Medicine and Health Sciences Commons^™

Assessing Change In Baseline Preparedness Knowledge In Long-Term Care Facilities, Heidi L. Wheeler

Theses & Dissertations

With much of the focus and federal resources in recent history going to support hospital preparedness, long-term care facilities have been left behind even though they house one of our most vulnerable populations. Few regulations and standards have required these facilities to keep pace with preparing for an increasingly volatile environment and aging society. This is changing with the proposal of new federal standards and regulations requiring more thorough and robust preparedness planning. These new requirements do not have to be overwhelming or burdensome to facilities but can be included quite simply into routine planning and training. This study looks …

Psychometric Properties Of Obstructive Sleep Apnea Screening Measures In Patients Referred To A Sleep Clinic, Jennifer N. Miller

Theses & Dissertations

Background: Obstructive Sleep Apnea (OSA) contributes to all-cause and cardiac mortality. There are no current guidelines for OSA screening in outpatient settings. An American Academy of Sleep Medicine task force is focusing on improving detection and categorization of OSA symptoms and severity to promote screening, assessment, and diagnosis of the disorder. The purpose of this study was to identify the psychometric properties of three self-report OSA screening measures (Berlin, Epworth Sleepiness Scale (ESS), STOP Bang) and an objective portable sleep monitor (PSM) compared to apnea-hypopnea index (AHI) levels (≥5, ≥ 15, and ≥ 30) from polysomnogram (PSG).

Methods: …

Local Minocycline To Reduce Future Inflammation And Bone Loss In Periodontal Maintenance Patients, Jeffery S. Jensen

Theses & Dissertations

The objectives of this study were to compare the effect of SRP+MM versus SRP alone on inflammatory cytokines, interleukin (IL)-1β and IL-1 receptor antagonist (ra), found in gingival crevicular fluid (GCF) and saliva, and correlate IL-1 values with clinical outcomes over a 2-year period of PMT. Fifty-five patients with an initial posterior pocket ≥5 mm and history of bleeding on probing (BOP) were randomized to test (SRP+MM, n=27) and control (SRP, n=28) groups. Clinical measurements and GCF samples were done at baseline and 24 months. SRP+MM or SRP were provided at 6-month intervals. IL-1β and IL-1ra were measured in GCF …

Mutations Affecting Epigenetic Regulators And Their Role In Peripheral T-Cell Lymphomas, Chao Wang

Theses & Dissertations

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of generally aggressive lymphoid malignancies, accounting for 10-15% of all non-Hodgkin lymphomas. Angioimmunoblastic T-cell lymphoma (AITL) represents approximately 20% of all PTCLs and is recognized as a distinct entity. Accurate diagnosis and classification of PTCL remain challenging. With the exception of ALK+ ALCL, patients with PTCL generally have a poor prognosis with standard chemotherapy and even with the availability of many novel drugs, including HDAC inhibitor (romidepsin and belinostat), gemcitabine, and bortezomib. Therefore, deciphering the pathogenesis of this group of diseases is needed to identify novel treatable targets for better therapeutic intervention. …

The Pathogenesis Of Natural Killer/T Cell Lymphoma, Bei Jiang

Theses & Dissertations

Extranodal natural killer/T-cell lymphomas (NKTCL) are uncommon lymphomas with poor prognosis. In order to gain a better understanding of the molecular pathogenesis of NKTCL, we obtained and compared the global gene expression profile, global somatic mutation profile, and global methylation profile of normal NK cells, malignant NK cell lines, and NKTCL patient samples. We showed that the JAK-STAT pathway was constitutively activated in NKTCL through the cooperation between activation of signal transducer and activator of transcription proteins (STATs) via activating mutations and inactivation of STAT suppressor protein suppressor of cytokine signaling 6 (SOCS6) through promoter hypermethylation. Activating STAT3 and STAT5B …

Antioxidant And Anti-Inflammatory Nutrients On Lung Function In Chronic Obstructive Pulmonary Disease, Jessica M. Hinds

Theses & Dissertations

Introduction Veterans are three times more likely to develop chronic obstructive pulmonary disease (COPD) than the general population. This is likely due to increased use of tobacco and exposure to environmental risk factors. Nutritional intake has been linked to COPD, and veterans report unique barriers to improving their eating habits.

