Medicine and Health Sciences Commons^™

Gestational Weight Gain, Pregnancy Outcomes, And Use Of Perinatal Health Services, Lujing Zhan

Theses and Dissertations

This dissertation consists of three studies that were undertaken to better understand 1) the role of gestational weight gain (GWG) during early pregnancy on subsequent blood pressure changes and the risk of pregnancy-induced hypertension (PIH), 2) the causal effect of GWG in both early and mid-late pregnancy on the subtypes of preterm births, and 3) the impact of personal capital on the use of perinatal health services (i.e., prenatal care use and preconception care counseling). The first two studies were based on the data from the 1988 National Maternal and Infant Health Survey and the third study employed the data …

Assessing The Structural Validity Of The Measure Of Processes Of Care (Mpoc-20) In Children With Epilepsy, Kariym Christopher Joachim

Electronic Thesis and Dissertation Repository

The goal of this thesis was to determine whether the 20-item Measure of Processes of Care (MPOC-20) questionnaire remains structurally/factorially valid among children with epilepsy, and to propose adaptations if it did not. Establishing the MPOC-20’s structural validity in this population makes it possible to draw conclusions on the potential effects of parent-perceived Family-Centred Care (FCC) on health outcomes within this population. Data came from the Health-related Quality of Life for Children with Epilepsy Study (HERQULES). Confirmatory Factor Analysis (CFA) indicated that the original five factor model fit poorly in children with epilepsy. An exploratory analysis within a CFA framework …

Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington

Doctor of Nursing Practice (DNP) Projects

The purpose of this project was to evaluate the patient experience in the emergency department (ED) and in the inpatient setting while correlating increased throughput and patient outcomes at a suburban Acute Care facility in Ohio. The culture in the organization has lacked accountability and ownership of the patients. The ED admitted length of stay (ALOS) was 358 minutes in the beginning of 2013. For the first time in the organization’s history, the ED ALOS is now typically less than the recommended benchmark of 300 minutes. A report of findings among ED’s surveyed showed the ALOS best practice is 244 …

Implementation Of A Helicobacter Pylori Test And Treat Program In Rural Nepal Facilitated By A Nurse Practitioner Doctor Of Nursing Practice Comprehensive Project Report, Shelley Bloom

Doctor of Nursing Practice (DNP) Projects

There are 30 million people in Nepal, 85% live in rural areas and have access to 15% of health care resources. This deficit in health care resources is supplemented by services provided by non-governmental organizations who organize short-term medical missions. At a rural Nepalese health post 45% of the patients complained of abdominal discomfort. As the prevalence of helicobacter pylori is 50-90% in Southeast Asia, the patients believed that they had helicobacter pylori.

In resource-poor communities, there is a gap between best practices and the care delivered. To decrease the gap in one rural Nepalese health post, a Nurse Practitioner …

Ent Educational Patient Bedside Tool, Alina M. Toma

Master's Projects and Capstones

Early educational and discharge preparations are an advantage to patients, the interdisciplinary team, and hospital. It was determined that lack in communication and coordination among staff members led to inadequate patient teaching, therefore an educational tool that is kept at the bedside may facilitate accountability and smoother transition to home.

The aim of the project is to improve the education of patients with tracheostomies and laryngectomies, and enhance staff communication and coordination by December 2014.

Analysis methods used included Failure Mode Effects Analysis (FMEA), fishbone diagram, process map, and SWOT analysis. The social learning theory is the framework chosen for …

A Comparison Of Clinical Trial And Model-Based Cost Estimates In Glaucoma – The Case Of Repeat Laser Trabeculoplasty In Ontario, Omar Akhtar

Electronic Thesis and Dissertation Repository

Background and objective: For cost-effectiveness analyses (CEA) of glaucoma interventions to be of use they require valid and accurate cost and effectiveness data. Costs remain understudied relative to effectiveness. The impact of cost estimation methods on resultant estimates is unknown in glaucoma. Direct measurement of costs is labour-intensive and expensive. Decision-analytic modelling of costs using literature sources, expert opinion, institutional experience and assumptions provides a quicker, less laborious alternative to empirical costing. A lack of long-term effectiveness data in chronic diseases like glaucoma means that modelling is widespread and inevitable, both for CEAs and budget impact projections. The same problem …

