellowship Program Mentoring Structure: A Survey Of Program Directors, Darren Q. Calley, Kirk R. Bentzen, Megan Frazee, Matthew D. Haberl

Posters and Presentations: Physical Therapy

Purpose/Hypothesis: Mentoring is a required component of physical therapy residency and fellowship training, and a primary reason applicants pursue training in these programs. Resources outlining core competencies for effective mentoring, mentor and mentee characteristics, and recommendations for effective mentoring have been described. However, little is known about the timing, structure, and process of how mentoring and feedback is implemented across residency and fellowship programs. The purpose of this study was to better understand the structure, timing, and delivery of mentoring and the role mentors and program directors (PDs) play in orthopaedic physical therapy residency and fellowship programs. A secondary purpose …

Effective Occupational Therapy Interventions To Decrease Picky Eating In Children: A Systematic Review, Savannah L. Jacobsen, Josie Cox, Alli Bos, Cherokee Ferguson, Stacey Smallfield, Molly Whitlow

Student Systematic Reviews: Occupational Therapy

PURPOSE: Picky eating is related to the lack of consumption in food variety by children when shown different foods (Wolstenholme et al., 2020). A 2015 study reported that almost half of children experience a period of picky eating at some point during early childhood, including almost 15% of children for whom picky eating does not resolve by age 6 (Cardona et al., 2015). The purpose of this systematic review is to identify interventions within the scope of occupational therapy that increase food acceptance in children under the age of seven years who demonstrate picky eating characteristics and who have no …

Student Wellness During Curriculum Implementation Of A Lifestyle Medicine Approach Within The Social-Ecological Model: A Longitudinal Study., Betsy J. Becker, Tessa Wells, Kathleen G. Volkman, Nicole M. Sleddens, Teresa Cochran

Posters and Presentations: Physical Therapy

Purpose

The student-life experience is an ideal time to implement lifelong wellness behaviors needed for the professional role. The ongoing effects of the COVID pandemic have amplified the need for Doctor of Physical Therapy (DPT) educational programs to train an emerging workforce that can, through personal wellness, withstand the stressors of personal and professional lives. The study purpose is to: a) evaluate the change in student wellness from matriculation to mid-program to completion after implementation of a curriculum based on a lifestyle medicine approach within the Social-Ecological Model, and b) compare student wellness between cohorts that matriculated before and during …

Student Wellness During Curriculum Implementation Of A Lifestyle Medicine Approach Within The Social-Ecological Model: A Longitudinal Study, Betsy J. Becker, Anne Skinner, Tessa Wells, Kathleen G. Volkman, Nicole M. Sleddens, Teresa Cochran

Posters and Presentations: Physical Therapy

Purpose

The student-life experience is an ideal time to implement lifelong wellness behaviors needed for the professional role. The ongoing effects of the COVID pandemic have amplified the need for Doctor of Physical Therapy (DPT) educational programs to train an emerging workforce that can, through personal wellness, withstand the stressors of personal and professional lives. The study purpose is to: a) evaluate the change in student wellness from matriculation to mid-program to completion after implementation of a curriculum based on a lifestyle medicine approach within the Social-Ecological Model, and b) compare student wellness between cohorts that matriculated before and during …

Agrichemicals (Nitrate And Atrazine) In Drinking Water And Adverse Health Outcomes In Children In Nebraska, Balkissa S. Ouattara

Theses & Dissertations

Objectives: This research was conducted to (1) determine the concentrations of atrazine, and nitrate, in Nebraska watersheds and counties; (2) calculate the incidence of pediatric cancers and prevalence of birth defects in Nebraska counties and watersheds, respectively; (3) assess the relationship between the contaminant levels and the incidence rate of pediatric cancers and birth defects prevalence.