Purpose The primary outcome of this study was to examine the relationship between antioxidant and anti-inflammatory nutrient intake and lung function in veterans with COPD. It was hypothesized that a higher intake of lutein + zeaxanthin, ß-cryptoxanthin, lycopene, retinol, ɑ-carotene, ß-carotene, vitamin C, vitamin D, ɑ-tocopherol, omega-3, zinc and selenium …

The Role Of Inflammatory Monocytes In Post-Influenza Methicillin-Resistant Staphylococcus Aureus Pneumonia, Karl J. Fischer

Theses & Dissertations

Secondary bacterial infections following influenza can lead to poor clinical outcomes and mortality. It is widely accepted that susceptibility to secondary bacterial infections is attributable to a suppressed innate antibacterial immunity. In contrast, a dysregulated host inflammatory response may also contribute to disease severity. Inflammation induced by viral infection alone significantly affects lung pathology, potentially exacerbating the destruction of the respiratory tract. Interestingly, the role of inflammatory mediators such as inflammatory monocytes have been extensively studied during influenza infection alone; however, their role during secondary bacterial infection are still not fully established. The objective of this study was to analyze …

Mobility Of Individuals With Multiple Sclerosis And The Influence Of Physical Therapy, Brenda L. Davies

Theses & Dissertations

One main purpose was to explore the compensatory gait strategies of individuals with multiple sclerosis (MS). To address this purpose, we quantified the mechanical work generated by the lower extremity joints during walking. The outcomes from this investi­gation suggested that individuals with MS redistribute positive mechanical work during walking to the hip in order to compensate for a reduced ability of the ankle to generate positive mechanical work. Additionally, we also explored the motor control of the ankle as a potential contributing factor to the mobility limitations of individuals with MS. The outcomes from this investigation indicated that individuals with …

Diet Quality Of Adolescent Females In Relation To Disease Risk, Heidi Pfeifer

Theses & Dissertations

Background: Many people are living longer with chronic diseases costing billions in healthcare costs every year. Many things influence the risk of chronic diseases but one easily modified risk factor is diet. Alternate Healthy Eating Index (AHEI) and Alternate Healthy Eating Index-2010 (AHEI-2010) diet quality indexes have been associated with chronic disease risk but has not been studied in disease risk in adolescents.

Purpose: The purpose of this study is to look at adolescent girls’ diet quality scores compared with known adult values associated with chronic diseases and risk of mortality.

Methods: This is a secondary analysis of a previous …

Proportion Of Heart Failure Patients Who Meet Criteria For Malnutrition Upon Hospital Admission Based On Aspen Guidelines, Sarah L. Johnson

Theses & Dissertations

Background: Current research estimates that approximately 50 percent of heart failure patients are categorized as malnourished. Heart failure patients are at increased risk of malnourishment due to increased catabolic processes that increase resting energy expenditure, decrease appetite, impair nutrient absorption, and lead to unintentional weight loss. The goal of standardized diagnostic criteria is to identify malnutrition early for more effective treatment. Current studies suggest the association of early diagnosis and nutrition intervention with increased positive patient outcomes and improved quality of life for heart failure (HF) patients. However, the proportion of patients with HF who meet criteria for malnutrition at …

Block Copolymer Based Magnetic Nanoclusters For Cancer-Theranostics: Synthesis, Characterization And In Vitro Evaluation, Hemant M. Vishwasrao

Theses & Dissertations

“There is plenty of room at the bottom”. In this visionary lecture in 1959 Prof. Richard Feynman spoke of the interesting ramifications of working with matter at the atomic scale. Since then, scientists have worked relentlessly towards realizing his vision. The influence of nanobiotechnology on material science and polymer chemistry has given rise to a new field called ‘theranostics’, combining drug delivery and diagnostics within the same nanostructures, thereby enabling simultaneous diagnosis, targeted drug delivery and continued therapy monitoring. Iron oxide nanoparticles (MNPs) are one such class of MRI contrast agents that can be converted into theranostic nanomedicines for cancer …

Color Stability, Physical Properties And Antifungal Effects Of Zro2 And Tio2 Nanoparticle Additions To Pigmented Polydimethylsiloxanes, Mazen Alkahtany

Theses & Dissertations

Introduction: Color changes, physical degradation and fungal infections are potential challenges to the longevity of polydimethylsiloxane (PDMS) elastomers. The purpose of this study was to evaluate potential improvements in color change, physical properties and anti fungal properties of PDMS loaded with TiO2 and ZrO2 nanoparticles.

