Digital Commons Network^™

Clinical Outcomes For Patients With Ventilator-Associated Pneumonia In Octogenarians, Nonagenarians, And Centenarians: A Population-Based Study, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Syed, Olga Sarah, Abdallah Hussein

Rowan-Virtua Research Day

We sought to examine the national inpatient sample data-base to describe in-hospital outcomes among patients over seventy who acquire ventilator-associated pneumonia after being on the ventilator for over 48 hours.

Assessing The Efficacy Of Prolonged Doxycycline Pep Use In High-Risk Populations For Sti Prevention, Lam Doan, Pearl Joslyn, Lizann Sung, Timothy Breiner, Sarah Marotta, Shikhar Rastogi

Rowan-Virtua Research Day

First recommended in October 2022, doxycycline post-exposure prophylaxis (DoxyPEP) has been increasingly used as a treatment for multiple sexually transmitted infections (STIs). To evaluate the efficacy of prolonged DoxyPEP use in high risk populations - men who have sex with men (MSM) and transgender women - for STIs, different sources addressing various aspects of DoxyPEP, its efficacy in STI prevention, and the potential consequences of its widespread use in terms of antimicrobial resistance were examined. Across 9 studies, DoxyPEP was found to decrease the incidence of bacterial STIs, specifically, syphilis, chlamydia, and gonorrhea with varying efficacy, especially for gonorrhea. Furthermore, …

Detection Of Covid-19 Variants, Christina Aglieco

Honors Scholar Theses

The outbreak of Covid-19 in December 2019 was devastating to many but led to major advancements in vaccine research and development. The development of a vaccine against SARS-CoV-2 infection offers protection for the public but cannot eliminate the risk of contracting Covid-19 due to the many viral mutations since the initial wild-type strain isolation in 2019. Analysis of these viral mutations will allow for the development of vaccines with greater protection against the new variants of the coronavirus. Secondary to Covid-19 infection seen in the pediatric population is Multisystem Inflammatory Syndrome in Children or MIS-C. Through qPCR analysis of pediatric …

A Review Of Praziquantel Resistance In Schistosomes And The Future Of Schistosomiasis Control, Gabriela G. Eastham

Senior Honors Theses

Schistosomiasis is a group of both acute and chronic parasitic trematode infections of the genus Schistosoma. Praziquantel (PZQ) has been the drug of choice to treat schistosomiasis for decades. Though it is effective against all three clinically relevant species, heavy reliance on PZQ has led to concerns of schistosome resistance, especially in areas that have implemented this drug in mass drug administration (MDA) programs. Although there is currently insufficient evidence to conclude that schistosomes are becoming resistant to PZQ on a large scale, other control methods are a necessity to best treat and eliminate schistosomiasis. This article summarizes the …

Highly Pathogenic Avian Influenza Outbreak Preparedness In The United States: A Scoping Review, Emma J. Gurley

Honors Theses

In order to gauge preparedness for an outbreak of highly pathogenic avian influenza (H5N1) in the United States, a scoping review of the current literature was conducted. This process involved (1) identifying the research question, (2) identifying studies relevant to the topic, (3) selecting studies for inclusion (4) charting the data, and (5) analyzing and reporting the final data. Ultimately, seventeen studies were deemed appropriate for examination within this scoping review and several key themes were identified. The results emphasize the importance of adopting a One Health approach, the key role that vaccination may well play in preventing the spread …

The Impact Of Stigma On Individuals Affected By Leprosy: A Pilot Study, Mardo Tarr

Capstone Experience: Master of Public Health

Background: Leprosy, while a treatable condition, continues to be associated with significant stigma, which adversely influences the physical, psychological, social, and economic well-being of affected individuals throughout their lives. The stigma linked to leprosy leads to social exclusion, mental health difficulties, and obstacles to accessing healthcare and employment opportunities (Brakel et al., 2019; Sermrittirong & Van Brakel, 2014). This research employs Life Course Theory to describe the long-term experiences of stigma, coping strategies, and social support individuals living with leprosy. By synthesizing findings from existing literature and conducting a qualitative interview, the study offers an in-depth understanding of how various …

