Science and Mathematics Education Commons^™

What Happens After They Leave The Ed? Following Up Acute Asthma Exacerbations After Changes In Clinical Practice Guidelines For Treatment, Phillip S. Wozniak, Jade B. Tam-Williams

Research Days

In 2022, Children’s Mercy Hospital (CMH) implemented a new clinical practice guideline (CPG) recommending single-dose dexamethasone as the first line oral steroid for treatment of mild to moderate acute asthma exacerbations. We assessed the impact of this CPG change on readmission rates after discharge from emergency department/urgent care (ED/UC). We hypothesized that single-dose dexamethasone would be non-inferior to a 5-day course of prednisone/prednisolone with respect to 7-day and 30-day acute care readmission rates and need for additional outpatient steroid courses.

Bilateral Buccal Myomucosal Flap Palatoplasty For The Management Of Velopharyngeal Dysfunction In Children, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Jill M. Arganbright

Research Days

Background: The use of bilateral myomucosal buccal flap palatoplasty (BMBFP) for velopharyngeal insufficiency (VPI) has increased in popularity. Despite the increasing popularity, there is a paucity in research examining their outcomes, especially in reference to the pediatric population.

Objectives/Goal: The objective of this paper was to investigate the utility of BMBFP for the correction of VPI in children.

Methods/Design: Retrospective chart review was performed using CPT codes to locate patients with BMBFP performed at our pediatric institution between July 2020 to July 2024. Data collected included demographics, associated syndromes, complications, pre-operative and post-operative resonance outcomes, and the need for revision …

Posterior Pharyngeal Flap For The Management Of Velopharyngeal Dysfunction: Comparing Outcomes For Children With 22q11.2 Deletion Syndrome To Those Without, Jay Szekely, Meghan Tracy, Janelle R. Noel-Macdonnell, Jill M. Arganbright

Research Days

Introduction (including objectives): Velopharyngeal dysfunction (VPD) is one of the most common clinical features of 22q11.2 deletion syndrome (22q11.2DS) and often requires surgical intervention; due to the multifactorial nature of VPD, these patients present unique and often complex surgical challenges. Prior studies have generally demonstrated poorer speech outcomes postoperatively in children with 22q11.2DS. The posterior pharyngeal flap (PPF) is often considered first-line surgical choice for correction of VPD in children with 22q11.2DS. The aim of this study is to compare PPF outcomes for children with 22q11.2DS to those without.

Methods: Retrospective review for pediatric patients diagnosed with VPI who underwent …

Soybean Oil-Derived Acrylate/Methacrylate Ether For High Resolution Additive Manufacturing (3d Printing) Technology, Tanuj Patel

Electronic Theses & Dissertations

Additive Manufacturing is one of the rapidly developing techniques, as industries continue to explore new ways to create prototypes and end-use parts, one of the significant challenges that remains is the reliance on petroleum-based plastics for 3D printing, especially in the production of photocurable resins. that may be used to prototype complex structures and sophisticated geometries that are typically challenging to produce with conventional methods. Thus, replacing petroleum-based plastics with renewable resources is increasingly important for additive manufacturing (3D printing) of photocurable resins. The use of bio-based renewable resources in AM is a feasible alternative to traditional petroleum-based plastics. Henceforth, …

Zn–Assisted Synthesis Of M (Mn/Fe/Co/Ni)-N-C Catalysts For Multifunctional Electrochemical Activity, Kemila A. Chaudhary

Electronic Theses & Dissertations

The design and development of atomically dispersed M-N-C catalysts (metal (M) supported on an nitrogen-carbon (NC) matrix with high multifunctional electrocatalytic performance is desirable but proved to be very challenging. Herein, we synthesized M-N-C catalysts (M = Fe, Co, Mn, and Ni) using Zn-assisted high temperature treatment and characterized using various techniques. The prepared catalysts were tested for their electrocatalytic performance towards oxygen and hydrogen evolution reaction (OER and HER) as well as oxygen reduction reaction (ORR) in alkaline media. The results indicated that Mn-N-C catalyst showed higher performance towards both the ORR (E_1/2 = 0.90 V) and …

