Digital Commons Network^™

Factors Associated With Omani’S Schoolteachers’ Reporting Behavior Of Suspected Cases Of Child Abuse And Neglect, Zeinab N. Alazri

Theses & Dissertations

Child abuse and neglect is a global problem that can result in severe negative consequences for victims and their societies. Numerous initiatives have been launched by the United Nations Children's Fund (UNICEF) to combat this problem. Recently, Sultanate Oman, an Arab country, has mandated schoolteachers to report suspected abuse and neglect cases to comply with UNICEF's recommendations. As schoolteachers spend a great deal of their time with children, they are in a good position to recognize and report suspected abuse and neglect cases so the victims can get the needed help and treatment. There is a dearth of information about …

Intention To Breastfeed: Breastfeeding Attitudes, Norms, Self-Efficacy, Social Support Network And Community Resources Of African American, Low-Income, Emerging Adult Women, Pregnant For The First Time, Sara E. Brown

Theses & Dissertations

African American (AA) women continue to have the lowest rates of breastfeeding. This continues to create a health disparity even though breastfeeding is extensively recognized in the scientific and health care communities as the optimal feeding choice for infants. This study examined the relationship between the external variables (social support network and community resources) and the explanatory variables (attitudes, norms, and perceived self-efficacy) and intention to breastfeed, for the AA, first time, low-income, emerging adult pregnant woman. The Integrated Behavior Model (IBM) was used as the theoretical framework to guide this study in better understanding the variables influencing breastfeeding intention. …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji

Theses & Dissertations

Refugee mothers are at an increased risk of suffering from stress and mental health conditions during the first year after giving birth to a child. The objective of this study is to enhance the early identification of treatable mental health conditions among perinatal women living within humanitarian settings. The central hypothesis is that a culturally specific approach can be helpful for the long-term success of mental health efforts. In this study, we use qualitative interview methods to understand the cultural paradigms and predisposing factors for perinatal depression related to being a Syrian refugee in Lebanon during the COVID-19 pandemic. In …

Post-Transplant Hepatic Graft Fibrosis In Pediatric Liver-Inclusive Transplant Recipients, Hanh D. Vo

Theses & Dissertations

Hepatic graft fibrosis is a common histologic finding following pediatric liver transplant (LT) that may affect the long-term graft outcome. Hence, it is essential to identify hepatic graft fibrosis at a stage where fibrosis is not yet clinically apparent but has the potential for progression to initiate appropriate intervention and prevent its progression. Liver biopsy is the gold standard for fibrosis staging, but it is invasive, requires general anesthesia in children, and has potential complications. Our long-term goal is to implement non-invasive tests to assess and monitor the progression of hepatic graft fibrosis in liver-inclusive transplant children. The work presented …

Development Of Macromolecular Prodrug Of Sinomenine For The Treatment Of Rheumatoid Arthritis, Roshni Mukundan

Theses & Dissertations

Inflammation is a natural response of the body to infections or any potential threat to the body. But, sometimes the immune system attacks its own body causing persistent inflammation leading to inflammatory diseases. One of the common chronic inflammatory diseases is rheumatoid arthritis (RA) which causes inflammation of the synovial membrane. The current treatments for RA are effective in controlling the symptoms but they come with severe side effects and economic burden. Further, the management of pain is still a problem with these drugs. Sinomenine is a natural alkaloid obtained from the Chinese medicinal plant Sinomenium acutum that has been …

Insights Into Cutaneous Squamous Cell Carcinoma Pathogenesis And Metastasis Using A Bedside-To-Bench Approach, Marissa Lobl

Theses & Dissertations

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer, affecting 1,000,000 people in the United States annually and causing approximately 9,000 deaths. SCC and basal cell carcinoma are the most common types of skin cancer arising in the superficial squamous cells or deeper basal cells of the epidermis, respectively. SCC is more likely to invade and metastasize, while basal cell cancer tends to grow locally. While the majority of cases of SCC are cured by surgery alone, approximately 2-5% of SCCs metastasize, at which point outcomes may be poor. Specific patient groups, particularly immunosuppressed patients, have a …

