Medicine and Health Sciences Commons^™

Ultrasonography-First Imaging Algorithm For Acute Appendicitis Diagnosis, Steven Lamar Moore

UNLV Theses, Dissertations, Professional Papers, and Capstones

Acute appendicitis (AA) is the most common cause of acute abdominal pain requiring surgery in pediatric, adult, and pregnant patients. Several etiologies are believed to trigger luminal obstruction, which causes mucus and bacteria proliferation, resulting in inflammation and wall tension with subsequent necrosis and rupture of the appendix. Most AA patients present with the primary complaint of abdominal pain, which Murphy first described the characteristic diagnostic sequence seen in approximately 50% of patients as colicky centralized abdominal pain with subsequent vomiting with the migration of pain to the right lower quadrant (RLQ), specifically, the right iliac fossa. The typical AA …

The Effects Of Transcranial Direct Current Stimulation On Motor Learning In Complex Motor Tasks, Milan Pantovic

UNLV Theses, Dissertations, Professional Papers, and Capstones

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has emerged over the past 10-12 years as safe, affordable, portable, easy to use, and potentially efficacious adjuvant training intervention in several aspects of human performance. tDCS has been shown to be able to improve both cognitive and motor function in a wide variety of populations such as young adults, older adults, stroke, Parkinson’s disease, and many others. However, the majority of tDCS research has been conducted in the motor system of healthy young adults, which will also be the focus of this dissertation.The basic effects of tDCS …

Identifying Gaps In Social Determinants Of Health Among Patients 65 Years And Older With Congestive Heart Failure: A Secondary Data Analysis, Sandra Pierre-Louis

UNLV Theses, Dissertations, Professional Papers, and Capstones

Congestive heart failure (CHF) is one of the most common healthcare problems for older adults. Because of its high and rising prevalence in this population and its significant influence on healthcare costs and quality of life, CHF is becoming a serious public health issue in the United States. More effective strategies for preventing and managing CHF in older people are desperately needed (Rich, 2015). The disease accounts for 3% of hospital admissions in the United States and affects more than 6.5 million Americans (White-Williams et al., 2020). Further, CHF is exacerbated by adverse social determinants of health (SDOH). This study …

Characterization Of Physical And Dosimetric Aspects Of Srs Hyperarc Treatment Technique, Emma S. Rickels

UNLV Theses, Dissertations, Professional Papers, and Capstones

HyperArc is a radiation therapy planning technique using stereotactic radiosurgical doses delivered via single isocenter volumetric modulated arcs (VMAT) for multi-lesion brain cancer. Due to the nature of these types of treatments it is imperative that the proper quality assurance is completed to ensure the safety of the patient. Geometric limits were assessed using a dose volume histogram (DVH) and known rotational errors of theoretical lesions of different dimensions and lengths from the isocenter. Dosimetric comparisons were evaluated using an ion chamber and Gafchromic EBT-XD film and portal dosimetry. The conclusions from these investigations were that patient rotation will result …

Assessment Of Oral Human Papillomavirus In Pediatric And Adult Patients Within A Multi-Ethnic Clinic Population, Melissa Kornhaber

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Human papillomavirus (HPV) encompasses a large family of oncogenic viruses responsible for increasing rates of both cervical and oral cancer, particularly among minority and low-income populations. Although this represents an increasingly significant public health risk, few studies have screened for oral HPV within Nevada. Based upon this information, the primary objective of this study was to provide a temporal analysis of oral HPV screening among a primarily low-income, minority patient population.

Methods: This retrospective analysis was reviewed and approved by the Institutional Review Board (IRB). In brief, unstimulated saliva samples were previously obtained from clinical patient volunteers that provided …

Family-Centered Psychosocial Care For Pediatric Oncology Patients, Jessica W. Casey

UNLV Theses, Dissertations, Professional Papers, and Capstones

Psychosocial conditions are prevalent in pediatric oncology patients (Kahalley et al., 2013). Family and social support are essential aspects of a patient's health care outcomes (Merck & McElfresh, 2019). Anxiety and depression are common in pediatric oncology patients due to trauma during treatment (Pao & Kazak, 2015). These patients also can have preexisting developmental or behavioral conditions before starting treatment. Treatment side effects can also cause cognitive and behavioral changes (Nixon, 2014b). Nurses should be knowledgeable and confident in their ability to care for patients' psychosocial health and development. The purpose of this Doctor of Nursing Practice (DNP) project is …

