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Orthodontically Induced External Root Resorption In Extraction Versus Non-Extraction Treatment Modalities – A Retrospective Cone-Beam Computed Tomography (Cbct) Study, Jaykishan Patel

Theses & Dissertations

Purpose of this study was to evaluate orthodontically induced external apical root resorption using cone beam computed tomography in patients receiving orthodontic treatment with or without extractions. Records of 188 consecutively treated patients who received orthodontic treatment with or without extractions were evaluated. Pre-and post-treatment root lengths of maxillary incisors, volumes of maxillary central incisors, and apex displacement of either right or left maxillary central incisors were measured using Invivo 5.4 or ITK-SNAP 3.8.0 software. After adjusting for initial length, treatment duration, tooth, sex, race, bracket type, and malocclusion, maxillary incisor reduction of root length in extraction group was 0.37 …

The Development Of Hyaluronan-Based Contract Agents For The Intraoperative Detection Of Pancreatic Tumors, Bowen Qi

Theses & Dissertations

Pancreatic ductal adenocarcinoma is highly lethal and surgical resection is the only potential curative treatment for the disease. Tumor-specific intraoperative fluorescence imaging could improve staging and surgical resection, thereby improving prognosis. In the first study, hyaluronic acid derived NPs with physico-chemically entrapped indocyanine green, termed NanoICG, were utilized for intraoperative near infrared fluorescence detection of pancreatic cancer. NanoICG accumulated significantly in an orthotopic pancreatic ductal adenocarcinoma model with safety profile both in vitro and in vivo. To maximize tumor signal, while minimizing signal in healthy pancreas and RES capture of macromolecules, in the next study, we describe the rational …

Affordable Care Act And Preventive Care Usage: A Mixed Method Analysis Of Cardiovascular Care, Brit Peek

Theses & Dissertations

It is a commonly held belief that access to health insurance affects the level of utilization of preventive care services, and thus plays a crucial role in the effective management of avoidable chronic illnesses, decreasing levels of premature mortality, and enabling individuals to live wholesome long lives. Based on this belief, among other goals, the Affordable Care Act (ACA) was designed to increase access to health insurance and related medical services for the population of the United States. This dissertation attempts to identify whether this belief is valid or not by testing whether the usage of preventive care changed between …

Preventive Healthcare Usage In The United States: Does Health Insurance Matter, Diane Rodriguez

Theses & Dissertations

The Centers for Disease Control in the United States has maintained that adults who avoid preventive care services are more likely to suffer from long term chronic diseases because they are not addressed or treated in a timely manner. Examining the effects of providing access to healthcare to uninsured adults and increasing preventive services can help in reducing chronic diseases and enable adults to live longer, healthier lives. The purpose of this study was to identify the relationship between the utilization of preventive health services and socioeconomic factors such as insurance status, race/ethnicity, household income, marital status, education, gender, age, …

The Effectiveness Of Registered Dietitians In Diabetes Case Management, Meghan C. Mclarney

Theses & Dissertations

OBJECTIVE: The objective of this paper is to investigate the effectiveness of diabetes education provided by registered dietitians (RD) in a diabetes case management (DCMs) model, compared to diabetes education provided by RDs in the usual care model (UCM) at an outpatient endocrinology clinic in Omaha, Nebraska. This study hypothesizes that education by RD DCMs will be equal or more efficacious in regards to primary outcomes of A1C and BMI and secondarily, lipid results and adherence (total encounters) when compared to outcomes of UC.

METHODS: This is a cross sectional retrospective review of patients with diabetes (n=946), receiving traditional RD …

Impediments To The Historical Development Of The Clinical Pap Test In The United States: Their Relevance In Optimizing Cervical Cancer Screening In The State Of Qatar, Nikolaos Chantziantoniou

Theses & Dissertations

Three hundred surveys listing 31 questions were distributed amongst women and men at Sidra Medicine, Doha, State of Qatar, to assess knowledge and perceptions of: Cervical cancer (CxCa); preventive Pap test screening; Human Papilloma Virus (HPV) vaccination; and, need for population-based screening. Survey questions captured categorical statistical data through four categories: (1) Socio-demographic; (2) Healthcare Services; (3) Health Literacy; and, (4) Self-efficacy and Perceptions. Hypothesis 1: 12 survey questions pertaining to CxCa and Pap testing revealed 8 statistically-significant dependencies; notably, 70% of respondents were aware of CxCa; however, 31.8% were unaware that CxCa may be curable; 33.7% were unaware …