Novel Rpl30 Variant In Diamond Blackfan Anemia Demonstrates Early Impact On Erythroid Differentiation With Downregulated Gata1-Hsp70, Alexandra Prosser-Dombrowski, Irina Pushel, Jacqelyn Nemechek, Priyanka Kumar, Jay L. Vivian, Jennifer Gerton, John M. Perry

Research Days

Background: Diamond Blackfan anemia (DBA) is an inherited bone marrow failure syndrome caused by ribosomal protein gene mutations leading to apoptosis of erythroid progenitors. We identified a novel heterozygous variant (c.167+769C>T) in the noncoding region of RPL30 in a patient diagnosed with DBA.

Objectives/Goal: We hypothesized that this variant stunts erythroid differentiation at the proerythroblast stage and is pathogenic for DBA.

Methods/Design: We developed an induced pluripotent stem cell (iPSC) model with a wild type (WT) and three CRISPR-Cas9 edited RPL30 mutant clones. iPSCs were differentiated into hematopoietic stem cells, which were assessed by flow cytometry and single cell …

Opportunities For Solid Organ Donation In The Neonatal Intensive Care Unit, Sarah Pippin, Jotishna Sharma, Ashley Sherman, Julie Weiner

Research Days

This study aims to characterize the theoretical eligibility of neonates undergoing withdrawal of care in the NICU for donation after circulatory determination of death (DCDD), with a focus on warm ischemic time (WIT) ≤ 90 minutes.

Abusive Head Trauma (Aht) Diagnoses: The Influence Of Clinical Presentation And Evidence Of Impact, Ruairi Smith-Dewey, Angela N. Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Christopher Greeley, Danielle Horton, Nicole Johnson, Jan Leonard, Megan Letson, Daniel M. Lindberg, Caitlin Mcnamara, Shalon Nienow, Ashley K. Sherman, Joanne Wood, James Anderst

Research Days

Background: In cases where Child Abuse Pediatricians (CAPs) diagnose abusive head trauma (AHT) in young children, some factors surrounding the diagnosis have been challenged including causative shaking, necessity of external signs of impact, or concomitant suspicious injuries. Evaluation of CAP diagnoses in children with subdural hemorrhage (SDH) can give insight into factors related to the frequency of abusive head trauma (AHT) diagnoses. Additionally, characterization of those with SDH+CSI without evidence of impact may inform controversies around AHT diagnoses.

Objectives/Goal: We aim to compare CAP diagnoses in subjects with SDH across clinical presentations and in the context of evidence of head …

In Search Of The Unknown Mimic Of Abusive Head Trauma., Ruairi Smith-Dewey, Angela N. Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Danielle Horton, Nicole Johnson, Jan Leonard, Megan Letson, Caitlin Mcnamara, Shalon Nienow, Ashley K. Sherman, Stuart Sommers, Joanne Wood, James Anderst

Research Days

Background:

Some claim that Child Abuse Pediatricians (CAPs) are misdiagnosing a yet-to-be-identified mimic as abusive head trauma (AHT), particularly in ill children with isolated subdural hemorrhage (SDH). Though not diagnostic criteria, specific social stressors have been identified as AHT risk factors. If a yet-to-be-identified mimic is meaningfully present within a group being evaluated for AHT, that group should have fewer AHT risk factors than children with actual AHT. The existence of such a mimic can be assessed by comparing the prevalence of AHT risk factors across groups: CAP-identified mimics, non-ill SDH only, ill SDH only, and SDH plus concomitant suspicious …

Engineering A Novel Treg Population To Control Autoimmune Diabetes, Sofia Colon Guzman, Elly Puckett, Mary A. Markiewicz, Ryan T. Fischer

Research Days

We created a model to test the immunosuppressive capacity of Helios+FOXP3+ eTregs compared to nTregs against islet-specific autoreactive T cells. We also showed that nTregs decrease the response of these cytotoxic T cells when co-cultured with BetaLox5 cells.