Restoring Trust In Public Health: An Analysis Of The Lasting Implications Of The Covid-19 Pandemic Response On Community Trust In Public Health In Nebraska, Kerri Dittrich

Capstone Experience: Master of Public Health

Background and Significance

Public trust is essential for effective public health efforts. In Nebraska, as in many regions, the pandemic response exposed strengths and vulnerabilities in the public health system. Misinformation, political discourse, inconsistent messaging, and poor communication contributed to growing mistrust, threatening the long-term success of public health programs and initiatives. While national trends have been studied, Nebraska-specific research remains limited.

Methods

An original descriptive survey was designed and administered to public health professionals in Nebraska to assess their perceptions of public trust in the local public health system before and after the COVID-19 pandemic. The survey also explored …

Severe Acute Malnutrtion Among Children Under Five In South Sudan, Rhoda Elia Iburu Kenyi

Capstone Experience: Master of Public Health

Severe acute malnutrition (SAM) is a life-threatening condition characterized by severe wasting. The World Health Organization defines SAM as a low weight-for-height Z-score (WHZ) less than -3 standard deviation (SD) from the median growth standard or the presence of edema of both feet and/or mid-upper arm circumference (MUAC) less than 115mm. SAM is a significant public health concern affecting children under five in developing countries, with South Sudan being one of the most severely affected regions. Persistent food insecurity, weak healthcare systems, and ongoing conflict contribute to the high SAM prevalence in the region, where political, religious, and social divisions, …

Active Shooter And Radiological Contamination Full-Scale Exercise, Elise M. Lowe

Capstone Experience: Master of Public Health

Planning and conducting exercises in rural settings highlights the unique features and challenges of emergency preparedness in rural America. Exercise designers must employ creative solutions to plan for player/controller contingencies, limited resources, and patient management across large geographical areas. This paper outlines the process by which a full-scale mass casualty exercise was conducted in a small Wyoming town. It analyzes some of the major problems encountered in rural exercise development and the solutions employed. The focus is on the success and failures of the exercise design based on direct observation/participation, hotwash forms, the after-action review, and direct feedback from participants. …

Implementing And Evaluating An Ai-Powered Visual Decision Support System To Improve Antibiotic Usage Among Physicians With A Built-In Early Warning System, Akua Sekyiwaa Osei-Nkwantabisa

Theses and Dissertations

The widespread misuse and excessive prescription of antibiotics have played a pivotal role in the emergence and proliferation of antibiotic-resistant bacteria, posing a critical global public health crisis. Addressing this challenge necessitates innovative solutions that enhance antimicrobial stewardship. This study presents the development and implementation of a visual decision support system designed to monitor and optimize antibiotic usage among healthcare providers. The proposed system integrates advanced machine learning algorithms with real-time data analytics to provide a dynamic, evidence-based decision support tool. Specifically, a neural network model was developed after evaluating multiple machine learning approaches, including Random Forest, Logistic Regression and …

Assessing The Relationship Between The Incidence Of Campylobacteriosis And Ecological Risk Factors In Tennessee, Emmanuel Angmorteh Mensah

Electronic Theses and Dissertations

Background: Campylobacteriosis although is the leading causes of bacterial diarrheal illnesses, have not gained prominent awareness and there are gaps in the understanding of transmission routes for sporadic, non-outbreak cases and their risk factors at the communal level to humans. This study, therefore, aimed to identify the campylobacteriosis risk factors and risk perception from the existing literature in the United States, determine the incidence and ecological risk factors for campylobacteriosis zip code level in Tennessee, and to perform spatiotemporal analysis of campylobacteriosis incidence cases in Tennessee.