A Critical Analysis Of Infant Mortality In Kalamazoo County, Audrey Jensen

Honors Theses

The following is a review of the state of infant and fetal health in Kalamazoo County in the 21st century. Since infant health is a marker for the effectiveness of health care, this review will analyze the leading causes of infant mortality in Kalamazoo County. Statistical indicators show that Kalamazoo County falls below both state and national IMR averages. The leading causes of infant mortality in Kalamazoo are considered preventable infant deaths. Therefore, this review will make recommendations for the reduction of IMR through the improvement of preventative prenatal healthcare practices.

The Impact Of Prenatal Stress On The Development Of Limbic System Structures, Alyssa Murray

Honors Theses

Stress in early life is well documented as detrimental for the brain’s developmental trajectory, while prenatal stress is minimally explored. In the prenatal period, the placenta prevents much of the mother’s cortisol from reaching the fetus, but the fetus is still exposed to some maternal cortisol, and exposure increases with increasing stress. One neural structure particularly susceptible to stress is the hippocampus. The goal of this review is to address the role prenatal stress may play in damaging the hippocampus, a structure integral to learning and memory functions. Correlations between prenatal stress and a reduction in volume and function of …

Neuroprotective Effects Of Retinal Ganglion Cells By Specific Alpha 7 Nicotine Acetylcholine Receptor Agonists And An Acetylcholineesterase Inhibitor, Sara Kaliszak

Honors Theses

In previous studies from this lab, an alpha7 nACh receptor was found to successfully modulate retinal ganglion cell neuroprotection against glutamate assault when bound to nicotinic acetylcholine receptors, or if an alpha7 nicotinic acetylcholine agonist, such as PNU-282987 was used in in vitro models (Wehrwein et al., 2004; Iwamoto et al., 2013). These in vitro studies support the hypothesis that activation of alpha7 nicotinic ACh receptors triggers neuroprotection against loss of retinal ganglion cells normally induced by excessive glutamate insult. The results from these in vitro studies instigated an in vivo study in our lab using a rat glaucoma model. …

Improving Mri Surface Coil Decoupling To Reduce B1 Distortion, Christian K. Larson

Theses and Dissertations

As clinical MRI systems continue to advance, larger focus is being given to image

uniformity. Good image uniformity begins with generating uniform magnetic fields, which

are easily distorted by induced currents on receive-only surface coils. It has become an

industry standard to combat these induced currents by placing RF blocking networks on

surface coils. This paper explores the effect of blocking network impedance of phased array surface coils on B1 distortion. It has been found and verified, that traditional approaches for blocking network design in complex phased arrays can leave undesirable B1 distortions at 3 Tesla. The traditional approach of …

Impact Of Gestational Exposure To 2,3,7,8-Tetrachlorodibenzo-P-Dioxin On T Lymphocyte Development, Lori S. Ahrenhoerster

Theses and Dissertations

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a ubiquitous environmental contaminant and the best characterized agonist of the arylhydrocarbon receptor (AHR), a transcription factor crucial to the detoxification of numerous xenobiotics. Studies in animals show that TCDD is immunosuppressive in adult exposures, and epidemiological studies have found an association between TCDD exposure and hematologic cancers. Additionally, developmental exposure to TCDD has been shown to increase the likelihood of autoimmunity and to impair immune response to later-life infections. The cells of the immune system are all descended from multipotent hematopoietic stem cells (HSCs) that originate in the fetus. This multipotency, defined as the ability to …

Designing A Mechanical Linkage Capable Of Decreasing Force Transfer From The Facemask To The Protective Helmet When Loading Occurs, Levi Hansen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction

Sports that involve extensive personal contact have a high incidence of injury. The introduction of regulations mandating the use of personal protective equipment in these sports is the most common injury control strategy (Marshall et al., 2002). Negligible attention has been paid to the mechanical linkage between the facemask and helmet as a means of reducing force transfer from the facemask, through the helmet, and to the head and or neck of the athlete.