Methods: 1% weight of 40 nm or 200 nm diameter TiO2 or ZrO2 nanoparticles were mixed into PDMS with 2% functional intrinsic yellow pigment and polymerized. Control materials contained 13% weight 200 nm silica. Samples were exposed to either 3000 hours of UVB radiation (200 μW/cm2) or darkness. Color parameters L*a*b* and ΔE*, ultimate tensile …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Gross Anatomy Dissection Videos: Effect On Student Dissection Confidence And Laboratory Examination Scores, Kevin J. Selting

Theses & Dissertations

As medical colleges across the world experience cadaver shortages, faculty shortages, and decreased time allotted to teaching gross anatomy, a need for different teaching modalities has emerged. New ways of teaching are being studied to optimize efficiency and to acquire the same, or better, student outcomes as before the previously mentioned variables became prevalent. This was the stimulus for our research. Dissection videos were made, closely adhering to the dissections performed by Physician Assistant, Physical therapy, and Medical students at the University of Nebraska Medical Center (UNMC). The current Gross Anatomy course at UNMC involves four written examinations covering material …

Global Trends In Cancer Burden Based On Geographic Location, Socio-Economic Status And Demographic Shift, Sanjib Chowdhury

Theses & Dissertations

The global burden of cancer is rising at an alarming rate. It remains as one of the top causes of morbidity and mortality worldwide. It is predicted that within 2020, there will be 15 million new cases of cancer in the world, with cancer-related deaths increasing to 12 million. According to the World Health Organization (WHO), the global cancer burden is expected to surge 57% worldwide in the next 20 years. A significant rise in cancer burden will occur in the low-income and middle-income (developing) countries not only due to demographic shifts, but also by the transition of risk factors …

Mechanisms Of Lateral-Inhibitory Feedback From Horizontal Cells To Cone Photoreceptors At The First Synapse Of The Retina, Ted J. Warren

Theses & Dissertations

Polarization of the horizontal cell (HC) membrane potential causes changes in the synaptic cleft pH that result in inhibitory feedback from HCs to cone photoreceptors (PRs). HCs average signals from many PRs and so negative feedback onto PR terminals from HCs subtracts the average luminance of the visual scene from the light responses of an individual cone. This feedback operates by changing the voltage-dependence and amplitude of the L-type Ca²⁺ current (I_Ca) that regulates synaptic release. Feedback regulation of PR Ca²⁺ channels involves protons but the mechanism by which this pH change occurs is unclear. We …

Genetic Predisposition And M1 Macrophage Polarization Created By Elastin-Derived Peptides Drive Abdominal Aortic Aneurysm Formation, Matthew A. Dale

Theses & Dissertations

Abdominal aortic aneurysm (AAA) is a dynamic vascular disease characterized by inflammatory cell invasion and extracellular matrix (ECM) degradation. Evidence has demonstrated a profound influence of genetic background on AAA formation. The work presented herein discusses two studies: the first demonstrates how genetic components can enhance the susceptibility to AAA formation and the second demonstrates how ECM degradation enhances AAA progression by influencing inflammatory cell phenotypes. An understanding of the pathways involved in AAA pathogenesis can help not only to identify potential patients at risk of AAA development, a heritable disease in which the incriminating component has yet to be …

Measurement Of Daily Energy Expenditure In Individuals With Chronic Heart Failure, Yanlong Li