Increasing Genetic Testing Rates To Improve Early Detection And Prevention Of Breast And Ovarian Cancer In Women, Makensey Beth Durrant

UNLV Theses, Dissertations, Professional Papers, and Capstones

Screening rates for cancer related genetic mutations are low in the primary care setting, despite evidence-based guidelines recommending screening in all patients who meet criteria. Genetic mutations, such as the breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations, drastically increase breast and ovarian cancer risk in patients. The United States Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN) provide evidence-based guidelines on criteria for genetic testing in women at risk for breast and ovarian cancer related gene mutations. Primary care providers (PCPs), including advanced practice registered nurses (APRNs), are at the front lines of preventative …

Effects Of A 12-Week Telehealth Exercise Intervention On Gait Speed And Gait Deviations In Adults With Down Syndrome, Robert Lum, Taylor Souza, Christopher Roys, Daniel Stopka

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Down syndrome (Ds) is associated with impairments affecting overall motor development including gait pattern and speed. Research on the effects of exercise on adults with Ds is lacking. The purpose of this study is to evaluate the effects of a 12-week telehealth exercise program on gait impairments in adults with Ds.

Methods: Twenty participants performed a 12-week telehealth exercise program based upon a diagnosis-specific procedure developed by Sarah Mann, PT, DPT. Gait deviations were assessed with the Ranchos Los Amigos Observational Gait Analysis. Comfortable gait speed was evaluated with the 4-meter walk test.

Results: Improvements in comfortable gait speed …

Increasing Human Papillomavirus Vaccination Intent And Knowledge Through An Educational Intervention, Angelica E. Musumeci

UNLV Theses, Dissertations, Professional Papers, and Capstones

Human papillomavirus (HPV) is a widely discussed topic in healthcare as it affects patients of all genders and ages who partake in sexual activity. The most significant concern it poses to those at risk is HPV-related cancer. Fortunately, a vaccination exists that targets specific strains associated with these types of cancers. Despite evidence-based research supporting the vaccination’s efficacy and safety, lack of awareness and misinformation diminish the receipt of the vaccine and drive the lack of protection. Thus, educational interventions directed at parents and caregivers, which aims to improve their understanding of HPV and the vaccination’s benefits, is key to …

Regional Health Benefits Of The Nevada Renewable Energy Initiative, Alireza Rezaee

UNLV Theses, Dissertations, Professional Papers, and Capstones

In recent years, there have been tremendous efforts to replace fossil fuels with renewable energy to mitigate emissions of greenhouse gases and air pollutants in the United States. Nevada was among the first states that established the renewable portfolio standards (RPS), requiring a certain percentage of electricity sold to the customers for consumption coming from renewable resources. The recent Nevada Senate Bill 358, signed by Nevada’s Governor in 2019, set a target that by 2030 not less than 50% of electricity sold in Nevada should come from renewable resources. This research investigates how this Bill could provide health benefits for …

Decreasing Central Line-Associated Bloodstream Infections In The Critical Care Unit, Kimberly J. Foxworth

UNLV Theses, Dissertations, Professional Papers, and Capstones

Central line-associated bloodstream infections (CLABSI) are a rising problem in the critical care setting in the United States. According to Flogren et al. (2007), "an estimated 248,000 bloodstream infections occur in hospitals across the United States each year, and a significant amount of these infections are associated with the use of a central venous catheter" (p.160). The Center for Disease Control and Prevention (CDC) defines a CLABSI as "recovery of a pathogen from blood culture (a single blood culture for organisms not commonly present on the skin and two or more blood cultures for organisms commonly present on the skin) …

Differential Expression Of Cellular And Exosomal Microrna Isolated From Oral Cancer Cells And Their Resistance To Chemotherapy, Brady Petersen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: MicroRNAs are abundant small non-coding RNA with a variety of known functions, including transcriptional activation and inhibition. Recent evidence has suggested that microRNA expression may influence the responsiveness of some cancers to chemotherapy, including liver and lung cancers. Some evidence has now suggested that specific microRNAs, such as miR-21, miR-155, and miR-375, may influence oral cancer responsiveness to chemotherapy – although much remains to be discovered.