Methods

A novel prototype mechanical linkage of reasonable simplicity that provides 360° of freedom in motion capable of decreasing force transfer from the facemask to …

Factor Structure Of The Cpt-Ii, Mary Vertinski

UNLV Theses, Dissertations, Professional Papers, and Capstones

The current study investigates the factor structure of the Conners' Continuous Performance Test-II (CPT-II) in four pediatric samples of participants: (a) patients with traumatic brain injury, (b) healthy controls, (c) patients with various clinical diagnoses, and (d) all of the previously mentioned subjects combined. Confirmatory factor analyses (CFA) were used to investigate a one-, three- and four-factor model fit of the data. None of the models examined were an adequate fit for the data; however, it appears that the four-factor model seemed to be the best fitting of the models examined. Failure to find reasonably adequate fit precluded further analyses.

Development Of A Translational, Tissue-Engineered Approach To Replacement Of Myocardial Infarct Scar Tissue, Jason Schulte

All Dissertations

Myocardial infarction (MI) affects nearly 600,000 individuals each year, and the resulting damage initiates a pathophysiological progression towards congestive heart failure (CHF). A shortage of donor organs precludes heart transplantation as a practical solution, and neither surgical intervention nor stem cell therapy have yielded consistent and sufficiently positive results in clinical investigation. To prevent CHF, prospective therapies must target the cause of the maladaptive cardiac remodeling which precedes it--the nonfunctional, dyskinetic infarct scar--and aim to replace it with functional cardiac muscle. Tissue engineering holds promise for the development of novel therapies to either halt or reverse post-MI cardiac remodeling. However, …

The Impact Of Inflammatory And Immune Response-Related Genetic Variants On Prostate Cancer Risk Among Men Of African Descent., Dominique Zilpha Jones

Electronic Theses and Dissertations

Background: In the U.S., prostate cancer (PCA) metastasis is associated with a 5-yr survival rate of 29% and disproportionately affects men of African descent. Single nucleotide polymorphisms (SNPs) may serve as genetic markers to identify individuals at high risk of developing PCA. Methods: We examined main and joint effects of 119 inflammatory and immune response-associated SNPs among men of African descent (535 controls, 279 cases) via logistic regression (LR) and entropy-based-multi-factor dimensionality reduction (MDR) modeling. Results: MDR yielded highly synergistic [(TLR10, TLR6 and IRF3), (TLR2, IRAK4), (IL1R2, IL10, IL10RA)] interaction …

Development Of A Heart Rate Variability Measurement System Using Embedded Electronics, Naresh Kumar Velmurugan

Graduate Theses and Dissertations

Recent advances in embedded electronics have a remarkable influence on the health care system. One of the most important applications is to monitor the health care of the patients at anytime and anyplace. In the last two decades, many researchers have focused mainly on heart rate variability (HRV) measurements. Patient's heart rate variability should be continuously monitored to help them in case of emergency. Under these circumstances, patients are required to have a HRV measuring kit for a constant observation.

The proposed project focuses on the development of a heart rate variability measurement system with the use of embedded electronics. …

Meeting The Needs Of Students With Traumatic Brain Lnjury, Heather K. Koole

Dissertations

School reintegration following pediatric traumatic brain injury (TBI) presents a number of challenges. This dissertation comprises three studies exploring common themes of best practice, training, and supporting success for students with TBI in school settings.

Study 1 reports the results of a survey of 70 speech-language pathologists (SLPs) who responded to questions about their use of clinical activities that described more or less contextualized services. Current literature supports contextualized service delivery as best practice. Findings indicated that 98% of participants reported using at least one contextualized practice. Higher use of contextualized practices was associated with working in schools (compared to …

Biomarker Discovery Of Liver Diseases Using Mass Spectrometry-Based Metabolomics., Xue Shi

Electronic Theses and Dissertations

Metabolomics has emerged as one of the latest of the "-omics" disciplines that can detect metabolite biomarkers in biological samples. The diverse characteristics of metabolites make the analytical platform challenging in metabolomics. Two bioanalytical platforms were developed in this study to investigate metabolite abundance changes under different biological conditions. We first developed a bioanalytical platform that coupled linear trap quadruple - Fourier transform ion cyclotron mass spectrometer (LTQ-FTICR MS) with direct infusion chip-based nano-electrospray ionization (DI-nESI) and applied it to study polychlorinated biphenyls (PCB) effects on non-alcoholic fatty liver disease (NAFLD). We also employed this platform in conjunction with in …

Development And Characterization Of An Autologous Whole Cell Breast Cancer Vaccine, Samantha Leigh Kurtz

Graduate Theses and Dissertations

Approximately 40,000 women will die from breast cancer in the United States in 2014. About 90% of these deaths will be due to metastases, rather than the primary tumor and majority of metastases are due to the recurrence and progression of non-metastatic disease. Current adjuvant treatments, such as chemotherapy and radiation, have severe side effects and may result in overtreatment and drug resistance.