Maternal Cognitions And The Origins Of Early Sensorimotor Based Play In Infants Born Preterm, Sandra L. Willett

Theses & Dissertations

Maternal cognitions are beliefs, perceptions, and expectations that guide parenting practices. For at-risk infants born prematurely, these maternal constructs may influence the caregiving environment and opportunities for motor experience. The impact of maternal cognitions on motor development in infants born preterm is not well-documented. This three-part dissertation systematically explores: 1) the nature and extent of existing evidence supporting the link between maternal cognitions and motor development of infants born preterm, 2) if maternal perception of infant vulnerability as measured by an adapted Vulnerable Baby Scale (VBS) can be validly and reliably quantified in mothers of infants born preterm and near …

Female Genital Mutilation And Its Medicalizationa Qualitative Study Among Healthcare Professionals And Community Leaders In Kisii County, Douglas Oimeke Mariita

Theses & Dissertations

Background: According to the World Health Organization (WHO), female genital mutilation (FGM) includes all procedures that involve removal of the female genitalia and / or injury to the female genital organs for cultural and / or any other nonmedical reason. The practice poses serious threats to women’s health hence violating their health and rights. FGM, also referred to as genital cutting, is deeply rooted amongst the Abagusii community of Kenya, with 84% of the girls cut as per Kenya Demographic Health Survey report of 2014 and the medicalized form slowly replacing the traditional cut. Overall in Kenya, the medicalized form …

Negative Appendectomy Rate And Associated Factors In Urban Referral Hospitals In Tanzania, Masawa Klint Nyamuryekung’E

Theses & Dissertations

Background: Acute appendicitis is a common surgical emergency. In atypical presentation, making a clinical diagnosis is difficult leading to delays with high perforation rate or misdiagnoses and high negative appendectomy rates. In the urban referral hospitals in Tanzania the baseline perforation rate, negative appendectomy rate, and factors that drive it are unknown. These could serve as measures of performance, and as evaluation parameters of future interventions aimed at improving acute appendicitis case management in Tanzania.

Objectives: The aim of this study was to establish the negative appendectomy rate and associated factors among patients undergoing emergency appendectomy for suspected acute appendicitis …

Prevalence And Outcome Of Asymptomatic Cryptococcal Antigenemia In Art Naive And Art Experienced Hiv Patients In Dar Es Salaam, Tanzania, Charles Mandela Makakala

Theses & Dissertations

Introduction: Cryptococcal meningitis (CM) is a highly fatal disease and contributes to about 20% of all-cause mortality in HIV/AIDS. Sub-Saharan Africa is facing substantial challenges in the treatment of the disease; the focus has been shifted towards prevention of the condition in ART-naive patients with CD4 counts of less than 100 cells/μL. Most studies and interventions have been conducted on ART-naive HIV patients despite there being cases and deaths due to cryptococcal meningitis among ART-experienced patients. Recent studies have shown that although there is an increase in ART coverage among HIV patients, this has not affected the incidence of cryptococcal …

Development Of Local Drug Delivery Systems For Periodontal Disease, Yosif Hassan Almoshari

Theses & Dissertations

Periodontitis is an inflammatory disease induced by complex interactions between the host immune system and pathogens that affect the integrity of teeth-supporting tissues. To prevent disease progression and thus preserve the alveolar bone structure, simultaneous anti-inflammatory and osteogenic intervention is essential. Hence, simvastatin (SIM) and a glycogen synthase kinase 3 beta inhibitor (BIO) were selected as anti-inflammatory and osteogenic agents.