Use Of Telehealth In Home-Based End-Of-Life Care For Children In Rural Regions, Meaghann S. Weaver

Theses & Dissertations

A national shortage in pediatric-trained providers results in certain geographies, primarily rural, where children with special needs are not able to access home-based care at their end-of-life. Advances in technology have made the use of telemedicine a potential modality for palliative care subspecialty clinicians to provide clinical care and support for adult-trained hospice teams. This dissertation utilizes four approaches to consider telehealth as an unexplored opportunity in care delivery: (1) a systematic review of telehealth measures and instruments to select the Technology Acceptance Model as a validated metric of telehealth acceptance uniquely now applied to pediatric care; (b) a pilot …

A Collection Of Research In Transplantation Surgery: The Importance Of Assessing Outcomes In A Field Dependent On The Availability Of Limited Resources, Amy J. Hargrove

Theses & Dissertations

This thesis is a collection of three independent projects related to transplantation surgery. In summary, project I involves an assessment of long-term quality of life outcomes of intestinal transplantation in pediatric patients who are now in adulthood, with comparison to other solid organ transplant patients. Health related quality of life surveys were completed in 14 adult patients who underwent intestine, liver, or kidney transplants as children. Project II evaluates pre-surgical characteristics of patients undergoing liver transplant to assess predictive factors for the need of venovenous bypass utilization intraoperatively by assessing trends at the University of Nebraska Medical Center in 95 …

Proof Of Concept: The Use Of Renal Biomarkers In Critically Ill Pediatric Patients For Therapeutic Drug Monitoring, Christopher Lee Shaffer

Theses & Dissertations

Acute kidney injury (AKI) is a serious and common complication in critically ill pediatric patients. The incidence of pediatric AKI continues to increase, especially in patients who undergo surgical correction of congenital heart defects. Serum creatinine and urine output are the most commonly used tools to assess renal function, with international guidelines standardizing AKI-definitions based upon these parameters. However, changes in serum creatinine can occur 24 hours or later after a renal insult event, delaying the diagnosis and potential interventions to reverse injury. It is critical to identify endogenous renal biomarkers within the pediatric population that are both timely and …

The Effect Of Simvastatin On Periodontonal Inflammation In Periodontal Maintenance Patients, Devin L. Christiansen

Theses & Dissertations

The purpose of this analysis of inflammation markers from a double blinded, randomized, controlled clinical trial was to determine if local application of simvastatin, combined with minimally invasive papilla reflection/root preparation (PR/RP) is effective in reducing markers of inflammation: 1) bleeding upon probing (BOP), 2) tissue inflammatory / anti-inflammatory gene activation (rt-PCR) and 3) corresponding gingival crevicular fluid (GCF) protein production in non-resolving 6-9 mm periodontal pockets in patients on periodontal maintenance therapy (PMT). Fifty periodontal maintenance patients diagnosed with advanced chronic adult periodontitis presenting with a 6-9 mm interproximal PD were included in study. Experimental (PR/RP+SIM; n=27) and control …

Apixaban To Prevent Thrombosis In Adult Patients Treated With Asparaginase, Krishna Gundabolu

Theses & Dissertations

The outcomes of pediatric acute lymphoblastic leukemia (ALL) have improved dramatically after intensification of the multi-agent chemotherapy backbone over a period of time starting from 1960’s, and asparaginase (ASP) is an important part of this success story. Adoption of such strategy in adult ALL and other high grade lymphoid neoplasms had been difficult due to higher anticipated toxicities including thrombosis. Many thrombosis prevention strategies including antithrombin (AT) replacement, Enoxaparin, unfractionated heparin (UFH) was studied but there is no firmly established evidence-based approach yet. We report the safety and efficacy of thrombosis prophylaxis with apixaban 2.5 mg orally twice daily for …

Urinary Bile Acid Indices As Prognostic Biomarkers For The Complications Of Liver Diseases, Wenkuan Li

Theses & Dissertations

Hepatobilary diseases cause the accumulation of toxic bile acids (BA) in the liver, blood, and other tissues, which may lead to an unfavorable prognosis. In this study, we compared the urinary BA profile in 257 patients with hepatobilary diseases during a 7-year follow-up period. We investigated the use of the urinary BA profile to develop logistic regression models to predict the prognosis of hepatobiliary diseases in terms of developing disease-related complications, especially for ascites. The urinary BA profile was characterized by calculating BA indices, which quantify the composition, metabolism, hydrophilicity, and toxicity of the BA profile. All patients had high …