Since greater than 90% of patients are diagnosed between stages I-III and have minimal residual disease after treatment, there is an opportunity to treat patients with an autologous breast cancer vaccine. Autologous vaccines under development have a …

Social Network Analysis (Sna) Of Clark County, Nevada Tuberculosis (Tb) Case And Contact Investigation Data To Determine Pediatric Risk Factors For Disease Transmission, Darin Michael Cozatt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Within the spectrum of childhood (infancy, early childhood, middle childhood, and adolescence), TB is a priority disease, and preventive care is recommended by the American Academy of Pediatrics (AAP)/Bright Futures initiative (AAP, 2008). Within the early childhood stage (15 months to 4 years), TB is classified as "HR2" (high risk 2), behind lead poisoning, which is "HR1" (AAP, 2008), the highest risk within this age range. Within the middle childhood stage (5 to 10 years), TB becomes an HR1. TB is preventable, and targeted screening is the best prevention method. The AAP/Bright Futures initiative further specifies the risk based on …

Lung Cancer Survival Disparities In Nevada, Chima Osuoha

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lung cancer is the leading cause of cancer death in both men and women in the United States. Nevada shows moderate incidence rates of lung cancer for men but high rates for women. Little is known about the lung cancer experience and survival characteristics of the nearly 2000 new cases occurring every year in the State. The purpose of this study was to measure the extent to which geographic area of residency, gender, race, health insurance, social economic status (SES) and stage at diagnosis were associated with survival in patients diagnosed with lung cancer in Nevada. This was a retrospective …

The Efficacy Of Music As A Non-Analgesic Method Of Reducing Pain Perception During Cold Pressor Trials, Amanda Lynn Ziemba

Masters Theses

The purpose of this project was to investigate the impact of differentiated onset of self-selected music on pain perception and pain tolerance during a cold pressor test. Subjects participated in four trials during which music was presented at different points of time in relation to their exposure to the cold pressor test. Results indicated that listening to music prior to and concurrently with the onset of the pain resulted in lower self-reported pain (F(3, 66) :3.25, p < .05). Behavioral results indicated that subjects were able to tolerate an average of 25s longer (F(2.04,44.81): I.56,p > .05.) when music was presented after the onset of painful stimuli. Both results have positive implications for the clinical use of music as …

Retinal Synaptic Function In The Absence Of The On Pathway., Kathryn Marie Heath Fransen

Electronic Theses and Dissertations

Complete Congenital Stationary Night Blindness (cCSNB) is a rare hereditary retinal disorder characterized by abnormal night vision. cCSNB is caused by postsynaptic defects in On bipolar cells (BCs) and is identified by the presence of an electroretinogram (ERG) with a normal a-wave, corresponding to photoreceptor function, and the absence of a b-wave, corresponding to a failure of On BC function. Through the study of genetic mutations in mouse that result in no b-wave ERG phenotypes, several proteins have been identified that play crucial roles in On BC signal transmission. I focused on four mouse models of cCSNB; Nyxnob (Nyctalopin mutant), …

Self-Regulation Theory And Self-Monitoring Of Blood Glucose Behavior In Type 2 Diabetes Mellitus., Jennifer E. F. Ward

Electronic Theses and Dissertations

The present study examined self-monitoring of blood glucose (SMBG) as part of a selfregulatory process of health decision-making using the Self-Regulation Model of illness perceptions, or Common Sense Model. Participants were N=185 individuals with type 2 diabetes from a specialty diabetes clinic prescribed subcutaneous insulin or other injectable diabetes medication at least daily. Collected information included both medical chart data and self-report questionnaires completed prior receiving lab results. Self-care burden was generally high; the modal prescribed times per day of injecting insulin was 4 with modal SMBG recommendations of 3-4 times per day. Participants reported high adherence to prescribed medication …