First, SIM is a HMG-CoA reductase inhibitor widely prescribed for hypercholesterolemia. It has been reported to ameliorate inflammation and promote osteogenesis. Its clinical applications on these potential secondary indications, however, have been hampered by its lack of osteotropicity and poor …

Recent Veterans’ Self-Management Of Health During Military To Civilian Life Transition: A Grounded Theory Study, Narda A. Ligotti

Theses & Dissertations

United States Veterans of combat within Iraq and/or Afghanistan return home to face an array of somatic and psychological health concerns. Little was known about how they manage their health after military discharge. The research question for this study was “how do OIF/OEF/OND combat Veterans and their primary support persons manage Veterans’ health at home?” There is little information about these Veterans’ perspective of self-management of health in the home. This study was designed to provide a theoretical understanding of self-management and family support in this population. The Family Management Style Framework (Knafl, Deatrick & Havill, 2012) was used as …

God, I Hope This Part Of My Life Is Over: A Focused Ethnography Of A Correctional Youth Facility’S Therapeutic Climate, Eric Meyer

Theses & Dissertations

Although all prisons have the same goal of isolating offenders from society, the precise strategies used vary from one jurisdiction to the next. Some prisons use means of punishment to gain inmate compliance. Other prisons concentrate their limited resources on rehabilitation. Contained within the following pages are details of a focused ethnography that was completed in a state correctional youth facility that housed males between the ages of 15 and 21 years, all of whom were convicted of violent crimes. This study had the objective of exploring the climate of therapy in this correctional youth facility where rehabilitative programs were …

The Effect Of Emdogain Periodontal Regenerative Material On Inflammation In Periodontal Maintenance Patients, Jessica M. Gradoville

Theses & Dissertations

The purpose of this double-blinded, randomized, controlled clinical trial was to determine if local application of enamel matrix protein derivative (Emdogain:EMD), combined with minimally-invasive papilla reflection is effective in reducing inflammation in periodontal pockets in patients on periodontal maintenance therapy (PMT).Fifty patients diagnosed with advanced chronic periodontitis presenting with a 6-9mm interproximal probing depth were included in the trial. Experimental (EMD; n=24) and control (saline, n=26) therapies were randomly allocated. Roots were treated with mini-flaps and root planing assisted with endoscope evaluation before EMD or saline application. Inflammation was assessed by bleeding on probing (BOP) at baseline, 6-, and 12-months …

Examining Depressive Symptoms Over Time In Women With Coronary Heart Disease, Sydney A. Buckland

Theses & Dissertations

Coronary heart disease (CHD) is the number one killer of women in the US. Women also experience roughly twice as much depression as men, and depression in CHD is associated with increased morbidity and mortality. Despite these facts, women continue to be under-represented in CHD research, and results by gender are not routinely reported.

Screening for depression in this population is problematic due to inconsistent inclusion of somatic symptoms on screening instruments and disagreement about appropriate cutoff scores.

This body of work clarifies the concept of depression in women with CHD, presents a systematic review of the longitudinal literature on …

Evaluation Of The Role Of Microvascular Pathology On Peripheral Artery Disease, Constance Mietus

Theses & Dissertations

Background: Peripheral Artery Disease (PAD) begins with atherosclerotic narrowing of arteries, including those that supply the legs. Individuals with PAD experience pain during walking, which becomes increasingly limiting. Studies from our group and others have shown that a myopathy is present in the skeletal muscle of PAD patients, and is characterized by myofiber degeneration, fibrosis, and remodeling of vessels ranging from 50 – 150 mm in diameter. However, microvascular pathology, particularly of the smallest microvessels (5 – 15 mm in diameter) remains poorly characterized. Furthermore, little is known about the relationships between microvascular architecture, microperfusion, and patient walking performance. We …

Potentially Reduced Exposure Products, Occupational Variations In Smoking, And Hardcore Smokers: Examining Important Elements In The Tobacco Use Spectrum, Raees A. Shaikh

Theses & Dissertations

The purpose of this research was to examine three important aspects of the smoking phenomenon that are, and will remain, important for the future of tobacco control research and policy. First and currently one of the most debated and researched topics in the tobacco research field relates to the group of products regarded by some as the potentially reduced exposure products (PREPs). We studied determinants of use of these products. Second aspect was to examine the socioeconomic subgroup of smokers based on their occupations who might potentially benefit from the use of PREPs and the third stage involved studying the …