Improving Adherence To Evidence Based Sti Care For Patients Who Tested Positive At Ed Index Visit Qi Project, Noelle Tran, Melissa Miller, Kim Barbee, Julie Jost, Christopher Kaberline, M Smith

Research Days

Problem Statement/Question:

Previous work improved clinician sexually transmitted infection (STI) testing behaviors, but overlooked treatment interventions needed to facilitate risk reduction, HIV and syphilis (RPR) testing, and STI retesting at three months—critical components that reduce morbidity and disease spread. We are not adhering to evidence-based STI care for adolescents who tested positive for STIs at the ED index visit.

Background/Project Intent (Aim Statement):

According to the Centers for Disease Control and Prevention (CDC), in 2023, over 2.4 million cases of RPR, gonorrhea (GC), and chlamydia (CT) were diagnosed; about half of reported cases were among adolescents and young adults aged …

Food Insecurity In Adolescent Athletes, Andrew Donaldson, Shannon Margherio, Jay Roberson, Kevin Latz

Research Days

Background: The prevalence of food insecurity among children in the United States is estimated at 21%. Food insecurity during childhood leads to worse school performance, more emotional and behavioral health concerns, and increased suicide attempts. Further, food insecurity has been noted to have multiple deleterious effects on the collegiate student athlete, including lower GPA, disordered eating, and substance use.

Hypothesis: Food insecurity is prevalent in the adolescent athlete population and exists across demographics.

Methods: Voluntary surveys were distributed to parents at all sports medicine clinics at our institution. Demographic data was collected including athlete age, race, school and school district, …

Item Response Predictors Of Disengagement On The Pisa, Juste M. Mehou

Masters Theses, 2020-current

International assessments, such as the Programme for International Student Assessment (PISA), are instrumental in understanding educational progress, assessing teaching effectiveness, and ensuring institutional accountability (OECD, 2023). Central to the validity of these assessments is the assumption that students will exert sufficient effort and perform to the best of their abilities (AERA, APA, & NCME, 2014). This assumption is essential to ensure that scores accurately reflect students' true abilities (Wise & Kong, 2005). However, there is a documented concern that students often exhibit low effort in low-stakes tests, such as the PISA, where individual results have no direct consequences (Wise & …

Undergraduate Student Experiences Of Flow In Culturally Relevant And Contextual Digital Math Games, Kaylie Kurland

UNLV Theses, Dissertations, Professional Papers, and Capstones

Students in co-requisite mathematics classes represent a diverse group of learners, with one thing in common: their previous math performance. This research investigates how playing culturally responsive educational games is associated with students' learning and experience of flow. Quantitative analyses revealed no significant differences in flow scores across demographic groups. However, students with stronger STEM identities reported experiencing higher levels of flow, on average. Math self-efficacy was not significantly associated with flow experiences. ANOVA results indicated that flow was not significantly related to final course grades (F = 0.465, p = 0.707, η² = 0.008), suggesting that students’ self-reported flow …

Accelerating Initial Cardiac Arrest Response In Medical-Surgical Nurses Through Virtual Reality Training, Carissa A. Hernandez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Through their limited exposure, non-critical care nurses may feel unprepared to respond when faced with a sudden emergency such as cardiac arrest. This Quality Improvement (QI) project employed virtual reality (VR) technology to improve nurse confidence, adherence to the American Heart Association (AHA) basic life support (BLS) algorithm, and documentation accuracy among medical-surgical nurses in a Veterans Affairs hospital in Nevada. The project addressed their ability to react promptly and effectively during these high-stakes emergencies. Methods: Following a scoping literature review from the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PubMed databases, this Evidence Based …

Enhancing Documentation Proficiency: Feasibility Of Integrating Ehr Go & Unfolding Case Studies In Occupational Therapy Education, Jeffery D. Holland Jr.