Development Of A Thin-Film Porous-Microelectrode Array (P-Mea) For Electrical Stimulation Of Engineered Cardiac Tissue., Hiren Vrajlal Trada 1977-

Electronic Theses and Dissertations

Electrical stimulation has been increasingly used by research groups to enhance and increase maturation of cells in an engineered cardiac tissue (ECT). Current methods are based on using off-the-shelf wires or electrodes to deliver a stimulus voltage to the in-vitro tissue in culture medium. A major issue with this approach is the generation of byproducts in the medium due to the voltage levels required, which are typically in the range of 5V-10V. No solution currently exists that can accomplish electrical stimulation of cells in an ECT at a low voltage level. Therefore, in this study a novel, porous, thinfilm, microelectrode …

Boundary Contour Based Surface Representation., Yong Su

Electronic Theses and Dissertations

We receive most information about our surrounding space and objects through the eyes. To reconstruct the 3D space and objects in the visual system from the 2D retinal images, surface representation must be a critical intermediate stage in the visual processing stream. It is hypothesized in the dissertation that the visual system represents textured surface by a border-to-interior strategy: boundary contours would be encoded first and then border-ownership assignments would be resolved. This process would solve the related problems such as figure-ground segregation, surface depth relationship, occlusion, transparency, etc. As a result, the boundary contours of the surfaces would be …

The Effect Of Spinal Cord Injury On Vagal Afferents., April N. Herrity

Electronic Theses and Dissertations

Spinal cord injury (SCI) is a significant public health concern that leaves patients with a multitude of life-long disabilities. Major complications of SCI apart from paralysis, include deficits in bladder and bowel function. Lower urinary tract dysfunction continues to remain a top priority issue affecting quality of life for this population. The majority of visceral organs receive a dual sensory innervation from both spinal nerves as well as the vagus nerve. Following SCI, the vagus nerve is a potential pathway through which information from regions below the level of a spinal injury can travel directly to the brainstem, bypassing the …

An Examination Of The Relationship Between Sense Of Coherence, Engagement In Health Behaviors, And Individual Coping Style., Dean Todd Misener 1973-

Electronic Theses and Dissertations

Stress is a pervasive issue among traditional college students; affecting their choice in health behaviors, and overall academic performance. What is not clear is why some students, despite the pervasiveness of stressors are able to do well in school and maintain/improve their health, while other students struggle to maintain their health and do poorly in school. Aaron Antonovsky theorized that when confronted with a stressor a person with a high sense of coherence (SOC) will be motivated to cope, believe the challenge is understood and that the necessary resources to cope with the stressor are available. Overall, Antonovsky theorized that …

Shape/Image Registration For Medical Imaging : Novel Algorithms And Applications., Ahmed Magdy Shalaby 1982-

Electronic Theses and Dissertations

This dissertation looks at two different categories of the registration approaches: Shape registration, and Image registration. It also considers the applications of these approaches into the medical imaging field. Shape registration is an important problem in computer vision, computer graphics and medical imaging. It has been handled in different manners in many applications like shapebased segmentation, shape recognition, and tracking. Image registration is the process of overlaying two or more images of the same scene taken at different times, from different viewpoints, and/or by different sensors. Many image processing applications like remote sensing, fusion of medical images, and computer-aided surgery …

Modulation Of The Ovarian Cancer Humoral Response By Tumor-Derived Exosomes., Carolyn Denise Roberson

Electronic Theses and Dissertations

The pathogenesis of epithelial ovarian cancer is complicated by its diagnosis during the latter stages of the disease resulting from lack of symptoms or from presence of symptoms that mimic other conditions. Because of the often fatal prognosis by the time of actual detection, efforts are being made to better understand the host immune response to ovarian cancer. In this study, the contributions of the humoral immune response were investigated by focusing on the role of tumor-derived exosomes and their ability to modulate humoral immune responses. First, ovarian cancer patient-derived free circulating antibodies were investigated for immunoreactivity to patient antigen. …