Objective: Based upon the lack of evidence in this area, the primary objective of this study was to evaluate microRNA expression and responsiveness among oral cancers.

Methods: Five commercially available oral cancer cell …

The Road Ahead: An Occupational Therapy Manual To Infant Development For Parents In The Nicu, Nicole Suzuki-Uyeno

UNLV Theses, Dissertations, Professional Papers, and Capstones

Occupational therapists have been collaborating with the parents of our tiniest patients in the neonatal intensive care unit (NICU) for quite some time. They have a wealth of information and expertise in the area on infant development and parent education. Admitting a baby to the NICU is a shock for most parents and can take a toll on a family. The role of the occupational therapist is to help educate the family and to provide the tools to safely take care of their baby and to smoothen the transition from the hospital to home.

In the NICU, the OT has …

The Occupational Therapy Approach To Pain Treatment: A Pain Curriculum, Rosalee Howell

UNLV Theses, Dissertations, Professional Papers, and Capstones

It is within the scope of the occupational therapy profession to treat patients experiencing pain. The holistic approach used to assess and treat patients to improve functional performance is vital in treating pain. The focus is to decrease the detrimental impact of pain on the patient’s mental health, enhancing their ability to function in social and vocational roles. However, education is not adequately addressed in occupational therapy programs and is vital in preparing clinicians to meet the patient’s needs effectively.

This Doctoral Capstone was developed to highlight the importance and the benefit of education in preparing clinicians to treat patients …

Improving Nurse Self-Efficacy Regarding Depression Among Cardiovascular Disease Patients: An Education Intervention, Presten Beatty

UNLV Theses, Dissertations, Professional Papers, and Capstones

Depression is a principal cause of increased morbidity, mortality, and decreased quality of life for cardiovascular disease patients. Low levels of nurse confidence have been the outcomes of several studies and anecdotal reports regarding providing care for and approaching patients with acute and chronic illnesses in conjunction with behavioral and mental health issues. Current literature suggests that improving nursing education on the prevalence and impacts of depression improves nurse confidence. Depression screening tool education provided to nurses, with detailed disease information, empowers nurses in their attitudes, knowledge, and behaviors regarding patient depression. By improving depression screening rates among cardiovascular disease …

Examining The Role Of Prosocial Tendencies And Social Anxiety In Hazardous Drinking Practices Among College Students, Helena M. Berlin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over 40% of the United States (US) population aged 18 to 25 is enrolled at postsecondary institutions, and 31.4% of college students report risky alcohol use (i.e., binge drinking). Identifying risk and protective factors for this population is a public health priority. The primary objective of this study was to examine the additive and multiplicative relationship of prosocial tendencies and social anxiety on hazardous drinking (AUDIT scores). A secondary aim was to examine whether these relationships differed by participation in college organizations (Greekaffiliation, athletic participation, both, and neither). Cross-sectional data were collected from 9,196 college students (ages 18-25) from 12 …

A Quality Improvement Project To Improve Health Care Provider Self-Efficacy In Rural Primary Pediatric Care Clinics Through Training Intervention, Alison Borgsmiller

UNLV Theses, Dissertations, Professional Papers, and Capstones

American Association of Pediatrics recommends screening for various developmental delays in children, but it does not explicitly recommend a tool for screening social and emotional development at well-child checks (WCCs). Therefore, provider self-efficacy (SE) is lacking, and screening rarely occurs. This quality improvement (QI) project sought to improve healthcare provider SE using the Ages and Stages Questionnaire: Social-Emotional, Second Edition (ASQ:SE-2), an evidence-based practice screening tool for identifying such delays in children at 30–60-month WCC visits.At rural healthcare centers in San Luis Obispo, California, participants completed the Self-Efficacy Twelve Questionnaire prior to and 30 days following a training intervention. While …

Reducing Door-To-Balloon Time In Stemi Via Er Nurse Driven Protocol, Torrie Clontz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over 605,000 patients will suffer an ST-segment elevated myocardial infarction in the United States each year. The gold-standard definitive treatment for this is percutaneous coronary angioplasty or the ballooning open and stenting of the blockage. The American Heart Association has set the evidence-based gold standard of 90-minutes from identification of blockage to reperfusion of heart muscle. In a health system in Las Vegas, NV, this goal is frequently missed due to lack of protocols in place to expedite patients towards definitive treatment. The purpose of this evidence-based practice change is to reduce STEMI patient morbidity and mortality via a nursing …