Method: To achieve the first aim, a scoping review was conducted to synthesize …

Knowledge, Attitudes, And Practices Regarding Antimicrobial Resistance And Antimicrobial Stewardship Among Healthcare Workers In Outpatient Medical Centers In Kenya: A Qualitative Study, Mary Kaniu, Wahu Gitakah, Rupali Jain, Ann Munyare, Rodney Adam, Aliza Monroe Wise

Paediatrics and Child Health, East Africa

Objective: Antimicrobial resistance (AMR) is a major global health threat with a projected 10 million deaths globally by 2050. Antimicrobial stewardship (AMS) programs are coordinated efforts involving doctors, nurses, pharmacists, and other healthcare providers. Understanding knowledge, attitudes, and practices of health providers is pivotal for implementing strategies to curb the spread of AMR. The aim of this study was to evaluate knowledge, attitudes, and practices surrounding AMR and AMS among healthcare workers in Kenya.

Design: A qualitative study using in-depth semi-structured interviews

Setting: 12 private outpatient clinics in Kenya.

Participants: Healthcare workers including administrators and clinicians. …

Pregnancy Care Integrating Translational Science, Everywhere (Precise): A Prospective Cohort Study Of African Pregnant And Non-Pregnant Women To Investigate Placental Disorders – Cohort Profile, Rachel Craik, Joseph Akuze, Marie-Laure Volvert, Hannah Blencowe, Moses Mukhanya, Angela Koech, Grace Mwashigadi, Marleen Temmerman, Marvin Ochieng, Emily Mwadime

Centre of Excellence in Women and Child Health

Purpose: The Pregnancies' Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and non-pregnant women. Alongside this, local infrastructure and expertise in the field of maternal and child health research were enhanced.

Participants: Pregnant women were recruited in participating health facilities in The Gambia, Kenya and Mozambique at their first antenatal visit or at the time a placental disorder was diagnosed (Kenya and The Gambia only). Follow-up study …

Public Health Messaging About Dengue On Facebook In Singapore During The Covid-19 Pandemic: Content Analysis, Shirley S. Ho, Mengxue Ou, Nova Mengxia Huang, Agnes S.F. Chuah, Vanessa S. Ho, Sonny Rosenthal

Research Collection College of Integrative Studies

Background:Dengue, a mosquito-borne disease, has been a health challenge in Singapore for decades. In 2020, during the COVID-19 pandemic, Singapore encountered a serious dengue outbreak and deployed various communication strategies to raise public awareness and mitigate dengue transmission.Objective:Drawing on the Crisis and Emergency Risk Communication (CERC) framework, this study examines how dengue-related messages communicated on Facebook (Meta) during the COVID-19 pandemic fall into the CERC themes. This study also seeks to understand how these themes differ between dengue outbreak (eg, 2020) and nonoutbreak years (eg, 2021). In addition, we explore how message themes on dengue changed across different CERC phases …

Implementing A Sustainable Antimicrobial Resistance Surveillance Across Riverside County, Felipe Aperador

Electronic Theses, Projects, and Dissertations

This project focuses on improving health surveillance in remote communities, addressing antimicrobial resistance (AMR) enhancing connectivity and data collection. Geographic barriers, high shipping costs, and logistical challenges have historically hindered healthcare delivery in underserved areas. By integrating healthcare facilities into a cohesive surveillance systems, would improve specimen collection and data analysis. A systematic review of literature identified key strategies, including governmental support, strengthening laboratory capacity, addressing logistical barriers, and enhancing connectivity. Notable results include insights to integrate new facilities when creating a surveillance network, supported by training and state-funded resources. Actionable steps, such as implementing National Action Plans, establishing National …

A Whole Person Care Approach To Ending The Hiv Epidemic In The Inland Empire, Roberto Daniel Gonzalez Coronado

