Public Health Commons^™

Derivation And Validation Of A General Predictive Model For Long Term Risks For Mortality And Invasive Cardiovascular Interventions In Congenital Heart Disease, David A. Danford

Capstone Experience

Introduction. Accurate assessment of prognosis is a key driver of clinical decision making in congenital heart disease (CHD), but is complicated because CHD represents such a diverse collection of conditions. The aim of this investigation is to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) in CHD and for time to death in CHD. Methods. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on …

Evaluating Nebraska Ems Providers' Ability And Willingness To Respond To Bioterrorism Emergencies, Ryan Houser

Capstone Experience

Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack, and identify factors that predict preparedness and willingness among Nebraska Emergency Medical Service providers, who are key to resilience in the face of an attack. The survey was available for one month in 2021 during which 190 EMS providers responded to the survey. The subjects included Registered Nurses, doctors, EMTs, and paramedics. Only 10% of the respondents are both …

Association Of New And/Or Progressive Multiple Organ Dysfunction Syndrome With Mortality And New Morbidity Among Children Encountering Septic Shock, Rachel L. Waworuntu

Capstone Experience

Despite reductions in sepsis mortality, there remains a substantial morbidity burden among children who survive sepsis. Furthermore, the majority develop multiple organ ‘group has historically been analyzed as a single cohort. Using the Life After Pediatric Sepsis Evaluation (LAPSE) investigation database, we studied the association of new and progressive multiple organ dysfunction syndrome (NPMODS) with morbidity and mortality among children with septic shock. We hypothesized that NPMODS represents a distinct phenotype based on evolving organ dysfunction. There was evidence of an association but it did not reach the 0.05 level of significance. We also hypothesized and confirmed that children with …

Impact Of Proton Pump Inhibitor Use On Effectiveness Of Immune Checkpoint Inhibitors In Advanced Cancer Patients, Ken Chen

Capstone Experience

Background: Gut microbiome plays a critical role in modulating therapeutic effect of immune checkpoint inhibitors (ICIs). Proton pump inhibitors (PPIs) may affect the gut microbiome by altering gut pH.

Objective: To evaluate if concurrent use of PPI 0-30 days before or after initiation of ICIs (nivolumab or pembrolizumab) is associated with poorer overall survival (OS) and progression-free survival (PFS) for patients with stage IV non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma, transitional cell carcinoma or head and neck squamous cell carcinoma compared with no PPI use.

Methods: This was a single-center retrospective cohort study of advanced cancer patients …