Methods: Pediatric cancers and birth defects data were obtained from the Nebraska Department of Health and Human Services. Water quality data were collected and retrieved from the Water Quality Portal and the Nebraska Groundwater Quality Clearinghouse. Geospatial and statistical analyses were conducted at the …

Evaluation Of Medication Optimization In The Setting Of Ecmo Therapy: Assessment Of Therapeutic Effectiveness, Greg Peitz

Theses & Dissertations

A series of studies within the setting of extracorporeal membrane oxygenation (ECMO) was undertaken to specifically answer questions related to medication optimization during this complex therapy. These studies included medication therapies involving optimal anticoagulation, analgesia delivery, fluid resuscitation, and infection related outcomes in the context of ECMO. Each investigation was retrospective in nature and included patients from a single institution. The results of these studies indicated the following: 1.) various anticoagulation goals do not impact severe, life-threatening bleeding events during ECMO therapy; 2.) sepsis is a common occurrence in the setting of ECMO; 3.) the choice of either a crystalloid …

Environmental Exposures And Human Health Challenges: Evidence-Based Insights From Health Surveillance Systems, Jagadeesh Puvvula

Theses & Dissertations

Human exposure to environmental hazards is associated with a variety of preventable adverse health outcomes. As the environmental health risks result from the complex interaction between hazard, exposure, and susceptibility, these exposure-outcome associations are heterogeneous across the population. Improving environmental health literacy by advocating evidence-based environmental risk communication could play a role in reinforcing protective behavior against environmental hazards. The use of public health surveillance systems to assess the exposure-response associations is one of the effective ways to quantify the environmental health risks. However, there are several gaps in effectively quantifying environmental health risks. This dissertation aims to address a …

The Effect Of Interproximal Home Regimens Of Inflammatory Biomarkers In Periodontal Maintenance Patients, Grace Moore

Theses & Dissertations

A survey of dental hygienists in general practice (DHGP; n = 74) and periodontal practice (DHPP; n = 62) indicated a difference (p £ 0.04) in preference for interproximal cleaning with oral irrigators (DHGP) and interproximal brushes (DHPP) during periodontal maintenance therapy (PMT). The purpose of the subsequent blinded, randomized controlled clinical trial was to compare the effect of interproximal cleaning aids on reducing inflammation in posterior pockets during PMT. Seventy-six patients on PMT with a 5-7 mm interproximal probing depth were randomly allocated to one of three groups: 1) interproximal brush with tracking device (IB + TD; n=23), 2) …

The Differences In Mental Well-Being For Individuals With And Without Service Dogs, Katelyn Morales

Capstone Experience

Trained service dogs can be used for many tasks, but the growing literature focuses on the benefits of the psychosocial health and well-being of individuals experiencing depression or anxiety. This study analyzes the effects of service dogs on the mental well-being of individuals with a diagnosed disability who have depression or anxiety. This quasi-experimental design assesses the mental well-being of individuals who have a service dog compared to those who do not have a service dog. Mental well-being was measured using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) and focused on individuals with a service dog and diagnosed depression or anxiety …

Disparities And Attitudes Toward Sars Cov2 Vaccine Among People With Disabilities, Ahmed A. Omar

Capstone Experience

The pandemic caused by SARSCOV2 that began in late 2019 posed a significant public health challenge for communities worldwide. The pandemic negatively impacted people's health, economy, and living conditions. Pharmaceutical companies worldwide have begun a race against time to invest in vaccine development to control and eliminate the worst outcomes of the COVID 19 associated disease. Scientific research resulted in several effective vaccines being developed and authorized for use in people (Salmeron Ríos S et al.).