Electronic Theses, Projects, and Dissertations

In the last 40 years, the United States has seen remarkable progress in the field of HIV treatment; however, the virus continues to burden the most vulnerable members of society, such as Men Who Have Sex with Men (MSM) and Intravenous Drug Users (IVDU). Unfortunately, these vulnerable members of society continue to lack stable social conditions to get into proper HIV treatment. These social conditions are referred to as social determinants of health, which are non-medical factors that influence whole-person care. With these members of society continuing to face greater social disparities, their linkage to care and retention to care …

Ocular Surface Squamous Neoplasia (Ossn) Risk Factors In Lusaka, Zambia: The Role Of Hiv And Socioeconomic Status, Stepfanie N. Siyumbwa, Peter Julius, Tabitha Nkhata, Obvious N. Chilyabanyama, Abraham Mengist, Gleb Haynatzki, Charles Wood

Capstone Experience: Master of Public Health

Objective

To identify and evaluate potential risk factors for OSSN at the University Teaching Hospital (UTH) in Lusaka, Zambia.

Methods

Data from 475 patients were analyzed retrospectively, and it included 390 with OSSN and 85 with benign biopsies. Variables with significance values

Results

Several key predictors of OSSN were identified after controlling for confounders in the household cooks sub-population, these were, a lower household income (adjusted odds ratio [aOR] = 0.64, 95% CI: 0.46–0.90, p = .009), a Lab confirmed HIV-positive status (aOR = 3.56, 95% CI: 1.72–7.21, p = .001) and exposure to biomass smoke (aOR = 2.47, 95% …

Healthcare Emergency Management Salary Survey Analysis, Grace E. Thiel

Capstone Experience: Master of Public Health

The field of emergency preparedness is an often unknown and unrecognized aspect of healthcare, forming an integral component of patient and worker safety. While an important field, there is limited data focused on the field pertaining to salaries of workers, resources utilized and produced, and the typical working environment. The purpose of this project is to assess salary and other demographic markers of healthcare emergency preparedness professionals in the United States. The project will compare salary, full-time equivalent levels, preparedness program budgets, and other markers across the country. The data from this study will also be compared to previous survey …

State Case Count As An Indicator Of Successful Multistate Outbreak Investigation, Lorisa M. Pennell

Capstone Experience: Master of Public Health

Background/Objectives: Shiga-Toxin producing Escherichia coli (STEC) is a contaminant found in multiple food types and causes multistate outbreaks due to the industrialization of food production. In this report I examine the differences in outbreaks categorized by the regulating agency responsible in outbreak prevention and compare outbreak case counts when organized by positive outbreak investigation and response outcomes.

Methods: STEC Multistate outbreak data was obtained from the Center for Disease Control’s National Outbreak Reporting System (NORS) for outbreaks occurring from 2006-2023. Outbreaks were organized into those regulated by either the US Food and Drug Administration (FDA) or the US Department of …

A Landscape Analysis Of Rapid Evidence Curation During The 2022 Sudan Virus Disease Outbreak In Uganda, Jemimah J. Wachap

Capstone Experience: Master of Public Health

Uganda's 2022 Sudan Virus Disease (SVD) outbreak emphasized the need for rapid and effective evidence curation in public health emergencies. This analysis examines evidence curation practices during the SVD response, identifying challenges and assessing the timeliness and effectiveness of strategies in low-resource settings. While global responses to previous outbreaks, like COVID-19, have advanced evidence synthesis, the SVD outbreak revealed infrastructure and data integration gaps. The study aims to map the evidence curation landscape, focusing on models and tools, such as data-sharing platforms, mobile Polymerase Chain Reaction (PCR) labs, and Integrated Management Systems (IMS). It will also address gaps in surveillance, …

Evaluating The Nebraska Medical Center's Repatriation Of Inter-Hospital Transfers, Natalie Crump

Capstone Experience: Master of Public Health

Background: Bed capacity challenges at large academic medical centers delay the transfer of rural patients, negatively impacting their safety and quality of care. Repatriating inter-hospital transfer (IHT) patients to referral facilities upon completing specialized care can improve tertiary hospital bed capacity and community hospital financial sustainability.