The Effect Of Locally Applied Simvastatin On Clinical Attachment Level And Alveolar Bone In Periodontal Maintenance Patients, Lauren Krell

Theses & Dissertations

The purpose of this double-blinded, randomized, controlled trial was to determine if the local application of simvastatin (SIM), combined with minimally invasive papilla reflection and root preparation (PR/RP), is effective in improving clinical attachment level (CAL), primary outcome measure; probing depth (PD) reduction; increasing interproximal bone height (IBH); and reducing bleeding on probing (BOP) in persistent 6-9 mm periodontal pockets in patients receiving periodontal maintenance therapy (PMT). Fifty patients with Stage III, Grade B periodontitis (AAP, 2018) presenting with a 6-9 mm interproximal PD with a history of bleeding on probing (BOP) were included in the study. Experimental 2.2 mg …

Health Service Utilization And Expenditure In Cardio-Metabolic Conditions In The United States Adults, Kavita Mosalpuria

Theses & Dissertations

Metabolic syndrome is multicomponent risk factor for cardiovascular diseases (CVD) and type 2 diabetes that reflects the clustering of at least 3 cardiometabolic risk factors, among hypertension, impaired glucose regulations, hypercholesterolemia, and obesity. CVD are the leading cause of death in the U.S. CVD occur at earlier age and is a major cause of death and disability among people with diabetes. As compared to Japan, 13.3% to 44% of the excess CVD mortality in the U.S. can be explained by the metabolic syndrome. The prevalence of metabolic syndrome was 34.3% in 2007 to 2014 and it increases with age. Metabolic …

The Prevalence Of Albuminuria In Children With Chronic Kidney Disease In Two Tertiary Hospitals In Nairobi, Kenya, Mercy Wambui Githumbi

Theses & Dissertations

Background: Chronic kidney disease (CKD) is a major health problem globally. In Africa, the burden in children remains unclear and is often reported as low. In developing countries, it is mainly due to secondary causes and nephrotic syndrome, while in the developed countries it is mainly due to congenital anomalies of kidney and urinary tract (CAKUT). The Kidney Disease: Improving Global Outcomes (KDIGO) defines CKD and utilises glomerular filtration rate (GFR) and albuminuria as an additional factor. Albuminuria is significant in prognostication of individuals with CKD as it is a marker of kidney damage. It is correlated with outcomes including …

Health-Related Quality Of Life Of Children With Gastroesophageal Reflux Disease After Nissen Fundoplication And Gastrostomy Tube Insertion, Felix Wafula Musibi

Theses & Dissertations

Background: Gastroesophageal reflux disease (GERD) negatively impacts the health-related quality of life (HRQoL). Nissen fundoplication is done when medical treatment fails. Goal of therapy is to eliminate symptoms and improve quality of life.

Justification: HRQoL is a key indicator that we can use to evaluate the impact of our interventions so that we can make evidence-based decisions and advice our patients appropriately based on the outcomes of these interventions.

Objectives: The primary objective was to assess the HRQoL of children with GERD after Nissen fundoplication alone or Nissen fundoplication and gastrostomy tube insertion.

Methods: Design- Observational …

Prevalence And Social Determinants Of Alcohol Use Disorders In Patients Attending Primary Care Clinics In Nairobi Kenya, Verah Kabwayi

Theses & Dissertations

No abstract provided.

Secondary Hyperparathyroidism And Its Clinical And Biochemical Associated Factors In Patients On Maintenance Hemodialysis In Dar Es Salaam, Doris Samwel

Theses & Dissertations

Background:

Chronic kidney disease affects 13.6% of adult people in Tanzania. Secondary hyperparathyroidism is associated with an increase in disability-adjusted life years, cardiovascular mortality, and all-cause mortality worldwide especially in patients on maintenance hemodialysis. Justification: In Tanzania, there is a lack of prevalence data of secondary hyperparathyroidism and the factors associated with it. Knowing the factors associated with it will help in the early screening of our patients and intervene early before its complications arise.