Theses & Dissertations

Being able to accurately monitor and quantify the amount of physical activity an individual with chronic heart failure (CHF) performs can be of assistance in developing appropriate interventions. This thesis attempted to evaluate the validity of the RT3 accelerometer (RT3) and 7-day Physical Activity Recall Questionnaire (7 day PAR) in measuring the daily activity levels of community dwelling individuals with CHF. Fifty-four individuals with CHF participated in a 7 day session to estimate their daily physical activity by using the RT3 accelerometer and 7-day PAR questionnaire. In addition, 15 of the 54 individuals participated in a second study in with …

Exploring Emergency Communication Experiences In Response To The 2010 Haiti Earthquake: Lessons Learned From International Donors And Local Government Agencies, Pierre Marie Barbara Roussel

Theses & Dissertations

Background:

In almost every disaster situation, the use of standardized communication procedures among humanitarian relief agencies has been identified as one of the efficient practices to minimize the mismanagement of resources and thus to maximize the response effort among actors to reduce the incidence impact on the public and to increase their resilience capabilities.

Agencies have access to several guidelines to follow during domestic disasters, but there have been very few manuals developed to guide relief organizations on best practices during international large and complex natural disasters such as the 2010 Haiti earthquake.

Haiti has experienced over its history several …

Essays On Immigration-Related Disparities In Health Behavior And Health Care Utilization, Yang Wang

Theses & Dissertations

The number of immigrants in the United States has recently been increasing significantly. Immigrants may experience some worse health outcomes than natives, due to substantial legal and socioeconomic barriers. Many immigration-related disparities in health behavior and health care utilization still remain unexplored. This dissertation comprises of 3 independent studies examining such disparities across immigration status, including (1) E-cigarette use and acculturation effects; (2) Cancer-related office-based medical provider visits among cancer patients; and (3) Potentially preventable emergency department visits.

Two nationally representative data sources included National Health Interview Survey and Medical Expenditure Panel Survey. We categorized the respondents into three immigration …

The Role Of Cbl Family Of E3 Ubiquitin Ligases In Intestinal Epithelial Homeostasis, Neha Zutshi

Theses & Dissertations

All adult organs are endowed with a small pool of resident stem cells that must be maintained throughout life to provide for cell turnover during homeostasis and tissue repair following any injury. The unique ability to self-renew as well as to differentiate into functional cells of organs in which they reside makes stem cells essential for the maintenance of organ systems. It is now becoming increasingly evident that aberrant activity of stem cells contributes to diseases such as cancer or tissue/organ atrophy. Thus, it is critical to better understand the mechanisms that regulate adult stem cells. Ligand-activated receptor tyrosine kinases …

Recurrent Mutations Of T-Cell Receptor And Co-Stimulatory Signaling Proteins In Peripheral T-Cell Lymphomas, Joseph Rohr

Theses & Dissertations

Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of mature T-cell neoplasms with a poor prognosis. Recently, mutations in TET2 and other epigenetic modifiers as well as RHOA have been identified in these diseases, particularly in angioimmunoblastic T-cell lymphoma (AITL). CD28 is the major co-stimulatory receptor in T-cells which, upon binding ligand, induces sustained T-cell proliferation and cytokine production when combined with T-cell receptor stimulation, through many signaling molecules including VAV1. This thesis identifies recurrent mutations in CD28 in PTCLs, as well as mutations in VAV1. Two residues of CD28 – D124 and T195 – were recurrently mutated in 11.3% …

Establishment Of Comprehensive Training Center In Tajikistan, Umeda Sadykova

Theses & Dissertations

There is a notable increase in the number of natural and manmade disasters all over the world in the past two decades. Emergency preparedness is a field that is drawing increased attention in many countries. Tajikistan is a disaster prone country with unforgiving nature and weak preparedness infrastructure/system. Tajikistan’s weak emergency preparedness system can be attributed to two main reasons; lack of coordination between the government and international emergency organizations, and the paucity of well trained and organized network of emergency professionals. This study drafted a proposal to establish a comprehensive training center in Tajikistan. This training center will be …