Objectives: This project aims to identify the barriers and facilitators to successful IHT repatriation and the process and outcome variables influenced by the Nebraska Medical Center’s reverse transfer program.

Study Design: A retrospective observational cohort study was conducted to identify barriers and facilitators of NM’s IHT repatriation program.

Methods: Descriptive and comparative analyses of …

A Research Report: What Are The Challenges That Refugee Women Experience When Seeking Healthcare Related To Pregnancy In The United States?, Manuela Krieger-Adi

Capstone Experience: Master of Public Health

Background

Refugees in the United States, including African refugee women, face many challenges in seeking healthcare after moving to the United States to resettle. It is urgent and essential to look into some of the health challenges the refugee community faces here in Omaha, Nebraska, that prevent them from seeking healthcare, especially when pregnant. This Capstone research project aims to focus on African refugee women, specifically in Omaha, Nebraska, and the challenges they face seeking healthcare related to pregnancy.

Methods

This research report involved five in-depth interviews conducted over Zoom. The target population was refugee mothers who had given …

Assessing The Association Between Total Cholesterol And Hospitalized Myocardial Infarction In Women Ages 32-70: An Analysis Of The Framingham Heart Study, Jolene L. Stapleton Duree

Capstone Experience: Master of Public Health

Objective

Heart disease is the leading cause of death in women that may go undiagnosed due to unexpected symptoms. The purpose of this analysis was to assess the effect of total cholesterol on the odds of hospitalized myocardial infarction (MI).

Methods

This analysis used a sample of 2,445 women from the Framingham Heart Study, an observational prospective cohort study. The exposure was total cholesterol, and the outcome was hospitalized MI. Logistic regression was used to estimate crude and adjusted odds ratios (OR). The adjusted models controlled for age, blood pressure, and diabetes. Effect modification by diabetes status was evaluated in …

The Burden Of Care: A Phenomenological Inquiry Into The Lived Experiences Of Homeless Shelter Administrators Leading Through The Pandemic And Lasting Implications On Program Operations, Marie Adele Wilson

Doctoral Dissertations and Projects

The theories guiding this study are Maslow's Hierarchy of Needs, conflict theory, and complex systems theory, which explain the relationship between the theory and resource limitations and acquisition, systems, and nature of acquiring human needs. The purpose of this phenomenological study is to describe homeless shelter administrators'/directors' experiences delivering services during the COVID-19 pandemic on the Eastern Coast of the United States and Texas. It further seeks to unravel how the pandemic informed the delivery of services and program administration related to homeless shelters and its impacts. The research questions sought to understand the impact of COVID-19 on delivering services …

Insights Into Cancer Awareness And Health Practices In Rural Kenya: A Cross-Sectional Study Of Esophageal, Breast, Prostate, Cervical, And Colorectal Cancers, Rosebella Iseme-Ondiek, Joseph Abuodha, Anthony Ngugi, Mansoor Saleh, Innocent Abayo

Population Health, East Africa

PURPOSE; In sub-Saharan Africa (SSA), there has been an epidemiologic transition from infectious diseases to noncommunicable diseases, including a projected doubling in incidence of cancer. Understanding the underlying factors driving this surge is crucial for designing effective strategies to mitigate the cancer burden. This study focuses on assessing knowledge, attitudes, screening practices, and health behaviors related to five most prevalent cancers in SSA: prostate, breast, cervical, esophageal, and colorectal—among a predominantly rural coastal population in Kenya.