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: This capstone project evaluated the feasibility of integrating EHR Go and Unfolding Case Studies (UCS) into the first-year curriculum of the University of Nevada, Las Vegas (UNLV) Occupational Therapy Doctorate (OTD) program. The goal was to enhance students’ SOAP (Subjective, Objective, Assessment, Plan) note documentation proficiency and critical thinking skills through simulation-based learning and increased exposure to real-world documentation expectations and examples. Feedback from 33 clinicians at Dignity Health St. Rose Dominican Hospital – Siena Campus informed the workshop design, and OTD faculty and graduate assistants at UNLV provided input on curriculum integration feasibility.Methods: A quasi-experimental, non-equivalent groups pretest-posttest …

Variation In Blood Culture Testing And Outcomes In Children Hospitalized With Three Common Infections., Smit Shah, Jessica L. Markham, Jennifer Goldman, Matt Hall, Jillian Cotter, Samantha A. House, Matthew J. Molloy, Michelle Polich, Michael J. Steiner, John R. Stephens, Michael J. Tchou, Ronald J. Teufel Ii, Irma Ugalde, Andrew Yu

Research Days

Background: Prior studies of blood culture (BC) testing in uncomplicated community acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) have demonstrated low utility of routine testing given similar rates of pathogen versus contaminant detection and little effect on clinical management. Understanding patterns and outcomes of BC testing can identify opportunities to curb unnecessary testing.

Objectives: The objectives of this study were to: 1) Evaluate BC testing trends over time for children hospitalized for CAP, SSTI, and UTI; and 2) describe differences in clinical outcomes between hospital groups with low, moderate, or high testing rates. …

Reducing Vancomycin Use In The Cicu, Karoline Krzywda, Ali Taber, Lauren Johnson

Research Days

Background/Aim Statement: In the CICU empiric vancomycin is frequently prescribed. This practice occurs without broad knowledge of the actual rates of methicillin resistant staph aureus (MRSA) and methicillin resistant staph epidermidis (MRSE) infections. Given the potential for harmful side effects of vancomycin as well as concern for growing antibiotic resistance, we sought to better characterize local unit prescribing practices and MRSA/MRSE infection rates to guide our QI project with an aim of reducing vancomycin use in the CICU.

Methods (include PDSA cycles): Patient data from January 2021 to January 2023 was analyzed. The number of monthly days spent on vancomycin …

A Risk Score To Predict Recurrent High Intensity Inpatient Resource Utilization For Children With Medical Complexity., Charles Maloy, Matthew Hall, Jessica L. Bettenhausen, Yui-Yee Chan, Leah Jones, Kathryn Kyler, Laura Plencner Md, Jessica Markham, Jacqueline M. Walker, Smit Shah, Sîan Best, Jonathan Ermer, Shelby Chesbro, Maria Newmaster, Henry T. Puls

Research Days

Background: Children with medical complexity (CMC) use a greater amount of inpatient resources and stand to benefit from unique care models and coordination. However, hospital resources can be limited, and a better understanding of which CMC are high resource users could improve hospital and staff planning.

Objectives/Goal: To develop a risk score predictive of recurrent high intensity inpatient utilization among CMC.

Methods/Design: We conducted a retrospective cohort study of children <18 years old with ≥3 complex chronic conditions (CCC) discharged from one of 48 children’s hospitals in the Pediatric Health Information System during 2021 and 2022. To reflect CMC typically cared for by a general medical service, children with cardiac procedures, dialysis, oncology, or transplant CCCs, and index hospitalization mortality were excluded. We used multivariable logistic regression to determine factors present on the index hospitalization associated with ≥5 hospitalizations or ≥3 hospitalizations with one lasting ≥25 days within any 365-day period (high inpatient utilization) in 2021-2023. We developed risk scoring system using model coefficients and defined the optimal risk score cutoff to maximize sensitivity and specificity. We then applied the risk score cutoff to children discharged to determine (a) ratio of predicted:actual CMC with recurrent high resource use and (b) the total predicted daily volume on 50th, 75th, and 90th percentile days for each hospital.