Objectives:

This study aimed to assess the magnitude of secondary hyperparathyroidism and its association with clinical and biochemical variables and further to measure the association …

Clinicians’ Perceptions Of Pediatric Assent For Invasive Bedside Procedures At Three Tertiary Referral Hospitals In Nairobi County, Kenya., Grace Petrine Oyito Omondi

Theses & Dissertations

Background: The medical profession is built on the foundation of morals and ethics guided by principles of beneficence, non- maleficence, autonomy and justice. In order for an individual to be sufficiently autonomous, the value of information is indispensable. The information allows the patient to make an informed decision concerning their healthcare. The patient then gives an informed consent or assent as is applicable to the pediatric population. Majority of the studies surrounding pediatric assent revolves around obtaining it for research. There is a paucity of literature in regards to pediatric assent for clinical treatment more so as regards clinicians’ …

Clinical Presentations Associated With Adverse Outcomes Among Patients Admitted With Dengue At A Tertiary Hospital In Dar Es Salaam., Nakiganda John Mkasa

Theses & Dissertations

Introduction

Dengue is one of the most important mosquito viral borne infections caused by four viral serotypes (DENV 1-4). In 2019 WHO named dengue as among the top ten global threats due to an increase in the number of cases worldwide. Tanzania is among the countries in Africa with multiple outbreaks; 2010, 2013-2014, and 2019. Dengue has variable clinical presentations ranging from nonspecific such as fever, joint pain, and fatigue to more serious such as hemorrhage and shock. Dengue can result in adverse outcomes such as ICU admissions and prolonged hospital stays. Clinical presentations associated with adverse outcomes have been …

The Utility Of An Initial Point-Of-Care Lactate In Predicting In-Hospital Mortality Among Adult Patients With Sepsis And Septic Shock At The Emergency Department Of A Tertiary Hospital In Nairobi, Gicheru B. Nyachira

Theses & Dissertations

Background: Sepsis is a leading cause of death and now a global health priority. Rapid identification, diagnosis and intervention can result in reduced in-hospital mortality. Elevated lactate has been shown to be a strong predictor of in-hospital mortality. However, the optimal cut-off has not been well defined. Identification of the optimal Point-of-Care (POC) lactate cut off that best predicts in-hospital mortality can therefore be used to rapidly risk stratify patients with suspected sepsis and septic shock presenting to the emergency department allowing for immediate intervention.

Objective: To determine the lactate cutoff from an initial Point-of-Care lactate result from a GEM …

Immunophenotypic Expression Profile Of Multiple Myeloma Cases At A Tertiary Hospital In Nairobi, Kenya, Isabella Chelagat Mengich

Theses & Dissertations

Background; Multiple myeloma (MM) is a heterogeneous disease with variable patient outcomes ranging from indolent to aggressive disease. GLOBOCAN data places Kenya amongst the top five African countries for MM incidence and MM-related mortality. Aberrant expression of CD56, CD117, Cyclin D1 and Ki-67 on neoplastic plasma cells has been demonstrated to be useful in disease prognostication. However, majority of the data on MM comes from western countries. The significance of expression of this markers is uncertain in our population. The aim of this study was to determine the immunophenotypic expression profile of CD56, CD117, Cyclin D1 and Ki-67 in a …

Knowledge, Attitudes And Practice Of Venous Thromboembolism Risk Assessment Among Surgical Doctors In Tanzania, Biswalo Mugeta Yango

Theses & Dissertations

Introduction

Surgical patients are at increased risk of venous thromboembolism due to the nature of their conditions and treatments. The incidence ranges from 61.3% to 64.9% in developed countries, compared to 43% in Africa. Although venous thromboembolism is fatal, it is potentially preventable. Physician-implemented risk assessment models reduce events by 70%. No country in sub-Sahara Africa has implemented a national venous thromboembolism risk assessment guideline. The subsequent burden is probably a reflection of low awareness and knowledge, negative attitudes, and substandard practice among physicians towards risk assessment. Justification In the current study, we assessed Tanzanian surgical doctors' knowledge, attitudes, and …