MATERIALS AND METHODS ;We used a cross-sectional study design targeting 1,500 adult respondents randomly selected from an existing community health and demographic surveillance system. …

Navigating Travel Therapy: Balancing Benefits And Risks For Optimal Wellness, Fangli Hu, Jun Wen, Wei Wang

Research outputs 2022 to 2026

This research note examines travel therapy as a novel healthcare approach in which positive travel experiences serve to promote well-being. It emphasizes the need for a balanced assessment of the benefits and risks associated with travel therapy, offering insights into this practice's evolving roles in the health and wellness domains.

Cdc’S Core Elements To Promote Diagnostic Excellence, Daniel J Morgan, Hardeep Singh, Arjun Srinivasan, Andrea Bradford, L Clifford Mcdonald, Preeta K Kutty

Faculty, Staff and Students Publications

Nearly a decade after the National Academy of Medicine released the "Improving Diagnosis in Health Care" report, diagnostic errors remain common, often leading to physical, psychological, emotional, and financial harm. Despite a robust body of research on potential solutions and next steps, the translation of these efforts to patient care has been limited. Improvement initiatives are still narrowly focused on selective themes such as diagnostic stewardship, preventing overdiagnosis, and enhancing clinical reasoning without comprehensively addressing vulnerable systems and processes surrounding diagnosis. To close this implementation gap, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of …

What Makes A Hospital Gown Functional? A Comparative Case Study Of Effective Patient-Centered Design Practices In Four (N = 4) Hospital Gowns, Robmarie Lopez

Patient Experience Journal

A hospital gown is essentially a patient uniform. Yet, the typical ``tie in the back'' hospital gown, standard garb for routine medical procedure, can have great influence over key intervention factors like receptiveness to treatment and patient self-esteem. Thus, the goals of this study are two-fold: 1) To understand patient perceptions of the standard hospital gown, and 2) To understand which principles and elements of design underpin effectively functional hospital gown redesign. Aim 1 was assessed via a comprehensive literature review of n = 5 qualitative or mixed-methods studies which surveyed or interviewed patients on their experience with the standard …

Factors Related To The Incidence Of Hypertension Among People Above 18 Years At The Cibatu Public Health Center, Bekasi Regency, Verizka Azra, Yustiyani Yustiyani, Minsarnawati Minsarnawati, Catur Rosidati

Indonesian Journal of Public Health Nutrition (IJPHN)

Hypertension is a non-communicable disease that still becomes a public health issue. The percentage of hypertension cases at Cibatu Public Health Center increased from 31.7% in 2021 to 37% in 2022. Based on a preliminary study, hypertension was found to be the most common non-communicable disease at Cibatu Public Health Center. This study aimed to identify factors associated with the incidence of hypertension among individuals aged 18 years and older at Cibatu Public Health Center, Bekasi Regency, in 2024.We conducted a cross-sectional study in May involving 121 respondents. This study used standardized questionnaires that had been validated in previous research, …

Exploring The Non-Communicable Disease Burden In Indonesia – Findings From The 2023 Health Survey, Akifa Laila Rusyda

Indonesian Journal of Public Health Nutrition (IJPHN)

The present study rigorously examines the correlation between obesity, high-risk dietary consumption, and unhealthy lifestyles with the prevalence of non-communicable diseases (NCDs) in Indonesia. The study employed a cross-sectional study design using secondary data from the 2023 Indonesian Health Survey, analyzing 38 units (n) representing Indonesia's provinces in 2023. The correlation analysis, conducted using Pearson's test with a significance level of 95% (α<0.05), revealed significant regional disparities in the prevalence of NCDs, dietary consumption, and lifestyle factors across Indonesia. Moreover, the findings reveal a statistically significant positive correlation between obesity, high-risk food consumption, and lifestyle risk factors with the prevalence of several NCDs, including diabetes mellitus, heart disease, hypertension, and chronic kidney disease. These results underscore the potential impact of our research on public health in Indonesia. The results highlight also the urgent need for targeted public health initiatives, such as policies promoting healthier food choices, controlling the food environment, encouraging physical activity, and supporting smoking cessation to mitigate the growing burden of NCDs in Indonesia.