Results: Of 44,432 included children, 9,596 (21.6%) had high inpatient utilization (Table). Children under 1 year of age had the highest odds of high inpatient utilization (OR 2.26 [95% CI: …

Failure To Launch: Pediatric Colorectal Surgery Center Utilization By Patients Over 18 Years Of Age, Vatche Melkonian, Andres Gonzalez Salazar, Cory Nonnemacher, Seth Saylors, Margaret Martin-Mclain, Iris Lim-Beutel, Rebecca Rentea

Research Days

Background: As patients with childhood colorectal diseases transition into adulthood, many continue to seek care at pediatric colorectal centers rather than transitioning to adult hospital systems. This preference often stems from a sense of comfort and familiarity with their pediatric care teams. Additionally, patients often perceive inadequacies in adult healthcare systems in managing their specific conditions. As these numbers of patients continue to grow, pediatric colorectal centers may face increasing demands on their resources, potentially diverting attention away from pediatric patients.

Objectives/Goal: The objective of this study was to assess the utilization of our pediatric colorectal center by patients aged …

Patterns And Growth Of A Dedicated Pediatric Coagulation Consult Service In A Freestanding Children's Hospital, Nicole Demarco, Shannon Carpenter, Brian Lee

Research Days

Background: Hospital-acquired thrombosis remains a significant concern in pediatric care, contributing to morbidity and extended hospital stays. At Children’s Mercy, a dedicated inpatient coagulation consultation service has existed for many years. Efforts have been made to implement prophylactic measures aimed at reducing the incidence of hospital-acquired thrombosis. With the recent COVID pandemic we saw an influx in prophylactic anticoagulation due to recommended guidelines.

Objectives: To characterize the impact increased efforts in thromboprophylaxis during and after the COVID-19 pandemic on care delivery and the development of thrombosis among pediatric hospitalized patients.

Methods: This retrospective review included all pediatric inpatients with a …

Multi-Omic Analysis Of Kmt2a-Rearranged Pediatric Acute Myeloid Leukemia Reveals Novel Pathways Of Interest, Trenton Edwards, Irina Pushel, Thomas Gremminger, Lisa Lansdon, Byunggil Yoo, Michaella Rekowski, Michael Washburn, Midhat Farooqi

Research Days

Objectives/Goals

Acute Myeloid Leukemia (AML) is the second most common leukemia among pediatric populations. Approximately 15% of pediatric AML cases have KMT2A gene rearrangements (KMT2A-r), which carry a worse prognosis. Our goal is to better characterize the biologic landscape of KMT2A-r pediatric AML. We hypothesize that a multi-omic approach will reveal mechanisms underlying the aggressive nature of KMT2A-r AML.

Methods/Study Population

This study makes use of deidentified peripheral blood and/or bone marrow samples banked in the Children’s Mercy Tumor Bank Biorepository. For this study, we used samples at diagnosis and remission from four KMT2A-r pediatric AML …

No Suspicion For Nocarh: A Cautionary Tale Of Anchoring Bias, Nicole Demarco, Shannon Haines, Julia Allyson Hays, Bonnie Sullivan, Michael Price, Kimberly A. Horii

Research Days

Neonatal onset of cytopenia autoinflammation rash and hemophagocytic lymphohistiocytosis syndrome (NOCARH), a subset of hemophagocytic lymphohistiocytosis (HLH), is a rare and life-threatening condition characterized by uncontrolled immune response. It presents a diagnostic challenge in neonates due to the overlap of clinical features with other conditions, particularly congenital infections.

Nrp And Pals In Icu Code Events At A Quaternary Care Pediatric Hospital: A ‘Compressed’ Analysis, Deepa Kumar, Mitch Kinkor, Stephen Pfeiffer, Allison Taber, Janelle R. Noel-Macdonnell Phd, Jessica Brunkhorst, Danielle Reed

Research Days

This is a retrospective observational study comparing code events in children less than 18 months of age who were resuscitated in the NICU, PICU, and CICU using neonatal resuscitation program (NRP) and pediatric advance life support (PALS).