Human Papillomavirus And Its Impact On Vulnerable Populations, Harpriya Kaur

Theses & Dissertations

Human papillomavirus (HPV) is the most common sexually transmitted infection. The infection is higher in certain racial/ethnic groups and those who are immunocompromised including pregnant women. Because immune system is suppressed during pregnancy, women are at higher risk of various types of infection including HPV, a known risk factor for pregnancy complications. However, its role in adverse pregnancy outcomes is unclear. Another high risk population is Northern Plain American Indian. In the Northern Plains region, American Indian women have significantly higher rate of HPV infection than white counterparts and are infected with different types of HPVs than the general population. …

Physical Activity Levels And Related Factors In Midwestern Rural Hispanic Or Latino Adults, Alison K. Clevette

Theses & Dissertations

The purpose of this dissertation was to examine physical activity levels and specific intrapersonal, interpersonal and community physical environment factors that influence physical activity in Midwestern rural Hispanic or Latino adults. Instruments used in the study included: Self-Efficacy for Exercise Behaviors Survey, Social Support for Exercise Survey, Short Acculturation Scale for Hispanics (SASH), and Neighborhood Environment Walkability Scale (NEWS). Physical activity was measured by 7-Day Physical Activity Recall and ActiGraph^® accelerometer data. In the study of 54 participants, it was found that there was a very low level of physical activity. For example, 97% of the time was spent …

Factors And Outcomes Associated With Potentially Inappropriate Medication Use In Rural Community-Dwelling Older Adults, Marcia Y. Shade

Theses & Dissertations

Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), …

Rural Nebraska Women's Explanatory Models Of Postpartum Depressive Symptomatology, Elizabeth Mollard

Theses & Dissertations

The purpose of this study was to construct the explanatory models of postpartum depressive symptomatology (PPDS) from the perspective of rural Nebraska women and to compare these models with the medical model of PPDS. A sample of 20 rural Nebraska women were interviewed in a one-on-one qualitative descriptive telephone interview using questions based on Kleinman’s (1980) explanatory model of illness. This study used feminist pragmatism as a guiding philosophical paradigm. Qualitative data were analyzed using content analysis, and results were compared and contrasted with the medical model of PPDS, which included the onset, symptoms, and duration listed in the DSM-5 …

Effects Of Prenatal Gestational Diabetes Nutrition Education Class And Individual Follow-Up On Maternal And Infant Outcomes, Samantha List

Theses & Dissertations

BACKGROUND: Gestational Diabetes Mellitus (GDM) is defined by glucose intolerance detected with the onset of pregnancy, and if gone undetected and untreated, can lead to morbidities for the mother and baby. Implementation of nutrition counseling can work to reduce the risk of complications through dietary modification promoted and adopted during pregnancy. Follow-up is important, as individual assessment is used to modify recommendations. GDM class and follow-up provided through the Diabetes Center of Nebraska Medicine covers and promotes proper management of blood glucose (BG) during pregnancy for women with GDM.

PURPOSE: The purpose of this study was to assess the impact …

Care Transitions: A Mixed Methods Study Using A Complexity Science Lens, Carol Geary

Theses & Dissertations

Research studies on care transitions from hospital to nursing home are few and heterogeneous, offering an inadequate characterization to support practice. The purpose of this study was to characterize multiple care transitions among hospitalized older adults with advanced chronic disease who were discharged to a nursing home. This prospective, mixed methods study used multiple case studies with an embedded quantitative strand and multiple sources of information.

Four cases included an index patient (an older hospitalized adult with advanced chronic illness), his or her informal caregiver, if available, and healthcare providers involved in the index patient’s care. Two hospitals and two …

Using Homeland Security Exercise Evaluation Program To Execute A Mass Prophylaxis Exercise In A Rural Community., Brian K. Smith

Theses & Dissertations

This project explores the execution of point of distribution exercises in a rural community. Harrison County Iowa is a rural county with a population over 15,000 located approximately 45 minutes north of the Omaha metro area. The project explored the existing point of distribution plans and inventory for the Harrison County Home and Public Health Department. Prior to this project, many staff at Harrison County Home and Public Health Department had no experience with table top or full scale exercises. The mass prophylaxis point of distribution plan had not been updated, and staff had not received training on the point …