Public health agencies like the Center for Disease Control and Prevention (CDC) prioritized high-risk populations for vaccination. This process is meant to accomplish the …

Examining Mental Health Disparities In A Rural County: A Community Health Needs Assessment Analysis, Dustin M. Schulz

Capstone Experience

Over 20% of adults in the United States experience some form of mental illness each year. Those residing in rural areas can see increased prevalence of mental illness, and typically face disparities in access and availability of services for mental health. The goal of this project was to examine the impact of mental health in Woodford County, Illinois using data collected through the 2022 Community Health Needs Assessment (CHNA) process, with the intent of identifying areas of improvement that could be implemented at the local level. Analysis of the CHNA data was conducted using frequency analysis in SAS 9.4 through …

An Analysis Of Demographics And Risk Factors Associated With Increasing Syphilis Cases In Iowa, Eleanore H. Nelson

Capstone Experience

Background:

Syphilis is easily detectable and treatable with the appropriate medical attention, yet national incidence rates have been on the rise since reaching an all-time low in 2000 (Shockman et al, 2014). Similar to HIV, men who have sex with other men (MSM), represent most syphilis transmission, yet in recent years, syphilis rates have concerningly increased among both genders and among all racial/ethnic groups (CDC, 2019).

Methods:

Surveillance data was collected on all syphilis cases reported to the Iowa Department of Public Health (IDPH) regarding demographics and risk factors of cases. Variables were analyzed using chi-square and Fisher’s exact tests, …

Overlaps And Gaps Of Preterm Birth Programs In The Triangle Area Of North Carolina, Amber Bobbitt

Capstone Experience

Background: Preterm birth rates are a long-standing issue that has yet to be adequately addressed and prioritized. Nationally about 1 in every 10 infants are born prematurely in the United States. In the state of North Carolina, 1 in every 9 live births was preterm in the year 2020. The aim of the study was to determine the strategies organizations use in North Carolina to reduce preterm births in comparison to the CDC’s Five Strategy framework and to understand how the organizations address health equity and measure/evaluate the success of their initiatives.

Methods: Semi-structured one-on-one interviews were conducted with four …

Intimate Partner Violence In Plastic Surgery Practice: Perceptions And Preparedness Amongst Practicing Plastic Surgeons, Sophie L. Cemaj, Collin J. Macdonald, Bria R. Meyer, Erin M. Shriver, Sean Figy

Graduate Medical Education Research Journal

INTRODUCTION

It is estimated that 4 of 10 women in the United States have experienced one or more forms of intimate partner violence (IPV) in their lifetime. The US Preventative Service Task Force recommends that clinicians screen women of reproductive age for IPV and refer women who screen positive to ongoing support services (B recommendation). We aim to identify the perceptions, attitudes, and preparedness of plastic surgeons regarding intimate partner violence

METHODS

An IRB approved survey was sent to members of the American Society of Plastic Surgeons. The survey contained three sections: (1) surgeon and practice demographics, (2) surgeon experience …

A Glimpse Into Urology Medical School Education: A Multi-Institutional Medical Student Survey, David Fu, Jesus Perez, Jinfeng Jiang, Christopher M. Deibert

Graduate Medical Education Research Journal

Introduction: Urological education and exposure for medical students is imperative as we face a growing geriatric population with increased urological needs. Previous research has examined American Urological Association (AUA) program director opinions of student exposure, but no surveys have been directed at current medical students. The purpose of this study is to quantify student exposure to and opinions of urology to determine precipitating factors that lead students towards or away from urology as a specialty of choice.

Methods: A 14 question (11 multiple choice and 3 fill-in-the blank) Google Survey was developed. Questions ranged from student exposure to urology, consideration …

Scholarly Activity In Residency: A Needs Assessment Of Challenges And Proposed Solutions, Jonathan Hall, Jana L. Wardian Phd, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Introduction

Resident physician participation in scholarly activity is associated with significant benefits ranging from trainees’ personal development to improved quality of patient care. Residency programs have taken varied approaches to improve resident engagement in scholarship, though interventions have demonstrated mixed results regarding objective measures of scholarly productivity. Concerns regarding waining interest in scholarship amongst internal medicine residents prompted a department-wide needs assessment to evaluate opportunities for scholarship and challenges preventing resident participation.

Methods

A web-based survey was developed and distributed to Department of Internal Medicine faculty and residents at the PGY2 level or higher and recent graduates within the last …

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

MD Honors Theses

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level Deprivation …