Improving Nurse Leaders’ Knowledge And Confidence In Transformational Leadership Skills In The Online Environment, Tanya Haight

UNLV Theses, Dissertations, Professional Papers, and Capstones

Leadership is critical to the success of most organizations, and the achievement of an organization's goals is largely dependent on the leaders' ability to engage, motivate, and influence their teams—often referred to as Transformational Leadership. This is especially true for healthcare organizations wherein the morbidity and mortality of patients may be affected by the quality of leadership. At the start of the COVID-19 pandemic, in-person meetings transitioned to the online format without nurse leaders' formal training. Leaders cited this lack of orientation as impeding their ability to sustain an online-virtual transformational leadership presence with their teams. They reported varying degrees …

The Effects Of Executive Function Between Anxiety And Math Achievement In Adolescents, Mckenzie Hall

UNLV Theses, Dissertations, Professional Papers, and Capstones

Anxiety in Children can develop into pervasive disorders in adulthood if not treated. Research shows dysfunctional Executive Function (EF) and anxiety are both shown to have a negative impact on math achievement in children and adolescents (Trezise & Reeve, 2018; Kalaycioglu, 2015; Owens, Stevenson, Hadwin & Norgate, 2012). Chung, Weyandt, and Swentosky (2014) found biological and neuropsychological support for EF as a unitary and multifaceted processor for regulating our emotional states as well as our daily procedures. Anderson’s (2002) model of Executive Control System (ECS) allows the factors of EF to be examined using a developmental approach towards EF processes. …

Comparative Expression Of Exosome-Derived Dental Pulp Stem Cell (Dpsc) Microrna, Matthew Hunsaker

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Dental pulp stem cells (DPSC) are pluripotent stem cells capable of differentiating into several tissue types. Several studies have demonstrated DPSC can be extracted from deciduous and permanent teeth, including third molars (wisdom teeth) - however, much less is known regarding the factors that determine and regulate pluripotency and differentiation responsiveness among these harvested DPSC. Recent evidence has suggested small, non-coding microRNAs mediate (in part) differentiation and self-renewal among some stromal and hematopoetic stem cells, although much remains to be discovered regarding microRNA regulation of DPSC phenotypes. Based upon this information, the overall goal of this study was to …

Quality Of Care: A Business Case For Us Hospitals, Iwimbong Kum Ghabowen

UNLV Theses, Dissertations, Professional Papers, and Capstones

The Patient Protection and Affordable Care Act present some threats and opportunities to many hospitals across the USA. Under the Value-Based Purchasing Program, acute care hospitals' rewards are tied to incentive payments for the quality of care provided in the inpatient hospital. In the last 20 years, growing research has examined the effects of the quality of care on the financial performance of hospitals. There is a gap in the literature, particularly exploring the relationship between quality and hospital financial performance using national samples. This dissertation investigates the association between patients' experience of care, 30-day readmission rates, and case-mix-index (CMI) …

The Nursing Leader’S Role In Decreasing Implicit Rationing By Improving The Nursing Work Environment, Allison Mchugh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite all the literature about missed care and its contributing factors, it is prevalent in most hospitals worldwide. Missed care is the result of care that is implicitly rationed. For this paper, implicit rationing is defined as how nurses decide what care is delivered based on the present work environment. Many factors influence implicit rationing. One such factor is the work environment. The association between the nursing work environment and implicit rationing is well described in the literature. The nursing leader is in a formal position responsible for patient outcomes and the nursing practice environment. Therefore, it is important to …

Improving Self-Efficacy And Knowledge While Reducing Anxiety In High-Risk Breast Cancer Patients Through Standardized Education, Shelley Miles

UNLV Theses, Dissertations, Professional Papers, and Capstones

Breast cancer is the leading cause of death of women in the United States. Patients at high risk for developing cancer are more easily identified in today’s world. Early identification might be due to strong family history or genetic mutations, such as BRCA1 or BRCA2. Screening and risk reduction guidelines have been developed over recent years for these patients. Adherence to these guidelines continues to be a problem. The factors stemming from this problem include lack of knowledge about being high-risk, understanding the guidelines, and anxiety and depression about the perceived risk of developing breast cancer. These factors can cause …