The Impact Of Race-Corrected Spirometry Results On Eligibility Into An Asthma Clinical Trial, Carina H. Perdew, Bridgette L. Jones, Wumi V. Akinjole

Research Days

BACKGROUND: Spirometry is a widely used pulmonary function test that assesses lung function by examining airflow and capacity. Spirometry measurements assist in the diagnosis, severity classification, and management of asthma, and can affect one’s eligibility into various events (e.g., clinical trials, high-risk jobs, sports). Reference equations are used to establish predicted values to account for biological variables such as age, sex, and height; however past clinical guidelines recommended utilizing race-correction. The incorporation of race may negatively impact people of color due to misrepresentation of one's lung function, consequently impacting future medical management. OBJECTIVES: To characterize differences in spirometry values across …

Emergency Department Utilization For Educational Prioritization For Children By Levels Of Community Advantage, Katherine Randolph, Chris Kennedy, Jennifer Watts, Matt Hall

Research Days

Background: Children with higher social deprivation have higher emergency department (ED) utilization. The Childhood Opportunity Index (COI) is a validated multidimensional measure of community advantage which includes access to resources and healthy neighborhood factors. Educational priorities are frequently not tied to risk data.

Objective: This study aimed to identify zip codes with higher-than-expected ED utilization by diagnoses to prioritize the development of educational initiatives for hospitals, emergency medical services, pediatrician offices, and the community.

Methods: We performed a population-based study of children aged 0-17 years who presented to an ED in Kansas or Missouri in 2023 using census data via …

Variables Affecting Neurodevelopmental Outcome In Infants With Critical Congenital Heart Disease, Elizabeth Loughman, Julie Weiner Do, Marcie Files Md

Research Days

Background: The mortality of cardiac conditions in infancy is improving with advances in surgical planning and medical management. Neurologic morbidity remains significant. Clinically correlating an infant with their neurologic exam, MRI/EEG, and subsequent developmental testing remains a challenge. Counseling regarding neurologic outcomes after cardiac intervention is difficult due to the wide range of findings that can sometimes be clinically irrelevant.

Purpose: The goal of this study is to identify factors associated with poor neurodevelopmental outcomes in infants with critical congenital heart defects (CCHD) as assessed by the Bayley Scales of Infant and Toddler Development Edition IV (Bayley).

Methods: This is …

Implementation Of A Weaning Protocol For Inhaled Nitric Oxide In A Level Iv Neonatal Intensive Care Unit, Elizabeth Loughman, Julie Weiner Do, Maryam El Tawil, Chris Nitkin Md

Research Days

Background: Decrease time to begin iNO weaning from 13 hours to 9.75 hours by 31 December 2024 in patients with persistent pulmonary hypertension of the newborn (PPHN).

Methods: Countermeasures include (1) provider education at each disciplinary level, (2) badge reminder cards and laminated copies of the protocol available at the bedside, (3) order set modifications, (4) abnormality tracking at huddles. Data collection will be automated through weekly Business Objects report. The main outcome measure will be time to first wean of iNO after meeting protocol criteria. Feedback regarding the ease of weaning will be generated via Gemba Rounds.

Results: These …

Effect Of Social Determinants Of Health On Clinic Visit Attendance In Patients With Hemophilia, Shailly Gaur Md, Brian Lee Phd, Mph, James Anderst Md, Msci, Katie Foote Lscsw, Lcsw, Osw-C, Andrea Bradley-Ewing Mpa, Ma, Shannon Carpenter Md

Research Days

Background

Social determinants of health (SDOH) create barriers to seeking care regularly, especially for patients with chronic disease. Patients with moderate-severe hemophilia A and B (factor 8 and 9 deficiencies respectively) have a life-long higher risk of bleeding and require chronic therapies. Specialized care is offered through hemophilia treatment centers (HTCs); however, these can be difficult to access for some individuals. Previous SDOH research in this patient population has been limited; therefore, it can be difficult to identify the barriers to care that exist. There is a need to examine SDOH more thoroughly to create patient-directed interventions to improve access …

Intraspinal Anomalies In Presumed Ais Does Not Increase The Risk Of Intraoperative Neuromonitoring Changes During Posterior Spinal Fusion, Connor Mathes, Bill Woodhams, Aaron Shaw, John Anderson, Michael Benvenuti, Richard Schwend

Research Days

This study aims to identify the association between intraoperative neuromonitoring changes during posterior spinal fusion surgery among patients with adolescent idiopathic scoliosis and those found to have intraspinal anomalies on standard preoperative imaging.