Clinical Consequences And Determinants Of False Positive Blood Cultures In Adult Hospitalized Patients, Sidra Liaquat

Theses & Dissertations

Blood cultures are the gold standard for detecting blood stream infections. However, in the US, 0.6-6% of all blood cultures get contaminated leading to adverse clinical outcomes such as unnecessarily prolonged hospital stay and antibiotic therapy. Using electronic medical records, we explored the clinical outcomes and patient-specific risk factors of contaminated blood cultures in an era where rapid blood culture testing was being utilized to provide blood culture results within hours. Rapid blood culture test results can help clinicians in early and more effective management of patients with contaminated blood cultures, thus improving clinical outcomes. We also studied the impact …

The Effect Of Obstacle Intervals On Foot Integrated Pressure And Obstacle Negotiation Strategy, Zhuo Wang

Theses & Dissertations

When stepping over a single obstacle, despite of some spatiotemporal parameter changes, the impulse of the leading and trailing leg stays the same. This is considered an efficient obstacle avoidance strategy. However, research has shown that the strategy of multiple obstacles negotiation is different from a single obstacle crossing. Would this efficient strategy still exist during multiple obstacles negotiation? This study attempted to answer this question. Nineteen healthy young adults were recruited in this study. Each participant was required to complete 15 trials under 3 conditions: one-step, two-step, and three-step intervals. Data were collected for foot integrated pressure (FIP), walking …

Is The Walking Pattern Similar Between Slope Walking And Obstacle Negotiation?, Jiani Lu

Theses & Dissertations

Studying biomechanical characteristics of human motion sheds light on the motor control strategies in the central nervous system. Slope walking and obstacle negotiation appear to have some similarities in control strategies based on subjective observation, but these two motions have never been compared objectively in biomechanics literature. This study aimed to investigate the similarities between obstacle negotiation and slope walking in kinematics and muscle activity. The similarities were determined by the correlation of the maximum heel elevation and muscle co-activation index between obstacle negotiation and inclined treadmill walking. The strength of correlation was compared in four different pairs of conditions: …

An Explanatory Sequential Mixed Methods Nutrition And Physical Activity Intervention Study On Changes In Knowledge, Self-Efficacy, And Outcome Expectations Of Fathers, Sarah Hortman

Theses & Dissertations

Overweight and obesity rates are a continuing concern resulting in poor health outcomes and annual healthcare costs in the billions of dollars. An upstream approach of health promotion is critical to change the focus from treatment and management to prevention of chronic disease. Preventing chronic disease through evidence-based health promotion practices incorporating educational interventions aimed at dietary and physical activity behaviors will preclude negative health outcomes including cardiovascular disease, type 2 diabetes, and hypertension.

The family environment is an important consideration in the prevention of chronic disease including obesity. Parents are role models for their children, including fathers who are …

From Pipeline To Health Equity: A Case Study Of Health Profession Pipeline Students, Sonja F. Tutsch

Theses & Dissertations

Health equity arises from the social determinants of health. Access to culturally and linguistically competent health services is a major determinant of health. Despite health profession pipeline intervention efforts spanning more than 50 years, diversity in the health professions has not been achieved, and disparities in health among members of minority groups remain prevalent. Health profession pipeline programs came into existence to help grow minority representation among health professionals serving in underserved, disadvantaged, communities, where disparities in health are most prevalent. One underlying assumption was that minority students from underserved communities understand the needs of these communities best and are …

The Driving Simulator Visual Field In Glaucoma – A Novel Task To Test Available Field Of View, Deepta Ghate

Theses & Dissertations

Glaucoma causes peripheral vision loss and impaired driving performance. We developed a novel driving simulator visual field task (DSVF) in a panoramic driving simulator to map the available field of view under different perceptual task loads in naturalistic settings. Our hypothesis is that “available field of view” will decrease with increasing task load in both glaucoma subjects and controls. This is a cross-sectional study with 28 glaucoma subjects and 19 controls. DSVF (60̊ x 20̊ visual field at 2.5 m) was tested in a high-fidelity interactive driving simulator in 4 different scenarios: a) no distractions b) no driving condition with …