Evaluation Of An Advance Care Planning Workshop To Improve The Self-Efficacy Of Health Care Providers, Joy Patrick

UNLV Theses, Dissertations, Professional Papers, and Capstones

Advance care planning (ACP) involves discussions between the patient and their care providers and those close to them about future care. Every patient is entitled to ACP; however, research has shown that providers do not regularly implement them for various reasons. In addition, multiple barriers may be preventing providers from initiating ACP. Among them are lack of knowledge and confidence, apprehension, time, and fear. This Doctor of Nursing Practice (DNP) addresses the problematic barriers to regular ACP discussions between providers and the patients. Specifically, the purpose of this DNP project is to develop, implement and evaluate an online module to …

The Association Between Neighborhood Social Media Use And Social Cohesion, Sense Of Community And Perceived Safety Among Adults In Clark County, Nevada, Emily Strickler

UNLV Theses, Dissertations, Professional Papers, and Capstones

Place-based health is a concept that suggests where you live has an effect on your health outcomes. Social health factors such as social cohesion, sense of community, and perceived safety are all influenced by the neighborhood environment, and positively associated with health outcomes such as self-reported minutes of physical activity and symptoms of depression. With the increasing popularity of social media sites used specifically for neighborhood purposes, more neighbors are connecting than ever before. The purpose of this study was to determine if use of neighborhood social media sites was associated with the social health factors of social cohesion, sense …

Parental Education On Human Papillomavirus Vaccination, Marguarette J. Suprien

UNLV Theses, Dissertations, Professional Papers, and Capstones

The human papillomavirus (HPV) is a worldwide condition that produces several diseases, including cervical, anogenital, and oral cancer, among others (Fishman et al., 2014). The Center for Disease Control and Prevention (CDC; 2016a) stated that HPV is among the most reported sexually transmitted diseases in the United States. Over 150 viruses are associated with HPV, and 40 types of the virus can be spread via sexual contact, including vaginal, oral, and anal sex (CDC, 2016; CDC, 2016b; CDC, 2016c). Evidence shows that approximately 79 million individuals are infected in the United States, and 14 million Americans are infected with the …

Mourning The Marathon: Black Men Rappers, Homicide Survivorship Bereavement, And The Rap Tribute Of Nipsey Hussle, Melvin L. Williams, Justin K. Winley, Justin Causey

Far West Popular Culture Association Annual Conference

Eritrean-American rapper Ermias “Nipsey Hussle” Asghedom’s murder represented a cultural cataclysmic event that startled the hip-hop community and triggered previous memories of Black men’s homicidal deaths in rap and Black American urban communities. Nipsey Hussle’s death inspired touching rap tribute songs by Black men rappers, who sought to commemorate his cultural legacy and express their bereavement pains as homicide survivors. Rap tribute songs occupy a significant history, as rappers historically employed them to honor hip-hop’s fallen soldiers, communicate their homicide survivorship bereavement processes, and speak about social perils in the Black community. Framed by critical race (CRT) and gender role …

The Meta-Mood Experience: Exploring The One-, Three-, And Four-Factor Models Of The Trait Meta-Mood Scale, Zain N. Raja, Jerald J. Novero, Susan E. Gutierrez, Orei Z. Odents, Fitsum A. Ayele

Undergraduate Research Symposium Posters

The meta-mood experience involves "thinking about mood, examining the relation between mood and thoughts, maintaining good moods, and altering bad moods" (Mayer & Gaschke, 1988). Meta-mood can help individuals have a better grasp of what they are feeling at different times.

The 30-item Trait Meta-Mood Scale (TMMS; Salovey et al., 1995) measures the extent to which people attend to, distinguish among, and regulate their mood and emotions.

Salovey et al. (1995) found three factors (Emotional Attention, Clarity, and Repair), while Palmer et al. (2003) found evidence for a fourth but left it unnamed.

We named the fourth factor in our …

Identification Of Lipid Species: Potential Biomarkers For Early Detection Of Hepatocellular Carcinoma, Kit Yee Leung, Kaylee Freitas

Undergraduate Research Symposium Posters

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. HCC is associated with cirrhosis. Poor survival rate of HCC is due to diagnosis of HCC at late stage.