Examining The Effects Of Approaches On Reducing Hospital Utilization: The Patient-Centered Medical Home, Continuity Of Care, And The Inpatient Palliative Consultation At The End-Of-Life, Xiaoting Sun

Theses & Dissertations

Background: It has become a national priority to reduce the high health care expenditure in the United States while improving the quality of care. Hospital care is taking up one-third of the healthcare spending, and services offered in hospitals are costly compared to others. Only one-twentieth of the patients with high-needs account for about half of the health care spending. They consuming a high level of hospital services if their conditions are not well-managed in the outpatient settings. Therefore, it is important to examine the effectiveness of the approaches that have the potentials to reduce costly care utilization through improvements …

A Beginner's Guide To Research Using Electronic Health Record Data, Jenenne A. Geske

Theses & Dissertations

Since the passage of the American Recovery and Reinvestment Act in 2009, the use of Electronic Health Records (EHRs) in the healthcare system has increased substantially. Accompanying this surge in EHR usage is a surge in healthcare data and increased opportunities to improve our understanding of health care through research using these data. The use of EHR data for research has many benefits, limitations and considerations. Using data that was originally intended to facilitate billing, insurance, and maintenance of clinical records for research can be fraught with challenges, but they can also be a rich source of information. This paper …

The Effect Of Enamel Matrix Derivative/Papilla Reflection Surgery On The Clinical And Alveolar Bone Outcomes In Periodontal Maintenance Patients, Erica E. Jasa

Theses & Dissertations

The purpose of this study was to determine if local application of enamel matrix derivative (Emdogain; EMD), combined with minimally invasive papilla reflection/root preparation (PR/RP), is effective in improving probe depth (PD), clinical attachment level (CAL), and interproximal bone height (IBH) in persistent 6-9 mm periodontal pockets in patients on periodontal maintenance therapy (PMT). Fifty periodontal maintenance patients with advanced chronic periodontitis presenting with a 6-9 mm interproximal PD were included in study. Experimental (PR/RP+EMD; n=24) and control (PR/RP+S; n=26) therapies were randomly allocated. Roots were treated with reflection of interproximal papillae, root planing assisted with endoscope evaluation, and acid …

Nursing Leaders’ Ethical Decision-Making About Professional Boundaries And Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design, Pamela Scott

Theses & Dissertations

The purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ …

Male Nurses’ Experience Of Gender Stereotyping Over The Past Five Decades: A Narrative Approach, Michael W. Finnegan

Theses & Dissertations

Negative stereotyping of men in nursing has been a chronic problem that has a direct effect on males and detracts from efforts to recruit and retain them. At this time in American history (2018), traditionally male-dominated professions are making significant progress toward the goal of a gender-balanced workplace. However, the opposite is not true. Traditionally female-dominated professions are not attracting or appealing to men. In the nursing profession, the number of male nurses is relatively small and has remained relatively fixed over time. Estimates vary between 6-15 percent, with the current average being approximately 11 percent (American Nurses Association, 2014). …

Complementary Feeding Practices And Their Determinants In Infants And Young Children On Follow Up At A Private Tertiary Hospital In Nairobi, Catherine Muthoni

Theses & Dissertations

Background: More than a third of all deaths in children under five years of age worldwide, are linked to maternal and child under-nutrition. Appropriate complementary feeding is one of the interventions with the greatest potential for reduction of nutrition-related diseases and mortalities, yet uptake of the recommended World Health Organisation (WHO) infant and young child feeding practices in Kenya remains low. Despite provision of nutrition education at Aga Khan University Hospital- Nairobi (AKUH-N), both growth faltering and over-weight trends have been observed, pointing to both under- and over-nutrition.

Objectives: This study investigated caregivers' knowledge , attitude and practice (KAP) of …

Comparison Of The Sofa And Qsofa Scores In Predicting In-Hospital Mortality Among Adult Critical Care Patients With Suspected Infection., Mohammed Said

Theses & Dissertations

Background: Sepsis is global health priority and the commonest cause of death in critical care. SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis, uses qSOFA and SOFA scores in place of the SIRS based definition for better prediction of mortality in patients with suspected infections. Their performance in predicting mortality in critical care units outside high- income countries remains largely unknown.

Objective: We compared the SOFA and qSOFA scores in predicting the hospital mortality of adult critical care patients admitted with suspected infection at the Aga Khan University Hospital Nairobi, Kenya.

Methods: We did a …

Does The Theory Of Reasoned Action Inform The Willingness Of Individuals Undergoing Genetic Testing To Seek Disclosure Of Incidental Findings Related To The Risk For Alzheimer Disease?, Alisa M. Forrest

Theses & Dissertations

Background: In recent years, researchers have increasingly employed genetic testing as a means for understanding and treating diseases like Alzheimer disease, a common progressive disease affecting cognition and behavior. Genetic studies hold the potential for major breakthroughs in treatment of diseases like Alzheimer disease. However, with the increase in the use of genomewide association, microarray, and whole genome sequencing comes the potential for a greater number of incidental findings in genetic research—findings not central to the aim of a study but nonetheless informative about a participant’s health. Although many studies have documented the ethical implications around disclosure of such findings …

The Experience Of Female Veterans’ Transitioning To Post—Active— Duty Health Care, Sarah A. Bradwisch

Theses & Dissertations

Problem Statement: Female veterans are growing in record numbers and are the fastest growing segment of the veteran population in the United States(U.S.). After discharge from the military, female veterans face a difficult challenge in finding quality, efficient, and gender-specific health care following active duty. The growing number of female veterans in the Department of Veterans Affairs (VA) health care facilities has highlighted gaps in access to care and quality of care for female veterans. Methodology: Interpretive phenomenology was used to better understand the meaning of 11 U.S. female veterans’ experiences. Semi-structured telephone interviews and the analytic approach of Martin …

Factors Associated With Cardiac Dysfunction Following Anthracyline-Based Chemotherapy In Adults In A Tertiary Hospital In Nairobi, Joseph Odunga Abuodha

Theses & Dissertations

Introduction: Anthracyclines are known to improve survival in some malignancies, but may also be associated with irreversible cardiotoxicity, which is partly dose dependent. Early detection of cardiotoxicity provides an opportunity for treatment adjustment. Several parameters predict development of clinically manifest cardiac dysfunction. The study aimed to evaluate clinical and echocardiographic parameters which predict development of cardiac dysfunction in a sub-Saharan African population.

Methods: Patients with a diagnosis of cancer and receiving anthracyclines at AKUH,N were evaluated if they met eligibility criteria (≥18years at first anthracycline administration, archived baseline echocardiogram, no prior history of heart disease or use of anthracyclines). …

Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi

Theses & Dissertations

Background: Stroke is a sudden neurological deficit due to a vascular cause, which can be ischaemic, haemorrhagic stroke or another cause. It is a leading cause of disability and long term functional impairment in the world. The definitive management of an acute ischaemic stroke is thrombolysis and/or mechanical thrombectomy, both of which has been shown to improve functional outcome but the utilization remains quite low in most hospitals, especially in Africa. This is due to certain pre-hospital and in-hospital barriers, and these factors have been shown to differ from country to country.

Objective: To determine the pre-hospital barriers that prevent …

The Effect Of Premedication With Intravenous Lornoxicam On Propofol Injection Pain At Induction Of General Anaesthesia In Adults: A Randomised Placebo-Controlled Trial, Dennis Omari Onyancha

Theses & Dissertations

Background: Propofol is widely used for the induction and maintenance of general anaesthesia and offers many key attractive pharmacological qualities that make it suitable for these indications. However, pain on injection is one of its major drawbacks and can be very distressing to patients. There is a paucity of studies that have looked at the effect of lornoxicam on propofol injection pain either as a sole intervention or in combination with any other method.

Primary objective: To determine whether premedication with intravenous lornoxicam had any effect on the intensity of propofol injection pain at induction of general anaesthesia in …

The Effect Of Saline Flush After Rocuronium Bolus On The Proportion Of Patients With Excellent Intubating Conditions In Adult Patients Undergoing Elective Surgery At Akuh-N, Ian Odari

Theses & Dissertations

Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time in which patients are predisposed to hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time, including the timing and the priming techniques, dose changes and use of a flush following the muscle relaxant. All these methods had positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, the plan is to …